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Biomedical subjects

L Wood

Publications and source records attributed to L Wood.

At least 145 records · Page 8Linked to original sources
PubMed1990

Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure.

The survival and ICU length of stay of 40 ARDS patients admitted to the ICU were analyzed to determine if a management strategy of lowering the pulmonary capillary wedge pressure (Ppw) was associated with an increased survival or a decreased ICU length of stay. ARDS was defined as three or four quadrant alveolar filling roentgenographically, a PaO2 less than 80 mm Hg with an FIO2 greater than .5 and a Ppw less than 18 mm Hg. Patients were divided into two groups: group 1 included all patients in whom there was a reduction of Ppw by at least 25 percent, and group 2 included patients in whom there was no, or less than a 25 percent reduction in Ppw. Survival was statistically different between the groups with 12 of 16 group 1 patients and seven of 24 group 2 patients surviving to hospital discharge. This difference remained statistically significant after stratifying patients by age and the APACHE II severity of illness index. We conclude that this retrospective analysis supports the notion that treatment of low pressure pulmonary edema with reduction of Ppw is associated with an increased survival.

Adult↗
PubMed1990

The role of the professional nurse in a bone marrow transplantation programme.

Two different methods of transplantation are available. The allogeneic procedure is the transfer of bone marrow between compatible siblings, whereas in autografting the patient's own haematopoietic stem cells are collected, stored, and subsequently reinfused. Both forms have become established in the treatment of the leukaemias, aplastic anaemia, the malignant lymphomas, myeloma and certain immunologic diseases. Similarly, these techniques are being used in solid tumour oncology to reconstitute bone marrow function after high doses of chemotherapy, which would otherwise result in irreversible myelotoxicity. The success of such programmes depends upon a well developed multidisciplinary approach, prominently involving experienced and dedicated nursing staff. The latter individuals will establish contact with the patient typically during the first admission for chemotherapy and this will be consolidated during subsequent outpatient visits. Then follows the highly specialised care of central venous lines and management of radiation or chemotherapy-related side effects, often with intensive care needed for safe reversal of sepsis that may, however, be associated with renal or cardiorespiratory dysfunction. Most importantly, and again centrally involving the professional nurse, is responsibility for all aspects of maintaining and operating the protected environment, together with laminar air-flow rooms. Additional interaction is also necessary with dieticians, social workers, liaison psychiatrists, occupational therapists and frequently the infectious disease, cardiovascular, respiratory and renal services. Furthermore, achievement of optimal results presupposes the availability of a dedicated cell support section, as well as the competence to cryopreserve haematopoietic stem cells and monitor the safety of this step with in vitro bone marrow culture--another role for the specialised or academic nurse.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Transplantation↗
PubMed1990

AIDS issue response.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Recombinant alpha-interferon as salvage therapy in multiple myeloma. A pilot study.

Ten patients with end-stage multiple myeloma refractory to conventional chemotherapy and hemibody irradiation received recombinant alpha-interferon as salvage therapy. The median duration of treatment was 8 weeks. One patient had an objective response and survived 8 months, whereas in the remaining 9 patients the disease progressed and median survival was 11.5 weeks. Side-effects were substantial and included confusion with extreme weakness, resulting in 5 patients refusing further therapy. The low response rate and the morbidity in this pilot study resulted in its discontinuation and the conclusion that recombinant alpha-interferon as single-agent therapy used for salvage in patients with refractory myeloma is of no value.

Aged↗
PubMed1989

The treatment of tumors by the induction of anemia and irradiation in hyperbaric oxygen.

Because increased effects have been achieved when murine tumors are irradiated after a period of hypoxia and because of anecdotal clinical experiences of an improved result after irradiation of previously anemic patients in hyperbaric oxygen, the relationship between irradiation and increased survival was investigated in seventy-two patients with advanced head and neck or cervical cancer. Anemia was achieved by means of a two-stage isovolemic venesection maintained for seventy-two hours, hemoglobin was returned to a normal level, and treatment in hyperbaric oxygen was started. Marked tumor shrinkage after the induction of anemia and before radiotherapy was seen and was probably disease, site, and hemoglobin level related. As a result, a possible new approach to cancer therapy is suggested. After completion of therapy, the 1-year disease-free survival for patients with head and neck and cervical cancer was not improved, but the 21-month survival for cervical cancer was improved. Further studies are strongly urged.

Adult↗
PubMed1989

Severe disease in a dairy herd associated with acute infection with bovine virus diarrhoea virus, Leptospira harjo and Coxiella burnetii.

Between November 1984 and February 1985, a serious outbreak of pyrexia, diarrhoea, agalactia, metritis and severe weight loss affected most of the recently calved cows in a 183-cow dairy herd in Norfolk. Fifteen cows died and 20 were culled. Forty cows aborted during or after the outbreak, and many of them produced mummified fetuses; 18 calves were stillborn and three others died soon after birth. Necropsy of three affected cows revealed ulceration of the gastrointestinal tract similar to that seen in cases of mucosal disease. Bovine virus diarrhoea virus was isolated from the intestines of one cow that died soon after the onset of illness. The virus was also isolated from the blood of four acutely ill cows and seroconversion was demonstrated in three of those that survived. The virus was isolated from three aborted fetuses, a stillborn calf and a live neonatal calf. Body fluids from two aborted fetuses were seropositive for the virus as were sera from all the aborting cows tested. In addition to widespread seroconversion to bovine virus diarrhoea virus during the outbreak, there was serological evidence of recent infection with Leptospira interrogans serovar hardjo and Coxiella burnetii in a high proportion of cows. It was concluded that this was primarily an acute outbreak of bovine virus diarrhoea but its unprecedented clinical severity was probably associated with the concurrent introduction of L hardjo and C burnetii into an immunologically naive herd during the main calving period. Epidemiological analysis suggested that the source of the virus and L hardjo was down-calving heifers returning from communal marsh grazing.

Abortion, Veterinary↗
PubMed1989

Vimentin cDNA clones covering the complete intermediate-filament protein are found in an EHS tumor cDNA library.

Intermediate filaments are part of the cytoskeleton of most cells. To analyze changes in intermediate filament synthesis, we have isolated two cDNA clones (pV-C25, pV-C877) that cover the complete coding sequence of the murine intermediate filament protein vimentin. The cDNA clones were isolated from a murine Engelbreth-Holm-Swan (EHS) tumor cDNA library by screening under (i) non-stringent conditions with a synthetic oligodeoxynucleotide (oligo), LW-36, which is specific for type-IV collagen, and (ii) stringent conditions with oligo LW75, which was derived from the vimentin clone pV-C25. The cDNA clones contain 38 nucleotides (nt) of the 5'-untranslated region, 1398 nt of the coding region and 7 nt of the 3'-untranslated region. Comparing the mouse sequence with the published sequence for vimentin from hamster, human and chicken, we find shared identities of 99, 97 and 87%, respectively. Since the cDNA clones have been isolated from a basement membrane tumor (EHS) cDNA library, we measured the vimentin mRNA production in EHS tumor cells in culture, and found that this mRNA is half as abundant as mRNA for type-IV mRNA.

Amino Acid Sequence↗
PubMed1989

Emergency caesarean section and symptomatic immune thrombocytopenic purpura.

A 24-year-old woman presented in labour with profound purpuric bleeding due to idiopathic immune thrombocytopenia. She was assessed as requiring immediate caesarean section for cephalopelvic disproportion and foetal distress. In view of her platelet count of 21 x 10(9)/L she was prepared with intravenous methylprednisolone, isovolaemic plasma exchange, and infusion of 400 mg/kg of gammaglobulin and 5 x 10(11) allogeneic platelets. Six hours after commencing the procedure, at a time when her platelet count was 97 x 11(9)/L, she went uneventful operation and with no further therapy this level subsequently reached 175 x 10(9)/L, at which time an uneventful operation was performed. The mother and her normal, full-term infant have been discharged; both are well and at follow-up have normal platelet counts. This experience illustrates that major surgery can safely be undertaken in severely thrombocytopenic patients, even as an emergency procedure, using this regimen.

Adult↗
PubMed1989

The comparison of gammaglobulin to steroids in treating adult immune thrombocytopenia. An interim analysis.

Symptomatic immune thrombocytopenia is a life-threatening situation which is conventionally treated in the adult with prednisone, although subsequent splenectomy is frequently unavoidable. Recently, high-dose intravenous gamma-globulin has been reported to be an effective alternative option, particularly in children. To determine the role of this agent in adults a controlled prospective trial has been undertaken. Previously untreated patients with immune thrombocytopenia were randomised to compare oral prednisone (1 mg/kg/day: Group 1: n = 13) to high-dose intravenous gamma-globulin (400 mg/kg on days 1 through 5: Group 2: n = 7), or a combination of both agents given on the same schedule (Group 3: n = 12). The time from diagnosis to commencement of treatment, initial platelet counts, age and sex were comparable in the three groups. At this interim analysis there has been no mortality, but one patient has suffered a cerebrovascular accident. Objective response, defined as a platelet count greater than 50 x 10(9)/l, was achieved in a median of 5, 5 and 3 days, whereas the time taken to reach peak counts were 9, 5 and 7 days, respectively. The relapse rates, percentage of patients subsequently requiring splenectomy for control of symptomatic bleeding and the postoperative course was comparable between the three groups. These data, although preliminary, re-emphasize differences between the paediatric and adult forms of immune thrombocytopenia and also suggest in the latter patients a need for caution before advocating replacement of prednisone by gammaglobulin as the primary form of treatment.

Adult↗
PubMed1989

An ultra-high sulfur keratin gene is expressed specifically during hair growth.

To study the regulation of the hair cycle in the mouse, we have isolated and characterized a gene for ultra high sulfur keratin that is expressed specifically during the active hair growth cycle. The gene (gUHSK-704Eco) was isolated as a member of a gene cluster on a recombinant phage with a DNA insert of 18 kb that was isolated by screening a murine genomic library at low stringency with a synthetic oligonucleotide derived from a sheep high sulfur keratin gene (Powell, Nucleic Acids Res. 1983 11, 5327). The murine ultra-high sulfur keratin gene has no intervening sequence; the 558 nucleotide of the coding region specify 186 amino acids, of which 70 (37%) are cysteine. A Cys-Cys-Gln-Pro repeat is found 12 times within the coding region. RNA dot blots show that the ultra-high sulfur keratin gene is expressed during the hair cycle concomitant with the anterior-posterior temporal pattern of the normal murine hair cycle.

Amino Acid Sequence↗
PubMed1989

The chronic leukaemias.

The slow progression of both chronic granulocytic and lymphocytic leukaemia, when compared to their acute counterparts, has been used as an argument to support less aggressive therapy or even, in some instances, a watch-and-wait policy. This conservative approach is bolstered by a number of observations including the ease with which haematologic control can initially be achieved, the older age of patients with the lymphocytic variant and the paucity of controlled data showing that long disease-free survival or cure can result from the use of aggressive treatment. Given these circumstances, it is not surprising that many such individuals are managed outside specialised centres using a variety of agents and schedules, both of which may, on occasions, be inappropriate. Accumulating evidence suggests a need to reconsider these practices since cure is now possible in selected patients with chronic granulocytic leukaemia while the use of multi-drug regimens in the lymphatic form can significantly improve survival. These advances are the result of carefully conducted clinical trials involving many individuals the world over and constitute the basis for advocating early referral to those institutions where all the necessary expertise is available.

Adult↗
PubMed1989

Myeloma--the integral role played by the professional nurse.

Myeloma is a malignancy of plasma cells which are terminally differentiated B-lymphocytes. The diagnosis may be made incidentally at routine blood testing, when an abnormality is found in the plasma proteins on electrophoresis. More usually the patients are symptomatic, with bone pain, anaemia, evidence of renal failure, or the metabolic abnormalities associated with increased plasma calcium and urate levels. Effective treatment will extend survival from 7 to approximately 30 months and at the same time improve the quality of life. Treatment is multidisciplinary, prominently involves the professional nurse and may arbitrarily be divided into two stages. Firstly, reversible lesions, such as dehydration and plasma hyperviscosity must be corrected, hypercalcaemia and hyperuricaemia improved and, if necessary, renal dialysis undertaken. Secondly, but of equal importance, is the need for specific therapy to be directed against the tumour itself, and both cytotoxic agents and irradiation have an important role to play. More recently, newer approaches have included high dose chemotherapy and bone marrow transplantation.

Combined Modality Therapy↗