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Biomedical subjects

M Alexander

Publications and source records attributed to M Alexander.

At least 109 records · Page 6Linked to original sources
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↗
PubMed1994

Individualized gonadotropin regimens for follicular stimulation in macaques during in vitro fertilization (IVF) cycles.

Follicular stimulation was compared in macaques receiving sequential gonadotropin treatment which was terminated after seven, eight, or nine days depending on the time required to attain preselected criteria of follicular maturation. Although estradiol levels and follicle sizes varied, the number of follicles and oocytes/animal, oocyte nuclear maturity, IVF rates and progesterone levels during the luteal phase were similar among groups. Reducing the duration of gonadotropin treatment to individualize follicular stimulation regimens does not compromise follicle or gamete quality.

Animals↗
PubMed1994

Roles of bacterial attachment and spontaneous partitioning in the biodegradation of naphthalene initially present in nonaqueous-phase liquids.

The mineralization by an Arthrobacter sp. of naphthalene initially dissolved in di(2-ethylhexyl)phthalate exhibited a slow phase followed by a rapid phase. Triton X-100, which inhibited cell attachment, prevented the onset of the second phase. Triton X-100 increased the extent of mineralization of naphthalene initially present in 2,2,4,4,6,8,8-heptamethylnonane. Cells attached to the interface mineralized the aromatic hydrocarbon at a rate four times higher than the rate of partitioning in the absence of microorganisms, but this microbial activity was markedly reduced by Triton X-100. We suggest that utilization of naphthalene originally present in nonaqueous-phase liquids may involve a partitioning-limited initial stage carried out by bacteria freely suspended in the aqueous phase and a subsequent, more rapid stage effected by bacteria present directly at the nonaqueous-liquid-water interface.

Arthrobacter↗
PubMed1993

A comparison of the bioeffects of four different modes of stone therapy on renal function and morphology.

A variety of therapeutic options exists for removal of symptomatic renal calculi, including extracorporeal shock wave lithotripsy, percutaneous nephrostolithotomy and open pyelolithotomy or nephrolithotomy. Although lithotripsy offers the advantage of reduced patient morbidity, the relative alterations in renal function and morphology for each of the respective treatment modalities have not been completely assessed. We evaluated 17 pigs (40 to 50 lb.) for evidence of histologic and functional renal changes after a pyelotomy (N = 3) or nephrotomy (N = 4), piezoelectric lithotripsy (N = 5), or placement of a percutaneous nephrostomy tube with balloon dilation (N = 5). Pathologic evaluation one month after treatment revealed no renal scarring in the animals that underwent a pyelotomy and minimal parenchymal fibrosis in the nephrotomy and lithotripsy groups (0.014 +/- 0.001% and 0.015 +/- 0.002%, respectively). In contrast, the percutaneous nephrostomy group demonstrated 1.53 +/- 0.4% of the treated kidney to be involved by scarring (p < 0.001). Despite the statistically significant increase in renal scarring after percutaneous nephrostomy, neither creatinine and PAH clearances nor renal plasma flows changed significantly among the four treatment groups. Moreover, no change in renal function after treatment was observed when compared with baseline evaluations. All four therapeutic options for renal stone removal appear to result in small amounts of renal parenchymal damage but are not associated with significant alterations in renal function.

Animals↗