Changes in AVP following aggressive diuretic therapy of severe congestive cardiac failure in elderly patients.
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Aged↗
Biomedical subjects
D Sykes
Publications and source records attributed to D Sykes.
Measuring blood pressure in the elderly: does atrial fibrillation increase observer variability?
OBJECTIVE: To compare the interobserver and intraobserver variability of blood pressure measurements in geriatric patients in atrial fibrillation and in sinus rhythm. DESIGN: Prospective assessment of blood pressure measurements carried out in random order in two groups of elderly patients by five doctors unaware of the aims of the study. SETTING: Acute assessment wards for geriatric medicine, Cardiff Royal Infirmary. PATIENTS: 50 Elderly patients in sinus rhythm and 50 in atrial fibrillation. MAIN OUTCOME MEASURES: Interobserver and intraobserver variability of blood pressure measurements in the two groups expressed as the coefficient of variability and compared by the Mann-Whitney U test. RESULTS: Interobserver variability was significantly greater in the patients with atrial fibrillation for both systolic and diastolic pressures. Intraobserver variability was significantly greater in the atrial fibrillation group for diastolic pressures but the difference was not significant for systolic pressures. These differences were not related to pulse rate, age, or level of blood pressure. CONCLUSIONS: The findings suggest that in the presence of atrial fibrillation physicians' interpretations of Korotkoff sounds are less uniform, which may have important clinical implications. Possibly a standardised methodology may overcome this problem.
Aged↗
Patient-controlled analgesia in postoperative pain: the relation of psychological factors to pain and analgesic use.
The surgical experience is often characterized by fear, stress, and pain. Whenever an individual has to confront a painful or stressful event such as surgery, the individual's opportunity to control some aspect of the situation may actually influence the degree of pain experienced. Patient-controlled analgesia (PCA) is a relatively new method of analgesic administration that allows the postoperative patient to self-administer analgesic drug. The present study examined the relationship of psychological variables, including anxiety, depression, coping strategies, and social support, to pain and PCA use in a sample of 80 adults who underwent orthopaedic surgeries. Regression analyses controlling for age and type of opioid revealed that the psychological measures were important predictors of pain and PCA use. Patients with higher anxiety levels and less social support had higher postoperative pain and made more frequent PCA demands.
Age Factors↗
Isolation and characterization of cortisol-sensitive and -resistant P1798 mouse lymphosarcoma cell lines.
Three cell lines have been isolated and characterized from the P1798 mouse lymphosarcoma. One line, derived from a glucocorticoid-resistant tumor, was glucocorticoid-resistant in vitro. The other two cell lines, derived from glucocorticoid-sensitive and -resistant parental tumors, respectively, were shown to be glucocorticoid-sensitive in vitro. The glucocorticoid receptor from all three cell lines bound glucocorticoid with similar affinity and capacity. However, based on Sephacryl S-300 gel filtration, the glucocorticoid receptor from the resistant cell line was smaller than that of the two sensitive cell lines. Moreover, the glucocorticoid receptor from the resistant cell line accumulated to a greater extent in the nucleus. This resistant cell line thus resembles the nti variant of the S49 lymphoma cell line. All three cell lines were tumorigenic and metastatic when reimplanted into mice, contained the normal mouse diploid complement of 40 chromosomes and exhibited the same responsiveness to cortisol in vivo as they did in vitro. It is concluded that the ready passage of these cell lines in vitro or in vivo and the presence of the small receptor in the resistant line should make them excellent model systems for the study of glucocorticoid resistance.
Animals↗
Effect of Streptococcus pneumoniae on human respiratory epithelium in vitro.
A total of 11 of 15 Streptococcus pneumoniae culture filtrates and all five bacterial autolysates produced by cell death in the stationary phase caused slowed ciliary beating and disruption of the surface integrity of human respiratory epithelium in organ culture. This effect was inhibited by cholesterol and was heat labile and reduced by standing at room temperature but was stable at -40 degrees C. The activity was detected at the late stationary phase of culture and was associated with the presence of hemolytic activity. Gel filtration of a concentrated culture filtrate and autolysate both yielded a single fraction of approximately 50 kilodaltons which slowed ciliary beating and were the only fractions with hemolytic activity. Rabbit antiserum to pneumolysin, a sulfhydryl-activated hemolytic cytotoxin released by S. pneumoniae during autolysis, neutralized the effect of the culture filtrate on respiratory epithelium. Both native and recombinant pneumolysin caused ciliary slowing and epithelial disruption. Electron microscopy showed a toxic effect of pneumolysin on epithelial cells: cytoplasmic blebs, mitochondrial swelling, cellular extrusion, and cell death, but no change in ciliary ultrastructure. Recombinant pneumolysin (10 micrograms/ml) caused ciliary slowing in the absence of changes in cell ultrastructure. Release of pneumolysin in the respiratory tract during infection may perturb host defenses, allowing bacterial proliferation and spread.
Autolysis↗
Factors influencing total cholesterol and high-density lipoprotein cholesterol concentrations in a population at high coronary risk.
Serum total cholesterol and high-density lipoprotein (HDL) cholesterol concentrations were measured in 1122 men and 1147 women aged between 25 and 64 years during the first Belfast MONICA survey, and the results subjected to multiple regression analysis. In both men and women, total cholesterol increased with age. Although HDL-cholesterol showed little variation with age, the values were considerably higher in women than men. Total cholesterol increased with body mass index while HDL-cholesterol decreased, and these findings persisted after adjustment for age. Regular exercise was associated with higher HDL-cholesterol values, even after adjustment for age and body mass index. Among men and women who abstained from alcohol, lower values of HDL-cholesterol were observed. In both sexes, cigarette smoking was associated with significant increases in total cholesterol values and decreases in HDL-cholesterol values, though some of these findings became apparent only after adjustment for other relevant factors. Perhaps surprisingly, a measure of health knowledge showed no association with blood lipid concentrations.
Adult↗
A giant thyroid cyst.
The case report describes a female of 82 who presented with a very large goitre caused by a solitary thyroid cyst that was successfully treated by aspiration.
Aged↗
Pyocyanin and 1-hydroxyphenazine produced by Pseudomonas aeruginosa inhibit the beating of human respiratory cilia in vitro.
Pseudomonas aeruginosa culture filtrates varied in their ability to slow human ciliary beat frequency (7-71%). This activity did not correlate with known virulence factors. However, a close correlation (r = 0.97) existed between ciliary slowing and pigment content. In a prolonged culture, the increase in activity correlated (r = 0.94) with pigment accumulation. Gel filtration of lyophilized filtrate yielded a single peak of activity corresponding to the pigment fraction. Pyocyanin extracted from an active strain, and 1-hydroxyphenazine were purified by high performance liquid chromatography, and characterized by ultraviolet absorbance spectra and mass spectrometry. Both slowed cilia in a dose-dependent manner, and were synthesized and shown to be indistinguishable from the biological compounds. Pyocyanin caused gradual onset of slowing and ultimate widespread ciliostasis with epithelial disruption. 1-hydroxyphenazine caused rapid onset of ciliary slowing associated with dyskinesia and ciliostasis. Pyocyanin assayed within filtrates accounted for a significant proportion of the bioactivity present.
Alginates↗
Pulmonary disease associated with Pseudomonas aeruginosa in cystic fibrosis: current status of the host-bacterium interaction.
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Cilia↗
Immunoglobulin E-dependent stimulation of human alveolar macrophages: significance in type 1 hypersensitivity.
Human alveolar macrophages were obtained during diagnostic bronchoalveolar lavage. Cells were cultured, and morphological examination (including electron microscopy) revealed that not more than 5% of the cultured cells were identifiable as cells other than alveolar macrophages. The cells were sensitized with human myeloma immunoglobulin E. and then challenged with anti-immunoglobulin E anti-sera. The experiments employed a highly specific monoclonal antibody and three affinity purified reagents. The formation of immunoglobulin E/anti-immunoglobulin E complexes facilitated release from alveolar macrophages of leukotriene B4, prostaglandin F2 alpha, thromboxane B2 and the lysosomal hydrolase N-acetyl-beta-D-glucosaminidase. There was no release of active oxygen species, with this stimulus, as measured by lucigenin chemiluminescence. Immunoglobulin E receptors were identified histochemically on the surface of human alveolar macrophages, and were visualized as conjugates with colloidal gold by electron microscopy. These results support the view that human alveolar macrophages may contribute to type 1 hypersensitivity reactions in the lung.
Asthma↗
Multiple respiratory tract stenoses associated with mucociliary dysfunction.
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Animals↗
Prophylactic use of cefotaxime in elective biliary surgery.
This paper describes a randomized trial of 66 patients undergoing elective biliary surgery, half of whom received 1 g of intravenous injection of cefotaxime at the time of induction of anaesthesia and half who had no treatment. A 12.5% wound infection rate in the untreated patients was observed compared to a complete absence of infection in the treated patients.
Cefotaxime↗
The use of cholecystokinin in diagnosing biliary pain.
Some patients who present with a story of gallbladder disease may have a normal oral cholecystogram. In some such cases an intravenous injection of cholecystokinin may reproduce their symptoms and it is suggested that this is a positive indication for advising a cholecystectomy.
Adult↗
The solitary thyroid nodule.
In a 4-year period the solitary thyroid nodule was the most common form of thyroid pathology seen in the surgical section of a thyroid clinic. The cold thyroid nodule was the most frequent type of solitary nodule and half of these were unilocular cysts which were treated by aspiration and sclerotherapy. Cytological examination of the aspirated fluid revealed no evidence of malignant cells. Emphasis is placed on recommending operation if aspiration fails to cause the mass to disappear.
Adolescent↗
The evaluation of cefuroxime in the prevention of postoperative infection.
Patients undergoing biliary surgery received either 750 mg cefuroxime i.m. with the premedication and then 8 hourly for 3 days ((group A) or 1.5 g cefuroxime i.v. at the time of induction of anaesthesia (group B) or not treatment (group C). Wound infections occurred in 3 out of 35 patients in group A, 1 out of 40 patients in group B and 11 out of 39 patients in group C (group B significantly different than group C, P less than 0.05). Eight patients (23%) in group C had chest complications. Cefuroxime was effective in the reduction of wound sepsis following biliary surgery and 1.5 g i.v. administered during induction of anaesthesia is the dosage of choice. The incidence of chest infection tended to be lower in patients receiving cefuroxime but many more patients would have to be studied for a conclusive result.
Adult↗
Diagnosis of primary hyperparathyroidism.
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Catheterization↗
Medroxyprogesterone acetate and reproductive processes in male dogs.
The treatment of normal male dogs with a depot preparation of medroxyprogesterone acetate (4 mg/kg) for 7 weeks reduced peripheral testosterone levels by 58%. No effects on testicular size and consistency, semen quality or libido were found.
Animals↗