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Biomedical subjects

J Manley

Publications and source records attributed to J Manley.

16 recordsLinked to original sources
PubMed2001

A randomized comparison of transcervical Foley catheter to intravaginal misoprostol for preinduction cervical ripening.

OBJECTIVE: To compare the efficacy of intravaginal misoprostol tablets with transcervical Foley catheter for preinduction cervical ripening. METHODS: Pregnant women who presented for induction of labor with unfavorable cervices (Bishop score less than 6) were assigned randomly to intravaginal misoprostol (50 microg tablet every 4 hours for a maximum of six doses) or 30-mL Foley catheter placed transcervically with maintenance of traction. RESULTS: Among 111 women, 53 were allocated to misoprostol and 58 to Foley bulb. Contractile abnormalities were more frequent in the misoprostol group (20.4%) than the Foley group (0%) (P <.001). No statistically significant differences were noted between groups in change in Bishop score, preinduction cervical ripening times, and total induction times. There were no statistically significant differences in mode of delivery or adverse neonatal outcomes. Uterine rupture occurred in one woman with two previous cesarean deliveries in the misoprostol group. CONCLUSION: Intravaginal misoprostol and transcervical Foley catheter are equivalent for cervical ripening. Uterine contractile abnormalities and meconium passage are more common with misoprostol.

Administration, Intravaginal↗
PubMed2001

Early transvaginal ultrasonography versus early cerclage in women with an unclear history of incompetent cervix.

OBJECTIVE: Our aim was to compare outcomes in women with a questionable history of incompetent cervix, followed up with early transvaginal ultrasonography, with outcomes in women who had early cerclage. STUDY DESIGN: Charts were reviewed and patients identified for incompetent cervix from our obstetric database from 1995 through 1997. We included women who had an unclear history of incompetent cervix as follows: second-trimester loss or termination, > or =3 first-trimester terminations, cone biopsy or loop electrosurgical excision, or exposure to diethylstilbestrol. The primary outcome variable was gestational age at delivery. RESULTS: A total of 106 women were included, 45 in the early cerclage group and 61 in the early transvaginal ultrasonography group. The mean gestational age at delivery was 35.1 weeks for the early cerclage group versus 36.1 weeks for the early transvaginal ultrasonography group. CONCLUSION: In women with an unclear history of incompetent cervix, early cerclage does not appear to offer significant benefit over early transvaginal ultrasonography.

Adult↗
PubMed1999

Therapeutic commitment and role security in work with men with violence-related problems: an investigation and test of a model.

This study investigated whether therapists' therapeutic commitment and role security could be important therapist factors in therapy with those client groups that are perceived as being difficult to work with. Therapeutic commitment represents how committed therapists were to such work and role security measures to how secure they felt in their role. This study explored whether these factors could potentially explain some of the individual variation found between therapists in treatment outcomes. Following a pilot study, 209 therapists, consisting of 20 violence counsellors, 56 Relate counsellors, 58 forensic and prison psychologists and 75 clinical psychologists, completed self-report questionnaires by post about their work with violent men. Therapists' therapeutic commitment and role security were found to correlate significantly with expectations of clinical outcome on a case vignette, and with the level of violence that was usually worked with. Role security and therapeutic commitment also correlated significantly with therapists' level of experience, education about violence, role support and self-esteem. Differences existed between the professional groups on these latter factors and also in therapeutic commitment and role security. The results indicated the importance of role security in dealing with violence.

Adult↗
PubMed1996

Single or bilateral lung transplantation for emphysema?

BACKGROUND: Most programs favor single lung transplantation for emphysema. However, this is controversial, and we have favored bilateral lung transplantation, confining single lung transplantation mainly to use in older patients and those of small stature. METHODS: A retrospective analysis was done of 119 consecutive lung transplantation procedures for emphysema at Barnes Hospital between 1989 and 1994 (50 single lung, 69 bilateral lung transplants) to (1) identify outcome differences between the two groups and (2) define the appropriate role of these two procedures. RESULTS: The single lung transplantation group was older and had a higher proportion of female patients. However, baseline pulmonary function (forced expiratory volume in 1 second), arterial oxygen tension, and exercise tolerance (6-minute walk distance) were similar. After transplantation, 90-day mortality (single lung transplantation 10% versus bilateral lung transplantation 7.2%; p = 0.74) and duration of mechanical ventilation, intensive care unit stay, and hospitalization were similar. Both groups achieved a significant and sustained improvement in forced expiratory volume, arterial carbon dioxide tension, arterial oxygen tension, and exercise tolerance within 3 months. However, the improvements in forced expiratory volume, arterial oxygen tension, and exercise tolerance were consistently significantly better in recipients of bilateral transplants at and beyond 6 months. Obliterative bronchiolitis was equally prevalent in both groups. Survival was similar but showed a trend toward better late survival in recipients of bilateral transplants (5-year actuarial survival: bilateral lung transplantation 53% versus single lung transplantation 41%). CONCLUSIONS: We conclude that (1) both procedures are satisfactory options in emphysema, producing durable results; (2) bilateral lung transplantation is not associated with increased operative mortality or morbidity and achieves superior improvements in spirometry findings, oxygenation, exercise tolerance, and possibly late survival; and (3) the superior improvements in function (and late survival) after bilateral lung transplantation may be attributed to the presence of more pulmonary reserve after the onset of obliterative bronchiolitis.

Actuarial Analysis↗
PubMed1994

Differences in early results after single-lung transplantation. Washington University Lung Transplant Group.

Single-lung transplantation is an effective treatment for end-stage pulmonary failure caused by a variety of lung diseases. Although single-lung recipients may undergo a similar operative procedure, physiologic differences in the remaining native lung dictate differences in postoperative management and perhaps outcome. To examine these effects on the early results after single-lung transplantation, we retrospectively reviewed the course of 83 patients undergoing single-lung transplantation from September 1988 through July 1993. The cause of the lung disease was obstructive (OLD) in 43, idiopathic pulmonary fibrosis (IPF) in 16, and primary pulmonary hypertension (PPH) in 24 patients. The hospital mortality was 5% in OLD, 13% in IPF, and 8% in PPH. Gas exchange as demonstrated by alveolar-arterial oxygen gradients was worse after transplantation in patients with IPF (349 +/- 159 mm Hg) or PPH (270 +/- 171 mm Hg) compared with patients with OLD (174 +/- 105 mm Hg; p < 0.05). Mean pulmonary artery pressures were higher in patients with IPF (28 +/- 6 mm Hg) and PPH (26 +/- 7 mm Hg) compared with patients with OLD (22 +/- 5 mm Hg; p < 0.05). Peak airway pressures after transplantation were greater in patients with IPF (36 +/- 6 cm H2O) compared with patients with OLD (28 +/- 6 cm H2O; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

A technique for monitoring respiratory responses in guinea pigs.

A piezoelectric crystal was used to detect respiration rates and pulmonary retractions of guinea pigs in response to intratracheal administration of histamine. Voltage output from the crystal was displayed on a recorder for visual processing and interfaced to a microcomputer for automatic data processing. Using intratracheal instillation of histamine, this system accurately reproduced the visual observations of respiratory responses in guinea pigs.

Animals↗
PubMed1981

Transcription of Simian virus 40 DNA in a HeLa whole cell extract.

Extracts of HeLa cells containing RNA polymerase II and other factors recognize specific sites on linear simian virus 40 (SV40) DNA for initiation of transcription. The most prominent RNA products transcribed from the early region of SV40 and th E strand are initiated at sites 0.67 and 0.655 on the SV40 map. These two RNAs are synthesized by polymerase II. Their 5' termini were positioned by sizing transcripts that extend from the initiation site to the end of the template restriction endonuclease fragment, and by S1-nuclease mapping of unlabeled RNA using DNA probes labeled at their 5' termini. The limit of resolution of mapping of 5' termini is approximately 25 nucleotides. RNAs with 5' termini at similar positions have been found during characterization of mRNAs produced in infected cells. Thus, the whole cell extract is probably initiating transcription on linear SV40 DNA in vitro at the same sites as RNAs synthesized in vivo. Two other processes frequently involved in mammalian cell mRNA biosynthesis, creation of specific 3'-terminal polyadenine tracts and RNA splicing, were not detected during the course of these studies.

Cell Transformation, Viral↗
PubMed1980

Regulation of adenovirus mRNA synthesis.

The lytic cycle of adenovirus is a tightly regulated sequence of stages. When this regulation is studied at the level of mRNA production, the most significant step in controlling gene expression is initiation of transcription. Thus in preceding from one stage of expression to another, viral factors seem to turn on transcription of new sets of genes. At the moment, it is thought that viral mRNA synthesis involves initiation of transcription at ten different promoter sites. It is likely that in some manner the frequency of an initiation of transcription at nine of these sites is affected by one or more viral gene products. With the recent development of soluble in vitro transcription systems that respond to exogenously added DNA, it should be possible to begin to study regulation of gene expression at this stage of transcription. At present, these systems yield the paradoxical observation that extracts prepared from uninfected human cells more efficiently recognize the late promoter as compared to the early promoter of adenovirus. As more is learned about regulation of synthesis of viral mRNAs, examples will surely be found where RNA processing and RNA turnover play a critical role in determining the level of mRNAs. Such cases are more likely to appear in the balancing of synthesis of different mRNAs derived from one transcriptional unit. Few experiments have been directed to this possibility and the study of adenovirus molecular biology is only now entering the age of maturity where these experiments are feasible.

Adenoviruses, Human↗
PubMed1976

Cerebral air embolism and cerebral edema: one regimen of treatment.

A case of cerebral air embolism responding immediately to compression to 6 atm is described. The patient, however, developed apparent cerebral edema while being decompressed. Subsequent recompression on oxygen was carried out twice daily at 60 ft (18 m, 2.8 ATA) for 60 min until the patient's symptoms had nearly cleared. While a number of other medications known to affect intracranial pressure were used, objective clinical improvement was noted only after hyperbaric oxygen. A question is raised of whether there is an association between the development of cerebral edema and the administration of intravenous 5% glucose in water.

Brain Edema↗
PubMedDate not supplied

Home health care in the continuum: a review.

An aging population, financial and technical changes, and consumer preference will drive the increase in the types and volume of service clients receive at home. Financial and technical changes will influence the structure of home care services, but home health agencies will continue to partner with primary, acute, and long-term institutional care to provide a continuum of services. However, the health care system will need to allocate sufficient resources to home health if it is to serve an increasing number of more frail and unstable clients. Lacking such resources, home care may not able to contribute appropriately to the continuum of care, and the effectiveness of the overall health care system may be compromised. Challenges to home health agencies' successful operations include decreased resources, changing payment methods, staff shortages, and structural changes in health care systems that fragment care of decrease attention to home health. Home health care's traditional goals of serving clients and caregivers directly and educating them toward health and independence can continue if these problems are resolved.

Aged↗