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Biomedical subjects

J M Gray

Publications and source records attributed to J M Gray.

At least 19 recordsLinked to original sources
PubMed2004

Management of the giant-cell tumours of the distal radius.

BACKGROUND: Giant-cell tumour of the distal radius is a rare neoplasm that affects the peri-articular metaphysial region of the bone. Curettage alone or with bone grafting has been reported to be associated with high incidence of local recurrence in these tumours. In the present series, we report the results of curettage only as the treatment for primary giant-cell tumour of the distal radius carried out at a single centre. PATIENTS AND RESULTS: A total of 287 patients with giant-cell tumour have been referred to us for treatment over the last 28 years; 24 of these were found to have lesion in the distal radius. One patient underwent endoprosthetic replacement of the distal radius. The remaining 23 patients underwent curettage of the primary neoplasm. Four out of the 23 (17%) patients developed local recurrence of disease, The mean time to local recurrence was 17 months (range, 9-27 months). Complications such as collapse of the articular cartilage are more common in patients with an extensive soft tissue component of the tumour. CONCLUSIONS: Curettage alone is adequate treatment for the majority of patients with giant-cell tumours of the distal radius but some form of stabilisation may be required in the presence of extensive bone destruction.

Adolescent↗
PubMed2001

Peroneal tenosynovitis following ankle sprains.

Peroneal tenosynovitis has a variety of causes which include inversion injury of the ankle. It is rarely reported and frequently misdiagnosed. We report the operative findings and outcome of surgical decompression in 19 patients who clinically presented following inversion injury with features suggestive of peroneal tenosynovitis. A review of the literature of this pathology is presented.

Adult↗
PubMed2000

Cognitive deficit induced by acute tryptophan depletion in patients with Alzheimer's disease.

OBJECTIVE: The study assessed the effects on global cognitive function and mood of a reduction of brain serotonin by means of acute tryptophan depletion in 16 patients with dementia of the Alzheimer type and in 16 cognitively intact comparison subjects. METHOD: In a double-blind, crossover design, subjects received a tryptophan-free amino acid drink to induce acute tryptophan depletion and, on a separate occasion, a placebo drink containing a balanced mixture of amino acids. On each occasion, ratings of depressed mood were made at baseline and 4 and 7 hours later, and the Modified Mini-Mental State was administered at baseline and 4 hours later. RESULTS: Patients with dementia of the Alzheimer type had a significantly lower mean score on the Modified Mini-Mental State after acute tryptophan depletion than after receiving placebo. The comparison group showed no difference in mean score on the Modified Mini-Mental State after acute tryptophan depletion and after receiving placebo. No significant changes in mood were found in either group. CONCLUSIONS: Acute tryptophan depletion significantly impaired cognitive function in patients with dementia of the Alzheimer type. Compromised serotonergic function, in combination with cholinergic deficit, may make an important contribution to cognitive decline in dementia of the Alzheimer type.

Aged↗
PubMed1999

The standardized family: an innovation in primary care education at the University of Massachusetts.

In 1995 as part of The Robert Wood Johnson Foundation's Generalist Physician Initiative, the University of Massachusetts (UMass) Medical School developed the "standardized family" as a new model for teaching the essential elements of primary care in a core curriculum format outside of the clinical setting. Using this model, a hypothetical family unit (the "McQ Family") serves as the focus for case-based clinical problem solving. This paper describes the standardized family model and provides two years of evaluation outcomes such as curriculum assessments, student performance outcomes, and correlation with external measures of clinical performance to support the effectiveness of this educational model. It discusses the transferability of the standardized family model from UMass Medical School to Pennsylvania State University College of Medicine and uses Pennsylvania State's adaptation (the "Hershey-Penn Family") to illustrate how the standardized family can be customized to integrate a core curriculum into a three-year longitudinal primary care program. The authors suggest that the standardized family model has the potential to meet a broad range of primary care teaching needs at other institutions.

Curriculum↗
PubMed1998

Effects of tamoxifen, fluphenazine and estradiol on ATP levels in preoptic area and hypothalamic slices from ovariectomized rats.

Tamoxifen, the major adjuvant drug treatment for estrogen-dependent breast cancer, has been shown previously to affect both estrogen-dependent and calcium/calmodulin-dependent pathways. In the current study, we developed an in vitro slice system to study the effects of tamoxifen on ATP levels in hypothalamic (HTH) and preoptic areas (POA) of the rat brain. Baseline data showed that, following a 2-h incubation, HTH and POA slices had comparable ATP levels to hippocampal slices, a system used extensively by researchers examining the metabolic responsiveness of the hippocampal region (HPC) of the brain. HTH-POA slice ATP levels remained steady for 2, 4 and 6 h, but fell to 11% of initial levels by 12 h. Neurons from HTH-POA slices incubated for 4 h appeared healthy and demonstrated robust protein synthesis as measured autoradiographically by incorporation of [3H]leucine. We explored the effects of tamoxifen (TAM), fluphenazine (FLU) and estradiol (E2) on ATP levels in HTH and POA slices. The effects of TAM were complex: a 4-h incubation with 10-6 M TAM led to decreased ATP levels in HTH (but not POA), and a 4-h incubation with 10-8 M led to increased ATP levels in POA (but not HTH); a 15-min exposure to 10-6 M TAM decreased ATP levels in POA (but not HTH) slices, while the exposure of slices to the lower concentration of TAM was without effect in either area. As with higher concentrations of TAM, 4-h incubation with 10-6 M FLU decreased ATP levels in HTH (but not POA), while incubation with E2 did not affect slice ATP levels. These data are consistent with the hypothesis that both TAM and FLU alter ATP levels in HTH slices via calmodulin- or calcium-mediated processes.

Adenosine Triphosphate↗
PubMed1998

Development of the technology for 'Diprifusor' TCI systems.

The availability of fast-acting intravenous drugs for anaesthesia has encouraged anaesthetists to gain a practical understanding of the pharmacodynamics and pharmacokinetics of these drugs to optimise their administration. 'Diprifusor' technology uses pharmacokinetic modelling to control the infusion rate of a pump, providing the anaesthetist with direct control of the blood concentration rather than indirect control by the infusion rate. The 'Diprifusor' electronics module is a dual microprocessor component that can be incorporated into an infusion pump to provide this mode of administration. This paper describes the module's infusion control system, prefilled syringe recognition system and the safety aspects addressed by the design.

Anesthesia, Intravenous↗
PubMed1998

Putting occupation into practice: occupation as ends, occupation as means.

This article addresses a difficulty that many occupational therapists experience: maintaining occupation as the core of their therapeutic intervention. This difficulty not only results from but also contributes to occupational therapy's struggle with professional identity. Current manifestations of the problem are described as component-driven practice and the narrowing of occupation to basic activities of daily living. The concepts of occupation as ends and occupation as means are proposed as a practical solution to guide treatment planning and merge remediation and adaptation within a single occupational session. Each concept is investigated in terms of its history within the profession and its usefulness for analyzing and solving therapeutic problems. These concepts are discussed as useful guidelines to help occupational therapists not only in their clinical decision making but also in their understanding and expression of the field's unique expertise. A case example, applying occupation as ends and occupation as means to evaluation and treatment, is presented.

Activities of Daily Living↗
PubMed1997

Impaired recognition of disgust in Huntington's disease gene carriers.

Face processing and facial expression recognition were investigated in the earliest stages of Huntington's disease, by studying 40 people who presented for genetic testing. Twenty-three of these 'at risk' individuals turned out not to carry the gene for Huntington's disease (the AR- group). Seventeen were found to be gene carriers (the AR+ group); 15 from genetic testing, and two who showed signs of early stages of Huntington's disease. A number of standard tasks were used to provide background information, including recognition memory for words, picture naming, verbal fluency, and figure copying; none revealed significant differences between the AR+ and AR- groups. Face processing abilities were investigated using tests of identification of familiar (famous) faces, unfamiliar face matching, recognition memory for faces, and recognition of facial expressions of emotion. No statistically significant differences between the AR+ and AR- groups were found for any of these tests, but the AR+ group showed a borderline overall impairment in recognizing facial expressions of emotion (0.05 < P < 0.1). When recognition of each of the six basic emotions used was examined separately, only disgust was found to be significantly impaired. This highly selective deficit in the recognition of disgust was confirmed in the subgroup of 15 individuals shown by genetic testing to be Huntington's gene carriers; it was therefore found in people who were free from clinical symptoms and did not perform significantly more poorly than non-carriers on any of the background tests, on any of the other face processing tasks, and even for recognition of any other basic emotion. This points strongly to the importance of the basal ganglia in the emotion of disgust.

Adult↗
PubMed1996

Late rehabilitation for closed head injury: a follow-up study of patients 1 year from time of discharge.

Subsequent to the setting up of an outpatient psychological service for head-injured patients, 50 patients were interviewed a year from the time of their discharge from our neurorehabilitation unit. The problems which persisted at this stage are presented and discussed. Some of the difficulties encountered in the evaluation of rehabilitation effects are identified. We conclude that: (1) there is a desperate need in the UK for more long-term support and rehabilitation services for this group of patients and (2) it is essential that such services are carefully monitored and evaluated despite the difficulties involved.

Adolescent↗
PubMed1995

Differing mechanisms of action of angiotensin-converting enzyme inhibition in black and white hypertensive patients. The Trandolapril Multicenter Study Group.

The antihypertensive effect of the angiotensin-converting enzyme inhibitor trandolapril administered in doses of 1, 2, and 4 mg/d was compared in 207 white patients and 91 black patients with mild to moderate hypertension following a double-blind, randomized, placebo-controlled, parallel study design. Trandolapril is a prodrug that is rapidly hydrolyzed to its active diacid metabolite, trandolaprilat. After 6 weeks of double-blind treatment, trandolapril lowered baseline sitting diastolic pressure in both white and black patients. A comparison of the antihypertensive response of the two populations revealed that the black patients required between two and four times the dose of trandolapril to obtain a response similar to that observed in the white patients. A dose of 1 mg/d trandolapril resulted in a 6.1 mm Hg mean decrease in baseline sitting diastolic pressure for white patients; a similar response (-6.5 mm Hg) was observed in the black patients at 4 mg/d. In contrast to the population differences in blood pressure, the decreases in angiotensin-converting enzyme activity were similar for both populations. An evaluation of trandolaprilat levels revealed that there were no racial differences in the trandolaprilat concentrations required to achieve a given degree of angiotensin-converting enzyme inhibition. Therefore, it appears that the antihypertensive response of black patients is not completely explained by a reduction in angiotensin-converting enzyme activity. The lack of response at a lower dose but increasing response at a higher dose could reflect another vasodepressor activity of trandolapril or just be evidence of reduced sensitivity of high blood pressure in blacks to angiotensin-converting enzyme inhibition.

Aldosterone↗
PubMed1993

Complex balance reactions in different sensory conditions: adolescents with and without idiopathic scoliosis.

We measured simple and complex balance responses with a force plate stabiliometer in 70 adolescents: 50 with idiopathic scoliosis (IS) and 20 controls. In stable static balance positions, the two groups performed similarly, but when the visual and somatosensory systems were challenged simultaneously, the IS group had a significantly higher mean body sway than the controls. Within the IS group, children with mild, nonprogressive curves that had not been operated on were significantly more likely to maintain their balance when the visual and somatosensory systems were challenged simultaneously than those with curves > or = 40 degrees, who had had surgery, and who had more rapid progression of the curve. These findings suggest that adolescents with IS have normal balance in static, stable positions but are not able to perform as well as normal adolescents in sensory-challenged positions, particularly if they have a severe, progressive curve. Longitudinal studies are needed to determine whether balance dysfunction can be used to predict progression of the curve.

Adolescent↗
PubMed1993

Estrogens and antiestrogens: actions and interactions with fluphenazine on food intake and body weight in rats.

Treatment of ovariectomized rats for 3 days with 2 micrograms estradiol benzoate (E2B), 6 micrograms ethinyl estradiol, or 1-2 mg of either of the antiestrogens nafoxidine or tamoxifen led to similar decreases in food intake, body weight gain, adipose tissue lipoprotein lipase activity, and hepatic fatty acid synthetase activity, despite their different effects on uterine growth and induction of progestin receptors in pituitary and adipose tissue. Longer-term (2 wk) treatment with tamoxifen resulted in similar transient changes in food intake and body weight gain, as did treatment with E2B. Daily administration of 50 micrograms fluphenazine (FLU) led to significant decreases in body weight, although there was no change in food intake. Concurrent administration of FLU with either E2B or tamoxifen led to additive effects on body weight and food intake change. None of the treatments had any effect on in vitro binding of [3H]tamoxifen to antiestrogen binding sites in pooled hypothalamic-preoptic area samples.

Animals↗
PubMed1993

ICI 182,780: a pure antiestrogen that affects behaviors and energy balance in rats without acting in the brain.

ICI 182,780 is one of a new class of steroidal antiestrogens that differs from nonsteroidal antiestrogens, such as tamoxifen, in a number of respects. 1) It is bound by estrogen receptors with a high affinity, similar to that for estradiol. 2) It is a "pure" antiestrogen in that it does not mimic any of the effects of estradiol. 3) This class of antiestrogens does not seem to be bound by antiestrogen binding sites. 4) ICI 182,780 may not be active in the brain after peripheral administration. Indeed, ICI 182,780 blocked in vivo cell nuclear binding of [3H]estradiol in uterus, pituitary, and adipose tissue but not in hypothalamus-preoptic area. In vitro, ICI 182,780 competed for binding by neural estrogen receptors with an affinity comparable with that for estradiol. When given to ovariectomized rats, ICI 182,780 did not mimic any of the actions of estradiol. Instead, ICI 182,780 treatment completely blocked the uterotrophic effects of estradiol and attenuated the actions of estradiol on linear growth, carcass fat content, fat pad weight, and sexual receptivity. Treatment with ICI 182,780 also attenuated the estrogenic effects of tamoxifen on food intake, body weight and composition, linear growth, and uterine weight. These findings support the concept that, in addition to its actions in the brain, estradiol can act peripherally to modulate regulatory behaviors, energy balance, and estrous behavior. They are also consistent with the hypothesis that nonsteroidal antiestrogens, such as tamoxifen, affect energy balance via estrogen receptors, rather than antiestrogen binding sites.

Animals↗
PubMed1993

Sacroiliac joint pyarthrosis.

Sacroiliac (SI) joint infection is rare, and symptoms are idiosyncratic and often confusing. This paper reviews six cases of SI joint infection with regard to their clinical manifestations, diagnostic imaging, and treatment. The six patients were seen over a 15-year period and had a mean age of 16.2 years and a mean follow-up of 44.2 months. The most common presenting symptom was fever (71.4%). The most common physical findings were elevated temperature and limited ipsilateral hip motion. In most cases the white blood cell count and erythrocyte sedimentation rate were elevated, and 71% of the cases had positive blood cultures. The most specific imaging study was the technetium bone scan. All patients were treated with 3 to 6 weeks of appropriate antibiotics and were asymptomatic and had a normal physical examination on follow-up. Routine anteroposterior roentgenograms of the pelvis demonstrated sclerosis of the affected SI joint in one third of the cases. There appeared to be no long-term sequelae in this group of patients.

Acute Disease↗
PubMed1992

Antiestrogen binding sites in brain and pituitary of ovariectomized rats.

In addition to interacting with estrogen binding sites in a number of tissues, antiestrogens have recently been shown to interact with a separate, estrogen-non-compatible, antiestrogen-specific binding site (AEBS). In order to better understand possible mechanisms by which the antiestrogens may effect behavioral and physiological changes, we have examined AEBS in several areas of the brain and pituitary in adult, ovariectomized rats. Single point binding assays with 2 nM [3H]tamoxifen (TAM) in the presence of saturating amounts (1 microM) E and +/- 1 microM TAM indicated the existence of specific binding to AEBS throughout the brain and pituitary. In most areas of the brain (cortex, cerebellum, amygdala, area postrema/nucleus of the solitary tract region) as well as pituitary. Scatchard analyses revealed the presence of a single AEBS with a dissociation constant (Kd = 1-4 x 10(-9) M) similar to that previously reported for other tissues. However, in both hypothalamus and preoptic area, an additional, higher affinity site (Kd = 6-9 x 10(-11) M) was found. Competitive inhibition studies revealed that there was little competition by the potent estrogen agonist, diethylstilbesterol, for AEBS binding. Antiestrogens competed in the following order: tamoxifen greater than or equal to nafoxidine much greater than keoxifene. Additional competitive inhibition studies were run using neurotransmitter antagonists. The phenothiazines, chlorpromazine and fluphenazine, bind to both D1 and D2 dopamine receptors and effectively compete with [3H]TAM for binding at the AEBS. Other pharmacological substances, including specific antagonists of the D2 sites, as well as antagonists of the norepinephrine, opiate, histamine, GABA and acetylcholine systems, were ineffective competitors for [3H]TAM binding.

Animals↗
PubMed1991

Lithotripsy as an outpatient service.

A lithotripsy outpatient service was introduced in Hamilton in April 1989 and between then and July 1990 452 patients with renal calculi were treated. The patients came from throughout New Zealand. A three month follow up showed that with stones less than 20 mm in diameter there was total clearance of residual fragments of less than 2 mm in 70% of patients. With stones of diameter greater than 20 mm the clearance rate was 50%. Posttreatment complications needing medical assistance occurred in 7% (31 patients). In 21 patients the stone either could not be found or did not disintegrate.

Ambulatory Care↗