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Biomedical subjects

J Gallagher

Publications and source records attributed to J Gallagher.

At least 55 records · Page 3Linked to original sources
PubMed1998

A critical analysis of on-scene helicopter transport on survival in a statewide trauma system.

BACKGROUND: Recently, questions have been raised regarding the effectiveness of helicopters in trauma care. We conducted a retrospective study to evaluate the effect of on-scene helicopter transport on survival after trauma in a statewide trauma system. METHODS: Data were obtained from a statewide trauma registry of 162,730 patients treated at 28 accredited trauma centers. Patients transported from the scene by helicopter (15,938) were compared with those transported by ground with advanced life support (ALS) (6,473). Interhospital transfers and transports without ALS were excluded. Statistical analysis was performed using one-way analysis of variance and logistic regression. RESULTS: Patients transported by helicopter were significantly (p < 0.01) younger, were more seriously injured, and had lower blood pressure. They were also more likely to be male and to have systolic blood pressure < 90 mm Hg. Logistic regression analysis revealed that when adjusting for other risk factors, transportation by helicopter did not affect the estimated odds of survival. CONCLUSION: A reappraisal of the cost-effectiveness of helicopter triage and transport criteria, when access to ground ALS squads is available, may be warranted.

Adolescent↗
PubMed1997

Estimation of the age of the ancestral arginine3500-->glutamine mutation in human apoB-100.

Familial defective apoB-100 (R3500Q) [FDB (R3500Q)] is caused by a mutation in the apoB gene (2p23.24). Almost all individuals with this disorder are of European descent, and in almost all cases the mutation is on a chromosome with a rare haplotype (194) at the apoB locus, suggesting that all FDB (R3500Q) probands are descended from a common ancestor in whom the original mutation occurred. The distribution of the mutation is consistent with an origin in Europe 6000-7000 years ago. We have estimated the amount of recombination between the apoB gene and markers on chromosome 2 in 34 FDB (R3500Q) probands in whom the mutation is on a 194 haplotype. Significant linkage disequilibrium was found between the apoB gene and marker D2S220. We have identified three YACs that contain the apoB gene and D2S220. The shortest restriction fragment common to the three YACs that contained both loci was 240 kb long. No shorter fragments with both loci were identified. On the assumption that 1000 kb corresponds to 1 cM, we deduce that the recombination distance between D2S220 and the apoB gene is about 0.24 cM. Combining this value with the linkage disequilibrium observed between the two loci in the probands, we estimate that the ancestral mutation occurred about 270 generations ago. We postulate that the original mutation occurred in the common ancestor of living FDB (R3500Q) probands, who lived in Europe about 6750 years ago. The errors in this estimate are discussed.

Apolipoprotein B-100↗
PubMed1997

Follicular variant of papillary carcinoma of the thyroid: fine-needle aspirates with histologic correlation.

Crile and Hazard reported in 1953 a follicular pattern of papillary thyroid carcinoma. Little has been said about this pattern in the cytologic literature. From more than 8,000 thyroid aspirates in our files, we reviewed all those diagnosed as "follicular variant of papillary carcinoma," "suspect follicular variant of papillary carcinoma," and "follicular neoplasm vs. follicular variant of papillary carcinoma." Also, we reviewed all aspirates in which a diagnosis of follicular variant of papillary carcinoma had been made on surgically excised glands, regardless of the cytologic diagnosis; 63 aspirates from 45 patients were collected. All smears were air-dried and stained with Diff-Quik. Most smears were very cellular ("tumor cellularity"), and the neoplastic follicular cells formed empty follicles, rosettes, tubules, and papillary structures. Nuclei were twice the size of red blood cells, had smooth contours, were hyperchromatic, and varied in shape but not much in size. Nuclear overlapping was common. Some nuclei had one small and almost pointed end, thereby resembling arrowheads. Intranuclear inclusions, multinucleated histiocytes, and psammoma bodies were uncommon. Pink-stained colloid was frequent.

Adult↗
PubMed1997

The mechanisms for adult-onset apraxia and developmental dyspraxia: an examination and comparison of error patterns.

OBJECTIVES: The purpose of this study was to determine whether persons with developmental dyspraxia and apraxia make similar errors during the performance of four types of tasks. METHOD: Three groups of subjects with dyspraxia or apraxia (i.e., children with learning disabilities and dyspraxia, young adults with learning disabilities and dyspraxia, older adults with left-hemisphere brain damage with apraxia) and three groups of age-matched control subjects (i.e., children, young adults, older adults) were observed performing transitive, intransitive, verbal command, and imitation tasks. Performance was scored on the basis of the types of errors made. Errors were classified as conceptual (nonrelated, unrecognizable, sequencing) or production (omission, perseveration, related, internal configuration, external configuration, incorrect movement, body part as object). RESULTS: No significant difference was found between conceptual and production error patterns for any group. In addition, there was no significant difference between the dyspraxia and apraxia groups or among the control groups on the specific types of production errors made. However, the dyspraxia and apraxia groups differed in the type of conceptual error made on the intransitive task. The body-part-as-object error was the most frequently made error on the transitive, verbal command, and imitation tasks, whereas the movement error was the most frequently made error on the intransitive task. CONCLUSION: Subjects with dyspraxia or apraxia make similar errors, suggesting that the praxis behaviors are similar.

Adult↗
PubMed1997

Religious freedom, reproductive health care, and hospital mergers.

This article examines the impact of hospital mergers and the formation of health care networks involving religious hospitals on the provision of reproductive health care. Although instances of access to such services being curtailed at non-Catholic religious facilities have been reported, no systematic study of hospitals owned by other religious denominations has yet been done. Accordingly, the author focuses on Roman Catholic institutions and policies. Efforts by Roman Catholic Bishops to enforce the Ethical and Religious Directives for Catholic Health Care Services on new institutional partners has led to the elimination of or severe restrictions on patient access to abortion, contraception, infertility treatments, and even to emergency contraception for rape victims. The article suggests steps that physicians, patients, and community organizations and activists can take to safeguard reproductive health care as new institutional and professional relationships are formed.

Catholicism↗
PubMed1996

Flumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy.

BACKGROUND: Flumazenil is a competitive benzodiazepine antagonist that acts to reverse their sedative and hypnotic effects. It is indicated in the management of benzodiazepine overdose, but its role in the routine reversal of endoscopic conscious sedation has not been defined. METHODS: Patients undergoing diagnostic upper endoscopy who received sedation with either diazepam or midazolam alone were given flumazenil 0.2 mg incrementally immediately following the procedure until awake. They were then asked to repeat three psychomotor tests measuring cognitive and motor skills, with their baseline scores compared with postprocedure scores over a 3-hour period. RESULTS: Full psychomotor function was restored to baseline values within 30 minutes after flumazenil in 79% of patients, with no differences in the reversal of psychomotor skill impairment observed between diazepam and midazolam sedation. There was no evidence of rebound sedation seen for up to 3 hours. No significant anterograde amnesia was evident in 78% of individuals. CONCLUSIONS: These results demonstrate that flumazenil's effects on reversing psychomotor impairment are similar when midazolam or diazepam are used for conscious sedation. However, the potential usefulness of routine flumazenil reversal of conscious sedation will require further evaluation of specific psychomotor performance skills (such as driving a car) before we lift the admonition against leaving the endoscopic suite unattended, driving a vehicle, or operating complicated machinery for several hours.

Adult↗
PubMed1996

Power of one: nurses and tobacco control.

OBJECTIVES: To review major events in cigarette marketing and smoking practices, and to examine courses of action that can be taken by nurses to impact public health and safety. DATA SOURCES: Journal articles and news reports relating to the tobacco industry and tobacco regulations. CONCLUSION: Every segment of society suffers economic and health consequences of tobacco use, yet the tobacco industry continues to successfully market and promote the use of tobacco. Successful approaches to control tobacco use can be initiated at the federal, state, or local level. IMPLICATIONS FOR NURSING PRACTICE: Any nurse can take positive action toward tobacco control in numerous ways: by increasing awareness of the need for tobacco control; initiating personal action such as education and contacting legislators; and supporting public action through joining groups or coalitions whose efforts are directed at tobacco control.

Advertising↗
PubMed1996

Recognition of tetrahedral 1,10-phenanthroline-cuprous chelates by transcriptionally active complexes does not depend on the sequence of the promoter.

BACKGROUND: The open complex formed at the initiation site of transcription within the active site of RNA polymerase is unique to actively transcribing genes and is thus an ideal target for the design of transcription inhibitors. Many redoxactive tetrahedral cuprous chelates of 1,10-phenanthroline (OP) or derivatives cleave the single-stranded template, principally at sequence positions -7 to -3, whereas the redox-inactive tetrahedral cuprous chelate of 2, 9-dimethyl-OP (neocuproine) blocks transcription, but does not cleave. The octahedral (OP)3-Fe2+ chelate has no effect. Different promoters can give different cleavage patterns. We therefore searched for structural determinants of the open complex that are important in the cleavage reaction. RESULTS: Using site-directed mutagenesis, we systematically altered the nucleotides at the cleavage sites of the Escherichia coli lac UV-5-RNA polymerase open complex (positions -6 to -4), which are highly variable in E. coli promoters. Surprisingly, these changes had little effect on catalytic activity, on transcription inhibition by the cuprous complex of neocuproine and on the cleavage patterns generated by the cuprous chelates of OP derivatives. The scission pattern of a lac UV-5 promoter mutant in which the cleavage sites have the sequence of the trp EDCBA promoter is that of the lac UV-5 promoter, not the trp EDCBA promoter. CONCLUSIONS: Nucleotide-specific interactions are not responsible for the observed cleavage patterns. The recognition of the tetrahedral OP chelate must be due to a specific structure of the single-stranded regions, determined by RNA polymerase-DNA interactions in the upstream regulatory region.

Chelating Agents↗
PubMed1996

Susceptibility to varicella zoster virus infection in health care workers.

Varicella zoster virus (VZV) is an occupational hazard for a percentage of health care staff. Nine hundred and seventy staff members attending the Occupational Health Department at Cork University Hospital took part in the survey. A latex agglutination assay was used to determine the health care workers immune status to VZV. Of the 970 workers tested, 928 (95.7%) were immune to VZV. The sensitivity, specificity and predictive value of an enquiry regarding a history of chicken-pox was determined on a sample of 206 health care workers. The positive predictive value was 95% (119/125) and the negative predictive value was 11% (4/35). The sensitivity of the enquiry was 79% (119/150), the specificity was 40% (4/10), reducing to 61% (119/195) and 36% (4/11) respectively when individuals with uncertain histories were included in the calculations. The advantages and disadvantages of selective staff screening are discussed. In the authors' opinion all health care workers involved in the clinical care of patients should be screened by serology for past VZV infection before taking up duty and those who are susceptible to VZV should be made aware of the risks and health effects associated with VZV if contracted.

Adult↗
PubMed1996

Controlled trial of lamotrigine (Lamictal) for treatment-resistant partial seizures.

The antiepileptic effect of lamotrigine (Lamictal) was assessed in a double-blind, placebo-controlled, crossover trial in 56 adult patients with refractory partial seizures. Lamotrigine or placebo was added to the patients' existing antiepileptic drugs (AEDs). The dose of lamotrigine varied from 75 to 400 mg daily. Thirty-eight patients completed the trial and 7 withdrew because of adverse experiences. There was a statistically significant reduction in seizure counts on lamotrigine compared with placebo for total seizures (30.3% reduction, 95% CI 8.4%, 47.0%), complex partial seizures (29.2% reduction, 95% CI 3.8%, 47.9%) and secondary generalised seizures (37.9%, CI 18.9%, 52.4%). The analysis of total seizure days showed a similar significant reduction during lamotrigine treatment for the same seizure categories. There was no statistically significant difference in reporting of adverse events between lamotrigine and placebo except for dizziness which was reported more frequently on lamotrigine than on placebo. There were no differences in abnormal haematological or biochemical findings between lamotrigine and placebo, and lamotrigine had no effect on plasma concentrations of concomitant AEDs.

Adolescent↗
PubMed1995

Management of cutaneous symptoms.

OBJECTIVE: To provide a review of the problems of malignant skin lesions, skin changes associated with cancer therapy, and required nursing care. DATA SOURCES: Published articles and book chapters that pertain to skin, malignant skin lesions, cutaneous toxicity from cancer therapy, pressure ulcers, and nursing care. CONCLUSIONS: Cutaneous symptoms as a result of the disease process or its treatment (chemotherapy, cytokines, radiation) interfere with optimal functioning and quality of life. The management and nursing care of malignant skin lesions, hyperpigmentation, changes in sensation, hypersensitivity reactions, acral erythema, erythema, desquamation, and pressure ulcers provide major treatment challenges for the oncology nurse. IMPLICATIONS FOR NURSING PRACTICE: Skilled assessment, prevention, intervention, and evaluation of skin problems can reduce the difficulties patients and family members encounter with cutaneous symptoms and promote self-care and optimal functioning.

Humans↗
PubMed1995

The use of aqueous cetylpyridinium chloride as a transport medium for suspected tuberculous tissues from badgers.

Deterioration of tuberculous tissue specimens from badgers during transit in the post was simulated in the laboratory, and it was found that unpreserved tissues showing miliary lesions and initially producing a confluent growth of Mycobacterium bovis became culture-negative over a period of 4 days at ambient summer temperatures (>20 degrees C). These findings implied that false negative results may be obtained from specimens containing only small numbers of bacilli following delays of 2 days between collection and culture. A bench trial of cetyl pyridinium chloride and bromide as preservatives showed viable bacillary numbers were maintained well. A field trial of a 1% aqueous solution of the chloride salt as a transport medium was carried out on 666 split tissue submissions and a significantly improved isolation rate was found from the preserved samples, with 40 (93%) of the total of 43 isolates of M. bovis compared with 27 isolates (63%) when no preservative was used. Isolation using the guinea pig test was attempted on 354 of these samples and yielded 38 (93%) of the 41 isolates, compared with culture of preserved samples which yielded 39 isolates (95%), an insignificant difference. The use of this transport medium maximised cultural isolations, such that no significant gain was achieved by the continued use of the animal test.

Journal Article↗
PubMed1995

Dietary fat modulates gastric lipase activity in healthy humans.

The aim of this study was to determine whether the amount of dietary fat modulates the activity of gastric lipase in humans. Gastric juice was collected from six healthy subjects after 2-wk periods of either a high-fat (50% of energy as fat) or low-fat (25% of energy as fat) diet. The collection period lasted 2 h, the first hour under baseline conditions and the second hour after pentagastrin stimulation (6 micrograms/kg body wt). Gastric lipase and pepsin activities were quantitated at 15-min intervals and total enzyme outputs were calculated. Under baseline conditions there was a tendency for higher output of gastric lipase and pepsin after the high-fat diet than after the low-fat diet (gastric lipase: 745 compared with 446 U/h, pepsin: 107,677 compared with 78,505 U/h). The difference in output between diet groups was significant after pentagastrin stimulation (gastric lipase: 1323 compared with 875 U/h, pepsin: 191,751 compared with 128,961 U/h, for high-fat compared with low-fat diet, respectively, P < 0.05). This study is the first to report that a high-fat diet leads to an increase in the activity of gastric enzymes in humans.

Adaptation, Physiological↗
PubMed1995

32P-postlabeling and HPLC separation of DNA adducts formed by diesel exhaust extracts in vitro and in mouse skin and lung after topical treatment.

Diesel exhaust extracts contain many carcinogenic compounds which have been shown to form polycyclic aromatic hydrocarbon (PAH)- and nitrated PAH-DNA adducts in rodent skin and lung. The aim of this study was to characterize by 32P-postlabeling, TLC and HPLC the primary postlabeled PAH-DNA adduct(s) formed in vitro and in vivo by diesel extracts. The diesel particle extracts had known concentrations of benzo[a]pyrene, benzo[b,j,k]-fluoranthenes (B[b,j,k]F) and chrysene. DNA adducts were analyzed in calf thymus DNA incubated in vitro with PAHs activated by S9 mix and in skin and lung DNA from topically treated mice. The main diesel-derived DNA adduct formed in vitro and in vivo did not co-migrate on HPLC and large TLC plates with (+/-)-r-7,t-8-dihydroxy-t-9,10-epoxy-7,8,9,10-tetrahydrobenzo[a]pyrene (anti BPDE)-, B[b]F-,B[j]F-,B[k]F-or chrysene-DNA adduct standards. By co-chromatography DNA adducts formed by chrysene from both in vitro and in vivo samples were identified. Nissan diesel extract containing higher PAH concentrations than Volkswagen automobile extract formed skin DNA adducts that co-migrated with chrysene- and anti BPDE- DNA-derived adducts. We conclude that the use of a highly sensitive 32P-postlabeling method combined with HPLC improves the identification of PAH adducts formed by complex mixtures such as diesel exhaust extracts.

7,8-Dihydro-7,8-dihydroxybenzo(a)pyrene 9,10-oxide↗
PubMed1995

Parenteral magnesium sulfate versus amiodarone in the therapy of atrial tachyarrhythmias: a prospective, randomized study.

OBJECTIVE: To compare the efficacy of parenteral magnesium sulfate vs. amiodarone in the therapy of atrial tachyarrhythmias in critically ill patients. DESIGN: Prospective, randomized study. SETTING: Multidisciplinary intensive care unit (ICU) at a university teaching hospital. PATIENTS: Forty-two patients, 21 medical and 21 surgical, of mean (SD) age 67 +/- 15 yrs and mean Acute Physiology and Chronic Health Evaluation II score of 22 +/- 6, with atrial tachyarrhythmias (ventricular response rate of > or = 120 beats/min) sustained for > or = 1 hr. INTERVENTIONS: After correction of the plasma potassium concentration to > or = 4.0 mmol/L, patients were randomly allocated to treatment with either a) magnesium sulfate 0.037 g/kg (37 mg/kg) bolus followed by 0.025 g/kg/hr (25 mg/kg/hr); or b) amiodarone 5 mg/kg bolus and 10 mg/kg/24-hr infusion. Therapeutic plasma magnesium concentration in the magnesium sulfate group was 1.4 to 2.0 mmol/L. Therapeutic end point was conversion to sinus rhythm over 24 hrs. MEASUREMENTS AND MAIN RESULTS: At study entry (time 0), initial mean ventricular response rate and systolic blood pressure were 151 +/- 16 (SD) beats/min and 127 +/- 30 mm Hg in the magnesium sulfate group vs. 153 +/- 23 beats/min and 123 +/- 23 mm Hg in the amiodarone group, respectively (p = .8 and .65). Plasma magnesium (time 0) was 0.84 +/- 0.20 vs. 1.02 +/- 0.22 mmol/L in the magnesium and amiodarone group, respectively (p = .1). Eight patients had chronic dysrhythmias (magnesium 3, amiodarone 5). Excluding the two patient deaths (amiodarone group, time 0 + 12 to 24 hrs), no significant change in systolic blood pressure subsequently occurred in either group. In the magnesium group, mean plasma magnesium concentrations were 1.48 +/- 0.36, 1.82 +/- 0.41, 2.16 +/- 0.45, and 1.92 +/- 0.49 mmol/L at time 0 + 1, 4, 12 and 24 hrs, respectively. By logistic regression, the probability of conversion to sinus rhythm was significantly better for magnesium than for amiodarone at time 0 + 4 (0.6 vs. 0.44), 12 (0.72 vs. 0.5), and 24 (0.78 vs. 0.5) hrs. In patients not converting to sinus rhythm, a significant decrease in ventricular response rate occurred at time 0 + to 0.5 hrs (mean decrease 19 beats/min, p = .0001), but there was no specific treatment effect between the magnesium and the amiodarone groups; thereafter, there was no significant reduction in ventricular response rate over time in either group. CONCLUSIONS: Intravenous magnesium sulfate is superior to amiodarone in the conversion of acute atrial tachyarrhythmias, while initial slowing of ventricular response rate in nonconverters appears equally efficacious with both agents.

APACHE↗