Atrophoderma of Pasini and Pierini: atrophy of dermis or subcutis?
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Adipose Tissue↗
Biomedical subjects
D MacFarlane
Publications and source records attributed to D MacFarlane.
Intra-articular and soft tissue injections: a survey of current practice.
Intra-articular and soft tissue injections are the two most frequently used procedures in rheumatological practice. A questionnaire completed by 172 consultant rheumatologists aimed to ascertain the techniques used in these procedures. The results showed a wide divergence of practice in almost every aspect of technique. Respondents were willing to undertake injections in almost any location, but differed widely regarding personal and patient preparation before injection. About one-quarter used no local anaesthetic, the majority using local anaesthetic before or with the corticosteroid. Admission overnight or as a day case for injection of weight-bearing joints was practised by 18%. Post-injection advice was extremely variable. The results suggest that there is at present no single consensus technique for intra-articular and soft tissue injections amongst British consultant rheumatologists.
Asepsis↗
Long-wave ultraviolet radiation induces protein kinase C in normal human keratinocytes.
Skin tumor promotion by phorbol ester is believed to be mediated by the phospholipid-dependent ser/thr kinase, protein kinase C (PKC). Long-wave ultraviolet radiation (320-400 nm, UVA), which has also been shown to promote skin tumors, induces elevated levels of PKC in murine fibroblasts, suggesting that UVA may promote the development of basal and squamous cell skin cancers by a mechanism involving PKC. To examine UVA effects on PKC in a model relevant to skin, we maintained normal human epidermal keratinocytes (NHEK) in serum-free medium and exposed the cultured cells to various doses of UVA or to the phorbol ester, 12-O-tetradecanoylphorbol-13-acetate (TPA). Fifty minutes after exposure to UVA (5-20 J/cm2), PKC activity was elevated up to three-fold in NHEK cytosolic fractions, and membrane-associated PKC activity was elevated up to two-fold by UVA. The TPA treatment induced a 10-fold increase in membrane-associate PKC activity only. Immunoblot analysis suggested that a UVA-induced increase in PKC protein occurred. Both UVA and TPA reduced the cell number by 50-75% in the first 24-48 h; however, irradiated cultures began to recover at 72 h post-UVA due to an increased proliferative rate beginning after 48 h. Treatment with TPA induced a high level of differentiation as measured by cornified envelope formation. Ultraviolet A irradiation exposure was not followed by increased differentiation. These findings suggest that acute UVA exposure elevates PKC activity in human keratinocytes and may act through PKC to promote actinic skin cancer. The molecular mechanism is like to differ from that of the phorbol esters, however.
Amino Acid Sequence↗
Neutrophil collagenase in sputum from patients with cystic fibrosis.
The potential role of neutrophil elastase in causing lung damage and exacerbating the inflammatory response in cystic fibrosis (CF) has received considerable attention. Although another potent neutrophil-derived enzyme, collagenase, is implicated in tissue destruction in several interstitial lung disorders, there has been no reference to this enzyme in CF. The objective of this study was to determine whether neutrophil collagenase is present in active form in CF sputum and, if so, whether it is related to disease severity. High levels of active collagenase were detected in sputum from patients with CF, and the majority of the enzyme present was of neutrophil origin. In a group of 16 patients with CF, negative relations between sputum collagenase activity and Shwachman score (r = -0.55, p < 0.05) and FEV1 (r = -0.59, p < 0.02) were noted, indicating an association between high collagenase activity and severity of disease. A positive correlation was observed between sputum collagenase and elastase activity (r = 0.62, p < 0.05). These results suggest that both neutrophil elastase and collagenase may play a significant role in lung destruction in CF.
Adolescent↗
A bedside decision instrument to elicit a patient's preference concerning adjuvant chemotherapy for breast cancer.
The objective of this study was to develop an instrument to help clinicians inform patients with breast cancer of risks and benefits of adjuvant chemotherapy as derived from clinical trials and to help the informed patient decide whether she prefers treatment or no treatment. The instrument consists of a visual aid (called the decision board) and written material. It provides detailed information on a patient's choices (chemotherapy or no chemotherapy), outcomes (recurrence or not), probabilities of outcomes and their meaning, and quality of life associated with treatment choice and outcome. The validity and reliability of the instrument were evaluated in 30 healthy female volunteers. It was first administered using standard estimates of recurrence for node-negative breast cancer (15% risk of recurrence without treatment, which is reduced to 10% with chemotherapy). A preference for treatment (or no treatment) was then elicited. The validity was evaluated by changing the information provided on risks and benefits and determining whether the preference changed in a predictable manner. To test for reliability, the instrument was administered 2 weeks later. Seventeen women chose chemotherapy and 13 chose no chemotherapy. In the former group, 14 women (82%) switched preference when the magnitude of benefit was reduced, and 16 (94%) switched when the toxicity of treatment was increased. For those women who chose not to receive chemotherapy, 12 (92%) switched when the benefit was increased and 100% switched when toxicity was eliminated. The reliability was excellent (kappa = 0.86). The instrument has been used to elicit treatment preferences in 37 newly presenting patients with high-risk, node-negative breast cancer and has been found to be acceptable and helpful to the patient.
Adult↗
Dietary fibre intakes in the United Kingdom before and after retirement from work.
During a 4-year longitudinal nutritional survey at the age of retirement from work, 94 subjects participated, both before and after retirement. Investigations included 7-day weighed dietary records, questionnaire interviews and health screening. A further 89 subjects added to the data by questionnaire interviews. Dietary fibre intakes calculated from the 7-day weighed dietary records were: pre-retirement 17.6 +/- 6.5 g/day, range 7-35 g; post-retirement 18.4 +/- 6.1 g/day, range 7-34 g. Before their retirement 88 per cent of the sample were not reaching the NACNE short-term recommendation of 25 g/day and 95 per cent had not reached the long-term recommendation of 30 g/day. There was little change in these percentages after retirement from work. Those individuals whose intakes were greater than 30 g/day had sometimes adopted a somewhat unusual style of eating. The percentage contributions to dietary fibre intake from the main food groups remained consistent, with vegetables and breads as the major sources, followed in importance by breakfast cereals and fruits. In spite of the ready availability of higher fibre foods, and publicity from the mass media and nutritional counselling, the increased awareness of the role of dietary fibre in the prevention of constipation had not, for the majority, altered food choice. There was a significantly higher intake of dietary fibre when breakfast was eaten daily but no significant effect on intake with alterations in food choice caused by dentures, chewing difficulties, indigestion or weight control.(ABSTRACT TRUNCATED AT 250 WORDS)
Bread↗
On-line computer-assisted exercise mapping.
The ability of exercise ECG body surface mapping to detect the presence and distribution of coronary artery disease was investigated in 76 patients presenting with chest pain. The ECG data were recorded from 16 leads regularly placed over the left praecordium. All 16 leads were input simultaneously to a PDP8 computer and 8-second samples were stored at rest, at the termination of symptom-limited exercise, and in the recovery period. ST isopotential surface maps were subsequently constructed. The presence and praecordial projection of ST abnormality were related to the arteriographic distribution of coronary disease. The ECG data were abnormal in 56 of 58 patients with coronary disease and permitted the identification of left anterior descending artery disease in 49 of 53, right coronary artery disease in 39 of 43, and circumflex artery disease in 24 of 30. Mapping separated those with single vessel from those with multiple vessel disease in 91% of patients with coronary disease. These preliminary results suggest that exercise ECG body surface mapping may provide an attractive non-invasive approach to the investigation of patients with coronary disease.
Adult↗