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Biomedical subjects

A J Pinder

Publications and source records attributed to A J Pinder.

5 recordsLinked to original sources
PubMed2003

Meningococcal meningitis after combined spinal-epidural analgesia.

We present a case of bacterial meningitis in a 32-year-old parturient following combined spinal-epidural analgesia for labour. The patient made a full recovery with no residual neurological sequelae, but important lessons were learnt. Firstly, investigating obstetricians and physicians were unaware that a combined spinal-epidural technique included an intrathecal component, so did not consider treating organisms that might be acquired by this route. Anaesthetists, on the other hand, in the absence of an isolated organism, saw this as a likely combined spinal-epidural complication. Infectious disease experts eventually diagnosed community-acquired meningococcal meningitis by analysing bacterial deoxyribonucleic acid (DNA) fragments using polymerase chain reaction studies. This test and the management of suspected meningitis in the post-partum period are discussed.

Journal Article↗
PubMed2002

Haemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia.

The haemodynamic effects of oxytocin receive scant attention in pharmacology texts, but may be clinically significant in vulnerable patients. Despite prescriber information recommending a dose of 5 international units by slow i.v. injection, it is the authors' experience that it is very common practice in the UK to give 10 units as a rapid injection. We therefore conducted a randomised, double-blind study of the haemodynamic changes induced by rapid bolus of 5 or 10 units of oxytocin in 34 healthy term parturients at caesarean section under spinal anaesthesia. There was a small but statistically significant (P < 0.05) reduction in mean arterial pressure from baseline 30 s after a 10-unit bolus. However, large, statistically significant increases in heart rate and cardiac output occurred 1 min after 5 units and 2 min after 10 units. These changes peaked 1 min after oxytocin administration and were greater in the 10-unit group (P < 0.05). The importance of these findings is that some women with hypovolaemia or cardiac disease may be unable to mount these compensatory responses and are therefore at risk of haemodynamic collapse after oxytocin boluses. This has been illustrated by a maternal death reported to the Confidential Enquiries into Maternal Deaths in the United Kingdom. The need to adhere to a dose regimen of 5 units by slow injection needs re-emphasis, but no evidence exists to claim that even this will be haemodynamically inert. We therefore recommend that oxytocin boluses be avoided in women with hypovolaemia or cardiac disease.

Clinical Trial↗
PubMed1989

Maize streak virus genes essential for systemic spread and symptom development.

The entire genome of single component geminiviruses such as maize streak virus (MSV) consists of a single-stranded circular DNA of ~2.7 kb. Although this size is sufficient to encode only three average sized proteins, the virus is capable of causing severe disease of many monocots with symptoms of chlorosis and stunting. We have identified viral gene functions essential for systemic spread and symptom development during MSV infection. Deletions and gene replacement mutants were created by site-directed mutagenesis and insertion between flanking MSV or reporter gene sequences contained in Agrobacterium T-DNA derived vectors. Following Agrobacterium-mediated inoculation of maize seedlings, the mutated MSV DNAs were excised from these binary vectors by homologous recombination within the flanking sequences. Our analyses show that the capsid gene of MSV, while not required for replication, is essential for systemic spread and subsequent disease development. The ;+' strand open reading frame (ORF) located immediately upstream from the capsid ORF and predicted to encode a 10.9 kd protein was also found to be dispensable for replication but essential for systemic spread. By this analysis, MSV sequences that support autonomous replication were localized to a 1.7 kb segment containing the two viral intergenic regions and two overlapping complementary ;-' strand ORFs. Despite the inability of the gene replacement mutants to spread systemically, both inoculated and newly developed leaves displayed chlorotic patterns similar to the phenotype observed in certain developmental mutants of maize. The similarity of the MSV mutant phenotype to these developmental mutants is discussed.

Journal Article↗