Percutaneous endoscopic gastrostomy feeding after acute dysphagic stroke. Speech and language therapists should have participated in study.
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Cerebrovascular Disorders↗
Biomedical subjects
J Kerr
Publications and source records attributed to J Kerr.
The crossover femoropopliteal bypass: a useful option for unilaterial iliofemoral occlusive disease.
OBJECTIVE: To study the outcome of treating critical limb ischaemia due to concurrent, unilateral iliac and femoral arterial occlusive disease by the placement of a crossover femoropopliteal bypass graft. DESIGN: Retrospective study of 10 patients unfit for aortic reconstruction whose disease was not amenable to endovascular therapy who were treated with this graft. MATERIALS: Seven grafts originated from the common femoral artery, two from aortobifemoral graft limbs and one from the common iliac artery. There was not direct revascularisation of the profunda femoris artery. The distal anastomosis was to the above-knee popliteal artery in nine cases and to the below-knee popliteal artery in one. OUTCOME MEASURES: Follow-up after discharge from hospital consisted of regular ankle-brachial index measurement and Duplex ultrasound scan assessment to record graft patency and limb salvage. RESULTS: The median duration of secondary patency was 52.5 months (range 14-84). During follow-up, there were four occlusive events. One graft had its patency restored, but in the other three patients, graft occlusion was associated with limb loss (at 18, 51 and 83 months respectively). In one of this latter group, surveillance had identified a failing graft and a jump graft prolonged patency for a further 34 months. CONCLUSION: This experience demonstrates that the crossover femoropopliteal bypass achieves satisfactory limb salvage in patients with extensive iliofemoral occlusive disease who are not suitable for major aortic reconstruction.
Aged↗
Volume rendering of visible human data for an anatomical virtual environment.
In this work, we utilize the axial anatomical human male sections from the National Library of Medicine's Visible Human Project to generate three-dimensional (3-D) volume representations of the human male subject. The two-dimensional (2-D) projection images were produced by combining ray tracing techniques with automated image segmentation routines. The resultant images provide accurate and realistic volumetric representations of the Visible Human data set which is ultimately needed in medical virtual environment simulation. Ray tracing techniques provide methods by which 2-D volume views of a 3-D voxel array can be produced. The cross-sectional images can be scanned at different angles to produce rotated views of the voxel array. By combining volume views at incremental angles over 360 degrees a full volumetric representation of the voxel array, in this case the human male data set, can be computer generated and displayed without the speed and memory limitations of trying to display the entire data array. Additional texture and feature information can be obtained from the data by applying optical property equations to the ray scans. The imaging effects that can be added to volume renderings using these equations include shading, shadowing, and transparency. The automated segmentation routines provide a means to distinguish between various anatomical structures of the body. These routines can be used to differentiate between skin, fat, muscle, cartilage, blood vessels, and bone. By combining automated segmentation routines with the ray-tracing techniques, 2-D volume views of various anatomical structures and features can be isolated from the full data set. Examples of these segmentation abilities are demonstrated for the human male data set which include volume views of the skeletal systems, the musculoskeletal system, and part of the vascular system. The methods described above allow us to generate lifelike images, NURBS surface models, and realistic texture maps of specific anatomical structures. We have the capability to generate images that are both accurate and lifelike, much like photographic anatomical atlases. We can also generate images, models, and textures that have the clarity of medical artwork/illustrations, by highlighting the coloring of the ray traced structures with conventional colors instead of the natural color of the specimen. We are currently in the process of generating a comprehensive reference atlas of volume rendered images of the human body, soon to be published by Mosby-Year Book. The segmentation techniques needed to create this atlas also offer the accuracy and realism needed to create surface models and texture maps for a virtual environment for surgery simulation.
Anatomy, Cross-Sectional↗
Thoracoscopic management of empyema in children.
The appropriate management of empyema in children is controversial. Traditional surgical approaches have included thoracotomy and open drainage, decortication, and thoracoplasty. While generally effective, these procedures can be associated with considerable morbidity. We have sought to assess the utility of video-assisted thoracoscopic adhesiolysis and pleural debridement for the treatment of empyema in children. Nine children with postpneumonic empyema unsuccessfully managed with a single attempt at closed tube thoracostomy underwent thoracoscopic drainage during the past 2 years. The empyema was successfully treated with this technique in seven patients with no further interventions being required. Procedures performed early in the fibrinopurulent stage were technically easier. The average time before chest tube removal was 8.5 days. An immunocompromised patient required a subsequent open decortication and a patient with a coagulopathy required two subsequent open procedures for drainage of a recurrent hemothorax. We conclude from this experience that video-assisted thoracoscopic adhesiolysis and pleural debridement can be successfully performed in children. Benefits include good visualization of the entire thoracic cavity for more effective debridement and efficient drainage, and subjectively diminished postoperative pain and associated morbidity.
Adolescent↗
Laparoscopic oophorectomy in children.
Laparoscopy is a well-established diagnostic and therapeutic modality for adult gynecologic surgery. We have sought to assess the feasibility of the laparoscopic approach to a particular gynecologic procedure, oophorectomy, in the pediatric population. Five patients under-went laparoscopic oophorectomy during the past year. The indication for oophorectomy in three cases was ovarian torsion---one in association with a hemorrhagic cyst another with a benign teratoma, and one that occurred prenatally. The fourth patient had a teratoma with significant solid component and the final patient was a young with Turner's syndrome who had laparoscopic exploration and removal of bilateral streak ovaries. Oophorectomy was successfully completed laparoscopically in each patient. In two cases a trocar site had to be widened to remove the specimen from the abdominal cavity. Post operative recovery was prompt, with time to discharge being an average of 2 days. From this experience we conclude that laparoscopic oophorectomy can be successfully accomplished in infants and children. It is technically an easy procedure and has the benefits of excellent visualization of the entire lower abdomen and pelvis including the contralateral ovary, rapid postoperative recovery, and good cosmetic result.
Adolescent↗
Increased expression of the NME1 gene is associated with metastasis in epithelial ovarian cancer.
The genetic events involved in the development of metastases of epithelial ovarian cancer are largely unknown. One gene postulated to play a role in tumour metastasis suppression is NME1 (nm23-H1), and an inverse relationship between NME1 expression and metastatic potential has been observed for some solid tumours. In this study we have investigated the levels of mRNA expression of the 2 isoforms of the NME gene, NME1 and NME2. A maximum of 45 tumours samples from 33 patients were available for Northern blot analysis. We observed variable levels expression of NME1 and NME2 mRNA. The average level of NME1, but not NME2, mRNA expression was statistically higher in metastatic biopsies when compared with primary tumour biopsies. To examine the possible tumour suppressor gene role of NME1 in ovarian tumours, 76 patients were investigated by Southern blot analysis to determine the rate of allelic deletion. Allele loss at 5 other chromosome 17 loci (D17S5, TP53, NF1, D17S74, D17S4) was also evaluated for many of these 76 patients. Allele loss was observed in 22/30 (73%) informative patients at the NME1 locus. We also observed high rates of allele loss at the other loci evaluated. No correlations with clinical stage, histological subtype or patient survival were observed in either mRNA or DNA analyses. We have established that tumour progression in ovarian cancer is accompanied by over-expression of the NME1 gene; however, despite high rates of allele loss at the NME1 locus, the concept that NME1 may be a candidate tumour suppressor gene in ovarian cancer cannot be confirmed by this study.
Base Sequence↗
The antibiotic cost calculator; an expert system for global antibiotic cost calculation.
An application to cost antibiotic therapy was developed using Object Vision, an object-oriented software development program. The application facilitates calculation of the cost of up to six antibiotics (three oral and three intravenous) in terms of acquisition, delivery, laboratory and complication components. The application consists of two files. The first file allows entry of basic cost data. The second file allows the user to define each antibiotic regimen and the management, and thus the cost, of complications relevant to the antibiotics being costed; costs are automatically calculated and displayed. The program also contains a help system; this comprises extensive explanation of each stage of the calculation process, a summary of recent literature on the percentage incidence of complications for commonly used antibiotics, and a bibliography. The summary and bibliography may be printed. The program is designed for use by hospitals, universities and pharmaceutical companies for calculation of total in-patient charges, marketing and research. It is a user-friendly system which dramatically reduces the inherent complexities of this area of medicine.
Anti-Bacterial Agents↗
Residual symptoms after partial remission: an important outcome in depression.
This paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.
Adolescent↗
Effects of bovine growth hormone (bGH) transgene expression or bGH treatment on reproductive functions in female mice.
Both physiological and excessive levels of growth hormone (GH) can affect reproductive functions. Overexpression of human (h) or bovine (b) GH in transgenic female mice was previously reported to be associated with reproductive deficits. The objectives of the present study were to determine the age of onset of puberty, the length of the estrous cycle, and the ovulation rate in transgenic and normal mice from a line expressing bGH with the phosphoenolpyruvate carboxykinase (PEPCK) promoter and characterized by very high levels of transgene expression. Transgenic females reached puberty, defined as the appearance of the vaginal introitus, earlier than their normal littermates, but at a higher body weight. Compared to normal animals, an increased number of transgenic females failed to mate during the 15-day period of observation, and pregnancy rates were reduced. However, ovulation rates, as estimated by counting CL and implantation sites on Day 7 postcoitum, were increased in transgenic females. Plasma bGH levels in transgenic females ranged from 700 to 2200 ng/ml and were negatively correlated with fertility. To assess the effect of bGH on the ovulation rate in non-transgenic mice, normal females were paired with normal males and injected for up to 3 days with either 0.75 mg bGH/day or 0.30 mg bGH/day (injected as a single dose or as 0.15 mg twice daily). Data from animals that mated after at least 2 days of bGH treatment were analyzed. The ovulation rate was increased in females treated with 0.75 mg bGH/day, as compared to controls, and in females injected with 0.15 mg bGH twice daily as compared to those given 0.3 mg bGH/day and to controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Infertility in transgenic mice overexpressing the bovine growth hormone gene: luteal failure secondary to prolactin deficiency.
Overexpression of growth hormone (GH) in transgenic mice is associated with various degrees of impairment of female reproductive functions. Transgenic PEPCK.bGH mice express high GH levels, and only around 20% of the females will carry gestation to Day 7. The objective of the present study was to investigate luteal function in PEPCK.bGH mice during early pregnancy, when CL are fully dependent on the pituitary. Plasma progesterone levels measured on Days 2 or 7 postcoitum (p.c.) were lower in transgenic than in normal females. In transgenic females with a previous history of infertility, daily injections of 1 mg progesterone starting on Day 2 p.c. significantly increased the proportion of animals pregnant on Day 7. When ovaries from transgenic mice were transplanted into ovariectomized normal littermates, the recipients exhibited normal vaginal cycles and responded to mating by vaginal cytology changes consistent with pseudopregnancy. In contrast, ovariectomized transgenic females bearing transplants of ovaries from normal mice had slightly prolonged estrous cycles and failed to become pseudopregnant after mating. Plasma progesterone levels on Days 2 and 7 p.c. in normal females with transgenic ovaries were not different from plasma progesterone levels measured in normal females into which normal ovaries had been transplanted. Twice-daily injections of 100 micrograms of prolactin (PRL) in saline or in polyvinylpyrrolidone starting on the evening of Day 2 p.c. were able to rescue luteal function. The proportion of PRL-injected transgenic animals that were pregnant on Day 7 was significantly higher than that of saline-injected transgenic controls and resembled the pregnancy rate of normal animals.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Infertility in transgenic mice overexpressing the bovine growth hormone gene: disruption of the neuroendocrine control of prolactin secretion during pregnancy.
Transgenic female mice overexpressing the bovine growth hormone (bGH) gene with the phosphoenolpyruvate carboxykinase (PEPCK) promoter exhibit severe reproductive deficits. Although these animals ovulate and conceive normally, pregnancy is arrested due to luteal failure, leading to the loss of embryos during early gestation. The results of replacement therapy suggested that luteal failure was secondary to prolactin (PRL) deficiency. The objective of this study was to examine the neuroendocrine control of PRL secretion during early pregnancy in PEPCKbGH-1 transgenic mice. Normal and transgenic littermates were killed by decapitation on Day 7 postcoitum (p.c.) at 1500, 1800, or 2100 h, i.e., the period including the expected diurnal PRL surge in pregnant mice. In normal females, plasma PRL levels were significantly elevated at 1800 h when compared to the levels measured at 1500 or 2100 h, but no temporal variation in PRL levels was found in transgenic mice. In normal females, the content of dopamine in the median eminence was reduced at 1800 h, i.e., at the time of the PRL surge. In contrast, no temporal changes were detected in the median eminence dopamine content in transgenic mice. Twice-daily injections of domperidone, a dopamine receptor blocker, increased the incidence of pregnancy in transgenic females. After treatment with aromatic amino acid decarboxylase inhibitor NSD-1015 on Day 7 p.c., plasma levels of PRL were similarly elevated in transgenic and normal females. However, the accumulation of 5-hydroxytryptophan (5-HTP) in the medial basal hypothalamus after this treatment was significantly smaller in transgenic than in normal females.(ABSTRACT TRUNCATED AT 250 WORDS)
5-Hydroxytryptophan↗
Antiinflammatory 4,5-diarylpyrroles: synthesis and QSAR.
A series of 2-substituted- and 2,3-disubstituted-4-(4-fluorophenyl)-5-[4-(methylsulfonyl)phenyl]-1H- pyrroles was synthesized and found to be active in the rat adjuvant arthritis model of inflammation. The most active compounds were the 2-halo derivatives in the order of chloro > bromo > iodo. The same pattern of activity was observed for the 2,3-dihalopyrroles. Quantitative structure-activity relationship studies suggested that the activity could be correlated with the molar refractivity and the inductive field effect of the 2-substituent and the lipophilicity of the 3-substituent.
Animals↗
Inhibition of fungal growth by Pseudomonas aeruginosa and Pseudomonas cepacia isolated from patients with cystic fibrosis.
This study was undertaken because of the infrequency of infections due to Candida species in patients with cystic fibrosis despite their extensive treatment with broad-spectrum antibiotics. In vitro susceptibility studies revealed significant inhibition of 11 strains of fungi known to infect human beings by 10 strains of Pseudomonas aeruginosa and nine strains of Pseudomonas cepacia isolated from the sputum of patients with cystic fibrosis. The fungi were Candida krusei, Candida keyfr, Candida guillermondii, Candida tropicalis, Candida lusitaniae, Candida parapsilosis, Candida pseudotropicalis, Candida albicans, Torulopsis glabrata, Saccharomyces cerevisiae and Aspergillus fumigatus. Inhibition of fungal growth by Escherichia coli (NCTC 10418), Staphylococcus aureus (NCTC 6571) and Haemophilus influenzae (NCTC 11931) could not be demonstrated. The continued presence in the sputum of patients with cystic fibrosis of strains of P. aeruginosa and P. cepacia, which produce antifungal substances, may inhibit growth of Candida species and so prevent overt Candida infections. A. fumigatus would seem to be the most important fungus causing disease in patients with cystic fibrosis. It is therefore interesting to note that this was the most resistant of all the fungi tested for inhibition by P. aeruginosa and P. cepacia.
Antibiosis↗
Homozygous deletions on the short arm of chromosome 9 in ovarian adenocarcinoma cell lines and loss of heterozygosity in sporadic tumors.
Rat ovarian surface epithelial cells transformed spontaneously in vitro have been found to have homozygous deletions of the interferon alpha (IFNA) gene. This suggests that inactivation of a tumor-suppressor gene in this region may be crucial for the development of ovarian cancer. We therefore used microsatellite markers and Southern analysis to examine the homologous region in humans--the short arm of chromosome 9--for deletions in sporadic ovarian adenocarcinomas and ovarian tumor cell lines. Loss of heterozygosity occurred in 34 (37%) of 91 informative sporadic tumors, including some benign, low-malignant-potential and early-stage tumors, suggesting that it is an early event in the development of ovarian adenocarcinoma. Furthermore, homozygous deletions on 9p were found in 2 of 10 independent cell lines. Deletion mapping of the tumors and lines indicates that the candidate suppressor gene inactivated as a consequence lies between D9S171 and the IFNA locus, a region that is also deleted in several other tumors and that contains the melanoma predisposition gene, MLM.
Adenocarcinoma↗
Fungal osteomyelitis of the temporal bone: a review of reported cases.
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Aspergillus flavus↗
Molecular mechanics calculations of the structures of polyamide nucleic acid DNA duplexes and triple helical hybrids.
Polyamide nucleic acids (PNAs) have emerged as useful agents for recognition of single- and double-stranded nucleic acids. Interresidue hydrogen bonds between the amide carbonyl nearest the nucleobase and chain NH moieties provide inherent stability to the helical conformation of PNA 1. Moving the amide carbonyl away from the nucleobase to the backbone, and replacing it with a methylene group, results in 2 lacking the stabilizing hydrogen bond. Oligomers of 2 do not interact with DNA. Modeling suggests that 2 displays a more extended conformation than 1, and nucleobase orientation is disrupted in 2 in the absence of a complementary DNA strand. This is in contrast to 1, which retains a centrosymmetric arrangement of nucleobases. Structures for 1-T10.DNA and (1-T10)2.DNA species spanned by a pyrimidine strand (D-loop) were constructed. In the triple helical (1-T10)2.DNA structure, the two PNA strands form the complementary Watson-Crick paired strand and the Hoogsteen base-paired strand in the major groove of the 1.DNA duplex. The PNA strands are proposed to bind antiparallel to one another in (1-T10)2.DNA structure. The factors suggested to account for the stability of this 2:1 complex are (i) a hydrophobic attraction between two PNA backbones and (ii) a favorable electrostatic effect resulting from replacement of a phosphodiester backbone by a neutral peptide backbone.
Base Sequence↗
Support for newly qualified entrants to the speech and language therapy profession. Implications for managers.
Reports on a survey of 1990 and 1991 graduates entering the speech and language therapy profession in the UK and on the experiences of six new therapists in one "good practice" area, Ayrshire and Arran Health Board. Results show that new therapists were given a great deal of help and support from professional managers, and valued it highly. They chose posts which offered a mixed client load and good induction packages. Pre-service training reflected work carried out in service, but all client groups had not been accessed during training. Issues relating to throughput and case-load management required most support. They made successful personal adaptations to the work environment, and managers found them effective overall. Calculates the costs of supporting new therapists. Highlights the need to maintain professional support and discusses the potential difficulties involved in doing so in relation to NHS reforms.
Adult↗