Biomedical subjects
M J Butler
Publications and source records attributed to M J Butler.
Irradiation injury to large arteries.
Four cases of irradiation injury to large arteries are presented and the literature is reviewed. Three patterns of injury have emerged. 1. Intimal damage resulting in mural thrombosis presenting within 5 years of irradiation. 2. Fibrotic occlusion presenting within 10 years of injury. 3. A predisposition to the development of atheroma together with periarterial fibrosis associated with a latent interval of 20 or more years. The treatment of choice is a bypass procedure of the arterial lesion.
A follow-up study of 48 patients with Reiter's syndrome.
A follow-up study of 48 patients with Reiter's syndrome was carried out in an attempt to clarify the clinical course of the disease. The mean age at the onset of Reiter's syndrome was 27.1 years (range 15 to 52 years) and when seen at follow-up 32.5 years (range 19 to 58 years). The average time from the onset of the first attack of peripheral arthritis to the time of follow-up was six and a half years (range 0.5 to 27 years). Only three patients had diarrhea prior to the onset of Reiter's syndrome. At follow-up 22 per cent of the patients were asymptomatic, 24 per cent had recurrent minor symptoms, 24 per cent had recurrent moderate symptoms, and 30 per cent had recurrent major symptoms. However, even in the last group, all patients were in functional classes 1 or 2 between the flares of disease. No patients in the series were in functional class 3 or 4, and 30 per cent were in class 1.
Scintigraphic evaluation and prognosis of patients with Reiter's syndrome.
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Thrombelastography during and after elective abdominal surgery.
Thrombelastography has been performed on recalcified whole blood from 50 patients before, during and after elective abdominal surgery. The characteristic changes of the thrombelastographic indices r, k and mA are described. During operation r and k shortened, but no change in mA was observed. This response was in part associated with an increase in factor VIII activity. Following operation, while r time was somewhat shortened, much more marked changes in k and mA were evident. Increasing fibrinogen concentration was the dominant factor in determining the post-operative changes in the thrombelastograph.
Ruptured abdominal aortic aneurysms.
The results of operation in 76 patients with a ruptured abdominal aortic aneurysm are presented with an analysis of the cause of operative death. Overall mortality was 58 per cent and preoperative hypotension significantly increased mortality; deterioration while awaiting operation made a successful outcome particularly unlikely. No group could be identified, however, in which operation was without hope of saving life, and age alone should not contraindicate surgery.
The interaction of core histones with DNA: equilibrium binding studies.
The binding of core histone proteins to DNA, measured as a function of [NaCl[ is a reversible process. Dissociation and reassociation occurs in two stages. Between 0.7 and 1.2 M NaCl H2a H2b bind non-cooperatively as an equimolar complex with deltaGo = 1.6 Kcals/mole at 4 degree C and 1.0 M NaCl. Between 1.2 and 2.0 M NaCl H3 and H4 bind cooperatively as an equimolar complex with delta Go = 7.4 Kcal/mole at 4 degree C and 1.0 M NaCl. The proper binding of H2a and H2b requires the presence of bound H3 and H4. Nuclease digestion of the H3-H4 DNA produces a tetramer of H3-H4 bound to fragments of DNA 145, 125 and 104 base pairs long. Thus an H3-H4 tetramer can protect fragments of DNA as long as those found in complete core particles and must therefore span the nucleosome core particle.
The structure of nucleolar chromatin in Physarum polycephalum.
The nucleolar DNA of Physarum polycephalum has been differentially labelled with 3H-thymidine and the structure of the nucleolar chromatin investigated by digestion with micrococcal nuclease. Nucleolar chromatin which had been labelled in G2 phase of the cell cycle and then digested before mitosis had an identical DNA repeat length to main band DNA (165 +/- 5 base pairs) but there was a definite indication that the rate of digestion was faster for nucleolar DNA than for main band DNA. Nucleolar chromatin which had been labelled in G2 and the label chased through mitosis into G2 phase of the next cycle showed an identical DNA repeat length to main band DNA and was also digested at the same rate. We conclude that nucleolar chromatin, at least 25 per cent of which is maximally transcriptionally active in G2, has a nucleosome-like structure.
Coronary artery spasm.
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Plasma catecholamine concentrations during operation.
Plasma catecholamines have been measured before, during and after operation in 40 patients undergoing elective major abdominal surgery and in 12 patients during open heart surgery. Plasma concentrations did not increase during abdominal surgery and showed only small increases during cardiopulmonary bypass. It appears that it is not possible to assess individual intra-operative sympatho-adrenal responses to surgical trauma by measurement of plasma catecholamine concentrations because of the efficiency of catecholamine uptake mechanisms.
The incidence of post-operative deep vein thrombosis after splenectomy.
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Serum levels of fibrin (ogen) degradation fragment E antigen in the diagnosis of deep vein thrombosis after abdominal and inguinal surgery.
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The adrenergic response to surgery involving cardiopulmonary bypass, as measured by plasma and urinary catecholamine concentrations.
Plasma and urinary catecholamine concentrations have been measured in 13 patients undergoing cardiac surgery involving cardiopulmonary bypass. The large and progressive increase in plasma catecholamines during bypass reported in previous studies has not been confirmed, and this may be a result of improvements in surgical, anaesthetic and perfusion techniques. The interpretation of urinary findings was complicated by the finding of a positive correlation between catecholamine excretion and urine flow-rate. The findings suggest the need to modify current concepts of the adrenergic response to cardiac surgery and bypass, and question the validity of measuring the urinary catecholamine concentration as an index of stress in these circumstances.
The coagulation and fibrinolytic response to splenectomy.
The responses of the coagulation and fibrinolytic systems in nine patients with Hodgkin's disease undergoing splenectomy and lymph node mapping have been compared with those in nine patients undergoing elective upper abdominal operation for benign conditions. Differences have been noted in base line levels of fibrinogen, prothrombin, partial thromboplastin time and euglobulin lysis time. Platelet count increases were exaggerated following splenectomy, but other parameters of coagulation activity behaved similarly in the two groups. There is no evidence from this study to support the suggestion that blood coagulability is increased more markedly following splenectomy than it is after other upper abdominal operations.
The influence of beta-adrenergic blockade upon baseline blood coagulation and fibrinolytic activity and upon the responses to venous occlusion.
Twenty volunteers were assessed for baseline coagulation (Thrombelastography, Factor VIII and platelet count) and fibrinolytic (Euglobulin Lysis Time and Fibrin(ogen) Degradation Products) activity two hours after ingestion of 60 mgm propranolol or an identical placebo administered on a double blind basis. The responses of these parameters to a fifteen minute period of venous occlusion was also assessed. Beta adrenergic blockade reduced baseline FDP titres but did not affect other parameters, nor the local response to venous occlusion. During occlusion no significant change in coagulation activity could be detected in the non-occluded arm, but a small but statistically significant shortening of ELT was observed. Since this effect was prevented by propranolol it is probably mediated through adrenergic mechanisms. Adrenergic stimuli appear to influence episodes of coagulation and fibrinolysis during everyday activity, but do not contribute to baseline levels of coagulation or fibrinolytic function.
The adrenergic response to cardiopulmonary bypass.
12 out of 13 patients who underwent cardiac surgery requiring extracorporeal circulation survived the operation. Arterial and venous catecholamines were measured throughout the operation. Larges rises in catecholamine levels were not seen although significant changes did occur in arteriovenous differences and also between samples at certain points in the operation. These facts do not agree with Lillehei's findings (3) and may reflect improvements in surgical technique, anaesthesia and the reduced time on bypass. However the lack of an overall measurable adrenergic response in terms of plasma catecholamine levels does agree with similar findings after open heart surgery (4) and during other surgical procedures (5).
Letter: Dopamine-beta-hydroxylase and sympatho-adrenal activity.
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Letter: Fibrinolytic activity and deep-vein thrombosis.
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