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Biomedical subjects

D James

Publications and source records attributed to D James.

At least 145 records · Page 8Linked to original sources
PubMed1990

Development of human fetal behavior: a review.

Most of the movements described during the course of gestation have already emerged before 16 weeks, and the presence of diurnal variation in human fetal behavior has been demonstrated from as early as 20 weeks gestation. Up to 26 weeks quiet intervals rarely exceed 5 min. After this age quiet intervals progressively increase in duration so that behavior appears cyclically rather than randomly distributed. Increasing linkage of the state variables results in identifiable fetal behavioral states from around 36 weeks. During the last trimester fetal activities are cycle- or state-dependent, so that prolonged, and often repeated, recording of behavior is necessary before any sinister conclusions can be drawn.

Circadian Rhythm↗
PubMed1990

Glucose transporter levels in spontaneously obese (db/db) insulin-resistant mice.

In the present study we examined mRNA and protein levels for the muscle/adipose tissue glucose transporter (GLUT-4) in various tissues of spontaneously obese mice (C57BL/KsJ, db/db) and their lean littermates (db/+). Obese (db/db) mice were studied at 5 wk of age, when they were rapidly gaining weight and were severely insulin resistant, evidenced by hyperglycemia (plasma glucose 683 +/- 60 vs. 169 +/- 4 mg/dl in db/+, P less than 0.05) and hyperinsulinemia (plasma insulin 14.9 +/- 0.53 vs. 1.52 +/- 0.08 ng/ml in db/+, P less than 0.05). The GLUT-4 mRNA was reduced in quadriceps muscle (67.5 +/- 8.5%, P = 0.02), but unaltered in adipose tissue (120 +/- 19%, NS), heart (95.7 +/- 6.1%, NS), or diaphragm (75.2 +/- 12.1%, NS) in obese (db/db) mice relative to levels in lean littermates. The GLUT-4 protein, measured by quantitative immunoblot analysis using two different GLUT-4 specific antibodies, was not different in five insulin-sensitive tissues including diaphragm, heart, red and white quadriceps muscle, and adipose tissue of obese (db/db) mice compared with tissue levels in lean littermates; these findings were consistent when measured relative to tissue DNA levels as an index of cell number. These data suggest that the marked defect in glucose utilization previously described in skeletal muscle of these young obese mice is not due to a decrease in the level of the major muscle glucose transporter. An alternate step in insulin-dependent activation of the glucose transport process is probably involved.

Adipose Tissue↗
PubMed1989

Air-filled microballoon manometry for use in anorectal physiology.

Manometry is fundamental to anorectal physiology but the water-filled manometric systems commonly used have several disadvantages. To investigate the 'new' air-filled microballoon system, we compared it with a standard water-filled equivalent by measuring sphincter length, maximum resting pressure (MRP) and maximum voluntary contraction pressure (MVC) in 44 patients using the station pull-through technique. A good correlation was found for all three parameters (Spearman correlation coefficient rs: sphincter length = 0.86, MRP = 0.86 and MVC = 0.94, P less than 0.001). Repeat studies in 15 patients showed excellent reproducibility (rs: sphincter length = 0.97, MRP = 0.96 and MVC = 0.97, P less than 0.001). Air-filled microballoon manometry gives results similar to a water-filled microballoon system and has many advantages.

Adult↗
PubMed1989

Contrast-enhanced abdominal computed tomography scanning and prediction of severity of acute pancreatitis: a prospective study.

One hundred and fifty-two patients were admitted to a single hospital with a diagnosis of acute pancreatitis during a 31-month period. Of these, 126 patients had contrast-enhanced abdominal computed tomography (CT) scans within 72 h of admission; 92 of these attacks were clinically mild, 34 were clinically severe. A single consultant radiologist reported the scans 'blind' and noted whether pancreatic enhancement was normal, increased or decreased, and whether there was loss of peripancreatic tissue planes. The maximum anteroposterior measurement of the pancreatic head and body were multiplied together to produce a 'pancreatic size index' (cm2). Significantly more patients with severe attacks had decreased pancreatic enhancement (79 versus 58 per cent, P = 0.01) and loss of peripancreatic tissue planes (82 versus 54 per cent, P = 0.006). The median (range) pancreatic size index for clinically severe attacks was 12.8 cm2 (3.0-52.5), and for mild attacks was 6.0 cm2 (1.1-23.4), P less than 0.0001. Modified Glasgow criteria had a sensitivity of 85 per cent and specificity of 79 per cent for clinically severe attacks. A pancreatic size index of greater than or equal to 10 cm2 had a sensitivity of 71 per cent and specificity of 77 per cent for clinically severe attacks. In conclusion, although there were highly significant differences between the clinically severe and mild groups with respect to pancreatic enhancement, peripancreatic tissue planes and pancreatic size indices, these CT criteria did not improve on modified Glasgow criteria for prediction of disease severity.

Acute Disease↗
PubMed1989

Diagnostic laparoscopy.

This report examines the value of laparoscopy as a diagnostic aid to one general surgeon. Seventy-seven consecutive patients who underwent this procedure are reported. In 31 patients, laparoscopy was performed for assessment of the cause of acute abdominal pain. Diagnosis was achieved in 28 patients (90 percent) and laparotomy was avoided in 17 (55 percent). Assessment of chronic abdominal pain in 11 patients yielded a diagnostic accuracy in 9 (82 percent) and laparotomy was avoided in 7 (64 percent). In 11 patients with abdominal trauma, diagnostic accuracy was 91 percent (10 of 11 patients) and laparotomy was not required in 6 (54 percent). In 21 patients with intraabdominal malignancy, 14 (67 percent) were accurately assessed, and in 8 (38 percent) formal exploration was spared. Three patients with obscure causes of ascites and jaundice were all accurately assessed without need for laparotomy. Based on our data, we believe the reports in the literature are reproducible by any abdominal surgeon who uses laparoscopy as a diagnostic aid in their practice.

Abdomen↗
PubMed1989

The specificity of the zimelidine reaction.

The first of a series of 5HT reuptake inhibitors, zimelidine was withdrawn because of associated hypersensitivity reactions. There was concern that such reactions might be seen with other compounds of this class. Two depressed patients who had a sensitivity reaction to treatment with zimelidine were crossed over to treatment with fluoxetine and no abnormalities were observed. Both patients remained well during uneventful long term treatment with fluoxetine.

Chemical and Drug Induced Liver Injury↗
PubMed1989

The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma.

Commonly used suture materials and techniques for perineal repair following vaginal delivery were compared in a randomized controlled trial involving 1574 women. Three comparisons were made using a modified factorial design. In the comparison of teflon-coated polyglycolic acid (Dexon plus) with chromic catgut for repair of the vagina and deep perineal tissues there was no clear difference other than less short-term analgesia being required in association with polyglycolic acid. Outcome was also similar after skin repair with either polyglycolic acid or chromic catgut or silk, although silk repair required more packets of material and was associated with delay in resuming sexual intercourse; polyglycolic acid was more likely to need removal than chromic catgut but it appeared to reduce the need for resuturing. There was no clear difference between continuous subcuticular and interrupted transcutaneous sutures for repair of perineal skin.

Adult↗
PubMed1989

Serial computed tomography scanning in acute pancreatitis: a prospective study.

One hundred and two patients with acute pancreatitis had abdominal computed tomography (CT) scans within 72 hours of admission, at one week and at six weeks. Twenty eight attacks were clinically severe, 74 clinically mild. Ninety three (91%) admission scans, 85 (84%) one week scans, and 52 (51%) six week scans were abnormal. The aetiology of the pancreatitis could be inferred from 28 (27%) of admission scans, the CT sign of fatty liver having a sensitivity of 21% and specificity of 100% for alcoholic aetiology. The sensitivity of CT for gall stone aetiology was 34%, specificity 100%. The pancreatic size indices (max anteroposterior measurement of head x max anteroposterior measurement of body) of those patients with severe attacks were significantly greater than those with mild attacks on admission, at one week and at six weeks (p less than 0.004). Fourteen pseudocysts were detected by CT, five (36%) of which were clinically apparent. The pseudocyst size indices (max anteroposterior x max transverse measurement) of the pseudocysts which were clinically apparent were significantly greater than those which were not apparent (p less than 0.01) and only those pseudocysts with a size index greater than or equal to 15 cm2 required treatment.

Acute Disease↗
PubMed1988

Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones.

121 patients with acute pancreatitis thought to be due to gallstones were randomised to treatment with urgent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) or with conventional treatment. They were stratified by predicted severity of the attack, according to the modified Glasgow system. ERCP was done within 72 h, and if common bileduct stones were identified, patients underwent ES immediately to extract the stones. There were fewer complications in the 59 patients who underwent ERCP +/- ES than among the 62 treated conventionally, the difference being confined to those whose attacks were predicted to be severe (6/25 ERCP +/- ES [1 death] compared with 17/28 conventional treatment [5 deaths]). Hospital stay was also shorter for patients with severe attacks who underwent ERCP +/- ES than for those who received conservative treatment (median 9.5 versus 17.0 days).

Acute Disease↗
PubMed1988

A computer system for the interactive planning and prediction of maxillofacial surgery.

A computer system has been developed for the simulation of facial surgery with interactive three-dimensional graphic techniques and data derived from computed tomographic scans and a purpose-built laser scanning system. The simulation includes the surgery on the hard tissues, and modeling of the soft tissue for prediction of the postoperative facial appearance. The facilities available are described and an example of their use is given.

Computer Graphics↗
PubMed1988

Fetal heart rate monitoring by telephone. II. Clinical experience in four centres with a commercially produced system.

A commercially produced domiciliary fetal monitoring (DFM) system was assessed in four centres in the UK (Bristol, Glasgow, London and Nottingham) chosen to allow for comprehensive assessment in various settings in many different women. Overall, 825 recordings were made from 368 women (2.24 per woman). There were 56 unsuccessful attempts at transmission (6.8%), most were due to problems with telephone equipment. The system worked most efficiently when a dedicated direct line was used. The data transmission time varied between 40 and 60 s. The median telephone time (including data transmission and conversation) with a dedicated direct line was 7 min. Mean acceptance times from the four centres were between 70 and 80%. All recordings with acceptance times of 40% or more were interpretable. Ten recordings were abnormal. The women and mid-wives were equally proficient at using the DFM system. The DFM system represents an important addition to current methods of fetal assessment. Specific guidelines are outlined.

England↗