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Biomedical subjects

M Alexander

Publications and source records attributed to M Alexander.

At least 91 records · Page 5Linked to original sources
PubMed1995

Hospitalization for congestive heart failure. Explaining racial differences.

OBJECTIVE: To determine whether the higher rate of hospitalization among African Americans for congestive heart failure (CHF) could be explained by racial differences in the prevalence of clinical risk factors for CHF. DESIGN: Retrospective cohort study. SETTING: A large health maintenance organization (HMO). PATIENTS: A sample of 64,877 enrollees (27% African American and 73% white) of the Northern California Kaiser Permanente Medical Care Program who took at least one multiphasic health checkup (MHC) at or after the age of 40 years and were free of CHF at that time. MAIN OUTCOME MEASURES: First hospitalization with a principal diagnosis of CHF. RESULTS: Among cohort members younger than 60 years at baseline MHC, the age-adjusted risk ratio (RR) (African American/white) for CHF hospitalization was 2.14 for men and 2.73 for women, while for persons 60 years of age and older at MHC, the age-adjusted RR was 1.48 for both sexes. Cox proportional hazards models were used to adjust for risk factors and length of follow-up. In persons aged 60 years and older, the race difference was explained by greater prevalence of hypertension and diabetes in African Americans (RR = 1.12; 95% confidence interval [CI], 0.94 to 1.34 after adjustment for hypertension and diabetes). In those younger than 60 years, findings differed by sex. For men, African-American race was no longer a significant predictor of CHF after adjusting for hypertension, diabetes, left ventricular hypertrophy on electrocardiogram, and body mass index (adjusted RR = 1.16; 95% CI, 0.86 to 1.56). However, among younger women, African Americans continued at increased risk despite adjustment for these variables as well as smoking, plasma cholesterol, renal function, alcohol use, and myocardial infarction (adjusted RR = 1.49; 95% CI, 1.00 to 2.21). CONCLUSIONS: In this HMO population, the race differences in first hospitalization for CHF are largely explained by known clinical and behavioral risk factors, although in younger women these risk factors do not completely explain the excess risk among African Americans. These findings highlight the role of hypertension and diabetes in the development of CHF, particularly among African Americans.

Black People↗
PubMed1995

Three-month efficacy and safety of once-daily diltiazem in chronic stable angina pectoris.

The 3-month efficacy and safety of a once-daily controlled formulation of diltiazem (180 to 360 mg/day) were assessed in a study of 54 patients with angina pectoris. This multicenter study was a nonrandomized, placebo run-in, open-label, 3-month trial followed by a 1-week, double-blind, randomized period during which most patients (89%) received placebo. There were only minimal changes in the time to termination (mean change +/- SEM -5.8 +/- 9.6 seconds), time to onset of angina (10.5 +/- 12.2 seconds), and the time to 1 mm ST-segment depression (2.9 +/- 12.5 seconds) from the end of the titration phase to the end of the open-label study. There were, however, statistically significant differences between the end of the 3-month treatment phase and the end of the 1-week randomized placebo phase for those 3 efficacy parameters (-37.3 +/- 11.2, -58.6 +/- 13.6, and -45.6 +/- 16.4 seconds, respectively). Diltiazem significantly decreased the frequency of anginal attacks and nitroglycerin use at the end of the 3-month treatment phase compared with results at the end of the randomized double-blind placebo phase. No new or unusual adverse events were reported during treatment. The present results suggest that there is no loss of efficacy of once-a-day diltiazem when administered for a long period to patients with chronic stable angina pectoris.

Aged↗
PubMed1995

Cloning and complete coding sequence of a novel human cathepsin expressed in giant cells of osteoclastomas.

A gene encoding a possible novel human cathepsin, a cysteine proteinase that is distinct from previously characterized enzymes, has been identified by differential screening of a human osteoclastoma cDNA library. This molecule, termed cathepsin X, appears to represent the human homolog of the osteoclast-expressed rabbit cathepsin OC-2. Cathepsin X (GenBank accession number U20280) is 93.9% identical to OC-2 at the amino acid level, and is 92% identical at the nucleotide level within the coding region. Cathepsin X is 52.2 and 46.9% identical to cathepsins S and L, respectively, and is therefore clearly distinct from these enzymes. Cathepsin X mRNA was localized to multinucleated giant cells within the osteoclastoma tumor by in situ hybridization. These data strongly support the hypothesis that cathepsin X represents a novel cysteine proteinase which is expressed at high levels in osteoclasts.

Amino Acid Sequence↗
PubMed1995

Use of surfactants and slurrying to enhance the biodegradation in soil of compounds initially dissolved in nonaqueous-phase liquids.

A study was conducted to find means of enhancing the biodegradation of hydrophobic organic compounds in nonaqueous-phase liquids (NAPLs). The effects of surfactants, identity of the NAPL and agitation was investigated. When present in NAPLs, phenanthrene, di-(2-ethylhexyl) phthalate (DEHP) and biphenyl were mineralized slowly in soil. Addition of Triton X-100 or Alfonic 810-60 did not enhance the degradation of phenanthrene initially in hexadecane or dibutyl phthalate. Slurrying the soil increased the rate and extent of mineralization of phenanthrene initially in hexadecane but not in dibutyl phthalate. Addition of either of the two surfactants to the slurries did not promote the transformation. Triton X-100, Alfonic 810-60 and Tergitol 15-S-9 below their critical micelle concentrations increased the rate and sometimes the extent of mineralization in soil slurries of phenanthrene initially in 2,2,4,4,6,8,8-heptamethylnonane, but other surfactants were not stimulatory. Slurrying the soil promoted the initial mineralization of DEHP initially in dibutyl phthalate, and Alfonic 810-60 and Triton X-100 further stimulated the rate and extent of degradation in the slurries. Alfonic 810-60 increased the extent of mineralization in slurries of biphenyl in hexadecane but not in dibutyl phthalate, cyclohexane, kerosene or two oils. Little mineralization of biphenyl or DEHP initially in dibutyl phthalate occurred in soil slurries, but Tween 80, Tergitol 15-S-40 and Tergitol 15-S-9 increased the extent of mineralization. However, vigorous agitation of the slurries of soil acclimated to DEHP or the use of small volumes of the NAPL resulted in marked enhancement of the degradation.(ABSTRACT TRUNCATED AT 250 WORDS)

Biodegradation, Environmental↗
PubMed1995

Posttraumatic cerebral arterial spasm.

Posttraumatic cerebral arterial spasm (vasospasm) has been demonstrated in the past by angiography, and recently by transcranial Doppler ultrasonography. Posttraumatic vasospasm is a delayed complication that involves the large basal intracranial arteries (e.g., internal carotid, middle cerebral, basilar) and occurs in 25-40% of head trauma patient. The time course of posttraumatic vasospasm resembles that of vasospasm associated with aneurysmal subarachnoid hemorrhage with onset occurring 2 or more days after injury. A study of the relationship of admission CT scan findings to the incidence of vasospasm suggests that intradural bleeding, which extends into the CSF (subarachnoid, intraventricular, and subdural hemorrhage), plays a role in the pathogenesis of posttraumatic arterial spasm. The preliminary results of a large prospective study of head trauma patients suggest that vasospasm may be an important determinant of outcome from severe head injury.

Brain Injuries↗
PubMed1995

Transplantation for primary hyperoxaluria in the USA.

US data were sought for transplantation in primary hyperoxaluria (PH). The USRDS recorded 194 patients since 1974. By lifetable analysis, survival was better for transplanted than for non-transplanted patients (P < 0.001), even after trimming data for age < 55 and end-stage renal disease since 1985 (63 patients, 39 transplanted, 24 not transplanted). Transplant survival was longer for living related donor (21) vs cadaveric (17) transplants. Twenty-nine kidney transplants in 22 children were registered in NAPRTCS. Interview data with physicians showed that eight of 17 living related donor kidneys functioned well, three were borderline and six were lost. All six cadaver kidneys were lost. Four of six kidney-liver transplants functioned, and two died. United Network for Organ Sharing recorded 13 kidney-liver transplants in 11 patients. Six initially functioned well; two were retransplanted. Ultimately seven lived and four died. Overall, transplant is better than no transplant; cadaver donation results are poor; living related kidney donation can succeed; and kidney-liver transplant is still problematic in the US, and rarely follows appropriate investigation. Until more cooperative effort can be achieved, isolated kidney living related donor transplant is preferable, and does not preclude kidney-liver transplant later.

Adolescent↗
PubMed1995

Comparative therapeutic studies with Tilavist.

Comparative clinical trials which include known therapies as well as placebos are essential in constructing a solid basis from which to 'launch' any new drug. This applies especially to eye drops for treatment of seasonal allergic conjunctivitis, where the symptomatology, already dependent on the vagaries of the natural pollen challenge season, is further influenced by a positive washing action of the placebo eye drops. Tilavist (2% nedocromil sodium ophthalmic solution) has therefore been compared with sodium cromoglycate eye drops and non-sedating antihistamine tablets, both mainstays in the treatment of seasonal allergy, in a series of double-masked, placebo-controlled, mainly multicentre studies. Nedocromil sodium, twice or four times daily, proved as effective overall as sodium cromoglycate (2% or 4% four times daily) in three seasonal trials, and was the more effective treatment in a study of patients with vernal keratoconjunctivitis. Its efficacy was most evident during peak periods of pollen challenge, when neither placebo nor sodium cromoglycate eye drops controlled breakthrough symptoms. Three further seasonal studies showed nedocromil sodium eye drops to be as effective as standard oral doses of astemizole and terfenadine, whilst a faster onset of action than terfenadine was reported in one multicentre study.

Administration, Oral↗
PubMed1995

Role of competition for inorganic nutrients in the biodegradation of mixtures of substrates.

A study was conducted to determine whether competition for inorganic nutrients affects the biodegradation of mixtures of substrates. Little benzylamine was mineralized by Pseudomonas putida in solutions with no added P, but the substrate was degraded if the medium contained 100 nM P. The enhancement by P addition did not occur if the medium also contained caprolactam and a caprolactam-utilizing strain of Pseudomonas aeruginosa. The suppression by the second bacterium was overcome by a higher P concentration. The rate of caprolactam utilization by P. aeruginosa was reduced if benzylamine and P. putida were also present in media with 100 nM P, but the suppression was absent if the solution contained a higher P concentration. Glutamate increased and inorganic N plus P decreased the length of the acclimation phase prior to benzylamine mineralization in lake water. We suggest that the effect of one biodegradable substrate on the metabolism of a second often results from a competition for inorganic nutrients.

Benzylamines↗
PubMed1995

Efficacy of Uniphyl, salbutamol, and their combination in asthmatic patients on high-dose inhaled steroids.

A group of 32 patients with moderately severe, chronic asthma (mean FEV1 55% of predicted), maintained on moderately high doses of inhaled corticosteroids (mean dose 1,100 micrograms/d), participated in this double-blind, placebo-controlled crossover study. The effect on pulmonary function of adding theophylline (U, once daily Uniphyl), inhaled salbutamol (S, 200 micrograms four times per day), and their combination (C) or placebo (P) was assessed on Day 14 of each treatment phase. Patients recorded peak expiratory flow, asthma symptom severity (morning and evening), and use of rescue salbutamol inhaler in daily diaries. Mean FEV1 between 0730 and 1800 h and maximum FEV1 between 0730 and 1300 h were significantly higher on U, S, and C compared with P (p < 0.006). Morning peak flow and FEV1 (0730 h) were significantly higher on U and C compared with S and P (p < 0.01). Evening peak flow was higher on U than P (p < 0.001), and C was higher than S and P (p < 0.01). Rescue salbutamol inhaler use was significantly higher on P than on U, C, or S (p = 0.0001). Patient rating of asthma symptoms during C was significantly better than on S or P (p < 0.05). Patient rating of asthma control and study phase preference was significantly higher on combination and Uniphyl alone than on placebo, the combination also being superior to salbutamol alone. Addition of Uniphyl or a combination of Uniphyl and salbutamol significantly improves pulmonary function and asthma symptoms in patients treated with high doses of inhaled corticosteroids and as-needed beta agonists.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Telemedicine in Australia. 1: The health-care system and the development of telemedicine.

Telemedicine developments are intimately linked to the society in which they occur. Some of the salient factors are: the structure of the health-care system, especially its funding arrangements and the relationship between hospital and community care; the telecommunications network environment and business developments in communications technology; geographic factors of distance and isolation; and government policy dealing with interacting sectors. These factors are all considered in this review of the background to telemedicine developments in Australia.

Australia↗
PubMed1995

Tuberculous peritonitis in an adolescent male.

OBJECTIVE: To report the use of a new diagnostic approach in children with tuberculous peritonitis. PATIENT: A 14-year-old boy with tuberculous peritonitis. RESULTS: None of the new diagnostic techniques helped us to make our diagnosis. CONCLUSION: More experience of using the new diagnostic techniques will be necessary before they supersede invasive procedures.

Adolescent↗
PubMed1995

The prognostic significance of race and survival from breast cancer: a model for assessing the reliability of reported survival differences.

For more than 20 years, black women with breast cancer have been reported to have a lower survival rate than white women with breast cancer. Despite correcting for stage and socioeconomic status, some studies continue to report race-related excess mortality. A reliability scoring system was developed, based primarily on the precision of the staging system used, and the likelihood that the quality of treatment was comparable. Studies that compared the survival of blacks and whites treated for breast cancer from 1968 to 1988 were included in this study. Studies that demonstrated relatively large differences in the 5-year survival between blacks and whites were associated with low reliability scores. Studies that reported little or no difference in 5-year survival rates were associated with relatively high reliability scores. This model and the literature on which it is based suggest that the reported survival differences associated with race can be explained by differences in stage at presentation and by differences in the quality of care received. Efforts directed at early detection and improvements in the quality of care delivered are likely to reduce the excess breast cancer mortality experienced by black women.

Black People↗
PubMed1995

Prolonged brainstem auditory evoked potential latencies in tropical pancreatic diabetics with normal hearing.

Twenty patients with Tropical Pancreatic Diabetes (TPD) were evaluated by Brainstem Auditory Evoked Potentials (BAEP) in order to detect any possible subclinical involvement of auditory pathways. The latencies of BAEP Wave III (p < 0.009) and V (p < 0.47) as well as the Interpeak Latencies I-III (p < 0.002), and I-V (p < 0.019) were significantly prolonged in patients with TPD when compared to age and sex matched healthy volunteers. There was correlation between the abnormalities of BAEP and duration of diabetes (p < 0.006), male sex of patients (p < 0.05), and the presence of retinopathy (p < 0.003) and nephropathy (p < 0.38). There was no significant correlation with the age of the patients, type of treatment, blood sugar levels and presence of peripheral neuropathy. These changes suggest a subclinical involvement of the auditory pathways in TDP patients.

Adult↗
PubMed1994

Prolonged antinociception following carbon dioxide anesthesia in the laboratory rat.

In the laboratory rat, inhalation (30 s) of high (> 70%) CO2 concentrations resulted in short-term (1-3 min) anesthesia, followed by a prolonged (up to 60 min) mild antinociception. Exposure to 100% CO2 resulted in significant thermal (hot-plate, 52 degrees, and tail-flick) and mechanical (tail-pinch, 886 g force) antinociception. Control animals, placed in the same chamber filled with air, showed no such effects. Rats exposed to 70% CO2 exhibited effects on the hot plate comparable to those seen after inhalation of 100% CO2, indicating that the response is not due to CO2-induced hypoxia. Additionally, recovery from halothane-induced anesthesia of comparable duration did not result in antinociception, confirming that anesthesia alone is not sufficient to produce the effect. Pretreatment with the opiate antagonist naltrexone (0.1-10 mg/kg i.p.) did not diminish the CO2-induced antinociception, suggesting that endogenous opioids are not obligatory in the mechanism of this response. Furthermore, hypophysectomy abolished hot-plate antinociception in animals exposed to 100% CO2 while sham-treated controls exhibited a pattern of hot-plate responses similar to that reported above. Taken together, these findings show that: (1) recovery from CO2-induced anesthesia results in a prolonged mild antinociception, detectable with thermal and mechanical nociceptive tests; and (2) this response may represent a novel from of environmentally induced antinociception, mediated by a non-opiate hormonal substance.

Anesthesia↗
PubMed1994

Microbial cometabolism of sucralose, a chlorinated disaccharide, in environmental samples.

During the rapid mineralization in soil of sucralose (4-chloro-4-deoxy-alpha, D-Galactopyranosyl-1,6-dichloro-1,6-dideoxy-beta, D-fructofuranoside), a metabolic product was formed that appears to be the corresponding unsaturated aldehyde. During the slow and incomplete mineralization of sucralose in lake water, which was not increased by the addition of nitrogen and phosphorus, the same compound was produced. That product was further metabolized by microorganisms in lake water and soil. Mineralization was also slow in sewage under aerobic conditions, but organic products were not detected. Little or no CO2 was formed from the disaccharide in flooded soil or anaerobic sewage. Bacteria in culture did not use sucralose as a carbon source but did convert it to the presumed unsaturated aldehyde, 1,6-dichloro-1,6-dideoxy-D-fructose and possibly the uronic acid of sucralose. Sucralose carbon was not incorporated into cells of two sucralose-metabolizing bacteria or the microbial biomass of sewage or lake water. The chlorinated disaccharide was slowly metabolized by a galactose oxidase preparation. It is concluded that the chlorinated sugar is acted on microbiologically by cometabolism.

Bacteria↗
PubMed1994

Characterization of systemic oxygen transport in end-stage chronic congestive heart failure.

Chronic congestive heart failure (CHF) is characterized by low cardiac index (CI) and low systemic oxygen delivery (DO2), which frequently are associated with lethal cardiogenic shock after acute myocardial infarction. Nevertheless, patients with severe CHF are able to survive with these low levels of systemic DO2 and CI. It was hypothesized that patients with CHF survive low CI and DO2 by downregulation of global metabolism and resting oxygen consumption (VO2) and a concomitant increase in systemic oxygen extraction ratio (O2ER). Therefore the objective of this study was to characterize the resting pattern of systemic oxygen transport (O2T) and utilization in patients with stable CHF. Seventeen patients with CHF (New York Heart Association functional class III or IV) for > or = 3 months and with left ventricular ejection fraction (EF) < 25% and whose condition was stable with conventional oral therapy were studied. The control group comprised 10 subjects (NYHA class I) who had coronary angiography and who were found to have normal left ventricular function and EF > 60%. Subjects underwent right-heart catheterization for measurement and calculation of hemodynamic and O2T variables (VO2, DO2, and O2ER). There were no significant differences in mean age (67 +/- 6 vs 64 +/- 17 years) or gender ratio (male:female 14:3 vs 7:3) between CHF and control groups, respectively. The cause of CHF was ischemic in 13 and idiopathic in 4 patients. There were 9 patients in NYHA class III and 8 in class IV.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗