Disseminated septic arthritis in a patient with common variable hypogammaglobulinemia.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
L Duffy
Publications and source records attributed to L Duffy.
Elevated cytokine and chemokine levels and prolonged pulmonary airflow resistance in a murine Mycoplasma pneumoniae pneumonia model: a microbiologic, histologic, immunologic, and respiratory plethysmographic profile.
Because Mycoplasma pneumoniae is hypothesized to play an important role in reactive airway disease/asthma, a comprehensive murine model of M. pneumoniae lower respiratory infection was established. BALB/c mice were intranasally inoculated once with M. pneumoniae and sacrificed at 0 to 42 days postinoculation. All mice became infected and developed histologic evidence of acute pulmonary inflammation, which cleared by 28 days postinoculation. By contrast, M. pneumoniae persisted in the respiratory tract for the entire 42 days studied. Tumor necrosis factor alpha, gamma interferon, interleukin-6 (IL-6), KC (functional IL-8), MIP-1alpha, and MCP-1/JE concentrations were significantly elevated in bronchoalveolar lavage samples, whereas IL-4 and IL-10 concentrations were not significantly elevated. Pulmonary airflow resistance, as measured by plethysmography, was detected 1 day postinoculation and persisted even after pulmonary inflammation had resolved at day 28. Serum anti-M. pneumoniae immunoglobulin G titers were positive in all mice by 35 days. This mouse model provides a means to investigate the immunopathogenesis of M. pneumoniae infection and its possible role in reactive airway disease/asthma.
Airway Resistance↗
A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy.
BACKGROUND: Morbidity following tonsillectomy continues to be a major concern to parents, children, and physicians alike. Reduction in post-operative complications, optimal control of pain, and satisfactory return to a normal lifestyle are all important to both family and society. This study compares both the complication and recovery rates after microbipolar dissection (MBPD) technique of tonsillectomy to two well established tonsillectomy techniques: hot knife (HK) and cold knife/cautery (CK/C). METHODS: A total of 200 consecutive patients presenting for tonsillectomy by the first author (MP) were randomized to either undergo MBPD or HK tonsillectomy. Concurrently, an additional two hundred patients were randomized to undergo MBPD or CK/C tonsillectomy by the second author (LB). Patients were prospectively followed for complications including bleeding and dehydration and multiple indicators of recovery rate. RESULTS: Postoperative bleeding of any kind was significantly less in the MBPD group than in the CK/C and HK groups (5 vs 12.4 vs 12.5% (P<0.001). The need for post-operative intervention for bleeding, i.e. local control or return to the operating room, was also significantly less in the MBPD group. Return to normal activity occurred 2 days earlier in the MBPD group versus either CK/C or HK (P<0.001). Additionally, earlier recovery was reflected in fewer total doses of pain medication in the MBPD group. Operative time was 3-5 min longer for MBPD (24.2 min) than for CK/C or HK (21.1 and 16.5 min, respectively); blood loss was similar (within 15 cc) among all treatment groups. CONCLUSION: MBPD tonsillectomy compared most favorably to conventional techniques (CK/C and to HK tonsillectomy). Important clinical outcome differences included a lower bleed rate, earlier recovery and fewer days lost from work and school. The financial impact is estimated to be quite favorable. MBPD tonsillectomy is now our preferred method in children.
Adolescent↗
Effect of cyclodextrins and polymers on triclosan availability and substantivity in toothpastes in vivo.
The aqueous solubility of triclosan is only about 10 microg/mL. This very low solubility can hamper its biological activity in the oral cavity, which could explain the mixed clinical results obtained from triclosan toothpaste trials. Triclosan availability in a silica-based toothpaste was improved through cyclodextrin solubilization. The triclosan in vivo availability was optimized through a series of phase-solubility studies and triclosan release studies. It was found that in toothpastes, natural beta-cyclodextrin (betaCD) was just as good a solubilizer as the more water-soluble betaCD derivatives. Furthermore, the amount of cyclodextrin could be reduced by as much as 60% through the addition of a small amount of carboxymethylcellulose (CMC), without affecting triclosan release from the toothpaste. Optimally, cyclodextrins resulted in an almost 3-fold enhancement of triclosan availability compared to an identical toothpaste containing no cyclodextrin. In vivo studies in humans showed that replacing triclosan with triclosan/betaCD in the toothpaste resulted in only moderate improvement in triclosan substantivity. However, replacing triclosan with triclosan/betaCD/CMC complex resulted in significant improvement in triclosan substantivity. Furthermore, the in vivo studies showed that replacing free triclosan with triclosan/betaCD/CMC complex resulted in an almost 3-fold increase in initial triclosan concentration in saliva after brushing and about 2-fold increase in duration of activity.
Adult↗
Comparison of adenosine and remifentanil infusions as adjuvants to desflurane anesthesia.
BACKGROUND: Because adenosine has been alleged to produce both anesthetic and analgesic sparing effects, a randomized, double-blinded study was designed to compare the perioperative effects of adenosine and remifentanil when administered as intravenous adjuvants during general anesthesia for major gynecologic procedures. METHODS: Thirty-two women were assigned randomly to one of two drug treatment groups. After premedication with 0.04 mg/kg intravenous midazolam, anesthesia was induced with 2 micro/kg intravenous fentanyl, 1.5 mg/kg intravenous propofol, and 0.6 mg/kg intravenous rocuronium, and maintained with desflurane, 2%, and nitrous oxide, 65%, in oxygen. Before skin incision, an infusion of either remifentanil (0.02 microg x kg(-1) x min(-1)) or adenosine (25 microg x kg(-1) x min(-1)) was started and subsequently titrated to maintain systolic blood pressure, heart rate, or both within 10-15% of the preincision values. RESULTS: Adenosine and remifentanil infusions were effective anesthetic adjuvants during lower abdominal surgery. Use of adenosine (mean +/- SEM, 166+/-17 microg x kg(-1) x min(-1)) was associated with a significantly greater decrease in systolic blood pressure and higher heart rate values compared with remifentanil (mean +/- SEM, 0.2+/-0.03 microg kg(-1) x min(-1)). Total postoperative opioid analgesic use was 45% and 27% lower in the adenosine group at 0-2 h and 2-24 h after surgery, respectively. CONCLUSIONS: Adjunctive use of a variable-rate infusion of adenosine during desflurane-nitrous oxide anesthesia was associated with acceptable hemodynamic stability during the intraoperative period. Compared with remifentanil, intraoperative use of adenosine was associated with a decreased requirement for opioid analgesics during the first 24 h after operation.
Adenosine↗
Effects of prophylactic nalmefene on the incidence of morphine-related side effects in patients receiving intravenous patient-controlled analgesia.
BACKGROUND: Opioid-related side effects associated with intravenous patient-controlled analgesia can be reduced by a low-dose naloxone infusion. The influence of nalmefene, a pure opioid antagonist with a longer duration of action, on opioid-related side effects has not been evaluated. This study was designed to determine the dose-response relation for nalmefene for the prevention of morphine-related side effects in patients receiving intravenous patient-controlled analgesia. METHODS: One hundred twenty women undergoing lower abdominal surgery were enrolled in the study. General anesthesia was induced using thiopental and rocuronium and maintained with desflurane, nitrous oxide, and fentanyl or sufentanil. All patients received neostigmine and glycopyrrolate to reverse residual neuromuscular blockade. No prophylactic antiemetics were administered. At the end of surgery, patients were randomized to receive saline, 15 microg nalmefene, or 25 microg nalmefene intravenously. The need for antiemetic and antipruritic drugs and the total consumption of morphine during the 24-h study were recorded. The incidences of postoperative nausea, vomiting, pruritus, and pain were recorded 30 min after patients were admitted to the postanesthesia care unit. In addition, patient remembrance of these side effects was noted at 24 h after operation. RESULTS: The need for antiemetic and antipruritic medications during the 24-h study period was significantly lower in the patients receiving nahmefene compared with those receiving placebo. However, the need to treat side effects was similar in the two nahmefene groups. Prophylactic administration of nalmefene reduced the patients remembrance of nausea and itching as assessed 24 h after operation. Although the total consumption of morphine during the 24-h study period was similar in the three groups, retrospectively patients who received nalmefene characterized their pain as less severe in the previous 24 h. CONCLUSION: Compared with placebo, prophylactic administration of nalmefene significantly decreased the need for antiemetics and antipruritic medications in patients receiving intravenous patient-controlled analgesia with morphine.
Adult↗
A sequential treatment regimen with melatonin and all-trans retinoic acid induces apoptosis in MCF-7 tumour cells.
Neoplastic events are marked by uncontrolled cell proliferation. One major focus of cancer research has been to identify treatments that reduce or inhibit cell growth. Over the years, various compounds, both naturally occurring and chemically synthesized, have been used to inhibit neoplastic cell proliferation. Two such oncostatic agents, melatonin and retinoic acid, have been shown to suppress the growth of hormone-responsive breast cancer. Currently, separate clinical protocols exist for the administration of retinoids and melatonin as adjuvant therapies for cancer. Using the oestrogen receptor (ER)-positive MCF-7 human breast tumour cell line, our laboratory has studied the effects of a sequential treatment regimen of melatonin followed by all-trans retinoic acid (atRA) on breast tumour cell proliferation in vitro. Incubation of hormonally responsive MCF-7 and T47D cells with melatonin (10(-9) M) followed 24 h later by atRA (10(-9) M) resulted in the complete cessation of cell growth as well as a reduction in the number of cells to below the initial plating density. This cytocidal effect is in contrast to the growth-suppressive effects seen with either hormone alone. This regimen of melatonin followed by atRA induced cytocidal effects on MCF-7 cells by activating pathways leading to apoptosis (programmed cell death) as evidenced by decreased ER and Bcl-2 and increased Bax and transforming growth factor beta 1 (TGF-beta1) expression. Apoptosis was reflected morphologically by an increase in the number of lysosomal bodies and perinuclear chromatin condensation, cytoplasmic blebbing and the presence of apoptotic bodies. The apoptotic effect of this sequential treatment with melatonin and atRA appears to be both cell and regimen specific as (a) ER-negative MDA-MB-231 and BT-20 breast tumour cells were unaffected, and (b) the simultaneous administration of melatonin and atRA was not associated with apoptosis in any of the breast cancer cell lines studied. Taken together, the results suggest that use of an appropriate regimen of melatonin and atRA should be considered for preclinical and clinical evaluation against ER-positive human breast cancer.
Antineoplastic Combined Chemotherapy Protocols↗
Otitis media: back to basics.
Explore the source record for details and available documents.
Acute Disease↗
Relationship between nasopharyngeal colonization and the development of otitis media in children. Tonawanda/Williamsville Pediatrics.
Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis are the predominant bacteria associated with otitis media. A cohort of 306 infants was followed from birth through 12 months to determine frequency and duration of colonization and risk of acute otitis media (AOM) and otitis media with effusion (OME). M. catarrhalis was the most common bacterium isolated. Infants colonized at < or = 3 months of age were at increased risk of AOM and OME. Early colonization with M. catarrhalis revealed the greatest risk (relative risk [RR] = 1.24), especially for OME (RR = 1.57). There was a strong relationship between the frequency of colonization and OM (r = .37, P < .001,) for each pathogen. Although S. pneumoniae, nontypeable H. influenzae, and M. catarrhalis are part of the normal nasopharyngeal flora during infancy, an increased rate of colonization may identify a subpopulation of children that is at increased risk of OM.
Acute Disease↗
Breastfeeding after strenuous aerobic exercise: a case report.
There are no documented adverse effects of breastfeeding after long distance running. This case describes an exclusively breastfed baby who cried after being breastfed about 1-2 hours following his mother's 5-mile run. When artificial baby milk was substituted for the postrun feeding only, the inconsolable crying did not occur. Testing the mother's breast milk before and after running showed a similar level of lactic acid; no other component was tested. Further research is needed in this area.
Breast Feeding↗
Adherence of nontypeable Haemophilus influenzae to respiratory epithelium of otitis-prone and normal children.
Three hundred six children were enrolled at birth in a prospective study of otitis media and followed up for 2 years. Adherence of nontypeable Haemophilus influenzae to buccal epithelial cells was compared between otitis-prone children and age- and sex-matched normal controls at birth, 1 year, and 2 years. The mean +/- SD/median percent adherence was similar for the two groups at birth (1.6 +/- 2.3/1.0 versus 1.2 +/- 1.4/1.0; NS) and at 2 years (1.6 +/- 1.7/1.5 versus 2.1 +/- 2.1/1.5; NS). At 1 year of age the adherence rate for the otitis-prone group (2.4 +/- 2.6/1.0) was statistically greater than that for the control group (1.0 +/- 1.3/0.0; p < .02). Because this difference is probably clinically insignificant, other explanations must be sought for the increased colonization rates of nontypeable H influenzae observed in otitis-prone children.
Bacterial Adhesion↗
Connecting the research and nursing processes: making a difference in baccalaureate students' attitudes and abilities.
Student nurses are often intimidated by the research process. They also frequently have negative attitudes about working with the elderly, especially in long-term care settings. This article describes a clinical project designed to help students improve their attitudes, knowledge, and skills toward research and care of the elderly by connecting the research process and the nursing process. Students implement research-based clinical practice in a long-term care setting. Student evaluations indicate that project goals are achieved. Nursing staff evaluation data indicate that they find student projects interesting and useful in updating resident care plans.
Aged↗
Epidemiology of nasopharyngeal colonization with nontypeable Haemophilus influenzae in the first two years of life.
A total of 200 children were followed from birth through 2 years of age with nasopharyngeal (NP) cultures to determine the normal colonization pattern of nontypeable H. influenzae (NTHI) in young children. NP cultures were obtained routinely at 13 scheduled visits. 44% of children became colonized by 2 years; acquisition was greatest in the first year. Colonization with the initial strain, as determined by outer membrane proteins, persisted from 1-5 months, median 2 months. Children carried one predominant strain at a time but became colonized with up to 7 different strains, mean 2.2, over 2 years. Three patterns of colonization were observed: i) rapid elimination of the initial strain, ii) prolonged colonization with the initial strain, and iii) colonization with different strains. Reacquisition of a previously carried strain was rare. Changes in outer membrane protein patterns reflected acquisition of new strains rather than phenotypic changes of old strains. Children colonized with 1 strain for < or = 2 months generated a greater mucosal antibody response, log 2.35, U/ng/ml SIgA, than children colonized with different strains, log 1.89, U/ng/ml SIgA, p <0.01. These data suggest that duration of colonization with one strain and the acquisition of a new strain is regulated by the local specific SIgA.
Bacterial Outer Membrane Proteins↗
Adherence of nontypable Haemophilus influenzae to respiratory epithelium of otitis prone and normal children.
The present study was designed to determine whether nontypable H. influenzae adhered differently to buccal cells from otitis prone compared with normal children. 306 children were enrolled at birth. They were examined at 1-6, 8, 10, 12, 15, 18, 21, and 24 months of age. Buccal cells were collected at 1, 12, and 24 months. 40 children were classified as OP (> or = 4 episodes by age 12 months or > or = 6 episodes by age 24 months). Adherence assays were conducted by incubating 1 x 10(4) buccal cells with 5 x 10(8) colony forming units of radiolabelled nontypable H. influenzae in 1 ml of salt solution with 0.1% gel at 37 degrees C for 60 min. Adherence was expressed as the % of organisms adherent to buccal cells. The adherence of buccal cells from otitis prone children were compared with age and sex matched controls who had not experienced otitis media and had not been colonized with nontypable H. influenzae.
Breast Feeding↗
Microbipolar dissection vs. cold knife/suction cautery tonsillectomy in children: preliminary results of a prospective study.
Tonsillectomy and adenoidectomy (T&A) is a common surgical procedure for which many different surgical techniques have been described. However, detailed information is lacking regarding complications or recovery rates for any particular procedure. A newly described technique for T&A, microbipolar dissection (MBPD) is being compared with cold knife dissection with suction cautery of bleeding vessels (CKC) in a prospective study of 200 children aged 2-16 years. Patients are randomly assigned and stratified by age-group into one of two treatment arms. Intraoperative and post-operative measures of T&A effectiveness relative to complications and patient recovery rate are being studied. The preliminary data presented here focus on the reliability of the measures and potential clinical relevance of the findings in 129 of these children, with anticipated confirmation of these tentative results after completion of the larger cohort. Thus far it appears that post-operative bleeding rates are significantly reduced, recovery rate is improved, and return to normal activities are all better in the MBPD patients. Although these data reflect small numbers of children and must be interpreted with caution, it appears that MBPD T&A holds great promise in reducing the morbidity associated with the CKC technique of T&A.
Adolescent↗
Acclimation of a non-indigenous sub-Arctic population: seasonal variation in thyroid function in interior Alaska.
Total, as well as free, T4 and T3 levels were obtained over four seasons for young male infantry soldiers assigned to interior Alaska. Significant seasonal variations were found in both T3 and T4. Total T4 and T3 levels were highest in winter, while free T4 and T3 levels were highest in early spring. Correlations with melatonin levels from a concurrent study showed an association between late day (17.00) mean spot melatonin levels during the preceding summer and T3 levels in winter and spring. Differences in seasonal T4 and T3 levels between indigenous and newly arrived people in the sub-Arctic may be related not only to cold acclimation but also to light.
Acclimatization↗
Epidemiology of nasopharyngeal colonization with nontypeable Haemophilus influenzae in the first 2 years of life.
Two hundred children were followed from birth through 2 years of age with nasopharyngeal cultures to determine the normal colonization pattern of nontypeable Haemophilus influenzae. Forty-four percent of the children were colonized on one or more occasions; the acquisition rate was greatest in the first year. Monthly prevalence rates were 11%. Colonization with the initial strain persisted 1-5 months (median, 2). Children carried 1 predominant strain at a time but became colonized with up to 7 different strains (mean, 2.2). Children colonized with a single strain for < or = 2 months produced a greater nasopharyngeal secretory IgA to nontypeable H. influenzae response than did children colonized with different strains (log 2.35 +/- 0.68 vs. 1.89 +/- 0.25 U of P6 secretory IgA/ng/mL of total secretory IgA, P < .01). The duration of colonization with a strain and acquisition of a new strain may be affected in part by the local production of specific secretory IgA.
Aging↗
Maternal plasma transfusion in the treatment of disseminated neonatal echovirus 11 infection.
Explore the source record for details and available documents.
Blood Component Transfusion↗