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Biomedical subjects

M Fisher

Publications and source records attributed to M Fisher.

At least 631 records · Page 35Linked to original sources
PubMedDate not supplied

Increased excretion of immunoreactive thromboxane B2 in cerebral ischemia.

Thromboxane B2 (TXB2) is the stable metabolite of thromboxane A2 (TXA2), a potent vasoconstrictor which induces irreversible platelet aggregation. The inhibition of TXA2 by aspirin and other agents has been associated with improved outcome following cerebral ischemia in clinical and laboratory studies. To investigate the relation of TXA2 production to cerebral ischemia, we measured the urinary excretion of TXA2 metabolites in 30 patients with acute cerebral ischemia. Urinary immunoreactive TXB2 for this group of ischemic patients was elevated compared to normals, 1818 +/- 344 pg/mg Cr (mean +/- SE) vs 880 +/- 122 pg/mg Cr (p less than .05). Among various subsets of the ischemic patients, those with severe stroke (2108 +/- 536 pg/mg Cr), large vessel disease (1646 +/- 335 pg/mg Cr), and cardiogenic stroke (2712 +/- 1045 pg/mg Cr) were all significantly elevated. Of the stroke patients, only the males demonstrated this significant elevation. These elevations of urinary immunoreactive TXB2 are consistent with a role for increased platelet activation in the pathogenesis of some forms of cerebral ischemia and suggest that gender differences in arachidonate metabolism may exist for stroke patients.

Acute Disease↗
PubMedDate not supplied

Delayed cerebral ischemia following arteriography.

Cerebral ischemic events associated with arteriography are usually attributed to catheter-induced emboli. We present three patients with cerebral ischemia occurring 6 to 48 hours post-arteriography. We suspected that alternate pathogenic mechanisms were in effect. To evaluate the possibility that sustained platelet activation occurs in association with arteriography, we measured the platelet-specific protein beta thromboglobulin (BTG) prior to and 24 hours following arteriography in two groups of patients. Group I had arteriography performed shortly after venipuncture, while Group II patients did not have arteriography between samples. Seven of eight Group I patients had an increase of BTG on day two, compared with two of eight group II patients (p less than 05). When compared to Group II changes, Group I had a significant increase of BTG on day two (p less than .05). We conclude that cerebral ischemic events associated with arteriography may occur on a delayed basis, and that platelet activation, manifested by increased BTG levels, may be one mechanism contributing to this phenomenon.

Adult↗
PubMedDate not supplied

Holter monitoring in patients with transient focal cerebral ischemia.

The value of continuous long-term ECG monitoring in patients with transient generalized neurological symptoms is well established, but its value in transient focal neurological deficits is less clear. A patient is reported who had significant dysrhythmias and transient focal cerebral symptoms which did not clear after cardiac pacing. Nineteen other patients were monitored as part of their evaluation for transient focal cerebral symptoms and were found to have essentially no cerebrally significant dysrhythmias. This report suggests cardiac dysrhythmias rarely cause such symptoms.

Aged↗
PubMedDate not supplied

Total parenteral nutrition by a nutrition support team: improved quality of care.

Most of the studies that have examined the effect of nutrition support teams (NST) on the quality of total parenteral nutrition (TPN) have found reductions in the frequency of metabolic and central venous catheter related complications. Previous studies have not examined the patterns of nutrient delivery (eg, calories and protein) when TPN is provided either by a primary physician or by a NST. We compared the quality of TPN care provided by our NST or by primary physicians utilizing nonspecialized hospital personnel and resources. As expected, catheter complications were significantly less frequent in NST patients. Assessment of nutritional status and nutrient requirements as well as nitrogen balance were performed and documented significantly more often in NST patients. In addition, nutritional goals for calories and protein were achieved and positive nitrogen balance documented more often in NST patients. The need to consult the NST physician to utilize the NST was not well received by primary attending and resident physicians and resulted in nonuse of the team. In the future, modification of NST policies will be explored to encourage greater utilization of the NST without compromising the high standard of nutrition care delivered by the NST.

Catheterization↗
PubMedDate not supplied

Oral ganciclovir: a new option for patients with CMV retinitis.

Cytomegalovirus retinitis is a major cause of morbidity in patients with AIDS. The conventional treatment approach has involved insertion of a central venous catheter and intravenous administration of ganciclovir and/or foscarnet. This has been associated with systemic toxicity, line-related sepsis, and implications for patient quality-of-life. An oral formulation of ganciclovir has now been licensed for use as maintenance therapy in CMV retinitis. Multicentred trials comparing oral and intravenous ganciclovir have suggested that although the efficacy may be marginally reduced with the oral formulation, the associated toxicity is significantly lower. With careful and informed decision-making by both clinician and patient, the opportunity exists to enhance the quality of life in this patient group.

Administration, Oral↗
PubMedDate not supplied

Health-related quality of life in individuals infected with HIV in the era of HAART.

PURPOSE: To compare health-related quality of life (HR-QOL) in individuals infected with HIV to general population levels and to assess the relationship between HR-QOL and markers of disease progression in the era of highly active antiretroviral therapy (HAART). METHOD: This was a cross-sectional questionnaire-based study. This study included 154 individuals at least 18 years old with HIV who either were attending a London hospital or were visited by a community team in Brighton. Study participants were asked to complete two HR-QOL questionnaires. This study used HR-QOL, as measured using the Medical Outcome Study HIV Health Survey (MOS-HIV) and EuroQoL self-report (EQ-5D) questionnaires, as the main outcome measure. Responses on the EQ-5D were compared with a published general population data set. The relationships between scores on the MOS-HIV and EQ-5D questionnaires and a number of independent variables including CD4 count and viral load were also assessed. RESULTS: Each analysis was based on the results of at least 128 questionnaires. The mean MOS-HIV mental and physical component scores were 43.2 (SD = 12.2) and 41.8 (SD = 13.2), respectively. After adjusting for differences in age and gender, it was shown that individuals with HIV reported significantly lower EQ-5D(utility) ( p =.0001) and EQ-5D(VAS) ( p =.0001) compared with the general population. However, further analysis revealed few significant associations between markers of disease progression and HR-QOL. CONCLUSION: Individuals with HIV generally recorded significantly lower HR-QOL compared with the general population. Thus, prevention of further transmissions of the virus is still likely to prevent significant morbidity losses in addition to mortality losses, despite the availability of HAART. However, disease progression as measured is not clearly related to further reductions in HR-QOL.

Adult↗
PubMedDate not supplied

The influence of pyridoxine in diabetic peripheral neuropathy.

To determine the role of pyridoxine in the treatment of diabetic peripheral neuropathy, 18 symptomatic diabetic patients were treated with vitamin B6 or placebo in a double-blind controlled study. Only one patient had a low plasma pyridoxal phosphate level at the start of the study. After 4 mo of treatment with pyridoxine hydrochloride (50 mg three times daily) 6 of 9 pyridoxine-treated and 4 of 9 placebo-treated patients noted significant relief from their neuropathic symptoms. There was no difference between the two groups with regard to fasting plasma glucose, motor nerve conduction velocity, or ophthalmologic examination at the beginning or at the conclusion of the study. Our results suggest that vitamin B6 deficiency is not a factor in the etiology of diabetic peripheral neuropathy. Furthermore, treating diabetic peripheral neuropathy with high dose vitamin B6 or placebo results in a similar frequency of symptomatic improvement.

Adult↗
PubMedDate not supplied

Coexisting endogenous lipoid pneumonia, cholesterol granulomas, and pulmonary alveolar proteinosis in a pediatric population: a clinical, radiographic, and pathologic correlation.

Benign pulmonary diseases that have been associated with the accumulation of endogenous lipids within the alveoli, bronchioles, and interstitial tissues include endogenous lipoid pneumonia (ELP), pulmonary alveolar proteinosis (PAP), pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG), various xanthomatous lesions, and malakoplakia. In ELP, fat-filled finely vacuolated macrophages fill the alveoli. In PAP, the aveoli become filled with cholesterol and periodic acid-Schiff (PAS)-positive acellular debris. In PICG, cholesterol esters are released from degenerating macrophages and, as organization occurs, the cholesterol is deposited in the form of acicular clefts within the interstitium. These morphologically distinct presentations of endogenous lipid deposition within the lung have long been thought to represent unique disease processes but several authors now postulate a possible relationship between these entities. We report here on the clinical, radiographic, and morphologic findings in eight pediatric patients with diverse primary disease processes who were subsequently found to have varying and often coexisting degrees of ELP, PAP, and PICG.

Adolescent↗
PubMedDate not supplied

Thriving enterprise.

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Curriculum↗