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Biomedical subjects

P White

Publications and source records attributed to P White.

At least 91 records · Page 5Linked to original sources
PubMed1999

Atypical C-ANCA following high dose intravenous immunoglobulin.

AIMS: (1) To assess a range of intravenous immunoglobulin products for atypical classical antineutrophil cytoplasmic antibody (C-ANCA) staining and to determine if this is present in patients treated with high dose intravenous immunoglobulin (2 g/kg/month) and replacement doses (200 mg/kg fortnightly); (2) using the United Kingdom national external quality assessment scheme (NEQAS), to determine if laboratories could differentiate this pattern from classical ANCA. METHODS: ANCA testing was performed on 30 batches of intravenous immunoglobulin from several manufacturers. Six patients treated with high dose intravenous immunoglobulin and 11 receiving replacement doses of immunoglobulin for hypogammaglobulinaemia were tested for ANCA by indirect immunofluorescence on cytospin preparations of ethanol fixed neutrophils and by enzyme linked immunosorbent assay (ELISA). One of the positive immunoglobulin batches was tested blindly by 125 laboratories involved in NEQAS by indirect immunofluorescence and by ELISA in some laboratories. RESULTS: 16 of 31 batches of intravenous immunoglobulin from six different manufacturers were atypical C-ANCA positive. Three of six patients receiving high dose intravenous immunoglobulin and none of 11 patients on replacement doses were atypical C-ANCA positive. The results of the NEQAS assessment by indirect immunofluorescence were 68% C-ANCA positive, 17% negative, 9% atypical C-ANCA, and 6% P-ANCA. CONCLUSIONS: Some but not all intravenous immunoglobulin products yield a positive atypical cANCA by indirect immunofluorescence. An identical pattern may be observed in patients receiving high dose intravenous immunoglobulin but not in those on replacement doses. Of laboratories participating in NEQAS, 68% reported this pattern as cANCA. This reinforces the importance of reporting only "classical ANCA," defined by international ANCA workshops, to maintain the specificity of ANCA immunofluorescence and its close disease associations.

Agammaglobulinemia↗
PubMed1999

A first British case of fish-eye disease presenting at age 75 years: a double heterozygote for defined and new mutations affecting LCAT structure and expression.

Fish-eye disease is a familial syndrome with corneal opacification, major high density lipoprotein (HDL) deficiency in plasma, significant cholesterol esterification in plasma on non-HDL lipoproteins, generally without premature coronary disease. This first British male case from unrelated British parents had infarcts when aged 49 and 73 years but was asymptomatic at age 81 years, with plasma cholesterol 4.3-7.1 mmol/litre, triglycerides 1.8-2.2 mmol/litre, HDL cholesterol < 0.1 mmol/litre, apolipoprotein A-I < 0.16 g/litre, lipoprotein(a) 0.61 g/litre. Cholesterol esterification was impaired using HDL-3 and A-I proteoliposomes but not using VLDL/IDL/LDL. The findings are those of LCAT deficiency with the classic fish-eye disease defect. Most of the 22 reported cases were homozygous or heterozygous for a Thr-Ile mutation at codon 123 of the lecithin:cholesterol acyltransferase (LCAT) gene. This patient was a double heterozygote for this mutation and a second new incompletely defined mutation affecting LCAT expression as defined by reduced mass and activity in plasma.

Aged↗
PubMed1999

Intravenous magnesium reduces infarct size after ischemia/reperfusion injury combined with a thrombogenic lesion in the left anterior descending artery.

Experimental studies have demonstrated that intravenous magnesium (Mg) can protect the ischemic myocardium and has an antithrombotic effect. In patients with myocardial infarction, the reperfusion injury is complicated by the presence of a thrombogenic area in the affected coronary artery that may cause repetitive thrombus formation and embolization. We investigated the effect of Mg on infarct size in a randomized study in pigs. Myocardial infarction was induced by a 50-minute mechanical occlusion of the left anterior descending artery combined with an arterial injury, which stimulated a dynamic thrombus formation with emboli shedding on reperfusion. Magnesium sulfate (6 mmol/20 min plus 3 mmol/h) or saline was started at 30 minutes after coronary occlusion. Real-time ventricular pressure-volume loops were generated from the left ventricle by using a microtip pressure manometer and a conductance catheter. Platelet accumulation in the myocardium was evaluated by using 111In-labeled platelets. After 4 hours of reperfusion, the infarct size/area at risk ratio in the placebo group was 46+/-0.06% (n=8) compared with 22+/-0.07% (n=6) in the Mg-treated animals (P=0. 03). Ejection fraction decreased significantly in the control group but not in the Mg-treated animals (P=0.03). Platelet accumulation in the myocardium did not change significantly between the Mg- and placebo-treated animals (placebo group, 191+/-19%; Mg group, 177+/-29%; NS). The present study demonstrates that intravenous Mg infusion is able to reduce infarct size by >50% and preserve the ejection fraction in this model where ischemia/reperfusion injury was evaluated in the presence of a thrombogenic area in the nutrient artery.

Animals↗
PubMed1999

Outcome for cancer patients requiring mechanical ventilation.

PURPOSE: To describe hospital survival for cancer patients who require mechanical ventilation. MATERIALS AND METHODS: A prospective, multicenter observational study was performed at five academic tertiary care hospitals. Demographic and clinical variables were obtained on consecutive cancer patients at initiation of mechanical ventilation, and information on vital status at hospital discharge was acquired. RESULTS: Our analysis was based on 782 adult cancer patients who met predetermined inclusion criteria. The overall observed hospital mortality was 76%, with no statistically significant differences among the five study centers. Seven variables (intubation after 24 hours, leukemia, progression or recurrence of cancer, allogeneic bone marrow transplantation, cardiac arrhythmias, presence of disseminated intravascular coagulation, and need for vasopressor therapy) were associated with an increased risk of death, whereas prior surgery with curative intent was protective. The predictive model based on these variables had an area under the receiver operating characteristic curve of 0.736, with Hosmer-Lemeshow goodness-of-fit statistics of 7.19; P = .52. CONCLUSION: This model can be used to estimate the probability of hospital survival for classes of adult cancer patients who require mechanical ventilation and can help to guide physicians, patients, and families in deciding goals and direction of treatment. Prospective independent validation in different medical settings is warranted.

Critical Care↗
PubMed1999

MRI assessment of the pre-vertebral soft tissues in acute cervical spine trauma.

This pictorial review illustrates the MRI appearances of pre-vertebral haematoma in acute cervical spine trauma. The review is based on 31 patients who underwent MRI within 5 days of injury. MRI showed pre-vertebral haematoma in 24 cases; soft tissue thickening was detected on conventional radiographs in 14 cases. MRI is more sensitive than radiography for the detection of pre-vertebral haematoma.

Cervical Vertebrae↗
PubMed1999

The higher risk of bleeding in lung transplant recipients from bronchoscopy is independent of traditional bleeding risks: results of a prospective cohort study.

STUDY OBJECTIVE: To determine whether recipients of lung transplants have a higher risk of bleeding from fiberoptic bronchoscopy (FOB) than other patients who undergo the procedure. DESIGN: Prospective cohort study. SETTING: Bronchoscopy services of Johns Hopkins Hospital, a tertiary referral center and Johns Hopkins Bayview Medical Center, a community hospital. PATIENTS: All adult patients (18 years) who underwent FOB between July 1, 1996 and June 30, 1997 by the full-time pulmonary medicine staff were included. A total of 720 procedures were performed, including 38 in lung transplant recipients. MEASUREMENTS: Bleeding was assessed by reviewing physician reports of bloody drainage after the procedure and whether the procedure was terminated early for bleeding. Patient reports of hemoptysis were assessed using questionnaires administered pre- and post-FOB. Predictor variables included patient demographics, bleeding parameters (platelets, prothrombin time, and activated partial thromboplastin time), immunosuppressive medications, aspirin use, use of transbronchial biopsy, and the time length of the procedure. RESULTS: Lung transplant recipients were significantly more likely to have used aspirin prior to FOB (18.4 vs 7.2%, p < 0.05) and to undergo transbronchial biopsy (64.9 vs 26.8%, p < 0.001). Lung transplant patients were more likely to have new or worsened hemoptysis (53.8 vs 24.6%, p < 0.001), to have > 25 mL of blood loss (44.5 vs 17.5%, p < 0.001) and to have the procedure terminated early for bleeding (5.4 vs 1.0%, p < 0.05). In multivariate analysis, predictors of new or worsened hemoptysis included lung transplant, longer procedure time, and older patient age. Independent predictors of greater blood loss included lung transplant, performance of transbronchial biopsy, longer procedure time, and older patient age. CONCLUSIONS: Lung transplant recipients are at higher risk of bleeding from bronchoscopy than are other patients. This propensity to bleed is independent of coagulation parameters, platelet count, immunosuppressive medication use, aspirin use, or performance of transbronchial biopsy. The higher risk of bleeding should be considered when assessing the risks and benefits of bronchoscopy in lung transplant recipients.

Adult↗
PubMed1999

Differential expression of thyroid hormone receptor isoforms is strikingly related to cardiac and skeletal muscle phenotype during postnatal development.

The genomic actions of thyroid hormones (THs) are mediated by receptors (TRs) that are encoded by two protooncogenes, c-erbA-alpha and c-erbA-beta. The precise functions of the TR isoforms are unclear and this study focuses on the potential roles of the TRalpha and TRbeta isoforms in mammalian striated muscles postnatally. The porcine TRalpha1, TRalpha2 and TRbeta1 cDNAs were first cloned, sequenced and characterised by Northern blotting. A quantitative analysis of TR isoform expression was then undertaken, using RNase protection analysis with novel riboprobes designed to detect relative expression levels of TRalpha1, TRalpha2, TRbeta1 and TRbeta2, in functionally distinct muscles from 7-week-old pigs kept under controlled conditions of nutrition and thermal environment. We found a striking muscle-specific pattern of TRalpha isoform distribution: in heart the mRNA level of TRalpha2 (non-TH binding) was markedly greater (P<0.01) than that of TRalpha1 (TH binding); in longissimus dorsi the opposite pattern of expression occurred (TRalpha1>TRalpha2, P<0.001); in soleus, diaphragm and rhomboideus there were no differences between the two isoforms. The overall abundance of TRbeta was very much lower than that of TRalpha, and TRbeta1 was expressed at a higher level than TRbeta2 in all muscles. Together with recent data from TR gene inactivation studies and the established role of TH in determining myosin heavy chain isoform expression and muscle phenotype, these results suggest a role for differential expression of TR isoforms in acquisition and maintenance of optimal cardiac and skeletal muscle function.

Amino Acid Sequence↗
PubMed1999

Breast-feeding initiation: predictors, attitudes, and practices among blacks and whites in rural Mississippi.

OBJECTIVES: We attempted to determine the incidence, predictors, attitudes, and practices of breast-feeding initiation among women in a low-income rural Mississippi community. METHODS: We interviewed 420 new mothers regarding breast-feeding. RESULTS: Ninety-six women (24%) initiated breast-feeding. More whites (44%) than blacks (20%) initiated breast-feeding. Of those 96, 59% planned to breast-feed for <6 months and 38% for 6 to 12 months. Among women who breast-fed, 78% said they did so because it was healthier. Among those not breast-feeding, most (48%) specifically stated, "I have no reason," while 20% hated the idea and 19% lacked time. About 73% of all women had been encouraged to breast-feed by nonphysicians (83%). For both races, the most significant predictor was a breast-feeding friend or relative. CONCLUSION: Breast-feeding rates in the Mississippi Delta are low, especially among blacks. Effective education programs are needed to increase these rates, and such programs should include friends, spouses, relatives, and significant others.

Adult↗
PubMed1998

General practitioner's perceptions of the route to evidence based medicine: a questionnaire survey.

OBJECTIVES: To determine the attitude of general practitioners towards evidence based medicine and their related educational needs. DESIGN: A questionnaire study of general practitioners. SETTING: General practice in the former Wessex region, England. SUBJECTS: Randomly selected sample of 25% of all general practitioners (452), of whom 302 replied. MAIN OUTCOME MEASURES: Respondents' attitude towards evidence based medicine, ability to access and interpret evidence, perceived barriers to practising evidence based medicine, and best method of moving from opinion based to evidence based medicine. RESULTS: Respondents mainly welcomed evidence based medicine and agreed that its practice improves patient care. They had a low level of awareness of extracting journals, review publications, and databases (only 40% knew of the Cochrane Database of Systematic Reviews), and, even if aware, many did not use them. In their surgeries 20% had access to bibliographic databases and 17% to the world wide web. Most had some understanding of the technical terms used. The major perceived barrier to practising evidence based medicine was lack of personal time. Respondents thought the most appropriate way to move towards evidence based general practice was by using evidence based guidelines or proposals developed by colleagues. CONCLUSION: Promoting and improving access to summaries of evidence, rather than teaching all general practitioners literature searching and critical appraisal, would be the more appropriate method of encouraging evidence based general practice. General practitioners who are skilled in accessing and interpreting evidence should be encouraged to develop local evidence based guidelines and advice.

Attitude of Health Personnel↗
PubMed1998

Signaling and adhesion activities of mammalian beta-catenin and plakoglobin in Drosophila.

The armadillo protein of Drosophila and its vertebrate homologues, beta-catenin and plakoglobin, are implicated in cell adhesion and wnt signaling. Here, we examine the conservation of these two functions by assaying the activities of mammalian beta-catenin and plakoglobin in Drosophila. We show that, in the female germ line, both mammalian beta-catenin and plakoglobin complement an armadillo mutation. We also show that shotgun mutant germ cells (which lack Drosophila E-cadherin) have a phenotype identical to that of armadillo mutant germ cells. It therefore appears that armadillo's role in the germ line is solely in a complex with Drosophila E-cadherin (possibly an adhesion complex), and both beta-catenin and plakoglobin can function in Drosophila cadherin complexes. In embryonic signaling assays, we find that plakoglobin has no detectable activity whereas beta-catenin's activity is weak. Surprisingly, when overexpressed, either in embryos or in wing imaginal disks, both beta-catenin and plakoglobin have dominant negative activity on signaling, an effect also obtained with COOH-terminally truncated armadillo. We suggest that the signaling complex, which has been shown by others to comprise armadillo and a member of the lymphocyte enhancer binding factor-1/T cell factor-family, may contain an additional factor that normally binds to the COOH-terminal region of armadillo.

Animals↗
PubMed1998

Model Analysis of Spatial Patterns in Mountain Pine Beetle Outbreaks.

The mountain pine beetle [MPB, Dendroctonus ponderosae Hopkins (Coleoptera: Scolytidae)] is an aggressive bark beetle, one that typically needs to kill host trees in order to successfully reproduce. This ecological adaptation has resulted in an organism that is both economically important and ecologically significant. Even though significant resources have been expended on MPB research, and a great deal of knowledge exists regarding individual aspects of MPB ecology, some of the most basic questions regarding outbreaks remain unanswered. In our opinion, one reason for the lack of synthesis and predictive power is the inadequate treatment of spatial dynamics in outbreak theories. This paper explicitly addresses the role of spatial dynamics in the precipitation and propagation of MPB outbreaks. We first describe a spatially dynamic model of the MPB/forest interaction that includes chemical ecology, spatial redistribution of beetles, attack, and resulting host mortality. The model is a system of 6 coupled, partial differential equations with 7 state variables and 20 parameters. It represents an attempt to capture the relatively complex predator/prey interaction between MPB and host trees by including the minimum phenomenological descriptions necessary for ecological credibility. This system of equations describes the temporal dynamics of: beetle attraction as a function of pheromone concentration; the change in numbers of flying and nesting beetles; tree resistance/susceptibility; and tree recovery from attack. Spatial dynamics are modeled by fluxes due to gradients in pheromones and kairomones, and the random redistribution of beetles in absence of semiochemicals. We then use the parameterized model to explore three issues central to the ecology of MPB/forest interaction. The first of these is in response to the need for objective ways to compare patterns of successful beetle attacks as they evolve in space. Simulation results indicate that at endemic levels, the pattern of successful attacks are determined almost exclusively by the underlying distribution of susceptible host trees (environmental determinism). As an outbreak develops, the pattern of successfully attacked trees switches to one that is dynamically driven by the self-generated semiochemical landscape (dynamic determinism). This switch from an environmentally determined spatial pattern to a dynamically driven pattern is the hallmark of an outbreak. We discuss the application of a spatial correlation coefficient that can be used to differentiate between the spatial distribution of killed trees in endemic and outbreak phases. The second issue we address through simulation is synchrony in adult emergence. Synchronous adult emergence is critical for the mass attack strategy necessary for overcoming tree defenses. Results from these simulations indicate that the degree of synchrony in adult emergence can have important consequences for assessing the risk of an outbreak. The final issue we investigate through simulation is the effect of spatial pattern of nurse trees (those successfully attacked the previous year) on outbreak potential. Simulations indicated that the spatial proximity of nurse trees was an important determinant of subsequent successful attacks. We conclude with a discussion of the general implications of our simulation experiments. Copyright 1998 Academic Press.

Journal Article↗
PubMed1998

Silent aspiration after coronary artery bypass grafting.

BACKGROUND: "Silent" aspiration was recognized to be a more frequent complication at this hospital in patients who have had coronary artery bypass grafting than in the general surgical population. METHODS: A case-control retrospective study covering a 4.5-year period was conducted to determine risk factors for pharyngeal dysfunction resulting in silent aspiration. RESULTS: Significant predictors of silent aspiration were age, history of cerebral vascular disease, insulin-dependent diabetes mellitus, myocardial infarction, and chronic obstructive pulmonary disease. Intraaortic balloon pump and number of units of fresh-frozen plasma were the only independent intraoperative factors associated with silent aspiration in a model using continuous variables directly. Cold fibrillation was used in 7 of 53 study cases but no control patients, so it could not be modeled. Postoperative complications occurring with greater frequency included neurologic complications, adverse pulmonary outcomes, repeat surgical interventions, infection, and death. Using an Aspiration Risk Profile developed from the retrospective study, in a detailed prospective study of 10 patients, 3 of 4 patients with postoperative dysphagia had objective evidence of stroke. CONCLUSIONS: These findings suggest that postoperative coronary artery bypass graft dysphagia may be the result of intraoperative cerebral injury, and that careful postoperative clinical evaluation of coronary artery bypass graft patients with risk factors may result in early diagnosis of pharyngeal dysfunction with the goals of preventing silent aspiration and reducing morbidity, mortality, and hospital cost.

Age Factors↗
PubMed1998

The detection of K-ras mutations in colorectal cancer using the amplification-refractory mutation system.

A total of 301 colorectal carcinoma (CRC) archival samples were analysed using the amplification-refractory mutation system (ARMS). Each sample was examined to determine the mutation status of codons 12 and 13 of the K-ras oncogene. The results from direct DNA sequence analysis carried out on 30 of the samples differed from the ARMS result in almost 50% of the cases as a result of the relative excess of wild-type to mutated DNA sequences. To assess the validity of the ARMS data, the polymerase chain reaction (PCR) was used to generate an amplicon from K-ras exon 1 from 23 of the samples. The PCR amplicons were cloned and sequenced, and the DNA sequence analysis of the cloned material was in agreement with the ARMS results in all but one case. This case represented a tumour that exhibited a five-nucleotide reversed inversion. The cloned sequence data confirm the sensitivity and specificity of the individual ARMS reactions and that it is possible in certain cases to detect additional, more complex, sequence variations.

Adenoma↗