Biomedical subjects
J Jones
Publications and source records attributed to J Jones.
Detection of heavy chain diseases in Hong Kong, 1984-85.
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An ELISA for IgM titer of human serum.
An ELISA for the measurement of serum immunoglobulins (Ig) of specific isotype is described which is reproducible, more sensitive than currently used methods and simple to perform. Data are presented to support the need to include a reference serum of known Ig content on the same plate as the specimen sera in order to compensate for plate-to-plate variability due to ambient conditions. This method should prove useful for monitoring changes in levels of specific Ig classes in the progression of diseases with immune system involvement or during a therapeutic regimen.
Reactivity of natural IgM antibodies with sperm head surface proteins. Use of an ELISA to characterize the reaction.
The data and system of analysis presented in this report have defined a subset of natural IgM antibodies in human sera that are reactive with specific members of a fraction of proteins extracted from human sperm heads. An ELISA has been developed in which, by use of a standardized reference serum, the relative values for total IgM and for sperm protein-reactive IgM may be derived for each serum. Those values, determined for 32 adult and 9 neonatal sera, indicate that the sperm protein-reactive IgM antibodies represent a reasonably constant proportion of the total serum IgM titer. Other assay data indicate that the reactivity between the antigenic sperm proteins and IgM antibodies is of high affinity. Although immunotransfers of this study have confirmed an earlier report (Rodman et al., 1985) that the immunoreactive elements of the sperm protein fraction include 7-9 separate bands or doublets, the data suggest that the reactivity is not a composite of multiple heterogeneous reactions but may be that of a few or a specific reaction, possibly involving homologous or cross-reactive antigenic determinants.
Cone synapses with Golgi-stained bipolar cells that are morphologically similar to a center-hyperpolarizing and a center-depolarizing bipolar cell type in the turtle retina.
Two types of Golgi-stained bipolar cells have been examined by light and electron microscopy to determine the ultrastructure of their synapses with photoreceptors and the spectral type of photoreceptor with which they connect in the retina of the turtle (Pseudemys scripta elegans). We have chosen bipolar cells that correspond in morphology to a center-hyperpolarizing type (H-bipolar) and a center-depolarizing type (D-bipolar) shown in Marchiafava and Weiler's paper (Proc. R. Soc. B 208:103-113, '80). The latter authors recorded intracellular responses and marked their cells with the fluorescent dye Procion yellow so that we have a clear picture of their morphology. These bipolars have been called B4 and B6, respectively, according to our recent classification scheme of Golgi-stained cells. Serial section electron microscopy of two B4 bipolars shows that they made wide-cleft, striated basal junctions with red and green cone pedicles. They connected to six or seven different cone pedicles. The three B6 bipolar cells studied made narrow-cleft, semi-invaginating basal junctions with cone pedicles. The dendrites of B6 bipolars did not become central elements at ribbon synapses although they invaginated toward the synaptic ribbon. Serial section electron microscopy indicated that B6 bipolars contacted three to five cone pedicles also of a red or green cone type. We suggest that in the case of these two varieties of bipolar cell in turtle retina, sign-conserving synapses with cones are wide-cleft basal junctions while sign-inverting synapses are narrow-cleft, semi-invaginating in morphology.
Readmission rates. The price of early discharge.
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Hibernoma. A case report and discussion of a rare tumor.
A case report is presented of a large retroperitoneal hibernoma along with the clinical, radiographic, and pathologic findings. Despite the unusual size and location of this hibernoma, the case illustrates the salient features of these rare tumors of brown fat origin. Pitfalls in preoperative diagnosis are discussed. To date, there has been no convincing evidence of malignant potential of this tumor, and total excision remains the treatment of choice.
Plasma immunoreactive beta-endorphin in non-insulin-dependent diabetes.
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Continuous monitoring of mixed venous oxygen saturation in septic shock.
Fiberoptic pulmonary artery catheters provide a practical method for continuously measuring the amount of oxygen in mixed venous blood. To characterize the usefulness of mixed venous oxygen saturation in managing patients with sepsis, we performed serial hemodynamic measurements on 20 patients with documented septic shock. There was a highly significant positive correlation between increases or decreases of 5% or more in mixed venous oxygen saturation and corresponding changes in oxygen delivery (r = 0.95) and oxygen consumption (r = 0.96). Mixed venous oxygen saturation less than 65% was clinically unacceptable in patients with sepsis and was associated with a poor prognosis. In this study, measurement of mixed venous oxygen saturation was a valuable predictor of survival in patients with septic shock and provided a means of continuously monitoring the status of tissue oxygenation.
Identification of prostaglandin E2 receptor sites in the embryonic murine palate.
This study reports the existence and characteristics of prostaglandin E2 (PGE2) receptor sites during development of the murine embryonic palate. A radioligand binding technique utilizing [3H]-PGE2 was employed in the identification and characterization of binding sites. On day 13 of gestation, palatal PGE2 receptor sites were saturable (at 3.5 nM [3H]-PGE2) with high affinity (KD 1.6 nM) and low capacity (0.018 fmole/mg protein). Specific [3H]-PGE2 binding was completely reversible by 30 min. The rank order of prostanoid binding affinity at specific PGE2 binding sites was: E2 greater than F2 alpha greater than A2 greater than E1 = D2. The ability of embryonic palate mesenchymal cells to respond to PGE2 with dose-dependent accumulations of intracellular cAMP demonstrated the functional nature of these binding sites. Analysis of palatal PGE2 receptor characteristics during the period of palatal development also indicated significant temporal alterations in both receptor affinity and density.
Haemorrhagic, traumatic tenosynovitis.
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Incidence and magnitude of catheter-induced hematuria.
Foley catheters were introduced into 47 human subjects after spontaneously voided urine was collected and the amount of hematuria caused by catheterization itself was measured. A statistically significant increase in urinary erythrocyte count was demonstrated after catheterization, but the effect was small. All but one patient had fewer than four cells per 400-power field that were attributable to the procedure. Males demonstrated greater amounts of catheter-induced hematocyturia than females. Microhematuria greater than three erythrocytes per high-powered field should not be attributed to urethral catheterization. Because urinary specimens are often collected after catheterization of multiply injured patients, and the presence of hematuria may indicate serious genitourinary injury in such patients, knowledge of the contribution of catheterization to the total amount of hematuria should improve the diagnostic accuracy of the initial urinalysis.
Diphenhydramine-induced toxic psychosis.
A 24-year-old man presented to the emergency department with acute anticholinergic symptoms, hallucinations, and bizarre behavior following a large ingestion of diphenhydramine (Benadryl). Because of the large number of nonprescription preparations containing this antihistamine, similar ingestions are becoming increasingly frequent. Minor anticholinergic side effects associated with diphenhydramine are general medical knowledge. The effects of overdosage are less well known. The clinical presentation of toxic psychosis, its differential diagnosis, and its subsequent treatment are discussed.
Hypokalemic periodic paralysis.
Generalized motor weakness is a common complaint in the emergency department and has a wide differential diagnosis that includes both organic and infectious etiologies. We report the case of a previously healthy young man with symptoms of muscular paralysis and associated hypokalemia. The clinical presentation of hypokalemic periodic paralysis, its differential diagnosis, and pertinent physical findings are discussed.
Biochemical aspects of orthodontic tooth movement. I. Cyclic nucleotide and prostaglandin concentrations in tissues surrounding orthodontically treated teeth in vivo.
The objective of this study was to extract and assay cyclic nucleotides and prostaglandins from tissues surrounding orthodontically treated canines in cats. Seven groups of three to five female cats were treated by 80 g tipping force to one maxillary canine for 0 to 28 days. Tissue samples were removed from sites of compression and tension around treated teeth, and from the corresponding control sites. Cyclic nucleotides and prostaglandins were simultaneously extracted by a solvent system at 0 to -5 degrees C. A portion of the aqueous fraction was used for cAMP assay by a binding protein method; cGMP was purified by column chromatography and measured by radioimmunoassay. The solvent fraction was dried, reconstituted with assay buffer, and each of the prostaglandins measured by radioimmunoassay. Analysis of variance showed no significant differences between summary control and treated sites at each of the time periods studied. However, when interactions at secondary and tertiary levels were considered (such as tension and compression, position [apical-gingival sites] of tissue sample, and jaws), significant differences were found in PGE, cAMP, and PGF2 alpha values. These results demonstrate that alterations in the levels of each of these substances in tissues surrounding teeth may be brought about by long-term applications of orthodontic force in vivo. The method of tissue sampling, however, does not permit measurement of the levels of these substances in target cells alone, thus diluting the acute response that may have occurred in these cells.
Cerebrospinal fluid cultures and analysis.
Prompt and accurate diagnosis of acute central nervous system infections is of vital importance to the emergency physician. With the advent of modern antimicrobial therapy, the nearly uniformly fatal outcome of untreated bacterial meningitis can be reduced substantially. Proper test selection is crucial in arriving at a correct and timely diagnosis. A variety of tests are currently available for evaluation of the patient with an acute central nervous system infection. We review the current state of the art in central nervous system testing. Cost considerations and an algorithm for efficient selection of appropriate tests are presented.
A geriatrics curriculum for emergency medicine training programs.
The growing number of elderly in the United States will continue to increase the demand for emergency services. Although the emergency medicine core curriculum, as defined by the American College of Emergency Physicians, requires mandatory training in pediatrics, there is no mention of geriatric care. A special body of knowledge regarding normal aging as well as the special presentation of disease in the elderly is required to provide optimum care for the aged patient. We present an integrated geriatric curriculum designed to operate within a three-year emergency medicine residency program. This curriculum identifies specific educational objectives for training in geriatric emergencies that can be summarized as follows: identify those impairments and functional disorders that often complicate diagnosis and therapy; acquire an understanding of how physiologic changes in aging affect normal laboratory and radiologic values; develop knowledge of drug side effects and interactions in this population; understand and treat the group of disease peculiar to the elderly; recognize diseases and injuries that present a different clinical picture in old age; and differentiate and treat common psychosocial emergencies in the elderly. These educational objectives are further defined using a specific interlinked framework of didactic presentations, journal clubs, case conferences, therapeutic audits, formal rotations, and consultants. This format will provide valuable educational experiences for the emergency medicine resident and may strengthen positive attitudes toward geriatric medicine.
Cathartic-induced magnesium toxicity during overdose management.
A 39-year-old women was admitted to the hospital following a large ingestion of a tricyclic antidepressant. The administration of magnesium citrate in repeated doses with activated charcoal resulted in a striking increase in serum magnesium levels followed by acute neuromuscular deterioration and respiratory depression. The patient required dialysis for control of hypermagnesemia. Her clinical condition improved slowly without further complication and she was discharged to a rehabilitation center.