Long-term management after splenectomy. Consider HIV infection in thrombocytopenia.
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HIV Infections↗
Biomedical subjects
M Fisher
Publications and source records attributed to M Fisher.
Eating attitudes in urban and suburban adolescents.
We administered the Eating Attitudes Test (EAT), Rosenberg Self-Esteem Scale, and Spielberger Trait Anxiety Inventory to two populations of high school students. The first group, 268 suburban females (mean age 16.2 years), completed their questionnaires in May 1988. The second population, 389 females and 281 males (mean age 16.0 years) in a city school with 92% black of Hispanic students, completed their questionnaires in February 1990 and were also measured for height and weight as part of a health screening. Scores of 21 or higher on the EAT-26 were achieved by 17.5% of the suburban females, 15.0% of the urban females, and 6.0% of the urban males. Significantly more suburban females (63%) considered themselves overweight, compared with both urban females (35%) and males (19%), yet only 14% of suburban females were calculated to be > 10% over ideal body weight, compared with 45% of urban females and 39% of urban males. Contrary to expectations, self-esteem was higher and anxiety lower in the urban students than the suburban students; self-esteem and anxiety were each significantly correlated with higher EAT scores in both populations, but believing oneself overweight was correlated with higher EAT scores in only the suburban students. These data indicate that abnormal eating attitudes are present among both urban and suburban students but with important differences in their manifestations and implications.
Adolescent↗
Spreading waves of decreased diffusion coefficient after cortical stimulation in the rat brain.
A method is demonstrated for the noninvasive detection and study of spreading cortical depression. Spreading depression (SD) was elicited in rats by topical application of potassium chloride to the exposed cortex. The apparent diffusion coefficient (Dapp) of water in a region of the cortex, measured using a PFG-NMR spin echo sequence with an observation time of 40 ms, declines 35% within 30 s and recovers to the normal value within the next 30 s. The region of decreased Dapp was shown to be 2 mm in size and to move in the cortex, away from the point of application, with a uniform velocity of 3.3 +/- 0.5 mm/min. The behavior of the affected region is consistent with other reports of the behavior of SD as monitored by electrophysiological means. The technique can be implemented on currently available MRI equipment and makes possible the noninvasive study of SD in animal models of neurological disorders, their therapeutic intervention, and possibly the study of SD in humans.
Animals↗
Subarachnoid hemorrhage: an update of pathogenesis, diagnosis and management.
Subarachnoid hemorrhage (SAH) remains a devastating neurological disorder, which most commonly develops after rupture of an intracranial aneurysm. Advances have occurred in the areas of epidemiology, diagnostic imaging, medical management and surgical intervention, related to aneurysmal SAH. Interested physicians must become aware of these and other advances to diagnose and manage this potentially lethal disorder more effectively. This review provides information about the pathogenesis and complications of aneurysmal SAH and an update of new and evolving treatment modalities to provide an in-depth overview for the clinician and researcher involved in this rapidly evolving field.
Arrhythmias, Cardiac↗
Purification and semienzymic synthesis of flavin adenine dinucleotide-3'-phosphate.
Nonradioactive immunoassays incorporating an element of amplification in their detection system require the use of components that are highly purified. Flavin adenine dinucleotide-3'-phosphate (FADP) is the primary substrate used in such an amplification assay. For incorporation into a simple, single-pot assay system, the concentration of contaminating flavin adenine dinucleotide (a prosthetic group for the enzyme D-aminoacid oxidase used in the amplification cascade assay) in this primary substrate must be minimized to achieve maximum sensitivity. Production of the substrate to a high degree of purity has been achieved using apo-glucose oxidase to specifically remove contaminating flavin adenine dinucleotide from solution and hydrolysis of a cyclic intermediate as a final production protocol by ribonuclease T2 to give the product in high yield. The use of continuous ultrafiltration reactors at each stage is described and compared to a final production step utilizing immobilized ribonuclease T2. These reactors allow large volumes of material to be handled and assist in the scale-up of these processes. The suitability of each protocol is assessed for the commercial production of FADP.
Apoproteins↗
Myocardial infarction, hyperkalaemia and ventricular tachycardia in a young male body-builder.
A 31-year-old body-builder taking anabolic steroids, amphetamines, frumil (frusemide and amiloride), and potassium supplements collapsed with a myocardial infarction. His serum potassium was 6.7 mmol/l and he had a run of ventricular tachycardia. He was unaware of the effects of the drugs on the heart.
Adult↗
Temperature dependent change of apparent diffusion coefficient of water in normal and ischemic brain of rats.
To identify the temperature dependent change of the apparent diffusion coefficient (ADC) of water in brain tissue, the ADC values of normal rat brain were measured over a range of body temperatures with monitoring of head temperature using a small water reference implanted under the temporalis muscle. An initial experiment using thermocouples implanted into the cortex, caudate-putamen, temporalis muscle, and rectum demonstrated that temperature in all regions were highly correlated over a temperature range from 33 to 39 degrees C. In another group of normal rats, brain ADC values varied almost uniformly with body temperature over the temperature range 33-39 degrees C, implying that brain ADC values accurately reflect changes in brain temperature. The effects of focal ischemia and administration of the noncompetitive N-methyl-D-aspartate (NMDA) antagonist, CNS-1102, on ADC were also examined, using the suture middle cerebral artery (MCA) occlusion model while maintaining the body temperature at 37 degrees C. ADC values and therefore brain temperature in the nonischemic and ischemic hemispheres were not affected by the drug. These experiments suggest that brain ADC measurement could be useful in animal studies and, potentially, in humans to assess the effects of pharmacologic intervention on brain temperature.
Animals↗
Effects of a novel NMDA receptor antagonist on experimental stroke quantitatively assessed by spectral EEG and infarct volume.
We used spectral electroencephalographic (EEG) analysis to demonstrate the physiological effect of focal brain ischaemia induced by permanent occlusion of the right middle cerebral artery in rats. A significant shift to lower frequency EEG activity occurred relative to the baseline power spectrum within one hour following the occlusion. Spectral EEG analysis also revealed a cerebroprotective effect of a noncompetitive N-methyl-D-aspartate receptor antagonist, CNS 1102, administered 15 min post-occlusion. Animals treated with this NMDA antagonist exhibited only 26.5% of the slowing in the ischaemic hemisphere compared to animals given a placebo. Post-mortem analysis conducted 24 h later also revealed reduced infarction volumes for the treated animals, there was a highly significant correlation between the extent of spectral EEG slowing during the initial development of the infarction and subsequent lesion size. These results suggest that spectral EEG analysis may be useful in the early evaluation of experimental and perhaps human stroke and for monitoring the effects of cerebroprotective therapies.
Animals↗
Bicoronary-pulmonary fistulae with coexistent mitral valve prolapse: a case report and literature review of coronary-pulmonary fistula.
Bicoronary-pulmonary artery fistulae are rare congenital coronary artery fistulae. We report the case of a 57-year-old man who presented with biventricular failure and angina pectoris. At angiography the coronary arteries were normal, but bicoronary-pulmonary fistulae were noted; severe mitral regurgitation secondary to mitral valve prolapse was also present. At right heart catheterization the calculated left to right shunt was 2.1. Fistula ligation and repair of both mitral and tricuspid valves was undertaken. The literature regarding coronary-pulmonary fistula is also reviewed.
Arterio-Arterial Fistula↗
The role of azoles in the treatment and prophylaxis of cryptococcal disease in HIV infection.
OBJECTIVE: To assess the role of azole therapy in the treatment and prophylaxis of cryptococcosis in HIV-seropositive individuals. STUDY DESIGN: Retrospective case review. SETTING: A dedicated HIV unit in London, UK. PATIENTS: Fifty individuals with a positive cryptococcal antigen or culture from any site between 1 January 1985 and 31 December 1992. RESULTS: Thirty-eight patients initially presented with meningitis and 12 with alternative disease, five of whom subsequently developed meningeal disease. The 12 patients who presented without meningitis received chronic suppressive therapy after the diagnosis of cryptococcal disease. Two patients receiving itraconazole developed meningitis as did three out of four treated with 200 mg fluconazole daily, but none of the six receiving 400 mg fluconazole daily. Treatment of cryptococcal meningitis was successful in 17 of the 19 patients given fluconazole but only three of the six receiving itraconazole. Following successful treatment of meningitis five out of seven patients given itraconazole and five out of seven given 200 mg fluconazole daily relapsed compared with three out of 25 receiving 400 mg fluconazole daily. CONCLUSION: Fluconazole is an effective treatment for cryptococcal meningitis. For prophylaxis following meningitis, a dose of 400 mg fluconazole is the preferred treatment; lower doses are associated with a higher relapse rate.
AIDS-Related Opportunistic Infections↗
Leadership and its transition among nursing administration graduate departments.
The researchers surveyed nursing administration department chairs about their roles and their department functions. Chairs defined their roles mostly in the academic realm, and they were most satisfied with their role as teacher. They also reported that they lacked the necessary preparation and experiences in several academic and management functions. Furthermore, they expected their successors would need more experience than themselves for all functions of the chair, except teaching and advising students. They also believed the most qualified person in the department was not as experienced as needed, although only 67% of the respondents could identify a potential successor from within the department.
Education, Nursing, Graduate↗
Adolescent inpatient units.
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Adolescent↗
Prophylactic neuroprotection for cerebral ischemia.
BACKGROUND: Treatments for acute ischemic stroke have evolved as knowledge about the pathophysiology of ischemic brain injury has advanced. Treatment strategies under development are aimed at offering neuroprotection acutely after focal cerebral ischemic injury, but delayed initiation of therapy may reduce efficacy. Pretreatment before ischemia begins could offer distinct advantages in patient groups at high risk for ischemic stroke. SUMMARY OF REVIEW: If a neuroprotective drug were available orally, safe, and relatively inexpensive, it could be considered for prophylactic use in high-risk populations. Prophylactic neuroprotection would include (1) short-term neuroprotection before and after high-stroke risk procedures, (2) long-term neuroprotection for primary and secondary intervention in populations at high risk for stroke, and (3) concomitant neuroprotection with agents that have multiple treatment effects. Patients undergoing procedures such as cardiac surgery, endarterectomy, or endovascular therapy, which have a risk of cerebral ischemic events during a defined period, might be considered for short-term, periprocedure prophylactic neuroprotection. Several populations at high long-term risk for initial ischemic stroke have been identified and include those with combinations of vascular risk factors, transient ischemic attacks, atrial fibrillation, and asymptomatic carotid stenosis. Such people, as well as those at risk for stroke recurrence after minor strokes, are readily identifiable and perhaps appropriate for long-term prophylactic neuroprotection. Patients with hypertension and cerebrovascular atherosclerosis have a high stroke risk, and therapies directed at these underlying disorders are available that also have concomitant neuroprotective effects. An ideal drug for trials in these patient groups has not yet been developed, and establishing its efficacy may prove to be an arduous and lengthy task. CONCLUSIONS: The possibility of ameliorating the consequences of an acute ischemic stroke by pretreating high-risk patients with appropriate neuroprotective agents needs to be explored. Several types of high-risk population for prophylactic neuroprotection can be envisioned and then studied in clinical trials.
Cerebrovascular Disorders↗
The competitive NMDA antagonist MDL-100,453 reduces infarct size after experimental stroke.
BACKGROUND AND PURPOSE: The competitive N-methyl-D-aspartate antagonist MDL-100,453 was used to determine whether a neuroprotective effect is demonstrable when the drug is administered beginning 30 minutes after the initiation of focal ischemia and whether the effect is related to blood levels of the drug. METHODS: Forty-eight Sprague-Dawley rats were randomly assigned to one of four intravenous treatment categories: a bolus of 100 mg/kg MDL-100,453 followed by a saline infusion for 24 hours, isotonic saline as a bolus and 100 mg/kg per 24 hours of MDL-100,453 as an infusion over 24 hours, active drug in the bolus and 24-hour infusion, and control treatment of an isotonic saline bolus and infusion. Focal cerebral ischemia was induced by the intraluminal suture, middle cerebral artery occlusion method. The drug infusion was accomplished by an osmotic minipump implanted under the skin and attached to the jugular vein, which delivered drug or vehicle over a period of 24 hours. Infarct volume was calculated using 2,3,5-triphenyltetrazolium chloride staining after 24 hours of middle cerebral artery occlusion. RESULTS: Infarct volume of animals that received the MDL-100,453 bolus injection followed by MDL-100,453 infusion was significantly smaller than that of controls (P < .01). A significant effect of infusion on the reduction of extent of infarct size was also demonstrated (P = .015). Moreover, a statistically significant inverse correlation was demonstrated between the infarct volume and blood levels of MDL-100,453 at 60 minutes and 120 minutes after injection (r = -.33 and r = -.49, respectively). CONCLUSIONS: We demonstrated a significant neuroprotective effect of MDL-100,453 when treatment was initiated 30 minutes after ischemia began and was maintained for 24 hours.
Animals↗
Validity of selected predictors for successful wearing of contact lenses.
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Adolescent↗
Regulation of GLUT2 glucose transporter expression in liver by thyroid hormone: evidence for hormonal regulation of the hepatic glucose transport system.
The extent to which the glucose transport system in hepatocytes is regulated in states of altered hepatic glucose metabolism is unclear. Because thyroid hormone is known to increase hepatic glucose output, we hypothesized that thyroid hormone might up-regulate expression of the principal hepatic glucose transporter, GLUT2, facilitating increased glucose efflux across the hepatocyte plasma membrane. GLUT2 protein concentration in crude liver membranes was twice as high in chronically hyperthyroid vs. hypothyroid animals, with intermediate levels in euthyroid controls. Similar results were obtained for total GLUT2 protein, measured in detergent extracts of liver. Northern analysis of total liver RNA demonstrated parallel changes in GLUT2 messenger RNA (mRNA) concentration per g tissue (hypothyroid, 76 +/- 6%; euthyroid, 100 +/- 11%; hyperthyroid, 158 +/- 12%; data expressed as percentage of mean euthyroid values). The daily administration of a large dose of T3 (100 micrograms/100 g BW) to hypothyroid rats caused a prompt increase in hepatic GLUT2 mRNA concentration (2.5-fold at 1 day), but only a modest and gradual change in hepatic GLUT2 protein concentration (+40% at 4 days), suggesting that the GLUT2 protein in liver may have a long half-life. We conclude that thyroid hormone regulates hepatic GLUT2 mRNA and protein expression. Up-regulation of GLUT2 protein expression by thyroid hormone may serve to facilitate increased hepatic glucose output. These results suggest that the hepatic GLUT2 glucose transporter, like the enzymes of gluconeogenesis and glycolysis, is indeed a regulatory target for hormones that control hepatic glucose metabolism.
Animals↗
Morning reduction of cerebral vasomotor reactivity.
We measured cerebral vasomotor reactivity during normoventilation, hyperventilation (hypocapnia), and breathing of 6% CO2 (hypercapnia) in 20 normal subjects during the hours of 6 to 8 AM, 1 to 3 PM, and 7 to 9 PM. Cerebral vasomotor reactivity was calculated, using transcranial Doppler, as percent change in the mean blood flow velocity of the middle cerebral artery per mm Hg change in end-tidal CO2 during hypocapnia and hypercapnia. Vasomotor reactivity during hypercapnia was lower in the morning (1.72 +/- 0.66 %/mm Hg) than in the afternoon (2.34 +/- 0.74 %/mm Hg, p < 0.01) and evening (2.31 +/- 0.56 %/mm Hg, p < 0.001). Vasomotor reactivity during hypocapnia did not vary significantly during the three periods (2.34 +/- 0.59 %/mm Hg in the morning, 2.43 +/- 0.51 %/mm Hg in the afternoon, and 2.26 +/- 0.52 %/mm Hg in the evening). This reduced morning response to hypercapnia suggests diminished vasodilator reserve during this period, and may be related to the increased stroke risk during the morning hours.
Adult↗
MRI diffusion mapping of reversible and irreversible ischemic injury in focal brain ischemia.
The reduction of the apparent diffusion coefficient (ADC) of water shortly after a focal ischemic insult is thought to reflect intracellular water accumulation (cytotoxic edema) related to high-energy metabolism failure and loss of ion homeostasis. We attempted to clarify whether varying ranges of ADC measurements in ischemic brain tissue can be used to differentiate between reversible and irreversible ischemic lesions before reperfusion in a temporary ischemia model. We induced 45 minutes of temporary ischemia in 12 rats using the middle cerebral artery suture occlusion method. Regional changes of ADC values were serially measured in seven regions of interest in each hemisphere and evaluated by delta ADC, defined as the difference between ADC value in an ischemic region and that in a contralateral homologous region. We acquired dynamic contrast-enhanced perfusion images 2 minutes before and after reperfusion to document reduced perfusion and its restoration. We confirmed the infarct area by 2,3,5-triphenyltetrazolium chloride staining 24 hours after occlusion and correlated this with the MRI studies. Recovery of initially reduced ADC values occurred only in ischemic regions where delta ADC values were not below -0.25 x 10(-5) cm2/sec. Although the extent of infarction at postmortem examination varied in regions with moderately decreased prereperfusion ADC values, more than 70% of regions of interest with slight declines of prereperfusion ADC values exhibited no infarction. ADC values progressively decreased after reperfusion in regions that initially had severely decreased prereperfusion ADC values, and postmortem examination always demonstrated infarction in such regions.(ABSTRACT TRUNCATED AT 250 WORDS)
Analysis of Variance↗