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Biomedical subjects

P M Buckley

Publications and source records attributed to P M Buckley.

At least 19 recordsLinked to original sources
PubMed1999

Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity.

AIMS: To investigate the "gut origin of sepsis" hypothesis. METHODS: Prospective controlled study of 279 surgical patients in which cultures of nasogastric aspirates were compared with those obtained from mesenteric lymph nodes taken at laparotomy and the organisms cultured from subsequent septic complications. Bacterial translocation was confirmed if positive cultures were obtained from mesenteric lymph nodes. Postoperative sepsis was defined as any positive culture in the postoperative period. Bacterial species obtained in gastric microflora, mesenteric lymph nodes, and postoperative septic complications were compared. RESULTS: Only 85/279 patients (31%) had a sterile nasogastric aspirate; the most frequently identified organism was Candida spp. (54%) and the most common enteric organism cultured was E coli (20%). Multiple organisms were isolated in 39% and occurred more frequently in patients aged over 70 years, those undergoing non-elective surgery, and in those requiring proximal gastrointestinal surgery. Postoperative sepsis was more common in these patients. Bacterial translocation occurred in 21% and was significantly more frequent in those with multiple organisms in their nasogastric aspirates. E coli was the commonest organism isolated from the lymph node specimens (48%) and septic foci (53%). Fungal translocation did not occur. An identical genus was identified in the nasogastric aspirate and the septic focus in 30% of patients, in the nasogastric aspirate and the lymph node in 31%, and in the lymph node and a postoperative septic focus in 45%. CONCLUSIONS: Proximal gut colonisation is associated with both increased bacterial translocation and septic morbidity. The commonality of organisms identified supports the gut origin of sepsis hypothesis.

Adolescent↗
PubMed1999

Multicenter clinical and analytical evaluation of the AxSYM troponin-I immunoassay to assist in the diagnosis of myocardial infarction.

We evaluated the AxSYM troponin I (cTnI) immunoassay for assisting in the detection of acute myocardial infarction (AMI). At four sites, the total imprecision (CV) over 20 days was 6.3-10.2%. The minimum detectable concentration was 0.14 +/- 0.05 microgram/L. Comparison of cTnI measurements between the AxSYM and Stratus (n = 406) over the dynamic range of the AxSYM assay demonstrated good correlation, r = 0.881, with a proportional bias: AxSYM cTnI = 3.50(Stratus cTnI) - 1. 10. The confidence intervals (95%) for the slope and intercept were 3.39-3.64 and -1.32 to -0.95, respectively. The expected cTnI concentration in healthy individuals was </=0.5 microgram/L, whereas the ROC curve-determined cutoff for AMI was 2.0 microgram/L. This gave a diagnostic sensitivity of 91.8% and specificity of 92.4% when tested in serial samples collected within 24 h of admission in 633 patients presenting with chest pain, of which 122 had an AMI. The concordances of the AxSYM cTnI with the Stratus cTnI, OPUS cTnI, and Access cTnI were 95.3%, 95.1%, and 94.3%, respectively, from patients with suspected AMI. The AxSYM cTnI demonstrated excellent clinical specificity, >/=96%, in skeletal muscle injury, chronic renal disease, and same-day noncardiac surgery patients.

Evaluation Studies as Topic↗
PubMed1997

Propofol in patients needing long-term sedation in intensive care: an assessment of the development of tolerance. A pilot study.

OBJECTIVE: To evaluate the possible development of tolerance in patients sedated with propofol in intensive care for more than 5 days. DESIGN: An open within patient non-comparative pilot study. SETTING: The intensive care unit of a hospital in the UK. PATIENTS: Twenty-three patients who were expected to need sedation with propofol for more than 5 days were included; of these, 11 were sedated continuously for between 5 and 10 days. INTERVENTIONS: Propofol was infused continuously at about 0.5-4 mg/kg per h to provide sedation at level 3 on the Ramsay scale (drowsy or asleep, responds easily to commands). Alfentanil was infused at a rate of about 0.5 microgram/kg per min. MEASUREMENTS AND RESULTS: Patients with a statistically significant increase in both infusion rate and blood concentration were considered to show tolerance, those that required an increasing infusion rate and constant (or decreasing) blood concentration were said to show increased clearance, and those that required constant (or decreasing) infusion rates and blood concentrations were classed as showing no tolerance. Of the 11 patients who were sedated for more than 5 days, three showed tolerance and three showed increased clearance while five showed no tolerance. The desired sedation level was achieved for the majority of the time for patients sedated between 5 and 10 days (mean 73-90%). There was some suggestion of a relationship between improving health (decreasing APACHE II scores) and the need for increased infusions of propofol. CONCLUSIONS: Although there were insufficient data to reach firm conclusions, the possibility of some relationship between the increasing need for propofol and improving condition in patients needing longer term intensive care cannot be ruled out.

APACHE↗
PubMed1991

Propofol and alfentanil infusions for sedation in intensive therapy.

Forty-four patients, with admission APACHE II scores between 5 and 24, undergoing mechanical ventilation in the intensive therapy unit, received a sedative regimen consisting of continuous infusions of propofol and alfentanil. Patients were randomly allocated to one of three groups to receive either alfentanil 0.25 microgram kg-1 min-1 (10 patients), 0.50 microgram kg-1 min-1 (15 patients) or 0.75 microgram kg-1 min-1 (18 patients) for analgesia. An infusion of propofol 20-200 mg h-1 ran concurrently to maintain a satisfactory level of sedation. Patients received the infusions for between 4 and 260 h and 38 patients spent more than 90% of this time at satisfactory sedation levels. After stopping the infusions all patients had short times to wakening (mean 3-18 min) and to establish spontaneous respiration (mean 8-28 min), suggesting no significant cumulation. Some depression of blood pressure was seen on starting the infusions, which was in general easily treated with fluids or small increases in inotropic agents. One patient, however, was withdrawn from the trial because of haemodynamic instability. This combination of drugs can be recommended for sedation of general intensive-therapy patients, provided the cost is not felt to be prohibitive.

Adolescent↗
PubMed1985

The consequences of fat body transplantation into young and old Drosophila.

Despite some age-related changes in cells, we observed no massive fat body involution during senescence of two species of Drosophila. Transplants of larval fat failed to prolong the life of old D. gibberosa. Transplanted larval fat persisted for weeks and underwent similar changes (except for glycogen stores) in old as in young hosts, suggesting that only minor changes in hemolymph composition occur with age.

Adipose Tissue↗
PubMed1985

Acute acalculous cholecystitis following multiple skeletal trauma. A report of three cases.

Three cases of acute acalculous cholecystitis are reported in patients with multisystem failure following major long-bone trauma. The diagnosis should be suspected in any such patient who develops septicaemia from an unidentified site. A high index of suspicion should be maintained, especially in patients who are sedated or in receipt of mechanical ventilation of the lungs and in whom physical signs may be minimal or absent.

Acute Disease↗
PubMed1984

Increase in resistance of in-line breathing filters in humidified air.

A study has been performed to measure the resistance of Pall Ultipor BB50 filters when exposed to humidified air for 48 h during artificial ventilation by an Engstrom Erica ventilator fitted with a Bennett Cascade Mk2 humidifier. A marked increase in resistance was demonstrated. A hypothesis is presented as to the aetiology of these findings together with details of minor modifications to the system which allow the use of these filters under clinically acceptable conditions.

Equipment Safety↗
PubMed1984

Direct solid-phase enzyme immunoassay of progesterone in saliva.

We have developed a rapid enzyme immunoassay for progesterone in saliva. This solid-phase assay is carried out on microtitre plates with no extraction or centrifugation steps. The detection limit of the assay is 200 fg per well (3.2 pmol/L). Intra- and interassay coefficients of variation for low, medium, and high concentrations of progesterone were 7.5, 16.0; 9.1, 8.3; and 8.7, 6.7%, respectively. Correlation between total plasma progesterone (assayed by enzyme immunoassay with extraction) and salivary progesterone concentrations was good (r = 0.848, p less than 0.001, n = 56). We found the assay useful for monitoring ovarian function. The analytical procedure is convenient, and one person can assay more than 200 saliva samples per working day. The turnaround time for 36 samples is 2 h, including 1.5 h of incubation time, when previously coated plates are used. We conclude that such assays are very suitable for measuring progesterone in serial saliva samples and could become the preferred method for monitoring ovarian function.

Adult↗
PubMed1983

Adhesion of mouse blastocysts to uterine epithelium in culture: a requirement for mutual surface interactions.

Blastocysts readily adhered to inert materials in culture, but they resisted adhesion to living cells even after several days under conditions which encouraged cell aggregation. As far as could be determined by observing their spreading behavior on polylysine- and polyglutamate-coated dishes, the mechanism of adhesion of blastocysts to inert surfaces was similar to that of freshly dissociated cells and cell lines. However, their adhesion to vesicles of isolated uterine epithelium, which was encouraged by hanging drop culture, was by a different mechanism that involved microvilli on both the embryonic and maternal surfaces. This interactive step, which was similar to that seen during attachment in vivo, was followed by a brief period of close trophoblast-epithelial contact which led ultimately to phagocytosis of sloughed epithelium. Blastocysts showed a clear preference for adhesion to cultured epithelium in vesicles that had begun to collapse. In this case the cells showed a columnar profile with sharply defined microvillous apexes, unlike the flattened cells in fully expanded vesicles or on culture dishes. We conclude that the preimplantation adhesion of mouse blastocysts requires specific changes on both the embryonic and maternal surfaces to overcome the mutual nonadhesiveness typical of epithelia. The relatively rapid adhesion of blastocysts to a culture dish, on the other hand, is more typical of the well-known spreading behavior of cells on a highly attractive surface.

Animals↗
PubMed1982

Mouse embryos and uterine epithelia show adhesive interactions in culture.

To investigate the cellular mechanisms in preimplantation adhesion of the mammalian blastocyst to uterine epithelium, it is essential to avoid the complexities of the maternal environment but at the same time prevent the introduction of competing artificial surfaces, to which embryos preferentially adhere. We demonstrate here that sealed vesicles of isolated uterine epithelium cultured together with blastocysts in hanging drops provide an optimum system for encouraging and observing the adhesive interactions. The responses of the embryonic and maternal cells were identical to those known in vivo. Microvilli were seen on both surfaces, and in places the membranes were drawn into close apposition with some desmosomelike junctions. After blastocyst adhesion occurred trophoblast cells invaded the epithelium and showed phagocytic activity, closely resembling the invasion that follows adhesion during normal pregnancy in mice. Key words blastocyst, cell adhesion, implantation, microvilli, phagocytosis, trophoblast.

Animals↗
PubMed1982

Ultrastructure of encapsulation of Schistosoma mansoni mother sporocysts by hemocytes of juveniles of the 10-R2 strain of Biomphalaria glabrata.

Dynamic aspects of the cellular responses of juvenile (2-3 mm shell diameter) 10-R2 strain Biomphalaria glabrata to newly penetrated Schistosoma mansoni (NIH-Sm-PR-1 strain) were studied at the ultrastructural level. As early as 3 hr postexposure (PE), host hemocytes had contacted the parasite's surface and by 7.5 hr, had phagocytosed sporocyst microvilli and small pieces of underlying tegument. Most sporocysts observed at 24 hr PE lacked tegumental cytoplasm, and germinal cells and other internal structures showed extensive pathological changes. By 48 hr, capsules were filled with hemocytes containing numerous, large phagosomes, and only scattered remnants of sporocyst material remained. Capsules were difficult to find at 4 days PE, suggesting that hemocytes participating in the encapsulation response had dispersed. Hemocytes responsible for the rapid and consistent destruction of S. mansoni sporocysts in the head-foot region typically formed extensive pseudopodia and contained large numbers of lysosomelike bodies, characteristics associated with granulocytes of B. glabrata. No evidence was found to suggest that hemocytes were lysed, or formed multinuclear syncytia, during the encapsulation response.

Animals↗
PubMed1980

Macrophagelike hemocytes of resistant Biomphalaria glabrata are cytotoxic for sporocysts of Schistosoma mansoni in vitro.

When Schistosoma mansoni miracidia penetrate resistant individuals of the intermediate host snail Biomphalaria glabrata, the sporocyst is encapsulated by hemocytes (macrophagelike cells of the snail circulation) and killed. In our in vitro model the same fate requires only sporocysts and snail hemolymph. However, when cultured in plasma alone (cell-free hemolymph), sporocysts remain viable for more than 3 days, regardless of whether the plasma is from susceptible or resistant snails. When hemolymph is used from susceptible snails, the sporocysts retain a normal healthy appearance. Furthermore, the parasite appears to express an offensive response to the hemocytes of susceptible snails. Ultrastructural study reveals that resistant-strain hemocytes destroy the parasite tegument; within 24 hr the sporocyst is damaged severely throughout. This cell-mediated, internal, defensive response of an invertebrate host closely resembles antibody-dependent, cell-mediated damage to schistosomula in mammalian hosts.

Animals↗
PubMed1975

Studies on the prevalence of type C virus associated with gibbon hematopoietic neoplasms.

Gibbon malignancy frequently involves the hematopoietic system and can occur in clusters. Virus isolated from gibbon neoplasms possessed typical type C virus morphology, and the virion measured 100 nm in diameter with an electron-dense nucleoid measuring approximately 75 nm. The virus incorporated 3H-uridine into the nucleic acid and rested at a buoyant density of 1.14-1.16 g/cm3. Intra-and interspecific antigenic determinants were present, and the intraspecific antigenic determinant was shared with the woolly monkey sarcoma virus but not with feline or murine type C viruses. The virus and antibody reactive to the virus are more prevalent in gibbon groups that experience leukemia than those free of hematopoietic neoplasms.

Animals↗