Search PubMed⌕ Search

Biomedical subjects

M Cleary

Publications and source records attributed to M Cleary.

60 records · Page 4Linked to original sources

Treatment of tardive dyskinesia with choline and tetrabenazine.

A patient with severe tardive dyskinesia due to long-term neuroleptic medication is described. The 2 factors immediately precipitating the onset of the disorder appeared to be the administration of benzhexol hydrochloride and the sudden termination of neuroleptic therapy. the disorder was satisfactorily controlled with choline chloride and a small dose of tetrabenazine. The suggested mechanism of tardive dyskinesia is discussed.

Aged↗

Presence of functional NMDA receptors in a human neuroblastoma cell line.

Data are presented that provide convincing evidence for the expression of structurally normal and functional NMDA receptors by acetylcholine-producing human LA-N-2 neuroblastoma cells in culture. Reverse transcription and polymerase chain reaction (RT-PCR), followed by cloning and DNA sequencing, revealed the presence in these cells of mRNA representing the key subunit, NMDAR1, of the receptor. This mRNA was further demonstrated by Northern analysis to be the same size as that described for human neurons. The neutral red cytotoxicity assay was utilized to examine the influence on these neuroblastoma cells of a 48-h incubation with either L-glutamic acid or the specific NMDA agonist N-phthalamoyl-L-glutamic acid (NPG). Cell cytotoxicity was shown by this assay to be increased through incubation with glutamate at 1 and 10 mM by 27 and 37%, and through incubation with NPG at 0.1 and 1 mM by 28 and 46%. A possible mechanism of these toxic effects was further evaluated using the whole-cell configuration of the patch-clamp technique and the specific NMDA agonists (+/-)1-aminocyclobutane-cis-1,3-dicarboxylic acid (ACDA) and NPG. Using this procedure, a voltage-dependent tetrodotoxin-sensitive inward sodium current was found to be increased (x 1.5) by L-glutamic acid and by both NMDA agonists in the presence of glycine. Another voltage-gated inward current, probably carried by calcium ions, was increased three- to fourfold. Hence, these glutamate activities observed in human LA-N-2 neuroblastoma cells appear to occur through the activation of functional NMDA receptors in much the same way as reported for neurons, and both glutamate and NMDA agonists can be toxic to these neuroblastoma cells. Our findings, therefore, suggest this cell line will provide a model suitable for investigating the mechanisms of NMDA-related long-term potentiation (LTP) in neurons and of the NMDA-related neurotoxic effects of glutamate in disease states that involve a reduction in cholinergic function.

Blotting, Northern↗

The impact of the establishment of a surgical high dependency unit on management of abdominal aortic aneurysm.

BACKGROUND: Our ability to maintain satisfactory levels of outcome after elective abdominal aortic aneurysm (AAA) surgery is increasingly strained by rising levels of co-morbidity in the presenting population. In this study we present a comparative outcome analysis of patients undergoing elective AAA surgery 18 months before and after the establishment of a surgical high dependency unit (HDU). METHODS: The preoperative status (ASA and POSSUM scores), operative factors and postoperative outcomes as well as duration of stay were calculated for 104 patients undergoing elective AAA repair (57 prior to the HDU opening and 47 patients afterwards). RESULTS: Patients undergoing surgery in the latter period had significantly higher ASA (2.5 +/- 0.06 versus 2.7 +/- 0.7; p = 0.007), overall POSSUM (33.2 +/- 0.5 versus 35.5 +/- 0.8; p = 0.02) and physiological POSSUM (16.3 +/- 0.3 versus 15.5 +/- 0.2; p = 0.048) scores than those operated on prior to establishment of the HDU (data are mean +/- SEM; 2-tailed p-score). The two groups had similar total lengths of hospital stay (518 versus 534 days). However, following establishment of the HDU patients occupied fewer ICU bed days (110 versus 181). This resulted in a saving of Euro 50,750. CONCLUSION: The efficiency and quality of care following elective AAA surgery can be improved by provision of HDU step-down facilities without significantly increased expenditure.

Aged↗

The Sternotomy Hemopump. A second generation intraarterial ventricular assist device.

The first generation Hemopump is a VAD based on a catheter mounted intraarterial axial flow blood pump that is placed through the femoral artery. Blood is withdrawn from the left ventricle through a transvalvular inflow cannula and pumped into the aorta. Clinical trials have demonstrated hemodynamic efficacy, improved survival, and low hemolysis in cardiogenic shock. The incidence of non-insertion of the device and fracture of the flexible drive cable limited its utility, however. In addition, some processes used in pilot production could not be adapted to volume manufacturing. A second generation device, the Sternotomy Hemopump, has been developed for insertion through the ascending aorta. Design changes include a shortened inflow cannula, higher flow hydraulics, and a more durable flexible drive cable. In addition, more efficient manufacturing processes were implemented. In a pulsatile mock loop the flow was 5.7 L/min at 100 mmHg. In vivo experiments of up to 2 weeks demonstrated a mean plasma free hemoglobin of 8.7 mg/dl, minimal valve injury, and an acceptable incidence of renal infarction. In vitro endurance demonstrated a 7 day reliability of 99.9% with a 95% confidence. A new clinical trial will evaluate the use of the Sternotomy Hemopump for nonoxygenator support during aorto-coronary artery bypass surgery.

Animals↗