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Biomedical subjects

S Thomas

Publications and source records attributed to S Thomas.

At least 559 records · Page 31Linked to original sources
PubMed1991

An educational program to improve quality of life for individuals with acoustic neuroma.

Nursing management of the patient with an acoustic neuroma begins during the preoperative period and continues into the rehabilitative phase following hospital discharge. This article describes the process of developing and implementing an acoustic neuroma educational program. Program content was determined by a survey which identified the type of information acoustic neuroma patients wanted before and after surgery. The survey also described the problems patients encountered once home. Included in the program is a preoperative informational video, a discharge booklet, a multidisciplinary rehabilitation group for outpatients and educational sessions for nurses from the hospital and community.

Adaptation, Psychological↗
PubMed1991

Urine calcium excretion, nephrogenous cyclic-adenosine monophosphate and serum parathyroid hormone levels in patients with essential hypertension.

To evaluate the role of calcium and the parathyroid gland in the pathophysiology of essential hypertension, creatinine clearance, urinary excretion of sodium, calcium and nephrogenous cyclic adenosine monophosphate (NcAMP) and serum parathyroid hormone (PTH) levels were measured in 25 newly diagnosed essentially hypertensive patients before institution of any treatment and in 25 age- and sex-matched normal volunteers. While no significant differences in creatinine clearance, serum total calcium levels or 24-hour sodium excretion existed between the two groups, hypertensives had a higher mean (+/- SD) 24-hour calcium excretion rate (199.0 +/- 44.7 vs. 152.8 +/- 33.6 mg, p less than 0.001), a higher mean NcAMP excretion rate (2.54 +/- 0.8 vs. 1.87 +/- 0.5 nmol/100 ml glomerular filtrate, p less than 0.001) and a higher mean serum PTH concentration (1.87 +/- 0.6 vs. 1.53 +/- 0.4 ng/ml, p less than 0.001) than the normotensives. A significant positive correlation existed between calcium and sodium excretion in both hypertensives (r = 0.66, p less than 0.001)) and normotensives (r = 0.67, p less than 0.001), but given the same levels of creatinine clearance and sodium excretion, hypertensives excreted more calcium than normotensives (p less than 0.001)). In both hypertensives and normotensives, serum PTH levels were positively correlated with NcAMP excretion (r = 0.42, p less than 0.05, and r = 0.41, p less than 0.05, respectively) and the ratio of urinary sodium to urinary calcium excretion (r = 0.59, p less than 0.001, and r = 0.75, p less than 0.001), respectively). The above results suggest that in essential hypertension, increased activity of parathyroid glands may occur as a consequence of increased urinary calcium losses which are presumably due to an intrinsic defect in renal calcium handling.

Adult↗
PubMed1991

Mithramycin inhibits SP1 binding and selectively inhibits transcriptional activity of the dihydrofolate reductase gene in vitro and in vivo.

The promoter of the human dihydrofolate reductase (DHFR) gene contains two consensus binding sites for the DNA binding protein Sp1. DNAse protection and gel mobility shift assays demonstrate binding of recombinant Sp1 to both decanucleotide Sp1 binding sequences which are located 49 and 14 base pairs upstream of the transcription start site. The more distal of the two binding sites exhibits a somewhat higher affinity for Sp1. The G-C specific DNA binding drug, mithramycin, binds to both consensus sequences and prevents subsequent Sp1 binding. Promoter-dependent in vitro transcription of a DHFR template is selectively inhibited by mithramycin when compared to the human H2b histone gene. A similar effect is also noted in vivo. Mithramycin treatment of MCF-7 human breast carcinoma cells containing an amplified DHFR gene induces selective inhibition of DHFR transcription initiation, resulting in a decline in DHFR mRNA level and enzyme activity. This selective inhibition of DHFR expression suggests that it is possible to modulate the overexpression of the DHFR gene in methotrexate resistant cells.

Base Sequence↗
PubMed1991

Adrenergic inhibition of carbon dioxide excretion by trout red blood cells in vitro is mediated by activation of Na+/H+ exchange.

We have used a sensitive new technique to assess the mechanism(s) of adrenergic inhibition of rainbow trout (Oncorhynchus mykiss) red blood cell (RBC) carbon dioxide excretion in vitro. The effect was only apparent using blood acidified to simulate metabolic acidosis. Red blood cell CO2 excretion was inhibited in a dose-dependent manner by physiologically relevant concentrations of noradrenaline (10-1000 nmol l-1) or adrenaline (100-1000 nmol l-1). The beta-adrenoceptor antagonist propranolol abolished the inhibitory effect of adrenaline, whereas the alpha-adrenoceptor antagonist phentolamine was without effect. The action of noradrenaline on RBC CO2 excretion was mimicked by the beta-adrenoceptor agonist isoproterenol, but not by the alpha-adrenoceptor agonist phenylephrine. Therefore, adrenergic inhibition of CO2 excretion is mediated by RBC beta-adrenoceptors, presumably of the beta 1 subtype. The Na+/H+ exchange inhibitor amiloride effectively blocked adrenergic stimulation of Na+/H+ exchange (as indicated from measurements of pHe and RBC pHi) and entirely prevented the inhibition of CO2 excretion. Noradrenaline significantly reduced the rate of CO2 excretion even in the presence of the Cl-/HCO3- exchange inhibitor SITS. Therefore, adrenergic inhibition of CO2 excretion is accomplished via activation of RBC Na+/H+ exchange rather than by a direct inhibition of Cl-/HCO3- exchange. The observed relationship between CO2 excretion rates and the RBC transmembrane pH difference (pHe-pHi) and the occurrence of the inhibition only at low pHe provide further evidence of the linkage with RBC Na+/H+ exchange. We suggest that adrenergic activation of RBC Na+/H+ exchange impedes CO2 excretion by causing a rise in intracellular HCO3- levels concurrent with a reduction of intracellular PCO2. The net result is a reduced gradient for HCO3- entry into the RBC in conjunction with a diminution of the outwardly directed PCO2 gradient. Thus, the rate of formation of CO2 from the dehydration of plasma HCO3- is reduced and, in turn, a portion of this CO2 is not excreted but recycled through the red blood cell.

Adrenergic Antagonists↗
PubMed1991

Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty.

Vascular complications after liver transplantation include occlusion or stenosis at the sites of anastomosis in the hepatic artery, portal vein, and vena cava. From our experience with more than 600 liver transplants, vascular stenoses have been identified in 10 patients and treated by balloon angioplasty in nine. Three patients with hepatic artery stenosis and deteriorating graft function were treated by balloon angioplasty with a coaxial technique. A specially designed catheter facilitated a successful femoral artery approach. Portal vein stenoses in three patients resulted in portal hypertension. These were treated by balloon dilatation via transhepatic catheterization of the portal vein. Stenoses of the suprahepatic caval anastomosis were dilated in three patients with severe lower limb edema. Technical success was achieved in all three cases of hepatic artery stenosis with improvement in graft function. Recurrent stenoses in two patients were successfully treated with repeated dilatations. Portal hypertension resolved in two of three patients after portal venoplasty. Dilatation of a caval stenosis resulted in the resolution of leg edema in all three cases. Repeated dilatation was required in one case. No reduction in the portal venous pressure gradient occurred after venoplasty in one case, and an ultimately fatal caval thrombosis developed in one patient with caval stenosis before venoplasty could be performed. Our experience suggests that balloon angioplasty of arterial and venous stenoses complicating hepatic transplantation carries little risk and is a useful procedure for the treatment of these problems.

Adult↗
PubMed1991

[Analysis of the PrP gene in a Tunisian family with Creutzfeldt-Jakob disease].

Results of PrP gene analysis in 5 of 9 members from a Jewish Tunisian family with Creutzfeldt-Jakob disease (CJD) showed a mutation at codon 200 involving substitution of lysine (Lys200) for glutamic acid (Glu200). This observation suggests that Lys200 allele probably tracks with CJD in this family and supports the possible genetic basis of the disease in the Mediterranean cluster. A second PrP variant not associated with Lys200 allele involving a short deletion in the coding sequence has also been found in only one subject.

Creutzfeldt-Jakob Syndrome↗
PubMed1991

Stress incontinence in women. Psychological status before and after treatment.

Sixty-three women with clinical and urodynamic evidence of stress incontinence were evaluated before and after incontinence surgery for symptoms of depression, nervousness, tension, sleep disturbances, decreased appetite, somatic weakness and headaches. Women treated successfully with surgery demonstrated a statistically significant improvement in their subjective psychologic status (P less than .05). Unsuccessful treatment, however, was not associated with a significant change in or deterioration of their symptoms. All the symptoms were evaluated individually to ascertain the specific effects of treatment. Sleep disturbances were significantly improved with successful treatment and worsened with unsuccessful treatment (P less than .05). Tension was significantly improved with successful therapy (P less than .05) but was unchanged if surgery was unsuccessful. Depression became worse with subjectively unsuccessful surgery. Headaches and appetite were not affected by the therapeutic outcome. Therapy can be instrumental in affecting the psychologic status of women with stress incontinence. If the psychologic disability continues after therapy and/or treatment is unsuccessful, a referral for psychologic evaluation should be considered.

Adult↗
PubMed1991

Quality of institutional and community human service programs in Canada and the United States.

This methodological and substantive study was based on Wolfensberger and Thomas' (1983) Program Analysis of Service Systems' Implementation of Normalization Goals (PASSING), a program evaluation method used by teams of trained raters to assess the quality of human service programs. PASSING is based on Social Role Valorization, an internationally influential theoretical and philosophical approach to structuring human services, particularly services for persons with handicaps or other potentially devaluing conditions. The data for this study were derived from a sample of 213 programs evaluated with PASSING during 1983-88 in Canada (45%), the United States (51%), and the United Kingdom (4%). The programs served mainly mentally retarded persons (40%), subgroups of clients with "mixed" (different) impairments and conditions (38%), or psychiatrically impaired persons (6%). The results showed that PASSING has adequate internal consistency and interrater reliability and yields data suitable for statistical treatment with interval-level, parametric procedures. The average level of quality of services in the sample on the total PASSING scale and its five subscales (Program Relevance, Intensity, Integrativeness, Image Projection, and Felicity) was only modest, however. Community group residences (n = 77) were of significantly better quality than community vocational programs (n = 56), and both were superior to institutional residences (n = 20). Also, Canadian programs (n = 76) were of significantly better quality than U.S. programs (n = 77). An outstanding vocational program that was not part of the study sample was used to illustrate concrete ways in which the quality of many human service programs could be greatly improved, typically at little cost.

Activities of Daily Living↗
PubMed1990

Immunity to measles in a large population of varying age. Significance with respect to vaccination.

During a measles outbreak, 660 hospital employees of widely varying ages were screened for immunity to the disease using an automated indirect fluorescent antibody technique. Of these 660 employees, 623 indicated their year of birth; 21 were seronegative and 13 had borderline titers. Of those born before 1957, 7 tested seronegative and 6 were borderline, while 12 of those born between 1959 and 1964 were seronegative and 3 were borderline. There are several possible reasons for these findings. It is concluded that mass immunization of high-risk populations during outbreaks, while effective, is difficult to justify scientifically because only a small percentage of subjects are not immune. If facilities permit, mass screening during outbreaks may be feasible. Preferably, continuous screening and vaccination of susceptible high-risk employees could be performed. Our study also does not validate exclusion from immunization programs those born prior to 1957 in view of the fact that both seronegativity and disease occur in this age group with significant frequency.

Adult↗
PubMed1990

Combined treatment with cyclosporin A and cortisone acetate minimizes the adverse bone effects of either agent alone.

Although cyclosporin A (CsA) and cortisone acetate (CRT) adversely affect bone, their combined effect on bone is unknown. Sprague Dawley rats were therefore administered either vehicle or CsA (7.5 mg/kg/day) by gavage and saline or CRT (2 mg/100 mg/day) by s.c. injection for 28 days. Group A received vehicle plus saline, group B CsA plus saline, group C vehicle plus CRT, and group D CsA/CRT. Serial bloods were sampled over a 28-day period for ionized calcium (Ca), PTH, 1,25 dihydroxyvitamin D (1,25(OH)2D), and bone gla protein (BGP osteocalcin) and tibia were examined on day 28 for histomorphometry. Results were compared with group A. Ca and PTH levels in groups B, C, and D were similar to those in group A during the study period. Group B had lower body weights, elevated levels of BGP, and an increase in 1,25(OH)2D. Group C developed weight loss and a decrease in BGP and 1,25(OH)2D. Group D had weight loss, BGP levels between those of group A and group C, and 1,25(OH)2D values similar to group A. Bone histomorphometry revealed high turnover osteopenia in group B and hyperostosis in group C with a decrease in bone formation and osteoclastlike cells. Combination therapy returned these to control values. In conclusion, the adverse effects of either CsA or CRT on bone in rats are minimized by combined therapy.

Animals↗