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Biomedical subjects

D Smith

Publications and source records attributed to D Smith.

At least 1,279 records · Page 71Linked to original sources
PubMedDate not supplied

Atraumatic subdural hematoma associated with pre-eclampsia.

A patient with pre-eclampsia at 31.7 weeks' gestation developed focal neurologic signs. Computerized tomography revealed a large cranial subdural hematoma. A subdural hematoma should be considered in any pre-eclamptic patient demonstrating lateralizing neurologic symptoms. Despite adequate treatment, an atraumatic subdural hematoma associated with pre-eclampsia carries a poor maternal prognosis.

Adult↗
PubMedDate not supplied

A good practice guide to the administration of substances and removal of blood, including routes and volumes.

This article is the result of an initiative between the European Federation of Pharmaceutical Industries Associations (EFPIA) and the European Centre for the Validation of Alternative Methods (ECVAM). Its objectives are to provide the researcher in the safety evaluation laboratory with an up-to-date, easy-to-use set of data sheets to aid in the study design process whilst at the same time affording maximum welfare considerations to the experimental animals. Although this article is targeted at researchers in the European Pharmaceutical Industry, it is considered that the principles underpinning the data sets and refinement proposals are equally applicable to all those who use these techniques on animals in their research, whether in research institutes, universities or other sectors of industry. The implications of this article may lead to discussion with regulators, such as those responsible for pharmacopoeial testing. There are numerous publications dealing with the administration of test substances and the removal of blood samples, and many laboratories also have their own "in-house" guidelines that have been developed by custom and practice over many years. Within European Union Directive 86/609EEC1 we have an obligation to refine experiments to cause the minimum amount of stress. We hope that this article will provide background data useful to those responsible for protocol design and review. This guide is based on peer-reviewed publications whenever possible, but where this is not possible we have used "in-house" data and the experience of those on the working party (as well as helpful comments submitted by the industry) for a final opinion. The guide also addresses the continuing need to refine the techniques associated with the administration of substances and the withdrawal of blood, and suggests ways of doing so. Data-sharing between laboratories should be encouraged to avoid duplication of animal work, as well as sharing practical skills concerning animal welfare and scientific problems caused by "overdosing" in some way or another. The recommendations in this guide refer to the "normal" animal, and special consideration is needed, for instance, during pregnancy and lactation. Interpretation of studies may be confounded when large volumes are administered or excessive sampling employed, particularly if anaesthetics are used.

Animals↗
PubMedDate not supplied

Velocity-encoded, phase-difference cine MRI measurements of coronary artery flow: dependence of flow accuracy on the number of cine frames.

Phase-contrast magnetic resonance imaging (PC-MRI) can be used to produce multiframe cine flow images of the coronary arteries. Accurate coronary flow measurement requires the elimination of respiratory motion artifacts using k-space segmentation to acquire the data in a single breath-hold. However, the duration of the breath-hold is proportional to the number of cine frames. In the present study, the number of cine frames was varied and the accuracies of the coronary flow measurements were assessed using perivascular US. For the range of flows studied (2 ml/min to 147 ml/min), the correlation coefficients for PC-MRI and US increased (.70-.98) and the limits of agreement improved (+/-45 ml.min-1 to +/-10 ml.min-1) as the number of cine frames increased from one to six. The results suggest that the accuracy of breath-hold cine PC-MRI measurements of coronary artery flow improves as the number of cine frames increases.

Animals↗
PubMedDate not supplied

Multicenter epidemiologic and health services research on therapeutics in the HMO Research Network Center for Education and Research on Therapeutics.

Research and education programs in therapeutics that combine the data, organizational capabilities, and expertise of several managed care organizations working in concert can serve an important role when a single organization is not large enough to address a question of interest, when diversity in populations or delivery systems is required, and when it is necessary to establish consistency of results in different settings. Nine members of the HMO Research Network, a consortium of health maintenance organizations (HMOs) that perform public domain research, have formed a Center for Education and Research on Therapeutics (CERT), sponsored by the Agency for Healthcare Research and Quality, to conduct multicenter research in therapeutics. The CERT uses a distributed organizational model with shared leadership, in which data reside at the originating organization until they are needed to support a specific study. Extraction of data from the host computer systems, and some manipulation of data, is typically accomplished through computer programs that are developed centrally, then modified for use at each site. For complex studies, pooled analysis files are created by a coordinating center, and then analysed by investigators throughout the HMOs. It is also possible to contact HMO members when necessary. This multicenter environment has several benefits, addressing: (1) a wide array of questions about the safety and effectiveness of therapeutics, (2) the impact of efforts to change clinicians' and patients' behavior, and (3) pharmacoeconomic and pharmacogenetic questions.

Community Networks↗
PubMedDate not supplied

Perineal endometrioma in episiotomy incisions: clinical features and management.

Four patients, 23--34 years old, who developed endometriomas at the site of an episiotomy 19 months to 11-years postpartum are reported. Pain, Swelling and pruritus varying in intensity with the menstrual cycle were present in all. Complete excision is curative. Symptoms of incompletely excised endometriomas may be controlled by local hormonal injections or systemic hormonal manipulation. The anatomy of the endometrium and its physiologic behavior are reviewed. A concept of WHY endometriomas develop is presented which is compatible with the theories of HOW they occur.

Adult↗
PubMedDate not supplied

The cost of managing diabetic foot ulceration in an Irish hospital.

BACKGROUND: Little is known about the economic impact of diabetic foot ulceration in the Irish healthcare setting. AIM: Audit of diabetic foot ulcer admissions in St James's Hospital between April 2001 and March 2002. METHODS: Hospital charts were reviewed and costs were calculated on the length of patients' hospital stay and the cost of individual investigations performed. RESULTS: Thirty patients were admitted with diabetic foot ulceration as the primary complaint. Amputation was performed in eight patients, two patients with a non-healing ulcer died. The average duration of each hospital admission was 20.3+/-30.7 days. Net in-hospital expenditure was 704,689, an average of 23,489.63 per hospital admission. CONCLUSIONS: The management of diabetic foot ulceration has a significant economic impact on the Irish healthcare budget. Treatment should therefore be focused on primary prevention through specialised foot clinics and a multidisciplinary team approach to reduce this economic burden.

Aged↗
PubMedDate not supplied

Thoracic aortic dissection or aneurysm: clinical presentation, diagnostic imaging and initial management in a tertiary referral centre.

Spontaneous thoracic aortic dissection carries a high mortality despite progress in diagnosis and treatment. Early and accurate diagnosis is paramount and dependent on clinical and diagnostic imaging skills. A retrospective review of 55 consecutive patients referred with suspected thoracic aortic dissection to a medical cardiology department was performed. Clinical follow up was complete to November 1995. Median age was 68 years (range 30-93), with 37 males, 18 females. Presenting complaints included interscapular chest pain in 23 (42 per cent), neurological deficit in 2 (4 per cent), and limb ischaemia in 8 (15 per cent). On examination 34 (62 per cent) patients had hypertension, 5 (9 per cent) a pulse deficit and 10 (18 per cent) aortic incompetence. Electrocardiography confirmed myocardial infarction in 1. Chest X-ray showed a widened mediastinum in 37 (67 per cent) patients. Dissection was confirmed in 35 (64 per cent) patients (13-DeBakey Type I, 6-Type II, 14-Type III); 10 had nondissecting aneurysm. Contrast aortography was equally sensitive (84 per cent) and more specific (100 per cent vs 80 per cent) than computed tomography for detection of dissection. Surgical repair was performed on 24 patients with concomitant coronary artery bypass grafting in 6. At follow up 33 patients were alive. Clinical diagnosis of thoracic aortic dissection or aneurysm may be difficult. Frequently more than one imaging modality may be required in order to provide all of the necessary information for optimal patient management.

Adult↗
PubMedDate not supplied

Elevated plasma concentrations of atrial and brain natriuretic peptide in type 1 diabetic subjects.

BACKGROUND: The intravenous infusion of atrial (ANP) and brain (BNP) natriuretic peptides have been shown to increase urinary albumin excretion in type 1 diabetes. AIMS: To measure plasma ANP and BNP concentrations in patients with type 1 diabetes and to examine the parameters associated with elevated plasma concentrations. Methods We measured plasma ANP and BNP concentrations, UAER, HbA1C systolic blood pressure, and left ventricular mass index. Plasma ANP and BNP were also measured in non-diabetic control subjects for comparison. RESULTS: Using multivariate regression analysis plasma ANP correlated positively with HbA1C (1.9 + 0.47, p = 0.0002), UAER (0.37 + 0.05, p = 0.00001), SBP (1.26 + 0.5, p = 0.01) and LVMI (00.46 + 0.25, p = 0.07). BNP was positively related with LVMI (0.95 + 0.4, p = 0.02), and UAER (0.56 + 0.08, p = 0.001). CONCLUSIONS: Plasma concentrations of ANP and BNP are elevated in some patients with type 1 diabetes. Plasma ANP concentrations are closely related to UAER and elevated plasma concentrations are associated with poor glycaemic control and systemic hypertension. Plasma BNP concentration is related to LVMI.

Adult↗
PubMedDate not supplied

Human DT-diaphorase, a potential cancer protecting enzyme. Its purification from abdominal adipose tissue.

The flavoprotein DT-diaphorase (EC 1.6.99.2) is believed to play an important role in the body's defense system. This enzyme has been purified 13,000-fold with a recovery of 58% from a cytosolic fraction of abdominal fat obtained from an obese patient undergoing elective surgery. Purification of the enzyme to electrophoretic homogeneity was achieved after two chromatographic steps: (1) affinity chromatography on azodicumarol Sepharose 6B; (2) anion exchange chromatography on DEAE Sephacel. The enzyme exhibits a monomer molecular mass of 32 kDa in SDS-PAGE and has 1 FAD prosthetic group per 32 kDa monomer. The FAD prosthetic group appears to be firmly attached to the apoproprotein. The enzyme reduces azodyes and quinones and demonstrates a broad substrate specificity. The enzyme has characteristics that are similar to DT-diaphorase purified from rodent liver, especially the rat liver enzyme. Estimated Km values for NADH, NADPH and menadione are 200, 140 and 3.3 microM, respectively. Vmax values for these substrates in the same order are 762, 667 and 294 mumol/mg.min. Dicumarol and warfarin exhibited competitive inhibition with pyridine nucleotides. The inhibition constants (Ki) for the drugs were estimated to be 10 nM and 2.2 microM, respectively. When compared to several other tissues, abdominal fat has one of the highest DT-diaphorase activities (Martin, L.F., Patrick, S.D. and Wallin, R. (1987) DT-diaphorase in morbidly obese patients. Cancer Lett., 36, 341-347), but the specific role of the enzyme in human fat is unknown.

Abdomen↗
PubMedDate not supplied

Sulbactam/ampicillin versus metronidazole/gentamicin in the treatment of post-cesarean section endometritis.

Sixty-seven patients diagnosed with post-cesarean-section endometritis were studied in a prospective comparative randomized trial of sulbactam/ampicillin, a new beta-lactamase inhibitor drug combination, versus treatment with metronidazole/gentamicin. The success rate was 91% for each antibiotic regimen. Mycoplasma spp. or Ureaplasma spp. were isolated from all treatment failures. Endometrial cultures revealed 2.3 aerobes as well as anaerobes per patient, with Enterococcus faecalis, Bacteroides bivius, and Escherichia coli the most frequently reported bacterial isolates in 64, 40, and 28% of all patients, respectively. Positive blood cultures were noted in 11 (15%) patients with Mycoplasma sp. the most commonly found isolate (45.5%). Sulbactam/ampicillin appears to be safe and equally effective as a metronidazole/aminoglycoside drug regimen in the treatment of postpartum endometritis.

Adult↗