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Biomedical subjects

E Taylor

Publications and source records attributed to E Taylor.

At least 163 records · Page 9Linked to original sources
PubMed1992

Immune serum markers and CD4 cell counts in HIV-infected intravenous drug users.

We examined the association of three serum immune markers with CD4 cell counts in a large cohort of i.v. drug users with and without human immunodeficiency virus (HIV) infection. Levels of beta 2-microglobulin and neopterin were significantly elevated in HIV-infected subjects and increased in association with decline in CD4 cell counts (all p less than 0.001). Serum IgA levels in HIV-seropositive individuals were significantly elevated only when the CD4 cell count was less than 200/microliters (p less than 0.001). After controlling for HIV status and CD4 count, recent history of hepatitis was associated with significantly higher beta 2-microglobulin (p = 0.028) and marginally higher neopterin (p = 0.052) levels. There was no association of race, gender, or drug use patterns with levels of serum immune markers after controlling for HIV status and CD4 count. These data indicate that immune activation is coupled with immunosuppression in HIV-infected i.v. drug users. In addition, beta 2-microglobulin and neopterin levels are elevated in persons with a recent history of hepatitis but not in those with recent non-AIDS-defining bacterial infections. Markers of immune activation do not vary by race, gender, or drug use patterns among i.v. drug users.

Biomarkers↗
PubMed1991

The long-term course of Lyme arthritis in children.

BACKGROUND AND METHODS: The natural history of Lyme disease is not completely known. We studied the long-term course of Lyme arthritis in 46 children in whom the onset of the disease occurred between 1976 and 1979 and who received no antibiotic therapy for at least the first four years of the illness. RESULTS: Of the 46 children (age range, 2 to 15 years), 33 (72 percent) initially had erythema migrans, 7 (15 percent) had influenza-like symptoms, and 6 (13 percent) had migratory joint pain. These manifestations were followed by brief attacks of arthritis, particularly affecting the knee. The percentage of children with recurrent episodes of arthritis declined each year. By year 4, only 10 children still had a mean of two episodes of arthritis per year; the duration of arthritis was generally longer in older children (P less than 0.05). During the sixth year of illness, two children (4 percent) had keratitis, and more than 10 years after the onset of disease, a subtle encephalopathy developed in two other children. Of the 39 children whom we were able to contact in 1988-1989, 12 (31 percent) still had occasional brief episodes of joint pain and 1 (3 percent) had marked fatigue. All 46 children had positive IgG antibody responses to Borrelia burgdorferi throughout the illness and on long-term follow-up. As compared with those who became asymptomatic, the children with recurrent symptoms more often had IgM responses to the spirochete and had significantly higher IgG titers (P less than 0.05). CONCLUSIONS: The course of initially untreated Lyme disease in children may include acute infection followed by attacks of arthritis and then by keratitis, subtle joint pain, or chronic encephalopathy.

Acute Disease↗
PubMed1991

Practical 3-D radiotherapy planning of brain tumors.

In postoperative radiotherapy of brain tumors it is usually the case that preoperative imaging studies, either CT or MRI, were performed outside of the purview of the radiation therapy department. Thus the target volume is defined in an imaging study that does not lend itself readily for entry to a 3-D treatment planning system. A method is described that adjusts the patient structure defined by scan data to an appropriate position for radiotherapy. Software tools that are simple to use have been incorporated in a 3-D treatment planning program that allows oblique treatment planes to be defined. The program provides beam's-eye-view plots of the fields that are used to overlay simulation films and will automatically describe a field blocking outline that provides a prescribed margin on the target volume or other structures that have been defined. Finally, dose calculations in arbitrary planes through the head are made and isodose plots produced.

Brain Neoplasms↗
PubMed1991

Does the anesthetic technique influence the postoperative analgesic requirement?

In order to determine the effect of two standard general anesthetic techniques on the postoperative analgesic requirement, 53 adults undergoing elective intra-abdominal surgery were randomly assigned to one of two anesthetic treatment groups according to an open parallel protocol design. One of the groups received an opioid-based anesthetic; the other group was administered an inhaled anesthetic. The postoperative analgesic requirement was quantified using a Baxter PCA device. The group receiving the opioid-based anesthetic required significantly less morphine in the recovery room (5.7 +/- 5.5 mg; mean +/- SD) compared with those receiving the conventional inhaled anesthetic (16.6 +/- 7.1 mg). During the first 8 hours after discharge from the recovery room there was a trend toward higher PCA morphine usage in the inhaled anesthetic group (25.6 +/- 15 mg vs. 18.6 +/- 13 mg); however, this difference was not statistically significant (p = 0.08). From 8 to 40 hours after surgery, the morphine usage was nonsignificantly higher in the opioid group (64 +/- 30 mg vs. 56 +/- 38 mg, p = 0.43). In conclusion, the general anesthetic technique used during an elective operation appeared to have little if any effect on the postoperative analgesic requirement after discharge from the recovery room.

Abdomen↗
PubMed1991

Endometrial relaxin: effects of mastectomy in the cyclic and pregnant guinea pig.

Mastectomy in the guinea pig increases the incidence of still births and neonatal deaths compared with intact animals. The guinea pig has the endometrial gland cells (EGC) as the major source of relaxin, and this hormone has possible roles in uterine quiescence, cervical dilatation, and lengthening of the interpubic ligament in pregnancy. An effect of mastectomy on uterine relaxin has been sought by immunocytochemical localization during the estrous cycle, mid and late pregnancy and on endometrial relaxin gene expression in the late pregnant mastectomized animal by Northern analysis. Endometrium from midpregnant (day 35) and late pregnant (day 63) and from lactating (days 5, 21, and 28) guinea pigs immunostained with antiserum to porcine relaxin by the avidinbiotin technique. By increasing the sensitivity of the latter, relaxin immunostaining was also detected for the first time in EGC from cyclic animals (days 9 and 14). A pattern and intensity of relaxin immunostaining could be readily assigned to each of the stages examined: estrous cycle, midpregnancy, late pregnancy, lactation, and post weaning. The dark uniform staining of the EGC in late pregnancy was followed by sporadic staining of the EGC in lactation, returning to the cyclic picture after weaning. Endometrium from mastectomized cyclic and late pregnant guinea pigs showed a reduction in the amount of immunostaining compared with the relevant control animals. The reduction was most pronounced in the mastectomized late pregnant guinea pig. This result was reflected in an apparently lower level of relaxin mRNA in the endometrium of these animals compared to intact controls. These data indicate a novel linkage between the mammary gland, either directly or indirectly, to the nonpregnant or pregnant uterus. The loss of this signal appears to be associated with subsequent problems at parturition which may be linked to the reduction in endometrial gland relaxin production. The nature of this signal from the mammary gland, normally considered to be an exocrine rather than an endocrine gland, is unknown.

Animals↗
PubMed1991

Survey of physical agent modality use.

Occupational therapists interested in physical disabilities practice (N = 629) responded to a questionnaire regarding their use of, training in, and opinions on physical agent modalities. Therapists in hand rehabilitation were the most frequent users of these modalities. Of the listed modalities, the most frequently used was hot and cold packs; the least used was ultrasound. The modalities used most frequently were typically performed without assistance, whereas those used less frequently were more likely to be performed with the assistance of a physical therapist. The most common educational experience for physical agent modality use was on-the-job training. Therapists who provided direct care were more positive about the use of these modalities in occupational therapy practice than were those who acted primarily as administrators, fieldwork educators, or supervisors. Respondents who specialized in hand therapy viewed modalities in a more positive light than did therapists in other areas of physical disabilities practice.

Attitude of Health Personnel↗
PubMed1991

Use of treatment activities in occupational therapy.

The purpose of this study was to determine the treatment activities used most often by occupational therapists associated with the Louisiana State University Medical Center's (LSUMC's) occupational therapy program. The results of this study were used to make changes in the teaching of treatment activities in the program. Two samples of clinicians--83 fieldwork supervisors and 59 former LSUMC students, mainly from the southeastern region of the country--identified how frequently their clinics had used each of 67 listed treatment activities in the past year. The results showed that noncraft activities were ranked as being used more frequently than either major or minor craft activities. This was true in all settings and all specialty areas of practice. In both groups, across all areas of practice, self-care and social skills activities ranked among the top five positions of activities frequently used in practice. Therapists in physical disabilities settings used crafts less frequently than therapists in mental health settings. As a result of this study, changes have been made in the teaching of treatment activities at LSUMC: Those activities that were ranked in the study as frequently used have been emphasized, and those ranked as infrequently used have been given less emphasis or deleted from the curriculum.

Activities of Daily Living↗
PubMed1991

Electron microscopy of herpes simplex hepatitis with hepatocyte pulmonary embolization in kwashiorkor.

We report a case of herpes simplex hepatitis in a child with edematous malnutrition. Electron microscopy showed virus in parenchymal cells, with pulmonary embolization of necrotic, infected hepatic cell fragments. Systemic dissemination of herpes simplex may be related both to the profound immunoincompetence associated with kwashiorkor and to a reduction in the circulating and fixed polyanions that normally inhibit viral attachment to cells.

Capillaries↗
PubMed1991

Substantial improvement in compliance with universal precautions in an emergency department following institution of policy.

Seven months following the introduction of an institutional policy mandating compliance with universal precautions (UPs), we observed 127 health care workers performing 1421 interventions on 155 critically ill and injured patients in an emergency department setting in July 1989. Results were compared with a similar study undertaken exactly 1 year previously when UPs were considered as guidelines only. Overall adherence to UPs improved from 44.0% to 72.7% from 1 year to the next. Adherence to UPs improved from 19.5% to 55.7% during interventions on patients with profuse bleeding and from 16.7% to 54.5% during performance of major procedures. Compliance improved from 47.9% to 81.0% for emergency department-based health care workers (residents, attending physicians, nurses, x-ray film technicians). Prehospital care providers, a group not accountable to the institution, remained particularly noncompliant with only 13% adherence. We conclude that mandating UPs as policy with a monitoring component is effective in ensuring a reasonable level of adherence. However, given current barrier technology, achieving appropriate levels of compliance during unscheduled visits by patients requiring immediate attention and rapid intervention remains a challenge.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Effacement of glomerular foot processes in kwashiorkor.

In a study of the pathogenesis of the oedema of kwashiorkor the ultrastructure of the kidneys from 6 children was examined shortly after they died from oedematous malnutrition. There was a generalised effacement of the glomerular epithelial cells onto the basement membrane. The filtration slits that remained were narrowed. The picture was similar to that seen in minimal-change nephrotic syndrome--but none of the children had albuminuria. The degree of effacement was statistically related to treatment with gentamicin. The findings suggest that there is a defect in the anionic charge of the glomerular basement membrane in oedematous malnutrition, that the membrane charge is more easily neutralised by cations such as gentamicin, and that, because proteinuria is not a feature of oedematous malnutrition, the proteinuria in other conditions associated with glomerular epithelial cell effacement (eg, minimal-change nephrotic syndrome) is due to something more complex than simple loss of charge.

Basement Membrane↗
PubMed1990

Blood and plasma donations among a cohort of intravenous drug users.

We evaluated the blood and plasma donation histories of a cohort of 2921 intravenous drug users in Baltimore, Md, and correlated these histories with their human immunodeficiency virus (HIV) serologic status, numbers of CD4 lymphocytes in the peripheral blood, and stigmata of intravenous drug use (scarred veins). Of the 793 intravenous drug users (27.1%) who had donated blood or plasma, 652 (82.2%) donated after they had started using intravenous drugs. Most subjects donated at commercial plasma centers, where they were paid $10 to $15 per donation. Although the HIV-1 seroprevalence of the entire cohort was 24.1%, the HIV-1 seroprevalence among those reporting plasma or blood donations declined progressively with time, from 17.1% in those who last donated in 1985 to 3.6% in those who last donated in 1988-1989. Many of the 437 intravenous drug users who had donated plasma or blood since 1985, when screening for HIV-1 was initiated, had not been notified and counseled about their HIV test results. Current programs to exclude individuals with a history of intravenous drug use from the plasma donor pool should be reevaluated and improved.

Baltimore↗
PubMed1990

Love and let die.

When the very technology that can save lives is only prolonging death, how should a patient decide whether to stop treatment--or help death along? In the last days of a ravaging disease, patients and their families face all but unbearable decisions. Is there a right to die? To commit suicide? To be killed on request? As the private dilemmas multiply, they have become the public province of interest groups, policymakers and the U.S. Supreme Court.

Decision Making↗
PubMed1990

A randomized trial of combination therapy with intralesional interferon alpha 2b and podophyllin versus podophyllin alone for the therapy of anogenital warts.

To determine the value of combining interferon with standard local therapy in the treatment of human papillomavirus infection, 97 patients with anogenital warts were randomized to a short course of either interferon plus podophyllin or podophyllin alone. Interferon alpha 2b (1.5 x 10(6) IU) was injected intralesionally and podophyllin resin applied topically to each of three warts once weekly for 3 weeks. Maximal responses occurred within 2 weeks of therapy, and overall there was complete clearance of treated warts in 67% of interferon and podophyllin versus 42% of podophyllin recipients (P less than .05, chi 2). Clearance rates were greater in women, patients with warts of less than or equal to 12 months' duration, and HIV-seronegative patients. Of patients with complete clearance, 67% of interferon and podophyllin and 65% of podophyllin recipients experienced recurrences. Thus, in short treatment courses of anogenital warts, intralesional interferon enhanced the effect of topical podophyllin, and trials of combination therapy using more intensive or prolonged regimens of interferon are warranted.

Administration, Topical↗