Cryoleucotomy: a new procedure for the control of intractable pain.
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Biomedical subjects
Publications and source records attributed to M Roberts.
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Bronchopulmonary dysplasia (BPD) is a chronic fibrotic lung disease of neonates. Fibronectin (FN), a component of the extracellular matrix, is increased in the tracheobronchial effluent of neonates destined to develop BPD. Pulmonary FN is derived from plasma and local cellular synthesis. In order to identify which pulmonary cells synthesize FN and to test the hypothesis that FN is more abundant in lungs with BPD, we examined the distribution of pulmonary FN by in situ hybridization (for mRNA) and immunohistochemistry (for protein) in neonatal autopsy lung specimens, comparing lungs with BPD to those without. We used a staging system in which BPD is characterized by disruption of alveolar architecture, severe vascular changes, airway epithelial necrosis, smooth muscle hypertrophy, and peribronchial fibrosis. FN mRNA and protein were found in vascular endothelium, macrophages, fibroblasts, vascular and airway smooth muscle, and chondrocytes as well as in the pulmonary parenchyma in neonates with and without BPD. Hyaline membranes, when present, immunostained intensely for FN protein. FN mRNA was not seen in airway epithelial cells of either group. FN mRNA and protein were first increased in early acute BPD with their levels appearing greatest during the chronic reparative stage of BPD. In long-standing "healed" BPD, lower levels of FN mRNA and protein were seen. These findings are consistent with the association of increased FN with adult fibrotic lung disease and the previously reported increase in FN tracheal effluent levels in infants with BPD. Our results suggest an important role for pulmonary cell-derived FN in the early inflammatory and later proliferative stages of BPD.
The most widely held current view on puerperal psychosis (PP) is that it is a mood disorder; some researchers have even suggested that it may be linked to bipolar mood disorder (BMD). To compare the phenomena of PP and BMD, 20 patients with PP were compared with 20 concurrent age-matched women with BMD, using the Structured Clinical Interview for DSM-III-R (SCID). To exclude patients with possible unipolar disorder, subjects with depression were not considered for inclusion in the study. A significantly greater proportion of the PP group experienced delusions of control, auditory hallucinations, blunted affect, and emotional turmoil. Seven (35%) of the PP patients fulfilled DSM-III-R criteria for BMD. These results do not support the hypothesis that PP and BMD are the same illness. Further research is necessary to explore the possibility of a link between these two conditions.
A 29-year-old white male with a recent history of gastroenteritis sustained a cardiac arrest at home. He was found to be in ventricular fibrillation and could not be resuscitated. Pathologic findings included focal aggregates of histiocytes, lymphocytes and occasional neutrophils in the myocardium as well as inflammatory changes in the colon, liver, and spleen. Blood cultures were positive for Salmonella heidelberg. The patient was seen 3 times by emergency departments prior to his demise. Death from Salmonella is rare except when associated with septicemia. The severity of illness and prognosis are often related to the site of infection and underlying disease processes.
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The surface antigen P.69/pertactin of Bordetella pertussis has been expressed using the polyhedron promoter of baculovirus in cultured insect cells. Either full-length or truncated prn DNA was used to express P.69 pertactin. The full-length gene gave rise to low levels of P.93 precursor protein, some of which was processed to P.69. The shortened prn expressed P.69 pertactin directly at levels up to 3.5 mg per litre. P.69 vaccinated animals were protected against aerosol challenge with virulent B. pertussis bacteria.
This study examined characteristics associated with weight control smoking among 281 sedentary women enrolled in a smoking cessation trial. A series of regression models were developed to identify predictors of weight control smoking as measured by the Smoking Situations Questionnaire. Predictor variables included demographic variables, dietary intake, weight gain following previous quit attempts, dietary restraint, self-efficacy for weight management, smoking behavior, exercise behavior, negative affect and psychological constructs relevant to smoking cessation, and exercise adoption. In the final predictor model, anticipation of weight gain in the current quit attempt, higher dietary restraint, younger age, greater Fagerstrom scores, greater number of pounds gained in previous quit attempts, and lower levels of self-efficacy to manage weight in negative affect situations were associated with smoking for weight control. Treatment implications for women who smoke for weight control reasons are discussed.
While Major Depressive Disorder (MDD) is associated with difficulty quitting smoking, few studies have examined the role of subsyndromal depression (SubD). We examined pretreatment differences in smoking, weight concerns, and negative affect among three groups of women (N = 281) enrolling in a smoking cessation program who responded to a self-report questionnaire about the lifetime presence of MDD symptoms: self-report positive for MDD, self-report positive for SubD, and self-report negative for depression (fulfilling either DSM-III-R symptom or duration criteria, but not both). Compared to MDD Subjects (Ss), SubD Ss were more likely to report eating disordered behaviors. Compared to Non-Depressed (Non-Dep) Ss, SubD Ss initiated smoking earlier, and reported greater previous withdrawal symptoms, more eating disordered behaviors, and higher anxiety, depression, and stress. Compared to Non-Dep Ss, MDD Ss reported a greater smoking rate during their heaviest usage period, greater previous withdrawal symptoms, lower self-efficacy to manage food intake (especially during negative affect situations), and greater depression and anxiety. Many of these significant differences disappeared when SubD Ss were combined with Non-Dep Ss and compared with MDD Ss as is done traditionally. SubD does not appear to be on a continuum with Non-Dep and MDD groups, but rather warrants further investigation as a discrete subset of smokers. The implications for assessment and treatment are discussed.
OBJECTIVE: Previous studies have demonstrated that coating spacers with ionic detergents minimizes the static charge and thereby improves in vivo drug deposition. The present study aims to examine the effect of coated spacers versus non-coated spacers in the clinical situation. METHODS: A randomized, double-blind study in children with asthma and a ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) of < or =72% predicted was carried out. Spirometry was performed at baseline and at 10 min and 20 min after inhalation of two puffs of salbutamol (100 microg/puff) through either a detergent-coated or a non-coated spacer. RESULTS: Fifty children were studied (mean age 11.6 years, range 7-18 years): 26 in the group using coated spacers (CG); and 24 in the group using non-coated spacers (NCG). The mean percentage change in FEV1 from baseline 10 min after inhalation was 18.8% (range 5-50%) in the CG versus 18.5% (range 3-35%) in the NCG. At 20 min after inhalation, the per cent increase in FEV1 was 19.8% (range 0-50%) in the CG versus 19.5% (range 9-35%) in the NCG. There was no significant difference between groups in the percentage change in FEV1 after 10 min (P = 0.91), or after 20 min (P = 0.93). CONCLUSIONS: There was no improvement in bronchodilatation from detergent-coated spacers in the present study, possibly because a maximal bronchodilator response was achieved with the lower output.
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Subcutaneous inoculation of Leishmania mexicana amastigotes into the shaven rumps of DBA/2 mice results in a unique 'no lesion growth' phenotype not observed in other mouse strains. Statistical analysis (Kolmogorov-Smirnov and log likelihood tests) of lesion diameters in F1, F2 and backcross progeny from (C57BL/6 x DBA/2) matings indicate that segregation between lesion growth and no lesion growth phenotypes comes under single gene control. The gene has been designated Scl-2 for susceptibility to cutaneous leishmaniasis locus 2. Preliminary mapping studies using 12 of the 26 BXD recombinant inbred mouse strains suggest a location for Scl-2 near Xmmv-8 on a region of mouse chromosome 4 showing homology with human 9p. The identification and mapping of this murine resistance gene could provide an important tool for genetic analysis of susceptibility and resistance to cutaneous leishmaniasis in man.
Hypersensitivity Lung Disease (HLD) includes Hypersensitivity Pneumonitis (HP), IgE triggered asthma and Allergic Bronchopulmonary Aspergillosis (ABPA). HP and ABPA are neither common nor rare. Both are important to diagnose as they can result in progressive irreversible lung damage. Serologic tests are useful in diagnosing or excluding HP and ABPA although the diagnostic skill of the physician is of prime importance. We report eight cases which were diagnostic problems in which the initial serologic examinations were incorrect. The diagnostician must be aware of both the clinical possibility of the HLD but also of the possibility or probability that the serologic report is not correct.
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As the peritoneal dialysis (PD) patient's residual renal function declines, the dialysis dose must be increased. However, the options for increasing the dose are limited to increasing the number of exchanges and/or the volume of each exchange. A review of the literature indicates that the dialysis dose can be significantly increased by flow-through PD, wherein the dialysate flows continuously into the peritoneal cavity through one catheter and out another and/or by regenerating the spent dialysate, thereby, significantly increasing the dialysate flow rate. Flow-thru PD has been used with and without dialysate regeneration. Regeneration has been used with standard inflow/outflow PD. In nearly all cases, substantially increased clearances over standard PD were obtained with reported urea and creatinine clearances as high as 58 and 48 ml/min, respectively. Applying flow-thru to the PD patient would require two catheters or a dual lumen catheter, and to obtain optimum clearances, the dialysate should be pumped through the peritoneal cavity at a high flow rate. Regenerating the dialysate allows high dialysate flow rates while reducing the total amount of dialysate required. For the continuous ambulatory peritoneal dialysis (CAPD) patient, the unit would have to be wearable; whereas for the patient on automated PD, flow-thru and/or regeneration PD could be incorporated into the equipment. With sorbent regeneration, the protein in the spent PD could be purified and returned to the patient thereby minimizing protein loss, increasing ultrafiltration, and enhancing the removal of protein-bound metabolic toxins.
The development of advanced communication technology has enabled clinicians and ceramists to deliver improved dental care to their patients. This article highlights the importance of communication between the clinician, laboratory technician, and patient for the fabrication and delivery of aesthetic restorations. The use of stone models, photography, shade prescriptions, and occlusal relationships is demonstrated as a means to achieve this objective. These principles are illustrated in the restoration of a patient who presented for aesthetic enhancement of the anterior maxilla.
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