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Biomedical subjects

D MacDonald

Publications and source records attributed to D MacDonald.

At least 73 records · Page 4Linked to original sources
PubMed1994

Adhesion molecule expression and the inflammatory cell infiltrate in delayed pressure urticaria.

We have investigated the kinetics of the leucocyte infiltrate in delayed pressure urticaria (DPU) in relation to the in vivo expression of the cytokine-regulated cell surface adhesion molecules, E-selectin (endothelial adhesion molecule-1, ELAM-1), intercellular adhesion molecule-1 (ICAM-1), and vascular adhesion molecule-1 (VCAM-1). Immunohistochemical analysis was performed on biopsies taken from unchallenged skin, and at 0, 2, 6, 24, 48 and 120 h after weighted rods had been applied to 13 patients with DPU. There was moderate to marked upregulation of E-selectin at 6 and 24 h after application of pressure. At 24 h, more patients showed expression of VCAM-1 on perivascular cells than before pressure. Moderate expression of ICAM-1 was present in some biopsies from both unchallenged and pressure-challenged skin, but there was no clear trend. In DPU, there was a significant increase in the neutrophil count at 2 h after a pressure challenge, with further increases at 6 and 24 h. The median cell counts per high-power field of eosinophils and monocyte/macrophages increased significantly at 24 h after pressure. Biopsies from four normal controls subjected to an identical pressure challenge showed no detectable changes in adhesion molecule expression or in the cell infiltrate. The findings in four patients with chronic idiopathic urticaria not associated with DPU were qualitatively similar to (but intermediate in severity between) the findings in DPU weals at 6 and 24 h. These results suggest that vascular endothelial activation is an early response to pressure challenge in DPU, and is also present in chronic idiopathic urticaria.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Cervicography.

Explore the source record for details and available documents.

Cervix Uteri↗
PubMed1993

Spinal subdural haematoma in a parturient after attempted epidural anaesthesia.

We report a case of spinal subdural haematoma with neurological deficit in a 36-yr-old woman following Caesarean section for severe preeclampsia and placental abruption. She had been taking chronic trifluoperazine treatment for depression. Her activated partial thromboplastin time (aPTT) was 49 sec (normal = 26-36) but all other tests of coagulation were normal. Epidural anaesthesia was attempted but, despite a negative test dose, injection of local anaesthetic resulted in a generalized seizure and general anaesthesia was induced. Seventy-two hours after delivery, she was found to have bilateral leg weakness, urinary incontinence, absent rectal sphincter tone and asymmetrical leg reflexes. The diagnosis of spinal haematoma was confirmed by magnetic resonance imaging. She underwent emergency laminectomy and made a full neurological recovery.

Adult↗
PubMed1993

Septic pelvic thrombophlebitis: an unusual treatable postpartum complication.

Septic pelvic thrombophlebitis is an uncommon but serious postpartum complication occurring in about 1 in 2,000 pregnancies, characterized by pain, antibiotic resistant fever and tachycardia. In about 50% of cases a pelvic mass is present which is usually right-sided (especially when the ovarian vein is involved). It is estimated to cause 18 maternal deaths per million pregnancies in the United States. Use of contrast enhanced CT scanning and a trial of heparin therapy increases the diagnostic certainty. It is particularly important because surgical management which may otherwise be suggested because of a spiking fever and a mass seems to be associated with a poorer prognosis than does conservative management.

Adult↗
PubMed1993

Potassium intake and urinary calcium excretion in healthy subjects.

Potassium depletion increases and potassium supplementation decreases urinary calcium excretion. To determine whether these experimental observations have any significance in healthy free living subjects, we measured 24 h urinary calcium, sodium, potassium and serum parathyroid hormone (PTH) in 142 healthy young (aged 18-40 years) female Chinese subjects. Sodium excretion and potassium excretion were positively correlated with calcium excretion (r = 0.494, p < 0.0001 and r = 0.181, p = 0.031, respectively). However stepwise multiple regression analysis showed that only urinary sodium excretion contributed to the excretion of calcium. We conclude that in free living subjects potassium intake has little effect on calcium excretion.

Adolescent↗
PubMed1992

Serum intact parathyroid hormone levels in elderly Chinese females with hip fracture.

Serum intact parathyroid hormone (PTH), 25 hydroxyvitamin D(25OHD), 1,25 dihydroxyvitamin D (1,25(OH)2D), albumin, and ionized calcium were measured in 61 Chinese female patients with hip fracture and 61 control subjects. Hip fracture patients had low albumin, ionized calcium, and 250HD levels. Serum PTH and 1,25(OH)2D values were not different between the two groups. We conclude that although 250HD level in hip fracture patients is low, there is no evidence of secondary hyperparathyroidism, suggesting that the low 250HD levels may be a secondary phenomenon in response to the fracture.

Aged↗
PubMed1992

Case report: fatal overdose with sustained-release verapamil.

Verapamil is generally a safe and effective drug in the treatment of many vascular disorders. During the past 10 years, a number of serious poisonings have been attributed to verapamil overdose. A relatively new problem is toxicity with the sustained-release form of verapamil. Complications of verapamil overdose can be understood as simply an extension of its pharmacologic activity. Consistently effective therapy remains elusive. Specific calcium channel blocker antidotes are under investigation, but supportive therapy remains the mainstay for serious verapamil overdose.

4-Aminopyridine↗
PubMed1992

Age-related changes in bone density, serum parathyroid hormone, calcium absorption and other indices of bone metabolism in Chinese women.

OBJECTIVE: To study the age-related changes in bone density, serum parathyroid hormone, calcium absorption and other indices of calcium metabolism in Chinese women who habitually have a low calcium intake. DESIGN: Cross-sectional study. SUBJECTS: One hundred and fifty-six healthy Chinese women aged 20-83 years. None were on any medication or vitamin supplements. Subjects over the age of 60 years were all living in a hostel; younger subjects were nurses or subjects attending a family clinic for minor illnesses. MEASUREMENTS: Fasting blood and urine samples were collected for biochemical measurements and calcium absorption was measured using 45Ca by the method of Marshall and Nordin. Bone density was measured by dual energy X-ray densitometry (Norland X R20 X-ray bone densitometer) at the left hip and lumbar spine. Serum parathyroid hormone was measured by a chemiluminometric assay. RESULTS: Plasma ionized calcium concentration, alkaline phosphatase, bicarbonate, plasma creatinine and serum B2 microglobulin were significantly higher in the elderly than in the young, whereas plasma phosphate and the anion gap were higher in the young. Urinary excretion of calcium, phosphate and hydroxyproline were all higher in older women. Plasma parathyroid hormone concentration was positively correlated with age even after taking into account the decline in renal function (as indicated by the rise in B2 microglobulin (r = 0.506, P less than 0.001). Serum concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were not lower in the older women. Fractional calcium absorption from an oral load of radiolabelled calcium was significantly lower in the older women and 37% of the older women were below the 2.5 percentile found in the younger women. Bone density measured by dual energy X-ray densitometry was also significantly lower in the elderly. CONCLUSION: In Chinese women there is an increase in PTH and a decrease in calcium absorption with age in spite of the presence of normal vitamin D metabolites.

Absorption↗
PubMed1992

Interrelationships between urinary sodium, calcium, hydroxyproline and serum PTH in healthy subjects.

The effect of sodium intake on the excretion of calcium, hydroxyproline (OHP) and serum parathyroid hormone (PTH) was examined. When seven healthy males increased their sodium intake by 200 mmol/day, excretion of calcium increased by 1.70 mmol/day and that of OHP by 27%. Serum PTH, however, did not increase significantly. In a cross-sectional study of 334 healthy female subjects there were strong positive correlations between fasting urinary sodium/creatinine (Na/Cr) and calcium/creatinine (Ca/Cr) ratios (r = 0.573) and between Na/Cr and urinary OHP/Cr ratios (r = 0.246). Serum PTH was negatively correlated with Na/Cr ratio (r = -0.161). We conclude that an increase in dietary sodium causes calciuria and an increase in hydroxyproline excretion. The results do not support the hypothesis that this is mediated by PTH.

Adult↗
PubMed1991

Fetal acidosis in labour: a prospective study on the effect of parity.

The effect of parity on intrapartum fetal scalp pH was investigated in 6466 patients in labour with a live fetus who were delivered in 1987. 350 (5.4%) required fetal scalp blood sampling for pH (FBS), 236 primigravidae (10.4%) and 114 multigravidae (2.7%) (P less than 0.001). Fetal acidosis (pH less than 7.20) was detected in 35 patients, 27 primigravidae (11.4%) and 8 multigravidae (7.0%) (P less than 0.001). The incidence of intrapartum acidosis in the 2275 primigravidae and the 4191 multigravidae was 1.2 and 0.2% respectively (P less than 0.001). The two deaths from birth asphyxia and three cases of neonatal seizures occurred in primigravidae. In primigravidae requiring FBS, fetal acidosis was not associated with the use of oxytocin or with increased duration of labour. Neonatal seizures were more common overall in primigravidae than in multigravidae and more common in patients requiring FBS than in those not requiring FBS (P less than 0.05). The higher incidence of FBS, fetal scalp acidosis and neonatal seizures in primigravidae has important implications for intrapartum fetal monitoring.

Acidosis↗
PubMed1991

Assay restriction profiles of three monoclonal antibodies recognizing the G3m(u) allotype. Development of an allotype specific assay.

Three monoclonal antibodies raised against a purified human IgG3 paraprotein were found to exhibit a restriction profile for IgG3/G3m(u) and pan-IgG specificity which was dependent on the assay system. When adapted to an IgG3 subclass capture ELISA, all three McAbs discriminated between paraproteins expressing G3m(u) and antithetical markers G3m(st). One of the antibodies (PNF69C) was selected and conditions were optimised for Gm typing purposes. Using this system G3m(u) could be detected on captured IgG3 derived from human sera. This system may prove useful in the elucidation of Gm allotype profiles.

Animals↗
PubMed1991

Electronic fetal heart monitoring, auscultation, and neonatal outcome.

In a large randomized, controlled study of fetal heart rate monitoring with either continuous electronic fetal heart monitoring or auscultation at specified intervals, only one pattern of deviation in the fetal heart rate correlated significantly with neonatal neurologic examinations at 0 to 48 hours and 72 hours to 1 week: late decelerations in stage 1 and in stage 2. Other variables from labor and delivery, specifically, duration of labor after hospital admission, failure of labor to progress, number of fetal scalp pH values, and presence of meconium were important predictors of neonatal outcome in the regression analyses. The fetal heart rate deviations did contribute significantly to the percent variance accounted for in the regression analyses with neonatal outcomes of Apgar scores at 1 and 5 minutes and serial neonatal neurologic examinations.

Apgar Score↗
PubMed1991

Hospice social work: a search for identity.

This article describes social work's contribution to hospice philosophy and practice, calls attention to the lack of a distinct social work function on hospice teams, and examines various ways to resolve the problem of social work identity in hospice care. Insights from recent peer discussions of hospice social workers tend to support Kulys and Davis's (1986) earlier findings that psychosocial care is provided regularly by hospice team members other than social workers. Options for strengthening the hospice social work role are discussed, including the development of more specific therapeutic techniques and social work leadership in conducting applied research. The importance of maintaining a value-based, critical perspective is stressed.

Aged↗
PubMed1991

The prevention of the maternal manifestations of pre-eclampsia by intensive antihypertensive treatment.

The purpose of the study was to determine if reduction of pregnancy hypertension to normal prevented the clinical maternal manifestations of pre-eclampsia. Thirty-six women with hypertension, but without proteinuria, were allotted at random to a test group of 17 who received intensive treatment, and a control group of 19 who were managed according to routine methods by hospital staff unconnected with the study. The development of proteinuria was chosen as an indicator of pre-eclampsia. Proteinuria developed significantly more often in the control group (in six of the 19 women) than in the test group (in one of the 17 women).

Adult↗