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Biomedical subjects

R Fink

Publications and source records attributed to R Fink.

At least 19 recordsLinked to original sources

Genetics of mutations affecting the development of a barley floral bract.

Two groups of mutants that affect the morphology of the lemma, a floral bract of barley, are described. The first comprises phenotypes associated with mutant alleles of calcaroides loci. On the lemma of these mutants, a well-organized neomorphic structure is formed, termed the sac. We provide a morphological description of wild-type (WT) and mutant lemmas, based on scanning electron microscopy (SEM), showing that both consist of similar tissues, but that the mutant is characterized by reversed growth polarity. The sac is a unique structure among grasses, and it is remarkable that recessive mutations at five different genetic loci lead to the same organ. The second group of mutants carry recessive alleles of two leafy lemma genes, both of which are necessary to cause the transformation of the lemma into a structure having all characteristics of a vegetative leaf, as shown by SEM analysis. The presence of sheath, blade, and ligule in the mutant lemma suggests that wild-type lemma development is interrupted at a leaf-like stage. The genes cal a, b, C, d, 23, lel1, and lel2 have now been mapped at precise positions on linkage groups 2, 7, 7, 3, 7, 5, and 7, respectively. The mutants considered in this article are unaffected in other floral organs. A model for lemma development is suggested.

Hordeum

Microsatellite repeats are not randomly distributed within Norway spruce (Picea abies K.) expressed sequences.

A Norway spruce (Picea abies K.) cDNA library obtained from vegetative bud tissue was screened for the presence of (AG)n and (AC)n microsatellite repeats. Ten (AG)n and six (AC)n microsatellites were found, with an average length of 25.5 repeat units. Most of the microsatellites are simple perfect repeats. The microsatellite distribution within the clones is clearly non-random, with different classes of repeats lying in different positions relative to the coding region and in a highly conserved orientation. An estimate of the frequency of dinucleotide microsatellites in expressed regions was obtained, showing that SSRs (simple sequence repeats) are found in genes about 20 times less frequently than in random genomic clones, with (AG)n repeats more frequent than (AC)n repeats. Potential applications of these sequences as expressed region-based molecular markers are shown by developing six SSR markers for the detection of natural variation in Norway spruce populations and testing two of them for the identification of illegitimate progenies from a mapping population.

DNA, Complementary

Prospective follow-up and pulmonary functions from a placebo-controlled randomized trial of ribavirin therapy in respiratory syncytial virus bronchiolitis. Ribavirin Study Group.

OBJECTIVE: To determine any long-term differences in adverse effects and pulmonary function between infants with respiratory syncytial virus and lower respiratory tract infection who were treated with ribavirin and a control group. STUDY DESIGN: Long-term follow-up included enumeration of episodes of respiratory illness, wheezing, and pneumonia and, ultimately, administration of pulmonary function tests (PFTs). Pulse oximetry was done at each visit. During the first 3 years we conducted follow-up in the fall and spring. In years 4 and 5 we conducted 1 visit per year. During years 5 through 7 we conducted PFTs, and starting with year 7 a methacholine chloride challenge was done if forced expiratory volume in 1 second (FEV1) was greater than 70% of predicted value. RESULTS: We prospectively enrolled (December 1983 to February 1985) in a randomized trial of ribavirin vs placebo children who were previously healthy, were premature, or had chronic pulmonary disease. One pulmonologist (R.F.; blinded) scored and interpreted the results of the PFTs. We studied 42 patients aged 1 to 33 months; 2 patients died (1 receiving ribavirin and 1 receiving placebo) and 5 patients receiving placebo were lost to follow-up; 35 patients (24 taking ribavirin and 11 taking placebo) attended 212 visits. Four patients were premature (3 in the ribavirin and 1 in the placebo group), and 3 of these had bronchopulmonary dysplasia (2 in the ribavirin and 1 in the placebo group). From years 1 to 3, there was more reactive airway disease, wheezing, and pneumonia in the placebo than in the ribavirin group (mean score, 22.3 for 12 placebo-treated patients vs. 15.8 for 23 ribavirin-treated patients; P = .07 by Kruskal-Wallis test); for all years, it was 22.0 for 11 placebo-treated patients vs. 16.0 for 22 ribavirin-treated patients (P = .10). After informed consent was given, 19 patients completed PFTs (13 receiving ribavirin and 6 receiving placebo); 7 of 13 ribavirin-treated patients (53%) had normal or mild PFT results vs. 0 of 6 placebo-treated patients (P = .04 by Fisher exact test). On methacholine challenge (7 ribavirin-treated patients and 5 placebo-treated patients), there was more reactivity in the placebo vs. the ribavirin group (exact P = .07). Scoring done by weighting for severity for 19 patients (13 ribavirin-treated patients and 6 placebo-treated patients) (even after correcting for asthma) showed a significant difference in favor of previously ribavirin-treated patients (exact P = .02). CONCLUSIONS: No outward effects were identified from ribavirin exposure. We observed no increase in reactive airway disease, wheezing, and pneumonia in the ribavirin compared with the placebo group. Weighted severity scores suggest long-term beneficial effect of ribavirin therapy; however, larger numbers should be evaluated.

Antiviral Agents

Total colectomy for Crohn's disease.

BACKGROUND: Total colectomy for Crohn's disease of the colon may be restorative with ileorectal anastomosis or with an ileostomy and rectal stump. The present paper retrospectively audits the results of total colectomy and in particular assesses the number of patients who had a permanent ileostomy and whether this was related to disease in the rectum at the time of the original operation. METHODS: A retrospective case note review was undertaken of patients operated upon between 1968 and 1994. RESULTS: Thirty-eight patients were identified (mean age 35 years; range 17-65 years). One patient died perioperatively from an anastomotic leak. Median follow-up for the remaining patients was 7 years (range 1-29 years). Ileorectal anastomosis was performed in 17 patients and total colectomy and ileostomy in 20 patients. Indications for surgery were failure of medical treatment (61%); toxic colitis (18%); abscess (8%); perforation (5%); large bowel obstruction (5%); and colovesical fistula (3%). Subsequent proctectomy (14 patients, 38%) was more likely with subtotal colectomy and ileostomy (nine patients, 45%) than ileorectal anastomosis (five patients, 29%). This was not statistically significant (P = 0.33). Additionally, seven patients had diversion of the rectum making 21 with an ileostomy (57%). Rectal involvement at the time of the original procedure significantly increased the likelihood of permanent ileostomy (P = 0.001). The presence of anal disease did not increase the prospect of ileostomy. One patient died with advanced adeno carcinoma in a defunctioned rectum. CONCLUSIONS: A permanent ileostomy after total colectomy for Crohn's disease is common and significantly more likely with rectal involvement.

Adolescent

Analysis of optimal design configurations for a multiple disk centrifugal blood pump.

A multiple disk centrifugal pump was analyzed as a blood pump for use in cardiac assistance or as a bridge to transplant device. The original configuration consisted of 6 parallel disks with 0.016 inch spacing between disks. This pump suffered from a degradation of flow with increasing afterload. A study was conducted to analyze flow performance as a function of afterload, preload, and motor speed. Configurations were examined including 4, 5, and 6 disks each with spacings of 0.15, 0.20, and 0.25 inches. Flow rates were examined for variations in afterload from 60-130 mm Hg, in preload from 0-20 mm Hg and for motor speeds of 1,250, 1,500, and 1,750 rpm. Analyses of afterload effects were intended to determine those configurations that produced less flow degradation with increasing afterload. Analyses of motor speed effects were intended to determine any configurations that produced greater flow increases with increasing motor speed. A hemolysis study was also performed. Both plasma free hemoglobin and the index of hemolysis were compared to data reported for other centrifugal blood flow devices. Results indicated that a 5 disk configuration with a 0.15 inch spacing produced optimal flow results with minimal degradation at higher afterloads. No optimal configuration based upon motor speed was indicated. Preload effects on pump performance were minimal. Hemolysis results indicated minimal blood damage with levels below those of many other centrifugal blood pump designs.

Animals

Localized fibrous nodular mesothelioma of the pelvis.

We present a case of localized fibrous nodular mesothelioma of the pelvis. There is one previously reported case of this uncommon pelvic tumor. We review and discuss the diagnostic and pathologic findings and relevant literature.

Adult

Approach to the seriously ill or terminal cancer patient who has a poor appetite.

Lack of appetite is a frequent complaint of patients with serious illness and is particularly bothersome to cancer patients and their families. As patients enter the terminal phase of their illness, poor appetite becomes an even more distressing problem that affects not only physical symptoms but also functional, social, and psychological aspects of a patient's quality of life. Family and friends frequently relate a patient's poor appetite as a specific contributor to their perception of lack of health. We have investigated a number of ways to approach the seriously ill or terminal cancer patient who has a poor appetite with education, dietary changes (including the use of smaller, more frequent meals but still providing the patient's favorite foods), and at times dietary supplements. Appetite stimulants such as Megace Oral Suspension (Bristol-Myers Squibb, Princeton, NJ) are used not so much for facilitating weight gain as for adding to the quality of life, including social and psychological well-being, by allowing patients to enjoy foods they like in a social family setting.

Appetite Stimulants

HMO data systems in population studies of access to care.

OBJECTIVES: A review of the current status of HMO data sets and their applicability to population studies of access to care. DATA SOURCES: Publications and reports based on research among different models of HMOs; reviews of HMO quality of care by national organizations; and HMO industry profiles. STUDY DESIGN: Design was a literature review of the content of HMO data sets: completeness of reporting, processing, and reporting. DATA COLLECTION: Publications and publicly available reports were reviewed. PRINCIPAL FINDINGS: Most HMOs are able to aggregate the number of services provided but demonstrate little ability to provide patient profiles. While their content is limited, HMO data sets are significant improvements over indemnity plan data, and where available, their accuracy in measuring health services utilization is superior to that of surveys. There are important differences among HMO delivery systems in their ability to provide useful data for population studies. CONCLUSIONS: A valuable resource, HMO data are limited by their content and the relative inaccessibility to IPAC-HMO information. This could be improved through new financial and technical support to HMOs interested in research.

Community Health Planning

Can gas exchange measurements be used for calculation of nutrient oxidation in mink (Mustela vison) exposed to short-term changes in energy supply?

Nutrient oxidation was calculated from gas exchange measurements for 6 control and 12 flush fed female mink, measured in six consecutive, one week periods. The energy supply to controls and flushed animals in periods 1 and 6 was ca 850 kJ ME/day, and during restriction and flush feeding, it was ca 450 kg ME/day and ca 1300 kJ ME/day, respectively. Over the total experimental period the energy intake was similar in both groups, but it differed significantly between periods in the flushed group. Protein, fat, and carbohydrate oxidation averaged 39, 38, and 21%, of the total heat production (HP), respectively in the control group. During restriction, protein oxidation was ca 35% of HP in flushed animals, then increasing to 55% of HP during the first period of refeeding. High values for fat oxidation were recorded during restriction because of fat mobilization and values were low when feed supply was ample. It was concluded that the calculation method was a good indicative method, but some short-comings were discussed.

Animals

Evaluation of awakening and recovery characteristics following anaesthesia with nitrous oxide and halothane fentanyl or both for brief outpatient procedures in infants.

This study compared recovery characteristics and postoperative ventilatory function when halothane, fentanyl or combination of halothane and fentanyl in addition to N2O were used for intraoperative anaesthesia in term infants undergoing hernia repair as outpatients. Sixty-six full term ASA PS I infants ages 1-12 months were studied. All received inhalation induction with N2O, O2 and halothane, followed by intravenous atropine and atracurium, tracheal intubation, and controlled ventilation. For anaesthesia maintenance, patients were randomized into one of three groups. Group I received 70% N2O, 30% O2 and halothane. Group II received 70% N2O, 30% O2, halothane and 2 micrograms.kg-1 fentanyl. Group III received 70% N2O, 30% O2 and 10 micrograms.kg-1 fentanyl. Awakening times were similar in all three groups, however, Group I patients had significantly shorter recovery and discharge times than those of Group II and III. None of the patients experienced postoperative apnoea or periodic breathing. One patient in Group III experienced two brief episodes of bradycardia not associated with apnoea or arterial desaturation (SpO2 > 90% for greater than 30 s). Decreased SpO2 occurred less frequently in Group I (5.9%) compared to Group II (22.7%) and Group III (19.0%) patients, however, the group differences were not significant. Transcutaneous CO2 (TcCO2) values were not statistically different among the three groups. Pain scores were initially lower in Groups II and III, but at 120 min the differences were not significant. Postoperative apnoea was not observed in this study. SpO2 < 90% and TcCO2 > 9 kPa (70 mmHg) was more common in infants receiving 2 and 10 micrograms.kg-1 fentanyl than in infants receiving halothane and nitrous oxide anaesthesia. Infants < 3 months old did not have a higher incidence of SpO2 < 90% or significantly higher TcCO2 values when compared to infants > 3 months old. Fentanyl in doses used in this study did not prolong awakening time but did prolong recovery and discharge times in outpatient infants.

Ambulatory Surgical Procedures

Anal pathology in patients with Crohn's disease.

BACKGROUND: A distinctive feature of patients suffering from Crohn's disease is a predisposition to develop a variety of anal complications. The aetiology of such conditions is unclear, and the reported incidence of anal involvement in Crohn's disease varies party due to the various criteria used for classification. This study aims to review the management of patients with symptomatic anal pathology associated with Crohn's disease at St Vincent's Hospital, Melbourne. METHODS: A database of 306 patients with Crohn's disease referred to the department between January 1978 and October 1994 was reviewed to identify those patients with symptomatic anal disease. The anal pathology was recorded and classified. Demographic data and the clinical and surgery history of the patient were recorded. RESULTS: Of the 306 patients with Crohn's disease, 129 (42.4%) were identified as having symptomatic anal pathology. Patients were likely to present with anal symptoms after they had been diagnosed as having intestinal Crohn's disease (46.1%). The commonest presentations were perianal abscess (29.5%), anal fissure (27.6%), and low anal fistula (26.7%). A minority of patients presented with high/complex anal fistulae (3.8%), or recto-vaginal fistulae (5.2%). Five per cent of patients had Crohn's disease localized to the anal area. The pattern of intestinal disease in the remaining patients was small bowel 21.1%. small bowel and colon 31.9%, and colon 43.0%. A total of 244 local anal and surgical procedures were performed on these patients; the commonest of these were drainage of an abscess (38.5%), examination under anaesthetic (29.1%), and laying open of a low anal fistula (22.5%). Following surgical treatment, the recurrence rate for perianal abscesses was 13%, and for low anal fistulae 6%. CONCLUSIONS: The majority of patients with Crohn's disease who develop anal pathology have an excellent prognosis. A minority of patients develop complex anal complex anal fistulae and these remain a therapeutic challenge.

Adult

Effect of activated oxygen species in human lymphocytes.

The cytogenetic effectiveness of activated oxygen species (AOS) generated by the superoxide forming xanthine-xanthine oxidase (X/XO) system was studied in human lymphocyte cultures. The observed chromosome damage was exclusively of the chromatid type. In the experiments a clear dependence of aberration induction on XO concentration and exposure time could be demonstrated. While using anti-AOS agents, the H2O2 antagonist catalase and the hydroxyl radical scavenger formate reduced X/XO induced chromosome damage whereas superoxide dismutase (SOD) did not. In the presence of SOD, aberration frequency was even enhanced. The results indicate that the chromosome damage is caused indirectly via H2O2 formation from spontaneous dismutation of superoxide, whereas H2O2 might be reduced intracellularly giving rise to the highly reactive hydroxyl radical. This effect might be enhanced by SOD, possibly by raising the intracellular amount of easily membrane passing H2O2. Thus, referring to chromosome aberrations, SOD, which is generally reported to protect from AOS, is capable of increasing oxygen mediated biological damage. This observation might be explained by the involvement of DNA associated transition metal, like iron or copper ions, in reducing H2O2. DNA bound copper ions, thought to be necessary for maintenance of DNA quaternary structure, might represent a generator complex for the hydroxyl radical by reduction of X/XO derived hydrogen peroxide. This might cause 'site specific damage' to the DNA which is subsequently converted into chromatid-type aberration by S-dependent misreplication and/or misrepair. This is different to the formation of radiation induced chromosome aberrations which arise by an S-phase independent mechanism.

Antioxidants

Crohn's disease: a colon and rectal department experience.

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (ranger 11-93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric fistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%, intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4), 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion, the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.

Adolescent

A preliminary flow visualization study in a multiple disk centrifugal artificial ventricle.

Flow patterns in a multiple disk centrifugal pump were analyzed so that the device could be incorporated as a ventricular assist or a bridge-to-transplant device. The pump operates either in pulsatile or steady flow modes with the ability to change modes within a fraction of a second. The pump was tested on a mock circulatory system consisting of an arterial fluid capacitor, a systemic resistor, and a venous capacitor. Arterial volume flow rate, arterial pressure, inlet (venous) pressure, and pump rotation speed are continually monitored. A glycerin/water solution is used as a blood analog. Flow visualization was performed with a 3 mW yellow laser, sheet lens, neutrally buoyant amberlite particles, and both still and motion picture photography. Flow patterns matched theoretical predictions very well; inlet flow spread radially outward through the disk annular spaces while propelled by shear and centrifugal forces.

Blood Cells