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Biomedical subjects

A Milburn

Publications and source records attributed to A Milburn.

18 recordsLinked to original sources
PubMed2002

Workshop 8 (synthesis): challenges of expanding ecological sanitation into urban areas.

After seven papers discussing specific examples of ecological sanitation projects, the workshop considered the background, motivation and feasibility of this technology. It was agreed that ecological sanitation could help tackle water scarcity, health protection and, by recycling water and nutrients into agriculture, food scarcity. Dense cities are probably unsuitable for its implementation, but rural, town and peri-urban areas are promising. Key issues that remains are: the microbiological and chemical risks associated with the technology; the need for major information, education and support programmes; effective linking to reuse schemes; tailoring systems to meet local physical, socio-economic and cultural circumstances.

Agriculture↗
PubMed1994

Prospective diagnosis of 1,006 consecutive cases of congenital heart disease in the fetus.

OBJECTIVE: This report describes our experience with fetal congenital heart disease since 1980. BACKGROUND: Knowledge and expertise in the diagnosis, management and natural history of fetal congenital heart disease is increasingly demanded by both obstetricians and parents. The analysis of a large series should help the pediatric cardiologist to provide this service. METHODS: The notes of 1,006 patients, where a prospective diagnosis of fetal congenital heart disease was made, were reviewed. The reason for referral, the diagnosis made, the accuracy of diagnosis, the fetal karyotype and the outcome of the pregnancy were noted. The cases were grouped into malformation categories, and the spectrum of disease seen was compared with that found in infants. RESULTS: Most fetal cardiac anomalies are now suspected by the ultrasonographer during obstetric scanning. A different incidence of abnormalities is seen compared with that expected in infants. Chromosomal anomalies were more frequent in the fetus than in live births. The accuracy of diagnosis was good. The survival rate after diagnosis was poor because of frequent parental choice to interrupt pregnancy and the complexity of disease. CONCLUSIONS: A large experience with fetal congenital heart disease allows the spectrum of disease to be described with accuracy and compared with that in infancy. Knowledge of the natural history of heart malformations when they present in the fetus allows accurate counseling to be offered to the parents. If the trend in parental decisions found in this series continues, a smaller number of infants and children with complex cardiac lesions will present in postnatal life.

Female↗
PubMed1993

Multidisciplinary approach to chronic pelvic pain.

Both diagnosis and management of CPP may be greatly facilitated by a multidisciplinary approach integrating specific medical interventions with cognitive-behavioral pain strategies and concurrent treatment of psychological morbidity. Available data suggest that measured outcomes, including pain severity, global health status, and somatization, associated with this approach are significantly better than those observed after isolated medical interventions. Because of the chronicity of many of the psychological and social variables predisposing to recurrent symptom formation, care must be continuous and longitudinal if recurrent adverse sequelae, including disability, inappropriate health care utilization, and depression, are to be prevented.

Chronic Disease↗
PubMed1986

The effects of temporary ischaemia on rat muscle spindles.

Soleus muscle of adult rat is revascularized 5-8 days after sectioning the supplying blood vessels. The temporary ischaemia thus produced results in the rapid concomitant degeneration of extra- and intrafusal muscle fibres along with their nerve terminals and supplying axons. The basal lamina of all muscle fibres usually remains intact throughout the degenerative phase. Necrotic sarcoplasm is removed by phagocytic cells. Satellite cells survive the temporary ischaemia and give rise to presumptive myoblasts which fill the basal-lamina tubes. These myoblasts fuse to form myotubes which, by the 14th day after devascularization, are maturing into muscle fibres in the absence of any innervation. Within the spindle, nuclear-bag fibres degenerate more rapidly than nuclear-chain fibres. Regeneration proceeds more rapidly within the basal-lamina tubes of the original bag fibres than within those of the chain fibres. Reinnervation of regenerating extra- and intrafusal fibres begins 21 days after devascularization and is completed some 7 days later, during which time further equatorial differentiation of some reinnervated intrafusal fibres may occur. Regenerated spindles vary considerably with respect to their innervation and equatorial nucleation. Most contain short, thin, additional muscle fibres as well as those that have regenerated within the basal-lamina tubes of the original fibres.

Animals↗
PubMed1984

Stages in the development of cat muscle spindles.

The structure of developing spindles has been examined in cat peroneal muscles by light and electron microscopy, beginning at the 34- to 38-day foetal stage. By this stage alpha motoneurons have formed end-plates on primary myotubes. Secondary extrafusal myotubes then develop beneath the basal lamina of primary myotubes, and are innervated by motor axons early in their assembly. First-series secondary myotubes separate from primary myotubes prior to the development of subsequent series. The assembly of extrafusal fibres is completed by birth. Intrafusal fibres assemble in a similar manner. At the 34- to 38-day foetal stage developing spindles consist of a single primary myotube containing a small accumulation of myonuclei beneath the terminals of the Ia afferent axon. Simple motor nerve terminals also innervate this myotube, which will ultimately become the bag2 fibre of the mature spindle. Secondary intrafusal myotubes then assemble beneath the basal lamina of the primary bag2 myotube, in the order presumptive bag1, long-chain, intermediate-chain and typical-chain fibres. Their assembly begins at the equator, beneath the sensory terminals, and spreads to the poles. The bag1 and long-chain myotubes separate from the bag2 in the spindle pole prior to the development of the other chain fibres. The assembly of intrafusal fibres is completed by birth. The periaxial space begins to develop in the first postnatal week. The development of tandem spindles containing b2c units is described. The role of sensory and motor innervation in the assembly and differentiation of mammalian intrafusal fibres is discussed.

Animals↗
PubMed1976

The effect of the local anaesthetic bupivacaine on the muscle spindle of rat.

The effects of a long-lasting local anaesthetic, bupivacaine, in combination with hyaluronidase, on the intrafusal muscle fibres of adult rat muscle spindles have been investigated by light and electron microscopy. Necrotic changes in the axial bundle are present within 4 h of the combined drug injection and are widespread by 2 days. The equatorial nucleation of the spindle is lost owing to the necrosis of the myonuclei. Satellite cells, however, appear to survive these changes, even where the underlying muscle fibres are grossly necrotic. Sensory nerve terminals undergo necrosis during this period and plate-type fusimotor nerve terminals withdraw from the degenerating muscle fibres. Macrophage infiltration and early regeneration of the axial bundle is apparent by the third day. Myoblasts first appear at the periphery of the affected muscle fibres, but decrease in number as regeneration proceeds. By the end of the third week, regeneration of the muscle component is complete and re-innervating fusimotor nerve terminals established. The encapsulated regions of the spindle remain abnormal, without recognizable bags or chains of nuclei, although the muscle fibres differ both in size and ultrastructure. Regenerating sensory axons make contacts with the intrafusal bundle that differ in their configuration and ultrastructure from normal terminals. The production of enucleated spindles is discussed in the light of the morphogenetic influences of the spindle nerve terminals, as well as the possible use of such a model in discovering the function of nuclear bags and nuclear chains.

Animals↗
PubMedDate not supplied

Outcome of intermittent tachyarrhythmias in the fetus.

Persistent fetal tachycardias are known to have an adverse effect on fetal outcome. The outcomes of intermittent fetal tachyarrhythmias over a 12-year period at a tertiary fetal cardiology center were studied. Main outcome criteria included control of arrhythmia and death during the prenatal or postnatal period. A total of 28 fetuses had an intermittent tachyarrhythmia: 4 had intermittent atrial flutter and 24 had supraventricular tachycardia. At the time of presentation 14 fetuses were hydropic, and in 5 of the 14 an arrhythmia had not been noted prior to referral. Of the 28 fetuses, 23 were treated by drug administration to the mother. Control of arrhythmia was achieved in 10 of 11 (91%) nonhydropic fetuses and 8 of 12 (67%) hydropic fetuses, with resolution of hydrops in four cases. In the overall group there was one intrauterine death, two neonatal deaths, and one infant death, all of which occurred in the hydropic group. The arrhythmia recurred postnatally in 11 of 23 (48%) fetuses. We conclude that intermittent tachyarrhythmias may have a deleterious effect on the fetus with a significant risk of death pre- or postnatally. The fetus with nonimmune hydrops should be evaluated for a cardiac cause. Maternal antiarrhythmic therapy is indicated for intermittent fetal tachyarrhythmias. There is a high risk of recurrence of the arrhythmia during infancy, particularly if hydrops was documented during the prenatal period or if Wolff-Parkinson-White syndrome is diagnosed. Fetal echocardiography is a useful tool for diagnosis and for monitoring the progress of the fetus.

Anti-Arrhythmia Agents↗