Biomedical subjects
Publications and source records attributed to P Kennedy.
Myxomas are one of the most common cardiac tumors but usually are confined to the atria. Although described in all cardiac chambers and on all cardiac valves, only one postmortem case of an aortic valve myxoma has been published. We present the case of a young man with an aortic valve myxoma with peripheral embolization. The other pathologic conditions with which valvular myxomas can be confused are compared and discussed.
Mice and rabbits immunized with recombinant forms of malaria vaccine candidate antigens rhoptry-associated proteins 1 and 2 (RAP-1, RAP-2 and rRAP-1, rRAP-2) produce antibodies at titres equivalent to monoclonal antibody ascites fluid raised against the native proteins. Sera from animals immunized with rRAP-1 contain antibodies which recognize the native protein by indirect immunofluorescence and immunoblotting, partially inhibit erythrocyte invasion in vitro and are long lasting. Epitope mapping shows these antibodies predominantly recognize epitopes in the N-terminal third of rRAP-1, some of which coincide with the targets of inhibitory monoclonal antibodies. By contrast, sera from animals immunized with rRAP-2 contain antibodies which recognize the recombinant but not the native protein.
The effects of spinal cord injury in childhood upon later psychological adjustment were investigated by comparing a group of 86 people injured as children with a control group (matched for time since injury and level of injury) of people injured as adults. It was hypothesized that adolescence is a crucial period in psychological development and that the effect of spinal cord injury on body image, self-concept and social relationships during adolescence will have a long-term negative effect on psychological well-being. However, on overall measures of depression, self-esteem and self-perception, there were no significant differences between the experimental and control groups. Furthermore, there were no significant differences between paraplegics and tetraplegics, between men women, or between those who were involved in a significant intimate relationship and those who were not. These findings support previous research which has suggested that organic variables, such as age at injury and level of injury, are not predictive of long-term psychological adjustment.
Many studies have suggested a relationship between coping strategies used to deal with stressors and levels of psychological well-being. To explore this further the current study examined such relationships in people who have sustained a spinal cord injury. Measures of psychological impact and coping strategies were taken from those in their sixth week post-injury (N = 41) and those between four and seven years post-injury (N = 30). The results were analysed using stepwise multiple regression. This provided a number of models containing coping strategies that accounted for a certain proportion of the variance in each of the psychological impact variables. While the results help to identify specific coping strategies associated with better adjustment, they also highlight the need to adopt a longitudinal approach in the investigation of psychological responses to spinal cord injury.
In-vivo fluorine-19 nuclear magnetic resonance spectroscopy (NMRS) allows non-invasive, real-time, chemical identification of specific fluorinated compounds inside human tumours after administration of fluorouracil (5-fluorouracil). Kinetic measures of the administered drug and metabolites allow estimation of the tumoral half-life of fluorouracil. We studied 57 patients by 19F NMRS immediately after they had received 600 mg/m2 fluorouracil intravenously. Serial spectra were acquired with the surface coil positioned on the skin above the tumour. We defined an intratumoral half-life of fluorouracil of 20 min or more as indicating trapping of the drug, based on the blood half-life of 8-12 min. 19 patients had intratumoral half-lives indicating trapping of fluorouracil, 27 had half-lives less than 20 min, and 11 had no detectable fluorouracil in their tumours. 8 of 9 evaluable patients whose tumours showed trapping had partial responses to chemotherapy that included fluorouracil compared with only 2 of 25 patients whose tumours did not trap the drug (p = 0.000021). 19F NMRS can identify patients likely to respond to chemotherapy with fluorouracil and could be used clinically to tailor optimum treatment.
BACKGROUND: To determine if routine radiographic evaluation of the cervical spine could be eliminated in the alert, sober trauma patient who has no neck pain, tenderness, or other major injuries without a significant increase in missed occult injury. DESIGN: Prospective cohort study. SETTING: Emergency department and general surgery service at a military tertiary medical center. MAIN OUTCOME MEASURE: Those patients with cervical spine injuries. RESULTS: Sixteen patients (2%) had cervical spine injuries, all had signs and/or symptoms of their injury on presentation. Ninety-six patients (14%) who were not intoxicated and had no neck pain, tenderness, or other major injuries were evaluated. None of these patients had abnormal cervical spine studies. Two hundred ninety patients (43%) were followed up between 30 to 150 days. No missed injuries were noted. CONCLUSIONS: These results indicate that blunt trauma patients may not require cervical spine roentgenography if they meet the following criteria: absence of mental status changes, intoxication, neck pain or tenderness, neurologic signs or symptoms, or simultaneous major distracting injury. Because of the small incidence of cervical spine injuries, further studies are necessary to evaluate the positive predictive value of history and physical examination of the cervical spine in a trauma patient.
OBJECTIVE: To determine whether surgeons who had received appropriate training in the technique of total thyroidectomy could continue to perform the procedure with minimal morbidity after moving to a provincial surgical practice. DESIGN: Comparison of the complication rates from total thyroidectomy between a specialized endocrine surgical unit and provincial centers. SETTING AND PATIENTS: Six hundred fifty patients undergoing total thyroidectomy by two surgeons over a 5-year period in the endocrine surgical unit at Royal North Shore Hospital, St Leonards, Australia, were compared with 120 patients undergoing total thyroidectomy by seven provincial surgeons who were former trainees in the unit. MAIN OUTCOME MEASURES: Indications for surgery and specific complications of thyroidectomy including recurrent laryngeal nerve palsy, permanent hypoparathyroidism, and postoperative bleeding. RESULTS: Each of the seven surgeons in provincial practice performed only between two and 16 thyroidectomies annually. The percentage of total thyroidectomies for benign and malignant disease was identical for both the endocrine surgical unit and provincial center groups (44%). There was no difference in the incidence of recurrent laryngeal nerve palsy, permanent hypoparathyroidism, or postoperative bleeding between the two groups. CONCLUSION: Total thyroidectomy is an operation that always engenders controversy relating to the morbidity of recurrent laryngeal nerve and parathyroid injury. Surgeons who have completed a well-designed training program and who have become proficient at total thyroidectomy as trainees will remain proficient at the procedure despite practicing in a provincial center. Achieving a low morbidity rate demands meticulous attention to operative technique and anatomical detail.
Spasticity is a common problem following spinal cord injury. The drug of choice to control spasms is baclofen. There would appear to be no reported studies which have evaluated the psychological and emotional effect of this drug. This preliminary study investigated a number of such effects, including depression, anxiety and general mood state. First, we examined 10 subjects before and during the administration of baclofen. They were then compared to a control group of 12 subjects. A second cohort of 12 subjects taking baclofen were compared to a control group of nine subjects at a specific time after injury. Results indicated that whilst some significant differences were found, suggesting an increase in fatigue with use of baclofen, no major adverse psychological effects were noted. The implications of these results were discussed and suggestions for further research were highlighted.
The Central Sydney Area Health Service has developed and piloted a Hospital in the Home program as an alternative to inpatient admission. Hospital in the Home offers the opportunity for increased productivity of existing hospital services, and advantages for patients in terms of satisfaction and improved or comparable clinical outcomes. Having developed treatment protocols and established a core Hospital in the Home team, a wider demonstration project across three hospitals within the Central Sydney Area Health Service is proposed.
Compared with conventional chemotherapy, use of liposomes loaded with therapeutic agents is less toxic and more effective in experimental tumours in vivo. We have assessed efficacy and toxicity of liposomal daunorubicin (40 mg/m2 every 2 weeks) in 25 patients with HIV-associated Kaposi's sarcoma of poor prognosis. In 24 evaluable patients, there were 2 complete remissions (8.3%) and 13 partial remissions (54.2%). 5 of 11 patients with doxorubicin-resistant Kaposi's sarcoma had partial remissions. Median duration of response was 12 weeks. Quality of life improved after treatment with a response rate of 71% for physical performance and 74% for emotion. Myelosuppression was the commonest adverse event. Vomiting, stomatitis, and alopecia were rare and mild. Liposomal daunorubicin is safe and effective in HIV-associated Kaposi's sarcoma and improves quality of life. The treatment is effective even in patients resistant to other chemotherapy.
In recent years the Functional Independence Measure has emerged as a standard assessment instrument for use in rehabilitation and therapy programmes for disabled persons, including those with spinal cord injury (SCI). This measure was devised to be rated by a clinician familiar with the patient. We studied 40 spinal cord injury patients who were rated on the FIM by a clinician within the 6 weeks prior to discharge, and who then rated themselves on the FIM at one month post discharge. There was a strong correlation between the differently rated scores. This suggests that the FIM can be given to patients as a self-report questionnaire, thus reducing time of assessment and increasing assessment potential.
Despite the empirically established beneficial effects of laughter on psychological health, humor remains a much neglected area of research. This study examined the psychological impact of humor on people with SCI, the hypothesis being that it would significantly reduce the deleterious psychological effects of the injury. Mood state, frequency of intrusive thoughts and avoidance behavior of eight male inpatients at the National Spinal Injuries Centre were monitored before and after exposure to a series of five humorous video presentations. Although differences in these parameters were in the predicted direction, statistical analysis revealed no significant effect. Nevertheless, this pilot study highlighted pertinent issues and suggested modifications for further exploration.
The White Paper, Health of the Nation, and the Patients' Charter both seek to emphasise the importance of fully involving and informing patients about the treatment they receive. Much work on implementation of these documents has concentrated on achieving specific targets which, although essential, ignore the key managerial theme of changing behaviour, approach and attitudes in the staff/patient relationship and ensuring that patients are empowered through this relationship. Paul Kennedy and Nigel Pearce suggest that carefully planned and managed change through the use of a comparatively simple and well established approach has a major impact on the achievement of these initiatives.
Proteolipid protein (PLP; M(r) 30,000) is a highly conserved major polytopic membrane protein in myelin but its cellular function remains obscure. Neurological mutant mice can often provide model systems for human genetic disorders. Mutations of the X-chromosome-linked PLP gene are lethal, identified first in the jimpy mouse and subsequently in patients with Pelizaeus-Merzbacher disease. The unexplained phenotype of these mutations includes degeneration and premature cell death of oligodendrocytes with associated hypomyelination. Here we show that a new mouse mutant rumpshaker is defined by the amino-acid substitution Ile-to-Thr at residue 186 in a membrane-embedded domain of PLP. Surprisingly, rumpshaker mice, although myelin-deficient, have normal longevity and a full complement of morphologically normal oligodendrocytes. Hypomyelination can thus be genetically separated from the PLP-dependent oligodendrocyte degeneration. We suggest that PLP has a vital function in glial cell development, distinct from its later role in myelin assembly, and that this dichotomy of action may explain the clinical spectrum of Pelizaeus-Merzbacher disease.
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Testicular feminization syndrome was diagnosed in a mare with aggressive, stallion like behavior and a history of infertility. She was found to have a high baseline testosterone concentration suggesting that testicular tissue was present, and ovarian-like structures examined by use of transrectal ultrasonography had the appearance typical of testicular tissue. Although her external female genitalia appeared normal, her vagina ended in a blind sac, and no cervix or uterus were identified. Surgery was performed, and structures removed from the abdominal cavity were determined to be hypoplastic testicles. Removal of the testicular tissue resulted in complete resolution of her aggressive behavior. Chromosomal evaluation revealed that the mare had 64X,Y (normal male) karyotype. Testicular feminization syndrome is a condition characterized by insensitivity of reproductive tissues to androgens during development because of an abnormality in androgen receptors. This androgen insensitivity results in development of normal external female genitalia, with high testosterone concentrations being released from developing testicles. Testicular feminization syndrome has not been commonly diagnosed in horses, but should be considered as a differential diagnosis for overly aggressive mares with a history of infertility.
Ionization chamber and thermoluminescent dosimeter measurements were made to verify the dosimetry data provided to the Radiation Therapy Chart Review office of interinstitutional electron intraoperative radiotherapy clinical trials. The ionization measurements included intraoperative radiotherapy applicator output and depth dose measurements made at the stated 80% and 50% depths at 14 different radiotherapy facilities. Mailable thermoluminescent dosimeter measurements, including output and depth dose measurements were made at 16 institutions. The mailable thermoluminescent dosimeter results show similar inter-institutional agreement, both for output and depth dose comparison, with the corresponding ion chamber results for intraoperative radiotherapy applicators. These results are compared to similar measurements made for conventional electron applicators.