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Biomedical subjects

J Singer

Publications and source records attributed to J Singer.

At least 73 records · Page 4Linked to original sources

Early stages of spinal ganglion formation during tail regeneration in the newt, Notophthalmus viridescens.

Stages in the development of sensory ganglia in the regenerating newt tail after amputation are described by taking advantage of the rostrocaudal developmental gradient of the regenerating tail. A series of ganglia, beginning at the tip of the regenerate and progressing rostrally, were examined. Eight-week regenerates were used because they showed the most complete array of stages. The first recognizable ganglia appear as small clusters of cells sitting dorsally on the already established ventral roots. The cluster of ganglionic cells steadily expands with the addition of many new cells. Signs of cell differentiation within the ganglion precede the formation of the dorsal root rudiment, which assumes several different configurations but most commonly enters the cord close to the ventral root. Our material suggests that ganglion precursor cells originate in the ventral region of the developing spinal cord and migrate out of the cord by travelling along the ventral root until, at a suitable distance from the cord, they halt, proliferate, and eventually differentiate. In the regenerate, we saw no evidence of neural crest cells--such as those that give rise to ganglia in the trunk region during development--forming at the dorsal region of the regenerated neural tube. Nor was there any morphological evidence of mesenchymal contribution to the ganglion cell clusters.

Animals

Quality of life in patients with inflammatory bowel disease.

To investigate the effect of inflammatory bowel disease (IBD) on the quality of life, we interviewed 43 patients with ulcerative colitis (UC) and 54 with Crohn's disease. Patients identified frequent and important problems in five areas. Primary bowel symptoms, systemic symptoms, and altered emotional function were common; functional and social impairment were less frequent. Systemic symptoms such as fatigue were more prevalent in patients with Crohn's disease. Apart from primary bowel complaints, patients seldom volunteered other facets of quality of life impairment; this was particularly true for impairment of emotional function. We conclude that despite troublesome intestinal and systemic symptoms, most patients with IBD avoid major disruption in work and personal lives. Physicians must inquire specifically about emotional problems relating to IBD; in particular, fear of surgery is important to address. Psychosocial interventions should be targeted to those patients with problems in this area.

Adult

Dialyzer re-use--a multiple crossover study with random allocation to order of treatment.

A multiple crossover research study was used to evaluate the effect of dialyzer re-use on fever, blood leaks, serum urea and creatinine values and symptoms. Each of 6 crossover periods consisted of 4 weeks on either single-use or re-use, 1 week washout, 4 weeks on the alternative treatment and 1 week washout. The re-use consisted of 6 uses of each dialyzer and the washout weeks consisted of 3 single-use sessions. Analysis of paired observations within rather than between patients showed no effects of time (i.e. among crossover periods 1 through 6) or number of re-uses (i.e. among uses 1 through 6). There was no significant difference for temperature change during dialysis, blood leak rate, or the serum urea and creatinine values before the first dialysis of each washout period. There were no differences for symptoms of pruritus, cramps, nausea, headache, chest pain, backache or fatigue. There were no clinical advantages or disadvantages associated with dialyzer re-use.

Cellulose

Evidence for clonal development and stem cell origin of M7 megakaryocytic leukemia.

Previous studies have shown that acute nonlymphocytic leukemias are clonal diseases in which there is heterogeneity in the pattern of stem cell differentiative expression. To determine whether M7 megakaryocytic leukemia is a clonal disease and to evaluate the differentiative expression of the cells involved by the leukemia we studied a patient with megakaryocytic leukemia who was heterozygous for the X-chromosome-linked glucose-6-phosphate dehydrogenase (G6PD). The diagnosis of megakaryocytic leukemia was based on results obtained with the immunogold method and ultrastructural studies with the monoclonal anti-Gplla/IIIb antibody, 10E5. Direct testing of blood and marrow mononuclear cells and blood platelets demonstrated only A-type G6PD, whereas skin exhibited both B and A enzymes. The results indicate that the megakaryocytic leukemia in this patient was clonal at the time of study. To determine the differentiative expression of the stem cells, granulocyte/macrophage colony forming units and erythroid burst forming units were cultured and the resultant colonies were tested for G6PD. The results indicate that the stem cells involved by the leukemia exhibited differentiative expression multipotent for the megakaryocytic and granulocytic pathways, but no definitive conclusion could be made regarding the erythroid lineage.

Clone Cells

Supportive follow-up for cigarette smokers in a family practice: issues of method, analysis and state of the art.

Kozlowski and Page have criticized a study published in 1982 in CMAJ on the effects of supportive follow-up on the rate at which patients quit smoking cigarettes. We agree with some of their general sentiments about the need for establishing a consensus on the evaluation of smoking cessation programs. More specifically, we defend the particular analysis originally used, given the state of knowledge and constraints on the study. We examine their main objections: the definition of successful cessation, the design of the study, the exclusion of patients lost to follow-up, the methods of statistical analysis used and the strength of more recent evidence on the usefulness of follow-up visits. We believe that the role of supportive follow-up deserves further evaluation.

Evaluation Studies as Topic

A smoking cessation intervention program for family physicians.

Family physicians are able to approach many patients who smoke but are often hesitant to help them quit. Lack of knowledge about effective interventions is a major reason for this hesitancy. The important components that have been tested in physician-initiated smoking cessation interventions are advice to quit, information about the risks of smoking and techniques for quitting, nicotine gum, setting a date for quitting and offers of supportive follow-up visits. We describe a cessation program developed for family physicians that incorporates these factors into three types of visits over a 2-month period: the challenge visit, which occurs during a regular office visit and focuses on advice and setting a date to quit; the quit-date visit, which involves instructing patients on the proper use of nicotine gum, if applicable, and confirming their desire to quit; and four supportive follow-up visits, which provide continuing encouragement for 2 months and allow physicians to monitor withdrawal symptoms, relapses and other problems. Such a program can be effectively incorporated into a general practice.

Chewing Gum

Open finger tip healing and replacement after distal amputation in rhesus monkey with comparison to limb regeneration in lower vertebrates.

The left thumbs and great toes of three 8 1/2 month old Rhesus monkeys (Macaca mulatta) were amputated in guillotine fashion one millimeter distal to the base of the nail and allowed to heal by the conservative open wound method. Healing occurred in seven to ten days in these small digits. Each of the thumbs and toes grew back with some blunting and shortening of the digit tips, but were functional. The new structures were cosmetically pleasing as in the human instances. The nails grew essentially to normal size and shape supported by the remaining portions of the distal phalanges. Histological studies showed no evidence of blastema formation such as is observed in the regenerating limb of the Urodele (newt) taken as the comparative representative. The possibility of improving the regrowth is discussed against the background of our knowledge of the importance of nerve during limb regeneration in lower vertebrates.

Amputation, Surgical

The consent form as a possible cause of side effects.

In a multicenter trial of aspirin or sulfinpyrazone in the treatment of unstable angina, we examined the possible importance to the outcome of mentioning potential side effects in the consent form. Inclusion, in two of the three centers, of a statement outlining possible gastrointestinal side effects resulted in a sixfold increase (P less than 0.001) in the number of subjects in these centers withdrawing from the study because of subjective, minor gastrointestinal symptoms. Major gastrointestinal complications such as peptic ulcer or bleeding as diagnosed by study physicians were similar in the three centers. Furthermore, no patient discontinued therapy because of subjective, nongastrointestinal side effects. Post hoc analysis suggests that the inclusion of gastrointestinal side effects in the consent form may have increased the likelihood of patients attributing gastrointestinal symptoms to drug therapy, leading to subsequent withdrawal from the study.

Angina Pectoris

Characteristics of employment and job satisfaction in nontraditional dental hygiene practice settings.

Little is known concerning the employment characteristics of hygienists practicing in nontraditional settings. Respondents were identified through screening (n = 38,380) a listing of the entire population of hygienists licensed in the United States. The screening identified 1,301 hygienists practicing in nontraditional settings. These hygienists were mailed comprehensive questionnaires; completed questionnaires were returned by 84.3 percent of the hygienists. Data were collected describing hygienists' reasons for seeking employment in nontraditional settings, their sources of information concerning job opportunities in nontraditional settings, benefits, and job satisfaction. The main source of information concerning employment opportunities in nontraditional settings was "word of mouth." Hygienists were motivated to seek employment in nontraditional settings primarily by a desire for a more challenging position and personal satisfaction. The hygienists were overwhelmingly satisfied with all aspects of nontraditional employment except opportunities for advancement. Respondents were found to receive standard benefits similar to those of employees in other industries.

Dental Hygienists

Upper Ottawa street landfill site health study.

This report describes the design and conduct of two sequential historical prospective morbidity surveys of workers and residents from the Upper Ottawa Street Landfill Site in Hamilton, Ontario. The workers study was carried out first and was a hypothesis-generating study. Workers and controls were administered a health questionnaire, which was followed by an assessment of recall bias through medical chart abstraction. Multiple criteria were used to identify health problems associated with landfill site exposure. Those problems with highest credibility included clusters of respiratory, skin, narcotic, and mood disorders. These formed the hypothesis base in the subsequent health study of residents living adjacent to the landfill site. In that study, the association between mood, narcotic, skin, and respiratory conditions with landfill site exposure was confirmed using the following criteria: strength of association; consistency with the workers study; risk gradient by duration of residence and proximity to the landfill; absence of evidence that less healthy people moved to the area; specificity; and the absence of recall bias. The validity of these associations were reduced by three principal problems: the high refusal rate among the control population; socioeconomic status differences between the study groups; and the fact that the conditions found in excess were imprecisely defined and potentially interchangeable with other conditions. Offsetting these problems were the multiple criteria used to assess each hypothesis, which were applied according to present rules. Evidence is presented that supports the hypothesis that vapors, fumes, or particulate matter emanating from the landfill site, as well as direct skin exposure, may have lead to the health problems found in excess. Evidence is also presented supporting the hypothesis that perception of exposure and, therefore, of risk, may explain the results of the study. However, based on the analyses performed, it is the conclusion of the authors that the adverse effects seen were more likely the result of chemical exposure than of perception of risk.

Adult

An epidemiological description of physical, social and psychological problems in multiple sclerosis.

Chronic disorders such as multiple sclerosis have important behavioural consequences on the lives of patients. The purpose of this study was to describe the frequency distribution of psychosocial disability among a referral clinic population of multiple sclerosis patients and to identify associated factors. A cross-sectional survey was conducted of 301 patients using four health indexes to assess quality of life. An 82% response rate was obtained. In the results are presented the frequencies of behavioural problems compared with the general population and a family practice group. While physical function was found to be closely associated with disease severity, psychosocial disability bore little relationship to the underlying disease or to sociodemographic variables including social class. Eighty percent of psychosocial disability remained unexplained. The physical aspects of multiple sclerosis were not predictive of emotional or social morbidity. The major implication of these findings is that the impact of disease on patients, as distinct from the disease itself, should be dealt with as health problems in their own right.

Activities of Daily Living

Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial.

We performed a randomized, double-blind, placebo-controlled trial in 555 patients with unstable angina who were hospitalized in coronary care units. Patients received one of four possible treatment regimens: aspirin (325 mg four times daily), sulfinpyrazone (200 mg four times daily), both, or neither. They were entered into the trial within eight days of hospitalization and were treated and followed for up to two years (mean, 18 months). The incidence of cardiac death and nonfatal myocardial infarction, considered together, was 8.6 per cent in the groups given aspirin and 17.0 per cent in the other groups, representing a risk reduction with aspirin of 51 per cent (P = 0.008). The corresponding figures for either cardiac death alone or death from any cause were 3.0 per cent in the groups given aspirin and 11.7 per cent in the other groups, representing a risk reduction of 71 per cent (P = 0.004). Analysis by intention to treat yielded smaller risk reductions with aspirin of 30 per cent (P = 0.072), 56 per cent (P = 0.009), and 43 per cent (P = 0.035) for the outcomes of cardiac death or nonfatal acute myocardial infarction, cardiac death alone, and all deaths, respectively. There was no observed benefit of sulfinpyrazone for any outcome event, and there was no evidence of an interaction between sulfinpyrazone and aspirin. Considered together with the results of a previous clinical trial, these findings provide strong evidence for a beneficial effect of aspirin in patients with unstable angina.

Angina Pectoris

Effect of bromocriptine mesylate on induced hyperprolactinemia in stabilized psychiatric outpatients undergoing neuroleptic treatment.

Therapeutic doses of phenothiazines increased serum levels of prolactin, resulting in a number of side effects. Bromocriptine, a potent dopamine agonist, appears to effectively reduce the serum prolactin level. In this open pilot study, bromocriptine mesylate (Parlodel, Sandoz) was administered in an escalating dose schedule to 11 stabilized psychiatric outpatients with hyperprolactinemia resulting from thioridazine HCl (Mellaril, Sandoz) treatment. 6 of 9 patients showed decreases. Overall global psychiatric evaluations were unchanged over the course of combined therapy for all but 1 patient, who showed improvement. The trend of decreased prolactin serum levels indicates that bromocriptine mesylate may prove a useful adjunct to reduce the side effects of hyperprolactinemia.

Adolescent