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Biomedical subjects

J Price

Publications and source records attributed to J Price.

414 records · Page 23Linked to original sources
PubMedDate not supplied

Transplacental arteriovenous gradients for glucose, insulin, glucagon and placental lactogen during normoglycaemia in human pregnancy at term.

The potential contributions of placental extraction and degradation to glucoregulatory hormone turnover in late pregnancy were assessed by measuring arteriovenous differences for glucose, insulin, glucagon and human placental lactogen (hPL) across the uterine and fetal circulation in ten pregnant women at the time of elective caesarean section. The observations were made during stable conditions of euglycaemia; values for maternal arterial glucose, insulin, glucagon and hPL were 78.8 +/- 5.0 mg/dl, 10.1 +/- 2.1 microU/ml, 72.0 +/- 8.5 pg/ml and 5.18 +/- 0.59 micrograms/ml, respectively. The glucose decrements observed consistently across the uterus and fetus indicated uptake by the placenta and fetus, and in the maternal circulation the arterial-uterine vein increment for hPL was 2.10 +/- 0.44 micrograms/ml. However, within the limits of analytical accuracy, no significant gradient could be demonstrated for insulin across the uterine (maternal) or umbilical (fetal) circulations. A small (8.5 per cent) but significant arteriovenous difference for glucagon was observed across the uterus but none was found on the fetal side of the placenta. The findings indicate that detectable gradients for insulin cannot be demonstrated under basal conditions of metabolism and at normal rates of placental blood flow. The results do not exclude the possibility of more significant extraction ratios under other physiological conditions or at higher concentrations of glucoregulatory hormones.

Adult↗
PubMedDate not supplied

Repeated bone lead levels in Queensland, Australia--previously a high lead environment.

Bone lead levels (finger and tibia) were measured, both in vivo and in vitro, with an x-ray fluorescence technique. In vivo finger-bone lead levels of 105 volunteers were estimated and subsequently re-estimated after a 5-y period. In many instances, elevated levels in some of these individuals probably resulted from lead ingested during childhood (i.e., more than 60 y ago). A decline in finger-bone lead from the initial value was accompanied by a mean finger-bone lead half-life of 6.2 y (n = 25); many individual's half-life values were less than 3.0 y. Perhaps one reason for these low values is the special propensity of finger bone to resorption during the involutional period, at which time there are high levels of circulating parathormone.

Adult↗
PubMedDate not supplied

Bone lead measurements in patients with chronic renal disease studied over time.

Results of longitudinal studies that involved the measurement of lead by different methodologies are presented for two groups of patients with chronic renal disease. Methodologies for all patients included x-ray fluorescence measurements of finger-bone lead. These measurements were conducted 5 y apart for one group of patients (n = 15). Initial measurements for the other group (n = 15) were supplemented by bone lead levels obtained either from skull at craniotomy or from skull, and sometimes rib, at autopsy. Most subjects also underwent ethylenediaminetetraacetic acid (specifically CaNa2 EDTA) lead-mobilization testing. A correlation between rate of decrease in finger-bone lead and immunoreactive parathormone levels was suggested. Renal patients were compared with age-matched controls, and their bone half-lives did not differ. The data are discussed and related to other results obtained from clinical and nonclinical populations in which trabecular and cortical bones were studied, and our results were consistent with evidence that more rapid turnover of lead occurs in trabecular bone than in cortical bone. No support was found for the hypothesis that patients who undergo renal dialysis accumulate lead in bone.

Aged↗
PubMedDate not supplied

Diplopia following subcutaneous injections of botulinum A toxin for facial spasms.

PURPOSE: To study the incidence, cause, recovery time, and prevention of diplopia following subcutaneous injection of botulinum A toxin for the treatment of facial spasms. METHODS: Patients who experienced diplopia after botulinum A toxin injections had their deviations examined in detail. When the muscle that caused diplopia was identifiable, the injection closest to that muscle was omitted in the next treatment in an attempt to prevent diplopia. RESULTS: Of 250 patients receiving about 1500 sets of injections, 25 (1.7%) incidents of diplopia occurred in 10 patients. Excluding two patients who declined further treatment after having diplopia on their first botulinum A toxin treatment, seven of the remaining eight patients had multiple incidents of diplopia. The most common pattern of diplopia was "uncertain diagnosis." The most common identifiable cause of diplopia was paresis of the inferior oblique muscle. Omission of the injection into the central portion of the lower eyelids in the next treatment prevented recurrence of diplopia in only one of the four patients. No significant correlation between botulinum A toxin doses injected and times to recovery was noted. CONCLUSIONS: Diplopia following botulinum A toxin treatment is uncommon. Seven patients (3% of patients studied) had 22 episodes of diplopia (88% of episodes). When diplopia occurs, it tends to recur on reinjection, sometimes with a prolonged recovery time. This response may not be dose dependent. The extraocular muscles of some patients may be more susceptible to chemodenervation than others, or botulinum A toxin may diffuse to extraocular muscles more easily in some patients than in others.

Aged↗
PubMedDate not supplied

The Brisbane floods, January 1974: their impact on health.

In the 12 months following the Brisbane flood of 1974, 234 flooded families (695 persons) and 163 non-flooded families (507 persons) were interviewed to ascertain changes in health status. We found that the number of visits to general practitioners, hospitals and specialists were all significantly increased for flooded persons in the year following the flood. Persistent psychological symptoms, which included irritability, nervous tension and depressed mood, predominated in those seeking medical care, and the consumption of sleeping tablets and psychotropic drugs rose. Increased psychological symptoms were significantly more common in female than in male flood victims and significantly more common in both sexes than increased physical complaints. There was no increase in mortality after the flood. The incidence of psychiatric symptoms was directly related to dissatisfaction with help received.

Adult↗
PubMedDate not supplied

Psychological effects of source isolation nursing (2): Patient satisfaction.

AIM: This study is part two of a research project (Davies and Rees 2000) aiming to investigate the relationship between mood, patient satisfaction and a range of quality of care factors among patients nursed in source isolation in acute and rehabilitation settings. METHOD: A small audit-style evaluation of aspects of the overall clinical care of patients nursed in isolation. Twenty one patients being nursed in source isolation were interviewed to assess factors relating to delivery of care. RESULTS: The authors noted frequent mood disturbances among isolated patients, although most were generally satisfied with their care and surroundings. Factors associated with patient satisfaction included being kept up to date with progress and procedures, having a comfortable environment and good communication between staff and patients. CONCLUSION: The authors suggest that staff training should include consistent use of verbal and written information. The patients should be allowed access to telephone and television, and their surroundings should be kept clean.

Adult↗
PubMedDate not supplied

Judging the effectiveness of clinical pathways for pneumonia: the role of risk adjustment.

CONTEXT: Although observational studies suggest that clinical pathways may decrease costs and improve quality in hospitalized patients with community-acquired pneumonia, inferences from these studies are limited by potential selection bias and inadequate case-mix adjustment. OBJECTIVE: To compare the assessment of a clinical pathway for community-acquired pneumonia with and without adjusting for patient characteristics and disease severity. DESIGN: Retrospective cohort study. PATIENTS AND SETTING: Consecutive series of adult patients admitted with clinical diagnosis of community-acquired pneumonia, treated with either a clinical pathway (which included guidelines for antibiotics, tests, and ancillary care) or usual care. MAIN OUTCOME MEASURES: Total hospital charges, length of stay, clinical deterioration (requiring mechanical ventilation or intensive care unit transfer), and in-hospital mortality. We used multiple linear and logistic regression to adjust for patient case mix. RESULTS: Compared with patients receiving usual care (n = 275), patients in the pathway group (n = 97) were more likely to be treated by family physicians than specialists and had lower pneumonia severity scores. In the unadjusted analysis, total hospital charges were lower among pathway patients ($2456; 95% CI, $175 to $4737; P = 0.04); in the adjusted analysis, the difference in total charges was smaller (average reduction $1807; CI, $4164 lower to $549 higher; P = 0.13). In the unadjusted analysis, length of stay was lower among pathway patients (1.8 days lower; CI, 3.9 lower to 0.4 higher; P = 0.12); in the adjusted analysis, the difference in length of stay was smaller (0.9 days lower; CI, 3.2 lower to 1.3 higher; P = 0.4). Although unadjusted analysis showed significantly lower in-hospital mortality in pathway patients, this difference was not confirmed in the adjusted analysis. CONCLUSIONS: Clinical pathways may reduce costs and improve quality of care in community-acquired pneumonia. In nonrandomized studies, however, selection bias and case-mix differences may explain some of the apparent effectiveness.

Adult↗
PubMedDate not supplied

Pseudoconduction of atrial flutter of a recipient atrium.

A nine-year-old girl had an episode of atrial flutter and a nonsustained wide QRS tachycardia during her initial hospitalization after orthotopic heart transplantation. Evaluation of her ECG and telemetric tracing revealed atrial flutter of the recipient atrium and sinus rhythm of the donor atrium. The wide QRS tachycardia was an accelerated ventricular rhythm that was also found on subsequent 24-hour ambulatory ECG monitoring. Timely recognition of recipient atrial arrhythmias prevents inappropriate clinical intervention.

Atrial Flutter↗
PubMedDate not supplied

The Wernicke-Korsakoff syndrome: a reappraisal in Queensland with special reference to prevention.

The Wernicke-Korsakoff syndrome occurs most frequently in alcoholic patients when they become thiamin deficient. First admissions to psychiatric units with the chronic component of this syndrome, Korsakoff's psychosis, peaked in Queensland in 1975-1976. The fall in hospital admission rates since this time could relate to a decline in per-capita alcohol consumption in Australia, or to more awareness of the thiamin needs of drinkers. Alternatively, the improvement may be illusory: although many cases of Wernicke's encephalopathy are being diagnosed, many of these patients are not receiving psychiatric assessment and treatment, perhaps because admission to psychiatric hospital beds is more difficult than it was formerly. Patients who are diagnosed as having Korsakoff's psychosis fare badly in the community, and have a greatly increased mortality rate than do such patients in hospital. Optimal care for such patients is necessarily costly of medical resources. Of available preventive measures, evidence is presented to support the fortification of beer with thiamin and the provision of community educational programmes. The fortification of flour with thiamin may have little impact on the thiamin-deficiency syndromes that arise in problem drinkers in Queensland.

Alcohol Amnestic Disorder↗
PubMedDate not supplied

Properties and regional distribution of ocular aldehyde dehydrogenase in the rat.

The rat eye possesses cytoplasmic aldehyde dehydrogenase (ALDH) activity. The enzyme is present in whole eye, in ocular fluids and is distributed in specific ocular regions. The specific activity of cornea ALDH was the highest among 6 regions studied. The ciliary body and iris combined displayed second largest activity followed by even distribution of ALDH in the retina, the sclera and the surrounding connective tissue. The cloroid and lens did not show measurable ALDH activity. The kinetics property of cornea-ALDH indicate high Vmax. In vitro addition of equal protein concentration of individual ocular regional preparations to the cornea decreased specific activity of cornea-ALDH suggesting of protein interaction and/or substrate competition phenomenon. Short-term oral administration of Vitamin A resulted in statistically insignificant increase of whole ocular tissue ALDH from controls as contrasted with inhibition of ALDH in the ocular fluid by similar short-term oral administration of disulfiram.

Acetaldehyde↗