Reduced nocturnal blood pressure fall is similar in continuous ambulatory peritoneal dialysis to that in hemodialysis and undialysed end-stage renal disease.
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Adult↗
Biomedical subjects
M A Jones
Publications and source records attributed to M A Jones.
Intra-abdominal desmoplastic small round-cell tumor in a postmenopausal female. Report of a case and review of the literature.
Intra-abdominal desmoplastic small round cell tumor is a rare malignancy which tends to occur in adolescent males. Fewer than 30 cases of this malignancy have been described, and long term survival is poor. We present a case of intra-abdominal desmoplastic small round cell tumor occurring in a post-menopausal woman that mimicked ovarian carcinoma. The clinicopathologic features and literature are reviewed.
Desmin↗
Analysis of a measles epidemic.
In January, February and March of 1989 an epidemic of rubeola occurred on the campus of Texas Tech University. A vaccination programme was initiated as soon as the epidemic was confirmed. Extensive case histories of all confirmed cases were collected by the Lubbock City Health Department and given an exhaustive statistical analysis by a group from the Department of Mathematics at Texas Tech University. The data and statistical analysis were used to formulate stochastic and deterministic models of the measles epidemic based on the standard SEIR model. The analysis and the simulations indicate that in order to prevent a measles outbreak on a university campus a high rate of immunity may be required (> 98 per cent). The assumptions in the models raise some interesting questions regarding social contacts which require further investigation.
Antibody Formation↗
Five primary malignancies in a single patient: a report of two cases and a review of the literature.
Two patients who developed five independent primary malignancies are reported. Each developed multiple distinct malignancies over 45 and 29 years, respectively. The medical literature and etiology of this rare phenomenon are discussed.
Aged↗
Mesonephric remnant hyperplasia of the cervix: a clinicopathologic analysis of 14 cases.
Lesions derived from mesonephric remnants in the uterine cervix are rare. We describe 14 patients with benign, hyperplastic mesonephric remnant lesions. The patients ranged in age from 31 to 81 years (mean, 47). Four were postmenopausal. The lesions were incidental findings in all but 2 of the patients and frequently had been submitted for consultative pathologic opinion. Two patients did, however, present with symptoms (vaginal bleeding) likely attributable to their lesions and 1 of them had a cervical abnormality on clinical examination. Microscopically, the lesions were composed of lobular or diffuse proliferations of small, round mesonephric tubules which were frequently deep within the cervical wall and often extended to the surface of the cervix. Five of the patients had a referring diagnosis of probable or definite cervical adenocarcinoma due to the infiltrative appearance of the lesions. No mesonephric carcinomas were encountered. Hyperplastic lesions of mesonephric remnants are usually benign, incidental findings but may on occasion be associated with clinical symptomatology and are a potential source of diagnostic confusion for the pathologist.
Adult↗
Consolidation intraperitoneal chemotherapy in epithelial ovarian cancer patients following negative second-look laparotomy.
Fifty-six patients with Stage III ovarian carcinoma who had a negative second-look laparotomy following optimum cytoreduction, cisplatin, and cyclophosphamide chemotherapy were enrolled in a pilot study to receive consolidation intraperitoneal (IP) chemotherapy. Forty-one patients received three courses of IP cisplatin (80 mg/m2). Fifteen patients with cisplatin-induced toxicity received three courses of IP mitoxantrone (10 mg/m2). Toxicity was minimal, with only 2 patients suffering peritonitis and 1 patient developing an enterotomy at the time of catheter removal. Median follow-up for the IP cisplatin and IP mitoxantrone group has been 24 and 30 months, respectively. Ten of the 41 patients (24%) who received IP cisplatin and 4/15 (26%) of the IP mitoxantrone patients have recurred (P = ns). Median time to recurrence was 18 months for both groups. This study indicates that consolidation intraperitoneal chemotherapy following negative second-look laparotomy is feasible with either cisplatin or mitoxantrone. However, many of these patients still recurred and prospective trials will be required to determine which (if any) consolidation intraperitoneal treatment is best following a negative second-look laparotomy.
Carcinoma↗
Acute (24 hr) toxicity of a combination of four nephrotoxicants in rats compared with the toxicity of the individual compounds.
To identify possible hazards of combined exposure to chemicals with the same target organ, a 24-hr single dose experiment was carried out in which the renal toxicity of mercuric chloride, potassium dichromate, d-limonene and hexachloro-1:3-butadiene administered simultaneously was compared with the nephrotoxicity of the individual compounds, using a total of 11 groups each consisting of five 12-wk-old male Wistar rats. The dose levels used were based on the results of a range-finding study with the individual compounds in the same strain of rats kept under similar experimental conditions, and comprised the 'Minimum-Nephrotoxic-Effect Level' (MNEL) and the 'No-Nephrotoxic-Effect Level' (NNEL) of each of the four compounds alone and in combination. A group of vehicle-treated rats served as controls. At the MNEL of the combination, antagonism of effects was encountered, seen for example as less severely increased activity of gamma-glutamyl transferase in the urine. Synergism of effects was also observed, for example increased severity of renal tubular necrosis, and more markedly increased activity of urinary lysozyme, lactate dehydrogenase, alkaline phosphatase and N-acetyl-beta-glucosaminidase. More importantly, however, at the NNEL of the combination no signs of impaired renal function or renal damage were observed, suggesting absence of both dose additivity and potentiating interaction at the tested subeffective levels of the individual nephrotoxicants.
Acetylglucosaminidase↗
Single-dose pharmacokinetics of recombinant human erythropoietin in preterm infants after intravenous and subcutaneous administration.
Pharmacokinetics of recombinant human erythropoietin (rHuEPO) were studied in a group of very low birth weight infants after both intravenous and subcutaneous administration. The volume of distribution was larger and the clearance more rapid than those reported in adults. The maximum concentration of erythropoietin after subcutaneous doses of rHuEPO was variable, but bioavailability was high (42%) compared with values reported in adults. These observations could be useful in optimizing treatment of the anemia of prematurity with rHuEPO.
Anemia, Neonatal↗
The metabolism of AIDS-associated mycoplasmas.
Mycoplasma fermentans and Mycoplasma pirum have been recovered from human immunodeficiency virus (HIV)-positive persons. M. fermentans has been isolated with much higher frequency from HIV-positive than from HIV-negative persons. Mycoplasma genitalium has been detected by polymerase chain reaction in the blood of a patient with AIDS. Little is known about the biology of these mycoplasmas, especially their physiology, biochemistry, and growth response to inhibitors of essential metabolic loci or transport. Metabolically, they resemble other Mycoplasma species. Those studied lack cytochromes, the tricarboxylic acid cycle, and portions of the hexose monophosphate shunt. According to limited data, they fix CO2, use ATP to phosphorylate fructose-6-phosphate, have substrate phosphorylation and transaminase(s), and interconvert most purines and pyrimidines. The synthesis of thymidine may be limited. They may require a variety of essential small molecules for optimal growth (e.g., pyridoxal phosphate, ribose-1-phosphate). Their pathogenic potential and cultural lability may involve the production of the superoxide anion and the hydroxyl radical. We hypothesize that the mycoplasmas generate toxic oxygenated products that damage the host cell, probably membrane, permitting the mycoplasmas to gain easier access to the interior of the cell. The mycoplasma-damaged host cell membrane may also effect the maturation or release of HIV particles from the cell.
AIDS-Related Opportunistic Infections↗
Human hydatid disease: evaluation of an ELISA for diagnosis, population screening and monitoring of control programmes.
The routine use of ELISA and complement fixation tests in the diagnosis of suspected clinical cases of hydatid disease was evaluated. In the ELISA test, dialysed and filtered sheep cyst fluid was used as antigen and two positive cut-off points--+3SD and +2SD of the mean absorbance values of the control sera--were evaluated. The predictive values of ELISA tests were 82% and 90% for positive tests, and 86% and 82% for negative tests, respectively with the two cut-off points. In a population survey of blood donors and veterinary workers in Powys, 4% and 8%, respectively, had ELISA values above the lower cut-off point. However, it would not be appropriate to use the same test for diagnostic population screening in Wales since the predictive value of the test is likely to be very low in this setting. Serological surveys with the ELISA may be of use in monitoring the progress of the South Powys Hydatid Control Programme. The use of cumulative percentages was found to be a useful method of comparing whole distributions of results in different populations.
Animals↗
Sensory and sympathetic nerve sprouting in the rat cornea following neonatal administration of capsaicin.
Corneal sensory and sympathetic nerves exert opposing actions on corneal mitogenesis and wound healing. The mechanisms by which these nerves exert their actions are unknown; however, the release of axonally transported neuropeptides has been postulated. In the present study, we investigated changes in innervation densities of calcitonin gene-related peptide (CGRP-) and tyrosine hydroxylase (TH-)immunoreactive (IR) nerves of the rat cornea following neonatal capsaicin administration, and the relationships between these changes and the development of neuroparalytic keratitis. Newborn rats were injected with capsaicin on each of the first 3 days of life. Forty-eight hours after the last injection, corneal CGRP immunostaining had totally disappeared from the cornea, whereas TH immunostaining was relatively unaffected. Over the next several weeks, a dramatic reinnervation of the cornea took place. By 6-8 weeks both the CGRP- and TH-IR corneal innervation density in the capsaicin-treated animals exceeded that of age-matched control or normal animals; that is, the corneas had become "hyper-reinnervated." The pattern of innervation that returned was grossly abnormal and was characterized by the presence of a bizarre subepithelial plexus of fine stromal sprouts; an abundance of myelinated axons; and complex, atypical, epithelial leash morphologies. Retrograde transport of wheatgerm agglutinin conjugated to horseradish peroxidase (WGA:HRP) from the central cornea in control and capsaicin-treated adult animals labeled an average of 143 and 47 trigeminal ganglion cells, respectively (with mean diameters of 25.7 +/- 0.49 microns and 34.3 +/- 0.72 microns), suggesting a 67% decrease in corneal afferent neurons in the capsaicin-treated animals. Transection of the ophthalmomaxillary nerve in adult capsaicin-treated animals completely eliminated corneal CGRP-IR staining, and extirpation of the superior cervical ganglion resulted in the loss of 70-80% of corneal TH-IR nerves, thus demonstrating the sensory and predominantly sympathetic origins, respectively, of these fiber populations. Chronic keratitis and neovascularization developed in the capsaicin-treated animals by approximately 3 weeks of age, achieved a maximum intensity between 4 and 6 weeks, and showed some gradual improvement thereafter. However, the keratitis never completely disappeared, even after 13 months. In conclusion, these data show that corneal sensory (CGRP-IR) and sympathetic (TH-IR) nerve fibers undergo extensive sprouting following partial corneal sensory denervation with the neurotoxin capsaicin. However, the resultant "hyper-reinnervation" is morphologically abnormal and, for reasons unknown, functionally incapable of preventing or totally reversing the keratitis.
Adrenergic Fibers↗
Retaining nurses through conflict resolution. Training staff to confront problems and communicate openly can improve the work climate.
The way nurses resolve conflict may be leading them to quit their jobs or leave the profession altogether. Conflict is inevitable in a dynamic organization. What is important is not to avoid conflict but to seek its resolution in a constructive manner. Organizational conflict is typically resolved through one of five strategies: withdrawal, force, conciliation, compromise, or confrontation. A recent study of nurses in three different hospitals showed that the approach they use most is withdrawal. This might manifest itself in a request to change shifts or assignments and may lead to a job change and, eventually, abandonment of the field altogether. Given this scenario, changing nurses' conflict resolution style may help administrators combat the nursing shortage. Healthcare organizations must examine themselves to determine why nurses so frequently use withdrawal; then they must restructure work relationships as needed. Next, organizations need to increase nurses' awareness of the problem and train them to use a resolution style more conducive to building stable relationships: confrontation. Staff should also be trained in effective communications skills to develop trust and openness in their relationships.
Communication↗
Cervical metastases in advanced ovarian malignancies.
Cervical metastases from ovarian malignancies are a rare event. In order to better define the incidence and pathogenesis of this phenomenon we retrospectively reviewed the charts and pathologic material from 171 Stage III ovarian malignancies. Nine patients (5.3%) were identified with cervical metastases and three patterns of spread to the cervix were recognized: 1) lymphatic permeation only; 2) para-cervical soft tissue extension and 3) direct stromal myometrial invasion. All of the patients with cervical metastases had high grade (Broder's grade III or IV) tumors and extensive abdominal disease at presentation. Although four patients had a positive or suspicious pap smear, none of these had cervical involvement. We conclude that ovarian metastases to the cervix are a rare event, occurring late in the course of the disease and arise from a variety of modes of spread.
Adenocarcinoma↗
Parathyroid carcinoma: the relationship of nuclear DNA content to clinical outcome.
This article reports the use of flow cytometry to determine tumor nuclear DNA content and its correlations with clinical outcome in a series of patients with parathyroid carcinoma. Information concerning nine patients with parathyroid cancer (aged 25 to 88 years) was reviewed. Paraffin-embedded, formalin-fixed archival tissue was used to determine tumor DNA content flow cytometrically. Twenty-five operative procedures were performed in nine patients, including 11 parathyroidectomies, two wide local excisions, six central neck dissections, and four median sternotomies for resection of metastases. With flow cytometry used to determine a tumor DNA index, five patients had evidence of tumor aneuploidy; in two patients two aneuploid peaks were evident. The DNA index ranged from 0.7 (hypodiploid) to 1.92 (mean, 1.31). Follow-up ranged from 1 to 18 years. Four patients died. Five were alive 1 to 13 years after diagnosis of parathyroid disease. Four of the five patients with evidence of tumor aneuploidy had metastatic disease and died, and the fifth has had three local recurrences. The four patients with diploid tumors were alive and free of disease 1, 3, 4, and 8 years after the initial operation. It is concluded that in patients with clinically or pathologically demonstrated parathyroid cancer, flow cytometry may help differentiate those whose cancers are likely to behave indolently (diploid tumors) from those with tumors (aneuploid) more likely to behave aggressively by recurring locally or metastasizing.
Adult↗
Rabbit blastocysts accumulate platelet-activating factor (PAF) and lyso-PAF in vitro.
Platelet-activating factor (1-O-alkyl-2-acetyl-sn-glycero-3-phosphorylcholine; PAF) is a very potent phospholipid, which has been demonstrated to stimulate smooth muscle and change vascular permeability. PAF has been detected in the rabbit preimplantation uterine endometrium and has been demonstrated to bind specifically to rabbit uterine membranes. To evaluate the possible role of PAF in maternal-embryonic chemical communication, we report here that rabbit blastocysts can accumulate [3H]PAF from their environment. Blastocysts were able to accumulate [3H]PAF as time-, buffer-, age-, and concentration-dependent functions. The accumulation was inhibited by some PAF receptor antagonists, such as U66985, as well as by unlabeled PAF and lyso-PAF, indicating that the accumulation process may be receptor mediated. The data support the current model of PAF as a paracrine factor in preimplantation stages of reproduction.
Animals↗
Clinical reasoning in manual therapy.
Clinical reasoning refers to the cognitive process or thinking used in the evaluation and management of a patient. In this article, clinical reasoning research and expert-novice studies are examined to provide insight into the growing understanding of clinical reasoning and the nature of expertise. Although hypothetico-deductive methods of reasoning are used by clinicians at all levels of experience, experts appear to possess a superior organization of knowledge. Experts often reach a diagnosis based on pure pattern recognition of clinical patterns. With an atypical problem, however, the expert, like the novice, appears to rely more on hypothetico-deductive clinical reasoning. Five categories of hypotheses are proposed for physical therapists using a hypothetico-deductive method of clinical reasoning. A model of the clinical reasoning process for physical therapists is presented to bring attention to the hypothesis generation, testing, and modification that I feel should take place through all aspects of the patient encounter. Examples of common errors in clinical reasoning are highlighted, and suggestions for facilitating clinical reasoning in our students are made.
Bias↗
Primary hyperparathyroidism: pathology, flow cytometric DNA analysis, and surgical treatment.
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Adenoma↗
Job conflict resolution styles of nurses.
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Conflict, Psychological↗