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Biomedical subjects

P Sullivan

Publications and source records attributed to P Sullivan.

At least 73 records · Page 4Linked to original sources
PubMed1998

Effect of chronic theophylline treatment on the methacholine dose-response curve in allergic asthmatic subjects.

Theophylline is a bronchodilator and immunomodulator drug which has recently been demonstrated to attenuate the recruitment and activation of inflammatory cells into lungs of asthmatics. This study investigated the effect of chronic treatment with theophylline for its ability to alter airway responsiveness, as indicated by changes in airway sensitivity and reactivity to inhaled methacholine. The subjects studied were mild asthmatics who relied on beta-agonist medication only and who were randomized into two groups, one receiving theophylline (median dose 250 mg twice daily; range 250-375 mg twice daily) and the other placebo. A number of parameters was measured before and after treatment, including baseline forced expiratory volume in one second (FEV1), the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20; sensitivity), dose-response slope (reactivity) and percentage eosinophils, eosinophil cationic protein and T-cell markers in peripheral blood (by flow cytometry). After 2 months of treatment with theophylline there was a significant lowering of airway reactivity (slope) to methacholine and improvement in methacholine sensitivity (PC20). However, such changes were not associated with any significant change in the number or activation status of eosinophils and lymphocytes in peripheral blood. In conclusion, chronic treatment with theophylline reduces the reactivity of the airways to methacholine, which might be beneficial in the treatment of persistent asthma. The cellular mechanisms of this improvement remain to be clarified.

Adult↗
PubMed1998

Variation in the measurements of basement membrane thickness and inflammatory cell number in bronchial biopsies.

We do not have an estimate of how much tissue is needed for a reliable measure of bronchial epithelial reticular basement membrane (RBM) thickness or for counts of inflammatory cells. An assessment of the frequency distribution and variance of data from repeat measurements of RBM thickness and biopsy section inflammatory cell counts in cases with asthma (n=6), chronic obstructive pulmonary disease (COPD; n=5), and normal healthy subjects (n=7) was made. Tissue sections were stained with haematoxylin and eosin or by immunohistochemistry for EG2, mast cell tryptase and CD3-positive cells. Measurements of RBM thickness in individuals followed a log-normal distribution. For a precision of approximately +/-15%, 31-45 measurements were required. In contrast, inflammatory cell counts for each individual did not follow a normal distribution. There was high variance such that the cumulative weighted mean did not become stable until at least 5-10 mm of tissue underlying the RBM had been included. In conclusion multiple measurements of reticular basement membrane thickness or tissue section cell counts should be made for each individual in studies of bronchial biopsies. It is recommended that reticular basement membrane thickness should be measured at 20 mm intervals over a 1 mm reticular basement membrane length and that a zone beneath it of at least 5-10 mm of reticular basement membrane should be included for counts of inflammatory cells.

Adult↗
PubMed1998

Psychosocial correlates of unprotected anal sex in a cohort of gay men attending an HIV-negative support group.

The objective of this report is to identify psychosocial correlates of unprotected anal sex among attendants at a support group for HIV-negative gay and bisexual men. Presupport group measures were given to 55 self-identified urban HIV-negative gay and bisexual men in a high-incidence HIV location (San Francisco) attending a 10-week, weekly, 2-hour support group at the University of California at San Francisco (UCSF) AIDS Health Project. Participants completed self-administered questionnaires that included measures of perceived risk, condom self-efficacy, social support, HIV knowledge, and depression. At baseline, 25% of the participants reported unprotected anal sex (receptive or insertive) in the two months preceding enrollment. This finding was independent of whether the participant was single or involved in a relationship, and whether or not the participant's partner was infected with HIV. Participants were found to generally have very high AIDS knowledge and low depression scores. In bivariate analysis, unprotected anal sex was associated with low condom self-efficacy, low AIDS knowledge, dissatisfaction with social support, and lower commitment to safer sex. In multivariate analysis, unprotected anal sex was independently associated with low condom self-efficacy (p = .006), and low AIDS knowledge (p = .007). Additionally, a borderline significant result was found when measuring satisfaction with social support (p =.085). No association was found between depression scores and unprotected sexual activity.

Adult↗
PubMed1997

Physicians debate Internet-related marital problems on CMA's online service.

The Internet itself has been the topic recently on the CMA's Internet-based discussion group for physicians, Clinical Q&A. A recent discussion involved physicians from around the country who have dealt with patients with marital problems related to the Internet. They concluded that the Internet may have made problems manifest, but the underlying issue--marital disharmony--already existed.

Computer Communication Networks↗
PubMed1997

Dubin calls on CMPA to eliminate fee differentials, adopt flat fee for all physicians.

Charles Dubin's massive review of the Canadian Medical Protective Association supports the CMPA's policy of maintaining a large reserve for malpractice coverage, but calls for a major overhaul of the association's fee structure. Regardless of the risks their practices pose, says Dubin, all doctors should pay the same fee in order to keep physicians practising in high-risk specialties such as obstetrics and orthopedic surgery. The alternative, said CMPA president Dr. Bill Thomas, is an exodus from certain specialties because of massive bills for malpractice insurance.

Canada↗
PubMed1997

Right to bill may affect amount of tobacco counselling by MDs.

Unpublished data from Health Canada indicate that only 32% of Canada's family physicians believe they can bill their health plans for providing smoking-cessation counselling to patients with no smoking-related illness. A CMA study of provincial billing codes determined that all provinces and territories except British Columbia and Alberta have billing codes for clinical tobacco interventions, which include counselling. Ontario leads the way with 4 separate codes.

Canada↗
PubMed1997

Dexamethasone, cyclophosphamide, idarubicin and etoposide (DC-IE): a novel, intensive induction chemotherapy regimen for patients with high-risk multiple myeloma.

We evaluated toxicities and responses to a novel, dose intensive and time sequenced, chemotherapy programme (DC-IE) in 45 patients with high-risk myeloma. DC-IE consisted of: dexamethasone (days 1-4); cyclophosphamide (day 5); idarubicin and etoposide (days 8-10). Complete response (CR) was achieved in four patients, six patients achieved near complete responses (nCR) and 21 patients achieved a partial remission (PR). Overall response rate was 76% (CI 56-94%) for newly diagnosed patients (n = 21) and 62% (CI 36-81%) for relapsed/refractory patients (n = 24). Toxicities were limited to myelosuppression; two patients died of sepsis during neutropenia (4%). DC-IE is active and tolerable for high-risk multiple myeloma, including patients with relapsed or refractory disease to anthracycline containing regimens.

Adult↗
PubMed1997

Absence of detectable antibody in a patient infected with human immunodeficiency virus.

Infection with human immunodeficiency virus (HIV) is routinely and easily diagnosed with use of enzyme immunoassay (EIA) test kits. We describe an unusual patient who developed AIDS despite testing negative for antibodies to HIV 35 times over a 4-year period. HIV infection was confirmed by the results of p24-antigen assays and polymerase chain reaction amplification of proviral DNA. Sequence analysis of the virus demonstrated that it was closely related to a strain obtained from the patient's sexual partner. The explanation for this patient's persistently negative EIA results is unclear. However, this case does suggest that physicians who treat patients with AIDS-defining conditions but for whom standard HIV antibody testing is negative should consider the possibility that HIV infection is present and may be identified by additional testing procedures.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Evaluation and use of a dry chemistry analyser in Antarctica.

The Australian National Antarctic Research Expeditions (ANARE) currently operate scientific stations at four remote locations in Antarctica. Each of these stations requires an accurate, easy to use, and flexible biochemical analyser for clinical diagnosis and management. The Ektachem DT60, DTE and DTSC modules were selected and initially assessed during a wintering expedition at the ANARE station on sub-Antarctic Macquarie Island and during an extended scientific voyage to Antarctica. In the initial field assessment, accuracy was assessed by measuring a range of analytes in samples from pathology interlaboratory quality assurance programs. In 90% of the samples tested, analyte recordings were within 2 standard deviations of the mean provided. Kodatrol controls were tested regularly to assess the calibration stability of the machine and to measure within-day and between-day imprecision. Blood was also taken monthly from all expeditioners, analysed, and immediate results of cholesterol and triglyceride compared with results from identical samples frozen and analysed later in Australia. Cholesterol and triglyceride were the analytes chosen as the results obtained could be used as part of a larger study concerning dietary fats and cardiovascular risk factors. Analysis of the results indicated that the Ektachem DT modules satisfied criteria of accuracy and precision. They were relatively economical to use. Maintenance and training were simple and appropriate to the conditions of use. As a result of this favourable assessment, Ektachem machines were obtained for all four of the Australian Antarctic stations and have been in use at those sites for the last six years. Comment is made on experience with these analysers during that time, including discussion of clinical cases in which the availability of such biochemistry has proved useful. Some of the problems encountered are also discussed. It is considered that use of these biochemical analysers has assisted the solo medical practitioner in the isolated Antarctic region.

Antarctic Regions↗
PubMed1996

Surgical centre provided military backdrop for CMA annual meeting in Sydney.

A section of a military field hospital was on display during the CMA's recent annual meeting in Sydney, NS. It was from 1 Canadian Field Hospital, which is currently involved in a major reorganization that will see it almost triple in size. A military physician said the hospital's advanced surgical centres have stare-of-the-art equipment.

Canada↗
PubMed1996

Community care for the severely mentally ill: a review.

This article considers the wide range of health policy initiatives designed to provide a framework for the provision of mental health services in the community. It is important that psychiatric nurses understand both the development and content of these policies as they have clear and important implications for their clinical practice when caring for the severely mentally ill on a day-to-day basis.

Community Health Nursing↗
PubMed1996

Breast-feeding still faces many roadblocks, national survey finds.

Although breast-feeding receives strong support from physicians, recent focus groups conducted for Health Canada found that it still faces roadblocks because some new mothers find it too embarrassing. In some cases, their male partners oppose breast-feeding. The solution appears to be more and better education provided very early in pregnancy. There is also a need to "spell out explicitly" the role male partners can play in supporting breast-feeding.

Attitude to Health↗
PubMed1996

Human apolipoprotein E2, E3, and E4 isoform-specific transgenic mice: human-like pattern of glial and neuronal immunoreactivity in central nervous system not observed in wild-type mice.

Apolipoprotein E (apoE) and its three major alleles (APOE2, E3, and E4) have been implicated in Alzheimer's disease and other neurological disorders. Little is known of the role apoE plays in normal brain function and pathology. To create a model to study apoE in brain, we have generated APOE transgenic mice using microinjection of allele-specific human genomic fragments to establish founders which were then bred to APOE knockout mice lacking a functional mouse apoE protein. This allows the study of apoE without interference from the endogenous mouse APOE gene. Results demonstrate that transgenic lines have been established that transcribe and express apoE appropriately in brain, liver, and other tissues. High cholesterol levels found in APOE knockout mice are substantially corrected in the APOE transgenic lines. ApoE immunoreactivity has been detected in glial cells and selected classes of neurons in all three isoform-specific transgenics. This pattern of immunoreactivity is similar to that observed in nonhuman primates and man, and contrasts with the strictly glial staining pattern of normal rodents.

Alleles↗
PubMed1996

Continuous epidural infusion of ropivacaine for the prevention of postoperative pain after major orthopaedic surgery: a dose-finding study.

PURPOSE: A dose-finding study to investigate the use of epidural infusions of ropivacaine for postoperative analgesia following orthopaedic surgery. METHODS: This was a randomized, double-blind study. Surgery was performed using a combination of a lumbar epidural block utilizing ropivacaine 0.5% and a standardized general anaesthetic. Postoperatively, an epidural infusion of the study solution (saline, ropivacaine 0.1%, 0.2% or 0.3%) was started at the rate of 10 ml.hr-1 and continued for 21 hr after arrival in the PACU. Analgesia was supplemented with PCA morphine (dose = 1.0 mg, lock-out = 5 min). RESULTS: Forty-four patients completed the study. The ropivacaine 0.1%, 0.2%, 0.3% groups required less morphine over the 21 hr than the saline group (P < 0.01). The VAS pain scores were also lower in the three ropivacaine groups (P < 0.001). The ropivacaine groups maintained sensory anaesthesia to pinprick when compared with saline (P < 0.05). The motor block in the 0.3% group was significantly higher than the saline group at all times (P < 0.05), and higher than the 0.1% group at eight hours (P < 0.01), while the 0.2% group had higher Bromage scores than saline at 4 and 21 hr (P < 0.05). CONCLUSIONS: The use of continuous epidural infusions of ropivacaine 0.1%, 0.2% and 0.3% at 10 ml.hr-1 improved postoperative pain relief and decreased PCA morphine requirements in patients undergoing major orthopaedic surgery. The 0.1% and 0.2% concentrations produced similar sensory anaesthesia with less motor blockade than the 0.3% concentration.

Adult↗
PubMed1996

Improved detection of disseminated pheochromocytoma using post therapy I-131 MIBG scanning.

A 50-year-old man had metastatic pheochromocytoma to the left frontal bone. The primary adrenal tumor was removed 12 years previously. Bone scanning and diagnostic I-131 and I-123 MIBG imaging showed metastatic lesions in the right femur and midthoracic spine. However, post-therapy I-131 MIBG scanning showed extensive and widespread metastatic disease. Post-therapeutic I-131 MIBG whole-body scanning was necessary to more fully assess the extent of metastatic pheochromocytoma.

3-Iodobenzylguanidine↗