Biomedical subjects
Publications and source records attributed to C Butler.
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K-Sol is a widely used corneal preservation medium. It has an excellent record for corneal storage and no previous report of contamination. During September 1988, on five of our K-Sol-stored donor rims Propionibacterium acnes grew. Cultures of unopened K-Sol also yielded P acnes. This report reviews previous contaminations of corneal storage media and the special characteristics of P acnes that enabled it to survive precautions taken against infection. The detection of P acnes was not obvious, and we emphasize the need for appropriate culturing of all donors, both aerobically and anaerobically, and close scrutiny of delayed inflammation in postoperative patients.
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To determine if loperamide is effective and safe in treating watery diarrhoea, we randomly assigned 50 adult expatriates in Bangladesh with more than three unformed stools in the previous 24 hours and illness of less than 72 hours to receive loperamide or a placebo. On entry into the five day study patients took two capsules (one loperamide capsule = 2 mg) and one after each unformed stool up to a maximum of eight per day. The groups did not significantly differ in pretreatment features or pathogens identified. Mean number of stools on study day 1 was 2.6 in the loperamide group and 4.0 in the placebo group (p = 0.035); on day 2 it was 1.3 versus 3.4 (p less than 0.001). Differences in stool frequencies during the final three study days, or proportion of patients with cramps, nausea, or vomiting on any study day, were not significant. No serious side effects occurred in either group. We conclude that loperamide, by decreasing stool frequency during the early part of illness, may have a role in the symptomatic treatment of this self-limiting disease.
The implementation of MELVYL MEDLINE, a successful online end-user system in the University of California (UC) health sciences libraries greatly enhanced the capabilities of reference desk service by providing immediate access to current medical literature from the MEDLINE database. With these enhancements, the extent of the impact on the delivery of reference service was not anticipated. Concurrent with providing traditional reference service requests, there was a constant need for individualized end-user instruction by MELVYL MEDLINE users, and continual maintenance of workstation equipment and supplies. This paper describes the experiences at the UC Irvine (UCI) Biomedical Library and compares these experiences with other UC health sciences libraries. The purpose of this paper is to discuss some of the issues which must be considered when planning for the implementation of an end-user system within the reference service function.
A retrospective review of placental materials (membranes, chorionic plate, umbilical cord) derived from preterm birth is reported. All those studied had intact membranes on admission and did not have spontaneous rupture. Those with preterm labor unresponsive to tocolysis, including those with brief and more prolonged labors, were compared with those delivered preterm because of maternal or fetal indications without labor. Those with labor had inflammatory changes in all three sites of greater frequency than those without labor. Those with longer labors had significantly higher rates of inflammation than those without labor. In this population, removing the influence of spontaneous rupture and labor over 6 hours long greatly diminished the likelihood of inferring that inflammation of the choriamniotic environment is a cause of preterm labor unresponsive to tocolysis.
Electrical stimulation of an acutely decentralized stellate or middle cervical ganglion or cardiopulmonary nerve augments cardiac chronotropism or inotropism; as the stimulation continues there is a gradual reduction of this augmentation following the peak response, i.e., an inhibition of augmentation. The amount of this inhibition was found to be dependent upon the region of the heart investigated and the neural structure stimulated. The cardiac parameters which were augmented the most displayed the greatest inhibition. Maximum augmentation or inhibition occurred, in most instances, when 5-20 Hz stimuli were used. Inhibition of augmentation was overcome when the stimulation frequency was subsequently increased or following the administration of nicotine or tyramine, indicating that the inhibition was not primarily due to the lack of availability of noradrenaline in the nerve terminals of the efferent postganglionic sympathetic neurons. Furthermore, as infusions of isoproterenol or noradrenaline during the period of inhibition could still augment cardiac responses, whereas during the early peak responses they did not, the inhibition of augmentation does not appear to be due primarily to down regulation of cardiac myocyte beta-adrenergic receptors. The inhibition was modified by hexamethonium but not by phentolamine or atropine. Inhibition occurred when all ipsilateral cardiopulmonary nerves connected with acutely decentralized middle cervical and stellate ganglia were stimulated, whereas significant inhibition did not occur when these nerves were stimulated after they had been disconnected from the ipsilateral decentralized ganglia. Taken together these data indicate that the inhibition of cardiac augmentation which occurs during relatively long-term stimulation of intrathoracic sympathetic neural elements is due in large part to nicotinic cholinergic synaptic mechanisms that lie primarily in the major thoracic autonomic ganglia. They also indicate that long-term stimulation in intrathoracic sympathetic neural elements with frequencies as low as 2 Hz may augment the heart as much as higher stimulation frequencies, depending upon the structure stimulated and the cardiovascular parameter monitored.
Forty patients with epithelial ovarian tumors underwent cyto-reductive surgery followed by a five drug (Adriamycin, D.D.P., 5FU, M.T.X. and C.T.X.) combination chemo and progestin therapy. They all had an initial complete clinical response and 58% were complete histologic responders. One patient developed reactivated disease six months after a negative second look laparotomy. Two of four fatal outcomes were due to development of mixed mesodermal tumors in patients who originally had serous cystadenocarcinomas. We conclude that this regimen is highly effective, independent of residual tumor size, histologic grade of tumor and prior therapy. Its attendant toxicity is acceptably low.
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In conjunction with a population-based case-control study of lung cancer in New Mexico, the histopathology of cases diagnosed during 1980 and 1981 and during 1970-72 was reviewed. Adequate histologic or cytologic material was obtained for 725 cases, with 308 during 1970-72 and 417 during 1980-81. The light microscopic histologic type was classified on the basis of review by 2 pathologists. No significant differences were found in the histologic-type distributions in Hispanics and non-Hispanic whites. In males, the distributions of histologic types were similar in the two time periods, but in non-Hispanic white women the proportion of adenocarcinoma declined during 1980-81 as the proportion of small cell carcinoma increased. The panel classification was compared with that recorded by the New Mexico Tumor Registry. Overall agreement was 52.1% for 1970-72 and increased to 65.2% for 1980-81. The discrepancies between the two classifications were largest for the categories of large cell undifferentiated carcinoma and "other malignancy."
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A retrospective review of placental material derived primarily from preterm deliveries was conducted and inflammatory changes graded on a scale of 0-3. Reviewers were blind as to the clinical outcomes. Other reviewers, unaware of the pathologic results, surveyed the clinical data, and results were combined for analysis. The findings suggest that placental and membrane inflammation probably precedes preterm spontaneous rupture of membranes in 8-30% of cases without labor. The duration of ruptured membranes and labor enhance the frequency of inflammation. Inflammation is not associated with significant puerperal infection unless cesarean delivery occurs. Perinatal morbidity and mortality were not significantly enhanced nor associated with conservative management of spontaneous preterm rupture of membranes in this population beyond the influence of fetal weight and gestational age.
We studied cardiac tissues of a patient who died of severe rheumatic myocarditis. Multiple Aschoff lesions were present throughout both ventricles and auricles. Immunofluorescence studies showed large monocytoid cells staining with OKM1 and anti-Leu M-3 as well as anti-Ia. Scattered T cells in areas of focal myocarditis stained with OKT3. Parallel staining for cardiac myosin-heavy chain antigens showed patchy dissolution of cardiac muscle fibers and traces of cardiac myosin within large monocytoid Aschoff cells.
We treated eight children, aged 7 weeks to 17 years, for lung abscess. Each abscess followed an episode of aspiration or a bacterial pneumonia. Associated conditions were leukemia, congenital immune deficiency, endocarditis, cerebral palsy, and prematurity. Seven of the 8 children had polymicrobial infections, usually containing both aerobic and anaerobic bacteria. The success of medical treatment by antibiotics and chest physiotherapy was age related; 3 of the 8 children, aged 10 to 17 years, recovered on this regimen, whereas five children, aged 7 weeks to 7 years, required catheter drainage or resection for cure. Drainage by catheter pneumonostomy was performed for solitary peripheral bacterial abscesses. A large intercostal catheter was inserted into the cavity, either operatively or percutaneously. Wedge resection was performed for multiple, central, or fungal abscesses. Pneumonostomy was curative in 3 of 4 children. One chronic abscess recurred after pneumonostomy and required resection. Wedge resection was curative in the two children who came to thoracotomy; lobectomy was not necessary. Although all eight children recovered from their lung abscesses, three of them died within a year of sepsis. Lung abscess today occurs in immunocompromised children who are vulnerable to fatal infections. Chest physiotherapy is unlikely to achieve good drainage in children under 7 years of age. Medical failures can be identified within the first week of treatment. Early and aggressive surgical treatment is indicated in such children, and may be lifesaving.
This study reports the effects of powered mobility on the self-initiated behavior of six children with various disabilities who, between 23 and 38 months of age, learnt to use motorized wheelchairs in less than three weeks. Using a multiple baseline design, two-hour observation periods were video-recorded at 10-day intervals before and after they achieved independent mobility. Frequency of self-initiated interaction with objects, spatial exploration and communication with care-giver were analyzed. Three children increased all three types of behavior; one increased in two types but decreased in interaction with objects; and two increased in spatial exploration only.
This study evaluated the effects of placebo medication on pulmonary responses in asthmatics, and investigated the roles of expectancy and anxiety. Twelve adult asthmatics were recruited for a laboratory experiment described as a study of the effectiveness of a new bronchodilator. Distilled nebulized water was inhaled in each session. The solution was described as water in session 1 (control), while in sessions 2 and 3 subjects were told that the nebulizer contained a chemical likely to cause chest tightness and wheezing (bronchoconstrictive suggestion). Prior to the inhalation sequence in sessions 2 and 3, subjects inhaled from an aerosol that they were told contained either a powerful new drug (placebo) or a non-active substance (neutral). Pulmonary function was measured with the forced oscillation technique and spirometry, while autonomic parameters, anxiety and expectancies were also monitored. Pulmonary function deteriorated following the inhalations accompanied by bronchoconstrictive suggestion, and this effect was abolished by pre-treatment with placebo. Neither subject expectations nor changes in anxiety were associated with the experimental manipulations. The implications of these results for theories of placebo action are considered.
We assessed survival in a population-based series of patients with lung cancer presenting with a solitary nodule. Using a population-based cancer registry, we identified 674 incident lung cancer cases in Bernalillo County, New Mexico, from 1977 to 1981. Both clinical information and chest roentgenograms were reviewed to identify 83 solitary nodule cases and 479 nonsolitary nodule cases. Chest roentgenograms were unavailable for 112. There were 83 patients with solitary nodules (55 men and 28 women), and adenocarcinoma was the predominant cell type. Overall, 5-yr survival was significantly greater for the patients with solitary nodules (24%) than for those with nonsolitary nodules (8%) (p less than 0.001). Of the 41 patients with solitary nodules who had surgery and Stage I disease, 49% lived 5 yr. In contrast, none of the 39 who did not have surgery lived longer than 2 yr. Our results imply that the varying survival described in previous series of patients with solitary nodules reflects different patient selection criteria.