An appreciation of Professor Ramesh Kumar (1938-2000).
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England↗
Biomedical subjects
M Marks
Publications and source records attributed to M Marks.
Two-year follow-up after a randomised controlled trial of self- and clinician-accompanied exposure for phobia/panic disorders.
BACKGROUND: Long-term follow-up has rarely been reported after self-exposure therapy for phobias. AIMS: Completion of such a follow-up. METHOD: Two-year follow-up was achieved in 68 (85%) of 80 patients with phobias who had completed a previous 14-week randomised controlled trial comparing therapist-accompanied self-exposure, self-exposure or self-relaxation. Measures were self-reported ratings of symptoms, satisfaction and use of other treatment. RESULTS: Improvement at week 14 was maintained 2 years later. Clinician-accompanied exposure and self-exposure did not differ on any measure. Compliance with self-exposure homework during weeks 0-8 predicted more improvement 2 years later. Patients who failed to improve with relaxation by week 14 improved after subsequent crossover to exposure. A need for more treatment for their phobias was still felt by 33 patients (49%). CONCLUSIONS: Patients with phobias maintained their improvement to 2-year follow-up after the end of self-exposure therapy.
Adult↗
Changes in neurite outgrowth but not in cell division induced by low EMF exposure: influence of field strength and culture conditions on responses in rat PC12 pheochromocytoma cells.
The effects of low electromagnetic field (EMF) exposure (4.5-15.8 microT, 50 Hz AC) on neurite outgrowth and cell division in rat PC12 pheochromocytoma cells were examined. The study involved two separate experimental series in which culture conditions during exposure to the magnetic fields differed. In series 1 (14 experiments in which culture conditions were not strongly conducive to cell differentiation [15% serum]), exposure to 4.5-8.25 microT for 23 h significantly inhibited neurite outgrowth by 21.5 +/- 1.3% (by Manova, p = 0.003). In contrast, in series 2 (12 experiments in which culture conditions promoted cellular differentiation [4% serum]), exposure to 4.35-8.25 microT for 23 h significantly stimulated neurite outgrowth by 16.9 +/- 1.1% (by Manova, p = 0.009). Thus, in both series, exposure to a narrow range of low EMF has significant, but opposite effects on neurite outgrowth. Exposure to higher fields, 8.25-12.5 microT (series 1) and 8.25-15.8 microT (series 2) had no significant effect on neurite outgrowth. These data, when considered with other reports, suggest that neuronal differentiation can be altered by low level EMF exposure. While this may not be detrimental, it merits further research. At present, the reasons for the significant changes in neurite outgrowth being confined to the same narrow field strength are unclear. As stated above, culture conditions in series 2 were more conducive to cell differentiation than those in series 1. This is reflected in the lower number of cells in control samples in series 2, at the end of the 23-h incubation, than in series 1 (- 16.9 +/- 1.7%, p = 0.003). As the same numbers were plated in both series, the medium used in series 1 allows more of the PC12 cells to divide; this is consistent with some cells reverting to a non-neuronal adrenal chromaffin phenotype [L. Greene, A. Tischler. Establishment of a noradrenergic clonal line of rat adrenal pheochromocytoma cells which respond to nerve growth factor. Proc. Natl. Acad. Sci. U. S. A., 73 (1976) 2424-2426]. Exposure to both ranges of magnetic fields (4.35-8.25 and 8.25-15.8 microT) has no effect on cell division. Thus, there is no evidence in this study that there is a mitogenic effect arising from low EMF exposure.
Adrenal Gland Neoplasms↗
Meningococcal pericarditis in a 2-year-old child: reactive or infectious?
Pericarditis is an uncommon manifestation of infection of Neisseria meningitidis. Pericarditis may be caused by direct invasion or immune-complex-mediated (reactive) inflammation. We outline the case of a two-year-old girl with probable reactive pericarditis, review the cases reported in the English literature since 1966 and discuss the pathogenesis of meningococcal pericarditis.
Child, Preschool↗
Utility of rush paraffin-embedded tangential sections in the management of cutaneous neoplasms.
BACKGROUND: Mohs micrographic surgery (MMS) modified by the use of tangential, formalin-fixed, paraffin-embedded histologic specimens is advantageous in treating selected skin neoplasms. OBJECTIVE: To review the use of our experience with a modification of MMS to treat lentigo maligna melanoma (LMM), lentigo maligna (LM) and other melanoma in situ (MIS) lesions, dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), and angiosarcoma. METHODS: Our experience utilizing a modification of MMS in the treatment of 77 patients with LM or other MIS, 23 patients with LMM, 11 patients with DFSP, 1 patient with AFX, and 1 patient with angiosarcoma was reviewed. Length of follow-up and rate of recurrence were examined. A literature review of this pertinent modification of the Mohs technique was performed. RESULTS: One hundred fourteen patients underwent MMS for melanocytic (LM, MIS, LMM), spindle cell (DFSP, AFX), and vascular malignant neoplasms. One patient developed locally recurrent LM and one patient with LMM developed satellite metastasis. Regional lymph node metastasis occurred in one patient with LMM and in a patient with angiosarcoma. CONCLUSION: The use of Mohs micrographic surgery in conjunction with rush formalin-fixed, paraffin-embedded tangential histologic sections provides the accuracy and tissue conservation of the Mohs procedure while ensuring more confident interpretation of histology in cases of lentigo maligna, lentigo maligna melanoma, dermatofibrosarcoma protuberans, atypical fibroxanthoma, and angiosarcoma.
Aged↗
Initial validation of the functional impairment scale for children and adolescents.
OBJECTIVE: Two studies assessed the validity of the Functional Impairment Scale for Children and Adolescents (FISCA), a multidimensional parent-report questionnaire. METHOD: In study 1, quasi-exploratory and confirmatory procedures tested whether FISCA data for 804 inpatients (mean age = 13.4, 456 boys), collected October 1994 through December 1995, fit a 3-factor model. Study 2 (n = 330) used survival and discriminant analyses to predict recidivism status at 3 and 6 months follow-up from FISCA scores at intake. RESULTS: The 8 FISCA scales reduced to 3 factors describing undercontrolled aggression, social role violations, and self-focused aspects of child functional impairment. Serious impairment on the Aggression and School scales each predicted a 3-fold increase in recidivism risk. Together, impairment scores for Aggression, School, Thinking, and Delinquency correctly identified 73% of the recidivists. However, 51% of the nonrecidivists also were classified as recidivists. CONCLUSIONS: Although these data initially support the FISCA's validity, they underscore the need for more effective strategies to identify severely impaired children whose problems will be sporadic or short-lived.
Adolescent↗
Anterior uveitis and its relation to stress.
BACKGROUND/AIMS: Idiopathic recurrent acute anterior uveitis (RAAU) is a common reason for attendance at ophthalmic casualty departments. Patients who suffer with this condition may have multiple recurrent episodes which are often debilitating and necessitate time off work. If recurrences are identified early and treatment initiated rapidly, the inflammation can be minimised and settles quickly on topical treatment with a speedy functional recovery by the patient. It has been our clinical impression that some patients with RAAU relate recurrences of inflammation to psychological factors. Therefore stress could be a trigger factor for recurrence, and at such times, patients should be alert to the early signs of uveitis and seek prompt examination by an ophthalmologist. This study tests the hypothesis that stressful life events are associated with the onset of RAAU. METHODS: The number of stressful life events in patients presenting to the casualty department with RAAU in the month immediately preceding symptom onset was compared with a control group of patients with other ocular problems taken from the casualty department using the Holmes and Rahe scale and the Spielberger state-trait anxiety inventory. RESULTS: 35 patients with RAAU did not report a higher number of stressful life events or higher levels of anxiety compared with 29 controls in this study on both Holmes and Rahe scale and Spielberger state-trait anxiety inventory. Scores for both groups were comparable with those published for normal adults of the same age and sex. CONCLUSION: Stress was not shown in this study to be involved in triggering the recurrence of idiopathic acute anterior uveitis.
Acute Disease↗
Effect of telephone follow-up on frequency of health maintenance visits among children attending free immunization clinics: a randomized, controlled trial.
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Adolescent↗
The role of traumatic experiences in the genesis of obsessive-compulsive disorder.
This paper discusses the role of traumatic stress in the genesis of obsessive-compulsive disorder. While the early classical conditioning theory of the onset of obsessive-compulsive disorder has only limited empirical support, authorities have always recognised the role of stress in precipitating this disorder, and in triggering relapse in those who have been successfully treated. Here, clinical cases are cited that show a causal link between severe trauma and the onset of obsessive-compulsive disorder. The nature of the traumatic reaction and the possible mechanisms by which it leads to frank obsessive-compulsive disorder are discussed. The apparent links between this and posttraumatic stress disorder are also explored. Finally, implications for therapy are considered.
Adolescent↗
Comparison of a beta-lactam alone versus beta-lactam and an aminoglycoside for pulmonary exacerbation in cystic fibrosis.
UNLABELLED: We determined whether a beta-lactam and an aminoglycoside have efficacy greater than a beta-lactam alone in the management of a pulmonary exacerbation in patients with cystic fibrosis. STUDY DESIGN: Azlocillin and placebo or azlocillin and tobramycin were administered to 76 patients with a pulmonary exacerbation caused by Pseudomonas aeruginosa in a randomized double-blind, third-party monitored protocol. Improvement was assessed by standardized clinical evaluation, pulmonary function testing, sputum bacterial density, sputum DNA content, and time to the next pulmonary exacerbation requiring hospitalization. RESULTS: No significant difference was seen between the 2 treatment groups in clinical evaluation, sputum DNA concentration, forced vital capacity, forced expiratory volume in second 1, or peak expiratory flow rate at the end of treatment (33 receiving azlocillin alone and 43 both antibiotics); adverse reactions were equivalent in each group. Sputum P. aeruginosa density decreased more with combination therapy (P =.034). On follow-up evaluation, an average of 26 days after the end of treatment, all outcome indicators had worsened in both groups. Time to readmission for a new pulmonary exacerbation was significantly longer in the group receiving azlocillin plus tobramycin (P <.001). Treatment-emergent tobramycin resistance occurred in both groups and was more frequent with combination therapy. CONCLUSION: We conclude that the combination of a beta-lactam and an aminoglycoside produces a longer clinical remission than a beta-lactam alone and slightly better initial improvement.
Adolescent↗
Up-training loading responses in older adults.
This randomized, experimental-control group, multiple-observation study examined the ability of older adults to use center of pressure feedback to up-train the vertical loading response (LR) and the impact that such training had on changes in clinical tests of balance. Eleven community ambulators, aged at least 65 years, with no recent history of falls were recruited by convenience sampling. Each group received 6 baseline sessions and 6 control/training sessions, followed by 1 posttest session. All sessions included visual cueing about stance equilibrium followed by 30 randomly timed dynamic, toes-up perturbations (8 degrees, 66 degrees per second). Training consisted of verbal instructions with visual and auditory feedback of a 225 msec response window to shape an increase in total LR following perturbations. Subjects in the experimental group demonstrated a tendency to decrease vertical loading relative to baseline regardless of visual and verbal feedback encouraging strategies to increase it. Specifically, the T3 or 150-225 msec component of the response window showed a decline from session 7 to session 12. Up-training, however, appears to cause a faster rate of rise to the maintenance window, but this event probably occurs too late to correct for a loss of balance. No correlation was found between change in load values and change in performance on clinical balance tests.
Accidental Falls↗
Age-related changes in neuronal nicotinic acetylcholine receptor subunit alpha4 expression are modified by long-term nicotine administration.
The distribution of the neuronal nicotinic acetylcholine receptor subunit alpha4 (nAChRalpha4) in the brains of young (2-4 months) or aged (24-28 months) CBA/J mice was examined using immunohistochemical staining. Anti-nAChRalpha4 immunoreactivity corresponded with nAChRalpha4 RNA expression and high-affinity [3H]nicotine binding. Immunostaining in aged mice relative to that in young animals was diminished in the medial septum and diagonal band but was unchanged in the globus pallidus and substantia nigra. The staining of neurons was almost completely absent in the hippocampus of aged animals. The oral administration of nicotine to aged animals for 6 weeks did not alter nAChRalpha4 expression relative to that in aged controls. However, the long-term delivery of nicotine (11 months) to 14-month-old animals corresponded with the highly specific preservation of nAChRalpha4 expression in some neurons of the dentate gyrus region and in neurite processes of remaining neurons of the hippocampal CA1 region. These results support the conclusion that the loss of nAChRalpha4 expression occurs in key cholinergic regions during normal aging. Furthermore, sustained long-term nicotine delivery may promote highly region-specific retention of nAChR expression, but only if initiated before normal age-related receptor decline.
Acetylcholine↗
From the laboratory to the hospital, adults to adolescents, and disorders to personality: the case of psychological reactance.
Study 1 assessed whether trait reactance in disturbed adolescents (ages 12 to 17) is part of the same constellation of personality variables associated with reactance in adults, and Study 2 examined whether reactance predicts inpatient treatment duration and outcomes. Correlations between reactance and MMPI-A variables among 76 inpatients (41 girls) showed that reactance is associated with oppositional, nonaffiliative, and narcissistic traits in disturbed adolescents as well as adults. Reactance predicted longer hospital stays among 176 adolescents (90 girls), and also changes in aggression, mood problems, and substance abuse among those in middle (n=89) but not early (n=87) adolescence. Additional analyses identified "typically male" and "typically female" patterns of reactance-change relationships. The clinical significance and utility of these findings are discussed.
Adolescent↗
Identifiability of Individual Contributions in a Threshold Public Goods Experiment.
This paper experimentally examines how information affects behavior in a threshold public goods game. Three treatments investigate how subjects react to varying amounts of information about the contribution behavior of other group members. Results suggest that revealing anonymous information about others' contributions leads to a significant decrease in contributions and an increase in the variance of contributions. In contrast, when individual contributions are identified by subject number, average contributions increase and the variance of contributions decreases significantly. Copyright 1998 Academic Press.
Journal Article↗
Cognitive characteristics of seasonal affective disorder: a preliminary investigation.
Light therapy, the current treatment for Seasonal Affective Disorder (SAD), does not help everyone suffering from SAD. This paper examines whether patients with SAD potentially might benefit from cognitive behaviour therapy by investigating whether they show a similar cognitive profile to those with non-seasonal depression for whom cognitive therapy has been shown to be effective. Ten subjects with SAD were compared to 11 non-seasonally depressed and 10 normal controls on a range of measures including the Automatic Thoughts Questionnaire and the Dysfunctional Assumptions Scale. One-way analysis of variance showed that the SAD group reported significantly more negative automatic thoughts and dysfunctional attitudes than a non-depressed control group but did not differ from a group with non-seasonal depression. The results suggest that patients with SAD may respond to cognitive behaviour therapy like those with non-seasonal depression. Further research is therefore recommended to examine the efficacy of cognitive therapy as a complementary addition to light therapy in the treatment of SAD and to examine other cognitive aspects of SAD.
Adult↗
Adenocarcinoma of the urachus and bladder expresses a unique colonic epithelial epitope: an immunohistochemical study.
PURPOSE: Primary adenocarcinoma of the bladder is a rare neoplasm whose histogenesis is poorly understood. Current data support the concept that adenocarcinoma of the bladder and urachus evolves from zones of intestinal metaplasia that become dysplastic and invasive. To address this hypothesis further we determined the immunoreactivity of benign and malignant epithelial tissue from the bladder and urachus with a monoclonal antibody that is reactive with colonic epithelium to evaluate the presence of a common reactive epitope. MATERIALS AND METHODS: The monoclonal antibody 7E12H12 (IgM isotype), developed against a colonic epithelial protein, was used in an immunoperoxidase assay to survey formalin fixed, paraffin embedded archival tissue specimens. A total of 26 specimens obtained by endoscopic biopsy or extirpative surgery, including benign and malignant bladder and urachal epithelial abnormalities, was chosen for retrospective evaluation. RESULTS: All adenocarcinoma reacted positively regardless of the histological variant, differentiation, or bladder or urachal origin. In contrast, transitional cell and squamous cell carcinomas were nonreactive. Also, the pattern of reactivity in tissues that contained benign epithelial proliferations suggested a stepwise transition with no reactivity in normal urothelium or Brunn's epithelial nests, rare staining of cystitis cystica, and uniformly positive reactivity in cystitis glandularis and frank colonic intestinal metaplasia of the bladder and urachus. CONCLUSIONS: The shared, aberrant phenotypic expression of a unique colonic epitope in benign epithelial metaplasia, and adenocarcinoma of the bladder and urachus suggests a common underlying pathway toward adenocarcinoma in cystic and urachal adenocarcinoma. The implications for diagnostic pathology are discussed.
Adenocarcinoma↗
Nicotinic receptor subunits alpha 3, alpha 4, and beta 2 and high affinity nicotine binding sites are expressed by P19 embryonal cells.
Controlled exposure to retinoic acid (RA) induces the murine embryonal carcinoma cell line P19S18O1A1 (P19) to differentiate into a variety of cell types. One of the cell types exhibits neuronal-like morphology and expresses neuronal markers including neurofilament proteins, glutamate receptors, and the cholinergic enzymes choline acetyl-transferase and acetylcholinesterase. In this study we use Northern blot analysis, double-label immunocytochemistry, and single cell RNA analysis using polymerase chain reaction to show that RA-treated P19 cells with neuronal-like morphology also express neuronal nicotinic acetylcholine receptor (nAChR) subunits alpha 3, alpha 4, and beta 2. Greater than 80% of RA-treated P19 cells with a neuronal-like phenotype express nAChR alpha 4 subunit transcripts and both alpha 4 and beta 2 protein. The RA-induced expression of alpha 3 transcripts accounts for a comparably small number of nAChR-containing cells (< 20%) of which half coexpress alpha 4 transcripts. Expression of high-levels of alpha 4 RNA is dependent upon both cell-cell contact and RA exposure. The appearance of nAChR subunits also coincides with RA-induced expression of high affinity [3H]-nicotine binding receptors. The P19 cell line offers an inducible neuronal cell system to study mammalian neuronal nicotinic receptor expression and the development of high affinity nicotinic binding sites similar to those expressed in the mammalian central nervous system.
Animals↗
Posttraumatic pseudolipoma.
A pseudolipoma is a benign fatty tumor whose etiology is undetermined but is postulated to be secondary to a tear in Scarpa's fascia resulting in herniation of deeper fat through Scarpa's layer. We report ten cases of trauma that resulted in pseudolipoma formation. The literature is reviewed and treatment options are discussed.
Adolescent↗