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Biomedical subjects

J Franklin

Publications and source records attributed to J Franklin.

At least 91 records · Page 5Linked to original sources
PubMed1992

Survival after implantation of the cardioverter defibrillator.

The actuarial survival of 60 consecutive recipients of the implanted cardioverter defibrillator (ICD) were compared with 120 matched concurrent medically treated patients using a case-control design. All ICD patients and controls presented with either sustained ventricular tachycardia or ventricular fibrillation. Controls were matched to ICD recipients according to 5 variables: age, left ventricular ejection fraction, arrhythmia at presentation, underlying heart disease and drug therapy status. Mean ages were 58 and 59 years in ICD patients and controls, and the average ejection fractions were 36 and 35%. Coronary artery disease was present in 75 and 79% of ICD patients and controls, respectively. During follow-up, sudden deaths were fewer in ICD recipients than in controls (5 vs 10%, p less than 0.01). At 1 and 3 years, actuarial survival was 0.89 vs 0.72 and 0.65 vs 0.49 for ICD recipients and controls. The 5-year actuarial survival curves were significantly different by the Cox proportional hazards model (p less than 0.05). It is concluded that in this retrospective case-control study, the use of the ICD in the management of patients at risk for sudden death results in improved probability of survival.

Actuarial Analysis↗
PubMed1992

A "calcium set-point hypothesis" of neuronal dependence on neurotrophic factor.

In this commentary, we discuss evidence suggesting that cytoplasmic free calcium concentration determines neurotrophic factor dependence. Developing sympathetic and neural crest-derived sensory neurons require nerve growth factor (NGF) for survival both in vivo and in vitro. Chronic depolarization of these cells in culture causes a modest sustained elevation of cytoplasmic calcium concentration and promotes their survival in the absence of NGF. The amount of calcium increase caused by depolarization is closely correlated with the ability of the cells to survive in NGF-free medium. At an optimal calcium concentration, that we refer to as a "set point," survival is equivalent to that of cells grown in the presence of NGF.

Animals↗
PubMed1991

Management of severe hypertension in childhood Takayasu's arteritis.

Six children presented with severe hypertension caused by Takayasu's arteritis (TA), of whom four had bilateral renal artery narrowing and two coarctation syndrome. Two presented with hypertensive encephalopathy and four with congestive cardiac failure. All had a strongly positive skin reactions to purified protein derivative of mycobacterium tuberculosis. Bilateral renal arterial bypass grafts performed in two children resulted in prolonged normalization of their blood pressures, but the grafts clotted 12-18 months later. Primary renal autotransplantation was unsuccessful in two children, one with bilateral renal arterial narrowing and iliac vessel involvement and one with a long coarctation. Secondary renal autotransplantation was successful in a third child with localized aortitis. A successful aortic patch graft was performed in one child with coarctation of the aorta. Angiotensin-converting-enzyme inhibitors should be used with caution in treating the hypertension caused by TA, since bilateral renal arterial narrowing is common and their administration may result in renal insufficiency. The long-term prognosis is guarded in severely hypertensive children with extensive vascular disease due to TA.

Adolescent↗
PubMed1991

Laparoscopic removal of a large colonic lipoma. Report of a case.

A 72-year-old white male was found to have a 6-cm submucosal mass at 35 cm on screening sigmoidoscopy. The lesion had all the characteristics of a submucosal lipoma. Instead of performing a laparotomy with its potential morbidity, the lesion was removed laparoscopically in its entirety without untoward operative sequelae. Laparoscopic techniques have had a profound impact on the treatment of patients with surgical disorders. This new technology can be applied to selected patients with colorectal diseases.

Aged↗
PubMed1991

Biotechnology awareness study, Part 1: Where scientists get their information.

A model study, funded by the National Library of Medicine (NLM) and conducted by the Southeastern/Atlantic Regional Medical Library (RML) and the University of Maryland Health Sciences Library, attempted to assess the information needs of researchers in the developing field of biotechnology and to determine the resources available to meet those needs in major academic health sciences centers. Nine medical schools in RML Region 2 were selected to participate in a biotechnology awareness study. A survey was conducted of the nine medical school libraries to assess their support of biotechnology research. To identify the information needs of scientists engaged in biotechnology-related research at the schools, a written survey was sent to the deans of the nine institutions and selected scientists they had identified. This was followed by individual, in-depth interviews with both the deans and scientists surveyed. In general, scientists obtained information from three major sources: their own experiments, personal communication with other scientists, and textual material (print or electronic). For textual information, most study participants relied on personal journal subscriptions. Tangential journals were scanned in the department's library. Only a few of these scientists came to the health sciences library on a regular basis. Further, the study found that personal computers have had a major impact on how biotechnologists get and use information. Implications of these findings for libraries and librarians are discussed.

Awareness↗
PubMed1990

Effect of ceftazidime and gentamicin on the oropharyngeal and faecal flora of patients with haematological malignancies.

Thirty-four patients with haematological malignancies were studied to investigate the effect of empirical broad-spectrum antibiotic therapy (ceftazidime and gentamicin) on the gastro-intestinal flora. Twenty-five patients with acute myeloid leukaemia or post-autologous bone-marrow transplantation were given framycetin, nystatin and colistin (Fracon), and two patients with non-Hodgkin's Lymphoma were on co-trimoxazole, as long-term gut prophylaxis. Semi-quantitative microbiology was carried out on oropharyngeal swabs and quantitative microbiology on faecal specimens. The oropharyngeal flora consisted mainly of streptococci, coagulase-negative staphylococci and coryneforms, and was little affected by ceftazidime/gentamicin. A strain of Enterobacter cloacae resistant to ceftazidime and gentamicin colonized one patient, who later developed septicaemia. The faecal flora of patients on Fracon was dominated by enterococci; the few enterobacteria present were eliminated by ceftazidime/gentamicin. The anaerobic flora was absent in 15% of patients; in the remainder, it consisted mainly of Bacteroides spp., and was little affected by ceftazidime/gentamicin. The faecal flora of patients not on Fracon always contained anaerobes, and some strains of enterobacteria persisted throughout antibiotic treatment. None of the patients was colonized by Clostridium difficile or Pseudomonas aeruginosa. Broad-spectrum therapy with ceftazidime and gentamicin appeared to have little effect on the gastro-intestinal flora, except to encourage the overgrowth of enterococci and reduce the numbers of enterobacteria.

Ceftazidime↗
PubMed1990

The diagnosis of multiple personality disorder based on subtle dissociative signs.

Patients with multiple personality disorder (MPD) often present with subtle dissociative signs and symptoms rather than with the clear-cut, overt dissociative signs and symptoms usually associated with MPD. Because most MPD patients usually conceal their condition, there are only limited periods in their lives when they show florid, overt symptoms that can be easily diagnosed. During these other times, MPD patients often show subtle dissociative signs in their affects, thoughts, memories, behaviors, object relations, and transferences. These indirect manifestations of MPD are evidence of the patient's dissociative pathology and occur when their alters influence each other, partly emerge, or subtly shift. A familiarity with these subtle dissociative signs would allow the therapist to be aware of what MPD looks like when it is camouflaged and expressed indirectly. A recognition of these indirect manifestations would enable the clinician to suspect the diagnosis, explore the possible alters, and diagnose the patient's underlying dissociative pathology when present.

Adult↗
PubMed1989

An epidemiologic study of risk factors in two teenage suicide clusters.

Two clusters of teenage suicides occurred in Texas between February 1983 and October 1984. The eight suicides from the first cluster and the six from the second were investigated together in a case-control study using a closed-response questionnaire administered to parents. Three control teenagers were matched with each case subject on the basis of school district, grade, race, and sex. Questions concerned the direct and indirect exposures of subjects to previous suicides as well as their life circumstances and behaviors. Case subjects were not more likely than control subjects to have had direct exposure to suicide as measured by their acquaintance with a person who committed suicide. Similarly, indirect exposure to suicide through the media was not associated significantly with suicide. Case subjects were more likely to have attempted or threatened suicide previously, to have damaged themselves physically, and to have known someone closely who died violently. Case subjects were more likely to have broken up with their girlfriends or boyfriends recently. They also had moved more often than control subjects, attended more schools, and lived with more parent figures. Identification of high-risk youths through knowledge of relevant risk factors can help to direct preventive services to those young people most susceptible to suicide.

Adolescent↗
PubMed1989

The tangible cost implications of a hospital outbreak of multiply-resistant Salmonella.

A hospital outbreak of multiply-resistant Salmonella heidelberg infection, which affected 17 patients and 2 staff, is described. The tangible cost of the outbreak was estimated at 21 pounds 151, 17 pounds 989 (85.1%) of which was borne by the hospital. The cost to the Microbiology Department was 3596 pounds (17.0% of the total). A detailed analysis of the costs and implications for staffing disruption is given and a comparison is made with the costs of preventive activities. Ways of containing expenses in the event of an outbreak and the economic implications for clinical budgeting and privatization of the laboratory service are considered.

Clinical Laboratory Techniques↗
PubMed1989

Functional relationships and structural determinants of two bacteriophage T4 lysozymes: a soluble (gene e) and a baseplate-associated (gene 5) protein.

Lysozymes have proved useful for analyzing the relation between protein structure and function and evolution. In bacteriophage T4, the major soluble lysozyme is the product of the e gene, gpe (gene product = gp). This lysozyme destroys the wall of its host, Escherichia coli, at the end of infection to release progeny particles. Phage T4 contains two additional lysozymes that facilitate penetration of the baseplates into host cell walls during adsorption. At least one of these, a 44-kD protein, is encoded by gene 5. We show here that a segment of the gp5 lysozyme amino acid sequence, deduced from the DNA sequence of gene 5, is remarkably similar to that of the T4 gene e lysozyme. Both T4 lysozymes are somewhat similar to the lysozyme of the Salmonella phage P22, but there is little significant DNA sequence homology among the two T4 lysozyme genes and the P22 lysozyme gene. We speculate that these lysozymes are adapted to differences in the composition of the cell walls of E. coli and S. typhimurium. The cloned gene 5 of the phage T4 directs synthesis of a 63-kD precursor protein that is approximately 19 kD larger than the gene 5 protein isolated from baseplates. Gp5 first associates with gp26 to form the central hub of this structure.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1989

Carotid artery injuries: experience with 124 cases.

This is a retrospective study of 124 patients with carotid injuries. The common carotid artery was injured in 84% of the patients. Associated trauma to the internal jugular vein was present in 26%. Most patients (56%) were dead on arrival to the hospital and of those who were operated on, the mortality was 22% (overall mortality, 66%). All operative mortalities had severe shock or neurologic deficits on admission. We performed repair on all patients with preoperative neurologic deficits and the mortality was 64%. The use of a shunt did not influence the prognosis. We believe that there is no place for an emergency angiogram in order to diagnose a carotid injury or to plan the operation.

Adult↗
PubMed1988

Surgical approaches to vertebral artery injuries.

Twenty patients with penetrating injuries of the vertebral artery who were treated as emergencies were subjected to the following operative approaches: five cases, Henry's approach (posterior) and modified Henry's approach (anterior); five cases, limited exposure and application of metal clips; four cases, plugging of the arterial defect with Oxycell or crushed muscle; three cases, control with ligatures and non-conventional exposure of the artery; one case, inflation of a balloon catheter within the vertebral canal; one case, repair of the lacerated first extraosseous part of the vertebral artery. One patient died from exsanguination on the operating table, before any repair was possible. The overall mortality was 20 per cent and the mean hospital stay 6.1 days. Thirty-five per cent of the patients presented with neurological complications, and 55 per cent left the hospital well. No advantage of Henry's classical approach over limited exposure and control with metal clips was shown, when mortality, hospital stay and long-term problems were compared. Because of its relative simplicity we suggest that the metal clipping of the vertebral artery, above and below the site of injury, is an effective technique that can be used to stop the bleeding. One case presented as a false aneurysm of the vertebral artery, following a stab wound. This was successfully treated with excision of the aneurysm and vertebrovertebral artery bypass, using a saphenous vein graft.

Adult↗