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Biomedical subjects

R E Anderson

Publications and source records attributed to R E Anderson.

At least 199 records · Page 11Linked to original sources

The autopsy crisis reexamined: the case for a national autopsy policy.

The use of autopsy in medical practice in the United States has declined drastically over the past 25 years. Physicians conduct post-mortem examinations on less than 12 percent of persons who die in hospitals and on proportionally far fewer people who die at home. Without due assessment of causes of death, pathologists lose opportunities to conduct critical diagnostic exercises, and society fails to obtain accurate health statistics. Medical practitioners, legislators, insurers, and the public should consider diverse features of a national policy for assuring that sufficient numbers of autopsies are competently performed and their findings appropriately employed.

Autopsy↗

Intraventricular infusion of HBGF-2 promotes cerebral angiogenesis in Wistar rat.

The angiogenic effects of chronic intraventricular infusion of basic fibroblastic growth factor (HBGF-2) were assessed in the Wistar rat cerebral cortex. HBGF-2 increased both capillary density and area of perfused vasculature without altering capillary diameters in periventricular cortex adjacent to the site of infusion. Although it has been demonstrated that growth factors can cause brain endothelial proliferation in vitro, this is the first report of in vivo cerebral angiogenesis.

Animals↗

The effect of carbon dioxide on the diameter of brain capillaries.

Cerebral capillaries in cats subjected to variations in carbon dioxide tensions were studied using carbon black perfusion fixation. Five animals each were grouped into hypocapnia, normocapnia, and hypercapnia and 500 cortical, 250 white matter and 250 caudate nucleus capillaries per group were analyzed at 400 x magnification. Capillary diameters were found to change significantly in the cortex (6.1-10.0 microns), white matter (6.5-9.6 microns) and caudate nucleus (6.3-8.8 microns) from hypocapnia to hypercapnia, respectively. These findings suggest that capillary vasomotion occurs and that capillaries are not rigid tubes as previously portrayed.

Animals↗

Unique molecular species composition of glycerolipids of frog rod outer segments.

The composition and metabolism of molecular species of glycerolipids, including phosphatidic acid (PA), phosphatidylinositol (PI) and diacylglycerol (DG), were studied in four frog retinal fractions prepared by discontinuous sucrose gradient centrifugation. Six glycerolipid classes were isolated from the lipid extracts of each fraction and converted to their corresponding 1,2-diacylglycerol acetates by acetolysis for quantitation of their molecular species by HPLC. Rod outer segments (ROS) showed a distinctive molecular species composition in all glycerolipid classes except phosphatidylcholine (PC). The relative amounts of dipolyunsaturated species in ROS were higher in phosphatidylethanolamine (PE), phosphatidylserine (PS), and PA, compared to the other retinal fractions. PI and DG of ROS had a similar molecular species composition and contained only small amounts of dipolyunsaturated species. A unique feature of the molecular species of ROS PI and DG was that they had high amounts of species containing docosahexaenoic acid (22: 6 omega 3), while PI and DG from the other retinal membranes consisted mostly of species containing arachidonic acid (20: 4 omega 6). Following in vitro incubation of frog retinas with [2-3H] glycerol, the mass and radioactivity distributions among molecular species were determined following HPLC fractionation. The unique species composition of PS in ROS is determined mainly by selective translocation from the inner segments to ROS, since the dpm %, representative of newly synthesized species composition of the same glycerolipid classes in the other membrane fractions. This suggests that the distinctive species composition of PE and PA in ROS is determined not by selective translocation from the inner segments, but by remodeling processes taking place in the ROS.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Phosphoinositide metabolism in frog rod outer segments.

Previous studies have shown that vertebrate rod outer segments (ROS) have a light activated phospholipase C which hydrolyzes phosphatidylinositol-4,5-bisphosphonate (PIP2). Three different experimental approaches have been used to test the hypothesis that the phosphatidylinositol (PI) biosynthetic cycle is present in ROS and that PIP2 can be regenerated from DG independent of rod inner segments. In the first study, enzyme activities of the PI cycle were assayed simultaneously in the presence of CTP, myo-inositol and [gamma-32P]ATP using endogenous lipids as substrates. Under these conditions, broken (leaky) ROS prepared by continuous sucrose gradient centrifugation showed PI, PIP and DG kinase activities similar to those found in intact ROS and non-ROS membranes, whereas PI synthetase activity was much lower in the leaky ROS than in the other two fractions. The relative distribution of PI synthetase specific activity in the three membrane preparations was similar to that of the microsomal enzyme marker cytochrome c reductase. ROS prepared by discontinuous sucrose gradient centrifugation showed only 2-3% of whole homogenate PI synthetase or phosphatidyl: cytidyl transferase activities, and the distribution of activities was the same as for microsomal and mitochondrial marker enzymes. In the second study, whole retinas were incubated with myo-[2-3H]inositol or [2-3H]glycerol in vitro, and the time course of incorporation of radioactivity into PI and other phospholipids was determined for ROS and three other retinal fractions. Over a 10-hr period, the rate of incorporation of myo-[2-3H]inositol or [2-3H]glycerol into PI in ROS was lowest among the various retinal fractions. In the third study, chemical analysis of the molecular species composition of PI, DG and phosphatidic acid (PA) from ROS shows that PA is substantially different from PI and DG, the latter two being quite similar. These results are consistent with a precursor-product relationship between PI and DG, but not with the conversion of DG to PA or of PA to PI. Taken together, these three studies indicate that ROS do not have PI synthetase or phosphatidyl: cytidyl transferase activities, but do have DG, PI and PIP kinase activities. Thus, the PI in ROS lost through rapid turnover must be replaced with molecules derived from de novo synthesis in the inner segment of the photoreceptor cell.

Animals↗

Medical uncertainty and the autopsy: occult benefits for students.

The autopsy has been of great importance in educating students regarding medical uncertainty. The marked decline in the use of the autopsy in medical education and continuing education has contributed significantly to the current discomfort among physicians regarding medical uncertainty and medical errors, which, in turn, has furthered the decline of the autopsy. Inordinate guilt, denial, and other defensive behaviors that many physicians marshall in response to uncertainty and error prevent these individuals from learning from their mistakes. The autopsy experience during medical school, properly utilized, helps students to confront fallibility and sets the stage for later successful management of uncertainty and error.

Autopsy↗

Toward a population-based assessment of death due to pulmonary embolism in New Mexico.

During a 5-year period (1981 through 1985), 586 of 46,512 (1.26%) deaths in New Mexico had pulmonary embolism (PE) listed on the death certificate. The frequency of death due to PE was mentioned more frequently in the autopsied than in the non-autopsied component of the study (2.4% v 1.1%). This observation, together with published data on the accuracy of clinical diagnostics among persons dying with autopsy-documented PE, suggests that the frequency of death due to this disease is considerably higher than previously thought. Among autopsied persons who died of PE, risk factors and associated diseases are not appreciably different for those who die in or out of the hospital. Important associations with respect to persons dying of PE include male gender, advanced age, serious medical or surgical disease, immobilization, and trauma.

Adolescent↗

Effects of norethindrone on gonadotropin and ovarian steroid secretion when used for cycle programming during in vitro fertilization.

Norethindrone (NET) has been used for cycle programming and may result in attenuated responses to controlled ovarian hyperstimulation. The effects of NET on gonadotropin secretion, its bioavailability to the ovary, and its effect on ovarian steroidogenesis in vivo and in vitro were assessed. Endogenous secretion of luteinizing hormone and follicle-stimulating hormone was attenuated by 59% and 50%, respectively, after 2 weeks of orally administered NET. Twelve hours after a single 10-mg oral dose, significant levels of NET were measured in samples of peripheral (8.8 +/- 1.9 ng/mL) and ovarian venous blood (10.5 +/- 3.1 ng/mL), follicular fluid (7.1 +/- 2.1 ng/mL), and homogenates of ovarian tissue (8.0 +/- 0.6 ng/g). Furthermore, NET was detectable in follicular fluid 2 weeks after its withdrawal (863 +/- 149 pg/mL). However, there were no effects of NET on follicular fluid levels of estradiol and progesterone in vivo or on luteinized granulosa cell steroidogenesis in vitro. We conclude that when used for cycle programming in in vitro fertilization, NET does not inhibit ovarian steroidogenesis but does affect the hypothalamic-pituitary axis.

Adult↗

The novel dihydronaphthyridine Ca2+ channel blocker CI-951 improves CBF, brain pHi, and EEG recovery in focal cerebral ischemia.

The effects of the novel dihydronaphthyridine Ca2+ antagonist CI-951 on focal cerebral ischemia were assessed during MCA occlusion in 30 white New Zealand rabbits under 1.0% halothane anesthesia. In vivo brain pHi and focal CBF were measured with umbelliferone fluorescence. Baseline normocapnic brain pHi and CBF were 7.02 +/- 0.02 and 48.4 +/- 2.9 ml/100 g/min, respectively. In the severe ischemic regions, 15 min postocclusion brain pHi and CBF were 6.62 +/- 0.04 and 14.4 +/- 0.7 ml/100 g/min in controls vs. 6.60 +/- 0.02 and 12.9 +/- 2.3 ml/100 g/min, respectively, in animals destined to receive CI-951. Twenty minutes after MCA occlusion, CI-951 was administered at 0.5 microgram/kg/min and brain pHi and CBF were determined in both regions of severe and moderate ischemia for 4 h postocclusion. Control severe ischemic sites demonstrated no significant improvement in brain pHi and only mild increases in CBF over the next 4 h. CI-951 caused significant improvement in both of these parameters. Postocclusion 4 h brain pHi and CBF measured 6.69 +/- 0.04 and 18.5 +/- 3.2 ml/100 g/min in controls vs. 7.01 +/- 0.04 and 41.7 +/- 5.3 ml/100 g/min, respectively, in CI-951 animals (p less than 0.001). Similar improvements were observed in moderate ischemic sites. In animals that demonstrated postocclusion EEG attenuation, 75% of CI-951 animals had EEG recovery as compared to 18% in controls. CI-951 may be a useful therapeutic agent for focal cerebral ischemia if histological and outcome studies verify these data.

Animals↗

MK-801 attenuates capillary bed compression and hypoperfusion following incomplete focal cerebral ischemia.

The effects of the N-methyl-D-aspartate (NMDA) antagonist MK-801 on capillary beds and CBF following 1 h of transient incomplete focal cerebral ischemia were studied by examining 133Xe CBF, capillary diameter, and area of perfused vasculature. Capillary diameter increased from a control of 5.24 +/- 0.37 to 8.62 +/- 0.57 microns (p less than 0.001) and area of perfused vasculature from 20,943 +/- 1,151 to 30,442 +/- 1,691 microns2/x 10 magnification field (p less than 0.001) with MK-801 1.0 mg/kg administered 30 min prior to ischemia. After flow restoration in control animals, there was a relative hypoperfusion with eventual normalization of CBF over 60 min. Alternatively, in MK-801 1.0 mg/kg animals, there was rapid normalization of CBF upon flow restoration without the postischemic hypoperfusion observed in controls. On histological analysis, there was consistently less neuronal edema in MK-801-treated animals. These results support the hypothesis that hypoperfusion following incomplete focal cerebral ischemia may be due in part to NMDA-mediated cellular edema with subsequent extravascular capillary bed compression.

Animals↗

Detection and management of pathological, non-palpable, cystic adnexal masses.

Ten patients with normal bimanual pelvic examinations were found to have small, non-palpable adnexal cysts by transvaginal ultrasound examination. After failing to respond to a course of observation and suppressive therapy with combination oral contraceptives, surgical evaluation was performed. In each case, histological examination returned a pathological diagnosis (endometrioma, serous cystadenoma, mature cystic teratoma, inflammatory cyst). This series suggests that transvaginal ultrasonography may be used to detect adnexal pathology before it is clinically apparent. A scheme for management of this clinical entity is proposed.

Adnexal Diseases↗

A comparative study in opening and closing pressures of cerebral aneurysm clips.

Modern aneurysm clips with newer metallurgic properties and state-of-the-art designs have evolved through the years. Regretfully, manufacturers are still not required to provide product information regarding clip strength, and when such information is supplied, there is no interbrand consistency to how it is obtained. This experiment compares the closing pressures of 5 commonly used brands of aneurysm clips: Yasargil, Sugita, Sundt-Kees, Vari-Angle McFadden, and Heifetz. Interclip comparison is also made of opening pressures, that is, the arterial pressure required to open an aneurysm clip. Findings show a distinct difference in closing forces among these brands of aneurysm clips. The study of opening forces indicates that the important factors determining clip release or displacement were the failure of the clip to cross the vessel completely and intrinsic characteristics of the vascular wall.

Constriction↗

Whose realities?

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Humans↗

Use of beta 2-microglobulin level and CD4 lymphocyte count to predict development of acquired immunodeficiency syndrome in persons with human immunodeficiency virus infection.

Serum beta 2-microglobulin (beta 2M) levels were measured by radioimmunoassay in 962 unmarried men recruited by probability sampling from areas in San Francisco, Calif, most severely affected by the epidemic of acquired immunodeficiency syndrome (AIDS). From July 1984 to December 1987, 65 incident AIDS cases occurred in 388 homosexual/bisexual men infected by the human immunodeficiency virus (HIV) at the time of recruitment. The mean level of beta 2M in uninfected individuals at entry was 170 nmol/L. In HIV-seropositive patients who had not developed AIDS, the mean beta 2M level was 254 nmol/L, and in those who had developed AIDS, the beta 2M level was 347 nmol/L. After 36 months of follow-up, 34% of individuals with beta 2M levels greater than 322 nmol/L at entry developed AIDS, 21% of individuals with levels between 246 and 322 nmol/L developed AIDS, while only 7.3% of those with levels below 246 nmol/L developed AIDS. The beta 2M level predicted the development of AIDS independently of the CD4 lymphocyte count in HIV-seropositive individuals. Thus, 65.5% of HIV-seropositive individuals with beta 2M levels above 322 nmol/L and CD4 lymphocyte counts of below 500/microL developed AIDS in 3 years. This represents an 18.4-fold increased relative hazard at 3 years over individuals with beta 2M and CD4 cell counts within the reference range for uninfected individuals. A nomogram is provided that allows the easy calculation of the probability of an HIV-infected person developing AIDS in 36 months depending on prevalent levels of CD4 lymphocytes and serum beta 2M.

Acquired Immunodeficiency Syndrome↗