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Biomedical subjects

D Cahill

Publications and source records attributed to D Cahill.

36 records · Page 2Linked to original sources
PubMed1999

Treatment of thoracolumbar trauma: comparison of complications of operative versus nonoperative treatment.

The complications from the acute hospital stays of 235 patients with unstable thoracolumbar fractures were reviewed and compared based on patients who underwent surgical stabilization and those treated with an aggressive nonoperative course of 6 weeks on a kinetic bed. Complications such as deep venous thromboses, pulmonary emboli, and decubitus occur in patients with spine trauma. The perception is that surgical intervention decreases such complications and allows for earlier mobilization. The authors sought to determine the actual rate of occurrence and compare the groups for surgical and nonoperative complications. Two hundred thirty-five charts were reviewed. One hundred seventeen patients were treated with surgical stabilization, and 118 patients were treated with a nonoperative course of 6 weeks on a kinetic bed. Complications were assessed from the medical record. There was no significant difference in the occurrence of decubitus, deep venous thromboses, pulmonary emboli, or mortality between the two groups. Deep wound infections occurred in 8% of the operative cases. The length of stay was 24 days longer in the nonoperative group. Both operative and nonoperative treatments of thoracolumbar fractures are viable alternatives. The complication rates are similar, with the exception of wound infection. The length of hospital stay is longer in the nonoperative group. The selection of treatment method remains a matter of controversy.

Adult↗
PubMed1998

A method for global protein expression and antibody screening on high-density filters of an arrayed cDNA library.

We have developed a technique to establish catalogues of protein products of arrayed cDNA clones identified by DNA hybridisation or sequencing. A human fetal brain cDNA library was directionally cloned in a bacterial vector that allows IPTG-inducible expression of His6-tagged fusion proteins. Using robot technology, the library was arrayed in microtitre plates and gridded onto high-density in situ filters. A monoclonal antibody recognising the N-terminal RGSH6sequence of expressed proteins (RGS.His antibody, Qiagen) detected 20% of the library as putative expression clones. Two example genes, GAPDH and HSP90alpha, were identified on high-density filters using DNA probes and antibodies against their proteins.

Antibodies, Monoclonal↗
PubMed1998

Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery.

BACKGROUND: The risk of rupture of large abdominal aortic aneurysms (AAAs) remains uncertain. This study aimed to provide data to help decide whether or not to operate on high-risk patients. METHODS: Clinicians were asked to refer all patients with an AAA, even if unfit or elderly. One hundred and ninety-two patients with an intact AAA of 5 cm or greater in diameter were seen in 9 years; 59 had no elective operation and follow-up data were available for 57 at a minimum of 2 years. Initial AAA diameters were 5.0-5-9 cm (n=25) and 6.0 cm or more (n=32). Survival curves were constructed for both groups. RESULTS: At the end of the study 50 of 57 patients had died. Median survival was 18 (range 1-90) months. Twenty (35 per cent) suffered rupture at a median interval of 18 (range 1-38) months. The risk of rupture within 3 years was 28 (95 per cent confidence interval 12-49) per cent for 5.0-5.9-cm AAAs and 41 (24-59) per cent for AAAs of 6 cm or greater. In 133 elective AAA operations in fit patients the 30-day mortality rate was 3 per cent. CONCLUSION: The risk of rupture within 3 years of diagnosis of an AAA of 5 cm or greater exceeds the expected operative mortality rate for fit patients. However, the majority of patients unfit for surgery died from other causes, and only a few would have benefited from aneurysm repair.

Age Factors↗
PubMed1993

No thank you kindly.

Explore the source record for details and available documents.

Angioplasty, Balloon, Coronary↗
PubMed1993

Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study.

A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebo-controlled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 micrograms of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a four-point scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.

Adult↗
PubMed1992

Using videotape instruction and feedback to improve adolescents' mothering behaviors.

The effects of videotape instruction and feedback (videotherapy) on mothering behaviors were evaluated in this longitudinal study. In this study, 31 adolescents and their healthy infants were randomly assigned to experimental and control groups. All subjects were videotaped during structured mother-infant teaching episodes in their homes at 1 and 2 months postpartum. Experimental group subjects reviewed the videotaped 1-month teaching episode and received feedback from a specially trained professional nurse who emphasized positive aspects of maternal behavior. Instruction was individualized according to the mother's needs. Results of a repeated measures MONOVA revealed significant differences in the pattern of change over time between subjects in the experimental and control groups on a measure of actual maternal behaviors. Adolescents receiving videotape instruction and feedback obtained significantly higher maternal behavior scores at 1 and 2 months postpartum.

Adolescent↗
PubMed1992

Amyl nitrite: use as a smooth muscle relaxant in difficult preterm cesarean section.

Amyl nitrite is a smooth muscle relaxant that has been used clinically to facilitate uterine relaxation in difficult deliveries. In this retrospective study, we evaluate the safety of amyl nitrite use during preterm cesarean deliveries, and we assess possible advantageous effects on surgical incision choice. Women who received amyl nitrite cesarean section were compared to a control group matched for gestational age, fetal presentation, and mode of delivery who did not receive amyl nitrite. There were no statistical differences between the groups in the independent variables (maternal age, parity, medical or obstetric history, type of anesthesia, anesthesia or obstetric attending physician, antepartum hematocrit, or neonatal weight). Outcome (dependent) variables (estimated blood loss, Apgar scores, postpartum hematocrit, cord gases, or postpartum complications) were assessed, and there were no significant differences between the groups. Low transverse cesarean section was performed more frequently in the amyl nitrite group (58 of 64) than in the comparison group (48 of 64) (p less than 0.03). Considering the 128 women with and without amyl nitrite together, the decrease in hematocrit observed postpartum was greater after classic section (7%) than after low transverse section (4%) (p less than 0.002). We conclude that the use of amyl nitrite during preterm cesarean section poses no threat to mother or fetus and may facilitate delivery by allowing the performance of a low transverse rather than a classic cesarean section without maternal or neonatal complications.

Amyl Nitrite↗
PubMed1992

Placement of anterior cervical instrumentation without intraoperative radiography.

Adequate fixation with several commonly used anterior cervical plate systems requires that the screws penetrate both the anterior and posterior cortices of the vertebral bodies. This report emphasizes the shortcomings of plain film and fluoroscopic examinations in confirming screw position through the posterior vertebral cortex in three patients with lower cervical trauma or tumor. These cases and radiographs of isolated vertebrae from the cervicothoracic region demonstrate the inadequacy of plain film/fluoroscopy for determination of the position of anterior cervical plate screws in relation to the posterior cortex. Only axial images such as those obtained with computed tomography are able to show the exact relationship of the screws to the posterior cortical curvature in C7 and T1.

Adolescent↗
PubMed1990

Cellular immunity in species with variable rejection of vascularized grafts.

We studied the in vitro and in vivo cellular response in three distinctly different xenograft models, using C57BL/6 mice as responders and Lewis rats (LR), Golden Syrian hamsters (GSH), and Strain 2 guinea pigs (GP) as stimulators. Previous work has shown that cardiac grafts from rats, hamsters, and guinea pigs are rejected by C57BL/6 mice in 7 days, 4 days, and 10 min., respectively. In xenogeneic mixed lymphocyte culture, response was in general greatest to GSH splenocytes: stimulation index (S.I.) = 11.4 +/- 3.6 followed by the response to LR cells, S.I. = 3.5 +/- .09, which was less than that of an allogeneic control C57BL/6 anti-DBA, S.I. = 8.4 +/- 1.7. GP stimulator splenocytes produced inhibition of response (S.I. = 0.23 +/- .07) with all counts being below baseline and remaining low despite addition of IL-1, IL-2, or both. In fact, these cells were inhibitory to other allo or xeno mixed lymphocyte cultures in a dose-dependent manner. Cytotoxicity studies revealed maximal killing of ConA blasts in the allogeneic control followed by killing of GSH blasts and LR blasts and no killing of GP blasts. There was also a moderate degree of nonspecific killing between allo and xeno systems. In vivo analysis of cell-mediated cytotoxicity was done using a sponge matrix allograft model. The sponge was injected with donor cells and implanted into C57BL/6 mice. The response to donor cells was tested using cells accumulating in the sponge. There was maximal response to GSH cells greater than DBA greater than LR greater than GP.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Comparison of in vivo and in vitro immune response to purified hepatocytes.

We have previously reported that freshly isolated percoll-purified hepatocytes are MHC class I+, Class II- and stimulate allospecific cytotoxicity in mixed lymphocyte hepatocyte culture. In this report we determined the immunogenicity of purified hepatocytes in vivo using a modification of the sponge matrix allograft model. We found that hepatocytes were immunogenic in vivo because they stimulated the development of cytolytic effectors in allogeneic but not syngeneic hepatocyte sponge matrix allografts. These cytolytic effectors were not macrophages (because cytotoxicity was intact after nylon wool depletion of the bulk sponge effectors) but rather were Ly2+, L3T4- T cells. Cytolytic effectors in both MLHC and hepatocyte sponge matrix allografts demonstrated marked specificity for allogeneic MHC class I antigen of stimulator and donor hepatocytes, respectively. Allospecific cytolytic T cells developed in both MLHC and hepatocyte sponge matrix allografts across an isolated MHC class I genetic disparity but not across an isolated class II genetic disparity. Finally, sequential phenotypic analysis of host cells infiltrating allogeneic hepatocyte sponge matrix allografts demonstrated the presence of macrophages, Ly2+, L3T4- and Ly2-, L3T4+ T cells.

Animals↗
PubMed1989

Multicenter study of autologous adrenal medullary transplantation to the corpus striatum in patients with advanced Parkinson's disease.

In 19 patients with severe Parkinson's disease, we replicated the surgical procedures developed by Madrazo et al. for transplantation of the adrenal medulla to the striatum, and followed them for six months after operation. We monitored their motor function with the use of standardized scales and determined the amount and quality of "on" and "off" time (the hours of the waking day when the antiparkinsonian medications were effective and ineffective, respectively). We found significant improvement in focal areas of motor function. The mean percentage of on time during the day increased from 47.6 percent to 75.0 percent (P = 0.012); the mean percentage of on time without chorea increased from 26.6 percent to 59.2 percent (P = 0.006); the mean severity of off time decreased as assessed by both the Activities of Daily Living subscale of the Unified Parkinson's Disease Scale (P = 0.002) and the Schwab and England scale (P = 0.037). In contrast to the finding of Madrazo et al., however, the dosages of antiparkinsonian medications could not be decreased and postoperative morbidity was substantial. Despite cautious optimism, we conclude that the widespread use of this procedure outside of research centers is premature, since the improvement we found was slighter than in the previous cases.

Activities of Daily Living↗
PubMed1989

Verapamil and chlorpromazine inhibit the budding of Sindbis and vesicular stomatitis viruses from infected chicken embryo fibroblasts.

Two agents, verapamil and chlorpromazine, which affect calcium levels in cells were tested as inhibitors of Sindbis and vesicular stomatitis virus replication in chicken embryo fibroblasts. At levels which did not greatly inhibit general protein synthesis, both drugs appeared to selectively block virus formation at the final stages of virus assembly and budding. Viral nucleoprotein synthesis and transport of viral glycoproteins to the cell plasma membrane were not inhibited under conditions that blocked virus particle release into the cell culture medium. The effects of the drugs were reversible but no morphologically distinct virus-specific structures were detected in the inhibited cells.

Animals↗
PubMed1987

Experience with the Pelorus stereotactic system.

The Pelorus stereotactic system, by its unique approach, alleviates the need for the traditional head frame and computer-generated coordinates which are common to most other systems. Despite its simplicity, it sacrifices nothing in terms of the range of problems for which it can be used to diagnose and treat. In fact, its unencumbered design may make it more appropriate for advanced procedures than conventional systems.

Humans↗
PubMedDate not supplied

Couette membrane filtration with constant shear stress.

Recent developments in the field of blood component separation have revealed the usefulness of membrane filtration using couette type configurations and Taylor vortices as an efficient and effective method. The authors have analyzed in detail the physical and chemical effects on whole blood separated into protein rich plasma, and concentrated red blood cell suspensions, using this technique. The authors also have calculated and demonstrated the technical specifications required to provide laminar flow with Taylor Vortex formation throughout the device, as well as those required to retain constant shear stress on the blood components as viscosity changes. By maintaining constant shear stress below a critical level, it is possible to avoid shear induced hemolysis and to maintain maximal separation efficiency throughout the procedure. The device has further been designed to alter the filtration velocity along the membrane so that the critical filtration velocity is nowhere exceeded, i.e., concentration polarization effects are prevented.

Blood Component Removal↗