A trial of early discharge with homecare compared to conventional hospital care for patients undergoing coronary artery bypass grafting.
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Coronary Artery Bypass↗
Biomedical subjects
H Goodman
Publications and source records attributed to H Goodman.
[Immunoglobulin light chain amyloidosis: recent molecular, clinical and therapeutic approach].
AL amyloidosis is a rare disorder characterised by tissue deposition of a fibrillary proteinaceous material, formed from monoclonal immunoglobulin light (or exceptionally heavy) chains. Although it may complicate multiple myeloma or B-cell lymphomas, AL amyloidosis is often associated with a low burden of clonal plasma cells ("primitive" AL amyloidosis). The mechanisms involved in the formation of AL amyloid deposits remain unclear, but are probably related to structural peculiarities of monoclonal immunoglobulin light chains. AL amyloidosis is usually a systemic disease, often revealed by renal involvement, the most common complication of the disease. The longterm prognosis of AL amyloidosis is poor, mainly related to amyloid restrictive cardiomyopathy leading to congestive heart failure. Oral melphalan and prednisone is considered the standard treatment for AL amyloidosis, but with limited increase in the median survival. High-dose intra-venous melphalan with autologous stem cell transplantation is an effective treatment, aimed at eliminating the clonaly expanded plasma cells, which has been shown to induce complete hematologic remissions and to prolong survival. However, the tolerability of such treatment is low, limiting its use to selected patients. The development of new drugs, able to interfere with amyloid fibril deposition, may provide a new therapeutic approach.
Amyloidosis↗
The impact of pre-operative education on recovery following coronary artery bypass surgery. A randomized controlled clinical trial.
AIMS: Research has demonstrated the beneficial impact that pre-operative education exerts on the postoperative recovery of patients having surgery but little work has focused specifically on cardiac surgery. Therefore a randomized controlled trial was designed to elucidate the consequences of pre-operative education, given before admission, on postoperative pain, anxiety, depression and wellbeing in the 6 months following a first episode of coronary artery surgery. METHOD AND RESULTS: Three hundred and fifty-six people were randomized into the study, with 188 in the experimental and 168 in the control arms. Patients in the experimental group received the intervention, a day of education by members of the multidisciplinary team, prior to admission for surgery. Experimental and control subjects had the usual care, which involved education on admission and throughout their stay in hospital. Measurement was conducted on entry to the study, before randomization, and at 3 days, 6 weeks, 3 months and 6 months following operation. A variety of tools were used: the SF-36 Health Status questionnaire, the Hospital Anxiety and Depression scale, the General Well-Being questionnaire and a pain measurement tool. Analysis was done using the intention-totreat principle and non-parametric statistics. There were no significant differences between groups in the primary outcomes namely anxiety (P=0.09) and pain (P=0.48), or in depression (P=0.62) and wellbeing ('worn out' P=0.11; 'tense and uptight' P=0.29) 6 months after operation. This was also the case 3 days after coronary artery surgery. There was a significant difference in length of hospital stay (P=0.01) with the experimental group having the longer stay. These findings contrast with much of the existing evidence. CONCLUSION: The findings demonstrate that there is no benefit to be gained from this form of pre-operative education and that there is an associated increase in length of hospital stay. Future research could examine an ongoing programme of education and support, and might use alternative methods such as CD-ROM or the Internet.
Adult↗
Anxiety, depression and functional capacity in older women with mitral valve stenosis.
Mitral valve stenosis can lead to a range of symptoms that affect daily life. As many of the people with this problem are elderly, the difficulties resulting from age can be exacerbated by illness. A pilot descriptive study was designed to examine the differences in anxiety, depression and functional capacity in women with mitral valve stenosis who were aged over 60 years when compared to a similar group of volunteers who did not have any cardiac disease. Measurement was undertaken using the Hospital Anxiety and Depression scale, the SF-36 Health Status questionnaire and the Functional Limitations Profile. Forty women were recruited to the study: 20 women with mitral valve stenosis and 20 volunteers. Each person was asked to complete the three questionnaires on one occasion only. Non-parametric statistics were used for analysis. Patients fared worse than volunteers with significant differences between groups in respect of anxiety (P = 0.03), depression (P = 0.02) and overall function (P < 0.001), but not in physical (P = 0.52) or mental health (P = 0.32). Future research could focus on strategies that would help alleviate anxiety and depression and improve functional capacity in older women with mitral valve stenosis.
Aged↗
Depression and posttraumatic stress disorder at three months after mild to moderate traumatic brain injury.
To investigate the frequency and risk factors of major depressive disorder (MDD) after mild to moderate traumatic brain injury (TBI), 69 TBI and 52 general trauma (GT) patients were prospectively recruited and studied at 3-months postinjury. There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups. Therefore, a composite MDD group (TBI and GT patients) was compared to patients who were nondepressed. Female gender was related to MDD, but no other risk factors were identified. MDD was associated with disability (Glasgow Outcome Scale, Community Integration Questionnaire) and cognitive impairment. MDD was comorbid with posttraumatic stress disorder. Implications for postacute management of mild to moderate TBI are discussed.
Adolescent↗
Validity and sensitivity to change of the extended Glasgow Outcome Scale in mild to moderate traumatic brain injury.
Using a structured outcome interview, this study addressed the validity and sensitivity to change of the Glasgow Outcome Scale (GOS) and the Extended GOS (GOSE) in a prospective study of patients who sustained mild (n = 30) to moderate (n = 13) traumatic brain injury (TBI) or general trauma (n = 44). The patients were recruited from the emergency center or inpatient units of Ben Taub General Hospital and invited to participate in follow-up examinations at 3 and 6 months. Using a series of functional outcome measures, assessment of affective status, and neuropsychological tests as criteria, the validity of the GOSE generally exceeded the GOS. Analysis of the outcome data for the patients who completed both the 3-month and 6-month assessments disclosed that the GOSE was more sensitive to change than the GOS. Comparison of the 3-month outcome data disclosed that the GOSE and GOS scores did not differ for the TBI and general trauma groups. These findings lend further support for utilization of the GOSE in clinical trials when it is based on a structured interview.
Adult↗
FIN219, an auxin-regulated gene, defines a link between phytochrome A and the downstream regulator COP1 in light control of Arabidopsis development.
Light signals perceived by photoreceptors are transduced to negatively regulate COP1, a key repressor of photomorphogenic development. To identify genes involved in light inactivation of COP1, a genetic screen was employed to identify extragenic modifier mutations of a temperature-sensitive cop1 allele. One suppressor mutation isolated also exhibited a far-red-specific long hypocotyl phenotype in a wild-type background. Further phenotypic analyses of this new mutation, named fin219, suggested that it defines a novel phytochrome A signaling component. Genetic analysis indicated that FIN219 interacts closely with another phytochrome A signaling component, FHY1. Molecular characterization of FIN219 indicated that it encodes a cytoplasmic localized protein highly similar to the GH3 family of proteins and its expression is rapidly induced by auxin. In contrast to its loss-of-function mutant phenotype, overexpression of FIN219 results in a far-red-specific hyperphotomorphogenic response. Our data suggest that FIN219 may define a critical link for phytochrome A-mediated far-red inactivation of COP1 and a possible cross-talk juncture between auxin regulation and phytochrome signaling.
Amino Acid Sequence↗
Analysis of 1.9 Mb of contiguous sequence from chromosome 4 of Arabidopsis thaliana.
The plant Arabidopsis thaliana (Arabidopsis) has become an important model species for the study of many aspects of plant biology. The relatively small size of the nuclear genome and the availability of extensive physical maps of the five chromosomes provide a feasible basis for initiating sequencing of the five chromosomes. The YAC (yeast artificial chromosome)-based physical map of chromosome 4 was used to construct a sequence-ready map of cosmid and BAC (bacterial artificial chromosome) clones covering a 1.9-megabase (Mb) contiguous region, and the sequence of this region is reported here. Analysis of the sequence revealed an average gene density of one gene every 4.8 kilobases (kb), and 54% of the predicted genes had significant similarity to known genes. Other interesting features were found, such as the sequence of a disease-resistance gene locus, the distribution of retroelements, the frequent occurrence of clustered gene families, and the sequence of several classes of genes not previously encountered in plants.
Arabidopsis↗
Enhanced lymphoproliferation and diminished autoimmunity in CD4-deficient MRL/lpr mice.
MRL/lpr mice spontaneously develop an autoimmune disease with features of systemic lupus erythematosus. They also develop a lymphoproliferative disorder characterized by a massive accumulation of double-negative (DN) T cells that lack both CD4 and CD8. To clarify the role of CD4 in autoimmunity and lymphoproliferation in these mice, CD4-deficient MRL/lpr mice were generated. CD4-deficient MRL/lpr mice developed massive expansion of DN T cells in the blood, spleen, and lymph nodes, which significantly exceeded the degree of lymphoproliferation in CD4-expressing control MRL/lpr mice. Despite this lymphoproliferation, CD4-deficient MRL/lpr mice produced little, if any, antibodies to double-stranded DNA, and they had prolonged survival relative to CD4-expressing littermates. However, they eventually developed moderately severe nephritis, characterized by immunoglobulin and complement deposition in glomeruli, vasculitis, and renal infiltration by CD8+ T cells. These findings indicate that (1) lymphoproliferation in MRL/lpr mice does not require the expression of CD4; (2) autoantibody production in MRL/lpr mice is dependent on the expression of CD4 and not on the accumulation of DN T cells; and (3) the development of nephritis in MRL/lpr mice involves both CD4-dependent and CD4-independent mechanisms.
Animals↗
Patients' perceptions of their education needs in the first six weeks following discharge after cardiac surgery.
The aim of this study was to discover what information and support patients feel they need in the 6-week rehabilitation period following discharge after cardiac surgery. It was undertaken at the request of the hospital multidisciplinary cardiac rehabilitation team to enable them to plan a package of information to meet those needs. It was a local study aiming to gain insight into the patients' own views by asking them to keep a diary over the 6-week period and then take part in an unstructured interview when they returned for their 6-week out-patient appointment. The analysis of the respondents' comments gave an insight into their whole experience of the first 6 weeks following discharge. The themes which emerged were wide-ranging and were grouped under the headings of the early discharge needs of pain relief and sleep promotion, psychological needs, practical needs and community support. To take the study forward, several recommendations were made to improve the rehabilitation experience. These included additions to the literature and patient education sessions, and changes to ensure a smoother transition into the community. The findings also suggest the need for improvements in and further research into the whole area of the psychological preparation for discharge after cardiac surgery.
Activities of Daily Living↗
Geriatric rehabilitation.
The United States population is aging, and the number of people over age 85 is expected to quadruple early in the next century. Advancing age increases the likihood of aquiring a disabling condition. By the next century, every other visit to a health provider will be made by an elderly person. Nurse practitioners will see increasing numbers of older patients. They will be called on to differentiate normal aging states from pathological conditions. A focus on promoting vigorous aging, minimizing disabling conditions, and restoring or preserving function and independence will assist the practitioner in appropriate evaluation and treatment of the elderly.
Accidental Falls↗
Acute-phase response and the hypercoagulable state in pulmonary tuberculosis.
In our experience, severe pulmonary tuberculosis (PTB) is often complicated by deep venous thrombosis (DVT). Because of the association between inflammation and haemostatic changes that can result in a hypercoagulable state, we have prospectively examined such predisposing factors in representative patients. Sequential analyses in a control group with active PTB showed anaemia, thrombocytosis, elevations in plasma fibrinogen, fibrin(ogen) degradation products (FDP), tissue plasminogen activator (t-PA) and inhibitor (PAI-1) with depressed antithrombin III levels. Age, sex and disease matched individuals with venographically proven DVT had higher FDP (15.8 +/- 14.3 v 3.2 +/- 1.7 micrograms/ml:P < 0.01), t-PA (19.4 +/- 14.9 v 11.3 +/- 0.8 ng/ml:P < 0.01), and functional PAI-1 activity (11.6 +/- 6.3 v 4.2 +/- 4.1:P < 0.01) with lower platelet counts (347 +/- 110 v 563 +/- 230 x 10(9)/1:P < 0.01). Fibrinogen levels in all patients rose during the first 2 weeks of therapy and, together with related disturbances, corrected within 12 weeks. In conclusion, elevated plasma fibrinogen with impaired fibrinolysis coupled with a decrease in antithrombin III and reactive thrombocytosis would appear to favour the development of DVT in PTB.
Acute-Phase Reaction↗
Is there a future for the general hospital?
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England↗
Estimation of the number of HIV infections averted by screening of blood.
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AIDS Serodiagnosis↗
Geriatric rehabilitation.
The United States population is aging, and the number of people over age 85 is expected to quadruple early in the next century. Advancing age increases the likelihood of acquiring a disabling condition. By the next century, every other visit to a health provider will be made by an elderly person. Nurse practitioners will see increasing numbers of older patients. They will be called on to differentiate normal aging states from pathological conditions. A focus on promoting vigorous aging, minimizing disabling conditions, and restoring or preserving function and independence will assist the practitioner in appropriate evaluation and treatment of the elderly.
Aged↗
Phase I pharmacokinetic study of the hypoxic cell sensitizer etanidazole with carboplatin and cyclophosphamide in the treatment of advanced ovarian cancer.
PURPOSE: A Phase I study was undertaken to determine the maximum tolerated dose of the hypoxic cell sensitizer etanidazole which could be administered with carboplatin and cyclophosphamide, to determine whether adequate serum levels of etanidazole were achieved to allow for alkylating agent sensitization, and whether pretreatment with etanidazole altered carboplatin pharmacokinetics. METHODS AND MATERIALS: Patients received 2 g/m2 of intravenous etanidazole followed by a second dose of 4 g/m2 90 min later, followed by intravenous carboplatin (300 mg/m2) and cyclophosphamide (600 mg/m2) for four treatment cycles. Patients received an additional two cycles of carboplatin and cyclophosphamide without etanidazole. RESULTS: Two patients who received a total of 24 g/m2 of etanidazole developed Grade 1 neurotoxicity, and therefore etanidazole doses were not escalated further. The grade of granulocytopenia was worse after cycles with etanidazole than after those without (p = 0.03), but clinical outcome was not different. Etanidazole levels were adequate for alkylating agent sensitization (> 70 ug/ml) in all patients for the majority of the 7 h of testing. Pharmacokinetic data suggested t1/2 alpha and t1/2 beta for carboplatin were prolonged after pretreatment with etanidazole. CONCLUSION: Etanidazole, 2 g/m2 followed by 4 g/m2 90 min later, is safe and results in adequate serum levels for alkylating agent sensitization. Neurotoxicity appears to prevent dose escalation of etanidazole, and an interaction between etanidazole and carboplatin may have enhanced neurotoxicity in these patients.
Antineoplastic Combined Chemotherapy Protocols↗
Analysis of HPV-positive and -negative vulvar carcinomas for alterations in c-myc, Ha-, Ki-, and N-ras genes.
Mutation or overexpression of certain host genes, including c-myc, Ha-ras, and Ki-ras, have been associated with genital squamous neoplasia, specifically in the cervix, and have been implicated in the natural history of these tumors. The relationship of these host gene alterations to vulvar squamous cell carcinomas has not been previously studied. We analyzed archival material from 13 human papillomavirus-positive and -negative vulvar squamous cell carcinomas for mutations in Ha-, Ki-, and N-ras genes, and a smaller number of fresh samples for c-myc amplification, using PCR-based assays. For comparison, eight cervical squamous cell carcinomas (three fixed and five fresh) were also analyzed. Analysis for ras mutations revealed a previously reported silent allelic variant at nucleotide 1744 in the Ha-ras gene, but no mutations in codons 12, 13, or 61. Similarly, genomic amplification of c-myc beyond a maximum of three haploid copies was not identified in the cases. These findings indicate that alterations in myc or ras sequences are not linked to vulvar squamous cell carcinomas or to the presence or absence of HPV nucleic acids. Moreover, they apparently will not distinguish vulvar from cervical carcinomas, both groups appearing to be unlikely to harbor these sequence alterations.
Base Sequence↗
Case report: rectal stenosis due to extramedullary haemopoiesis--radiological features.
Although extramedullary haemopoiesis (EMH) is relatively common in myelofibrosis, it is seldom symptomatic and rarely involves the intestinal tract. We report a case in which perirectal infiltrate resulted in clinically symptomatic constipation. The barium enema showed tubular rectal narrowing with mucosal pleating. On computed tomography a poorly marginated soft tissue mass was shown to be replacing the perirectal fat.
Aged↗