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Biomedical subjects

J C Johnson

Publications and source records attributed to J C Johnson.

At least 19 recordsLinked to original sources
PubMed1992

Prognostic significance of polymerase chain reaction detected human papillomavirus of tumors and lymph nodes in surgically treated stage IB cervical cancer.

This study describes the prognostic role of polymerase chain reaction detected human papillomavirus (HPV) in Stage IB cervical cancer patients treated with radical hysterectomy and pelvic and paraaortic node dissection. All tumors were confined to the cervix and all margins and nodes were disease free. Twenty-one patients were analyzed: 6 patients recurred within 20 months of initial therapy, while 15 had no evidence of disease with a minimum follow-up of 36 months. Polymerase chain reaction (PCR) was performed on paraffin-block tissue of the hysterectomy specimen cervical tumor and lymph nodes. Oligonucleotide probes for HPV types 6, 11, 16, 18, 31, 33, and 35 were used with consensus primers for uncharacterized HPV types created from an L1 constant region. Control tissues were run with each tumor sample to assure against contamination. HPV type confirmation was performed using diagnostic restriction sites. HPV was detected in all cervical tumors. Recurring tumors were infected with multiple types of HPV in all 6 tumors versus only 5 of 15 nonrecurring tumors being multiply infected (P = 0.023). No tumor had HPV 6 or 11, and the incidence of HPV 16, 31, 33, and 35 was not significantly different for recurrent versus nonrecurrent groups. HPV 18 was found in 5 of 6 recurring cancers versus 1 of 15 nonrecurring tumors (P = 0.0029). PCR typing of the histologically negative nodes that had been obtained at radical hysterectomy was done in all 6 recurring patients and in 6 nonrecurring patients. The recurrent patients had a significantly higher incidence of lymph nodes positive for HPV DNA (71%) than the nonrecurring patients (35%) (P = 0.0047). These observations suggest that HPV 18 cervical cancer patients, those with infections of multiple types, and those with HPV DNA in histologically negative lymph nodes may be at increased risk for recurrence.

Adult↗
PubMed1992

High frequency of latent and clinical human papillomavirus cervical infections in immunocompromised human immunodeficiency virus-infected women.

In 32 human immunodeficiency virus (HIV)-infected women, routine gynecologic examination was performed with colposcopy and Papanicolaou smear; cervical swabs were collected for human papillomavirus (HPV) DNA screening and typing; and immune status was assessed by CD4 T-cell count. Dot blot analysis was specifically chosen for HPV DNA screening to detect only relatively substantial HPV DNA infections. Polymerase chain reaction analysis was used for precise DNA typing of dot blot-positive samples. The HPV data were assessed for immune status; a subject with a CD4 T-cell count below 200/microL was considered functionally immunosuppressed. The frequency of dot blot positivity was fivefold higher among immunocompromised (nine of ten) than relatively immunocompetent (four of 22) HIV-infected women. Moreover, four immunosuppressed women, compared with no immunocompetent subjects, had evidence of HPV DNA without signs of HPV-associated lesions by cytology or histology (ie, latent HPV infection). Furthermore, four of nine of the immunocompromised, compared with four of 21 immunocompetent, subjects had cervical intraepithelial neoplasia. These frequencies are high compared with those reported in the general population. Finally, HPV 18 was detected in five of the ten women with CD4 T-cell counts below 200/microL and in only one of the 22 with CD4 T-cell counts above that level. These results suggest that the normal immune system suppresses latent and clinical HPV cervical infections and that the efficiency of suppression may be HPV type-specific. Furthermore, impaired immune status, as reflected by CD4 T-cell count, is an important factor increasing the severity of HPV-induced cervical infections in this population.

Adult↗
PubMed1992

Prospective versus retrospective methods of identifying patients with delirium.

OBJECTIVE: To determine if DSM-III criteria or clinical or discharge diagnoses, reviewed retrospectively, are as accurate an indicator of the presence of delirium as prospective evaluation by a psychiatrist. DESIGN: Selection of delirious patients prospectively by a psychiatrist, followed by retrospective record review of the same patients. SETTING: A referral-based university hospital. PATIENTS: From a sample of 235 consecutive medical patients over age 70, 47 delirious patients were identified prospectively by a research psychiatrist using DSM-III criteria. The medical record of these delirious patients was reviewed after discharge for evidence of delirium. RESULTS: Four patients were assigned ICD-9 codes suggestive of delirium (sensitivity 0.09). Review of physicians' diagnoses correctly identified 8 of 47 (sensitivity 0.17) patients as being delirious or acutely confused. The specific diagnostic criteria necessary to meet a DSM-III diagnosis of delirium could be ascertained from 10 of 47 records (sensitivity 0.21). CONCLUSION: The retrospective medical record review is very imprecise in establishing the diagnosis of delirium. As research in this field moves from descriptive epidemiology to studies of pathogenesis and treatment, prospective designs will be needed.

Abstracting and Indexing↗
PubMed1992

Functional status outcomes of a nursing intervention in hospitalized elderly.

This paper examines the effectiveness of a nursing intervention for elderly hospitalized patients (N = 235) as measured by functional outcomes. A nursing intervention targeted at factors which influence acute confusion or delirium employed strategies to educate nursing staff, mobilize patients, monitor medication and make environmental and sensory modifications. Subjects who received the intervention were more likely to improve in functional status from admission to discharge than subjects who did not receive the intervention.

Activities of Daily Living↗
PubMed1992

Effect of sleep deprivation on brain metabolism of depressed patients.

OBJECTIVE: Sleep deprivation is a rapid, nonpharmacologic antidepressant intervention that is effective for a subset of depressed patients. The objective of this study was to identify which brain structures' activity differentiates responders from nonresponders and to study how metabolism in these brain regions changes with mood. METHOD: Regional cerebral glucose metabolism was assessed by positron emission tomography (PET) with [18F]deoxyglucose (FDG) before and after total sleep deprivation in 15 unmedicated awake patients with unipolar major depression and 15 normal control subjects, who did the continuous performance test during FDG uptake. RESULTS: After sleep deprivation, four patients showed a 40% or more improvement on the Hamilton Rating Scale for Depression. Before sleep deprivation the depressed responders had a significantly higher cingulate cortex metabolic rate than the depressed nonresponders, and this normalized after sleep deprivation. The normal control subjects and nonresponding depressed patients showed no change in cingulate metabolic rate after sleep deprivation. CONCLUSIONS: Overactivation of the limbic system as assessed by PET scans may characterize a subset of depressed patients. Normalization of activity with sleep deprivation is associated with a decrease in depression.

Adult↗
PubMed1992

Calculation of radiation dose at a bone-to-marrow interface using Monte Carlo modeling techniques (EGS4)

Radiation dose rate profiles at a bone-to-marrow interface were calculated by simulating a uniform radiation source at the center of the endosteal layer in a long bone. Isotopes (153Sm, 186Re, and 166Ho) were assumed to assimilate as surface agents and the dose profiles were calculated on a microscopic scale using the Electron-Gamma Shower (EGS4) computer program. We validated our computational model against published dose factors (delta) for uniform volume distributed sources replicating them to an accuracy of better than 95%. The calculated dose distributions illustrate the relative contribution of atomic electrons, beta, and photon fractions. The backscatter contribution to marrow dose increased from 3% to 4% at the source to 6% to 8% at a marrow depth of 100 microns. Backscattered dose fraction was not significantly different among the three isotopes. The dose contribution from the three isotopes was remarkably similar at ranges between 25 and 125 microns.

Bone Marrow↗
PubMed1991

PET in generalized anxiety disorder.

Positron emission tomography (PET) measurements of cerebral glucose use were made in 18 patients with generalized anxiety disorder (GAD) during a passive viewing task off medication, and an active vigilance viewing task before and after medication or placebo treatment. In the passive viewing task, patients with GAD were compared with 15 normal controls. A significant difference in pattern of absolute brain metabolism was found. Patients showed lower absolute metabolic rates in basal ganglia and white matter. Relative metabolism was increased in the left inferior area 17 in the occipital lobe, right posterior temporal lobe, and the right precentral frontal gyrus. Significant left-right asymmetry of the parahippocampal gyri was not found in patients with GAD. An active vigilance task resulted in activation of relative basal ganglia metabolism in patients. Benzodiazepine therapy resulted in decreases in absolute metabolic rates for cortical surface, limbic system, and basal ganglia and was not associated with normalization of patterns of glucose metabolism. Change in anxiety scores was significantly correlated with change in limbic system and basal ganglia for the placebo group. The normal-anxious difference in the basal ganglia and the change seen in this region after benzodiazepine treatment are suggestive of a role in anxiety for this structure.

Adult↗
PubMed1991

Prehospital care: the future of emergency medical services.

Most prehospital interventions, both pharmacologic and procedural, have been accepted without clear demonstrations of their abilities to impact patient outcomes or without clear indications that withholding or delaying the intervention pending arrival at a definitive emergency department will adversely affect the patient. Interventions that have the benefit of supportive research have been applied equally to urban and nonurban emergency medical services environments. In selecting interventions, inadequate consideration has been given to the differences in emergency medical services personnel training, frequencies of their exposure to patients, frequencies of skill use, and availabilities of effective continuing education programs in the urban and nonurban environments. These issues are discussed, and the necessary focus of the future of emergency medical services in urban, suburban, and rural environments is predicted.

Clinical Competence↗
PubMed1991

Recombinant alpha-interferon and verruca plantaris. A review of the literature.

The authors review the literature and report the mechanisms of action, chemical properties, pharmacokinetics, adverse effects, and clinical studies of recombinant alpha-interferon. The authors believe that clinical trials should be performed with recombinant alpha-interferon therapy on verruca plantaris to prove or disprove the effectiveness of interferon as a potential treatment modality for these commonly encountered lesions.

Clinical Trials as Topic↗
PubMed1991

Amantadine-related adverse reactions among African-American elderly nursing home residents.

To identify factors associated with the development of adverse reactions to amantadine prophylaxis for influenza in a predominantly African-American nursing home population, we retrospectively reviewed the records of 100 residents who did and 45 who did not receive amantadine. During the 4 weeks of amantadine treatment, three independent observers rated all new symptoms as either related or unrelated to amantadine. Two types of comparison were made. Among patients receiving amantadine, those who did or did not develop new symptoms believed to be related to amantadine were compared by age, underlying diagnoses, type and number of medications, and renal function. Similar comparisons were made between patients who did and those who did not receive amantadine. The 100 residents who received amantadine prophylaxis had significantly more nonspecific symptoms than the 45 who did not receive amantadine. Otherwise, the two groups were comparable with regard to age, renal function, number of diagnoses, and medications. Of the 100 residents given amantadine, 16% were judged to experience amantadine-related adverse reactions. Those developing amantadine-related symptoms were significantly more likely to have nonspecific symptoms and to use psychotropic medications.

Aged↗
PubMed1990

Effect of host cell on the in vitro characteristics expressed by two bovine viral diarrhea virus strains.

Growth curves, immunofluorescence assays and radioimmunoprecipitation analysis of bovine viral diarrhea virus (BVDV)-specified polypeptides were used to determine the susceptibility of bovine endothelial cells (BECs) to infection with strains of BVDV. One strain of the virus, NY1, normally non-cytopathic when grown in bovine turbinate cells (BTUs), did not parallel this type behavior in BECs. Virus replication kinetics, morphological changes in infected cells and resolution of viral polypeptides suggest that NY1 replicated and showed cytopathologic changes in infected BECs similar to a cytopathic strain of BVDV, strain C24V. Two previously unreported viral polypeptides were identified in NY1-infected endothelial cells. These polypeptides had molecular weights of 92,000 (92kDa) and 72kDa. These findings suggest that BVDV-cell interactions occurring in BECs differ from those observed in similarly infected BTUs.

Animals↗
PubMed1990

A suture "retractor": a technical aid for bucket-handle meniscal resections.

Meniscal repair, healing, and survival have been demonstrated in the literature. Meniscal preservation is, however, not always possible. We present a technique that may aid the surgeon in difficult bucket handle resections by stabilizing a portion of the meniscus with a "suture retractor" prior to resecting either a posterior or anterior meniscal horn. This technique may also be modified to prepare the inner rim when one is performing meniscal repair.

Humans↗
PubMed1990

Using DSM-III criteria to diagnose delirium in elderly general medical patients.

Studies of delirium in general medical populations have used criteria for delirium different from current DSM-III or DSM-IIIR criteria of the American Psychiatric Association, or have used DSM-III or DSM-IIIR criteria without operationalizing the components of these criteria. Therefore this prospective study was conducted to establish an approach to operationalizing DSM-III criteria and to determine the incidence and prevalence of delirium. Two hundred thirty-five consecutive subjects age 70 and over admitted to general medicine underwent daily standardized screening. Patients with low scores on screening tests or clinical evidence suggestive of any psychiatric disorder and controls were seen by a psychiatrist, who determined whether delirium was present by applying explicit operational definitions to each component of the DSM-III criteria for delirium. We conclude that the syndrome of delirium as defined by the American Psychiatric Association is prevalent on admission among elderly on general medical services, but the number of cases developing in the hospital is much less than often stated in the literature.

Aged↗
PubMed1990

Effects of bovine somatotropin on milk yield and composition, body weight, and condition score of Holstein and Jersey cows.

Forty cows (20 Holstein, 20 Jersey) were administered 0, 5, 10, 15, or 20 mg of recombinantly derived bST daily to determine the effect on milk yield, milk composition, body weight, and body condition score. Administration of bST was from 75 +/- 7 d through 305 d postpartum. A total mixed diet of 45% corn silage and 55% of a concentrate mixture (dry basis) was provided for ad libitum intake. Milk yield of Holstein and Jersey cows administered 20 mg of bST increased 25.3 and 22.8%, respectively, over controls. Fat-corrected milk from Holsteins and Jerseys that were administered 20 mg of somatotropin increased 32.2 and 18.7% over controls, but Jersey response was greatest when 15 mg of bST were administered (27.1% over controls). Dry matter intake of the 20 mg bST group was 13.5% greater than DM intake of controls. Apparent efficiency of production increased linearly with increasing somatotropin. There was no significant change in body weight, but body condition score declined linearly with increasing somatotropin. Most milk composition measures were unaffected by somatotropin. Jersey and Holstein milk yield increased quadratically and linearly, respectively, with somatotropin dose.

Analysis of Variance↗
PubMed1990

Effects of bovine somatotropin on dry matter intake, milk yield and body temperature in Holstein and Jersey cows during heat stress.

Thirty-one lactating Holstein and Jersey cows were used to determine the effect of daily injections of 0 or 20 mg of recombinant bST in hot, humid weather. The comparison period lasted 80 d, from mid-June through August. The maximum and minimum ambient temperature and relative humidity averaged 34.6 and 22.2 degrees C and 100 and 59.8%, respectively. Body temperatures of somatotropin-treated Holsteins were elevated over controls by .2 and .3 degrees C at the a.m. and p.m. milkings, respectively, whereas corresponding treatment effects for Jerseys were .5 and .6 degrees C, thus demonstrating a breed by treatment interaction. The response of milk and FCM yields and apparent efficiency of production to somatotropin administration depended on the level of production prior to treatment. Cows at low pretreatment production increased milk and FCM yields to a greater degree than did cows at higher production. A breed by treatment interaction showed that Holsteins increased milk and FCM yields more than Jerseys upon administration of somatotropin. Intake of DM was not affected by treatment. Cows administered bST lost BW and condition score. Greater heat stress was associated with the higher milk production of cows administered bST.

Animals↗
PubMed1990

Delirium in the elderly.

Delirium, an acute confusional state, is an organic brain syndrome that manifests deficits in attention, irrelevant or rambling speech, and other cognitive deficits. Its symptoms often fluctuate over the course of the day, and patients may be hyperactive--for example, restless and screaming--or hypoactive--for example, quiet, inactive, and stuporous. Occurring in approximately 20% of hospitalized elderly patients, delirium is the most common psychiatric syndrome in acutely ill general medical and surgical patients. Fifteen to 30% of delirious patients expire, and others are prone to a variety of complications: falls, pressure ulcers, oversedation, dehydration, and others. Almost any acute illness can cause delirium in the elderly, but the most common offenders are acute infections and drugs. Many patients have a pre-existing dementia. The first step in arriving at a correct diagnosis is to distinguish delirium from other psychiatric syndromes that can cause confusion, such as dementia, depression, schizophrenia, and mania. Once delirium is established, a comprehensive general examination and a mental status examination is required. Routine laboratory and radiologic tests are directed at the common metabolic and infectious disorders that precipitate delirium. Treatment is directed at the underlying acute illness. In all patients, it is important (1) to treat the underlying acute illness, (2) to provide appropriate fluid and electrolytes, (3) to discontinue any unnecessary drugs, and (4) to allay the patient's fear and agitation through the use of simple, repetitive instructions, orientation cues, and by limiting the use of physical restraints. If psychotropic medications are needed to treat psychotic symptoms, to prevent patients from harming themselves or others, or to facilitate necessary diagnostic and therapeutic interventions, then haloperidol is the drug of choice in most instances. Drugs with anticholinergic properties should be avoided.

Aged↗