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Biomedical subjects

M Piper

Publications and source records attributed to M Piper.

At least 19 recordsLinked to original sources
PubMed1990

Terminal cancer care and patients' preference for place of death: a prospective study.

OBJECTIVE: To assess the preference of terminally ill patients with cancer for their place of final care. DESIGN: Prospective study of randomly selected patients with cancer from hospital and the community who were expected to die within a year. Patients expected to live less than two months were interviewed at two week intervals; otherwise patients were interviewed monthly. Their main carer was interviewed three months after the patient's death. SETTING: District general hospital, hospices, and patients' homes. MAIN OUTCOME MEASURE: Stated preferred place of final care; actual place of death; reason for final hospital admission for those in hospital; community care provision required for home care. RESULTS: Of 98 patients approached, 84 (86%) agreed to be interviewed, of whom 70 (83%) died during the study and 59 (84%) stated a preferred place of final care: 34 (58%) wished to die at home given existing circumstances, 12 (20%) in hospital, 12 (20%) in a hospice, and one (2%) elsewhere. Their own home was the preferred place of care for 17 (94%) of the patients who died there, whereas of the 32 patients who died in hospital 22 (69%) had stated a preference to die elsewhere. Had circumstances been more favourable 67% (41) of patients would have preferred to die at home, 16% (10) in hospital, and 15% (9) in hospice. CONCLUSION: With a limited increase in community care 50% more patients with cancer could be supported to die at home, as they and their carers would prefer.

Consumer Behavior↗
PubMed1990

Serial magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy.

We prospectively performed magnetic resonance imaging (MRI) studies during the neonatal period, and at 4 and 8 months of age, on 15 term infants with hypoxic-ischemic encephalopathy, and compared the results with their neurodevelopmental outcome at 18 months of age. Cerebral palsy developed in nine infants, two infants were classified as having abnormalities of tone and delayed motor milestones that were suggestive of cerebral palsy, and four infants were normal. Structural abnormalities, delayed myelination, or a combination of the two were detected with MRI at 8 months of age in all nine infants with later development of cerebral palsy. Three of the four normal infants and one infant with suggestive abnormalities had normal serial MRI findings. Each of the remaining two infants (one normal, one with suggestive abnormalities) had isolated persistent ventricular dilation on all three MRI studies. Our results suggest that 8 months appears to be the earliest time at which MRI findings correlate well with later adverse neurodevelopmental outcome in this population.

Age Factors↗
PubMed1989

Hypocomplementemic proliferative glomerulonephritis with C3 nephritic-factor-like activity in multiple myeloma.

Advanced renal failure, nephrotic-range proteinuria due to proliferative glomerulonephritis and multiple myeloma with circulating IgG2 lambda and free lambda light-chain paraproteins occurred in a 31-year-old male. Commonly established causes of renal failure in multiple myeloma were excluded. Immunofluorescence revealed heavy granular glomerular deposition of C3. Serum C3 was decreased, and C3c was increased. C3 nephritic-factor (C3 NeF)-like activity was demonstrated in the serum. Plasmapheresis and chemotherapy resulted in a decrease in paraprotein concentration up to 90%, a decrease in C3 NeF-like activity to negligible, normal serum complement levels and a marked improvement in both renal function and proteinuria. With reference to the literature, the possibility of a syndrome of paraproteinemia, C3 NeF-like activity and glomerulonephritis is forwarded.

Adult↗
PubMed1988

Developmental outcome in very low birth weight infants 6 to 36 months old.

A cohort of 78 infants weighing less than 1500 g at birth was followed prospectively to determine the impact of birth weight, age of assessment, and skill area on their developmental performance. Five skill areas were tested using the Griffiths Mental Scales of Development at 6, 12, 24, and 36 months of age. Infants were divided into three birth weight groups: less than 750 g, 750-1000 g, and 1001-1500 g. A significant age and skill interaction was found, with the locomotor and eye-hand skills decreasing consistently over time, and the personal-social and hearing and speech skills initially decreasing and then rising from 12 to 36 months. Infants born at less than 1000 g consistently performed more poorly than those born at 1001-1500 g. Explanations for the variation in scores and the implications of these findings to the evaluation of low birth weight infants are discussed.

Child Development↗
PubMed1987

Treatment of relapsing Clostridium difficile diarrhoea by administration of a non-toxigenic strain.

Two patients with relapsing Clostridium difficile diarrhoea following metronidazole and vancomycin therapy were colonised with a non-toxigenic avirulent Clostridium difficile strain given orally in three doses. Both patients appeared to respond without side-effects. Oral bacteriotherapy with a defined nontoxigenic strain of Clostridium difficile would appear to represent an acceptable, alternative and novel way to treat hospitalised patients who relapse with Clostridium difficile diarrhoea after specific antibiotic therapy.

Aged↗
PubMed1985

Evaluation of heterologous ARS activity in S. cerevisiae using cloned DNA from S. pombe.

Cloned segments of Schizosaccharomyces pombe genomic DNA were screened for ARS activity in the native host, S. pombe, using high frequency transformation, phenotypic instability and extrachromosomal maintenance of unrearranged plasmid sequences as criteria for ARS function. This analysis revealed 12 ARS elements in a total of 230 kb of chromosomal DNA, indicating an average frequency of one ARS every 19 kb of genomic DNA. We then used these clones to assess the reliability of the S. cerevisiae assay for detecting ARS elements in heterologous DNA. The results show that not only does the S. cerevisiae assay fail to detect a large proportion of true ARS elements but it also wrongly identifies a significant proportion of clones which did not display ARS activity in the native host. We would therefore recommend restraint when extrapolating from observed ARS function of heterologous DNA in S. cerevisiae to a presumed analogous role in the original host.

Base Sequence↗
PubMed1985

Diarrhoea due to enterotoxigenic Clostridium perfringens: clinical features and management of a cluster of ten cases.

Clostridium perfringens has recently been shown to be associated with antibiotic-associated diarrhoea. We describe here the clinical features and management of an outbreak of diarrhoea in a Geriatric Unit. Ten cases were due to enterotoxigenic C. perfringens and in these cases there was a highly significant correlation with recent antibiotic administration (P = 0.0001). The importance of early recognition of C. perfringens as a cause of infective diarrhoea in the elderly is stressed.

Aged↗
PubMed1984

Cloning of B cells from autoimmune MRL-lpr/lpr and MRL.xid mice.

The relationship between colony formation (cloning) of B cells and their activation in murine autoimmunity was investigated in MRL-lpr/lpr and MRL.xid mice. Cells from MRL-lpr/lpr mice showed similar requirements for in vitro growth as normal CBA/J and BALB/c cells, with maximal colony formation in the presence of the supporting factors lipopolysaccharide and sheep red blood cells. The frequency of colony-forming cells from MRL-lpr/lpr spleens or hapten-specific B-cell preparations was slightly greater than the two normal control strains, with this difference significant only for a comparison of BALB/c and MRL-lpr/lpr spleens. In contrast, MRL-lpr/lpr mice bearing the xid gene for B-cell immunodeficiency (MRL.xid) had markedly reduced B-cell colony formation. These mice nevertheless expressed anti-DNA antibodies, although at levels reduced from that of MRL-lpr/lpr controls. These results indicate that enhanced in vitro colony formation need not accompany B-cell hyperactivity in murine autoimmune disease and that autoantibody production can occur in mice with impairment in this growth property.

Animals↗
PubMed1983

Hapten-specific murine colony-forming B cells. III. Delineation of functional B cell subpopulations grown under different conditions.

The influence of anti-immunoglobulin M (IgM) and anti-IgD on the ability of fluorescein (FL)-specific B cells to proliferate in a colony-forming assay, and of their progeny to further differentiate in response to different FL-antigens was studied. Splenic FL-specific B cells were purified on FL-gelatin plates and were then cultured in semisolid agar in the presence or absence of anti-mu, and anti-delta, or both. Experiments were performed under conditions of either sheep red blood cell (SRBC)-potentiated or SRBC + lipopolysaccharide (LPS)-potentiated colony growth. The resulting colonies were then tested in secondary filler cell-dependent microcultures for the ability to be triggered by different classes of FL-antigens to yield plaque-forming cells (PFC). Anti-delta inhibited 47% of colony growth under both agar culture conditions. Anti-mu inhibited 55% of colony growth in SRBC + LPS-potentiated agar cultures, and inhibited 72% if only SRBC was present. If anti-delta and anti-mu were added together, inhibition was nearly additive. When anti-Ig-treated colonies were tested for PFC responses against FL-polymerized flagellin (POL), both normal and anti-delta resistant colonies, grown under both agar culture conditions, responded well. Anti-mu resistant colonies were refractory to FL-POL challenge. Only normal or anti-delta resistant colonies grown in SRBC + LPS agar cultures were able to respond well to FL-Ficoll, whereas even normal SRBC-potentiated colonies responded poorly. All except SRBC-potentiated, anti-mu treated colonies were able to respond to nonspecific signals present in cultures containing FL-KLH and activated T cell help. These data suggest that addition of specific anti-Ig antibodies, and variation of agar culture conditions, can select for B cell subpopulations responsive only to certain types of antigens.

Animals↗
PubMed1982

Construction of a Schizosaccharomyces pombe gene bank in a yeast bacterial shuttle vector and its use to isolate genes by complementation.

A gene bank of partial Sau3A restriction fragments of S. pombe DNA has been constructed in the plasmid vector, pDB248', which is capable of high frequency transformation of S. pombe. Procedures are described which enable plasmids to be recovered from S. pombe by their reintroduction into E. coli. These methods have been used to detect the S. pombe genes lys 1+, ade 6+ and his 2+ in the gene bank by complementation of mutant gene functions, and to physically isolate the lys 1+ gene.

Ascomycota↗
PubMed1982

Effect of recent antigen exposure on the functional expression of B cell subpopulations.

We investigated whether the definition of functional B cell subpopulations changes after the exposure of B cells to specific antigen. Recent in vivo priming with fluorescein- (FL) coupled T-independent (TI) antigens leads to an augmentation of the subsequent in vitro responses of B cells to FL-coupled TI antigens, including FL-polymerized flagellin, FL-lipopolysaccharide, and FL-Brucella abortus, as well as a FL-coupled T-dependent (TD) antigen, FL-keyhole limpet hemocyanin (KLH). This effect, which is evident 7 days after priming, is of short duration in that B cells from FL-Ficoll injected mice display normal responsiveness 3 wk after priming. When mice are primed with FL-KLH, the TD antigen, B cells responsive to a subsequent FL-KLH challenge are expanded, but not short-term cross-priming for any of the TI antigen challenges is observed. Limiting dilution precursor analysis shows that B cell populations responding to different FL-coupled TD and TI antigens overlap in unimmunized animals. FL-TI antigen priming induces not only quantitative changes in the responding B cells (increased precursor frequencies) but also results in functional changes in FL-specific B cells. The primed B cells now respond to FL-hapten in a carrier-restricted manner and behave as independent (non-overlapping) subpopulations. We suggest that B cell responses to different forms of the same hapten are influenced in part by their recent "history" of antigenic exposure.

Animals↗
PubMed1981

Prenatal diagnosis for the detection of Down syndrome: why are so few eligible women tested?

Postpartum women greater than or equal to 33 years were interviewed about their attitudes to and knowledge and use of prenatal diagnosis. Overall, 68 per cent had heard of prenatal diagnosis: nevertheless, only 30 per cent of those greater than or equal to 35 had actually been tested. The only significant difference between eligible women who were tested and those who were not was maternal age. Of those tested, half requested it for themselves; conversely, only two thirds of women requesting the procedure actually received it. Among women not tested, 82 per cent were never offered the procedure by the physician. Expressed attitudes to prenatal diagnosis were strongly positive among all women, with 75 per cent continuing to want testing after learning both their age-specific risk of having an affected child and the possible risks of amniocentesis. The data document a potential demand for amniocentesis far in excess of current use and present service facilities. They suggest, moreover, that underuse may reflect professional hesitation and underreferral more than consumer lack of demand or reluctance to be tested.

Adult↗
PubMed1979

Prediction of outcome of patients admitted to a geriatric department.

The reliability of a clinical prognosis of outcome at six weeks has been investigated in a series of 1092 consecutive admissions to a geriatric department. The prognosis was made within a day of admission and made use only of the history and clinical findings. The results for discharge were good but categorization of patients who died or who stayed longer than six weeks was less reliable. Unpredicted deaths were often sudden or related to disease with developed after assessment. Other errors were due to over-optimism in forecasting response to medical treatment or rehabilitation. In other cases progressive deterioration had not been clearly recognized at our assessment based on a single point in time.

Aged↗