Biomedical subjects
Publications and source records attributed to M Oliver.
1. A 27-year-old, previously healthy, worker accidentally drank a solution containing 1,3-dichloropropene. 2. He developed gastrointestinal distress, adult respiratory distress syndrome, haematological and hepatorenal functional impairment and died after 40 h. 3. Damage to the pancreas was also thought to have been caused by the chemical as part of a multiorgan disorder.
This study reports the results of a 2-yr clinical trial with GH in 95 short prepubertal children with non-GH-deficient intrauterine growth retardation. This randomized, double blind, controlled study compared the effects of placebo (restricted to the first 6 months) and two doses of GH (0.4 and 1.2 IU/kg.week) given sc 6 days/week for 2 yr. A significant GH dose-dependent growth acceleration was observed. Mean height gain (SDS/CA) was 0.66 +/- 0.07 in group I (low dose, 0.4 IU/kg.week) compared to 1.25 +/- 0.07 in group II (high dose, 1.2 IU/kg.week). Mean bone maturation progression (expressed in months) was 26.2 +/- 1.7 and 30.2 +/- 1.5 over 24 months in groups I and II, respectively. Onset of puberty was observed in some patients of both groups. Whether chronic use of a high GH dose will advance the onset of puberty remains to be established. A great variability of growth acceleration was seen among GH dose groups, suggesting that factors in addition to GH dose might modulate individual responses to treatment. In conclusion, it is suggested that in these patients, dose-dependent catch-up growth could be induced by GH treatment.
We have previously found that lipoprotein lipase (LPL) induces tumor necrosis factor alpha (TNF alpha) mRNA expression and TNF alpha protein production in the ANA-1 macrophage cell line and in resident murine macrophages. The present study was designed to elucidate the intracellular signalling pathways involved in the LPL-induced TNF alpha gene expression. Treatment of macrophages with two protein kinase C (PKC) inhibitors, 1-(5-isoquinolinesulfonyl)-2-methylpiperazine hydrochloride (H7) and calphostin C, suppressed LPL-induced TNF alpha mRNA expression and protein production. In contrast, no inhibition of the TNF alpha mRNA expression occurred when macrophages were exposed to an inhibitor of calmodulin-dependent kinase N-(6-amino-hexyl)-5-chloro-1-naphthalene-sulfonamide hydrochloride (W7). Overnight treatment of ANA-1 cells with 100 ng/ml 4 beta-phorbol 12 beta-myristate 13 alpha-acetate (PMA) caused the suppression of both PKC activity and LPL-induced TNF alpha mRNA expression. We have also found that LPL treatment increased PKC activity in macrophages and induced a translocation of this enzyme from the cytosol to the membrane. Finally, we have demonstrated that H7 inhibited the enhancement of nuclear protein binding to the NFkB consensus sequence in the promoter of the TNF alpha gene that we observed in LPL-treated macrophages. Moreover, the treatment of macrophages with H7 abolished the stabilization of TNF alpha mRNA in response to LPL. Overall these data demonstrate that LPL induces TNF alpha mRNA expression in a PKC-dependent manner and that the PKC effect involves transcriptional events as well as posttranscriptional modifications.
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The pathological changes in the syndrome of celiac disease, folate deficiency, bilateral occipital calcifications, and intractable epilepsy have not been previously described. A child with this disorder had a field defect correlating with active lateralized epileptic discharges and asymmetrical lesions. After resection of the right occipital lobe she was seizure free for 4 years. A cortical vascular abnormality with patchy pial angiomatosis, fibrosed veins, and large jagged microcalcifications was found. These pathological abnormalities were similar though not identical to those found in the Sturge-Weber syndrome.
OBJECTIVE: To assess the potential benefits of using extended trained ambulance personnel (paramedics) as primary responders for domiciliary obstetric and gynecological emergencies. DESIGN: An observational study of performance and analysis of operational data in a newly established service. SETTING: A mixed urban and rural population served by South Glamorgan Health Authority. MAIN OUTCOME MEASURES: Work load, response times, management and transfer of patients, efficiency of communications and appropriateness of training. RESULTS: There was an initial increase in requests above that when a hospital-based service operated. Targets for response times were met. The mean response time for providing appropriate skilled help was halved compared with the previous arrangements and a safe and efficient service was provided. Prompt transport and advance notice and preparation for reception in the delivery unit contributed to optimal management. Medical staff depletion in the delivery unit was minimised. CONCLUSION: An Emergency Domiciliary Obstetric Service based on primary response by specially trained ambulance service paramedics can beneficially replace traditional hospital-based Obstetric Flying Squads.
The potential impact on aquatic ecosystems of supplementing the diets of beef cattle with selenium (Se) was studied on 4 northern California ranches. All study sites included an area of concentrated use by cattle that had diets supplemented with Se. In each case, a stream flowed through the site and provided a control sampling area upstream and a treated sampling area downstream. Specimens of water, sediment, algae, aquatic plants, aquatic invertebrates, and fish were analyzed fluorometrically for total Se content. Significant differences in Se concentration were not found between specimens from upstream control areas and those from downstream areas subjected to use by Se-treated cattle. Evidence was not found that Se supplementation in cattle at maximal permitted concentrations caused Se accumulation in associated aquatic ecosystems.
Neodymium:YAG laser capsulotomy was performed in 65 eyes of 65 patients because of vision loss due to posterior capsular opacification or wrinkling following uneventful extracapsular cataract extraction with intraocular lens implantation. Eyes with pre-existing macular pathology were excluded from this study. In all of the eyes the posterior capsule was successfully opened. None developed clinical or angiographic cystoid macular oedema. One eye developed retinal detachment nine months after capsulotomy.
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The course of cystoid macular oedema (CMO) following extracapsular cataract extraction with posterior chamber intraocular lens implantation was prospectively studied in 44 eyes of 44 consecutive diabetic patients without preoperative CMO. In 50% of eyes CMO was observed 6 weeks after surgery and in 25% was still present at 1 year. The preoperative presence of diabetic retinopathy significantly affected the postoperative onset and persistence of CMO. CMO occurred postoperatively in only 32% of eyes without pre-existing diabetic retinopathy and in 81% of eyes with pre-existing diabetic retinopathy (p < 0.05). CMO persisted at 1 year after surgery in only 7% of eyes without pre-existing diabetic retinopathy and in 56% of eyes in which diabetic retinopathy persisted (p < 0.01). Angiographic CMO (that is, detectable only on fluorescein angiography) was more common than clinical CMO (detectable on ophthalmoscopic examination as well) in eyes with no pre-existing diabetic retinopathy, whereas clinical CMO was seen more often than angiographic CMO when diabetic retinopathy was present preoperatively (p < 0.01). The course and final visual outcome of angiographic CMO were more favourable than in clinical CMO. Final visual acuity of at least 6/12 was achieved in 86% of eyes with angiographic CMO and in only 33% of eyes with clinical CMO. On the basis of the above findings we believe that cataract extraction should not be recommended for eyes with pre-existing diabetic retinopathy until the vision has deteriorated to at least 6/30-6/60.
The course of diabetic retinopathy following extracapsular cataract extraction with posterior chamber lens implantation in eyes previously treated by laser photocoagulation for diabetic retinopathy was retrospectively studied in 33 eyes (33 patients). In 20 eyes (61%) there was no change in the retinal status postoperatively. In 13 (39%) there was postoperative progression of diabetic retinopathy compared with the fellow non-operated eye, in which progression occurred in nine eyes (27%). The severity of the preoperative status affected the incidence of progression. Four eyes (12%) developed complications of diabetic retinopathy--that is, rubeosis iridis and vitreous haemorrhage--which regressed after lasering. Cystoid macular oedema developed in 13 eyes (39%) and its incidence varied according to the postoperative course of diabetic retinopathy. The majority of the eyes showed a postoperative improvement in vision.
Trabeculectomy and subsequent subconjunctival injections of 5-fluorouracil (5-FU) were performed in four eyes (two children) with congenital glaucoma. Each of these eyes had previously undergone either goniotomy, trabeculotomy, or both; these procedures, however, had failed to control intraocular pressure (IOP) and progressive optic nerve damage. Sixteen and a half months (+/- 1.5 months) after the trabeculectomy and 5-FU treatments, the IOP in these eyes was in the low teens and there was no evidence of further optic-nerve or visual-field deterioration. Although trabeculectomy has been shown to be unsuccessful in managing congenital glaucoma, when it is done with the adjunct of subconjunctival injections of 5-FU, it may be advisable in these cases after previous surgery has failed.
The purpose of the study was to define the relationship between the salt intake and the levels of arterial blood pressure in adolescent people. Seventy-eight youngs between 12 and 18 years old with diastolic/systolic blood pressure above 95 percentile formed the hypertensive group; a similar population with the same characteristic (age, sex, race, weight and height) with normal blood pressure were selected as a control group. The salt taste threshold was carried out through tasting a saline solution in different concentrations, till it could be distinguished as salted. Moreover, 45 hypertensive adolescent were follow-up for 12 weeks under a hiposodic diet and consequently a new salt taste threshold was done. The results showed that the control group had a salt perception under 80 mg %, instead the hypertensive group showed a higher threshold (above 160 mg %). Those hypertensive adolescent which were followed for 12 weeks changed its pattern in this way: in 24, a lesser perception was observed with a reduction in their blood pressure in 11 of them. These findings suggest that hypertensive adolescent had an elevated threshold for salt, usually above 160 mg % and the test should be helpful for the identification of a subgroup "salt-sensible".
Five patients with mild to moderate retinopathy to both eyes underwent complication-free cataract surgery in one eye. Within three months of surgery deterioration of the retinopathy was observed in the operated eye only. In four patients there was an increase of intraretinal haemorrhages and hard exudates, accompanied by clinically significant macular oedema manifested as retinal thickening and extensive fluorescein leakage from both the macular and the peripapillary capillary networks. Of these four patients one also developed retinal ischaemia, evident ophthalmoscopically by flame-shaped haemorrhages and cotton-wool spots and angiographically by areas of capillary non-perfusion. The fifth patient showed proliferation of new blood vessels and vitreous haemorrhage. Diabetic patients scheduled for cataract surgery should undergo a thorough preoperative evaluation of any existing retinopathy. Postoperatively they should be followed up at close intervals so that any progression of retinopathy can be promptly detected and considered for laser treatment.
The course of diabetic retinopathy following cataract extraction was studied retrospectively in 89 patients (89 eyes). Cataract extraction was extracapsular in 12 eyes (13.5%), extracapsular with intraocular lens implantation in 37 (41.6%), and intracapsular in 40 (45%). In 55 eyes (61.8%) there was no change in the retinal status after surgery, and in 34 (38.2%) there was progression of diabetic retinopathy. In the eyes showing progression there was appearance or aggravation of non-proliferative changes in 85.3% and development of proliferative diabetic retinopathy in 14.7%. Most of these eyes (91%) deteriorated within six months of surgery. Risk factors for the progression of diabetic retinopathy were the preoperative existence of diabetic retinopathy (p less than 0.005) and the need for antidiabetic agents in addition to dietary control in the management of diabetes (p less than 0.025).
Recovery of the anterior segment following extracapsular cataract extraction and posterior chamber intraocular lens implantation in 112 diabetic eyes was compared to that in 108 eyes of nondiabetic patients who underwent a similar procedure. The incidence of postoperative anterior segment complications was significantly higher in the diabetic than in the nondiabetic patients. The main complications were pigment dispersion, appearance of fibrin, development of posterior synechiae, and--rarely, and only in diabetic patients--pupillary block and transient iridal vascular congestion. The fibrin resolved following increased administration of steroids by means of eye drops and subconjunctival injections, with or without the addition of systemic steroids. Women were found to be at greater risk for development of posterior synechiae (P less than .025). Accumulation of fibrin was seen more often in women and in patients with preexisting diabetic retinopathy than in other patients, although the difference was not significant.