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Biomedical subjects

J Norman

Publications and source records attributed to J Norman.

At least 91 records · Page 5Linked to original sources
PubMed1997

Minimally invasive videoscopic parathyroidectomy: a feasibility study in dogs and humans.

BACKGROUND: With increasing experience using preoperative sestamibi nuclear scanning, several reports have shown that selective unilateral neck exploration is sufficient in most patients with primary hyperparathyroidism. The current study was undertaken to determine the feasibility of videoscopic parathyroidectomy as a means to decrease scar size while allowing adequate exposure for the identification of normal parathyroid glands and removal of those glands that are enlarged. STUDY DESIGN: Eight mongrel dogs underwent removal of all parathyroid glands and both lobes of the thyroid using videoscopic techniques. Once the technical aspects of the operation were established, four patients with primary hyperparathyroidism underwent sestamibi-directed unilateral videoscopic neck exploration with attempted parathyroid removal. RESULTS: All thyroid and parathyroid tissues were removed from each dog without complications. Maintenance of an adequate working space proved to be the major difficulty that necessitated placement of a small mechanical retractor. This problem was even more severe in humans, which prevented the identification of one of four adenomas and three of four normal glands. CONCLUSIONS: Although videoscopic surgery is possible within the loose connective tissues of the canine neck, the inability to establish an adequate working space within the neck of humans and the location of parathyroid glands behind the thyroid precludes the use of this technique for patients with hyperparathyroidism.

Adenoma↗
PubMed1997

Confirmatory interleukin-1 receptor antagonist trial in severe sepsis: a phase III, randomized, double-blind, placebo-controlled, multicenter trial. The Interleukin-1 Receptor Antagonist Sepsis Investigator Group.

OBJECTIVE: To determine the therapeutic efficacy and safety of recombinant human interleukin-1 receptor antagonist (rhIL-1ra) in the treatment of patients with severe sepsis. DESIGN: Prospective, randomized, double-blind, placebo-controlled, multicenter trial with a planned, midstudy, interim analysis. SETTING: Ninety-one academic medical center intensive care units in North America and Europe. PATIENTS: Patients with severe sepsis or septic shock (n = 696) received standard supportive care and antimicrobial therapy for sepsis, in addition to rhIL-1ra or placebo. INTERVENTIONS: Patients were randomized to receive either rhIL-1ra (100 mg) or placebo (vehicle) by intravenous bolus, followed by a 72-hr continuous intravenous infusion of either rhIL-1ra (2.0 mg/kg/hr) or placebo. MEASUREMENTS AND MAIN RESULTS: The study was terminated after an interim analysis found that it was unlikely that the primary efficacy end points would be met. The 28-day, all-cause mortality rate was 33.1% (116/350) in the rhIL-1ra treatment group, while the mortality rate in the placebo group was 36.4% (126/346), yielding a 9% reduction in mortality rate (p = .36). The patients were well matched at the time of study entry; 52.9% of placebo-treated patients were in shock while 50.9% of rhIL-1ra-treated patients were in shock at the time of study entry (p = .30). The mortality rate did not significantly differ between treatment groups when analyzed on the basis of site of infection, infecting microorganism, presence of bacteremia, shock, organ dysfunction, or predicted risk of mortality at the time of study entry. No excess number of adverse reactions or microbial superinfections were attributable to rhIL-1ra treatment in this study. CONCLUSIONS: A 72-hr, continuous intravenous infusion of rhIL-1ra failed to demonstrate a statistically significant reduction in mortality when compared with standard therapy in this multicenter clinical trial. If rhIL-1ra treatment has any therapeutic activity in severe sepsis, the incremental benefits are small and will be difficult to demonstrate in a patient population as defined by this clinical trial.

Adult↗
PubMed1997

Is HTLV-1 status another antenatal screening test that we need?

Human T-lymphocytic virus type 1 (HTLV-1) carriage is associated with a 2% to 5% lifetime risk of developing a severe, if not fatal, disease. In our Inner London antenatal population, we found that the carrier rate was 0.3%. The antenatal transmission rate is known to be very low, but if the infant is breastfed the transmission rate is up to 25%. It is therefore possible to interrupt the transmission cycle by advising against breastfeeding. The ethical and fiscal issues surrounding antenatal testing are addressed.

Enzyme-Linked Immunosorbent Assay↗
PubMed1997

The Technique of Intraoperative Nuclear Mapping to Facilitate Minimally Invasive Parathyroidectomy.

BACKGROUND: Despite the fact that primary hyperparathyroidism (HPTH) is the result of a single adenoma in 85% to 92% of cases and is cured following the removal of this one gland, many surgeons continue to perform a complete bilateral neck exploration for patients with primary HPTH. The advent of the sestamibi scan now enables the identification of patients with a single adenoma. METHODS: The use of preoperative sestamibi scanning followed immediately by minimally invasive parathyroidectomy using intraoperative nuclear mapping allows cure for primary HPTH in properly selected patients. RESULTS: Reports have shown that preoperative sestamibi scanning has a sensitivity of approximately 90% and a specificity of almost 100% in identifying patients with a single adenoma. Intraoperative mapping allows a limited dissection to be performed under local anesthesia in an outpatient setting in approximately 80% of all patients with primary hyperparathyroidism. The details of this new technique - patient selection, timing, use of the intraoperative nuclear probe, and surgical exploration - are described. CONCLUSIONS: When selected appropriately, most patients with primary HPTH can be successfully treated through a minimally invasive technique.

Journal Article↗
PubMed1997

Small molecule inhibition of tumor necrosis factor gene processing during acute pancreatitis prevents cytokine cascade progression and attenuates pancreatitis severity.

The morbidity and mortality associated with acute pancreatitis are primarily a result of pancreatic parenchymal necrosis and the development of marked pulmonary dysfunction. Recent evidence suggests that both of these conditions are propagated by interleukin (IL)-1 beta and tumor necrosis factor (TNF)-alpha, which are produced in large quantities within these organs. Because the generation of these cytokines occurs in a predictable manner early in the development of acute pancreatitis, we aimed to determine whether cytokine gene processing could be inhibited in vivo and what effects this would have on pancreatitis severity. Mild [caerulein, 50 micrograms/kg/hour intraperitoneally (IP) x 4; n = 40] or severe (choline-deficient diet; n = 40) necrotizing pancreatitis was induced in NIH swiss mice. Animals were randomly given a novel small molecule (CNI-1493; 10 mg/kg IP) known to inhibit macrophage production of TNF and IL-1 in vitro by inhibiting translation of TNF mRNA into protein. Control animals received IP vehicle. All animals with acute pancreatitis showed dramatic up-regulation of the IL-1 beta and TNF-alpha genes. Those animals receiving CNI-1493 demonstrated attenuated production of both species of mRNA in pancreatic as well as pulmonary tissue (P < 0.01). Markers of pancreatitis severity such as serum amylase and lipase, as well as pancreatic necrosis, were decreased in animals treated with CNI-1493 (all P < 0.05). Posttranscriptional blockade of TNF production precludes induction of the proinflammatory cytokine cascade that normally occurs during acute pancreatitis. This lack of cytokine gene processing in the pancreas and lungs results in dramatic reductions in tissue damage and pancreatitis severity, which is not model dependent. This is the first time that a small molecule has been shown to influence this disease.

Amylases↗
PubMed1996

A novel cationic lipid greatly enhances plasmid DNA delivery and expression in mouse lung.

Effective gene therapy for lung tissue requires the use of efficient vehicles to deliver the gene of interest into lung cells. When plasmid DNA encoding chloramphenicol acetyltransferase (CAT) was administered intranasally to BALB/c mice without carrier lipids, CAT activity was detected in mouse lung extracts. Plasmid DNA delivered with optimally formulated commercially available transfection reagents expressed up to 10-fold more CAT activity in lung than observed with naked DNA alone. Liposome formulations consisting of (+/-)-N-(3-aminopropyl)-N,N-dimethyl-2,3-bis (dodecyloxy)-1-propanaminium bromide (GAP-DLRIE) plus the neutral colipid dioleoylphosphatidylethanolamine (DOPE) enhanced CAT expression by more than 100-fold relative to plasmid DNA alone. A single administration of GAP-DLRIE liposome-CAT DNA complexes to mouse lung elicited peak expression at days 1-4 posttransfection, followed by a gradual return to baseline by day 21 postadministration. Readministration of GAP-DLRIE liposome CAT complexes at day 21 led to another transient peak of reporter gene expression. Histological examination of lungs treated with GAP-DLRIE complexed beta-galactosidase DNA revealed that alveolar epithelial cells were the primary locus of expression and that up to 1% of all alveoli contained epithelial cells expressing the transgene.

Administration, Intranasal↗
PubMed1996

An improved plasmid DNA expression vector for direct injection into skeletal muscle.

In previous work, the direct injection of 50 micrograms of a plasmid DNA vector encoding firefly luciferase (VR1205) into murine quadriceps muscle produced an average of 6.5 ng of luciferase per muscle at 7 days postinjection. In this report, various elements of the VR1205 vector were modified to increase gene expression levels or to eliminate undesired viral sequences. Expression of the modified vectors was then compared to VR1205 using the intramuscular injection assay. In general, modifications to promoter, enhancer, and intronic sequences either decreased luciferase expression levels or had no effect. However, modifications to the polyadenylation and transcriptional termination sequences, plasmid backbone elements, and the luciferase gene itself each increased luciferase expression levels. The best-expressing vector, designated VR1255, contained a combination of these incrementally beneficial changes. A single intramuscular injection of 50 micrograms of VR1255 produced 300 ng of luciferase at 7 days postinjection, an expression level 46-fold higher than the VR1205 vector (or 22-fold higher, excluding modifications to the luciferase gene) and 154-fold higher than a commercially available luciferase expression vector. Thus, VR1255 represents an improved plasmid DNA vector that may be useful for gene therapy applications.

Animals↗
PubMed1996

Converting an alcohol to an amine in a cationic lipid dramatically alters the co-lipid requirement, cellular transfection activity and the ultrastructure of DNA-cytofectin complexes.

Cytofectins are positively charged lipophilic molecules that readily form complexes with DNA and other anionic polynucleotides. Normally, cytofectins are combined with an activity-augmenting phospholipid such as dioleoylphosphatidylethanolamine (DOPE), and a film of dried, mixed lipid is prepared and hydrated to form cationic liposomes. The liposome solution is then mixed with a plasmid DNA solution to afford cytofectin-DNA complexes which, when presented to living cells, are internalized and the transgene is expressed. One of the most potent cytofectins, dimyristoyl Rosenthal inhibitor ether (DMRIE), is presently being used to deliver transcriptionally active DNA into human tumor tissues. Here we report the remarkable consequences of replacing the alcohol moiety of DMRIE with a primary amine. The resulting cytofectin, called beta-aminoethyl-DMRIE (betaAE-DMRIE), promoted high level transfection over a broad range of DNA and cationic lipid concentrations. A comparison of in vitro transfection activity between DMRIE and betaAE-DMRIE in 10 cell types revealed that betaAE-DMRIE was more active than DMRIE, and that betaAE-DMRIE, unlike DMRIE, was maximally effective in the absence of colipid. The consequences of the alcohol-to-amine conversion on the structure of the cytofectin/DNA complex was also examined by Atomic Force Microscopy. Strikingly dissimilar images were found for plasmid DNA alone and for the plasmid complexes of betaAE-DMRIE and DMRIE/DOPE.

Alcohols↗
PubMed1996

Chiloscyllium plagiosum low-density lipoprotein receptor: evolutionary conservation of five different functional domains.

All five functional domains of the low-density lipoprotein (LDL) receptor were assembled in their modern form more than 450 million years ago, as revealed from the cloning and sequencing of an LDL receptor cDNA from Chiloscyllium plagiosum (banded cat shark). The shark LDL receptor has the same overall architecture as the mammalian and amphibian counterparts. Each of the seven cysteine-rich repeats in the ligand binding domain resembles its counterpart in the human LDL receptor more than it does the other repeats in the shark receptor as suggested by the presence of unique "signature" sequences, indicating that these repeats had already acquired their independent structures by the time of shark development. Furthermore, amino acid sequences of the entire ligand binding domain of shark LDL receptor show 35% identity over a stretch of 294 residues with a Lymnaea stagnalis G-protein-linked receptor (LSGLR). The region of homology between these unrelated proteins includes conservation of most of the unique characteristics of the cysteine-rich repeats of LDL receptor at the expected positions in LSGLR. The results presented are consistent with the hypothesis that all seven repeats in the ligand binding domain of LDL receptor may have been lifted directly from an ancestral gene instead of being evolutionary duplications of a single repeat recruited by the primitive LDL receptor from another gene.

Amino Acid Sequence↗
PubMed1996

Nitric oxide and the myometrium.

Nitric oxide (NO) is a potent smooth muscle relaxant in blood vessels, the gastrointestinal tract and the respiratory system. Recent evidence has shown that NO has a relaxant (tocolytic) effect on myometrium. NO is produced within the female genital tract during pregnancy, and a reduction in NO synthesis may be involved in the initiation of parturition. Furthermore, the administration of NO donors may be useful in inhibiting uterine contractions in situations where such activity is unwanted, e.g., in preterm labour. NO is also produced in the myometrium in the nonpregnant state, and has potential roles in the facilitation of implantation and the prevention of dysmenorrhoea. This article aims to examine the evidence suggesting that NO has a physiological role in the maintenance of pregnancy and potential pharmacological use in the treatment of preterm labour.

Animals↗
PubMed1996

Tissue-specific regulation of glutamine synthetase gene expression in acute pancreatitis is confirmed by using interleukin-1 receptor knockout mice.

BACKGROUND: Acute pancreatitis causes a pronounced depletion of plasma and muscle glutamine pools. In several other catabolic disease states expression of the enzyme glutamine synthetase (GS) is induced in lung and muscle to support glutamine secretion by these organs. The hormonal mediators of GS induction have not been conclusively identified. We used mice deficient for the expression of the type 1 interleukin-1 receptor (IL-1R1 knockout mice) to investigate the expression of GS during acute edematous pancreatitis. METHODS: Acute edematous pancreatitis was induced in adult male wild-type and IL-1R1 knockout mice by means of the intraperitoneal administration of cerulein, and their conditions were monitored. Five organs, including lung, liver, gastrocnemius muscle, spleen, and pancreas, were assayed for relative GS messenger RNA (mRNA) content by Northern blotting. RESULTS: The ultimate severity of pancreatitis was reduced by IL-1R1 deficiency. GS mRNA levels increased during progression of pancreatitis in lung, spleen, and muscle tissue from each group. No consistent increase in GS mRNA level was observed in liver. IL-1R1 deficiency did not affect GS mRNA expression in lung tissue but consistently retarded GS induction in the spleens of knockout animals. IL-1R deficiency altered the kinetics of GS induction in muscle. CONCLUSIONS: Cerulein-induced experimental pancreatitis causes an induction in GS mRNA levels in a tissue-specific fashion. IL-1R1 deficiency reduced the ultimate severity of the condition and altered the induction of GS mRNA in the spleen and muscle.

Animals↗
PubMed1996

Power lines and ionizing radiation.

The magnetic field and ionizing radiation dose rate were measured near ground level in the vicinity of a utility power line. The dose rate was monitored using thermoluminescence detectors. Measurements were made at distances up to about 100 m from the main transmission line from the Kewaunee Nuclear Power Plant while the plant was in operation and while the plant was shut down for refueling. No evidence was found that the dose rate is significantly different in the presence of the magnetic field from the power line than in its absence.

Climate↗
PubMed1996

Simulators for anesthesia.

Two commercially available complete anesthetic simulators were studied in the United States. Although there are some differences between the two systems, each consists of an adult manikin allowing some direct anesthetic interventions, a system of producing physiologic signals to any commercial monitoring system, and the ability to interface with an anesthetic machine and ventilator. In addition, both simulators model the responses to a variety of drugs used by anesthetists. With their associated computer controls, it is possible to mimic a number of recognized anesthetic critical situations and to record the responses made by the anesthetist and determine the effects on the "patient." In use, one system is devoted principally to teaching crisis resource management to anesthetists. The other system is used more generally to teach anesthetists how to approach a variety of problems. In our opinion, each system could be used in either of these ways. Both systems are capable of development into valuable teaching tools for anesthetists and for others involved in critical care. There is potential for the training of paramedics or nurses involved in anesthetic and recovery room care and intensive care. Other options include the investigation of critical events and the development and subsequent testing of clinical management protocols. Anesthetists are familiar with the use of manikins in the teaching of airway management and basic and advanced life support. Newer manikins can be used to practice skills in intravascular cannulation; some can be used with monitoring equipment and defibrillators to provide more realistic teaching. Computer programs, especially those for personal computers (PCs), can also be used to simulate the pharmacophysiologic behavior of patients in a variety of states. Now available are combined systems using manikins controlled by computer, with interfaces to anesthetic machines, ventilators, and monitoring equipment. Two systems are commercially available in the United States. In this report, we briefly describe their technical specifications and how we saw them being used.

Adult↗
PubMed1996

Ethnic differences in women with HIV infection in Britain and Ireland. The study group for the mrc collaborative study of HIV infection in women.

OBJECTIVE: To examine ethnic differences in the socio-epidemiological and clinical characteristics of a cohort of women with HIV infection in Britain and Ireland. DESIGN AND METHODS: Analysis of baseline data (ethnic group, sexual history, likely route of HIV infection, reasons for HIV testing and first AIDS-defining disease) from 400 women with HIV infection recruited into a cohort study from 15 genitourinary medicine/HIV clinics in Britain and Ireland. RESULTS: Sixty-five per cent of women were white and 29% black African. Their median number of lifetime sexual partners was seven and three, respectively (P < 0.001). Ninety-three per cent of black African and 43% of white women were probably infected through sexual intercourse. Injecting drug use was the most likely route of infection in 55% of white women, but none of the black African women. Perceived risk (33%) or investigation of symptoms (26%) were the most common reasons for HIV testing. Seven per cent of white women and 16% of black African women (P < 0.001) had AIDS when HIV infection was diagnosed. The distribution of first AIDS-defining diagnoses differed (P = 0.001) by ethnic group. For white women, the most common disease was Pneumocystis carinii pneumonia; for black African women it was pulmonary tuberculosis. CONCLUSION: There are important differences between black African and white women in sexual history and route of transmission, disease stage at diagnosis and pattern of AIDS-defining diseases.

AIDS Serodiagnosis↗