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Biomedical subjects

J E Thompson

Publications and source records attributed to J E Thompson.

At least 145 records · Page 8Linked to original sources
PubMed1990

Predictive factors for bactibilia in acute cholecystitis.

Acute cholecystitis is well established as one of the high-risk factors bactibilla and wound infection. However, many patients with acute cholecystitis do not have bactibillia. Therefore, we analyzed 20 clinical and laboratory parameters in 49 patients with acute cholecystitis to determine which factor(s) predicted bactibilla. Twenty-one (42.9%) of 49 patients with pathologically proved acute cholecystitis had positive bile and/or gallbladder wall cultures. Univariate analysis suggested that a preoperative temperature greater than 37.3 degrees C, a total serum bilirubin level greater than 8.6 mumol/L, and a white blood cell count greater than 14.1 x 10(9)/L were the best predictors of bactibilia. Multifactorial analysis demonstrated that the 17 patients with zero or one predictive factor had a significantly lower chance of having bactibilia than the 32 patients with two or three predictive factors (6% vs 63%). We concluded that the culture status of patients with acute cholecystitis can be predicted preoperatively. We propose that patients with acute cholecystitis and zero or one of the predictive factors receive a single preoperative antibiotic dose. In patients with two or three predictive factors, antibiotics should be continued until culture data are available.

Acute Disease↗
PubMed1990

Cloned manganese superoxide dismutase reduces oxidative stress in Escherichia coli and Anacystis nidulans.

The Mn superoxide dismutase gene of Escherichia coli was subcloned into the E. coli-Anacystis nidulans shuttle vector pSG111 to make the plasmid pMYG1. Transformation of E. coli HB101 with pMYG1 resulted in a 6-fold increase in superoxide dismutase activity. There was also induction of Mn superoxide dismutase in the transformants upon exposure to paraquat, as evidenced by dramatically increased levels of the Mn superoxide dismutase polypeptide in cytoplasmic extracts and a 16-fold further increase in superoxide dismutase activity. As well, the E. coli transformants showed resistance to paraquat-mediated inhibition of growth. Anacystis nidulans, a cyanobacterium that has no detectable Mn superoxide dismutase and is, consequently, very sensitive to oxidative stress, was also transformed with pMYG1. The transformants had detectable levels of Mn superoxide dismutase protein and showed resistance to paraquat-mediated inhibition of growth and photobleaching of pigments. Paraquat is known to promote formation of the superoxide radical anion, O2-., and thus the data have been interpreted as indicating that the cloned Mn superoxide dismutase provides protection in both E. coli and A. nidulans against damage attributable to O2-..

Cloning, Molecular↗
PubMed1990

The bacteriology of gangrenous and perforated appendicitis--revisited.

By using optimum sampling, transport, and culture techniques in patients with gangrenous or perforated appendicitis, we recovered than has previously been reported. Thirty patients older than 12 years with histologically documented gangrenous or perforated appendicitis had peritoneal fluid, appendiceal tissue, and abscess contents (if present) cultured. Appendiceal tissue was obtained so as to exclude the lumen. A total of 223 anaerobes and 82 aerobic or faculatative bacteria were recovered, an average of 10.2 different organisms per specimen. Twenty-one different genera and more than 40 species were encountered. Bacteroides fragilis group and Escherichia coli were isolated from almost all specimens. Within the B. fragilis group, eight species were represented. Other frequent isolates included Peptostreptococcus (80%), Pseudomonas (40% [P. aeruginosa, 23.3%, other Pseudomonas spp., 16.7%]), B. splanchnicus (40%), B. intermedius (36.7%), and Lactobacillus (36.7%). Interestingly a previously undescribed fastidious gram-negative anaerobic bacillus was isolated from nearly one half of all patients. This organism was found to have low DNA homology (by dot blot) with the known organisms most closely resembling it.

Adolescent↗
PubMed1990

Characteristics of a membrane-associated lipoxygenase in tomato fruit.

Microsomal membranes isolated from the pericarp of maturegreen tomato (Lycopersicon esculentum) fruit rapidly metabolize exogenous radiolabeled linoleic acid into fatty acid oxidation products at 22 degrees C. The reaction is strongly inhibited by n-propyl gallate, an inhibitor of lipoxygenase. The membranes also rapidly metabolize 16:0/18:2(*) phosphatidylcholine into radiolabeled oxidation products that comigrate on TLC plates with those formed from free linoleic acid. At 30 degrees C, the formation of fatty acid oxidation products from 16:0/18:2(*) phosphatidylcholine is slower, and there is an initial accumulation of radiolabeled linoleic acid that is not evident at 22 degrees C, which can be attributed to the action of lipolytic acyl hydrolase. Radiolabeled phosphatidic acid and diacylglycerol are also formed during metabolism of 16:0/18:2(*) phosphatidylcholine by the microsomal membranes, and there is no breakdown of either linoleic acid or phosphatidylcholine by heat-denatured membranes. When Triton X-100 treated membranes were used, the same patterns of metabolite formation from radiolabeled linoleic acid and 16:0/18:2(*) phosphatidylcholine were observed. Thus, the enzymes mediating the breakdown of these radiolabeled compounds appear to be tightly associated with the membranes. Collectively, the data indicate that there is a lipoxygenase associated with microsomal membranes from tomato fruit that utilizes free fatty acid substrate released from phospholipids. The microsomal lipoxygenase is strongly active over a pH range of 4.5 to 8.0, comprises approximately 38% of the total (microsomal plus soluble) lipoxygenase activity in the tissue, has an apparent K(m) of 0.52 millimolar and an apparent V(max) of 0.186 millimoles per minute per milligram of protein. The membranous enzyme also cross-reacts with polyclonal antibodies raised against soybean lipoxygenase-1 and has an apparent molecular mass of 100 kilodaltons.

Journal Article↗
PubMed1990

Finding the borderline's border: can Martha Rogers help?

The psychodynamics of the client with a borderline personality disorder are reviewed within the context of Martha Rogers' Model of Unitary Human Beings. Emphasis is placed on the phenomena of transference and countertransference, which are viewed as resulting from the continual mutual interaction of human and environmental energy fields. Nursing interventions are postulated based on recognition of the fact that the nurse constitutes a significant part of the borderline client's environmental energy field.

Adolescent↗
PubMed1990

Complications of mechanical ventilation in a children's hospital multidisciplinary intensive care unit.

UNLABELLED: During a 12-week period, 204 consecutive patients admitted to the multidisciplinary intensive-care unit of a children's hospital were prospectively studied for complications of mechanical ventilation. METHOD: A respiratory therapist completed a standardized data form at the end of each shift for each ventilated patient. Patient age, sex, length of ventilation, diagnosis, and complications were noted. Complications were classified as relating to the endotracheal tube (ETT), the ventilator, or the patient's medical management, and were analyzed according to incidence (number per 100 patients or per 100 ventilator days) and to associated mortality. RESULTS: Patients ranged in age from newborn to 24 years. Sixty-three percent were male. Twenty-one percent of patients were managed by the medical staff, 11% by the general surgical staff, and 68% by the cardiac surgical staff. Average length of ventilation was 5.2 days. Overall survival rate was 91.7%. ETT complications reported as number per 100 patients were: pre-necrosis (13.0 [4/57 orally intubated patients and 23/147 nasally intubated patients]), ETT retaping complications (6.0), ETT plugging (1.0), and self-extubation (3.0). Ventilator complications reported as number per 100 ventilator days were: alarm failures (6.5), ventilator failures (0.7), and circuit problems (7.0). Medical complications reported as number per 100 patients were: massive gastric distension (8.8), right-upper-lobe collapse (4.4), pneumothorax (4.4), subcutaneous air (1.5), and pneumoperitoneum (1.0). ETT and ventilator complications showed no association with mortality. The large number of cardiac infants less than 24 months of age (n = 101) led us to further analyze this group for survival rate. We found that the survival rate was 93% for those requiring less than 7 days mechanical ventilation and 89.3% for those requiring greater than or equal to 7 days. As the study progressed, the respiratory therapists independently noted that their attentiveness to both patient and machine increased as did their awareness of complications. The incidence of alarm failure, circuit problems, and pre-necrosis was higher among the first 103 patients compared to the 101 patients entered into the study subsequently.

Adolescent↗
PubMed1990

Gangrenous and perforated appendicitis with peritonitis: treatment and bacteriology.

A comparison of single-agent antimicrobial therapy in the treatment of patients with perforated or gangrenous appendicitis and peritonitis was performed in a double-blind, randomized, prospective trial. Pathologic documentation of advanced appendicitis and positive intraoperative specimen cultures were required for inclusion in the study. Ceftizoxime (2 gm every 12 hours) and cefoxitin (2 gm every six hours) were compared. There were no significant differences between the treatment groups. Ninety-seven percent of patients treated with ceftizoxime and 89% of those treated with cefoxitin were cured or improved; there was no mortality in either group. By the use of optimal sampling, transport, and culture techniques, the number and diversity of bacteria recovered from these patients with advanced appendicitis were found to be much larger than previously suspected. Peritoneal fluid, abscess contents (if present), and appendiceal tissue (obtained so as to exclude the lumen) were cultured from all patients. An average number of 3.1 aerobic or facultative bacteria species and 8.5 anaerobic species were isolated from each specimen. Twenty-eight different genera and more than 55 species were encountered, including a previously undescribed fastidious gram-negative anaerobic bacillus. Bacteroides fragilis group and Escherichia coli were isolated from almost all specimens, and within the B fragilis group, eight species were represented. The recovery of such an unexpectedly large and diverse flora may be the reason for the therapeutic failures in these patients. We conclude that single-agent antimicrobial therapy in patients with advanced appendicitis and peritonitis is both safe and effective, and, with ceftizoxime, can be accomplished by a twice-daily dosing regimen.

Adult↗
PubMed1990

Applying the decision-making model: case study 1.

The options for decision making in this situation are reviewed in step 8. As you select one of these options or add one not listed, ask yourself the following questions: Why did I select that particular option? Is this option I selected consonant with my own personal and professional values? If not, where are the conflicts? Have I considered all the evidence in a logical sequence, or did I jump to my conclusion when I first read through the case? Have I had experience caring for a mother and infant in a similar situation? If so, to what extent did my previous experience influence my choice of action in this situation? Can I implement the decision? If not, why? This series of questions can assist the nurse or other health professional in actually making a decision and thinking about their personal reaction to implementing it (accountability). Critical thinking and taking time to analyze one's decision-making process are important tools that help each of us make morally appropriate decisions in clinical practice. The results are better patient care and the personal satisfaction of knowing you have done your best to promote the best interests of infants assigned to your care.

Adolescent↗
PubMed1990

Broad spectrum penicillin as an adequate therapy for acute cholangitis.

In a previous study of patients with acute cholecystitis, we demonstrated equal efficacy with a broad spectrum penicillin (piperacillin) and a penicillin plus amino-glycoside combination. Whether a single agent broad spectrum penicillin is adequate treatment for more severe infections, such as acute cholangitis, however, is still unclear. We, therefore, conducted a three center, prospective, randomized trial to determine whether or not a broad spectrum penicillin alone is adequate therapy for patients with acute cholangitis. During a 36 month period, 96 patients with sepsis and biliary obstruction were randomly assigned to receive either piperacillin (n = 49) or ampicillin plus tobramycin (n = 47). The two groups receiving antibiotics were similar with respect to all clinical and laboratory parameters. The incidence of blood cultures with positive results (20 versus 21 per cent) and underlying malignant lesions (51 versus 62 per cent) was also similar between the two groups. The percentage of patients with a clinical cure or significant improvement was the same in the two groups (69 versus 70 per cent). However, there was a significant difference in the cure rate between patients with benign and malignant biliary obstructions (83 versus 59 per cent, p less than 0.01). No significant differences were noted between the two antibiotic groups with respect to drug toxicity, but patients with malignant conditions were more prone to antibiotic related toxicities (2 versus 19 per cent, p less than 0.05). These data suggest that outcome of treatment in patients with acute cholangitis is similar with either a broad spectrum penicillin or a penicillin plus aminoglycoside combination and is dependent upon the nature of the biliary obstruction.

Acute Disease↗
PubMed1990

Sources of moral authority: what is right?

This variety of rightness--the end, the means, personal moral development--is a reminder of the need for tolerance of several "right" actions. Again, it is a balance between viewpoints, between concern for the individual and the rights of society. Tolerance is a major aspect of American history--tolerance for a variety of religious traditions, tolerance for a variety of ethnic and cultural traditions, tolerance for a variety of interpretations (values) of life and its meaning. We grow up with variety in religious beliefs, values, ethical principles, or theories (ethical pluralism). We also function at varying levels of moral development at different times, which influences our choice of what is right or good in nursing care. The variety of "right" actions can be confusing. We know firsthand the complexity of trying to choose among several morally right actions, one of which is in the best interests of the neonate and his family. This is the challenge of modern neonatal care. This is the challenge of bioethical decision making. This is the challenge for ethical nursing practice.

Decision Making↗
PubMed1990

Effects of furosemide on the racing times of Thoroughbreds.

The effects of furosemide on the racing times of 79 horses without exercise-induced pulmonary hemorrhage (EIPH) and 52 horses with EIPH were investigated. Racing times were adjusted to 1-mile equivalent racing times by 2 speed handicapping methods, and analysis of covariance was used to adjust actual racing times by winning time and distance for each race. All 3 methods of determining racing time indicated that geldings without EIPH had significantly faster racing times (P less than 0.05) when given furosemide before racing than when furosemide was not given before racing. Females and colts without EIPH were determined to have faster racing times when furosemide was given before racing, but the difference was not significant. Geldings with EIPH had significantly faster racing times (P = 0.0231) when given furosemide before racing, as determined by one of the speed handicapping methods. There was a strong correlation (range 0.9314 to 0.9751) between the 1-mile equivalent racing times, as determined by the 2 speed handicapping methods for horses with and without EIPH. Furosemide failed to prevent the development of EIPH in many horses that were previously considered to be EIPH-negative. When given furosemide, 62 (25.3%) of 235 EIPH-negative horses were EIPH-positive after racing. Furosemide had questionable efficacy for prevention of EIPH in known EIPH-positive horses. Thirty-two (61.5%) of 52 EIPH-positive horses given furosemide before a race remained EIPH-positive after that race.

Animals↗
PubMed1990

Moral development.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed1990

Pediatric cardiopulmonary arrests in rural populations.

We reviewed emergency department records that spanned a period of 5 years at seven rural hospitals to provide more specific data concerning pediatric resuscitation. The purpose was to plan better for preventive programs and to help rural health care providers prepare better for these difficult patients. Patients entered in the study had either cardiorespiratory arrest or respiratory arrest. Although the distribution by age was similar to studies from other areas, the outcome for cardiorespiratory arrests was as bad or worse (70 arrests with 3 survivors), and the outcome of respiratory arrests was as good or better (25 arrests with 21 survivors) as reported previously. Survival of arrest from trauma and accidents was markedly worse (16%) than survival from nontraumatic arrests (44%). The etiologies of the arrests were dominated by sudden infant death syndrome and pulmonary disease but with very few drownings or farm-related fatalities. This study should encourage rural health care providers to increase efforts in specific areas of trauma and accident prevention. Also, respiratory illness needs to be monitored aggressively and respiratory arrests treated more effectively to avoid the much more consistently lethal cardiac arrests. In addition, more careful prospective study of these patients may be able to identify care patterns that can be improved to increase survival in these groups.

Adolescent↗