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Biomedical subjects

J Munro

Publications and source records attributed to J Munro.

At least 73 records · Page 4Linked to original sources
PubMed1995

Calcium channel blockade and uncontrolled blood pressure during phaeochromocytoma surgery.

Phaeochromocytoma has traditionally been managed by preoperative adrenergic blockade followed by surgical devascularization and excision. Recently, various studies have reported the use of calcium channel blocking drug therapy, either as monotherapy or in combination with other non-adrenergic blocking antihypertensive medications for blood pressure control in the preoperative management of phaeochromocytoma. In this case report, diltiazem as monotherapy was used to establish adequate preoperative blood pressure control in a patient with metastatic phaeochromocytoma to the liver. During cryoablation therapy surgery of the liver metastasis, the patient demonstrated extreme blood pressure lability requiring nitroprusside and high end tidal concentrations of isoflurane for blood pressure control. This case report suggests that during resection of a phaeochromocytoma where tumour devascularization is not obtainable, calcium channel blocking drugs as monotherapy may be inadequate to control blood pressure extremes. The authors suggest that under clinical circumstances reported above strong consideration be given to the use of standard adrenergic blocking drug therapy pre- and intraoperatively.

Aged↗
PubMed1995

Can we prevent accidental injury to adolescents? A systematic review of the evidence.

OBJECTIVES: As part of the Department of Health strategy The Health of the Nation, a systematic review of published and unpublished literature relating to the effectiveness of interventions in reducing accidental injury in the population aged 15-24 years was carried out. METHODS: The literature was reviewed under the standard setting headings of road, work, home, and sports and leisure, and graded for quality of evidence and strength of recommendation using a scale published in the UK national epidemiologically based needs assessment programme. RESULTS: The most effective measures appear to be legislative and regulatory controls in road, sport, and workplace settings. Environmental engineering measures on the road and in sports have relatively low implementation costs and result in fewer injuries at all ages. There is little evidence that purely educational measures reduced injuries in the short term. Community based approaches may be effective in all age groups, and incentives to encourage safer behaviour hold promise but require further evaluation. The potential of multifactorial approaches seems greater than narrowly based linear approaches. CONCLUSIONS: Few interventions to reduce injury in adolescents have been rigorously evaluated using good quality randomised controlled trials, and where such evidence is available, fewer have been shown to be definitely worthwhile. Many studies relied on surrogate measures rather than actual injury rates, and substantial issues relating to the efficacy or implementation of preventive measures in adolescent and young adult populations remain unresolved.

Accident Prevention↗
PubMed1994

Measles in secondary school children: implications for vaccination policy.

The reported incidence of measles in children of secondary school age rose in 1992, after a progressive decline between 1988 and 1991. This rise was maintained in 1993. Several school and community based outbreaks of measles have occurred in the United Kingdom. This paper reports the investigation of an outbreak of measles based in a secondary school, which took place in 1992. Thirty clinical cases were detected among the school's 840 pupils and 10 sporadic cases occurred outside the school. Twenty-one of the school cases provided samples of serum, in 19 of which measles IgM was detected. The overall attack rate was 3.6%, with no significant differences attributable to age and sex. Vaccine efficacy was about 90%. This outbreak is one of the first to be described in the United Kingdom, although other countries (notably the United States) have reported measles in teenagers. The small degree of spread in the community may reflect the current high uptake of measles, mumps, and rubella vaccine and the catch up campaign that took place in 1988. The feasibility and cost effectiveness of various policy options to prevent future outbreaks in secondary schools are now being evaluated.

Adolescent↗
PubMed1994

The phylogenetic position of Pseudoamycolata halophobica (Akimov et al. 1989) and a proposal to reclassify it as Pseudonocardia halophobica.

The genus Pseudoamycolata was proposed for actinomycetes which closely resembled Amycolata species in most phenotypic features but lacked a key chemotaxonomic marker, phosphatidylcholine. We sequenced the 16S ribosomal DNA of Pseudoamycolata halophobica and found that this organism is very closely related to the genus Pseudonocardia, which now contains all of the strains formerly classified as members of the genus Amycolata. In light of these data, we believe that the absence of a single chemical characteristic is not sufficient to justify forming a new genus, and we propose that Pseudoamycolata halophobica (Akimov et al. 1989) should be reclassified as Pseudonocardia halophobica. The type strain is strain DSM 43089.

Actinomycetales↗
PubMed1994

Functional neuroimaging and pharmacogenetic studies of clozapine's action at dopamine receptors.

The factors that influence response to neuroleptic drugs are poorly understood. These factors may include clinical variables such as length of illness before treatment, age at onset, and the presence of negative symptoms; and pharmacologic factors such as rates of drug metabolism. For example, pharmacodynamic differences in therapeutic response to haloperidol have been observed between Chinese and Caucasian patients. Response rates may also reflect clinical heterogeneity, although familiality, history of obstetric trauma, or ventricular enlargement have been not shown to be significant factors. It is also possible that genetic differences in receptors that are targets for these drugs may influence response.

Adult↗
PubMed1993

Impulsivity and dyscontrol in bulimia nervosa: is impulsivity an independent phenomenon or a marker of severity?

Fifty-eight normal-weight DSM-III-R bulimia nervosa patients were compared with 27 normal controls on measures of bulimia nervosa, depression, impulsivity, obsessionality and impulse control (dyscontrol) behaviours. Patients scored higher than controls on all these measures. Almost half the patient cohort met Lacey's multi-impulsive bulimia criteria. When bulimic symptoms were controlled for in an analysis of covariance, multi-impulsive bulimics did not score significantly differently to non-impulsive bulimics on psychometric measures of impulsivity, obsessionality and depression. The concept of impulsivity is critically reviewed and newer concepts linking obsessionality and impulsivity are explored.

Adult↗
PubMed1993

A comparison of patient attitudes toward asthma self-management among acute and preventive care settings.

This study characterizes the attitudes regarding asthma and asthma care of low-income, African-American adults who receive care from acute care settings. As a point of reference, their attitudes and knowledge were compared with those of a group of patients receiving asthma care from a private setting that stresses preventive asthma self-management. Patients were assessed regarding attitudes toward (1) routine asthma self-care and decisions as to when to self-treat versus seek asthma care, (2) administration of asthma medications, (3) satisfaction with acute-care services, and (4) the desire for asthma education. Asthma morbidity, sociodemographic characteristics, awareness of environmental triggers, and daily stressors were also assessed. Responses of adults receiving most of their asthma care from acute care settings suggest the same pattern of failure to treat asthma regularly and delay in seeking care as implicated in asthma deaths among children. Emphasis on self-treatment of asthma symptoms, not preventive self-management, was apparent among the attitudes of the acute care patients. Lack of regular care, delay of treatment, and reliance on self-treatment via over-the-counter medications was noted. Implications of these findings for the development of asthma education programs are addressed.

Adult↗
PubMed1992

Why does length of stay vary for orthopaedic surgery?

This study examines the variation in length of stay in orthopaedic surgery in Grampian in 1988. It highlights the extent of variability across clinicians for patients with the same condition. The results indicate the importance of patient's age, type of admission and Diagnosis-Related Group. The inclusion of variables to identify the consultant in charge significantly improves the explanatory power of the model for all of the seven conditions investigated.

Adult↗
PubMed1992

Twenty-four hour C-peptide and insulin secretion rates and diurnal profiles of glucose, lipids and intermediary metabolites in cirrhosis.

1. To examine the contributions of hypersecretion and decreased insulin clearance to the hyperinsulinaemia of cirrhosis, insulin secretion was calculated over the day from serum C-peptide concentrations and C-peptide metabolic clearance rate. The latter was measured during infusions of recombinant human C-peptide. In cirrhotic patients (n = 9) insulin secretion rate was twice that of normal control subjects (n = 10), both in the basal state [02.00-07.00 hours, 15.7 +/- 2.1 (mean +/- SEM) nmol/h (2.6 +/- 0.4 units/h) versus 7.0 +/- 0.9 nmol/h (1.2 +/- 0.2 units/h), P < 0.002] and over 24 h [787 +/- 93 nmol (132 +/- 16 units) versus 346 +/- 34 nmol (58 +/- 6 units), P < 0.001]. However, the area under the serum insulin concentration curve was approximately six times greater in the cirrhotic patients (24 h basal, 6.3 +/- 1.0 versus 1.1 +/- 0.3 nmol l-1 h, P < 0.001; 24 h total, 21.7 +/- 3.2 versus 3.7 +/- 0.7 nmol l-1 h, P < 0.001). Thus, despite impairment of insulin clearance there is continuing hypersecretion of insulin in cirrhosis. 2. The relationship of carbohydrate and lipid metabolism with insulin secretion was assessed. In cirrhotic patients, 24 h blood glucose profiles showed a worsening of glucose tolerance over breakfast, despite greater insulin secretion compared with other meals, suggesting that the insulin insensitivity of cirrhosis is worse at this time. 3. Cirrhotic patients showed impaired suppression of blood glycerol levels after meals but normal suppression of serum non-esterified fatty acid concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Hydroxybutyric Acid↗
PubMed1992

Herpes simplex virus encephalitis: problems in diagnosis.

Six children aged 13 days to nine years with herpes simplex encephalitis (HSE) are presented. Institution of appropriate antiviral treatment was later than six days in three cases; original diagnosis in these cases were post-traumatic epilepsy, bacterial meningitis and febrile convulsion. Initially pyrexia was absent in two cases and cranial CT was normal in two cases. Encephalitic changes were observed on the EEGs of five children. Diagnosis was confirmed by paired serological titres, brain biopsy, vesicle culture and CSF titres. The outcome for all six children was poor. HSE should always be considered in children presenting with focal seizures, even when apyrexial and with normal CT findings. In such situations, saving CSF for antibody titres or antigen identification should be routine practice. Treatment with acyclovir is justified before precise virological diagnosis has been established.

Adolescent↗
PubMed1992

Detection of human papillomavirus DNA in skin warts from immunocompromised patients but not in semen from men whose wives have abnormal cervical cytology.

The epidemiology of human papillomaviruses (HPV) was studied in 61 immunocompromised patients (e.g. renal and cardiac transplants; Bowen's disease; genital cancer) undergoing therapy at the University Hospital of Wales at Cardiff U.K. Warts from various sites of these patients were studied for the presence of HPV types 6, 11, 16 and 18 using the dot-blot DNA hybridization technique. Four HPV-16 and one HPV-11 was detected. The presence of HPV-16 in our study is quite significant since it suggests the potential occurrence of genital HPV types in skin warts in immunocompromised patients and hence the need for screening such patients against HPV types. HPV, mainly types 16 and 18 are usually associated with genital cancer, cervical malignancies and cervical intraepithelial neoplasia. The semen of the husband of 30 women with cervical abnormalities and the semen of 30 husbands (control) of wives with normal cervix were tested for HPV-6, 11, 16 and 18. No HPV-DNA could be detected in all of the 60 specimen. This suggests that specimens were either truly negative for any of those types or because virus DNA could present in a small amount less than 5 pg/microliters in some patients. Whether semen plays a role in transmitting HPV is still controversial.

Condylomata Acuminata↗