Habitual hip dislocation in a child. Another cause of the snapping hip.
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Child, Preschool↗
Biomedical subjects
J Walker
Publications and source records attributed to J Walker.
An audit of ultrasound diagnosis of gallbladder calculi.
Many series suggest that ultrasound is an accurate method for demonstrating cholelithiasis. However, these series were often prospective and the examinations performed by experienced sonographers. This audit addresses whether the accuracy is maintained in daily practice. We reviewed the ultrasound scans of 128 patients who underwent cholecystectomy for cholelithiasis and compared the findings. The operative and ultrasound findings were at variance in eight of the 128 patients (6.2%). Five were reported as having gallstones on ultrasound but none were found at cholecystectomy, a false positive rate for ultrasound of 3.9%. Three had abnormal gallbladders with no gallstones on ultrasound but gallstones were found at operation, a false negative rate of 2.3%. To avoid false positive diagnoses, suboptimal examinations should be repeated and the scan should be repeated immediately pre-operatively if only small calculi are seen. Alternative imaging should be performed if necessary, either cholescintigraphy in the acute situation or elective oral cholecystography. Some false negative examinations may be avoided by performing repeat examinations if the gallbladder is thick-walled and tender. With these provisos we conclude that ultrasound correctly diagnoses cholelithiasis in daily practice.
Cholecystectomy↗
Workshops: a stimulus for change.
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Female↗
Potentiating effects of cigarette smoking and moderate exercise on the thermic effect of a meal.
The purposes of this study were: (i) to determine the relative thermic effects of smoking and exercise in fasted and postprandial states, and (ii) to determine whether there is a weight-controlling caloric advantage of moderate exercise in the postprandial state which might be used upon smoking cessation. The subjects were ten physically fit, young, male smokers. Twenty minutes of smoking (two cigarettes) while fasted resulted in a 6.0% (12.5 kcals/3h) increase in resting metabolic rate (RMR), and 20 minutes of walking (5.8 km/h) while fasted increased post-exercise RMR by 5.8% (11.7 kcals/3h). The thermic effect of a meal (TEM) (740 ml, 874 kcals) increased RMR 21.0% (42.3 kcals/3h), which was increased to 22.1% by smoking (45.0 kcals/3h). Exercise after a meal increased RMR 29.1% (58.1 kcals/3h). Post-prandial exercise potentiated the TEM, as the energy cost was 4.0 kcals/3h greater than the sum of the thermic effect of the meal plus the thermic effect of exercise in the fasted state. Postprandial exercise expended 112.2 kcals/20 min vs. 101.6 kcals/20 min for fasted exercise, a difference of 10.4%. The difference increased to 14.6% when the post-exercise thermic effect was included. It was concluded that the thermic effect of smoking and exercise were similar in the fasted state, but were substantially different postprandially. Moderate postprandial exercise appears to offer a substantial weight-controlling advantage when compared with fasted exercise.
Adult↗
When self-help begins at home. Pain control in cancer care.
Ineffective pain control prevents many people with advanced cancer from being cared for at home as they would wish. Teaching patients about their analgesia and encouraging the use of complementary techniques can help prevent unnecessary suffering.
Humans↗
Identification of HIV-1 envelope glycoprotein in the serum of AIDS and ARC patients.
Binding of the human immunodeficiency virus type 1 (HIV-1) external envelope glycoprotein (gp120) has been reported to alter the function and surface antigen expression of lymphocytes and monocytes in vitro. To determine whether these in vitro findings could be relevant in vivo, we searched for the presence of this antigen in the serum of patients with AIDS and the AIDS-related complex (ARC). Using an antigen capture enzyme-linked immunosorbent assay (ELISA) with polyclonal anti-gp120 antibody, we detected envelope antigens (gp160/120) in serum of 22 of 32 AIDS patients. In contrast, an ELISA using solid-phase recombinant CD4 to capture gp160/120 failed to detect any positives. A modification of the anti-gp120-based ELISA identified gp160/120-IgG immune complexes in all of 11 AIDS patients tested and in 4 ARC patients who were negative for gp160/120 antigen. We conclude that gp160/120, predominantly in the form of immune complexes, can be identified as circulating antigen in patients with AIDS. The potential pathogenic consequences of this antigenemia, its relation to soluble CD4 therapy, and its application as a clinical marker of disease merit further study.
AIDS-Related Complex↗
Canadian physicians and tobacco.
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Adolescent↗
Eicosapentaenoic acid ethyl ester as an antithrombotic agent: comparison to an extract of fish oil.
Evidence suggesting that dietary omega-3 polyunsaturated fatty acids decrease the risk of thrombosis comes mainly from studies involving supplementation with large amounts (15-20 g/day) of fish oil extract. We investigated the inhibition of platelet function by a moderate amount (4 g/d) of ethyl eicosapentaenoate (E-EPA) compared to a concentrated fish oil extract (6 g/d) when given as a supplement to an ordinary diet. We also determined the effects of these supplements on platelet EPA incorporation, thromboxane synthesis, calcium mobilization and fibrinogen binding. After 4 weeks, both omega-3 supplements increased the amount of EPA in platelet phospholipids. The fish oil extract, which contained docosahexaenoic acid (DHA), had increased the amount of DHA also. The total increase in omega-3 fatty acids was similar for both supplements. E-EPA decreased serum cholesterol by 13% and triacylglycerols, 35%; increased the bleeding time by 57% and the threshold dose of collagen needed to induce platelet aggregation by 46%. Thromboxane synthesis in response to collagen was decreased 65% by E-EPA. Thus, the dietary supplement of pure E-EPA was more effective in limiting platelet reactivity than a concentrated fish oil extract providing an equivalent amount of omega-3 fatty acids. As an antithrombotic agent, E-EPA should allow for reasonable daily doses in long-term treatment of cardiovascular disease.
Adenosine Triphosphate↗
Observations on the lobular organization of the human choriocapillaris.
Vascular casts (Batson mixture) of ocular angioarchitecture were prepared from ten human orbits removed at autopsy. The age of donor specimens ranged from seven months to 68 years. The time interval between death and injection of the orbits averaged seven hours with a range of five hours. The resulting vascular casts were examined using light microscopy and scanning electron microscopy (SEM). We present photomicrographs of our vascular casts that demonstrate predictable variations of the human choriocapillaris angioarchitecture according to the region of the choriocapillaris under examination (i.e. posterior pole, equatorial, peripheral, peripapillary, or submacular areas). Our discussion represents an effort to help clarify some persistent controversies concerning the human choroidal angioarchitecture.
Adult↗
Cystathionine beta-synthase and gamma-cystathionase in helminths.
The activities of gamma-cystathionase and cystathionine beta-synthase were investigated in a range of gastrointestinal, free-living and entomophagous nematodes. Although nematode gamma-cystathionase used the same range of substrates as the mammalian hepatic enzyme, its activity was extremely low and there were significant interspecies variations with respect to the relative order of active substrates. Like the mammalian liver enzyme, nematode cystathionine beta-synthase showed activity in the directions of both cystathionine synthesis and the forward and reverse "L-serine sulphhydrase" reactions. However, the most important feature of the survey was the widespread ability of nematode cystathionine beta-synthase to catalyse the non-mammalian "activated L-serine sulphhydrase" reaction (L-cysteine + R-SH----cysteine thioether + H2S). Additional survey work revealed that the ability to catalyse the activated L-serine sulphhydrase reaction was almost universal amongst nematodes. Activated L-serine sulphhydrase activity was also demonstrated in the acanthocephalan Pomphorhynchus laevis but was absent from cestodes and digeneans.
Acanthocephala↗
Treatment of femoral shaft fractures in children by external fixation.
Non-operative management is still the treatment of choice for closed fractures of the femoral shaft in children. Indications for operative intervention would include: children with multiple injuries; severe soft tissue damage; cases where reduction is difficult to maintain; and children not suitable for management by traction. Since 1984, 16 children (mean age 10.3 years) have had stabilization of their femoral shaft fractures by external fixation (Monofixateur) in the Trauma Department of the Hannover Medical School. The external fixation remained in place for a mean of 63 days. Of the 16 children, 15 have been reviewed, with a mean follow-up of 28.2 months. No children who were completely managed with this fixation had any clinically relevant malalignment, but six cases had up to 2 cm difference in leg length. Our observations and experience show that external fixation is a useful alternative for the operative management of femoral shaft fractures in children. It produces good stability, is less invasive, and allows early mobilization. In order to avoid differences in leg length, we recommend a good anatomical reduction with the external fixation being carried out as early as possible.
Adolescent↗
Studies on alanine aminotransferase in nematodes.
L-alanine aminotransferase was demonstrated in a range of gastrointestinal, free-living and entomophagous nematodes. As in mammals, nematode L-alanine aminotransferase was found to exist in the form of mitochondrial and cytosolic isoenzymes. Whilst the majority of nematode enzymes exhibited a greater overall capacity for L-alanine synthesis than for L-alanine catabolism in vitro, the opposite was true for rat liver L-alanine aminotransferase. In contrast with rat liver, certain gastrointestinal nematodes were apparently able to transaminate D-alanine at low rates. H. contortus cytosolic L-alanine aminotransferase differed significantly from the mammalian enzyme with respect to both thermal stability and response to potential protective reagents.
Alanine Transaminase↗
Pyridoxal 5'-phosphate dependent enzymes in the nematode Nippostrongylus brasiliensis.
Eight classes of pyridoxal 5'-phosphate dependent enzymes have been investigated in Nippostrongylus brasiliensis in parallel with rat tissues. The range of decarboxylases detected in N. brasiliensis was limited in comparison with rat tissues. N. brasiliensis possessed a highly active L-serine hydroxymethyltransferase, but in contrast with rat liver, 5-aminolevulinic acid synthetase was absent. Similar levels of L-serine and L-threonine dehydratase activities were detected in N. brasiliensis and rat liver, and both organisms lacked L-alanine racemase, L-tryptophan synthetase and L-methionine gamma-lyase. The demonstration of cystathionine beta-synthase and gamma-cystathionase in N. brasiliensis suggests the presence of a functional trans-sulphuration sequence. The substrate specificities of the nematode cystathionine beta-synthase and gamma-cystathionase varied significantly from those of the corresponding mammalian enzymes. Particularly striking was the ability of N. brasiliensis cystathionine beta-synthase to catalyse the non-mammalian 'activated L-serine sulphydrase' reaction (L-cysteine + R-SH----cysteine thioether + H2S). N. brasiliensis and rat liver exhibited comparable abilities to transaminate amino acids via the 2-oxoglutarate: glutamate system.
Animals↗
Experimental infection of goat fetuses in utero with a stable, rough mutant of Brucella abortus.
Fetuses of goats in their last trimester of pregnancy were experimentally infected with Brucella abortus strain RB51, a stable rough mutant deficient in the perosamine O-chain content of its lipopolysaccharide. RB51 maintained its rough phenotype in vivo and did not induce abortion. Infection with RB51 resulted in the production of significant levels of IgG type antibodies specific for B abortus cellular antigens distinct from the perosamine O-chain. These findings suggest that strain RB51 will be useful in the pregnant goat for studying the role of brucella antigens other than the lipopolysaccharide O-chain in the immune response to brucellosis.
Animals↗
Clinical and histologic features of vulvar carcinomas analyzed for human papillomavirus status: evidence that squamous cell carcinoma of the vulva has more than one etiology.
The association between the human papillomavirus (HPV) and malignant neoplasms of the uterine cervix is well established; however, its role in the pathogenesis of vulvar cancer has not been well defined. This study correlates the clinical and histopathologic features of 21 invasive carcinomas of the vulva with the presence of HPV DNA as detected by Southern blot and polymerase chain reaction (PCR) analysis. By one or both techniques, HPV DNA was detected in 10 of the 21 tumors analyzed; all HPVs containing tumors hybridized with HPV-16 probes, although PCR also detected HPV-6 in two of the HPV-16-containing tumors. No HPV-18 DNA was detected in any tumor by PCR or Southern blot hybridization. Both the invasive cancer and the surrounding intraepithelial disease tended to display histopathologic features that usually could distinguish HPV-associated cancers from those without HPV DNA. The intraepithelial lesions associated with HPV-containing tumors were of the bowenoid type with koilocytosis, while tumors lacking HPV generally demonstrated a simplex type of intraepithelial lesion. Invasive tumors with no viral DNA were more frequently keratinizing than the HPV-containing cancers. Race, parity, hormonal therapy, and alcohol use did not affect the HPV status; however, HPV DNA was more prevalent in the tumors of younger women and in those with a history of tobacco use. Human papillomavirus status had no impact on the stage of disease or its prognosis. These findings identify two subsets of vulvar carcinoma cases based on HPV hybridization data and the histopathologic characteristics of the tumor.
Adult↗
Near normalization of adolescent height with growth hormone therapy in very short children without growth hormone deficiency.
Ten prepubertal children with stature at or below the 1st percentile for height and without growth hormone deficiency received 0.3 U recombinant growth hormone per kilogram daily for 2 years before puberty. Their growth velocity increased from 4 +/- 0.3 cm/yr before treatment to 10.7 +/- 0.6 and 8.8 +/- 0.6 cm, respectively, during the first and second years of treatment, and then remained at 5.7 +/- 0.7 cm the year after the end of growth hormone administration. This resulted in a near normalization of adolescent height. Bone maturation paralleled chronologic age, and therefore the expected final height of the children increased by approximately 10 cm. Administration of growth hormone induced a reversible hyperinsulinemia, with moderate and transient changes in glucose metabolism. A prospective, randomized study, including an untreated cohort, will be needed to confirm the effects on final height and to determine the magnitude of the response in familial short stature.
Adolescent↗
Protective functions of health and self-esteem against depression in older adults facing illness or bereavement.
Four functions were examined by which health and self-esteem could ward off depression over time in older adults. Adults (N = 1,074)--55 years and older--were interviewed 5 times at 6-month intervals. Demographic and prevent depression controls were included. Neither health nor self-esteem served as an interactive buffer. Both had direct negative effects on depression, independent of events, over 2 years. Neither illnesses nor bereavements had direct effects on depression; both had indirect effects through other events; illness also had indirect effects by weakening health. Health had stronger preventive effect on illnesses but was more vulnerable to undesirable events than was self-esteem. There was little support for the specificity hypothesis that a close match between event and resource would increase resource effects.
Adaptation, Psychological↗