Malfunctioning central venous catheters.
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Catheterization, Central Venous↗
Biomedical subjects
J Hancock
Publications and source records attributed to J Hancock.
Randomised trial of elective stenting after successful percutaneous transluminal coronary angioplasty of occluded coronary arteries.
BACKGROUND: The value of angioplasty in occluded coronary arteries is limited by a restenosis/reocclusion rate of 50-70%. In patients with subtotal occlusion, stent implantation has been shown to reduce clinical and angiographic restenosis. Retrospective observational studies have suggested that stenting could reduce restenosis in total occlusions. The value of sustained coronary patency on global and regional left ventricular function in this clinical setting has not been defined clearly. OBJECTIVES: To assess the medium term effect of elective intracoronary stent deployment after successful percutaneous transluminal coronary angioplasty (PTCA) of an occluded coronary artery. METHODS: Sixty patients with a total coronary occlusion successfully treated by PTCA were randomised to receive an intracoronary stent or no stent. Patients underwent clinical and angiographic follow up at six months. RESULTS: Thirty patients received a stent (group A) and 30 were treated by angioplasty alone (group B), all with initial success. One patient in group B required repeat angioplasty with stenting at 24 hours and one patient died after 10 days. Angiographic follow up was available for 57 patients. This showed a significantly reduced reocclusion rate in group A compared with group B (7% v 29%, p < 0.01) and a tendency to a reduced restenosis rate (22% v 40%, p = 0.105) in patients with no reocclusion. Left ventricular function, both global and regional, improved in group A. Only the regional left ventricular function in the area supplied by the target coronary artery improved in group B. Recurrence of symptoms and clinical events such as repeat angioplasty, coronary artery bypass grafting, death or myocardial infarction tended to be reduced in group A (4 (13%) v 9 (30%)). CONCLUSIONS: Intracoronary stent insertion is effective in reducing the rate of reocclusion and shows a trend towards reduced restenosis after opening of a total coronary occlusion by balloon angioplasty. Sustained patency of the target coronary artery is associated with improvement in global and regional left ventricular function.
Adult↗
Caring for the mentally ill.
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Consultants↗
Pulmonary surfactant protein SP-B interacts similarly with dipalmitoylphosphatidylglycerol and dipalmitoylphosphatidylcholine in phosphatidylcholine/phosphatidylglycerol mixtures.
Porcine pulmonary surfactant-associated protein SP-B was incorporated into bilayers of chain-perdeuterated dipalmitoylphosphatidylglycerol (DPPG-d62) and into bilayers containing 70 mol % dipalmitoylphosphatidylcholine (DPPC) and 30 mol % DPPG-d62 or 70 mol % chain-perdeuterated DPPC (DPPC-d62) and 30 mol % DPPG. The effect of SP-B on the phase behavior, lipid chain order, and dynamics in these bilayers was examined using deuterium nuclear magnetic resonance (2H-NMR). In both DPPG-d62 and the mixed lipid system, SP-B is found to have little effect on chain order in the liquid crystalline phase. With 11% (w/w) SP-B present, both bilayer systems display a continuous change from liquid crystal to gel with no evidence of two-phase coexistence near the transition. Despite its limited effect on chain order in these bilayers, SP-B is found to strongly perturb chain deuteron transverse relaxation in the liquid crystal and gel phases of DPPG-d62 and the DPPC/DPPG (7:3) mixtures. The observation that SP-B associates with the bilayer in a way which substantially alters the slow motions responsible for transverse relaxation without significantly affecting chain order in either the liquid crystal or gel phases may place some constraints on possible models for that association.
1,2-Dipalmitoylphosphatidylcholine↗
What NMR can tell us about where lung surfactant proteins live.
2H-NMR is beginning to provide some insights into the way in which the hydrophobic surfactant proteins SP-B and SP-C interact with phospholipid bilayers in multilamellar structures. Both proteins have a significant effect on slow bilayer motions. In many ways, the effect of SP-C on the surrounding bilayer is similar to that of other transmembrane proteins. Ca2+ appears to modify the way in which SP-C perturbs the bilayers containing DPPG. The effect of SP-B on bilayers differs, in subtle ways, from that expected for a transmembrane protein.
1,2-Dipalmitoylphosphatidylcholine↗
Characteristics of firearms involved in fatalities.
OBJECTIVES: To document the types of firearms associated with firearm fatalities, and to determine the availability of information on firearm characteristics in existing data sources. DESIGN: Review of police, medical examiner, and crime laboratory records for all firearm homicides and review of medical examiner records for all suicides and unintentional and undetermined firearm fatalities. SETTING: City of Milwaukee, Wis, from 1990 through 1994. POPULATION: A total of 175 firearm suicides and 524 firearm homicides. MAIN OUTCOME MEASURES: Source of data; circumstances and means of death; host demographic characteristics; firearm make, model, caliber, barrel length, and serial number. RESULTS: Handguns accounted for 468 (89%) of 524 firearm homicides and 124 (71%) of 175 firearm suicides. Handguns of .25 caliber accounted for 14% (n = 63) of 438 firearm homicides and 12% (n = 15) of all firearm suicides in which caliber was known. The Raven MP-25 was the single most commonly identified firearm and accounted for 10% (n = 15) of 153 handgun homicide cases and 7% (n = 7) of the 76 suicide cases in which the manufacturer of the firearm was identified. From all data sources combined, information on firearm type was available in 681 (97%) of 699 cases, caliber/gauge in 636 cases (91%), manufacturer/model in 309 cases (44%), and serial number in 276 cases (40%). CONCLUSIONS: Inexpensive, short-barreled .25-caliber handguns were the most common weapon type associated with firearm homicides and suicides in Milwaukee during 1990 through 1994. Product-specific information is a crucial part of planning appropriate injury countermeasures for firearms. In combination, police, crime laboratory, and medical examiner data can supply this information with modest changes in data collection procedures.
Data Collection↗
The effects of prematurity on long-term outcome.
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Developmental Disabilities↗
Immunomagnetic colloids for the enrichment of tumor cells from peripheral blood and bone marrow: a model system.
The characterization of tumor cells in bone marrow harvested for autologous bone marrow rescue remains a problem due to the limited sensitivities of the techniques available for their analysis. This complicates the use of purging techniques as their usefulness is debated, specifically because it is not known if they can remove all residual tumor cells from either peripheral blood stem cell harvests or bone marrow. Apart from developing more sensitive techniques for tumor detection, one way of increasing our efficiency at identifying rare malignant cells in normal hematopoietic cells is to develop approaches to enrich the population of interest prior to analysis. Here, we describe a laboratory-based system for tumour enrichment employing panels of monoclonal antibodies (MAbs) and an immunomagnetic colloid. In model systems, tumor cells could be enriched approximately 100-fold with high yield and purity. The adaptations of this technology to permit further cell enrichment and the choice of either an immunological technique or a molecular approach to tumor identification are discussed in detail.
Bone Marrow↗
A prospective audit of asthma management following emergency asthma treatment at a teaching hospital.
OBJECTIVE: To audit the assessment and treatment of acute asthma and the subsequent application of the Australian Asthma Management Plan. DESIGN: Prospective audit of case notes with follow-up telephone questionnaire and clinical assessment at 8-12 weeks after discharge. SETTING: Tertiary-level teaching hospital. MAIN OUTCOME MEASURES: Comparison with published guidelines for acute and ongoing asthma management. RESULTS: Asthma severity was objectively assessed in the Primary and Emergency Care Department, with lung function performed in 95% of acute presentations. Clinical history and examination were documented completely in 28% of presentations. Corticosteroids were underused and there was inappropriate use of ipratropium bromide. At 8-12 weeks follow-up most patients were symptomatic with limited activity due to asthma (46%) and impaired lung function (66%). One-third of patients were undertreated. Asthma management skills were seriously inadequate: only 20% of patients were performing peak flow monitoring, and only 21% recalled receiving specific instructions for the management of future exacerbations. Inhaler technique was inadequate in one-third of patients and asthma knowledge was poor. These deficits were more frequent in patients not admitted to hospital. CONCLUSION: This audit identified suboptimal assessment and treatment of acute asthma, and deficits in the implementation of the Australian Asthma Management Plan following discharge. Patients in this audit were undertreated and not provided with the skills to manage future attacks of asthma.
Adolescent↗
Neuropsychological status of children treated for brain tumors: a critical review and integrative analysis.
The literature on the neuropsychological status of children with primary brain tumors was reviewed to identify English-language publications reporting the results of standardized, quantitative measures of patient function. The 22 studies that met these review criteria, representing 544 patients, were evaluated to assess the relationship between traditional risk factors (age at diagnosis, tumor location, radiation therapy, and time since completion of treatment), as well as subsequent intellectual development, academic achievement, psychosocial adjustment, and neuropsychological status. The impact of other potentially salient factors, such as seizures and sensory and motor deficits, was evaluated when possible. Despite inconsistent reporting of demographic and treatment-related effects across studies which precluded formal meta-analysis, we were able to confirm the primary importance of radiation therapy volume and age at treatment on IQ. No effects were detected for tumor location. Younger children treated with cranial (whole brain) irradiation showed a 14-point deficit in IQ as compared with their older counterparts. No significant differences were noted between older children receiving local or cranial irradiation, although both groups had IQ levels 12-14 points lower than those not irradiated. The high-risk groups identified in this study require increased clinical surveillance. Definitive evaluation of potential risk factors for neuropsychological impairment will depend on more complete reporting of relevant patient characteristics and interinstitutional studies.
Adolescent↗
A pilot study of monoclonal antibody targeted radiotherapy in the treatment of central nervous system leukaemia in children.
A pilot study was performed to investigate the toxicity, pharmacokinetics and therapeutic effect of intrathecally administered radiolabelled monoclonal antibody (MAb) in patients with meningeal acute lymphoblastic leukaemia (ALL). Six children aged 3-16, in second or subsequent central nervous system (CNS) relapse of ALL, received between 629 and 1480 MBq of 131Iodine conjugated to either MAb HD37 (CD19, n = 2) or WCMH15.14 (CD10, n = 4). Conjugate was administered as a single injection either via an Ommaya reservoir (n = 4) or by lumbar puncture (n = 2). Acute toxicity was manifest by headache (n = 4), nausea and vomiting (n = 4) and pyrexia (n = 2). All acute symptoms resolved within 72 h. Transient myelosuppression occurred in three patients. Pharmacokinetic studies included investigation of whole body, blood and CSF clearance of isotope. 131I was seen to clear from the CSF by biexponential kinetics. Five patients responded to therapy. In four, the CSF became clear of blast cells at both 2 and 4 weeks following antibody injection, but evidence of relapse was seen at 6 weeks. The fifth patient, with blast cells present on a cytospin preparation, responded to therapy over an 8-week period but relapsed at 12 weeks. This study demonstrates the potential of targeted radiotherapy in CNS ALL, but further studies are necessary to increase the length of remission.
Adolescent↗
An assessment of patient satisfaction in hospital.
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Humans↗
Self-management of adrenal insufficiency by rectal hydrocortisone.
An alternative to intramuscular hydrocortisone self-injection was evaluated in healthy controls and in patients with adrenal insufficiency. Plasma cortisol concentrations were assayed after administration of 200 mg hydrocortisone by intramuscular injection (10 healthy subjects) or after insertion of an identical dose by rectal suppository (12 healthy subjects, 3 patients with adrenal failure). Plasma cortisol concentrations peaked at 1 hour (about 4000 nmol/l) following intramuscular injection and declined thereafter. After rectal administration, levels peaked at between 1 and 2 hours and persisted for 8 or more hours. Similar levels were achieved at 4 hours (about 1000 nmol/l) by both methods of administration. Self-treatment by rectal suppository may be useful in the prevention of Addisonian crises.
Administration, Rectal↗
Monoclonal and polyclonal antibodies reactive with the 1-32 amino terminal sequence of the alpha subunit of human 32K inhibin.
A monoclonal antibody was made after immunization of mice with the 1-32 amino terminal peptide of the alpha subunit of 32K human ovarian inhibin. The IgG2a mouse antibody reacted 6 times better with bovine 1-32 peptide than it did with 32K bovine inhibin. By contrast sheep polyclonal antibodies made by a similar method had a 29 fold bias in reactivity towards the immunizing peptide. Relative to homologous 1-32 peptide standards, the monoclonal antibody measured apparently higher amounts of immunoreactive material(s) in human (13.5 fold) and bovine (27 fold) follicular fluids than did the polyclonal anti 1-32 peptide antibodies. Immunochemical studies revealed that the epitope recognized by the monoclonal antibody was different from the major epitope recognized by the polyclonal antibodies. The monoclonal antibody reacted much better with human inhibin 1-32 sequences than with bovine (73 fold) or porcine (23 fold). Although the 32K form of human inhibin has not yet been purified, it can be inferred that the monoclonal antibody would be able to detect as little as 2 ng/ml of 32K human inhibin in competitive radioimmunoassays. The antibody must also react with some of the multiple molecular forms of inhibin found in human follicular fluids, and it was shown to function well in the quantitative immunoaffinity extraction of inhibin-like immunoreactivity from follicular fluid. It seems likely that this monoclonal antibody will prove a useful tool for research on human inhibin.
Amino Acid Sequence↗
Caring for children. How to ease them through surgery.
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Adolescent↗
Epidemiological-environmental study of lead acid battery workers. II. Acute effects of sulfuric acid on the respiratory system.
Two hundred and twenty-five (225) workers in five lead acid battery plants were administered a questionnaire containing work-related symptoms, underwent spirometry, and had personal samples for H2SO4 taken over the shift. Most personal samples were less than 1 mg/m3 H2SO4. Mass median aerodynamic diameter of H2SO4 from area samples in the formation areas was 2.6-10 micron. Workers with a higher exposure to acid did not have an increased rate of acute work-related symptoms. Changes in pulmonary function over the shift were not related to levels of airborne lead or airborne acid, sex, age, or smoking status. In acclimated workers, there is no evidence of acute symptoms or reductions in pulmonary function over the shift at concentrations less than 1 mg/m3.
Adult↗
Epidemiological-environmental study of lead acid battery workers. III. Chronic effects of sulfuric acid on the respiratory system and teeth.
The effects of long-term exposure to sulfuric acid mist on the teeth and respiratory system were studied in 248 workers in five plants manufacturing lead acid batteries. The prevalence of cough, phlegm, dyspnea, and wheezing as determined by questionnaire were not associated with estimates of cumulative acid exposure. There was only one case of irregular opacities seen on the chest radiographs. There was no statistically significant association of reduced FEV1, peak flow, FEF50, and FEF75 with acid exposure although the higher exposed group had lower mean values. FVC in the high exposure group showed a statistically significant reduction compared to the low exposure group, but there was no significant association when exposure was analyzed as a continuous variable. The ratio of observed to expected prevalence of teeth etching and erosion was about four times greater in the high acid-exposure group. The earliest case of etching occurred after 4 months exposure to an estimated average exposure of 0.23 mg/m3 sulfuric acid.
Adult↗
Genetic screening of newborn in Australia. Results for 1981.
Since screening of newborn infants for phenylketonuria (PKU) by the Guthrie bacterial inhibition assay was established in the 1960s, 3 017 703 infants have been tested in Australia. Two hundred and fifty-one cases of PKU (0.83/10 000) and six cases of the variant forms of malignant hyperphenylalaninaemia (MHPA) (0.02/10 000) have been detected. In 1981, 11 infants with PKU were detected. Screening for congenital hypothyroidism was carried out in seven States, and 66 new cases were detected in 1981 (2.13/10 000). In Adelaide, 154 310 infants have been tested for galactosaemia and a total of seven cases have now been detected (0.45/10 000). In New South Wales, 35 955 infants have been tested for cystic fibrosis of the pancreas, and 17 cases were found (4.73/10 000).
Australia↗