Biomedical subjects
Publications and source records attributed to M Coe.
We report a child affected by Wernicke's encephalopathy (WE), which was unsuspected clinically. MRI suggested the correct diagnosis and prompted appropriate thiamine replacement. WE is a difficult condition to recognise, especially in children, and MRI may be useful in the diagnosis of the disease.
BACKGROUND: An unexplained increase has occurred in the incidence of invasive meningococcal disease in adolescents and young adults. METHODS: We investigated a cluster of serogroup C meningococcal disease in 3 previously healthy young adults who had attended a party in Maryland. Molecular subtyping was done on the isolates from the 3 cluster cases and 4 control isolates by pulsed-field gel electrophoresis (PFGE). The only common exposure was attendance at the party, where a large number of people reportedly smoked tobacco or marijuana and/or drank alcohol. RESULTS: The PFGE analysis of the 3 case isolates showed identical molecular subtypes. CONCLUSION: This investigation strongly suggests that transmission of the cluster strain occurred at the party. Transmission may have occurred in part as a result of the recently described risk factors of binge drinking and smoking. Taken together, these findings suggest that some of the recent increase in invasive meningococcal disease may be due to modifiable risk factors.
The purpose of this study was to explore male caregivers' perceptions of formal support. The men were caregivers of adults with cognitive impairment. The study involved secondary analysis of interview data on perceptions of support that had not been previously analyzed from the perspective of formal support. Techniques of data analysis used in grounded theory were applied to 62 guided interactive interviews conducted with 24 male caregivers during a period of 18 months. The men experienced a process of making concessions for care in the following four sequential stages: resisting, giving in, opening the door, and making the match. Personal barriers deterred the caregivers from seeking help, and once the caregivers engaged formal help the influence of characteristics of the health care system and individual staff members had both enabling and disabling effects. For caregivers whose use of formal support involved admitting their relative to a long-term care facility, the phase of making the match was followed by redesigning their caregiver role.
Amino compounds are abundant within the renal inner medulla, but their possible role during hypertonic stress is not clear. Renal epithelial Madin-Darby canine kidney cells were used to examine the osmoregulation of system A transport, a major Na(+)-dependent process for neutral amino acid transport. System A activity was markedly increased after 6 h of hypertonic challenge, and intracellular alanine content increased more than twofold. The activation of system A was reversed after 24 h of hypertonic challenge. This downregulation was accompanied by the activation of betaine transport, as measured by gamma-aminobutyric acid uptake. Extracellular betaine prevented the early activation of system A. The hypertonic activation of system A was blocked by actinomycin D and cycloheximide. When cells were returned to isotonic medium after hypertonic activation, the recovery of system A transport also was partially inhibited by actinomycin D and puromycin. The results are consistent with the possibility that hypertonicity, by disrupting a repressor protein, leads to increased synthesis of a system A-related protein. The isotonic recovery may require synthesis of new repressor proteins.
Despite the availability and wide use of modern imaging techniques, the diagnosis of Meckel's diverticulum is difficult. The signs and symptoms vary from none to those of an acute abdomen or gastrointestinal bleeding. Findings on physical examination may be inconsistent because of the variable location of the diverticulum, and bleeding may occur with no appreciable physical findings. Finally, small diverticula are often concealed by overlying small-bowel loops on routine small-bowel barium studies. The purposes of this article are to review the use of available techniques for the imaging diagnosis of Meckel's diverticulum, to discuss the relative advantages and indications for the various procedures, and to emphasize the role each plays in specific clinical circumstances. The embryology, anatomy, and clinical presentation of Meckel's diverticulum are also briefly discussed.
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The feasibility of a new method for reconstruction of the isolated scapholunate ligament tear with a scapholunate allograft was studied biomechanically using a fresh cadaver upper extremity model. Seven specimens were first tested intact for wrist range of motion, contact characteristics of the radiocarpal articulation, and relative motion of the scaphoid with respect to the lunate. Then a segment consisting of the radial third of the lunate, the adjoining scapholunate interosseus ligament, and the proximal pole of the scaphoid was resected. This segment was matched to a donor allograft of similar size and geometry, which was then placed into the recipient carpus and secured with one central transverse Kirschner wire and two shorter interfragmentary Kirschner wires placed into the lunate and scaphoid. The allografted specimen was subjected to the same tests as the intact wrist. Results showed that there were no significant differences in wrist range of motion, radiocarpal articular surface contact area and pressure, and relative flexion-extension rotation between the scaphoid and lunate during passive radioulnar deviation between the intact and allografted wrists.
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MR phlebography was recently proposed as a possible alternative to contrast venography in the detection of deep venous thrombosis. We focused our work on the study of the pelvic veins since it is at this level that contrast venography and the other noninvasive techniques, i.e., phlebography, impedance plethysmography and US, exhibit their major limitations. Thirty patients underwent MR phlebography: 13 of them had a diagnosis of DVT of the pelvic venous district and the other 17 had negative results for this condition. All the patients were also examined with color-Doppler US at the pelvis and legs. In all the patients submitted to MR phlebography, thrombosis site and presence were demonstrated, with diagnostic information also on its extent and adhesion to vein wall. To conclude, MR phlebography can provide contrast venography-like images in a noninvasive way, with high accuracy (100% sensitivity and 90% specificity) especially in the pelvic district where the limitations of other techniques are more apparent. Larger series of patients must be studied to assess the actual role of MR phlebography in the patients with DVT or at high risk for this condition.