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Biomedical subjects

G Carlson

Publications and source records attributed to G Carlson.

At least 37 records · Page 2Linked to original sources
PubMed1998

Prevalence and severity of substance use disorders and onset of psychosis in first-admission psychotic patients.

BACKGROUND: Past studies have found inconsistent evidence that substance use disorders are related to earlier onset of schizophrenia or more severe symptoms. This study examines prevalence and severity of current substance use disorders and onset of psychotic illness in a multi-facility sample. METHODS: Data are from the Suffolk County Mental Health Project, an epidemiological study of first admission psychosis. The SCID and instruments measuring symptomatology, personality and background characteristics were administered. Respondents were stratified into three groups: (a) no life-time substance diagnosis; (b) in remission or reporting current mild use at admission; and (c) current moderate-severe substance abuse at admission. RESULTS: Using the SCID severity rating, 17.4% of males and 6.2% of the females had moderate or severe current substance abuse, while 41.5% of males and 68.2% of females had no lifetime substance diagnosis. In almost all cases categorized as moderate-severe, the substance diagnosis predated onset of psychosis. Females categorized as moderate-severe have an earlier age of onset of psychosis than did females in the other groups. There were only slight differences in symptom severity among the groups but more marked antisocial behaviour in the moderate-severe group. Variables discriminating the moderate-severe from non-abuse groups were BPRS thought disturbance, adult anti-social behaviour and current cigarette smoking for males and adult anti-social behaviour and child-teen antisocial behaviour for females. CONCLUSIONS: Severity of substance abuse does not appear to be a pivotal correlate of the early features of psychotic illness.

Adolescent↗
PubMed1997

Anterior cervical pseudarthrosis. Natural history and treatment.

STUDY DESIGN: A retrospective study of long-term clinical outcomes in 48 patients with pseudarthroses after anterior cervical discectomy and fusion. OBJECTIVES: To determine the natural history, risk factors, and treatment outcomes in a large population with documented pseudarthrosis after anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA: Recent reports suggest that pseudarthrosis after anterior cervical discectomy and fusion adversely affects clinical outcome. Little data regarding cervical pseudarthroses have been published, and conclusions have been drawn from reports with small patient populations and short-term follow-up periods. METHODS: Forty-eight patients with radiographically documented pseudarthrosis after anterior cervical discectomy and fusion were studied. Patients were examined and radiographs made at regular intervals (mean follow-up, 66 months). Clinical results were based on patients' assessment of pain, prescription drug use, activity level and Odom's criteria. Clinical outcomes in patients who underwent surgical repair of the pseudarthrosis are reported. RESULTS: Of the 48 patients, 32 (67%) with pseudarthroses were symptomatic at latest follow-up or at the time of further surgery. Of the 32 patients, 9 had a symptom-free period of at least 2 years after the anterior cervical discectomy and fusion before redeveloping cervical symptoms after a traumatic episode. Of 48 patients with pseudarthroses, 16 (33%) remained asymptomatic at a mean of 5.1 years after anterior cervical discectomy and fusion. A younger age at the time of anterior cervical discectomy and fusion increased the likelihood of the pseudarthrosis becoming symptomatic. After multiple level anterior cervical discectomy and fusion, the caudal-most operated level accounted for 82% of the pseudarthroses. Sixteen patients had an anterior repair of the pseudarthrosis, and fusion was achieved in 14. Six patients underwent posterior pseudarthrosis repair, and all healed. In patients in whom fusion was achieved with a second cervical operation, the results were excellent in 19 and good in 1. CONCLUSION: A pseudarthrosis after anterior cervical discectomy and fusion is frequently associated with a poor clinical outcome. Surgical repair of the pseudarthrosis with an anterior or posterior approach seems to have a high likelihood of a successful clinical outcome.

Adult↗
PubMed1997

Phosphorylation of linker histones by a protein kinase A-like activity in mitotic nuclei.

Micronuclear linker histones of the ciliated protozoan, Tetrahymena thermophila, are extensively phosphorylated in vivo. Each of these polypeptides, alpha, beta, gamma, and delta, contains sites for phosphorylation by cyclic-AMP dependent protein kinase (PKA) but not Cdc2 kinase, and some data have been presented implicating PKA kinase in their phosphorylation in vitro and in vivo (Sweet, M. T., and Allis, C. D. (1993) Chromosoma 102, 637-647; Sweet, M. T., Jones, K., and Allis, C. D. (1996) J. Cell Biol., in press). In this report we have extended these analyses by showing that Cdc2 and PKA kinase are not evenly distributed between micro- and macronuclei. Macronuclei, but not micronuclei, contain a 36-kDa polypeptide that is immunoreactive with p34Cdc2 antibodies. In contrast, a 40-kDa polypeptide is detected with PKA antibodies in micronuclei, that is not detected in macronuclei. In support, extracts from micronuclei, but not macronuclei, contain a kinase activity that resembles some, but not all, characteristics of PKA from other sources. Immunodepletion experiments using anti-PKA antibodies show that a 40-kDa polypeptide can be specifically removed from these extracts with a concomitant loss in kinase activity. Microsequence analyses of delta demonstrate that this linker histone is phosphorylated in vivo on two PKA consensus sequences located in its carboxyl-terminal domain, an optimum PKA consensus sequence, Arg-Lys-Asn-Ser, and a less optimal PKA sequence, Lys-Ser-Ser-Val. Collectively, these results suggest that PKA or a PKA-like kinase is responsible for the phosphorylation of linker histone in mitotically dividing micronuclei. In contrast, macronuclei, which divide amitotically, phosphorylate linker histone H1 using a distinct, Cdc2-like kinase.

Amino Acid Sequence↗
PubMed1997

Underprediction of pain in children undergoing ear piercing.

Ear piercing is a brief, standard, painful stimulus which is submitted to voluntarily, offering a unique opportunity for research on children's anticipation of pain in a naturalistic context. Self-ratings on visual analogue scales of fear, predicted pain, and experienced pain were collected, as each ear was pierced in turn, from 32 girls aged 5-11 yr. Of these, 69% underpredicted their pain on the first ear. These underpredictors of pain on the first ear expected and reported significantly greater pain when the second ear was pierced than did overpredictors or children who accurately predicted the pain for the first ear. Fear scores taken before the first ear was pierced did not significantly predict pain for the second ear. Younger children made less accurate predictions and were more likely to use the extremes of the scale. The results, which are consistent with those of previous studies of prediction of pain and anxiety, have implications for preparation of children for brief procedural pain: they support recommendations to encourage children to expect realistic rather than minimal amounts of pain.

Analysis of Variance↗
PubMed1997

Mutant presenilins of Alzheimer's disease increase production of 42-residue amyloid beta-protein in both transfected cells and transgenic mice.

The mechanism by which mutations in the presenilin (PS) genes cause the most aggressive form of early-onset Alzheimer's disease (AD) is unknown, but fibroblasts from mutation carriers secrete increased levels of the amyloidogenic A beta 42 peptide, the main component of AD plaques. We established transfected cell and transgenic mouse models that coexpress human PS and amyloid beta-protein precursor (APP) genes and analyzed quantitatively the effects of PS expression on APP processing. In both models, expression of wild-type PS genes did not alter APP levels, alpha- and beta-secretase activity and A beta production. In the transfected cells, PS1 and PS2 mutations caused a highly significant increase in A beta 42 secretion in all mutant clones. Likewise, mutant but not wildtype PS1 transgenic mice showed significant overproduction of A beta 42 in the brain, and this effect was detectable as early as 2-4 months of age. Different PS mutations had differential effects on A beta generation. The extent of A beta 42 increase did not correlate with presenilin expression levels. Our data demonstrate that the presenilin mutations cause a dominant gain of function and may induce AD by enhancing A beta 42 production, thus promoting cerebral beta-amyloidosis.

Alzheimer Disease↗
PubMed1997

Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience.

OBJECTIVE: The purpose of the study is to define those patient variables that contribute to morbidity and mortality of median sternotomy wound infection and the results of treatment by debridement and closure by muscle flaps. BACKGROUND: Infection of the median sternotomy wound after open heart surgery is a devastating complication associated with significant mortality. Twenty years ago, these wounds were treated with either open packing or antibiotic irrigation, with a mortality approaching 50% in some series. In 1975, the authors began treating these wounds with radical sternal debridement followed by closure using muscle or omental flaps. The mortality of sternal wound infection has dropped to < 10%. METHODS: The authors' total experience with 409 patients treated over 20 years is described in relation to flap choices, hospital days after sternal wound closure, and incidence rates of morbidity and mortality. One hundred eighty-six patients treated since January 1988 were studied to determine which patient variables had impact on rates of flap closure complications, recurrent sternal wound infection, or death. Variables included obesity, history of smoking, hypertension, diabetes, poststernotomy septicemia, internal mammary artery harvest, use of intra-aortic balloon pump, and perioperative myocardial infarction and were analyzed using chi square tests. Fisher's exact tests, and multivariable logistic regression analysis. RESULTS: The mortality rate over 20 years was 8.1% (33/49). Additional procedures for recurrent sternal wound infection were necessary in 5.1% of patients. Thirty-one patients (7.6%) required treatment for hematoma, and 11 patients (2.7%) required hernia repair. Among patients treated since 1988, variables strongly associated with mortality were septicemia (p < 0.00001), perioperative myocardial infarction (p = 0.006), and intra-aortic balloon pump (p = 0.0168). Factors associated with wound closure complications were intra-aortic balloon pump (p = 0.0287), hypertension (p = 0.0335), and history of smoking (p = 0.0741). Factors associated with recurrent infection were history of sternotomy (p = 0.008) and patients treated for sternal wound infection from 1988 to 1992 (p = 0.024). Mean hospital stay after sternal wound reconstruction declined from 18.6 days (1988-1992) to 12.4 days (1993-1996) (p = 0.005). To clarify management decisions of these difficult cases, a classification of sternal wound infection is presented. CONCLUSIONS: Using the principles of sternal wound debridement and early flap coverage, the authors have achieved a significant reduction in mortality after sternal wound infection and have reduced the mean hospital stay after sternal wound closure of these critically ill patients. Further reductions in mortality will depend on earlier detection of mediastinitis, before onset of septicemia, and ongoing improvements in the critical care of patients with multisystem organ failure.

Debridement↗
PubMed1997

Management of nasopharyngeal and oropharyngeal stenosis in children.

Nasopharyngeal stenosis and oropharyngeal stenosis are rare and challenging problems in the pediatric population. The most common etiology is currently the surgical trauma associated with adenotonsillectomy. Stenosis can vary from a thin band to a complete obstructing cicatrix. Presenting symptoms range from mild hyponasal speech to severe airway obstruction. We present a series of eight children with varying degrees of stenosis and associated symptoms. Choice of treatment varied with the severity of disease. In our series, successful interventions included triamcinolone acetonide injection, lysis of adhesions, rotational and advancement mucosal flaps, and jejunal free flap. Preoperative evaluation and individualized surgical repair are essential for successful treatment.

Adenoidectomy↗
PubMed1997

Comparison of intratumoral administration of cisplatin versus bleomycin for treatment of periocular squamous cell carcinomas in horses.

OBJECTIVE: To compare therapeutic benefits of intratumoral administration of cisplatin and bleomycin for squamous cell carcinoma of the eyelids in horses. ANIMALS: 25 horses with 27 T2-stage periocular squamous cell carcinomas. PROCEDURE: Horses were treated 4 times at 2-week intervals with a slow-release formulation of cisplatin (1 mg/cm3 of tissue) or bleomycin (1 IU/cm3 of tissue). A two-stage design was used to minimize the sample size in each treatment arm. RESULTS: The local control rate at 1 year for lesions treated with cisplatin was 93 +/- 6%, and with bleomycin was 78 +/- 10%. Difference in local control duration between the 2 treatment groups was not significantly different. A high tumor proliferative fraction index value was associated with a higher local (infield) control rate, but also with a higher risk of marginal and regional recurrences. Tumors with a low proliferative fraction index value (< 28%) had 9.5-times higher (P = 0.0411) risk of recurrence than those with a high index value. Local acute reactions were similar in the 2 treatment groups, and chronic reactions were not observed. CONCLUSIONS: Cisplatin and bleomycin were effective anticancer agents for carcinoma of the eyelid in horses. Based on therapeutic benefit and treatment cost, cisplatin was found to be a better choice for intratumoral chemotherapy of eyelid carcinomas. CLINICAL RELEVANCE: Results of this study confirm the value of intratumoral chemotherapy, using cisplatin, for treatment of cutaneous squamous cell carcinomas in horses.

Animals↗
PubMed1996

Multicenter comparison of the diagnostic performance of free prostate-specific antigen.

OBJECTIVES: This study examined the multicenter clinical performance of noncomplexed (free) prostate-specific antigen (PSA) in men presenting with total PSA values between 2.5 to 20 ng/mL. METHODS: Prebiopsy serum samples were obtained from 1,081 consecutively accrued, histologically diagnosed men between the ages of 40 and 75 years with total PSA values falling between 2.5 and 20 ng/mL. Total PSA was determined by either the Tosoh AIA-1200 or Hybritech method. Free PSA values were determined using the Dianon PSA II immunoradiometric method. Free PSA was expressed as a percentage of total PSA. Immunochemistry was performed at each accrual site. RESULTS: Among men diagnosed with prostate cancer (CaP), only 4% (21/520) had proportions of free to total PSA values > 25%. Conversely, among men with benign prostatic disease, only 2% (13/561) had proportions of free to total PSA values < 7%. These results confirm those of previous research. Differences among sites were found in age and prostate volume. CONCLUSIONS: These data confirm that free PSA values < 7% are highly suspicious for CaP whereas free PSA values > 25% suggest absence of malignancy. The data also suggest that age and/or prostate volume influences the serum level of free PSA but does not affect the diagnostic cutoff points of 7% and 25%. Future analysis is needed to confirm that younger men with small prostates are at higher risk for CaP.

Adult↗
PubMed1996

Using proportions of free to total prostate-specific antigen, age, and total prostate-specific antigen to predict the probability of prostate cancer.

OBJECTIVES: This study was undertaken to define the probability of prostate cancer as a function of the proportion of free to total prostate-specific antigen (FTPSA), total PSA, and age for those patients with total PSA levels between 2.5 and 20.0 ng/mL. METHODS: Prebiopsy serums were obtained from 428 untreated patients (165 malignant, 263 benign) who had undergone sextant six-core biopsy. Each patient had no prior history of prostate cancer and a prebiopsy total PSA value between 2.5 and 20.0 ng/mL. Total PSA levels were determined using the PA immunoassay performed on the TOSOH AIA-1200 automated immunoassay instrument. Free PSA levels were determined using a monoclonal-polyclonal antibody sandwich radioimmunoassay. RESULTS: In men with total PSA values between 2.5 and 20.0 ng/mL, the FTPSA significantly differentiated between patients with benign and malignant histologic states. Log linear modeling indicated distinct differences in the risk for cancer as a function of FTPSA, total PSA, and age. The highest probability for cancer was observed in men greater than 70 years of age who had a FTPSA less than 7% and total PSA more than 10.0 ng/mL. Conversely, the lowest probability for cancer was observed in patients less than 60 years of age who had a FTPSA more than 25% and a total PSA less than 4 ng/mL. CONCLUSIONS: The probability that prostate cancer will be found on biopsy has a marked gradient that is associated with age, total PSA, and FTPSA. The extreme ends of FTPSA of less than 7% and more than 25% are diagnostic for prostate cancer and benign prostatic disease, respectively.

Adult↗
PubMed1995

Measurement of the proportion of free to total prostate-specific antigen improves diagnostic performance of prostate-specific antigen in the diagnostic gray zone of total prostate-specific antigen.

OBJECTIVES: This study examined the clinical significance of non-complexed (free) prostate-specific antigen (PSA) in the differential diagnosis of prostate cancer with an emphasis on patients with total PSA values between 4.0 and 10.0 ng/mL (the diagnostic gray zone). METHODS: Serum samples were obtained from three specimen banks. Patient samples consisted of 55 untreated histologically confirmed primary cancer, 62 men with untreated benign prostatic disease histologically confirmed by 6 negative sextant biopsies, and 64 asymptomatic healthy male controls with normal digital rectal examinations and PSA values less than 4.0 ng/mL. All patients were between the ages of 50 and 75 years. Total PSA levels were determined using the PA immunoassay performed on the TOSOH AIA-1200 automated immunoassay instrument. Free PSA levels were determined using a monoclonal-polyclonal antibody sandwich radioimmunoassay. The proportion of free to total PSA was calculated by dividing the patient's free PSA value by the total PSA value. RESULTS: When all subjects were included, both total PSA and the proportion of free to total PSA significantly differentiated between patients with prostate cancer and patients with benign histologic conditions (P < 0.0001). However, in men with total PSA values between 4.0 and 10.0 ng/mL, the proportion of free to total PSA significantly differentiated between patients with benign and malignant histologic conditions (P = 0.0004), whereas the total PSA did not (P = 0.13). Among this subgroup of patients, the analysis of sensitivity and specificity showed that the proportion of free to total PSA had a clearly higher specificity compared with that of the total PSA at the same level of sensitivity. CONCLUSIONS: Measurement of the free PSA level in a patient's serum and calculation of the proportion of free to total PSA enhances the ability to distinguish benign histologic conditions from cancer while retaining high sensitivity for detecting cancer in men who present with total PSA levels between 4.0 and 10.0 ng/mL. A large-scale population-based study is currently in progress to confirm this preliminary finding.

Aged↗
PubMed1995

Polyhydramnios-oligohydramnios in a twin pregnancy complicated by fetal glomerulocystic kidney disease.

Polyhydramnios and oligohydramnios in twin gestation is most often caused by twin-twin transfusion syndrome. Presented is a monozygotic twin pair with polyhydramnios and oligohydramnios, in which both twins had glomerulocystic kidney disease of differing severity. The more severely affected donor twin died of renal failure in the neonatal period. The surviving twin is well following unilateral nephrectomy. This case illustrates the varied spectrum of pathology in glomerulocystic kidney disease.

Adult↗
PubMed1994

Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection.

Between 1980 and 1993, 18 patients underwent formal laparotomy after laparostomy and healing of the peritoneal cavity by granulation. The majority (12 patients) were men and the median age was 47 (range 22-67) years. Intraabdominal infection following surgery for Crohn's disease (four patients) and necrotizing pancreatitis (six) was the most common primary condition requiring laparostomy. A total of 23 reconstructive operations were carried out on the 18 patients a median of 6 (range 1-18) months after laparostomy. The indication for surgery was for closure and/or resection of an enteric fistula in 13 patients. The site of the fistula included three gastric, two duodenal, 11 small bowel and seven colonic. A further four patients required operation for closure or refashioning of a stoma. Five patients subsequently required a second laparotomy: two for elective restoration of bowel continuity, two for recurrent fistula and one for an acute abdomen. After reconstructive surgery following laparostomy 16 patients were discharged home alive and well, one requiring home parenteral nutrition for short bowel syndrome. In contrast, the two oldest patients in the series died from multiple organ failure immediately after initial reconstructive surgery. Both had pre-existing medical problems and in neither was there evidence of further intra-abdominal infection after reconstruction.

Abdomen↗
PubMed1994

Correspondence.

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Letter↗
PubMed1994

Persistence of replicating coxsackievirus B3 in the athymic murine heart is associated with development of myocarditic lesions.

Coxsackievirus B3 (CVB3)-induced myocarditis was studied in euthymic (nu/+) and athymic (nu/nu) C3H/HeN (H-2k) mice. Mice were inoculated intraperitoneally with 10(6) p.f.u. of CVB3 (Nancy strain) and sacrificed at intervals up to 92 days post-inoculation (p.i.). Viraemia peaked at day 2 to 3 p.i. and ceased at day 5 to 7 p.i. in a synchronized manner in both sets of mice. Very few infectious particles were detected in the blood of nu/nu mice after day 14 p.i. In nu/nu mice, CVB3 persisted in myocardial tissue with constant titres between 2.7 +/- 1.9 x 10(4) and 7.6 +/- 5.2 x 10(4) p.f.u./mg from day 3 to 92 p.i., which were comparable to those of nu/+ mice in the acute phase. In nu/+ mice, the virus was recovered from all animals examined by day 11 p.i. and from three out of 13 mice between days 14 and 21 p.i., yet no virus was recovered from nu/+ mice at day 42 p.i. In nu/nu mice, sense and antisense RNA for CVB3 was detected in the myocardial tissue up to day 42 p.i. by in situ hybridization and up to day 92 p.i. by reverse transcriptase-PCR. Neither sense nor antisense RNA was detected after day 21 p.i. in nu/+ mice with the same techniques. Myocardial tissue damage was analysed morphologically. At day 92 p.i., the area of myocardial injury peaked at 23% of the section in nu/nu mice. In contrast, less than 0.6% of tissue sections contained lesions in nu/+ mice. A neutralizing antibody response to CVB3 was observed in both nu/nu and nu/+ mice. The mean titre of neutralizing antibody was significantly higher at day 21 p.i. in nu/+ mice, but similar at day 42 p.i. with nu/nu and nu/+ mice. Perforin-producing natural killer-like cells, which are considered to play an important role in causing acute myocarditic lesions in immunocompetent mice, were found in the lesions of nu/nu mice persistently infected with CVB3. Prolonged tumour necrosis factor-alpha mRNA synthesis detected in nu/nu mice appears to reflect the continuous activation of macrophages, which extend phagocytic reactions to virus-infected myocytes. These immunological results suggested that the host immune response devoid of antigen-specific T cell function is not sufficient to terminate CVB3 infection in nu/nu mice. Also, it appears that competent cellular immunity, on the whole, plays a role in curing rather than in aggravating myocarditis in nu+mice.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1994

Six-month stability of psychiatric diagnoses in first-admission patients with psychosis.

OBJECTIVE: The short-term diagnostic stability of schizophrenic and other psychotic disorders was examined in first-admission patients, with attention to the principal reasons for diagnostic change. METHOD: Hospitalized first-admission patients (N = 278) participating in an epidemiologic study were interviewed at baseline and after 6 months with the Structured Clinical Interview for DSM-III-R. A best estimate diagnosis was made at both time points with the use of all available sources of information. Reasons for changes in diagnosis were determined by two psychiatrists. RESULTS: Affective psychosis and schizophrenic disorders were relatively stable broad diagnostic categories over the 6-month period, with 86.5%-88.9% of the patients remaining in the same category, although findings for specific diagnoses within these categories ranged from 61.5% to 85.7%. The groups with unknown and nonspecific diagnoses showed less stability; the diagnoses of more than one-third of these patients remained unknown or nonspecific at the 6-month evaluation. If the 6-month diagnoses are used as the research standard, somewhat lower percentages of patients received the same diagnoses at baseline. Forty-three percent of the changes in diagnosis were attributed to the clinical course of illness; the rest were attributed to the diagnostic process itself. CONCLUSIONS: A longitudinal diagnostic assessment based on multiple sources of information is crucial for categorizing first-admission psychotic patients, particularly those who do not initially fit into a DSM-III-R category. The short-term stability of a diagnosis is a function of multiple factors, including the changing clinical picture, additional sources of information, and new interpretations of original data.

Adolescent↗
PubMed1993

The effect of carbamazepine on the white blood cell count in cocaine abusers.

Various medication therapies have been attempted to assist in detoxification and abstinence maintenance among cocaine users. The safety of these medications in this unique population has not been documented. Carbamazepine, an anticonvulsant being used with this population, is known to cause leukopenia and agranulocytosis in seizure patients. Analysis of data involving two different populations of cocaine users treated with carbamazepine revealed no statistically or clinically significant changes in total white blood cell count, or in any component white cell, using endpoint analysis, lowpoint analysis, or regression analysis. These results should be reassuring to the addiction medicine clinician.

Adolescent↗