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Biomedical subjects

M G Fitzgerald

Publications and source records attributed to M G Fitzgerald.

At least 19 recordsLinked to original sources
PubMed2000

Psychosocial assessments and outcomes in organ transplantation.

A qualitative review was conducted to define the term psychosocial as applied to transplant patients and to summarize evidence regarding the role and impact of psychosocial assessments and outcomes across the transplant process. English-language case series and empirical studies from January 1970 through April 1990 that were abstracted in Medline and Psychological Abstracts or listed in publications' bibliographies were used as data sources. A qualitative analysis was performed to determine the depth of the case reports and whether the empirical reports obtained statistically reliable, clinically significant findings. The authors conclude that psychosocial assessments differ in content and application to candidate selection depending on the transplant program. Psychosocial status before transplant does not consistently affect medical outcomes after transplant. Psychosocial status generally improves with transplant, although difficulties are prevalent in psychological adjustment and in compliance with medical regimens. Psychiatric history can predict psychological outcomes after transplant but does not consistently predict compliance. Social supports and coping strategies strengthen psychosocial outcomes. Posttransplant psychosocial outcomes may predict physical morbidity and mortality.

Humans↗
PubMed2000

Use of a high-risk alcohol relapse scale in evaluating liver transplant candidates.

BACKGROUND: Methods to improve assessment, selection, and monitoring of patients with alcoholic cirrhosis who pursue liver transplantation are sought continuously. We chose to investigate the use of the High-Risk Alcohol Relapse (HRAR) scale in our transplant population in the hope that it would improve our ability to identify and follow patients at highest risk for alcohol relapse. METHODS: Detailed alcohol histories of 207 patients evaluated for liver transplantation were collected and graded for severity by using the HRAR. The HRAR provides information on the duration of alcohol use (a measure of chronicity), daily quantity of alcohol use, and rehabilitation experiences (treatment responsiveness). Posttransplant alcohol use was monitored through clinical follow-up in the transplant clinic. RESULTS: Although men and women had similar years of heavy drinking pretransplant, women's daily alcohol consumption was significantly less than men's. HRAR scores did not distinguish those listed for transplant from those not listed or those who drank posttransplant from those who did not. Transplant patients were predominantly in the low-risk group (83% had an HRAR score <4). CONCLUSIONS: The HRAR did not have predictive ability in our transplant population. Few of our patients were rated as high risk, and few drank posttransplant. Nevertheless, identifying patients at high risk may improve clinical care and decrease the rate of posttransplant alcohol consumption.

Adult↗
PubMed1998

Outcome of liver transplantation in critically ill patients with alcoholic cirrhosis: survival according to medical variables and sobriety.

BACKGROUND: At our center from August 1989 to December 1992, 834 adults underwent orthotopic liver transplantation (OLT) using tacrolimus as the primary immunosuppressive agent. A total of 183 adults (22%) had alcohol-related liver disease. Patients with alcoholic cirrhosis had a better though not statistically significant 5-year survival rate compared with all other patients. We were interested in specific predictors of survival, particularly for alcoholic cirrhotics who were gravely ill at the point of transplantation. METHODS: For the 78 patients with alcohol-related liver disease who were United Network for Organ Sharing status IIA (critically ill) at the point of transplantation, variables of length of sobriety, alcohol rehabilitation, and medical variables (ventilator support, dialysis, vasopressor support, degree of encephalopathy, and infection) were assessed for contribution to survival. RESULTS: Although there was a trend toward poorer survival in patients with the shortest length of sobriety (< or =1 month), pre-OLT length of sobriety or alcohol rehabilitation did not predict survival. However, these patients tended to be in multiorgan failure and encephalopathic. Nevertheless, pre-OLT dialysis requirement was the only variable that predicted poorer survival (P < 0.002). This study was not designed to evaluate recidivism. However, we know that 24% of these patients have used alcohol at some point after OLT. CONCLUSIONS: Short pre-OLT length of sobriety may not predict which patients are likely to resume alcohol consumption after OLT, but it may identify patients in whom there will exist a variety of poor outcome variables. In our study, in these patients, post-OLT survival was associated with medical rather than alcohol history variables.

Adult↗
PubMed1996

Psychiatric evaluations of small intestine transplantation patients.

We are gaining experience in small intestine transplantation, however, the procedure is still experimental. Morbidity and mortality can be significant with frequent rehospitalizations. The indications for small intestine transplantation are varied though most patients have developed short gut syndrome requiring total parenteral nutrition (TPN) for nutritional support. Patients may present with a chronic illness (such as Crohn's disease), chronic pain, and psychiatric comorbidity that may need to be addressed during the perioperative period. Faced with the complicated postoperative course, transplant recipients develop a range of endogenous and organic psychiatric disorders. Psychiatric treatment may be complicated by these factors in addition to the nutritional, biochemical, and metabolic abnormalities of a transplanted small intestine.

Adult↗
PubMed1992

Chromosomal assignment of 46 brain cDNAs.

Expressed sequence tags (ESTs) have been obtained from several hundred brain cDNAs as an initial effort to characterize expressed brain genes. These ESTs will become tools for human genome mapping and they will also provide candidate causative genes for inherited disorders affecting the central nervous system. We have developed a procedure for the rapid chromosomal assignment of these ESTs: cDNA sequences are first analyzed by a computer program to determine regions likely not to be interrupted by introns in the genomic DNA. A pair of oligonucleotide primers is then designed to amplify this region by the polymerase chain reaction using DNA template from human-rodent somatic cell hybrid chromosomal panels. The chromosomal assignment of the cDNA is determined by studying the segregation of the amplified products in these panels. In this paper we describe the mapping of 46 brain ESTs, as well as observations on the amplification of rodent sequences.

Animals↗
PubMed1992

Rapid and reliable fluorescent cycle sequencing of double-stranded templates.

Automated DNA sequencing is an extremely valuable technique which requires very high quality DNA templates to be carried out successfully. While it has been possible to readily produce large numbers of such templates from M13 or other single-stranded vectors for several years, the sequencing of double-stranded DNA templates using the ABI 373 DNA Sequencer has had a considerably lower success rate. We describe how the combination of a new fluorescent, dideoxy sequencing method, called cycle-sequencing, coupled with modifications to template isolation procedures based on Qiagen columns, makes fluorescent sequencing of double-stranded templates a reliable procedure. From a single five milliliter culture enough DNA can be isolated (up to 20 micrograms) to do 4-8 sequencing reactions, each of which yields 400-500 bases of high quality sequence data. These procedures make the routine use of double-stranded DNA templates a viable strategy in automated DNA sequencing projects.

Base Sequence↗
PubMed1991

Changes in beta 1- and beta 2-adrenergic receptor mRNA levels in brown adipose tissue and heart of hypothyroid rats.

The aim of the present work was to study the effect of hypothyroidism on the expression of the beta-adrenergic receptor (beta-AR) in interscapular brown adipose tissue and heart. The total density of plasma membrane beta-AR per tissue is decreased by 44% in hypothyroid rat interscapular brown adipose tissue and by 55% in hypothyroid rat heart compared with euthyroid controls. The effects of hypothyroidism on the density of both beta 1- and beta 2-AR subtypes were also determined in competition displacement experiments. The densities of beta 1- and beta 2-AR per tissue are decreased by 50% and 48% respectively in interscapular brown adipose tissue and by 52% and 54% in the heart. Northern blot analysis of poly(A)+ RNA from hypothyroid rat interscapular brown adipose tissue demonstrated that the levels of beta 1- and beta 2-AR mRNA per tissue are decreased by 73% and 58% respectively, whereas in hypothyroid heart, only the beta 1-AR mRNA is decreased, by 43%. The effect of hypothyroidism on the beta 1-AR mRNA is significantly more marked in the interscapular brown adipose tissue than in the heart. These results indicate that beta-AR mRNA levels are differentially regulated in rat interscapular brown adipose tissue and heart, and suggest that the decrease in beta-AR number in interscapular brown adipose tissue and heart of hypothyroid animals may in part be explained by a decreased steady-state level of beta-AR mRNA.

Adipose Tissue, Brown↗
PubMed1989

Xiaoke tea, a Chinese herbal treatment for diabetes mellitus.

Xiaoke tea, a traditional Chinese treatment for diabetes mellitus, lowered blood glucose concentrations in streptozotocin diabetic mice. To investigate Xiaoke clinically, a double-blind crossover study was undertaken in 12 non-insulin-treated diabetic patients. Xiaoke tea and ordinary tea (infusion of 2.72 g, 4 times daily) were consumed in random order for 4 weeks. A standard breakfast meal was taken before and after each treatment period. Xiaoke did not significantly affect glycosylated haemoglobin, basal or post-breakfast serum glucose and insulin concentrations, intermediary metabolite concentrations, triglyceride and cholesterol. No adverse side-effects of Xiaoke were evident.

Blood Glucose↗
PubMed1988

Diuretics and hyperkalaemia in diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) often presents with hyperkalaemia. We investigated whether it was more likely in patients taking potassium-retaining diuretics. A retrospective survey of all patients (552 cases) presenting in DKA between 1974 and 1984 was undertaken. Initial biochemical data were compared for patients recorded as taking potassium-retaining diuretics (7 cases) at the time of presentation with those taking potassium-losing diuretics (13 cases), and age matched control groups were selected from those who presented in DKA but were not taking diuretics. There was no significant difference in initial serum potassium levels between the diuretic treated groups. The serum sodium was higher in the control group than in the potassium losing group (p = 0.045) and the serum urea significantly lower (p = 0.045). We conclude that potassium-retaining diuretics do not predispose to hyperkalaemia in diabetic ketoacidosis.

Adult↗
PubMed1988

Low affinity antibody to rubella antigen in patients after rubella infection in utero.

As a measure of the affinity of antirubella antibody, the resistance of the antibody to elution was used by increasing concentration of ammonium thiocyanate. The term affinity index has been used to define the molarity of thiocyanate which leads to a reduction of 50% of the initial density. The serum from a group of patients with intrauterine rubella was compared with the serum from a group of deaf children, some of whom could have rubella, and a group of controls with antibody following natural infection. The results show that the affinity index of patients with rubella is significantly lower than that of controls. The other deaf patients span the range of indices of the rubella and control groups suggesting that a number of those children could have deafness caused by intrauterine rubella.

Adult↗
PubMed1987

Fine needle aspiration cytology in the management of euthyroid goitre.

The role of fine needle aspiration cytology was examined in a series of 115 euthyroid patients referred with thyroid enlargement presenting consecutively to a joint medical and surgical thyroid clinic from April 1985 to December 1986. Needle aspiration was performed at first clinic attendance and repeated two to six months later in 39 subjects. Patients were classified according to cytological features of the thyroid aspirate. A diagnosis of benign colloid goitre was made in 59 patients, lymphocytic thyroiditis in 11, thyroid cyst in 32 and in addition there were 13 reports of suspicious or malignant cytological features. Malignancy was confirmed histologically in six patients in this group and five more had follicular adenomata. There were two false positive reports of 'suspicious' cytological features. During a median period of observation of 11.4 months one false negative cytological diagnosis has emerged in a further patient with follicular adenoma. Accuracy in the diagnosis of thyroid neoplasia of 97 per cent has thus been achieved. Fine needle aspiration cytology has replaced isotope and ultrasound scanning in our practice. The number of 99mTc scans performed in the investigation of goitre fell from 77 in 1984 to three in 1986. Neoplastic tissue was removed at operation in 40 per cent of cases proceeding to surgery (20 subjects), compared with a predicted rate of 9.6 per cent if all solitary nodules had been removed. Aspiration cytology performed at first clinic attendance has led to improved selection of patients for surgery and hence economy in their management.

Adolescent↗
PubMed1986

Antibody avidity determination by ELISA using thiocyanate elution.

Antibody avidity of human anti-rubella antibodies has been determined using the chaotropic thiocyanate ion in ELISA assays. Independence of antibody level and affinity was shown and the pattern of post-vaccination antibody affinity established. A variation of the standard ELISA assay was developed where replicate wells containing antibody bound to antigens were exposed to increasing concentrations of the chaotropic thiocyanate ion. Resistance to thiocyanate elution was utilised as the measure of avidity and an index (affinity index) representing 50% of effective antibody binding was used to compare different sera. The interplate coefficient of variation for the affinity index was 12.6% whereas the intraplate coefficient of variation was 4.1%.

Antibodies, Viral↗
PubMed1986

Clinical characteristics and aetiological classification of insulin-dependent diabetes in the elderly.

In a prospective study of 195 newly-diagnosed diabetic patients aged 65 years or over, 80 (41.0 per cent) were treated initially by diet, 89 (45.6 per cent) by diet and oral hypoglycaemic agents, and 26 (13.3 per cent) by diet and insulin. Fifteen patients (7.7 per cent) died within a year of diagnosis. Of 26 patients treated with insulin, six died in the first year, 14 were successfully transferred to diet and oral agent treatment and six continued on insulin--two of whom failed to a trial of oral agents, two showed only a temporary response and two received no trial. A further nine patients were taking insulin 12 months after diagnosis because of no response (eight patients) or a transient response (one patient) only to oral agents. Age, percentage ideal body weight, history of acute onset, blood glucose, glycosylated haemoglobin, and random C-peptide concentration at diagnosis did not discriminate between patients requiring insulin at 12 months and those successfully treated without insulin. Patients who were insulin-dependent 12 months after diagnosis had an increased frequency of ketonuria at diagnosis and a previous medical history of endocrine disease. In insulin-dependent patients there was an increased frequency of HLA DR3 but not DR4 and an increased frequency of thyroid microsomal and gastric parietal cell antibodies but not islet cell antibodies. It is concluded that elderly newly-diagnosed diabetic patients who are treated at diagnosis with insulin are not necessarily insulin dependent and can be given a trial of oral agents with safety.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Influence of diabetes on mortality and morbidity following operations for obstructive jaundice.

The influence of diabetes on mortality and morbidity following operations for obstructive jaundice has been assessed in 118 consecutive patients, all of whom received antibiotic cover, subcutaneous heparin and intravenous mannitol. 44 patients had diabetes mellitus (37%). There were 12 post operative deaths (10%). Factors which significantly contributed to mortality included; admission values for alkaline phosphatase, creatinine, haematocrit, bilirubin and age of patient over 70 years. Although mortality was not increased in diabetics, wound sepsis was significantly more common (20% and 4% respectively; p less than 0.02). The majority of infections were due to antibiotic sensitive Staphylococcus aureus. Diabetes did not influence survival after operation for malignant disease.

Age Factors↗
PubMed1982

Cell structure and percent viability by a slide centrifuge technique.

It was found that a slide centrifuge (Cytospin) preparation of a cell suspension allowed a reliable assessment of not only cell structure but also the percentage of non-viable cells. The non-viable cells appeared as "smear" cells and paralleled in number the cells taking up trypan blue. Direct experiment showed the unstained viable cells in a trypan blue cell suspension remained intact in a Cytospin preparation while the cells taking up trypan blue were the "smear" cells. The non-viability of the "smear" cells was confirmed by their inability to survive in culture.

Animals↗
PubMed1982

Value of serum glucose assay as part of the biochemical profile in screening for diabetes.

The value of adding serum glucose assay to the 'biochemical profile' was assessed by a detailed follow-up of all inpatients with serum glucose concentrations of 10 mmol/l or more. After excluding patients who were on intravenous glucose infusions or were known to be diabetic. 1 in 10 was found to have unsuspected diabetes by further blood glucose measurements, glucose tolerance tests, and clinical assessment. The incidence was 0.8% of all inpatients receiving a biochemical profile, and in a full year 64 diabetics would be detected. The extra cost of laboratory tests was only 20 pounds for each diabetic detected.

Autoanalysis↗