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Biomedical subjects

L Carr

Publications and source records attributed to L Carr.

At least 37 records · Page 2Linked to original sources
PubMed1998

Status dystonicus: the syndrome and its management.

Patients with dystonic syndromes sometimes develop increasingly frequent and relentless episodes of devastating generalized dystonia which we call status dystonicus. Twelve cases of status dystonicus, of various underlying aetiologies, are presented. Possible precipitating factors were identified in only five cases: intercurrent infection (one); discontinuation of lithium (one) and tetrabenazine (one); and the introduction of clonazepam (two). Nine patients required mechanical ventilation and three others were sedated with intravenous chlormethiazole. Drug therapy used included benzhexol, tetrabenazine, pimozide, baclofen, chlorpromazine, haloperidol, carbamazepine and acetozolamide. Two patients underwent thalamotomies, one of whom improved. Two patients died, five returned to their pre-status dystonicus condition, two eventually made a full recovery and three were worse. Patients with status dystonicus should be managed on an intensive care unit as they may develop bulbar and respiratory complications which may require ventilation. Metabolic problems encountered can include rhabdomyolysis with acute renal failure. Drug therapy with benzhexol, tetrabenazine and pimozide or haloperidol may be beneficial in some cases.

Adolescent↗
PubMed1997

Campylobacter jejuni in broiler chickens: colonization and humoral immunity following oral vaccination and experimental infection.

A formalin inactivated, Campylobacter jejuni whole cell vaccine, either with or without Escherichia coli heat labile toxin (LT) as a mucosal adjuvant, was administered orally to broiler chickens. Three vaccine trials were performed, differing in the number of vaccinations, and time of administration, as well as the inclusion and dose of LT. The overall reductions of C. jejuni colonization in the vaccinated chickens ranged from 16 to 93% compared with non-vaccinated controls. Enhanced levels of anti-C. jejuni secretory IgA antibodies were demonstrated in vaccinated chickens. Vaccination also appeared to induce an anamnestic response to C. jejuni antigens in the 14-33 kDa range, as demonstrated by Western immunoblots. Interestingly, the inclusion of LT in the vaccine regimen did not appear to boost the immunogenicity of the vaccine. These results are encouraging and suggest that future development of successful oral vaccines for the control of enteropathogenic Campylobacter in poultry is feasible.

Administration, Oral↗
PubMed1996

Omega-3 fatty acid supplementation and lipoprotein(a) concentrations in patients with chronic glomerular diseases.

Renal disease patients often exhibit alterations in the lipid profile which may become an important risk of accelerated atherosclerosis and contribute to disease progression. Among such alterations, increased levels of lipoprotein(a) [Lp(a)] are common and may be related, in part, to the degree of proteinuria. Omega-3 polyunsaturated fatty acids (omega-3 FA) have been reported to decrease Lp(a) concentrations in nonrenal subjects. In addition, they have recently been shown to reduce proteinuria in patients with chronic glomerular disease. We therefore tested the hypothesis that omega-3 FA treatment in patients with chronic glomerular disease may reduce Lp(a) concentrations. Eight patients (2 with membranous glomerulonephritis, 6 with focal glomerular sclerosis) were submitted to a total of 13 six-week courses of treatment with omega-3 FA, at a dose of 3 g/day with a triglyceride preparation (n = 4) and of 7.7 g/day with an ethyl-ester preparation (n = 9). Both treatments significantly increased the proportions of omega-3 to omega-6 FA in total serum lipids, documenting compliance to treatment. Both treatments were also effective in decreasing serum thromboxane (from mean 490 +/- (SEM) 70 to 325 +/- 49 ng/ml, p < 0.05, in the high-dose group) and prolonging the bleeding time (from 5.8 +/- 0.4 to 7.7 +/- 0.5 min, p < 0.05, in the high-dose group), thus documenting the biological efficacy of treatment. However, despite a significant reduction in serum triglyceride levels (from 137 +/- 20 to 104 +/- 19 mg/dl in the high-dose group), Lp(a) concentrations did not change (292 +/- 120 U/l before, 315 +/- 130 U/l after the high-dose therapy). Treatment-related changes in proteinuria (from 2.9 +/- 0.5 to 2.1 +/- 0.7 g/24 h) were not related at all to changes in Lp(a) levels. We conclude that omega-3 FA do not decrease Lp(a) concentrations in renal patients with chronic glomerular diseases and that Lp(a) levels are unlikely to be related to the degree of proteinuria within the short-term modifications induced by omega-3 FA.

Adult↗
PubMed1996

Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn's disease. A randomized controlled multicenter trial. Study Group Members (German Crohn's Disease Study Group).

BACKGROUND: There is no established therapy for maintaining remission in patients with Crohn's disease. Following different suggestions from the literature, two potential interventions for maintaining remission were tested against placebo, using either 5 g/day of a highly concentrated omega-3 fatty acid compound or a carbohydrate-reduced diet (84 g/day). METHODS: A total of 204 patients were recruited after they had had an acute relapse. After remission (CDAI < or = 150) was attained with steroid therapy, patients were randomized to receive either omega-3 fatty acids (n = 70), placebo (n = 65), or diet (n = 69). Low-dose prednisolone was given to all patients for the first 8 weeks of intervention. CDAI and an acute-phase protein (CRP) were used as criteria for a relapse. RESULTS: The proportion of patients without relapse within a year were similar in the placebo and active treatment group (intention-to-treat analysis: placebo, 30%; active treatment, 30%; protocol-adhering patients, 29% versus 28%). Patients did gain benefit (53%; p = 0.023) for as long as they maintained the diet. However, intention-to-treat analysis (diet group, 40%) did not show a noticeable difference when compared with placebo. CONCLUSIONS: Omega-3 fatty acids did not show an effect on extending the remission in Crohn's disease. For the diet patients the question remains whether the noncompliant patients dropped out early because they sensed a relapse approaching or whether their condition deteriorated because they failed to comply with the diet.

Adult↗
PubMed1996

Case history: cornerstone in the neuro-ophthalmic examination.

A comprehensive case history is vital in the diagnosis and management of neuro-ophthalmic disease. This history is developed throughout an examination, and it is expanded whenever follow-up evaluations occur. Major objectives for developing a neuro-ophthalmic case history include having the patient reveal any clues suggesting that organic lesions exist, and subsequently exploring for characteristic ocular and nonocular symptoms that might prove helpful in localizing such lesions. The history is considered when selecting diagnostic procedures for the workup of neuro-ophthalmic patients, and it is especially vital in the decision as to which management options to pursue.

Eye Diseases↗
PubMed1996

Post-insertion visits in medicated complete denture wearers.

The effect of systemic disease and medication on the number of post-insertion visits was investigated in 157 patients requiring new complete dentures, who were referred to a specialist prosthodontic practice. We found that the number of recall visits increased with age, particularly in patients medicated for central nervous system or psychiatric disorders, and more so with cardiovascular diseases treated with diuretics.

Adult↗
PubMed1995

Production of transforming growth factor-alpha by normal and polycystic ovaries.

The mechanism of anovulation in polycystic ovary (PCO) syndrome remains unknown. As circulating concentrations of FSH are apparently normal, and in vivo, granulosa cells from anovulatory PCO are hyperresponsive to FSH, it has been suggested that the lack of follicular development in anovulatory PCO is caused by overexpression of a paracrine growth factor that inhibits steroidogenesis. Epidermal growth factor and the structurally homologous transforming growth factor-alpha (TGF alpha) are suitable candidates for this role, but although the production of the latter has been demonstrated in the ovary, no comparison has been performed between the levels in normal ovaries and PCO. We compared the levels of TGF alpha in follicular fluid and in granulosa cell- and theca- and stroma-conditioned media from normal ovaries and PCO. TGF alpha was present in the range of 0.2-200 ng/mL in follicular fluid. There was a significant inverse correlation of TGF alpha with follicle size, with no differences between follicles from normal ovaries and PCO. Granulosa cell-conditioned medium contained concentrations of TGF alpha ranging from 0.1-200 ng/1000 cells. There was a wide range of concentrations in theca- and stroma-conditioned media, with levels varying from 0.2-100 ng/mg tissue and no consistent effect of LH. There were no significant differences between the levels from normal ovaries or PCO in medium conditioned by any compartment of the ovary. We conclude that the failure of folliculogenesis in PCO syndrome is not likely to be due to overproduction of TGF alpha by the ovary.

Anovulation↗
PubMed1994

Survival of fixed implant-supported prostheses related to cantilever lengths.

Various lengths of cantilevers for fixed implant-supported prostheses have been recommended in the literature. No scientific data are available for selecting specific lengths, and different views are reported. Authors contend that longer cantilevers lead to increased risk of failure. This study examined survival of fixed implant-supported prostheses using different cantilever lengths and offers clinical support for the contention.

Dental Implantation, Endosseous↗
PubMed1994

Eosinophilia-myalgia syndrome in Germany: an epidemiologic review.

OBJECTIVE: To review the epidemiologic features of eosinophilia-myalgia syndrome (EMS) in Germany. DESIGN: We determined the incidence of EMS in Germany through May 1992 and analyzed the dose of L-tryptophan used, the duration of intake, and the concurrent medications. MATERIAL AND METHODS: All patients receiving L-tryptophan preparations in Germany were already under medical supervision before the onset of the disease; thus, information on patient history and other potential risk factors was readily available. Because of the drug status of L-tryptophan preparations, brands could be accurately traced back to suppliers of raw materials. Statistical differences in age and gender of patients, dose of L-tryptophan, eosinophil count, and skin involvement were sought between patients with and those without concurrent medications. RESULTS: On the basis of guidelines established by the Centers for Disease Control and Prevention, 105 patients fulfilled the criteria for EMS. No apparent correlation was found between the incidence of EMS and the dose of L-tryptophan or the duration of intake before onset of EMS. Assessment of the study group showed that 45% were taking various other medications, whereas 55% were taking L-tryptophan only. Analysis by type of pharmaceutical agent showed no preponderance of a specific concurrent drug (in particular, psychotropic drugs). Thus, concurrently used medications did not seem to be an important variable. All cases of EMS were associated with L-tryptophan from formulators that had used raw materials from the previously implicated source. CONCLUSION: This study supports the pathophysiologic role of a contaminant in L-tryptophan in the occurrence of cases of EMS in Germany.

Adult↗
PubMed1994

Chemical pathways of peptide degradation. VII. Solid state chemical instability of an aspartyl residue in a model hexapeptide.

The chemical stability of an Asp-hexapeptide (Val-Tyr-Pro-Asp-Gly-Ala) in lyophilized formulations was evaluated as a function of multiple formulation variables--specifically pH of the bulk solution, temperature, moisture content, and type of bulking agent (amorphous vs. crystalline). The disappearance of the starting Asp-hexapeptide in the solid state conformed to pseudo-first-order reversible kinetics. This type of degradation profile was accounted for by the product distribution. The factorial experimental design of this study allowed statistical analysis of the effects of individual formulation variable (main effects) as well as those of two-factor interactions on the degradation of the Asp-hexapeptide. Analysis of Variance (ANOVA) calculations of the main effects indicated that while the influence of pH of the starting solution was not statistically significant, residual moisture level, temperature, and, especially, type of bulking agent had a significant impact on the solid state chemical reactivity of the hexapeptide. Furthermore, depending on which type of excipient was used in the lyophilized formulations, residual moisture level and temperature could be important stability variables. These types of factorial experiments have proven to be useful in the rapid identification of significant formulation variables in a given system and, consequently, in optimization of formulations.

Amino Acid Sequence↗
PubMed1993

Diseases, medication, and postinsertion visits in complete denture wearers.

The records of 268 patients were used to assess the effects of five disease/drug complexes on the number of postinsertion visits in complete denture wearers. The data were analyzed with SAS and BMDP computer packages. The results showed a statistically significant increase in the number of postinsertion visits in patients who had central nervous system or psychiatric disorders. Practitioners are alerted to consider the ergonomic implications at the outset of treatment.

Adult↗
PubMed1993

n-3 fatty acids reduce proteinuria in patients with chronic glomerular disease.

Dietary supplementation with n-3 polyunsaturated fatty acids (n-3 PUFA) has been shown to reduce proteinuria in experimental models of renal diseases, but their potential role in the treatment of human renal disease is unknown. We administered n-3 PUFA in the form of triglycerides [with eicosapentaenoic (EPA)+docosahexaenoic (DHA) = 3 g/day into 4 patients] and of ethyl esters (EPA+DHA = 7.7 g/day) into 10 patients (one patient twice) with chronic glomerular disease (membranous glomerulonephritis and focal glomerular sclerosis), all diagnosed histologically. Serum albumin was > 2.4 g/dl and serum creatinine < 2.5 mg/dl in all patients. Treatment was given for periods of six weeks, followed by a prolonged follow-up for 27 weeks in 10 cases. Dietary supplementation with n-3 PUFA caused the expected reduction in platelet generation of thromboxane B2 (mean +/- SEM, from 490 +/- 70 ng/ml at baseline, to 342 +/- 147 ng/ml at 6 weeks, P < 0.05) of serum triglycerides (from 236 +/- 60 to 170 +/- 43, P < 0.01), and a prolongation of the bleeding time (from 5.8 +/- 0.4 min to 7.7 +/- 0.4 min, P < 0.01) in patients treated with ethyl esters. A modest but significant reduction in serum total cholesterol was noticed (from 275 +/- 27 to 252 +/- 24 mg/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Acrylic resin finger prosthesis.

A technique is described for the prosthetic replacement of two fingers using acrylic resin. Retention was obtained using finger rings. The stages of the technique are outlined. Advantages and disadvantages are briefly stated.

Acrylic Resins↗