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Biomedical subjects

M A Robinson

Publications and source records attributed to M A Robinson.

At least 73 records · Page 4Linked to original sources

Segregation of polymorphic T-cell receptor genes in human families.

Polymorphism in the genes encoding the constant (C) region of the beta chain of the T-cell antigen receptor (CT beta, also called C beta) has been detected by molecular genotyping analyses. In initial screenings, a panel of restriction endonucleases was used to digest DNA samples from two individuals; the digested samples were subjected to Southern blot analyses using a CT beta probe. The enzyme Bgl II revealed restriction-fragment-length polymorphism in these samples and was subsequently used to test 59 individual members of eight different families. Polymorphic fragments detected in six of the families could be used to follow the segregation of T-cell receptor genes; in many cases maternal and/or paternal haplotypes could be assigned. All members of two additional families displayed a single CT beta hybridizing fragment. In one family the DNA sample from one of the children lacked an expected Bgl II restriction fragment. On the basis of analyses with other restriction enzymes, the most likely explanation is that the lymphoblastoid B-cell line used as a source of genomic DNA for this individual had rearranged or altered CT beta genes. Restriction-fragment-length polymorphisms used to discriminate CT beta haplotypes in families provide useful markers that will facilitate linkage studies and genetic analyses of T-cell function.

DNA↗

Recombination within the HLA-D region. Correlation of molecular genotyping with functional data.

Molecular genotyping of the HLA-D/DR region in a family correlated with serologic and cellular typing data. It was further possible to predict a subtle difference in SB region-related functions from such molecular studies. A family that included an individual who inherited an HLA haplotype with a paternal recombination between HLA-B and the HLA-D/DR region was identified by classic HLA typing techniques. Segregation of HLA-D/DR region genes in this family was studied by Southern blot analysis using cDNA probes for DR alpha, DR beta, DC alpha, DC beta, and SB beta. Restriction enzyme fragment polymorphisms observed for every gene tested were in concordance with assigned HLA haplotypes (including the individual known to have inherited a paternal recombinant haplotype) with one exception: two HLA identical siblings were observed to have different SB beta restriction fragment patterns. Further testing revealed that one individual inherited a maternal HLA haplotype recombinant between the HLA-D/DR region and SB beta. Although both maternal SB alleles typed as SB4, allelic differences could be detected cellularly by primed lymphocytes and by the differential expression of a class II cell surface antigen using monoclonal antibody. Therefore, predicted and nonpredicted recombinant haplotypes were detected in a family by molecular genotyping.

DNA Restriction Enzymes↗

Telephone notification of relatives of emergency and critical care patients.

Inconsistency in contacting the families of acutely ill patients can negatively affect relatives and induce stress in emergency department staff. Role clarification and performance guidelines are discussed in the context of a telephone notification of relatives checklist, with staff advised in six specific interventions to facilitate consistency; promote clarity; and prevent fears and fantasies, potential misunderstanding, reckless driving, and feelings of helplessness.

Adaptation, Psychological↗

The predictive value of the serum digoxin concentration in the management of hospitalized patients.

Serum digoxin concentration (SDC) was compared with clinical and ancillary predictors as a guide to adjustment of digoxin dose and as a test for digitalis toxicity in a total of 76 hospitalized patients during a period of 9 months. The mean SDC (3.6 +/- 2.5 nmoles/liter) associated with unexpected discontinuation of therapy was significantly higher (p less than 0.001) than that (1.1 +/- 0.6 nmoles/liter) associated with unaltered digoxin dose, while the mean SDC (0.6 +/- 0.4 nmole/liter) associated with unexpected dose increase was significantly lower (p less than 0.05). There was no significant association between other pharmacokinetic or pharmacodynamic predictors and therapeutic intention. There was a 13% incidence of confirmed digitalis intoxication. The mean SDC (3.6 +/- 1.9 nmoles/liter) of patients presenting and confirmed as digitalis toxic was significantly higher (p less than 0.001) than that (1.4 +/- 0.6 nmoles/liter) involving a situation in which digitalis toxicity could not initially be excluded by other means. The predictive value of an SDC greater than or equal to 2.6 nmoles/liter for toxicity was 80%, and its efficiency for diagnosing both toxicity and nontoxicity was 95%. The SDC was thus shown to be a valid test of digitalis toxicity and to provide extraordinary information enabling the clinician to modulate digoxin therapy precisely.

Cardiovascular Diseases↗

Informing the family of sudden death.

Physicians are neither trained nor prepared for delivering the news of sudden death. The unique stresses which tax a physician during the medical or surgical emergency can affect the way he delivers the news. There are distinct strategies for preparing and delivering the news of death. An informative, chronologically ordered account of events up to and including the death, delivered after taking time to review all the facts, makes the task less stressful and is less likely to elicit unnecessary confusion and anger in survivors.

Communication↗

Reassessment of fistula puncture site blood loss.

Fistula puncture site blood loss during and after hemodialysis was measured in 12 patients with end-stage renal disease. It was found to be 0.74 +/- 0.32 ml per dialysis and 115.4 +/- 49.9 ml per year in patients with Cimino A-V fistulas. Puncture site blood leak in patients with heterologous grafts was 1.77 +/- 0.36 ml per dialysis and 276.1 +/- 56.1 ml per year. The values obtained in this study are 5 to 10 folds less than those found in the original reports. Recent advances in dialytic technology are probably responsible for the observed improvement. The results also suggest that Cimino A-V fistulas are superior to the heterologous graft.

Adult↗

Association of sick sinus and Lown-Ganong-Levine syndromes.

A 38-year-old woman presented with syncopal attacks for 27 years. The electrophysiology techniques which enabled the diagnosis of both sinus node dysfunction (sick sinus syndrome) and presence of an atrionodal bypass tract (Lown-Ganong-Levine syndrome) are illustrated.

Adult↗

Control of bleeding from cannulation sites with topical thrombin in dialyzed patients.

Topical thrombin was applied to the cannulation sites during and after withdrawal of the needles. The duration of bleeding was reduced by 50% compared to the control period in patients with various internal arteriovenous communications undergoing maintenance hemodialysis treatment. Accordingly, use of topical thrombin appears effective in saving patients and staffs time, minimizing the blood loss in these anemic patients, and preventing the possible injurious effect of prolonged compression of vascular access to accomplish hemostasis.

Catheterization↗

Target antigens of cell-mediated lympholysis discrimination of HLA subtypes by cytotoxic lymphocytes.

The evolution of HLA specificities has been toward ever-increasing refinement; one example is a subdivision of HLA-B5, the supertype specificity originally defined as 4a. HLA-B5 can now be further subdivided into Bw51 amd Bw52 by serologic means. Whereas the specificity Bw51 can be detected by specific sera, the identification of Bw52 must frequently be deduced from knowledge of B5 and Bw51, although serology has progressed rapidly. There has been no comparable development in identifying fine specificities by cellular cytotoxicity in populations. We have now found that cytotoxic effectors of exquisite specificity can be generated against Bw52 by sensitization of cells from a Bw51 donor and vice versa; Bw51 and Bw52 can in this way be recognized with equal ease. This may set a precedent for recognizing fine specificities of other HLA antigens that cannot yet be identified serologically or can be identified only imprecisely. These fine distinctions may have great relevance in allotransplantation and in understanding disease susceptibility.

Absorption↗

The diastolic murmur of renal failure.

A characteristic and transient early diastolic precordial murmur is commonly heard in patients with renal failure. On the basis of its clinical characteristics, this murmur has previously been attributed to functional aortic incompetence. We undertook a formal cardiac investigation, including aortography, in six of eight patients with renal failure in whom such a bruit developed. Aortic regurgitation was detected in only one of the six. Echocardiography revealed no abnormality of aortic-valve function but did indicate the presence of a small pericardial effusion in each of the five patients examined. We conclude that the early diastolic murmur associated with renal failure does not usually arise from functional aortic incompetence but may be a sound of pericardial origin.

Adult↗

Clinical and haemodynamic effects of minoxidil in refractory hypertension.

Thirteen patients whose hypertension had been resistant to conventional drug therapy, had minoxidil added to their regimen in doses from 5 to 60 mg/day. All responded with satisfactory reductions of blood pressure to mean values of 149/90mm Hg (supine) and 143/89mm Hg (standing). A significant portion of their previous antihypertensive therapy was either greatly decreased or withdrawn completely. Although fluid retention occurred in most patients as the dose of minoxidil was increased, this could be successfully checked by the use of diuretics. It was considered that in addition to beta-adrenoreceptor blocking drugs to control the reflexly induced cardiac stimulation, sufficiently aggressive diuretic therapy is mandatory to ensure the successful use of this drug. Haemodynamic evaluations in seven patients clearly showed that lowering of blood pressure was the result of decreases in peripheral vascular resistance as significant increases in the cardiac index occurred in all patients.

Adult↗