Trigeminal sensory neuropathy and rheumatoid arthritis: case study of a rare association.
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Adult↗
Biomedical subjects
M J Burke
Publications and source records attributed to M J Burke.
Perfused rat intrahepatic bile ducts secrete and absorb water, solute, and ions.
BACKGROUND & AIMS: We report a novel approach to study biliary water, bile acid, and HCO(3)(-) transport: the microperfusion of intrahepatic bile duct units (IBDUs) isolated from normal rat liver. METHODS: To study water transport, IBDUs were perfused in vitro with a membrane-impermeant fluorescent volume marker, fluorescein sulfonate; net water movement (J(v)) and osmotic water permeability (P(f)) were then calculated. To study solute transport, IBDUs were perfused with taurocholic acid (TCA) and bile acid uptake was calculated from the concentrations of TCA in the perfused and collected solutions. To study ion transport, IBDUs were perfused with the cell-impermeant pH-sensitive dye BCECF dextran; luminal pH was determined from fluorescence excitation ratios. RESULTS: When inward (secretory) or outward (absorptive) osmotic gradients were established across IBDUs, water movement was observed from bath to lumen (i.e., secretion) and from lumen to bath (i.e., absorption). The perfused IBDUs absorbed TCA in a saturable, sodium-dependent manner; in addition, TCA absorption was blocked in a dose-dependent fashion by S0960, a specific inhibitor of the Na(+)/bile acid cotransporter. Addition of forskolin to HCO(3)(-)-containing (but not HCO(3)(-)-free) bath buffer resulted in lumen alkalinization reflecting HCO(3)(-) transport into the lumen of perfused IBDUs. CONCLUSIONS: The results provide direct functional evidence that intrahepatic bile ducts both secrete and absorb water in response to osmotic gradients, actively absorb bile acid, and transport HCO(3)(-).
Absorption↗
A micropower dry-electrode ECG preamplifier.
This paper describes the development of a very low-power preamplifier intended for use in pasteless-electrode recording of the human electrocardiogram. The expected input signal range is 100 microV-10 mV from a lead-II electrode configuration. The amplifier provides a gain of 43 dB in a 3-dB bandwidth of 0.05 Hz-2 kHz with a defined high input impedance of 75 M omega. It uses a driven common electrode to enhance rejection of common-mode interfering signals, including low-frequency motion artifact, achieving a common-mode rejection ratio (CMRR) of better than 80 dB over its entire bandwidth. The gain and phase characteristics meet the recommendations of the American Heart Association, ensuring low distortion of the output ECG signal and making it suitable for clinical monitoring. The amplifier has a power consumption of 30 microW operating from a 3.3-V battery and is intended for use in small, lightweight, portable electrocardiographic equipment and heart-rate monitoring instrumentation.
Artifacts↗
Occult aneurysmal hemorrhage in a child. Case report and literature review.
A unique case of the diagnosis and treatment of a ruptured cerebral aneurysm in a 5-year-old male is presented. The child presented with subarachnoid hemorrhage, and initial CT imaging indicated a right posterior communicating artery aneurysm. Cerebral angiography and MRI/MRA were normal. Repeat cerebral angiogram 3 weeks later was also normal. Sixteen months later, an angiogram was performed to evaluate a subtle carotid bruit found on exam. A carotid bifurcation aneurysm pointing inferior and posterior was found. Craniotomy to clip the aneurysm was performed, and marked adherent gliosis around the lesion was found, supporting the fact that this was the causal lesion of his bleed in the past. Albeit a single case report, it underscores the need for very long-term follow-up and evaluation of idiopathic pediatric subarachnoid hemorrhage.
Aneurysm, Ruptured↗
Therapeutic drug monitoring of antidepressants: cost implications and relevance to clinical practice.
Despite evidence to support its potential benefit in clinical practice, therapeutic drug monitoring (TDM) is under-utilised and underdeveloped in the field of psychiatry. In antidepressant pharmacotherapy drug dose is emphasised as the critical treatment variable. However, dose in, and of, itself can be a strikingly misleading predictor of drug concentration and, hence, treatment effect. For antidepressant drugs, plasma concentrations at a given dose have been shown to vary in excess of 40-fold. The clinical relevance of this variability is that at a standard antidepressant dosage only some patients will have tissue drug concentrations associated with an optimal response whereas others will have either low, ineffective drug concentrations or unnecessarily high concentrations which may be poorly tolerated. Among clinicians and healthcare agencies there is an under-appreciation of the degree of pharmacokinetic variability found in patients and how that might impact on the patients response to pharmacotherapy. Hence there is a perception that TDM is an unnecessary, complicated and costly procedure. This is actually unfounded. There are data to suggest that TDM can favourably affect the outcome of antidepressant treatment by providing a rational alternative to the inherently slower, trial and error practice of dosage titration based on clinical response. It is unlikely that TDM will become a standard of care for all antidepressant agents and all patients. Therefore the question becomes for which antidepressant agents, for which patients and under what circumstances, is TDM more cost-effective than traditional dose titration. The use of TDM to optimise the efficient use of selected antidepressant agents could potentially free up healthcare resources to fund other equally deserving treatments. This article provides a discussion of the major classes of antidepressant drugs with regard to their pharmacological features that predict the utility of TDM in clinical practice. Recommendations are made for the practical application of TDM and the directions for further research.
Antidepressive Agents↗
Age stereotyping at work: the role of rater and contextual factors on evaluations of job applicants.
Using refinements of hypotheses by L. M. Finkelstein, M. J. Burke, and N. S. Raju (1995), the authors examined the effects of rater age, age salience, and job-relevant information on 324 managers' ratings of an older or a younger hypothetical applicant's interpersonal skills, economic worth, and likelihood of being interviewed. They hypothesized that age identity would interact with age salience to produce ingroup biases that would lead raters to favor workers from their own age groups. There was a main effect of target age on all dependent variables, with the strongest effects on the ratings of economic worth: The participants rated the older target as less economically beneficial than the younger target. When age was highly salient and when the raters identified psychologically with their age groups, older raters actually disfavored older workers in ratings of economic worth. The authors also discuss directions of future research into the roles of the target's economic worth and the rater's age identity in age stereotyping and age discrimination in employment decisions.
Adult↗
Death due to alcoholic complications in a young woman with a severe eating disorder: a case report.
OBJECTIVE: Recently, a good deal of attention has been focused on alcoholism and eating disorders as comorbid conditions. Early identification of biologic, psychologic, and sociocultural factors that contribute to comorbid alcoholism and eating disorders may improve the outcome for such patients. METHOD: The following case report is of a 26-year-old woman who developed a severe eating disorder in her early teens that was followed by alcoholism. RESULTS: The combination of eating disorder and alcoholism in this patient led to approximately 70 hospitalizations for medical complications of her alcoholism. This paper chronicles her last few living months including her death due to alcoholic complications.
Adult↗
Clinicoeconomics in geropsychiatry.
The question becomes, who will manage managed care and what will be used as a basis for rational decision making? It has been suggested that a policy-regulating body composed of health care providers, payors, and patients be formed to oversee the process of health care reform and to discourage profit-driven managed care practices. It is particularly appealing to incorporate health care consumers into this process as representatives of evolving societal values. To make rational decisions, the proposed regulatory body will need data. In this regard the discipline of clinicoeconormics could provide information on the effectiveness and relative value of health care interventions. Geropsychiatrists must be willing to join the effort to learn about and participate in clinicoeconomics to shift the debate from the bottom line of a balance sheet to the preservation of quality care for the elderly and mentally ill.
Aged↗
Pharmacokinetics of the newer antidepressants.
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1-Naphthylamine↗
Normal sutural fusion and the etiology of single sutural craniosynostosis: the microspicule hypothesis.
Single sutural craniosynostosis is a disorder wherein a calvarial suture fuses prematurely, resulting in an abnormally shaped head. Children afflicted are normal neurologically, and the bone bridging the sutures is normal histologically. The mechanism of normal or pathologic sutural fusion is unknown. These facts prompted the authors to reexamine normal sutural anatomy and the concepts of skull growth in an animal model. Histochemical staining to identify osteoblasts and osteoclasts and tetracycline labeling were performed on neonatal rabbit calvarial sutures. Osteoblasts are found on all bony surfaces including the sutural edges, but do not extend across the sutural space. Thus the periosteum per se does not bridge the suture. Osteoclasts are found only in the diploic space. Thus, there is no mechanism to remove bone at/or within the suture. Tetracycline labeling revealed immense bone production at the suture as compared with dural and periosteal surfaces. Microscopic spicules of bone bridging the suture were identified. Based upon the above observations, we propose a new hypothesis for the mechanism of normal and pathologic sutural fusion. Bony microspicules normally and intermittently form and bridge the suture. As there is no mechanism to remove these spicules, we propose that normal mechanical forces cause them to fracture. A spicule that fails to fracture functions as a scaffold, upon which more bone is deposited, resulting in sutural fusion. Single sutural craniosynostosis results when a normal process occurs prematurely.
Animals↗
Note on the role of negative affectivity in understanding relationships between self-reports of exercise and sick leave.
Previous research indicates that observed correlations between self-reports of job stress and self-reports of strain may be reduced after partialling out the variance due to the personality trait of negative affectivity. The present study examined the effect of negative affectivity on the relationships between self-reports of exercise and strain in a sample of 128 governmental employees. While the magnitudes of the bivariate correlations between exercise and strain were small, the results of semipartial correlation analyses were somewhat consistent with expectations that the magnitudes of bivariate correlations between exercise participation and self-reports of strain would be reduced after controlling for negative affectivity in measures of strain. The implications of these findings for incorporating a measure of negative affectivity in studies of exercise-strain relationships involving self-reports are discussed.
Affect↗
Low-power ECG amplifier/detector for dry-electrode heart rate monitoring.
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Electrocardiography, Ambulatory↗
A computer-controlled, closed-loop infusion system for infusing muscle relaxants: its use during motor-evoked potential monitoring.
A microcomputer-controlled closed-loop infusion system (MCCLIS) has been developed that provides stable intraoperative levels of partial neuromuscular blockade. Complete neuromuscular blockade interferes with intraoperative motor-evoked potential (MEP) monitoring used for patients undergoing surgical procedures that place them at risk for spinal cord ischemia. Nine patients were studied during which the MCCLIS maintained stable levels of partial neuromuscular blockade and allowed transcranial magnetic motor-evoked potential (TcM-MEP) monitoring during thoracoabdominal aortic aneurysmectomy. The use of TcM-MEP for monitoring intraoperative spinal cord function was balanced against surgical considerations for muscle relaxation with 80% to 90% neuromuscular blockade fulfilling each requirement. Intraoperative adjustment of partial neuromuscular blockade to facilitate TcM-MEP monitoring was also possible with the MCCLIS. The MCCLIS should allow for further investigation into the sensitivity, specificity, and predictability of TcM-MEP monitoring for any patient at risk for intraoperative spinal cord ischemia including those undergoing thoracoabdominal aortic aneurysmectomy.
Action Potentials↗
Pharmacoeconomic considerations when evaluating treatment options for major depressive disorder.
The goal of this paper is to increase the psychiatrist's awareness of issues and methods in pharmacoeconomics with the hope that this will lead to greater physician involvement in the ongoing cost-management debates. This paper will first examine the underlying dynamics of health economics as they relate to the treatment of major depressive disorder. It will then discuss cost-benefit factors in antidepressant pharmacotherapy with special focus on the economic implications of clinically relevant differences among antidepressant drug classes. The paper ends with a review of methods for the economic analysis of drug therapies and a discussion of research needs in this area.
Adult↗
A versatile, computer-controlled, closed-loop system for continuous infusion of muscle relaxants.
A computer-controlled, closed-loop system for continuous infusion of muscle relaxants that allows the operator to choose either atracurium besylate or vecuronium bromide to provide any desired target level of neuromuscular blockade is described. This new system offers certain advantages over computer-controlled systems described previously for continuous infusion of muscle relaxants--that is, the option to choose either of two muscle relaxants to be infused and the inclusion of monitors to provide feedback about the dosage needed to produce a target level of neuromuscular blockade. The clinical performance of this system was tested in 36 patients who were 18 to 65 years old, were classified in American Society of Anesthesiologists physical status 1 or 2, and were undergoing elective orthopedic, abdominal, or thoracic procedures. In all patients, the control algorithm rapidly induced the target level of neuromuscular blockade and maintained that level of blockade at steady state with minimal oscillation. We conclude that the automatic feedback control system described can induce and precisely maintain any predetermined target level of neuromuscular blockade.
Adolescent↗
The role of negative affectivity in understanding relations between self-reports of stressors and strains: a comment on the applied psychology literature.
On the basis of a brief review of the health, organizational, and personality psychology literatures supportive of the expectation that observed relations between self-reports of stressors and strains are influenced by the mood-dispositional dimension negative affectivity (NA), reanalyses of four data sets were conducted. The results of these reanalyses, contrary to the assertions of several authors in the applied psychology literature, offered further support for the hypothesized "nuisance" properties of NA in studies involving relations between self-reports of stressors and strain. A discussion of how NA and other mood-dispositional dimensions may be of interest to investigators concerned with relations between self-reports of any condition of employment and any affective state of workers is presented.
Depression↗
Determinants of retinal vascular abnormalities in children and adolescents with essential hypertension.
The predictors of retinal vascular abnormalities in patients with elevated BP have not been studied extensively in children or adults. The purpose of this study was to investigate potential correlates of arteriolar narrowing, tortuosity and arteriovenous nicking in a population of children and adolescents with essential hypertension. A total of 97 subjects, aged 6-23 years, were studied. Retinal vascular abnormalities were determined by photographs of the optic fundus which were interpreted independently by two opthalmologists. In 50 subjects (51%) there were one or more abnormalities. Potential correlates of retinal abnormalities included: (1) demographic factors, (2) body size, (3) level of BP and duration of hypertension, (4) family history of cardiovascular disease, (5) treatment with antihypertensive medication, (6) dietary sodium intake, (7) laboratory analyses, (8) the reactivity of BP and heart rate to playing a video game, and (9) cardiovascular reactivity to exercise. Using stepwise multiple logistic regression, the variables that were independently associated with the presence of retinal vascular abnormalities were family income, dietary sodium intake, fasting blood glucose, pulse pressure during mental stress and the change in SBP from rest to maximum exercise. In addition, subjects with more than one retinal vascular abnormality had higher average DBP during follow-up in the Hypertension Clinic and a smaller rise in SBP from rest to maximum exercise. Identification of these independent predictors of retinal vascular abnormalities and factors associated with more than one abnormality may provide insight into the pathogenesis of hypertensive vascular disease.
Adolescent↗
Therapeutic drug monitoring. Principles and practice.
TDM represents an important tool in the optimal use of selected psychiatric medications. Its role in therapy varies depending on the drug being prescribed. For some medications, such as lithium and tricyclic antidepressants, it should be a standard aspect of care. For other drugs, such as benzodiazepines, it is not helpful. Unfortunately, the use of TDM often follows an "all or none" pattern. Some clinicians rarely use it even for drugs like TCAs where it is critical to optimal care. Others use it excessively; repeating levels when it is not necessary or for drugs for which it is not necessary. It is hoped that this article has provided a basis for the thoughtful application of TDM in psychiatry as well as a review of the available data.
Dose-Response Relationship, Drug↗