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Biomedical subjects

J Holmes

Publications and source records attributed to J Holmes.

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

General practitioner perceptions of treatment benefits and costs in patients with hyperlipidaemia.

This study explored general practitioner (GP) perceptions of use of treatments to manage hyperlipidaemia and their cost implications. GPs recognized different levels of coronary heart disease (CHD) risk, but were not always aware of which were major factors. Most were unfamiliar with published guidelines on managing hyperlipidaemia, and were likely to initiate drug therapies even in low-risk patients with mild hyperlipidaemia. Clearer advice is needed on whom to treat and on dietary intervention with high-fibre as well as low-fat diets.

Anticholesteremic Agents↗
PubMed1998

The changing aims of psychoanalytic psychotherapy. An integrative perspective.

The purpose of this paper is to relate traditional psychoanalytic ideas on aims and outcomes to the changing world of contemporary psychoanalytic psychotherapy, with its financial constraints and theoretical and technical innovations. An emphasis on splitting rather than repression, on the nature of the attachment between therapist and patient, and on realistic goals and modest change all characterise contemporary perspectives. Recent developments in the cognitive behavioural psychotherapy literature indicate possible areas of overlap with psychoanalytic psychotherapy. Attachment theory proposes that patient-therapist attunement is likely to be a key variable in outcome. Since attunement is intrinsically responsive rather than directive, the paradox of psychoanalytic 'aimlessness' is inherent in the nature of psychoanalytic psychotherapy.

Awareness↗
PubMed1998

Predicting prognosis in lung cancer: use of proliferation marker, Ki67 monoclonal antibody.

An investigation was carried out to assess the prognostic significance of proliferation marker Ki67 in a group of lung cancer patients treated by surgery (limited disease). Tissue was not available for Ki67 immunostaining in inoperable group. The diagnosis is established by bronchial biopsy which does not carry enough tissue for frozen section and counting. This study is supplemented by estimating the prognostic significance of histological sub-types in the operable group and in a group of inoperable patients with extensive disease. These are usually treated by radiotherapy and/or chemotherapy. In all, 267 patients were studied including 105 treated by surgery. These patients attended King's College and Brompton Hospital, UK, between 1986 and 1989. With regard to proliferation marker Ki67 done for the surgical group, only patients with Ki67 scores of less than 5% did survive significantly longer than the rest. Histology did not make any significant contribution in determining prognosis in both operable and inoperable groups. Although follow-up is limited (mean 20 months), Ki67 antibody seems promising in identifying low and high grade disease in the initial stage of lung cancer. It may prove useful for category of patients with high scores to be placed on chemotherapy/radiotherapy. Results suggest that in the case of lung tumour, proliferative activity is a better prognostic indicator than histological type.

Adenocarcinoma↗
PubMed1997

Hybrid process for the conversion of lignocellulosic materials.

Because of the recalcitrant nature of lignocellulosic materials, it is important to pretreat the biomass in order to obtain a suitable material for the bioconversion. In this study, two different types of pretreatments were performed. The first experiment used a 2-gal Parr reactor operated at 140, 150, 160, and 170 degrees C with sulfuric acid concentrations varying from 0.5 to 2%. A second pretreatment was performed with a two-stage low-temperature process. The first-stage pretreatment was performed at 100 or 120 degrees C with sulfuric acid concentrations of 0.5, 2, and 5% followed by a second-stage pretreatment at 120 degrees C with 2% acid concentration. The best residues for enzymatic hydrolysis and simultaneous saccharification and fermentations (SSF) came from the higher temperature pretreatment with the Parr reactor. However, a large portion of the xylose fraction was degraded to furfural and glucose was degraded to HMF. On the contrary, the two-stage low temperature pretreatment resulted in a very low percentage of xylose degradation, and no glucose degradation. The residues from this two-stage pretreatment performed satisfactorily toward the production of ethanol by SSFs. This study discusses the results obtained from these experiments.

Biomass↗
PubMed1997

Cardiovascular collapse after femoral prosthesis surgery for acute hip fracture.

PURPOSE: Prosthetic revision of hip fractures may result in embolization of tissue products leading to death. In this report, from cases reported to the Anaesthesia Advisory Committee to the Chief Coroner of Ontario, emphasis is placed on the immediate resuscitative procedures which may offset a fatal outcome. CLINICAL FEATURES: Two elderly patients are reported in whom hip fractures necessitated primary prosthetic hip repair. The first patient, with a history of limited cardiac reserve and syncope, suffered a subcapital hip fracture. Under general anaesthesia, a Moore's prosthesis was inserted. The anaesthetic period remained relatively stable until surgical reaming of the femoral canal. Bradycardia, hypotension and cyanosis developed and quickly proceeded to a fatal cardiac arrest. Autopsy demonstrated diffuse pulmonary embolism of fat and thrombus. The second patient suffered a fracture around the stem of a previously inserted femoral prosthesis. Under general anaesthesia, a new cemented hip prosthesis was inserted, following which hypotension occurred. This was supported with small doses of ephedrine, ventilation was controlled with oxygen and the procedure was quickly terminated. Despite addition of a dopamine infusion, cardiac arrest and death followed. Autopsy disclosed massive fat and bone marrow embolization. CONCLUSION: The combination of hip fracture, activated clotting factors and borderline cardiopulmonary function presents a risk of death from embolization of tissue products released during the placement of a cemented hip prosthesis. While the outcome of this catastrophe is generally poor, all practitioners should be prepared to immediately institute resuscitative procedures to manage the accompanying cardiovascular collapse.

Acute Disease↗
PubMed1997

t(3;21) following peripheral blood stem cell transplantation in chronic phase chronic myeloid leukaemia.

A 40-year-old male with Ph-positive CML underwent PBSC autografting after initial treatment with hydroxyurea and interferon. Following autograft he remained in chronic phase with cytogenetic or molecular evidence of low levels of residual Ph-positive cells. However, additional cytogenetic abnormalities, including t(3;21) typically seen in therapy-related myelodysplastic syndrome (MDS) and AML and blast crisis of CML, developed as an independent cell line following the autograft. More than 4 years after the autograft, the patient remains in chronic phase with no evidence of accelerated phase or blast crisis of CML, but with a concurrent MDS. We report a case of CML who developed therapy-related MDS following PBSC autograft while still remaining in chronic phase.

Adult↗
PubMed1997

The prevalence of fragile-X syndrome in an institution for people with learning disability.

The prevalence of Fragile-X syndrome in those with learning disability has been reported. There is little agreement regarding the prevalence rate which varies between 0% and 16%. We report a study investigating the prevalence of Fragile-X syndrome in two institutions for those with learning disability, using DNA testing. We found a rate of 0.7%, which is one of the lowest record rates. We also found that physical signs could be used as a reliable discriminator to determine those likely to have the disorder. We conclude that indiscriminate mass screening of those with learning disability for the Fragile-X syndrome is probably not useful because, in adults, physical signs and a family history of learning disability can predict those likely to have the disorder.

Adult↗
PubMed1997

Attachment, autonomy, intimacy: some clinical implications of attachment theory.

This paper reviews the origins and current state of attachment theory, especially as relevant to the practice of psychotherapy. It is suggested that attachment experience becomes internalized as self-narrative around the age 3-5, and that these self-narratives form the basis of reflexive self-function and autobiographical competence in later life, as revealed by the Adult Attachment Interview. It proposes that the fundamental aims of psychotherapy can be characterized as the search for intimacy and autonomy, arising on the basis of parental attunement and containment of healthy protest, of which analogues are to be found in adult psychotherapy. A 'triangle of attachment' is introduced at whose apices are attachment, detachment and 'non-attachment' respectively. Attachment, which arises out of a secure base, provides the starting point for intimacy; the capacity for healthy protest and therefore detachment is the basis of autonomy; from non-attachment comes the capacity to reflect on oneself and so to disidentify with painful or traumatic experience.

Adult↗
PubMed1997

Does erythropoietin accelerate malignant transformation in multiple myeloma?

Growth factors or humoral agents can support haemopoiesis in various bone marrow disorders. They have the ability to act on multiple cell lineages and in myeloid cells, and the potential to act on the neoplastic equivalent of normal cells. Anaemia is a common feature of multiple myeloma seen in at least two-thirds of patients at presentation. Erythropoietin is increasingly being used with variable effect for the treatment of this anaemia, especially in cases associated with renal failure and in patients in whom blood transfusion may be undesirable or contraindicated. We describe a patient treated with recombinant erythropoietin who developed fulminating malignant transformation. The demonstration of erythropoietin receptors on a human myeloma cell line and the occurrence of the rare complication of plasma cell leukaemia in our patient stresses the need for caution and invites detailed clinical and laboratory studies before its general use.

Anemia↗
PubMed1997

Nocturnal enuresis: economic impacts and self-esteem preliminary research results.

Bedwetting is a common complaint, affecting approximately 10% of 7-year old children in the developed world and causing an economic drain on society. Not only is the cost of nocturnal enuresis borne by the families, but also by national health services and state health insurance. Although previous studies have examined the direct costs of nocturnal enuresis, the current paper also investigates the indirect costs to some selected families, such as the extra housework that is involved. The total cost of having an enuretic child was estimated on a case study basis in five countries with results being reported here for three countries (Sweden, UK and Germany). The study considered costs over a period of 3 months, with questionnaires on self-perceived self-esteem being included for the child. The critical factors influencing overall costs were the number of wet nights per week, necessitating washing and drying, and the costs of the treatment itself. Overall, the study found that total costs of not treating enuresis in heavy bedwetters can be higher than with any of the treatment alternatives, which must be seen as an additional burden to families with a child suffering from lower self-esteem.

Child↗
PubMed1996

Isolation and expression of cDNAs from rainbow trout (Oncorhynchus mykiss) that encode two novel basic helix-loop-Helix/PER-ARNT-SIM (bHLH/PAS) proteins with distinct functions in the presence of the aryl hydrocarbon receptor. Evidence for alternative mRNA splicing and dominant negative activity in the bHLH/PAS family.

cDNAs encoding two distinct basic helix-loop-helix/PER-ARNT-SIM (bHLH/PAS) proteins with similarity to the mammalian aryl hydrocarbon nuclear translocator (ARNT) protein were isolated from RTG-2 rainbow trout gonad cells. The deduced proteins, termed rtARNTa and rtARNTb, are identical over the first 533 amino acids and contain a basic helix-loop-helix domain that is 100% identical to human ARNT. rtARNTa and rtARNTb differ in their COOH-terminal domains due to the presence of an additional 373 base pairs of sequence that have the characteristics of an alternatively spliced exon. The presence of the 373-base pair region causes a shift in the reading frame. rtARNTa lacks the sequence and has a COOH-terminal domain of 104 residues rich in proline, serine, and threonine. rtARNTb contains the sequence and has a COOH-terminal domain of 190 residues rich in glutamine and asparagine. mRNAs for both rtARNT splice variants were detected in RTG-2 gonad cells, trout liver, and gonad tissue. rtARNTa and rtARNb protein were identified in cell lysates from RTG-2 cells. Transfection of rtARNT expression vectors into murine Hepa-1 cells that are defective in ARNT function (type II) result in rtARNT protein expression localized to the nucleus. Treatment of these cells with 2,3,7,8-tetrachlorodibenzo-p-dioxin results in a 20-fold greater induction of endogenous P4501A1 protein in cells expressing rtARNTb when compared with rtARNTa, even though both proteins effectively dimerize with the aryl hydrocarbon receptor. The decreased function of rtARNTa appears to be due to inefficient binding of rtARNTa.AHR complexes to DNA. In addition, the presence of rtARNTa can reduce the aryl hydrocarbon receptor-dependent function of rtARNTb in vivo and in vitro.

Alternative Splicing↗
PubMed1996

A Scottish family with Bazex-Dupré-Christol syndrome: follicular atrophoderma, congenital hypotrichosis, and basal cell carcinoma.

Bazex-Dupre-Christol syndrome (BDCS) is an X linked dominant disorder of the hair follicle characterised by follicular atrophoderma, multiple basal cell carcinomas, hypotrichosis, milia, and localised hypohidrosis. Follicular atrophoderma (FA) are follicular funnel shaped depressions, "ice pick marks", seen most commonly on the dorsum of the hands. We describe the first known Scottish family with this syndrome, five affected members spanning three generations. They have hypohidrosis confined to the face, coarse hair, dry skin, milia, and follicular atrophoderma. All the adults have a history of multiple basal cell carcinomas. None of them has any skeletal feature suggestive of Gorlin's syndrome. The clinical features, skin histology, and scanning electron microscopic (SEM) examination of the hair are described and illustrated. The features are compared with 15 previous reports of BDCS and four reports in which this is a possible diagnosis are also reviewed. BDCS should be considered as a differential diagnosis in patients with early onset or familial basal cell carcinomas.

Adult↗
PubMed1996

Lifetime cost of stroke in the United States.

BACKGROUND AND PURPOSE: Stroke imposes a substantial economic burden on individuals and society. This study estimates the lifetime direct and indirect costs associated with the three major types of stroke: subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (ISC). METHODS: We developed a model of the lifetime cost of incident strokes occurring in 1990. An epidemiological model of stroke incidence, survival, and recurrence was developed based on a review of the literature. Data on direct cost of treating stroke were obtained from Medicare claims data, the 1987 National Medical Expenditure Survey (NMES), and insurance claims data representing a group of large, self-insured employers. Indirect costs (the value of foregone market and nonmarket production) associated with premature morbidity and mortality were estimated based on data from the US Bureau of Economic Analysis and the 1987 NMES. RESULTS: The lifetime cost per person of first strokes occurring in 1990 is estimated to be $228,030 for SAH, $123,565 for ICH, $90,981 for ISC, and $103,576 averaged across all stroke sub-types. Indirect costs accounted for 58.0% of lifetime costs. Aggregate lifetime cost associated with an estimated 392,344 first strokes in 1990 was $40.6 billion: $5.6 billion for SAH, $6.0 billion for ICH, and $29.0 billion for ISC. Acute-care costs incurred in the 2 years following a first stroke accounted for 45.0%, long-term ambulatory care accounted for 35.0%, and nursing home costs accounted for 17.5% of aggregate lifetime costs of stroke. CONCLUSIONS: The lifetime cost of stroke varies considerably by type of stroke and entails considerable costs beyond the first 2 years after a stroke.

Adolescent↗