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Biomedical subjects

D Robertson

Publications and source records attributed to D Robertson.

At least 127 records · Page 7Linked to original sources
PubMed1999

Medium-term results of a mobile bearing total knee replacement.

Mobile bearing total knee arthroplasty kinematically allows the advantages of large and congruent surface contact and low contact pressures, while preserving flexion, extension, and rotation in knee motion. In allowing for these degrees of freedom, the interface between bone and component also is protected from high stress. The Self Aligning I total knee arthroplasty initially was implanted in patients after its development at the authors' institution in 1990. Between 1990 and 1994, 141 patients with osteoarthritis of the knee underwent 172 total knee replacements using this system. At average followup of 5.6 years (range, 5-8 years), clinical results using this system showed a 94% satisfaction rate (good or very good). Two revision surgeries have been performed for polyethylene wear, with none of the remaining knees showing evidence of discernible wear. Complications included four cases of deep infection, four cases where a press fit femoral component failed (nonporous coated) and the patients required revision surgery, four traumatic fractures (three patellar and one supracondylar), one popliteal artery occlusion, and one revision for stiffness. Three patients required manipulation under anesthesia for arthrofibrosis. Kaplan-Meier survival curves show the probability of survival to be 91.7%, with revision surgery for any reason as an end point, and 98.8% for revision surgery because of polyethylene wear as an end point. Following the initial learning curve with this prosthesis, the medium term results using this system show maintenance of clinical success. No progressive evidence of polyethylene wear with time has been found, supporting the concept of mobile bearing arthroplasty in extending the service life of total knee arthroplasty.

Aged↗
PubMed1999

[Consensus on the diagnosis of multi-system atrophy].

We report the results of a consensus conference on the diagnosis of multiple system atrophy. We describe the clinical features of the disease, which include four domains: autonomic failure/urinary dysfunction, parkinsonism and cerebellar ataxia, and corticospinal dysfunction. We set criteria to define the relative importance of these features. The diagnosis of possible multiple system atrophy requires one criterion plus two features from separate domains. The diagnosis of probable multiple system atrophy requires the criterion for autonomic failure/urinary dysfunction plus poor levodopa responsive parkinsonism or cerebellar ataxia. The diagnosis of definite multiple system atrophy requires pathological confirmation.

Diagnosis, Differential↗
PubMed1999

Orthostatic intolerance: emerging genetic and environmental etiologies.

Orthostatic intolerance (OI) is common after space flight and resembles the disabling idiopathic orthostatic intolerance commonly observed in otherwise healthy young individuals. OI can arise from reduced sympathetic nervous system activity and, paradoxically, also from increased sympathetic nervous system activity. Patients with early manifestations of pure autonomic failure demonstrate an etiology based upon reduced sympathetic nervous system activity. Patients with hyperadrenergia demonstrate an etiology based on increased sympathetic nervous activity. For many years, we have recognized that the microgravity environment induces adaptation in the cardiovascular system and its autonomic control mechanisms that lead to the presence of OI on return to gravity. Understanding the nature of OI in astronauts returning from space as well as in the relevant patient population on earth has been a priority of Vanderbilt's Center for Space Physiology and Medicine in recent years. A major purpose of the autonomic experiment in the Neurolab mission was to identify whether the OI experienced by astronauts on return to earth was best explained by a hypoadrenergic or hyperadrenergic state. To address this question, we analyzed sympathetic nervous system activity inflight by 1) measurement of plasma catecholamines; 2) assessment of peroneal microneurographic sympathetic nerve traffic; and 3) assessment of norepinephrine spillover and clearance during infusion of tritiated norepinephrine. These studies documented a slight (five bursts per minute) increase in muscle sympathetic nerve activity, a 200 pg/ml increase in plasma norepinephrine level, and a 350 ng/min increase in norepinephrine clearance. Plasma norepinephrine and norepinephrine spillover and clearance were also raised on recovery day. These data indicate that enhanced sympathetic activation, rather than reduced sympathetic activation, accompanies the orthostatic intolerance following microgravity.

Autonomic Nervous System Diseases↗
PubMed1999

Multiple system atrophy: clinical presentation and diagnosis.

Multiple system atrophy (MSA) describes a relatively uncommon, debilitating disorder that is frequently misdiagnosed as Parkinson's disease. Patients with MSA show various combinations of parkinsonism, cerebellar ataxia, pyramidal signs and progressive autonomic failure, especially cardiovascular and urologic autonomic dysfunction. Few treatment options exist. Although some patients initially respond well to dopaminergic treatment for their parkinsonian symptoms, striatal degeneration occurs, and levodopa often becomes ineffective. Thus, physicians may provide only symptomatic treatment and support for patients with MSA. In this paper, we present a case study of a 68-year-old woman who came to the Vanderbilt Movement Disorders Clinic with severe autonomic dysfunction and parkinsonism, previously diagnosed as Parkinson's disease. Following autonomic function tests as well as clinical evaluation, she was diagnosed with MSA and began treatment for orthostatic hypotension and micturition dysfunction.

Aged↗
PubMed1998

Consensus statement on the diagnosis of multiple system atrophy.

We report the results of a consensus conference on the diagnosis of multiple system atrophy (MSA). We describe the clinical features of the disease, which include four domains: autonomic failure/urinary dysfunction, parkinsonism and cerebellar ataxia, and corticospinal dysfunction. We set criteria to define the relative importance of these features. The diagnosis of possible MSA requires one criterion plus two features from separate other domains. The diagnosis of probable MSA requires the criterion for autonomic failure/urinary dysfunction plus poorly levodopa responsive parkinsonism or cerebellar ataxia. The diagnosis of definite MSA requires pathological confirmation.

Autonomic Nervous System Diseases↗
PubMed1998

Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control.

BACKGROUND: Chronic orthostatic intolerance (COI) is a debilitating autonomic condition in young adults. Its neurohumoral and hemodynamic profiles suggest possible alterations of postural sympathetic function and of baroreflex control of heart rate (HR). METHODS AND RESULTS: In 16 COI patients and 16 healthy volunteers, intra-arterial blood pressure (BP), ECG, central venous pressure (CVP), and muscle sympathetic nerve activity (MSNA) were recorded at rest and during 75 degrees tilt. Spectral analysis of RR interval and systolic arterial pressure (SAP) variabilities provided indices of sympathovagal modulation of the sinoatrial node (ratio of low-frequency to high-frequency components, LF/HF) and of sympathetic vasomotor control (LFSAP). Baroreflex mechanisms were assessed (1) by the slope of the regression line obtained from changes of RR interval and MSNA evoked by pharmacologically induced alterations in BP and (2) by the index alpha, obtained from cross-spectral analysis of RR and SAP variabilities. At rest, HR, MSNA, LF/HF, and LFSAP were higher in COI patients, whereas BP and CVP were similar in the two groups. During tilt, BP did not change and CVP fell by the same extent in the 2 groups; the increase of HR and LF/HF was more pronounced in COI patients. Conversely, the increase of MSNA was lower in COI than in control subjects. Baroreflex sensitivity was similar in COI and control subjects at rest; tilt reduced alpha similarly in both groups. CONCLUSIONS: COI is characterized by an overall enhancement of noradrenergic tone at rest and by a blunted postganglionic sympathetic response to standing, with a compensatory cardiac sympathetic overactivity. Baroreflex mechanisms maintain their functional responsiveness. These data suggest that in COI, the functional distribution of central sympathetic tone to the heart and vasculature is abnormal.

Adult↗
PubMed1998

Glucose transporter GLUT1 localization in human foetus telencephalon.

The endothelial cells of the mature cerebral microvessels, provided with barrier devices (blood-brain barrier, BBB), selectively express the glucose transporter isoform 1 (GLUT1). Presence and localization of the GLUT1 were studied by immunogold silver staining (IGSS) labelling on ultrathin sections of foetal human telencephalon tissue embedded in Lowicryl HM20 according to the progressive lowering of temperature (PLT) method. In the microvascular endothelial cells of the human telencephalon GLUT1 molecules are detected at the 12th gestational week and their expression is increased at the 18th week. In both ages, the transporter is mainly localized on the ablumenal and lateral endothelial cell membranes, and at 18 weeks a greater number of GLUT1 antigenic sites are also seen at the lumenal membrane. Our findings demonstrate both the expression and subcellular localization of GLUT1 be developmentally regulated and suggest an early functioning of the BBB-GLUT1 transporter in the developing human brain.

Blood-Brain Barrier↗
PubMed1998

L-Mandelate dehydrogenase from Rhodotorula graminis: cloning, sequencing and kinetic characterization of the recombinant enzyme and its independently expressed flavin domain.

The l-mandelate dehydrogenase (L-MDH) from the yeast Rhodotorula graminis is a mitochondrial flavocytochrome b2 which catalyses the oxidation of mandelate to phenylglyoxylate coupled with the reduction of cytochrome c. We have used the N-terminal sequence of the enzyme to isolate the gene encoding this enzyme using the PCR. Comparison of the genomic sequence with the sequence of cDNA prepared by reverse transcription PCR revealed the presence of 11 introns in the coding region. The predicted amino acid sequence indicates a close relationship with the flavocytochromes b2 from Saccharomyces cerevisiae and Hansenula anomala, with about 40% identity to each. The sequence shows that a key residue for substrate specificity in S. cerevisiae flavocytochrome b2, Leu-230, is replaced by Gly in L-MDH. This substitution is likely to play an important part in determining the different substrate specificities of the two enzymes. We have developed an expression system and purification protocol for recombinant L-MDH. In addition, we have expressed and purified the flavin-containing domain of L-MDH independently of its cytochrome domain. Detailed steady-state and pre-steady-state kinetic investigations of both L-MDH and its independently expressed flavin domain have been carried out. These indicate that L-MDH is efficient with both physiological (cytochrome c, kcat=225 s-1 at 25 degrees C) and artificial (ferricyanide, kcat=550 s-1 at 25 degrees C) electron acceptors. Kinetic isotope effects with [2-2H]mandelate indicate that H-C-2 bond cleavage contributes somewhat to rate-limitation. However, the value of the isotope effect erodes significantly as the catalytic cycle proceeds. Reduction potentials at 25 degrees C were measured as -120 mV for the 2-electron reduction of the flavin and -10 mV for the 1-electron reduction of the haem. The general trends seen in the kinetic studies show marked similarities to those observed previously with the flavocytochrome b2 (L-lactate dehydrogenase) from S. cerevisiae.

Alcohol Oxidoreductases↗
PubMed1998

Consensus statement on the diagnosis of multiple system atrophy. American Autonomic Society and American Academy of Neurology.

We report the results of a consensus conference on the diagnosis of multiple system atrophy (MSA). We describe the clinical features of the disease, which include four domains: autonomic failure/urinary dysfunction, parkinsonism and cerebellar ataxia, and corticospinal dysfunction. We set criteria to define the relative importance of these features. The diagnosis of possible MSA requires one criterion plus two features from separate domains. The diagnosis of probable MSA requires the criterion for autonomic failure/urinary dysfunction plus poor levodopa responsive parkinsonism or cerebellar ataxia. The diagnosis of definite MSA requires pathological confirmation.

Antiparkinson Agents↗
PubMed1998

Abnormalities of the QT interval in primary disorders of autonomic failure.

BACKGROUND: Experimental evidence shows that activation of the autonomic nervous system influences ventricular repolarization and, therefore, the QT interval on the ECG. To test the hypothesis that the QT interval is abnormal in autonomic dysfunction, we examined ECGs in patients with severe primary autonomic failure and in patients with congenital dopamine beta-hydroxylase (DbetaH) deficiency who are unable to synthesize norepinephrine and epinephrine. SUBJECTS AND METHODS: Maximal QT and rate-corrected QT (QTc) intervals and adjusted QTc dispersion [(maximal QTc - minimum QTc on 12 lead ECG)/square root of the number of leads measured] were determined in blinded fashion from ECGs of 67 patients with primary autonomic failure (36 patients with multiple system atrophy [MSA], and 31 patients with pure autonomic failure [PAF]) and 17 age- and sex-matched healthy controls. ECGs of 5 patients with congenital DbetaH deficiency and 6 age- and sex-matched controls were also analyzed. RESULTS: Patients with MSA and PAF had significantly prolonged maximum QTc intervals (492+/-58 ms(1/2) and 502+/-61 ms(1/2) [mean +/- SD]), respectively, compared with controls (450+/-18 ms(1/2), P < .05 and P < .01, respectively). A similar but not significant trend was observed for QT. QTc dispersion was also increased in MSA (40+/-20 ms(1/2), P < .05 vs controls) and PAF patients (32+/-19 ms(1/2), NS) compared with controls (21+/-5 ms(1/2)). In contrast, patients with congenital DbetaH deficiency did not have significantly different RR, QT, QTc intervals, or QTc dispersion when compared with controls. CONCLUSIONS: Patients with primary autonomic failure who have combined parasympathetic and sympathetic failure have abnormally prolonged QT interval and increased QT dispersion. However, QT interval in patients with congenital DbetaH deficiency was not significantly different from controls. It is possible, therefore, that QT abnormalities in patients with primary autonomic failure are not solely caused by lesions of the sympathetic nervous system, and that the parasympathetic nervous system is likely to have a modulatory role in ventricular repolarization.

Aged↗
PubMed1998

Contrasting actions of pressor agents in severe autonomic failure.

BACKGROUND: Orthostatic hypotension is the most disabling symptom of autonomic failure. The choice of a pressor agent is largely empiric, and it would be of great value to define predictors of a response. PATIENTS AND METHODS: In 35 patients with severe orthostatic hypotension due to multiple system atrophy or pure autonomic failure, we determined the effect on seated systolic blood pressure (SBP) of placebo, phenylpropanolamine (12.5 mg and 25 mg), yohimbine (5.4 mg), indomethacin (50 mg), ibuprofen (600 mg), caffeine (250 mg), and methylphenidate (5 mg). In a subgroup of patients, we compared the pressor effect of midodrine (5 mg) with the effect of phenylpropanolamine (12.5 mg). RESULTS: There were no significant differences in the pressor responses between patients with multiple system atrophy or pure autonomic failure. When compared with placebo, the pressor response was significant for phenylpropanolamine, yohimbine, and indomethacin. In a subgroup of patients, we confirmed that this pressor effect of phenylpropanolamine, yohimbine, and indomethacin corresponded to a significant increase in standing SBP. The pressor responses to ibuprofen, caffeine, and methylphenidate were not significantly different from placebo. Phenylpropanolamine and midodrine elicited similar pressor responses. There were no significant associations between drug response and autonomic function testing, postprandial hypotension, or plasma catecholamine levels. CONCLUSIONS: We conclude that significant increases in systolic blood pressure can be obtained in patients with orthostatic hypotension due to primary autonomic failure with phenylpropanolamine in low doses or yohimbine or indomethacin in moderate doses. The response to a pressor agent cannot be predicted by autonomic function testing or plasma catecholamines. Therefore, empiric testing with a sequence of medications, based on the risk of side effects in the individual patient and the probability of a response, is a useful approach.

Aged↗
PubMed1998

Substance P-sensitive neurones in the rat auditory brainstem: possible relationship to medial olivocochlear neurones.

Using in vitro techniques, intracellular microelectrode recordings were made from the regions of origin of medial olivocochlear neurones in the rat auditory brainstem. Cells were characterised according to their action potential shape and their excitatory response to bath application of micromolar concentrations of the peptide neurotransmitter substance P and were filled with biocytin by injection through the intracellular microelectrode for subsequent morphological reconstruction. Cells with a rapid component to the after-hyperpolarising phase of their action potentials (AHP2 cells) were most likely to show excitatory effects of substance P. Histological reconstruction showed that these cells were stellate with numerous large, slowly tapering dendrites exhibiting small. scattered spines. In examples in which the major axon was not cut near the cell body, the axons ascended dorsally out of the superior olivary complex, in a manner that was consistent with the trajectory of axons of medial olivocochlear neurones. These features differed from other cells in the ventral nucleus of the trapezoid body that were unresponsive to substance P. In a further series of experiments, medial olivocochlear cells in the same region were retrogradely labeled by prior intracochlear injection with fast blue and recordings were made under direct visual observation using either microelectrode impalement or whole-cell patch methods. These data support the view that medial olivocochlear neurones are substance P-sensitive and exhibit a characteristic spike shape. These data strongly suggest that medial olivocochlear neurones possess receptors for substance P and may therefore receive excitatory input from a substance P-utilising neural pathway.

Action Potentials↗