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Biomedical subjects

L Barrett

Publications and source records attributed to L Barrett.

At least 19 recordsLinked to original sources
PubMed1997

Testing to predict outcome after transurethral resection of the prostate.

PURPOSE: We assessed the ability of routine clinical tests to predict outcome following transurethral resection of the prostate. MATERIALS AND METHODS: A total of 556 men randomized into a trial of surgery versus watchful waiting was evaluated preoperatively with symptom interview, quality of life assessment, uroflowmetry, urinalysis, standard chemistry panel, post-void residual urine determination and cystoscopy. The ability to predict avoidance of postoperative complications, and improvement in quality of life and genitourinary symptoms was assessed in the 249 men randomized to undergo transurethral resection of the prostate. RESULTS: Patients with the highest symptom scores were most likely to have symptom improvement and those most bothered by the symptoms were most likely to have improvement in quality of life. No objective tests measuring physiological parameters made clinically significant contributions toward predicting these outcomes. Lower obstructive symptom scores and larger perioperative infusions of intravenous fluids were associated with a greater chance of complications. CONCLUSIONS: Symptom analysis and quality of life assessment are most useful in selecting patients for transurethral resection of the prostate. Objective diagnostic tests are of limited additional benefit.

Follow-Up Studies↗
PubMed1996

Satisfaction with care received from family physicians: a comparison of Medicaid enrollees and other patients.

BACKGROUND: Patient satisfaction is an important component used to assess quality of health care. Limited access to and choice of physicians, perception of receiving second-class care by recipients, and possible negative caregiver attitudes could cause Medicaid enrollees to be less satisfied with their physicians than other patients. METHODS: A cross-sectional survey was conducted of 603 patients visiting four family practice residency clinics during a 1-week period that yielded a 72% response or 436 usable surveys. The 39-item survey included basic demographics (age, gender, site, and first-time visit status), five of Ware's "dimensions" of patient satisfaction, a composite score for life satisfaction, a measure of patient confidence in the local medical care community, and questions about how patients felt they were treated, based on insurance type. It was hypothesized that Medicaid enrollees would not be as satisfied with their care as other patients. RESULTS: The study hypothesis was rejected after using two-sample t tests and regression analyses. Lower levels of patient satisfaction were not found in Medicaid enrollees, even after adjusting for the effects of differing demographic characteristics, possible different life satisfaction levels, and possible different levels of confidence in the local medical care community. CONCLUSIONS: The results of this study show that enrollment in Medicaid did not result in lower levels of patient satisfaction. Future research about these issues in settings other than family practice residency clinics is needed.

Adolescent↗
PubMed1995

Distal innominate artery transection and cervical spine injury.

Distal innominate artery injury secondary to blunt trauma had not previously been reported. We present a case of distal innominate artery transection associated with a cervical spine dislocation. A mechanism for this unusual vascular injury is proposed. An organized diagnostic and treatment plan is emphasized.

Adult↗
PubMed1994

Complement C1q does not bind monomeric beta-amyloid.

The tendency of both labeled and unlabeled beta-amyloid to bind in solution to C1q, the recognition species in the complement cascade, was examined using both hydrodynamic and spectroscopic methods. Potential binding interactions were evaluated using a purified synthetic beta-amyloid 1-40 sequence, alone, and selectively labeled at the amino terminus with spectroscopic probes. The probes permitted both absorbance and fluorescence analyses of beta-amyloid binding interactions. Under conditions used for the analyses beta-amyloid exists exclusively as a monomer in solution, and C1q retains an intact quaternary structure and is capable of binding to IgM. When mixed together the monomeric beta-amyloid does not bind to, or interact with, the complement C1q at concentrations below approximately 100 microM. The data suggest that if beta-amyloid toxicity is associated with complement activation in Alzheimer's disease then monomeric beta-amyloid is likely not responsible for activation through the classical complement pathway.

Amyloid beta-Peptides↗
PubMed1994

Quantitation of parasitemia by competitive polymerase chain reaction amplification of parasite kDNA minicircles during chronic infection with Trypanosoma cruzi.

Methods for detecting parasitemia in chronic Trypanosoma cruzi infection are either insensitive or nonquantitative. The polymerase chain reaction (PCR), used to detect parasite kinetoplast (k) minicircle DNA, has been shown to be virtually 100% sensitive and specific in chronically infected persons. This technique has now been modified to be quantitative by using a competitor DNA. The competitive PCR yields equal amounts of kDNA and competitor PCR products when they are mixed in equimolar ratios. Thus, the amount of parasites can be estimated from the quantity of competitor DNA at the equivalency point. Blood from 5 chronically infected mice gave results consistent with 3-260 parasites/mL, and blood from 1 chronically infected person yielded 4 parasites/mL. These are the first quantitative estimates of parasitemia in chronic T. cruzi infection. This technique could be useful for studying the natural history of T. cruzi infection and the response to therapy.

Adult↗
PubMed1993

FL-160 proteins of Trypanosoma cruzi are expressed from a multigene family and contain two distinct epitopes that mimic nervous tissues.

The partial sequence of a gene encoding the COOH terminus of a protein of apparent molecular weight of 160 kD associated with the flagellum of trypomastigotes of Trypanosoma cruzi (FL-160 now renamed to FL-160-1) has been previously reported. The COOH terminus of FL-160-1 has an epitope, defined by 12 amino acids, which molecularly miMics a nervous tissue antigen of 48 kD found in myenteric plexus, sciatic nerve, and a subset of cells in the central nervous system. We now report that FL-160 is a family of highly related genes. The sequence has been determined for the entire open reading frame (ORF) of one of the members of the FL-160 gene family (FL-160-2) and three other partial ORFs. Sequence analysis reveals the various members of the FL-160 gene family to be approximately 80% homologous in the predicted amino acid sequence, but all retain the 12-amino acid molecular mimicry epitope on the COOH terminus. Comparison of the sequence of FL-160-2 to other sequences demonstrates amino acid homology to bacterial sialidase (27%), members of the SA85 gene family (25-30%) and the shed acute-phase antigen/neuraminidase/trans-sialidase gene family (25-30%). Quantitative hybridization at high stringency suggests 750 copies of FL-160 are present in the DNA of each parasite. Reverse transcription and sequence analysis demonstrates that at least five of the members of the FL-160 gene family are transcribed. The NH2 terminus of one of the FL-160 gene products was expressed and antibodies prepared. Antibodies directed to either the COOH or the NH2 terminus of FL-160 bind a 160-kD T. cruzi protein. Both antibodies bind the surface membrane in the flagellar pocket of the trypomastigote. Antibodies to the NH2 terminus bind epineurium and scattered linear densities in sciatic nerve in a pattern distinct from the pattern with antibodies to the COOH terminus. Thus, there are at least two distinct molecular mimicry epitopes on the FL-160 molecule and both mimic epitopes found in nervous tissues. FL-160 may be involved in the generation of autoimmunity to nervous tissues by molecular mimicry, observed in chronic Chagas' disease.

Amino Acid Sequence↗
PubMed1992

Cysticercosis: first 12 months of reporting in California.

Cysticercosis, a sometimes fatal ailment caused by larvae of the pork tapeworm Taenia solium, became a reportable disease in California in 1989. During the first year, from 1 April 1989 through 31 March 1990, 134 cases were reported to the California Department of Health Services. All of the 112 patients for whom laboratory diagnostic test data were obtained had neurocysticercosis. Nearly all (117) of the 127 patients whose race and ethnic background were known had a Hispanic background, and most of the 112 patients whose country of birth or prior residence was known had immigrated from T. solium-endemic countries. However, three of 11 patients born in the United States said they had never traveled outside the country, and it appears possible that indigenous transmission has been occurring. These findings affirm that neurocysticercosis should be included in the differential diagnosis of neurologic symptoms in patients who have immigrated from or traveled to T. solium-endemic countries, and also in those who have been in close contact with immigrants from endemic countries.

Adolescent↗
PubMed1991

Evaluation of dacryocystorhinostomy failure with computed tomography and computed tomographic dacryocystography.

Five patients with dacryocystorhinostomy failures were examined with computed tomography or computed tomographic dacryocystography. In computed tomographic dacryocystography, radiopaque dye was instilled into the lacrimal sac before computed tomography to show its shape, location, and relation to surrounding structures. Problems with the bony ostium were detected in all five patients. Recurrent nasal polyposis, a retained metallic clip, and an unresected ethmoid air cell were also identified. Computed tomography and computed tomographic dacryocystography provided important information that facilitated reoperation after dacryocystorhinostomy failure.

Adolescent↗
PubMed1991

Reliability and validity of two self-rating scales in the assessment of childhood depression.

A comparison was made of the reliability and validity of two self-rating scales, the Children's Depression Inventory (CDI) and Depression Self-Rating Scale (DSRS), in the diagnosis of depression in 93 children (aged 8-16 years) attending a university child psychiatry department. The two scales were of comparable merit but had only moderate discrimination between depressed and non-depressed children, with each scale having a misclassification rate of 25%. Better agreement was obtained in more verbally intelligent children, irrespective of age. Girls scored higher on the instruments than boys. No significant relationship was found between teacher assessment of classroom behaviour and the two self-rating depression instruments.

Adolescent↗
PubMed1990

Magnetic resonance imaging and computed tomography in a model of wooden foreign bodies in the orbit.

Wooden foreign bodies in the orbit are not detectable by standard roentgenography. Reports in the literature on the ability of computed tomography (CT) to detect orbital wooden foreign bodies have varied. To evaluate whether magnetic resonance imaging (MRI) would offer any advantage over CT in detecting wood in the orbit. MRI and CT were performed on an in vitro model of wooden foreign bodies in the orbit. Woods of different types and sizes were studied in vegetable fat backgrounds chosen to simulate orbital fat. On CT, most types of wood were hypodense to fat. Appropriate window settings were critical in the detection of wood by CT: in this model, a window width of 1000 Hounsfield units was optimal. On MRI, all types of wood were hypointense to fat. Small pieces of wood were surrounded by an MRI truncation artifact consisting of hyperintense spots. T1-weighted images demonstrated wood better than T2-weighted images and required less scanning time than either proton density or T2-weighted images, MRI was superior to CT in detecting the smallest pieces of wood. The role of MRI in the detection of orbital wooden foreign bodies in clinical practice remains to be determined.

Eye Foreign Bodies↗
PubMed1989

Chromosome studies of males in an institution for the mentally handicapped.

Karyotypes were examined in 512 (91.9%) of 557 male patients in an institution for the mentally handicapped. A total of 110 (21.5%) had an abnormal karyotype: 65 (12.7%) with Down's syndrome, 30 (5.9%) with the fragile X syndrome, 13 (2.5%) with autosomal anomalies other than Down's syndrome (12 unbalanced, one balanced), and two (0.4%) with sex chromosome anomalies.

Aneuploidy↗
PubMed1988

Optic nerve dysfunction in thyroid eye disease: CT.

Optic nerve dysfunction in thyroid eye disease is thought to be due to compression of the optic nerve by enlarged extraocular muscles near the orbital apex. High-resolution computed tomography (CT) scans of 78 orbits of 31 patients with thyroid eye disease were reviewed. Axial scans alone were inadequate for demonstrating compression of the optic nerve. With a coronal reformatted scan from the axial scans, a muscular index was devised and measured to reflect extraocular muscle impingement on the optic nerve. Orbits with optic nerve dysfunction had significantly higher muscular indices than those without optic nerve dysfunction, supporting the hypothesis that optic nerve dysfunction is usually secondary to compression by enlarged extraocular muscles. Muscular indices of 67% or greater in patients with optic nerve dysfunction were diagnostic of compressive optic neuropathy, while muscular indices of less than 50% appeared to exclude optic nerve compression. A single case of optic nerve dysfunction without muscular compression is also discussed.

Exophthalmos↗
PubMed1985

High-resolution computed tomography in multiple sclerosis.

Eighty-five patients were classified as having definite (n = 34), probable (n = 18), or possible (n = 33) multiple sclerosis using the criteria of Poser. Each patient had an enhanced computed tomographic examination, and most had cerebrospinal fluid and evoked response studies at the same time. Abnormalities including focal decreased brain density, abnormal enhancement, and cerebrospinal fluid space enlargement were found in 62% of patients (85% of those with definite, 39% of those with probable, and 52% of those with possible multiple sclerosis), and abnormal enhancing areas were demonstrated in 29% (44% of those with definite, 17% of those with probable, and 21% of those with possible disease). In the subgroup of patients with definite multiple sclerosis and recent clinical exacerbation (within the prior 8 weeks), abnormal enhancement was present in 89%. There was a strong correlation between clinical exacerbation and abnormal contrast enhancement. Cerebrospinal fluid studies (IgG, white blood cell count, total protein) had no correlation with exacerbation or abnormal enhancement. Maps of low-density and enhancing areas were similar to those previously described in postmortem studies. Computed tomography thus provides an in vivo, objective, and anatomically specific map of the brain parenchyma and the integrity of the blood-brain barrier that is useful in research studies evaluating the treatment of multiple sclerosis. It is also useful in patients in whom the diagnosis of multiple sclerosis is suspected but not certain on the basis of clinical and laboratory evaluation.

Adult↗
PubMed1985

Early-onset Alzheimer's disease: an analysis of CT findings.

Brain computed tomographic scans of 60 patients with early-onset Alzheimer's disease (mean age, 60.7 years) were compared with those of age- and sex-matched control subjects. Computed tomographic analysis included standard ventricular measurements as well as subjective ratings of ventricular and sulcal size. These indices were correlated with the results of a battery of neuropsychological tests and electroencephalographic findings. Linear measurements of ventricular size were significantly greater in the patients with Alzheimer's disease than in the age-matched control group (p less than 0.0005). Using subjective appraisal of ventricular and sulcal size, the neuroradiologist noted abnormalities significantly more often in patients than in controls (p less than 0.0005). Linear measurements of ventricular size correlated significantly (p less than 0.05) with the severity of aphasia and dementia and the presence of electroencephalographic abnormalities. There was, however, no correlation between the subjective judgment of cortical atrophy and the degree of impairment as measured by neuropsychological tests. The findings in this study demonstrate the usefulness of computed tomographic imaging in Alzheimer's disease of early onset.

Age Factors↗
PubMed1984

Differential recovery of circulating T cell subsets after nodal irradiation for Hodgkin's disease.

To better understand the immunologic effects of lymphoid irradiation (LI), blood levels of T cell subsets were sequentially monitored in 15 patients before, during, and after irradiation treatment for Hodgkin's disease. Blood levels of all lymphocytes, T cells, and T cell subsets (defined by OKT4 and OKT8) fell dramatically and in similar proportions during early therapy, reaching levels less than 20 to 25% of control by the completion of mantle irradiation, and continuing at very depressed levels through the completion of therapy. Blood levels of OKT8-reactive (OKT8+) cells returned to pretreatment levels (402 +/- 38/mm3 vs 360 +/- 32/mm3 pretreatment) between 6 to 8 mo after LI, whereas blood levels of OKT4-reactive (OKT4+) cells returned to only 42% of previous values (242 +/- 22/mm3 vs 584 +/- 34/mm3 pretreatment) over the same period. The pre-LI ratio of OKT4+ to OKT8+ cells was 1.85 +/- 0.24 and fell to 0.65 +/- 0.05 between 6 to 8 mo after LI. During the recovery period, discrepancies of 208 +/- 32 cells/mm3 (3 to 5 months post LI) and 198 +/- 32 cells/mm3 (6 to 8 mo post LI) developed between the blood levels of OKT3+ cells and the sum of OKT4+ and OKT8+ cells. This suggests the emergence of OKT4+/OKT3-, OKT8+/OKT3-, and/or OKT4+/OKT8+ cells. In five patients, the sum of OKT4+ and OKT8+ cells was compared with the number of cells simultaneously co-stained by OKT4 and OKT8. It appeared that a significant proportion of the cells were OKT4+/OKT3- and OKT8+/OKT3- lymphocytes. We concluded that LI is similarly cytotoxic to peripheral blood T cell subpopulations. The reversed ratio after LI is a result of a slower repopulation of the peripheral blood by OKT4+ cells relative to OKT8+ cells. T cells after LI show a high degree of antigenic immaturity. It is postulated that the bone marrow that lies outside the fields of treatment and contains predominantly immature OKT8+/OKT3- cells is a major source of T cells repopulating the peripheral blood after LI.

Adult↗