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Biomedical subjects

E Tobin

Publications and source records attributed to E Tobin.

17 recordsLinked to original sources
PubMed2006

Laryngeal collapse in seven brachycephalic puppies.

OBJECTIVES: To document the histories, clinical findings, and management of seven puppies with laryngeal collapse occurring secondarily to brachycephalic airway syndrome. METHODS: Seven brachycephalic puppies aged between 4.5 and six months underwent surgery for management of brachycephalic airway syndrome following presentation for exercise intolerance and increased respiratory noise and effort. RESULTS: Stenotic nares of varying severity and an elongated soft palate were common to all dogs. All dogs had tracheal hypoplasia and this was severe in four dogs. Laryngeal collapse was present in all dogs. Two dogs had stage I, four dogs stage II, and one dog stage III laryngeal collapse. The dog with stage III laryngeal collapse and one dog with stage II laryngeal collapse died. There was no apparent association between the changes evident on thoracic radiographs or the degree of tracheal hypoplasia and postoperative outcome. CLINICAL SIGNIFICANCE: The development of severe secondary laryngeal changes in dogs aged six months or less supports the suggestion that immature brachycephalic dogs should undergo assessment and, if indicated, surgery as soon as any clinical signs of BAS are apparent.

Airway Obstruction↗
PubMed2004

Gastrocutaneous fistula as a result of migration of a foreign body in a dog.

A six-year-old, female Tibetan terrier was referred for investigation of a non-healing wound on the left caudal thorax. A subcutaneous swelling had initially developed on the chest wall, followed by a draining tract from which seropurulent fluid drained for two months. There had been no response to antibiotic treatment. Following radiographic and ultrasonographic examinations, a bone sequestrum from a fractured rib or a foreign body was suspected. Surgical exploration of the wound identified a sinus tract and a wooden foreign body (an ice-lolly stick) was located in subcutaneous tissues. Partial wound dehiscence of the surgical site occurred postoperatively, but healed after 10 days. One month later, fluid began to discharge from the area again. Further surgical exploration confirmed a gastrocutaneous fistula. Dissection of the fistula and surgical closure of the stomach, body wall and skin led to resolution of all signs.

Animals↗
PubMed2003

Recurrent 'sterile' verrucous cyst abscesses and epidermodysplasia verruciformis-like eruption associated with idiopathic CD4 lymphopenia.

Rupture of follicular (epidermoid) cysts is believed to be the consequence of bacterial infection. We report a 24-year-old man with idiopathic CD4 lymphopenia and chronic Mycobacterium avium intracellulare infection who developed multiple, recurring painful abscesses over the distal extremities that increased in number and severity when systemic steroid and interferon-gamma treatment was instituted for interstitial lung disease. Cultures were consistently negative for microorganisms, but pathological examination revealed ruptured epidermoid cyst walls with human papillomavirus (HPV) viropathic changes (keratinocytes with perinuclear halos and abundant basophilic keratohyaline granules). Cutaneous examination showed numerous, widespread flat-topped papules and achromic macules over the extremities, head and neck. Nested polymerase chain reaction analysis for HPV DNA revealed that the abscess-related cyst walls harboured epidermodysplasia verruciformis (EV)-associated HPV types 20, 24, alb-7 (AY013872) and 80. His cutaneous lesions harboured HPV types 3, 8 and 80. Similar to past reports, our patient developed an EV-like eruption in the setting of immunodeficiency. In this instance, EV-associated HPV infection of the follicular infundibular epithelium or pre-existing cysts in the setting of immunodeficiency may have led to cystic growth, rupture and subsequent painful inflammation.

Abscess↗
PubMed2003

Assessment of a simple artificial neural network for predicting residual neuromuscular block.

BACKGROUND: Postoperative residual curarization (PORC) after surgery is common and its detection has a high error rate. Artificial neural networks are being used increasingly to examine complex data. We hypothesized that a neural network would enhance prediction of PORC. METHODS: In 40 previously reported patients, neuromuscular function, neuromuscular block/antagonist usage and time intervals were recorded throughout anaesthesia until tracheal extubation by an observer uninvolved in patient care. PORC was defined as significant 'fade' (train of four <0.7) at extubation. Neuromuscular function was classified as PORC (value=1) or no PORC (value=0). A back-propagation neural network was trained to assign similar values (0, 1) for prediction of PORC, by examining the impact of (i) the degree of spontaneous recovery at reversal, and (ii) the time since pharmacological reversal, using the jackknife method. Successful prediction was defined as attainment of a predicted value within 0.2 of the target value. RESULTS: Twenty-six patients (65%) had PORC at tracheal extubation. Clinical detection of PORC had a sensitivity of 0 and specificity of 1, with an indeterminate positive predictive value and a negative predictive value of 0.35. Using the artificial neural network, one patient with residual block and one with adequate neuromuscular function were incorrectly classified during the test phase, with no indeterminate predictions, giving an artificial neural network sensitivity of 0.96 (chi(2)=44, P<0.001) and specificity of 0.92 (P=1), with a positive predictive value of 0.96 and a negative predictive value of 0.93 (chi(2)=12, P<0.001). CONCLUSIONS: Neural network-based prediction, using readily available clinical measurements, is significantly better than human judgement in predicting recovery of neuromuscular function.

Adult↗
PubMed2002

Silver coated materials for external fixation devices: in vitro biocompatibility and genotoxicity.

The most significant complication in external fixation is pin tract infection causally related to the highly adaptive ability of bacteria to colonise the surfaces of "inert" biomaterials or of adjacent damaged tissue cells. The hypothesis that coating a pin with a silver-containing compound will decrease bacterial colonisation and/or pin tract infection has been confirmed in other studies in vitro and in vivo experiments. In this work, biocompatibility of silver-coated orthopaedic external fixation pins was compared with stainless steel controls in an in vitro study. Human peripheral blood lymphocytes were used to assess the possible genotoxic effect of silver, studying the frequency of sister-chromatid exchanges and micronuclei while fibroblasts (NIH 3T3) and osteoblast-like cells were used for cytotoxicity and cytocompatibility studies. These studies have shown that silver is neither genotoxic nor cytotoxic as compared to stainless steel, a material in wide use as a metal implant. At 4 days cells cultured on the silver-coated material evidenced good cell spreading and a higher cell count with respect to the uncoated material. It appears that the addition of silver onto implantable medical devices could be beneficial when specific biological properties, such as antibacterial behaviour, are required. Based on these and the previous bacterial studies it seems like the toxicity towards bacteria was quite a bit greater than that towards the human cells.

3T3 Cells↗
PubMed2002

Atracurium is associated with postoperative residual curarization.

BACKGROUND: Residual paralysis following the use of neuromuscular blocking drugs remains a clinical problem. As part of departmental quality assurance, we examined the degree of postoperative residual curarization (PORC) following atracurium. METHODS: Forty patients undergoing general anaesthesia involving atracurium were studied. Quantitative neuromuscular monitoring (mechanomyography, Myograph 2000, Biometer, Denmark) was performed by assessing the response to supramaximal train-of-four (TOF) stimulation of the ulnar nerve. Anaesthesia was provided by non-participating clinicians who were blinded to the study data. A TOF ratio </=0.7 at extubation was classified as PORC. RESULTS: At antagonism of neuromuscular block, 70% (28/40) of patients had a TOF ratio </=0.7, and 65% (26/40) of patients had a TOF ratio </=0.7 at extubation. Peripheral nerve stimulator use was associated with a longer interval from antagonism of block to extubation (P=0.01), but was not associated with differences in atracurium dosage or a reduction in PORC at extubation. Patients with TOF ratio </=0.7 at extubation had surgery of shorter duration [59 (SEM 6) vs 103 (9) min, P<0.001], greater doses of atracurium relative to the duration of surgery [6 (1) vs 11 (1) micro g kg(-1) min(-1), P<0.005], and shorter intervals from administration of last dose of atracurium to antagonism of neuromuscular block [29 (2) vs 53 (9) min, P<0.005] and from antagonism to extubation [6 (1) vs 15 (4) min, P<0.01]. Duration of surgical procedure was the sole multivariate predictor of PORC [odds ratio 0.94 (95% confidence intervals 0.91-0.98), P<0.01]. CONCLUSIONS: PORC remains a clinical problem despite use of intermediate-duration neuromuscular blocking drugs and peripheral nerve stimulators. Patients undergoing procedures of short duration may be at risk of inappropriately early tracheal extubation, possibly due to work pressures. The association between suboptimal antagonism of neuromuscular blockade and short procedures needs reinforcement during postgraduate training and departmental quality assurance.

Adult↗
PubMed2001

In vivo evaluation of bone tissue behavior on ion implanted surfaces.

The ion implantation process offers several unique advantages over other surfaces modifications techniques, in regard to ion release and material mechanical characteristics. The aim of this study was to evaluate the in vivo bone tissue response to ion implanted surfaces. Untreated and nitrogen-ion-implanted stainless steel implants were inserted in the tibia diaphysis (cortical bone) and proximal tibia epiphysis (trabecular bone) of 12 New Zealand White rabbits. The animals were divided into three groups of four animals each, which were maintained for 4, 12 and 24 weeks according to internationally accepted and standardized procedures. At sacrifice, the implants were retrieved with surrounding bone and fixed in 4% neutral buffered formaldehyde and embedded in polymethylmethacrylate (PMMA). The samples were reduced in slices and stained with hematoxylin-eosin, light-green, fuchsin acid and giemsa solution for histological evaluation; fluorescent markers were also used to assess bone apposition. Histomorphometric evaluation was used to determine the extent of bone-material contact. Results from histological and morphometrical analyses revealed active remodeling of bone around both types of implants (control and ion implanted). However, faster bone deposition was observed around the treated material (12 weeks). Both materials reached similar endpoints, as no significant differences between them were evident at 24 weeks. The results demonstrate that ion implanted stainless steel has similar, or slightly enhanced, biological compatibility in contact with bone compared to untreated material; thus it may be a useful material in biomedical applications where reduced ion release or enhanced mechanical properties (as provided by ion implantation) are required.

Journal Article↗
PubMed1997

p55 Tumor necrosis factor receptor fusion protein in the treatment of patients with severe sepsis and septic shock. A randomized controlled multicenter trial. Ro 45-2081 Study Group.

OBJECTIVE: To evaluate the safety and efficacy of p55 tumor necrosis factor receptor fusion protein, a recombinant chimeric protein of human p55 (type I) tumor necrosis factor receptor (CD120a) extracellular domain and IgG1 sequences (referred to as p55-IgG), in the treatment of patients with severe sepsis or septic shock. DESIGN: Randomized, prospective, multicenter, double-blind, placebo-controlled clinical trial. SETTING: Forty-four community and university-affiliated hospitals in the United States and Europe. PATIENTS: There were 498 patients enrolled in this clinical trial. INTERVENTION: Patients prospectively stratified within each site into refractory shock or severe sepsis groups were randomized to receive a single infusion of p55-IgG, 0.083 mg/kg, 0.042 mg/kg, or 0.008 mg/kg, or placebo. Patients received standard aggressive medical/surgical care during the 28-day postinfusion period. OUTCOME MEASURE: Twenty-eight-day all-cause mortality. RESULTS: The distribution of variables describing demographics, organ system dysfunction or failure, infecting microorganisms, predicted mortality, plasma interleukin 6 levels, and plasma tumor necrosis factor alpha (TNF-alpha) levels were similar among patients in the p55-IgG and placebo treatment arms. A planned interim analysis was performed after 201 patients were enrolled. Because a statistically nonsignificant trend toward increased mortality was present in patients who had received 0.008 mg/kg, this treatment arm was discontinued, and the study continued with 3 arms. Among all infused patients, there was a statistically nonsignificant trend toward reduced 28-day all-cause mortality in those who received p55-IgG compared with placebo-treated patients (5% reduction, 0.042 mg/kg vs placebo; 15% reduction, 0.083 mg/kg vs placebo; P=.30). However, in patients with severe sepsis and early septic shock (n=247), therapy with p55-IgG, 0.083 mg/kg, was associated with a 36% reduction in 28-day all-cause mortality compared with placebo (P=.07): 20 (23%) of 87 patients died among those treated with p55-IgG, 0.083 mg/kg; 30 (37%) of 82 among those treated with p55-IgG, 0.042 mg/kg; and 28 (36%) of 78 in the placebo group. A prospectively planned logistic regression analysis to assess treatment effect on 28-day all-cause mortality by means of predicted mortality and serum interleukin 6 levels as continuous covariates demonstrated a significant improvement in outcome for the patients with severe sepsis treated with p55-IgG, 0.083 mg/kg, compared with placebo (P=.01). Serious adverse events, including death and the development of new organ system dysfunction, were reported in 65% of patients infused with placebo, with no increased frequency (56%) present in the 2 p55-IgG treatment arms. There were no reports of immediate hypersensitivity reactions caused by p55-IgG. CONCLUSIONS: In this dose-finding study, there was no decrease in mortality between placebo and p55-IgG in all infused patients. In the prospectively defined population of patients with severe sepsis who received p55-IgG, 0.083 mg/kg, there was a trend toward reduced mortality at day 28 that became significant when predicted mortality and plasma interleukin 6 levels were included in a logistic regression analysis.

APACHE↗
PubMed1996

Supplies and technical considerations for ruminant and swine anesthesia.

These authors hope that this article will augment the ability of the practitioner to procure and successfully use the appropriate catheter and ancillary supplies for any aspect of ruminant and swine anesthesia. Although we recognize that the cost of these supplies may be a limiting factor in their use, we hope that options discussed in this article will facilitate the preparation of direct intravenous lines in increasing numbers of anesthetic procedures in the future. The driving force for this article is to facilitate the anesthetic experience for animal and veterinarian alike and--as always--to preserve life by practicing the best possible and affordable medicine under every situation.

Anesthesia↗
PubMed1991

Interleukin-6 expression in primary macrophages infected with human immunodeficiency virus-1 (HIV-1).

We have investigated the effects of human immunodeficiency virus type-1 (HIV-1) infection on constitutive and lipopolysaccharide (LPS)-induced expression of interleukin-6 (IL-6) in cultured blood monocyte-derived macrophages. Highly productive and cytopathic infection of macrophages was established with the macrophage-tropic HIV-1 BaL strain. On Days 14-28 post infection, infected and mock-infected cells were activated with LPS or control medium for 6-24 hours before harvesting culture supernatants and cellular RNA. IL-6 bioactivity in culture supernatants was measured with the IL-6-dependent B9 cell line. IL-6 mRNA levels were quantitated by Northern blot analysis with scanning densitometry. In the absence of LPS activation, IL-6 activity was near or below the limit of detection in supernatants from both infected and uninfected cultures. Similarly, without LPS stimulation, IL-6 mRNA was not detectable in either infected or uninfected macrophages. After activation with LPS, marked increases in IL-6 mRNA levels and supernatant bioactivity were evident in both infected and uninfected cultures, but the response to LPS was consistently greater in infected macrophages. LPS-induced IL-6 mRNA levels and supernatant bioactivity were 7.4- and 4.4-fold higher, respectively, in infected compared with uninfected macrophages (n = 5, p less than .05). These studies demonstrate that highly productive HIV-1 infection does not increase constitutive IL-6 expression in macrophages, but does prime macrophages for an augmented IL-6 response to LPS. These findings may help define the mechanisms responsible for increased IL-6 production in patients with HIV-1 infection.

Cells, Cultured↗
PubMed1991

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Cancer Care Facilities↗
PubMed1990

Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate.

Persistence of Helicobacter pylori after duodenal ulcer healing is associated with high rates of ulcer relapse. We compared colloidal bismuth subcitrate alone with CBS combined with one of four antibiotic regimens in the treatment of duodenal ulcers. Endoscopy and antral biopsies were performed before treatment and four weeks afterwards. Biopsy specimens were examined for histological evidence of gastritis and by Gram stain and culture for H pylori infection. Altogether 141 patients were allocated to one of five treatment groups. Giving CBS and metronidazole (400 mg tid for 7 days) with and without amoxycillin (500 mg tid) achieved higher clearance rates of H pylori than treatment with CBS alone (p less than 0.01). These two combinations also achieved higher rates of antral gastritis healing than CBS alone (p less than 0.01 and p less than 0.05 respectively). Susceptibility to metronidazole was tested in 29 isolates before and in seven isolates after treatment with metronidazole by disc diffusion test and minimum inhibitory concentration assay. Twenty seven (93%) of the isolates were sensitive before treatment while six of seven (86%) were resistant afterwards. Four of the six resistant strains had acquired resistance during treatment and one of these had acquired metronidazole resistance despite concomitant treatment with amoxycillin, to which it remained sensitive. CBS with adjuvant metronidazole at a dose of 400 mg tid for seven days significantly improves the eradication of H pylori compared with CBS alone. Acquired metronidazole resistance, however, seems to be an important cause of failure to eradicate H pylori.

Amoxicillin↗
PubMed1984

Neurocrest and colonic tumors: new clinical syndrome. Report of three cases.

This report describes three patients with both multiple intestinal polyps and tumors of neural crest origin. This combination of findings may represent a new clinical syndrome. The embryologic relationships between tumors derived from endoderm and tumors derived from neurocrest are described. An inherent defect in tissue proliferation or repair is postulated to explain the abnormal growth in these two different cell lines.

Adenoma↗
PubMed1980

The value of progesterone receptor assays in the management of advanced breast cancer.

Estrogen and progesterone receptor determinations were performed on 518 specimens at the Surgical Research Laboratory of the Maimonides Medical Center. Of these, 41% were ERP and PgRP positive; 17% were ERP positive and PgRP negative; 38% were ERP negative and PgRP negative, and 3.9% were ERP negative, PgRP positive. Sixty-two patients with advanced breast cancer were treated with either an endocrine ablative procedure or with antihormonal therapy. In the two treatment groups the overall response rate when both receptors were positive was 79%, with a higher percentage of responders in the endocrine ablative group (88% vs. 69%). In addition, a greater duration of response was achieved in those patients treated with endocrine ablation. The overall predictability of response was achieved in those patients treated with endocrine ablation. The overall predictability of response or failure to hormonal therapy is 91% if the progesterone receptor alone is utilized to select treatment and an endocrine ablative procedure is performed. The predictability of response based on the estrogen receptors presence or absence is 70%.

Adult↗
PubMedDate not supplied

Critical thinking. Strategies for clinical practice.

Critical thinking is an elusive concept. As a profession, nursing has yet to accept a universal definition of critical thinking. Despite the lack of consensus, nurse leaders in academia and practice settings overwhelmingly agree that critical thinking is essential. It is clear, considering the healthcare environment, nurses need to use critical thinking as a process for decision making in the clinical arena. This article clarifies critical thinking in practice by illuminating the imperative role it plays. Suggestions for fostering critical thinking, including specific strategies, provide a framework for practice.

Clinical Competence↗
PubMedDate not supplied

Silver modification of polyethylene terephthalate textiles for antimicrobial protection.

The safety and in vitro effectiveness of applying silver to polyethylene terephthalate fabric mechanical heart valve (MHV) sewing cuffs for the prevention of prosthetic valve endocarditis (PVE) were evaluated. PVE is an infrequent but grave complication of cardiac surgery associated with mortality rates potentially exceeding 50%. A poor response to antibiotic therapy is partly responsible for the high mortality rates. Silver is a well known antimicrobial agent with broad effectiveness. Preliminary in vitro microbial challenge studies of the coated fabric using the New York State 63 bacteriostatic test and Dow Corning Shake Flask test showed a > or = 97% reduction for most organisms tested. Sheep mitral valve replacement studies suggest comparable tissue ingrowth of uncoated and coated fabric with a more organized, thinner pannus formed on silver coated fabric. Low levels of silver were present in the serum at all time periods. These results indicate MHVs with silver coated cuffs may provide additional protection against PVE.

Animals↗