Biomedical subjects
Publications and source records attributed to D Thompson.
Three cases of haemorrhage after the use of a silastic dural substitute are presented. In all cases the implant was removed and further haemorrhage has not occurred. Published work is reviewed and the implications for the continued use of silastic are discussed.
The objectives of this study were to determine whether the maternal plasma corticotrophin-releasing hormone (CRH) concentration influences the amount of uterine contractility induced by infused oxytocin during induction of labour, and secondly to assess changes in CRH and beta-endorphin in response to stress during labour. Serial plasma CRH and beta-endorphin measurements were made in 40 women undergoing induction of labour and correlated with uterine contractility, cervical dilatation, length of labour, analgesic usage and fetal distress. The plasma CRH concentration did not change throughout labour. In subjects receiving infused oxytocin there was a significant positive correlation between plasma CRH and the amount of uterine activity, and a high plasma CRH level was associated with shorter labour. The plasma beta-endorphin level rose with progressive cervical dilatation and fell after epidural anaesthesia. The plasma CRH level did not correlate with the plasma beta-endorphin level or rise with fetal distress. We conclude that high levels of maternal plasma CRH are associated with an increase in the uterine contractile response to infused oxytocin. The maternal plasma CRH level does not vary in response to maternal or fetal stress, but beta-endorphin secretion does rise in response to the stress of labour and is influenced by pain perception.
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Ninety mothers appraised the specific sources and types of social support they received in relation to specific types of demands of caring for a child with a chronic condition. Qualitative data were collected during home interviews with the mothers of children with diabetes, spina bifida, or cystic fibrosis. Virtually all of the mothers described primary caregiver demands that were directly related to the child's condition, such as physical care, health care in illness situations, and the child's psychological and social development. Many mothers also reported secondary demands related to their own needs, family roles and relationships, and the mother's activities outside the home. Mothers experienced gaps in the support provided for specific caregiving burdens and encountered stressful interactions with their partners and health professionals in particular.
Alcohol-fixed, toluidine-blue-stained smears from 24 astrocytomas (12 low grade and 12 high grade or anaplastic) were included in the study. In each case 50 nuclei from representative areas of the tumor were selected for analysis; quantitative features pertaining to both the entire nucleus and the nucleoli were computed. Nuclear features were nuclear area and total optical density. Nucleolar features were number of nucleoli per nucleus, nucleolar area, variance of the nucleolar area, and mean and variance of the distance of nucleoli from the nuclear membrane. The results showed distinct changes in a number of nuclear and nucleolar features from low to high grade astrocytomas. Features expressing the most pronounced nuclear changes were area, grey level nonuniformity and run percentage. Changes were also found in the following nucleolar features: number of nucleoli, nucleolar area, variance of nucleolar area, nucleolar location and variance of nucleolar location. Linear discriminant analysis was carried out to determine a direction in feature space along which astrocytomas of low and high grade might be ranked. The nuclear area, number of low gray value pixels and a run length feature provided a useful linear combination. The study showed that one can derive a set of objective criteria from morphometric measurements that allows an ordering of astrocytoma cases along an axis and that might be used for continuous grading.
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The diagnosis and grading of prostatic intraepithelial neoplasia (PIN) are affected by uncertainties that arise from the fact that almost all our knowledge of PIN histopathology is not expressed in numeric form but rather in descriptive linguistic terms, words and concepts. A Bayesian belief network (BBN) was used to reduce the problem of uncertainty in diagnostic clue assessment while considering the dependencies between elements in the reasoning sequence. A shallow network was developed with an open-tree topology, with a root node containing the diagnostic alternatives and seven first-level descendant nodes for the diagnostic clues. One of these nodes was based on tissue architecture and the others on cell features. The results obtained with prototypes of relative likelihood ratios showed that beliefs for the diagnostic alternatives are very high. The network can grade and differentiate PIN lesions from other prostate lesions with certainty. A number of diagnostic clues greater than seven did not significantly improve network performance, whereas a reduced number of clues resulted in decreased beliefs. A BBN for PIN diagnosis and grading offers a descriptive classifier that is readily implemented and allows the use of linguistic, fuzzy variables. A BBN allows the accumulation of evidence presented by diagnostic clues, each offering only weak evidence.
The inside story of how Bill and Hillary Clinton fashioned the health-care plan. Their own aides often battled over the Clintons' approach.
The rate of spontaneous and mitomycin C induced chromosome breakage and sister chromatid exchange (SCE) was studied in three related cases diagnosed with VACTERL-H syndrome. There have been recent reports of sporadic patients with VACTERL-H in whom high rates of chromosome breakage were observed. This has led to the suggestion that some of these patients may represent the severe expression of Fanconi anemia. The pattern of inheritance in our family is highly suggestive of X-linked recessive inheritance supporting the hypothesis that VACTERL-H is, at least in some cases, a syndrome and not an association.
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Skin mucus of the frog Xenopus laevis, contacted orally by snakes, induces dyskinetic oral movements and climbing behavior that promote escape. The mucus contains peptides and indoleamines known to produce drug-induced movement disorders in other species. We hypothesized that inhibition of monoamine oxidase-A (MAO-A) by N-methyl-N-propargyl-3-(2,4-dichlorophenoxy)-propylamine [clorgyline (CLG)] and MAO-B by R(-)-N, alpha-Dimethyl-N-2-propynyl-benzene-ethanamine [L-deprenyl (LDL)] would selectively modify mucus-induced behaviors by elevating norepinephrine and serotonin (with CLG), phenylethylamine (with LDL), or dopamine (with both drugs). In Experiment 1 (EXP1), adult snakes received mucus and/or 20 micrograms/g (IP) of both drugs. In EXP2, juveniles received mucus and/or 5, 10, and 20 micrograms CLG or LDL. CLG given alone had no effect on tongue flicking, activity, and climbing (EXP1,2). LDL alone decreased tongue flicking in EXP2 and increased climbing (EXP1,2). Given with mucus, both drugs further lowered the tongue flicking rates attenuated by mucus (EXP1,2); only LDL potentiated mucus-induced climbing. Yawning was the only mucus-induced dyskinesia attenuated (20 micrograms CLG, adults; 20 micrograms LDL, juveniles). We suggest that dopamine and/or phenylethylamine, the substrates for MAO-B, may promote mucus-induced climbing and tongue flicking but may have some protective role against mucus-induced yawning in water snakes.
The transforming growth factor beta family of peptides have diverse actions on the reproductive tracts of primates and rodents. In this study we report the expression of high levels of mRNA of one member of this superfamily, TGF-beta 2, in the pregnant mouse uterus. Using Northern blot analysis and in situ hybridization techniques, we have examined the pattern of expression of TGF-beta 1, TGF-beta 2 and colony-stimulating factor (CSF-1) in mouse maternal and fetal tissue at specific days of gestation. We report here that TGF-beta 2 is synthesized primarily in maternal decidual and uterine epithelial tissues. We observed a shift in the major site of synthesis from decidua to uterus between days 8.5 and 10.5 of gestation. These data demonstrate that the expression of TGF-beta 2 is differentially regulated in the decidua and uterine epithelial cells at various times during gestation. Small amounts of TGF-beta 2 mRNAs were detected in the fetus, and none was detected in placenta, yolk sac, or amniotic membrane. The uterus is likely the major site of synthesis of the TGF-beta 2 found in mouse amniotic fluid. TGF-beta 1 mRNAs are expressed in the uterus at markedly lower levels when compared to TGF-beta 2 mRNAs in both the decidua and uterus. Our results suggest that there is a unique regulation of TGF-beta 2 during pregnancy which may depend on pregnancy hormone(s) and differentiates it from the other mammalian isoforms of the TGF-beta s. TGF-beta 2 may play an important, albeit unknown, role at the maternal/fetal interface.
Life-threatening infections with Trichinella spiralis are rare in countries that have adopted laws requiring cooking of raw garbage fed to pigs. Thus such infections may pose a diagnostic dilemma for clinicians unfamiliar with their presentation. We report a case of imported trichinosis in a Mexican national who developed respiratory failure, myocarditis, and sinus arrest. The patient recovered uneventfully after the administration of benzimidazole and corticosteroid drugs, although a pacemaker was required to maintain normal cardiac rhythm. Symptomatic myocarditis is a rare complication of trichinosis that is often associated with increased morbidity and mortality. This report illustrates and reviews important features of the epidemiology, clinical presentation, and management of trichinosis.
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The Great Urban Outdoors is a management development exercise with a difference. Most outdoor exercises take place in an "unfamiliar" rural setting. This one is set in an urban environment, which is reasoned to have an air of unfamiliarity to many health care managers. Stresses the need to clear learning objectives and active tutoring. For this exercise, proposes a framework based on a model of managerial leadership. Explains how the location and tasks to be carried out can be varied to suit the participants. Particular stress is laid on the debriefing phase, to ensure that the learning objectives have been met and can be applied to real health care challenges.
We have evaluated the autoantibody profiles in the sera of 117 patients with systemic lupus erythematosus (SLE) and compared and contrasted the clinical and laboratory features of the disease of patients segregated according to an autoantibody profile. Using this approach we are able to demonstrate that autoantibody profiles identified subsets of patients with SLE. Patients with a negative autoantibody profile had fewer clinical and laboratory features of their disease when compared to the other subsets of patients. In contrast, patients with profile A (anti-nDNA and/or anti-Sm antibodies) had a statistically significant increase in malar rash, renal and hematologic involvement and hypocomplementemia when compared to patients with a negative profile. Patients with profile B (anti-nRNP antibodies) had a clinical pattern of disease different from that of patients with profile A and had a statistically significant increase in Raynaud's phenomenon when compared to patients with a negative profile. Patients with profile C (anti-SSA and/or anti-SSB antibodies) had a statistically significant increase in lupus-related rashes and photosensitivity. None of the lupus patients reviewed in this study has profile D (antibodies to centromere and/or Scl-70), this profile being seen largely in patients with scleroderma or one of its variants. Both patients with profile E (anti-histone antibodies) had drug-induced lupus. We conclude that the use of autoantibody profiles defines subsets of patients with lupus that may have clinical, therapeutic and prognostic implications.