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Biomedical subjects

M Sullivan

Publications and source records attributed to M Sullivan.

At least 109 records · Page 6Linked to original sources
PubMed1999

Double pulse transthoracic defibrillation in the calf using percent fibrillation cycle length as spacing determinate.

Recent studies have found that when multiple pulses of energy are used for defibrillation with implantable electrodes, the spacing between these pulses is better determined as a percentage of the fibrillation cycle length (CL), rather than as a fixed function of time. Here, this concept is further tested in the transthoracic defibrillation of calves, which are approximately the size of heavy humans. Eleven 90-110 kg calves (101 +/- 6 kg) were used in evaluating the effectiveness in achieving transthoracic ventricular defibrillation of ten double pulse waveforms (two 50 A 4-ms rectangular monopulses) having leading edge-to-edge spacings of 4 ms (a 50 A 8-ms rectangular monopulse) and 50, 60, 70, 80, 90, 100, 110, 120, 130 percent fibrillation CL, respectively. In each of these waveforms, the total time when 50 A current was flowing (on time) was 8 ms. Our results show an unequivocal adverse interaction between the pulses, when the spacing is around 60%-70% fibrillation CL; but that the two pulses combined to defibrillate as effectively as a single 8-ms pulse when the spacing is around 110%-130% fibrillation CL. Electrocardiographic analysis suggests that the adverse interaction is due to a refibrillation phenomenon. This study confirms that double pulses can interact and have a negative effect on defibrillation efficacy. Our data suggests that the mechanism of this interaction involves the second pulse reinitiating fibrillation when the pulse separation is in a critical range of values. Our results are also compatible with the hypothesis that the spacing of multiple pulses is better determined as a percentage of the fibrillation CL than as absolute time, although more study is necessary to fully test this hypothesis.

Animals↗
PubMed1999

Long term consequences of gastrectomy for patient's quality of life: the impact of reconstructive techniques.

OBJECTIVE: During recent years considerable interest has been focused on quality of life as an additional therapeutic outcome measure in the surgical treatment of gastric carcinoma. However, the long term consequences of gastrectomy and the impact on quality of life of different reconstructive techniques are still a matter of controversy. To broaden the criteria for choice of treatment, we conducted a prospective randomized clinical trial to determine the impact of various gastrectomy procedures on quality of life during a 5-yr follow-up period. METHODS: Consecutive patients (n = 64) eligible for curative gastric cancer surgery were randomized to have either total (n = 31) or subtotal (n = 13) gastrectomy or a jejunal S-shaped pouch (n = 20) as a gastric substitute after total gastrectomy. Assessments of quality of life were made on seven occasions during a 5-yr period: within 1 wk before surgery, 3 and 12 months after the surgical intervention, and then once/yr. All patients were interviewed by one of two psychiatrists, who rated their symptoms and introduced standardized self-report questionnaires covering both general and specific aspects of life. The raters were blinded for the patients' group affiliations. RESULTS: Survival rates were similar in all treatment groups. Patients who had a total gastrectomy continued to suffer from alimentary symptoms, especially indigestion and diarrhea, during the entire follow-up period. However, patients who underwent subtotal gastrectomy had a significantly better outcome already during the first postoperative yr. Patients given a gastric substitute after gastrectomy improved with the passage of time and had an even better outcome in the long run. CONCLUSIONS: To optimize the rehabilitation after gastrectomy, patients' quality of life must be taken into consideration. When subtotal gastrectomy is clinically feasible, this procedure has advantages in the early postoperative period. However, a pouch reconstruction after total gastrectomy should be considered in patients having a favorable tumor status suggesting a fair chance of long term survival.

Aged↗
PubMed1999

Cyclosporin as the sole treatment for anal furunculosis: preliminary results.

Cyclosporin was used, as the sole agent, to treat six cases of anal furunculosis, allowing the clinical response to the drug to be evaluated. The initial dose was 7.5 mg/kg twice a day. Following one week of treatment, whole blood cyclosporin trough levels were measured and the dose was adjusted to obtain a stable trough level of 400 to 600 ng/ml. In all dogs, the lesions were found to follow a similar pattern of resolution throughout the course of treatment. The presenting signs disappeared within one week of treatment, with a reduction in lesion size of 50 to 90 per cent. Lesions then gradually healed over the remainder of the treatment, which lasted from 10 to 20 weeks. One case required cryosurgical treatment to resolve a 2 mm diameter persistent ulcerated lesion following 18 weeks of treatment. The length of follow-up was four to 14 months (mean 7.7 months). One case developed recurrence of the lesions eight weeks post-treatment.

Animals↗
PubMed1999

Subdural injection of contrast medium as a complication of myelography.

In a retrospective evaluation of 654 canine and feline myelograms, 58 were found to have been complicated by injection of the contrast medium into the subdural space. The medium was present predominantly dorsal to the spinal cord, with a sharp dorsal border and an undulating ventral border. Confirmation that this myelographic appearance was due to subdural localisation was achieved using fresh cadavers injected with contrast medium labelled with Indian ink. It was further showed that the dorsal accumulation of contrast medium was due to the denticulate ligaments which restricted the ventral extension of the contrast medium.

Animals↗
PubMed1999

Injury hospitalizations among American Indian youth in Washington.

OBJECTIVE: To determine the rate and causes of hospitalizations for injury among American Indian and Alaska Native (AI/AN) youth in the state of Washington, and to compare this with the rate of hospitalizations for injury among youth of all races. METHODS: Subjects were aged 0-19 years and were admitted to civilian hospitals for care of an injury (International Classification of Diseases N codes 800-995) in Washington between 1990 and 1994. Deaths occurring in the prehospital setting and emergency department are not included. Using several fields of identifying information, the Washington state hospital discharge database was linked with the Indian Health Service (IHS) patient registration database to identify AI/AN youth. Denominator data included the total age specific IHS user population for American Indians and US Census derived population estimates. Incidence ratios (IRs) were calculated to compare rates of hospitalization between AI/AN youth and all youth in Washington. RESULTS: A total of 694 and 29,048 hospitalizations for injury were identified for AI/AN youth and all races, respectively. The rate of hospitalization for injuries among AI/AN youth was 507 discharges per 100,000 youth (IR = 1.30; 95% confidence interval (CI) 1.20 to 1.40. The leading mechanism of injury was motor vehicles (IR 1.73, CI 1.49 to 2.01), followed by falls (IR 0.95, CI 0.79 to 1.15), and poisoning (IR 1.20, CI 0.80 to 1.78). The disparity was greater for intentional injuries (IR 1.71, CI 1.44 to 2.04). The highest IR for all unintentional injuries was for injuries from fire (IR 2.35, CI 1.42 to 3.87). AI/AN children aged 15-19 had the greatest disparity for rates of injury hospitalization (IR 1.4, CI 1.25 to 1.56). CONCLUSION: AI/AN youth in Washington had a higher hospitalization rate for injury compared with all youth in the state. Disparities were greatest for injuries related to motor vehicles and assaults. When linked, hospital discharge data can be used for surveillance of AI/AN hospitalizations.

Adolescent↗
PubMed1999

Examining associations between childhood asthma and traffic flow using a geographic information system.

Using geographic information systems (GIS) and routinely collected data, we explored whether childhood residence near busy roads was associated with asthma in a low-income population in San Diego County, California. We examined the locations of residences of 5,996 children [less than/equal to] 14 years of age who were diagnosed with asthma in 1993 and compared them to a random control series of nonrespiratory diagnoses (n = 2,284). Locations of the children's residences were linked to traffic count data at streets within 550 ft. We also examined the number of medical care visits in 1993 for children with asthma to determine if the number of visits was related to traffic flow. Analysis of the distribution of cases and controls by quintiles and by the 90th, 95th, and 99th percentiles of traffic flow at the highest traffic street, nearest street, and total of all streets within a 550-ft buffer region did not show any significantly elevated odds ratios. However, among cases, those residing near high traffic flows (measured at the nearest street) were more likely than those residing near lower traffic flows to have two or more medical care visits for asthma than to have only one visit for asthma during the year. The results of this exploratory study suggest that higher traffic flows may be related to an increase in repeated medical visits for asthmatic children. Repeated exposure to particulate matter and other air pollutants from traffic exhaust may aggravate asthmatic symptoms in individuals already diagnosed with asthma.

Adolescent↗
PubMed1999

Ethics of assisted suicide and euthanasia.

Nursing's social contract includes respecting and protecting human life. Issues surrounding assisted suicide challenge these ethics, not to mention the legal system.

American Nurses' Association↗
PubMed1998

Identification and characterization of the human homologue of the short PDE4A cAMP-specific phosphodiesterase RD1 (PDE4A1) by analysis of the human HSPDE4A gene locus located at chromosome 19p13.2.

The HSPDE4A gene spans 50 kb, consists of at least 17 exons and is orientated 5'-3', telomere to centromere. It is located at chromosome 19p13.2, being 350 kb proximal to the gene encoding TYK2 and 850 kb distal to the gene encoding the low-density lipoprotein receptor. Its structure is consistent with the production of active 'long' and 'short' isoenzymes as the result of alternative mRNA splicing at two splice junctions. Identified is the single alternatively spliced 5' exon encoding the unique N-terminal region of the long isoenzyme HSPDE4A4B (pde46). The upstream conserved regions, UCR1 and UCR2, which form characteristic domains of PDE4 long forms are each encoded by three exons. The PDE4A-subfamily-specific linker region LR1, which joins UCR1 and UCR2, is encoded by two exons, whereas LR2, which joins UCR2 to the catalytic unit, is encoded by a single exon. Identification of exons encoding an enzymically inactive product of this gene, HSPDE4A8A (2el), indicates that this is an authentic gene product. The 5' exon encoding the unique N-terminal region of the human homologue of the rodent isoform RNPDE4A1A (RD1) was located, and the splice junction used to produce this short PDE4A isoform shown to occur at a different position from that seen in both the rat PDE4B and PDE4D genes. Reverse transcriptase PCR analysis indicates that RD1 homologues are conserved across species, having a conserved membrane-targeting region and a hypervariable LR2 region. Human RD1 was expressed transiently in COS-7 cells and detected as an 83 kDa species primarily associated with the high-speed membrane fraction. Human RD1 exhibited a Km for cAMP of about 3 microM, an IC50 value for inhibition by the PDE4-selective inhibitor rolipram of about 0.3 microM and was considerably more thermostable than rat RD1. Human RD1 was generated as a mature 80 kDa species in an in vitro transcription-translation system and shown to be capable of binding to membranes. Knowledge of the gene structure and the associated sequence information should facilitate analysis of the involvement of PDE4A in hereditary disorders that may result from alterations in enzyme expression, activity, regulation and intracellular targeting and serve as a resource for determining authenticity of cloned PDE4A species.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1998

Intrathoracic tracheal avulsion and pseudodiverticulum following pneumomediastinum in a cat.

A case of tracheal avulsion with pneumomediastinum and pseudodiverticulum formation in a cat is described. Radiographs taken at initial presentation showed a pneumomediastinum with fractures of the right first to sixth ribs. Conservative treatment resolved the pneumomediastinum but following initial improvement the cat developed dyspnoea. Radiography and image intensification at this time showed a tracheal diverticulum at the level of the fourth rib. Surgical resection of the diverticulum and stenotic tracheal ends was performed via a right fourth intercostal lateral thoracotomy. The airway was maintained throughout the procedure using a bridging endotracheal tube. The cat made an unremarkable recovery following surgery.

Anastomosis, Surgical↗
PubMed1998

RNA folding at millisecond intervals by synchrotron hydroxyl radical footprinting.

Radiolysis of water with a synchrotron x-ray beam permits the hydroxyl radical-accessible surface of an RNA to be mapped with nucleotide resolution in 10 milliseconds. Application of this method to folding of the Tetrahymena ribozyme revealed that the most stable domain of the tertiary structure, P4-P6, formed cooperatively within 3 seconds. Exterior helices became protected from hydroxyl radicals in 10 seconds, whereas the catalytic center required minutes to be completely folded. The results show that rapid collapse to a partially disordered state is followed by a slow search for the active structure.

Animals↗
PubMed1998

Malnutrition and food intake in relation to quality of life in head and neck cancer patients.

BACKGROUND: The quality of life (QL) of cancer patients has attracted an increasing interest in recent years. Patients with head and neck cancer often have troublesome symptoms due to the disease and to treatment side effects, which will have an impact on the patient's QL. The aim of this study was to evaluate the possibility of studying QL in relation to well-known clinical parameters. METHODS: Patient's QL was evaluated according to the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) combined with a diagnosis-specific questionnaire. Quality of life was measured in a cross section of head and neck cancer patients (n = 48) and related to nutritional status, energy intake, severity of disease, and 2-year survival. RESULTS: Fifty-one percent of the patients (mean age, 67 years) fulfilled the criteria proposed for malnutrition, and 55% had a negative energy balance. We did not find any correlation between the severity of the cancer disease and the patient's self-rated QL. However, we found significantly better QL ratings among the 2-year survivors (mean, 63; range 52-76 versus mean, 42; range, 31-54; p < .05). There were few correlations between the QL items and malnutrition. CONCLUSIONS: Quality of life measurements offer objective information on well-being, sometimes quite opposite that of other clinical parameters, such as tumor stage. Furthermore, QL measurements may be of prognostic value concerning the survival of head and neck cancer patients.

Adult↗
PubMed1998

Obturator prostheses after cancer surgery: an approach to speech outcome assessment.

PURPOSE: This article describes a speech assessment protocol for patients using either obturator prostheses or speech aid prostheses for surgically acquired defects due to cancer of the maxilla and/or soft palate. METHODS: This protocol is structured according to the executive summary of "Disability in America: Toward a National Agenda For Prevention" a report formulated by the Institute of Medicine that describes four levels of disorder: (1) pathology, (2) impairment, (3) functional limitation, and (4) disability. Assessment instruments included (1) the Sentence Intelligibility Test to measure the rate and understandability of speech, (2) a speech physiology system to measure appropriate separation of the nasal/nasopharyngeal and oral compartments, (3) a 13-point interval scale to rate speech nasality, and (4) a scale to rate self-perceptions of communication effectiveness. RESULTS: The results from two patients are reported to illustrate the outcome assessment protocol.

Disability Evaluation↗
PubMed1998

Following the folding of RNA with time-resolved synchrotron X-ray footprinting.

The rapid mixing synchrotron X-ray footprinting technique described in this article allows nucleic acid folding and ligand binding reactions to be followed on a millisecond time resolution with single nucleotide resolution. In principle, the change in .OH protection of every nucleotide in a nucleic acid hundreds of nucleotides long can be monitored separately. In addition, a wide range of solution conditions are compatible with the radiolytic generation of .OH. These characteristics of synchrotron X-ray footprinting create opportunities for conducting thermodynamic and kinetic studies of nucleic acids that are both comprehensive and detailed. Kinetic footprinting studies of a number of systems have been initiated by the Center for Synchrotron Biosciences using this technique.

Flow Injection Analysis↗
PubMed1998

The need to redefine the practice of health promotion in the United Kingdom.

It is argued that since the late 1970s the practice of health promotion within the UK has become, at least in part, bound up with the ideological bias of Conservative political thinking. The shift in political thought that occurred with the advent of Thatcherism, a shift characterised by individualism as opposed to collectivism and consensus politics of earlier decades, has heralded a belief in the paramount importance of the responsibility of the individual for maintaining a healthy lifestyle. This strategy fails to consider the social, cultural, and economic context within which individuals find themselves over which little or no control can be exercised. A politicisation of the concept of health promotion has thus taken place which has placed the emphasis on the over-riding responsibility of the individual for his or her health. Such a selective approach to health is inefficient. It is further argued that a purely structuralist perspective, one that negates the influence of the individual, is equally inefficient. If the new Labour administration is to promote the population's health to any more effective manner it must be recognised that while the individual does have a distinct role to play in his or her own health, that individual must also be considered within his or her social, cultural and economic context. An holistic approach to promoting the health of the population must be multi-factorial acknowledging the influence of social, cultural, economic and medical factors, as well as the role of the individual.

Attitude to Health↗
PubMed1998

An audit of patient acceptance of one-stop diagnosis for symptomatic breast disease.

AIMS: The impetus for optimizing outpatient provision of breast-care services has come both from the patient and management in order to reduce anxiety and make full use of scarce resources. The one-stop diagnostic clinic for the investigation of symptomatic breast lesions is a relatively recent concept with well-known service benefits. However, acceptance to the patient has not been previously investigated. RESULTS: The results of this prospective audit demonstrate a high level of patient satisfaction with the multi-disciplinary, one-stop breast clinic.

Ambulatory Care↗