Biomedical subjects
Publications and source records attributed to J Hurley.
The Brown Bowel Syndrome is characterised by degeneration and pigmentation of large bowel mucosa. We present a report of this unusual syndrome in which, for the first time, a functional deficit, reflected in a reduced internal and sphincter tone, is documented. This abnormality was reversed following sub-total colectomy and vitamin E therapy.
We report a case of rupture of an acquired sinus of Valsalva aneurysm secondary to Aspergillus endocarditis in a patient with chronic lymphocytic leukaemia and idiopathic thrombocytopaenia purpura. Despite adequate repair and haemodynamic correction, with an apparent excellent initial result, the patient died of overwhelming sepsis at twelve days postoperatively. This case demonstrates an unusual cause of rupture of a sinus of Valsalva aneurysm and the morbidity associated with immunological dysfunction in the post-operative period.
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Shoulder arthroscopy may be a useful tool to the surgeon in confirming a diagnosis for therapeutic treatment of a diagnosed condition. Shoulder arthroscopy has provided valuable information in establishing a diagnosis in the athletic individual when overlapping symptoms make a clinical diagnosis difficult. Shoulder arthroscopy for shoulder instability is in its developmental stages with early studies showing a high redislocation rate. Impingement syndrome is initially treated with conservative methods; however, if this is unsuccessful acromioplasty can be considered. Arthroscopic acromioplasty allows a thorough examination of the glenohumeral joint. Patients with rotator cuff tears may get pain relief with arthroscopic debridement. Inflammatory diseases such as rheumatoid arthritis can be treated with arthroscopic synovectomy. Shoulder arthroscopy is a valuable tool in the treatment and diagnosis of shoulder disorders.
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Recoverin, a recently discovered 23-kDa calcium-binding protein, activates retinal rod guanylate cyclase when the calcium level is lowered in the submicromolar range. We report here the cloning and sequencing of a cDNA for recoverin from a bovine retinal expression library. The recoverin coding sequence was inserted into a pET-11a expression vector under control of the T7 phage promoter. A second expression system, in which the coding sequence was placed under control of the lambda phage PR promoter, gave 10-fold higher yields (10 mg of purified recoverin per liter of Escherichia coli culture). The finding that retinal recoverin is myristoylated at its amino terminus led us to coexpress the recombinant protein and N-myristoyltransferase (EC 2.3.1.97). Myristoylated recombinant recoverin formed in this way in E. coli is like retinal recoverin in exhibiting a large calcium-induced shift in its tryptophan fluorescence emission spectrum. The availability of abundant protein enabled us to crystallize unmyristoylated recombinant recoverin and initiate x-ray studies. The space group of tetragonal crystals obtained from 75% saturation ammonium sulfate is I4 with unit cell dimensions a = 85.1 A and c = 59.8 A. These crystals of the calcium-bound form of the protein diffracted to a resolution of 2.2 A. The expression systems described here open the door to high-resolution x-ray crystallographic and nuclear magnetic resonance studies of this new member of the EF-hand superfamily and to the elucidation of its precise mode of action as a calcium switch.
We reviewed magnetic resonance imaging (MRI) scans of 15 asymptomatic patients at 6 months to 1 year following meniscal repair procedures. All of the patients were found to have persistent MRI signals in the region of the repair. Nine of the 17 meniscal repairs in the 15 patients had persistent grade 3 signals. Arthrograms were performed on six patients (eight meniscal repairs). Seven of these postoperative menisci showed grade 3 signals on MRI. Only one meniscus was shown to have a complete tear by arthrogram. There were no false negative scans. The overall accuracy, defined as the percentage of postoperative menisci correctly diagnosed by MRI, was 38% (3/8). MRI is a useful preoperative diagnostic study following knee injury. This report demonstrates, however, that present MRI modalities are unable to distinguish between scar tissue of healed meniscal repairs and meniscal tears. Therefore, it is not a useful diagnostic tool in evaluating reinjury following successful meniscal repair.
Brigham and Women's Hospital is converting its financial, administrative and clinical information systems from a mini-computer environment to a platform based on MUMPS and a network of several thousand personal computers. This article describes the project rationale and status and provides an overview of the architecture of the new system. The initial results of the project indicate that the personal computer network can provide large amounts of processor power and storage at costs per unit of power and storage that are several times less expensive than the minicomputer environment. The performance of the converted Accounts Payable system indicates that the architecture can deliver acceptable performance.
In an attempt to limit its health care expenditures, Ontario is, as one option, exploring the possibilities of a capitated system for service delivery payments as opposed to the present mixture of global budgets and fee-for-service. After reviewing the literatures on capitation (primarily American) and on resource allocation (primarily British), the paper sets out to establish a capitation rate, based on 'need' and not prior use, for a range of health services in the northern Ontarian community of Fort Frances-Rainy River. The difficulties and limitations of the needs-based approach are explored. The results reported show the setting of the local population characteristics against provincial average health care utilization data to generate expected use rates, which are then adjusted for need and other factors, particularly relative costs and sparsity. Finally these adjusted rates are applied to current provincial expenditures to derive a target share. This target is then expressed in relation to the planning population to derive the capitation rate.
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As the United States enters a period of adequate physician supply (or even surplus), policies to ameliorate the maldistribution of physicians across communities and medical specialties will depend more heavily on explicit redistributional incentives. Targeted financial incentives are an obvious method for encouraging desirable practice choices. This paper simulates the effect of a series of incomes policies on the distribution of sample physicians across specialties, community sizes, and practice modes. The predictions are based on the estimated parameters of a simultaneous choice model for these three dimensions of a physician's practice. The results suggest that policies based on financial incentives are more effective than previous research has indicated.
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An examination of patient data from three medical districts that vary in urban/rural composition and in their proportion of proprietary hospitals was undertaken to determine if high-cost patients whose illnesses place them in "problem" DRGs (diagnosis-related groups identified as "problems" through interviews with private hospital administrators and from information published by the Wisconsin Hospital Association) are being shifted from non-Department of Veterans Affairs (non-VA) hospitals to VA hospitals. Two outcome measures were employed to detect shifting: patient transfers between non-VA and VA hospitals and discharges of veterans in a sample of DRGs identified as unprofitable by private hospitals. A comparison of patient transfers for fiscal year 1982 and fiscal year 1984 (pre- and post-DRG implementation) revealed substantial increases in the number of transfers, but there appeared to be no concentration of transfers in particular DRGs. An examination of discharges for FY 1982 and FY 1984 within 21 problem DRGs showed average increases ranging from 27 percent to 41 percent among patients aged 65 years or older. A comparison of discharges within a sample of 21 randomly selected DRGs showed either no increase or small decreases in discharges from FY 1982 to FY 1984. The possibility is discussed that some of the cost reductions (or slowing of the rise in costs) attributed to the prospective payment system are merely phantom savings. Hospitals may simply be shifting costs from Medicare to the VA system.
Retinoids are known to modulate sebaceous gland activity in humans and animals. The nonpolar arotinoid Ro 15-0778 [(E)-1,2,3,4-tetrahydro-1,1,4,4-tetramethyl-6-(1-methyl-2-phenylethen yl) naphthalene] does not contain a polar end group and is devoid of the classical retinoid side effects of hypervitaminosis A. The favorable toxicological profile stimulated the evaluation of this arotinoid in animal models of sebum production. In castrated, testosterone-stimulated male rats, Ro 15-0778 is 50 times more potent than 13-cis-retinoic acid in inhibiting the production and subsequent secretion of sebum. The oral ED50 value of Ro 15-0778 is 30 micrograms/kg, while an oral dose of 0.5 mg/kg inhibited sebum secretion nearly 100%. In testosterone-stimulated female rats, Ro 15-0778 inhibits sebum secretion significantly with an oral ED50 of 140 micrograms/kg and an s.c. ED50 of 75 micrograms/kg. Ro 15-0778 was also evaluated for its ability to prevent testosterone induction of the immature hamster flank organ. The topical ED50 is 0.53 mg/kg and the oral ED50 is 38 mg/kg. This arotinoid is similarly active in mature male hamsters without testosterone treatment. In addition, the retinoid is active topically and orally in reducing the size of the gerbil abdominal sebaceous gland. The compound exhibits no antiandrogenic activity when tested in ventral prostrate and seminal vesicle assays in rats. Additionally, the compound does not have estrogenic activity when tested in the rat uterine weight assay. High doses of Ro 15-0778 in humans did not demonstrate significant sebum-suppressing activity.(ABSTRACT TRUNCATED AT 250 WORDS)
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