13 emergency problems in older people.
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Aged↗
Biomedical subjects
P Lawson
Publications and source records attributed to P Lawson.
Asymptomatic papules on a child. Perforating granuloma annulare.
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Child↗
Changes in maternal middle cerebral artery blood flow velocity associated with general anesthesia in severe preeclampsia.
UNLABELLED: In women with severe preeclampsia, significant increases in mean arterial pressures (MAP) are common after rapid induction of general anesthesia (GA) and tracheal intubation. The objectives of this prospective study were to assess the effects of the rapid induction-intubation technique on middle cerebral artery (MCA) flow velocity in severe preeclampsia and to examine the correlation between mean MCA flow velocity (Vm) and MAP. Eight women with severe preeclampsia (study group) and six normotensive women at term (control group) scheduled to undergo cesarean section under GA were studied. Before induction, patients in the study group received i.v. labetalol in divided doses to lower diastolic pressures to <100 mm Hg. Anesthesia was induced with pentothal 4-5 mg/kg, followed by succinylcholine 1.5 mg/kg to facilitate tracheal intubation. A transcranial Doppler was used to measure Vm. Both Vm and MAP were recorded before induction and every minute for 6 min after intubation. In the study group, after the administration of labetalol, MAP decreased from 129 +/- 9 to 113 +/- 9 mm Hg (P < 0.05), and Vm decreased from 59 +/- 11 to 54 +/- 10 cm/s (P < 0.05). After intubation, MAP increased from 113 +/- 9 to 134 +/- 5 mm Hg (P < 0.001), and Vm increased from 54 +/- 10 to 70 +/- 10 cm/s (P < 0.001). In the control group, while MAP increased significantly from 89 +/- 6 to 96 +/- 4 mm Hg (P < 0.05) after intubation, the concurrent increase in Vm from 49 +/- 5 to 54 +/- 7 cm/s was not significant. There was a significant positive pooled correlation between Vm and MAP (r = 0.5, P < 0.0006) in the study group but not in the control group (r = 0.24). After induction and intubation, both Vm and MAP values were significantly increased in the study group patients at all observation points compared with the control group patients. The findings indicate that Vm increases significantly after rapid-sequence induction of GA and tracheal intubation in women with severe preeclampsia, and there seems to be a direct relationship between MAP and Vm. IMPLICATIONS: In women with severe preeclampsia, rapid-sequence induction of general anesthesia and tracheal intubation can cause severe hypertension. Our results indicate that the increase in blood pressure is associated with a significant increase in maternal cerebral blood flow velocity and that there is a significant correlation between these two variables.
Adult↗
Isolation and characterization of a new member of the scavenger receptor superfamily, glycoprotein-340 (gp-340), as a lung surfactant protein-D binding molecule.
We have purified a previously unknown glycoprotein (designated gp-340) from human bronchioalveolar lung washings from a patient with alveolar proteinosis. gp-340 was identified by its calcium-dependent binding to lung surfactant protein D (SP-D) and by its molecular mass of 340 kDa in the reduced state on SDS-polyacrylamide gel electrophoresis (PAGE). gp-340 was purified from the 10,000 x g pellet of the lavage fluid by ion-exchange and gel permeation chromatography. On SDS-PAGE, gp-340 showed an apparent molecular mass of 290 kDa in the unreduced state. On gel chromatography under non-dissociating conditions, the apparent molecular mass of gp-340 was >1000 kDa. The presence of N-linked glycosylation was shown by digestion with N-glycosidase F, which reduced the apparent molecular mass of gp-340 under reducing condition to about 300 kDa. Partial amino acid sequence data showed the presence of scavenger-receptor type domains. Monoclonal and polyclonal antibodies were raised against gp-340, and their specificities were confirmed by Western blotting. The antibodies were used for immunohistochemical localization of gp-340 in the lung, where it was found on the surface of and within alveolar macrophages. Direct binding between gp-340 and SP-D took place at physiological ionic strength, required the presence of calcium, and was not inhibited by maltose. The binding between SP-D and mannan also required the presence of calcium, but this interaction was completely inhibited by maltose. The same binding pattern was seen between gp-340 and recombinant human SP-D composed of the trimeric neck region and three carbohydrate recognition domains. These findings indicate that the binding between gp-340 and SP-D is a protein-protein interaction rather than a lectin-carbohydrate interaction and that the binding to gp-340 takes place via the carbohydrate recognition domain of SP-D. We conclude that gp-340 is a new member of the scavenger-receptor superfamily and likely to be a truncated form of a receptor for SP-D.
Amino Acid Sequence↗
Prenatal diagnosis of left ventricular aneurysm in the late second trimester: a case report.
Fetal echocardiography in a 24-year-old woman at 24 weeks' gestation demonstrated a left ventricular aneurysm and pericardial effusion. The patient was treated with oral digoxin followed by intensive antepartum monitoring. Intrauterine fetal demise occurred at 31 weeks. The autopsy confirmed the presence of an apical left ventricular aneurysm. This is a rare congenital cardiac anomaly, which has been reported in only three prior cases. This represents the earliest prenatal diagnosis of this condition.
Adult↗
Squamous cell carcinoma of the distal urethra in a patient with congenital hypospadias.
A previously well 43-yr-old man with congenital hypospadias presented with a fungating lesion of 2 mths duration and surrounding the ventral urethral opening. After biopsy showed this to be a squamous cell carcinoma, a definitive procedure of partial penile amputation and urethroplasty was performed. This is believed to be the first reported case of squamous cell carcinoma of the distal urethra in conjunction with hypospadias.
Adult↗
Criteria for consistent and high sensitivity of DNA in situ hybridization on paraffin sections: optimal proteolytic enzyme digestion.
It is technically challenging for the detection of target DNA in low abundancy, such as viral DNA sequences in latently infected cells by nonisotopic in situ hybridization (ISH). Consistent result is even more difficult to achieve on routine paraffin sections. Proteolytic enzyme digestion is most critical for both consistency and sensitivity of the technique. We here have investigated the effect of enzyme digestion on cell morphology, protein and DNA reduction, and hybridization efficiency. The results demonstrated that enzyme digestion improves efficiency of ISH through a process involving partial DNA purification on sections. There is a clear relationship between proteolytic enzyme digestion, morphology changes, and hybridization efficiency. Although detection of DNA sequences in abundance can be achieved within a relatively wide range of digestion levels, maximum hybridization efficiency was always related to the cells, which showed morphology of nuclear swollen, weak homogeneous chromatin staining with hematoxylin and loss of visible nuclear membrane. Detection of viral DNA in low copy number critically depends on the creation of the morphologic changes by enzyme digestion. The morphological changes would therefore serve as important criteria for optimal digestion, result interpretation, and comparison.
Anal Canal↗
Diagnosis of Clostridium difficile associated diarrhea: comparison of three rapid methods employing different markers for detection.
Latex agglutination and the enzyme immunoassays Cytoclone (EIA-C) and VIDAS (EIA-V) were compared with a cytotoxicity assay for the diagnosis of Clostridium difficile associated diarrhea. Among patients with discrepant results, the cytotoxicity assay and clinical assessment were used to evaluate the performance of the latex agglutination and EIA tests. Clostridium difficile associated diarrhea was documented in 30/149 samples (20.1%) from 130 patients. All test results matched in 113 instances. Latex agglutination, EIA-C, and EIA-V yielded false positive results in 10, 4, and 7 samples and false negative results in 8, 9, and 14 samples, respectively. Latex agglutination demonstrated 87.8% efficiency compared with 91.3% for EIA-C and 85.7% for EIA-V and 3 min hands-on time compared with 4.5 min for EIA-V and 10 min for EIA-C. On the basis of these findings and given the fact that all rapid tests have their shortcomings, we believe that latex agglutination is the most practical method.
Biomarkers↗
Characterization of a psychrotrophic Clostridium causing spoilage in vacuum-packed cooked pork: description of Clostridium algidicarnis sp. nov.
A Clostridium species causing spoilage of vacuum-packed refrigerated pork was isolated and characterized. The unknown organism differed phenotypically from other clostridial species usually associated with spoilage. Phylogenetic analyses based on 16S rRNA gene sequencing demonstrated that the psychrotroph represents a distinct line of descent within the genus Clostridium. It is proposed that the organism be classified as a new species of the genus Clostridium, Clostridium algidicarnis.
Animals↗
Treatment of iron deficiency anaemia with iron in children.
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Anemia, Hypochromic↗
Provisional identification of Haemophilus influenzae from sputum cultures within 1 h by rapid enzyme tests.
Possible Haemophilus influenzae colonies in cultures of sputum samples are currently identified by tests for dependence on X and V factors. This method requires further overnight culture and may give a relatively high number of false negative results. Identification of suspected H. influenzae colonies by a 5-min test for production of indole and beta-galactosidase followed by a 1-h porphyrin test was compared with tests for dependence on X and V factors. A commercially produced form of the rapid tests (Haemstrip, Lab M, Bury, Lancs) was used to test 252 potential haemophilus colonies from cultures of sputum samples on heated blood agar. Colonies that were beta-galactosidase-positive after 5 min were considered to be non-H. influenzae and those that were beta-galactosidase-negative but indole-positive were considered to be H. influenzae. At this stage the test had a sensitivity of 99.4% and a specificity of 90.9%. After 1 h, only colonies that were beta-galactosidase- and porphyrin-negative were considered to be H. influenzae, the sensitivity was then 99.5% and the specificity 100%. Similar results were found with colonies from sputum cultures on selective heated blood agar containing bacitracin. The X and V dependence and Haemstrip results were in 97.6% agreement in a double blind test. Of 100 non-haemophilus colonies tested by Haemstrip, two pseudomonads could have been identified as H. influenzae by this method. The high positive predictive value of Haemstrip results depends partly on the initial recognition of potential haemophilus colonies.
Bacteriological Techniques↗
Preventing iron deficiency in preschool children by implementing an educational and screening programme in an inner city practice.
OBJECTIVE: To assess the feasibility and acceptability of screening young children for iron deficiency in a deprived inner city practice and to assess the effects of a programme of dietary education. DESIGN: Prospective study of children in general practice, comparison with historical controls. SETTING: A deprived inner city practice. PATIENTS: 127 Children aged 13-24 months. Findings were compared with those in 110 children of the same age studied previously. INTERVENTIONS: All mothers received dietary education antenatally and in the first year after giving birth. Screening for iron deficiency (defined as mean cell volume less than 75 fl and haemoglobin concentration less than 105 g/l) and haemoglobinopathy (when appropriate) was offered for all children attending for immunisation against measles, mumps, and rubella over 12 months; capillary blood samples were taken after immunisation. MAIN OUTCOME MEASURES: Uptake of the screening programme expressed as the percentage of all children eligible for immunisation who were screened, and the effectiveness of the dietary education as shown by the prevalence of iron deficiency in the two groups. RESULTS: Altogether, 122 of the 127 (96%) children who attended for immunisation had their haemoglobin concentration and mean cell volume measured; 90% of all children aged 13-24 months in the practice were screened. Dietary education, clinical procedures, and counselling were incorporated successfully into the clinic's work. Ten children (8%) were iron deficient, all of whom responded to iron supplements, and eight had a haemoglobinopathy trait. In the previous study 110 children (70%) had been screened and 28 children (25%) had been iron deficient. The two groups were similar in terms of sex, social class, and ethnic group. CONCLUSIONS: Screening young children for iron deficiency, sickle cell disease, and thalassaemia when they attended for immunisation was acceptable and successful in a socially deprived inner city practice. Dietary education may have accounted for some of the reduction in the prevalence of iron deficiency that occurred over the two years.
Anemia, Hypochromic↗
A national survey of antimicrobial resistance in Staphylococcus aureus in Australian teaching hospitals.
An extensive survey of the in-vitro susceptibility of clinical isolates of Staphylococcus aureus to 18 antimicrobial agents was conducted over three separate periods during 1986-1987 in 14 teaching hospitals in major Australian cities. The survey aimed to document the prevalence of resistance to a wide variety of drugs that are important as antistaphylococcal agents or as epidemiological markers. More than 7500 isolates were examined. Nationally, the prevalence of resistance was 85.3% to penicillin G, 14.4% to methicillin, 14.0% to amoxycillin/clavulanate, 9% to cephalothin, 5.4% to cephamandole, 9.9% to cefotaxime, 25.0% to erythromycin, 11.2% to clindamycin, 21.7% to tetracycline, 13.0% to gentamicin, 1.9% to amikacin, 5.8% to chloramphenicol, 18.3% to trimethoprim, 0.6% to rifampicin, 3.0% to fusidic acid and 1.2% to novobiocin. For none of the strains was resistance to vancomycin confirmed by minimal-inhibitory-concentration determination. A high proportion of the resistances was harboured in methicillin-resistant Staph. aureus, except for resistance to penicillin G, erythromycin and tetracycline. The prevalence of methicillin resistance varied widely among the states: 25.2% in Queensland, 23.5% in Victoria, 12.6% in New South Wales/the Australian Capital Territory, 11.3% in South Australia and 0.4% in Western Australia. Isolates from blood cultures were slightly-more susceptible to antimicrobial agents than were isolates from other body sites. Six common profiles of resistance to penicillin G, methicillin, erythromycin, clindamycin and tetracycline accounted for more than 95% of the isolates that were tested against all five agents. Vancomycin remains the most important antistaphylococcal drug in areas where resistance to methicillin is common.
Anti-Bacterial Agents↗
The effects of compounds related to gamma-aminobutyrate and benzodiazepine receptors on behavioural responses to anxiogenic stimuli in the rat: punished barpressing.
Rats were trained to press a bar for sucrose reward on a random-interval (RI) schedule and footshock punishment was then introduced for 3-min intrusion periods (signalled by a tone) on an independent RI schedule. Shock intensity was individually adjusted to produce stable intermediate levels of response suppression during the tone for each animal. Groups of animals were then allocated to a number of separate experiments in which they were systemically injected with anxiolytics (chlordiazepoxide HCl or sodium amylobarbitone), GABA antagonists (picrotoxin or bicuculline), the GABA (A) agonist muscimol, the GABA(B) agonist baclofen, an antagonist (RO 15-1788) at the benzodiazepine receptor and, an inverse agonist (FG 7142) at this receptor. The results showed that the alleviation of punishment-induced suppression of barpressing produced by chlordiazepoxide was blocked or partially blocked by RO 15-1788, picrotoxin and bicuculline but not by FG 7142; that picrotoxin (but not FG 7142) increased the suppression of responding by punishment; that neither muscimol nor baclofen affected responding on their own, but their combination weakly but reliably released punished responding from suppression; and that the anti-punishment effect of amylobarbitone was unaffected by either picrotoxin or bicuculline, though the barbiturate reversed the punishment-enhancing effect of picrotoxin. These results are discussed in the light of the hypothesis that anxiolytic behavioural effects are due to increased GABAergic inhibition.
Amobarbital↗
Observations on blood lipid and intermediary metabolite concentrations during conventional insulin treatment or CSII.
An objective of The Kroc Collaborative Study Group trial of the feasibility of maintaining improved control of plasma glucose concentrations with continuous subcutaneous insulin infusion (CSII) was to test the non-glycemic aspects of metabolic control in relation to microvascular disease. Serum lipid levels were assessed in the 68 patients completing the 8-mo trial, before and after randomization to conventional insulin treatment (CIT) or CSII. During CSII, fasting serum cholesterol concentrations, normal at baseline (186 +/- 7 mg/dl), were unchanged at 4 and 8 mo (183 +/- 8 and 186 +/- 10 mg/dl). Fasting serum triglyceride concentrations fell on treatment with CSII (baseline 90 +/- 12 mg/dl, 8 mo 60 +/- 7 mg/dl, P less than 0.01), but were unchanged during CIT (baseline 88 +/- 8 mg/dl, 8 mo 83 +/- 10 mg/dl). Thirty-two patients in three centers had 24-h profiles of intermediary metabolites measured at baseline (0), 4, and 8 mo. Mean 24-h venous blood lactate levels fell during CSII (baseline 1.28 +/- 0.12 mmol/L, 4 mo 0.99 +/- 0.4 mmol/L, P less than 0.05; 8 mo 1.05 +/- 0.11 mmol/L), but blood alanine levels were unchanged. Venous blood 3-hydroxybutyrate fell from 0.12 X /divided by 1.18 mmol/L at baseline to 0.06 X /divided by 1.22 mmol/L at 8 mo during CSII (P less than 0.01), mainly due to decreases at 0400 and 0600 h. Decreases in fasting serum triglyceride levels confirm previous investigations of insulin-dependent diabetic subjects treated with CSII; decreases of venous blood lactate and 3-hydroxybutyrate levels toward normal indicate that these metabolic effects of CSII recognized in short-term studies are sustained over an 8-mo period.
Diabetes Mellitus↗
The effect of continuous subcutaneous insulin infusion on serum lipids.
The effect of continuous subcutaneous insulin infusion (CSII) on serum lipids was examined in 2 groups of insulin dependent diabetic patients. Twelve paired patients selected by a random procedure to be treated with CSII or conventional insulin injections had lipids measured monthly for 6 months. A more heterogenous group of 13 CSII treated patients including the 6 randomised patients had lipids measured initially and after their maximum duration of CSII (range 3 to 18 months). Significant falls were seen in HbAI, plasma glucose and triglycerides in CSII treated patients whether the 6 randomised or the group of 13 were examined. High density, lipoprotein cholesterol (HDL-C) rose significantly in both groups. In the larger group of 13, a drop in the low density lipoprotein cholesterol (LDL-C) to HDL-C ratio and LDL-C was also seen. Control patients showed no significant changes. These findings confirm but are slightly different from improvements in lipids found in other studies of long-term CSII. In addition it was demonstrated that these changes could be maintained in patients managed outside the strict rigors of a controlled study.
Adolescent↗
Severe diabetic retinopathy in adolescents.
This paper reports on 9 patients aged 13-18 years (mean 15.4) with severe diabetic retinopathy. Two patients were prepubertal and 4 were going through puberty. Hypertension was present in 2 patients, while 4 had proteinuria. Severe preproliferative disease was present in 3 patients initially and proliferative retinopathy in the remainder. In 5 this retinopathy was considered to be florid. Two patients seen prior to 1975 had pituitary ablation, while those seen after 1975 were treated by extensive argon and xenon arc photocoagulation. Proliferative lesions regressed in both groups. At the latest follow-up 7 of the 9 patients achieved a final visual acuity of 6/9 or better in at least one eye. One patient became blind. Proliferative retinopathy advances rapidly in adolescents, but photocoagulation, as used now, can maintain vision in most.
Adolescent↗