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Biomedical subjects

E Smith

Publications and source records attributed to E Smith.

At least 487 records · Page 27Linked to original sources

Enumeration of phagocytosed Staphylococcus aureus inside cells of the mouse macrophage cell line J774 by bioluminescence, fluorescence and viable counting techniques.

In order to quantify intracellular Staphylococcus aureus within a macrophage-like cell line by a bioluminescence technique, the mouse cell line J774 and opsonized Staphylococcus aureus were incubated together to allow phagocytosis to occur. Experiments using UV microscopy and fluorescent stained S. aureus were performed to determine an estimate of the mean intracellular bacterial numbers. For enumeration of intracellular bacteria by a bioluminescence technique, extracellular bacteria were removed by washing, the macrophages lysed mechanically and osmotically and treated with apyrase to remove somatic ATP. Bacterial cells were washed and the intracellular ATP measured by firefly luciferase bioluminescence in a luminometer. This new method of enumerating intracellular bacteria was compared to the conventional method of viable counts and found to correlate (r = 0.78). The bioluminescence assay developed was found to be a relatively rapid alternative method to the techniques currently used to enumerate intracellular bacteria and could prove advantageous in studies of intracellular killing and effects of antimicrobial agents on intracellular pathogens.

Animals↗

Acute hemodynamic effects of tocainide in patients undergoing cardiac catheterization.

To characterize the acute hemodynamic effects of tocainide hydrochloride, a new antiarrhythmic agent, 11 patients undergoing diagnostic cardiac catheterization were given intravenous infusions of the drug for 15 minutes at rates of 0.50 (six patients) or 0.75 (five patients) mg/kg/min. The hemodynamic status of these subjects was determined before, during, and for 15 minutes after treatment, and blood levels of tocainide were followed during and after treatment. Tocainide blood levels at the end of the infusions were 14.9 +/- 1.6 microgram/ml (S.E.) and 15 minutes later were 6.0 +/- 0.7 microgram/ml. In these subjects treatment was not associated with significant changes in Ao or PCW, but it was associated with a statistically significant but small decrease in LV dp/dt. At the same time, LVED was not significantly elevated. Treatment was also accompanied by small increases in PA diastolic and mean pressures, but RA and RV were unchanged. Significant changes were not seen in HR, CO, CI, SV, SVR, or PVR. Thus, the intravenous infusion of 0.50 and 0.75 mg/kg/min of tocainide for 15 minutes produced small but statistically significant depression of left ventricular function without producing changes in CO or clinical evidence of congestive heart failure.

Adult↗

Peripheral neuropathy in lead-intoxicated sickle cell patients.

Peripheral neuropathy and hypertension caused by lead intoxication are reported in two children with sickle cell anemia. One child had generalized weakness in the initial occurrence and distal paralysis during a relapse two years later. The second child had foot and wrist drop. Both had slow peripheral nerve conduction velocities during the episodes. Chelation therapy was successful and resulted in a return of strength (over a period of several months) and a normalization of the blood pressures. Children with sickle cell anemia who are subjected to lead intoxication appear to be predisposed to peripheral nerve damage.

Anemia, Sickle Cell↗

Prevalence of obstructive airflow limitation in Irish collegiate athletes.

BACKGROUND: Asthma prevalence in athletes is variable, depending on the sport and training conditions. AIMS: To investigate the prevalence of obstructive airflow limitation, asthma control and lung volume differences in a control group and five groups of collegiate athletes--outdoor field, indoor court, endurance, combat sports and swimming. METHODS: Three hundred and five athletes completed a respiratory questionnaire and performed spirometry during normal training conditions, to determine FEV1, FVC and PEFR pre- and at 5, 10 and 15 minutes post-exercise. Between and within group analysis was carried out using single factor and repeated measures ANOVA. RESULTS: Previous diagnosis of asthma was reported by 24%, outdoor field sports 4.9%, indoor court sports 2.3%, endurance events 2.6%, combat sports 3%, swimming 6.9% and controls 4.3%. Mean FEV1 and FVC data, expressed as percentage of predicted, were greatest in swimming and lowest in controls. Swimming showed a significant rise in FEV1 post-exercise, indoor court and endurance sports demonstrated no change and outdoor field, combat and control groups showed a fall in FEV1 post-exercise. CONCLUSION: Warm humid training conditions appear protective against exercise-induced asthma. The greatest reductions in lung volumes occurred following high intensity exercise under cool conditions in the poorly aerobically conditioned.

Adult↗

Chemosensitization in vitro: potentiation of melphalan toxicity by misonidazole, metronidazole and nitrofurazone.

Misonidazole, metronidazole and nitrofurazone can enhance the cytotoxicity of melphalan in vitro if the cells are subjected to a hypoxic pretreatment with the drug prior to exposure of melphalan in air. Potentiation of melphalan is dependent upon the concentrations of the nitro compound and the duration of the hypoxic pretreatment. On a concentration basis, nitrofurazone was most effective at enhancing melphalan toxicity and metronidazole was the least effective. This potentiating activity correlates with the electron affinity of each drug.

Animals↗

Epidemiology of specific language impairment: prenatal and perinatal risk factors.

The prenatal and perinatal risk factors likely to be associated with specific language impairment (SLI) were examined in this study. A review of existing research showed that there have been few studies on this topic. Among children with SLI, greater rates of near relatives with language learning problems has been found. Data obtained from a case-control study of 177 children with SLI and 925 children without sensory, developmental disorders, or language impairment were studied using a parental questionnaire concerning exposures during the prenatal and perinatal period for the index children. Differences between the children with SLI and controls were found for parental characteristics regarding education, positive history of language and learning problems, tobacco smoking, and breast feeding. No support was found for elevated rates of maternal exposure to disease or occupational chemical substances.

Child↗

Extended storage of platelets in a new plastic container. II. In vivo response to infusion of platelets stored for 5 days.

A new blood container material (PL 1240 plastic) made of polyvinyl chloride containing a tri(2-ethylhexyl) trimellitate plasticizer was evaluated in three laboratories. When platelet concentrates (50-60 ml) were stored on a variety of agitators for 7 days at 22 +/- 2 degrees C, poststorage pH (mean +/- SD) ranged from 7.29 +/- 0.05 (6 rpm elliptical rotator) to 6.87 +/- 0.8 (70 cycles per minute flatbed agitator). The platelet counts ranged from 1.51 +/- 0.12 to 0.95 +/- 0.36 X 10(6) per microliter. Morphology scores and hypotonic shock response values of platelets stored 7 days in PL 1240 plastic containers were better than those noted following 3-day storage of control platelets in PL 146 plastic containers. The percent discharge of lactic dehydrogenase from platelets stored 7 days in PL 1240 plastic containers for 3 days (p less than 0.05). Mean platelet recoveries of 44 +/- 15 percent (n = 11; 111Indium) and 39 +/- 8 percent (n = 29; 51Chromium) were seen when autologous platelets were infused following 5-day storage in PL 1240 plastic bags. Platelet half-lives of 3.6 +/- 0.4 (n = 9) 4.1 +/- 0.4 (n = 20) days were reported in the two laboratories which used 51Cr labeling, while survival values of 7.0 +/- 1.0, 2.8 +/- 0.8, and 5.4 +/- 1.9 days were seen when data from the 111Indium studies (n = 11) were analyzed using linear, exponential, and multiple hit programs, respectively. Platelets stored for 5 days also were administered to 13 thrombocytopenic oncology patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Platelets↗

Gastrointestinal radiology. A study of iopanoate metabolism and toxicity in isolated cell cultures.

Radiologists are familiar with certain toxic manifestations of biliary and urinary contrast media (ie, acute tubular necrosis in dehydrated patients with diabetes or multiple myeloma), and with the specific effects of contrast media on other diagnostic tests (ie, I uptake, PBI, etc). These have been studied because of their clinical and diagnostic impact upon patient management. It has become apparent that many subtle, though perhaps predictable, drug interactions occur. Some of these are of obvious clinical and therapeutic significance and have been studied and described in detail. The authors have tried to establish the effects of clinically used drugs on the contrast medium iopanoic acid. The fact that both drugs thus far studied - aspirin and cholestyramine - have profound laboratory effects on iopanoic acid suggests that some systematic approach to the study of the clinical pharmacology of contrast agents is desirable. Others have also observed effects of contrast media on various clinical and laboratory parameters, but most observations are isolated empirical observations, and our basic understanding of the mechanisms involved are crude at best. How might this problem be approached? Although in vivo pharmacokinetic studies in unanesthetized animals allow identification of possible drug-drug interactions in the absence of multiple clinical variables and let us do crossover studies with each animal acting as its own control, such studies are difficult, expensive, and do little to establish the mechanism of the interaction. The authors are currently approaching this problem with a more basic technique. In conjunction with colleagues in gastroenterology and pharmacy, they are studying iopanoate metabolism and aspirin-iopanoate interaction in isolated hepatocyte monolayer cultures. The preliminary data from these experiments will be presented, and the significance of these results and the potential usefulness of this model will be discussed.

Animals↗

Angiotensin-converting enzyme inhibitory activity of SCH 31846, a new non-sulfhydryl inhibitor.

SCH 31846, 1-(N-[1(S)-(ethoxycarbonyl)-3-phenylpropyl]-(S)-alanyl)-cis, syn-octahydro-(H-indole-2-S)-carboxylic acid; CI-907; PD 109, 763-2, is a new non-sulfhydryl-containing, angiotensin-converting enzyme (ACE) inhibitor. The present investigation describes its ACE inhibitory properties and compares them to those of MK 421. The diacid of SCH 31846 inhibited rabbit pulmonary ACE with an IC50 of 2.2 nM (MK 421 diacid 2.5 nM). The drug behaved as a competitive and specific inhibitor in vitro. SCH 31846 and its diacid effectively inhibited pressor actions of intravenous injection of angiotensin I (AI) in anesthetized rats. ID50 values were 27 and 11 micrograms/kg for SCH 31846 and SCH 31846 diacid, respectively (MK 421 and MK 421 diacid 57 and 15 micrograms/kg, respectively). Oral administration of SCH 31846 (0.03-1 mg/kg) inhibited pressor actions of AI in conscious rats with a duration of over 16 h at 0.3 and 1 mg/kg. SCH 31846 was 2.2 times as potent as MK 421 in this regard. The diacid of SCH 31846 was considerably less potent than the ester, implying poor oral absorption of the former. Effective ACE inhibition, as judged by attenuation of pressor actions of AI, was noted in dogs after both intravenous and oral administrations of SCH 31846. Onset of action was more rapid than that of MK 421. Intravenous administration of SCH 31846 inhibited the renal vascular actions of intrarenal injection of AI, indicating effective blockade of the renal enzyme. Intracerebroventricular administration of SCH 31846 diacid blocked pressor responses to intracerebroventricular AI, whereas oral administration of SCH 31846 (10 mg/kg) did not, implying that SCH 31846 inhibits brain ACE but does not gain access to the cerebral enzyme when administered orally. These data indicate that SCH 31846 is a potent and specific non-sulfhydryl ACE inhibitor. As such, it should be useful in the treatment of hypertension and heart failure.

Administration, Oral↗

The acute antiarrhythmic effects of droxicainide and lidocaine in unanesthetized dogs.

Two groups of unanesthetized dogs, each consisting of six animals with ventricular tachycardia caused by two-stage ligation of the anterior descending branch of the left coronary artery on the day before treatment, were given continuous intravenous infusions of 0.5 mg/kg/min of either droxicainide [DL-N-(2-hydroxyethyl) pipecolinyl-2,6-dimethylanilide] hydrochloride or lidocaine hydrochloride until convulsions occurred. At low cumulative doses of either drug, the infusions produced a progressive reduction in the frequency of ventricular ectopic beats, but no significant changes in the sinus rate, the PR or QRS intervals of normal sinus beats, the arterial and central venous pressures, or the respiratory rate. At higher cumulative doses lidocaine produced sedation, and both drugs produced emesis and then convulsions that subsided soon after termination of treatment. With respect to both the cumulative doses and plasma concentrations at which they reduced the frequency of ectopic beats by 25, 50, and 75% and at which they produced convulsions, droxicainide was a more potent antiarrhythmic agent than lidocaine and had a wider margin of safety.

Anilides↗

Patterns and trends of sexual behavior, HIV testing, and HIV prevalence among all sexually transmitted disease clinic attenders in Denmark.

BACKGROUND AND OBJECTIVES: Persons attending a sexually transmitted disease (STD) clinic have shown to be at a higher risk for HIV infection than the population in general. We evaluate the patterns of HIV prevalence and testing in relation to reported risk behavior. STUDY DESIGN: Data have been collected on all new attenders at the Danish STD clinics. The study period was January 1, 1990 through March 1992. RESULTS: Testing for HIV was accepted by 74% and more often by women than men and more outside Copenhagen than in the city itself. Acceptance was lowest among homo/bisexual men seen in Copenhagen. The HIV prevalence was highest among homo/bisexual men with drug use (10.0%) and lowest among heterosexual men (0.3%) and women (0.2%). Among heterosexuals the test activity increased over time, and the test activity increased and the prevalence of HIV antibodies decreased with the number of reported sex partners. Among heterosexuals HIV infection was associated with not being born in Denmark and age (> or = 30 years old in women and > or = 35 years old in men). CONCLUSION: These results are relevant for the national HIV surveillance programs and campaigns, and stress the importance of offering HIV testing to all persons attending for an STD examination.

AIDS Serodiagnosis↗

The use of a hydrofibre dressing in fulminating necrotizing fasciitis.

This article describes a case of necrotizing fasciitis in a 52-year-old man with previously undiagnosed diabetes. Treatment involved massive debridement and subsequent dressing of the open surgical wound. A modern hydrofibre dressing (Aquacel) was inserted intraoperatively and subsequently continued postoperatively. Wound healing occurred over 3 months and the patient was discharged with no disability. The dressing managed the exudate level and kept the wound moist. It also was well tolerated by the patient, was comfortable and easy for the nurses to remove and apply.

Carboxymethylcellulose Sodium↗

Pharmacokinetics of saquinavir-SGC in HIV-infected pregnant women.

PURPOSE: To evaluate saquinavir (SQV) pharmacokinetics, tolerance, and safety in 10 HIV-infected pregnant women between 14-32 weeks gestation. METHOD: This was a phase I, prospective, area-under-the-curve (AUC) targeted study. Antepartum treatment consisted of SQV 1200 mg tid, lamivudine 150 mg bid, and zidovudine 200 mg tid. The SQV targeted exposure was an 8-hour AUC (AUC(8)) of 3000 ng. h/mL; the study was to be halted if the first 4 participants did not achieve this AUC(8). Cord blood and plasma samples were collected in neonates at birth. RESULTS: Four women completed the SQV pharmacokinetic assessments. Exposure in all 4 patients was below the target AUC(8). Median (range) AUC(8) and trough (C8H) were 1672 (738-2614) ng. h/mL and 60 (<15-332) ng/mL, respectively. Oral clearance (CL/F) was 9.3 (5.1-16.6) L/h/kg and C(max) was 599 (177-953) ng/mL. Cord and neonate plasma concentrations were mostly undetectable; 1 of 5 infants was HIV-infected at 24 weeks. CONCLUSION: These data suggest highly variable SQV pharmacokinetics in pregnant women, and exposure at 1200 mg tid may not be adequate for longer term therapy; both the AUC(8) and C8H were considerably below average. Because ritonavir has been shown to significantly increase SQV concentrations, this combination should be further explored in this population.

Adult↗

Synthesis of N-(4'-pyridoxyl)sphingosine and its uptake and metabolism by isolated cells.

N-(4'-pyridoxyl)sphingosine was synthesized and characterized as a stable compound for specialized delivery of a bioactive lipid. It was found to be facilely taken up by hepatocytes although by a mechanism more typical for lipids than the one used by natural vitamin B6. Some of the N-(4'-pyridoxyl)sphingosine was metabolically acted upon inside the cell to release pyridoxal 5'-phosphate and sphingosine, but formation of pyridoxal 5'-phosphate from the synthetic compound was poor compared with natural vitamin forms of B6, which may partly be due to entrapment within cell membranes and to constraints at the level of cytosolic pyridoxal kinase which is responsible for phosphorylation of the vitamin. Unlike the parent long-chain base, the B6 conjugate was not particularly cytotoxic. Furthermore, the compound was neither an activator nor inhibitor of the respiratory burst of human neutrophils. These findings identify N-(4'-pyridoxyl)sphingosine as an interesting tool for studies of the cellular transport, metabolism, and functions of both vitamin B6 and sphingosine.

Animals↗

Developing nurse endoscopy through re-engineering.

Innovative developments in nursing roles have been one of the benefits of re-engineering at The Leicester Royal Infirmary NHS Trust. In the third in a series of four reports, the author describes nursing innovation in endoscopy.

Clinical Protocols↗

Hungry for action.

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Aged↗

Comparison of four methods (L/S ratio, TDx FLM, lamellar bodies, PG) for fetal lung maturity using meta-analysis.

Multiple factors in the past encouraged physicians to order laboratory tests excessively and perhaps even abusively. The shift in the financing of health care to managed care and capitation will create an environment where physicians will be more receptive to laboratory efforts to influence their test ordering behavior toward cost-effectiveness. Various strategies to modify physicians' test-ordering behavior have met with only mixed success due to lack of data to support the desired result: reducing laboratory tests that are not specifically indicated for a particular patient. The current dynamics in the health care industry in general and in the clinical laboratory in particular place increasing value on information about the overall process of health-care delivery. This information can be derived from data from what were formerly considered discrete, transactional events, i.e., specific publications. Combining data from articles dealing with the same subject (meta-analysis) is increasingly being used to assess the value of the overall process of delivery (the outcome). Although considered ¿arm chair¿ research, meta-analysis is an important tool in evaluating the worth of a method in patient care. We chose to evaluate, given the current literature, which laboratory test--lecithin/ sphingomyelin ratio, surfactant/albumin ratio, lamellar bodies, or phosphatidylglycerol--is the best and most cost effective method to screen for fetal lung maturity. We identified all pertinent literature from 1966 to the present using a search of Medline.

Albumins↗

Utilization of LDH isoenzymes in the diagnosis of myocardial infarction.

With the arrival of managed care, increased pressure is being placed on the health-care system to reduce the use of laboratory services. When evaluating less expensive methods to measure CK-MB to help reduce costs of triaging patients suspected of having myocardial infarction (MI), we also had an opportunity to evaluate the ordering pattern of LDH isoenzymes for these same patients. We found that LDH isoenzymes were continuously ordered as a routine test at least 14% of the time. We worked with the Division of Cardiology to reduce the use of LDH isoenzymes in two ways: 1) by changing the protocol of triaging suspected MI patients and 2) by reporting the test result only after director approval. This article summarizes our approach to reducing the use of LDH isoenzymes, an expensive test in terms of reagent cost and technician time.

Clinical Laboratory Techniques↗