Biomedical subjects
J Rowe
Publications and source records attributed to J Rowe.
Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients.
We evaluated the occurrence and persistence of delirium in 325 elderly patients admitted to a teaching hospital from either a defined community or a long-term care facility. Of the study participants, 34 (10.5%) had Diagnostic and Statistical Manual of Mental Disorders, Third Edition--defined delirium at initial evaluation; of the remaining patients, 91 (31.3%) developed new-onset delirium. An additional 110 patients also experienced individual symptoms of delirium without meeting full criteria. Preexisting cognitive impairment and advanced age were associated with increased risk of incident delirium in the community sample but not the institutional one. Delirium was not associated with an increased risk of mortality, but it was associated with a prolonged hospital stay and an increased risk of institutional placement among community-dwelling elderly. Only five patients (4%) experienced resolution of all new symptoms of delirium before hospital discharge, and only 20.8% and 17.7%, respectively, had resolution of all new symptoms by 3 and 6 months after hospital discharge. These data suggest that delirium is a common disorder that may be substantially less transient than currently believed and that incomplete manifestations of the syndrome may be frequent.
Monoclonal antibodies raised against semi-purified preparations of human islets define subpopulations of pancreatic cells.
Monoclonal antibodies were produced from fusions between splenocytes from BALB/c mice immunised with purified human islets and the mouse myeloma cell line NS-0/Uncl. Supernatants from uncloned hybrids were screened by immunohistology on frozen sections of human pancreas. The range of specificities appeared to reflect the relative purity of the human islet preparations used. Eight monoclonal antibodies were investigated further, four of these bound to islet cells, two to acinar cells, one to ductal cells and one to occasional cells. The antigens recognised by these antibodies were characterised by immunohistology using a number of different tissues, as well as haemagglutination, immunoblotting and radioimmunoassay for insulin. Seven of the eight antibodies studied were IgM. One acinar cell antibody (IgG2a) precipitated proteins of 200Kd and 11OKd molecular weight. None of the antibodies bound directly to insulin. Seven of the antibodies appear to have defined previously unreported epitopes in the pancreas and will prove useful in further studies of human pancreatic cells.
Phase II study of mitoxantrone and 5-azacytidine for accelerated and blast crisis of chronic myelogenous leukemia: a study of the Eastern Cooperative Oncology Group.
A total of 40 evaluable patients were treated for blastic crisis of chronic myelogenous leukemia with mitoxantrone, 12 mg/m2 per day for three days and 5-azacytidine 150 mg/m2 per day for 5 days. Toxicity was primarily hematologic and was manageable. The overall response rate was 23%, including five complete responders, two partial responders, and two with hematologic improvement. Cytogenetic and immunophenotypic characterization of the leukemia was performed on all patients with aspirable bone marrow, and these results were correlated with response and survival, but did not have predictive value once the patient was in blastic crisis. Only initial platelet count (p = 0.02), hemoglobin (p = 0.03), and lower white blood cell count (p = 0.09) were somewhat predictive of response. Lack of hepatic involvement (p = 0.05), lower white blood cell count (0.05), and higher platelet count (p = 0.02) were predictive of prolonged survival. Although response did not strongly correlate with survival, one third of responders were alive at one year. This regimen produces results similar to those of other recently published regimens in this disease. Earlier intervention and more effective therapy is necessary in these patients.
Postmenopausal bleeding from unusual endometrial polyps in women on chronic tamoxifen therapy.
There are recent reports of postmenopausal bleeding from endometrial polyps in women receiving tamoxifen therapy for breast cancer. We describe four additional patients who presented with vaginal bleeding, and emphasize the pathology. These polyps demonstrated cystically dilated glands in all cases and stromal decidualization in two; in one instance, metastatic breast carcinoma was present in the polyp. The mechanisms by which tamoxifen may affect the development of these polyps are discussed.
Isolation and purification of microvascular endothelium from human decidual tissue in the late phase of pregnancy.
Normal pregnancy demands significant structural and physiologic adaptations of the uterine microvasculature, to facilitate adequate placentation. In pregnancies complicated by pregnancy-associated hypertension (preeclampsia), this process is defective, resulting in a high incidence of intrauterine growth retardation. The microvascular endothelium, a focal point for both initiation and inhibition of coagulation and control of vascular tone, may well contribute to development and aggravation of these abnormalities. We describe a method for isolation, purification, and culture of human decidual endothelial cells from biopsies performed at the time of cesarean section. The separation procedure is technically simple, requires only a small piece of tissue, and takes approximately 2 hours to perform. Some of the unique features of these cells in culture are outlined. This technique will permit the close examination of various aspects of the function of these cells in normal pregnancy, and their comparison with cells from pregnancies complicated by hypertension.
Molecular genetic studies on the mode of action of azole antifungal agents.
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Purification of recombinant dog tissue inhibitor of metalloproteinases.
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Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization.
Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.
Mothers' remembrances of newborn intensive care: a predictive study.
Six months after discharge, 94 mothers described their memories of their infant's hospitalization on an NICU. Mothers of sicker infants, those who had claimed difficulties with NICU staff, and those who felt less attached to their infant more often described painful reminders of this crisis. Pleasurable reminders were reported more often by mothers who had perceived greater personal control over their infant's recovery and had construed a purpose in this crisis. Mothers described several benefits of their memories and were more likely to do so when they had perceived a purpose in their misfortune.
Human monoclonal antibodies to human cytomegalovirus.
Human monoclonal antibodies (HMAbs) to human cytomegalovirus (HCMV) have been developed by using electric field-induced cell fusion of human B lymphocytes to the human-mouse cell line SBC-H20. By this procedure, multiple hybridomas have been produced that secrete IgG 1 HMAbs with distinct patterns of indirect immunofluorescence on HCMV-infected cells. HMAbs Z01 and X20 immunoprecipitated a major protein at 64 kDa. HMAb Z02 immunoprecipitated a major protein of 48-50 kDa. HMAb Z10 identified a single protein at 65 kDa and HMAb X16 identified proteins at 100, 65, and 36-38 kDa. The HMAbs demonstrated varying degrees of virus-neutralizing activity. The production of HMAbs to HCMV provides an important approach to studying the human host response to HCMV by elucidating biologically relevant antigens and epitopes. In addition, HMAbs are a potentially unlimited source of relevant human antibodies for treating life-threatening HCMV infection.
Effects of formal support on mothers' adaptation to the hospital-to-home transition of high-risk infants: the benefits and costs of helping.
94 mothers were randomly assigned to a control group or to a group who received a formal support program designed to aid their adaptation to the transition from hospital to home care of high-risk infants. Mothers' predischarge need for support and the severity of infants' predischarge medical problems moderated program effects assessed 6 months after NICU discharge. Positive effects of the program on mothers' sense of competence, perceived control, and responsiveness were evident for mothers who had needed the most support. But at low levels of need for support, participation in the program had negative effects on these outcomes. A similar pattern was found for the effects of the program on mothers' positive mood as a function of the severity of infants' medical problems. Secondary findings suggest why some mothers may benefit from formal support after NICU discharge and others may experience at least temporary disruptions in their adaptation from such support.
Nursing assessment of children of alcoholics.
Children of alcoholics frequently grow up in families that do not foster growth. They learn roles and rules that help them survive in the family but that are not always helpful in the world outside. These children are at risk for a wide range of problems including teratogenic effects, academic problems, child abuse, psychiatric disorders, substance abuse, and other psychosocial and behavioral difficulties. Nurses who work with children or parents should be prepared to identify the possibility of parental alcoholism and the associated risks.
Premenstrual syndrome. Etiology and treatment possibilities.
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Effect of changes in dietary sodium on active electrolyte transport by erythrocytes at different stages of human pregnancy.
1. Active electrolyte transport was examined in erythrocytes from women in the second and third trimesters of pregnancy and post partum, and compared with that in ovulating women. 2. There was a significant reduction in intracellular sodium ([Na]i) and increase in intracellular potassium ([K]i) in pregnancy with a return towards normal values in the post-partum period. 3. Maximum specific ouabain binding [number of Na+,K+-adenosine triphosphatase (Na+, K+-ATPase) units] was increased by 70% in pregnancy and returned slowly towards normal values post partum. 4. Na+,K+-ATPase activity as determined by ouabain-sensitive 86Rb influx in artificial media was also increased in pregnancy by 13%. It returned towards normal post partum. 5. The increases in Na+,K+-ATPase in pregnancy were not closely related to the concomitant increases in aldosterone or cholesterol nor to reticulocytosis and were not affected by 7 days of high (greater than 250 mmol/day) or low (less than 50 mmol/day) sodium intake.
Methods of assessment of erythrocyte Na+-K+-ATPase function in normal and hypertensive pregnancy.
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Adaptational features of mothers' risk and prevention appraisals after the birth of high-risk infants.
Sixty-seven mothers were interviewed at the time of their child's discharge from a newborn intensive care unit and 6 months after hospital discharge. After 6 months, mothers who had done more to prevent adverse pregnancy outcomes, had been more optimistic about the outcomes of their pregnancy, and saw their infant's complications as more avoidable reported greater concurrent mood disturbance and/or more distress ensuing from their child's hospitalization. Mothers' risk and prevention appraisals also played a role in their attitudes toward future childbearing, independent of mothers' reproductive history, the severity of the infants' medical condition, and the infant's behavioral difficulty at 6 months. The single most important predictor of mothers' expectations of future pregnancies, however, was whether the child was first born.
Yersinia pestis: a case of mistaken identity.
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