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Biomedical subjects

K Christopher

Publications and source records attributed to K Christopher.

17 recordsLinked to original sources
PubMed2001

Oculopharyngeal muscular dystrophy complicating airway management.

Oculopharyngeal muscular dystrophy (OPMD) is an uncommon autosomal dominant disorder characterized by late onset and slow progression. Complications of OPMD include ptosis and progressive dysphagia leading to eventual malnutrition and aspiration. We report a rare case of OPMD complicating mechanical ventilator management following emergent surgery. OPMD and the resulting dysphagia contributed to multiple intubations, tracheostomy, aspiration pneumonia, and a prolonged hospital course. Awareness of the possibility of OPMD in intubated patients with a history of dysphagia is crucial for avoidance of complications.

Aged↗
PubMed2000

Controlled comparison of L-5-methyltetrahydrofolate versus folic acid for the treatment of hyperhomocysteinemia in hemodialysis patients.

BACKGROUND: The hyperhomocysteinemia regularly found in hemodialysis patients is largely refractory to combined oral B-vitamin supplementation featuring supraphysiological doses of folic acid. We evaluated whether a high-dose L-5-methyltetrahydrofolate-based regimen provided improved total homocysteine (tHcy)-lowering efficacy in chronic hemodialysis patients. METHODS AND RESULTS: We block-randomized 50 chronic, stable hemodialysis patients on the basis of their screening predialysis tHcy levels, sex, and dialysis center into 2 groups of 25 subjects treated for 12 weeks with oral folic acid at 15 mg/d (FA group) or an equimolar amount (17 mg/d) of oral L-5-methyltetrahydrofolate (MTHF group). All 50 subjects also received 50 mg/d of oral vitamin B(6) and 1.0 mg/d of oral vitamin B(12). The mean percent reductions (+/-95% CIs) in predialysis tHcy were not significantly different: MTHF, 17.0% (12.0% to 22.0%); FA, 14.8% (9.6% to 20.1%); P=0.444 by matched ANCOVA adjusted for pretreatment tHcy. Final on-treatment values (mean with 95% CI) were MTHF, 20.0 micromol/L (18.8 to 21.2 micromol/L); FA, 19.5 micromol/L (18.3 to 20.7 micromol/L). Moreover, neither treatment resulted in "normalization" of tHcy levels (ie, final on-treatment values <12 micromol/L) among a significantly different or clinically meaningful number of patients: MTHF, 2 of 25 (8%); FA, 0 of 25 (0%); Fisher's exact test of between-groups difference, P=0.490. CONCLUSIONS: Relative to high-dose folic acid, high-dose oral L-5-methyltetrahydrofolate-based supplementation does not afford improved tHcy-lowering efficacy in hemodialysis patients. The preponderance of hemodialysis patients (ie, >90%) exhibit mild hyperhomocysteinemia refractory to treatment with either regimen. This treatment refractoriness is not related to defects in folate absorption or circulating plasma and tissue distribution.

Administration, Oral↗
PubMed1996

Respiratory distress, weakness, and electrolyte abnormalities.

A 56-year old man was admitted to the hospital with malaise, weakness, and fatigue. He was short of breath and had bilateral foot edema. Even though he had been very active a month earlier, he could no longer climb stairs. For the last two weeks, he had had a cough producing green sputum, a "tight feeling" in his chest, polyuria, and polydipsia. He had not had radiating chest pain, palpitations, leg pain or erythema, hemoptysis, diaphoresis, flushing, fever, chills, nausea, vomiting, diarrhea, or a loud snore.

Adrenocorticotropic Hormone↗
PubMed1996

Stimulation of cilia beat frequency by serotonin is mediated by a Ca2+ influx in ciliated cells of Helisoma trivolvis embryos

Serotonin (5-HT) has been established as a regulator of ciliary beating in numerous systems. In early embryos of Helisoma trivolvis, a cilia-driven rotational movement is modulated by the release of endogenous serotonin from a pair of embryonic neurons, ENC1s, directly onto the ciliated epithelium. The present study was undertaken to examine the signal transduction mechanisms underlying serotonin-mediated cilio-excitation in Helisoma trivolvis embryos. Using time-lapse videomicroscopy, the ciliary beat frequency (CBF) of cultured embryonic ciliated cells was measured in response to various pharmacological manipulations. Serotonin increased CBF in a dose-dependent manner. Addition of 8-bromo-cyclic AMP, isobutylmethylxanthine (IBMX) or a combination of forskolin and IBMX, treatments that elevate the concentration of intracellular cyclic AMP, did not mimic the serotonin-induced increase in CBF. Thus, cyclic AMP does not appear to be involved in the regulation of CBF in this system. In contrast, depolarizing the cells with KCl or veratridine, and artificially raising the intracellular Ca2+ concentration with thapsigargin or A23187, caused a serotonin-like increase in CBF. Furthermore, the serotonin response was abolished in a Ca2+-depleted medium or in a medium containing the L-type Ca2+ channel blockers verapamil or nifedipine. These results suggest that serotonin-stimulated cilio-excitation in cultured Helisoma trivolvis cells involves an influx of Ca2+ to increase intracellular Ca2+ concentration. The link between serotonin-receptor binding and Ca2+ influx in these cells has yet to be determined.

Journal Article↗
PubMed1989

Cromolyn sodium is effective in adult chronic asthmatics.

We studied 68 chronic asthmatic patients, 18 to 76 yr of age, with a percent predicted FEV1 between 33 and 81, comparing cromolyn sodium with placebo. We used a double-blind, comparative group trial design. A 4-wk baseline period was followed by 3 months of active treatment or placebo. Patients recorded symptom severity and frequency of study drug and concomitant medication usage on daily diary cards. At each clinic visit, patients independently assessed the effectiveness of the test medication in controlling their asthma. Physicians also assessed the severity of the patients' symptoms, pulmonary function, and effectiveness of test medication at monthly intervals. Methacholine challenges were done pre- and post-treatment. Use of concomitant therapy was reduced according to a specified schedule. There was significant improvement in the severity of daytime asthma, nighttime asthma, and cough as assessed by the patients in the cromolyn sodium group. Mean use of concomitant medications decreased significantly in cromolyn sodium patients. Despite the reductions in the use of bronchodilators, pulmonary function (FEV1, FVC, FEF25-75) improved significantly in the cromolyn sodium group. Similar improvements did not occur in the control group. The physicians' assessments of symptoms showed significant improvement in favor of the cromolyn sodium group. Both physicians and patients judged cromolyn sodium to be moderately or very effective for 61% of the patients as compared to 27% (by physicians) and 24% (by patients) in the placebo group. There was no significant difference in methacholine response between the two groups, although the mean value for methacholine sensitivity in the cromolyn sodium group was significantly less at the end of the study than at baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Accuracy and reproducibility of cholesterol assay in the western Cape.

The accuracy and precision of cholesterol assay in the western Cape region is reported. The survey was carried out over 15 weeks utilising three human EDTA plasma pools with normal, borderline high and high cholesterol levels respectively. All 11 laboratories in the region providing a service to academic, provincial or military hospitals or to the private medical sector were included in the study. Ten of the 11 laboratories utilised automated enzymatic methods of cholesterol assay whereas 1 used a manual procedure based on the Liebermann-Burchard reaction. Methods were standardised by means of a variety of commercial calibrator material in all except 1 laboratory which used reference sera from the Centers for Disease Control, Atlanta. The performance of the 4 best laboratories met the standard of precision recommended for cholesterol assay, viz. total coefficient of variation of less than or equal to 2.5%. However, only 2 of the 11 laboratories achieved the optimum objective of an overall bias of less than 2.0% together with precision of less than or equal to 2.5%. Rational use of cholesterol assay for diagnosis and management will therefore require standardisation of cholesterol assay on a common reference material and greater attention to analytical factors influencing the reproducibility of results. Intrinsic biological variation also contributes uncertainty to the interpretation of a single value. Thus important clinical decisions must be based on two or more assays carried out using appropriate methodology.

Cholesterol↗
PubMed1988

Obstructive sleep apnea syndrome: preoperative radiologic evaluation.

The purpose of this study was to determine whether lateral radiographs of the pharynx and fluoroscopy of the lateral pharynx in the sleeping patient could be used as predictors of surgical success in patients undergoing soft-palate surgery for obstructive sleep apnea. A total of 12 patients had surgery after radiologic evaluation. There were six surgical successes and six failures. No successes occurred in patients with a soft-palate length of less than 46 mm, nor were there any successes among patients whose initial point of obstruction on fluoroscopy was inferior to the level of the soft palate. There was one surgical failure among patients in whom fluoroscopy showed upper airway obstruction beginning at the level of the soft palate during sleep. Results suggest that a patient is most likely to benefit from soft-palate resection if the soft palate is long--we conservatively suggest greater than 40 mm--and if sleep fluoroscopy of the lateral pharynx shows airway obstruction beginning at the level of the soft palate.

Fluoroscopy↗
PubMed1987

Vocal cord dysfunction: the importance of psychologic factors and provocation challenge testing.

We present three case reports involving patients with vocal cord dysfunction. The onset of symptoms in one case was coincident with a generalized cutaneous reaction to penicillin with laryngeal involvement. The other cases had been misdiagnosed as food allergy and chemical sensitivity. We describe the psychologic factors in these cases in terms of the primary and secondary gain operative in the somatoform disorder of conversion reaction and emphasize the importance of belief and learned sensitivity in the induction of symptoms. The necessity of considering psychologic factors and the use of blinded, controlled, provocation challenges to evaluate subjective symptomatology is underscored. This study emphasizes the heterogenicity of clinical presentations involving vocal cord dysfunction and illustrates the value of fiberoptic-assisted examination of laryngeal function in conjunction with provocation challenge testing in establishing causal relationships for specific clinical symptoms.

Adult↗
PubMed1984

Inaccurate tourniquet pressure-gauge readings--a widespread problem.

Complications due to inaccurate pneumatic tourniquet pressure-gauge readings have been well described. However, no standard protocol for regular testing of the tourniquet apparatus, especially at the pressures used in clinical practice, appears to have been developed. We therefore developed a protocol for testing the Kidde pneumatic tourniquet apparatus and used this protocol to test 13 apparatuses in regular use at several hospitals in the Western Cape. We found that 8 of the apparatuses checked were inaccurate by as much as 350 mmHg, 8 had defective valves and 1 was considered to be too dangerous for further clinical use. This random survey shows that the majority of pneumatic tourniquet apparatuses in clinical use may be inaccurate and that more frequent testing and appropriate maintenance are indicated.

Equipment Failure↗