Pott's disease revisited. Paravertebral abscess extending into the right lower extremity.
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Aged↗
Biomedical subjects
C C Baker
Publications and source records attributed to C C Baker.
Macrophage antigen presentation and interleukin 1 production after cecal ligation and puncture in C3H/HeN and C3H/HeJ mice.
Following cecal ligation and puncture with a 25-gauge needle, endotoxin-sensitive C3H/HeN mice have a 45% mortality compared with no mortality in endotoxin-resistant C2H/HeJ mice. Macrophage production of interleukin 1 and antigen presentation were studied in these two strains of mice following cecal ligation and puncture at 2, 4, 8, 16, and 24 hours and at 2, 4, 6, and 8 days. Splenic macrophages were cultured with a T-helper cell clone (D10.G4.1), and antigen presentation and interleukin 1 production were measured by D10.G4.1 proliferation. Macrophage antigen presentation by C2H/HeJ mice was markedly increased compared with that in C3H/HeN mice at all times after cecal ligation and puncture, most strikingly at 2 days (185m740 cpm for C3H/HeJ mice vs 30,300 for C2H/HeN mice). Macrophage interleukin 1 production was significantly increased in C3H/HeJ mice vs C3H/HeN mice at all times after cecal ligation and puncture (except at 2 days) and was maximal at 8 days (25,000 cpm for C3H/HeJ mice vs 5190 for C3H/HeN mice). These data suggest that the differences in mortality after cecal ligation and puncture between these two strains of mice may relate to a supranormal response of macrophages of C3H/HeJ mice or to an inadequate response of macrophages of C3H/HeN mice.
Animals↗
Outcome following femur fracture and subsequent cecal ligation and puncture in endotoxin-sensitive (C3H/HeN) and endotoxin-resistant (C3H/HeJ) mice.
This study examined the effect of sepsis following trauma in a reproducible model of sepsis--cecal ligation and puncture (CLP)--in endotoxin-sensitive (C3H/HeN) and endotoxin-resistant (CeH/HeJ) mice. Studies used CLP with a 25-gauge needle at different time intervals following injury, as induced by femur fracture (FF), to determine the effects of sublethal sepsis on survival after trauma. There was a 3% mortality for FF alone in both groups. Mortality in C3H/HeJ mice was not significantly increased over FF alone except when CLP followed FF by 3 days (45%, P less than 0.02, Chi-square). In contrast, C3H/HeN mice had significantly increased mortality rates (75 to 90%, P less than 0.001) versus FF alone at all intervals between FF and CLP. Mortality for FF plus CLP was significantly greater for C3H/HeN compared to C3H/HeJ (P less than 0.001) for all time intervals between FF and CLP. In conclusion, animals exposed to a septic episode following FF had significantly greater mortality than FF animals without a septic challenge. Endotoxin-sensitive mice had significantly higher mortality after CLP and significantly increased mortality when CLP followed FF (regardless of timing) compared to endotoxin-resistant mice.
Animals↗
Acute appendicitis following blunt abdominal trauma. Incidence or coincidence?
Inflammation of the appendix is a common cause of acute abdominal pain. The etiology and pathophysiology of appendicitis have been well described. The initiating factor often is obstruction of the appendiceal lumen by inspissated stool, barium, food, parasites, or hyperplastic lymphoid tissue. Two patients have been identified who developed appendicitis temporally related to blunt abdominal trauma, without other clear etiology. Although absolute documentation of trauma as an etiologic factor in these cases is difficult, theoretical mechanisms for the occurrence are discussed. In the setting of right lower quadrant pain following mild to moderate blunt abdominal trauma, acute appendicitis should be considered as a possibility.
Abdominal Injuries↗
Acute Physiology and Chronic Health Evaluation (APACHE II) score and outcome in the surgical intensive care unit: an analysis of multiple intervention and outcome variables in 1,238 patients.
OBJECTIVE: To assess the statistical association of the Acute Physiology and Chronic Health Evaluation (APACHE II) score with multiple intervention and outcome variables in surgical ICU patients. DESIGN: Continuous data collection on every patient admitted to the surgical ICU for a 21-month period. MATERIALS AND METHODS: For every admitted patient in the surgical ICU, APACHE II scores were calculated and the relationship between APACHE II score as an independent predictor of outcome was assessed with multiple outcome variables selected for study. The outcome and intervention variables tested included: treatment intervention measures such as days on ventilator; days with an arterial catheter, central venous catheter, triple lumen catheter, pulmonary artery catheter; days receiving total parenteral nutrition; days receiving tube feedings; number of transducers per days in the ICU; number of infusion pumps per ICU days, days in the hospital, number of complete blood counts; number of electrolyte determinations; number of blood gases; number of units of blood transfused; ICU and hospital mortality rates in the presence of complications, including: respiratory distress syndrome, renal failure, congestive heart failure, coma, requirement of cardiopulmonary resuscitation, and others. RESULTS: The APACHE II score was statistically associated with each intervention and outcome variable tested. Unfortunately, the associations, although consistent, were weak with r2 values ranging from .03 to a maximum of .22 for Pearson's correlation coefficients. CONCLUSION: The APACHE II score was statistically associated with all the variables examined in our surgical patients, but its predictive power for the individual surgical patient was limited. These findings suggest that the score may be useful for retrospective analyses of large cohorts of patients but should not be used as a triage tool or as a predictor of outcome for the individual patient. Triage decisions should continue to be based on the best available clinical judgment.
Adult↗
Comparison of the ability of adult and pediatric trauma scores to predict pediatric outcome following major trauma.
The Pediatric Trauma Score (PTS) has been identified as the only accurate and adequate means of predicting outcome in pediatric trauma. In answer to the increasing number of trauma patients arriving at local hospitals, the ability of the adult Trauma Score (TS) to predict pediatric trauma outcome was tested. Of the total 2,604 pediatric trauma cases in the North Carolina State Trauma Registry, 441 had both a PTS and TS available for analysis. The primary measures of outcome were emergency department and hospital dispositions. Logistic regression demonstrated that TS (R2 = 0.50) was a stronger predictor of pediatric outcome and PTS (R2 = 0.35) for emergency department disposition and TS (R2 = 0.63) with PTS (R2 = 0.51) for hospital disposition. The correlation between TS and PTS was high (R = 0.8). Stepwise discriminant analysis demonstrated that TS was the stronger predictor of outcome and the PTS added only 9% (partial R2 = 0.09) more accuracy to TS for emergency department disposition and only 6% (partial R2 = 0.06) for hospital disposition. The results of this research demonstrate that TS is a useful method of predicting outcome in pediatric trauma. The use of both scores for each patient does not increase the predictive value of the scores.
Adolescent↗
An element in the bovine papillomavirus late 3' untranslated region reduces polyadenylated cytoplasmic RNA levels.
Expression of the two bovine papillomavirus type 1 (BPV-1) late genes, L1 and L2, coding for the two capsid proteins, is limited to terminally differentiated keratinocytes in bovine fibropapillomas. This pattern of expression is determined both by the activity of the late promoter and by the inhibition of late region expression in less well differentiated cells. Inhibition of L1 and L2 mRNA production in nonpermissive cells must occur since the late region potentially could be transcribed from early region promoters. Nuclear runoff analysis of the late region has demonstrated that up to 95% of transcripts which are initiated in the early region in nonpermissive cells terminate within the late region upstream of the late polyadenylation site (C. C. Baker and J. Noe, J. Virol. 63:3529-3534, 1989). However, very few of the primary transcripts which include the late polyadenylation site are processed into mRNA. In this study, we have used expression vectors to characterize an inhibitory element active in nonpermissive cells which is located in the late 3' untranslated region (3'UTR). While the late polyadenylation site is functional in these cells, a 53-bp element in the late 3'UTR reduces levels of polyadenylated cytoplasmic RNA. This element inhibited chloramphenicol acetyltransferase (CAT) expression 6- to 10-fold when cloned in the sense orientation into the 3'UTR of a CAT expression vector. No block to expression was seen when the fragment was cloned immediately downstream of the poly(A) site, in an intron upstream of the CAT coding sequence, or in an antisense orientation in the 3'UTR. When the same fragment was deleted from a BPV-1 L1 expression vector, a sixfold increase in mRNA levels was seen. Actinomycin D chase experiments using BPV-1 L1 expression vectors indicated that the element does not destabilize cytoplasmic polyadenylated RNA. Therefore, the element must act before the mature mRNA reaches the cytoplasm. The data presented are consistent with effects on nuclear stability and/or inhibition of polyadenylation or nuclear transport.
3T3 Cells↗
Clarification of the role of CT scan in the acute evaluation of blunt abdominal trauma.
We reviewed 100 patients sustaining blunt trauma whose initial evaluation included an abdominal computed tomographic scan (CT) to assess the role of this modality in managing these patients. Indications for CT scan were suspicion of abdominal injury based on mechanism of injury (46), tenderness (22), falling hematocrit (9), hematuria (5), pain (4), and hyperamylasemia (1). Thirty-four patients had abdominal injury, and four scans identified non-traumatic pathology; 66 patients had no evidence of abdominal injury. There were no additional abdominal injuries detected during the hospitalizations. Mechanism of injury was the only indication for CT scan in 20 patients, none of whom had evidence of abdominal injury. CT scan charges for these 20 patients accounted for 5.5% of the total hospital bill ($204,070). Hospital costs would have been reduced by $11,270 if these patients had been followed clinically. Fifteen patients with soft tissue contusions and normal CT scans were hospitalized less than 72 hours. Room and other hospital charges accounted for 38.5% of the hospital bill; these are costs that would have been saved if these patients had been discharged from the emergency service. Several conclusions can be made from this study. First, abdominal CT scan is a sensitive test for abdominal injury. Secondly, patients without objective signs of abdominal injury whose other injuries warrant admission allowing further observation should be followed clinically and do not need the additional expense of abdominal CT scan. Finally, mechanism of injury alone is not an indication for CT scan.
Abdominal Injuries↗
Blunt hepatic and splenic trauma: where have all the surgeons gone?
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Humans↗
Transforming growth factor-beta expression in fibropapillomas induced by bovine papillomavirus type 1, in normal bovine skin, and in BPV-1-transformed cells.
There is substantial evidence to suggest that transforming growth factor-beta (TGF-beta) plays an important role in wound healing and tissue repair as well as in carcinogenesis. It has also been observed that naturally occurring bovine papillomavirus type 1 (BPV-1)-induced bovine fibropapillomas occur predominantly at traumatized sites of the body, suggesting that humoral factors released in wounds might be important for papillomavirus infection. We have therefore investigated the possible role of TGF-beta 1 in BPV-1 infections. Two antipeptide antibodies which recognize different epitopes in the N-terminus of TGF-beta 1 were used to localize TGF-beta 1 in bovine fibropapillomas and normal bovine skin using immunohistochemical methods. Staining by anti-LC(1-30) is intracellular in suprabasal keratinocytes of the epidermis as well as the hair follicles and sebaceous glands and correlates with known sites of TGF-beta 1 mRNA synthesis. Anti-CC(1-30) staining is extracellular in the immediately underlying dermis. Neither the pattern nor intensity of TGF-beta 1 staining was affected by BPV-1 infection. C127 cells and BPV-1-transformed C127 cells were compared for TGF-beta 1 mRNA expression and secretion of TGF-beta 1 peptide. Although the levels of messenger RNA and secreted TGF-beta 1 peptide were similar in both cell types, five- to six-fold greater amounts of TGF-beta-like activity per cell was detected in media conditioned by the uninfected cells. TGF-beta 1 treatment had no effect on the growth rate of either cell type or on BPV-1 gene expression in the transformed cells.
Animals↗
Responses of lactating Holstein cows to chilled drinking water in high ambient temperatures.
In Experiment 1, 12 lactating Holstein cows were provided drinking water of either 10.6 or 27.0 degrees C for 24 h/d in a changeover design to examine the effects of water temperature on feed intake, water intake, respiration rate, rectal temperature, plasma thyroid hormone concentration, and milk yield. The 1st wk of each 3-wk treatment period was for adjustment and the next 2 wk were comparison periods. Least squares means for DM intake as a percentage of body weight were 3.68 and 3.57 for 10.6 and 27.0 degrees C treatment groups. Water intakes in liters per kilogram of dry feed consumed as a percentage of body weight were 21.3 and 20.3. Respiration rates were 70.5 and 81.0 breaths per minute; rectal temperatures were 39.7 and 39.9 degrees C, Triiodothyronine averaged .88 and .75 ng/ml; thyroxine, 42.4 and 39.2 ng/ml; cortisol, 3.03 and 2.06 ng/ml; and progesterone in milk, 4.58 and 3.15 ng/ml for the 10.6 and 27.0 degrees C treatment groups. Milk yield averaged 25.9 and 24.7 kg/d and FCM averaged 25.6 and 23.6 kg/d, respectively. In Experiment 2, 24 cows given a choice of chilled or warm water showed a clear preference (about 98%) for the warm water. If cows are given chilled water of 10 degrees C continuously, no warm drinking water should be available. Chilled drinking water lowered respiration rates and body temperatures and increased feed intake and milk yield.
Animals↗
Angiographic embolization of traumatic hepatic artery pseudoaneursym.
The development of hepatic artery pseudoaneurysm represents a difficult therapeutic challenge as a vascular complication of hepatic trauma. Depending on the location of the pseudoaneurysm, this complication may represent a substantial technical challenge: recently hepatic artery pseudoaneurysms have been managed nonoperatively in selected patients. We report definitive control of a traumatic hepatic artery pseudoaneurysm with angiographic placement of detachable silicone balloons that allowed precise proximal and distal occlusion. Follow-up arteriogram at four weeks confirmed complete occlusion of the isolated segment without recurrence. The use and fate of detachable silicone balloons are discussed.
Accidents, Traffic↗
Cardiac contusion. The effect on operative management of the patient with trauma injuries.
Sixty-four patients with cardiac contusion documented by electrocardiographic changes and creatine kinase MB fraction assay following blunt chest injury were reviewed to assess the impact of cardiac contusion on subsequent management. Fifty-eight patients had elevated creatine kinase MB levels; 35 patients had electrocardiographic abnormalities, including ST-segment and T-wave changes (25), premature ventricular contraction (ten), right bundle-branch block (nine), atrioventricular block (three), atrial fibrillation (three), and premature atrial contraction (two). Thirty patients underwent general anesthesia. There were only four perioperative complications: ventricular ectopy, ventricular fibrillation, nodal rhythm, and pulmonary edema. There were no deaths attributable to cardiac contusion. In summary, patients with blunt trauma who have sustained a cardiac contusion can undergo elective operation with a low incidence of complication. In the emergency setting, however, hemodynamic monitoring for early detection of arrhythmias is indicated.
Adolescent↗
Transforming growth factor-beta 1: histochemical localization with antibodies to different epitopes.
We have localized transforming growth factor-beta (TGF-beta) in many cells and tissues with immunohistochemical methods, using two polyclonal antisera raised to different synthetic preparations of a peptide corresponding to the amino-terminal 30 amino acids of TGF-beta 1. These two antibodies give distinct staining patterns; the staining by anti-CC(1-30) is intracellular. This differential staining pattern is consistently observed in several systems, including cultured tumor cells; mouse embryonic, neonatal, and adult tissues; bovine fibropapillomas; and human colon carcinomas. The extracellular staining by anti-CC(1-30) partially resembles that seen with an antibody to fibronectin, suggesting that extracellular TGF-beta may be bound to matrix proteins. The intracellular staining by anti-LC(1-30) is similar to that seen with two other antibodies raised to peptides corresponding to either amino acids 266-278 of the TGF-beta 1 precursor sequence or to amino acids 50-75 of mature TGF-beta 1, suggesting that anti-LC(1-30) stains sites of TGF-beta synthesis. Results from RIA and ELISAs indicate that anti-LC(1-30) and anti-CC(1-30) recognize different epitopes of this peptide and of TGF-beta 1 itself.
Animals↗
Nonoperative management of adult blunt splenic trauma. Criteria for successful outcome.
Nonoperative management of blunt splenic trauma in adults is controversial despite numerous reports advocating this mode of therapy. Blunt splenic trauma is frequently managed without operation at our institution and, to define criteria that may predict a successful outcome, a retrospective review (1980 to 1988) of all adult splenic injuries was undertaken. Splenic injuries were documented by scintillation studies, CAT scanning, or at laparotomy. Sixty of 252 (24%) splenic injuries were initially treated without operation, which included bed rest, ICU monitoring, frequent physical exams, nasogastric tube, serial hematocrits, and follow-up splenic imaging. Five patients (5 of 60) failed nonoperative management and required interval laparotomy. Reasons for failure included blood loss greater than four units, enlarging splenic defect, or increasing peritoneal signs. Parameters predicting a successful outcome were localized trauma to the left flank or abdomen, hemodynamic stability, transfusion requirements less than four units, rapid return of GI function, age less than 60 years, and early resolution of splenic defects on imaging studies. No morbidity or deaths resulted from delayed operative intervention. In carefully selected adult patients, blunt splenic trauma may be successfully managed without operation.
Adolescent↗
Terminal B-cell maturation and immunoglobulin (Ig) synthesis in vitro in patients with major injury.
This study evaluated B-lymphocyte function in 30 patients following major trauma with frequent screening over a period of 21 days post-trauma. Peripheral blood mononuclear cells (PBMC) were phenotyped with monoclonal antibodies and in vitro B-cell function was tested both for unstimulated cells (spontaneous) and following stimulation with pokeweed mitogen (PWM). The capacity for terminal B-cell maturation into plasma cells was assessed by the number of cells bearing cytoplasmic immunoglobulin (CIg+). Although the number of circulating B cells in the trauma patients was not decreased following injury (12 +/- 2%), the number of CIg+ cells was significantly decreased (0.2 +/- 0.1 to 3.0 +/- 1.5) compared to controls (5 +/- 1) up to 21 days post-trauma (p less than or equal to 0.01). Spontaneous B-cell synthesis of IgA, IgM, and IgG was significantly depressed on day 1, but IgA was within normal range (159 +/- 30 ng/ml) by day 3, and IgA levels were supranormal (118 to 300% of control) on days 5-10 before returning to normal on days 14 to 21. Synthesis of IgG was 100 +/- 20 ng/ml on day 3 (control, 165 +/- 31 ng/ml), and IgG levels were supranormal (+45 to +139%) thereafter. On the other hand, IgM synthesis was decreased on all days studied (120 +/- 35 to 220 +/- 70 ng/ml) compared to controls (366 +/- 105 ng/ml). Synthesis of all Ig subclasses in PWM cultures followed a similar pattern. There was a marked monocytosis (30 +/- 2% LeuM3 + PBMC's) compared to control values (13 +/- 2% LeuM3+ PBMC's).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Facial pain, headache, and temporomandibular joint inflammation.
We studied one hundred patients with suspected temporomandibular joint (TMJ) arthropathy in whom 64 also complained of headache and/or facial pain, using high field surface coil magnetic resonance (MR) imaging, and found that headache and facial pain are commonly observed in association with inflammatory arthropathy of the TMJ. Each patient complained of pain and/or tenderness localized to the immediate vicinity of at least one TMJ. Pathologic joint effusion was demonstrated by MR in 88 of the painful joints studied. Significant meniscus displacement, with or without meniscus deformity and alteration of intrinsic signal intensity was present in 94 of the 100 painful joints examined. Fascial inflammation and atrophy of the ipsilateral muscles of mastication were observed occasionally with painful joints. There were no mechanical TMJ symptoms, such as joint clicking, crepitus or locking in 14 internally deranged and painful joints, 12 of which exhibited joint effusion and local inflammation. At least 80 patients described occlusal changes within 12 months of imaging. 28 of the pathologic joints in the series underwent subsequent meniscectomy, including routine histologic evaluation of surgical material. We conclude that internal derangement and inflammation of the TMJ should be considered in patients with unexplained headache and/or facial pain, even if mechanical TMJ symptoms are absent.
Adolescent↗
Transcriptional termination between bovine papillomavirus type 1 (BPV-1) early and late polyadenylation sites blocks late transcription in BPV-1-transformed cells.
Bovine papillomavirus type 1 (BPV-1) is a small DNA tumor virus which induces fibropapillomas in cattle and transforms rodent cells in culture. Transcripts are derived from a single strand of the circular viral genome, which has multiple promoters and two polyadenylation sites. In the transformed cell, the first (early) polyadenylation site is utilized exclusively and, therefore, only the early region is expressed. Transcription of the late genes, which requires use of the second (late) polyadenylation site, is seen only in the fully differentiated keratinocytes of the fibropapilloma. In this study, nascent RNA chain analysis of BPV-1-transformed C127 cells was used to demonstrate that at least 90% of the RNA polymerases which transcribe past the early polyadenylation site terminate transcription within the late region before reaching the late polyadenylation site. Therefore, transcription termination is at least partially responsible for the absence of late transcription in the BPV-1-transformed cell and is likely to be an important mechanism for regulation of papillomavirus late transcription during keratinocyte differentiation.
Animals↗