Search PubMed⌕ Search

Biomedical subjects

D Roberts

Publications and source records attributed to D Roberts.

At least 37 records · Page 2Linked to original sources
PubMed1996

Peritonitis, functional catheter loss and the sitting of the Dacron cuff in chronic peritoneal dialysis catheters in children.

Functional peritoneal dialysis catheter loss due to persistent or recurrent peritonitis is a common clinical problem in paediatric patients. To examine the effect of positioning of the cuff on infection and loss rate we compared catheters where the cuff was buried in the rectus sheath (deep cuffs) with those where the cuff was sutured to the external oblique muscle, just below the subcutaneous fascia (superficial cuffs). Of 62 catheters inserted into 35 patients (median age 7.76 yrs, range 0-17 yrs) 28 were lost through peritonitis of which 19 (68%) were due to Staph. aureus infection, usually associated with exit site colonisation or infection. 12 out of 20 catheters with superficial cuffs were lost through infection compared with 16 out of 42 with deep cuffs (relative risk reduction 37%, p = ns). Controlling for patient age and infecting organism made no difference to this statistic. 15 out of 21 catheters inserted into patients < 2yrs of age were lost through peritonitis compared to 13 out of 41 catheters inserted into patients over 2 yrs of age (p = 0.037). We conclude that although siting of the Dacron cuff in the rectus sheath is somewhat protective against penetrating infection this is still a major problem in the infant and young child where alternative strategies for the prevention of Staph. aureus infection need to be sought.

Adolescent↗
PubMed1996

Prevalence and significance of implantation site trophoblastic atypia in hydatidiform moles and spontaneous abortions.

The authors studied the prevalence and significance of implantation site trophoblastic atypia in hydatidiform moles and spontaneous abortions. Three pathologists independently categorized 99 early abortion specimens regarding diagnosis (spontaneous abortion, partial hydatidiform mole, complete hydatidiform mole); qualitative atypia of implantation site trophoblast (absent, mild, moderate-severe); and quantitative atypia of implantation site trophoblast (absent, focal, diffuse). Interobserver agreement was good to excellent regarding diagnosis (kappa 0.66-0.79) and poor to fair regarding qualitative atypia of implantation site trophoblast (kappa 0.20-0.43). By consensus diagnosis, implantation site trophoblastic atypia was mild and focal in 5% of 22 spontaneous abortions; predominantly focal in 40% of 30 partial moles (33% mild atypia; 7% moderate-severe atypia); and, predominantly diffuse in 87% of 47 complete moles (21% mild atypia; 66% moderate-severe atypia). Among hydatidiform moles, the subsequent development of persistent gestational trophoblastic tumor did not relate to the degree of implantation site trophoblastic atypia. The authors conclude that trophoblast of the implantation site exhibits focal, mild atypia in some partial hydatidiform moles,and diffuse marked atypia in most complete hydatidiform moles. Thus, implantation site trophoblastic atypia may be a useful pathologic guideline regarding the diagnosis and classification of hydatidiform moles.

Abortion, Spontaneous↗
PubMed1996

Mosquitoes (Diptera:Culicidae) breeding in brackish water: female ovipositional preferences or larval survival?

Four species of mosquitoes were abundant in concrete reservoir tanks containing brackish water that ranged from 16 to 39% sea water. The ability of the larvae to survive in various salinities was compared for each species with the ovipositional preferences of the adult females to determine whether the 2 traits were correlated. Southern house mosquito, Culex quinquefasciatus Say, normally was not present in the tanks but survived well in salinities up to 25% sea water. However, gravid females almost always oviposited in fresh water. Culex sitiens Weidemann larvae survived best in saline water (66% sea water), but oviposition was greatest in 28% sea water; both larval survival and the frequency of oviposition were low in fresh water. Culex sinaiticus Kirkpatrick survived salinities up to 50% sea water, but the females refused to blood-feed; therefore, their ovipositional preferences were not tested. Larvae of Anopheles stephensi Liston and An. culicifacies Giles survived best in fresh water, but some An. stephensi were able to tolerate up to 50% sea water. The females had a similar ovipositional preference for fresh water. The preferred salinity for oviposition did not correspond with larval survival for Cx. quinquefasciatus and Cx. sitiens, but did compare well in An. stephensi and An. culicifacies.

Animals↗
PubMed1996

Half-dose aprotinin does not affect haemorheological properties in patients undergoing bypass surgery.

OBJECTIVE: To investigate haemorheological changes in patients undergoing coronary artery bypass grafting and to determine whether the protective effect on haemorheology of high-dose aprotinin also exists under a half-dose regimen. METHODS: Forty patients were studied in a double-blind, placebo-controlled study design. Patients in the aprotinin group received half of the standard high dose of aprotinin during surgery. Erythrocyte and white-cell clogging rates as well as whole blood and plasma viscosity were measured. Viscosity results were expressed as a ratio to the viscosity of saline. RESULTS: Erythrocyte and white-cell clogging rates were increased significantly, whereas whole blood and plasma viscosity were decreased significantly during cardiopulmonary bypass. The reduction in viscosity had a strong correlation to haemodilution. There was no significant difference in any of the measured variables between the aprotinin and the placebo groups. CONCLUSION: This study showed that blood cell damage occurred during cardiopulmonary bypass surgery, as measured by a raised clogging rate. This tendency was the same in both groups and therefore no increased potential for microthrombi could be attributed to aprotinin haemorheologically. However, half-dose aprotinin did not show any preserving effect in haemorheology when the blood-cell clogging rate and blood viscosity were studied.

Aged↗
PubMed1996

Detection and serogroup differentiation of Salmonella spp. in food within 30 hours by enrichment-immunoassay with a T6 monoclonal antibody capture enzyme-linked immunosorbent assay.

We previously described an antigen capture enzyme-linked immunosorbent assay which makes use of monoclonal antibody T6, which recognizes an epitope on the outer core polysaccharide of Salmonella lipopolysaccharide molecules that is common to almost all Salmonella serovars. In this paper, we show that this assay can detect between 10(5) and 10(7) Salmonella cells per ml even in the presence of excess Escherichia coli. A total of 153 of 154 (99%) serogroup A to E strains and 51 of 78 (71%) serogroup F to 67 strains were reactive as determined by this assay. This corresponds to a detection rate of approximately 98% of all salmonellae known to affect humans. None of the 65 strains of non-Salmonella bacteria tested positive. Taking advantage of the O-factor polysaccharides also present on the antigen captured by the immobilized T6 antibody, we showed that 136 of 154 Salmonella serogroup A to E strains (88%) were correctly differentiated according to their serogroups by use of enzyme conjugates of a panel of O-factor-specific monoclonal antibodies. We evaluated this assay for the detection and serogroup differentiation of salmonellae directly from enrichment cultures of simulated food, eggs, pork, and infant formula milk. All 26 samples which had been contaminated with Salmonella spp. were detected by T6 (100% sensitivity), with only one false-positive result from 101 samples not contaminated by Salmonella spp. (99% specificity). The detection time was substantially reduced to between 17 and 29 h, depending on the enrichment methods used. Since there were no false-negative results, we concluded that this enrichment-immunoassay method can afford rapid screening for Salmonella spp. in food samples.

Animals↗
PubMed1996

Nonvalvular myocardial involvement in metastatic carcinoid disease.

A patient with the unusual post mortem finding of myocardial metastatic carcinoid tumour without classical valvular or endocardial carcinoid disease is described. This rare occurrence may represent an aggressive type of carcinoid tumour, with metastatic disease occurring before the development of classical fibrous valvular and endocardial pathology.

Aged↗
PubMed1996

Response of ventilator-dependent patients to different levels of proportional assist.

Proportional-assist ventilation (PAV) is a form of ventilatory support in which airway pressure increases in proportion to patient effort. Because it effectively reduces the mechanical load to an adjustable extent, PAV permits the study of the pattern of breathing in patients with respiratory disease when unconstrained by abnormal respiratory mechanics. We studied 11 patients with assorted medical problems requiring ventilatory support. The patients were switched to PAV, and the level of support was varied from near-maximal levels to the lowest tolerable level. Each level was maintained for several minutes while ventilation (VE), tidal volume (VT), and respiratory rate (f) were monitored. The breathing pattern observed with the highest assist varied substantially among patients. The ranges (and means) of VE, VT, and f were 5.6-18.7 (12.8) l/min, 203-844 (517) ml, and 18-33 (25) breaths/min, respectively. The correlation between VT and VE at the highest assist was very high (r = 0.91), suggesting that ventilatory demand is the most important determinant of VT variability. There were no systematic changes in breathing pattern as the level of assist was altered; at the highest and lowest levels of support, VE, VT, and f were, respectively, 12.8 +/- 5.4 (SD) vs. 11.6 +/- 4.3 l/min, 517 +/- 217 vs. 459 +/- 175 ml, and 25.0 +/- 4.2 vs. 25.7 +/- 3.9 breaths/min. These results indicate that within each patient, in a given state, there exist unique values for a desired VE, VT, and f that are largely independent of the mechanical load; if assist is increased, patient effort is decreased to maintain the desired ventilatory targets.

Adult↗
PubMed1996

Erythropoietin does not demonstrate circadian rhythm in healthy men.

The hormone erythropoietin (Epo) produced in the kidneys in response to hypoxia stimulates the production of red blood cells. We measured serum Epo levels in 26 healthy men over a 24-h period to determine whether Epo is secreted according to a circadian rhythm. Samples were collected every 2-4 h, and Epo was measured by using a radioimmunoassay (INCSTAR Epo-trac). To determine whether blood collection had any effect on Epo production, one-half of the subjects began the collection period in the morning and the other half in the evening. Exercise and the use of prostaglandin inhibitors were prohibited to eliminate fluctuations in Epo production in response to discrete stimuli. The daily Epo concentration for all subjects combined was 15.5 +/- 5.3 (SD) U/l. No significant circadian variation in serum Epo concentrations was observed in either group or when both groups were combined; however, a measure of individual variance was observed (mean deviation = 0.8 +/- 0.4 U/l).

Adult↗
PubMed1996

Noninvasive positive-pressure ventilation in acute respiratory distress without prior chronic respiratory failure.

We evaluated the efficacy of noninvasive mechanical ventilation (NIMV) in alleviating distress and avoiding intubation in patients with de novo acute respiratory failure complicating primary medical disorders. Eleven consecutive patients with severe respiratory distress were entered. In all patients a decision to intubate on an urgent basis had been made, but NIMV could be initiated within minutes. The patients suffered from acute pulmonary edema (five), sepsis/ARDS (two), status asthmaticus (two), and severe pneumonia (two). Dyspnea score (max=10) was (+/- SD) 8.4 +.- 1.6, scale for accessory muscle use (max=5) was 4.2 +/- 0.7, and respiratory rate was 37.6 +/- 3.8 min -1. Pa CO2, pH, and base excess (BE) were 48 +/- 18 mm Hg, 7.27 +/- 0.13, and -5.5 +/- 7.4, respectively, with five patients showing severe metabolic acidosis (BE < - 10). NIMV was applied using proportional assist ventilation. There were three early failures. These included the two patients with sepsis/ARDS who did not tolerate the mask. One patient failed because Pa CO2 and pH deteriorated despite subjective improvement. The remaining eight patients demonstrated progressive improvement, and none required intubation. The duration of NIMV was 3 h to 2 d. We conclude that when NIMV is made available on a "few minutes" basis, selected patients with severe de novo respiratory distress/failure caused by reversible medical disorders, who would otherwise have been intubated, can be given substantial relief and be spared intubation.

Acid-Base Imbalance↗
PubMed1996

Factors influencing haemostasis and blood transfusion in cardiac surgery.

To find out the risk factors influencing perioperative bleeding and use of blood products in cardiac surgery so that appropriate interventions can be selected for blood conservation, risk factors were analysed in 343 cardiac surgical patients, retrospectively, by multiple regression technique. The results showed that the factors related to postoperative bleeding were male gender, Higgins score, cardiopulmonary bypass (CPB) time, operation procedures, intraoperative blood loss and use of internal mammary artery (IMA) graft. Factors related to perioperative homologous blood transfusions were emergency surgery, preoperative haemoglobin level, Higgins score, intraoperative blood loss, operation time and operation procedures. The geometric mean of postoperative bleeding in the entire series was 1085 ml and the mean packed red cell, plasma and platelet transfusions were 3.29 +/- 0.4, 1.96 +/- 0.39 and 0.21 +/- 0.05 units respectively. The incidence of homologous blood transfusion during the hospital stay was 58.9% for the entire series and 54.5% in the nonrevision patients. Emergency patients received significantly more blood transfusion (p = 0.0001). Perioperative blood loss and transfusions are still problems in cardiac surgery and certain patient groups in this study were identified as high risk; available blood conservation techniques, therefore, are recommended in these patients.

Blood Transfusion↗
PubMed1996

The provision of a palliative care service in a teaching hospital and subsequent evaluation of that service.

A survey at a large tertiary referral hospital showed that patients with cancer and HIV disease had poorly controlled symptoms. A palliative care service was introduced, employing a doctor and part-time pharmacist. The doctor was available to see and advise about terminally ill patients. With the pharmacists, an educational programme of meetings, teaching sessions and information leaflets was developed. One year after the introduction of the service a repeat survey all patients with cancer or HIV disease was carried out. Problems on admission were similar in both surveys, but fewer patients' symptom scores deteriorated during their hospital stay. There was a significantly increased use of appropriate opioid analgesics and NSAIDs. Staff were satisfied with the service.

Attitude of Health Personnel↗
PubMed1996

Paracetamol self-poisoning. Characteristics, prevention and harm reduction.

BACKGROUND: Paracetamol is now the most common drug used for self-poisoning in the UK and is associated with potentially fatal liver damage. Patients admitted to hospital because of paracetamol overdoses were studied in order to determine their characteristics and factors which might have deterred them from taking paracetamol or reduced the dangers of the overdose. METHOD: Eighty patients were studied in hospital using a structured interview schedule, measures of depression and suicidal intent, information collected through the Oxford Monitoring System for Attempted Suicide, and the results of liver function tests. RESULTS: Acute liver dysfunction (25 patients) was associated with consumption of more than 25 tablets (odds ration 4.46, 95% CI 1.31 to 17.41, P = 0.014). The proportionate use of tablets from blister packs (60%) and loose preparations (46%; 5 patients using both types) reflected their general availability. More of those who took tablets from a loose preparation consumed 25 or more tablets (69%) than those who used a blister-pack preparation (40%; odds ratio = 3.0, 95% CI 1.12 to 9.95, P = 0.028). Only 20 patients thought that any type of warning label would have deterred them from taking a paracetamol overdose. CONCLUSIONS: Establishing a maximum number of tablets (e.g. 25) that can be available in individual preparations is likely to reduce the dangers of paracetamol self-poisoning. The potential effects of other measures are uncertain.

Acetaminophen↗
PubMed1996

The antidiabetic drug metformin elevates receptor tyrosine kinase activity and inositol 1,4,5-trisphosphate mass in Xenopus oocytes.

Although metformin is an important antidiabetic, its mechanism of action is still unknown. To study its mechanism, we examined metformin stimulation of insulin action on the Xenopus oocyte. Similar to therapeutic concentrations, maximal stimulation of insulin-induced meiotic cell division was achieved at about 1-10 microg/ml (or 7.7-77 /microM) metformin. An equivalent concentration of metformin was required to elevate receptor tyrosine kinase activity (in whole cells or a membrane-cortex preparation) and, through this tyrosine kinase activation, inositol 1,4,5-trisphosphate (IP3) production. With whole cells, the preincubation time for metformin stimulation of insulin action (approximately 1 h) was equivalent to the time required for metformin to maximize tyrosine phosphorylation and raise IP3, levels. With the membrane-cortex preparation, metformin was active within minutes; thus, metformin may act at an intracellular site. Since metformin can increase IP3, mass, we prevented elevation of calcium by prior microinjection of a calcium chelator or heparin (a drug that inhibits IP3 binding to the IP3 receptor). Both the chelator and heparin blocked metformin stimulation of insulin action on whole cells. Since microinjection of IP3, also stimulates insulin action, metformin may stimulate insulin action by elevation of intracellular calcium in addition to activation of the receptor tyrosine kinase.

Animals↗
PubMed1996

A leap in the dark.

Explore the source record for details and available documents.

Financing, Construction↗
PubMed1996

Surgical treatment of coronary artery fistulae associated with other cardiovascular anomalies.

OBJECTIVE: To evaluate retrospectively our surgical experience, techniques and long-term results in 11 patients with coronary artery fistulae associated with other cardiovascular anomalies. METHODS: From January 1980 to April 1995, 11 patients with coronary artery fistulae associated with other cardiovascular anomalies were found among 20,000 open-heart procedures and treated surgically. Besides closure of the fistulae, coronary artery bypass grafting was performed in 5 patients with atherosclerotic coronary artery disease, and aneurysm angioplasty was done in 4 patients with coronary artery aneurysm. Ventricular septal defect and patent ductus arteriosus were closed in one patient and mitral valve replacement was performed in another patient. RESULTS: There were no surgical deaths, but one late death due to acute myocardial infarction occurred 6 months after surgery. The mean follow-up time was 75.7 months and all patients' functional status improved by an average 1.4 judged by the New York Heart Association functional classification. CONCLUSIONS: Coronary artery fistula associated with other cardiovascular anomalies will aggravate symptoms and cause deterioration of heart function. Therefore, evaluation and surgical intervention should be done as soon as possible to restore coronary blood flow and correct concomitant cardiovascular anomalies. The surgical results are excellent with a low operative risk and good long-term results.

Adult↗
PubMed1995

Shock-excited OH maser emission outlining the galactic center supernova remnant G359.1-0.05.

A search using the Very Large Array was performed for 1720-megahertz OH maser line emission from a number of nonthermal radio continuum sources in the galactic center region. The 1720-megahertz transition has recently been noted for its potential as a tracer of shock activity. The most striking result was the detection of extended 1720-megahertz OH maser emission, as well as a number of compact OH maser features, along the interface between a large-scale continuum shell (G359.1-0.5) and its surrounding ring of high-velocity molecular gas. The morphological correlation among the neutral gas, the nonthermal shell, and the maser features provides strong support for the hypothesis that the 1720-megahertz maser line of OH arises from gas shocked by the impact of the expanding supernova remnant into the molecular material. However, the radial velocities of the molecular cloud surrounding G359.1-0.5 are more negative than that of the OH maser spots by more than 50 kilometers per second. Here it is suggested that only the low-radial-velocity component of the carbon monoxide material at the limb of the remnant satisfies the physical conditions required for collisional pumping of the OH 1720-megahertz line behind the expanding shock front.

Astronomical Phenomena↗
PubMed1995

Results of the international study of the implantable pacemaker cardioverter-defibrillator. A comparison of epicardial and endocardial lead systems. The Pacemaker-Cardioverter-Defibrillator Investigators.

BACKGROUND: The purpose of the present report was to document clinical experience derived from the implantation of 2834 epicardial and endocardial cardioverter-defibrillators (ICDs) in 2807 patients who were followed for almost 1 year and to compare the results obtained with the two systems. METHODS AND RESULTS: Patients in the two groups had similar clinical characteristics. More than half of the patients had a total of almost 50,000 spontaneous ventricular tachyarrhythmias that were terminated with equal success (approximately 98%) by epicardial and endocardial ICDs. Lead dislodgement and pocket infection occurred more often with the endocardial than with the epicardial ICD, whereas perioperative mortality was higher with the epicardial ICD than with the endocardial ICD. Mortality from sudden cardiac death was 1.4% in the epicardial ICD group and 0.6% in the endocardial ICD group at 1 year (P = .069). Overall mortality at 1 year was 12.2% and 6.9% for the epicardial and endocardial groups, respectively (P < .001), reflecting the higher surgical mortality for the epicardial system. CONCLUSIONS: The endocardial ICD is as effective as the epicardial ICD but incurs lower perioperative mortality.

Adult↗