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Biomedical subjects

A J Evans

Publications and source records attributed to A J Evans.

At least 19 recordsLinked to original sources
PubMed1994

Anticipatory grief: a theoretical challenge.

The theories of loss and grief described by Freud and Bowlby have provided considerable interest in anticipatory grief. Anticipatory grief is assumed to be akin to post-death grief, but commencing prior to the loss of the loved one. 'Grief work' completed during the anticipatory period is purported to mitigate against abnormal grief reactions after death and enhance adjustment to loss. Research conducted to investigate the link between anticipatory grief and postbereavement adjustment has not, however, yielded conclusive findings. It is argued that the intellectual vision of researchers has been obscured by the traditional view of grief leading to conceptual confusion in the theoretical literature and equivocal findings of the empirical investigations. The limited view of the 'death event' as the only loss incurred fails to consider the past, present and future losses that may occur as a result of terminal disease. The physiological, psychological, interpersonal and sociocultural factors evident in the terminal situation serve to highlight the existence of many previously unconsidered variables which may determine the anticipatory grief experience. Until the influence of these determining variables is acknowledged and researchers learn to look beyond the parameters of the traditional models of grief, the costs and/or benefits of the anticipatory period will remain largely undefined. A good starting point may be the adoption of the alternative label, 'terminal response'.

Adaptation, Psychological↗
PubMed1992

Lipolysis is a prerequisite for lipid accumulation in HepG2 cells induced by large hypertriglyceridemic very low density lipoproteins.

Lipoprotein kinetic studies have demonstrated that a large proportion of Sf 60-400 very low density lipoprotein (VLDL) is cleared directly from the circulation in Type IV hypertriglyceridemic subjects, at an unknown tissue site. The present studies were designed to investigate the role of hepatocytes in this process and to define the conditions, whereby Type IV Sf 60-400 VLDL would induce lipid accumulation in HepG2 cells. Type IV VLDL (Sf 60-400) failed to augment the total cholesterol, esterified cholesterol, or triglyceride content of HepG2 cells following 24-h incubations. Coincubation of bovine milk lipoprotein lipase (LPL) and Type IV VLDL with HepG2 cells induced a 3-fold increment in cellular esterified cholesterol mass (p less than 0.005) and a 7-fold increase in cellular triglyceride mass (p less than 0.005), compared to VLDL alone. The increased cellular lipid mass was associated with increased oleate incorporation into cellular cholesterol esters and triglycerides. Exogenous LPL hydrolyzed 76% of the VLDL triglyceride over 24 h. LPL action on Type IV VLDL was sufficient to promote cellular uptake of these lipoproteins, while elevated media-free fatty acid levels were not. Although HepG2 cells secrete apolipoprotein (apo) E, we assessed the role of VLDL-associated apoE in the lipid accumulation induced by VLDL plus LPL. ApoE-rich and apoE-poor Type IV VLDL subfractions induced similar increments in cellular esterified cholesterol in the presence of LPL, despite a 4-fold difference in apoE content. Sf 60-400 VLDL, from subjects homozygous for the defective apoE2, plus LPL, behaved identically to Type IV VLDL plus LPL. Type IV VLDL plus LPL, preincubated with anti-apoE (1D7) and apoB (5E11) monoclonal antibodies, known to block the binding of apoE and -B, respectively, to the LDL receptor failed to block lipid accumulation. In contrast, apoE-poor Type IV VLDL, apoE2 VLDL, and VLDL plus 1D7 were taken up poorly by J774 cells, cells that secrete LPL, but not apoE. These studies suggest that lipolytic remodeling of large Type IV VLDL by LPL is a prerequisite for their uptake by HepG2 cells and that HepG2 cell-secreted apoE rather than VLDL-associated apoE is the ligand involved in uptake.

Animals↗
PubMed1992

Bisphosphonate space measurement in Paget's disease of bone treated with APD.

The bisphosphonate space (BPS) is a quantitative measurement of skeletal uptake of 99mTc-HMDP. We measured BPS in 36 patients with Paget's disease of bone, both before and 6 months after treatment with intravenous APD (disodium pamidronate) infusions. BPS fell after treatment, but proportionally less than serum alkaline phosphatase (ALP) and fasting urinary hydroxyproline/creatinine (HYPRO). There was no dose-response relationship between the dose of APD given and the percentage reduction in ALP and HYPRO at 6 months. Log dose of APD/pretreatment BPS, however, predicted the percentage reduction in ALP and HYPRO very well, and from the respective regression equations it was possible to predict the dose of APD needed to achieve normal values of ALP and HYPRO. In the 10 patients who achieved a normal ALP and 9 patients a normal HYPRO after more than 6 months treatment with APD (range 7-18 months), the predicted dose of APD agreed closely with the actual dose. In conclusion, our data support the idea that log dose APD/pretreatment BPS is a valid predictor of biochemical response in Paget's disease.

Alkaline Phosphatase↗
PubMed1992

Patterns of breast calcification in patients on renal dialysis.

Patients on renal dialysis are prone to form areas of metastatic calcification in soft tissues. In this study we have analysed the mammograms of 16 women on renal dialysis and compared them with a control group of 32 women attending for routine mammographic screening. We found a significant increase in vascular and parenchymal calcifications in the women on renal dialysis. Ductal calcifications were no more prevalent in the patients on dialysis, and in no case did the calcification simulate malignancy.

Breast Diseases↗
PubMed1992

Relationship between structure and function of dietary fibre: a comparative study of the effects of three galactomannans on cholesterol metabolism in the rat.

Male adult rats were fed on diets containing 80 g/kg galactomannans with different galactose (G): mannose (M) ratios/kg. The galactomannans were compared with purified cellulose (Solkaflok) and the animal were also fed on a basal diet free from fibre. All diets contained cholesterol (10 g/kg) and sodium cholate (2 g/kg). The three galactomannans were fenugreek gum (1G:1M), guar gum (1G:2M) and locust-bean gum (1G:4M). In comparison with the fibre-free and Solkaflok diets, all three galactomannans lowered the concentrations of cholesterol in both liver and blood plasma. The galactomannans also decreased the rate of hepatic synthesis of cholesterol. Dietary galactomannans increased caecal volatile fatty acids, particularly propionic, increased the weight of the caecum and its contents and increased the amount of water in the faeces. The increase in propionic acid production was significantly related to a decrease in caecal pH, but not to changes in plasma cholesterol or hepatic cholesterol synthesis. These effects were significantly influenced by chemical composition and structure of the galactomannan; they were most evident when the proportion of galactose in the galactomannan was highest (i.e. fenugreek gum). The three galactomannans also differed markedly in their effects on the viscosity of the digesta, but the galactomannan which gave the highest viscosity was least effective in lowering plasma cholesterol. A separate experiment with perfused loops of small intestine in vivo showed that the most effective galactomannan, fenugreek gum, had no direct effect on cholesterol absorption.

Animals↗
PubMed1992

Magnetic resonance imaging--cardiac ejection fraction measurements. Phantom study comparing four different methods.

The accuracy of cardiac ejection fraction (EF) measurements with thin, contiguous cine-magnetic resonance imaging (MR) sections is well established. Still, faster imaging and measurement techniques would be desirable. The authors evaluated the accuracy of four different MR EF measurements methods in a biventricular, anthropomorphic, foam-latex rubber phantom which was connected via noncompliant fluid-filled tubing to a pulsatile flow pump. Nine contiguous 10 mm cine-MR sections (TR/TE, 25/13; flip angle, 45 degrees) were obtained through the heart in long and short cardiac axes at 16 frames per cardiac cycle at a pump rate of 60 beats/minute. EF measurements were based on either the multi-slice summation technique (nine contiguous 10-mm sections versus four 10-mm sections spaced 10 mm apart) or the area-length method (single largest long section versus combination of largest long- and short-axis section). Three replications were performed for each of the tested EFs (40.8%, 29.4%, and 13.4%), which were compared with actual EFs. EF measurements based on contiguous 1-cm sections correlated best with the actual EFs. Average relative errors ranged from 3.2% to 6.0%. EF measurements based on every other section were less accurate; average relative errors were between 5.2% and 10.2%. Single and biplane area-length algorithm EF measurements were significantly less accurate; average relative errors were as high as 59%. EF measurements based on multi-slice summation are more accurate than those based on the area-length algorithm. Contiguous 1-cm section acquisitions are most accurate and most time consuming. With slight decrease of accuracy, acquisition and processing times can be halved by skipping every other slice.

Humans↗
PubMed1991

Case report: in utero diagnosis of a vein of Galen aneurysm using colour flow Doppler.

We report the ante-natal diagnosis of a vein of Galen aneurysm using colour flow Doppler at 33 weeks gestation. Ultrasound demonstrated a midline, tubular, echo-free structure superior to the thalamus extending posteriorly. Venous flow was demonstrated within the structure using colour flow Doppler. The diagnosis was confirmed by post-natal sonography. We believe this to be the first ante-natal diagnosis of this condition using colour flow Doppler.

Adult↗
PubMed1991

Cine phase-contrast magnetic resonance imaging for analysis of flow phenomena in experimental aortic dissection.

Using a 1.5 T magnetic resonance imaging (MRI) system, cine phase-contrast and magnitude images were obtained in three phantoms that simulated different anatomic configurations of aortic dissection. The dissection phantoms were made of compliant materials, and pulsatile flow was used in all experiments. Phantoms differed only in the location of the fenestration between the true and false lumens (I: an upstream "entry" only, II: both upstream "entry" and downstream "re-entry," and III: a downstream "entry" only). Flow jets, flap motion, and wave propagation were clearly visualized in cine MR images of each phantom, and quantitatively analyzed with reference to the stimulated cardiac cycle of the pump. Flow in the false lumen was always bidirectional. Upstream and downstream flow waves collided and dispersed within the false lumen. Flow through the false lumen was the same in phantoms I and II, and least in phantom III. The average area of the true lumen was largest in phantom III and smallest in I. Phantom I had the highest overall flow rate in the false lumen and greatest change in false lumen size during the cardiac cycle, while the downstream "entry" phantom had the lowest of both parameters. Flow phenomena in aortic dissections can be studied by cine phase-contrast MRI.

Aortic Dissection↗
PubMed1991

The assay of urinary growth hormone in normal and acromegalic adults.

OBJECTIVES: To establish a normal range for urinary growth hormone in adults and to investigate the urinary growth hormone levels in patients with acromegaly, comparing these with the serum growth hormone results of a glucose tolerance test. We also studied the molecular identity of the growth hormone recognized by our assay method. DESIGN: Overnight urine samples and, in some cases, timed urine samples taken during the day were obtained from healthy volunteers and acromegalic patients. A standard glucose tolerance test with serum growth hormone measurements was performed on the acromegalic patients. PATIENTS: One hundred and thirty-five normal adults and 33 acromegalic patients were studied. MEASUREMENTS: Urinary growth hormone was measured using a sensitive and precise assay developed previously. RESULTS: In healthy volunteers overnight urinary growth hormone values fell gradually with increasing age, but there was no significant difference between men and women in any decade or between smokers and non-smokers. Sexual intercourse had no detectable effect on the values, but there was a large increase following strenuous exercise. Studies of the diurnal patterns in normal and abnormal adults suggested that it might be possible to diagnose acromegaly on a random urine sample. Gel filtration studies on a urine sample from an acromegalic patient showed a single peak of molecular weight 22,000. Using overnight collections there was clear discrimination between the values given by the normal adults and the acromegalic patients and an excellent correlation between urinary growth hormone levels in acromegalic patients and the mean serum growth hormone in a glucose tolerance test. CONCLUSIONS: In contrast to some other groups we conclude that urinary growth hormone provides a useful, non-invasive screening test for acromegaly, but this conclusion depends crucially on the assay being sensitive and precise at low values.

Acromegaly↗
PubMed1990

Urinary growth hormone excretion as a screening test for growth hormone deficiency.

Overnight urinary growth hormone secretion was measured by an immunoradiometric assay incorporating commercially available reagents, in 41 normal prepubertal school-children from three age groups: 3-5 years, 6-7 years, and 9-10 years. There was no significant difference between the groups expressing the results as total microU/specimen and so they have been combined to provide a prepubertal reference range of 2.25-10.50 microU/night. Prepubertal children with growth hormone deficiency who had not been receiving growth hormone treatment for two days had overnight urinary growth hormone concentrations well below this range. Urinary growth hormone was assayed in 49 children undergoing investigation for short stature with conventional provocative testing, and those shown to have growth hormone deficiency had correspondingly low overnight urinary growth hormone concentrations. There was, in addition, a strong correlation between overnight urinary growth hormone concentrations and peak serum response to provocation. This simple urine assay may provide a useful screening test for growth hormone deficiency.

Adolescent↗
PubMed1990

Rapid MR imaging of blood flow with a phase-sensitive, limited-flip-angle, gradient recalled pulse sequence: preliminary experience.

To assess blood flow rapidly, a limited-flip-angle, gradient recalled pulse sequence was modified to acquire two views at the same phase-encoding step in successive repetitions. One view is obtained with first-moment flow compensation, while the second view is obtained with selectable flow encoding (non-zero first moment) along one direction. Blood flowing along the encoded direction acquires a phase difference between the two views, resulting in signal dependent on both direction and speed of flow. Stationary tissues undergo no phase change. Therefore, the phase shift between the two views produces an image that spatially renders flow direction and velocity. With a 24-msec repetition time, a 256 X 128 matrix, and two excitations, data acquisition is completed in 13 seconds per location (both a magnitude image and a flow image are produced at each location). Images generated with flow phantoms confirmed the accuracy of this method. Preliminary clinical evidence in 23 human subjects suggests that this method is useful in evaluating portal hypertension, distinguishing arterial from venous flow, distinguishing between slow flow and clot, and confirming the presence of clot. This method appears to be a fast, easy way to assess blood flow in large vessels.

Adolescent↗
PubMed1990

Identification and metabolic characteristics of an apolipoprotein C-II variant isolated from a hypertriglyceridemic subject.

The very low density lipoprotein (VLDL) apolipoproteins from a Type IV hypertriglyceridemic Caucasian subject (plasma TG: 645 mg/dl) and his brother (plasma TG: 328 mg/dl) were separated by isoelectric focusing gel electrophoresis (IEF) and found to contain two isoforms of apoC-II, identified by immunoblot. These corresponded to normal apoC-II-1 (isoelectric point: pI 4.88) and a variant isoform (apoC-II-v, pI 4.74). The pI of C-II-v was not altered by neuraminidase treatment, indicating that it was not sialylated. The concentration of total immunoreactive C-II in VLDL was elevated (18 mg/dl vs normal; 5.0 +/- 2 mg/dl) but similar to that in other Type IV subjects. In VLDL, which contained 90% of the plasma immunoreactive apoC-II, the ratio (by IEF) of C-II-1:C-II-v was 2:1, whereas in high density lipoproteins (HDL) the ratio was 1:1. VLDL apoB turnover was measured after the pulse injection of 125I-labeled VLDL. VLDL apoB kinetic parameters for the proband and four Type IV subjects were similar: production rate, 28 mg/kg per day versus 30 mg/kg per day; fractional catabolic rate, 1.62.day-1 versus 1.96.day-1; and pool size, 17 mg/kg versus 18 mg/kg. The decline in VLDL triglyceride (TG) after the infusion of heparin (9,000 IU over 4 h) was also similar to that observed in Type IV subjects. In VLDL, the fractional catabolic rates of apoC-II-1 and C-II-v were similar (C-II-1: 0.31.day-1, C-II-v: 0.29.day-1) whereas in HDL, although similar to each other, the rates were greater than in VLDL (C-II-1: 0.48.day-1, C-II-v: 0.44.day-1). VLDL and HDL from the proband were normal in their ability to activate bovine skim milk lipase, compared to Type IV VLDL and HDL without C-II-v. Purified apoC-II-1 and apoC-II-v activated the milk lipase to a similar extent (at 1 microgram of C-II; C-II-1: 34 units/h, C-II-v: 35 units/h). Thus, apoC-II-v is a newly recognized isoform of apoC-II-1. It remains to be determined whether this mutation plays a role in the genesis of hypertriglyceridemia.

Adult↗
PubMed1989

Infection following caesarean section.

In a prospective clinical study of post-operative infection in 124 patients undergoing Caesarean section, 39 (31.5%) patients developed a total of 45 infections. There was no significant difference in infection rates between elective and emergency procedures. Five patients (4%) developed endometritis, wound infection was found in 14 (11.3%) and 18 patients (14.5%) developed a post-operative urinary tract infection. Pre-operative C-reactive protein levels and intraoperative swabs of the uterine cavity were not helpful in the early detection of endometritis. The risk factors predisposing to post-caesarean infection were obesity and low socioeconomic status.

Cesarean Section↗
PubMed1989

Evaluation of flow through simulated vascular stenoses with gradient echo magnetic resonance imaging.

Magnetic resonance imaging using gradient echo sequences can quickly generate dynamic images of the cardiovascular system. We used a gradient echo sequence (repetition time = 21 milliseconds, echo time = 12 milliseconds, flip angle = 30 degrees) to evaluate how a simulated vascular stenoses affects the signal intensity of flowing fluid. Axial slices were obtained at regular intervals along a plastic tube containing a circular constriction (25%, 51%, or 73% reduction of cross-sectional area). Image data collected at each slice level were used to reconstruct 32 images evenly spaced in time over one cycle of pulsatile flow. Contrast ratios were calculated between signal intensities from tube lumen and surrounding stationary water jacket. Upstream from each stenosis, signal intensity increased during systole and decreased during diastole, paralleling the changes in velocity we measured with a flow probe. However, within the 51% and 73% stenoses and just beyond them, there were consistent decreases in systolic signal intensity. Flow through the 25% constriction had little effect on the signal intensity pattern. These results suggest that the gradient echo pulse sequence may be useful in evaluating disturbed flow associated with vascular stenoses.

Arterial Occlusive Diseases↗