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Biomedical subjects

L Sullivan

Publications and source records attributed to L Sullivan.

At least 91 records · Page 5Linked to original sources
PubMed1990

The quality of life of three functional spinal cord injury subgroups in a Swedish community.

Vast community provisions in Sweden are intended to offer spinal cord injury (SCI) subjects equal opportunities and the same living standards as the able-bodied. This study on all 56 subjects representing 3 distinct functional subgroups, out of a consecutive series treated at a Spinal Unit, explored the skills used in a wide range of community living activities and the details of these subjects' quality of life (QL). C6-tetraplegics with complete lesions (n = 15), wheelchair-bound paraplegics (n = 23) and ambulant paraplegics (n = 18) varied in physical independence in proportion to their disabilities but disturbances of mood states and QL perception did not differ between groups or from a control population sample. Eighty per cent of the subjects were engaged in gainful employment or education. Work/education, home management and mobility in the neighbourhood were clearly restricted by more severe disability but social and recreational activities were not. Degree of social activity and ability to drive a car were closely associated with levels of mental well-being and of perceived QL. Access to transport and home-help services, appropriate housing and technical aids included few unmet subjective needs, possibly explaining why these environmental factors did not inhibit the activity levels of the study population. Extensive society support and stimulation can satisfy important needs and expectations of well-functioning SCI subjects.

Activities of Daily Living↗
PubMed1990

An evolving agenda for the AAMC's second century.

The author presents a discussion of current problems in health care delivery and considers potential solutions. He notes that in the United States there is a wide disparity in health care status between the white population and the poor and minority communities, and that this disparity exists in virtually every health care category. Inadequate access to health care services, perpetuated by the high cost of health care, is part of the problem. The author analyzes many legislative and administrative steps that have been taken to address these issues, and many more that should be carefully examined. More emphasis on health promotion and disease prevention is vital. Another solution is to further enhance the biomedical research enterprise and work to prepare the regulatory system to quickly, safely, and effectively infuse this knowledge into the health care delivery system. Another solution is for physicians to be adequately prepared for this practice of medicine in the years to come.

Delivery of Health Care↗
PubMed1989

Primary malignant fibrous histiocytoma of the pancreas.

A patient with a large tumor of the head and body of the pancreas had a Whipple procedure performed after the intraoperative diagnosis of "mesenchymal tumor" was made. The final histopathologic diagnosis was malignant fibrous histiocytoma arising in the pancreas. The patient died of postoperative complications, and no metastatic disease was found at autopsy. This is the first detailed description of a primary pancreatic malignant fibrous histiocytoma.

Adult↗
PubMed1987

Photodynamic therapy in the management of resistant lower urinary tract carcinoma.

Twenty-three patients with resistant transitional cell carcinoma (TCC) of the bladder and posterior urethra had photodynamic therapy (PDT). Seventy-two hours after an intravenous injection with 2 mg/kg of the photosensitizer dihematoporphyrin ether (DHE) (Photofrin II, Photomedica, Raritan, NJ), each patient received cystoscopic light treatment. The light dose to the whole bladder using the bulb diffuser ranged from 5 to 60 J/cm2; power density ranged from 9 to 22 mW/cm2. The focal light dose ranged from 100 to 200 J/cm2 at a power density from 100 to 200 mW/cm2. To treat the urethra, a diffuser fiber was used to deliver 200 to 400 J/linear cm at a power of 110 to 300 mW/cm. In the 19 of 23 patients who were treated for resistant superficial TCC, 83.3% of the tumors had responded at the initial follow-up evaluation. Seven patients had a complete response and 10 had a partial response. Three of 19 patients who received inadequate light treatment failed to respond. Control of intractable gross hematuria was the only benefit for patients with locally invasive disease (greater than or equal to T2). Irritating lower urinary tract symptoms that varied in severity and duration occurred in all patients. Four patients experienced bladder shrinkage, which did not resolve. Although the light and drug doses remain to be determined, a whole bladder light dose of 15 to 20 J/cm2 with a drug dose of 2 mg/kg seems to be effective enough without producing permanent adverse effects in the bladder.

Aged↗
PubMed1986

Physical, psychologic, and social function in chronic pain patients after epidural spinal electrical stimulation.

The overall function, pain, and mood disturbance of 54 patients with benign chronic pain were studied as to their response to epidural spinal electrical stimulation (ESES) more than 12 months after the implantation of ESES electrodes. Both responder (n = 23) and nonresponder (n = 31) pain patients demonstrated extensively worse physical and psychosocial function on the Sickness Impact Profile (SIP) and worse self-rated mood disturbance on the Mood Adjective Check List (MACL) than a control population sample. Responders to ESES were insignificantly less impaired in physical functions of daily life than nonresponders, but clearly less inhibited in the social pattern of contact. Self-rated pain sensation differed 36% between responders and nonresponders, and the pain measures of all pain patients correlated with total mood disturbance on the MACL and with its dimensions for depression and fatigue. Social characteristics, sex, diagnoses, comorbidity, and duration of pain did not discriminate. In a supplementary prospective short-term study, pain ratings had improved by 30% 3 weeks after implantations. The night sleep and general psychic balance (SIP category emotional behavior) were then also significantly improved. A shortened SIP version of 8 items optimizing responder-nonresponder differences and 12 items of mood disturbance are suggested to supplement pain ratings for overall assessment of chronic pain patients. A wider usage of ESES is recommended for pain patients who can comply to the regimen, because the surgical technique is now simple and safe.

Activities of Daily Living↗
PubMed1984

The effect of acute and chronic exercise on thyroid hormones in obesity.

Thyroid hormones were measured before, during and after acute exercise (60 min) or physical training (3 months) in obese women. Thyroid stimulating hormone concentration increased during acute work and decreased immediately after. No changes were seen during the two following days. An increase was seen after ten days as well as after three months of physical training. Thyroxine concentrations showed no changes. 3,5,3'-Triiodothyronine decreased slightly immediately after acute exercise, and after three months of physical training, 3,3',5'-triiodothyronine (reverse triiodothyronine) increased slowly during and after acute exercise. A negative correlation was found between changes in fasting insulin and thyroxine and a positive correlation between changes in blood pressure and triiodothyronine after training. Lack of agreement in previous reports is probably due to methodological differences such as methods more or less susceptible to fatty acid interference, and thyroid hormones changing differently during acute work and before and after physical training. The duration of the study may also be of importance, even 3 months possibly being too short for attaining equilibrium in thyroid homeostasis.

Exercise Test↗
PubMed1982

Permanganate oxidation of senile cerebral amyloid and its relationship to AA protein.

Immunoreactivity for AA protein was rarely detected in briefly fixed amyloid of senile plaques and dyshoric angiopathy, but was not observed in Congophilic angiopathy. Plaque and dyshoric amyloid exhibited variable sensitivity to permanganate oxidation; Congophilic angiopathy was resistant to oxidation. In contrast to systemic amyloid composed of AA protein, the rare immunoreactivity of senile cerebral amyloid was lost with prolonged fixation. This study demonstrates that the fibrillar protein of senile cerebral amyloid differs from that of systemic amyloid of AA type.

Aged↗
PubMed1982

Obesity, diabetes mellitus and physical activity--metabolic responses to physical training in adipose and muscle tissues.

The demand of the untrained skeletal muscle to produce additional mechanical work by utilizing more nutrients is the origin of the structural and metabolic adaptation of the muscle. The expanding capillary surface, in response to a lower vascular resistance during repeated contraction, enables the different fibre types to increase their oxygen extraction, and to adapt their uptake of substrates (glucose, FFA). The muscle fibre types in humans are selectively recruited for differing work intensity but the oxidative potential (SDH) increases in all types with long-term physical training. Details of the mechanism by which insulin promotes glucose uptake are unclear but there is some evidence that the hormonal stimulation involves cellular uptake of the insulin-receptor complex of the membrane. Hypoxia and raised cytoplasmic levels of calcium in muscle cells after work exert an insulin-like action on glucose uptake, which may be ascribed to the intracellular acidity.--The interrelationship between glucose and FFA oxidation is in part regulated by known key enzymes of the contracting muscle, but the exact extramuscular substrate mobilization appears to require both hormonal and supplementary feed-back control in storage organs.--During prolonged muscular exercise, the successive utilization of carbohydrate and fat from endogenous and exogenous stores can, however, in principle be attributed to known hormonal regulation.--Oral intake of glucose solution before and during work evokes a prolonged glucose utilization with relative hyperinsulinemia and hypoglucagonemia, preventing hepatic glycogenolysis. A prerequisite for successful endurance training is the improved capacity to use FFA as substrate. The necessary lipolysis in adipocytes is mainly mediated by an increased cellular exposure and sensitivity to catecholamines, but the delayed adaptation of the fat cells to their hormonal environment, especially insulin, in relation to the progress of the training is likely to modify the lipolytic response.

Adipose Tissue↗
PubMed1980

Fat cell number, resting metabolic rate, mean heart rate, and insulin elevation while seeing and smelling food as predictors of slimming.

The explanatory value of total fat cell number, resting metabolic rate, mean heart rate during sleep, and peripheral insulin while seeing and smelling food were examined in relation to weight reduction in 19 obese women on a 1100-kcal/day diet. The insulin response while seeing and smelling food was expressed as the insulin area (mU x min x 1(-1)) over the baseline level. Food was presented in front of the patient for 5 min. Insulin was determined in short intervals 20 min before and 20 min after start of food presentation. Fat cell number, resting metabolic rate, and mean heart rate during sleep were determined with standard techniques. All patients went through a period of weight loss, a plateau phase, and a period of weight regain. Body weight, fat cell number, resting metabolic rate, and/or heart rate correlated significantly with degree and rate of weight loss, duration of plateau phase, and rate of regain. In multiple regression analysis fat cell number and resting metabolic rate explained 81% of the variance for weight loss, 66% for rate of regain, and 29% for duration. For duration, only fat cell number contributed significantly. The variance of rate of weight loss was explained up to 49% by metabolic rate and insulin response while seeing and smelling food. The possibility of predicting weight reduction to a certain target weight is of great practical importance since the patients can obtain a realistic goal for their efforts to reduce body weight. Hopefully systematic investigations of factors associated with the inability of obese subjects to maintain weight reduction will improve treatment in the future.

Adipose Tissue↗
PubMed1979

Effects of long-term physical training on body fat, metabolism, and blood pressure in obesity.

Twenty-seven women with varying degrees of obesity were physically trained for 6 mo on an ad lib. diet. Body fat changes were positively correlated with the number of fat cells in adipose tissue. Obese women with fewer fat cells decreased in weight during training whereas women with severe obesity and an increased number of fat cells even gained weight. Blood pressure decreased consistently after training. Blood pressure elevation was not associated with body fat mass, nor was a decrease in blood pressure associated with a decrease in body fat or with pretraining blood pressure level. There were, instead, correlations between decreases in blood pressure on the one hand and initial concentrations and decreases in plasma insulin and triglycerides and blood glucose on the other. These results suggest an association between elevated blood pressure and metabolic variables. The possibility of treating and preventing early essential hypertension with methods that also correct the metabolic derangement, such as diet and exercise, should be given high priority in further research.

Adipose Tissue↗
PubMed1978

Effects of physical training and lean body mass of plasma amino acids in man.

Postabsorptive plasma amino acid and insulin concentrations were determined in subjects with hyperplastic obesity and in nonobese controls before and after a 6-wk period of physical training. After the training period the plasma concentrations of insulin and leucine decreased and the concentration of alanine increased in the obese subjects. No changes were noticed in the controls. The obese subjects had elevated plasma levels of valine, isoleucine, leucine, tyrosine, and phenylalanine before as well as after physical training. The concentrations of these amino acids were correlated to the plasma insulin level and to lean body mass before but only to lean body mass after physical training. It is suggested that the lean body mass, whick is higher in hyperplastic obesity, contributes to the elevated concentrations of amino acids, and it is unlikely that the insulin decreases in the obese subjects after physical training is mediated through an effect of amino acids on insulin secretion.

Adult↗
PubMed1978

Serum amyloid A: evidence for its origin in polymorphonuclear leukocytes.

In this study the presence of an amyloid A, antigenically related material was determined in four subpopulations of human leukocytes. Monocytes, granulocytes, thymus-derived lymphocytes, and bone marrow-derived and null lymphocytes were isolated from the peripheral blood of five apparently normal subjects, two patients with secondary amyloidosis, three patients with acute infections, and seven patients with metastatic cancer. Mononuclear leukocytes, isolated from the interface of a Ficoll-Hypaque gradient, were separated into monocytes, thymus-derived lymphocytes, and bone marrow-derived plus null lymphocytes by glass adherence and depletion of sheep erythrocyte rosette-forming lymphocytes. Granulocytes were isolated by sedimentation in 2% methyl cellulose from the erythrocyte-rich pellet formed at the bottom of the Ficoll-Hypaque gradient. The four isolated leukocyte subpopulations were cultured and, at varying intervals, the amyloid A content of the culture medium and of sonicated, 2 x 10(6) cells was determined by radioimmunoassay. Our results indicated a 2-14 times greater amount of amyloid A-related material in the sonicated granulocytes compared with the individuals' serum amyloid A levels. The mononuclear subpopulations showed a low or negligible amyloid A content. The amount of amyloid A antigenic material was further found to increase in cultured granulocytes, reaching a peak value between the 16th and 30th h of culture. The granulocytes of only two out of eight individuals tested released amyloid A antigenically related material into the culture medium. This release was found to be blocked by the presence of colchicine, vincristine, puromycin, or cycloheximide in the culture medium. In contrast, only the presence of puromycin or cycloheximide was shown to significantly inhibit the intracellular increase of amyloid A in the cultured granulocytes. Thus, it appears that among the circulating blood cells, the granulocytes produce amyloid A antigenically related material and could release it under conditions that remain to be further defined.

Adult↗