Care of the elderly: partners in care.
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Biomedical subjects
Publications and source records attributed to K Turner.
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1. Ten venoms of the genus Crotalus (Crotalus adamanteus, Crotalus atrox, Crotalus durissus durissus, Crotalus horridus horridus, Crotalus lepidus, Crotalus polystictus, Crotalus molossus molossus, Crotalus pusillus, Crotalus scutulatus scutulatus, venom B, and Crotalus viridis lutosus) were fractionated using HPLC anion and cation exchange chromatography. 2. HPLC venom fractions were tested for hemorrhagic, hemolytic, and proteolytic activities. 3. Crude Virginia opossum (Didelphis virginiana) serum neutralized the hemorrhagic activity of HPLC fractions.
Two selenium (Se) supplementation trials were conducted in successive years involving a total of 70 red deer calves 3-15 months of age grazing pasture containing 30-57 ppb of Se on a dry matter basis. The trials compared growth rate, whole blood Se and glutathione peroxidase (GSHpx) concentrations of calves which received periodic doses of oral Se or a single injection of barium selenate (equivalent to 50 mg Se) or no Se supplementation. There were no significant weight gain differences between treated and untreated groups in either trial. Whole blood GSHpx levels were strongly correlated with blood Se levels (r = 0.9278) and produced the following regression equation: GSHpx = 0.0155 Se - 2.292. In both years the 3 month old calves had GSHpx levels of 6-9 kU/I which probably derived from maternal transfer of Se. The GSHpx levels in unsupplemented calves declined from these levels to a minimum in winter (group means approximately 2.6) and then progressively rose the following spring and summer. Periodical oral dosing with Se or a single injection of barium selenate significantly elevated blood Se and GSHpx levels throughout the trials.
The authors report the case of a 21-year old, non-immunocompromised girl who presented with severe acute heart failure associated with Toxoplasma infection. The outcome was favourable: cure without sequelae was obtained in a few months with a symptomatic and specific treatment consisting of spiramycin and methylprednisolone. This case is interesting for several reasons. The occurrence of such an acute heart disease is extremely rare in patients with toxoplasmic myocarditis, and so is the presence of a septal focus suspected on the basis of a predominantly septal hypokinesia at echocardiography and of enzymatic changes. The development of an acute heart failure should suggest a diagnosis of toxoplasmic myocarditis, which is rare but important since a specific treatment is available.
The authors report bilateral secondary tumors of the kidney in two patients: one previously treated for an epidermoid tumor, the other for an anaplastic bronchial tumor. In both patients, clinical and radiological features were those of a malignant process. Scan-guided percutaneous fine needle aspiration provided the material necessary to make a definitive cytological diagnosis; it was thus possible to assess the malignancy and recognize the histological type of lesions.
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We report the findings in two sisters with active cirrhosis and an anti-liver-kidney microsomal antibody (anti-LKM) of the autoimmune type. This unusual disease is characterized by the presence of high levels of antibodies that react with the smooth and rough endoplasmic reticulum of the liver and other tissues. Our patients had the usual features of chronic hepatitis associated with presence of antibodies: they were young girls, they had anti-LKM antibodies of autoimmune type persisting at a high titer during the whole course of the disease, but with no smooth muscle antibodies; one had a low level of IgA. The occurrence of two cases in the same family has not yet been reported and is probably not coincidental because of the rare occurrence of this disease.
The pH measurements of 185 samples of ascitic fluid in 169 cirrhotic and 16 noncirrhotic patients were analyzed to assess their diagnostic and prognostic value. The 169 cirrhotic patients were divided into four groups: sterile ascites (group 1), spontaneous bacterial peritonitis (group 2), probable spontaneous bacterial peritonitis (group 3), and bacterascites (group 4). Mean ascitic fluid pH values were lower (p less than 0.001) in patients of groups 2 (7.24 +/- 0.17) and 3 (7.34 +/- 0.11) than in patients of groups 1 (7.44 +/- 0.06) and 4 (7.45 +/- 0.08), but there was an important overlap between these groups. Mean arterial-ascitic fluid pH gradient values were higher (p less than 0.001) in patients of groups 2 (0.21 +/- 0.16) and 3 (0.10 +/- 0.13) than in patients of groups 1 (0.02 +/- 0.05) and 4 (0.02 +/- 0.05). This gradient had a better discriminant power than ascitic fluid pH alone. Sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy for the diagnosis of certain or probable spontaneous bacterial peritonitis were, respectively, 47%, 99%, 88%, 89%, and 89% for ascitic fluid pH values less than 7.32; 66%, 99%, 91%, 93%, and 92% for arterial-ascitic fluid pH gradient values greater than 0.10; and 97%, 96%, 86%, 99%, and 96% for polymorphonuclear cell count greater than 75/microliter. Ascitic fluid pH values appeared to have a high prognostic value, as 6 of 7 cirrhotic patients with ascitic fluid pH values less than 7.15 died rapidly. Low ascitic fluid pH values were found in patients with malignant and pancreatic ascites and tuberculous peritonitis but not in patients with cardiac ascites. We conclude that in cirrhotic patients with certain or probable spontaneous bacterial peritonitis (a) arterial-ascitic fluid pH gradient measurements had a slightly higher diagnostic value than ascitic fluid pH measurements but a slightly lower diagnostic value than polymorphonuclear cell count and (b) ascitic fluid pH measurements had a high prognostic value. In noncirrhotic patients, ascitic fluid pH and arterial-ascitic fluid pH gradient measurements had a poor diagnostic value.
Female inbred Hooded Lister (HL) rats were each infected with 20 metacercariae (Mc) of Fasciola hepatica. Remarkable variations between the number of flukes established in the bile ducts suggest the presence of individual, perhaps genetically controlled, differences in immune responsiveness of HL rats to F. hepatica. Serum (4 ml) from HL rats infected with 20 Mc 6 weeks prior to transfer partially protected rats against a F. hepatica challenge infection. However, 1 X 10(6) lymphoid cells originating from rats of the same age and stage of infection did not show the same protective qualities. Furthermore, attempts to immunise HL rats i.p. with either juvenile or adult excretory/secretory (ES) products, or somatic tissue antigens and AlOH3-gel as adjuvant failed. When compared to other investigations, the present results further suggest that both the adjuvant and the route of administration are crucial for the stimulation of a protective immunity to F. hepatica. Low titers and low anamnestic responses of haemagglutinating antibodies after prior immunisation with juvenile ES antigens or both juvenile ES and somatic tissue antigen suggest the occurrence of an immunosuppressive effect caused by juvenile ES products. The total serum IgE-levels in immunised groups were generally lower when compared to the challenge control group, whereas the F. hepatica ES-specific IgE-levels rose after challenge, but immediately decreased again when compared to challenge controls. These findings support the hypothesis of an immunomodulatory effect caused by the vaccination scheme.
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The effect of infection with the liver fluke Fasciola hepatica on serum, bile and faecal immunoglobulin and antibody levels was studied in Scottish Blackface sheep. In the serum the immunoglobulins showing the most marked increase were IgG1 and IgG2 and their maximal values were reached at 16 weeks after infection. In the bile IgG2 rose to peak values at two weeks and IgG1, IgA and IgM were maximal at four weeks after infection. The levels of faecal IgG and IgA were low after primary infection but after reinfection a rapid increase in IgA concentration was observed within one to two weeks. Haemagglutinating antibody levels against egg antigens, juvenile and adult excretory-secretory antigens and adult fluke somatic antigens were evaluated. In the sera high titres were observed starting from two to four weeks after infection and persisting until 14 to 16 weeks. Bile haemagglutinating antibodies against excretory-secretory antigens showed the highest level at two and four weeks after infection while antibodies against adult somatic antigens reached maximal titres between four and eight weeks. Faecal antibody levels after primary infection were low but increased rapidly within two weeks after reinfection, coinciding with the elevation in faecal IgA concentration. However, there was no reduction in the number of flukes established in reinfected animals.
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F. hepatica infection of rats caused a prolonged elevation of serum total IgE reflecting the continued presence of live worms in the host. Infection with 40 metacercariae stimulated higher total IgE levels than infection with 20 metacercariae. The parasite specific IgE response was biphasic, the first peak coinciding with the migratory phase in the liver parenchyma and the second with the establishment of flukes in the bile ducts.
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