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Biomedical subjects

J Ferguson

Publications and source records attributed to J Ferguson.

At least 109 records · Page 6Linked to original sources
PubMed1999

Seven year follow up of children presenting to the accident and emergency department with irritable hip.

OBJECTIVE: To assess an established protocol for managing children with irritable hip in the accident and emergency department. METHODS: Retrospective seven year follow up of all children managed under an established hip pain protocol. The main outcome measure was of failure of the protocol to identify serious pathology. RESULTS: A total of 103 children met the criteria for assessment using the protocol. Sixty were allowed home, and outpatient follow up arranged. All of these children except one were diagnosed as having transient synovitis. This child had Perthes' disease and was diagnosed at first presentation. Forty three children were admitted, with eight subsequently having a diagnosis other than transient synovitis of the hip. It was possible to review 80 children seven years later. Of these children no long term problems were encountered. CONCLUSION: The protocol used in the department for children with irritable hip is successful in identifying those children with transient synovitis of the hip, or other benign causes, and therefore not requiring hospital admission. Long term follow up showed that no serious pathology was missed.

Adolescent↗
PubMed1999

Examination of metabolism of viscera drained by the portal vein in neonatal calves, using short-term intravenous infusions of glutamine and other nutrients.

OBJECTIVE: To quantify glutamine use in viscera drained by the portal vein in neonatal calves and to assess the relative nutritional importance of glutamine, glucose, and acetate for enterocytes. ANIMALS: 5 healthy neonatal calves. PROCEDURE: A femoral artery, jugular vein, and the portal vein were surgically cannulated in each calf. Blood flow in the portal vein was measured by use of an ultrasonographic transit-time flow probe. A series of solutions was infused on 4 days for each calf. On the infusion days, acetate, glucose, glutamine, and saline (0.9% NaCl; control) solutions were administered IV during 1-hour periods via the jugular vein. Venous and arterial blood samples were collected during the last 15 minutes of each 1-hour infusion. RESULTS: Uptake of glutamine and glucose by viscera drained by the portal vein was 0.3+/-1.1 and 1.9+/-3.1 micromol/kg0.75/min, respectively, during saline infusion. During acetate, glucose, and saline infusions, glucose was a greater source of energy for the intestines than was glutamine. However, during glutamine infusion, uptake of glutamine by viscera drained by the portal vein increased significantly (29.9+/-11.2 micromol/kg0.75/min), which was associated with an increase in ammonia production (7.0+/-0.5 micromol/kg0.75/min). Toxicosis was not associated with IV administration of glutamine. CONCLUSION: Glutamine infusion resulted in an increase in glutamine uptake by viscera drained by the portal vein, which was associated with an increase in ammonia production and a slight increase in oxygen consumption. CLINICAL RELEVANCE: These solutions may be used to develop treatments that enhance healing of intestines of diarrheic calves.

Acetates↗
PubMed1999

Nutrient uptake by viscera drained by the portal vein in neonatal calves during intravenous infusion of glutamine.

OBJECTIVE: To quantify glutamine use by viscera drained by the portal vein in neonatal calves and to determine whether uptake could be stimulated by long-term IV infusion or long-term use of oral supplements. ANIMALS: 4 healthy neonatal calves. PROCEDURE: A femoral artery, jugular vein, and the portal vein were surgically cannulated in each calf. Blood flow in the portal vein was measured, using an ultrasonic transit-time flow probe. Calves were given an IV infusion of glutamine on days 6, 8, and 10 after surgery. Before the first infusion, calves were fed a diet of milk only. The diet was supplemented with glutamine for the second and third infusions. Glutamine was administered via the jugular vein during a 5-hour period. Venous and arterial blood samples were collected every hour for 5 hours. RESULTS: During glutamine infusion, uptake of glutamine by viscera drained by the portal vein increased in association with increased production of ammonia. Glutamine supplementation of the diet did not alter glutamine uptake. Glutamine infusion did not increase viscera uptake of indispensable amino acids. Long-term use of glutamine supplements or infusion of glutamine for periods of more than 1 hour increased glutamine uptake by viscera. Arterial leucine concentration and uptake of leucine by the viscera decreased during glutamine infusion, indicating that leucine became the limiting factor. CONCLUSION: Glutamine administration (supplements or infusions) to calves may require that a mixture of amino acids be provided to improve effectiveness. CLINICAL RELEVANCE: Glutamine may be beneficial in treatments designed to promote intestinal healing in diarrheic calves.

Absorption↗
PubMed1998

Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial.

CONTEXT: The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder; however, empirical support for this assertion has been weaker for children and adolescents than for adults. OBJECTIVE: To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder. DESIGN: Randomized, double-blind, placebo-controlled trial. PATIENTS: One hundred eighty-seven patients: 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years randomized to receive either sertraline (53 children, 39 adolescents) or placebo (54 children, 41 adolescents). SETTING: Twelve US academic and community clinics with experience conducting randomized controlled trials. INTERVENTION: Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy, after which patients continued to receive this dosage of medication for 8 more weeks. Control patients received placebo. MAIN OUTCOME MEASURES: The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH GOCS), and the NIMH Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) rating scales. RESULTS: In intent-to-treat analyses, patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS (adjusted mean, -6.8vs -3.4, respectively; P=.005), the NIMH GOCS (-2.2 vs -1.3, respectively; P=.02), and the CGI-I (2.7 vs 3.3, respectively; P=.002) scales. Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study. Based on CGI-I ratings at end point, 42% of patients receiving sertraline and 26% of patients receiving placebo were very much or much improved. Neither age nor sex predicted response to treatment. The incidence of insomnia, nausea, agitation, and tremor were significantly greater in patients receiving sertraline; 12 (13%) of 92 sertraline-treated patients and 3 (3.2%) of 95 placebo-treated patients discontinued prematurely because of adverse medical events (P=.02). No clinically meaningful abnormalities were apparent on vital sign determinations, laboratory findings, or electrocardiographic measurements. CONCLUSION: Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder.

Adolescent↗
PubMed1998

Expression of human papillomavirus type 16 L1 protein in Escherichia coli: denaturation, renaturation, and self-assembly of virus-like particles in vitro.

Major capsid protein L1 of HPV16 was produced in a fused form in Escherichia coli using an inducible expression system. The protein formed insoluble aggregations (inclusion bodies) and the yield was more than 10% of total cell proteins. The inclusion bodies were isolated and solubilised with 8 M urea and the L1 proteins were purified by chromatographic separation. Following removal of the urea by gradual dialysis, the denatured L1 proteins spontaneously renatured and subsequently assembled into polymorphologic aggregations in vitro. Electron microscopy showed that the assembled material included structures resembling native empty capsids as well as incompletely formed capsids. After separation from the pool of polymorphologic structures by sucrose gradient sedimentation, the correctly formed virus-like particles (VLE. coliPs) were recognised by a HPV16 type-specific, conformational-dependent monoclonal antibody in an ELISA. This system offers not only a model for investigation of the intrinsic interactions that occur during L1 assembly, but also a potential route for convenient manufacture of highly purified VLP vaccines.

Capsid Proteins↗
PubMed1998

Ziprasidone 40 and 120 mg/day in the acute exacerbation of schizophrenia and schizoaffective disorder: a 4-week placebo-controlled trial.

A double-blind, placebo-controlled, multicenter study, was performed to evaluate the efficacy and safety of ziprasidone in 139 patients with an acute exacerbation of schizophrenia or schizoaffective disorder. Patients were randomized to receive ziprasidone 40 mg/day, 120 mg/day or placebo for 28 days. Ziprasidone 120 mg/day was significantly more effective than placebo in improving the BPRS total, CGI-S. BPRS depression cluster and BPRS anergia cluster scores (all P < 0.05). Similarly, the percentages of patients classified as responders on the BPRS (> or = 30% reduction) and the CGI improvement (score < or = 2) were significantly greater with ziprasidone 120 mg/day compared with placebo (P < 0.05). The number of patients who experienced an adverse event was similar in all three treatment groups, and discontinuation due to adverse events was rare (five of 91 ziprasidone-treated patients). The most frequently reported adverse events, that were more common in either ziprasidone group than in the placebo group, were dyspepsia, constipation, nausea and abdominal pain. There was a notably low incidence extrapyramidal side-effects (including akathisia) and postural hypotension and no pattern of laboratory abnormalities or apparent weight gain. Ziprasidone-treated patients were not clinically different from placebo-treated patients on the Simpson-Angus Rating scale, Barnes Akathisia scale and AIMS assessments. These results indicate that ziprasidone 120 mg/day is effective in the treatment of the positive, negative and affective symptoms of schizophrenia and schizoaffective disorder with a very low side-effect burden.

Acute Disease↗
PubMed1998

In utero nephropathy, Denys-Drash syndrome and Potter phenotype.

We report an unusual case of Denys-Drash syndrome presenting in a newborn infant with end-stage renal failure of antenatal origin and Potter phenotype. DNA analysis showed a novel missense change in arginine 394 of zinc finger 3 of the WT1 gene. This mutation may lead to an earlier and more severe presentation of Denys-Drash syndrome. It may be of interest to look for this mutation in other Potter phenotype cases.

Abnormalities, Multiple↗
PubMed1998

The photosensitivity dermatitis and actinic reticuloid syndrome (chronic actinic dermatitis) occurring in seven young atopic dermatitis patients.

Seven young patients with atopic dermatitis (AD) who presented with a marked photoexposed site dermatitis have been investigated in detail. The results of phototesting, patch testing and other investigations were compatible with the diagnosis of photosensitivity dermatitis/actinic reticuloid syndrome (PD/AR) (chronic actinic dermatitis). It is known that AD patients may have photoaggravation of their dermatitis or exacerbation secondary to a photodermatosis, such as polymorphic light eruption, actinic prurigo or drug-induced phototoxicity. The patients we describe, however, appear to be an uncommon AD subgroup affected by PD/AR. We recommend that all AD patients who have a history of sunlight-induced exacerbation or marked intolerance of PUVA or ultraviolet B phototherapy should have phototesting and patch testing conducted.

Adult↗
PubMed1998

Narrow-band (TL-01) ultraviolet B phototherapy for chronic plaque psoriasis: three times or five times weekly treatment?

Three and five times weekly narrow-band TL-01 (311-313 nm) ultraviolet (UV) B phototherapy regimens for chronic plaque psoriasis were compared in a randomized, observer-blinded, half-body, within-patient paired study. Twenty-one patients [13 men, eight women, age range 21-68 years, skin phototypes I (two patients), II (14) and III (five)] entered the study. Sixteen reached clearance or minimal residual activity (MRA) on both sides. Of the other five, three withdrew because they did not reach clearance or MRA on the 5x weekly side by a maximum of 30 treatments, one when he was satisfied with moderate improvement and one because of repeated failure to attend. Those who completed treatment reached clearance or MRA after a median of 35 days with 5x weekly treatment compared with 40 days with 3x weekly treatment (P = 0.007), but required a median of 23.5 compared with 17 UVB exposures (P = 0.001) and 94 minimal erythema dose multiples (MEDs) compared with 64 MEDs (P = 0.01). Fifteen (of 16) developed at least one episode of well-demarcated erythema during 5x weekly treatment compared with just three of 16 treated 3x weekly (P < 0.001). There was no significant difference between regimens in duration of remission. For this skin phototype I-III population, the more rapid clearance of psoriasis with 5x weekly phototherapy is not, for the majority of patients, sufficient to justify the extra exposures and higher UVB dose. We no longer use 5x weekly phototherapy for psoriasis.

Adult↗
PubMed1998

Narrowband ultraviolet B (TL-01) phototherapy for psoriasis: which incremental regimen?

Narrowband (311-313 nm) ultraviolet B phototherapy with the Philips TL-01 lamp is used increasingly in the treatment of psoriasis with little information available on the optimum irradiation regimen. We compared a high and a low incremental dose regimen in 20 patients with symmetrical chronic plaque psoriasis using a randomized half body study and thrice weekly exposures. Paired trunk, leg and arm plaques of psoriasis were scored blind prior to and at each treatment for scaling, erythema and induration. Patients were treated to clearance or minimal residual activity and followed up until relapse. The low increment regimen achieved a 10% reduction in the median cumulative dose to clearance (16,401 vs. 18,246 mJ/cm2) with one extra treatment in 50% of the patients. However, the duration of treatment (median 53.5 days) was identical for both regimens except for one patient because there were 50% fewer episodes of erythema requiring postponement of treatment with the low increment regimen. We now favour the low increment regimen for phototherapy in our psoriasis population.

Adult↗
PubMed1998

Experimental laparoscopic and thoracoscopic discectomy and instrumented spinal fusion. A feasibility study using a porcine model.

To explore the safety and the effectiveness of laparoscopic and thoracoscopic spinal surgery, an acute/non-survival animal trial was performed in 5 pigs using rigid and flexible endoscopes, flouroscopy, a holmium-YAG laser, and prototype instruments and implants. Our study aimed to approach the intervertebral disc space and spinal canal using laparoscopic and thoracoscopic techniques and to explore the potential and limits for endoscopic anterior spinal decompression and fusion. In a lateral recumbency access was provided to the anterolateral aspect of the lumbar spine from L1/2 to L7/S1, the thoracic spine was accessible from T2/3 to the diaphragmatic insertion. Complete disc space emptying with penetration into the spinal canal could be performed, epidural bleeding could be controlled by a hemostatic sponge, however bleeding restricted visualization for further endoscopic manipulation in the spinal canal. Intervertebral fusion was accomplished at T6/7, L4/5 and L7/S1 using small fragment plates with 3.5 mm screws and iliac bone grafts or prototype carbon fiber cages. On post mortem examination we found no dural tears and no nerve root damage, all animals had stabilized fusion sites and good implant position. We conclude that minimally invasive thoracoscopic and laparoscopic approaches to the spine are feasible and safe to perform disc decompression and implant placement for spinal fusion. In addition to currently performed laparoscopic interbody fusion, also plate fixation to reestablish lordosis of the lumbar spine is feasible at least in the porcine model. Careful disc decompression must be performed prior to implant introduction to prevent iatrogenic disc protrusion and spinal cord or nerve root compression. However, further surgical exploration of the spinal canal using these techniques does not provide adequate visualization of epidural spaces and therefore must be regarded as unsafe.

Animals↗
PubMed1998

A hazard assessment of artificial tanning units.

As a result of increasing concern over the use of artificial tanning units, many local government recreation departments are phasing out the use of sunbeds on their premises, resulting in some clients switching to high street parlours about which little is known. An Environmental Health survey was conducted in all 32 tanning premises within a local government area (Perth & Kinross, Scotland). A number of significant problems emerged in the private sector. In this group, there was no form of cumulative UV exposure control in 89% of premises and 81% failed to give adequate advice and information to customers. We conducted UV spectral irradiation measurements in 38 tanning units using a double grating spectroradiometer. When a carcinogenic weighting factor was applied to these measurements, it was found that a 10 min exposure in a high intensity stand-up cabinet carried the same carcinogenic risk as approximately 30 min of local (56 degrees North) mid-day summer sunlight or 10 min of Mediterranean sunlight at mid-day. A questionnaire completed by 57 customers revealed a wide pattern of usage; 6 (10%) had more than 20 h exposure in the previous 12 months and 3 (5%) had made regular use of sunbeds for the previous 16 to 20 years. These results indicate that there is a need for continuing public education and surveillance of commercial artificial tanning units.

Beauty Culture↗
PubMed1998

Non-invasive assessment of cardiac output in children.

BACKGROUND: Stroke distance, the systolic velocity integral of aortic blood flow, is a linear analogue of stroke volume; its product with heart rate is minute distance, analogous to cardiac output. OBJECTIVE: To investigate the feasibility of assessing cardiac output in children with a simple non-invasive Doppler ultrasound technique, and to determine the normal range of values. METHODS: Peak aortic blood velocity, stroke distance, and minute distance were measured through the suprasternal window in 166 children (mean age 9.6 years, range 2-14) using a portable non-imaging Doppler ultrasound instrument. RESULTS: The technique was well tolerated by all the children participating. Mean peak aortic blood velocity was 138 cm/s and was independent of age. Mean stroke distance was 31.8 cm and showed a small but significant increase with age; mean minute distance was 2490 cm and fell with age, as did heart rate. CONCLUSIONS: Suprasternal Doppler ultrasound measurement of stroke distance is a convenient, well tolerated, non-invasive technique for the assessment of cardiac output in children. The normal range of values during childhood has been established. The technique has great potential for assessing hypovolaemia in children.

Adolescent↗
PubMed1998

Foreign body ingestion in children: an audit of transit time.

OBJECTIVES: To study the pattern of ingestion of radio-opaque foreign bodies in children and to ascertain the average transit time to passage per rectum in order to rationalise future management. METHODS: This prospective study consisted of 100 children under the age of 14 years, presenting to the accident and emergency department of the Royal Aberdeen Children's Hospital having ingested a radio-opaque foreign body. All children had initial radiography and were subsequently followed up in an attempt to ascertain the transit time of the foreign body. RESULTS: The majority of ingestions (73%) were in younger children (5 years and under). The time taken to pass the foreign bodies per rectum varied greatly. Almost half were never recovered. Transit time appears to increase with age. Three children were given oral cisapride to increase gastric motility after prolonged retention in the stomach. CONCLUSIONS: Transit time is very variable and cannot be predicted. Sifting of the stools is unpleasant and unhelpful. Repeat radiography should not be encouraged as this results in unnecessary radiation. Cisapride may be useful in cases where there is prolonged retention of a foreign body in the stomach. There may be an indication for routine use of cisapride in all cases of ingested foreign bodies, however further audit would be required.

Adolescent↗
PubMed1998

Sertraline in the treatment of panic disorder. A multi-site, double-blind, placebo-controlled, fixed-dose investigation.

BACKGROUND: This study compared the efficacy and safety of sertraline to placebo in treating panic disorder. METHOD: 178 out-patients with panic disorder who exhibited at least four panic attacks during the four weeks prior to screening and three during the two weeks of lead-in were randomly assigned to 12 weeks of double-blind treatment with sertraline (50, 100 or 200 mg) or placebo. RESULTS: Sertraline was superior to placebo in reducing the number of panic attacks, situational attacks, unexpected attacks, limited symptom attacks, and time spent worrying (all P < 0.01) and the Hamilton Anxiety Scale (P < 0.05), although Clinical Global Impression (Improvement) did not significantly differentiate groups at 12 weeks and at end-point. No serious adverse events were associated with sertraline. No dose relationship was found for adverse events; overall drop-out rates were not different for sertraline or placebo, although more sertraline-treated subjects discontinued for adverse events, typically early in the study. Only dry mouth and ejaculation failure (primarily ejaculation delay) were associated significantly with sertraline. CONCLUSIONS: Sertraline was effective and safe in reducing panic attacks. Higher doses were no more effective than the 50 mg dose.

Adolescent↗
PubMed1998

In-kind giving: it's a good thing ... but don't be naive.

In-kind giving is of great importance to fund raisers, but it raises many red flags. This article explores in-kind giving on both sides of the table, with corporate givers and charitable takers, and suggests new ways of looking at these gifts.

Charities↗
PubMed1998

Long-term surgical preparation of portal vein-drained viscera for determination of their nutritional requirements in preruminant calves.

OBJECTIVE: To develop a surgical preparation to study the nutrient concentration difference across the portal vein-drained viscera of preruminant calves over a 2-week period. ANIMALS: 9 healthy preruminant male Holstein calves. PROCEDURE: A bilateral subcostal approach was used to reach the portal area to provide access for proper placement of an ultrasonic transit time flow probe around the portal vein. The umbilical vein was used as an entry point for the portal vein catheter. The femoral artery was also catheterized. Calves were observed daily, and food intake was recorded. Body weight was recorded weekly. The calves were euthanatized, and necropsy was performed 2 weeks after surgery. RESULTS: Of the 9 calves, 7 recovered without surgical complications. Within 24 hours of surgery, 1 calf developed an intestinal hernia at the flank incision that was surgically repaired without further complications. One calf was euthanatized a week after surgery because it developed septicemia secondary to catheter-related infection. CONCLUSION: The bilateral subcostal approach provided access to the portal area, and the umbilical vein was useful as an entry point. Application of an ultrasonic flow probe provided consistent measurements of blood flow over a 2-week period. CLINICAL RELEVANCE: These results may have implications for development of treatment to promote gastrointestinal tract healing in calves with diarrhea.

Animal Nutritional Physiological Phenomena↗