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Biomedical subjects

T Burke

Publications and source records attributed to T Burke.

At least 127 records · Page 7Linked to original sources
PubMed1981

Noncardiogenic pulmonary edema and invasive cardiovascular monitoring.

When a parturient develops clinical and roentgenographic evidence of pulmonary edema during labor or delivery, the obstetric staff often concludes that iatrogenic overhydration or left ventricular failure is the cause. This impression may be reinforced by increased central venous pressure measurements. Although acute respiratory failure (ARF) (non-cardiogenic pulmonary edema) is well described in the medical and surgical literature, the diagnosis is rarely, if ever, made in the obstetric patient unless aspiration pneumonitis is suspected. Unfortunately the usual historic and clinical findings do not differentiate ARF from cardiogenic pulmonary edema. The diagnosis of ARF is based on the finding of pulmonary edema in the absence of an elevated pulmonary capillary wedge pressure. As invasive cardiovascular monitoring is not usually part of the obstetrician's armamentarium, many cases of ARF may be mislabeled and mistreated as cardiogenic pulmonary edema. Four illustrative cases are presented.

Adult↗
PubMed1980

Hemodynamic monitoring of cardiogenic pulmonary edema complicating toxemia of pregnancy.

Swan-Ganz catheters were used in the care of 3 toxemic parturients who developed pulmonary edema. Initial pulmonary capillary wedge pressures (PCWP) ranged from 22 to 33 torr, indicating decompensated left ventricular failure. Simultaneous central venous pressures were essentially normal. Isolated left ventricular dysfunction was primarily the result of increased afterload and responded to afterload reduction with arteriolar vasodilators. Continued measurement of PCWP permitted the titration of afterload reduction to the levels associated with normal ventricular filling pressures and volume. Since the relationship between right and left ventricular pressures may be disturbed in cardiogenic pulmonary edema, the Swan-Ganz catheter is the preferred method of hemodynamic monitoring in toxemic patients who develop cardiopulmonary dysfunction.

Adult↗
PubMedDate not supplied

Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial.

CONTEXT: The optimal antimicrobial regimen and treatment duration for acute uncomplicated pyelonephritis are unknown. OBJECTIVE: To compare the efficacy and safety of a 7-day ciprofloxacin regimen and a 14-day trimethoprim-sulfamethoxazole regimen for the treatment of acute pyelonephritis in women. DESIGN: Randomized, double-blind comparative trial conducted from October 1994 through January 1997. SETTING: Twenty-five outpatient centers in the United States. PATIENTS: Of 378 enrolled premenopausal women aged at least 18 years with clinical diagnosis of acute uncomplicated pyelonephritis, 255 were included in the analysis. Other individuals were excluded for no baseline causative organism, inadequate receipt of study drug, loss to follow-up, no appropriate cultures, and other reasons. INTERVENTIONS: Patients were randomized to oral ciprofloxacin, 500 mg twice per day for 7 days (with or without an initial 400-mg intravenous dose) followed by placebo for 7 days (n = 128 included in analysis) vs trimethoprim-sulfamethoxazole, 160/800 mg twice per day for 14 days (with or without intravenous ceftriaxone, 1 g) (n = 127 included in the analysis). MAIN OUTCOME MEASURE: Continued bacteriologic and clinical cure, such that alternative antimicrobial drugs were not required, among evaluable patients through the 4- to 11-day posttherapy visit, compared by treatment group. RESULTS: At 4 to 11 days posttherapy, bacteriologic cure rates were 99% (112 of 113) for the ciprofloxacin regimen and 89% (90 of 101) for the trimethoprim-sulfamethoxazole regimen (95% confidence interval [CI] for difference, 0.04-0.16; P = .004). Clinical cure rates were 96% (109 of 113) for the ciprofloxacin regimen and 83% (92 of 111) for the trimethoprim-sulfamethoxazole regimen (95% CI, 0.06-0.22; P = .002). Escherichia coli, which caused more than 90% of infections, was more frequently resistant to trimethoprim-sulfamethoxazole (18%) than to ciprofloxacin (0%; P<.001). Among trimethoprim-sulfamethoxazole-treated patients, drug resistance was associated with greater bacteriologic and clinical failure rates (P<.001 for both). Drug-related adverse events occurred in 24% of 191 ciprofloxacin-treated patients and in 33% of 187 trimethoprim-sulfamethoxazole-treated patients, respectively (95% CI, -0.001 to 0.2). CONCLUSIONS: In our study of outpatient treatment of acute uncomplicated pyelonephritis in women, a 7-day ciprofloxacin regimen was associated with greater bacteriologic and clinical cure rates than a 14-day trimethoprim-sulfamethoxazole regimen, especially in patients infected with trimethoprim-sulfamethoxazole-resistant strains.

Acute Disease↗
PubMedDate not supplied

DNA fingerprinting in birds.

Several regions of the human genome are highly variable in populations because the number of repeats in these regions of a short 'minisatellite' sequence varies at high frequency. Different minisatellites have a core sequence in common, however, and probes made up of tandem repeats of this core sequence detect many highly variable DNA fragments in several species including humans, cats, dogs and mice. The hypervariable sequences detected in this way are dispersed in the genome and their variability means that they can be used as a DNA 'fingerprint', providing a novel method for the identification of individuals, confirmation of biological relationships and human genetic analysis. We show here that human minisatellite-derived probes also detect highly variable regions in bird DNAs. Segregation analysis in a house sparrow family confirms that these regions comprise many mostly heterozygous dispersed loci and we conclude that house sparrow DNA fingerprints are analogous to those of humans. Fingerprint analysis identified one nestling, with fingerprint bands not present in the parent pair's fingerprints, which we conclude resulted from an extrapair copulation. Extrabond copulations have been described in many wild bird species, but their success and hence adaptive significance have rarely been quantifiable. DNA fingerprinting will be of great significance to studies of the sociobiology, demography and ecology of wild birds.

Animals↗
PubMedDate not supplied

Linkage of AD HSP and cognitive impairment to chromosome 2p: haplotype and phenotype analysis indicates variable expression and low or delayed penetrance.

We report linkage of a family affected with autosomal dominant hereditary spastic paraparesis (HSP) and/or cognitive impairment to the HSP locus on chromosome 2p. To date all families linked to this locus have been affected with 'pure' HSP. The specific pattern of cognitive impairment in this family is characterised primarily by deficits in visuo-spatial functions. We also present genetic studies that indicate variable expression and low or delayed penetrance. We have constructed a haplotype flanked by polymorphic markers D2S400 and D2S2331 that was present in 12 individuals affected with spastic paraparesis. The severity of spasticity varied markedly among these individuals. In addition four of these individuals (aged 62-70) also had a specific form of cognitive impairment. The disease haplotype was also present in an individual (age 57) who had an identical pattern of cognitive impairment as the only sign of the disease supporting the hypothesis that spastic paraparesis and cognitive impairment are the result of variable expression of a single gene (rather than a co-incidental occurrence). Haplotype reconstruction for all participating family members revealed the presence of this disease haplotype in six individuals who had normal neurological and neuropsychological examinations. All six are below the maximal age of onset in the family--60 years. This is evidence for low or late penetrance of the AD HSP gene in this family. The identification of normal individuals carrying the disease haplotype demonstrates the importance of genetic studies in combination with clinical examination when counselling at risk family members.

Aged↗
PubMedDate not supplied

Role of exposure databases in risk management.

Despite the development of numerous national exposure-related databases, exposure assessment remains a weak link in the chain of risk assessment and risk-management activities. Most databases include measures of environmental releases or concentrations of pollutants in specific media, but do not include actual measures of exposure. If accurate estimates of exposure experienced by populations or individuals are absent, it is impossible to judge the effectiveness of risk-management strategies. The Risk Management Work Group evaluation identified the following needs: refinement of measurements of total exposure experienced by individuals, improved characterization of the distribution of exposures in the population, longitudinal monitoring of exposure trends, and improved information about the public health implications of exposure. Recommendations are presented with the hope that the utility of existing databases will be improved and that future initiatives will be developed that meet the needs of risk management.

Databases, Factual↗
PubMedDate not supplied

Temporal neocorticectomy in management of intractable epilepsy: long-term outcome and predictive factors.

We report the results of a long-term follow-up study of 50 patients who underwent removal of temporal neocortex with preservation of deeper limbic structures as surgical therapy for intractable temporal lobe epilepsy. The follow-up period ranged from 3 to 15 years. Preoperative EEG investigations were based on interictal discharges alone. Three factors were predictive of a good outcome: (a) A clear unilateral anterior-midtemporal focus (p less than 0.01), (b) stereotypical onset of temporal lobe seizure (p less than 0.005), and (c) greater volume of tissue removed at operation (p less than 0.05). Overall results showed that 62% of patients experienced an outcome of "cure" or "almost cure," as classified according to a modified version of Crandall's criteria (Crandall's I and II). Those who experienced a significant reduction in seizures but who continued to have intractable epilepsy (Crandall's III) were not considered to have had a good result. Overall outcome compares favorably with other that of centers using different surgical approaches and indicates that neocorticectomy is a suitable procedure in a highly selected population even when limited resources are available.

Adaptation, Psychological↗
PubMedDate not supplied

Letter and category fluency in Alzheimer's disease: a prognostic indicator of progression?

This study investigated differential patterns of performance by 40 Alzheimer's disease (AD) patients on standardised letter and category fluency tests. The performance of 24 age and education matched controls was used to classify patients as relatively more letter fluency impaired (L < C, n = 15) or more category fluency impaired (C < L, n = 25), and clinical features distinguishing these patient subgroups were investigated. Category performance was equally impaired in both patient subgroups, whereas the L < C subgroups were particularly impaired on letter fluency. The subgroups differed significantly in duration of illness (24 months for L < C group, 47 months for C < L group; t = 2.69, p = 0.01) but did not differ in global dementia severity, age, education, general language ability, or functional status. Data on annual rate of change (ARC) on the Mini-Mental State Examination were available for 26 patients. While not statistically significant, subgroup ARC differences were suggestive of more rapid decline in the L < C patients, consistent with the finding of shorter duration of illness in this group. Word fluency tests may have potential as early predictors of rate of progression in AD.

Aged↗
PubMedDate not supplied

Myoepithelioma of the retroperitoneum.

An abdominal mass detected in a 36-year-old man was thought from radiologic studies to be a renal neoplasm, but at surgery the kidney was found to be uninvolved. The 9.5-cm retroperitoneal tumor was resected totally and found to be encapsulated, and it appeared to be benign by light microscopy. The pattern of the spindle cells throughout the tumor suggested a cellular schwannoma, but immunocytochemical and ultrastructural studies did not support schwannian differentiation and instead revealed epithelial and smooth muscle features compatible with a myoepithelioma.

Actins↗
PubMedDate not supplied

Cellular schwannoma of the bronchus.

A cellular schwannoma in a bronchus of a 64-year-old female is reported with immunocytochemical and ultrastructural observations. One previous case arising in the lung has been reported. The tumor formed a 3-cm exophytic mass in a segmental bronchus. Pneumonectomy was performed. The tumor was moderately cellular and devoid of Verocay bodies, and the spindle cells were immunoreactive for S-100 protein. Electron microscopy revealed schwannian features that were less developed than in a classic schwannoma.

Bronchial Neoplasms↗
PubMedDate not supplied

Intellectual and educational attainment in albinism.

We studied the intellectual and educational ability of a group of 18 albino children as compared with that of a group of demographically matched controls. Intellectual ability was measured using Raven's Standard Progressive Matrices, and educational ability was measured by the reading, spelling, and arithmetic tests of the Wide Range Achievement Test. There was no statistically significant difference in intelligence of the two groups. However, there was a significant difference in reading, spelling, and arithmetic skills. No correlation was found between the clinical features of the albino children and their performance on the intelligence or educational tests.

Adolescent↗
PubMedDate not supplied

Upper gastrointestinal tolerability of celecoxib compared with diclofenac in the treatment of osteoarthritis and rheumatoid arthritis.

OBJECTIVE: To compare the upper gastrointestinal (UGI) tolerability of celecoxib (a cyclooxygenase-2 specific inhibitor) and diclofenac using data from three randomised, double-blind clinical trials in osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: Patients in two OA studies received either celecoxib 100 mg BID (n = 545), diclofenac 50 mg BID or TID (n = 540), or placebo (n = 200) for 6 weeks. In the RA study, patients received celecoxib 200 mg BID (n = 326) or diclofenac 75 mg BID (n = 329) for 24 weeks. The cumulative incidence of abdominal pain, dyspepsia, nausea or any of these events (UGI tolerability composite endpoint) after the first 6 weeks was estimated using time-to-event analysis. RESULTS: In the pooled OA trials, the cumulative incidence of the composite endpoint was significantly higher with diclofenac (17.6%; 95% CI: 14.4-20.9%) than celecoxib (11.1%; 95% CI: 8.4-13.8%; p = 0.002) and comparable with placebo (13.3%; 95% CI: 8.1-18.4%; p = 0.157). In the PA trial, the cumulative incidence of the UGI tolerability composite endpoint was also significantly higher with diclofenac (20.7%; 95% CI: 16.3-25.1%) than celecoxib (15.9%; 95% CI: 11.9-20.0%; p = 0.013). Celecoxib was also better tolerated than diclofenac in this trial in terms of the cumulative incidences of abdominal pain (p = 0.031) and dyspepsia (p = 0.062). The results of the UGI tolerability composite endpoint analysis were confirmed using the Cox proportional hazards model to controlfor other predictors of UGI adverse events. CONCLUSION: The UGI tolerability of therapeutic dosages of celecoxib was significantly better than diclofenac in patients with RA or OA.

Abdominal Pain↗