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Biomedical subjects

M Burke

Publications and source records attributed to M Burke.

At least 217 records · Page 12Linked to original sources

Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy.

Coeliac disease is underdiagnosed partly because of insufficient recognition of more subtle presentations and partly because of the relative difficulty of jejunal biopsy. We have compared new case detection of small intestinal villous atrophy in the 5 years following changing to endoscopic multiple biopsy with our preceding 9 year experience utilizing jejunal capsule suction biopsy. The detection rate for small intestinal disease doubled while the number of patients investigated by small bowel biopsy increased threefold. We recommend that endoscopic duodenal biopsy replace jejunal biopsy for routine diagnostic purposes.

Atrophy↗

A five year audit of the role of parathyroid hormone assays and thallium-technetium isotope subtraction scanning in the preoperative investigation of primary hyperparathyroidism.

An audit has been performed of the value of parathyroid hormone assays and thallium-technetium isotope scanning in the pre-operative investigation of 67 hypercalcaemic patients referred for surgery over a 5 year period. Parathyroid hormone assay by region-specific technique was found to have a diagnostic sensitivity of 75% (n = 52) whilst the more recent assay for the intact molecule was 97% sensitive (n = 34). Thallium-technetium isotope scanning was only 64% sensitive overall (n = 59), due in part to the small size of adenomata now being referred for surgery. This study confirms the role of the intact parathyroid hormone assay but questions that of thallium-technetium isotope scanning in standard protocols of investigation for hypercalcaemia.

Adult↗

Air in the portal vein: sonographic and Doppler manifestations.

Three patients with portal venous gas (one with radiographic and computed tomographic findings) had similar sonographic and Doppler patterns in the portal vein (PV). These patterns consisted of hyperechogenic foci moving within the lumen of the PV, producing sharp bidirectional spikes superimposed on the usual Doppler tracing of the PV. An injection of 0.25-0.50 cm3 of air, oxygen, nitrogen, and carbon dioxide into the jejunal vein of nine dogs yielded identical portal venous sonographic and Doppler patterns. In addition, the liver parenchyma of the dogs became hyperechogenic after the injection of gas. Gas in the PV is accompanied by the following signs: echogenic, moving foci within the lumen of the PV; sharp spikes on Doppler spectral display; and hyperechogenic foci within the liver parenchyma.

Adult↗

Wire-guided balloon coloplasty--a new treatment for colorectal strictures?

A new technique for dilatation of colorectal anastomotic strictures--wire-guided balloon coloplasty--is described. It is suitable for high strictures, may be performed without general anaesthetic and is repeatable. It does not require endoscopy and may be used to relieve obstructive symptoms in both benign and malignant strictures so avoiding the need for a defunctioning colostomy.

Aged↗

Escherichia coli XerC recombinase is required for chromosomal segregation at cell division.

XerC is a site-specific recombinase of the bacteriophage lambda integrase family that is encoded by xerC at 3700 kbp on the genetic map of Escherichia coli. The protein was originally identified through its role in converting multimers of plasmid ColE1 to monomers; only monomers are stably inherited. Here we demonstrate that XerC also has a role in the segregation of replicated chromosomes at cell division. xerC mutants form filaments with aberrant nucleotides that appear unable to partition correctly. A DNA segment (dif) from the replication terminus region of the E. coli chromosome binds XerC and acts as a substrate for XerC-mediated site-specific recombination when inserted into multicopy plasmids. This dif segment contains a region of 28 bp with sequence similarity to the crossover region of ColE1 cer. The cell division phenotype of xerC mutants is suppressed in strains deficient in homologous recombination, suggesting that the role of XerC/dif in chromosomal metabolism is to convert any chromosomal multimers (arising through homologous recombination) to monomers.

Aminopeptidases↗

Wedge excision of lips and ears.

The wedge resection of malignant lesions on exposed parts of the lip and ear is a straightforward procedure. The keys to success include knowing the anatomy of these structures, careful marking of lines of incision, stopping bleeding and the meticulous realignment of skin surfaces.

Ear Neoplasms↗

Cross-linking of the 25- and 20-kilodalton fragments of skeletal myosin subfragment 1 by a bifunctional ATP analogue.

The bifunctional photoreactive ATP analogue azidonitrobenzoyl-8-azido-ATP (ANB-8-N3-ATP) was synthesized. This ATP analogue carriers photoreactive azido groups at the eighth position of the adenine ring and at the 3' position of ribose. Photolysis of this analogue in the presence of skeletal muscle alpha-chymotryptic subfragment 1 (S-1) resulted in a new 120-kDa band, while photolysis in the presence of the tryptic S-1 produced a new 45-kDa band. The 45-kDa peptide was shown to be combined with the 25-kDa N-terminal and 20-kDa C-terminal fragments since it was labeled with a monoclonal antibody specific for the N-terminal 25-kDa segment of the S-1 heavy chain, and it was also found to retain the fluorescence of (iodoacetamido)fluorescein attached specifically to the SH-1 thiol of the C-terminal 20-kDa segment. These results indicate that the 25- and 20-kDa peptides are in close contact with the ATPase active site.

Adenosine Triphosphate↗

Disproportionate-share payment sparks policy debate.

Despite a recent Congressional Budget Office report questioning the need for Medicare's disproportionate-share adjustment for many hospitals, federal lawmakers not only continue to support the add-on but hope to increase it in FY 1991. However, congressional debate over the issue was widened to include some fundamental questions about the original legislative intent of creating the disproportionate-share payments and what such funding is used for today.

Data Collection↗

Women in medicine: practice patterns and attitudes.

Increasing numbers of women are entering medicine in Canada. In 1959 women accounted for 6% of the medical school graduates, but by 1989 they accounted for 44%. Although there has been little systematic investigation of the impact of this increase on Canada's health care system, there are grounds for believing that female physicians bring with them distinctive values and interests, which may be reflected in the way they conduct their professional practices. We used data from a recent national survey of 2398 Canadian physicians to examine differences between women and men in their practices and their attitudes toward health care issues. Significant differences were found in the organization and management of the practices. Women preferred group over solo practice and were overrepresented in community health centres, health service organizations and centres locaux de services communautaires in Quebec. One-third of the women, as compared with half of the men, were in specialties. Even after adjusting for differences in workloads the incomes of the women were significantly lower than those of the men. Only minor differences were observed in the assessment of the health care system and alternative modes of organizing health care services. We believe that the differences were due to the double workload of women as professionals and family caregivers and the powerful socialization effects of medical education. As women overcome their minority status in the medical profession, differences between the sexes may become more apparent. Thus, the extent and effects of the progressive increase in the number of women in Canadian medicine should be assessed on an ongoing basis.

Attitude of Health Personnel↗

High Medicare hospitals seek fair share from Congress.

Hospitals with high levels of Medicare patients convinced Congress that they deserved a different rate of payment from other hospitals. Now, prospects are dimming for urban and other hospitals seeking a special funding increase for their high Medicare patient loads. The Prospective Payment Assessment Commission has advised Congress that special treatment should not be granted until further study has been completed. This article looks at both sides of the debate and gives a statistical picture of Medicare-dependent hospitals.

Economics, Hospital↗