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Biomedical subjects

M Abrahams

Publications and source records attributed to M Abrahams.

9 recordsLinked to original sources

The effects of human burn injury on urinary nitrate excretion.

Different studies have demonstrated both an increase and a decrease in the biosynthesis of nitric oxide (NO) during the first 2 days following experimental and human burn trauma. This study investigated changes in urinary nitrate excretion in humans following thermal injury in order to determine the temporal relationship between NO release and the initial injury. Urinary nitrate was measured in daily 24-h urine collections taken on days 1-7 following burn injury from 15 patients. The control group consisted of 11 healthy, age- and sex-matched patients who kept a nitrate-restricted diet for five days prior to collection of a single 24-h urine sample. The burns group had a mean age of 41.9 +/- 19.4 (mean +/- S.D.) years and a mean total burn surface area (TBSA) of 30.2 +/- 24.9% (mean +/- S.D.). In the burn injured patients, urinary nitrate levels peaked at day 4 and a 2-fold increase relative to day 1 was observed. Urinary nitrate levels were significantly higher in the burns group than the control group on days 4 and 5 only (p < 0.05 for both days). There was no correlation between TBSA and the measured urinary nitrate levels. This study confirms that the biosynthesis of NO is increased during the first week following burn trauma and establishes that the renal elimination of the by-products of NO metabolism is not increased during the first three days after injury. Notwithstanding the potential effects of burns on nitrate distribution, our findings may reflect a delay in the release of NO following the initial insult.

Adolescent

Intact proprioception and control of labour pain during epidural analgesia.

BACKGROUND: Accurate proprioception is critical while walking, yet an ambulatory epidural regimen that provides adequate analgesia for labour while simultaneously preserving proprioceptive input has not been described. METHODS: Sixty primigravidae in established labour received bupivacaine 15 mg (15 ml of 0.1% w/v) and fentanyl 100 micrograms through a lumbar epidural catheter. Clinical assessment of dorsal column sensory function included: vibration sense, distal proprioception and the Romberg test, and were all performed before catheter insertion and 30 min after the study bolus. Sensory modalities were also tested compared to an unblocked dermatome. Pain was scored on a 0-10 cm visual analogue scale (VAS) before and 30 min after induction. Intensity of the motor block was tested using a modified Bromage score (grade 1-6). RESULTS: The study bolus provided reliable analgesia with 43 parturients attaining a VAS pain score of zero. Mean duration of analgesia was 67.5 min (SD 22.85). All parturients retained the ability to perform a partial knee bend while standing (grade 6). No mothers exhibited impaired distal proprioception, altered vibration sense or a positive Romberg sign. CONCLUSION: This study confirms that the addition of lumbar epidural fentanyl 100 micrograms to 15 mg of epidural bupivacaine provides good control of labour pain with no motor block and establishes that this combination preserves dorsal column sensory function.

Adult

Cerebrospinal fluid concentrations of propofol during anaesthesia in humans.

The concentration of propofol in and surrounding the human brain during propofol anaesthesia is unknown. We measured simultaneously the concentration of propofol in cerebrospinal fluid (CSF) from an indwelling intraventricular catheter and the concentration in arterial blood in five neurosurgical patients before, during induction (at 2.5 and 5 min) and during a maintenance propofol infusion (at 15 and 30 min). After induction of anaesthesia with propofol 2 mg kg-1, anaesthesia was maintained with an infusion of 8 mg kg-1 h-1 for 15 min and then reduced to 6 mg kg-1 h-1. The plasma concentration of propofol increased rapidly during induction and reached a plateau concentration of mean 2.24 (SD 0.66) micrograms ml-1 after 5 min. The concentration of propofol in CSF showed a slower increase during induction and remained almost constant at 35.5 (19.6) ng ml-1 at 15-30 min after induction. The CSF concentration of propofol that we measured was 1.6% of the plasma concentration and consistent with the high protein binding of the drug in plasma.

Adult

Composition and antimalarial activity in vitro of the essential oil of Tetradenia riparia.

The essential oil from the leaves and stems of Tetradenia riparia was analysed by GC and GC/MS and 35 components were identified. The main constituents were alpha-terpineol (22.6%), fenchone (13.6%), beta-fenchyl alcohol (10.7%), beta-caryophyllene (7.9%), and perillyl alcohol (6.0%). Moderate antimalarial activities were recorded against two strains of Plasmodium falciparum.

Animals

Apoptosis abnormalities of splenic lymphocytes in autoimmune lpr and gld mice.

The murine gene lpr encodes an aberrant form of the apoptosis-inducing receptor Fas. The gene gld, which causes an autoimmune syndrome phenotypically identical to that caused by lpr, encodes a mutant Fas ligand. Because the lpr gene must be expressed in both T and B cells to produce autoimmune disease, it might be anticipated that apoptosis abnormalities would be present in both. Therefore, we quantitated apoptosis in T and B cells from lpr, gld, and normal mice in a short-term in vitro culture system. Freshly isolated spleen cells from normal, lpr, or gld mice showed little or no apoptosis as assessed by quantitative DNA flow cytometry. However, after overnight culture, both T and B cells showed substantial spontaneous apoptosis. Such apoptosis increased strikingly with age in normal but not in autoimmune B cells. CD23low B cells, which are prominent in lpr and gld mice, were particularly notable for high levels of programmed cell death in normal mice. The apoptosis caused by the gld defect could not be corrected by coculture with normal spleen cells. The persistence with age of low levels of B cell apoptosis in lpr and gld mice presumably reflects deficient Fas/Fas ligand interactions. The further localization of the B cell apoptosis defect to the unusual CD23low B cells, which accumulate in lpr and gld mice, adds to the evidence that these cells may be of critical importance to autoimmunity.

Animals

Edna Langley.

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Child Health Services

Mastectomy in a large public hospital.

Thirty women undergoing mastectomy for carcinoma of the breast in a large teaching hospital were interviewed. All indicated a very real need to discuss their experiences, and felt that the interview had been beneficial to them. Most had found the "lump" themselves--but often described it as a "hardness", a "ridge", or a "thickening". More than half felt that the counselling afforded to them had been inadequate--especially in the realm of sexual adjustment--but, if their marriages had been stable before operation, subsequent deterioration was unlikely. The threat of malignancy, rather than that of breast loss, was uppermost in the minds of most patients. It should not be assumed that postmastectomy problems do not exist because patients do not mention them, especially in large busy follow-up clinics, where privacy may be inadequate. If doctors are unable or unwilling to afford this service to their mastectomy patients, it may be necessary to delegate it to other health professionals and mastectomy volunteers.

Adult