Midwives of the future deserve better!
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Humans↗
Biomedical subjects
J Wallis
Publications and source records attributed to J Wallis.
In-vivo validation of videodensitometric coronary cross-sectional area measurement using dual-energy digital subtraction angiography.
Previous studies indicate that conventional geometric edge detection techniques, used in quantitative coronary arteriography (QCA), have significant limitations in quantitating coronary cross-sectional area of small diameter (D) vessels (D < 1.00 mm) and lesions with complex cross-section. As a solution to this problem, we have previously reported on an in-vitro validation of a videodensitometric technique that quantitates the absolute cross-sectional area including small vessel diameter (D < 1.00 mm) and any complex shape of the vessel cross-section. For in-vivo validation, plastic tubing (5-8 mm long) with different shape complex cross-section with known cross-sectional area (A = 0.8-4.5 mm2) were percutaneously wedged in the coronary arteries of anesthetized pigs (40-50 kg). Contrast material injections (6-10 ml at 2-4 ml/sec) were made into the left main coronary artery during image acquisition using a motion immune dual-energy subtraction technique, where low and high X-ray energy and filtration were switched at 30 Hz. A comparison was made between the actual and measured cross-sectional area using the videodensitometry and edge detection techniques in tissue suppressed energy subtracted images. In eighteen comparisons the videodensitometry technique produced significantly improved results (slope = 0.87, intercept = 0.24 mm2, r = 0.94) when compared to the edge detection technique (slope = 0.42, intercept = 1.99 mm2, r = 0.39). Also, a cylindrical vessel phantom (D = 1.00-4.75 mm) was used to test the ability to calculate and correct for the effect of the out of plane angle of the arterial segment on the cross-sectional area estimation of the videodensitometry technique. After corrections were made for the out of plane angle using two different projections, there was a good correlation between the actual and the measured cross-sectional area using the videodensitometry technique (slope = 0.91, intercept = 0.11 mm2, r = 0.99). These data suggest that it is possible to quantitate absolute cross-sectional area without any assumption regarding the arterial shape using videodensitometry in conjunction with the motion immune dual-energy subtraction technique.
Angiography, Digital Subtraction↗
Which teen mothers choose Norplant?
PURPOSE: The objective of this study was to determine if there are sociodemographic differences between adolescent mothers who choose to use Norplant after delivery and those who do not. We hypothesized that those adolescent mothers who are at highest risk for repeat adolescent pregnancy are least likely to select Norplant as a postpartum contraceptive. METHODS: We prospectively compared the prevalence of epidemiologic risk factors for repeat adolescent pregnancy in a group of 187 consecutively delivered 13-18-year-olds who were enrolled in a comprehensive, multidisciplinary, adolescent-oriented maternity program. The study subjects were interviewed at delivery; 100 subsequently had a Norplant inserted (Norplant users). Student's t-tests and chi-square analyses were used to compare Norplant users and refusers. RESULTS: We found no statistically significant differences between Norplant users and refusers with regard to: age, race, Medicaid, or marital or school status. Compared to Norplant refusers, Norplant users were less likely to be primiparous (79% compared to 90%; p = .04) and more likely to have poor school grades (20% compared to 7%; p = .001). Norplant users were more likely to state that they had had trouble remembering to use contraceptives in the past (32% compared to 14%; p = .005). CONCLUSIONS: These data do not support the study hypothesis and are encouraging because they suggest that Norplant may reduce repeat pregnancy among adolescent parents.
Adolescent↗
Structure of the human N-cadherin gene: YAC analysis and fine chromosomal mapping to 18q11.2.
The cadherins are a large family of cell adhesion molecules involved in calcium-dependent recognition and adhesion events. We have used YAC analysis to determine the structure of the human N-cadherin gene. An 850-kb YAC was isolated and the entire N-cadherin gene mapped to a 250-kb region spanning three putative CpG islands. A PCR and cosmid subcloning strategy was used to define the boundaries for the 16 exons that compose the gene. These were shown to be not only highly conserved between mouse and human N-cadherin genes, but also similar to other cadherins. The first and second introns of the gene are large, a property conserved between the mouse and human genes. In situ hybridization with YAC DNA refined the map position of N-cadherin to human chromosome 18q11.2.
Animals↗
Patterns of predation by chimpanzees on red colobus monkeys in Gombe National Park, 1982-1991.
Predatory patterns in wild chimpanzees are important evidence in the continuing debate about the role of hunting in the behavior of early hominids. Data are presented on the predator-prey ecology of red colobus monkeys Colobus badius tephrosceles) and chimpanzees (Pan troglodytes schweinfurthii) in Gombe National Park, Tanzania, from 1982 through 1991. During this period chimpanzees were observed to kill 429 mammalian prey items, 350 of which were red colobus. Hunts were undertaken by chimpanzees in 71.5% of encounters with red colobus, and in 52.2% of all hunts at least one colobus was caught. Hunting occurred in all months, but its frequency peaked in the late dry season months of August and September, and was lowest in the rainy months of April and May. There was greater seasonality of hunting from 1982 to 1991 than previously reported for Gombe. Hunting success varied between 40% in the rainy season and 65% in the dry season. Sixty multiple kills of colobus were reported in which from two to seven colobus were killed. Approximately 75% of all colobus caught were immatures; juveniles were the most preyed upon age class. Adult and adolescent male chimpanzees made 89.3% of all kills; the 10.7% of kills made by adult females was an increase over the 4% figure for female kills reported in the preceding decade. Hunting showed a strong "binge" tendency, with the explanation for binges likely related to social rather than ecological factors. These results are discussed in light of earlier hunting data for Gombe chimpanzees, and compared with data from other chimpanzee field studies.
Age Factors↗
Intravascular ultrasound imaging after excimer laser angioplasty.
To help elucidate the mechanism of excimer laser coronary angioplasty (ELCA), intravascular ultrasound (IVUS) imaging was performed in 19 of 29 patients who were treated with ELCA. The results were compared with a non-randomized control group of 18 patients who had IVUS studies both before and after PTCA alone. After ELCA alone, lumen diameter (1.9 x 1.7 mm) and lumen cross-sectional area (CSA) (2.9 mm2) by IVUS were not significantly different from baseline values in the patients before PTCA alone (2.1 x 1.8 mm, 3.2 mm2). After balloon dilatation in the laser treated group, lumen diameter (2.5 x 2.1 mm) and lumen CSA (4.9 mm2) were significantly greater than those post ELCA alone. However, there was no difference in lumen CSA or atheroma CSA in the group treated with excimer laser plus balloon dilatation vs. these measurements in the group treated with PTCA alone. ELCA does not ablate a large amount of atheroma (9% reduction) but creates a pathway to permit easier passage of a PTCA balloon. These quantitative and morphologic results may help explain why the restenosis rate with ELCA is similar to PTCA alone.
Adult↗
Paternity exclusion in a community of wild chimpanzees using hypervariable simple sequence repeats.
We report the use of hypervariable simple sequence repeat (SSR) nuclear loci to study paternity in a community of wild chimpanzees (Pan troglodytes schweinfurthii) in Gombe National Park, Tanzania. All 43 living members of a habituated community were sampled and 35 were genotyped at 8 SSR loci using DNA amplified from hair. Paternity exclusions were performed for 25 chimpanzees including 10 for whom the mother was also genotyped. In each case 12-20 males were potential fathers based on their age and/or direct observation of sexual behaviour. 179 tests involving potential father/offspring combinations were performed. In four cases the data permit the probable identification of the previously undetermined father; these are the first such determinations for free-ranging chimpanzees, and the first based on non-invasive sampling. In another four cases we were able to exclude all but two to five potential fathers, and in the remaining cases we were able to exclude all living males. For molecular ecologists SSR genotype databases offer important advantages over currently popular minisatellite DNA finger-printing: they can be analysed unequivocally using traditional population genetics techniques and they can be expanded through time and space by other researchers.
Alleles↗
Prediction of cardiovascular death in men undergoing noninvasive evaluation for coronary artery disease.
OBJECTIVE: To develop prediction rules from clinical and exercise test data identifying patients at high and low risk for cardiovascular events among a group of male veterans. DESIGN: Prognostic study with prospective gathering of data and routine follow-up of consecutive patients referred for exercise testing. Patients only underwent noninvasive evaluation for coronary artery disease. No validation cohort is yet available. SETTING: A 1200-bed Veterans Affairs Medical Center. PATIENTS: Of 3609 men referred for exercise testing between 1984 and 1990, 2546 patients remained evaluable after exclusion of those who underwent subsequent cardiac catheterization, those with significant valvular heart disease, and those who had previous coronary artery bypass surgery. MEASUREMENTS: Evaluation included recording of clinical data on a standardized form and a standard treadmill test followed by assessment of cardiovascular events. RESULTS: During a mean follow-up period (+/- SD) of 2.75 (+/- 18) years, 119 cardiovascular deaths and 44 nonfatal myocardial infarctions occurred in 2546 patients. The Cox proportional hazards model showed the following characteristics to be statistically independent predictors of time until cardiovascular death: history of congestive heart failure or digoxin use, exercise-induced ST depression, change in systolic blood pressure during exercise, and exercise capacity. Using a simple score based on one item of clinical information (history of congestive heart failure or digoxin use) and three exercise test responses (ST depression, exercise capacity, and change in systolic blood pressure), 77% of patients were categorized as low risk (annual cardiac mortality rate, less than 2%), 18% as moderate risk (annual cardiac mortality rate, 7%), and 6% as high risk (annual cardiac mortality rate, 15%; hazard ratio, 10; 95% confidence interval, 6 to 17). This model has not yet been validated. CONCLUSIONS: Variables available from the usual non-invasive work-up of patients with known or suspected coronary artery disease can be used to predict future risk for cardiovascular death.
Aged↗
Prediction of cardiovascular death by means of clinical and exercise test variables in patients selected for cardiac catheterization.
The objective of this report is the development of a population-specific prediction rule based on clinical and exercise test data that would estimate the risk of cardiovascular death in patients selected for cardiac catheterization. Prospective data and follow-up information were obtained from patients who underwent cardiac catheterization soon after clinical assessment and exercise testing. Males (n = 588) referred for evaluation of coronary heart disease from 1984 to 1990 were selected after exclusion of patients with significant valvular heart disease and patients with prior cardiac surgery. Half had a prior myocardial infarction and half complained of typical angina pectoris. All patients performed a treadmill test and were selected for clinical reasons to undergo coronary angiography within 3 months. Over a mean follow-up period of 2.5 years (+/- 1.4 years), there were 39 cardiovascular deaths and 45 nonfatal myocardial infarctions. The Cox proportional hazards model demonstrated the following characteristics to be statistically significant independent predictors of time until cardiovascular death: history of congestive heart failure (hazards ratio of 4), ST depression on the resting ECG (hazards ratio of 3), and a drop in systolic blood pressure below the resting value during exercise (hazards ratio of 5). Exercise-induced ST depression was not associated with either death or nonfatal myocardial infarction. A simple score based on one item of clinical information (history of congestive heart failure), a resting ECG finding (ST depression), and an exercise test response (exertional hypotension) stratified our patients for 4 years after testing from 75% with a low risk (annual cardiac mortality rate of 1%), 17% with a moderate risk (annual mortality rate of 7%), and 1% with a high risk (annual cardiac mortality rate of 12%, with a hazards ratio of 20 and 95% confidence interval from 6 to 70X). It was concluded that the variables available from the usual noninvasive workup of patients with known or suspected coronary artery disease enable prediction of risk of cardiovascular death. Three quarters of those usually undergoing cardiac catheterization can be identified by simple noninvasive variables as being at such low risk that invasive intervention is unlikely to improve prognosis.
Aged↗
Structure of the genes encoding the neural cell adhesion molecules N-CAM and N-cadherin.
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Animals↗
Endobronchial chondromatous hamartoma: a rare cause of lobar collapse treated by endoscopic removal.
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Bronchi↗
Contamination of underwater seal drainage systems in thoracic surgery.
The incidence of bacteriological contamination of drainage fluid (water constituting the underwater seal plus drainage effluent) was studied in 38 patients (50 chest drains), up to 6 days after thoracotomy. No bacteriological contamination was demonstrated in any of the samples taken during this period of time. We conclude that the underwater seal drainage system may be left for up to 6 days postoperatively without change of any of its components and without risk of contamination.
Drainage↗
Identification of CpG islands in a physical map encompassing the Friedreich's ataxia locus.
The Friedreich's ataxia locus has been previously assigned to chromosome 9q 13-21.1 by the demonstration of tight linkage to two anonymous DNA markers. MCT112 (Z greater than 80, theta = 0) and DR47 (Z greater than 50, theta = 0). The absence of recombination between these three loci has prevented the resolution of gene/probe order in this region, impeding strategies for gene isolation. We report physical mapping over a 4-Mb genomic interval, linking the markers MCT112 and DR47 on a common 460-kb NotI fragment and identifying 11 CpG islands in the 1.7-Mb interval most likely to contain the Friedreich's ataxia locus. Four of these islands were detected only by analysis of three YAC clones spanning a 700-kb interval including the MCT112/DR47 cluster. Without clear evidence of the precise location of the disease locus from recombination events, each of these regions must be considered as specifying a potential "candidate" sequence for the mutated gene.
Chromosome Mapping↗
Giant thymic carcinoid.
Thymic carcinoid is a rare tumour. It may present with ectopic endocrine secretion or with symptoms of compression as a result of its size. A case is reported which presented with symptoms of compression where the size of the tumour was uniquely large such as to warrant the term giant thymic carcinoid. The typical histological features are described, together with its possible origin and its likely prognosis.
Carcinoid Tumor↗
Identification of a hypervariable microsatellite polymorphism within D9S15 tightly linked to Friedrich's ataxia.
We have identified a hypervariable microsatellite sequence within the chromosome 9 marker MCT112 (D9S15), which we have previously shown to be tightly linked to Friedreich's ataxia (FRDA). The system detects 7 alleles ranging in size from 195 to 209 base pairs, and substantially increases informativity at the MCT112 locus. This enhances its use for genetic counselling in affected families. Recalculated combined linkage data between the FRDA locus and MCT112 gives a maximal lod score of 66.91 at a recombination fraction of theta = 0). There is no evidence of linkage disequilibrium.
Alleles↗
Hydroxyurea-induced acute alveolitis in a patient with chronic myeloid leukaemia.
A number of cytotoxic agents have been implicated in the production of widespread pulmonary alveolar damage. We present a case of life-threatening alveolitis in a patient on hydroxyurea for chronic myeloid leukaemia. The clinical course suggests that the alveolitis was induced by the hydroxyurea. This is the first reported case of hydroxyurea-induced pulmonary alveolitis.
Aged↗
Inhaled foreign bodies in the adult as a cause of unresolved pneumonia.
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Aged↗
A comparative study of standard and slow-release oral lithium carbonate products.
Lithium serum levels were drawn over one steady-state dosing interval in 8 bipolar disorder patients receiving long-term lithium therapy: (i) after standard-release lithium (STD); and (ii) after changing to 2 weeks' continuous dosing of a slow-release (SR) preparation. Rate of absorption of the SR preparation was significantly slower than the STD preparation measured by the peak/trough difference, percentage peak/trough fluctuation and percentage swing. The extent of absorption measured by the area under the concentration time curve was not significantly different for the two preparations. Serum lithium levels drawn within 2 hours after administration of the SR preparation are likely to be within the range 0- -18% of the 12-hour standard serum lithium with a 95% limit of confidence. The STD preparation shows a deviation in the same period of -14.5-70%. These results suggest that if a patient taking the SR preparation presents within 2 hours after administration a serum lithium level would still be meaningful, whereas for a patient taking the STD preparation it is essential that blood be drawn 12 hours after administration for meaningful interpretation.
Administration, Oral↗