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Biomedical subjects

M R Moore

Publications and source records attributed to M R Moore.

At least 91 records · Page 5Linked to original sources
PubMed1991

Harvey Cushing's postoperative sketches of pediatric brain tumors.

Harvey Cushing was a man of many talents. Not only was he a premier surgeon and scientist, but a prolific author and artist as well. In this paper, we present two postoperative sketches of pediatric brain tumors drawn by Dr. Cushing. These sketches are representative of drawings which accompany many of his operative notes at the Peter Bent Brigham Hospital. About 25% of Cushing's surgical sketches depict operations performed on children. The most commonly drawn childhood tumors were craniopharyngiomas and gliomas of the brain stem and cerebellum. These drawings reveal how Cushing maintained detailed records of his surgical experience. It is clearly evident from these records that Dr. Cushing gained substantial experience in the treatment of pediatric brain tumors.

Brain Neoplasms↗
PubMed1991

Neuropeptides.

This review summarizes the revolutionary impact of brain peptides on our understanding of the nervous system and then discusses the localization, distribution, synthesis, receptor sites, and possible function of 32 brain peptides. The peptides are discussed in three subgroups: I) the opioid peptides, which include beta-endorphin, the enkephalins, and dynorphin; II) the pituitary releasing hormones, most of which are wide-spread in the brain and include corticotropin-releasing hormone, luteinizing hormone-releasing hormone, somatostatin, and thyrotropin-releasing hormone; and III) a selection of 12 other peptides potentially important for neurological function, including vasopressin, oxytocin, substance P, cholecystokinin, bombesin, neurotensin, renin, angiotensin, vasoactive intestinal polypeptide, neuropeptide Y, calcitonin gene-related peptide, and calcitonin. Within each individual peptide section, the possible physiological roles in anterior pituitary hormone release, blood-flow regulation, feeding behavior, temperature regulation, nociception, memory and learning, and movement are reviewed. Further, where noted, the peptide findings in Huntington's, Alzheimer's, Parkinson's and psychiatric diseases are emphasized.

Humans↗
PubMed1991

Cholelithiasis in patients with variegate porphyria.

Four patients with variegate porphyria (VP) who developed symptoms attributable to cholelithiasis are described. Elective cholecystectomy was performed uneventfully in two of these patients in whom the diagnosis of porphyria had previously been made. The third patient was not known to have porphyria at the time of surgery and developed a fulminating attack which proved fatal. The major haem precursor overproduced in VP is protoporphyrinogen and protoporphyrin was present in the gallstones available for analysis. Our experience suggests that patients with VP have an increased risk of cholelithiasis which may be related to the overproduction of protoporphyrinogen and increased bile concentration of protoporphyrin.

Adult↗
PubMed1991

Analysis of factors related to truncal decompensation following Cotrel-Dubousset instrumentation.

Spinal imbalance following Cotrel-Dubousset (CD) instrumentation for adolescent idiopathic scoliosis is a problem that is recognized with increasing frequency. We reviewed the clinical records and radiographs of 41 consecutive patients treated with CD instrumentation and attempted to identify factors related to postoperative worsening of spinal balance. Spinal balance was determined by the perpendicular distance of C7 to the center sacral line. Twenty-five were decompensated postoperatively. Sixteen patients had balance that was worse relative to the preoperative films. Eleven of 16 patients with worsened balance postoperative were King type III curves. Of 16 patients with worsened balance postoperatively, 13 had been fused to or below the lower neutral vertebra. Overcorrection of either the primary curve or the composite curve (sum of the measurable curves) relative to the preoperative bending films was not related to postoperative worsening of spinal balance. Fusion to the neutral or stable vertebra with CD instrumentation runs a high risk for postoperative worsening of spinal balance when the derotation maneuver is used. Consideration should be given to avoiding the derotation maneuver in larger type II curves in order to preserve spinal balance and avoid extension of instrumentation into the middle or lower lumbar spine.

Adolescent↗
PubMed1991

Kenneth McKenzie, Harvey Cushing, and the early neurosurgical treatment of spasmodic torticollis.

In 1923, Dr. Kenneth McKenzie trained at the Peter Bent Brigham Hospital under Dr. Harvey Cushing. At that time, a patient with spasmodic torticollis came to Cushing and was treated with an innovative operation for this disorder with good results. This case sparked an interest in Dr. McKenzie, who published the case 1 year later. In reviewing the surgical histories from the Peter Bent Brigham Hospital, we have found the original records of this well-documented case. The record includes postoperative drawings of the intraoperative field by Dr. Cushing, a sketch by Dr. McKenzie illustrating the postoperative sensory examination, and pre- and postoperative photographs of the patient.

History, 20th Century↗
PubMed1991

Relationship between vertebral intraosseous pressure, pH, PO2, pCO2, and magnetic resonance imaging signal inhomogeneity in patients with back pain. An in vivo study.

The cause of back pain in many patients in unknown. The pain experienced by patients with osteoarthritis of large joints has been associated with intraosseous abnormalities of elevated pressure, venous dilatations, and abnormalities of pH, pCO2, and pO2. Magnetic resonance imaging demonstrates an abnormal signal in the vertebral bodies of some patients with degenerative disc disease. The intraosseous pressure as well as the intraosseous pH, pO2, and pCO2 in a group of patients undergoing anterior spine surgery was studied, and the results were correlated to the preoperative magnetic resonance imaging appearance. Vertebral bodies with an abnormal magnetic resonance imaging signal had pressures 55% higher than vertebral bodies with a homogeneous signal; they also had significantly decreased pH and increased pCO2. Bodies with Type I changes had pressures 73% higher than those with a normal signal. No differences in pO2 were identified. These findings suggest that abnormalities of intraosseous pressure or blood gas concentrations may be related to mechanisms of pain production in some patients with back pain. These abnormalities can be identified by magnetic resonance imaging. Further investigation is needed to determine if therapeutic manipulation of these variables can be effective in relieving axial spinal pain.

Back Pain↗
PubMed1991

Erythroid 5-aminolaevulinate synthase activity during normal and iron deficient erythropoiesis.

Reduced erythroblast 5-aminolaevulinate (ALA) synthase activity was observed during iron/haem deficient erythropoiesis. Enzyme activity was reduced approximately threefold to levels similar to those previously detected during sideroblastic erythropoiesis. This response would appear to be erythroblast specific as haem deficiency is known to stimulate hepatic ALA synthase activity. It is, however, unclear as to whether this reduced enzyme activity relates to iron deficiency or to the consequent haem deficiency.

5-Aminolevulinate Synthetase↗
PubMed1991

A comparative study of the effects of delta-aminolaevulinic acid and the GABAA agonist, muscimol, in rat jejunal preparations.

Preparations of rat jejunum were tested for their responsiveness to the GABAA receptor agonist, muscimol, and to the haem precursor, delta-aminolaevulinic acid (ALA). Both muscimol (1.0-30 microM) and ALA (1.0 microM-3.0 mM) elicited a concentration-dependent increase in tone. Pretreatment with the GABAA antagonist, bicuculline (10(-5) M), blocked effects of muscimol at all concentrations tested and attenuated effects of 0.3 mM ALA. However, bicuculline enhanced responsiveness of the preparations to ALA at low concentrations (0.01-0.05 microM), as also did picrotoxin (10(-5) M), eliciting a significant increase of tone. The significance of these findings is discussed. This finding of pharmacological activity by ALA at concentrations comparable with its blood levels during acute attacks of intermittent porphyria provides support for the proposal that is may play a role in the aetiology of the gastrointestinal manifestations of this disease.

Aminolevulinic Acid↗
PubMed1990

Elevation of blood lactate and pyruvate levels in acute intermittent porphyria--a reflection of haem deficiency?

Blood lactate concentrations after glucose loading were significantly higher in 6 patients with acute intermittent porphyria in clinical remission than in 6 control subjects and the percentage rise in glucose pyruvate and lactate concentrations were greater in the porphyric subjects than in the control group. It is postulated that the raised lactate levels in the porphyric patient group may reflect haem deficiency affecting the cytochromes of the terminal respiratory chain.

Adult↗
PubMed1990

High-performance liquid chromatographic analyses of porphyrins in hamster Harderian glands.

Porphyrin content and 5-aminolaevulinate synthase activity of the Harderian gland were measured in intact and gonadectomized male and female hamsters; porphyrin profiles were analysed by high-pressure liquid chromatography. The total porphyrin content of the two female groups was similar, but enzyme activity in females ovariectomised for 20 weeks significantly decreased. Intact males have low porphyrin content and enzyme activity, while in castrates (6 weeks) both increased to female levels. Protoporphyrin IX formed 93% of total porphyrins in intact females, compared with 70% of total porphyrins in intact males. The remainder in both sexes was chiefly penta- and hexacarboxylic porphyrins and coproporphyrin and (in females) Harderoporphyrin. Gonadectomy in either sex resulted in protoporphyrin levels intermediate between male and female values.

5-Aminolevulinate Synthetase↗
PubMed1990

Elevation of hormone-binding globulins in acute intermittent porphyria.

Sex hormone-binding globulin (SHBG), thyroxine-binding globulin (TBG) and cortisol-binding globulin (CBG) were measured in plasma of 26 patients with acute intermittent porphyria (AIP). Twelve patients had clinically manifest disease and all had elevated SHBG levels. All but one of 14 patients with latent porphyria had normal SHBG levels. TBG was elevated in 9 of the patients with clinically manifest porphyria and CBG elevated in three. Levels of TBG and CBG were either normal or only slightly elevated in those with latent porphyria. In a prospective study of 30 attacks of AIP in 7 patients, SHBG levels fell between admission and discharge, the fall being significant in the group of 21 attacks treated with haem arginate (p less than 0.001). Our findings suggest that a close correlation exists between elevated SHBG and clinical expression of AIP.

Adolescent↗
PubMed1990

Historical vignette. The neurosurgeon's neurosurgeon: cushing operates on a Penfield.

In his autobiography, Dr. Wilder Penfield relates the medical history of his sister, Mrs. Ruth Inglis, who developed a right frontal oligodendroglioma. Penfield performed the initial craniotomy on her, and after her death, reported the case in a paper on frontal lobe function in humans. Although Penfield has provided more than adequate information on certain aspects of his sister's illness, little has been published concerning her subsequent operation performed by Dr. Harvey Cushing at the Peter Bent Brigham Hospital. We feel this case is significant for several reasons. First, it sheds some light on Penfield's personal relationship with Cushing and his sister; it also shows the deep interest that Dr. Cushing took in his patients. Second, this case nicely illustrates how Cushing used his postoperative drawings to make his operative notes more precise. Finally, we see a sample of the work done by Dr. Louise Eisenhardt as pathologist at the Peter Bent Brigham Hospital.

Boston↗
PubMed1990

The porphyrias.

The porphyrias are a group of metabolic disorders arising from defects in the haem biosynthetic pathway. Most forms are inherited as Mendelian autosomal dominant characters, but some are recessive and others acquired. There is a linked group of diseases, which are not porphyrias, but have in common alterations of haem biosynthesis. The haem biosynthetic pathway is now well understood and the molecular biology of its function and dysfunction in the porphyrias is currently an area of major investigation. The acute porphyrias are of most importance since attacks of these may be life-threatening. A variety of factors may precipitate these attacks including various drugs, alcohol, strict dieting or fasting and hormonal fluctuations. The non-acute porphyrias are largely dermatological conditions, which present clinically as cutaneous photosensitivity. The dermatological changes are brought about by the photosensitizing properties of circulating porphyrins. On the basis of this photoactivity, porphyrins are now being used, therapeutically, in the treatment of cancer.

Acute Disease↗