Care of pregnant women infected with HIV.
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CD4-Positive T-Lymphocytes↗
Biomedical subjects
S Thompson
Publications and source records attributed to S Thompson.
A new percutaneous technique for establishing venous bypass access in orthotopic liver transplantation.
Partial veno-venous bypass (VVB) is commonly used in orthotopic liver transplantation (OLT). Venous access for blood return during VVB classically uses a surgical cutdown on the left axillary vein (LAV), which may prolong operating time and can be associated with significant complications. The authors have developed an alternative means of establishing venous access whereby the anesthesia team places 8.5F venous cannulae preoperatively in one or two vessels (internal jugular, antecubital, or subclavian) percutaneously using the Seldinger technique. These cannulae then serve to accept venous return from below the diaphragm via a centrifugal pump. The aim fo the present study was to compare the hemodynamic profiles obtained during the anhepatic phase of OLT in patients in whom either a conventional LAV catheter (group 1) or percutaneous catheters (group 2) were used for return flow from a centrifugal pump. There were no identifiable complications related to venous access in either group of patients. Total operating room time was 800 +/- 30 minutes in group 1 and 720 +/- 40 minutes in group 2 (P = 0.17). Hemodynamic parameters were determined from continuous strip chart recordings of arterial, right atrial, and inferior vena caval (IVCP) pressures. Cardiac output (CO) was measured by thermodilution whereas pump flow was determined by an electromagnetic probe. Renal perfusion pressure (RPP) was calculated as the difference between mean arterial pressure (MAP) and IVCP. Bypass pump flow was greater, but not significantly different between group 1 (3.0 +/- 0.2 L/min) and group 2 (2.4 +/- 0.2 L/min) (P = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)
Axillary Vein↗
Delayed hemolysis of white cell-reduced red cells.
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Centrifugation↗
Aesthetic facial reconstruction: blending human perception and the facial subunit theory.
Facial reconstructive surgical results play a key role in how an individual accepts themselves and how society accepts the individual. Surgeons must strive to create the most aesthetic results, which includes reestablishing the expected contours, highlights, and landmarks. By understanding the subunits theory, plastic surgical nurses can provide patients with knowledgeable preoperative teaching, and can better anticipate the scope and necessary equipment for each reconstruction.
Anthropometry↗
Integrated health and education input in the development of educational resources about asthma for schools.
The development of educational packages on health-related topics has become common in school curricula. This paper describes an integrated health and education input in the development of an educational package about asthma for Year 8 high school students. Ownership and educational relevance of the package (ensuring its appropriateness for inclusion within the Personal Development/Health/Physical Education curriculum) was achieved by collaboration between teachers with an understanding of the principles of curriculum design and health professionals with content knowledge about asthma. The model used for the production of the package about asthma could be extended to other health topics.
Adolescent↗
The 58,000-dalton cellular inhibitor of the interferon-induced double-stranded RNA-activated protein kinase (PKR) is a member of the tetratricopeptide repeat family of proteins.
PKR is a serine/threonine protein kinase induced by interferon treatment and activated by double-stranded RNAs. As a result of activation, PKR becomes autophosphorylated and catalyzes phosphorylation of the alpha subunit of protein synthesis eukaryotic initiation factor 2 (eIF-2). While studying the regulation of PKR in virus-infected cells, we found that a cellular 58-kDa protein (P58) was recruited by influenza virus to downregulate PKR and thus avoid the kinase's deleterious effects on viral protein synthesis and replication. We now report on the cloning, sequencing, expression, and structural analysis of the P58 PKR inhibitor, a 504-amino-acid hydrophilic protein. P58, expressed as a histidine fusion protein in Escherichia coli, blocked both the autophosphorylation of PKR and phosphorylation of the alpha subunit of eIF-2. Western blot (immunoblot) analysis showed that P58 is present not only in bovine cells but also in human, monkey, and mouse cells, suggesting the protein is highly conserved. Computer analysis revealed that P58 contains regions of homology to the DnaJ family of proteins and a much lesser degree of similarity to the PKR natural substrate, eIF-2 alpha. Finally, P58 contains nine tandemly arranged 34-amino-acid repeats, demonstrating that the PKR inhibitor is a member of the tetratricopeptide repeat family of proteins, the only member identified thus far with a known biochemical function.
Amino Acid Sequence↗
Detection of pooled secretions above endotracheal-tube cuffs: value of plain radiographs in sheep cadavers and patients.
OBJECTIVE: Mechanical ventilation is thought to increase the risk of nosocomial pneumonia by permitting leakage of bacteria-laden gastro-oropharyngeal secretions into the upper airways. The goal of this study was (a) to validate radiographic signs of pooled secretions above endotracheal-tube cuffs (supracuff liquid) in an animal model and (b) to determine whether suctionable pooled supracuff liquid can be identified on bedside radiographs of intubated patients. MATERIALS AND METHODS: Diagnostic criteria for supracuff liquid were initially validated by three radiologists interpreting 162 randomized radiographs made in an intubated sheep cadaver. The primary criteria included (a) replacement of the normal supracuff lucency with liquid opacity and (b) the formation of a sharp interface between the lucency of the upper edge of the cuff below and the liquid above. Graded infusions of 0, 3, 8, 13, and 23 ml of saline were made in triplicate into the space above the cuff, and radiographs were evaluated for the presence or absence of saline. The validated diagnostic criteria were used by two radiologists to estimate the frequency with which pooled liquid was seen on portable chest radiographs of 47 patients undergoing elective short-term postanesthetic mechanical ventilation. RESULTS: In the sheep-cadaver model, the diagnostic criteria for supracuff liquid allowed successful differentiation between no liquid, a small amount of liquid (3-8 ml), and a large amount of liquid (13-23 ml; c2, p < .0001). In a clinical study, radiographic signs of supracuff liquid were identified in 57% of 47 patients. In a small subset of patients (n = 18), the estimated liquid volume (mean +/- SEM) was calculated to be 7.8 +/- 1.1 ml (range = 2.1-18.4 ml). CONCLUSIONS: Radiography is a sensitive means of identifying small volumes of supracuff liquid above the inflated cuffs of endotracheal tubes. Potentially contaminating liquid pooled above the cuff of an endotracheal tube can be identified in about half of patients undergoing short-term mechanical ventilation. Our results suggest the suction of the supracuff space may be a reasonable prophylactic maneuver against nosocomial pneumonia. A much larger study is suggested to investigate the actual relation between pooled supracuff liquid and the development of nosocomial pneumonia.
Adult↗
Inhibition of HIV-1 replication by ribozymes that show poor activity in vitro.
Self-cleaving RNAs (ribozymes) can be engineered to cleave target RNAs of choice in a sequence-specific manner (1). Consequently, they could be used to inhibit virus replication or to analyse host gene function in vivo. However, ribozymes that are catalytic in vitro are generally disappointing when analysed in cells unless expressed at high levels relative to their target RNAs (2, 3). Here we provide evidence that this can be overcome by optimizing ribozyme structure using cellular rather than cell-free assays. We show that ribozymes of relatively long flanking complementary regions (FCRs), while poor catalysts in vitro, can produce profound inhibition of HIV replication in cells. By examining a series of ribozymes in which the FCRs vary from 9 to 564 nucleotides, we establish that the optimum length for activity in the cell is > or = 33 nucleotides.
Base Sequence↗
The glycosylation of haptoglobin in rheumatoid arthritis.
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Adult↗
Abnormally fucosylated haptoglobin as a marker for alcoholic liver disease but not excessive alcohol consumption or non-alcoholic liver disease.
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Adult↗
Acute leukemias of different lineages have similar MLL gene fusions encoding related chimeric proteins resulting from chromosomal translocation.
The MLL gene, on human chromosome 11q23, undergoes chromosomal translocation in acute leukemias, resulting in gene fusion with AF4 (chromosome 4) and ENL (chromosome 19). We report here translocation of MLL with nine different chromosomes and two paracentric chromosome 11 deletions in early B cell, B- or T-cell lineage, or nonlymphocytic acute leukemias. The mRNA translocation junction from 22 t(4;11) patients, including six adult leukemias, and nine t(11;19) tumors reveals a remarkable conservation of breakpoints within MLL, AF4, or ENL genes, irrespective of tumor phenotype. Typically, the breakpoints are upstream of the zinc-finger region of MLL, and deletion of this region can accompany translocation, supporting the der(11) chromosome as the important component in leukemogenesis. Partial sequence of a fusion between MLL and the AFX1 gene from chromosome X shows the latter to be rich in Ser/Pro codons, like the ENL mRNA. These data suggest that the heterogeneous 11q23 abnormalities might cause attachment of Ser/Pro-rich segments to the NH2 terminus of MLL, lacking the zinc-finger region, and that translocations occur in early hematopoietic cells, before commitment to distinct lineages.
Acute Disease↗
Monosaccharide composition of haptoglobin purified from alcoholic cirrhotic and control sera determined by HPAE.
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Chromatography, Ion Exchange↗
Discrepancies in tuberculin skin test results with two commercial products in a population of intravenous drug users.
Screening for tuberculosis (using the Mantoux test) and human immunodeficiency virus (HIV) was conducted among intravenous drug users (IVDUs) recruited from a San Francisco Bay Area neighborhood. Of 178 IVDUs skin-tested with one commercial purified protein derivative (PPD) preparation, a reaction of > or = 5 mm of induration occurred in 62 (47%) of 133 HIV-negative and 13 (29%) of 45 HIV-positive IVDUs (P = .037). Forty-two IVDUs with an initial PPD reaction > or = 5 mm were retested with a second commercial preparation; 11 (26%) had no reaction (0 mm) on retesting. These 11 were 5 (56%) of 9 HIV-positive and 6 (18%) of 33 HIV-negative persons (P = .038). These discrepancies may be unique to specific lots of product or may reflect more general differences. A degree of caution in evaluating unexpected tuberculin skin test results may be indicated. Response to different tuberculin products by HIV status should be further evaluated.
Acquired Immunodeficiency Syndrome↗
Centrifugal ventricular assist device for support of the failing heart after cardiac surgery.
OBJECTIVE: To determine the morbidity and mortality associated with use of centrifugal ventricular assist devices for postcardiotomy cardiogenic shock and to determine factors that might influence outcome and thus, aid in patient selection. DESIGN: A retrospective study. SETTING: Surgical intensive care unit in a university hospital. PATIENTS: During a 6-yr period, a total of 7,385 adult patients underwent cardiac operations requiring cardiopulmonary bypass. Myocardial protection consisted of single-dose cold crystalloid cardioplegia and continuous topical hypothermia by saline lavage. A total of 72 (1%) patients developed postcardiotomy cardiogenic shock. Of 72 patients, 28 met the institutional criteria and were placed on centrifugal ventricular assist devices. INTERVENTIONS: Twenty-eight adult patients with postcardiotomy cardiogenic shock were supported with centrifugal ventricular assist devices. MEASUREMENTS AND MAIN RESULTS: A total of 15 patients received left ventricular assist devices, five received right ventricular assist devices, and eight received both right and left ventricular assist devices. Mean age of ventricular assistance patients was 50.8 +/- 12.9 yrs (range 22 to 72), and mean duration of ventricular assistance was 2.8 +/- 2.5 days (range 4 hrs to 10 days; median 2 days). Twenty-five complications occurred in 16 patients and included bleeding (13), tamponade (2), systemic embolism (6), seizures (2), and sepsis (2). Nine patients required reexploration for bleeding or tamponade. Nine (32%) of 28 patients were discharged from the hospital. Ventricular assistance for cardiac failure after transplantation was associated with improved survival (p < .10), while age > 50 yrs and postoperative tamponade each showed trends toward association with mortality (p = .10). Survival was not predicted by gender, weight, time on cardiopulmonary bypass, aortic cross-clamp time, urgency of operation, or preoperative congestive heart failure. At 27 +/- 20 months follow-up, all survivors were alive and New York Heart Association functional class I or II. CONCLUSIONS: These results document a low incidence of ventricular assist device use in a surgical practice that employs a relatively simple method of myocardial protection. When postcardiotomy ventricular assistance was necessary, a centrifugal pump was used and successful outcome and satisfactory long-term results were possible in nearly one third of patients. Ventricular assistance for cardiac failure after transplantation was associated with improved survival. Older age is a relative contraindication to mechanical ventricular assistance.
Adult↗
The frequency of reactions to sunscreens: results of a longitudinal population-based study on the regular use of sunscreens in Australia.
Six-hundred-and-three people aged 40 or more years, from Maryborough in central Victoria, were enrolled in a randomized longitudinal study, which required daily application of either a SPF 15+, broad-spectrum, water-resistant sunscreen cream or the cream base without the active ingredients. The study duration was 7 months, from September 1991 until April 1992. One-hundred-and-fourteen (18.9%) of these subjects developed an adverse reaction to the cream they were applying. Patch testing, photopatch testing and scratch testing with the ingredients of the creams revealed that only a small proportion (< 10%) of the inflammatory eruptions were allergic in nature. None of the people tested was allergic to the sunscreen active ingredients. History and examination findings, where available, suggested that the majority of adverse responses were consistent with an irritant reaction, both to the sunscreen preparation and the base cream control. A higher than expected proportion of the people who developed an adverse reaction had a personal history consistent with atopy. Other reactions included acneiform eruptions and contact urticaria. A frequency of reactions to sunscreen preparations of over 15% means that further work is necessary to improve both the formulation of such products, and the manner and conditions under which they are used, to ensure satisfactory compliance.
Adult↗
Evaluation of a commercial enzyme-linked immunosorbent assay (ELISA) kit for serological diagnosis of Helicobacter pylori infection in a group of non-ulcer dyspepsia sufferers.
Helicobacter pylori infection of the stomach is associated with gastritis and peptic ulceration and may be causative. A noninvasive test for this organism might be useful in managing some patients with dyspepsia without the need for further investigation. We have evaluated a new commercially available serological test (Helico-G ELISA, Porton Cambridge, UK) for this infection to assess its diagnostic accuracy in a retrospective study of 115 patients with non-ulcer dyspepsia. Sixty-three of these patients (55%) were found to have H. pylori infection and gastritis on histology. A sensitivity of 81% and specificity of 90% were obtained. No significant fall in the antibody titres was found in a subgroup of 15 patients who were selected to complete a course of triple therapy despite significant improvement in their dyspepsia score and confirmed eradication of H. pylori organism in 80% of these patients. We conclude that the test has limited value in aiding clinical decision of managing patients with dyspepsia.
Adult↗
Group psychotherapy during radiotherapy: effects on emotional and physical distress.
OBJECTIVE: The purpose of this study was to ascertain whether group psychotherapy during radiotherapy for cancer significantly decreases patients' emotional and physical distress. METHOD: Twenty-four patients receiving radiotherapy were randomly selected for group psychotherapy (six patients per group, 90-minute weekly sessions for 10 weeks). Another 24 patients served as control subjects. Each patient was given the Schedule for Affective Disorders and Schizophrenia (SADS) at the onset of radiotherapy, midway through radiotherapy, at the end of radiotherapy, and 4 and 8 weeks after radiotherapy ended. RESULTS: The combined SADS items for depression, pessimism and hopelessness, somatic preoccupation and worry, social isolation and withdrawal, insomnia, and anxiety and agitation were used as a measure of emotional distress. The combined SADS items for anorexia, nausea and vomiting, and fatigue were used as a measure of physical distress. By 4 weeks after the end of radiotherapy, the patients who received group psychotherapy showed significant decreases in both emotional and physical symptoms, and the decreases were greater than those for the control patients. The subjects who initially seemed unaware of their cancer diagnoses had the lowest baseline levels of emotional and physical distress, but 4 weeks after the end of radiotherapy they had high distress levels. CONCLUSIONS: Group therapy may enhance quality of life for cancer patients undergoing radiotherapy by reducing their emotional and physical distress. The degree to which patients acknowledge the diagnosis of malignancy may be a factor in their initial distress level and their response to radiotherapy and group therapy.
Adult↗
Assessing the needs of breast cancer patients and their families.
Patient needs have long been elicited only through the use of customer satisfaction surveys, which unfortunately are not designed to obtain the in-depth information needed to guide the improvement of health care services. Through the use of the integrative group process and the help of many patients and hospital staffs, we developed a needs assessment survey for women with breast cancer. This article outlines this process and the results and discusses how we used these results to create a computer program designed to help women with breast cancer and their families.
Adult↗