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Biomedical subjects

D Mullins

Publications and source records attributed to D Mullins.

At least 37 records · Page 2Linked to original sources
PubMed1995

Subcutaneous Castleman's disease of the wrist.

Castleman's disease usually occurs as a solitary lesion in the mediastinum and less frequently in the neck region. Two variants are recognized, the more common hyaline-vascular type and the plasma cell type. A third hybrid, or intermediate, variant exists that shares features with both the hyaline-vascular and plasma cell types. Uncommonly, these lesions occur outside the mediastinum or neck region. We report a case of subcutaneous Castleman's disease of the intermediate type on the wrist of a 56-year-old woman without systemic symptoms.

Capillaries↗
PubMed1995

Nitric oxide inhalation in infants and children: physiologic and clinical implications.

Nitric oxide is a significant biologic mediator in a number of physiologic processes. Clinical and laboratory studies in both human and animal models have uncovered a number of conditions responsive to nitric oxide therapy. The use of inhaled nitric oxide is rapidly expanding into neonatal and pediatric critical care. Presently, the primary clinical indication for nitric oxide is pulmonary hypertension of either a primary or secondary etiology. Some patient populations that are refractory to conventional management demonstrate significant improvement when receiving nitric oxide therapy. This article discusses the physiologic properties of nitric oxide, as well as its diagnostic and therapeutic indications. Specific issues regarding nitric oxide delivery, monitoring, safety standards, and nursing care are also addressed.

Administration, Inhalation↗
PubMed1994

Multinucleate cell angiohistiocytoma of the upper lip.

Multinucleate cell angiohistiocytoma is a rare benign fibrohistiocytic vascular tumor with distinctive histologic features. It appears clinically as small, slow-growing, grouped reddish-brown to purple papules and nodules that may be mistaken for other vascular proliferative or reactive conditions. Multinucleate cell angiohistiocytoma tends to occur more frequently in women, to favor the extremities, and to appear as multiple lesions. We report a case of solitary multinucleate cell angiohistiocytoma that appeared as a nodule on the upper lip of a man but that otherwise demonstrated characteristic histologic and immunohistochemical features. Greater awareness of this uncommon benign lesion will facilitate diagnosis and appropriate management.

Adult↗
PubMed1993

High-level expression of antibody-plasminogen activator fusion proteins in hybridoma cells.

We show that the mouse gamma 2b heavy chain or human beta-globin 3' untranslated region can greatly enhance protein expression in myeloma cells transfected by genes coding for antibody-plasminogen activator fusion proteins. Expression plasmids were constructed containing a cloned genomic heavy chain variable region from fibrin-specific monoclonal antibody 59D8, a cloned genomic constant region of the mouse gamma 2b heavy chain, and DNA sequence coding for either tissue-type plasminogen activator (tPA) or a segment of urokinase (UK) and their respective 3' untranslated sequences. Cell lines transfected with these constructs, pSVtPA (tPA) and pSVUKG(UK), produced extremely low levels of mRNA and protein (0.008-0.06 micrograms/ml) in comparison with the parental 59D8 myeloma cell line (7.6-10 micrograms/ml). In vitro nuclear run-off analysis indicated that the low steady-state levels of mRNA encoded by pSVUKG(UK) did not result from a lower rate of transcription of the transfected gene (relative to the rate of transcription of the endogenous heavy chain gene in the 59D8 parent cells). In an attempt to increase protein secretion, we assembled the expression plasmids pSVtPA(Ig), pSVUKG(Ig), and pSVUKG(beta), in which the 3' untranslated region of the mouse gamma 2b heavy chain or human beta-globin gene was substituted for the 3' untranslated region of the plasminogen activator gene. Analysis of supernatant media from cell lines transfected with these constructs showed an increase in recombinant protein secretion of 68 to 100 fold in comparison with that from cell lines transfected with pSVtPA(tPA) or pSVUKG(UK).

Amino Acid Sequence↗
PubMed1993

Role of laparoscopy in the evaluation of abdominal trauma.

This prospective study was designed to determine if laparoscopy is a safe and accurate method for abdominal evaluation in the trauma patient. Thirty-two patients who presented with blunt or penetrating trauma and who were scheduled for celiotomy based on clinical evaluation constituted the study group. The patients underwent diagnostic laparoscopy prior to exploratory celiotomy. One of 6 (16%) patients with blunt abdominal trauma and 5 of 26 (19%) patients with penetrating abdominal trauma had significant injuries that were found at the time of operation but not visualized during laparoscopy. The missed injuries involved the liver, pancreas, stomach, duodenum, small bowel, small bowel mesentery, ureter, and urinary bladder. The correlation between the laparoscopist and the trauma surgeon as to the need to perform a celiotomy was 97%. Complications occurred in 2 of 32 patients. Eleven patients with anterior abdominal penetrating injuries had no evidence of penetration of the abdominal cavity at laparoscopy, and had no evidence of injury at celiotomy. We concluded that (1) there are areas within the abdominal cavity that cannot be accurately visualized with laparoscopy; (2) the evaluation of penetration of the peritoneal cavity from anterior penetrating injury appears to be accurate; (3) a number of injuries were not identified; and (4) further investigation of this procedure for the evaluation of abdominal trauma is required to assess its safety and accuracy.

Abdominal Injuries↗
PubMed1993

Reconsideration of the quality circle process as a contemporary management strategy.

The quality circle group problem-solving process contains the potential for finding solutions to today's health care challenges. It provides the mechanism to integrate the strongest problem-solving capabilities of both managers and staff. If the complex challenges that are occurring daily as well as those that have been carried forth from the last decade are to be solved, it is evident that there is a need to find a mechanism to combine the best and brightest insights of both managers and staff. The quality circle process is one such mechanism. Health care supervisors are invited to reconsider this process as a contemporary management strategy that blends in well with the current movement toward continuous quality improvement.

Evaluation Studies as Topic↗
PubMed1992

Decline in creatinine clearance in a patient with glomerulomegaly associated with a congenital cyanotic heart disease.

Glomerulomegaly is associated with congenital cyanotic heart disease and has heretofore been considered a benign condition. We describe a patient with congenital cyanotic heart disease and glomerulomegaly. Deterioration of renal function was demonstrated by comparison of creatinine clearances measured at the time of kidney biopsy and 4 years later. No alteration in kidney histology other than glomerulomegaly and focal glomerulosclerosis at autopsy could account for this deterioration. This is the first description of deterioration of renal function in a patient with glomerulomegaly and congenital cyanotic heart disease. This observation may influence the management of patients with glomerulomegaly and congenital cyanotic heart disease who are potential recipients of heart or heart-lung allografts.

Adult↗
PubMed1992

Immunostaining for P-glycoprotein in the diagnosis of thyroid carcinomas.

The morphologic distinction between thyroid carcinoma and certain benign thyroid conditions can be difficult in selected cases. P-glycoprotein (Pgp), a glycoprotein associated with tumor multidrug resistance, has been reported to be expressed in thyroid carcinoma but not in benign thyroid conditions. To determine the specificity of immunostaining for Pgp in the diagnosis of thyroid carcinoma, we studied formalin-fixed, paraffin-embedded tissue from 69 cases of various thyroid lesions using a commercially available monoclonal antibody to Pgp (C219, Centocor, Malvern, PA) and an avidin-biotin-peroxidase complex technique. Positive reactivity was seen in 15 of 37 (41%) benign thyroid conditions and in 23 of 32 (72%) thyroid carcinomas. We conclude that immunostaining for Pgp is not specific in the diagnosis of thyroid carcinoma.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1991

A recombinant chimeric plasminogen activator with high affinity for fibrin has increased thrombolytic potency in vitro and in vivo.

A recombinant plasminogen activator with high fibrin affinity and specificity was expressed by transfecting hybridoma cells with a plasmid that combines sequence coding for low molecular mass (32 kDa) single-chain urokinase-type plasminogen activator [scuPA(32kDa)] and anti-fibrin monoclonal antibody 59D8. The expression of the recombinant molecule [r-scuPA(32kDa)-59D8] was optimized by replacing the 3' untranslated region (initially that of high molecular mass scuPA) in the plasmid with the 3' untranslated region of either beta-globin or mouse immunoglobulin. This modification resulted in a greater than 100-fold improvement in the level of protein expression. The 103-kDa r-scuPA(32kDa)-59D8 protein displayed catalytic activity indistinguishable from that of high molecular mass scuPA and fibrin binding comparable to that of native antibody 59D8. r-scuPA(32kDa)-59D8 was 6 times more potent than high molecular mass scuPA in lysing a human plasma clot in vitro and was 20 times more potent than high molecular mass scuPA in the rabbit jugular vein model of thrombolysis. Molecules of this type may serve as prototypes for highly specific, antibody-targeted enzymes suitable for human use.

Animals↗
PubMed1990

Intraocular pressure-dependent light sensitivity in glaucoma.

The intraocular pressure-dependent light sensitivity of discrete retinal points was measured using the Heijl-Krakau automated light-emitting diode perimeter with an appropriate software program. A total of 300 measurements of light sensitivity were recorded from six retinal points during the test period of 8-10 min; increased intraocular pressure was induced using a Langham scleral suction-cup system. The ocular pulsatile blood flow and the ophthalmic arterial pressure were measured in the same patients. The fluctuation of the light sensitivity was less than 5% over the test period in healthy eyes and remained unaffected by an intraocular-pressure increment of 20 mm Hg; a small decrease of sensitivity occurred at a pressure increment of 30 mm Hg. In glaucomatous eyes the light sensitivity was lower and the fluctuation of the light sensitivity at some but not all retinal points was substantially greater than in the controls. In the glaucomatous eyes, and intraocular-pressure increment of 20 mm Hg increased the fluctuation and decreased the light sensitivity. The pulsatile ocular blood flow was lower in the glaucomatous eyes but not severe enough to be solely responsible for the loss of vision. The coexistence of retinal points with normal and abnormal stabilities of light sensitivity in glaucomatous eyes was consistent with impaired blood flow in the lamina cribrosa.

Adult↗
PubMed1987

Toxicity of enzymically-oxidized low-density lipoprotein.

Intravenous injection of cholesterol oxidase into hyperlipidemic rabbits in which aortic atheromatous lesions have been induced by dietary means is lethal within hours, whereas injection of the same enzyme into normal rabbits has no visible adverse effect. The lethal effect of the enzyme is explicable by the finding that injection of cholesterol-oxidase treated low-density lipoprotein kills normal rabbits, in contrast to untreated low-density lipoprotein which does not. Enzymically oxidized low-density lipoprotein was also found to be cytotoxic for two human cell lines and for cultured bovine aortic endothelial cells. We suggest that in vivo enzymic conversion of low-density lipoprotein cholesterol to low-density lipoprotein cholestenone may possibly play a role in the initiation of atheromatous lesions in humans.

3-Hydroxysteroid Dehydrogenases↗
PubMed1987

Diagnosing psychiatric disorders in adolescent females with abdominal pain.

Psychiatric diseases, recently renamed psychiatric disorders by the American Psychiatric Association, are commonly associated with abdominal pain in adolescents but may be difficult to diagnose. In a prospective study, we evaluated four psychiatric scales, including the Childhood Depression Inventory (CDI) and the Speilberger State-Trait Anxiety Inventory (STAI) as aids in the diagnosis of psychiatric disorders in 40 adolescent females with abdominal pain. Final diagnosis of organic-dysfunctional disease was made in 32 patients, and a psychiatric disorder was found in eight. Only the CDI (p = 0.001) and the State (p = 0.006) and Trait (p = 0.022) scales of the STAI had significantly different mean values between subjects with organic-dysfunctional disease and a psychiatric disorder. Almost all subjects with a psychiatric disorder had abnormally high scores, whereas the subjects with organic-dysfunctional disease did not. We conclude that three brief, self-administered psychiatric scales may be useful in differentiating between organic-dysfunctional disease and a psychiatric disorder in adolescent patients with abdominal pain.

Abdomen↗
PubMed1987

Rorschach assessment of borderline children.

Projective testing may provide the clinician with a valuable context in which childhood borderline conditions may be investigated. The purpose of this study was to determine if Rorschach scores could be useful in diagnosing borderline disorders. Rorschach scores from a group of 13 borderline children and 10 conduct disorder children were compared using a step-down discriminate analysis. The results indicated that children in these two groups could be correctly classified beyond chance levels using Rorschach scores. Three variable, content analysis, human movement, and animal movement were the strongest contributors in separating the two groups. The Rorschach measure of form quality (i.e., adequacy of perception) was notable in that it failed to produce any independent discriminatory power in this analysis. As in the case of adult borderline testing using the Rorschach, novel scoring procedures, used in conjunction with standard scoring procedures may lead to further clarification of childhood borderline disorders.

Borderline Personality Disorder↗
PubMed1987

Two cases of benzodiazepine toxicity in children.

While benzodiazepines have been widely used in adult populations, their role in the treatment of anxiety disorders in children and adolescents has not been well established. The authors report on two cases in which benzodiazepine use resulted in psychotic symptoms. The importance of eliciting a careful history as well as being familiar with drugs' side effects and withdrawal effects is stressed.

Age Factors↗
PubMed1986

Brief psychiatric rating scale for children: quantitative scoring of medical records.

The utility of the Brief Psychiatric Rating Scale for Children (BPRS-C) for transcribing narrative medical records into standard quantitative form for research purposes is examined. Three clinicians independently read and rated the records of 40 child and adolescent patients. Interrater reliabilities were adequate in most major domains of psychopathology, the one notable exception being symptoms in the anxiety domain. On the basis of these results, the BPRS-C appears appropriate for use in administrative and audit reviews, as well as in epidemiological and program evaluation research in which medical records are the primary sources of information.

Adolescent↗
PubMedDate not supplied

A novel method for replacement of the dislodged tracheostomy tube: the nasogastric tube "guidewire" technique.

Unscheduled replacement of dislodged tracheostomy tubes can be a challenging procedure for the physician and a frightening event for the patient. Forceful attempts at replacement are both painful and dangerous; such attempts may disrupt the soft tissues adjacent to the tracheostomy tract, creating a false passage and potentiating acute respiratory failure. We describe a technique using a standard nasogastric tube that allows safe and precise replacement of tracheostomy tubes in both sedated and combative patients under routine and emergent conditions.

Humans↗