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Biomedical subjects

M D Daley

Publications and source records attributed to M D Daley.

At least 19 recordsLinked to original sources
PubMed2001

Preemptive analgesic effects of ketorolac in ankle fracture surgery.

BACKGROUND: Preemptive analgesia has been difficult to show in human experiments. If ketorolac has preemptive effects, then there may be an advantage to administering it at the beginning of surgery despite the potential for increased blood loss. METHODS: The authors performed a randomized, double-blind, controlled trial of 48 patients scheduled for ankle fracture surgery in a county trauma hospital. Anesthesia management was standardized and included adequate opioid analgesia (5 microg/kg fentanyl and 0.1 mg/kg morphine). Intravenous 30 mg ketorolac was administered to 23 patients before tourniquet inflation and to 25 patients after tourniquet inflation. Visual analog scale pain scores, morphine patient-controlled analgesia consumption, nausea-vomiting, and postoperative bleeding were measured. RESULTS: The 23 patients given ketorolac before tourniquet inflation had no increase in pain postoperatively compared with their preoperative baseline (P = 0.280). The 25 patients who received ketorolac minutes later after tourniquet inflation had significant increases in their postoperative pain compared with their preoperative baseline (P = 0.00116). This effect was short-lived, and by 6 h the pain score in this group was not significantly more than it was preoperatively. Intergroup comparison showed a lower visual analog scale score at 2 (P = 0.0203) and 4 h (P = 0.00549) in the preemptive group and lower nausea scores at hour 6 (P = 0.00704). There was no difference in patient-controlled analgesia consumption between groups. CONCLUSIONS: Intravenous 30 mg ketorolac appears to have preemptive analgesic effects in patients undergoing ankle fracture repair. Ketorolac administered before tourniquet inflation prevents postoperative pain being perceived as more intense than preoperative pain.

Adult↗
PubMed1999

Tracheal extubation of adult surgical patients while deeply anesthetized: a survey of United States anesthesiologists.

STUDY OBJECTIVE: To examine current practice regarding the performance of tracheal extubation of adult surgical patients while deeply anesthetized (deep extubation). DESIGN AND SETTING: Survey comprised of an anonymous written questionnaire mailed to 1,000 randomly selected active American Society of Anesthesiologists members. MEASUREMENTS AND MAIN RESULTS: Questionnaires were mailed between February and April 1998. Five hundred eighty-three completed forms were returned, 538 of which were suitable for data analysis. Responses from anesthesiologists who infrequently or never administer general anesthetics to adult surgical patients were excluded. The overall frequency of deep extubation of adults was "never" for 106 respondents (19.7%), "rarely" for 87 (16.2%), and "more frequently" for 345 (64.1%). The most common reasons for never performing deep extubations were lack of necessity and concern regarding potential laryngospasm and aspiration. The most frequent indications for deep extubations were unclipped intracranial aneurysm, reactive airway disease, and open-globe eye surgery. The most frequent contraindications to deep extubations for those who otherwise perform the technique were difficult airway, aspiration risk, and obesity. After performing a deep extubation, 44.0% of respondents remain with the patient in the operating room until he or she is awake. Deep extubations were perceived to have no consistent effect on operating room turnover time by 61.6% of anesthesiologists who perform them. CONCLUSIONS: Most anesthesiologists in this survey perform deep extubations in adult surgical patients. Lack of necessity and potential respiratory complications were the main reasons cited by those who do not use the technique. Future investigations are necessary to examine the risk-to-benefit ratio of the technique in adults. Our results may be used to determine which potential indications should be examined in such studies and to help delineate the standard of care followed in this country.

Adult↗
PubMed1995

Introduction to modern molecular biology: fundamental concepts and techniques.

Over the past 15 years, knowledge of the molecular pathophysiology of human disease has increased at a remarkable pace. Most of this progress can be attributed to concomitant advances in basic molecular biology and, specifically, the development of an ever-expanding aramentarium of technologies for analysis of gene structure and function referred to as recombinant DNA technology. In this article, we provide an introduction to this technology by describing the basic language, principles, and tools of molecular biology as well as a few of the most widely used recombinant DNA techniques. By necessity, this discussion does not encompass the huge body of available molecular methodologies, but the information provided here should provide a sufficient framework for appreciating how recombinant DNA has already impacted, and how it will most certainly reshape, the practice of medicine.

Animals↗
PubMed1994

Oxygenation and ventilation characteristics of thoracic surgical patients the night before surgery.

Studies of the respiratory effects of perioperative analgesic and anesthetic agents are complicated by evidence that healthy subjects and those with COPD may have abnormalities of oxygenation and ventilation during sleep. This report thus characterizes respiration during sleep preoperatively in a population frequently examined in postoperative analgesia studies. Sixty-two thoracic surgical patients were monitored by continuous respiratory inductive plethysmography, 49 of whom also had continuous pulse oximetry and bi-hourly blood gas measurements. The mean respiratory rate (RR) at each hour during sleep was similar to the awake RR (P > 0.06). The minimum RR during sleep was 7.6 +/- 2.1 (2.6-9.8; median 7.9). At least 1 apnea (tidal volume < 100 mL for > or = 15 sec) occurred in 77% of subjects, and 32% had > or = 1 slow respiratory rate (SRR; 5-min RR < 10 beats/min) episode. The mean SpO2 for hours 2 to 4 was significantly less than while awake (P < 0.0015), but the differences were < or = 1.1%. The minimum SpO2 was 88 +/- 7% (62-97; 89) and 40% of subjects had > or = 1 desaturation (DESAT90; SpO2 < 90% for > or = 15 sec) episode. The pH at hours 2 and 4 was significantly (P < 0.0009) less than while awake, but the differences were only 0.02. Other bi-hourly pH, PaCO2, and PaO2 values were similar to the awake values (P > 0.02). Interpatient variability was high, especially for episodic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Immunoglobulin heavy chain variable gene utilization in human large cell and Burkitt's lymphoma cell lines.

To elucidate the genetic origins of human B-cell lymphomas, we have used northern analysis to establish the profile of immunoglobulin heavy chain variable region (VH) gene utilization in 14 Burkitt's and 10 large cell lymphomas. Our results indicate that the pattern of VH gene subgroup expression in these tumors is similar to the distribution of VH subgroups utilized in the normal repertoire of adult peripheral blood B cells. This finding suggests that these 2 types of lymphomas originate from a relatively diverse population of B cells and that antigenic drive, at least by a single antigen species, does not represent a major etiologic factor in the genesis of this class of B-cell neoplasms. However, the utilization of genes from the VH3 subgroup by 65% of the lymphomas examined in this study raises the possibility that antibodies directed against conserved VH3 subgroup determinant(s) may be of value in treating at least some affected individuals.

Antibody Specificity↗
PubMed1993

Genetic analysis of the variable region genes encoding a monospecific human natural anti-DNA antibody.

Recent evidence suggests that natural autoantibodies may play an integral role in the development of the normal immune repertoire. To explore the genetic origins of these antibodies, we have isolated and sequenced the variable (V) region genes encoding both the heavy (H) and light (L) chains of a natural anti-DNA antibody, Kim11.4. The genes appear to be derived from the VH4.18 (subgroup VHIV), JH5, Hum1L1 (subgroup V lambda I) and J lambda 3 germline genes. The origin of the H chain diversity gene is more obscure, being potentially derived from one or more of several germline genes, arranged in either the forward or reverse orientations. Both the Kim11.4 VH and VL genes share significant degrees of similarity with those utilized in other autoantibodies, indicating that at least some degree of V restriction may exist in human autoreactive B cells. The pattern of nucleotide differences between the Kim11.4 VH and VL genes and their putative germline counterparts suggests that the Kim11.4 genes may have undergone somatic mutation and arisen as a result of antigen selection.

Amino Acid Sequence↗
PubMed1992

Molecular characterization of the human immunoglobulin V lambda I germline gene repertoire.

To advance our understanding of the human immunoglobulin V lambda germline gene contribution to normal as well as autoimmune responses, we have isolated and sequenced six germline genes of the V lambda I subgroup. These genes can be divided into three sub-subgroups on the basis of greater than or equal to 93% nucleotide sequence homology and greater than or equal to 88% deduced amino acid sequence similarity. Examination of all cDNA and protein sequences available for expressed V lambda I genes supports the assignment of these three sub-subgroups. Sequence comparisons also suggest that germline gene members of two of these sub-subgroups, I-a and I-b, are preferentially utilized in the expressed V lambda I repertoire. This finding may be at least partially attributable to regulatory sequence abnormalities apparent in two of the other V lambda I germline genes (Humlv101 and Humlv104) which may interfere with their expression.

Amino Acid Sequence↗
PubMed1992

Molecular analysis of human immunoglobulin V lambda germline genes: subgroups V lambda III and V lambda IV.

Three human immunoglobulin V lambda germline genes have been isolated: two from the V lambda IV subgroup and one from the V lambda III subgroup. The V lambda III gene and one of the V lambda IV genes appear to be functional (each being utilized in at least two expressed V lambda genes), despite deviations from the reported consensus sequences in their promoter TATA-box and recombination signal sequence elements. The other V lambda IV gene is a pseudogene. Of the 20 human V lambda germline genes characterized to date, 45% are pseudogenes or vestigial genes.

Amino Acid Sequence↗