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Biomedical subjects

D Spencer

Publications and source records attributed to D Spencer.

At least 19 recordsLinked to original sources
PubMed1998

Endoscopic intracorporal abdominoplasty: a review of 85 cases.

The specialty of plastic surgery has witnessed an explosion of novel procedures with the advent of endoscopy. Surgeons are making more aggressive attempts to reduce the length of scars and subsequent morbidity associated with traditional "open" procedures. Our purpose is to present a new technique of endoscopic abdominoplasty that has largely replaced traditional "full open" techniques at our institution. Since 1985, 85 patients have undergone a procedure that we call the endoscopic intracorporal abdominoplasty. This technique combines traditional abdominal wall liposuction with endoscopic intracorporal plication of the rectus fascia by using a series of horizontal mattress sutures. The procedure is performed using three 1-cm incisions and a series of midline and lateral skin nicks. These 85 patients were compared with 25 patients who underwent traditional open abdominoplasty with anterior plication of the rectus fascia. Average length of surgery was 127 minutes compared to 149 minutes with the open techniques. Length of hospitalization at our institution was 1 postoperative day compared to an average of 3 days with open techniques. No drains were used with the endoscopic techniques, and all of the open procedures had two drains placed. The perioperative rate of morbidity for the intracorporal abdominoplasty was 15 percent (13 of 85 patients) and with the open abdominoplasty cases it was 24 percent (6 of 25 patients). Our conclusion is that the endoscopic intracorporal abdominoplasty reduces operative scars and effectively plicates the rectus fascia, thereby reducing abdominal wall laxity. It has a rate of morbidity in a skilled laparoscopist's hands no greater than with traditional open abdominoplasty.

Abdominal Muscles↗
PubMed1998

Intracranial hypotension presenting with severe encephalopathy. Case report.

A patient with severe and protracted symptoms from intracranial hypotension is described. The patient's presentation was marked by diffuse encephalopathy and profound depression of consciousness. This case report expands the presently known clinical spectrum of this uncommon and generally benign illness. The clinical and laboratory findings typically observed in the syndrome of intracranial hypotension are outlined. The pathophysiological mechanisms of the phenomenon are briefly discussed. Intracranial hypotension is a potentially severe illness with specific treatments that are distinct from the treatment of most neurological diseases. Three cardinal features--postural headache, pachymeningitis, and descent of midline cerebral structures--should prompt the diagnosis.

Adult↗
PubMed1998

Novel methods for studying new antiepileptic drug pharmacology.

A number of new antiepileptic drugs act by indirect mechanisms and thus produce effects that may not best be measured by traditional blood studies of the drugs and their metabolites. Study of the indirect action of these drugs on GABA-mediated inhibition by microdialysis and nuclear MR spectroscopy has proved more relevant. These new investigative techniques may also prove valuable as compounds affecting glutamate or other excitatory neurotransmitters are developed.

Animals↗
PubMed1997

Enhanced methionine levels and increased nutritive value of seeds of transgenic lupins (Lupinus angustifolius L.) expressing a sunflower seed albumin gene.

With the aim of improving the nutritive value of an important grain legume crop, a chimeric gene specifying seed-specific expression of a sulfur-rich, sunflower seed albumin was stably transformed into narrow-leafed lupin (Lupinus angustifolius L.). Sunflower seed albumin accounted for 5% of extractable seed protein in a line containing a single tandem insertion of the transferred DNA. The transgenic seeds contained less sulfate and more total amino acid sulfur than the nontransgenic parent line. This was associated with a 94% increase in methionine content and a 12% reduction in cysteine content. There was no statistically significant change in other amino acids or in total nitrogen or total sulfur contents of the seeds. In feeding trials with rats, the transgenic seeds gave statistically significant increases in live weight gain, true protein digestibility, biological value, and net protein utilization, compared with wild-type seeds. These findings demonstrate the feasibility of using genetic engineering to improve the nutritive value of grain crops.

Albumins↗
PubMed1997

The Centre for Palliative Care Education and Research.

This article describes the role and function of the Centre for Palliative Care Education and Research at the University of Central England in Birmingham. The authors describe the development of the centre, which is a multidisciplinary venture in collaboration with Cancer Relief Macmillan Fund and palliative care providers throughout the west Midlands. Current educational and research initiatives are identified and some future challenges indicated.

Academies and Institutes↗
PubMed1997

Embryonal adenoma of the kidney: a report of two cases.

Embryonal (metanephric) adenoma of the kidney, like Wilms' tumor, exhibits small monomorphic, blue cells arranged as vague, tubular rosettes. Unlike Wilms' tumor, which requires chemotherapy or multi-modality therapy for optimal management, the available evidence indicates that embryonal adenoma is most likely cured by simple enucleation or nephrectomy. Two women, age 54 (Case 1) and 78 (Case 2), respectively, underwent needle biopsy for a radiologically well circumscribed renal lesion with associated hematuria. The cellular smears contained vague rosette-like arrangement of small, blue cells with scant cytoplasm and evenly distributed, fine, nuclear chromatin. In cell blocks, these cells were arranged as compact, primitive, tubular rosettes or rare, moresolid clusters. Assuming that the absence of undifferentiated blastema and primitive glomeruli represented a sampling error, a diagnosis suggesting of Wilms' tumor was made in Case 1. At nephrectomy, despite extensive sampling, the typical triphasic Wilms' morphology and anaplastic or necrotic areas were not seen. In the presence of architectural monotony, the diagnosis in Case 1 was amended to embryonal adenoma. Case 2 was cytologically diagnosed as embryonal adenoma of the kidney and is being followed conservatively. In our opinion, the presence of monotypic architecture at cytology/histology is very helpful in differentiating renal embryonal (metanephric) adenoma from Wilms' tumor.

Adenoma↗
PubMed1996

Physician reactions to the health care revolution. A grief model approach.

The American health care reform revolution has brought about major changes in the practice of medicine. As integral components of the health care system, physicians have felt the full impact of most of these changes. Change often involves losses for those affected, and, in this case, physicians are no exception. Many physicians have experienced losses of financial security, social status, independent clinical decision making and resource utilization, the practice option of independent private practice, hospital governance power, freedom of choice in specialty selection and geographic practice location, physician collegiality, continuity of patient relationships, and autonomy. We use Kübler-Ross' grieving model to help understand physician responses to their losses inherent in health care system reform. The grieving stages of denial, anger, bargaining, depression, and acceptance are applied to these physician responses and suggestions given to help physicians through this grieving process.

Anger↗
PubMed1996

Accumulation of a sulphur-rich seed albumin from sunflower in the leaves of transgenic subterranean clover (Trifolium subterraneum L.).

A gene encoding a sulphur-rich, sunflower seed albumin (23% cysteine plus methionine) was modified to contain the promoter for the 35S RNA of cauliflower mosaic virus, in order to obtain leaf expression in transgenic plants. In addition, a sequence encoding an endoplasmic reticulum-retention signal was added to the 3' end of the coding region so as to stabilize the protein by diverting it away from the vacuole. The modified gene was introduced into subterranean clover (T. subterraneum L.) and its expression was detected by northern and western blots and by immunogold localization. The albumin was accumulated in the lumen of the endoplasmic reticulum, and, among six independent, transformed lines, it accumulated in the leaves of T0 transgenic plants at varying levels up to 0.3% of the total extractable protein. The level of accumulation of the sunflower albumin increased with increasing leaf age, and in the older leaves of the most highly expressing plants of the T1 generation it reached 1.3% of total extractable protein. Expression of the SSA gene was stable in the first and second generation progeny. These results indicate that there is potential for significantly improving the nutritional value of subterranean clover for ruminant animals such as sheep by expressing genes that code for sulphur-rich, rumen-stable proteins in leaves.

Albumins↗
PubMed1996

Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas.

Data from 55 consecutive patients with low-grade astrocytomas treated between 1982 and 1990 were analyzed to determine specific outcome factors, including time to recurrence, incidence of anaplastic transformation, and survival. Gender, type of symptoms, contrast enhancement, and timing of radiation therapy were not significant in determining outcome. Patients who had symptoms for > 2 years and underwent gross-total resection of the tumor, with age as a continuous variable, were associated with significantly longer time to recurrence and survival. Within the population of patients with low-grade astrocytomas, patients with chronic epilepsy clearly had the best prognoses. There were no tumor recurrences or deaths in 27 patients with chronic epilepsy, regardless of the extent of surgery and without the use of radiotherapy. Ten-year survival was 100% for 31 patients who underwent gross-total tumor resection, regardless of the length of preoperative symptoms. Immediate postoperative radiotherapy did not prolong the time to recurrence, reduce the incidence of transition to more malignant tumors at recurrence, or increase the length of survival when compared with delayed radiotherapy. Because recurrence with a high-grade lesion caused 92% of the mortality in our series, the benefit in patients who underwent aggressive surgery seems to result from a significant decrease in the risk of recurrence when compared with patients who underwent anything less than gross-total resection. Our data also suggest that variability in the natural history of low-grade astrocytomas has a strong influence in determining survival and that tumors associated with chronic epilepsy are much less likely to become more malignant over time.

Adult↗
PubMed1996

Variants of Kaposi's sarcoma in Southern Africa. A retrospective analysis (1980-1992).

All types of Kaposi's sarcoma (KS) are represented in the Southern African region. We present a retrospective analysis of patients with KS, treated and followed up at the Johannesburg General Hospital over a 12-year period (1980-1992). One hundred and nineteen patients with KS, divided into four groups according to their etiology (classical; endemic African; renal transplant recipients; epidemic AIDS-related) were analyzed. Choice of treatment (radiotherapy or chemotherapy) was individualized and based on clinical criteria, extent of disease and severity of symptoms. Kaposi's sarcoma showed a very high response rate to radiation therapy, regardless of variant, radiation modality or schedule. Chemotherapy was also effective in the more aggressive pattern of endemic African KS. Epidemic Kaposi's sarcoma showed the same poor outcome as demonstrated by its Western counterpart. We conclude that radiation therapy can provide excellent palliation with only minimal side-effects in all variants of KS seen in Southern Africa.

Acquired Immunodeficiency Syndrome↗