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Biomedical subjects

M Ellis

Publications and source records attributed to M Ellis.

At least 109 records · Page 6Linked to original sources
PubMed1998

Severe juvenile vaginal bleeding due to Glanzmann's thrombasthenia: case report and review of the literature.

Glanzmann's thrombasthenia is a rare inherited hematological disorder defined by deficiency or abnormality of the glycoprotein (GP) IIb-IIIa complex. Presenting symptoms are hemorrhagic events, mainly epistaxis, purpura, or menorrhagia. We describe the clinical course and management of a 14-year-old girl with Glanzmann's thrombasthenia and severe menorrhagia. Following treatment with 20 U of packed red blood cells, 37 U of platelets, 7 U of fresh frozen plasma, cryoprecipitate, intravenous estrogens, and methylergotrine maleate with no improvement, the uterine cavity was packed for 48 hr. This unusual procedure halted the bleeding and avoided the necessity for a hysterectomy. When treating acute menorrhagia in patients with Glanzmann's thrombasthenia, the physician should be familiar with the characteristics and all treatment modalities for this disorder.

Adolescent↗
PubMed1998

An EORTC multicentre prospective survey of invasive aspergillosis in haematological patients: diagnosis and therapeutic outcome. EORTC Invasive Fungal Infections Cooperative Group.

OBJECTIVES: The EORTC Invasive Fungal Infections Cooperative Group (IFICG) conducted a prospective survey by questionnaire of all cases of invasive aspergillosis (IA) in cancer patients to ascertain current diagnostic and therapeutic approaches. METHODS: All members of the IFICG were asked prospectively to complete a detailed questionnaire for each IA case identified in their institution over a 12-month period. RESULTS: One hundred and thirty questionnaires were returned. All cases were independently evaluated (DWD & JC) and 123 were eligible. Cases came from 20 hospitals in eight countries and the number of cases per institution varied from 1-21. Acute myeloid leukaemia (AML) (60, 49%), acute lymphoblastic leukaemia (ALL) (21, 17%) and lymphoma (11, 9%) were the most frequent underlying diseases, and 16 (12%) patients had received an allogeneic bone marrow transplant. Pulmonary involvement was present in 87%, infection of sinuses/nose in 16% and brain in 8%. The chest radiograph was initially normal in 9% of those with primary pulmonary disease. The diagnosis was confirmed in 50%, probable in 31% and possible in 19%. The evidence for IA was on the basis of clinical and radiological features alone in 28%, with culture or histology in another 31% and 9%, respectively, and with both culture and histology in 29%. In three (2%) patients with diagnosis was based on culture or histology alone. Treatment was given to 120 patients (98%)-amphotericin B 75%, lipid-associated amphotericin B 36%, itraconazole 40%, flucytosine 12%, growth factors 33%, lobectomy 5%. At 3 months after diagnosis or first suspicion of IA, 44 (36%) patients were alive and 79 (64%) dead. Outcome was best in those with AML (30% death and 46% with a complete antifungal response or cure). Growth factors (mostly granulocyte colony stimulating factor) appeared not to influence outcome (P = 0.99). CONCLUSION: IA remains a considerable diagnostic and therapeutic challenge. No single diagnostic procedure was universally successful and a multifaceted approach including surgery is necessary. There was no discernable difference in outcome between initial therapy with amphotericin B, itraconazole or lipid-associated amphotericin B, although numbers are limited and the study was retrospective.

Adolescent↗
PubMed1998

An EORTC international multicenter randomized trial (EORTC number 19923) comparing two dosages of liposomal amphotericin B for treatment of invasive aspergillosis.

This is the first completed prospective randomized clinical efficacy trial of antifungals in the treatment of invasive aspergillosis (IA) and the first to compare the clinical efficacy of two dosages of liposomal amphotericin B (L-AmB) for IA in neutropenic patients with cancer or those undergoing bone marrow transplantation. Eighty-seven of 120 patients were eligible and evaluable. Clinical responses were documented for 26 (64%) of 41 patients receiving 1 mg/(kg.d) (L-AmB-1) and 22 (48%) of 46 receiving 4 mg/(kg.d) (L-AmB-4). Radiologic response rates were similar: 24 (58%) of the L-AmB-1 recipients and 24(52%) of the L-AmB-4 recipients. The six-month survival rates were 43% (L-AmB-1) and 37% (L-AmB-4). These differences were not significant. The numbers of deaths directly due to IA at 6 months were similar: 9 (22%) of 41 L-AmB-1 recipients and 9 (20%) of 46 L-AmB-4 recipients. No other variable independently influenced survival, apart from central nervous system IA. L-AmB is effective in treating approximately 50%-60% of patients who have IA. A 1-mg/(kg.d) dosage is as effective as a 4-mg/(kg.d) dosage, and no advantages to use of the higher, more expensive, dosage has been observed.

Adult↗
PubMed1998

Factors affecting home delivery in the Kathmandu Valley, Nepal.

This nested case-control study compares the characteristics of mothers having home or institutional deliveries in Kathmandu, Nepal, and explores the reasons given by mothers for a home delivery. The delivery patterns of mothers were identified in a cross-sectional survey of two communities: an urban area of central Kathmandu (Kalimati) and a peri-urban area (Kirtipur and Panga) five kilometres from the city centre. 357 pregnant women were identified from a survey of 6130 households: 183 from 3663 households in Kirtipur and Panga, 174 from 2467 households in Kalimati. Methods involved a structured baseline household questionnaire and detailed follow-up of identified pregnant women with structured and semi-structured interviews in hospital and the community. The main outcome measures were social and economic household details of pregnant women; pregnancy and obstetric details; place of delivery; delivery attendant; and reasons given for home delivery. The delivery place of 334/357 (94%) of the pregnant women identified at the survey was determined. 272 (81%) had an institutional delivery and 62 (19%) delivered at home. In univariate analysis comparing home and institutional deliverers, maternal education, parity, and poverty indicators (income, size of house, ownership of house) were associated with place of delivery. After multivariate analysis, low maternal educational level (no education, OR 5.04 [95% CI 1.61-15.8], class 1-10, OR 3.36 [1.04-10.8] compared to those with higher education) and multiparity (OR 3.1 [1.63-5.74] compared to primiparity) were significant risk factors for a home delivery. Of home deliverers, only 24% used a traditional birth attendant, and over half were unplanned due to precipitate labour or lack of transport. We conclude that poor education and multiparity rather than poverty per se increase the risk of a home delivery in Kathmandu. Training TBAs in this setting would probably not be cost-effective. Community-based midwife-run delivery units could reduce the incidence of unplanned home deliveries.

Adult↗
PubMed1998

Liquid crystal thermometry for the detection of neonatal hypothermia in Nepal.

We assessed the sensitivity, specificity and likelihood ratio of a low cost liquid crystal strip thermometer (LCT) compared with axillary mercury thermometry for the detection of neonatal hypothermia in Nepal. The subjects were 76 healthy newborns in the government maternity hospital of Kathmandu, Nepal in winter. The validity of LCT for the detection of neonatal hypothermia (less than 36 degrees C) showed a sensitivity of 83 per cent, specificity 96 per cent, positive predictive value 98 per cent and a likelihood ratio of 23. Use of LCT on newborns in this setting raises a measured pretest probability of first day hypothermia of 63 per cent to a post-test probability of 97 per cent. Liquid crystal thermometry is a simple, low-cost, and valid method for identifying core hypothermia in newborns. It is ideal for isolated rural communities where LCT strips could be added to delivery kits.

Female↗
PubMed1998

Effects of feeder type, space allowance, and mixing on the growth performance and feed intake pattern of growing pigs.

The effect of crowding and mixing on growth performance and feed intake pattern were investigated in growing pigs in a 4-wk study. Feeding pattern was monitored using automated feed intake recording equipment (F.I.R.E.). A total of 256 Yorkshire x Hampshire and purebred Duroc pigs (initial weight 35.8+/-.86 kg) were allocated to one of the eight treatment combinations in a 2x2x2 factorial arrangement (feeder type [conventional feeder vs F.I.R.E. feeder], space allowance [.56 vs .25 m2/pig], and mixing strategy [mixed vs unmixed; mixing at start of wk 1 and 3]). Pigs were housed in groups of eight, balanced for genotype and sex (barrows and gilts), and had free access to a corn-soybean meal diet (17% crude protein, 3,296 kcal ME/kg). There was no difference in growth performance between feeder types. Crowding and mixing had no effect on daily feed intake but they depressed growth rate by 15.7 and 7.1%, respectively, and the effects of the two stressors were additive. Gain:feed ratio was reduced by crowding (10.0%) but not by mixing. Crowded pigs made fewer (11.2 vs 15.7; SEM = .51), and longer (12.5 vs 8.9 min; SEM .41) feeder visits and had higher feed intake per visit (196.2 vs 145.5 g; SEM = 5.94) than uncrowded animals. Mixing produced changes in feeding pattern in the 1st wk after mixing but not over the 4-wk period. This study showed that crowding and mixing depressed growth rates in an additive manner and altered feeding behavior.

Animal Feed↗
PubMed1998

Growth performance of pigs subjected to multiple concurrent environmental stressors.

The effects of many single stressors have been reported, but how pigs perform when subjected to more than one or two stressors at a time, as is common in commercial swine production, has not. To study this, 256 Yorkshire x Hampshire or purebred Duroc pigs (34.7+/-.5 kg) were subjected to one of the eight treatment combinations (2 x 2 x 2 factorial) of ambient temperature (constant thermoneutral [24 degrees C] or high cycling temperature [28 to 34 degrees C]), stocking density (.56 or .25 m2/pig), and social group (static group or regrouped at the start of wk 1 and 3) during a 4-wk experiment. The temperature regimens were imposed in two adjacent mechanically ventilated rooms, and each temperature was imposed in each room across two trials. Four barrows and four gilts were assigned to each of the eight pens in the two rooms, and they always had free access to water and a corn-soybean meal-based diet. Treatments were imposed after a 7-d acclimation period at 24 degrees C and .56 m2/pig. Weight gain and feed intake were measured weekly. The main effects of each of the stressors for 4-wk ADG and ADFI were significant (P < .05). The stress of high temperature, high stocking density, and regrouping depressed 4-wk ADG by 12, 16 and 10% and ADFI by 7, 6, and 5%, respectively. Of the possible 60 stressor interactions for ADG, ADFI, and gain:feed (G:F), there were no significant three-way interactions and only six two-way interactions, suggesting that the effects of the individual stressors were additive. Accordingly, the growth rate of pigs subjected to the single stressor of high cycling temperature, restricted space allowance, or regrouping was depressed 10, 16, and 11%, respectively, and ADG of pigs subjected to all three stressors simultaneously was depressed by 31%. Stressor additivity was further corroborated by examining the effect of stressor order, or the number of stressors imposed simultaneously. As the number of stressors increased from 0 to 3, ADG, ADFI, and G:F decreased linearly. These data suggest that multiple concurrent stressors affect growth performance of pigs in a predictable fashion (i.e., additively) and indicate that avoidance or removal of a given stressor is advantageous even when other uncontrollable stressors persist.

Animal Feed↗
PubMed1998

Pork carcass composition: I. Interrelationships of compositional end points.

Thirty pork carcasses were used to evaluate the interrelationships between compositional end points and the accuracy of predicting various end points from one another. Right sides were fabricated into Boston butt, picnic, anterior belly, posterior belly, anterior loin, posterior loin, and ham. Carcass composition was determined on the right side using physical dissection and chemical analyses of soft tissue. Left sides were ground (whole-side grind). Linear measures and chemical composition were made on left sides. Using dissectable components, high (r > .85) correlations occurred between percentage of fat-free lean and percentage of lipid, percentage of dissectable fat, and lipid in the whole-side grind; between weights of dissectable lean and fat-free lean; and between weights of lipid in the whole-side grind and lipid, dissectable fat, and dissectible lean. Dissectable lean percentage and fat (percentage and weight) could be predicted using weight of lipid, weight of fat-free lean, and side weight. Any physical measure could be accurately estimated from any compositional end point (r2 = .79 to .93). Regression equations using 10th-rib linear measures and hot carcass weights predicted compositional end points with R2 > or = .80, with the exception of dissectable lean (R2 = .56).

Adipose Tissue↗
PubMed1998

Pork carcass composition: II. Use of indicator cuts for predicting carcass composition.

Right sides of 30 pork carcasses were fabricated into indicator cuts (Boston butt, picnic, anterior belly, posterior belly, anterior loin, posterior loin, and ham) and used to determine carcass composition by physical dissection and chemical analysis of soft tissue. Linear measures and chemical composition of whole-side grind were collected from left sides. Dissection of indicator cuts to predict dissectable composition of the side were much better indicators than linear measures (R2 = .70 to .94). Chemical analyses of soft tissue (lean + lipid) from the loin and anterior belly were better predictors of fat-free lean and extractable lipid composition of the side than linear measures; 89% of the variation in dissectable lean of the side was explained by the use of dissectable components of the anterior loin. The loin served as the best overall indicator cut across the various end points evaluated; 92% of the variation in dissectable lean of the side was explained using dissectable components of the shoulder. The anterior belly was a good indicator for percentage of dissectable lean, fat, fat-free lean, and extractable lipid.

Adipose Tissue↗
PubMed1998

An Apgar score of three or less at one minute is not diagnostic of birth asphyxia but is a useful screening test for neonatal encephalopathy.

OBJECTIVE: To evaluate the relationship between an Apgar score of three or less at one minute of life and the subsequent risk of developing neonatal encephalopathy (NE). DESIGN: Prospective. SETTING: The principal maternity hospital of Kathmandu, Nepal, a low income country, where over 50% of the local population deliver. METHODS: All liveborn infants over a 12 month period with a birthweight of 500 g or more were assessed by the Apgar scoring system at one minute of age. All term infants with neurological abnormalities presenting in the first day of life were systematically examined and described according to a conventionally defined encephalopathy grading system. Major congenital malformations and neonatal infections were excluded. RESULTS: Over 12 months there were 14,771 total births of a weight of 500 g or more of which 14,371 were live births and 400 were stillbirths. Of 734 infants with 1 min Apgar of three or less, 91 developed NE. The positive and negative predictive values of 1 min Apgar of three or less for NE were 11.4% and 99.9%, respectively. The probability of developing NE rose from 0.6% (amongst all infants born at this hospital) to 11.2% (amongst infants born with a one minute Apgar of three or less). CONCLUSIONS: An Apgar score of 3 or less at one minute is a useful screening test for clinically significant birth asphyxia (NE). It overestimates by eight fold the scale of the birth asphyxia problem, but identifies a high risk group requiring further observation of their neurological condition.

Apgar Score↗
PubMed1998

When immigrants are not migrants: counting arrivals of the foreign born using the U.S. census.

"This paper compares characteristics of recent immigrant arrivals in the United States using two measures from the decennial U.S. census: the came-to-stay question and the migration question.... Among recent arrivals, defined as those who reported they came to stay in the quinquennium preceding the census, a large number were resident in the United States five years before the census date. Furthermore, the proportion of recent arrivals present in the United States five years before the census increased between 1975-1980 and 1985-1990.... Generally, in both the 1975-1980 and 1985-1990 cohorts, those resident in the United States five years before the census have significantly less schooling and lower incomes than those who were abroad."

Americas↗
PubMed1997

Characterization and chromosomal localization of PTPRO, a novel receptor protein tyrosine phosphatase, expressed in hematopoietic stem cells.

Hematopoietic stem cells (HSCs) support blood cells throughout life by utilizing their self-renewing and multilineage differentiating capabilities. Hematopoietic growth factors mediate their effects on stem cells by the tyrosine phosphorylation of proteins. Regulation of tyrosine phosphorylation is partially mediated by protein tyrosine phosphatases (PTPases). A possible mechanism by which hematopoietic stem cells maintain their self-renewing capacity and undifferentiated state is by controlling the balanced and opposing actions of protein tyrosine kinases (PTKs), receptors for growth factors, and PTPases. We have characterized the expression of PTPases in 5-fluorouracil (5-FU)-treated murine bone marrow cells, which represent a very primitive population of progenitors enriched for reconstituting stem cells, by using a consensus polymerase chain reaction (PCR) method. Several PTPases were expressed abundantly in the 5-FU-treated bone marrow stem cells. A novel PTP, termed protein tyrosine phosphatase receptor omicron (PTPRO), which is related to the homotypically adhering kappa, mu and PCP-2 receptor-type tyrosine phosphatases, was identified and characterized. We have cloned the murine and full-length human PTPRO cDNAs which share 89% homology, indicating that PTPRO is highly conserved between these species. The human PTPRO cDNA clone encodes a polypeptide of 1439 amino acids (aa) and has a calculated molecular mass of approximately 162 kDa. PTPRO consists of an extracellular segment containing a MAM domain, an immunoglobulin (Ig) domain, four fibronectin-type III (FN-III) repeats, a transmembrane segment, and two tandem intracellular PTP domains. The human PTPRO gene was assigned to human chromosome 1p35-pter using Southern blot analyses of genomic DNAs from rodent/human somatic hybrid cell lines containing human chromosome 1 or the p35-pter region of the chromosome. The mouse Ptpro gene was mapped to chromosome 4, closely linked to D4Mit16 and Elp1 (elliptocytosis-1), by using genomic DNAs from a (C57BL/6J x Mus spretus)F1 x Mus spretus backcross. In fetal tissues, PTPRO expression was observed in the brain and lung, whereas lower levels were observed in the kidney. In adult tissues, PTPRO was less restricted and was observed in the lung, heart, skeletal muscle, prostate, testis, and in various areas of the brain, indicating that PTPRO expression is developmentally regulated. Expression of PTPRO was also observed in human CD34+ bone marrow cells and 5-FU-treated murine primitive stem cells. These results suggest a potential role for PTPRO in stem cell adhesion and in mediating homophilic cell-cell interactions in other cell types.

Amino Acid Sequence↗
PubMed1997

Effect of repeated dosing on the pharmacokinetics of oral fluconazole in bone marrow transplant patients.

We examined the pharmacokinetics of fluconazole in 11 bone marrow transplant patients after multiple oral daily dose of 200 mg of this drug. Blood was sampled at different intervals on day 1, day 13, and day 27. No dose was given on day 2, day 14, and day 28 to allow the concentration-time data to be collected over 48 hours. The 24 hour urine was also collected, and fluconazole was analyzed in both plasma and urine by a high performance liquid chromatography. The plasma concentration-time data were best described by the one-compartment model with first-order absorption. The overall inter-day change and the difference between day 1 and day 27 in the rate constant for absorption (ka), peak plasma concentration (Cmax), through plasma concentration (Cmin), time-to-peak (tmax), area-under-the-curve 0-24 (AUC0-24), rate constant for elimination (ka), mean residence time after oral administration (MRTor), and fraction of the dose excreted unchanged in urine 24 hours (fu24) were significant (P < or = 0.0029 and P < or = 0.01, respectively). However, the difference between day 1 and day 13 was significant (P < or = 0.05) only in ka, tmax, Cmax, Cmin, and AUC0-24, and between day 13 and day 27 was significant (P < or = 0.05) only in ka, Cmin, ka, and MRTor. There was no significant inter-day change in the renal clearance. The significant (P < or = 0.05) increases in Cmax, Cmin, and AUC0-24 after the dose given on day 13 as compared with day 1, and in Cmin on day 27 as compared with day 13 indicate that, in contrast to volunteers, the steady state condition was not reached on day 13 and possibly not on day 27 in these patients. This perhaps should be taken into account when prescribing fluconazole to seriously ill patients.

Adolescent↗
PubMed1997

Correlation of adenosine thallium 201 perfusion patterns with markers for inducible ischemia.

To determine the frequency of true myocardial ischemia caused by hemodynamic, metabolic, and regional functional abnormalities after intravenous adenosine infusion in patients with coronary artery disease, 13 patients--11 with coronary artery disease--received intravenous adenosine and thallium 201 during cardiac catheterization. Intracoronary adenosine levels increased by an average of 9.4-fold over baseline. Of the 11 patients, all had > or = 70% stenoses with a mean number of redistribution defects per patient of 3.3 +/- 0.7. Only two (18%) patients had new wall motion abnormalities detected by echocardiography during adenosine infusion. Pulmonary capillary wedge pressure did not significantly rise (13 +/- 7 to 17 +/- 8 mm Hg, p= NS). Lactate production occurred in two patients. Coronary sinus oxygen saturation levels rose from 29% +/- 6% to 68% +/- 8%, consistent with less myocardial oxygen extraction. Thus, despite a high prevalence of defects detected by 201Tl, the prevalence of true myocardial ischemia in patients with coronary artery disease undergoing pharmacologic stress imaging with intravenous adenosine is low. Perfusion defects induced by vasodilator stress are predominantly caused by heterogeneity of flow reserve rather than true ischemia.

Adenosine↗
PubMed1997

Duplex imaging findings predict stenosis after carotid endarterectomy.

PURPOSE: This study was performed to determine whether early duplex findings predicted restenosis after carotid endarterectomy. METHODS: One hundred ninety-two symptomatic patients who underwent carotid endarterectomy were studied with color duplex imaging at 1 day and 1 week after surgery to identify minor residual disease (causing < 50% stenosis), arterial kinking, and suture stricture, and to measure the external and luminal diameters of the carotid bulb and distal internal carotid artery. Patients were then observed prospectively with duplex surveillance for a median of 24 months to identify > 50% restenosis. RESULTS: Twenty-five stenoses > 50% of the operated carotid artery (13%) were identified, four at 1 day (residual) and 21 at a median follow-up of 6 months (restenosis). On multiple logistic regression analysis, > 50% restenosis was found to be associated with minor day-1 residual stenosis (p = 0.01) and with small luminal diameter of the distal internal carotid artery (p = 0.03) as measured 1 week after carotid endarterectomy. Life table analysis showed restenosis at 24 months to be more common for patients with below-median than patients with above-median carotid bulb external diameter (18% vs 5%, respectively; p = 0.01). CONCLUSIONS: Duplex scanning within a week of carotid endarterectomy identifies > 50% residual stenosis, in addition to minor residual 25% to 50% stenosis and small carotid dimensions, which are good predictors of > 50% restenosis at 6 months.

Adult↗
PubMed1997

Clinical follow-up rather than duplex surveillance after carotid endarterectomy.

PURPOSE: The value of duplex surveillance and the significance of contralateral carotid disease after endarterectomy have been assessed. METHODS: Three hundred five patients were observed prospectively after carotid endarterectomy for a median time of 36 months (range, 6 to 96 months), with duplex surveillance performed at 1 day; 1 week; 3, 6, 9, and 12 months; and then each year after endarterectomy. RESULTS: Thirty patients (10%) had ipsilateral symptoms (13 strokes, 17 transient ischemic attacks [TIAs]) at a median time of 6 months (range, 0 to 60 months). Life table analysis demonstrated that ipsilateral stroke was equally common for patients who had > or = 50% restenosis (3% at 36 months) and those who did not (6% at 36 months, p > 0.5). Twenty-three patients (8%) developed symptoms (stroke 5, TIA 14) attributable to the contralateral carotid artery at a median time of 9 months (range, 0 to 36 months) after endarterectomy. By life table analysis, 40% of patients with 70% to 99%, 6% with 50% to 69%, 1% with < 50% contralateral internal carotid stenosis, and 5% with contralateral carotid occlusion at the time of endarterectomy had a contralateral TIA in the 36 months after endarterectomy (p < 0.01). However, contralateral stroke was not significantly more common for patients with severe contralateral internal carotid stenosis demonstrated at the time of endarterectomy (< 50% stenosis, 0%; 50% to 69%, 3%; 70% to 99%, 7%; occlusion, 6% stroke rate at 36 months). Seven of the 32 patients who developed progression of contralateral disease had a TIA, compared with 11 of 227 patients who did not develop progression of contralateral disease (p < 0.01). None of the 12 patients who progressed from a < 70% to a 70% to 99% contralateral stenosis had a stroke. CONCLUSIONS: After carotid endarterectomy restenosis is rarely associated with symptoms; contralateral stroke is rare and is not associated with progressive internal carotid artery disease suitable for endarterectomy. This study has shown no benefit from long-term duplex surveillance after carotid endarterectomy. Selective clinical follow-up of patients who have high-grade contralateral stenoses would appear more appropriate.

Carotid Artery, Internal↗