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Biomedical subjects

D Patel

Publications and source records attributed to D Patel.

At least 145 records · Page 8Linked to original sources

Multiple Beau's lines in a patient with fever of unknown origin.

We describe a case of fever of unknown origin (FUO) of 9 months' duration in which the finding of regularly spaced multiple Beau's lines (the "ladder nail" sign) pointed to the possibility of a relapsing fever of the Pel-Ebstein variety and an underlying lymphoma. Subsequent investigation confirmed the association of the Beau's lines and fever, as well as the diagnosis of Hodgkin's disease as the cause of the FUO. In this setting, Beau's lines may provide an important diagnostic clue and should be carefully looked for on physical examination.

Fever of Unknown Origin↗

Subcellular fractionation studies indicate an intracellular localization for human monocyte specific esterase (MSE).

Human monocyte-specific esterase (MSE) is one of the few haemopoietic cell enzymes that show absolute lineage restriction. Although the function of MSE has yet to be deduced, its potential role in tumour cell killing has stimulated particular interest. Knowledge of subcellular localization of MSE is fundamental to understanding its function and, in this context, it is widely believed that MSE is expressed as a plasma membrane ectoenzyme; a contention that is largely based upon experiments which examined fixed cells by ultrastructural cytochemistry. However, as recent molecular studies of human MSE indicate, a number of inconsistencies between its structure and a membrane localization, we applied the techniques of phase separation in the non-ionic detergent Triton X-114 and differential centrifugation to further investigate whether this particular esterase species is membrane-bound or associated with an intracellular organelle. These studies provide strong evidence that MSE is in fact a soluble intracellular enzyme that is almost certainly located within the lumen of the endoplasmic reticulum.

Carboxylic Ester Hydrolases↗

Early mobilisation after percutaneous cardiac catheterisation using collagen plug (VasoSeal) haemostasis.

OBJECTIVE: To assess the efficacy and safety of a haemostatic bovine collagen plug (VasoSeal) in reducing patient immobilisation after cardiac catheterisation from a percutaneous femoral arterial approach. DESIGN: A non-randomised, prospective analysis of a new biodegradable haemostatic agent on an intention to treat basis. SETTING: The catheterisation suite of a regional cardiothoracic unit. PATIENTS: A series of 63 patients having various diagnostic investigations and therapeutic interventions agreed to participate in this study. INTERVENTIONS: Cardiac catheterisation was performed from a percutaneous femoral artery approach. Patients taking aspirin and those who required formal anticoagulation were not excluded. Patients were measured for the appropriate sized collagen delivery system at the beginning of the procedure. At the end of the procedure two bovine collagen plugs were applied to the surface of the femoral artery through the channel created by the application device. MAIN OUTCOME MEASURES: Incidence of successful delivery, insertion time, immediate outcome, inpatient complications, success of mobilisation of the patient at one and two hours after the procedure, and whether these variables relate to individual patient characteristics. RESULTS: Successful placement of the device was achieved in 57 of 63 consecutive patients (90.5%). The mean (SD) insertion time was 86 (24) seconds. Six (9.5%) patients did not receive the haemostat because of femoral artery perforation by the tissue dilator (n = 3), inability to compress the femoral artery proximal to the site of delivery (n = 1), pre-existing haematoma (n = 1), or patient withdrawal from the study (n = 1). Uncomplicated mobilisation within two hours of investigation was possible in 54 of 57 (94.7%) patients receiving this device. A sizeable haematoma (> 5 x 5 cm) prevented early mobilisation in the remaining three patients. Mobilisation was uncomplicated in 32 of 34 (94.1%) patients mobilised at two hours and 22 of 23 (95.6%) at one hour (NS). One patient who was mobilised early without complication later developed evidence of claudication in the treated leg. Femoral arteriography showed a smooth intraluminal filling defect attached to the wall of the femoral artery at the puncture site. This obstruction, presumed to be a collagen plug, was treated successfully with angioplasty. Sheath size, arterial pressure, the use of aspirin, heparin or warfarin, and body mass index did not influence patient outcome. The pattern of complications did not relate to a learning curve experience. CONCLUSIONS: The bovine collagen haemostat is a relatively safe and effective device that allows far earlier patient mobilisation than conventional haemostasis after diagnostic and therapeutic interventions from a percutaneous femoral artery approach. These results have important implications for patients undergoing investigation in mobile x ray units or in hospital based day case units.

Adult↗

Prognostic significance of transient ST segment changes after coronary artery bypass surgery: a long-term (4-10 year) follow up study.

OBJECTIVE: To assess the long-term (four to 10 years) prognostic significance of transient ST segment changes on ambulatory ST segment monitoring after coronary artery bypass grafting (CABG). PATIENTS AND METHODS: 76 patients (67 men, nine women) underwent CABG between 1982 and 1984 (n = 31) and between 1987 and 1988 (n = 45) and at a mean age of 57. All underwent 48 hours of ambulatory ST segment monitoring at a mean of 19 weeks after surgery. The results were available for assessment. All general practitioners were contacted and patients' notes reviewed. Patients were contacted by telephone. Details were recorded of intervening events (acute myocardial infarction, unstable angina, need for further revascularisation, and deaths). Event free survival curves were produced for those with and without transient ST segment changes during routine postoperative ambulatory ST segment monitoring. RESULTS: During 3213 hours of monitoring after CABG, 21 (27.6%) of 76 patients had transient ST segment changes, of which 70% were silent. Over a mean 70 month follow up period, patients with such ischaemic changes were no more likely to have either an objective (myocardial infarction or cardiac death) or subjective (unstable angina or another revascularisation) event than those patients without ischaemic changes. This finding was the same in patients operated on between 1987 and 1988 and between 1982 and 1984. CONCLUSIONS: Although ambulatory ST segment monitoring is becoming increasingly popular in some countries as a routine investigation for ischaemia in various coronary subgroups, the findings of such an investigation, when performed after CABG, do not help to identify a subgroup more likely to have an adverse outcome during up to 10 years of follow up. There seems to be no reason to perform this investigation after surgery, and particularly to refer patients for reinvestigation because of the detection of predominantly silent ST segment changes of uncertain relevance.

Adult↗

Glucose affects the severity of hypoxic-ischemic brain injury in newborn pigs.

BACKGROUND AND PURPOSE: The administration of glucose has been shown to worsen brain injury in adult animals but has no effect on the severity of injury in newborn rats. We wished to see whether the results in newborn rats could be extended to another newborn animal. METHODS: In 44 0- to 3-day-old piglets, hypoxic-ischemic central nervous system damage was induced by ligation of both carotid arteries and reduction of their blood pressure to two-thirds normal for one-half hour. In the last 15 minutes of this half hour, oxygen concentration was reduced to 6%. The piglets were randomized to receive either 2 mL/kg 50% dextrose in water followed by 2 mL/kg per hour for 2.5 hours beginning before ischemia or enough insulin to reduce their resting blood sugar to approximately 2 mmol/L. RESULTS: Neurological exam scores in the glucose-treated piglets at 1 day after injury were significantly worse than those in the insulin-treated group. Pathological examination scores were poorer in the glucose-treated group (13.6 +/- 1.9 [mean +/- SEM]) than in the insulin-treated group (24.7 +/- 1.4, P < .01). CONCLUSIONS: Increasing serum glucose during hypoxic-ischemic injury to the newborn piglet's brain worsens brain injury.

Animals↗

Meniscal tears of the knee: preliminary comparison of three-dimensional MR reconstruction with two-dimensional MR imaging and arthroscopy.

OBJECTIVE: A pilot study was performed to evaluate the usefulness of three-dimensional (3D) MR reconstructions in detecting meniscal tears. MATERIALS AND METHODS: Reconstructions of 24 knee menisci were made by using data from standard two-dimensional (2D) MR images. The results were compared with findings on 2D MR images and at arthroscopy. RESULTS: All 17 arthroscopically proved meniscal tears were shown on the 3D reconstructions. Seven tears in five patients were shown on 3D reconstruction but not on 2D MR images, even on retrospective examination. Three of the seven were radial tears and four were horizontal tears. The seven missed tears were all located in the posterior horns. CONCLUSION: Three-dimensional reconstructions are accurate for determining meniscal abnormalities and may be better than 2D imaging for evaluating the posterior horns of the menisci. Three-dimensional reconstructions may be indicated when 2D MR imaging shows no abnormality in patients in whom clinical findings strongly suggest a meniscal tear.

Arthroscopy↗

c-MYC mRNA is present in human sperm cells.

Stage-specific expression of proto-oncogenes, including c-myc, has been demonstrated during spermatogenesis in testis. Some of these proto-oncogenes are expressed postmeiotically, especially in the round spermatid stage. Recently, we demonstrated the presence of c-myc protein in mature ejaculated sperm cells with a possible role in sperm cell function. Since the half-life of c-myc protein has been shown to be short, we suspected the presence of c-myc mRNA in human sperm cells. In the present study, the presence of the c-myc mRNA transcript in human sperm cells was investigated by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis and in situ hybridization. Total RNA, 5-10 micrograms, was extracted from 0.2-0.5 ml of pelleted human sperm cells by NP-40 lysis procedure, and was used to construct cDNA with pd(N)6 random primer and Moloney Murine Leukemia Virus (MMLV) reverse transcriptase. The PCR with sperm cDNA and primers #P1 and #P2, both from exon 3, resulted in amplification of the expected 322 bp product. Primers #P3 and #P4, which are located in exon 2 and exon 3, respectively, and are 1.37 kb apart, gave the expected PCR amplified 313 bp product ruling out the possibility of DNA contamination. The presence of c-myc mRNA in human sperm cells was further confirmed by in situ hybridization using a digoxigenin labelled DNA probe, containing exon 2 of the c-myc gene sequence. The c-myc specific DNA probe reacted with the postacrosomal mid-piece and tail regions of both noncapacitated as well as capacitated methanol-fixed sperm cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Base Sequence↗

Can signal intensity of the continuous wave Doppler regurgitant jet estimate severity of mitral regurgitation?

Visual estimates of the intensity of the continuous wave (CW) Doppler regurgitant jet signal have been used to estimate the severity of valvular regurgitation. Theoretically, the strength of the reflected Doppler signal is a function of the number of scatterers. To test this approach quantitatively, free jets were produced in 27 experiments using a power injector and cornstarch suspension varying in concentration from 1% to 3%. Flow volume was varied from 5 to 15 ml, and orifice diameter varied from 2.5 to 10 mm. Machine settings were kept constant. Also, 22 patients with mitral regurgitation (MR)--5 mild, 11 moderate, and 6 severe by angiography--were studied. Average signal intensity under the CW Doppler flow curve was calculated using a computer image processor. In MR patients, average regurgitant flow (RF) intensity was compared with average mitral forward flow (FF) signal intensity. (1) The intensity under the CW flow signal in the free jet experiments correlated well with injection volume (r greater than 0.98). (2) RF average signal intensity did not correlate with angiographic MR severity (r = 0.21), but the ratio of RF to FF average signal intensity did correlate with MR severity (r = 0.73). (3) The sensitivity and the specificity of an RF/FF ratio greater than 0.65 for angiographically severe mitral regurgitation were both 83%. (4) The sensitivity and specificity of an RF/FF ratio less than 0.50 for angiographic mild mitral regurgitation were both 80%. The ratio of regurgitant to forward mitral flow CW Doppler signal intensity appears to be an accurate and clinically applicable method for estimating the severity of mitral regurgitation.

Adult↗

Ultrastructural quantification of collagen fibrils in the central region of the articular disc of the temporomandibular joint of the cat and the guinea pig.

This quantitative ultrastructural analysis was made on articular discs from four guinea pigs and four cats. Mean diameters of collagen fibrils were small (approximately 45 nm) and showed unimodal distributions. These features are consistent for connective tissues subjected to compressional forces. The relatively high percentage volume of the extracellular matrix occupied by collagen in the articular disc of the guinea pig (approximately 60 per cent) and the presence of crimping is, however, more typical of a connective tissue subjected to tension. Two differences were discernible between the collagen in the articular discs of the guinea pig and cat. First, the percentage volume occupied by collagen for the guinea pig disc was significantly higher than for the cat. Second, the frequency distribution of collagen fibril diameters for the cat, although unimodal, was skewed. These differences possibly reflect the different types of movement at the temporomandibular joints in the two species.

Actin Cytoskeleton↗

Purification of human monocyte-specific esterase (MSE): molecular and kinetic characteristics.

Human monocyte-specific esterase (MSE) derived from leukaemic AMoL-M5 blast cells was purified to homogeneity by the sequential application of anion-exchange, hydrophobic interaction, affinity and gel filtration chromatographic procedures. The resulting enzymatically active MSE primarily existed as an apparent trimer which, under both reducing and non-reducing conditions, dissociated to an inactive 63.4 kD glycoprotein monomer. Electrophoretic studies further confirmed that purified MSE comprised a narrow series of pI (5.5-6.1) forms and one main charge species. Neuraminidase failed to modify observed pI values for individual MSE isoenzymes, and endoglycosidase H treatment revealed that the deglycosylated form of MSE had an apparent molecular weight of 60.1 kD. In support of the known cytochemical characteristics of human MSE, substrate kinetic studies demonstrated that purified enzyme hydrolysed esters of higher acyl chain length (butyrate > propionate > acetate) but did not show peptidase activity. Amino acid sequencing of the MSE N-terminus further revealed that there was almost complete identity with human alveolar macrophage esterase and close similarities with rat and rabbit liver carboxylesterases. These kinetic and molecular studies are particularly important in elucidating the biological and functional role(s) of one of the few haemopoietic cell enzymes that can be considered truly lineage-specific.

Amino Acid Sequence↗

Regurgitant volume estimation in patients with mitral regurgitation: initial studies using color Doppler "proximal isovelocity surface area" method.

Doppler color flow mapping of a proximal isovelocity surface area (PISA), calculated from a blue-red aliasing radius, has been shown in vitro to be accurate for estimating volume flow rate across a narrowed orifice. Volume flow rate (in cm 3/sec) can be calculated as PISA (in cm 2) x aliasing velocity (in cm/sec). This method has advantages over other color Doppler approaches in that PISA-derived volume flow rate calculations appear to be independent of machine parameter settings and orifice shape. We evaluated the clinical applicability of the PISA method in 49 patients with native valve mitral regurgitation (MR). Color Doppler flow mapping was performed at color aliasing velocities of 54-72 cm/sec. Twenty-four patients were excluded because a color aliasing radius was not clearly seen: 20 of these 24 patients had mild MR. In the remaining 25 patients, the ratio of maximum regurgitant jet area-to-left atrial area, as well as the regurgitant stroke volume estimated using the time-velocity integral method, were compared to regurgitant stroke volume calculated from the PISA method. Maximum PISA was calculated using a formula derived from previous in vitro studies: PISA = 8.05 x r 2, where r is the maximum color Doppler aliasing radius in the apical four-chamber view.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗

Conditional defect in mRNA 3' end processing caused by a mutation in the gene for poly(A) polymerase.

Maturation of most eukaryotic mRNA 3' ends requires endonucleolytic cleavage and polyadenylation of precursor mRNAs. To further understand the mechanism and function of mRNA 3' end processing, we identified a temperature-sensitive mutant of Saccharomyces cerevisiae defective for polyadenylation. Genetic analysis showed that the polyadenylation defect and the temperature sensitivity for growth result from a single mutation. Biochemical analysis of extracts from this mutant shows that the polyadenylation defect occurs at a step following normal site-specific cleavage of a pre-mRNA at its polyadenylation site. Molecular cloning and characterization of the wild-type allele of the mutated gene revealed that it (PAP1) encodes a previously characterized poly(A) polymerase with unknown RNA substrate specificity. Analysis of mRNA levels and structure in vivo indicate that shift of growing, mutant cells to the nonpermissive temperature results in the production of poly(A)-deficient mRNAs which appear to end at their normal cleavage sites. Interestingly, measurement of the rate of protein synthesis after the temperature shift shows that translation continues long after the apparent loss of polyadenylated mRNA. Our characterization of the pap1-1 defect implicates this gene as essential for mRNA 3' end formation in S. cerevisiae.

Cloning, Molecular↗

Cranial computed tomographic observations in multi-infarct dementia. A controlled study.

BACKGROUND AND PURPOSE: We compared cranial computed tomography findings among 58 multi-infarct dementia index cases and 74 multi-infarct control subjects without cognitive impairment to identify potential determinants of multi-infarct dementia. METHODS: The cranial computed tomography records of acute ischemic stroke patients with a history of multiple cerebral infarcts were compared to determine the number, location, and size of cerebral infarcts; the pattern of infarction; brain volume loss; and the degree of white matter lucency, sulcal enlargement, and ventricular enlargement. Multi-infarct patients were divided into two groups: 1) index cases were defined as those with multi-infarct dementia as defined by the Diagnostic and Statistical Manual of Mental Disorders, edition 3 (DSM-III) criteria; and 2) control subjects were defined as those multi-infarct patients without dementia or multi-infarct dementia according to DSM-III criteria. RESULTS: Overall, multi-infarct index cases had more cerebral infarcts, more cortical and subcortical left hemisphere infarcts, higher mean ventricular volume to brain volume ratio, more extensive enlargement of the body of the lateral ventricles and cortical sulci, and a higher prevalence of white matter lucencies. Among multi-infarct cases and control subjects the most frequent site of infarction was the subcortical region, and the most frequent pattern of infarction was lacunar. Stepwise logistic regression analysis examined cranial computed tomography as well as other factors and showed that level of education, stroke severity, left cortical infarction, and diffuse enlargement of the left lateral ventricle were the best overall predictors of multi-infarct dementia. CONCLUSIONS: Level of education, stroke severity, and left hemisphere infarction may be predictors of multi-infarct dementia.

Brain↗

Glycerol metabolism and triglyceride-fatty acid cycling in the human newborn: effect of maternal diabetes and intrauterine growth retardation.

Kinetics of glycerol metabolism and triglyceride/fatty acid cycling were quantified in 12 healthy, normal, appropriate-for-gestational-age (AGA) infants, eight small-for-gestational-age (SGA) infants, and five infants of insulin-dependent diabetic mothers (IDM) at less than 48 h of age. Stable isotope-labeled [2-13C]glycerol and [6,6-2H2]glucose in combination with indirect respiratory calorimetry were used. The tracers were used as constant rate infusion and steady state isotopic enrichment of glucose, glycerol, and bicarbonate was measured by mass spectrometric methods. After a 7- to 9-h fast, the plasma glucose, glycerol, and FFA concentrations were similar in the AGA and IDM groups. In the SGA group, the plasma glucose concentration was significantly lower than that in the AGA group throughout the study, but plasma FFA and glycerol concentrations were not different from those in the AGA infants. Plasma betahydroxybutyrate concentration was significantly elevated in the AGA group compared with IDM and SGA infants (AGA 0.59 +/- 0.39, SGA 0.35 +/- 0.09, IDM 0.33 +/- 0.21 mmol/L; mean +/- SD). The rate of appearance of glycerol was significantly elevated (p less than 0.05) in SGA infants (AGA 9.47 +/- 2.11, IDM 9.55 +/- 2.14, SGA 12.15 +/- 3.87 mumol/kg.min). Between 80 and 90% of glycerol turnover was converted to glucose, accounting for 20% of glucose turnover with no significant difference in the three groups. Approximately 35% of glycerol carbon was recovered in the bicarbonate (CO2) pool. Less than 5% of CO2 carbon was derived from glycerol. Estimation of triglyceride-fatty acid cycle revealed that the triglyceride energy mobilized was increased in SGA infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗

Simultaneous patient-side measurement of hemoglobin, glucose, and cholesterol in finger-stick blood.

We describe a multianalyte assay system for patient-side use comprising single-use plastic cartridges and a small monitor. Hemoglobin, glucose, and cholesterol can be simultaneously measured in 3 min in an unmeasured volume of blood. The sample is drawn by capillary action into four channels for delivery to assay-specific stacks containing a set of closely apposed layers. The distal layer is a membrane that acts as the optical surface for reflectance optics. For glucose and cholesterol assays, erythrocytes are removed by a fibrous filter layer and oxidase-peroxidase chemical reactions contained in the optical membrane generate a colored product. For hemoglobin measurement, blood is lysed by detergent contained in a porous disk. The amount of color reaching the optical membrane is measured by fiber optics. To ensure fail-safe operation, sensors verify sample sufficiency and degree of hemolysis. The assays perform comparably with laboratory methods.

Blood Glucose↗

Inhibitor studies of purified haemopoietic (myeloid) cell esterases. Evidence for the existence of distinct enzyme species.

Human myeloid cells synthesize and express two major species of esterase, defined by isoelectric focusing (IEF). The first of these (MonEst) is specifically associated with haemopoietic cells of monocytic lineage, whereas the other species (ComEst) is common to all myeloid cells (granulocytes and monocytes) irrespective of lineage affiliation. Having recently purified these two species of human myeloid cell esterase, this present study extensively investigated the effects of 17 different inhibitors on their ability to hydrolyse the synthetic substrate alpha-naphthyl acetate (alpha NA). Significant inhibition of both ComEst and MonEst was exerted by 1% sodium dodecyl sulphate (SDS) and 1.0 mM diethyl pyrocarbonate (DEPC), but the patterns of inhibition for the two esterase species with the remaining compounds studied differed considerably; for example, 0.2 mM phenylmethylsulphonyl fluoride (PMSF), 5.0 x 10(-3) M dichloroisocoumarin (DCIC) and 0.1 mM N-tosyl-L-phenylalanine chloromethyl ketone (TPCK) all inhibited MonEst but not ComEst. Mechanisms of inhibition were also examined and these studies established that SDS, PMSF, DCIC and TPCK irreversibly inactivated MonEst whilst the inhibition of ComEst by SDS was reversible. Analysis of inhibition kinetics further showed that (a) the reversible inhibition of both ComEst and MonEst by sodium fluoride (NaF) was noncompetitive (with Ki values of 1.28 and 0.01 mM, respectively, indicating a marked difference in sensitivity); (b) the inhibition of MonEst by PMSF was of 'mixed' noncompetitive-competitive type; and (c) that DEPC exerted noncompetitive inhibition with similar Ki values (0.05 mM) for both esterase species. These observations unequivocably demonstrate that ComEst and MonEst are unrelated enzyme species, with a common ability to hydrolyse alpha NA, and that these esterase show marked differences with respect to their active sites as adjudged by inhibitor sensitivities. These observations are particularly relevant to the histochemical analysis of these enzymes and to the elucidation of their in vivo functions.

Acetylesterase↗

Conservation of position and exclusive expression of mouse Xist from the inactive X chromosome.

X-chromosome inactivation in mammals is a regulatory phenomenon whereby one of the two X chromosomes in female cells is genetically inactivated, resulting in dosage compensation for X-linked genes between males and females. In both man and mouse, X-chromosome inactivation is thought to proceed from a single cis-acting switch region or inactivation centre (XIC/Xic). In the human, XIC has been mapped to band Xq13 (ref. 6) and in the mouse to band XD (ref. 7), and comparative mapping has shown that the XIC regions in the two species are syntenic. The recently described human XIST gene maps to the XIC region and seems to be expressed only from the inactive X chromosome. We report here that the mouse Xist gene maps to the Xic region of the mouse X chromosome and, using an interspecific Mus spretus/Mus musculus domesticus F1 hybrid mouse carrying the T(X;16)16H translocation, show that Xist is exclusively expressed from the inactive X chromosome. Conservation between man and mouse of chromosomal position and unique expression exclusively from the inactive X chromosome lends support to the hypothesis that XIST and its mouse homologue are involved in X-chromosome inactivation.

Animals↗

An additional editing site is present in apolipoprotein B mRNA.

Human intestinal apolipoprotein (apo) B mRNA undergoes a C to U RNA editing at nucleotide 6666 to generate a translation stop at codon 2153, which defines the carboxy-terminal of apo B48. Here we show that two of eleven human intestinal cDNAs spanning residue 6666 were edited from a genomically-encoded C to a T at residue 6802 as well as at residue 6666. This additional editing converts Thr (ACA) codon 2198 to Ile (AUA). Synthetic RNA including the nucleotide 6802 was edited in vitro by intestinal extracts at 10-15% of the editing efficiency of nucleotide 6666. A sequence is identified as important for recognition by the editing activity. No secondary structural homology was identified between the two edited sites. No other sequence in the region between 6411 and 6893 nucleotides of apo B mRNA was found to be edited in vivo or in vitro. Apo B RNA editing extracts from intestine did not edit maize cytochrome oxidase II mRNA.

Apolipoproteins B↗