Biomedical subjects
Publications and source records attributed to P Wilson.
We report a new potentially dangerous complication of nasal continuous positive airway pressure applied for the treatment of obstructive sleep apnea syndrome. A middle-aged woman had cerebrospinal fluid leak after using nasal CPAP, with generalized seizures and pneumocephalus. She did fine with conservative therapy for the CSF leak and discontinuation of nasal CPAP.
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In the past decade, changes in health care reimbursement and emphasis on cost containment have changed patterns of health care delivery. Among these changes are the rapid decline of the hospital as the center of care, and an emphasis on managed systems of health care delivery. Health maintenance organizations (HMOs) have grown rapidly, and now control a significant portion of the health care marketplace. As such, HMOs provide nontraditional employment settings for allied health professionals. To date, little is known regarding the status of allied health professionals in the HMO setting. The purpose of this study was to describe the perceived need for nontraditional multicompetent allied health professionals in the HMO setting. Results indicate that group and staff model HMOs have a high number of traditionally prepared allied health professionals. In addition, a large number of these sites employ multicompetent professionals, most of whom receive "in-house" training. Further research regarding the role expectations for such professionals is indicated.
To examine the presence and distribution of oestrogen receptors in the normal breast during the menstrual cycle cytological samples obtained by fine needle aspiration from 69 premenopausal women with normal breasts were analysed immunocytochemically with a monoclonal antibody to oestrogen receptor; samples from 15 postmenopausal women were also analysed. The receptor content of breast cancers from 83 premenopausal women was also determined in relation to when during the menstrual cycle excision was performed. In the normal premenopausal women oestrogen receptors were detected in the nuclei of epithelial cells in 21 out 68 (31%) assessable samples. All 21 of these samples were obtained from the 35 women who were studied during the first half of their menstrual cycle (days 28 to 14). None of the 33 samples obtained during the second half of the cycle contained oestrogen receptors. Samples were assessable in eight of the postmenopausal women, six giving a positive result for oestrogen receptor. Fifty one of the 83 carcinomas were positive for oestrogen receptor, 24 having been excised during the first half of the cycle and 27 during the second half. Production of oestrogen receptor protein is suppressed at the time of ovulation in the normal breast epithelium of premenopausal women. In contrast, breast carcinoma cells either synthesise this protein continuously throughout the cycle or fail to express it despite fluctuations of serum hormone concentrations.
The somatotopic organization of the light touch receptive fields of single unidentified dorsal horn neurons in the lumbosacral spinal cord has been studied in the neonatal cat anesthetized with chloralose. Satisfactory recordings were obtained from single dorsal horn neurons in kittens aged 3-6 days. Reconstruction of recording tracks from pontamine blue dye spots and comparisons of the depths of recording sites with Nissl-stained sections of cord showed that most single-unit recordings were obtained from laminae III and IV of Rexed. In animals of all ages neurons were found which responded briskly to light cutaneous mechanical stimulation. Their receptive fields varied widely in size, being smallest on the distal digits and largest on proximal skin. Receptive field areas were similar in proportion to the size of the hindlimb to those seen in the equivalent region in the adult cat. Because of the shape of the dorsal horn and the relatively narrow dorsal columns in neonatal kittens it proved difficult to locate units with receptive fields on proximal skin. Nevertheless the main features of the somatotopic organization of the dorsal horn were similar to those in the adult cat. Thus the somatotopic map of the kitten showed a medial representation of glabrous skin that was bounded laterally by the representation of the hairy skin of the toes. Proximal skin was represented in the lateral parts of the dorsal horn, a region which was not easily accessible for microelectrode recording. The individual toes were represented in a rostral to caudal sequence such that toe 2 was represented rostrally and toe 5 caudally. Around the toe representation the medial surface of the foot was represented rostrally, the ventrolateral surface caudally, and the dorsal surface laterally. The results indicate that the mature organization of light touch receptive fields of dorsal horn neurons in the lumbosacral cord of the cat is already largely present at birth.
The purpose of this study was to establish the time course and magnitude of changes in 1,25-dihydroxy-vitamin D receptor activity in rat mammary gland during pregnancy and lactation and to correlate these changes with casein production and alkaline phosphatase activity. Marked increases in both 1,25-dihydroxyvitamin D3 receptor and alkaline phosphatase activities were seen towards the end of pregnancy but the time course of these changes was not synchronous. Receptor activity was first detectable at 11 days of pregnancy with a marked rise in receptor levels at 3 days post-partum. Changes in alkaline phosphatase activity more closely correlated with casein production and peak activity was observed at the time of parturition. We conclude that 1,25-dihydroxyvitamin D3 receptor content increases during pregnancy and lactation and may be involved in maintaining milk calcium concentration.
We used a mixture of antisera to prostatic specific acid phosphatase, prostatic specific antigen, epithelial membrane antigen and cytokeratin to examine multiple marrow aspirates from patients with local (15) and metastatic prostatic carcinoma (15), and benign prostatic hypertrophy (10). We found moderate to large numbers of tumor cells in the bone marrow of 11 of 15 (73 per cent) patients with known metastatic disease and small numbers of abnormal cells in 2 of 15 (13 per cent) patients with apparently local disease. No tumor cells were found in patients with benign prostatic hypertrophy, and only 2 patients with metastatic disease had tumor cells in the bone marrow when conventional hematomorphological preparations were examined. These findings suggest that immunocytochemistry can increase the detection rate of metastatic prostatic carcinoma cells. Further followup of larger numbers of patients with local carcinoma will reveal whether the presence of micrometastases denotes a poor prognosis.
This paper examines the impact on adolescence of major cultural changes brought about by the advent of television, the combined threat of Nuclear War and Aids and changes in social values and family structures. The main thesis is that the volume and pace of these contemporary changes have an unsettling effect on internal experience and create conditions in society that replicate those that give rise to the development of narcissistic disturbance in early childhood development. Narcissism is seen as central in adolescence and inadequately modulated in the prevailing "culture of narcissism". An example is given of such disturbance in a young man. The relevance of psychoanalysis as a body of knowledge and as an activity concerned with self and object relatedness is discussed, followed by an illustration of psychoanalysis in practice in a therapeutic community for adolescents, Peper Harow.
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We developed an immunocytochemical technique to visualize the receptors for 1,25-dihydroxyvitamin D [1,25-(OH)2D receptor] in cryostat sections of normal human tissues, using a rat monoclonal antibody (9A7 gamma) to the chick intestinal receptor, which has been found to react with mammalian 1,25-(OH)2D receptors. Localization of the antigen was predominantly nuclear, with little cytoplasmic immunoreactivity. Specific staining was seen in the nuclei of many normal epithelial tissues, including liver, kidney, thyroid, adrenal, gastrointestinal tract, breast, and skin. No nuclear staining was seen when tissue sections were incubated with normal rat immunoglobulin G or when the monoclonal antibody was preincubated with a receptor-enriched chick intestinal cytosol preparation. Our results demonstrate that the receptor for 1,25-(OH)2D is localized in the nucleus and widely distributed in normal human tissues.
Marginal bands were isolated from newt red blood cells and, using monochromatic light from an ultraviolet microbeam, the marginal band microtubules were irradiated in vitro to produce areas of reduced birefringence (ARBs). The ARBs neither moved nor changed shape after they were formed, though the marginal bands sometimes changed shape during the irradiation. Marginal band ARBs were regions in which the microtubules were locally depolymerized, as determined by electron microscopy and immunofluorescence. The action spectrum for producing ARBs on marginal band microtubules in vitro matches very closely the action spectrum for producing ARBs on crane-fly spermatocyte chromosomal spindle fibres in vivo, which indicates that ARBs in vivo are produced by the ultraviolet light acting directly on the microtubules (as opposed to an intermediate component), and confirms, without complications inherent in the fixation of living cells, that ARBs on spindle fibres in vivo are regions in which microtubules are locally depolymerized.
We have developed an immunocytochemical technique to visualize the receptor for 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] in cryostat sections of human breast tumors and normal human breast tissue utilizing a monoclonal antibody (9A7 gamma) to chick intestinal receptor which recognizes mammalian 1,25(OH)2D3 receptor. Specific staining was observed in the nuclei of tumor cells. Previous studies by our group have shown that a high proportion of breast tumors bind radiolabeled 1,25(OH)2D3 and we have confirmed this, demonstrating immunocytochemical 1,25(OH)2D3 receptor in 43 of 55 (78%) of breast carcinomas. No correlation with the presence of immunostainable estrogen receptor was found in these breast cancer specimens. Sections of normal breast showed immunoreactivity in the nuclei of epithelial cells of the lobules and ducts. Our results demonstrate that the receptor for 1,25(OH)2D3 resides predominantly in the nucleus of breast carcinoma cells. The reason for its prominent expression in breast cancers is not yet known but may be related to growth regulation.
We have developed an immunocytochemical staining procedure (ERICA) using a monoclonal antibody to the estrogen receptor (ER) to determine ER status from samples obtained by fine needle aspiration of primary and recurrent breast cancer tissue (cyto-ERICA). ER status was assessable on 214 of 246 smeared aspirates from breast cancer patients. In 143 (66.8%) assessable smears positive nuclear staining was observed but was completely absent in 71 (33.2%) cases. In 107 cases we were able to compare results with those obtained with the quantifiable dextrancoated charcoal (DCC) radioligand binding technique using surgically excised material. We observed qualitative agreement in 53 of 62 (85.5%) of primary specimens and 16 of 16 (100%) recurrent samples compared to the subsequent DCC result on the same sample. Aspirates obtained from new secondary deposits were also assessed and in 16 of 19 (84.2%) cases results agreed with that established previously by DCC on the primary breast tumor. In a further 6 of 10 (60%) cases the cyto-ERICA result obtained from recurrent samples qualitatively agreed with that determined by DCC on a previous recurrent lesion. A comparison of staining of aspirates was also made against frozen tissue sections stained with the monoclonal antibody (tissue-ERICA). Where comparison was made of primary tumor specimens agreement was observed in 40 of 45 (88.9%) of cases while specimens from secondary lesions agreed qualitatively in 14 of 17 (82.3%) of cases. In a small number of samples where tissue-ERICA was performed on an earlier lesion to that aspirated for cyto-ERICA an agreement of 4 of 5 (80%) was observed. This technique shows good sensitivity in demonstrating ER in aspirate specimens, should therefore permit us to determine ER status before surgery for primary breast cancer, and may also mean that surgery for recurrent disease to determine receptor status is no longer necessary.
An immunocytochemical technique has been developed to detect the oestrogen receptor (ER) in samples obtained by fine-needle aspiration of primary or secondary breast carcinoma tissue. 45 (75%) of 60 samples contained sufficient cells for analysis. 19 (90%) of 21 patients who responded to endocrine therapy had samples with ER-positive cells compared with only 7 (39%) of 18 of those who did not respond (p less than 0.001). This test, which causes little pain to the patient and does not need a surgical biopsy, is as accurate as any other method of predicting the response to endocrine treatment in breast cancer.
Extracellular and intracellular recordings were made from antidromically identified spinocervical tract (SCT) cells in the medial part of the lumbosacral dorsal horn in anesthetized cats. The low threshold mechanoreceptive fields (RFs) of 18 cells were mapped during extracellular recording, and for 15 the RF included an area of glabrous skin. Intracellular recordings were made from 6 of these during electrical microstimulation of glabrous skin and all showed excitatory postsynaptic potentials at latencies consistent with conduction over group II primary afferent fibers. The distance from the medial border of the dorsal horn of the recording loci of 12 cells, 4 of which were injected with horseradish peroxidase, was measured. It is concluded that some medially situated SCT cells receive excitatory input from low threshold group II primary afferent fibers from glabrous skin.
The effect of chronic transection of the sciatic and saphenous nerves on the receptive fields of dorsal horn neurons in the L7 segment has been reinvestigated in six cats anesthetized with chloralose. Following nerve transection only a narrow lateral band of dorsal horn contained neurons with light touch receptive fields; these were situated on the proximal part of the hind limb. Dorsal horn neurons situated more than about 0.25 mm medial of the lateral edge (at the level of lamina IV) of the dorsal horn lost their light touch receptive fields, and did not acquire new light touch RFs on the proximal part of the hind limb for as long as 49 days after nerve transection. There was thus no sign of the extensive mediolateral reorganization of somatotopy described by some previous workers. Many affected neurons throughout laminae IV to VI became phasically responsive to mechanical stimulation of unidentified mechanoreceptors in deep tissue (e.g., muscle, tendon, joints, and fasciae) of the proximal part of the limb. Some of these neurons had quite low thresholds to mechanical distortion. A small proportion of neurons in medial lamina V and VI may acquire large, high-threshold cutaneous mechanoreceptive fields on the proximal part of the limb. The relation of these time-dependent changes to the known distribution of primary afferent fibers within the dorsal horn is discussed.
Rats were anaesthetized with ten anaesthetics. Ketamine and enflurane gave the lowest concentration of creatine phosphate and ATP and the highest of lactate in brain, while giving the highest concentration of the high-energy phosphates and the lowest of lactate in skeletal muscle. In general, intraperitoneally-administered anaesthetics gave higher concentrations of creatine phosphate and ATP and lower concentrations of lactate in brain than did the inhalant anaesthetics. The most rapid induction of anaesthesia was achieved with halothane and enflurane, while ketamine gave variable induction times and poor analgesia. Halothane stimulated glycolysis and lowered the concentrations of high-energy phosphates in skeletal muscle.