Vigabatrin-induced optic neuropathy.
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Anticonvulsants↗
Biomedical subjects
P Kearney
Publications and source records attributed to P Kearney.
Allogeneic bone marrow transplantation from a donor with severe active rheumatoid arthritis not resulting in adoptive transfer of disease to recipient.
We report a patient who underwent allogeneic bone marrow transplantation from a sibling with longstanding untreated severe active rheumatoid arthritis. After 4 years of follow-up there is no evidence of adoptive transfer of rheumatoid arthritis to the recipient. This case, along with another recently reported case, provides reassurance that haemopoietic stem cell transplantation from a donor with systemic autoimmune disease may not necessarily result in adoptive transfer of the disease. All previous reports of transfer of autoimmunity in humans have been of organ-specific autoimmune diseases and we speculate that pathophysiological differences might account for why systemic autoimmune disease is not transferred.
Adoptive Transfer↗
Enteral feeding in the home environment.
Nutritional status has a major influence on wound healing, immunity, and quality of life for home care patients. This article presents the rationale, guidelines, and troubleshooting strategies home care nurses can use in caring for patients receiving enteral nutrition.
Community Health Nursing↗
Importance of calibration for diameter and area determination by intravascular ultrasound.
BACKGROUND: Intravascular ultrasound (IVUS) permits quantitative assessment of the lumen diameter and area of coronary arteries. The experimental study was performed to evaluate the accuracy of diameter and area measurements. METHODS AND RESULTS: Lumen quantitation (lumen diameter D and cross-sectional area A) in lucite tubes (lumen diameter 2.5 to 5.7 mm, Plexiglas) was performed using a mechanical IVUS system (HP console, 3.5 F catheter, Boston Scientific, 30 MHz). The influence of fluid type (blood, water and saline solution), fluid temperature (20 degrees C/37 degrees C), catheter to catheter variation, gain setting and ultrasound frequency (12, 20 and 30 MHz) was determined. In blood at 20 degrees C there was a constant deviation of the measured diameter from the true luminal diameter of -0.29 +/- -0.04 mm (p < 0.06). In water and saline solution at 20 degrees C the mean deviation from true diameter was -0.21 +/- -0.06 mm (p < 0.06). At 37 degrees C, the deviation in blood was greater than at 20 degrees (-0.34 +/- -0.02 mm) which is > 10% in a 3 mm tube (p < 0.06). Three of the ten catheters tested in water at 20 degrees C underestimated true diameter by more than -0.3 mm. The deviation from true diameter (5 mm tube) with varying gain settings was -0.14 mm to -0.23 mm compared to -0.19 mm at standard settings (p > 0.288). At 12 MHz diameter measured was over-estimated. The error in absolute area estimation increased with increasing diameter tested in blood at 37 degrees C (-1.21 to -2.72 mm2), whereas the relative error ([Measured Area-True Area]/True Area x 100 [%]) was more striking at smaller diameters (up to -25% in the 2.5 mm tube). CONCLUSION: Luminal diameters and areas are underestimated by this particular IVUS system. When IVUS imaging and measurements are made during coronary interventions this error should be taken into account with regard to appropriate sizing of the device and the assessment of the postprocedure result. Because systematic errors might also occur in other IVUS system (not tested in this study), it is advisable to ensure that each system is validated prior to clinical use, especially when exact measurements are required.
Calibration↗
Intravascular ultrasound detected classification of coronary lesions as a predictor of dissections after balloon angioplasty.
Dissection after balloon angioplasty of coronary arteries may give rise to an unfavourable early outcome. Compared with coronary angiography, intravascular ultrasound (IVUS) allows more detailed characterisation of dissections. We investigated the incidence and type of dissections after balloon angioplasty in calcified coronary lesions. IVUS was performed in 43 patients with 48 lesions before and after percutaneous balloon angioplasty. Significant calcification was defined as an arc of more than 90 degrees with typical acoustic shadowing. Dissections were classified as type A when the media was not involved by the dissection and as type B when media involvement had occurred. In the group with significant calcification dissection was observed in 79% of the cases vs 38% in the control group (p < 0.03). Type B dissection was present in 71% of the dissections in the calcified lesions vs. 15% in the control group (p < 0.02). The balloon diameter and the ratio of balloon area to vessel area was not different in both groups but the required pressure for the first complete balloon inflation was significantly greater in the group with calcified lesions (9.46 +/- 3.6 atm vs. 6.65 +/- 2.6 atm; p < 0.001). Thus balloon angioplasty in calcified coronary lesions is more likely to lead to dissection with frequency involve the media.
Adult↗
Differences in the morphology of unstable and stable coronary lesions and their impact on the mechanisms of angioplasty. An in vivo study with intravascular ultrasound.
The aim of this study was to compare the morphology of stable and unstable coronary lesions using intravascular ultrasound in patients undergoing coronary balloon angioplasty and to determine whether lesion morphology had any influence on the mechanism of balloon angioplasty. Thirty three (15 stable and 18 unstable) patients undergoing single lesion percutaneous transluminal coronary angioplasty were studied with intravascular ultrasound before and after intervention. All examinations, recorded on S-VHS video tape, were studied off-line and matched sites from the point of minimum lumen area after the procedure and the corresponding site prior to intervention were compared. The morphology of lesions before intervention was noted and the mechanisms of angioplasty (vessel stretch, lesion remodelling and lesion tears) were determined by comparing pre- and post-interventional morphology and dimensions. The only significant morphological difference between stable and unstable lesions was the presence of a demarcated inner layer in unstable lesions, delimited by a fine circumferential line. This pattern was noted in 77% (14/18) of unstable lesions and in 7% (1/15) of stable lesions (P < 0.01). Unstable lesions tended to have more echolucent zones than stable lesions (72% (13/18) vs 46% (7/15), P = 0.13). The mechanisms of angioplasty were also found to differ. Whereas lesion remodelling (or 'compression') was seen in 77% (14/18) of unstable lesions, it occurred in only 13% (2/15) of stable lesions and mean lesion cross-sectional area reduction was greater in unstable lesions, - 14.8 +/- 8.3% (2.1 +/- 1.3 mm2) compared to stable lesions, - 4.1 +/- 8.4% (0.42 +/- 0.9 mm2), P < 0.01. In contrast, vessel stretch was seen more frequently in stable lesions (73%, 11/15) compared to unstable lesions (22%, 4/18) P < 0.01 and the mean increase in vessel cross-sectional area was + 13.5 +/- 6.8 (1.6 +/- 0.9 mm2) in stable lesions compared to + 5.5 +/- 5.6% (0.8 +/- 0.9 mm2) in unstable lesions, P < 0.01. Lesion tear was present to a similar degree in both groups of patients. In this observational study we found a set of echographic markers that distinguished unstable lesions. The mechanisms of angioplasty differed between stable and unstable angina, with greater lesion remodelling seen in unstable lesions and vessel stretch in stable lesions. Taken together, these findings suggest that the markers we describe may be echographic indicators of mural thrombus.
Angina Pectoris↗
Value of intracoronary ultrasound and Doppler in the differentiation of angiographically normal coronary arteries: a prospective study in patients with angina pectoris.
BACKGROUND: A substantial proportion of patients undergoing heart catheterization for suspected coronary artery disease have normal angiograms. Coronary morphology and blood flow velocity can be assessed very accurately with intracoronary ultrasound and Doppler. The purpose of this study was to use both methods to classify further patients with suspected coronary artery disease but with coronary angiograms adjudged normal at the time. METHODS AND RESULTS: In forty-four patients with suspected coronary artery disease and normal coronary angiograms, intracoronary ultrasound and intracoronary Doppler were performed in the left anterior descending and left main coronary arteries. Coronary flow reserve was obtained by calculating the ratio of the maximal coronary flow mean velocity after the intracoronary administration of 10 mg papaverine to the coronary flow mean velocity at rest. Of 44 patients, 16 (36%) (group I) were found to have normal coronary morphology by intracoronary ultrasound and normal (> 3.0) coronary flow reserve (5.3 +/- 1.8). In seven patients (16%) (group II) there were normal intracoronary ultrasonic findings but a reduced coronary flow reserve (2.1 +/- 0.4). Plaque formation was found in a total of 21 (48%) of the 44 patients; mean plaque sizes were 3.6 +/- 1.6 mm2 for those in group III (normal coronary flow reserve) and 5.0 +/- 2.3 mm2 for those in group IV (reduced coronary flow reserve). Vessel area in both of these groups (16.3 +/- 8.0 mm2 and 19.2 +/- 6.1 mm2) was significantly larger than that of group I (14.6 +/- 5.7 mm2, P < 0.01). Plaque calcification was found in 25% of those in group III and 44% of those in group IV. Thus, only 36% of the patients with normal angiograms were true normal, 48% exhibited early stage of coronary atherosclerosis, and the other 16% might be considered as syndrome X. CONCLUSION: Intracoronary ultrasound and Doppler can be used to differentiate further heart disease in patients with normal coronary angiograms. Only a minority were true normal. Early signs of atherosclerosis cannot be detected by coronary angiography. This may have important therapeutic and prognostic implications.
Adult↗
The traditional and emerging role of nuts in healthful diets.
Throughout history, nuts have been a staple food providing energy, protein, essential fatty acids, vitamins, and minerals. Today, nuts are classified as part of the USDA Food Guide Pyramid's Meat/ Meat Alternate Group. Foods in this group contribute protein as well as important vitamins and minerals to the diet. Nuts are also being studied for their potential health benefits. Research suggests that there may be a connection between frequent nut consumption and a reduced incidence of coronary heart disease. Thus, tradition and promising scientific evidence combine to support the role of nuts in healthful eating.
Coronary Disease↗
Biological properties of renal oncocytoma cells in culture.
This paper sought to determine biological properties of oncocytoma cells, both in vivo and in vitro, which may serve as useful diagnostic indicators. Cell lines were grown in short-term culture from two renal oncocytomas following enzymatic dissociation, characterised by immunohistochemistry and electron microscopy, and further studied for abnormal p53 or retinoblastoma genes. Cells in culture were shown to maintain the morphological attributes of the primary lesion, including the overproduction of mitochondria. Despite the absence of vimentin staining in the primary tumour, cells in culture were shown to express this intermediate filament. Immunohistochemistry for P53 protein demonstrated an overexpression in one of the tumours, suggesting that mutation had occurred. Restriction fragment length polymorphisms of the retinoblastoma and the p53 genes were not demonstrated. Mutation of the p53 gene does occur in oncocytomas. The maintenance of the phenotype of oncocytoma cells in culture suggests that in vitro studies may be useful in the identification of unique properties of the tumour.
Adenoma, Oxyphilic↗
Audit of antibiotic usage in medium-sized general hospital over an 11-year period. The impact of antibiotic policies.
The objective of the present study was to evaluate trends in antibiotic expenditure over an 11-year period (1982-1992) in a 370-bed district general hospital in Northern Ireland and to examine the impact of two separate antibiotic policies on antibiotic usage. A further objective was to examine the attitudes of prescribers to the second policy. Drug utilization review was used to collect information on antibiotic expenditure and usage before and after introduction of separate antibiotic policies in 1985 (not intensively monitored) and 1989 (intensively monitored). A main questionnaire was used to determine the attitudes of prescribers. The first policy (1985) showed no benefits with regard to the number of antibiotic entities stocked (45 before, 45 after), number of dosage units issued (9.3% increase) or expenditure (33.3% increase). The 1989 policy led to significant reductions in the number of antibiotic entities stocked (28.9%), number of antibiotics issued (11.9%) and expenditure (6.1%). Expenditure began to spiral upwards when active monitoring of the second policy was suspended. The majority of prescribers (87.2%) who responded to the questionnaire (56.5% response rate) felt that the 1989 policy made a positive contribution to antibiotic usage in the hospital.
Anti-Bacterial Agents↗
[Intravascular ultrasonography in coronary heart disease. Current aspects in the pathogenesis].
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Adolescent↗
Open access echocardiography in management of heart failure in the community.
OBJECTIVE: To assess the value of an open access echocardiography service. DESIGN: Study of new open access service for general practitioners, who were invited to refer patients taking diuretics for suspected heart failure, untreated patients with symptoms of possible heart failure, and asymptomatic patients with risk factors for left ventricular systolic dysfunction. SETTING: Regional cardiology centre. SUBJECTS: 259 consecutive patients. MAIN OUTCOME MEASURES: Presence or absence of left ventricular systolic dysfunction and consequent changes in clinical management. RESULTS: 119 treated patients, 99 untreated patients, and nine asymptomatic patients were referred over five months. 32 were considered to be inappropriately referred. Among the treated patients, 31 had impaired left ventricular systolic function and five had valvular disease; angiotensin converting enzyme inhibitors were recommended for 34 of these patients. In addition, 53 were thought not to need diuretics. Eight untreated patients had impaired systolic function and six valvular disease. CONCLUSIONS: The service was well used by general practitioners and led to advice to change management in more than two thirds of patients.
Adolescent↗
Acute coronary artery closure following intracoronary ultrasound examination.
Two patients undergoing intracoronary ultrasound examination were complicated by acute coronary artery closure. One of the complications was thought to be caused by intimal dissection and thrombus formation and the other was thought to be caused by intimal dissection and subsequent embolization. The complications were successfully managed conservatively in both cases.
Acute Disease↗
Improvement of coronary morphology and blood flow after stenting. Assessment by intravascular ultrasound and intracoronary Doppler.
Intravascular ultrasound (IVUS) and intracoronary Doppler (ICD) were performed in eight patients (54.3 +/- 6.5 years, 6 male) immediately after PTCA and after stenting. ICD was also performed before PTCA. After PTCA, IVUS has demonstrated intimal rupture in all patients. After stenting, IVUS revealed wall wrapping of the intimal flap with a free lumen in all patients. The lumen diameter was 2.42 +/- 0.55 mm after PTCA and was 2.74 +/- 0.49 mm after stenting (p < 0.001). The cross-sectional area increased from 4.70 +/- 1.99 mm2 post-PTCA to 6.40 +/- 2.15 mm2 post-stent (p < 0.005). Coronary flow velocity reserve, calculated by the ratio of mean flow velocity at rest and after intracoronary papaverine administration, increased from 2.05 +/- 1.01 to 2.99 +/- 1.14 after PTCA (p = 0.015); and increased to 4.51 +/- 1.33 after stenting (p < 0.001). The morphological data derived from IVUS correlated with the functional information obtained with ICD. In addition to its established role in bail out situations, stent implantation may be considered when a suboptimal morphological and functional result has been demonstrated.
Angioplasty, Balloon, Coronary↗
Intravascular ultrasound approach to the diagnosis of coronary artery aneurysms.
Coronary artery aneurysms are usually diagnosed by contrast coronary angiography, which portrays the silhouette of the lumen but cannot distinguish true and false aneurysms. To differentiate true and false aneurysms and to study the morphologic changes of the vessel wall, intravascular ultrasound (IVUS) was performed in patients with angiographic signs of coronary artery aneurysms. We used a 4.8F or 3.5F, 20 MHz IVUS catheter for ultrasound examination. Fourteen patients (12 men and two women ranging in age from 43 to 73 years) with angiographic signs of coronary aneurysm were enrolled. IVUS imaging was optimally obtained in all patients. The vessel area, lumen area, and plaque area of the aneurysm segment and of the proximal and distal segments were determined. IVUS showed that both the proximal and distal reference segments were severely affected by atherosclerotic lesions in all the patients and by calcium deposits in six patients. The percent stenoses were 63.0% +/- 13.7% and 60.9% +/- 17.8% in the proximal and distal reference segments, respectively. In nine patients the walls of the aneurysms showed signs of atherosclerosis. Three angiographically indicated aneurysms were found to be plaque ruptures. Although the lumen and the vessel areas of the aneurysm segments were larger than those of the proximal and distal segments (p < 0.01 and (p < 0.001), no significant differences in plaque area and plaque composition were found between the aneurysm segment and adjacent vessel segments (p > 0.05). In conclusion, IVUS allows detailed characterization of coronary aneurysms. Atherosclerosis seems to play an important role in the formation of acquired coronary aneurysms.
Adult↗
Clinical predictors of unstable coronary lesion morphology.
We evaluated prospectively clinical and angiographic data in 400 patients, 200 with unstable and 200 with stable angina in order to determine which clinical markers could reliably predict unstable coronary artery lesions. Comparison of the angiogram of 200 patients with unstable and 200 with stable angina revealed a high-grade lesion (42% vs 23%, P < 0.0001), complex lesion morphology (49% vs 20%, P < 0.0001) and thrombus-containing lesions (7% vs 1%, P = 0.006) as typical findings in patients with unstable angina. A high-grade lesion and/or complex lesion (including thrombotic lesions but excluding total occlusion) was found in 61% of unstable and 34% of stable patients (P < 0.0001). Clinical features including the Braunwald classification of unstable angina were then evaluated by means of a multivariate approach with regard to their ability to predict the presence of unstable coronary artery lesions. Multivariate analysis revealed an abnormal ECG as the single most predictive clinical indicator of complex lesion morphology (P < 0.0001, odds ratio 4,2). The clinical presentation of recent onset of angina was highly predictive of a high grade lesion (P = 0.0003, odds ratio 3,2). The endpoint of a high-grade and/or a complex lesion was identified by an abnormal ECG (P = 0.0015, odds ratio 3,0) and recent onset angina (P = 0.0119, odds ratio 2,5). Thus, a high grade and/or complex lesion, typical of patients with unstable angina, was best identified by the clinical feature of recent onset angina and/or abnormal ECG changes.
Aged↗
Improved specificity of ribozyme-mediated cleavage of bcr-abl mRNA.
Ribozyme-mediated cleavage of bcr-abl mRNA has been shown to be associated with the concomitant cleavage of bcr mRNA. The possible role of this ribozyme as a clinical therapeutic constrained us to improve its target specificity. Consequently, three modified ribozymes (Rz7-9) were created, each carrying a single base mismatch in the sequence immediately 5' of the cleavage site, while a fourth ribozyme (Rz10) was targeted to a nearby site. Each was compared with the parent ribozyme for its ability to cleave synthetic bcr-abl and bcr substrates, and it was shown that alteration of the second base 5' of the cleavage site created a ribozyme with significantly improved specificity for its substrate. Rz10 was shown to exclusively act on bcr-abl, but the efficiency of cleavage was reduced compared to that shown by ribozymes 6, 8, and 9.
Base Sequence↗
[Reconstruction methods for 3D imaging and quantification of intracoronary ultrasound cross-sectional images using biplanar fluoroscopy. Initial experiences in vitro and in vivo].
In this investigation, we studied the feasibility of 3D-reconstruction from 2D cross-sectional intracoronary ultrasound images. A computer-aided, automated 3D-reconstruction was used to generate cylindrical and sagittal format of vessels in vitro (n = 9) and in vivo (n = 48). Ultrasound 2D-images were acquired with a 20 MHz mechanical intracoronary ultrasound catheter (Boston Scientific). A slow pullback (about 1 mm/s) of the catheter was performed during continuous recording of the ultrasound images. The recorded 2D-images were then fed to an image processing computer. Correction and scaling of the axial vessel dimensions was performed by the assessment of the catheter position in the simultaneously recorded biplane fluoroscopy. Digitized data were then processed to 3D-images with use of voxel space modeling. The 3D-views from any plane can be reconstructed. The in-vitro study demonstrated that the reconstructed images were able to correctly portray the pathological changes of the vessel wall in all specimen as proved by pathologic examination. In the in-vivo study, 3D-reconstruction provided not only a spatial visualization of the coronary arterial disorders (such as coronary aneurysm, coronary dissection, spontaneous plaque rupture etc.) but also provides the potential to quantify the mass of lesions. By combining sagittal and cylindrical views, 3D-reconstruction enables longitudinal and orthogonal imaging of the both the vessel lumen and vessel wall, therefore, it has the advantage of cross-sectional viewing as obtained from intracoronary ultrasound and the longitudinal viewing as derived from coronary angiography. These preliminary results of the study indicate that 3D-reconstruction of coronary segments is a promising technique for studying coronary artery disease. Analysis can be based not only on single or multiple cross-sectional images but also on vessel segments facilitating serial studies as for instance studies assessing the progression and regression of atherosclerosis.
Aortic Dissection↗