Metastatic ovarian carcinoid.
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Carcinoid Tumor↗
Biomedical subjects
K Gilmour
Publications and source records attributed to K Gilmour.
Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation.
Adenovirus (AdV) infections are a frequent cause of morbidity and mortality following allogeneic stem cell transplantation (SCT), and disseminated infection is associated with high mortality, particularly in paediatric SCT. Here, we describe an approach to reduce mortality from adenoviraemia by combining prospective monitoring for the occurrence of adenoviraemia using a sensitive polymerase chain reaction method, early antiviral therapy and prompt withdrawal of immunosuppression. A total of 155 consecutive paediatric SCT procedures were prospectively monitored, of which 113 (73%) transplants involved donors other than matched siblings and 126 (83%) employed T-cell depletion. Adenoviraemia was detected in 26/155 (17%) transplants and developed exclusively in patients who had received T-cell-depleted grafts. Withdrawal of immunosuppression coupled with early antiviral therapy led to resolution of adenoviraemia in 19/26 (81%) patients with only five patients succumbing to disseminate AdV infection. Survival from adenoviraemia was associated with lymphocyte recovery to above 0.3x10(9)/l. Mortality was closely linked with the absence of lymphocyte recovery because of profound T-cell depletion of the graft with CD34+ magnetic-activated cell sorting. Mortality from disseminated AdV infection was 5/26 (19%) in this study, which is significantly lower than previously reported.
Adenoviridae↗
Spontaneous pregnancies in patients with resistant ovary syndrome while on HRT.
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Adult↗
Multicentre laboratory evaluation of Brugia Rapid dipstick test for detection of brugian filariasis.
A multicentre evaluation of the Brugia Rapid dipstick test was performed using 1263 serum samples in four international laboratories, i.e. T.D. Medical College (TDMC, India), National Institutes of Health (NIH, USA), Swiss Tropical Institute (STI, Switzerland) and Leiden University Medical Centre (LUMC, Netherlands). In comparison with microscopy, the dipstick demonstrated sensitivities of 97.2% (70 of 72) at TDMC, 91.6% (175 of 191) at LUMC and 100% (six of six) at STI. Sera of chronic patients showed a positivity rate of 11.3% (19 of 168) and 61.2% (71of 116) at TDMC and LUMC, respectively. All 266 sera of non-endemic normals from STI, NIH and LUMC tested negative with the dipstick. At LUMC, sera of 'endemic normals' (amicrofilaraemics with no clinical disease) from an area with approximately 35% microfilaria positivity showed 60.8% positive results (31 of 51), thus demonstrating the likelihood of many cryptic infections occurring in this population. Specificities of the test with Onchocerca volvulus sera were 98.8% (80 of 81) and 100% (10 of 10) at the NIH and STI, respectively; while specificity with Loa loa sera at the NIH was 84.6% (44 of 52). At the STI, the dipstick test also demonstrated 100% specificity when tested with 75 sera from various protozoan and helminthic infections.
Animals↗
Who wants a caesarean section? A study of women's personal experience of vaginal and caesarean delivery.
The Changing Childbirth report, 1999, explicitly endorsed the right of women to be involved in childbirth decisions and to have a choice in childbirth and it has been suggested that maternal requests for a caesarean birth has been a significant factor in the recently observed increases in caesarean section rates. There have been reports of both obstetrician's views and midwives' views regarding the mode of delivery. However, there is a lack of literature reporting the views of women who have experienced personally both a caesarean section and a vaginal delivery. Fifty women in Milton Keynes who had had at least one vaginal delivery and at least one caesarean section were asked for their opinion.
Adult↗
Unique distribution of the anion exchange protein in the sea lamprey, Petromyzon marinus.
The purpose of the present study was to examine the distribution of the anion exchange protein in the sea lamprey. Southern blots showed that genomic DNA of juvenile lampreys possesses several regions that are similar to segments of the AE gene from other vertebrates. However, physiological experiments examining rapid anion fluxes across the red blood cell (rbc) membrane and molecular experiments examining mRNA transcript levels both indicated that the anion exchange protein is absent in sea lamprey rbcs. In contrast, lamprey kidney, skeletal muscle, liver and heart tissue all appeared to possess mRNA transcripts for an AE protein. Further evidence for the presence of an AE protein in kidney tissue was obtained from Western blots. In order to evaluate the impact of the apparent rbc anion exchange limitations, the bicarbonate permeability of lamprey rbcs was also evaluated using mass spectrometry. The bicarbonate permeability of the lamprey rbc membrane was an order of magnitude lower than that of trout rbcs. Taken together, these results indicate that the gene for the AE protein is indeed present in lampreys, but it is not expressed in the rbc. Moreover, the process of CO2 transport in lamprey probably does not involve bicarbonate transport across the rbc membrane.
Animals↗
GP use of anti-D.
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Abortion, Spontaneous↗
An anger management programme for adults with learning disabilities.
Speech and language therapy aims to increase the functional communication of adults with learning disabilities through the implementation of interaction group programmes but the full therapeutic benefit may be reduced because of individual clients' presenting challenging behaviours. The pilot Anger Management Programme aimed to reduce clients' challenging behaviour through increased communication use and with a focus on multidisciplinary collaborative NHS health trust and social work team working practices. An in-service training package and two client-group programmes were devised and positively received both from a client provision and multidisciplinary skill-merge perspective. The paper details the introduction to the study, its objectives, methodology and qualitative analysis.
Adult↗
Extracellular carbonic anhydrase and an acid-base disequilibrium in the blood of the dogfish Squalus acanthias
The electrometric [Delta]pH method and an in vitro radioisotopic HCO3- dehydration assay were used to demonstrate the presence of true extracellular carbonic anhydrase (CA) activity in the blood of the Pacific spiny dogfish Squalus acanthias. An extracorporeal circulation and stopflow technique were then used to characterise the acid­base disequilibrium in the arterial (postbranchial) blood. During the stopflow period, arterial pH (pHa) decreased by 0.028±0.003 units (mean ± s.e.m., N=27), in contrast to the increase in pHa of 0.029±0.006 units (mean ± s.e.m., N=6) observed in seawater-acclimated rainbow trout Oncorhynchus mykiss under similar conditions. The negative disequilibrium in dogfish blood was abolished by the addition of bovine CA to the circulation, while inhibition by benzolamide of extracellular and gill membrane-bound CA activities reversed the direction of the acid­base disequilibrium such that pHa increased by 0.059±0.016 units (mean ± s.e.m., N=6) during the stopflow period. When the CA activity of red blood cells (rbcs) was additionally inhibited using acetazolamide, the magnitude of the negative disequilibrium was increased significantly to -0.045±0.007 units (mean ± s.e.m., N=6). Blockage of the rbc Cl-/HCO3- exchanger using 4,4'-diisothiocyanostilbene-2,2'-disulphonic acid (DIDS) also increased the magnitude of the negative disequilibrium, in this case to -0.089±0.008 units (mean ± s.e.m., N=6). Exposure of dogfish to hypercapnia had no effect on the disequilibrium, whereas the disequilibrium was significantly larger under hypoxic conditions, at -0.049±0.008 units (mean ± s.e.m., N=6). The results are interpreted within a framework in which the absence of a positive CO2 excretion disequilibrium in the arterial blood of the spiny dogfish is attributed to the membrane-bound and extracellular CA activities. The negative disequilibrium may arise from the continuation of Cl-/HCO3- exchange in the postbranchial blood and/or the hydration of CO2 added to the plasma postbranchially. Two possible sources of this CO2 are discussed; rbc CO2 production or the admixture of blood having 'low' and 'high' CO2 tensions, i.e. the mixing of postbranchial blood with blood which has bypassed the respiratory exchange surface.
Journal Article↗
Intestinal base excretion in the seawater-adapted rainbow trout: a role in acid-base balance?
A potential role for the intestine of seawater-adapted teleosts in acid­base regulation was investigated following earlier reports of highly alkaline rectal fluids in the gulf toadfish Opsanus beta. Rectal samples taken from starved seawater-adapted rainbow trout had a high fluid pH (8.90±0.03; mean ± s.e.m., N=13) and base (HCO3-+2CO32-) content of 157±26 mequiv kg-1 (N=11). In trout fitted with rectal catheters, rectal fluid was voided at a rate of 0.47±0.11 ml kg-1 h-1 (N=8), giving a net base excretion rate of 114±15 µequiv kg-1 h-1 (N=7). Drinking rates averaged 3.12±0.48 ml kg-1 h-1 (N=8), and accounted for only 6 % of the base excreted via the intestine, indicating substantial net transport of endogenously derived base into the intestine. Rectally excreted base was approximately balanced by an equivalent efflux of net acid from non-rectal sources (possibly as NH4+ excretion via the gills). Samples taken from four sites along the intestine revealed that the most anterior region (the pyloric intestine) was responsible for the majority of HCO3-+2CO32- accumulation. The pyloric intestine was subsequently perfused in situ to investigate possible mechanisms of base secretion. Net base fluxes were found to be dependent on luminal Cl-, 76 % stimulated by amiloride, 20 % inhibited by 10(-4) mol l-1 acetazolamide, but unaffected by either 10(-4) mol l-1 SITS or 2x10(-5) mol l-1 DIDS. This suggests that the mechanism of base secretion within the pyloric intestine may involve a Cl-/HCO3--ATPase. It is speculated that intestinal base secretion may play a role in facilitating osmoregulation of seawater-adapted teleosts.
Journal Article↗
Consequences of catecholamine release on ventilation and blood oxygen transport during hypoxia and hypercapnia in an elasmobranch Squalus acanthias and a teleost Oncorhynchus mykiss
The marine dogfish (Squalus acanthias) and the seawater-adapted rainbow trout (Oncorhynchus mykiss) were exposed to acute environmental hypercapnia or hypoxia to evaluate (i) the dynamics of catecholamine release into the circulation and (ii) the impact of catecholamine release on gill ventilation and blood oxygen transport. This comparison was undertaken to test the hypothesis that the pattern and consequences of catecholamine release differ in the two species according to the presence or absence of a Root effect and a red blood cell (rbc) ss-adrenergic response. Hypercapnia and hypoxia elicited marked increases in plasma catecholamine levels in the trout but not in the dogfish. In the trout, catecholamine release occurred abruptly during hypoxia when arterial PO2 (PaO2) decreased below 2.7 kPa. In the dogfish, plasma catecholamine levels remained stable during hypoxia even when PaO2 fell below 2.0 kPa. Trout and dogfish displayed pronounced hyperventilatory responses during both hypercapnia and hypoxia. In trout, the hyperventilatory response consisted of an increase in ventilation amplitude (estimated by opercular cavity pressure changes) with no change in ventilation frequency (fv), whereas in the dogfish, both amplitude (estimated by spiracular cavity pressure changes) and fv increased significantly. The use of an extracorporeal circulation and frequent blood sampling demonstrated that plasma catecholamine levels and ventilation amplitude were not correlated during hypoxia in either species. During hypercapnia in trout, the bolus injection of a catecholamine cocktail (final nominal circulating levels 200 nmol l-1 adrenaline, 50 nmol l-1 noradrenaline) caused a rapid (within 2 min) 33 % reduction in ventilation amplitude that persisted for 3 min; fv was unaffected. This hypoventilatory response occurred concurrently with activation of rbc Na+/H+ exchange and an increase in arterial blood O2 content (CaO2) and O2 specifically bound to haemoglobin (O2/Hb). During hypoxia in trout, a similar injection of catecholamines activated rbc Na+/H+ exchange and increased O2/Hb yet was without effect on ventilation amplitude or fv. In dogfish during hypercapnia or hypoxia, injection of a catecholamine cocktail (final nominal circulating levels 125 nmol l-1 adrenaline, 125 nmol l-1 noradrenaline) caused slight but significant reductions in fv (3-4 min-1) without affecting ventilation amplitude. Catecholamine injections did not affect blood oxygen transport in dogfish. The results demonstrate significant differences in the nature of catecholamine release in dogfish and trout that may reflect, in part, the absence of a Root effect and rbc adrenergic Na+/H+ exchange in the elasmobranch. The present data do not support the hypothesis that circulating catecholamines play a major role in controlling breathing during hypoxia or hypercapnia.
Journal Article↗
THE EFFECTS OF HYPOXIA, HYPEROXIA OR HYPERCAPNIA ON THE ACID-BASE DISEQUILIBRIUM IN THE ARTERIAL BLOOD OF RAINBOW TROUT
An extracorporeal circulation in combination with a stop­flow technique was used to characterize the acid­base disequilibrium in the arterial blood of rainbow trout Oncorhynchus mykiss during environmental hypoxia, hyperoxia or hypercapnia. Arterial blood was routed from the coeliac artery through an external circuit in which pH (pHa), partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were monitored continuously. The stop­flow condition was imposed by turning off the pump which drove the external loop. Water PO2 or PCO2 was adjusted to give the experimental conditions by bubbling N2, O2 or CO2 through a water equilibration column supplying the fish. During normoxia, the arterial blood exhibited a positive acid­base disequilibrium of approximately 0.04 pH units; that is, pH increased over the stop­flow period by 0.04 units. The extent of the imbalance was increased significantly by hypoxia (final PaO2=2.7­3.7 kPa; deltapH=0.05 units). In fish exposed to hyperoxia (final PaO2=47­67 kPa), the direction of the disequilibrium was reversed; pHa declined by 0.03 units. During hyperoxia, CO2 excretion was impaired by 63 % and the PCO2 of postbranchial blood was higher than that of prebranchial blood. It is therefore conceivable that a reversal of the normal, outwardly directed, diffusion gradient for CO2 accounted for the negative disequilibrium; CO2 uptake at the gills would drive plasma CO2/HCO3-/H+ reactions towards CO2 hydration and H+ formation. During hypercapnia, fish exhibited a twofold increase in the positive pH disequilibrium (deltapH=0.06 units). The results of this study confirmed the existence of an acid­base disequilibrium in the arterial blood of rainbow trout and clearly demonstrated that the extent and/or direction of the disequilibrium are influenced by the respiratory status of the fish.
Journal Article↗
THE EFFECTS OF BRANCHIAL CHLORIDE CELL PROLIFERATION ON RESPIRATORY FUNCTION IN THE RAINBOW TROUT ONCORHYNCHUS MYKISS
The objectives of this study were to induce chloride cell (CC) proliferation on the gill lamellae of rainbow trout Oncorhynchus mykiss and to evaluate the consequences for respiratory function. Chronic elevation of hormone levels was used to induce CC proliferation; fish were injected with a combination of cortisol (8 mg kg-1 intramuscularly every day for 10 days) and ovine growth hormone (2 mg kg-1 intraperitoneally every second day for 10 days). The extent of CC proliferation was quantified using scanning electron microscopy and a two-dimensional analysis. An extracorporeal preparation in combination with environmental hypoxia was used to assess the effects of CC proliferation on respiratory function. Arterial blood was routed from the coeliac artery through an external circuit in which pH (pHa), partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were monitored continuously. Environmental hypoxia was imposed by gassing a water equilibration column supplying the experimental chamber with N2. The hormone treatment increased the average CC surface area by 2.7-fold and CC density by 2.2-fold; the combined effect was a fivefold increase in CC fractional area. While the PaO2 values of hormone-treated and control fish were similar at PwO2>12.0 kPa, the arterial O2 tensions of treated fish were significantly lower than those of the control group for PwO2¾12.0 kPa. In comparison with control fish at all environmental O2 tensions, the hormone-treated fish exhibited elevated PaCO2 values and a significant acidosis. The effects of CC proliferation on blood gas variables in hormone-treated fish were accompanied by a significantly elevated ventilation amplitude and a lowered ventilation frequency. The results of this study demonstrated (i) that impairment of respiratory gas transfer coincides with CC proliferation, (ii) that O2 and CO2 transfer are influenced differently and (iii) that partial compensation is achieved through physiological adjustments.
Journal Article↗