PubMed Health⌕ Search

Biomedical subjects

R Hunter

Publications and source records attributed to R Hunter.

At least 37 records · Page 2Linked to original sources
PubMed2000

The Scottish and Manchester randomised trial of neo-adjuvant chemotherapy for advanced cervical cancer.

204 eligible patients were entered into a multicentre randomised trial of neo-adjuvant chemotherapy prior to radical radiotherapy. The aim of this study was to assess whether there was any survival advantage in patients undergoing chemotherapy and radiotherapy compared with those given radiotherapy alone. Patients were aged up to 70 years, performance status 0-1/2, with bulky stage IIb, stage III or stage IVa squamous or adenosquamous carcinoma. Three cycles of methotrexate 100 mg/m2 and cisplatin 50 mg/m2 were given at 2-weekly intervals before radical radiotherapy. 104 eligible patients received the combination treatment and 100 radiotherapy only. The two arms of the study were well balanced for tumour and patient characteristics. The response rate to chemotherapy was 49%, 33% of patients in the radiotherapy (XRT) alone arm and 45% of the combination arm were clinically free of tumour at the end of treatment. The median follow-up for surviving patients is 5.4 years (range: 11 months-8 years) and 84% have been followed-up for more than 4 years. 134 patients have died (68 XRT only, 66 combined arm). The median survival RT alone was 111 weeks (95% confidence interval (CI) 72-151 weeks), combination arm 125 weeks (95% CI 79-170 weeks). The estimated death ratio is 0.79 (P = 0.19, 95% CI 0.56-1.12). The estimated 3-year survival is 40% (95% CI 30-50%) RT only compared with 47% (95% CI 37-57%) in the combination arm. Acute and late toxicity of radiotherapy was not increased by the addition of chemotherapy.

Adult↗
PubMed2000

The shape of the HIV/AIDS epidemic in Puerto Rico.

This study presents information on AIDS patients in Puerto Rico, including their general sociodemographic profile, some risk-related parameters, characteristics of vulnerable groups, and elements of the clinical spectrum of the disease. Data were analyzed from the Puerto Rico AIDS Surveillance Program and available studies about the HIV/AIDS epidemic in Puerto Rico. A total of 23,089 AIDS cases was reported to the Puerto Rico AIDS Surveillance Program from January 1981 through February 1999. The HIV/AIDS epidemic has affected mostly males and females between the ages of 30 and 49, though cases have also been reported for other age groups. The cumulative proportion of persons with AIDS who are women has increased tremendously, from 11.4% for the 1981-1986 period to 21.6% for the entire 1981-1999 period. In Puerto Rico the category of injecting drug users (IDUs) accounts for the majority of the AIDS cases (52%), followed by heterosexual contact (22%), and men who have sex with men (17%). The three main diagnoses for AIDS on the island are wasting syndrome (30.7%); esophageal, bronchial, and lung candidiasis (29.4%); and Pneumocystis carinii pneumonia (26.8%). According to 1994 vital statistics for Puerto Rico, AIDS was the fourth-leading cause of death. The overall reported AIDS mortality rate was 42.0 per 100,000 persons, with the rate for males, 67.8, much higher than it was for females, 17.4. AIDS is the first cause of death among persons between 30 and 39 years old. Intense efforts are needed to better understand the epidemic in Puerto Rico and its biology, social and family impacts, and financial costs.

AIDS-Related Opportunistic Infections↗
PubMed2000

Quantification and synthesis of cocaine- and amphetamine-regulated transcript peptide (79-102)-like immunoreactivity and mRNA in rat tissues.

The distribution of cocaine- and amphetamine-regulated transcript peptide (79-102)-like immunoreactivity (CART-LI) was quantified in brain and peripheral tissues of male and female Wistar rats, and male obese (fa/fa) and heterozygous (Fa/+) Zucker rats using a specific RIA. CART-LI tissue levels have not been quantified previously. The assay, using cocaine- and amphetamine-regulated transcript (CART) (79-102) as a standard and radioactive tracer and an antibody to CART (79-102) fragment, detected CART-LI in all brain regions examined, the anterior and posterior pituitary, the spinal cord and throughout the gastrointestinal tract of both male and female Wistar rats. The highest concentrations were found in the hypothalamus, duodenum, anterior pituitary and posterior pituitary (50.6+/-4.4, 26.1+/-4.2, 50.0+/-1.3 and 373.0+/-55.2 pmol/g wet tissue respectively, means+/- s.e.m., n=6-10 male animals). There was no significant variation between the sexes. The concentrations of CART-LI in hypothalami and anterior and posterior pituitaries from fa/fa rats were significantly (P<0002) lower than those of Fa/+ controls (35.9+/-2.1 vs 53.9+/-4.9,<0.6 vs 1.8+/-0.4 and 114+/-9.1 vs 255.5+/- 20.9 pmol/g wet tissue respectively, means+/- s.e.m., n=7). Gel permeation chromatography of regions of rat brain and gastrointestinal tract showed possible differential processing between regions. CART-LI was released from hypothalamic tissue slices in a calcium-dependent fashion by potassium-induced depolarisation. Northern blot analysis detected CART mRNA in the hypothalamus, anterior pituitary, brain stem, cerebellum and spinal cord. The pattern o! f distribution of CART mRNA and CART-LI in various neural and other tissues is in accord with a role for CART as a neurotransmitter.

Animals↗
PubMed1999

Nosocomial transmission of penicillin-resistant Streptococcus pneumoniae.

Two patients were found to harbor intermediate-level penicillin-resistant Streptococcus pneumoniae in a pediatric hospital setting. For the first patient, the bacterium was isolated from a tracheal aspirate, and for the second patient, a positive blood culture was found a short time after the index case. Two molecular typing techniques (enterobacterial repetitive intergenic consensus sequence polymerase chain reaction, and repetitive sequence-based polymerase chain reaction) demonstrated homology among these isolates, which suggests person-to-person spread. We propose the need for institution-based infection control precautions that will limit the spread of penicillin-resistant pneumococci.

Child, Preschool↗
PubMed1999

Investigation of distal aortic compliance and vasodilator responsiveness in heart failure due to proximal aortic stenosis in the guinea pig.

Hypotension and syncope are recognized features of chronic aortic stenosis. This study examined vasomotor responses and dynamic compliance in isolated abdominal aortae after chronic constriction of the ascending aorta. Guinea pigs underwent constriction of the ascending aorta or sham operation. Sections of descending aorta were removed for studies of contractile performance and compliance. Dynamic compliance was measured using a feedback-controlled pulsatile pressure system at frequencies of 0.5, 1.5 and 2.5 Hz and mean pressures from 40 to 100 mmHg. Chronic (149+/-6 days) aortic constriction resulted in significant increases in organ weight/body weight ratios for left ventricle (58%), right ventricle (100%) and lung (61%). The presence of heart failure was indicated by increased lung weights, left ventricular end-diastolic pressure and systemic vascular resistance, reduced cardiac output and increased levels of plasma atrial natriuretic peptide (166%), adrenaline (x20), noradrenaline (106%) and dopamine (x3). Aortic rings showed similar constrictor responses to phenylephrine and angiotensin II, but maximal vasodilator responses to acetylcholine and isoprenaline were significantly increased (144% and 48% respectively). Dilator responses to sodium nitroprusside, forskolin and cromokalim were unchanged. Compliance of all vessels decreased with increasing pulsatile frequency and to a lesser extent with increased mean pressure, but were similar in aortic-constricted and control groups. Chronic constriction of the ascending aorta resulted in heart failure and increased vasodilator responses to acetylcholine and isoprenaline in the distal aorta while dynamic compliance was unchanged. We hypothesize that increased endothelium-mediated vasodilatation may contribute to hypotension and syncope in patients with left ventricular outflow obstruction.

Animals↗
PubMed1998

Isolation and identification of canine adenovirus type-2 from the upper respiratory tract of a dog.

AIM: To report on the isolation and identification of canine adenovirus type-2 (CAV-2) from a greyhound dog with tracheitis/tonsillitis. METHODS: Virus isolation was performed with Madin and Darby canine kidney (MDCK) cell monolayers using standard virological techniques. The isolated virus was identified by haemagglutination inhibition and serum neutralisation tests. Viral DNA was extracted from infected MDCK cells and subjected to restriction endonuclease analysis using the endonuclease enzymes Bam HI, Bgl II, Eco RI and Hind III. RESULTS: A virus, designated 5 113-87, was isolated in MDCK cells yielding typical cytopathic effect. The virus could be neutralised with a CAV-2 specific reference antiserum and also showed some cross neutralisation with CAV-1 specific reference antiserum. The virus 5 113-87 had a high haemagglutination inhibition titre with CAV-2 antiserum using human group 0 red blood-cells and CAV-1 and CAV-2 reference antisera. This virus also had DNA restriction profiles identical to those of the reference CAV-2 (Toronto A26/61), whereas previously isolated strains of adenovirus from dogs in New Zealand had DNA restriction patterns identical to the prototype CAV-1 strain (Utrecht). CONCLUSION: The findings show that the virus 5 113-87 isolated from the upper respiratory tract of a dog in New Zealand is CAV-2.

Journal Article↗
PubMed1998

Characterization of the histamine H2 receptor structural components involved in dual signaling.

We previously demonstrated that the histamine H2 receptor can activate both adenylate cyclase (AC) and phospholipase C (PLC) signaling pathways via separate GTP-dependent mechanisms. We examined whether H2 receptor-specific peptides corresponding to the amino (N) or carboxyl terminus (C) of the second (2i) or third (3i) intracytoplasmic loops or the carboxyl terminal tail (P4iN) could effect histamine- stimulated AC and PLC activity in cell membranes prepared from HEPA cells stably transfected to express the canine H2 histamine receptor cDNA. Tiotidine binding and basal signaling were not altered by the synthetic peptides. H2P2iN, H2P2iC, H2P3iN and H2P4iN did not effect histamine stimulated AC activity although H2P3iC (10(-4) M) significantly inhibited this parameter (65.6 +/- 7.2% of maximal stimulation) (n = 6). Combination of the five peptides (H2P2iN, H2P2iC, H2P3iN, H2P3iC and H2P4iN) abolished histamine stimulated AC activity. Although all of the peptides inhibited histamine-stimulated PLC activity to a moderate degree individually, H2P3iC (10(-4) M) had the greatest effect, decreasing PLC activation to 20.8 +/- 6.3% of maximal stimulation (IC50 = 7.5 X 10(-7) M) (n = 6). H2P3iC and the peptide combination did not alter, forskolin, GTP gamma s or epinephrine-stimulated AC activity nor GTP gamma s and vasopressin-stimulated PLC. These studies demonstrate that both the second and third intracytoplasmic loops of the histamine H2 receptor are linked to separate signaling pathways in a differential manner.

Adenylyl Cyclases↗
PubMed1997

Alzheimer's disease in the United Kingdom: developing patient and carer support strategies to encourage care in the community.

Alzheimer's disease is a growing challenge for care providers and purchasers. With the shift away from the provision of long term institutional care in most developed countries, there is a growing tendency for patients with Alzheimer's disease to be cared for at home. In the United Kingdom, this change of direction contrasts with the policies of the 1980s and 90s which focused more attention on controlling costs than on assessment of the needs of the patient and carer and patient management. In recent years, the resources available for management of Alzheimer's disease have focused on institutional care, coupled with drug treatment to control difficult behaviour as the disease progresses. For these reasons, the current system has led to crisis management rather than preventive support--that is, long term care for a few rather than assistance in the home before the crises occur and institutional care is needed. Despite recent innovations in the care of patients with Alzheimer's disease, the nature of the support that patients and carers receive is poorly defined and sometimes inadequate. As a result of the shift towards care in the community, the informal carer occupies an increasingly central role in the care of these patients and the issue of how the best quality of care may be defined and delivered is an issue which is now ripe for review. The objective of this paper is to redefine the type of support that patients and carers should receive so that the disease can be managed more effectively in the community. The needs of patients with Alzheimer's disease and their carers are many and this should be taken into account in defining the quality and structure of healthcare support. This paper shows how new initiatives, combined with recently available symptomatic drug treatment, can allow patients with Alzheimer's disease to be maintained at home for longer. This will have the dual impact of raising the quality of care for patients and improving the quality of life for their carers. Moreover, maintaining patients in a home environment will tend to limit public and private expenditure on institutional care due to a possible delay in the need for it.

Aged↗
PubMed1997

The Belfast Cord Blood Bank.

The first cord blood bank in the British Isles was established in Belfast in June 1993. Cord blood (CB) is rich in haematopoietic progenitor cells and has been used successfully as a substitute for bone marrow transplants in over 200 patients world-wide. Most have received CB from a histocompatible sibling, but reports include several unrelated HLA matched transplants. In addition to the cryopreservation of 400 units of donated CB in the Cord Blood Bank, we have stored eight CB collections from siblings of children with leukaemia in Northern Ireland. A pilot study in collaboration with the maternity unit in the Mater Infirmorum Hospital confirmed the feasibility of a CB banking programme and highlighted many issues relating to Good Manufacturing Practice (GMP). The authors describe experience of collecting 824 units of CB over three years and discuss a few of the wider implications of this innovation in the management of patients requiring myeloablative therapy.

Adult↗
PubMed1997

Psychological and behavioral issues of a cohort of Puerto Rican HIV/AIDS patients.

UNLABELLED: The current study describes the psychological and behavioral issues of a cohort of Puerto Rican HIV/AIDS patients. Differences in the depression mean score were determined and the predictor variables of depression among a cohort of Puerto Rican HIV/AIDS patients were also identified. DESIGN: Cross-sectional survey of a longitudinal cohort (N=1,500). METHODS: The setting of this study was the Immunologic Clinic and the Dr. Ramón Ruiz Arnau University Hospital in Bayamón, Puerto Rico. The sample was composed initially of 58 patients who had completed the Beck Inventory depression test (alpha Cronbach=0.93) and who were registered at the HIV/AIDS Central Registry between April 1995 and July 1996. RESULTS: Women had higher depression scores than men. High education groups (>12th grade) had lower depression scores than low education groups. Patients reporting heterosexual practices had higher depression score than patients without that practice. A multiple linear regression showed that predictors variables of the depression score were gender and education. CONCLUSIONS: A wide spectrum of psychological and behavioral features were present within the HIV/AIDS sample, including depression.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Gender-related differences in the spectrum of HIV disease in the Bayamón area, Puerto Rico.

We compare prevalence (by actual presence or history of condition) rates of selected AIDS-defining conditions across genders in a sample of 1,498 HIV-infected participants who visited our health service facilities between mid 1992 and early 1996. The comparisons were performed globally (considering all subjects) and on a subsample of participants whose most probable mode of infection with HIV was through (self-reported) use of injecting drugs. Global analysis revealed no significant differences across genders for any of the conditions considered; the most prevalent condition being Pneumocystis carinii pneumonia. Subsample-specific analysis (injecting drug users), however, revealed that women from this subgroup were likelier to have (present or by history) at least one AIDS-defining condition; they were also significantly likelier to specifically report candidiasis and Pneumocystis carinii pneumonia.

AIDS-Related Opportunistic Infections↗
PubMed1997

Psycho social and clinical spectrum of HIV/AIDS injecting drug users in Bayamón, Puerto Rico.

OBJECTIVES: To describe the demographic characteristics, the risk related practices, and the clinical and immunological features of Puerto Rican HIV injecting drug users (IDU's). DESIGN: Cross-sectional survey of a longitudinal cohort (N=1,500). METHODS: The HIV Central Registry at the Universidad Central del Caribe has been recruiting HIV/AIDS patients attending the Immunologic Clinic and the University Hospital Ramón Ruiz Arnau since may 1992. 1500 patients have been interviewed and a record including demographic, risk related, clinical and immunologic data has been created for each one of them. Chi square and t-tests were performed to assess the potential significant differences of the TDU's vs the non-IDU's. RESULTS: 57.1% of the HIV/AIDS patients were IDU's. Most of them were males, had a lower education level, with an age fluctuating between 27 to 36 years old and most of them were unemployed. Most IDU's reported to have had heterosexual relations. With regard to the clinical spectrum, Pneumocystis carinii pneumonia (PCP) was the only indicative condition associated with injecting drug use (IDU), as well as bacterial endocarditis, chronic diarrhea, night sweats and idiopathic fever. The spectrum of vulnerabilities of IDU's is larger than that of non-IDU's, with regard to psycho-social, behavioral and clinical features. These vulnerabilities can limit their access to services and render their compliance to treatment more difficult.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Profile of HIV patients with and without bacterial endocarditis.

Bacterial endocarditis (BE) is a serious medical condition seen in the injecting drug users (IDU) with or without HIV. Studies report a low prevalence of BE in HIV/AIDS patients and the clinical manifestations have been considered non-specific making early diagnosis difficult. The HIV Registry in our Center has recruited 1500 HIV/AIDS cases since May 1992. We decided to review and compare the clinical and epidemiological variables of patients admitted to the Registry with BE (23 pts) and without. Fever, sweats and weight loss were seen most frequent in BE patients as well as meningitis and pneumonia. The majority of the patients were IDU. Staphylococcus aureus was the most common pathogen. The tricuspid valve was the most affected valve. Mild insufficiency was the rule. The mortality in BE patients was higher than in the total group. The triad of IDU, the described constitutional signs and symptoms and coexisting meningitis and/or pneumonia, in the HIV/AIDS patient, should alert the physician to the presence of BE particularly in the outpatient setting were a more aggressive diagnostic approach should probably be attempted.

Adult↗
PubMed1996

Injured stable knee with acute effusion: MRI evaluation.

This study was done to evaluate the magnetic resonance imaging (MRI) findings in acute traumatic effusions of the knee without ligament instability or radiographic abnormality other than the effusion. On reviewing the charts of 927 patients who had MRI of the knee, we found 114 patients who met the following criteria for inclusion in this study: (1) acute effusion by examination or history, (2) ligament stability on examination, and (3) normal findings on radiographs (excluding effusion). The total of 144 pathologic diagnoses made by MRI included bone injury (53%), disruption of the anterior cruciate ligament (19%), sprain of the medial collateral ligament (12%), medial meniscus tear (11%), lateral meniscus tear (5%), and rupture of the posterior cruciate ligament ( < 1%). Eight studies (7%) were read as normal. These MRI data are significantly different from data of previous studies using arthroscopy to evaluate acute knee injuries without ligament instability. The findings more accurately reflect the injury pattern seen in this setting because MRI can show both bone and soft tissue injury. From this study, we conclude that bone injury is the most common cause of acute effusion in the patient with ligament stability and normal radiographs.

Adolescent↗
PubMed1995

Signet-ring carcinoma in Crohn's disease presenting as a neck mass.

We report a case of signet cell carcinoma of the colon in a patient with Crohn's disease. Signet cell carcinoma, also termed linitis plastica, is an unusual malignancy of the colon and is rarely associated with Crohn's disease. In general, metastatic disease is evident at the time of diagnosis, and the prognosis is uniformly poor. The radiographic, endoscopic, and histological features are discussed.

Carcinoma, Signet Ring Cell↗