Search PubMed⌕ Search

Biomedical subjects

D Phillips

Publications and source records attributed to D Phillips.

At least 145 records · Page 8Linked to original sources

Selective necrosis in dimethylhydrazine-induced rat colon tumors using phthalocyanine photodynamic therapy.

Photodynamic therapy is a relatively new method for the local destruction of tumors based on the administration of a photosensitizing agent that is retained in tumors and then activated to produce cytotoxic agents following irradiation with light. The selective retention of photosensitizers by dimethylhydrazine-induced colonic tumors over adjacent normal tissue is small (2:1, tumor to normal), making the possibility of producing selective tumor necrosis with total sparing of normal tissue difficult. Colonic cancers and adjacent normal colon were treated with the same light doses from an argon-pumped dye laser 48 h after intravenous injection of 0.5 or 5 mg/kg of the photosensitizer, aluminum-sulfonated phthalocyanine. There was little difference between the amount of necrosis in the tumor and the adjacent normal colon if the injected dose of photosensitizer was 5 mg/kg. However, at the lower dose of 0.5 mg/g, up to 2 mm of necrosis could be produced in the tumor without damaging the normal colon. In vivo fluorescence measurements showed that the photosensitizer was photodegraded during irradiation. This was confirmed by in vitro fluorescence scans of the normal colon after irradiation; the fluorescence from the photosensitizer was lowest at the point of irradiation. It is postulated that at low dosage, selective necrosis can occur because the photosensitizer is photodegraded in the normal colon before a threshold photodynamic dose is reached, whereas in tumor containing twice as much photosensitizer, a photodynamic threshold dose can be achieved and necrosis produced.

1,2-Dimethylhydrazine↗

Resource management in New Zealand hospitals: the RUS (resource utilization system) system--an illustration of its applications.

This study demonstrates a potential application in the planning and policy area of a resource management system (known as the Resource Utilisation System (RUS)) first introduced into New Zealand in 1987 and now becoming the definitive resource management tool in the New Zealand public hospital sector. A retrospective cohort of 193 individuals (mean age 60.2 years, 73% males) admitted to Dunedin Public hospital with their first acute myocardial infarction in 1978 was followed through for 10 years in order to describe their inpatient resource utilisation as well as their morbidity and mortality experience. The cumulative mortality for the group over 10 years was 57%. The potential years of life lost (PYLL) amounted to 1340 years, or 6.9 years per person. The overall inpatient resource utilisation amounted to $2,317,300 for the whole group, or $12,006 per person (1988 NZ dollars) over the 10 years follow-up.

Cohort Studies↗

"Isolated" elevation of alkaline phosphatase: significance in hospitalized patients.

The significance of alkaline phosphatase (AP) elevation with otherwise normal transaminase and bilirubin values remains unclear. We evaluated the clinical outcome of hospitalized patients with an "isolated" AP elevation. Eighty-seven inpatients with isolated AP elevation were identified during February 1984 and followed for 1 year. Forty-five of 87 patients had normalization of AP during the follow-up period, usually within 1-3 months. The most common diagnoses in this group were congestive heart failure in nine, benign bone disease in six, and treatable malignancy in three patients. Twelve patients had no apparent explanation for the transient rise of AP. Persistent AP elevations were noted in 42 patients--14 of whom had terminal malignancies. Clinically obvious life-threatening diagnoses were made in 24 of the patients with persistent AP elevation. The etiology of AP elevation remained enigmatic in seven patients: two died, four are stable during 1 1/2-3 years of follow-up, and one patient was found to have metastatic carcinoma 17 months later. If the initial AP was greater than 1 1/2 times normal, there was a higher likelihood of persistent elevation (68% vs. 41%, p less than 0.05). Isolated elevations of AP in inpatients may be associated with a variety of medical illnesses and often normalize within months. If the AP elevation is persistent, there is usually a clinically obvious diagnosis. A reasonable approach to such patients is a careful history, physical exam, and routine lab studies to detect obvious diagnoses, followed by repeat enzyme determination at 1-3 months.

Alkaline Phosphatase↗

Granuloma gluteale infantum: case report and review of the literature.

Granuloma gluteale infantum, a benign granulomatous eruption involving the gluteal region, histologically shows a nonspecific dermal inflammatory infiltrate composed of neutrophils, lymphocytes, histiocytes, plasma cells, and eosinophils. It is important to recognize this condition, as it may clinically simulate a neoplastic process. It arises as a complication of primary irritant diaper dermatitis, however, and typically resolves without treatment.

Biopsy↗

Autosomal dominant transmission of autoantibodies to thyroglobulin and thyroid peroxidase.

The inheritance of autoantibodies to thyroglobulin and thyroid peroxidase (thyroid microsomal antigen) has been reevaluated with newly developed ultrasensitive assays that depend on the direct interaction between antibody and radiolabeled antigen. In a study of 16 families with autoimmune thyroid disease, autoantibodies to thyroid peroxidase (TPO) were found to be inherited as a dominant Mendelian trait in females with reduced penetrance in males. Similar results were obtained with thyroglobulin (Tg) autoantibodies. Genetic linkage analysis of the loci for TPO and Tg autoantibodies with 28 polymorphic serological markers (including HLA and Gm allotypes) was carried out in 9 families. LOD scores for some serological markers (such as Gm) were uninformative, but linkage with other markers, notably the HLA antigens -A, B, -DR, -DQ, and BF on chromosome 6, could be excluded. Further studies using a comprehensive panel of gene probes to analyze DNA from families with autoimmune thyroid disease should permit the localization of the gene cluster responsible for regulating the ability to produce autoantibodies to TPO and Tg in man.

Adolescent↗

Physician controlled drug records.

A general understanding of the laws and regulations of the applicable standards of conduct in the use of controlled drugs will assist every physician in recognizing potential problems and dealing with them in an effective manner without the risk of disciplinary action. The investigators for the Arkansas State Medical Board routinely check controlled drug prescribing, ordering and prescribing habits by random periodic surveys throughout the state. Records that accurately reflect a diagnostic assessment of a medical condition and complete accountability for controlled drugs administered, dispensed or prescribed would substantially reduce the likelihood of excessive prescribing for other than legitimate medical purposes.

Arkansas↗

Withdrawal from maternity care. A comparison of family physicians in Ontario, Canada, and the United States.

To determine the relative importance of factors influencing the withdrawal of family physicians from maternity care, two studies, one done in Ontario, Canada, and the other done in the United States, were compared. The proportion of residency-trained family physicians who provide maternity care at the initiation of their careers and the proportion who have given up maternity care are nearly identical in the United States and Canada. Both studies found that about one half of the family physicians who currently provide maternity care were giving consideration to stopping. The reasons underlying this withdrawal were multifactorial. Malpractice issues were the predominant concern of United States family physicians, but the data from the studies indicate that other issues, such as interference with lifestyle and office practice and the effect of attitudes of obstetricians, should not be overlooked.

Adult↗

Diurnal variation in vision after radial keratotomy.

We tested eight patients who had undergone radial keratotomy with regard to refraction, keratometry, corneal thickness, and intraocular pressure one to two weeks after surgery. Patients were examined immediately after eye-lid opening at 7:30 A.M. and again at 4:00 P.M. The contralateral eye was used as a control. The treated eye was 1.48 +/- 0.24 diopters (mean +/- S.E.M.) more hyperopic at the morning examination compared to the afternoon visit, whereas the control eye had an insignificant shift (0.16 +/- 0.06 diopters). The treated eye was significantly flatter (1.37 +/- 0.19 diopters) in the morning than in the afternoon when compared to the control eyes, which were only 0.11 +/- 0.09 diopter flatter. The intraocular pressure changed insignificantly in both the treated and control eyes (-0.5 +/- 0.53 mm Hg and -0.5 +/- 0.84 mm Hg, respectively). The mean morning corneal thickness was significantly greater (5.7%) than the afternoon thickness when compared to the controls (1.7% morning increase in thickness). These data suggest that diurnal variation in corneal thickness after radial keratotomy plays a role in diurnal variation of vision in the early postoperative period.

Adult↗

What are the ideal photoproperties for a sensitizer?

For effective photosensitization of malignant tumours, a sensitizer should exhibit appreciable absorption at red to near-infrared wavelengths and generate cytotoxic species via oxygen-dependent photochemical reactions. These photosensitization mechanisms rely on the excitation of the sensitizer from its electronic ground state to the fluorescent singlet state, which is in turn transformed into the longer-lived triplet state. Efficient formation of this metastable state is required because it is the interaction of the triplet state with tissue components that generates cytotoxic species such as singlet oxygen. Measurement of fluorescence provides a useful means of probing the sensitizer, particularly because detection sensitivities for both the triplet state and the cytotoxic singlet oxygen are much lower. With the development of chemically well-defined sensitizers, in vivo fluorescence detection has the potential to provide quantitative assessment of photoactive sensitizer distributions. The reactive properties of sensitizer triplet states and species such as singlet oxygen can result in significant sensitizer photodegradation, which may appear undesirable but can be exploited in vivo under certain conditions.

Photochemistry↗

Outbreak of nosocomial Flavobacterium meningosepticum respiratory infections associated with use of aerosolized polymyxin B.

Flavobacterium meningosepticum is an uncommon cause of adult nosocomial infection. On a medical/surgical intensive care unit we recently encountered an adult outbreak of respiratory colonization and infection caused by this organism, which was associated with the prophylactic use of aerosolized polymyxin B that had been used in an attempt to abort an outbreak of infection caused by highly resistant strains of Pseudomonas aeruginosa. Twenty isolates (95% from respiratory secretions) of F. meningosepticum from nine persons were identified during a 2 1/2-month period. No environmental source has been identified to date. Pneumonia developed in five patients, and two deaths associated with this organism occurred. All isolates were sensitive to ciprofloxacin; none were sensitive to other antibiotics tested, including third-generation cephalosporins, aminoglycosides, erythromycin, trimethoprim-sulfamethoxazole, antipseudomonal penicillins, aztreonam, and imipenem/cilastatin. Two patients with nosocomial pneumonia were successfully treated with oral ciprofloxacin. F. meningosepticum may emerge as an important pathogen if prophylactic use of polymyxin B becomes more widespread. Ciprofloxacin may become the agent of choice for treatment of this organism.

Administration, Inhalation↗

Federal programs affecting rural perinatal health care.

Access to perinatal health care in rural communities often depends on such factors as the availability, cost, and acceptability of services. The federal government has been providing rural perinatal health care both directly and indirectly, through grants for service delivery or research and through direct payment for service. The various federal programs supporting perinatal health care in rural communities are described, and what may need to be done in the future is discussed.

Female↗

Use of charge coupled device camera for imaging of intracellular phthalocyanines.

A highly sensitive charge-coupled device (CCD) camera, linked to a computerized image processor, has been used to obtain fluorescence images of chloro-aluminum sulfonated phthalocyanine (ClAlSPc), and its mono- to tetra-sulfonated constituents, in cells recovered from the peritoneal cavity of dye-treated mice. Immunofluorescence and cytochemistry showed that cells which preferentially took up ClAlSPc and its sulfonated species were predominantly of the monocyte-macrophage series. While this technique may be of use in determining the nature of those cells capable of taking up light sensitive dyes and, perhaps, the intracellular location of such agents, the possibility that photoinactivation by dye aggregation could reduce the sensitivity of this procedure is discussed.

Animals↗

Erythroderma from systemic contact dermatitis: a complication of systemic gentamicin in a patient with contact allergy to neomycin.

A patient who was sensitive to potassium dichromate and neomycin showed a universal exfoliative erythroderma following intravenous gentamicin therapy. When his ear canals were later treated with a neomycin-containing topical medication, he reacted so severely that the skin of his ears was temporarily depigmented. Withdrawal of aminoglycoside antibiotics along with use of a topical steroid preparation under occlusion brought the eruption under control. Since approximately half of the persons with contact allergy to neomycin will also react to gentamicin, it seems unwise to treat such patients with other intravenous aminoglycosides that are closely related chemically. In our patient, multiple patch tests to other aminoglycosides caused positive reactions to all reagents containing a deoxystreptamine ring, but there was no reaction to streptomycin, which lacks that structure.

Aged↗

Anabolic steroid legislation Act 249 of 1989.

Health care professionals are urged to be alert to the potential for adverse effects common to the use of anabolic steroids by athletes and others, including high school and college students active in varsity sports or body lifting. The Department of Health, Division of Pharmacy Services and Drug Control asks for cooperation and assistance in helping combat the illegal diversion by physicians and pharmacies of these hazardous drugs and to ensure that these drugs are available to patients only through legitimate channels. Act 249 of 1989 was enacted to prevent the distribution and use of illegal anabolic steroids and growth hormones and for purposes of defining and setting penalties for the illegal use.

Anabolic Agents↗

Factors influencing changes in obstetric care provided by family physicians: a national study.

In an effort to determine the factors underlying changes in obstetric practice by family physicians, a random sample of 505 residency-trained family physicians was surveyed by mailed questionnaire. Of the 329 who responded, 65% had at some time practiced obstetrics, but only 45% were practicing obstetrics at the time of the survey. Rising malpractice insurance premiums and fear of lawsuit were factors most likely to influence a family physician's decision to cease obstetric practice. Lifestyle concerns and the number of obstetricians practicing in the area were also important factors for all family physicians. Important differences were found between family physicians who never delivered babies and those who had at some time practiced obstetrics. Family physicians who have given up obstetric practice were found to feel well trained and competent in this practice. Since changes in obstetric practice patterns have had an adverse effect on the obstetric care of women in rural areas and for the medically indigent, these findings have important public health implications.

Attitude of Health Personnel↗

Highly sensitive assays of autoantibodies to thyroglobulin and to thyroid peroxidase.

These highly sensitive assays are based on the interaction between thyroid autoantibodies and 125I-labeled autoantigens. Serum samples are incubated with labeled thyroid peroxidase (TPO) or thyroglobulin (Tg) to allow the formation of antibody-labeled antigen complexes. The complexes are then precipitated by addition of solid-phase Protein A. In the presence of high concentrations of TPO antibody or Tg antibody, more than 50% of the respective labeled antigen was precipitated, whereas only 1-2% was precipitated in the absence of autoantibody. Interassay CVs were 3.2% and 5.7%, respectively, for the anti-TPO and anti-Tg assays. There was no cross-reactivity between Tg antibody and TPO antibody. Results correlated highly significantly with results from other assay systems based on antigen-coated cells or plastic supports, but the assays described here were considerably more sensitive. Scatchard analysis of the assay data provided information on the affinity and serum concentration of TPO autoantibodies (ka approximately 10(9) L/mol and concentrations up to 1 g/L) and Tg autoantibodies (ka approximately 4 x 10(10) L/mol and concentrations up to 1 g/L). Overall, these assays provide a sensitive, precise, and convenient system for measuring and investigating the properties of thyroid autoantibodies.

Antibody Specificity↗

An unusual cause of hip pain in a child.

In this perplexing case, a child with signs of apparent hip pain was treated for a sewing needle embedded in the sole of the foot. The diagnosis of foreign body easily could have been missed, because the external signs were minimal and the clinical findings indicated hip disease. However, the child's extreme distress seemed inconsistent with the initial normal findings. Only reexamination and looking beyond the obvious led to the diagnosis.

Child, Preschool↗