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Biomedical subjects

J Starr

Publications and source records attributed to J Starr.

At least 19 recordsLinked to original sources
PubMed2003

Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia?

BACKGROUND: The pathogenesis of and relationship between small deep (lacunar) infarcts, cerebral white matter disease (leukoaraiosis or white matter hyperintensities), and progressive cognitive impairment or dementia are much debated. SUMMARY OF COMMENT: We hypothesize that cerebral small-vessel endothelial (ie, blood-brain barrier) dysfunction, with leakage of plasma components into the vessel wall and surrounding brain tissue leading to neuronal damage, may contribute to the development of 3 overlapping and disabling cerebrovascular conditions: lacunar stroke, leukoaraiosis, and dementia. This hypothesis could explain the link between ischemic cerebral small-vessel disease and several apparently clinically distinct dementia syndromes. This hypothesis is supported by pathological, epidemiological, and experimental studies in lacunar stroke and leukoaraiosis and observations on the blood-brain barrier with MRI. We suspect that the potential significance of blood-brain barrier failure as a pathogenetic step linking vascular disease with common, disabling brain diseases of insidious onset has been overlooked. For example, lipohyalinosis, which has a pathological appearance of uncertain origin and is possibly responsible for some discrete lacunar infarcts, may be one end of a clinical spectrum of illness manifested by blood-brain barrier failure. CONCLUSIONS: Proof that blood-brain barrier failure is key to these conditions could provide a target for new treatments to reduce the effects of vascular disease on the brain and prevent cognitive decline and dementia.

Aging↗
PubMed2001

The NART as an index of prior intellectual functioning: a retrospective validity study covering a 66-year interval.

BACKGROUND: The National Adult Reading Test (NART) is widely used in research and clinical practice as an estimate of pre-morbid or prior ability. However, most of the evidence on the NART's validity as a measure of prior intellectual ability is based on concurrent administration of the NART and an IQ measure. METHOD: We followed up 179 individuals who had taken an IQ test (the Moray House Test) at age 11 and administered the NART and the Mini-Mental State Examination (MMSE) at age 77. A subset (N = 97) were also re-administered the original IQ test. RESULTS: The correlation between NART performance at age 77 and IQ age 11 was high and statistically significant (r = 0.73; P < 0001). This correlation was comparable to the correlation between NART and current IQ, and childhood IQ and current IQ, despite the shared influences on the latter variable pairings. The NART had a significant correlation with the MMSE but this correlation fell to near zero (r = 0.02) after partialling out the influence of childhood IQ. DISCUSSION: The pattern of results provides strong support for the claim that the NART primarily indexes prior (rather than current) intellectual ability.

Aged↗
PubMed2001

Parental causes of death in stroke.

There are many reports of familial aggregation in stroke. However, whether familial aggregation is largely due to genetic or environmental factors is not established. Consecutive subjects with stroke were matched with 2 controls per case of the same sex, born in the same year, district, and whose fathers had the same occupation. Presence on parental death certificates of cerebrovascular disease, other vascular disease, bronchial carcinoma, hypertension, diabetes mellitus and other causes of death was recorded. No significant difference in risk was found for cases having mother (odds ratio, OR 1.08, 95% confidence interval, CI, 0.74-1.57), father (OR 0.91, 95% CI 0.58-1.45) or either parent (OR 1.04, 95% CI 0.74-1.46) with cerebrovascular disease. Familial aggregation may reflect socioeconomic and other environmental factors.

Adult↗
PubMed2000

Myiasis due to Hypoderma lineatum infection mimicking the hypereosinophilic syndrome.

Myiasis is the infestation of live humans with larvae of Diptera (true flies). This report describes a protracted illness caused by infestation with Hypoderma lineatum, resembling the hypereosinophilic syndrome. A 35-year-old man had a 9-month multisystemic illness with pronounced eosinophilia, pleuritis, pericarditis, and myositis. Treatments including glucocorticoids did not alter the disease. Diagnostic studies included computed tomography, 2-dimensional echocardiography, leukocyte count, surgical biopsy of skin and muscle, blood immunoglobulin levels, and blood chemistry. Myiasis was recognized when a worm emerged from the patient's skin; after a second worm emerged, the patient's symptoms disappeared rapidly. Other determinations included IgE and IgG levels specific for H lineatum, Western blot, and immunofluorescence for eosinophil major basic protein; IgG antibodies to H lineatum decreased after emergence of the worms. The patient's symptoms mimicked the hypereosinophilic syndrome but resolved when the myiasis became apparent. Specific serologic analyses can identify infected patients, and ivermectin may be useful as treatment.

Adult↗
PubMed1997

Association between abdominal aortic diameter and peripheral vascular disease.

Fifty-four elderly people 81.2 years +/- 7.4 (mean age +/- s.d., range 66-98 years) were selected. These included 20 men (78.6 +/- 6.4 years, range 70-91 years) and 34 women (82.2 +/- 7.6 years, range 66-98 years). The relationship between the size of the abdominal aorta and various cardiovascular risk indicators such as calf:-brachial systolic pressure ratio, plasma cholesterol, triglycerides, and random blood glucose were examined. Abdominal aortic diameter correlated well with calf:-brachial systolic ratio measured by Doppler method over the posterior tibial artery and taking the lowest result of the right and left side (r = -0.28, P = 0.04). This correlation tended to be stronger in men (r = -0.55, P = 0.02) compared to women (r = -0.10, P = 0.57). However, the relationship tended to be confined to the systolic pressure in the left leg, raising the hypothesis that left-sided vascular disease is better related to aortic diameter, possibly due to a difference in the effects of reflected waves between the two sides. This needs further investigation. The contrast between the sexes was seen in the absence of any significant difference in resting blood pressure and calf:brachial systolic pressure ratio between the two. This finding suggests that the sex differences in the relationship between the size of the abdominal aorta and calf:brachial systolic pressure ratio are related to intrinsic properties of the arterial wall.

Aged↗
PubMed1996

Fresh frozen plasma prophylaxis for hereditary angioedema during pregnancy. A case report.

BACKGROUND: Hereditary angioedema (HAE) is an uncommon disorder of the complement system due to a deficiency or dysfunction of the inhibitor of the first component of complement (C1 INH). Clinically, HAE is characterized by episodic abdominal pain or edema of the extremities, face, larynx and vulva. Laryngeal edema is potentially lethal and accounts for mortality rates as high as 30%. Therapy is divided into short-term (fresh frozen plasma) and long-term (antifibrinolytic agents, hormonal therapy) prophylaxis, or acute treatment (epinephrine, steroids, antihistamines). CASE: An 18 year-old, primiparous woman presented with a history of multiple episodes of abdominal pain, swelling of abdomen and extremities. A diagnosis of hereditary angioedema was made based on the patient's and family's history and on decreased levels of C1 INH and complement component 4. Standard prophylactic methods were contraindicated due to potential teratogenic effects. Fresh frozen plasma given twice weekly over 2.5 months resulted in reduction in the number and severity of attacks and allowed successful completion of pregnancy. CONCLUSION: This is the first report of fresh frozen plasma therapy as a means of long-term prophylaxis in a pregnant woman. Fresh frozen plasma may serve as an alternate mode of long-term prophylaxis if the standard agents (antifibrinolytic, hormone) are unsuccessful or contraindicated.

Adolescent↗
PubMed1996

The prevalence of pseudohypertension in the elderly.

Pseudohypertension (PHT) could lead to the initiation of unnecessary antihypertensive treatment and potentially adverse consequences. The Finapres is reported to be a reliable alternative to intra-arterial blood pressure (BP) measurements and is unlikely to be distorted by arterial calcification, suggested to be a cause of PHT. Finapres measurements were compared with sphygmomanometric measures of brachial BP. PHT was defined as a systolic pressure (brachial) > or = 190 mm Hg and finger systolic < 160 mm Hg or a diastolic pressure (brachial) > or = 100 mm Hg and finger pressure < 90 mm Hg. One hundred and twenty-five elderly in-patients and out-patients, both hypertensive and normotensive, had a 2.5% prevalence of PHT (1 had diastolic PHT in the left arm, 1 had systolic PHT in the right arm and 1 had systolic PHT in both arms). A group without PHT, but with higher systolic readings with the sphygmomanometer compared with the Finapres (> or = 30 mm Hg) was identified. It was thought that the same factors may affect both pseudohypertensive and non-pseudohypertensive subjects with such large differences. Our data suggest that age plays a role in the presence of higher brachial pressures.

Age Factors↗
PubMed1995

Video-assisted endoscopic spinal surgery: thoracoscopic discectomy.

The use of new endoscopic techniques to conduct a thoracic discectomy is presented. The development of these endoscopic techniques through live porcine and cadaver models are outlined. It is concluded that the use of multiple ports for the endoscopic approach to the thoracic spine provides an exposure to the anterior and lateral spinal theca that is equal to the exposure afforded by the more extensive thoracotomy. Current techniques are being developed for transperitoneal and retroperitoneal endoscopic lumbar spine surgery.

Adult↗
PubMed1995

The changing face of community and institutional care for the elderly.

BACKGROUND: The NHS and Community Care Act 1990, implemented from 1 April 1993, was expected to alter profoundly the provision of domiciliary services to old people. This change needs to be compared with what would have happened if no action had taken place. We sought to identify trends in community and residential care before and after 1993 to facilitate this comparison. METHODS: Statistics were collated from diverse government publications and other authoritative sources. RESULTS: Between 1985 and 1993 there was a progressive contraction of public community and residential services, as well as hospital beds available to the elderly. The concomitant huge increase in places publicly funded in private old people's and nursing homes appears to have been little affected by the implementation of the NHS and Community Care Act. CONCLUSIONS: The NHS and Community Care Act has had little effect in curbing the institutionalization of old people, which has reached now the highest percentage this century at 7 per cent. A considerable expansion of community services would be required to return to the per capita provision of the early 1980s.

Aged↗
PubMed1992

A complex rearrangement associated with sex reversal and the Wolf-Hirschhorn syndrome: a cytogenetic and molecular study.

We report a male infant referred with multiple congenital abnormalities consistent with the Wolf-Hirschhorn syndrome. Cytogenetic analysis showed a chromosome complement of 46,XX with a deletion of 4p15.2----4pter and its replacement by material of unknown origin. The patient was positive for a number of Yp probes including SRY, the testis determining factor, and in situ hybridisation localised the Yp material to the tip of the short arm of one X chromosome. Using pDP230, a probe for the pseudoautosomal region, and M27 beta, which recognises a locus in proximal Xp, the material translocated on to 4p was identified as originating from the short arm of the paternal X chromosome. The most reasonable explanation for this complex rearrangement is two separate exchange events involving both chromatids of Xp during paternal meiosis. An aberrant X-Y interchange gave rise to the sex reversal and an X;4 translocation resulted in additional, apparently active Xp material and a deletion of 4p which produced the Wolf-Hirschhorn phenotype.

Adult↗
PubMed1990

Radiopaque acrylic resins containing miscible heavy-metal compounds.

Radiopacity is needed in order to facilitate diagnosis of polymeric appliances, which may be dislodged and become impacted in the upper respiratory or digestive tracts. In order for a stable, optically transparent, radiopaque material to be provided, heavy-metal compounds were investigated which we had previously shown to form homogeneous structures with methyl methacrylate-based systems. It was found that, when present in PMMA at 11 to 14%, several compounds of either bismuth or uranium or 35% of an organo-zirconium compound impart radiopacity equivalent to that of aluminum. A low level of cytotoxicity and lack of mutagenicity indicated that a high level of biocompatibility can be expected. Processing characteristics are somewhat altered, but formulations satisfactory for use in various dental devices were found.

Acrylic Resins↗
PubMed1990

Inconsistent esophageal Doppler cardiac output during acute blood loss.

Application of the Doppler principle can provide relatively noninvasive and continuous measurement of cardiac output. However, it is based on certain assumptions that may introduce error. Esophageal Doppler cardiac output was compared with Fick cardiac output during acute blood loss (35-45% estimated blood volume) in eight anesthetized pigs. Mean Fick cardiac output decreased from 4.8 to 1.9 l/min, mean Doppler cardiac output from 4.9 to 2.9 l/min. This was accompanied by a decrease in mean arterial pressure from 119 to 55 mmHg and increase in heart rate from a mean of 115 to 156 beats/min. There was an inconsistent association between the two methods both within and between individual animals. Cubic polynomial regression equations of cardiac output with time indicated small measurement error in Fick (R2: mean 0.93, range 0.99-0.75) as opposed to Doppler (R2: mean 0.67, range 0.93-0.16) cardiac output. In one animal Doppler cardiac output showed an increase with time and in one the Doppler cardiac output measurements were unrelated to time. There was highly variable association comparing Fick versus Doppler cardiac output with correlations ranging from -0.76 to 0.98. A sign test for mean differences indicated that Doppler derived cardiac output was higher than Fick cardiac output, and the chance of this occurring if the true difference was zero was less than 1 in 1,000. A test for homogeneity of correlations was also rejected. Inaccuracies in individual assumptions in the computation of esophageal Doppler cardiac output, especially unaccounted changes in aortic diameter, are responsible for the inconsistent and unpredictable values of Doppler cardiac output obtained in this experimental model of hemorrhage.

Acute Disease↗
PubMed1990

A linkage study of a large pedigree with X linked centronuclear myopathy.

Centronuclear myopathy (CNM) is a muscle wasting disorder that occurs in three distinct forms. Previous studies have shown linkage between the X linked form of the disease and the Xq28 probes ST14, DX13, and F8C. Our study on a previously unreported, three generation, X linked CNM family confirms linkage between these markers and the CNM locus (Z = 3.21, theta = 00). However, results from the laboratory of J-L Mandel (Samson and Hanover, personal communication) on a number of X linked CNM families exclude genetic linkage from the region Xq26-qter, suggesting genetic heterogeneity in this condition.

Cell Nucleus↗
PubMed1989

Swine model of early adult respiratory distress syndrome induced by intravenous ethchlorvynol.

Although ethchlorvynol (ECV) has been used to induce pulmonary damage in animals, changes after injection of this drug have not been studied, nor has the stability of the animal been assessed after injection. Continuously monitored hemodynamic and respiratory changes were followed during and after iv injection of 55 mg/kg ECV in ethanol into anesthetized, paralyzed, and ventilated swine (n = 5) and compared to changes in a control group given ethanol alone (n = 5). Arterial and mixed venous saturations were measured by fiberoptic vascular catheters and oxygen exchange by a gas monitor. Twelve direct and derived variables were monitored every 20 sec using a computer data acquisition system. Arterial oxygen saturation was kept at 90 +/- 2% by adjustment of FIO2. Ethanol produced only transitory changes during infusion. Significant elevations in pulmonary vascular resistance (PVR), shunt (Qsp/Qt) and deadspace (VD/VT) were observed during and after ECV. These were unaccompanied by changes in cardiac output or arterial pressure. PVR increased by 137%, Qsp/Qt by 67%, and VD/VT by 28% over 30 min. These changes were then sustained in the postinfusion period, producing a stable model of early adult respiratory distress syndrome for 3.5 h.

Animals↗
PubMed1989

Extensive short-bowel syndrome in neonates: outcome in the 1980s.

Fourteen infants with extensive short-bowel syndrome (SBS) were treated from 1978 through 1987 at the Children's Hospital, Columbus, Ohio. Extensive SBS was defined as a residual jejunoileum that was 25% or less than the normal expected length for each infant's gestational age. The cause of the SBS included gastroschisis (5), jejunal atresia (5), necrotizing enterocolitis (2), midgut volvulus (1), and congenital SBS (1). Infants had a mean residual jejunoileal length of 32 cm, which represented an average of 16% of normal expected jejunoileal length for gestational age. The most significant complications were associated with total parenteral nutrition (TPN): catheter sepsis (13/14 infants); cholestasis (8/14); central venous thrombosis (4/14); and cholelithiasis (3/14). The survival rate was 86%; two infants died of end-stage liver disease. Eight of 12 survivors (67%) have had intestinal adaptation develop and have discontinued TPN; three are maintained with combined TPN-enteral feeding; and one receives only TPN. Mean cost of the initial hospitalization was $315,000 with an average stay of 450 days. Survival and eventual enteral alimentation may be expected for most neonates with extensive SBS despite significant morbidity.

Adaptation, Physiological↗