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Biomedical subjects

Margaret Wilkinson

Publications and source records attributed to Margaret Wilkinson.

12 recordsLinked to original sources
PubMed2006

Intraoperative parathyroid hormone measurement during minimally invasive parathyroidectomy: does it "value-add" to decision-making?

BACKGROUND: Routine use of intraoperative parathyroid hormone levels (IOPTH) during minimally invasive parathyroidectomy (MIP) has been challenged simply because the test works best when needed least, ie, once a solitary adenoma has been resected, and is less accurate with multiple gland disease. It has also been shown not to be cost-effective. The aim of this study was to determine if IOPTH "value-added" to decision-making during MIP. STUDY DESIGN: The study group comprised 100 consecutive patients with sporadic hyperparathyroidism and an unequivocally positive sestamibi scan who were undergoing MIP in our unit from June 2004 until October 2005, from whom blood was collected for parathyroid hormone measurement preoperatively, preexcision, and at 10 and 30 minutes postremoval. No action was taken on the results of the test. RESULTS: Ninety-eight patients were cured by MIP alone. Two patients had persistent hyperparathyroidism, one of whom was cured with subsequent open reexploration and removal of a second adenoma, and the other remains hypercalcemic despite additional open neck exploration. IOPTH in both patients failed to fall in retrospect, only the first would have been cured by conversion at the time of operation. The value-added accuracy of IOPTH was really only 1%. In an additional nine patients, IOPTH at 10 minutes had failed to fall by > 50% from the highest level, those patients (9%) would have been subjected to an unnecessary conversion on the basis of a false-negative result. CONCLUSIONS: IOPTH does not substantially value-add to decision-making during MIP. Most patients will be cured with appropriate selection for MIP based on preoperative localization studies.

Adult↗
PubMed2006

The dreaming mind-brain: a Jungian perspective.

In this paper I discuss the nature and role of dream and the dreaming process in Jungian clinical practice in the light of neuroscience. Insights from contemporary neuroscience support rather than contest Jung's view that emotional truth, not censorship or disguise, underpins the dreaming process. I use clinical material to illustrate how work with dreams within the total interactive experience of the analytic dyad enables the development of the emotional scaffolding necessary for the development of 'mind'. Large scale evidence-based research reveals that dreaming is caused by brain activity during sleep that is both biochemically and regionally different from that of waking states. Recent imaging studies confirm that dreams are the mind's vehicle for the processing of emotional states of being, particularly the fear, anxiety, anger or elation that often figure prominently. Dream sleep is understood as also being the guardian of memory, playing a part in forgetting, encoding and affective organization of memory. In the clinical section of the paper I let a series of dreams speak for themselves, revealing the emotionally salient concerns of the dreamer, weaving past and present, transference and reality together in a way that demonstrates the healthy attempt of the brain-mind to come to terms with difficult emotional experience from the past. The dreams become dreamable as part of the meaning-making process of analysis.

Brain↗
PubMed2005

Surgery for hyperparathyroidism: does morphology or function matter most?

BACKGROUND: With minimally invasive parathyroidectomy (MIP) not all enlarged parathyroid glands are necessarily removed, and intraoperative measurement of parathyroid hormone levels (IO-PTH) does not necessarily predict multiple enlarged glands. The aim of this study was to compare morphology with function, using Ca(2+)-regulated PTH secretion. METHODS: PTH secretion was determined by perifusion: (1) cells from 12 normal parathyroids were compared with 14 parathyroid adenomas; (2) functional characteristics (PTH secretion, sestamibi uptake, IO-PTH decrease) were correlated with morphologic characteristics; (3) PTH secretion as a predictor of IO-PTH decrease was determined in 7 patients with 2 enlarged parathyroids. RESULTS: (1) There were significant differences between normal and pathological parathyroid cells consistent with reduced sensitivity to Ca(2+). Maximum secretion rates for normal and adenomatous cells were, respectively, 3.9 +/- 0.4 fg min(-1) cell(-1) and 2.0 +/- 0.4 fg min(-1) cell(-1) (P = .002) and minimum secretion rates, 0.7 +/- 0.1 fg min(-1) cell(-1) and 0.4 +/- 0.1 fg min(-1) cell(-1) (P = .008). However, the IC(50) value for Ca(2+) was elevated in adenomatous cells indicating an apparent loss of extracellular Ca(2+) sensitivity being 1.1 +/- 0.02 mmol/L for normal and 1.2 +/- 0.02 mmol/L for adenomatous cells (P = .02). (2) There was no overall correlation between PTH secretion and gland morphology. (3) In 5 of 7 cases, PTH secretion correctly predicted the decrease in IO-PTH. CONCLUSION: Parathyroid adenomas generally exhibit abnormal PTH secretory function; however, enlarged parathyroid glands that do not contribute to the biochemical changes of hyperparathyroidism do exist, and, in these cases, cellular secretory function is a useful predictor of IO-PTH dynamics.

Adenoma↗
PubMed2005

Undoing dissociation. Affective neuroscience: a contemporary Jungian clinical perspective.

In the last ten years both analysts and neuroscientists have begun to challenge the analytic world to explore the analytic view of the mind in relation to knowledge emerging from the field of neuroscience. I find that 'in many ways it is Jung's understanding of the mind, the human condition, and the self, that is most compatible with the insights that are emerging from neuroscience today' (Wilkinson 2004, p. 84). In this paper I consider the insights that neuroscience has to offer us as we seek to work with those patients whose early experience has diminished their capacity to be 'in mind' and with it their capacity for reflective self-function, whose defences are dissociative, whose need has been to keep unbearable experience at bay, out of mind. I look first at dissociationist theory and its development, then focus on the insights to be gained from neuroscience with regard to early trauma and its effect on the encoding and recall of memory. Finally, I turn to the nature of cure and argue that hemispheric integration is the key to undoing dissociation and the prelude to individuation.

Adolescent↗
PubMed2004

L-amino acids regulate parathyroid hormone secretion.

Parathyroid hormone (PTH) secretion is acutely regulated by the extracellular Ca(2+)-sensing receptor (CaR). Thus, Ca(2+) ions, and to a lesser extent Mg(2+) ions, have been viewed as the principal physiological regulators of PTH secretion. Herein we show that in physiological concentrations, l-amino acids acutely and reversibly activated the extracellular Ca(2+)-sensing receptor in normal human parathyroid cells and inhibited parathyroid hormone secretion. Individual l-amino acids, especially of the aromatic and aliphatic classes, as well as plasma-like amino acid mixtures, stereoselectively mobilized Ca(2+) ions in normal human parathyroid cells in the presence but not the absence of the CaR agonists, extracellular Ca(2+) (Ca(2+)(o)), or spermine. The order of potency was l-Trp = l-Phe > l-His > l-Ala > l-Glu > l-Arg = l-Leu. CaR-active amino acids also acutely and reversibly suppressed PTH secretion at physiological ionized Ca(2+) concentrations. At a Ca(2+)(o) of 1.1 mm and an amino acid concentration of 1 mm, CaR-active amino acids (l-Phe = l-Trp > l-His = l-Ala), but not CaR-inactive amino acids (l-Leu and l-Arg), stereoselectively suppressed PTH secretion by up to 40%, similar to the effect of raising Ca(2+)(o) to 1.2 mm. A physiologically relevant increase in the -fold concentration of the plasma-like amino acid mixture (from 1x to 2x) also reversibly suppressed PTH secretion in the Ca(2+)(o) concentration range 1.05-1.25 mm. In conclusion, l-amino acids acutely and reversibly activate endogenous CaRs and suppress PTH secretion at physiological concentrations. The results indicate that l-amino acids are physiological regulators of PTH secretion and thus whole body calcium metabolism.

Amino Acids↗
PubMed2004

Meaning construction and integration in children with hydrocephalus.

Text comprehension processes were investigated in children with hydrocephalus, a neurodevelopmental disorder associated with good word decoding, but deficient reading comprehension. In Experiment 1, hydrocephalus and control groups were similar in processes related to activating word meanings and using context to enhance meaning. The hydrocephalus group was poorer at suppressing contextually irrelevant meanings. In Experiment 2, the hydrocephalus group had difficulty integrating information from an earlier read sentence to understand a new sentence as textual distance between the two propositions increased, suggesting difficulty in reactivation processes related to comprehension. Results are discussed in relation to cognitive and neurocognitive models of comprehension.

Adolescent↗
PubMed2004

Medical education goes to prison: why?

The authors describe a pilot medical education program that developed a new and ongoing correctional medicine curriculum for third- and fourth-year medical students at Nova Southeastern University College of Osteopathic Medicine. During the first two years of the pilot program (2000-02), a total of 53 students were placed in one-month rotations in prison health care settings. Students received orientations, directed readings, and prison clinic experience under the director of board-certified physician preceptors. An evaluation of the pilot experience was conducted by student survey. The findings indicate that students had positive experiences related to continuity of care, access to pathology, access to procedures, and exposure to a unique managed care model. Students requested more structured curriculum and more opportunities to develop content understanding of the unique clinical aspects of prison health care. The authors conclude that given the increasing U.S. prison population, the constitutional requirement to provide medical care to inmates, and demand for career-oriented correctional physicians, the favorable outcome of this pilot educational program provides support for implementing such programs in medical schools throughout the country. They also speculate that the program may encourage some students to practice in correctional institutions as a career.

Clinical Clerkship↗
PubMed2004

The mind-brain relationship: the emergent self.

This paper explores the mind-brain relationship, using insights from contemporary neuroscience. It seeks to investigate how our brains become who we are, how subjective experience arises. In order to do this some explanation is given of the basic concepts of how the brain produces our subjective mental life. Current neuropsychological and neurobiological understanding of early brain development, memory, emotion and consciousness are explored. There is also an attempt at mapping the mind-brain-self relationship from a uniquely Jungian perspective. Clinical material is included in order to show the relevance of these insights to our work in the consulting room, arguing the value of the affect-regulating, relational aspects of the analytic dyad that forge new neural pathways through emotional connection. Such experience forms the emotional scaffolding necessary for the emergence of reflective function.

Brain↗
PubMed2003

Undoing trauma: contemporary neuroscience. A Jungian clinical perspective.

This paper uses insights from contemporary neuroscience and attachment theory to explore the profound dissociative defences associated with trauma. I discuss the effects of trauma on the emotional, intellectual and imaginative life of the individual and on the development of the self. Based on work with three patients with very different experiences of trauma, the paper offers clinical illustration of 'right brain to right brain' Jungian analysis. I argue that through repeated transference and countertransference experiences dissociative defences may be undone and change brought about.

Child↗
PubMed2002

Mathematics skills in good readers with hydrocephalus.

Children with hydrocephalus have poor math skills. We investigated the nature of their arithmetic computation errors by comparing written subtraction errors in good readers with hydrocephalus, typically developing good readers of the same age, and younger children matched for math level to the children with hydrocephalus. Children with hydrocephalus made more procedural errors (although not more fact retrieval or visual-spatial errors) than age-matched controls; they made the same number of procedural errors as younger, math-level matched children. We also investigated a broad range of math abilities, and found that children with hydrocephalus performed more poorly than age-matched controls on tests of geometry and applied math skills such as estimation and problem solving. Computation deficits in children with hydrocephalus reflect delayed development of procedural knowledge. Problems in specific math domains such as geometry and applied math, were associated with deficits in constituent cognitive skills such as visual spatial competence, memory, and general knowledge.

Age Factors↗
PubMedDate not supplied

Arithmetic processing in children with spina bifida: Calculation accuracy, strategy use, and fact retrieval fluency.

Three studies compared 98 children with spina bifida myelomeningocele (SBM)-a disorder associated with high rates of math disability and spatial deficits-to 94 typically developing children on multidigit subtraction and cognitive addition tasks. Children with SBM were classified into those with reading decoding and math disability, only math disability, and no reading or math disability. Study 1 showed that visual-spatial errors in multidigit arithmetic were not elevated in children with SBM. In Study 2, deficits in accuracy, speed, and strategy-use in single-digit addition characterized groups with math disability regardless of reading status. Accuracy and speed on single-digit addition was strongly related to performance on multidigit subtraction. A math-level matching design in Study 3 revealed less mastery of math facts by the group with SBM. The results are discussed with reference to cognitive and neuropsychological models of math disability.

Child↗