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Biomedical subjects

B Palmer

Publications and source records attributed to B Palmer.

At least 19 recordsLinked to original sources
PubMed1999

Incidence of tardive dyskinesia in early stages of low-dose treatment with typical neuroleptics in older patients.

OBJECTIVE: The authors studied the risk of tardive dyskinesia for older patients in the early stages of treatment with typical neuroleptics. METHOD: They examined the cumulative incidence of tardive dyskinesia 1, 3, 6, 9, and 12 months after the institution of neuroleptic therapy among 307 psychiatric outpatients over age 45. The patients' median dose was 68.4 mg/day of chlorpromazine equivalent. RESULTS: In the patients who had never received neuroleptics at baseline (N = 87), the mean cumulative incidence of tardive dyskinesia was 3.4% and 5.9% at 1 and 3 months, respectively. There was no significant difference in the 12-month cumulative incidence of tardive dyskinesia among patients who had been neuroleptic-naive at baseline (22.3%) and the 89 patients who had received neuroleptics before baseline for 1-30 days (24.6%); however, the 131 patients who had received neuroleptics before baseline for more than 30 days tended to have a greater cumulative 12-month incidence of tardive dyskinesia (36.9%). CONCLUSIONS: The risk of tardive dyskinesia in older outpatients is high, even with relatively short treatment with low doses of conventional neuroleptics.

Age Factors↗
PubMed1998

Human magnetic resonance imaging at 8 T.

In this work, we present the first human magnetic resonance image (MRI) obtained at ultrahigh field strengths (8 T). We demonstrate that clinical imaging will be possible at 8 T and that reasonable quality head images can be obtained at this field strength. Most importantly, we emphasize that the power required to excite the spins at 8 T is much lower than had previously been predicted by the nuclear magnetic resonance theory. A 90 degree pulse in the head at 8 T requires only approximately 0.085 J of energy (90 W for a 2-lobe 4 ms sinc pulse). Based on measurements at 4 T, 1-2 J of energy should have been utilized to achieve a 90 degree excitation at 8 T. The fact that the energy required for spin excitation at 8 T is much lower than predicted by the NMR theory, will be extremely important to the viability of ultrahigh field imaging, since concerns related to power absorption and specific absorption rate (SAR) violations at ultrahigh field are alleviated. As such, it will be possible to utilize RF intensive pulse sequences and adiabatic spin excitation at 8 T without significant risk to the subject.

Brain↗
PubMed1998

Contribution of the sensory and sympathetic nervous system to scalding-induced edema in the rat paw.

It has recently been hypothesized that both the sensory and sympathetic nervous system contribute to the inflammatory reaction. A scalding model was developed in anaesthetized rats to investigate the contribution of neuropeptides in heat-induced edema localized to the hindpaw. After immersing the paw in water at 60 degrees C for 10, 20, 30 and 60 s, edemic reactions were registered as change of paw volume in a plethysmograph and hindpaw perfusates collected to measure the content of neuropeptides by radioimmunoassay. A scalding period of 30 s induced the most prominent edemic reaction. There was a marked increase of the sensory neuropeptide neurokinin A and the sympathetic related transmitter neuropeptide Y in hindpaw perfusates after scalding. The effect of peripheral nerve ligation on edemic reaction and on the release of neuropeptides was investigated in rats scalded for 30 s at 60 degrees C. There was a significant decrease of edema formation in the scalded nerve ligated paw as compared with the scalded paw on the non-ligated side. Neurokinin A was not detected in nerve ligated rats before or after scalding, whereas mononeuropathic rats showed increased concentrations of neuropeptide Y. The present results indicate that the sensory as well as the sympathetic nervous system, possibly through the release of neuropeptides, may contribute to scald-induced edema.

Animals↗
PubMed1998

IgE and non-IgE mediated allergic disorders in systemic lupus erythematosus.

OBJECTIVE: To ascertain the prevalence of IgE and non-IgE mediated allergic disorders in patients with systemic lupus erythematosus (SLE). METHODS: 49 SLE cases (all satisfying at least four "Revised ARA Criteria") and 98 healthy, age, and sex matched controls (randomly selected through two urban general practices and one rural general practice) were interviewed by telephone to screen for a history of allergy. Subjects with a history of allergic rhinitis, asthma or atopic eczema then underwent skin prick testing to confirm underlying IgE mediated disease. RESULTS: Analysis of the data by conditional logistic regression revealed no significant difference in frequency of allergic disorders in SLE cases and controls (odds ratio (OR) 0.92, 95% confidence intervals (CI) 0.45, 1.86). In addition a subgroup analysis of subjects with IgE mediated/associated atopic disorders, showed that cases and controls were at a similar risk of having these conditions (OR 0.90, 95% CI 0.41, 1.96). CONCLUSIONS: This study suggests that people with SLE are not at an increased risk of IgE mediated/associated allergic disorders, in contrast with previous reports.

Adult↗
PubMed1998

Primary reconstructive surgery with a sliding flap for carcinoma of the Bartholin gland.

Bartholin gland tumours are rare and therefore recommendations concerning management have been based on small series. Although there is a tendency today to perform less radical surgery, meaning hemivulvectomy or a wide local excision, the anatomical position of these tumours often leads to a large postoperative defect. The objective of this report is to present data on three patients but mainly to describe our surgical technique where a sliding flap obtained from the gluteal region is used for primary closure. This surgical procedure offers a functional and cosmetically acceptable vulva which is of importance considering the relative young age of patients with Bartholin gland tumours.

Bartholin's Glands↗
PubMed1997

Modifying repetitive verbalizations of community-dwelling patients with AD.

Seven caregivers of a home-dwelling spouse with Alzheimer's disease were trained during 12 weekly home visits to implement behavior management programs including written cuing procedures in response to repetitive verbalizations. Data from 7 trained caregivers and 7 matched control caregivers who only tracked repetitive behavior were compared. Results revealed that trained caregivers were successful at decreasing patient repetitions using written cues. Patients of control subjects showed no systematic changes in behavioral disturbances due to behavior tracking. In addition, intervention effects lasted for 16 weeks or longer and several caregivers reported applying the cuing intervention to other, nontargeted behaviors. Trained caregivers' perceptions of their efficacy in managing difficult patient behavior improved significantly at the 3-month follow-up assessment when program staff were no longer visiting them weekly.

Aged↗
PubMed1997

Regional glucose uptake within hypoperfused swine myocardium as measured by positron emission tomography.

Chronic myocardial ischemia and 2-[18F]fluoro-2-deoxy-D-glucose (FDG) uptake were studied with positron emission tomography in 12 swine instrumented with an external constrictor on the left anterior descending coronary artery (LAD). Serial changes in function (by echocardiography), blood flow (with H215O) and FDG were determined weekly. At 1 wk, function was normal and FDG uptake in the LAD and non-LAD regions was 0.43 +/- 0.12 and 0.45 +/- 0.11 mumol. min-1.g-1, respectively (not significant). At approximately 5 wk, LAD wall thickening decreased to 18 +/- 5 from 27 +/- 8% (P < 0.05), whereas LAD and non-LAD blood flows were 0.68 +/- 0.28 and 1.03 +/- 0.25 ml.min-1.g-1, respectively (P < 0.05). At that time, FDG uptake in LAD and non-LAD regions was 0.60 +/- 0.43 and 0.49 +/- 0.30 mumol.min-1.g-1, respectively (P < 0.05). By the use of transmural biopsies (n = 6), ATP and creatine phosphate in the LAD region were 3.62 +/- 0.73 and 5.91 +/- 1.44 mumol/g wet wt, respectively, and neither differed from values in remote regions. In this model of chronic ischemia, hypoperfused dysfunctional regions were characterized by enhanced glucose uptake and preserved bioenergetics. This supports the concept that the myocardium adapts to chronic ischemia.

Adenosine Triphosphate↗
PubMed1997

Quality assurance in plastic surgery: reduction mammaplasty.

Continuous quality assessment is essential to keep the quality of health care high as well as being a powerful educational tool. Good surgical and aesthetic results and high levels of patient satisfaction are clinical indicators of good quality plastic surgery. Breast surgery, particularly reduction mammaplasty, makes up a considerable part of plastic surgery. We have developed quality indicators of this procedure for objective evaluation of the surgical results in general, the different techniques, and the different surgeons. Consideration was taken of the patient's subjective assessment. Data were collected on the "Reduction mammaplasty quality assurance sheet." We find this form sufficient and easy to handle and we can recommend it for use by other plastic surgeons.

Adolescent↗
PubMed1996

Risk factors for orofacial and limbtruncal tardive dyskinesia in older patients: a prospective longitudinal study.

Although there is a consensus that orofacial and limbtruncal subtypes of tardive dyskinesia (TD) exist and may represent distinct pathophysiologic entities, few studies have examined the incidence of and risk factors associated with the development of these TD subtypes. Two hundred and sixty-six middle-aged and elderly outpatients with a median duration of 21 days of total lifetime neuroleptic exposure at study entry were evaluated at 1- to 3-month intervals. Using "mild" dyskinesia in any part of the body for diagnosis of TD, the cumulative incidence of orofacial TD was 38.5 and 65.7% after 1 and 2 years, respectively, whereas that of limbtruncal TD was 18.6 and 32.6% after 1 and 2 years. Preclinical dyskinesia was predictive of both orofacial and limbtruncal TD. History of alcohol abuse or dependence was a significant predictor of orofacial TD only whereas tremor was a significant predictor of limbtruncal TD only. Findings support suggestions that orofacial and limbtruncal TD may represent specific subsyndromes with different risk factors.

Aged↗
PubMed1996

Comparison of vascular effects of calcitonin gene-related peptide and lidocaine on human veins.

Arterial and venous constriction during microsurgery are among the leading causes of flap failure. So far, pharmacologic tools have been proposed only for arterial constriction, and local anesthetics are commonly used to counteract the vascular spasm. The purpose of this study was to investigate the vascular effects of two known arterial vasodilators on human veins, in order to evaluate the possibility of their potential use during microsurgery. In vitro experiments were performed on 31 greater saphenous vein (SV) rings obtained from 20 patients and on 12 cephalic vein (CV) rings from 7 patients. The rings were mounted in organ baths and their isometric contractile activity was measured. Experiments were conducted by cumulatively adding calcitonin gene-related peptide (CGRP) or lidocaine to the organ baths. The endothelium was mechanically removed in 18 SV rings and in 6 CV rings. Results demonstrated that in vitro CGRP produced vasodilation only; no constrictive effects were seen. Lidocaine produced a biphasic response with contraction at low concentrations (1.5 x 10(-5) M, 1.5 x 10(-3) M) and release of the maximal contraction at higher concentrations, similar to that observed in arteries. Removal of the endothelium did not significantly affect contractile activity in either CGRP- or lidocaine-treated vessels. The data supported the conclusion that CGRP could be used to relieve venous constriction, and it is suggested that further studies on the clinical use of CGRP in microsurgery is warranted.

Calcitonin Gene-Related Peptide↗
PubMed1996

Calcitonin gene-related peptide in experimental ischemia. Implication of an endogenous anti-ischemic effect.

Ischemia resulting from flap harvesting and vascular manipulation during microsurgery may be responsible for flap ischemic sufferance and, ultimately, necrosis. Recently, the regulatory role of the sensory nervous system in ischemia has attracted much interest. Calcitonin gene-related peptide (CGRP), a neuropeptide, is a naturally occurring vasodilator with no constrictive effects. In the present study, we developed a model of partial, chronic ischemia in the rat epigastric flap and investigated the effects of ischemia on concentrations of CGRP-like immunoreactivity (-LI) in ischemic skin and in different regions of the rat brain (striatum, hippocampus, pituitary, hypothalamus, and frontal and occipital cortex). A neurovascular island flap based on the superficial epigastric vessels was raised in 10 animals. Ischemia of the flap was obtained by ligating the feeding artery so that the blood flow was reduced to 25% of the normal circulation. An electromagnetic Doppler positioned on the artery was used to monitor the blood flow reduction. Ten nonoperated animals were used as controls. Ten days after the operation, CGRP-LI was significantly increased in five of six brain regions analyzed (striatum excepted). Significantly decreased concentrations of CGRP-LI were found in seven ischemic flaps, as opposed to the control group. In the remaining three flaps, no significant changes in CGRP concentration were observed. The highest blood flux values (detected using a laser Doppler) in the flaps correlated positively with the highest concentrations of CGRP-LI in the flap tissue. The results of the present study suggest that endogenous CGRP may be involved in the adaptive response to ischemia.

Animals↗