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Biomedical subjects

M Chapman

Publications and source records attributed to M Chapman.

At least 37 records · Page 2Linked to original sources
PubMed2000

Early diagnosis of lymphedema in postsurgery breast cancer patients.

Lymphedema is an accumulation of lymph fluid in the limb resulting from an insufficiency of the lymphatic system. It is commonly associated with surgical or radiotherapy treatment for breast cancer. As with many progressively debilitating disorders, the effectiveness of treatment is significantly improved by earlier intervention. Multiple frequency bioelectrical impedance analysis (MFBIA) previously was shown to provide accurate relative measures of lymphedema in the upper limb in patients after treatment for breast cancer. This presentation reports progress to date on a three-year prospective study to evaluate the efficacy of MFBIA to predict the early onset of lymphedema in breast cancer patients following treatment. Bioelectrical impedance measurements of each upper limb were recorded in a group of healthy control subjects (n = 50) to determine the ratio of extracellular limb-fluid volumes. From this population, the expected normal range of asymmetry (99.7% confidence) between the limbs was determined. Patients undergoing surgery to treat breast cancer were recruited into the study, and MFBIA measurements were recorded presurgery, at one month and three months after surgery, and then at two-month intervals for up to 24 months postsurgery. When patients had an MFBIA measure outside the 99.7% range of the control group, they were referred to their physician for clinical assessment. Results to date: Over 100 patients were recruited into the study over the past two years; at present, 19 have developed lymphedema and, of these, 12 are receiving treatment. In each of these 19 cases, MFBIA predicted the onset of the condition up to four months before it could be clinically diagnosed. The false-negative rate currently is zero. The study will continue to monitor patients over the remaining year to accurately ascertain estimates of specificity and sensitivity of the procedure.

Adult↗
PubMed2000

Bridging the gap between conventional and alternative medicine.

BACKGROUND: The use of various forms of complementary and alternative medicine (CAM) has become widespread. We investigated this use in Madison, Wisconsin. METHODS: We conducted semistructured indepth interviews focused on the knowledge, attitudes, and behaviors of a random sample of 17 patients who had used both CAM and conventional therapies during the past year. Participants were recruited using telephone listings. Twenty alternative practitioners were selected to represent the major modalities. The topics discussed included healing philosophy, choices of therapeutic methods, and ideas concerning concurrent use of differing therapeutic modalities. An 8-member multidisciplinary team analyzed the transcripts individually and in group meetings. RESULTS: Four major themes emerged from the interview data: (1) holism, (2) empowerment, (3) access, and (4) legitimization. Both patients and providers distinguished between the socially legitimized and widely accessible but disempowering and mechanistic attributes of conventional medicine and the holistic and empowering but relatively less accessible and less legitimate nature of alternative healing. There was a strong call for integrating the best aspects of both. CONCLUSIONS: Practitioners and users of alternative therapies in the Madison area confirmed both the alternative and complementary natures of unconventional health care, called for more integrated and accessible health care, and provided insights that could be useful in bridging the gap between conventional and alternative medicine.

Attitude of Health Personnel↗
PubMed2000

Treatment resistance in anxiety disorders.

As primary care physicians become more comfortable prescribing treatments for anxiety disorders, mental health specialists increasingly are encountering patients with refractory anxiety. In this article, the authors briefly review causes of treatment resistance and approaches to failure to respond to treatment of specific anxiety disorders.

Anti-Anxiety Agents↗
PubMed1999

A comparison of two controlled-release delivery systems for the delivery of amiloride to control angiogenesis.

The diuretic amiloride has been reported to inhibit both Na+-H+ antiport and the urokinase-type plasminogen activator. As a consequence of these inhibitions, neovascularization may also be inhibited. We hypothesized that if amiloride could be effectively delivered in a site-specific manner, a system might be developed that could inhibit localized angiogenesis. In order to evaluate this possibility we conducted a study that compared two different controlled-release systems into which amiloride had been incorporated. The effectiveness of amiloride release from each delivery system was determined by quantitating angiogenic patterns in a chick chorioallantoic membrane (CAM) system using a fractal analysis software program. The two delivery systems compared were sucrose acetate isobutyrate (SAIB) and calcium alginate. Initial HPLC laboratory tests confirmed that amiloride could be released from both SAIB and calcium alginate in vitro in a sustained manner for 72 h. The CAM studies confirmed that neither SAIB nor calcium alginate alone promoted or inhibited angiogenesis when compared to nontreated controls. The release of amiloride from each delivery vehicle resulted in a significant (P < 0.05) inhibition of angiogenesis following both 24 and 48 h of release compared to controls. There was no difference in inhibition of angiogenesis, however, when comparing SAIB + amiloride treated CAMs with calcium alginate + amiloride treated CAMs. These data suggest that both SAIB and calcium alginate may be useful delivery vehicles for the localized application of amiloride to control angiogenesis. Such a system could potentially control tumor angiogenesis without systemic effects.

Alginates↗
PubMed1999

Washing the dog reduces dog allergen levels, but the dog needs to be washed twice a week.

BACKGROUND: Many asthmatic patients allergic to dogs refuse to part with their dog, and it is essential to develop techniques for lowering exposure with a dog in the home. OBJECTIVE: This study investigated the effect of dog washing on the subsequent recovery of Can f 1 from dog hair clippings and on the airborne allergen over a 7-day period. METHODS: Dogs, which had not been washed for at least the previous 3 weeks, were washed with a hand-held shower and proprietary shampoo. Hair clippings and dander samples from 25 dogs were collected before and immediately after washing. After these initial studies, 16 dogs had a small tuft of hair clipped from the collar or spinal area before washing and then daily for the next 7 days. Air sampling was performed in 5 homes, and the air samples were collected (airflow rate, 9 L/min) over an 8-hour period per day on 10 consecutive days (3 days of baseline sampling before washing and then 7 consecutive days after washing). Can f 1 level was measured by using 2-site ELISA. RESULTS: Washing significantly reduced recoverable Can f 1 from clippings (84% reduction: from 73 microg/g to 12 microg/g [geometric mean]; P <.0001) and from dander samples (86% reduction: from 347 microg/g to 50 microg/g [geometric mean]; P <.0001). There was a significant reduction in Can f 1 levels in dog hair over the observed 8-day period (F = 18.4, P <. 0001). By using a multiple comparison test, this observed significance was found to be due to the difference between the baseline levels and those on days 1 and 2 after washing, with no difference in the baseline Can f 1 compared with days 3 to 7. Airborne Can f 1 levels showed a downward trend, which reached statistical significance when the data were grouped into 3 sampling periods as follows: baseline (ie, mean of 3 days before sampling) was compared with days 1 to 4 after washing (41% reduction, 95% CI 13%-60%) and days 5 to 7 after washing (61% reduction, 95% CI 2%-84%; P =.014). CONCLUSIONS: Washing the dog reduces recoverable allergen from dog hair and dander. The dog needs to be washed at least twice a week to maintain the reduction in recoverable Can f 1 from its hair. Washing the dog achieves a modest reduction in the level of airborne Can f 1 in homes with a dog.

Air Pollution, Indoor↗
PubMed1999

The effect of air filtration on airborne dog allergen.

BACKGROUND: Effective methods of reducing dog allergen are required to help alleviate symptoms in asthmatic patients sensitized to dog who refuse to part with their pet. The aim of this study was to investigate the use of the high efficiency particulate air (HEPA) filter air cleaner to reduce airborne Can f 1 in homes with a dog. METHODS: The effect of a HEPA air cleaner was investigated in nine homes with a dog. Samples were collected from two rooms of each house concurrently, one of which contained the dog, on two separate days (active day - HEPA air cleaner on - and control day). Eight consecutive 1-h samples were collected from each room with a high-volume air sampler (airflow rate 60 l/ min). Can f 1 was determined by monoclonal-polyclonal antibody-based ELISA. RESULTS: Baseline airborne Can f 1 levels were 3.8-fold greater when sampling was performed with a dog in the room (GM 27.1 ng Can f 1/m3, range 2.63-329) than when the dog was elsewhere in the house (GM 7.1 ng Can f 1/m3, range 0.69-27.2). When the dog was elsewhere in the house, airborne Can f 1 levels fell on both active and control days, but the magnitude of the reduction was significantly greater on the active days (P<0.05), and was approximately 90% from baseline. With the dog in the room, a significant fall in airborne Can f 1 was observed only on active days (75% from baseline), but not on control days (active vs control P<0.001). CONCLUSIONS: HEPA air cleaners reduce airborne Can f 1 in homes with dogs. Furthermore, preventing the access of the dog to the bedroom and possibly the living room may reduce the total allergen load inhaled.

Air Pollution, Indoor↗
PubMed1999

Traumatic pancreatitis: long-term review of initial non-operative management in children.

OBJECTIVE: To assess the safety and long-term efficacy of an initial non-operative approach to the management of pancreatic trauma in children. METHODOLOGY: Retrospective case-note review of children admitted to our institution with the diagnosis of pancreatic trauma over a 10-year period from 1985 to 1994 inclusive. RESULTS: Fourteen children were identified with a diagnosis of traumatic pancreatitis. Eleven of the injuries were secondary to motor vehicle accidents or trauma from a bicycle handlebar. In seven patients there were associated intra-abdominal injuries and in eight patients the traumatic pancreatitis was complicated by development of a pseudocyst. Three pseudocysts settled without intervention, two resolved with percutaneous external drainage and the remaining three required open surgery. The mean in-patient stay was 21.2 days. The average length of follow-up was 7.7 years with no observed long-term complications. CONCLUSIONS: Non-operative management of traumatic pancreatitis in the absence of complete duct transection is safe in children and does not appear to be associated with adverse sequelae.

Accidents, Traffic↗
PubMed1999

Home within 24 hours of laparoscopic hysterectomy.

We assessed the feasibility of safe discharge home within 24 hours following laparoscopic hysterectomy in 30 patients who met the inclusion criteria and consented to be enrolled in the study group. Patients were admitted on the day of their surgery with the expectation of discharge within 24 hours. Appropriate home nursing follow-up and phone contact by the surgical team were organized preoperatively. Inclusion criteria were: age 30-65 years, absence of any major medical history that would require prolonged hospitalization, availability of home support for the first 48 hours after discharge and presence of a working telephone line and an address within the area of the Community Home Nursing service. All 30 operative procedures were completed without incident. Six patients underwent total laparoscopic hysterectomy (TLH) (all the procedures of hysterectomy being performed laparoscopically including the suturing of uterine arteries, colpotomy and closure of the vaginal vault. The uterus was removed vaginally) and 24 patients underwent laparoscopic hysterectomy (LH) (this techniques differs from TLH in that the colpotomy was performed laparoscopically but the uterosacral ligaments were divided vaginally and the vault also was closed vaginally after the uterus was removed vaginally). The average operating time was 115 minutes (range 85-150 minutes) and the average blood loss was 97 mL (20-250 mL). There were no intraoperative complications, no requirement for transfusion and no readmission to hospital for any of the patients in the study. Postoperative complications were minor (umbilical cellulitis (1), intestinal colic (1)) and both were treated with resolution of the symptoms. Ninety per cent of patients in the study were discharged within 24 hours of their surgery, the average duration of stay being 22.9 hours (20-24 hours). Three patients were not fit for discharge at 24 hours postoperatively due to general lethargy, migraine and nausea; their average discharge time was 53.5 hours. The study showed that laparoscopic hysterectomy can be associated with a reduction in length of in-patient stay compared to traditional laparotomy. Furthermore this reduction could be safely reduced to 24 hours following laparoscopic hysterectomy. There was also an associated cost saving in terms of inpatient bed days. Patient satisfaction with this protocol was high in this selected and motivated group.

Adult↗
PubMed1998

Acronema sippewissettensis Gen. Nov. Sp. Nov., microbial mat bicosoecid (Bicosoecales = Bicosoecida).

A heterotrophic mastigote from the flat laminated Microcoleus-dominated intertidal microbial mat at the Sippewissett salt marsh, Cape Cod, Massachusetts, was isolated into monoprotist culture in the same anoxic medium that led to spirochete and other anaerobic bacterial enrichments. The protist grew vigorously and was transferred indefinitely in oxic marine medium. Videomicroscopy as well as scanning and transmission electron microscopy were used to document its features. The swimming and perching behavior, nutritional mode (bactivory) and morphology including ultra-structure identify it as an aloricate bicosoecid. The presence of heteromorphic acronematic undulipodia, bilateral bipartite tubular mastigonemes, absence of a cytostome, absence of extrusomes, and presence of "Dauerstadien" (duration stages) distinguish this from other Cafeteriaceae bicosoecids. Cell division involves a closed intranuclear spindle. The unspecialized bicosoecid morphology and behavior juxtaposed with oomycete-like vesicles and mastigonemes suggest that this protist may be an extant descendant of a common ancestor of bicosoecids and other stramenopiles (e.g. labyrinthulids, thraustochytrids and oomycetes). A new genus and species, Acronema sippewissettensis, are proposed.

Animals↗
PubMed1998

The lordotic effect of the OSI frame on operative adolescent idiopathic scoliosis patients.

STUDY DESIGN: A prospective evaluation of adolescent idiopathic scoliosis patients undergoing operative treatment on the Orthopedic Systems Incorporated (OSI; Jackson) frame. OBJECTIVES: To investigate prospectively thoracic, thoracolumbar, and lumbar sagittal alignments in patients with adolescent idiopathic scoliosis who undergo an instrumented posterior spinal fusion on the OSI frame. SUMMARY OF BACKGROUND DATA: In several studies, it has been shown that patient positioning on various operative frames is an important component of ultimate lumbar sagittal alignment. However, these studies have all concentrated on the lumbar spine, and no sagittal plane alignment data in adolescent idiopathic scoliosis patients have been reported in the thoracic and thoracolumbar junction as it relates to intraoperative positioning, correction maneuvers and correlative postoperative results. METHODS: Thirty-nine patients with operative adolescent idiopathic scoliosis treated with an instrumented posterior spinal fusion on the OSI frame were prospectively evaluated. Standing preoperative, intraoperative, and postoperative long-cassette lateral radiographs were reviewed with regional and segmental Cobb measurements of the thoracic, thoracolumbar junction, and lumbar spine obtained. RESULTS: Thoracic kyphosis (T1-T12) measured +34 degrees before surgery, +28 degrees during surgery, and +30 degrees after surgery, Thus, a statistically significant decrease was noted in thoracic kyphosis secondary to prone positioning on the OSI frame ( P < 0.05). Thoracolumbar spine measurements from T10 to L2 also showed a lordotic trend from +2 degrees before surgery, to -4 degrees during surgery, to -8 degrees after surgery, which was also statistically significant (P < 0.05). Total lumbar lordosis from T12 to S1 remained relatively unchanged from -60 degrees before surgery, to -59 degrees during surgery, to -60 degrees after surgery. However, segmental lumbar lordosis measured from T12 to the lowest instrumented vertebra showed a statistically significant increase in lordosis from -17 degrees before surgery, to -19 degrees during surgery, to -23 degrees after surgery (P < 0.05). Those patients in whom lumbar pedicle screws were used (vs. hooks alone) had the greatest increase in lumbar instrumented lordosis. CONCLUSIONS: Performing adolescent idiopathic scoliosis correction on the OSI frame tends to decrease thoracic kyphosis, increase thoracolumbar lordosis, and increase segmental instrumented lumbar lordosis, while it maintains total lumbar lordosis.

Adolescent↗
PubMed1998

Smooth pursuit and saccadic abnormalities in first-episode schizophrenia.

BACKGROUND: Previous studies of oculomotor dysfunction in schizophrenia have tended to concentrate on abnormalities of smooth pursuit eye tracking in chronic medicated patients. We report the results of a study of smooth pursuit, reflexive and antisaccade performance in drug naive and antipsychotic treated first-episode schizophrenic patients. METHODS: Smooth pursuit and saccadic eye movements were recorded in 36 first-episode schizophrenic patients and 36 controls matched for age and estimated IQ. The schizophrenic patients were divided into drug-naive (N = 17) and antipsychotic treated groups (N = 19). RESULTS: Smooth pursuit velocity gain was significantly lower than controls only in the drug-naive patients. The treated patients did not differ significantly from either the controls or the untreated group. In an antisaccade paradigm both treated and drug-naive schizophrenic patients demonstrated an increased number of errors, but only drug-naive patients also demonstrated an increased latency in initiating correct antisaccades. CONCLUSIONS: These impairments are unlikely to be due to a generalized deficit in oculomotor function in the schizophrenic groups, as there were no differences between the groups in saccadic metrics on a reflexive saccade task. The results show that both smooth pursuit and saccadic abnormalities are present at the onset of schizophrenia and are integral to the disorder.

Adolescent↗
PubMed1998

Domestic allergens in public places III: house dust mite, cat, dog and cockroach allergens in British hospitals.

BACKGROUND: Exposure and sensitization to indoor allergens is a major cause of asthma. OBJECTIVES: This study investigated the levels of house dust mite, cat, dog and cockroach allergens in the dust and air in hospitals and the effects of regular vacuum cleaning on allergen levels in hospital chairs. METHODS: Der p 1, Fel d 1, Can f 1 and Bla g 2 were measured in the dust collected by vacuuming upholstered chairs and a 1 m2 area of carpet and mattress in 14 hospitals. Air samples were collected using an air sampler (flow rate 60 L/min) on 10 separate days for 4 h in the outpatient department in one of the hospitals during busy clinics when patients were waiting for their appointments. In addition, dust samples were collected on four occasions, at 4-weekly intervals, from 36 fabric covered chairs in the outpatient area of a busy chest clinic by vacuuming each chair for 2 min. During the intervening weeks, 18 of the chairs (active group) were each cleaned by vacuuming for 1 min, three times per week. Der p 1, Fel d 1, Can f 1 and Bla g 2 were assayed using monoclonal antibody-based ELISA. RESULTS: In total, 83 carpets, 69 mattresses and 42 upholstered chairs were sampled. The levels of dust mite allergen Der p 1 and cockroach allergen Bla g 2 found in the hospital setting were low. High levels of Fel d 1 (GM 22.9 microg/g, range 4.5-58) and Can f 1 (GM 21.6 microg/g, range 4-63) were found in upholstered chairs. Airborne Can f 1 was detected on every occasion (range 0.12-0.56 ng/m3), whilst detectable airborne Fel d 1 was found on 7 out of the 10 sampling days (range 0.09-0.22 ng/m3). Der p 1 and Bla g 2 were below the detection limit in all airborne samples. Following repeated vacuuming the mean cat and dog allergen levels decreased significantly (P<0.001) and were almost fivefold lower in the vacuumed chairs compared with the control group. CONCLUSIONS: Low levels of mite allergen are unlikely to be of any clinical significance to mite-sensitive asthmatic patients. However, upholstered chairs in hospitals constitute a significant reservoir of cat and dog allergen. Inhalation of airborne allergen in patients attending their hospital appointment may exacerbate asthma in those highly allergic to cats or dogs. These results question the wisdom of introducing soft furnishings and carpets into hospitals. Three-times weekly vacuuming significantly reduces allergen levels in upholstered chairs.

Air Pollution, Indoor↗
PubMed1998

Methods of creating pneumoperitoneum: a review of techniques and complications.

The existence of numerous techniques for the creation of pneumoperitoneum at laparoscopy indicates that none have been proven totally efficacious or complication free. These methods include the standard technique of insufflation after insertion of the Veress needle via the umbilicus or less commonly via the transfundal or transforniceal routes, open laparoscopy involving dissection through the linea alba and opening of the peritoneum under direct vision, and direct trocar insertion as well as variations on these techniques. After reviewing the methods available and surveying the existing data concerning the rates of failure and complications, we conclude that no single technique can claim to be overwhelmingly superior, and that laparoscopists should, therefore, acquaint themselves with at least two of these techniques. Finally, we recommend a large-scale combined survey by the colleges of obstetricians and gynecologists and surgeons on rates of failure and complications of the varied approaches of abdominal entry for laparoscopy.

Humans↗
PubMed1998

Risk levels for mite allergens. Are they meaningful?

Allergens found in house dust are among the most common environmental antigens to which man is naturally exposed. Standardized methods for measuring allergen exposure are essential for assessing the relationship between exposure, sensitization, and the severity of asthma. Monoclonal antibody-based assays are the most widely used method for assessing allergen exposure. In the effort to define the best "index of exposure" to mite allergens, several factors need to be investigated, including: 1) whether allergen should be measured in reservoir dust or airborne 2) whether the results of reservoir measurement should be expressed as recovered allergen per unit weight or per unit area. As yet, airborne sampling is insufficiently sensitive to produce reliable and repeatable results. Therefore, measurement of house-dust-mite allergen concentration in reservoir dust should be regarded as the best-validated index of exposure. The results should be expressed and reported both per unit weight (concentration) and per unit area. The strongest predictor of chronic symptoms and acute exacerbation of asthma is sensitization to indoor allergens. A simple dose-response relationship between IgE-mediated hypersensitivity and allergen exposure has been established. For example, exposure to more than 2 microg Group 1 mite allergen/g dust should be regarded as a risk factor for the development of IgE antibody and asthma in susceptible children. The quantitative relationship between exposure and symptoms in patients already sensitized is complex due to a number of possible confounding factors (e.g., other allergens, viruses, asthma medication). A simple threshold level for provocation of asthmatic symptoms has not been clearly defined.

Air Pollution, Indoor↗