PubMed Health⌕ Search

Biomedical subjects

R Adams

Publications and source records attributed to R Adams.

At least 73 records · Page 4Linked to original sources
PubMed1997

Asthma prevalence, morbidity and management practices in South Australia, 1992-1995.

BACKGROUND: The Spring South Australian Health Omnibus Survey (SSAHOS) has been used to monitor trends in asthma prevalence, asthma morbidity and asthma management practices between 1992 and 1995. AIMS: To determine if self-reported asthma prevalence and availability of asthma action plans were increasing. To identify deficiencies in asthma management and opportunities for intervention. METHODS: Representative population survey by trained interviewers using a multistage, systematic, clustered area sample of 4200 households in South Australia where people aged 15 years or more are living. RESULTS: Over 3000 interviews were conducted each year. Between 1992 and 1995 the self-reported prevalence of asthma in those aged 15 years or more increased significantly from 15.7% to 20.3% (p < 0.0005), and the prevalence of current asthma increased from 9.3% to 11.4% (p < 0.05). The self-reported availability of individual asthma action plans increased from 21.9% in 1992 to 42.2% in 1995 (p < 0.0005). In 1992, 21% had a nebuliser at home, and 10.5% had a peak flow meter. In 1993, 61.4% were using preventive medications, and 35% thought bronchodilators were 'preventer' medications. In 1994 and 1995, between 12.5% and 15.6% had nocturnal awakening weekly or more often, and 31.4% had morning asthma symptoms weekly or more often. Between 20.1% and 20.8% had lost days from usual activities during the last year. Those on incomes below $20,000 had more symptoms, had more admissions to hospital, and required more medication than those on higher incomes. CONCLUSIONS: Self-reported asthma prevalence has increased. There remains a gap between current asthma management and that recommended by the National Asthma Campaign.

Adolescent↗
PubMed1997

Serum creatinine is a poor marker of glomerular filtration rate in patients with spina bifida.

Serum creatinine is used to estimate the glomerular filtration rate (GFR). The serum creatinine, however, may not accurately reflect the GFR in spina bifida patients, who often have decreased overall muscle mass resulting from spinal cord abnormalities. The relationship between the serum creatinine and GFR (obtained by [(125)I]iothalamate clearance) was examined in a population of spina bifida patients. Age-matched patients without spina bifida were used as controls. Results demonstrate that, for serum creatinines above 0.5 mg/dL, serum creatinine is a very poor predictor of GFR. Two patients with serum creatinines of 2.2 mg/dL are near end-stage renal disease with GFRs of 12.5 and 13 mL/minute per 1.73m2 and two patients were initiated on dialysis at the conclusion of the study. It is concluded that obtaining a GFR from a clearance study and not serum creatinine is the only reliable method to assess renal function in spina bifida patients once the serum creatinine is greater than 0.5 mg/dL.

Adolescent↗
PubMed1997

Interleukin 8 released after acute myocardial infarction is mainly bound to erythrocytes.

OBJECTIVE: To determine whether rapid clearance of interleukin 8 (IL-8) from plasma through binding to the erythrocyte chemokine receptor may be responsible for failure to detect IL-8 consistently after acute myocardial infarction. DESIGN: Plasma concentrations of IL-8 were measured at frequent intervals in 43 consecutive patients. In 21 of these, erythrocyte bound IL-8 concentrations were also measured. The influence of infarct size, type of treatment, and the presence of early successful reperfusion on IL-8 release was assessed. RESULTS: Peak IL-8 concentrations in plasma were raised in 31 of the 43 patients (68%). Median plasma IL-8 concentrations were 16.0 pg/ml (range 2.4 to 225.0 pg/ml) six hours after the onset of chest pain. Twelve hours after the onset of symptoms, plasma IL-8 concentrations had already returned to normal in 27 patients. In contrast, in 18 of 21 patients (86%), erythrocyte bound IL-8 concentrations were raised at between 6 and 30 hours, with a median peak value of 59.8 pg/ml (range 19 to 148 pg/ml). No correlation between peak creatine kinase MB and peak IL-8 (plasma or erythrocyte bound) was observed. There was a significant difference in peak plasma IL-8 concentrations between patients who underwent direct PTCA (19.4 pg/ml) and those who received conservative treatment (9.9 pg/ml; p = 0.0206), but no correlation with the presence of early successful reperfusion. CONCLUSIONS: IL-8 is released in plasma after acute myocardial infarction and subsequently binds to red blood cells, resulting in only a transient rise of plasma IL-8 and a more prolonged increase of erythrocyte bound IL-8.

Biomarkers↗
PubMed1997

Semiconstrained total elbow replacement for the treatment of post-traumatic osteoarthrosis.

Forty-one consecutive patients were managed for post-traumatic osteoarthrosis or dysfunction of the elbow with use of a non-customized semiconstrained Coonrad-Morrey total elbow prosthesis. The average age at the time of the operation was fifty-seven years (range, thirty-two to eighty-two years). The patients were followed for an average of five years and eight months (range, two to twelve years). Radiographs were made at least two years postoperatively (average, five years and one month; range, two to twelve years) for thirty-nine of the forty-one patients. According to the Mayo elbow performance score, sixteen patients (39 per cent) had an excellent result, eighteen (44 per cent) had a good result, five (12 per cent) had a fair result, and two (5 per cent) had a poor result. Thirty-six (95 per cent) of the thirty-eight patients who had a functioning implant at the time of follow-up considered the outcome to be satisfactory. Preoperatively, thirty-seven patients (90 per cent) had moderate or severe pain; postoperatively, thirty (73 per cent) had no or only mild discomfort. Motion improved from an average arc of flexion of 40 to 118 degrees preoperatively to an average arc of flexion of 27 to 131 degrees postoperatively. All thirty-eight functioning implants rendered the elbow stable. Eleven patients (27 per cent) had a major complication. Nine of them (22 per cent of the series) needed an additional operation. There was no aseptic loosening, and most of the complications were primarily due to so-called mechanical failure. The ulnar component fractured in five patients (12 per cent), and the polyethylene bushings wore out in two (5 per cent). These complications were attributed principally to the performance of strenuous physical labor, such as lifting more than ten kilograms on a regular basis, against the advice of the surgeon; excessive preoperative deformity of the joint; or an unstable traumatic injury. Two patients (5 per cent) had an infection. Semiconstrained joint replacement of the elbow can be a reliable form of treatment, and frequently is the only viable option, for the difficult problems encountered with post-traumatic destruction of a joint. Restoration of function, relief of pain, and patient satisfaction can be achieved even when a patient is less than sixty years old if that patient has low demands and a low level of activity. However, the mechanical failures underscore the fact that this procedure is relatively contraindicated in patients who anticipate strenuous physical activity or who are not expected to comply with the postoperative protocol. This observation reflects the tendency for increased and excessive use of a previously functionless joint, after it has been rendered stable and pain-free, to lead to mechanical failure.

Adult↗
PubMed1997

Plinth padding and measures of posteroanterior lumbar stiffness.

OBJECTIVE: To investigate whether measurement of posteroanterior (PA) lumbar stiffness is affected by the presence of padding on the testing plinth. DESIGN: Within a repeated-measures design, measurements were made of lumbar PA stiffness in subjects without low back pain on both a rigid and a padded plinth surface. SUBJECTS: Nineteen subjects with no history of any low back pain requiring treatment over the preceding 12 months participated in this study. METHODS: PA stiffness was measured at L3 on two occasions under two different conditions. The first condition involved measurement of lumbar stiffness on a rigid plinth surface; the second involved measurement on a padded plinth surface. A reliable mechanical device was used to obtain the PA stiffness measures. RESULTS: Mean lumbar PA stiffness values obtained when testing on a padded plinth were 2.86 N/mm less than those values obtained when testing the same lumbar spines on a rigid plinth. A paired t test showed a significant difference between the PA stiffness measures at L3 obtained on the padded plinth and those obtained on the rigid plinth (t = 6.66, df = 18, p < or = .0001). CONCLUSIONS: These findings suggest that to improve the reliability of lumbar PA stiffness assessment, testing should be performed under the same plinth surface conditions.

Adult↗
PubMed1996

Treatment of Budd-Chiari syndrome with portosystemic shunt or liver transplantation.

BACKGROUND: Budd-Chiari syndrome is an uncommon disorder caused by obstruction to hepatic venous outflow, causing varying degrees of hepatic injury depending on the extent, severity, and acuity of the obstruction. PATIENTS AND METHODS: We reviewed the indications for operative intervention and the results of treating 32 patients with Budd-Chiari syndrome seen at Toronto Hospital between 1968 and 1995. RESULTS: Twenty-one patients underwent portosystemic shunt (PSS) and 7 patients underwent liver transplantation (LT) as their initial operative management. Three patients who initially had PSS subsequently required LT. Patients with cirrhosis found on biopsy and preservation of hepatocellular function were treated with PSS and showed no difference in outcome when compared with patients without cirrhosis (P = 0.35). Patients who were treated by PSS with retrohepatic vena caval compression, as shown by high caval gradients had outcomes similar to those for patients with low gradients (P = 0.31). Using the Kaplan-Meier method, 5-year survival of PSS patients was 57%. Liver transplantation was used to manage patients with hepatic decompensation, as well as patients with vena caval occlusion or failed PSS. The 5-year Kaplan-Meier survival for LT was 67%. CONCLUSIONS: Both PSS and LT are effective options in the management of Budd-Chiari syndrome. Portosystemic shunt is the preferred initial approach even with cirrhosis or retrohepatic caval compression as long as there is preservation of liver function and a patent vena cava. Liver transplantation should be used as primary therapy for patients with irreversible hepatic decompensation or vena caval occlusion, and it can be an effective salvage procedure following failed PSS.

Adolescent↗
PubMed1996

Stroke rehabilitation: are highly structured units more conducive to physical activity than less structured units?

OBJECTIVE: To determine if the physical design and organizational structure of rehabilitation units is related to the amount of patients' motor activity. DESIGN: An observational study was conducted; time samples of the motor activity of patients following stroke were taken between 7AM and 7PM both on weekdays and weekends. SETTING: Two rehabilitation units associated with general hospitals with different physical design and organizational structure. One unit was spread over a large area and had a highly organized daily structure; the other was small and informally organized. SUBJECTS: Inpatients with hemiplegia as a result of stroke who gave consent to participate. MAIN OUTCOME MEASURE: The nature and frequency of 14 motor activities were compared between units. RESULTS: No significant difference was found in any of the observed motor activities between the units when using independent groups t tests (p = 0.1-0.8). Subjects in both units spent more than 70% of their day in activities largely unrelated to physical outcome (eg, conversing with visitors or doing nothing observable) and less than 20% of the day in activities that could potentially contribute to their recovery (eg, in therapy or exercising independently). CONCLUSIONS: Rehabilitation units are not functioning as learning environments. The challenge is to identify and implement measures that will change this finding.

Aged↗
PubMed1996

Whole-body cooling of hyperthermic runners: comparison of two field therapies.

Severe exercise-induced hyperthermia requires rapid cooling. Of the many cooling modalities available, there is disagreement over which is the most effective. The purpose of this field study was to compare two cooling therapies for hyperthermic distance runners who had completed an 11.5-km summer foot race. Twenty-one distance runners (mean [+/- SE] initial rectal temperature 41.2 +/- 0.2 degrees C) were treated either by ice water immersion (1 to 3 degrees C, n = 14) or by air exposure while wrapped in wet towels (24.4 degrees C ambient, n = 7). Ice water immersion versus air exposure resulted in significantly different (P < .005) pretherapy to posttherapy changes in rectal temperature (-3.0 +/- 0.3 v -1.4 +/- 0.3 degrees C) and mean cooling rate (0.20 +/- 0.02 v 0.11 +/- 0.02 degrees C/min). Ice water immersion cooled approximately twice as fast as air exposure. These data refute the theory that ice water immersion is an inefficient cooling modality.

Adult↗
PubMed1996

Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards.

This study tested the theoretical proposition that qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. The research was undertaken in a local district general hospital during January 1995. The project aimed to look at local practices of qualified nurses related to oral care of patients hospitalized in medical wards. Extent of knowledge and current practice of care was examined using a questionnaire. Open and closed style questions were used. The sample comprised nurses on one elderly care ward and three general medical wards and the sample size was 34. The results revealed gaps in knowledge of oral care procedures. In particular, a lack of assessment and documentation was highlighted. However, the nurses indicated a high level of interest at updating themselves in this area of nursing. The limitations of this study are discussed.

Aged↗
PubMed1996

A comparison of pisiform and thumb grips in stiffness assessment.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether two versions of the posteroanterior (PA) pressure test provide similar stiffness information. SUBJECTS: Twenty subjects were asked to judge the magnitude of five stiffness stimuli provided by a mechanical device. METHODS: Subjects were required to rate the stiffness magnitude on a five-point scale using both the thumb-grip and pisiform-grip versions of the PA pressure test. Using signal detection theory methods, measures of both a subject's ability to discriminate between the stiffness stimuli and a subject's bias in perceived stiffness magnitude due to the testing method were obtained. These values were compared using analysis of trend within an analysis of variance framework. RESULTS: The two methods of performing the PA central pressure had similar stimulus discriminability. With the thumb-grip method, however, a substantial bias occurred, making the mechanical stimuli appear to be stiffer than when the pisiform grip was used. CONCLUSION AND DISCUSSION: The method of performing the PA central pressure test affects the perceived magnitude of stiffness stimuli. This results suggests that the two versions of this clinical test should not be used interchangeably.

Adult↗
PubMed1996

In vivo model of adeno-associated virus vector persistence and rescue.

Gene therapy vectors based on human DNA viruses could be mobilized or rescued from individuals who are subsequently infected with the corresponding wild-type (wt) helper viruses. This phenomenon has been effectively modeled in vitro with both adenovirus (Ad) and adeno-associated virus (AAV) vectors but has not previously been studied in vivo. In the current study, we have developed an in vivo model to study the interactions of a recombinant AAV vector (AAV-CFTR) with wt AAV type 2 (AAV2) and a host range mutant Ad (Ad2HR405) for which monkey cells are permissive (D.E.Brough, S.A.Rice, S.Sell, and D.F.Klessig, J. Virol. 55:206-212, 1985). AAV-CFTR was administered to the respiratory epithelium of the nose or lung of rhesus macaques. Primary cells were harvested from the infusion site at time points up to 3 months after vector administration to confirm vector DNA persistence. Vector DNA was present in episomal form and could be rescued in vitro only by addition of wt AAV2 and Ad. In in vivo rescue studies, vector was administered before or after wt-AAV2 and Ad2HR405 infection, and the shedding of AAV-CFTR was examined. Ad2HR405 and wt-AAV2 infections were established in the nose with concomitant administration. wt-AAV2 replication occurred in the lung when virus was administered directly at a high titer to the lower respiratory tract. AAV-CFTR vector rescue was also observed in the latter setting. Although these studies were performed with small numbers of animals within each group, it appears that AAV-CFTR DNA persists in the primate respiratory tract and that this model may be useful for studies of recombinant AAV vector rescue.

Adenoviridae↗
PubMed1996

Alpha-V/beta-3 and alpha-V/beta-5 integrin distribution in neoplastic kidney.

Integrins are transmembrane glycoproteins that mediate cell-cell and cell-matrix interactions. Altered integrin expression may contribute to tumor progression, invasiveness and metastases. The alpha-V/beta-3 (alpha v beta 3; osteopontin/ vitronectin receptor) has recently been implicated in neovascularization and tumor-induced angiogenesis. alpha v-Subunit also associates with beta 5 to form an alpha v beta 5-complex, another vitronectin receptor. We studied tissue distribution of alpha v beta 3-and alpha v beta 5-integrins, as well as alpha 1- and beta 1-subunits in nephrectomy samples from 7 subjects with localized renal cell carcinoma. Grossly and histologically uninvolved regions ('normal') from the same nephrectomy specimens were used for comparison. Integrin expression was studied with specific monoclonal antibodies and the immunoperoxidase technique. alpha v beta 3 was expressed in the glomerular epithelial cells, Bowman's capsule, vascular endothelium, and weakly in tubular epithelial cells. alpha v beta 5 had a similar distribution except for minimal expression on vascular endothelium. alpha 1-Expression was observed in mesangium and but weakly in Bowman's capsule. beta 1-Expression was seen in glomerular epithelial cells, Bowman's capsule, vascular epithelium and tubular epithelial cells. Unlike in 'normals', neoplastic expression was more heterogeneous alpha v beta 3 was expressed in tumor cells in 4/7 cases, vascular endothelium in 6/6, and in stroma in 4/7. alpha v beta 5 was weakly expressed in tumor cells in 4/5, vascular endothelium in 5/5, and stroma in 4/5 cases. alpha 1-Expression was seen in tumor cells in 3/7, vascular endothelium in 4/7 and in stroma in 7/7 cases. beta 1-Expression was seen in tumor cells in 7/7 cases, vascular endothelium in 7/7, and in stroma in 4/7 cases. This study delineates the pattern of expression of the alpha v beta 3-and alpha v beta 5-integrins in 'normal' and neoplastic human kidney. Variations in alpha v beta 3-and alpha v beta 5-integrin expression may play a role in normal and neoplastic processes of the kidney.

Adult↗
PubMed1996

Safety of single-dose administration of an adeno-associated virus (AAV)-CFTR vector in the primate lung.

Gene therapy for cystic fibrosis (CF) would ideally be accomplished with a vector capable of long-term expression of the cystic fibrosis transmembrane conductance regulator (CFTR) in the absence of a host inflammatory response. Recombinant adeno-associated virus (AAV)-CFTR vectors possess these characteristics in rabbits. Because the utility of AAV vectors as gene transfer agents has only been recognized recently, AAV vector-mediated transduction has never been modeled in a primate host, which is an important step before its use in humans. In order to test the safety and biological activity of AAV-CFTR, single doses of AAV-CFTR vector were administered by fiberoptic bronchoscopy to the posterior basal segment of the right lower lobe (RLL) of the lungs of 10 rhesus macaques with four matched vehicle-treated controls. Animals were followed for 10, 21, 90 or 180 days following vector instillation. Vector DNA transfer occurred in bronchial epithelial cells in the RLL of each animal that received vector as assessed by in situ DNA PCR. Vector mRNA was detectable for 180 days after administration as detected by RT-PCR and by RNase protection assay. Safety of vector administration was determined by measurements of pulmonary mechanics, arterial blood gas analysis, chest radiographs, and bronchoalveolar lavage (BAL) fluid analysis including cell count and quantification of inflammatory cytokines. Gross and microscopic pathologic examination were also performed. There was no evidence of inflammation or other toxicity, although vector DNA was found in extrapulmonary organs of some animals. These results indicate that transduction of the primate airway epithelium with the AAV-CFTR mediates long-term CFTR cDNA transfer and is relatively safe.

Animals↗
PubMed1996

Options in asthma management.

This paper emphasises the strategies that can be used by general practitioners in the management of asthma and reviews the new medications available for the severe asthmatic population. The principles of asthma management involve the assessment of asthma severity and the assessment of risk factors. An effective review process entails: identification of immediate patient concerns; a review of symptoms; lung function; and detection of altered compliance. In the setting of poor compliance additional strategies can be applied. Three relatively new medications are available. Salmeterol (long acting beta 2 agonist) and fluticasone (inhaled corticosteroid) are for use in the small proportion of asthmatics who have severe asthma. Nedocromil sodium is a cromoglycate-like drug mainly suitable for treatment of milder asthmatics.

Administration, Inhalation↗
PubMed1996

Vascular endothelial lesion in patients undergoing bone marrow transplantation.

Changes in endothelial cell activity are likely to play a role in the thrombotic complications of bone marrow transplantation (BMT) such as the development of veno-occlusive disease. Accordingly, we measured established plasma endothelial cell markers von Willebrand factor (vWf), soluble thrombomodulin (sTM), soluble ICAM-1 (sICAM-1), and possible inducers of these molecules, TNF alpha and elastase, in the plasma of 25 patients, 1 week before as well as 1 and 3 weeks after BMT. Compared to healthy age and sex-matched controls, patients exhibited increased vWf and sTM. One week after transplantation, there were significant increases in vWf and sICAM-1, with a significant fall in elastases. Three weeks after the transplantation, sICAM-1 and, to a lesser extent, vWf increased still further, whereas elastases were unchanged. There were no significant changes in sTM and in TNF alpha through the serial study. Our data suggest that before conditioning, vascular endothelium is damaged by both injury and activation, as seen by the variations of vWf and sTM. After transplantation, the enhancement of this damage seems to be more specifically related to activation, since we observed a strong subsequent increase in vWf and markedly in sICAM-1.

Adolescent↗
PubMed1995

The effect of phenylephrine on Müller muscle. A blepharogram study of eyelid motion.

PURPOSE: The blepharogram technique is used to study the effect of a drug on blinking. The authors show that ocular instillation of phenylephrine, a stimulant of Müller muscle of the eyelid, accelerates the up phase of the blink. METHODS: Motion of a tiny search coil glued to the eyelid moving in a weak magnetic field modifies an induced alternating current which is amplified and used to display the position of the upper eyelid in degrees on the ordinate of a graph with time in milliseconds on the abscissa. The graph is called a blepharogram. Blepharogram studies and individual blink analysis show the effect of phenylephrine on eyelid motion (blinking). RESULTS: Instillation of phenylephrine accelerated the up phase of the blink in all ten experimental subjects. In 65% of subjects, phenylephrine also produced or increased newly described N and M blepharogram patterns. CONCLUSION: This is the first instrumental detection of the effect of a pharmacologic agent on eyelid motion. The blepharogram technique provides insight into eyelid physiology and can be used to study any neuromuscular condition that affects eyelid motion.

Adult↗
PubMed1995

Modulation of a recombinant glycine transporter (GLYT1b) by activation of protein kinase C.

Treatment of human embryonic kidney cells (HEK 293 cells) expressing the mouse glycine transporter 1 (GLYT1b) with the protein kinase C (PKC) activator phorbol 12-myristate 13-acetate (PMA) decreased specific [3H]glycine uptake. This down-regulation resulted from a reduction of the maximal transport rate and was blocked by the PKC inhibitors 1-(5-isoquinolinylsulfonyl)-2-methylpiperazine (H7) and staurosporine. The inhibitory effect of PMA treatment was also observed after removing all five predicted phosphorylation sites for PKC in GLYT1b by site-directed mutagenesis. These data indicate that glycine transport by GLYT1b is modulated by PKC activation; however, this regulation may involve indirect phosphorylation mechanisms.

Amino Acid Transport Systems, Neutral↗