Biomedical subjects
Publications and source records attributed to T King.
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A relative cardiac hypertrophy has been observed in newborns chronically treated with dexamethasone. To test the hypothesis--that dexamethasone might alter steroid metabolism within the heart--rat pups were injected with vehicle, corticosterone (dosages 20 or 200 micrograms/pup/injection, or 1 mg/pup/injection) or dexamethasone (5 micrograms/pup/injection) on Day 2-6 and sacrificed on Day 7-8. Injections with dexamethasone in this dosage have induced the cardiac changes in this rat model. 11 beta-Hydroxysteroid dehydrogenase (11 beta-OHSD) activity was assessed in hearts from these adrenally intact rat pups by incubating tissues with 3H-corticosterone 10(-8) M for 60 min. On Day 7-8, controls transformed 10.3% +/- 1.1% (mean +/- SE) of the corticosterone (Compound B) to 11-dehydrocorticosterone (Compound A) generating 1.25 +/- 0.35 x 10(-12) moles A/mg protein (n = 8). Tissues from pups pretreated with corticosterone at all three dosages were not different from controls in percent metabolized and moles A/mg generated. In contrast, hearts from dexamethasone treated pups transformed only 4.5% +/- 1.0% of the corticosterone to A generating 3.19 +/- 0.05 x 10(-13) moles A/mg protein (n = 10) (P < 0.05 versus control in moles/mg protein metabolized). Cultured cardiomyocytes exposed to dexamethasone for 4 days in vitro also decreased their expression of 11 beta-OHSD mRNA. Readily metabolized endogenous glucocorticoids produced little or no effect on developing heart muscle while treatment with dexamethasone, a potent synthetic glucocorticoid, induced relative cardiac hypertrophy and downregulated 11 beta-OHSD mRNA expression and enzyme activity.
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Many nurse educators agree that gerontological content is sorely needed in nursing curricula. Unfortunately, the literature indicates no consensus on what content is essential. Nor do educators agree on how to include gerontological content: some authors argue for a required course; others favor integrated content; still others prefer to address gerontological nursing at the graduate level.
The significance of tightening abutment screws and gold cylinders to osseointegrated fixtures with the correct torque is demonstrated, and a simple relationship between applied torque and screw preload is derived by use of mechanical engineering principles. The principles of a number of tightening methods are outlined and assessments made of their accuracy. The difference between optimum and design torque is highlighted. The necessity and means of achieving optimum torque to ensure a reliable joint in clinical practice is discussed.
Pulmonary embolism (PE) is a common clinical entity, although the signs and symptoms that accompany it are nonspecific. This has led to the development of several diagnostic algorithms for diagnosis of PE. These approaches combine noninvasive tests such as ventilation/perfusion (V/Q) lung scanning, impedance plethysmography, and ultrasound, with invasive techniques such as venography and pulmonary angiography. To investigate the manner in which clinicians select and use these various diagnostic strategies, we retrospectively reviewed 316 consecutive cases of suspected PE to determine the sequence and type of diagnostic strategy employed by clinicians. We found that in the majority of cases, physicians chose not to further pursue a diagnosis of PE if the V/Q scan was nondiagnostic. These results suggest that physician behavior is often at variance with published clinical recommendations and that the implementation of clinical practice guidelines needs to be further examined.
BACKGROUND: Toxic epidermal necrolysis is a distinctive disorder that is readily identified clinically and histologically in advanced cases. Early on, however, toxic epidermal necrolysis may be difficult to identify. Some consider fixed drug eruption a limited form of toxic epidermal necrolysis. METHODS: Direct immunofluorescence was performed on biopsy material of erythematous skin lesions. RESULTS: Diffuse deposition of immunoreactants in the midmalpighian layer was noted. This finding has not been encountered in other disorders studied in our immunopathology laboratory. CONCLUSIONS: Diffuse immunoreactant deposition in the mid-epidermis should suggest a diagnosis of epidermal necrolysis either from toxic epidermal necrolysis or fixed drug eruption. Additional cases will need to be assessed to document the usefulness of this pattern for prospective diagnosis.
The presence or absence of horns in Bos taurus is thought to be under the genetic control of the autosomal polled locus, characterized by two alleles: P dominant over p, and causing the polled or hornless phenotype. We have demonstrated genetic linkage between the polled locus and two microsatellite markers, GMPOLL-1 and GMPOLL-2, and have assigned the corresponding linkage group to bovine chromosome 1. This confirms the existence of the postulated polled locus and the hypothesized inheritance pattern. It will allow marker assisted selection for the polledness trait in breeding programs and is a first step towards positional cloning and molecular study of a gene that has been subjected to both natural and artificial selection.
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A sero-epidemiological survey for heartwater was organized in 1992 in the Lesser Antilles, from Grenada to Saint Martin. Blood from about one percent of the ruminant livestock of the islands was randomly sampled and the sera were tested with an indirect ELISA. The percentage of positive sera was found to be 30% in Guadeloupe, 25% in Antigua, 2.2% in St.Martin, 1.3% in St. Kitts & Nevis, 3.8% in Montserrat, 1.7% in Dominica, 1.5% in St.Lucia, 1.5% in St.Vincent, 3.5% in Barbados, 2.9% in Grenada and 7% in Martinique. Ruminants from Guadeloupe and Antigua are known to be infected with heartwater. The low percentage of positive sera and the absence of clinical cases in the other islands strongly suggest that positive sera in these islands are probably due to non-specific cross reactions between Cowdria and other micro-organisms (possibly Ehrlichia) which remain to be isolated. In particular, the high percentages of positive sheep sera in Martinique (15%) and Montserrat (11%) should be further investigated.
An innovative curriculum has been designed for the Fiji School of Medicine to enable dental personnel to proceed through a sequence of educational modules on a career path leading from a dental assistant through other auxiliary grades to a dentist with a BDS degree. The courses for each grade are formulated to be relevant to the pattern of oral diseases in Fiji and the Pacific Islands; be designed in accordance with specified job-descriptions; have a strong community orientation, with emphasis on prevention and the promotion of oral health; permit exit and re-entry at each level; incorporate, where appropriate, the principle of problem-based learning; and incorporate procedures to ensure early establishment of clinical skills. Details of the first year and an outline of the structure of the course for the subsequent years are presented.
The role of cytokines in the growth and spreading of human hematologic malignancies has been underlined in recent years. Here we report evidence that a human 12-kDa B cell growth factor (BCGF-12KD) may function as a growth stimulatory factor in B cell chronic lymphocytic leukemia (B-CLL). First, recombinant BCGF-12KD induced dose-dependent DNA synthesis in neoplastic B cells of four B-CLL patients tested. Second, seven different B-CLL clones secreted a BCGF-12KD-like product that accounted for their proliferation. A neutralizing monoclonal antibody (mAb; Ac8) directed against a BCGF-12KD synthetic peptide inhibited the spontaneous growth of the leukemic B cells. The same mAb blocked DNA synthesis in normal tonsillar B lymphocytes induced by the culture supernatant of spontaneously proliferating B-CLL cells. Finally, BCGF-12KD mRNA was expressed in freshly isolated (two of three patients) as well as in vitro proliferating B-CLL cells (three of three patients). These findings strongly suggest that BCGF-12KD can modulate the growth of B-CLL cells in vivo as well as in vitro. They may offer significant insights into the biology of this frequent B lymphoproliferative disorder.
We examined the distribution of colonic mucosal mast cells in 25 patients with active ulcerative colitis, with a clear line of demarcation separating active inflammation from normal mucosa. Biopsies, at least one adjacent to the line of demarcation, one in inflamed mucosa, and one above were obtained during colonoscopy. Eight patients had elevated mast cells throughout the colon, and 12 had increased numbers at the line of demarcation of disease. Mean numbers of mast cells from these patients were 6.3 (+/- 2.1 SD) in active inflammation, 19.5 (+/- 7.1 SD) at the line of demarcation, and 15.8 (+/- 8.4 SD) in normal mucosa. Histologic inflammation decreased as mast cells increased. The accumulation of mast cells at the visible line of demarcation between normal and abnormal mucosa suggests mast cells play a critical role in either accelerating the process of inflammation or in suppressing continued extension of the disease.
To study the efficacy of an immediate postoperative prosthesis (IPOP) program, a retrospective review of 167 major lower-extremity amputations was performed. Patient enrollment in the IPOP program was based on the individual's potential for rehabilitation and participation in an aggressive postoperative physical therapy regimen, as determined by the surgeon, prosthetist, physical therapist, and social worker. Indications for amputation were intractable infection and/or severe unreconstructable arterial insufficiency. Sixty-five patients underwent 69 amputations with IPOP (59 below knee; 10 above knee). Successful program completion was defined as independent ambulation and occurred in 86% of those patients enrolled. The average interval from amputation to ambulation was 15.2 days for the below-knee amputees and 9.3 days for the above-knee amputees. Failure to complete the program occurred in 14% of patients and was due to noncompliance, stump infection, stump trauma, and death. The results of this review support the use of IPOP after major lower-extremity amputation.
A case of reversible vasospasm is reported in a 54-year-old man with a closed bimalleolar ankle fracture. On admission the patient had normal distal pulses and laboratory studies. He was a heavy smoker who continued to smoke in the hospital. Deep venous thrombosis (DVT) prophylaxis included dihydroergotamine and heparin (DHE-H). In the early postoperative period, marked spasm of all three arteries developed on the operative side. Smoking privileges and DHE-H were discontinued. The vasospasm resolved after intraarterial nitroglycerin. This case suggests an infrequent but potentially limb-threatening complication of DHE-H.
Thirty-two patients undergoing limb salvage procedures for complex vascular and orthopedic injuries of the lower extremity were studied in order to identify prognostic indicators for delayed amputation in this select group. A high incidence of nerve (38%), soft tissue (66%), and remote injury (47%) was noted. A comprehensive and integrated approach to vascular, orthopedic, and plastic reconstruction was utilized. Of the 32 patients studied, 1 (3.1%) died as a result of remote injury and sepsis. Amputation was required in 9 patients (28%), while 13 (56%) of the patients with limb salvage showed persistent functional or neurologic deficits. Infection was the most significant factor associated with amputation (p less than 0.0005) and was not avoided by the perioperative use of antibiotics. Delayed amputation resulted in a significant extension of total hospitalization (p less than 0.005). The authors favor an aggressive approach to limb salvage with IIIC injury but recommend early amputation in the presence of significant nerve disruption. An attentive use of tissue debridement, intravenous antibiotics, and early wound coverage is needed to limit infection.
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