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Biomedical subjects

N McLean

Publications and source records attributed to N McLean.

At least 19 recordsLinked to original sources
PubMed2005

Multidisciplinary management of Opitz G BBB syndrome.

Opitz G BBB syndrome is a rare condition characterized by the 3 major anomalies of hypertelorism, cleft lip and palate, and hypospadias, although there may be other associated anomalies. The underlying genetic causes are complex and consist of both X-linked recessive and autosomal dominant forms of the disorder. Previously, there have been publications on the underlying genetics and case reports, but there have been few reports regarding the long-term outcome. The aim in this study was to review the range of clinical presentation and evaluate outcomes of the multidisciplinary management of a cohort of patients with Opitz G BBB syndrome. In a 25-year period, 7 patients with Opitz G BBB syndrome were managed by the Australian Craniofacial Unit (ACFU), 5 male and 2 female. Most of the patients are now reaching skeletal maturity. Each one presented with a range of severity in the triad of hypertelorism, cleft lip and palate, and hypospadias anomalies. The males all exhibited the triad of anomalies, while the females both had hypertelorism, only 1 had isolated cleft palate, and neither had any genitourinary anomalies. Each patient underwent multidisciplinary assessment to make a treatment plan for staged management of different anomalies. Plan for surgical corrections of facial anomalies were performed according to the unit's protocol management of both hypertelorism and cleft lip and palate, but the presence of these coexisting anomalies required adjustment of the standard protocol of management of cleft lip and palate. In conclusion, we recommend that patients with Opitz G BBB syndrome require careful evaluation, and management of the anomalies should be in a coordinated manner by a multidisciplinary team.

Abnormalities, Multiple↗
PubMed2003

Family involvement in weight control, weight maintenance and weight-loss interventions: a systematic review of randomised trials.

OBJECTIVE: To conduct a descriptive systematic review into the nature and effectiveness of family involvement in weight control, weight maintenance and weight-loss interventions. METHOD: We searched Medline and Psyclit for English language papers describing randomised trials with at least 1-y follow-up that evaluated interventions incorporating a family-based component. Studies involving people with eating disorders, learning disabilities and undernutrition or malnutrition were excluded. Data were extracted on characteristics of the participants, study design, target behaviours, nature of the intervention and study outcomes. A taxonomy was developed and used to classify family involvement in behaviour change interventions. Interventions were also classified according to an existing taxonomy that characterised the behaviour change techniques employed. RESULTS: A total of 21 papers describing 16 intervention studies were identified. Studies were small (mean sample size: 52), heterogeneous, poorly described but with few losses to follow-up (median 15%). The majority were North American and aimed at weight loss. Few studies described a theoretical underpinning to the behaviour change techniques employed. There was a suggestion that spouse involvement increased effectiveness but that adolescents achieved greater weight loss when treated alone. In studies including children, beneficial effects were seen when greater numbers of behaviour change techniques were taught to both parents and children. CONCLUSION: Relatively few intervention studies exist in this important area, particularly studies targeting adolescents, and they highlight continued uncertainty about how best to involve family members. The studies provide limited support for the involvement of spouses. They suggest that parental involvement is associated with weight loss in children, and that use of a greater range of behaviour change techniques improves weight outcomes for both parents and children. The development of future interventions and assessment of factors influencing effectiveness may be improved by paying careful attention to which family members are targeted and how they are involved in the intervention in terms of setting goals for behaviour change, providing support and training in behaviour change techniques.

Adolescent↗
PubMed2002

Elite athletes: effects of the pressure to be thin.

This study represented the first attempt to examine the prevalence of eating disorders in a large sample of both male and female elite athletes compared to a matched control group of non-athletes. The subjects were 263 Australian elite athletes representing a variety of sports, and 263 non-athletes. All subjects were interviewed using the Composite International Diagnostic Interview and completed a number of self-report questionnaires. Both male and female athletes competing in sports that emphasise a lean body shape or a low body weight evidenced a significantly higher prevalence of eating disorders and eating disorder symptoms than other athletes and non-athletes. The results suggest that athletes do, in fact, have a higher prevalence of eating disorders than non-athletes. However, it is not so much being an athlete that places an individual at increased risk for developing an eating disorder; rather it is athletes competing in sports which emphasise the importance of a thin body shape or a low body weight who appear to be particularly vulnerable.

Adolescent↗
PubMed2001

Eating disorders in athletes: a review of the literature.

Over the last two decades an increasing amount of research has begun to examine the issue of eating disorders in athletes. While a number of studies in this area have been published, the results have not been able to clarify the nature of the relationship between athletic involvement and eating problems. This review critically evaluates existing studies of eating disorders in athletes, highlighting various methodological limitations. Studies are grouped under three main headings: uncontrolled studies; controlled studies; and studies comparing athletes with different body type requirements. A fourth section of the paper evaluates studies which have addressed the issue of gender differences in eating disorders among athletes. Suggestions are made for guidelines that will improve future research in this area.

Adolescent↗
PubMed2001

Melatonin is useful for recording sleep EEGs: a prospective audit of outcome.

The study aimed to determine if melatonin could reliably induce sleep in children undergoing sleep EEG without affecting the usefulness of the EEG itself. One hundred and sixty three children (112 males, 51 females; mean age 8 years, range 1 to 16 years) referred for sleep EEG were studied. The children were given 2 to 10 mg of melatonin, depending on age, just before EEG recording. Measurements included sleep-onset latency, adverse effects, and acceptability of the EEG. Usefulness and acceptability of melatonin-induced sleep EEG were compared with the standard technique of sleep EEG following sleep deprivation in 30 children (matched for sex and age). Sleep was obtained in 79% of the 163 children who received melatonin after an average of 33 minutes. Yield of epileptiform abnormalities demonstrated in the melatonin sleep EEG was similar to that reported in the literature for sleep-deprived EEGs. There was no significant adverse effect. When compared, a melatonin-induced sleep EEG was as useful as a sleep-deprived EEG. However, the children's behaviour on the day of the melatonin-induced sleep EEG recording was more acceptable to parents.

Antioxidants↗
PubMed2001

Local lung responses following local lung challenge with recombinant lungworm antigen in systemically sensitized sheep.

BACKGROUND: Chronic mast cell-mediated inflammation may contribute significantly towards the extensive tissue remodelling that is a feature of lungworm infection in ruminants. Understanding the factors that control tissue remodelling is a necessary step toward effective management and treatment of conditions that feature such pathology. OBJECTIVE: We sought to define in a novel ovine model system, the cellular, immune and mast cell phenotypic events that occur following local lung challenge with a recombinant protein antigen, DvA-1, derived from the ruminant lungworm nematode, Dictyocaulus viviparus. METHODS: Two spatially disparate lung segments in systemically sensitized sheep were challenged on three occasions with DvA-1 (3xDVA) and two further segments were challenged with saline (3xSAL). Two months after the third challenge, one of the two segments previously repeatedly challenged with DvA-1 was challenged again with DvA-1 (3xDVA:DVA) whilst the other was challenged with saline (3xDVA:SAL). A similar protocol was followed with the saline challenged segments (3xSAL:SAL and 3xSAL:DVA). Bronchoalveolar lavage fluid (BALF) (n = 16) and tissue (n = 3) were collected after the last challenge. RESULTS: Cellular changes 24 h after the fourth challenge were characterized by an increase in the absolute numbers of neutrophils and eosinophils in BALF from 3xDVA:DVA and 3xSAL:DVA segments. Local antibody production was implied through increased levels of antibody in both 3xDVA:DVA and 3xDVA:SAL segments, with the latter being unaffected by inflammation. Levels of active transforming growth factor beta-1 (TGF-beta(1)) were significantly increased in 3xDVA:SAL segments and a trend towards an increase was apparent in 3xDVA:DVA segments. Total TGF-beta1 levels were significantly correlated with eosinophil counts in all except the 3xDVA:SAL segments. Such changes in the bronchoalveolar space were complemented by increased ratios of sheep mast cell proteinase-1 expressing cells and tryptase expressing cells, to toluidine blue positive cells in airways from 3xDVA:DVA segments. CONCLUSION: Mast cell phenotypic events occurring as a consequence of antigen challenge were limited to segments in which changes in BALF were characterized by neutrophil influx and increased local antibody production.

Animals↗
PubMed1998

Current perspectives on anabolic steroids.

Steroids are used outside the realm of competitive athletics in Australia among a wide variety of groups with different motivations and goals. This paper provides an overview of the reasons for use; rates of usage; physical and psychological side effects; and sources of steroids. Issues associated with injecting steroids; their current legal status; and drug education and prevention programmes are reviewed briefly. Research involving identified sub-populations is needed to determine user profiles and prevalence rates of users and potential users. Studies of Australian users are also needed to obtain baseline information on areas of potential harm associated with steroids use, e.g. aggressive behaviour, needle-sharing behaviour, physical side effects and potential for dependency. It is concluded that future deterrence strategies should focus more on demand reduction, rather than supply.

Journal Article↗
PubMed1995

MRI T staging of squamous cell carcinoma of the oral cavity: radiological-pathological correlation.

Fifty patients with primary or suspected recurrent squamous cell carcinoma of the oral cavity were examined pre-operatively with magnetic resonance imaging (MRI) to determine the tumour stage. Pathological correlation was available in all cases. Twenty-five of 35 patients with primary disease were correctly staged (MR Tstage 0-4). In another four patients there was good size correlation between MR and pathology, but two cases had false positive MR interpretation of bone invasion. MRI has proved accurate at excluding the presence of bone invasion (negative predictive value 97%), but a positive scan may not discriminate between tumour and other dental pathology (positive predictive value 67%). Assessment of local extent was otherwise good with invasion of muscles of the floor of the mouth and muscles of mastication always predicted correctly. Salivary gland abnormality was frequent, and MRI correctly distinguished between obstructive sialectasis and direct invasion. The results of MR staging in patients with recurrent disease were less accurate. Where diagnostic scans can be obtained MRI can provide useful information for the surgeon or radiotherapist regarding the local extent of tumour, and may assist in treatment planning. Assessment of cervical lymphadenopathy can be performed as part of same procedure.

Adult↗
PubMed1994

Tyrosine kinase activity, cytoskeletal organization, and motility in human vascular endothelial cells.

Tyrosine phosphorylation of cytoskeletal proteins occurs during integrin-mediated cell adhesion to extracellular matrix proteins. We have investigated the role of tyrosine phosphorylation in the migration and initial spreading of human umbilical vein endothelial cells (HUVEC). Elevated phosphotyrosine concentrations were noted in the focal adhesions of HUVEC migrating into wounds. Anti-phosphotyrosine Western blots of extracts of wounded HUVEC monolayers demonstrated increased phosphorylation at 120-130 kDa when compared with extracts of intact monolayers. The pp125FAK immunoprecipitated from wounded monolayers exhibited increased kinase activity as compared to pp125FAK from intact monolayers. The time to wound closure in HUVEC monolayers was doubled by tyrphostin AG 213 treatment. The same concentration of AG 213 interfered with HUVEC focal adhesion and stress fiber formation. AG 213 inhibited adhesion-associated tyrosine phosphorylation of pp125FAK in HUVEC. Tyrphostins AG 213 and AG 808 inhibited pp125FAK activity in in vitro kinase assays. pp125FAK immunoprecipitates from HUVEC treated with both of these inhibitors also had kinase activity in vitro that was below levels seen in untreated HUVEC. These findings suggest that tyrosine phosphorylation of cytoskeletal proteins may be important in HUVEC spreading and migration and that pp125FAK may mediate phosphotyrosine formation during these processes.

Catechols↗
PubMed1992

A physical approach to the rehabilitation of patients disabled by chronic low back pain.

OBJECTIVE: To report the outcome of a multidisciplinary physically based program to treat sufferers of chronic low back pain who had not responded to previous treatment. DESIGN: Prospective intervention study. SETTING: The treatment program was conducted at the private practice of Brian C Edwards and Associates Rehabilitation Centre. PATIENTS: A total of 54 patients participated in the treatment program. All patients were medically referred. No specific exclusion criteria were used; however, all were not working and had not responded to previous treatment. INTERVENTION: The rehabilitation program consisted of mobilising physiotherapy, isokinetic testing, physical reconditioning, work hardening and psychological testing. This was carried out for seven hours a day, five days a week for four weeks. RESULTS: Of the 54 patients taking part in this trial 30 (55%) were successfully rehabilitated (returned to work) and remained so at a follow-up session one year later. CONCLUSION: While selection criteria for successful rehabilitation have not been established, the results do indicate that such physical rehabilitation programs have an important part to play in the rehabilitation of sufferers of chronic low back pain.

Adult↗
PubMed1990

Omental transfer in acute and chronic sternotomy wound breakdown.

Median sternotomy is complicated by deep infection in 1-5% of cases. Internal mammary artery grafting (especially bilateral) may increase incidence and severity. Mediastinitis accompanied by sternal necrosis has a reported mortality up to 30%. The defect resulting from removal of dead bone requires reconstruction and skin cover. Twelve patients are presented in whom this defect was abolished by omental transposition. There were no deaths. Seven had chronically infected wounds (median time to operation 100 days) with very large defects following multiple debridements resulting in total sternectomy; these were treated by omental transposition and meshed split-skin grafting. Five were treated 'acutely' (median time to operation 28 days p less than 0.02) using smaller omental flaps and direct myocutaneous closure, despite total sternectomy being required in 4. One was bleeding from an infected aorto-saphenous anastomosis following povidone-iodine irrigation. Median total hospital stay in the acute group was 49 vs. 82 days in the chronic group (p less than 0.01) who also had 4 major complications (p NS). All wounds healed but further surgery was required to stabilise the chest wall in 1 of the 'Chronic' group. It is concluded that for severe sternal infection early radical removal of necrotic tissue, omental transposition, and direct closure reduces morbidity and hospital stay. In one patient bleeding from a septic aortic erosion we consider the procedure to have been life-saving.

Aged↗
PubMed1978

Unusual aggregations of tubules associated with endoplasmic reticulum in digestive cells of Alderia modesta (Mollusca: Gastropoda: Sacoglossa).

Aggregations of cylindriform tubules closely packed in a hexagonal arrangement and associated with the rough-surfaced endoplasmic reticulum (RER) are described in cells of the digestive gland of a sacoglossan gastropod. Each tubule is approximately 61 nm in outer diameter and the central lumen is lined with a layer of finely granular material. The tubule wall is composed of approximately 22 dense subunits. Adjacent tubules are associated with a pair of indistinct granules. Membranes of the RER frequently join the aggregations. The lumen of a tubule may be continuous either with the intracisternal space of the RER or with the cytoplasmic matrix of the cell. It is suggested that the aggregations of tubules are elaborations of the endoplasmic reticulum.

Animals↗
PubMed1975

Hyperthermic perfusion of the distended urinary bladder in the management of recurrent transitional cell carcinoma.

The clinical and histological changes following hyperthermic perfusion of the distended urinary bladder have been studied in 13 patients with transitional cell carcinoma, persistent after radical radiotherapy. Continuous epidural anaesthesia was necessary to achieve a constant state of bladder relaxation during irrigation of the distended bladder. This form of hyperthermic perfusion of the bladder was effective in arresting uncontrollable haemorrhage from bladder tumours and may be of value in the treatment of this complication. Perfusion at an outflow temperature of 44 degrees C for 4 hours caused tumour necrosis. It was, however, associated with damage to the vasculature of the bladder and frequency of micturition which persisted after mucosal recovery. Perfusion at 43 degrees C also caused tumour necrosis and the after effects were less severe.

Carcinoma, Transitional Cell↗