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Biomedical subjects

D Kroll

Publications and source records attributed to D Kroll.

18 recordsLinked to original sources
PubMed2001

VIPP1, a nuclear gene of Arabidopsis thaliana essential for thylakoid membrane formation.

The conversion of light to chemical energy by the process of photosynthesis is localized to the thylakoid membrane network in plant chloroplasts. Although several pathways have been described that target proteins into and across the thylakoids, little is known about the origin of this membrane system or how the lipid backbone of the thylakoids is transported and fused with the target membrane. Thylakoid biogenesis and maintenance seem to involve the flow of membrane elements via vesicular transport. Here we show by mutational analysis that deletion of a single gene called VIPP1 (vesicle-inducing protein in plastids 1) is deleterious to thylakoid membrane formation. Although VIPP1 is a hydrophilic protein it is found in both the inner envelope and the thylakoid membranes. In VIPP1 deletion mutants vesicle formation is abolished. We propose that VIPP1 is essential for the maintenance of thylakoids by a transport pathway not previously recognized.

Amino Acid Sequence↗
PubMed2001

Prognostic value of stress-gated Tc-99m sestamibi SPECT after acute myocardial infarction.

Stress-gated technetium-99m (Tc-99 m) sestamibi single-photon emission computed tomography (SPECT) is used to risk stratify patients after acute myocardial infarction (AMI). In clinical practice, results of this test are used primarily to identify patients with myocardial ischemia for intervention. The value of this test to risk stratify patients with AMI not at high ischemic risk has not been addressed. More than 1-year follow-up was undertaken in 124 patients who underwent predischarge gated Tc-99m sestamibi SPECT studies and who did not undergo subsequent revascularization. Clinical variables and test-derived variables were evaluated to predict cardiac death, recurrent AMI, and hospitalization for unstable angina, congestive heart failure, or coronary revascularization. Independent predictors by multivariate analysis for cardiac death or recurrent AMI were a history of prior AMI (relative risk [RR] = 5.32, confidence interval [CI] 2.17 to 12.96), a low exercise capacity (RR = 6.84, CI 1.99 to 23.48), and left ventricular (LV) ejection fraction (EF) <40% (RR = 2.63, CI 1.04 to 6.38). The incidence of cardiac death or recurrent AMI was 29.8% in patients with a low exercise capacity versus 4.5% in those with good exercise capacity, and 38.1% in patients with LVEF <40% versus 9.4% in those with LVEF >40%. Independent predictors of cardiac death, AMI, or hospitalization for unstable angina, congestive heart failure, or revascularization were a history of prior AMI (RR = 2.24, CI 1.11 to 4.50) and LVEF <40% (RR = 3.13, CI 1.64 to 5.95). Among patients followed after AMI without revascularization Tc-99m sestamibi SPECT can identify a high-risk subset. The strongest independent predictors are poor exercise capacity and LVEF < 40%.

Adult↗
PubMed1997

General practitioners' views on the implementation of community-led maternity care in south Camden, London.

New recommendations suggesting that maternity care should be increasingly community-based have generated concern regarding the interprofessional cooperation between general practitioners and midwives. In Camden, London, this service was expanded in 1993. Although existing joint antenatal care arrangements between GPs and midwives were not expected to alter significantly, the shift of care from hospital to community midwives, and the expansion of community-led care to women with complications, was expected to have implications for the GPs. A questionnaire-based study asked GPs who provide antenatal care about their role and liaison with other professionals. Most were satisfied with the current arrangements; only a minority felt that their workload, clinical practice, or communication with obstetric teams had altered.

Attitude of Health Personnel↗
PubMed1997

Achieving continuity of care and carer.

The aims of a new service need to be clarified and agreed to avoid disappointment both for midwives and the women they are caring for. Midwives have different views, expectations and priorities, which may be determined by their previous experience. Providing continuity of care to mixed caseloads is complicated to organise, as women with complications need more time and different skills. The success of any service that aims to provide women with care from a small group of midwives depends on adequate staffing and resourcing.

Attitude of Health Personnel↗
PubMed1996

Is community-led maternity care a feasible option for women assessed at low risk and those with complicated pregnancies? Results of a population based study in south Camden, London.

OBJECTIVE: to assess the feasibility of obstetric offering community-led maternity care to most women, both those assessed to be at low obstetric risk and those with complicated pregnancies at 'booking'. Community-led care is defined as appropriate care by community midwives and general practitioners during pregnancy, birth and the puerperium, with routine hospital care kept to a minimum. DESIGN: observational study. SETTING: South Camden, London, UK: University College Obstetric Hospital and community. PARTICIPANTS: 453 women, resident in South Camden, including those 'booked' for home births, who were 'booked' for maternity care at University College Hospital between October 1993 and April 1994. MEASUREMENTS AND FINDINGS: this paper assesses the extent to which community midwives and general practitioners were able to give local women community-led care and describes the amount of care provided to women by their 'named' community midwives and team. Most local women were eligible for community-led care and 85% planned to have it. The majority of care was given by the community midwives, but the amount of hospital input varied. Women who remained at low obstetric risk generally had their antenatal care in the community, only attending hospital for two or three routine assessments and occasional extra referrals. Women attending hospital more frequently usually had a complicated pregnancy. Care given by a woman's 'named' midwives was generally provided antenatally, but care from familiar midwives was less common in labour and postnatally. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: community-led maternity care can be provided to the majority of women, even those with a complicated pregnancy, as long as specialist opinion and facilities are accessible and women are referred as necessary. Although the majority of women had access to local antenatal care from staff they got to know, the 'named' community midwives and teams found it difficult to provide comprehensive care, particularly to the women who developed complications, so priorities need to be established. Further research is needed to compare alternative models of care and their costs.

Community Health Nursing↗
PubMed1994

Spontaneous perinephric urinoma in pregnancy.

A rare case is presented of spontaneous urinary extravasation (urinary ascites) with left pleural effusion occurring during pregnancy. The clinical course, pathogenesis and treatment are described.

Adult↗
PubMed1994

Postnatal care: teamwork in the community.

To offer continuity of care as recommended by Changing Childbirth, close communication between midwives and health visitors is important. Selective postnatal visiting allows continuation of visits after the tenth day and encourages communication between the midwife and health visitor. Good communication between a midwife and health visitor can ensure that a framework of care is provided to support mothers as they develop self-confidence and independence. To ensure continuity of care, midwives should involve health visitors during the antenatal period wherever possible. Formal and informal lines of communication between midwives and health visitors should be encouraged.

Communication↗
PubMed1991

Fibrolamellar carcinoma of the liver in pregnancy. A case report.

Fibrolamellar carcinoma of the liver is a rare tumor that has not been previously reported to occur during pregnancy. A 22-year-old, pregnant Arab woman with documented fibrolamellar carcinoma of the liver was followed at our high-risk pregnancy unit. Despite the severity of the disease, the pregnancy and delivery were uneventful.

Adult↗
PubMed1990

Energy expenditure in normal labor.

The energy expenditure in 23 healthy parturient women during spontaneous labor was assessed by continuous measurement of their O2 consumption and CO2 production. Due to the intermittent character of uterine contractions, normal labor and delivery did not impose high energy demands on the parturient, whereas a prolonged labor and delivery in which energy input was high led to maternal metabolic disturbances.

Adult↗