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Biomedical subjects

J Small

Publications and source records attributed to J Small.

At least 19 recordsLinked to original sources
PubMed1997

Depression during mania. Treatment response to lithium or divalproex.

BACKGROUND: Little information exists from controlled studies about clinical characteristics that predict treatment response in mania. The presence of depressive symptoms during manic episodes may be associated with poor response to psychopharmacological treatments. This is an investigation of the relation between depressive symptoms and treatment response in acute manic episodes. METHODS AND DESIGN: In a parallel-group, double-blind study, 179 patients hospitalized for acute manic episodes were randomized to receive divalproex sodium, lithium carbonate, or placebo (ratio, 2:1:2). The study was carried out at 9 academic medical centers. Patients had comprehensive evaluations of behavior and symptoms before and during 3 weeks of treatment. The primary outcome measure, change in mania factor scores derived from the Schedule for Affective Disorders and Schizophrenia: Change Version, was compared in patients with and without depressive symptoms at baseline according to nurse- or physician-rated scales. RESULTS: Depressive symptoms were associated with poor antimanic response to lithium and with better response to divalproex. This was not due to differences in overall severity of illness, substance abuse, gender, age, or history. CONCLUSIONS: These data suggest that even a modest level of pretreatment depression-related symptoms is a robust predictor of lithium nonresponse, and is associated with better response to divalproex. Although their overall efficacy in acute mania is similar, lithium and divalproex may be most effective in clinically and biologically distinct groups of patients.

Adult↗
PubMed1997

Cochlear implant extrusion in a child with keratitis, ichthyosis and deafness syndrome.

We present a child with keratitis, ichthyosis and deafness (KID) syndrome implanted with a Nucleus device. We discuss the would complications of this child and the steps taken to deal with the problems encountered when the wound failed to heal, followed by the partial extrusion of her implant. Early surgical management involved resuturing the wound but when this failed a rotational flap was required to cover the implant package and allow eventual healing. Despite the wound problems and revision surgery she has a good audiological result.

Child↗
PubMed1995

The cyclic dilemma: organic, functional, and environmental interaction in a young teenager.

This Grand Rounds considers an early-adolescent female who demonstrated a mixed clinical picture including rapid cycling of psychotic behavior. The case presents issues commonly faced in hospital practice and provides an example of the use of standardized instruments in assessment and monitoring treatment, as well as a discussion of issues germane to inpatient child and adolescent psychiatrists and related treatment team members.

Adolescent↗
PubMed1995

Limb salvage after bony and vascular gunshot injuries in a five-week-old infant.

Combined bony and vascular injuries present challenging problems to orthopaedic and vascular surgeons. The use of temporary intraluminal vascular shunts produces significant reductions in ischaemia time and allows fracture stabilisation to be performed before definitive, delicate vascular repair. We report our management of a five-week-old infant who sustained a comminuted fracture of the femur with arterial and venous injuries in a shooting incident. Paediatric nasogastric feeding tubes were used as temporary vascular shunts to re-establish the distal circulation. Stabilisation of the fracture was then followed by vascular reconstruction and soft-tissue surgery, with a good result. We emphasise the need for skills from several surgical disciplines in the management of complex combined injuries.

Blood Vessel Prosthesis↗
PubMed1994

Expression of the myelin basic protein gene in transgenic mice expressing human neurotropic virus, JCV, early protein.

Transgenic mice containing the early region of the JC virus encoding T-antigen developed neurological disease resulting from dysmyelination in the central nervous system. In this study, we investigate expression of the myelin basic protein (MBP) gene, a major constituent of the myelin sheath, at the RNA level by Northern blot and S1 nuclease assay and at the protein level by Western blot analysis using anti-MBP antibody in two distinct transgenic lines exhibiting different degrees of dysmyelination. Results from Western blot analysis of proteins from the brains of these mice revealed great reductions in MBP levels that parallel the severity of dysmyelination in the corresponding animals. Analysis of MBP RNA by Northern and quantitative S1 assays exhibited no alterations in the transcription initiation sites of the MBP gene in these animals; however, a significant decrease in the level of MBP mRNA was detected, suggesting that T-antigen may negatively influence transcription of the MBP gene. Results from Northern and Western blot analysis of proteolipid protein revealed low-level expression of this gene. Expression of JCV T-antigen is developmentally regulated in the transgenic mice; it appears at 8 days postnatal, peaks at 15 days, and substantially decreases in 18-day-old mice. The programmed expression of JCV T-antigen, which overlaps with MBP gene transcription at the early stage of myelination, suggests the involvement of a pathway which modulates stage-specific regulation of myelin genes and viral gene expression in transgenic mice during brain development.

Animals↗
PubMed1993

Xamoterol in sinus node disease.

A pharmacological alternative to pace-maker implantation would be useful in some patients with sinoatrial disorder particularly since the single lead ventricular system usually fitted has disadvantages. Xamoterol, a cardioselective beta-receptor partial agonist, has been shown to increase heart rate both in animals and in man. We, therefore, studied the effects of Xamoterol in patients with sinoatrial disease in a double blind, cross-over trial in 10 patients. Mean heart rates and number and duration of pauses were compared during the treatment phases of the trial with Holter monitoring. Mean heart rates were significantly increased between 01:00 h and 05:00 h (P < or = 0.02) and between 05:00 h and 09:00 h (P < or = 0.01) on Xamoterol. The number of sinus pauses were eliminated or reduced on Xamoterol in six patients, but there was an increased frequency in three patients. Xamoterol, therefore, does increase the heart rate and reduce the number of pauses in sinoatrial disorder, but only in some patients.

Adult↗
PubMed1993

The sensory neuropathy of Friedreich's ataxia: an autopsy study of a case with prolonged survival.

Observations have been made on a patient with Friedreich's ataxia who died 52 years after the onset of symptoms. The pathology of the brain and spinal cord was typical of this disorder. Apart from loss of dorsal root ganglion cells, severe loss of secondary sensory neurons was observed, including the nucleus dorsalis in the spinal cord, the spinal and principal trigeminal nuclei and, in particular, the mesencephalic trigeminal nucleus in the brain stem. Morphometric studies on the first sacral nerve root and on the sural nerve at levels from midthigh to ankle revealed a distally accentuated axonal loss that predominantly affected larger myelinated nerve fibres. Regenerative activity was seen, mainly in the spinal root and proximally in the sural nerve. Relative myelin thickness, assessed by a g ratios, tended to be reduced. As teased fibre studies showed only limited evidence of demyelination/remyelination and of axonal regeneration, this therefore suggests the presence of a hypomyelination. The results confirm the presence of a distal axonopathy and provide no evidence that this is preceded by axonal atrophy.

Axons↗
PubMed1992

Prospective study of short and long regimens of gonadotropin-releasing hormone agonist in in vitro fertilization program.

OBJECTIVE: To assess the usefulness of a short regimen in ovulation induction in an in vitro fertilization (IVF) program. DESIGN: A prospective randomized trial was set up to compare long and short regimens of gonadotropin-releasing hormone agonist administration for ovulation induction in IVF. SETTING: Aberdeen Assisted Reproduction Unit. PATIENTS: Eighty-seven patients undergoing IVF were randomized between the two protocols. Stimulation regimen was the only variable being tested. MAIN OUTCOME MEASURES: Stimulation response and occurrence of luteinizing hormone (LH) surges. RESULTS: There was no difference in the stimulation requirements, response to stimulation, number of follicles aspirated, or the number of oocytes obtained. The fertilization rates, number of embryos transferred, and pregnancy rates were also similar in both groups. Like the long regimen, it prevents the occurrence of a premature LH surge. CONCLUSION: The short regimen is a useful and cheaper alternative in ovarian stimulation of patients undergoing IVF.

Adult↗
PubMed1991

Prolonged hemorrhagic shock decreases splanchnic prostacyclin synthesis.

The effect of increasing time of hemorrhage-induced hypotension on basal splanchnic prostanoid (PG) release was examined. Male Sprague-Dawley rats were anesthetized and hemorrhaged to 30 mm Hg for 30, 60, or 120 min (SK-30, SK-60, SK-120 groups). Following shock, the superior mesenteric artery and its end organ intestine (SV + SI) was cannulated and perfused in vitro with Krebs buffer at 3 ml/min. Basal SV + SI release of 6-keto-PGF1 alpha (6-keto), PGE2, and thromboxane B2 (TxB2) was measured in the SK groups by radioimmunoassay after 15, 30, 60, 90, and 120 min of perfusion and compared to sham-operated controls (SM-30, SM-60, and SM-120 groups). 6-Keto was the major PG released from the sham SV + SI groups and was two- to sixfold higher than PGE2 or TxB2 release. Acute shock for 30 min increased SV + SI 6-keto release threefold or higher than the SM-30 group after 15-90 min of perfusion. Acute shock for 60 or 120 min lowered all PG release below SM-60 and SM-120 levels. These data confirmed our earlier study which showed that the SV + SI attempted to compensate for acute hemorrhagic shock for 30 min by increased release of prostacyclin, a potent endogenous vasodilator. The present study showed that the capacity of the SV + SI to increase endogenous prostacyclin release following hemorrhagic shock was limited by the time duration of the hypotension.

6-Ketoprostaglandin F1 alpha↗
PubMed1991

Cadaveric renal transplantation in elderly recipients: is it worthwhile?

The aim of this study is to analyse whether or not old age alone significantly affects the outcome of patient and graft survival in cadaveric renal transplantation, and thus whether it should be a selection criterion for induction into transplant programmes, given the current shortfall in donor organs in the United Kingdom. Data is presented on all 307 solitary cadaveric renal allografts performed at Addenbrooke's Hospital, Cambridge between January 1983 and December 1987. Patients are divided into those aged less than 60 years (n = 243) and those aged 60 years and over (n = 45) at the time of transplantation. There is no significant difference in graft survival between the two groups (60.3% and 62.2%) at 18-60 months (mean 42 months) post-transplantation. Patient survival in the two groups is significantly different (83% and 64.4%, P less than 0.01) at the same point. Causes of graft loss, death, and end-stage renal failure are analysed. It is suggested that patients aged 60 years and over may require less immunosuppression but that graft loss from rejection in this group has a high associated mortality. We conclude that cadaveric renal transplantation in the elderly should only be undertaken after careful selection, paying particular attention to evidence of cardiovascular disease and full counselling of the risk of death with these patients.

Adult↗
PubMed1991

Hypoxia inhibits renal thromboxane and not prostacyclin release.

The effect of hypoxia on renal prostanoid synthesis and renal function was studied. The kidneys of male Sprague-Dawley rats were cannulated and perfused in vitro with Krebs-Henseleit buffer with a pO2 of 460 (control) or 60 mm torr (hypoxia). The rate of perfusion was adjusted to maintain perfusion pressure at 100 mm Hg. The renal venous effluent was collected at 15, 30, 60, 120, 150, and 180 min and assayed for basal release of 6-keto-PGF1 alpha, PGE2, and thromboxane B2 by radioimmunoassay and inulin and sodium clearance. Prostanoid release was high at 15 min, decreased to a lower level up to 120 min, and then progressively increased after 150 min of perfusion. Hypoxia significantly decreased TxB2 release at 30, 60, 150, and at 180 min but not PGE2 or 6-keto-PGF1 alpha release. Hypoxia proportionally decreased both sodium and inulin clearances suggesting that the decrease in renal function was from decreased renal flow. The kidney responded to the altered renal function by increasing the ratio of vasodilator to vasoconstrictor prostanoids by inhibition of TxB2 release.

6-Ketoprostaglandin F1 alpha↗
PubMed1988

Pain-free cutting of split skin grafts by application of a percutaneous local anaesthetic cream.

The use of a novel percutaneous anaesthetic preparation for the pain-free cutting of split skin grafts has been assessed in a series of 80 patients, age range 12 to 96 years. The technique was completely successful in 80% of these cases, with complete analgesia established within one hour of initial application. Duration of anaesthesia was such that pain-free cutting of the skin was possible up to 5 hours after initial application of the preparation. Failures of the technique were largely attributed to a loss of anaesthetic potency in the preparation, application of an inadequate amount to the site or patient anxiety. The use of the percutaneous anaesthetic preparation was found to offer considerable advantages over conventional infiltration anaesthesia for this type of surgery. Several additional surgical applications of percutaneous anaesthesia are also considered.

Administration, Cutaneous↗
PubMed1986

A field study of watery mouth: clinical, epidemiological, biochemical, haematological and bacteriological observations.

More than 500 cases of watery mouth in newborn lambs were recorded in 11 flocks and a detailed examination was performed in more than 200 cases. The condition occurred predominantly in lambs aged 24 to 48 hours. The incidence in a flock varied from 1 per cent to 24 per cent and the mortality in affected lambs varied from 7 per cent to 83 per cent. A bacteraemia was found in 38 per cent of the affected lambs. There were no consistent abnormalities of clinical biochemistry or haematology. Watery mouth was more common in twins and especially in triplets than in single lambs. In twins the highest incidence of watery mouth was recorded in lambs born to ewes in poor body condition. Antibiotic given orally within 15 minutes of birth greatly reduced the incidence of watery mouth.

Age Factors↗
PubMed1986

A simple system for recording lamb mortality used to improve flock management.

Many commercial sheep farmers do not record either the extent or the causes of their lamb losses but this information is essential if losses are to be reduced in the future. The major causes of death in newborn lambs are reviewed together with the common predisposing factors. The development and practical application of a simple system for recording lamb deaths is described. It is concluded that the application of this type of system, initiated, supervised and interpreted by the farmer's own veterinary surgeon, would indicate how to reduce the losses of lambs and would be a useful component of any flock health scheme.

Animal Husbandry↗