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Biomedical subjects

A Leach

Publications and source records attributed to A Leach.

At least 55 records · Page 3Linked to original sources
PubMed1993

The laryngeal mask in cardiopulmonary resuscitation in a district general hospital: a preliminary communication.

For a period of 13 months adult patients sustaining a cardiopulmonary arrest in the Royal East Sussex Hospital, Hastings, were attended by nursing staff and Operating Department Assistants (ODAs) specially trained in the use of the laryngeal mask (LM) as an airway adjunct. The LM was used 41 times in 40 patients. The LM failed on only two occasions, and was successful in three cases where endotracheal intubation proved impossible. No instances of aspiration were directly attributable to LM use. LM trained staff adopted its use enthusiastically, and skills acquired during training appeared not to fade over the period of the study. These results are considered to justify the performance of a large-scale trial of use of the LM in cardiac arrest patients.

Aged↗
PubMed1993

Tertiary amines related to brompheniramine: preferred conformations for N-oxygenation by the hog liver flavin-containing monooxygenase.

The metabolism of racemic, (D)- and (L)-brompheniramine, a widely used antihistamine, was studied with microsomes and with highly purified flavin-containing monooxygenase (FMO) from hog liver. In addition, a number of other similar tertiary amines were evaluated as substrates for FMO activity from hog liver and the kinetic constants obtained were compared with brompheniramine. Although some N-demethylation was observed, the major metabolite of brompheniramine and the other tertiary amines examined in hog liver microsomes was the metabolite containing an aliphatic nitrogen N-oxide. Brompheniramine was extensively N-oxygenated by the highly purified FMO from hog liver. N-Oxygenation of brompheniramine in both microsomes and with highly purified FMO from hog liver was enantioselective. The Km for N-oxygenation of (D)-brompheniramine was markedly lower than the Km for (L)-brompheniramine. (E)- and (Z)-zimeldine are less conformationally flexible model compounds of brompheniramine, and these compounds were also examined and were found to be stereoselectively N-oxygenated by the highly purified FMO from hog liver. The similarities and differences in Km and Vmax values were evaluated in terms of possible conformations of the substrates determined by SYBYL molecular mechanics calculations. Distance map data indicated that FMO preferentially accommodated selected conformations of tertiary amines. Thus, (D)-brompheniramine and (Z)-zimeldine presumably have the aliphatic tertiary amine nitrogen atom and aromatic ring center at a defined distance and geometry and were more efficiently N-oxygenated than their respective isomers.

Amines↗
PubMed1993

Lobar hemorrhage in the elderly. The undiminishing importance of hypertension.

BACKGROUND AND PURPOSE: We sought to determine whether hypertension is less common in primary lobar hemorrhage than intracerebral hemorrhage in other locations and whether the frequency of hypertension in lobar hemorrhage diminishes with advancing age. METHODS: We identified all cases of intracerebral hemorrhage in Greater Cincinnati during 1988 by review of hospital and autopsy records as well as computed tomographic and magnetic resonance scans. RESULTS: During 1988, 66 primary lobar hemorrhages occurred, constituting 46% of all intracerebral hemorrhages in those under 75 years of age and 34% in those age 75 and older. A history of hypertension was present in 67% of patients with lobar, 73% of those with deep, 73% of those with cerebellar, and 78% of those with pontine hemorrhages. Left ventricular hypertrophy was present in 21% of patients with lobar, 27% of those with deep, and 47% of those with pontine/cerebellar hemorrhages. The frequency of hypertension in patients with lobar hemorrhage did not decrease with advancing age. CONCLUSIONS: The proportion of all intracerebral hemorrhages that are lobar does not increase with advancing age. Hypertension is nearly as common in primary lobar hemorrhage as in deep, cerebellar, and pontine hemorrhages, and its importance as an associated condition for lobar hemorrhage does not diminish with advancing age.

Adult↗
PubMed1993

Stroke in children within a major metropolitan area: the surprising importance of intracerebral hemorrhage.

Our objective was to determine the incidence rate of stroke and stroke subtypes in children. We reviewed the medical records, autopsy records, and brain imaging studies of all children with a possible stroke within the Greater Cincinnati metropolitan area population of nearly 1.3 million during 1988 and 1989. Traumatic brain hemorrhages and germinal matrix hemorrhages were excluded. Of the 295,577 children in Greater Cincinnati, medical records of 178 children were screened. Sixteen cases (13 whites and three blacks) less than age 15 years fit strictly defined criteria for first-ever stroke. The incidence rate for cerebral infarction was 1.2 cases per 100,000 (95% confidence interval, 0.3 to 2.0). The combined incidence rate for intracerebral hemorrhage and subarachnoid hemorrhage was 1.5 cases per 100,000 children (95% confidence interval, 0.4 to 2.3). The incidence rate of all stroke in white children was 2.6 cases per 100,000 (95% confidence interval, 1.2 to 4.1), compared to 3.1 per 100,000 in black children (95% confidence interval, 0 to 6.6). The combined 30-day mortality for intracerebral hemorrhage and subarachnoid hemorrhage was 22% (two of nine) compared to 14% (one of seven) for cerebral infarction. We conclude that in contrast to the picture in adults, hemorrhagic stroke among infants and children is at least as common as ischemic infarction.

Adolescent↗
PubMed1992

Comparison of a blood-free medium and a filtration technique for the isolation of Campylobacter spp. from diarrhoeal stools of hospitalised patients in central Australia.

Single specimens of diarrhoeal stool from 676 patients, mostly aboriginals aged less than 5 years, admitted to Alice Springs Hospital, central Australia, for diarrhoea between Sept. 1988 and Feb. 1989, were examined for Campylobacter spp. by culture on a blood-free medium with selective supplement (BFM; Oxoid) and blood agar overlaid with a membrane filter (FM). Campylobacter spp. were isolated on either BFM or FM or both from 225 patients. Campylobacter spp. were isolated on BFM alone from 75 patients and on FM alone from 213 patients (p less than 0.001; chi 2 test). Most campylobacters isolated on BFM were C. jejuni. All C. jejuni subsp. doylei, all "C. upsaliensis" except one, all C. laridis, C. fetus subsp. fetus and several uncharacterised Campylobacter isolates were isolated on FM only. C. jejuni was isolated on BFM but not FM from several patients, and vice versa. Serotyping of C. jejuni and C. coli isolated from both media showed the serotypes recovered from the two media to be different in some patients. In some patients concurrent infection with several species or serotypes (up to five) of Campylobacter, or both, was shown for the first time by the use of FM. We conclude that the use in combination of a selective medium and a non-selective medium with a filtration technique are better than either medium alone for the isolation of Campylobacter spp.

Acute Disease↗
PubMed1992

Serotype distribution of Campylobacter jejuni and Campylobacter coli isolated from hospitalized patients with diarrhea in central Australia.

Campylobacter jejuni and/or Campylobacter coli was cultured from 218 of 1,078 patients of all age groups admitted to Alice Springs Hospital, Alice Springs, central Australia, between July 1988 and June 1989 for treatment of diarrhea. One hundred sixty-six Campylobacter colonies from 127 patients were subjected to O serotyping by using the Penner typing scheme. All except 29 colonies could be serotyped. A total of 46 serotypes were identified, and the predominant serotypes were O:8, 17, O:22, O:1,44, and O:19. A large proportion of colonies reacted with more than one antiserum, and nine serotypes had antigenic compositions not observed previously. Several patients had multiple infections with more than one serotype, and some patients were shown for the first time to be infected with up to three different serotypes. Repeated reinfections with different serotypes were seen in some patients. In some patients, provided it was not due to reinfection with the same serotype, long-term excretion of the same serotype was seen, and for the first time, one patient showed evidence of excretion of the same serotype for up to 73 days.

Antigens, Bacterial↗
PubMed1989

Variables related to research utilization in nursing: an empirical investigation.

The purpose of the correlational study was to identify variables which were related to utilization of research in the clinical area. A convenience sample of 59 nurses from a community hospital in the southwest part of the United States was utilized for the sample. The concepts of attitude, support and availability were identified through the literature and used as independent variables for this study. Scales were developed from past research and tested for validity and reliability. Results indicated that attitude and availability were related to research utilization (R = 0.65, P less than or equal to 0.00). In addition, the support of administrators was also important in determining research use. Results from this study can be used to develop strategies to increase research utilization.

Adult↗
PubMed1982

Morphometry and cytodiagnosis of breast lesions.

Cells aspirated from breast lesions and smeared on slides were subjected to computer assisted morphometric analysis. Three groups of cases were studied. The first were those collected from patients with known benign and malignant lesions. The second group were 143 unselected consecutive aspirates from breast lesions and the third, a group with a needle aspirate cytodiagnosis "suspicious of malignancy". The analysis showed the malignant cells to have larger nuclei with more anisokaryosis and more variation in the nuclear cytoplasmic ratios when compared with benign cells. When this form of semiautomatic analysis was applied to the "suspicious" group the accuracy of cytodiagnosis was improved.

Biopsy, Needle↗
PubMed1981

Hemodynamic effects of disopyramide at rest and during exercise in normal subjects.

The hemodynamic effects of disopyramide phosphate, 2.0 mg/kg body weight, given intravenously over a period of five minutes were studied at rest and during exercise in ten patients without clinical or angiographic evidence of heart disease. Following disopyramide, the resting cardiac index was lower (4.0 +/- 0.6 vs 4.3 +/- 0.6 liters/min/m2, mean +/- 1 SD,P less than 0.05), while left ventricular end-diastolic pressure (16 +/- 4 vs 11 +/- 4 mm Hg, P less than 0.001), pulmonary arterial (PA) mean pressure (20 +/- 5 vs 17 +/- 5 mm Hg, P less than 0.05), and brachial arterial (BA) mean pressure (105 +/- 8 vs 96 +/- 7 mm Hg, P less than 0.05), were higher than the pre-infusion resting values. During exercise, there was no change in left ventricular end-diastolic pressure while cardiac index rose from 4.0 +/- 0.6 to 6.5 +/- 0.6 liters/min/m2 (P less than 0.001) and left ventricular stroke work index increased from 62 +/- 19 to 84 +/- 22 gm/beat/m2 (P less than 0.001). The normal hemodynamic response during exercise after disopyramide despite the apparent depression of left ventricular function at rest probably reflects the positive inotropic effect of enhanced sympathoadrenergic activity.

Adult↗
PubMed1978

Alterations in the tRNA's of Escherichia coli recovered from lethally infected animals.

Escherichia coli grown in chemically defined iron-deficient media or in fluids containing the iron-binding proteins transferrin, lactoferrin, or ovotransferrin have well-characterized alterations in the chromatographic properties of tRNA's containing the modified nucleoside 2-methylthio-N6-(delta2-isopentenyl)-adenosine. The present work shows that similar tRNA alterations occur in E. coli O111 recovered from the peritoneal cavities of lethally infected guinea pigs and rabbits. Adding iron to these in vivo-grown bacteria resulted in the rapid conversion of chromatographically abnormal tRNA's to the normal species. The work strongly suggests that host iron-binding proteins, present in mucosal and other secretions, can affect the metabolism of invading organisms. The idea that the tRNA alterations are connected with the adaptation of E. coli to growth under the iron restricted conditions imposed by iron-binding proteins in tissue fluids, and thus with bacterial pathogenicity, is therefore made particularly attractive.

Animals↗