Joint planning. Get together.
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Community Health Planning↗
Biomedical subjects
G Sutton
Publications and source records attributed to G Sutton.
Tenuous link between ischaemic threshold and both ambulatory ischaemia and symptom status over time in stable angina: a 5-year follow-up study.
This study evaluates changes in ischaemic threshold over a 5-year period in patients with stable angina pectoris, who did not suffer any intervening cardiac event. Changes in ischaemic threshold are related to alterations in symptomatic status and ambulatory ischaemia. Over long-term follow-up, there is a significant fall in ischaemic threshold in such patients (mean heart rate at onset of ischaemia fell from 104 +/- 17.8 to 97 +/- 17.4 bpm: P < 0.001), but this is not matched by a worsening of either symptoms or ischaemia during daily life. In the 68% of patients that had a reduction in ischaemic threshold of > or = 5 bpm, 68% had either definite reduction or no change in symptoms and 84% had either reduction, abolition or no change in transient ischaemic activity. The dissociation between ischaemic threshold, ambulatory ischaemia and symptoms has implications for long-term monitoring and management of the patient with stable angina.
Adult↗
Ifosfamide and doxorubicin in the treatment of advanced leiomyosarcomas of the uterus: a Gynecologic Oncology Group study.
This is a Phase II groupwide study of the Gynecologic Oncology Group (GOG) to determine the toxicity and efficacy of a combination of ifosfamide and doxorubicin in patients with advanced or metastatic leiomyosarcomas of the uterus who had not received other chemotherapy. Thirty-five women were entered into this study; 1 patient was ineligible (primary not documented), leaving 34 patients treated with ifosfamide, 5.0 g/m2/24 hr, and mesna, 6.0 g/m2/36 hr, by continuous IV infusion preceded by doxorubicin, 50 mg/m2 iv over 15 min. Each course of therapy was repeated every 3 weeks if counts allowed. One patient was inevaluable for response, leaving 34 evaluable for toxicity and 33 evaluable for response of chemotherapy. GOG grade 3 or 4 granulocytopenia occurred in 17 patients (48.6%), 2 patients developed granulocytopenic fever (5.7%), and 1 died of sepsis. Two patients developed grade 3 thrombocytopenia, and 1 died of cardiotoxicity. There were nine partial and one complete responses for an overall response rate of 30.3%; the response duration averaged 4 months. The combination of ifosfamide and doxorubicin is toxic but has moderate activity in patients with advanced or metastatic leiomyosarcoma of the uterus.
Adult↗
Ifosfamide treatment of recurrent or metastatic endometrial stromal sarcomas previously unexposed to chemotherapy: a study of the Gynecologic Oncology Group.
OBJECTIVE: To determine the effectiveness and toxicity of ifosfamide chemotherapy in women with metastatic or recurrent endometrial stromal sarcomas unexposed to other chemotherapy. METHODS: In a prospective, multi-institutional phase II study conducted by the Gynecology Oncology Group, the starting dose of ifosfamide was 1.5 g/m2 given daily intravenously (i.v.) for 5 days (reduced to 1.2 g/m2 daily in patients who had previously received radiotherapy). Mesna (2 mercaptoethane sodium sulfonate) was given i.v. immediately and at 4 and 8 hours after the administration of ifosfamide. Each dose of mesna was 20% of the total daily dose of ifosfamide. Patients were treated every 3 weeks if blood counts permitted. Therapy was discontinued if there was progression of the cancer or unacceptable toxicity. RESULTS: Twenty-two patients were entered into this study. One was excluded from analysis because of the wrong histologic type, leaving 21 evaluable for response and toxicity. Gynecologic Oncology Group grade 3 or 4 granulocytopenia occurred in four patients (19%), and one patient each experienced Gynecologic Oncology Group grade 4 anemia and genitourinary toxicity. Three patients experienced complete tumor responses and four had partial responses, for an overall response rate of 33.3%. CONCLUSION: Ifosfamide is active in the therapy of women with chemotherapy-naive metastatic or recurrent endometrial stromal sarcomas.
Antineoplastic Agents, Alkylating↗
The construction of Arabidopsis expressed sequence tag assemblies. A new resource to facilitate gene identification.
The generation of large numbers of partial cDNA sequences, or expressed sequence tags (ESTs), has provided a method with which to sample a large number of genes from an organism. More than 25,000 Arabidopsis thaliana ESTs have been deposited in public databases, producing the largest collection of ESTs for any plant species. We describe here the application of a method of reducing redundancy and increasing information content in this collection by grouping overlapping ESTs representing the same gene into a "contig" or assembly. The increased information content of these assemblies allows more putative identifications to be assigned based on the results of similarity searches with nucleotide and protein databases. The results of this analysis indicate that sequence information is available for approximately 12,600 nonoverlapping ESTs from Arabidopsis. Comparison of the assemblies with 953 Arabidopsis coding sequences indicates that up to 57% of all Arabidopsis genes are represented by an EST. Clustering analysis of these sequences suggests that between 300 and 700 gene families are represented by between 700 and 2000 sequences in the EST database. A database of the assembled sequences, their putative identifications, and cellular roles is available through the World Wide Web.
Arabidopsis↗
The minimal gene complement of Mycoplasma genitalium.
The complete nucleotide sequence (580,070 base pairs) of the Mycoplasma genitalium genome, the smallest known genome of any free-living organism, has been determined by whole-genome random sequencing and assembly. A total of only 470 predicted coding regions were identified that include genes required for DNA replication, transcription and translation, DNA repair, cellular transport, and energy metabolism. Comparison of this genome to that of Haemophilus influenzae suggests that differences in genome content are reflected as profound differences in physiology and metabolic capacity between these two organisms.
Antigenic Variation↗
Malignant degeneration of a mature cystic teratoma five decades after discovery.
Malignant degeneration of mature cystic teratomas has been reported in 1-3% of cases. A patient with the unusual occurrence of a stage IIIC squamous cell carcinoma arising in a mature teratoma over 50 years after initial diagnosis is presented. The patient was treated with pelvic radiotherapy. The role of serum squamous cell carcinoma antigen in detecting degeneration of mature cystic teratomas at an early stage is considered.
Aged↗
Retroperitoneal leiomyosarcoma: eight cases and a literature review.
Leiomyosarcoma, a rare malignancy of smooth muscle, may arise from the retroperitoneum and present with the same vague symptoms as a malignancy of the pelvic organs. The purpose of this paper is to review eight cases of retroperitoneal leiomyosarcoma and to illustrate the presenting symptoms, prognostic indicators, and outcomes of patients seen at Indiana University Medical Center between 1989 and 1994. Patients in this study were white females who presented between the ages of 46 and 73 (mean age of 61.4) with nonspecific presenting symptoms of weight loss and back pain (37.5% for each). Tumor size (mean diameter of 14.6 cm in the range 4 to 35 cm), tumor extension, and the presence of distant metastases were of greater prognostic significance than tumor grade (7/8 were grade II, 1/8 was grade I). Surgical resection improved long-term prognosis; three of five patients undergoing resection are alive with no evidence of disease compared to zero of three treated nonsurgically. Due to location and vague presenting symptoms, this tumor continues to have a bleak prognosis and further evaluation and innovative treatment are required before a reasonable cure rate may be expected.
Aged↗
Detection of ambulatory ischaemia is not of practical clinical value in the routine management of patients with stable angina. A long-term follow-up study.
It has been reported that medically treated patients with stable angina and positive exercise test for ischaemia have an adverse 1-2 year outlook if they are shown also to have transient, and predominantly silent, ischaemic episodes detected by ambulatory ST segment monitoring during their daily activities: it has been suggested that this investigation could be used to identify patients more likely to benefit from early investigation and treatment. We assessed the long-term (up to 65 months) prognostic significance of transient ischaemic episodes during daily activities in 172 patients routinely attending cardiac outpatients with medically treated stable angina who had undergone exercise testing and 48 h of ambulatory ST segment monitoring between February 1988 and August 1989 for this purpose. A positive exercise test for ischaemia was not a prerequisite for inclusion. One hundred and four patients (60.5%) had a positive exercise test for ischaemia and 72 (42%) had transient ischaemia during daily activities (63 had both tests positive). Over a median 50-month follow-up period 54 patients suffered at least one cardiac event (primary event: cardiac death n = 7; non-fatal myocardial infarction n = 11; unstable angina n = 18; elective CABG/PTCA n = 18). Two further patients suffered non-cardiac death. Cardiac events, either objective (cardiac death or non-fatal myocardial infarction) or subjective (unstable angina or revascularisation) were no more likely to occur in those with transient ischaemia during daily life when compared with those without, at follow-up times up to 65 months.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Intraspecific variation in small-subunit rRNA sequences in GenBank: why single sequences may not adequately represent prokaryotic taxa.
Small-subunit rRNA (SSU rRNA) sequencing is a powerful tool to detect, identify, and classify prokaryotic organisms, and there is currently an explosion of SSU rRNA sequencing in the microbiology community. We report unexpectedly high levels of intraspecific variation (within and between strains) of prokaryote SSU rRNA sequences deposited in GenBank. A total of 82% of the prokaryote species with two published SSU rRNA sequences had more variable positions than a 0.1% random sequencing error would predict, and 48% of these sequence pairs had more variable positions than predicted by a 1.0% random sequencing error. Other sources of sequence variability must account for some of this intraspecific variation. Given these results, phylogenetic studies and biodiversity estimates obtained by using prokaryotic SSU rRNA sequences cannot proceed under the assumption that rRNA sequences of single operons from single isolates adequately represent their taxa. Sequencing SSU rRNA molecules from multiple operons and multiple isolates is highly recommended to obtain meaningful phylogenetic hypotheses, as is careful attention to accurate strain identification.
Bacteria↗
Excimer retreatment for scarring and regression after photorefractive keratectomy for myopia.
AIMS/BACKGROUND: Scarring associated with regression of refractive effect can occur after photorefractive keratectomy (PRK) for myopia. The experience of treating these complications is reported. METHODS: Eighteen of 285 eyes (6.3%) were retreated with the excimer laser. Age, sex, preoperative primary treatment keratometry, pre-primary treatment, pre-retreatment and post-retreatment spherical equivalents, best corrected and uncorrected visual acuities were recorded and analysed. RESULTS: At 6 months post-retreatment, the mean spherical equivalent was -2.07 dioptres (D) (SD 4.60 D). This spherical equivalent persisted in eyes followed for 12 months (-2.85D, SD 4.09 D). Nine of 18 eyes (50%) had uncorrected visual acuity of 6/12 (20/40) or better. If retreatment was undertaken within 6.5 months of the initial PRK, then scarring was likely to recur (p = 0.035). Nine of 10 eyes (90%) which had a retreatment spherical equivalent less than two thirds of their primary treatment spherical equivalent were within plus or minus 1.25D from emmetropia after retreatment. Four of 11 eyes (36%) followed for 12 months after retreatment rescarred with further regression. CONCLUSION: The data showed that eyes with scarring and regression of myopia should not be treated with PRK within 6 months of the initial procedure. Eyes with the highest percentage of regression towards their initial myopia tend to have a poor response to retreatment.
Adult↗
Crystallization and preliminary X-ray investigation of recombinant simian immunodeficiency virus matrix protein.
Simian immunodeficiency virus matrix protein has been crystallized from Tris-HCl buffer with polyethylene glycol and isopropanol as precipitants. The crystals belong to space group C2 with unit cell dimensions a = 69.9 A, b = 115.2 A, c = 32.5 A, beta = 108.1 degrees and diffract X rays to a minimum Bragg spacing of 2 A. These crystals appear suitable for a high resolution structure analysis.
Crystallization↗
Comparison of the effect of heparin and aspirin versus aspirin alone on transient myocardial ischemia and in-hospital prognosis in patients with unstable angina.
OBJECTIVES: This study compared the effects of heparin and aspirin versus aspirin alone on transient myocardial ischemia and in-hospital prognosis in patients with unstable angina. BACKGROUND: Transient myocardial ischemia occurring in patients with unstable angina is associated with an adverse prognosis. Heparin and aspirin are two drugs used frequently in the treatment of this condition, but the effect of combination therapy versus aspirin alone on transient myocardial ischemia is unknown. METHODS: Two hundred eighty-five consecutive patients with unstable angina were randomized to receive either intravenous heparin plus oral aspirin (150 mg once daily) (Group H + A) or aspirin alone (Group A). Patients also received a beta-adrenergic blocking agent, diltiazem and intravenous nitrates. ST segment monitoring was performed for the 1st 48 h of treatment. Patients were followed up for the duration of their in-hospital stay. RESULTS: One hundred fifty-four patients (30 women, mean [+/- SEM] age 58.3 +/- 0.8 years) received heparin and aspirin (Group H + A), and 131 patients (26 women, mean age 60.6 +/- 0.8 years) received aspirin only (Group A). ST segment monitoring (11,622 h) yielded 244 episodes of transient myocardial ischemia of a total duration of 7,819 min. There were no significant differences between the two treatment arms in the number of patients with transient myocardial ischemia (27 [18%] in Group H + A vs. 31 [24%] in Group A), number of episodes (96 in Group H + A vs. 148 in Group A) or total duration of transient myocardial ischemia (2,911 min in Group H + A vs. 4,908 min in Group A). The incidence of in-hospital myocardial infarction or death was significantly higher in patients with transient myocardial ischemia (53% vs. 22%, p < 0.0001). Five of the six deaths occurred in patients with transient myocardial ischemia. Event-free survival from myocardial infarction or death was similar in both treatment groups. Preadmission therapy with aspirin was associated with a lower in-hospital infarction rate (19% vs. 34%, p = 0.01). CONCLUSIONS: The presence of transient myocardial ischemia in patients with unstable angina is associated with a significantly higher incidence of myocardial infarction or death in hospital. Combined therapy with heparin and aspirin compared with aspirin alone makes no difference in the development of these events, nor does it reduce the development of transient myocardial ischemia.
Adult↗
Duplex controlled angioplasty.
Duplex examination was carried out to assess lesions in peripheral arteries amenable to angioplasty. With the help of a special catheter, angioplasty of these lesions was performed under Duplex control. Sixteen patients presenting with claudication were examined by Duplex and 38 lesions were identified (31 stenoses, seven occlusions) and all the findings except one (vessel E1) were confirmed by subsequent angiography. Sixteen lesions were considered amenable to angioplasty and 13 lesions (in 10 patients) were selected for Duplex controlled angioplasty. A new catheter system which has a piezo-electric transducer at the centre of the balloon and integrated to a Duplex scanner via a catheter system interface, was used for the procedure. This allows the exact position of the balloon to be represented on the screen. Thirteen lesions (seven superficial femoral artery (SFA), three external iliac, two common iliac and one graft) were subjected to angioplasty under Duplex control. In one patient, the SFA was punctured directly under ultrasound control as the profunda was diseased. The guide wire was visualised in all cases and in the majority of cases, balloon size for the angioplasty was chosen by measurement of the arterial diameter by Duplex, which was also used for haemodynamic evaluation before, during and after the procedure. Eleven lesions (85%) underwent angioplasty entirely under Duplex control and additional X-ray control was needed in only two cases. In conclusion, Duplex allows the monitoring of both anatomical and haemodynamic parameters during angioplasty. It also reduces the risk of ionising radiation. Our initial experience has been encouraging as angioplasty was performed in the majority of lesions purely under Duplex control.
Angioplasty, Balloon↗
The effect of acidosis on the labelling of urinary ammonia during infusion of [amide-15N]glutamine in human subjects.
In three experiments [amide-15N]glutamine was infused intravenously in male volunteers. After 4-8 h of infusion acidosis was achieved by an oral dose of CaCl2 (1 mmol/kg). In one subject acidosis was maintained for 5 d. The acid load produced an approximately 3-fold increase in urinary NH3 excretion, with a small (approximately 20%) and transient increase in the isotope abundance of urinary NH3. Estimates of glutamine production rate (flux) were obtained in two experiments. There was no evidence that it was increased in acidosis. The extra NH3 production by the kidney represented only a very small part, about 3%, of the total glutamine production rate.
Acidosis↗
Chemotherapy of epithelial ovarian cancer: an overview.
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Antineoplastic Agents↗
Refractive keratoplasty for post-graft astigmatism.
Refractive keratoplasty using modified relaxing incisions with compression sutures was performed on 33 patients with high post-keratoplasty astigmatism. The mean reduction in keratometric astigmatism was 8.38 dioptres from a preoperative mean of 12.21 dioptres (SD, 3.59) to 3.93 dioptres (SD, 2.13). All patients noted a marked functional improvement. Two patients required reoperation. One patient required resuturing. Our modification of undercutting the relaxing incisions greatly increases the range of astigmatism that can be treated with this technique.
Astigmatism↗