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W E Thomas

Publications and source records attributed to W E Thomas.

At least 19 recordsLinked to original sources

Multiple factors influence the binding of a soluble, Ca2+-independent, diacylglycerol kinase to unilamellar phosphoglyceride vesicles.

We studied the influence of membrane lipids, MgCl2, and ATP on the ability of a soluble diacylglycerol kinase to bind to 100-nm lipid vesicles. The enzyme did not bind detectably to vesicles that contained phosphatidylcholine alone or to vesicles that contained 50 mol % phosphatidylcholine + 50 mol % phosphatidylethanolamine. But it did bind to vesicles that contained anionic phosphoglycerides, and maximal binding occurred (in the presence of MgCl2) when the vesicles contained anionic phosphoglycerides alone. When increasing amounts of phosphatidylcholine were included in phosphatidylserine-containing vesicles, enzyme binding to the vesicles decreased by as much as 1000-fold. However, when increasing amounts of phosphatidylethanolamine were included in phosphatidylserine-containing vesicles, little change in binding occurred until the concentration of phosphatidylserine was reduced to below 25 mol %. These results and results obtained with vesicles that contained various mixtures of anionic phosphoglycerides, phosphatidylcholine, phosphatidylethanolamine, and unesterified cholesterol provided evidence that anionic phosphoglycerides were positive effectors of binding, phosphatidylcholine was a negative effector, and phosphatidylethanolamine and unesterified cholesterol were essentially neutral diluents. Other experiments showed that diacylglycerol and some of its structural analogues also were important, positive effectors of enzyme binding and that addition of ATP to the medium increased their effects. The combined results of the study suggest that the enzyme may bind to vesicles via at least two types of binding sites: one type that requires anionic phospholipids and is enhanced by Mg2+ but inhibited by phosphatidylcholine, and one type that requires diacylglycerol and is enhanced by ATP.

3T3 Cells

Affinity purification and catalytic properties of a soluble, Ca2+-independent, diacylglycerol kinase.

We used a new procedure that involved selective enzyme binding to lipid vesicles to partially purify a soluble diacylglycerol kinase, then studied the relation between enzyme-vesicle binding and activity in vesicle-based assays. The vesicle-binding procedure required about 2 h, increased the enzyme's specific activity 50-fold with a 50% yield of activity, and combined well with additional purification steps. Studies of the activity of the partially purified diacylglycerol kinase toward vesicle-associated diacylglycerols revealed linear reaction kinetics that reflected enzyme binding to the vesicles; factors known to influence enzyme binding to the vesicles affected enzyme activity only indirectly, not by influencing the diacylglycerol kinase reaction itself. On the other hand, special incubation experiments that caused both substrate depletion in vesicles and enzyme stalling provided evidence that the diacylglycerol kinase could desorb from these vesicles, adsorb to freshly added, substrate-containing vesicles, and resume catalysis of phosphorylation reactions. The molecular basis for this enzyme-vesicle "hopping" behavior remains to be clarified. But enzyme-catalyzed conversion of diacylglycerol to phosphatidic acid may not have been a contributing factor because separate, enzyme-vesicle binding experiments showed that the enzyme had only a marginally higher affinity for diacylglycerol-containing vesicles than it did for vesicles that contained comparable amounts of phosphatidic acid. The combined results of our experiments suggest that the linear rates of diacylglycerol phosphorylation observed in standard assays with diacylglycerol-containing vesicles may have been combined functions of both the rate of enzyme hopping among vesicles and the rate of diacylglycerol phosphorylation by enzyme that was bound transiently on substrate-containing vesicles.

3T3 Cells

Are complications of endoscopic sphincterotomy age related?

BACKGROUND: Endoscopic retrograde cholangiopancreatography sphincterotomy is increasingly performed in younger patients undergoing laparoscopic cholecystectomy. However, the safety of endoscopic sphincterotomy in this age group, relative to that in older patients, is unknown. AIM: To determine whether the development of short term complications following endoscopic sphincterotomy is age related. PATIENTS AND METHODS: A prospective multicentre audit of 958 patients (mean age 73, range 14-97, years) undergoing a total of 1000 endoscopic sphincterotomies. RESULTS: Two deaths occurred, both from postsphincterotomy acute pancreatitis. Postprocedural complications developed in 24 patients: pancreatitis in 10, ascending cholangitis in seven, bleeding in four, and retroperitoneal perforation in three. There were six complications (five cases of pancreatitis and one bleed; 2.2%) and no deaths in the 281 (29.3%) patients aged under 65 years. In comparison, 18 (2.6%) of the 677 patients aged over 65 years developed a complication (cholangitis in seven, pancreatitis in five, bleeding in three, and perforation in three). Patients under 35, 45, 55, and 65 years were not at significantly increased risk of complication than those over these ages (relative risk for those under compared with those over 65 years 0.83, 95% confidence intervals 0.41-1.67, p = 0.74). CONCLUSION: Short term complications following endoscopic sphincterotomy are not related to age. Younger patients undergoing laparoscopic cholecystectomy need not be denied endoscopic sphincterotomy for fear that the risks are greater than if they undergo surgical exploration of the common bile duct.

Adolescent

Extracorporeal shockwave lithotripsy for common bile duct stones.

BACKGROUND: Successful extraction of common bile duct stones after endoscopic sphincterotomy may be achieved in 86-96 per cent of cases. However, some stones are too large to be removed in this manner. This study looks at the role of extracorporeal shock-wave lithotripsy to break up common bile duct stones as an adjunct to sphincterotomy in patients with stones greater than 10 mm in size. METHODS: Twenty-seven patients with large (10-35 mm) common bile duct stones were treated with piezoelectric generated extracorporeal shock-wave lithotripsy (ESWL) following failed stone extraction after endoscopic sphincterotomy (ES). The stones were visualized ultrasonographically and a piezolith 2300 Wolf lithotripter used to administer the shockwaves. RESULTS: Visualized stone fragmentation was reported in 20 of 48 sessions. Clearance of targeted stones was achieved in 18 of the 27 patients, but actual duct clearance was demonstrated in only 17 of the 27. There were few adverse effects and mortality was nil. CONCLUSION: This study concludes that ESWL following failed ES is a useful additional treatment option for very large bile duct stones, but should only be used after surgical risk and past history of biliary disease have been carefully reviewed and found to contraindicate conventional surgical management. An algorithm of treatment options for common bile duct stones is presented.

Adult

Local anaesthesia for major general surgical procedures. A review of 116 cases over 12 years.

Between 1980 and 1992, 116 patients had either a simple mastectomy (32) or intra-abdominal procedures (84) under local anaesthesia (0.5-1% lignocaine with 1:200 000 adrenaline). A wide variety of general surgical procedures were feasible using only supplementary intravenous sedation (54%). Complications were uncommon and related to surgical procedure (three incorrect diagnoses, three procedures impossible) rather than the anaesthetic technique. There were no anaesthetic toxicity or postoperative problems. Local anaesthesia is extremely safe and facilitates larger surgical procedures than is generally appreciated.

Abdomen

Randomized comparison of oral and intravenous fluid regimens after gallbladder surgery.

Numerous studies of post-operative fluid status have utilized sophisticated measurements of electrolyte distribution and fluid shift without relating results to clinical practice. The aim of this prospective randomized study was to investigate the response of patients undergoing abdominal surgery of moderate severity to conservative post-operative fluid administration. Forty-five patients undergoing open cholecystectomy were randomized to receive 2.51 of fluid (1 l normal saline and 1.51 5% dextrose), 1 l of normal saline, or free oral fluids (groups 1, 2, 3, respectively). Serum and urine osmolality and electrolytes were measured pre-operatively and at 24 and 48 h post-operatively. Patients remained in the study irrespective of the urine output. Plasma electrolytes and osmolality remained within normal limits in all three groups despite significant changes in urine electrolyte and osmolality in groups 2 and 3. This confirms that a conservative approach to fluid administration has no detrimental effect on hydration in fit patients with uncomplicated surgery.

Adult

Longitudinal changes in bone mineral density and bone turnover in postmenopausal women with primary hyperparathyroidism.

The aims of this study were to determine 1) whether primary hyperparathyroidism (PHPT) is associated with accelerated bone loss in postmenopausal women, 2) whether bone mineral density (BMD) and bone turnover change to a similar extent with surgery and hormone replacement therapy (HRT) in these patients, and 3) whether biochemical markers of bone turnover measured at baseline can be used to predict the change in BMD in these patients after different therapies. We studied 33 postmenopausal women with PHPT; their ages at the time of study ranged from 48-80 yr (mean +/- SD, 63 +/- 10). Total body (TB), lumbar spine (LS), and femoral neck (FN) BMD and biochemical markers of bone turnover were measured at baseline and 10-30 months (19 +/- 5) after parathyroid surgery, HRT, or no treatment. BMD was measured in 33 age-matched healthy controls at baseline and at a mean of 24 months. Baseline biochemical markers of bone turnover were measured in controls. In PHPT at baseline, the mean z-score of BMD was -1.25 at TB (95% confidence interval, -1.64 to -0.86), -0.95 at LS (-1.37 to -0.53), and -1.30 at FN (-1.65 to -0.95), whereas the mean z score was 0.45 for serum carboxy-terminal propeptide of human type I procollagen (0.02-0.89), 1.05 for bone alkaline phosphatase (0.38-1.71), 2.38 for 24-h urinary excretion of cross-linked N-terminal telopeptide of type I collagen (NTx; 1.63-3.13), and 2.36 for 24-h urinary excretion of galactosyl hydroxylysine (1.97-2.74). After surgery and HRT, BMD increased and bone turnover decreased during the follow-up. In the untreated group, BMD decreased at TB and FN, and levels of bone alkaline phosphatase, NTx/creatinine, and galactosyl hydroxylysine/creatinine increased. When the rate of change in BMD (percentage per yr) was compared with that in the control group, bone gain was significant at all three skeletal sites after surgery and HRT, and bone loss was significant at TB and FN, but not at LS, in the untreated group. There was a weak, but significant, correlation between baseline urinary NTx and the change in femoral neck BMD in the untreated group (r = -0.36; P = 0.05). We conclude that untreated postmenopausal women with PHPT have low BMD resulting from accelerated bone loss at the TB and FN. Surgery and HRT both restore BMD and bone turnover toward normal in postmenopausal women with PHPT. A single measurement of bone turnover is insufficient to predict BMD changes in individual patients with PHPT.

Aged

A preliminary evaluation of an innovative synthetic soft tissue simulation module ('Skilltray') for use in basic surgical skills workshops.

The results of a preliminary evaluation comparing the relative merits of biological (freshly-prepared animal offal tissue) and synthetic (Skilltray) simulation modalities are presented, subsequent to their use during two basic surgical skills courses organised by The Royal College of Surgeons of England and The Royal College of Physicians and Surgeons of Glasgow in September 1995, and at which 18 SHO grade surgical trainees attended. Each trainee completed a questionnaire at the end of the first session on the second day of the course to assist the evaluation. Our conclusions were as follows: 1. The synthetic tissues evaluated provided a useful and functionally reproducible means for learning the basic exercises included in the mandatory skills course. 2. Freshly-prepared animal tissues undoubtedly provided a more "realistic' medium for rehearsing the basic surgical techniques taught. Trainees preferred to use the synthetic tissues initially and then to progress to the fresh equivalents subsequently. 3. The Skilltray provided all the requisite elements for rehearsing basic tissue handling, suturing, and anastomotic techniques in a self-contained, easily transportable module. We would suggest that such a unit be given to each participant to take away at the end of the basic skills course, to enable consolidation of the skills learned. 4. Where the use of fresh tissues is not possible the highly functional nature of the synthetic simulators evaluated make it acceptable then to use them as the only training modality.

Artificial Organs

Cavitation of mesenteric lymph nodes: a rare complication of coeliac disease, associated with a poor outcome.

Five cases are presented, all of which showed peculiar cavitation of mesenteric lymph nodes. Clinically, three presented with abdominal symptoms, a mass or obstruction, warranting laparotomy. Two patients showed cavitating mesenteric lymph nodes at autopsy. Lymph nodes were enlarged with central, partly cystic degeneration; milky fluid exuded from the cut surface. In each case, investigation showed intestinal villous atrophy and splenic atrophy; coeliac disease was confirmed by response to gluten withdrawal. Three patients died, two from cachexia and the other from pneumonia; the other two are alive and well one year and six years after presentation. Review of the literature shows 12 previously reported cases, with a mortality of about 50%. The diagnosis is made by the histopathologist, alerting appropriate treatment. The pathogenesis is unknown.

Adult

Cellular forms and functions of brain microglia.

Consistent with the recent characterization of microglial cells as macrophages, an overall picture for the unique function of these cells in CNS tissue has developed. The microglia are derived from blood monocytes that migrate into the tissue during fetal development and subsequently remain after complete formation of the blood-brain barrier. These monocytes give rise to the ramified microglia of adult tissue through the developmental intermediate of amoeboid microglia. Ramified microglia appear uniquely adapted in contrast to other tissue macrophages based on their stability or lack of turnover and mitotic capability. The ramified cells, while usually downregulated, can convert into active macrophages termed reactive microglia; this conversion appears to occur nonspecifically in response to any injury. Further, reactive microglial cells can fuse to form giant multinucleated cells during viral infections. Each microglia cell form possesses a characteristic morphology and differing functional state with regard to macrophage activity. In their role as tissue macrophages, microglia are involved in immune responses, tissue transplantation, and AIDS dementia complex, as well as many other neurological mechanisms and diseases.

Animals

Who's afraid of informed consent?

OBJECTIVE: To test the assumption that patients will become unduly anxious if they are given detailed information about the risks of surgery in an attempt to obtain fully informed consent. DESIGN: Preoperative anxiety assessed before and after patients were randomly allocated an information sheet containing either simple or detailed descriptions of possible postoperative complications. SETTING: Four surgical wards at two Sheffield hospitals. SUBJECTS: 96 men undergoing elective inguinal hernia repair under general anaesthesia. MAIN OUTCOME MEASURE: Change in anxiety level observed after receiving information about potential complications. RESULTS: Detailed information did not increase patient anxiety (mean Spielberger score at baseline 33.7 (95% confidence interval 31.3 to 36.2), after information 34.8 (32.1 to 37.5); p = 0.20, paired t test). A simple explanation of the facts provided a statistically significant degree of reassurance (mean score at baseline 34.6 (31.5 to 37.6), after information 32.3 (29.8 to 34.9); p = 0.012), although this small effect is likely to be clinically important only in those whose baseline anxiety was high (r = 0.27, p = 0.05). CONCLUSIONS: In men undergoing elective inguinal hernia repair a very detailed account of what might go wrong does not increase patient anxiety significantly and has the advantage of allowing patients a fully informed choice before they consent to surgery, thus reducing the potential for subsequent litigation.

Anxiety

Histochemical evidence for microglia-like macrophages in the rat trigeminal ganglion.

Of the 4 major cell types in CNS parenchyma, microglia appear to serve the unique functional role of tissue macrophages. The distribution of equivalent cells in the PNS is unclear. Recently, the B4 isolectin of Griffonia simplicifolia was shown to bind selectively to microglia as well as to other macrophages under specific conditions. In the present study, this lectin was used to assess the existence of macrophages in the rat trigeminal ganglion. Vibratome sections of fixed ganglia were incubated with horseradish peroxidase (HRP)-conjugated isolectin, an HRP reaction subsequently performed, and sections processed for histology and viewed by light microscopy. Staining activity was found to be localised to a population of cells throughout the ganglion. These cells possessed small oval somata and several thin crenated processes, an appearance typical of ramified microglia. Stained cells also exhibited a regular, evenly spaced tissue distribution similar to CNS microglia. Finally, similar cells were also labelled by thiamine pyrophosphatase histochemistry, a cellular marker for CNS microglia/macrophages. It was concluded that there are microglia-like macrophages in the trigeminal ganglion and that these cells may function in immune reactions.

Animals

Identifying potential gun offenders.

According to the results of a Saulwick Age Poll (The Age, 13 June 1988) one in three Australians aged 18 to 24 would like to have a gun. Many of them join pistol shooting clubs. Target pistol shooting, part of the Olympic Games programme, is a safe sport. It develops self discipline, teaches body control, to make decisions under pressure, how to handle stress and think logically as an individual. There are about 70 pistol clubs in Victoria. Following the rule "prevention is better than the cure" MISC introduced screening of new members. The system--interview, the questionnaire, a probation period--was found during the two year trial period successful as a strategy to identify people who are potential risks to society.

Adult