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Biomedical subjects

P Cooper

Publications and source records attributed to P Cooper.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy.

BACKGROUND: Non-cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting. AIMS: This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina-like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory. PATIENTS AND METHODS: Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication. RESULTS: Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores. CONCLUSION: Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.

Anxiety↗
PubMed2006

Platelet-derived growth factor (PDGF) isoform and PDGF receptor expression in drug-induced gingival overgrowth and hereditary gingival fibrosis.

OBJECTIVE: To investigate possible associations between platelet-derived growth factor (PDGF), PDGF receptor expression and macrophages in drug-induced and hereditary gingival overgrowth. MATERIALS AND METHODS: Tissues from patients with drug-induced gingival overgrowth (DIGO) (n = 10) and hereditary gingival fibrosis (n = 10) were studied and compared with 'control' gingiva (n = 10). Expression of PDGF and its alpha and beta receptors was investigated immunohistochemically and by RT-PCR. Macrophages were identified by immunostaining for CD68. RESULTS: PDGF isoforms and receptors were detected in most cells within all specimens. There were no differences in the numbers of macrophages, or fibroblasts expressing PDGF or receptors, between groups. The level of PDGF expression by fibroblasts, determined by absorbance measurements, was similar between groups for PDGF A. Significantly lower levels of total PDGF and the receptors were detected in drug-induced overgrowth compared to those in hereditary fibrosis (P < 0.004) and control specimens (P < 0.034). All specimens expressed mRNA for PDGF A, PDGF B and alpha and beta receptors. CONCLUSIONS: These data do not support a pivotal role for macrophage-derived PDGF B in the pathogenesis of DIGO. They suggest that fibroblasts in drug-induced lesions have a lowered capacity to produce, and respond to, PDGF, a property not shared by fibroblasts associated with hereditary fibrosis.

Adolescent↗
PubMed2006

Absorption characteristics of EC-MPS--an enteric-coated formulation of mycophenolic sodium.

UNLABELLED: Enteric-coated mycophenolate sodium is an advanced formulation delivering mycophenolic acid (MPA), designed to improve MPA-related upper gastrointestinal adverse events by delaying MPA release until the small intestine. OBJECTIVE: Two studies were undertaken to identify the absolute bioavailability and dose-proportionality of enteric-coated mycophenolate sodium in stable renal transplant patients receiving cyclosporine. METHODS: Study 1: The mean MPA AUC(0-t) was shown to be greater after MPA infusion than after oral enteric-coated mycophenolate sodium (42.1 vs. 28.9 microg x h/ml). Mean absolute bioavailability was 0.71 +/- 0.21 (SD). Study 2: The AUC(0-t) and C(max) for MPA were proportional to the dose of enteric-coated mycophenolate sodium, similarly mean AUC(0-infinity) and C(max) for MPA glucuronide were proportional to dose administered. RESULTS AND CONCLUSIONS: In patients receiving cyclosporine the absolute bioavailability of MPA provided by enteric-coated mycophenolate sodium is equivalent to that provided by mycophenolate mofetil when administered in combination with cyclosporine, and exhibits dose-proportionality. Enteric-coated mycophenolate sodium was well tolerated from 180 - 2,160 mg with no serious adverse events reported.

Administration, Oral↗
PubMed2006

Phototherapy and exchange transfusion for neonatal hyperbilirubinaemia: neonatal academic hospitals' consensus guidelines for South African hospitals and primary care facilities.

The purpose of this document is to address the current lack of consensus regarding the management of hyperbilirubinaemia in neonates in South Africa. If left untreated, severe neonatal hyperbilirubinaemia may cause kernicterus and ultimately death and the severity of neonatal jaundice is often underestimated clinically. However, if phototherapy is instituted timely and at the correct intensity an exchange transfusion can usually be avoided. The literature describing intervention thresholds for phototherapy and exchange transfusion in both term and preterm infants is therefore reviewed and specific intervention thresholds that can be used throughout South Africa are proposed and presented graphically. A simplified version for use in a primary care setting is also presented. All academic heads of neonatology departments throughout South Africa were consulted in the process of drawing up this document and consensus was achieved.

Bilirubin↗
PubMed2005

The performance of vertical flow constructed wetland systems with special reference to the significance of oxygen transfer and hydraulic loading rates.

The paper reviews the development of the vertical flow (VF) reed beds/constructed wetlands over the past 20 years. The performance of VF systems (and their use within hybrid systems) is analysed by reference to a number of brief case studies. The oxygen transfer rate (OTR) achieved is absolutely critical to the sizing of the systems. The author reviews the reported OTRs and comments on the existing design equations proposed for calculation of the area of beds. The 1st generation of VF systems used a set of parallel beds that were dosed one at a time in rotation and then rested for a period of days because there was considerable concern (based on early experience) that they would become clogged. In the past 10 years a number of new designs of 2nd generation VF beds have been built which make use of a single bed and hence operate without any resting periods. The hydraulic loading rate and the selection of the bed media, which are critical to the design and hence successful operation of these 2nd generation compact VF beds, are described. It is now possible to produce a very high quality of effluent from VF beds alone sized at 2 m2/pe when treating domestic sewage.

Biodegradation, Environmental↗
PubMed2005

Factors affecting the longevity of sub-surface horizontal flow systems operating as tertiary treatment for sewage effluent.

Compared with other forms of domestic wastewater treatment, reed beds require very little in the way of operational and maintenance input. This is even more markedly the case with tertiary treatment systems (than with secondary treatment systems) where the necessary maintenance amounts to only a few days/year. Unfortunately, in practice this frequently results in them receiving little or no attention at all. Tertiary treatment reed beds are not a "fit and forget" solution but they are often treated this way because they are very forgiving and abuse-tolerant. After a number of years a few of these tertiary reed beds have deteriorated to an extent whereby they are close to failing to comply with the regulator's requirements. Severn Trent Water Ltd has recognised this situation and has committed a budget for a programme of reed bed maintenance. This work has started with a survey of the condition of their beds and particularly to determine the common problems and hence the maintenance regime required. Five main problems occurred either singly or in combination namely: (a) sludge deposition; (b) above surface flooding (partially caused by (a), (c), and (d)); (c) inlet flow distributor problems/clogging; (d) outlet collector problems/incorrect level; (e) weed infestation.

Biodegradation, Environmental↗
PubMed2004

Delineation of brain metastases on CT images for planning radiosurgery: concerns regarding accuracy.

Conformal radiotherapy requires confidence that the images used for target delineation accurately reflect the pathological dimensions of the target. Radiosurgery, which is a conformal radiotherapy technique, is often used to treat brain metastases. The images of brain metastases can be affected by the method of image acquisition. A prospective study was undertaken to evaluate the effect of delay on CT images of brain metastases selected for radiosurgical treatment. A median delay from contrast administration of 65 min resulted in an increase in the volume of the metastases in 86% of cases when compared with the volumes of the same metastases determined from CT images acquired immediately following the administration of contrast medium. The magnitude of the increase in volume was sufficient to cause radiosurgery planners to select larger collimator sizes for radiosurgery plans based on the delayed CT images in 92% of cases. No significant intraobserver or interobserver variation was found in the group of radiosurgery planners. Differences in image acquisition may account in part for the differences in local control reported in the radiosurgical treatment of brain metastases.

Brain Neoplasms↗
PubMed2003

Mental health of parents caring for infants.

The postpartum period is a sensitive time due to the presence and demands of the developing infant. The care provided by a mother to her infant during this period may be compromised if she is suffering from postnatal depression or postpartum psychosis. Evidence has been emerging which suggests that postnatal depression and postpartum psychoses have adverse effects on the quality of the mother-infant relationship and also on the infant's subsequent cognitive and emotional development. Presented is a review of the literature relating to how these conditions impact on parenting and infant outcomes, what measures are in place to detect these conditions and evidence-based models of best clinical practice are proposed.

Adult↗
PubMed2003

Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome.

BACKGROUND: We have previously shown that hypnotherapy alters rectal sensitivity in some patients with irritable bowel syndrome. However, this previous study used incremental volume distension of a latex balloon, which might be susceptible to subject response bias and might compromise the assessment of compliance. In addition, the study group was symptomatically rather than physiologically defined. AIM: To assess the effect of hypnotherapy on rectal sensitivity in hypersensitive, hyposensitive and normally sensitive irritable bowel syndrome patients using a distension technique (barostat) that addresses these technical issues. METHODS: Twenty-three irritable bowel syndrome (Rome I) patients (aged 24-72 years) were assessed before and after 12 weeks of hypnotherapy in terms of rectal sensitivity, symptomatology, anxiety and depression. Normal values for sensitivity were established in 17 healthy volunteers (aged 20-55 years). RESULTS: Compared with controls, 10 patients were hypersensitive, seven hyposensitive and six normally sensitive before treatment. Following hypnotherapy, the mean pain sensory threshold increased in the hypersensitive group (P = 0.04) and decreased in the hyposensitive group, although the latter failed to reach statistical significance (P = 0.19). Normal sensory perception was unchanged. Sensory improvement in the hypersensitive patients tended to correlate with a reduction in abdominal pain (r = 0.714, P = 0.07). CONCLUSION: Hypnotherapy improves abnormal sensory perception in irritable bowel syndrome, leaving normal sensation unchanged.

Abdominal Pain↗
PubMed2003

Ketogenic diet for epilepsy.

BACKGROUND: The ketogenic diet is a diet high in fat but low in carbohydrate and it is suggested that this diet reduces seizure frequency. Currently, this diet is used mainly for children who continue to have seizures despite treatment with antiepileptic drugs. OBJECTIVES: To overview the evidence from randomized controlled trials regarding the effects of ketogenic diets. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trials register (26 March 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003) and EMBASE (1980 to March 2003). SELECTION CRITERIA: Randomized controlled trials of ketogenic diets for people with epilepsy. DATA COLLECTION AND ANALYSIS: We planned for two reviewers to independently apply inclusion criteria and extract data. MAIN RESULTS: No randomized controlled trials were found. REVIEWER'S CONCLUSIONS: There is no reliable evidence from randomized controlled trials to support the use of ketogenic diets for people with epilepsy. There are large observational studies, some prospective, suggesting an effect on seizures. These effects need validating in randomized controlled trials. For those with a difficult epilepsy on multiple antiepileptic drugs, we consider the ketogenic diet a possible option.

Child↗
PubMed2003

Tracheomalacia, timing of symptoms, and thymic enlargement: cause or coincidence?

The authors report a case of severe primary tracheomalacia in a 3-month-old boy. The left lobe of the enlarged thymus was resected at operation to facilitate aortopexy. The authors suggest a possible role for the enlarging thymus contributing to the delayed onset of the symptoms of tracheomalacia, despite the presence of the tracheal lesion from birth.

Humans↗
PubMed2002

Indexing artefacts using a tertiary collimator and a method to avoid them.

A tertiary, slotted grid collimator has been proposed as a method by which the spatial resolution of radiation fields shaped using a multileaf collimator (MLC) may be improved. The prototype device previously reported in the literature allowed each slot in the grid to be aligned with each pair of opposing leaves in the MLC. Irradiation through the collimator resulted in a regular pattern of high dose strips, with the width of each strip defined by the width of the slot and the length by the relative separation of the MLC leaf pair. To complete the field, the patient must be indexed relative to the collimator, with the number of sub-fields required determined by the width of the slots and the spacing between them. This indexing is achieved by rotation of the collimator along a radius centred on the radiation source, thus avoiding the effects of beam divergence on the uniformity of delivered composite beams. However, rotation of the tertiary collimator has been shown to result in artefacts in field definition. The source of such artefacts is the proximity of the long edge of a slot to the junction between two MLC leaves, if one leaf is withdrawn with respect to the next. A simple cause for such artefacts was identified as a small misalignment between the slot edge and the leaf junction. Another source of such effects is the finite size of the radiation source, which allows for partial shielding effects beyond the leaf edge. Finally, the effect of the leaf edge penumbra was identified as the cause of potential areas of underdose within the field boundary. Measurements were performed using a mini-diode of the potential magnitude of the last two effects for slot widths of 2.5 and 5.0 mm beneath a single open MLC leaf. For both slot widths, the unwanted overdose due to partial shielding by neighbouring leaves did not exceed 8% of the dose with the slot at the centre of the single open leaf. The potential for underdose within the field was a much more significant effect, especially for the narrower slot, with the peak intensity through the 2.5 mm slot positioned just inside the open leaf only reaching 41% of that measured with it positioned centrally. Such an arrangement of slots and leaves is unavoidable if the separation between neighbouring slots is identical to that of the MLC leaves (1 cm at isocentre). An alternative arrangement is proposed, and has been demonstrated to avoid the generation of the artefacts detailed above.

Artifacts↗
PubMed2002

cDNA cloning of a salivary chymotrypsin-like protease and the identification of six additional cDNAs encoding putative digestive proteases from the green mirid, Creontiades dilutus (Hemiptera: Miridae).

RT-PCR with degenerate primers was used to amplify partial cDNA fragments for one serine protease gene and three cysteine protease genes from poly(A) RNA isolated from the midgut of the green mirid, Creontiades dilutus. The serine protease amplicon showed homology to insect trypsin-like protease genes, and all three cysteine protease amplicons showed homology to cathepsin L-like protease genes.RT-PCR was also used to amplify fragments of three serine protease genes from salivary gland poly(A) RNA. One of these salivary gland serine protease amplicons was used to screen a whole organism cDNA library to isolate a full length cDNA clone, designated CdSp1 (Accession AY055753), which encodes a putative chymotrypsin-like protease. CdSp1 codes for a 293 amino acid protein that contains a signal peptide and activation peptide, as well as the catalytic triad present in all serine proteases and several of the binding pocket residues characteristic of chymotrypsins. In situ hybridisation showed that the transcript is expressed in the posterior lobe of the principal salivary gland, but not in the anterior lobe of the principal salivary gland, the accessory salivary gland or the midgut.

Amino Acid Sequence↗
PubMed2002

Paediatric flexible bronchoscopy.

Flexible bronchoscopy is an emerging diagnostic, therapeutic and supportive procedure used in paediatric respiratory medicine. Despite the improvements in instruments and anaesthetic support for this procedure, supervised training, strict quality-control measures and ongoing research are essential to ensure standards of safe practice and judicial use of the procedure.

Anesthesia↗
PubMed2002

Visceral sensation and emotion: a study using hypnosis.

BACKGROUND AND OBJECTIVES: We have previously shown that hypnosis can be used to study the effect of different emotions on the motility of the gastrointestinal tract. These studies demonstrated that both anger and excitement increased colonic motility while happiness led to a reduction. The purpose of this study was to investigate the effect of hypnotically induced emotion on the visceral sensitivity of the gut. METHODS: Sensory responses to balloon distension of the rectum and compliance were assessed in 20 patients with irritable bowel syndrome (IBS) (aged 17-64 years; 17 female) diagnosed by the Rome I criteria. Patients were studied on four separate occasions in random order either awake (control) or in hypnosis, during which anger, happiness, or relaxation (neutral emotion) were induced. RESULTS: Hypnotic relaxation increased the distension volume required to induce discomfort (p=0.05) while anger reduced this threshold compared with relaxation (p<0.05), happiness (p<0.01), and awake conditions (p<0.001). Happiness did not further alter sensitivity from that observed during relaxation. There were no associated changes in rectal compliance or wall tension. CONCLUSIONS: Further to our previous observations on motility, this study shows that emotion can also affect an IBS patient's perception of rectal distension and demonstrates the critical role of the mind in modulating gastrointestinal physiology. These results emphasise how awareness of the emotional state of the patient is important when either measuring visceral sensitivity or treating IBS.

Adolescent↗
PubMed2001

Preliminary characterisation of digestive proteases of the green mirid, Creontiades dilutus (Hemiptera: Miridae).

Protease activities in the secreted saliva, salivary glands and midgut of the green mirid, Creontiades dilutus, were investigated. The saliva and salivary glands had more protease activity than the midgut, but no differences in protease activity levels were detected between male and female mirids, adult mirids and third instar nymphs, or between fed and starved mirids. In the salivary glands, chymotrypsin-like serine proteases predominated, as characterised by inhibitor specificity, basic pH optima, and hydrolysis of N-benzoyl-L-tyrosine p-nitroanilide and N-succinyl-ala-ala-pro-leu p-nitroanilide. The pH optimum of midgut extracts was acidic (pH 4), implying that acidic proteases predominate. However, protease activity was inhibited substantially by both aprotinin and E-64, suggesting the presence of both serine and cysteine proteases in the midgut of the green mirid.

Animals↗
PubMed2001

Soft tissue reconstruction for calcaneal fractures or osteomyelitis.

A systematic approach of the surgical management of a calcaneal fracture can minimize the potential of soft tissue complications. When reducing a closed calcaneal fracture, the incision used affects the postoperative complications. The L-shaped incision with the horizontal limb lying on the lateral glabrous junction ensures maximum blood flow to either side of the incision. Whether or not the wound can be closed primarily depends on the preexisting edema, the lost calcaneal height, and the delay between the fracture and reduction (Fig. 20). The wrinkle test is a good indicator that the incision can be closed primarily if the amount of height restored is minimal. If the edema is too great, steps should be taken to reduce it sufficiently to allow successful wound closure. If the wound, after reduction, is too wide to allow primary closure, an ADM flap laterally or an AHM flap medially should be used. For larger defects, a free flap should be considered. The three important steps to reconstruction of soft tissue defects around the calcaneus include good blood supply, a infection-free wound, and the simplest soft tissue reconstructive option that covers the wound successfully. Adequate blood supply can be determined by the use of Doppler. If the supply is inadequate, revascularization is necessary before proceeding. Achieving a clean wound requires aggressive debridement, intravenous antibiotics, and good wound care. Adjuncts that can help in achieving a clean wound include topical antibiotics (silver sulfadiazine), the VAC, and hyperbaric oxygen. Osteomyelitis has to be treated aggressively. Any suspicious bone has to be removed. Only clean, healthy, bleeding bone is left behind. Antibiotic beads can be useful when there is doubt as to whether the cancellous bone is infection-free. The beads are not a substitute for good debridement, however. Soft tissue reconstruction ranges from delayed primary closure to the use of microsurgical free flaps (Fig. 21). When bone or hardware is exposed, a muscle flap should cover the wound because of the extra blood supply it carries with it. The soft tissue option depends on the width of the wound. For wounds 1 cm wide or less, the options include allowing the wound to close by secondary intention (VAC), delayed primary closure, or a local muscle flap. For wounds 2 cm wide or less, allowing the wound to close by secondary intention (VAC) and a local muscle flap are the best options. For wider wounds, one has to assess whether the local muscle flap has sufficient bulk to close the defect. If it does, it is the simplest solution. If the local muscle is inadequate, a microsurgical free flap has to be used. The VAC sometimes can convert a large wound to a smaller wound so that a local muscle flap can be used. This procedure takes time, however, and adds to the cost of the repair.

Ankle↗