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Biomedical subjects

E Cox

Publications and source records attributed to E Cox.

At least 109 records · Page 6Linked to original sources

Effect of antisecretory drugs on experimentally induced weanling diarrhoea in piglets.

In 45 newly-weaned 3 to 4-week-old piglets, diarrhoea was induced by a combined infection with transmissible gastroenteritis (TGE) virus and enterotoxigenic E. coli (ETEC) strains. In untreated control animals this dual inoculation resulted in profuse diarrhoea, vomiting, hypovolaemic shock and death of 77% of the animals within five days of TGE virus inoculation. Antisecretory drugs were administered intramuscularly for three consecutive days after experimental infection. The neurolepticum chlorpromazine, at 2 mg/kg/24 h, resulted in a significant inhibition of diarrhoea and vomiting, and in an increase in weight gain and survival. Sedation and hypothermia, however, were serious side-effects. The alpha 2 agonist clonidine, at 80 micrograms/kg/12 h, induced a significant antidiarrhoeal effect and a reduction in mortality. The drug, however, provoked decreased activity of alpha 2-adrenergic excitation and incoordination. The beta-adrenergic antagonist propranolol, at 0.33 mg/kg/8 h, and the calcium channel blocker verapamil, at 2 mg/kg/8 h, had no beneficial effect on the experimentally induced diarrhoea.

Animals↗

Video self-portraits: a novel approach to group psychotherapy with young adults.

A group therapy model was formulated for exploring the intersubjective processes of adolescents and young adults whose group bonds had been fragmented by their severe emotional illnesses. The model involved having adolescents and young adults who were psychiatric inpatients make video self-portraits; that is, videotapes which focused on various aspects of their emotional pathology. These tapes were then presented before a larger group of nine patients for discussion. The video team method is shown to aid in self-disclosure and facilitate the working through of severe emotional conflicts in this age group. It is an especially useful method with more severely disturbed patients for whom narcissistic self pathology is a prominent feature.

Adaptation, Psychological↗

Effect of chlorpromazine on experimental diarrhoea in just-weaned piglets.

In just-weaned piglets (n = 30, 3-4 weeks) diarrhoea (100%) and vomiting (66%) were provoked by inoculation with transmissible gastroenteritis virus and enterotoxigenic E. coli strains (O149: K91: K88ac; LT, STa and STb enterotoxin positive). This combined infection resulted in a mortality of 71% within 7 days. During this period animals revealed a decrease in body weight, in arterial pressure, in leukocyte count, in plasma pH and in plasma lactic acid concentrations, and an increase in heart rate and in total plasma protein concentration. In shocked and expiring piglets an increase in haematocrit and a decrease in base excess and actual bicarbonate were observed. Chlorpromazine, administered intramuscularly on 3 successive days following the dual infection in 8 K88ac susceptible pigs, in a dosage of 2 and 1.5 mg/kg.24 h, somewhat retarded the appearance of severe diarrhoea and suppressed vomiting. These beneficial effects, however, did not result in an increased survival.

Animals↗

Escherichia coli sepsis and endotoxemia in conscious young pigs.

In conscious pigs the influence of intravenous infusion of live E. coli (7 x 10(8)/kg), of the equivalent amount of endotoxin (20 micrograms/kg) or of a high dose of endotoxin (2.5 mg/kg) on the hemodynamic, clinical and pathological parameters and on survival rate was studied. E. coli and endotoxin infusion resulted in pulmonary hypertension, systemic arterial hypotension, a decrease in cardiac output and an increase in heart rate. Clinical signs were characterized by respiratory and nervous disturbances, whereas necropsy revealed hemorrhages and edema in several organs. Although these findings were similar in the three groups, a marked difference in lethality was observed. Infusion of E. coli or of the high dose of endotoxin resulted in a significant mortality, whereas all pigs survived the infusion of the low dose of endotoxin. This suggests that the lethal pathophysiological mechanisms may only become activated when a sufficient amount of endotoxin is released into the circulation.

Animals↗

Pathophysiology of diarrhoea induced by a combined infection with transmissible gastroenteritis virus and enterotoxigenic Escherichia coli in newly-weaned piglets and the effect of flurbiprofen treatment.

In newly-weaned 3-4 week old piglets (n = 29) diarrhoea (100%) and vomiting (65%) were induced by inoculation with transmissible gastroenteritis virus and enterotoxigenic E. coli strains (0(149):K91:K88ac; LT, STa and STb enterotoxin positive). This combined infection resulted in pronounced mortality within 7 days. During this period the piglets had decreases in body weight, arterial pressure and leucocyte count and increases in heart rate and in total plasma protein concentration. The plasma pH and lactic acid concentration decreased, whereas the values for pO2, pCO2 and frequency of respiration did not change significantly. No significant changes in the serum concentrations of potassium, chloride or calcium were observed, whereas sodium concentration revealed a transient increase. In shocked and dying piglets an increase in haematocrit was observed, whereas base excess and bicarbonate concentration decreased. Flurbiprofen, a potent non-steroidal anti-inflammatory drug, administered intramuscularly on 3 successive days following the combined infection at a dosage of 1 mg/kg/12 h was without beneficial effect on diarrhoea or mortality.

Animals↗

Toxic shock syndrome after a human bite to the hand.

The first known case of toxic shock syndrome resulting from a human bite is reported. An awareness of the presenting features and clinical manifestations are needed in the early recognition and intensive medical management of this life-threatening condition.

Adult↗

Effect of experimentally-induced villus atrophy on adhesion of K88ac-positive Escherichia coli in just-weaned piglets.

Three- to four-week-old, just-weaned piglets were infected with transmissible gastroenteritis (TGE) virus and the next day with K88ac+ enterotoxigenic Escherichia coli (ETEC). Histological examination of caudal jejunum and ileum of piglets killed 2-3 days after virus challenge (1-2 days after ETEC infection) revealed severe villus atrophy especially in the jejunum compared with controls (P less than 0.05). Four-5 days after TGE virus infection villus length increased and after 7 days it was near normal. Villi scraped from jejunal and ileal mucosa of the piglets were incubated in vitro with K88ac+ E. coli and the number of bacteria adhering to 250 micron villus brush border was counted. Attachment of bacteria to villi of piglets killed 2-3 days after TGE virus infection was significantly decreased in comparison with adhesion to villi of non-infected piglets or of piglets killed 7 days after the virus infection. Correlation between in vitro adhesion and villus height was 0.6649 (P less than 0.001). The results suggest that the experimentally-induced villus atrophy was attended with a temporarily diminished susceptibility of villus enterocytes to adhesion of K88ac+ E. coli.

Animals↗

Infertile or childless by choice? A multipractice survey of women aged 35 and 50.

Eleven general practitioners examined the medical records of all women on their lists born in 1950 (617 patients) and 1935 (533 patients) to determine the prevalence of childlessness and specialist consultations about infertility. Eighty eight (14.3%) of the women born in 1950 and 41 (7.7%) of those born in 1935 were childless. Sixty eight women born in 1950 (11.0%) and 17 born in 1935 (3.2%) were considered childless by choice. Involuntary childlessness was found in 20 (3.3%) of the women born in 1950 and 24 (4.5%) born in 1935. Forty two (6.8%) of the women born in 1950 had consulted a specialist about infertility as compared with 19 (3.6%) born in 1935. This study found a significant increase in voluntary childlessness among the younger women; there was no evidence of a change in the prevalence of involuntary childlessness despite the increasing demand for specialist referral, which appeared to be made by women who were parous or destined to become so.

Adult↗

In vitro adhesion of K88ab-, K88ac- and K88ad-positive Escherichia coli to intestinal villi, to buccal cells and to erythrocytes of weaned piglets.

The phenotype of 21 weaned piglets, concerning adhesion of Escherichia coli possessing K88ab, K88ac or K88ad fimbriae to pig cells, was determined in an in vitro assay. Comparison was made with adhesion of these three K88 variant strains to buccal mucosal epithelial cells and to erythrocytes (haemagglutination) in the same piglets. Whereas adhesion of the three K88 variant strains to intestinal villi was piglet specific, buccal cell adhesion (BCA) and haemagglutination (HA) were not. The K88ab strain was weakly adhesive or non-adhesive in the BCA and negative in the HA test. K88ac strains consistently gave negative and K88ad consistently gave positive results in both assays. After washing the bacteria with phosphate-buffered saline, the K88ab strain revealed a positive HA test. Neither the BCA, nor HA test can be used to determine the pig intestinal adhesive phenotype.

Animals↗

The prognostic significance of recall antigen testing in melanoma patients.

A quantitative assessment of the long-term prognostic value and clinical usefulness of recall antigen reactions in patients with malignant melanoma is not available. The authors evaluated longitudinal observations of survival made in 846 patients over a 12-year period. Each patient was initially studied with Mantoux-type recall antigen skin tests. The patients were categorized with respect to the following: high (greater than 5 mm) or low (less than or equal to 5 mm) averaged skin test reaction diameters at 48 hr; Clark level; tumor stage (I = localized tumor, II = local extension and/or region lymph node metastasis, III = systemic metastasis); ulceration; site of primary; histologic type; age; and sex. The percentage of high reactors in Stages I, II, and III were 44.3%, 37.4%, and 25%, respectively. Survival was evaluated with the Cox-Mantell hazard function model and the Cox regression model. The significant (chi-squared; probability) risk factors detected were tumor stage (94.58; less than or equal to 0.0001), Clark level (19.37; less than or equal to 0.0001), sex (16.97; less than or equal to 0.0001), and skin test reactivity (7.48; less than or equal to 0.0062). A significant relationship also was detected between skin test reactor status and the tumor stage (p less than or equal to 0.0330). When evaluated within each stage of disease, skin test reactivity predicted survival only in Stage II patients (p less than or equal to 0.0080). Five-year survival estimates among Stage II patients were 58% among high reactors and 38% among low reactors.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

Malignant melanoma in the elderly.

Advancing age is associated with poorer prognosis in malignant melanoma. We studied 3,872 cases of malignant melanoma to evaluate whether the effect of age could be analyzed relative to sex, tumor depth, primary site, and other clinical and pathologic variables. The sex distribution by age shows a slight female predominance in the early and late decades but male predominance in the middle years. The percentage of patients with metastatic disease at initial diagnosis did not vary with age, despite greater diameter and depth of lesions in the older patients. In fact, in the older age groups, initial nodal metastasis occurred slightly less frequently. Trunk primaries decreased in frequency with increasing age, while extremity lesions remained relatively constant, and face, nose, and ear lesions increased. This was in part related to the histopathologic type, as lentigo maligna lesions increased in frequency with age, superficial spreading lesions were somewhat less frequent in the older age group and nodular types were fairly constant. On the basis of both Clark's level and Breslow thickness, there was an increasing proportion of deeper penetrating lesions in the older age group. The mean diameter of these lesions on the skin surface was also greater for the older patients. This would suggest that lesions in the older individual remain confined to the local site longer, penetrate and spread, but do not necessarily metastasize more rapidly. Cox model regression analysis of survival time within stage showed that age was highly significant as a poor prognostic factor. Though the adverse relation of advancing age with survival was partially explained by predominance of other unfavorable factors, such as primary site, depth of lesion, or histologic type, age remained an independent poor prognostic factor (chi 2 = 5.3; P = .02) for death due to melanoma.

Adolescent↗

A randomized trial of low doses of alpha interferon in patients with breast cancer.

A randomized Phase II study was planned to test two doses of human lymphoblastoid interferon (Wellferon) in patients with metastatic breast cancer. Thirty-seven patients were entered and received either 0.5 or 3.0 million units three times a week for three months. The dose selection was based on earlier Phase I studies in order to maximize NK (natural killer) stimulation and the amount tolerated without undue toxicity. Twenty-nine patients were evaluable. There was only one excellent partial remission, sustained for one year. There were small and statistically insignificant NK increases in both groups. From this and a review of the literature, we conclude that alpha interferon has negligible activity in breast cancer.

Breast Neoplasms↗

Malignant melanoma and pregnancy.

Confusion exists concerning the influence of pregnancy on survival in patients with malignant melanoma. To evaluate this problem a retrospective computer-aided study was performed of women in the child-bearing years treated for Stage I cutaneous melanoma at the Duke University Comprehensive Cancer Center. Fifty-eight women were identified who had melanoma arise during pregnancy (Group 1) and 43 patients were noted who became pregnant within 5 years of diagnosis of their melanoma (Group 2). Appropriate control groups matched for the clinical variables of age, primary site, and stage of disease and the pathologic variables of Clark's Level, tumor thickness, ulceration, and histologic type were selected from the cohort of 2938 melanoma patients seen at Duke. Actuarial survivals for Group 1 and 2 patients did not differ from their respective controls, although the small number of deaths in each group resulted in wide confidence intervals. When actuarial disease-free intervals were plotted, there was a significant difference between women who had melanoma develop during pregnancy when compared to their controls (P = 0.04). In a multivariate regression analysis, after adjustment for the influence of the more significant prognostic factors for Stage 1 melanoma, including Clark's Level, ulceration and tumor thickness, the effect of pregnancy on disease-free interval became more apparent (P = 0.02). No difference in actuarial disease-free interval was noted in the melanoma patients who elected to become pregnant within 5 years of diagnosis (P = 0.31). A multivariate regression analysis confirmed this finding. These data indicate that although an intercurrent melanoma during pregnancy has a worse prognosis than the control groups, once a woman has been diagnosed as having a cutaneous melanoma, a subsequent pregnancy has no effect on recurrence rate or survival.

Actuarial Analysis↗

Long-term clinical outcome of immediate reconstruction after mastectomy.

Immediate reconstruction of a breast removed for treatment of carcinoma can be accomplished without altering the cancer-ablative surgical procedure. The theoretical possibility that reconstruction might compromise the cure rate has tempered enthusiasm for this approach. To test this issue, the relapse-free survival of 101 patients who underwent breast reconstruction in the immediate postmastectomy period was compared with that of 377 patients with breast cancer who underwent mastectomy without immediate reconstruction. This comparison was accomplished using multivariable statistical techniques to correct for baseline inequalities between the patient groups. After adjustment for the relevant prognostic factors, no significant difference remained between the two groups. We conclude that immediate reconstruction has no discernible adverse influence on the natural history of surgically treated breast carcinoma.

Adult↗