PubMed Health⌕ Search

Biomedical subjects

D S Anderson

Publications and source records attributed to D S Anderson.

At least 19 recordsLinked to original sources

Crystallographic and biochemical analyses of the metal-free Haemophilus influenzae Fe3+-binding protein.

The crystal structure of the iron-free (apo) form of the Haemophilus influenzae Fe(3+)-binding protein (hFbp) has been determined to 1.75 A resolution. Information from this structure complements that derived from the holo structure with respect to the delineation of the process of iron binding and release. A 21 degrees rotation separates the two structural domains when the apo form is compared with the holo conformer, indicating that upon release of iron, the protein undergoes a change in conformation by bending about the central beta-sheet hinge. A surprising finding in the apo-hFbp structure was that the ternary binding site anion, observed in the crystals as phosphate, remained bound. In solution, apo-hFbp bound phosphate with an affinity K(d) of 2.3 x 10(-3) M. The presence of this ternary binding site anion appears to arrange the C-terminal iron-binding residues conducive to complementary binding to Fe(3+), while residues in the N-terminal binding domain must undergo induced fit to accommodate the Fe(3+) ligand. These observations suggest a binding process, the first step of which is the binding of a synergistic anion such as phosphate to the C-terminal domain. Next, iron binds to the preordered half-site on the C-terminal domain. Finally, the presence of iron organizes the N-terminal half-site and closes the interdomain hinge. The use of the synergistic anion and this iron binding process results in an extremely high affinity of the Fe(3+)-binding proteins for Fe(3+) (nFbp K'(eff) = 2.4 x 10(18) M(-1)). This high-affinity ligand binding process is unique among the family of bacterial periplasmic binding proteins and has interesting implications in the mechanism of iron removal from the Fe(3+)-binding proteins during FbpABC-mediated iron transport across the cytoplasmic membrane.

Anions↗

Residency program director evaluations do not correlate with performance on a required 4th-year objective structured clinical examination.

BACKGROUND: Assessment of resident performance is a complex task. PURPOSE: To correlate performance on a 4th-year objective structured clinical examination (OSCE) with residency program director assessment, class rank, and U.S. Medical Licensing Examination (USMLE) scores. METHODS: We surveyed program directors about the performance of 50 graduates from our medical school chosen to represent the highest (OSCEHI) and lowest (OSCELO) 25 performers on our required 4th-year OSCE. Program directors were unaware of the OSCE scores of the graduates. RESULTS: OSCE scores did not correlate with Likert scores for any survey parameter studied (r < .23, p > .13 for all comparisons). Similarly, program director evaluations did not correlate with class rank or USMLE scores (r < .26, p > .09 for all comparisons). CONCLUSIONS: We concluded that program director evaluations of resident performance do not appear to correlate with objective tests of either clinical skills or knowledge taken during medical school. These findings suggest that more structured and objective evaluative tools might improve postgraduate training program assessment of trainees.

Clinical Competence↗

Abnormal duodenal bile composition in patients with acalculous chronic cholecystitis.

OBJECTIVE: Our goal was to characterize biliary lipid composition in patients with the syndrome of chronic biliary pain, absence of gallstones, and inflammation of the gallbladder mucosa (acalculous chronic cholecystitis). METHODS: Duodenal bile, obtained from 27 patients with a history of right upper quadrant pain and with negative imaging studies of the biliary tract, was analyzed enzymatically for bile acids, phospholipids, and cholesterol. Fifteen patients were found to have inflammation and/or fibrosis of the gallbladder at cholecystectomy. RESULTS: The 15 patients with abnormal gallbladder histology had more dilute duodenal bile, as indicated by a low bile acid concentration and a lower proportion of phospholipids (p < 0.01) when values were compared with those of duodenal bile samples from postmenopausal women without gallbladder disease or from radiolucent gallstone subjects participating in the National Cooperative Gallstone Study. Cholecystectomy relieved pain in 9 of 14 patients. CONCLUSIONS: Some patients with acalculous chronic cholecystitis have duodenal bile samples characterized by a decreased bile acid concentration and a decreased proportion of biliary phospholipids. The low biliary bile acid concentration may result from impaired gallbladder contraction and/or secretion by the biliary tract epithelium. The low proportion of phospholipid may result from posthepatic hydrolysis of luminal phosphatidylcholine followed by absorption of the hydrolysis products. The latter process could be caused by and/or contribute to mucosal inflammation and would also elevate the cholesterol saturation of bile, increasing the risk for cholesterol gallstone formation.

Adult↗

Proteome studies of Saccharomyces cerevisiae: identification and characterization of abundant proteins.

Two-dimensional (2-D) gel electrophoresis can now be coupled with protein identification techniques and genome sequence information for direct detection, identification, and characterization of large numbers of proteins from microbial organisms. 2-D electrophoresis, and new protein identification techniques such as amino acid composition, are proteome research techniques in that they allow direct characterization of many proteins at the same time. Another new tool important for yeast proteome research is the Yeast Protein Database (YPD), which provides the sequence-derived protein properties needed for spot identification and tabulations of the currently known properties of the yeast proteins. Studies presented here extend the yeast 2-D protein map to 169 identified spots based upon the recent completion of the yeast genome sequence, and they show that methods of spot identification based on predicted isoelectric point, predicted molecular mass, and determination of partial amino acid composition from radiolabeled gels are powerful enough for the identification of at least 80% of the spots representing abundant proteins. Comparison of proteins predicted by YPD to be detectable on 2-D gels based on calculated molecular mass, isoelectric point and codon bias (a predictor of abundance) with proteins identified in this study suggests that many glycoproteins and integral membrane proteins are missing from the 2-D gel patterns. Using the 2-D gel map and the information available in YDP, 2-D gel experiments were analyzed to characterize the yeast proteins associated with: (i) an environmental change (heat shock), (ii) a temperature-sensitive mutation (the prp2 mRNA splicing mutant), (iii) a mutation affecting post-translational modification (N-terminal acetylation), and (iv) a purified subcellular fraction (the ribosomal proteins). The methods used here should allow future extension of these studies to many more proteins of the yeast proteome.

Databases, Factual↗

Cycloserine-induced Stevens-Johnson syndrome in an AIDS patient with multidrug-resistant tuberculosis.

We report a case of cycloserine-induced Stevens-Johnson syndrome (SJS) in a 38-year-old male with the acquired immune deficiency syndrome (AIDS) and multidrug resistant tuberculosis (MDR-TB). The patient developed a cutaneous reaction after 60 days of therapy with ofloxacin, streptomycin (SM), pyrazinamide (PZA), ethambutol (EMB), and cycloserine (CSN). All drugs were stopped and the rash improved. Due to the severity of his disease, anti-tuberculosis drugs were resumed, one at a time. The patient developed a recurrent rash consistent with SJS, which began when CSN was restarted. CSN was stopped and the SJS began to gradually resolve with palliative treatment despite continuation of the other anti-tuberculosis drugs. However, the patient's overall condition gradually deteriorated and he died. To our knowledge, this is the first case of probable CSN-related SJS.

AIDS-Related Opportunistic Infections↗

Analysis of the costs and benefits of using standardized patients to help teach physical diagnosis.

BACKGROUND: Although a majority of medical schools use standardized patients (SPs) for teaching or evaluating students, the costs and benefits of such programs have not been examined in depth. In 1992-93 the Tulane University School of Medicine reduced by 40% the faculty-precepted sessions in its physical diagnosis program in order to incorporate seven focused examinations using SPs to teach basic examination skills. METHOD: Costs for the revised program included costs for SPs, staff, supplies, and faculty. Faculty cost was estimated at a minimum to equal hourly salary and at a maximum to equal this salary plus potential collectible billings. An objective structured clinical examination (OSCE) was used to assess the skill acquisitions of 150 second-year students in 1991-92, before SPs were used, and in 1992-93, when SPs were used. An unpaired t-test was then used to compare the OSCE performances of the two groups of students. Chi-square analysis was used to compare the evaluations of the physical diagnosis program by the 1992-93 and 1991-92 students. RESULTS: The cost of incorporating SPs into the program was $43,800. The amount of time spent teaching by faculty was reduced by 608 hours, costing between $33 (salary) and $108 (salary plus potential revenue) per hour. Thus, the total savings in the cost of faculty time was between $20,064 and $65,664. Despite the reduction in faculty involvement, the students' performance on the OSCE did not change, and the students' evaluations of the course became significantly more favorable. CONCLUSION: The incorporation of SPs as instructors in the physical diagnosis program was accomplished at a minimal cost and resulted in an increase in students' enthusiasm for the purpose, with no loss of skill acquisition as measured by the OSCE.

Clinical Competence↗

Neurofilament-like immunoreactivity in the sea anemone Condylactis gigantea (Cnidaria: Anthozoa).

The neuronal cytoskeleton contains neurofilament proteins that serve as markers for nervous tissue in many species across phyla. Antiserum generated to mammalian neurofilaments was used for immunocytochemical staining of tissues in the sea anemone Condylactis gigantea (Cnidaria: Anthozoa). Specific staining, visible at the light and electron microscope levels, was found in the tissues of the tentacle. Proteins were extracted from the tissues and solubilized. SDS-polyacrylamide gel electrophoresis and Western blotting revealed two bands of MWr 156 kD and 74 kD that reacted with antiserum generated to neurofilaments. The protein bands also bound a monoclonal antibody shown to react with a highly conserved epitope in many classes of intermediate filaments. These data suggest that the neurons of this anthozoan contain neurofilament-like proteins with molecular properties similar to those of mammalian neurons.

Animals↗

Blunt bile duct injuries in children.

Three of 87 children with blunt liver injuries initially managed without operation required late intervention for bile leakage. Abdominal computed tomography scans in these patients showed liver injuries extending into the porta hepatis. Clinical courses were characterized by persistent abdominal pain, low-grade fever, and prolonged ileus. Radionucleide scan confirmed the suspicion of bile leakage. One patient had complete transection of the common bile duct, which was repaired surgically. Another had partial transection of the left hepatic duct, managed successfully with transampullary biliary decompression. The third patient with an intrahepatic injury was managed with a drain placed at celiotomy. Nonoperative management of blunt pediatric liver injuries carries a risk of persistent bile leakage. Radionucleide scan and endoscopic retrograde cholangiopancreatography are reliable modes of diagnosis and localization. Transampullary biliary decompression is a newer, effective modality for management of the proximal and/or partial bile duct injuries. Treatment must be individualized according to the site and extent of injury.

Bile Ducts↗

Assessing the consistency and educational benefits of students' clinical experiences during an ambulatory care internal medicine rotation.

BACKGROUND: Although ambulatory care settings are being used increasingly in undergraduate clinical education, variability in the depth and breadth of students' contacts with basic medical problems may compromise the educational benefits of this teaching modality. The present study examines the nature of such variation and the educational effectiveness of ambulatory care education. METHOD: During the one-month ambulatory care component of the third-year internal medicine rotation at the University of Michigan Medical School, 43 students in 1989-90 and 1990-91 recorded the patient problems they saw at a hospital and satellite clinics. In addition, the students' diagnostic-recognition abilities were assessed before and after the component. The extents of the students' experiences in various categories of patient problems were quantified and correlated with their diagnostic abilities in relevant content areas. RESULTS: The students saw many categories of problems but few instances in any given category. There were numerous and potentially worrisome gaps in their exposure to several typical ambulatory care problems. Although the students showed significant increases in diagnostic-recognition abilities, these increases were not correlated with the students' levels of experience in any of the relevant problem categories. CONCLUSION: The variability and potentially worrisome gaps in the students' experiences in the ambulatory care settings studied are probably representative of students' experiences in such settings, and should be considered in the implementation and evaluation of educational experiences in ambulatory care.

Adult↗

Vigabatrin--plasma enantiomer concentrations and clinical effects.

Plasma concentrations of the [R]- and [S]- enantiomers of the new anticonvulsant vigabatrin were measured by an enantiospecific gas-liquid chromatographic assay in a group of therapy-resistant epileptic patients in whom racemic vigabatrin was added to their existing antiepileptic drug regimens. The peak plasma concentrations of the biologically active [S]-enantiomer of vigabatrin were correlated with those of the [R]-enantiomer, with drug dose, seizure frequency and change in score on various tests of psychological function administered prior to and when the subjects were under steady-state conditions following vigabatrin therapy. Plasma [S]-vigabatrin concentrations correlated with drug dose, [R]-vigabatrin concentration and change in score of certain psychological tests reflecting verbal memory, recall and speed of information processing. No definite pharmacokinetic interactions were detected, though plasma phenobarbitone concentrations tended to fall during vigabatrin administration. There were too few data to assess the relation between [S]-vigabatrin concentrations and seizure frequency.

Adolescent↗

A case of Rh isoimmunization: should threatened first-trimester abortion be an indication for Rh immune globulin prophylaxis?

Despite the recommended 28 weeks' gestation antenatal, postnatal, and postabortion prophylaxis with Rh immune globulin, residual Rh immunization still occurs in Rh-negative women. We describe a patient whose history suggests development of an anti-D antibody after first-trimester bleeding. To our knowledge, this is the first such case reported in the English literature.

Abortion, Threatened↗

Career preferences and career outcomes of Australian medical students.

Students entering three Australian medical schools were followed over a 15-year period to trace both movement into the profession and the longer-term outcomes of early career aspirations. A variety of student entry characteristics are examined together with aspirations, attainments and self-images. The results indicate that women, rather than men, are more likely to enter medical school with aspirations that involve specialty training. As they proceed through medical school, both groups move away from the idea of pursuing specialty training, although women tend to decide earlier than men that specialty practice is not for them. Women students are more likely than men to attain career goals if these involve general practice and less likely to if these involve specialization. The results indicate that although at graduation women medical practitioners have the same career goals and desires as men, if additional training is required women are unlikely to have their aspirations fulfilled.

Australia↗

Treatment of diabetic diarrhea and orthostatic hypotension with somatostatin analogue SMS 201-995.

A diabetic patient was treated with a somatostatin analogue, SMS 201-995, to control chronic diarrhea and orthostatic hypotension. The patient was injected with 50 micrograms, 100 micrograms, and 150 micrograms of SMS 201-995 subcutaneously twice daily for three days at each dose. Stool weight decreased from a basal mean value of 906 g per 24 hours to 628 g, 445 g, and 408 g per 24 hours, respectively. Diarrhea remained suppressed for 18 months when the patient was last seen. When SMS 201-995 was then given at 5 micrograms to 10 micrograms per hour by continuous subcutaneous infusion, stool weight decreased to a mean of 321 g per 24 hours. Basal blood pressure, which averaged 99/71 mm Hg, rose to 133/91 mm Hg five minutes after 75 micrograms of SMS 201-995 was injected subcutaneously; it remained elevated for six hours after injection. Serum motilin levels decreased significantly from 126 pg/ml before injection of SMS 201-995 to 52 pg/ml after injection. Serum norepinephrine levels rose from 50 pg/ml supine (normal range, 150 to 550 pg/ml) and 52 pg/ml erect before injection of SMS 201-995 to 72 pg/ml supine and 110 pg/ml erect after injection. SMS 201-995 may raise blood pressure, in part by increasing the release of circulating norepinephrine.

Blood Pressure↗

Spontaneous bacterial peritonitis in Wilson's disease.

Spontaneous bacterial peritonitis associated with Wilson's disease has been previously reported in only one case. We report two cases where this infection developed and seriously complicated the course of illness. As with spontaneous bacterial peritonitis occurring with other underlying diseases, early diagnosis and treatment are critical to improved outcome. Recognition that it can occur with Wilson's disease is important, and paracentesis should be performed without delay when suspicious features are present.

Adult↗