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Biomedical subjects

J W Moore

Publications and source records attributed to J W Moore.

At least 73 records · Page 4Linked to original sources
PubMed1996

Morbidity and mortality after single- and double-stapled colorectal anastomoses in patients with carcinoma of the rectum.

BACKGROUND: The optimal method of restoring intestinal continuity after rectal resection has been controversial. This study aims to compare the morbidity, mortality and survival of patients having either single-stapled (SS) or double-stapled (DS) colorectal anastomoses following resection of the rectum for cancer. METHODS: Peri-operative and long-term follow-up data were prospectively documented in all patients undergoing rectal resection for carcinoma with a stapled anastomosis at our institution over a 14-year period. Patients were stratified by anastomotic technique (SS or DS). Peri-operative mortality, complications potentially related to anastomotic technique and cancer-related outcome were compared. RESULTS: Two hundred and thirty-five patients had SS and 65 patients had DS anastomoses. The groups were well matched for age, sex, and tumour stage. Double-stapled anastomoses were used more frequently in the distal third of the rectum (P < 0.001). The distal margin of resection was not influenced by anastomotic technique. Major anastomotic leakage in 2.9% of SS cases was not significantly different from 6.1% of DS cases, and leakage was not influenced by anastomotic technique at any given level of the rectum. Two-year local recurrence rates were not significantly different between groups (SS 3.5%; DS 5.9%). CONCLUSIONS: These results suggest that the double-stapling technique is as safe as the single-stapling technique for constructing an anastomosis after excision of the rectum for cancer, in terms of the risk of leakage, the development of an anastomotic stricture, or local recurrence.

Aged↗
PubMed1996

Lymphovascular clearance in laparoscopically assisted right hemicolectomy is similar to open surgery.

BACKGROUND: The application of laparoscopic techniques to malignant colorectal disease has led to concerns regarding the adequacy of excision achieved. This study was performed to compare specimen histopathology following laparoscopically assisted right hemicolectomy (LARHC) with that following open right hemicolectomy (ORHC). METHODS: Data regarding patient details and tumour pathology were obtained by case-note review and from the Concord Hospital Colorectal Cancer Database. Thirty-two patients had LARHC for neoplastic lesions and 34 had ORHC for similar lesions over the same period. The two groups were well matched with respect to age, sex, weight and tumour characteristics. Early stage disease was more common in the LARHC group. RESULTS: There was no clinically significant difference between the groups in terms of margins of clearance or number of lymph nodes harvested. CONCLUSIONS: LARHC allows lymphovascular clearance indistinguishable from that afforded by open surgery. Long term outcome and survival data are required to confirm its role in the treatment of malignant colorectal disease.

Adenocarcinoma, Mucinous↗
PubMed1996

WAIS-R short-forms: criterion validity in healthy and clinical samples.

Regression equations developed by Crawford, Allan & Jack (1992) to estimate full-length WAIS-R IQs from seven short-forms were evaluated in healthy (N = 153) and neurological (N = 471) cross-validation samples. In the healthy sample the correlations between the short-forms and full-length IQs did not differ significantly from those obtained by Crawford et al. (1992). In the neurological sample the six- and seven-subtest short-forms, proposed by Crawford et al. (1992) and Warrington, James & Maciejewski (1986) respectively, differed from the other short-forms in that they had significantly higher criterion validity coefficients and did not systematically under- or overestimate IQs.

Adult↗
PubMed1996

Spatial regulation of a zebrafish patched homologue reflects the roles of sonic hedgehog and protein kinase A in neural tube and somite patterning.

Signalling by members of the Hedgehog family of secreted proteins plays a central role in the development of vertebrate and invertebrate embryos. In Drosophila, transduction of the Hedgehog signal is intimately associated with the activity of protein kinase A and the product of the segment polarity gene patched. We have cloned a homologue of patched from the zebrafish Danio rerio and analysed the spatiotemporal regulation of its transcription during embryonic development in both wild-type and mutant animals. We find a striking correlation between the accumulation of patched1 transcripts and cells responding to sonic hedgehog activity both in the neurectoderm and mesoderm, suggesting that like its Drosophila counterpart, patched1 is regulated by sonic hedgehog activity. Consistent with this interpretation, mis-expression of sonic hedgehog results in ectopic activation of patched1 transcription. Using dominant negative and constitutively active forms of the protein kinase A subunits, we also show that expression of patched1 as well as of other sonic hedgehog targets, is regulated by protein kinase A activity. Taken together, our findings suggest that the mechanism of signalling by Hedgehog family proteins has been highly conserved during evolution.

Amino Acid Sequence↗
PubMed1996

The effects of calcium channel blockade on agouti-induced obesity.

We have previously observed that obese viable yellow (Avy/a) mice exhibit increased intracellular Ca2+ ([Ca2+]i) and fatty acid synthase (FAS) gene expression; further, recombinant agouti protein increases in cultured adipocytes and these effects are inhibited by Ca2+ channel blockade. Accordingly, we determined the effect of Ca2+ channel blockade (nifedipine for 4 wk) on FAS and obesity in transgenic mice expressing the agouti gene in a ubiquitous manner. The transgenic mice initially were significantly heavier (30.5+/-0.6 vs. 27.3+/-0.3 g; P<0.001) and exhibited a 0.81 degrees C lower initial core temperature (P<0.0005), an approximately twofold increase in fat pad weights (P=0.002), a sevenfold increase in adipose FAS activity (P=0.009), and a twofold increase in plasma insulin level (P<0.05) compared to control mice. Nifedipine treatment resulted in an 18% decrease in fat pad weights (P<0.007) and a 74% decrease in adipose FAS activity (P=0.03), normalized circulating insulin levels and insulin sensitivity (P<0.05), and transiently elevated core temperature in the transgenic mice, but was without effect in the control mice. These data suggest that agouti regulates FAS, fat storage, and possibly thermogenesis, at least partially, via a [Ca2+]i-dependent mechanism, and that Ca2+ channel blockade may partially attenuate agouti-induced obesity.

Adipose Tissue↗
PubMed1995

Randomised trial of lipid lowering dietary advice in general practice: the effects on serum lipids, lipoproteins, and antioxidants.

OBJECTIVE: To determine the relative efficacy in general practice of dietary advice given by a dietitian, a practice nurse, or a diet leaflet alone in reducing total and low density lipoprotein cholesterol concentration. DESIGN: Randomised six month parallel trial. SETTING: A general practice in Oxfordshire. SUBJECTS: 2004 subjects aged 35-64 years were screened for hypercholesterolaemia; 163 men and 146 women with a repeat total cholesterol concentration of 6.0-8.5 mmol/l entered the trial. INTERVENTIONS: Individual advice provided by a dietitian using a diet history, a practice nurse using a structured food frequency questionnaire, or a detailed diet leaflet sent by post. All three groups were advised to limit the energy provided by fat to 30% or less and to increase carbohydrate and dietary fibre. MAIN OUTCOME MEASURES: Concentrations of total cholesterol and low density and high density lipoprotein cholesterol after six months; antioxidant concentration and body mass index. RESULTS: No significant differences were found at the end of the trial between groups in mean concentrations of lipids, lipoproteins, and antioxidants or body mass index. After data were pooled from the three groups, the mean total cholesterol concentration fell by 1.9% (0.13 mmol/l, 95% confidence interval 0.06 to 0.22, P < 0.001) to 7.00 mmol/l, and low density lipoprotein cholesterol also fell. The total carotenoid concentration increased by 53 nmol/l (95% confidence interval 3.0 to 103, P = 0.039). CONCLUSIONS: Dietary advice is equally effective when given by a dietitian, a practice nurse, or a diet leaflet alone but results in only a small reduction in total and low density lipoprotein cholesterol. To obtain a better response more intensive intervention than is normally available in primary care is probably necessary.

Antioxidants↗
PubMed1995

Repeat use of occluding spring coils to close residual patent ductus arteriosus.

Recent studies have shown that small- and moderate-size patent ductus arteriosus (PDA) may be closed with occluding spring coils. As with other percutaneous devices, a low incidence of residual PDAs has been observed in medium-term follow-up. This report describes experience with closing residual PDA by repeat use of occluding spring coils.

Angioplasty, Balloon, Coronary↗
PubMed1995

Rapid DNA haplotyping using a multiplex heteroduplex approach: application to Duchenne muscular dystrophy carrier testing.

A new strategy has been developed for rapid haplotype analysis based on an initial multiplex amplification of several polymorphic sites, followed by heteroduplex detection. Heteroduplexes formed between two different alleles are detected because they migrate differently than the corresponding homoduplexes in Hydrolink-MDE gel. This simple, rapid method does not depend on specific sequences such as restriction enzyme sites or CA boxes and does not require the use of isotope. This approach has been tested using commonly occurring polymorphisms spanning the dystrophin gene as a model. We describe the use of the method to assign the carrier status of females in Duchenne muscular dystrophy (DMD) pedigrees. The method may be used for other genetic diseases when mutations are unknown or there are few dinucleotide markers in the gene proximity, and for the identification of haplotype backgrounds of mutant alleles.

Base Sequence↗
PubMed1995

Percutaneous use of stents to correct pulmonary artery stenosis in young children after cavopulmonary anastomosis.

Pulmonary artery distortion is a risk factor among candidates for the Fontan procedure. In 57 patients evaluated by catheterization after successful cavopulmonary anastomosis, 8 had proximal left pulmonary artery (LPA) stenosis, either discrete (4 patients) or long segment (4 patients). Median age was 27 months (range 19 to 60 months). Median weight was 11.4 kg (range 9.1 to 20.0). Mean diameter at LPA stenosis was 4.4 +/- 0.4. Proximal right pulmonary artery mean diameter was 10.4 +/- 1.0 mm. After angiographic and hemodynamic assessment, short 11F sheaths were placed in the right internal jugular (6 patients) or subclavian veins (2 patients). Pulmonary artery angioplasty and stent placement were performed. LPA stenoses were enlarged using 10 Palmaz stents dilated to 10 mm (7 patients) or to 12 mm (3 patients). Poststent angiograms showed that narrowest LPA dimensions were significantly enlarged to 9.9 mm +/- 1.0 mm, p < 001). There were no complications. Follow-up studies (catheterizations in 4 patients, echocardiograms in 8 patients) were performed 4 to 9 months after stent implantation. No restenosis was observed. Five patients had completion of their Fontan procedures; three patients are pending Fontan completion. This study demonstrates the efficacy and safety of the percutaneous use of Palmaz stents to correct pulmonary artery stenosis in young children after cavopulmonary anastomosis.

Child, Preschool↗
PubMed1995

Factors influencing perioperative morbidity during palliation of the univentricular heart.

BACKGROUND: The modified Fontan procedure has become the treatment of choice for patients born with a univentricular heart. Although the operative mortality has steadily decreased in recent years, the hospital stay is still prolonged in many patients due to fluid retention and pleural effusions. METHODS: We retrospectively analyzed subsets of patients undergoing the bidirectional cavopulmonary shunt (BDCPS) and modified Fontan procedure in an attempt to define factors influencing operative mortality and morbidity. RESULTS: Multivariate analysis of 64 patients undergoing BDCPS revealed that age 6 months or less, concomitant operation, mean pulmonary pressure of 15 mm Hg or less, and mean pulmonary artery ratio of 1.8:1 or less were not statistically significant indicators of risk. Abnormal pulmonary artery architecture was a significant predictor of early and late death (p < or = 0.01). Retrospective analysis of 71 patients undergoing the modified Fontan procedure revealed no significant relationship between duration of pleural effusions and age at operation, preoperative oxygen saturation, pulmonary artery pressure, ventricular end-diastolic pressure, or prior BDCPS: Patients with important aortopulmonary collateral vessels defined by angiography had prolonged pleural drainage. Selective use of the total extracardiac conduit and the fenestrated Fontan resulted in low overall mortality with no statistical differences between subsets of patients undergoing different modifications of the Fontan procedure. CONCLUSIONS: These data indicate that the operative risk for BDCPS or modified Fontan procedure is quite low if a procedure appropriate for the patient is selected. Abnormal pulmonary artery architecture is an important risk factor for death after the BDCPS: Aortopulmonary collateral vessels are associated with fluid retention and pleural effusions after a modified Fontan procedure. Important aortopulmonary collateral vessels should be occluded before or during the modified Fontan procedure.

Adolescent↗
PubMed1995

Connections to cerebellar cortex (Larsell's HVI) in the rabbit: a WGA-HRP study with implications for classical eyeblink conditioning.

Conditioned eyeblink responses are presumably learned in the cerebellum and relayed to motoneurons by way of the red nucleus. Projections from the red nucleus to cerebellar cortex (Larsell's lobule HVI) could be important for shaping temporally adaptive features of the conditioned response. Rabbits that had pipettes containing wheat germ agglutinated horseradish peroxidase (WGA-HRP) implanted unilaterally into HVI showed retrograde labeling of neurons within subregions of the contralateral red nucleus implicated in eyeblink conditioning by lesioning and recording studies. Retrogradely labeled neurons were also observed in the pontine nuclei, inferior olive, and spinal trigeminal nucleus pars oralis. Projections to HVI provide a possible neural substrate for implementing time-derivative computational models of learning in the cerebellum. Time-derivative models are capable of describing the timing and topography of conditioned responses.

Animals↗
PubMed1995

Phlegmonous enterocolitis: a rare form of inflammatory bowel disease.

Phlegmonous enterocolitis is a rarely encountered and almost universally fatal bacterial infection seen most often in the alcoholic population. Despite being first described in 1842, fewer than 60 cases have been reported. The role of surgical management in this condition is unknown. We present a case of phlegmonous enterocolitis with a successful outcome after total colectomy.

Adult↗
PubMed1995

Transcatheter occlusion of patent ductus arteriosus.

This article reviews the current status of transcatheter technology, which has been applied to close the patent ductus arteriosus (PDA). Pioneering work in this field was performed by Porstmann in the 1960s and Rashkind in the 1970s. Devices which have been implanted in the PDA have basic designs as plugs, umbrellas, or coils. The experience reported with each type of device is detailed. Issues and controversies are examined. It appears that coils should be the preferred method for closing smaller PDAs (3-mm diameter or smaller), and Rashkind or similar devices, if available, should be reserved for larger PDAs (> 3-mm diameter). Surgery is necessary for neonatal and for rare large PDAs. Transcatheter technology is still evolving and may become more effective and cheaper.

Cardiac Catheterization↗
PubMed1995

Renin, angiotensin II, and the development of effusions following bidirectional Glenn and Fontan procedures.

Pleural effusions are a troublesome complication following bidirectional Glenn and Fontan procedures. It was our hypothesis that effusions may be related to alterations in hormones that regulate fluid homeostasis. We made serial determinations (by radioimmunoassay) of antidiuretic hormone, cortisol, aldosterone, angiotensin II, and renin in patients undergoing bidirectional Glenn (n = 16) and Fontan procedures (n = 24). There were six patients who developed effusions following surgery. These patients had a different endocrinological pattern characterized by persistent elevation in renin (28 +/- 9 vs 9 +/- 5 ng/mL per hour, p < 0.01) and angiotensin II (110 +/- 33 vs 33 +/- 14 ng/L, p < 0.01) on the fifth postoperative day as compared to patients who did not develop effusions. These data demonstrate that patients who develop effusions following bidirectional Glenn and Fontan procedures have activation of their renin-angiotensin system.

Adolescent↗
PubMed1994

Percutaneous closure of the small patent ductus arteriosus using occluding spring coils.

OBJECTIVES: This report summarizes our experience with the use of occluding spring coils to close the small patent ductus arteriosus. BACKGROUND: Several patent ductus arteriosus occluders (most notably the Rashkind device) have been developed and studied. Occluding spring coils have been used to close abnormal vessels and vascular connections. We previously reported the use of occluding spring coils to close the small patent ductus arteriosus in a small group of patients. This report describes our series of patients having patent ductus arteriosus closure with occluding spring coils. METHODS: Between June 1990 and June 1993, 30 patients underwent cardiac catheterization to have patent ductus arteriosus closure by occluding spring coils. Selection criteria were age > 6 months and narrowest patent ductus arteriosus internal dimension < or = 3.0 mm by color flow imaging. Definitive selection was based on review of aortograms performed at catheterization. A 5.2F coronary catheter was used to deliver one or two standard occluding spring coils. A loop was delivered in the main pulmonary artery, and the remainder of the coil was delivered across the patent ductus arteriosus and into the aortic diverticulum. Patent ductus arteriosus closure was confirmed by aortography or color flow imaging, or both. Follow-up after coil placement occurred at 6 weeks and 6 months and included two-view chest radiography, echocardiography and color flow imaging. RESULTS: Of the 30 patients, 29 had successful implantation by one (27 patients) or two (2 patients) occluding spring coils. Of these 29 patients, 19 had a clinically apparent and 10 had a silent patent ductus arteriosus. Average ductus minimal internal dimension was 1.7 mm (range 1.0 to 3.0). Complete closure of the ductus was confirmed in 27 patients by aortography or color flow imaging or both (in 24 within 4 h, in 2 after 6 weeks and in 1 after 6 months). Six weeks after implantation, two patients had a tiny residual patent ductus arteriosus noted on color flow imaging. One patient did not have successful implantation. This patient had a 3.2-mm ductus, and two coils migrated to the distal left pulmonary artery and could not be retrieved. There were no deaths or any significant complications noted during early or late follow-up in these patients. CONCLUSIONS: Occluding spring coils may have additional application in closing the small patent ductus arteriosus.

Aortography↗
PubMed1994

Comparison of the hormonal response after bidirectional Glenn and Fontan procedures.

Fluid retention is a frequent complication after the bidirectional Glenn and Fontan procedures. It was our hypothesis that this fluid retention may have a hormonal basis. To test this hypothesis, we made serial determinations of antidiuretic hormone, cortisol, aldosterone, angiotensin, and renin before and after operation in patients undergoing a bidirectional Glenn (n = 15) or Fontan (n = 18) procedure. Patients undergoing a bidirectional Glenn procedure had elevations in antidiuretic hormone, cortisol, and aldosterone immediately after operation. However, none of the hormonal elevations persisted by the fifth postoperative day. In contrast, patients undergoing a Fontan procedure had elevations in antidiuretic hormone, cortisol, aldosterone, renin, and angiotensin II in the immediate postoperative period. Five days postoperatively, the renin and angiotensin II levels remained elevated compared with the preoperative values. The data demonstrate that patients undergoing a bidirectional Glenn procedure and those undergoing a Fontan procedure have different patterns of hormonal response. These results suggest that hormonal factors may contribute to fluid retention after these operations.

Aldosterone↗
PubMed1994

Bone density of normal women in relation to endogenous and exogenous oestrogens.

To evaluate the relationship between duration of hormone replacement therapy (HRT) and forearm bone density, a population-based study has been conducted of 4638 women comparing bone density of 1079 women who had taken HRT for varying times with those who had never taken it. Forearm bone mineral content (BMC) was measured by single photon absorptiometry. Additionally, free oestradiol and sex hormone binding globulin levels were measured in women with high and low bone mineral content. There were no detectable differences in BMC in those who took HRT for up to 24 months compared with those who did not. Thereafter there were significant positive regression coefficients for duration periods of 2 to 5 yr (beta = 0.77, P = 0.04 and beta = 1.76, P = 0.03) and more than 5 yr (beta = 1.66, P < 0.0005 and beta = 1.87, P = 0.009) in post-menopausal and oophorectomized women. The major determinants of BMC were height, and in post-menopausal or oophorectomized women, age. Weight and parity also had additional explanatory power for pre- and post-menopausal women. Those who were in the highest quintile of BMC but had never taken HRT showed significantly elevated percentage free oestradiol compared with those in the lowest quintile. Thus HRT is osteoprotective if taken after the menopause for more than 24 months.

Adult↗