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Biomedical subjects

J Fisher

Publications and source records attributed to J Fisher.

At least 343 records · Page 19Linked to original sources
PubMed1991

Should disease-modifying agents be used in mild rheumatoid arthritis?

A 12-month double-blind controlled study comparing hydroxychloroquine 400 mg daily with placebo in 104 patients with mild RA was conducted to see whether patients with mild rheumatoid arthritis (RA) benefit from treatment with disease-modifying agents. Mild RA was defined as synovitis limited to the hands and feet, an ESR less than 30 mm/h and C-reactive protein less than 20 mg/l, a situation where accepted clinical practice is to use a non-steroidal anti-inflammatory agent alone. By 6 months, the improvement of clinical and laboratory parameters in the hydroxychloroquine treated patients was significant compared with pretreatment levels and significantly greater than the control group. This improvement was maintained at 12 months. In addition, fewer patients withdrew through lack of efficacy, eight on hydroxychloroquine versus 18 on placebo. The implications of treating this well defined group of patients is discussed.

Arthritis, Rheumatoid↗
PubMed1991

Fetal monitoring with pulse oximetry.

Continuous fetal monitoring was achieved with a fetal scalp pulse oximetry sensor in 86 labours. The average recorded fetal oxygen saturation in early labour (cervical dilatation less than 5 cm) was 68% (SD 13%). At the end of labour (cervical dilatation greater than or equal to 9 cm) the recorded mean oxygen saturation was 58% (SD 17%). The largest range of readings during a single labour was 81%-11% but this drop was associated with cord compression. The average SD during 1 h of normal labour was 10%. A second group of 40 fetuses was monitored during induction of labour before and after elective amniotomy. Oxygen saturation did not appear to change after amniotomy (mean change -0.4%, SD 1.2%) and there was no difference between mean antenatal or early intrapartum readings. We excluded the amniochorionic membranes as a possible source of data corruption by measuring their in vitro absorption spectra and confirming that they do not preferentially absorb light of either 660 or 940 nm wavelength. Non-invasive pulse oximetry can be used to monitor the fetus before and during labour.

Amnion↗
PubMed1991

Hydrodynamic function of second generation porcine bioprosthetic heart valves.

The hydrodynamic function and leaflet dynamics of second generation porcine valves prepared with low- or zero-pressure fixation have been studied and compared to first generation porcine bioprostheses, bileaflet, and tilting disc mechanical valves. The Carpentier-Edwards Supra-Annular and Hancock II valves showed lower pressure drops than the Medtronic Intact valve and first generation porcine valves, and comparable overall energy losses to mechanical valves at normal cardiac outputs. Only the zero-pressure fixed Intact valve showed synchronous leaflet opening. Delayed leaflet opening and high opening pressures were found in both low- and high-pressure fixed porcine valves. All porcine bioprostheses showed high open leaflet bending strains. Fixation of valve leaflets with "near zero" pressure fixation and a more physiological neutral geometry is necessary to ensure synchronous leaflet opening at low flows and a reduction in commissural bending strains.

Biomechanical Phenomena↗
PubMed1991

Hemodynamic changes during retrograde left-heart catheterization in patients with aortic stenosis.

Pulmonary artery pressures in patients with aortic stenosis have been related to postoperative prognosis and surgical risk. However, while right- and left-heart pressures should be measured simultaneously, a catheter lying across the stenotic aortic valve might alter left- and right-heart pressures. To assess this phenomenon, right- and left-heart pressures were recorded before and after retrograde crossing of the aortic valve in 51 patients (30 patients with and 21 without aortic stenosis). In aortic stenosis, the mean pulmonary artery pressure increased (p less than 0.001) after transaortic valvular pressure catheter placement (average 4 mm Hg, peak 19 mm Hg); in the absence of aortic stenosis, the mean pulmonary artery pressure did not change (average 0 mm Hg; NS). A similar response was noted for the mean pulmonary capillary wedge pressure. Hemodynamic changes did not correlate with the severity of aortic stenosis or with left ventricular performance. Right-heart pressures should be determined without transaortic valvular catheter in place, if accurate interpretation of the hemodynamic effects of aortic stenosis is to be achieved.

Aortic Valve Stenosis↗
PubMed1991

Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction. Results of a prospective, international, multicenter study.

BACKGROUND: The Catheter Ablation Registry was the first international, multicenter, prospective study of the safety and efficacy of catheter ablation. METHODS AND RESULTS: From August 1987 through March 1990, the study comprised 136 patients in whom only DC energy was used in attempted production of third-degree atrioventricular block to treat uncontrollable supraventricular tachycardias. Eight patients died during hospitalization for ablation. In seven (5.1%), the ablation may have contributed to their deaths. Causes of death included ventricular fibrillation (five patients, three with polymorphic ventricular tachycardia), progressive heart failure (one patient), and respiratory failure (two patients, one dying after resuscitation from ventricular fibrillation). Compared with survivors, patients who died were more likely to have had prior aborted sudden death (38% versus 2%, p less than 0.05), congestive heart failure (88% versus 22%, p less than 0.001), cardiomyopathy (50% versus 16%, p less than 0.05), lower baseline systolic blood pressure (106 versus 138 mm Hg, p less than 0.001), prolonged baseline and postablation corrected QT interval (p less than 0.01), and markedly reduced ejection fraction (27% versus 52%, p less than 0.001). Ablation successfully produced third-degree atrioventricular block in 88% of the patients who died and in 83% of survivors. CONCLUSIONS: Catheter ablation of the atrioventricular junction with DC energy carries a significant, previously unrecognized risk of death (5.1%), particularly from lethal arrhythmias, when applied to patients with severe left ventricular dysfunction. Great care should be taken in these seriously ill patients to guard against postablation ventricular arrhythmias.

Bundle of His↗
PubMed1991

Design considerations for cushion form bearings in artificial hip joints.

Lubrication mechanisms and contact mechanics have been analysed in a new generation of 'cushion form' bearings for artificial hip joints, which comprise low elastic modulus layers on the articulating surfaces. Comparisons have been made with 'hard' bearings used in existing prostheses and also with the natural hip joint. Lubricating film thicknesses are enhanced by larger contact areas and lower contact pressures. For a fixed contact area, simultaneous changes in layer thickness and radial clearance have been shown to have a small effect on elastohydrodynamic film thickness. Hard bearings designed with the same contact area as the cushion bearings produced a similar film thickness, but lubricant film thickness is not optimized in current designs. The main advantage of using a cushion bearing with low elastic modulus layers was found to be associated with microelastohydrodynamic lubrication. Careful selection of the elastic modulus is important in order to ensure that this lubrication regime was effective. Low elastic modulus layers may also produce local deformations, which enhance squeeze film action. The elastic modulus of the material should not be lower than necessary to produce effective microelastohydrodynamic lubrication, as a further reduction in modulus only increases the strain distribution in the material. A lubricant film thickness of 0.3 microns has been predicted for a cushion hip prosthesis with a femoral head diameter of 32 mm and radius of contact zone of 16 mm, using a 2 mm thick layer with an elastic modulus of 20 MPa.

Biomechanical Phenomena↗
PubMed1991

Tribology of total artificial joints.

The tribology of total artificial replacement joints is reviewed. The majority of prosthesis currently implanted comprise a hard metallic component which articulates on ultra high molecular weight polyethylene surface. These relatively hard bearing surfaces operate with a mixed or boundary lubrication regime, which results in wear and wear debris from the ultra high molecular weight polyethylene surface. This debris can contribute to loosening and ultimate failure of the prostheses. The tribological performance of these joints has been considered and a number of factors which may contribute to increased wear rates have been identified. Cushion bearing surfaces consisting of low elastic modulus materials which can articulate with full fluid film lubrication are also described. These bearing surfaces have shown the potential for greatly reducing wear debris.

Ceramics↗
PubMed1991

Stress analysis of cushion form bearings for total hip replacements.

Cushion form bearings comprise a thin layer of low elastic modulus material on the articulating surface of the bearing, which can deform to help preserve a film of lubricant between the bearing surfaces and therefore reduce friction and wear. The long-term function of this type of bearing is dependent on the strength and durability of this compliant layer. Finite difference and finite element methods have been used to analyse the stress distribution in the compliant layer of cushion form bearing for artificial hip joints under physiological loading conditions. A good agreement between finite difference and finite element methods was found. Under normal loading, the highest value of the maximum shear stress was found to be at the interface between the compliant layer and the more rigid substrate close to the edge of the contact. The values of maximum shear stress in the centre of the contact close to the articulating surface were lower than in the equivalent Hertzian contact. A friction force acting at the surface had little effect on the stress distribution for coefficients of friction less than 0.05. However, for higher values of friction coefficient (larger than 0.2), corresponding to inadequate lubrication, the maximum shear stress increased by a factor of four and was found to be located at the surface. The analysis predicts that the mode of failure will be at the interface with the substrate under fluid film or mixed lubrication conditions and at the articulating surface when the bearing runs dry with higher levels of friction. Both failure modes have been observed experimentally under the conditions specified.

Biocompatible Materials↗
PubMed1990

Glomerulocystic kidney disease: case report.

A newborn infant with abdominal masses was found to have Glomerulocystic Kidney Disease. Imaging showed markedly enlarged kidneys with multiple macroscopic cysts. Radiographic and clinical findings are discussed.

Humans↗
PubMed1990

Epidural anaesthesia for labour and caesarean section in a parturient with a single ventricle and transposition of the great arteries.

We describe a case of a 29-year-old parturient with a single ventricle and transposition of the great arteries who had lumbar epidural analgesia/anaesthesia with a local anaesthetic for labour, emergency Caesarean section and postoperative pain. Her outcome and that of her baby was successful. The anaesthetic techniques used in other parturients with similar congenital cardiac anomalies are reviewed.

Adult↗
PubMed1990

PC-based system for collection and analysis of physiological data.

A personal computer based system for data acquisition and analysis appropriate to physiological experiments is described in detail. The system is independent of the details of the analog signal generation. The software, written in C, is modular and easily portable to other PC systems. The system is capable of: (a) sampling many analog signals at an appropriate rate (100 Hz), (b) storing large quantities of digitized data, (c) analysing digitized waveforms to obtain signal parameters, and (d) storing signal parameters in a format suitable for statistical analysis. Computer processed cardiopulmonary data are compared with data derived from standard ICU equipment.

Algorithms↗
PubMed1990

Fatigue and wear of dental materials.

Fatigue and wear are two of the many basic physical processes which contribute to the degradation of restorative materials. The mechanisms of these are discussed in the context of general engineering and the dental environment. More work is required to define the processes involved in intraoral degradation of materials.

Dental Materials↗
PubMed1990

Expression of the multiple drug resistance gene (mdr-1) and epitope masking in chronic lymphatic leukaemia.

Resistance to cytotoxic agents is a common clinical problem in the treatment of chronic lymphatic leukaemia (CLL). The multidrug resistant (MDR) phenotype characterized by increased levels of a specific cell membrane p-glycoprotein, confers cross resistance to a wide range of structurally dissimilar antineoplastic drugs. We have studied the expression of this p-glycoprotein in chronic lymphatic leukaemia measured by immunofluorescence using a monoclonal antibody MRK 16 by flow cytometry. Initial results showed that only 12% of lymphocyte samples from CLL patients showed increased p-glycoprotein, conflicting with a previous observation that 53% of CLL patients had an increased level of mdr-1 mRNA. Treatment of the cells with neuraminidase to remove sialic acid residues increased the proportion of patients showing increased p-glycoprotein to 52%. This suggest that in a subset of CLL patients post translational modification of the protein occurs masking the epitope recognized by MRK 16. Abnormal sialylation patterns associated with malignancy are a well-recognized phenomenon.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1990

Human adenoidal organ culture: a model to study nontypable Haemophilus influenzae (NTHI) and other bacterial interactions with nasopharyngeal mucosa--implications in otitis media.

Nontypable Haemophilus influenzae (NTHI) has become the predominant cause of both acute suppurative otitis media and chronic otitis media with effusion. It has now been well-demonstrated that both outer membrane proteins and restriction fragment analysis of the bacterial genomes of concomitant nasopharyngeal and middle ear effusion isolates of NTHI are identical. It is therefore of critical importance to understand the mechanisms whereby bacteria that are present in normal healthy children in small numbers become the predominant organism in the nasopharynx in otitis media. The studies presented here suggest that nontypable Haemophilus influenzae can effectively decrease ciliary function as measured by stroboscopic illumination of ciliary beat frequency on human adenoidal organ culture. This organism also produces significant histopathologic and ultrastructural damage to the epithelial cells and cilia of adenoid organ culture, demonstrated by both light microscopy and scanning electron microscopy. The data suggest the following hypothesis: nontypable Haemophilus influenzae can destroy mucociliary function and allow increased bacterial replication in the mucus overlying the nasopharyngeal mucosa. The mucociliary system of the eustachian tube may also be involved in a similar manner, thus allowing bacteria to enter the middle ear space via the eustachian tube.

Adenoids↗
PubMed1990

The influence of bone and bone cement debris on counterface roughness in sliding wear tests of ultra-high molecular weight polyethylene on stainless steel.

Studies of explanted hip prostheses have shown high wear rates of ultra-high molecular weight polyethylene (UHMWPE) acetabular cups and roughening of the surface of the metallic femoral head. Bone and bone cement particles have also been found in the articulating surfaces of some joints. It has been proposed that bone or bone cement particles may cause scratching and deterioration in the surface finish of metallic femoral heads, thus producing increased wear rates and excessive amounts of wear debris. Sliding wear tests of UHMWPE pins on stainless steel have been performed with particles of different types of bone and bone cement added. Damage to the stainless steel counterface and the motion of particles through the interface have been studied. Particles of bone cement with zirconium and barium sulphate additives and particles of cortical bone scratched the stainless steel counterface. The cement particles with zirconium additive produced significantly greater surface damage. The number of particles entering the contact and embedding in the UHMWPE pin was dependent on particle size and geometry, surface roughness and contact stress. Particles are likely to cause surface roughening and increased wear rates in artificial joints.

Bone Cements↗