Surgical management of cervicomedullary compression in achondroplastic patients.
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Achondroplasia↗
Biomedical subjects
R McPherson
Publications and source records attributed to R McPherson.
Complications of surgical and percutaneous nonendoscopic gastrostomy: review of 233 patients.
A retrospective study was undertaken to compare the complications of surgical feeding gastrostomy in 100 consecutive patients with those of percutaneous nonendoscopic gastrostomy in 133 consecutive patients. The age and sex distribution and indications for gastrostomy were similar in both groups. Thirty-day mortality in the surgical group was 12% and in the percutaneous group 7.5%. Complications requiring surgical treatment occurred in 8% and 1.5% of the surgical and percutaneous patients, respectively. Significant nonsurgical complications, such as bleeding, aspiration, and myocardial infarction, occurred in 11% of patients undergoing surgical gastroscopy and 3.0% of those with percutaneous gastrostomy. Minor complications, such as mild wound infection and pericatheter leakage, occurred in 14% of surgical patients and in 0.7% of percutaneous patients. Overall, there were significantly fewer complications with percutaneous gastrostomy than with surgical gastrostomy (p less than 0.01). We conclude that percutaneous, nonendoscopic gastrostomy is safer than surgical gastrostomy and hence the preferred method for long-term enteral feeding.
Adolescent↗
An investigation of an estrogen-binding component in the liver and plasma of brook char, Salvelinus fontinalis.
1. Estrogen-binding activity was investigated in liver nuclear and cytosolic preparations of sexually mature female brook char, Salvelinus fontinalis. Nuclear salt extracts of estrogen-injected fish were found to contain high affinity binding sites (Kd = 1.6 nM, capacity = 2.8 fM/ug DNA). 2. Low levels of high-affinity specific binding activity were found in the cytosol of both injected and untreated fish (Kd = 7.5 nM, capacity = 16.1 fM/mg protein). 3. Binding sites in both preparations were specific for estrogens with no significant competition by 5 alpha-dihydrotestosterone, progesterone, or cortisone. 4. A plasma-binder was found to have distinctive differences with regard to structural specificity compared to the estrogen-binding component in liver. It was found to have no affinity for diethylstilbestrol while having some affinity for both 5 alpha-dihydrotestosterone and progesterone. 5. The brook char liver estrogen-binding component was observed to have characteristics in common with estrogen receptors found in other vertebrates.
Animals↗
Percutaneous gastrostomy for enteral feeding.
Over a period of 18 months, percutaneous nonendoscopic gastrostomy using the Seldinger technique was successfully performed in 32 adults for enteral feeding. There were no deaths or major morbidity related to the procedure. Three patients died of existing disease within 30 days; one had peritoneal irritation following dislodgement of the catheter two days after the procedure but responded to conservative treatment with antibiotics alone. The authors conclude that this procedure is simple and safe and represents the preferred method of gastrostomy for enteral feeding.
Adolescent↗
Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures.
Stimulation of centromedian (CM) thalamic nuclei has been proposed as a treatment for seizures. We implanted programmable subcutaneous (s.c.) stimulators into CM bilaterally in 7 patients with intractable epilepsy to test feasibility and safety. Stimulation was on or off in 3-month blocks, with a 3-month washout period in a double-blind, cross-over protocol. Stimuli were delivered as 90-microseconds pulses at 65 pulses/s, 1 min of each 5 min for 2 h/day, with voltage set to half the sensory threshold. Stimulation was safe and well-tolerated, with a mean reduction of tonic-clonic seizure frequency of 30% with respect to baseline when stimulator was on versus a decrease of 8% when the stimulator was off. There was no improvement in total number of generalized seizures with stimulation, and treatment differences were not statistically significant. Stimulation at low intensity did not alter the EEG acutely, but high-intensity stimulation induced slow waves or 2-3 Hz spike-waves with ipsilateral frontal maximum. In an open-label follow-up segment with stimulator trains continuing for 24 h/day, 3 of 6 patients reported at least a 50% decrease in seizure frequency. There were no side effects. This pilot project demonstrated the feasibility of controlled study of thalamic stimulation in epilepsy, but further study will be needed to demonstrate efficacy.
Adolescent↗
Osteochondral dowel transplantation for repair of focal defects in the knee: an outcome study using an ovine model.
OBJECTIVE: A model system was developed to objectively assess the quality of articular cartilage after surgical reconstruction of focal defects in the median femoral condyle using osteochondral dowel grafts. STUDY DESIGN: The surgical technique was developed and customized to reproducibly minimize surgical trauma and graft instability in order to improve the survival of the transplanted cartilage and the long-term integrity of the joint surfaces. ANIMALS OR SAMPLE POPULATION: 24 adult female Suffolk-Romanoff crossbred sheep. METHODS: Biomechanical creep testing, paravital staining for chondrocyte viability, histological analysis, and gross morphological analysis were performed at 3, 6, and 12 months postoperatively to compare fresh autografted osteochondral dowels with allografts that had been subject to a freezing protocol known to kill chondrocytes. The latter was used to investigate the time course of cartilage degeneration after injury. These two groups were also compared with normal unoperated control tissue. RESULTS: Biomechanical behavior, chondrocyte survival, and cartilage histology differed significantly between fresh grafts and those that had been frozen. CONCLUSIONS: Indentation testing and paravital staining were able to identify degenerative changes earlier than other methods of assessment. The technique developed here reproducibly and reliably transplanted osteochondral dowel grafts while minimizing the confounding effects of surgical trauma and graft instability. CLINICAL RELEVANCE: The technique provides both a promising surgical technique for the repair of focal defects of the medial femoral condyle and a sensitive model for the future study of cryopreservation strategies for articular cartilage.
Animals↗
Increase in plasma cholesteryl ester transfer protein during probucol treatment. Relation to changes in high density lipoprotein composition.
Probucol is a hypolipidemic agent that causes a marked decrease in high density lipoprotein (HDL) cholesterol. To investigate the mechanism of this effect, two studies were performed in hypercholesterolemic patients who had been stabilized previously on diet and were not receiving other lipid-lowering medication. Plasma cholesteryl ester transfer protein (CETP) concentrations were measured in fasting plasma samples before and after 10 weeks of probucol therapy using a sensitive and specific radioimmunoassay. Plasma total and low density lipoprotein cholesterol concentrations decreased, whereas apolipoprotein (apo) B was unchanged. Plasma apo E concentrations increased markedly. HDL cholesterol and apo A-I decreased in all subjects. These effects of probucol were accompanied by even more striking changes in plasma CETP concentrations, which increased by a mean of 64%. In a second study of six hypercholesterolemic subjects, the time-course effects of probucol on CETP and HDL subspecies were studied. Significant increases in plasma apo E and in CETP occurred after 4 weeks, and CETP, but not apo E, increased further after 16 weeks of treatment. Concomitant and opposite changes occurred in HDL composition, with decreases in HDL cholesterol and lipoprotein containing apo A-I. The increase in plasma CETP concentrations, the decrease in HDL cholesterol, and the increase in plasma apo E concentrations observed during probucol treatment are changes consistent with a postulated increase in reverse cholesterol transport via the remnant pathway.
Apolipoprotein A-I↗
Plasma concentrations of cholesteryl ester transfer protein in hyperlipoproteinemia. Relation to cholesteryl ester transfer protein activity and other lipoprotein variables.
Cholesteryl ester transfer protein (CETP) mediates an important pathway for reverse cholesterol transport. Concentrations of CETP in fasting plasma were measured by radioimmunoassay in two different groups of hyperlipoproteinemic subjects. Plasma CETP concentrations measured by radioimmunoassay correlated closely with cholesterol ester transfer activity in normal plasma (r = 0.86). In the first group of 58 patients, plasma CETP concentrations were significantly increased, as compared with those in 79 normal subjects and in hypercholesterolemic (+26%) and combined hyperlipoproteinemic (+25%) subjects but were not altered in moderately hypertriglyceridemic subjects. Marked elevations in plasma CETP levels were documented in patients with dysbetalipoproteinemia (+68%) and severe chylomicronemia (+85%). Similar results were obtained in a second population of 50 hyperlipoproteinemic subjects. Significant correlations were found between plasma CETP levels and total cholesterol (r = 0.52), very low density lipoprotein (VLDL) cholesterol (r = 0.63), and apolipoprotein E concentration (r = 0.40). Correction of the lipoprotein phenotype by dietary means resulted in significant reductions in plasma CETP concentrations in patients with chylomicronemia and dysbetalipoproteinemia. In these subjects, plasma high density lipoprotein cholesterol concentrations increased as CETP decreased. These studies indicate that CETP levels increase in association with enhanced peripheral cholesterol transport via low density lipoprotein, beta-VLDL, or chylomicron remnants.
Adult↗
Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventive hormone therapy.
Although practice guidelines suggest that postmenopausal women learn about the benefits and risks and consider their values when deciding about hormone therapy, the optimal decision-support method has not been established. In a randomized controlled trial, the authors compared the efficacy of a general educational pamphlet with that of a tailored decision aid. The pamphlet briefly summarized benefits, risks, and likely beneficiaries in general terms. The decision aid, delivered via booklet and audiotape, provided: detailed benefits and risks using functional terms and probabilities tailored to clinical risk; and steps for considering the issue in a woman's own situation, including a value-clarification exercise. Compared with the pamphlet group, the decision-aid group had statistically significant (p < 0.05) improvements in terms of realistic personal expectations of the benefits and risks, decisional conflict, and perceived acceptability of the intervention. Levels of general knowledge about the main benefits and risks were comparable for the two interventions. It is concluded that tailored decision aids prepare women for decision making better than do general pamphlets.
Aged↗
Comparison of the short-term efficacy and tolerability of lovastatin and pravastatin in the management of primary hypercholesterolemia.
Few data are available on the relative efficacy and tolerability of lovastatin and pravastatin, two 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, currently available in North America for treatment of hypercholesterolemia. The recommended starting dose is 20 mg QD with the evening meal for lovastatin. The recommended starting dose is 10 mg or 20 mg once daily at bedtime for pravastatin. In a double blind, double placebo, multicenter, randomized study, we compared the changes in plasma lipids and apolipoproteins in 217 patients with primary hypercholesterolemia treated for eight weeks with lovastatin 20 mg QD to pravastatin 10 mg QD or pravastatin 20 mg QD. The reductions in total cholesterol (TC) (21%), low-density lipoprotein cholesterol (LDL-C) (28%), and apolipoprotein B (apo B) (22%) were comparable for the lovastatin 20-mg and pravastatin 20-mg groups. Lovastatin 20 mg QD was significantly more effective than pravastatin 10 mg QD in lowering TC and LDL-C after four weeks of therapy and in the reduction of apo B after four and eight weeks of therapy. At the end of eight weeks of therapy, the mean reductions in TC and LDL-C were numerically greater with lovastatin 20 mg QD compared with pravastatin 10 mg QD, but the differences were not statistically significant. At the end of eight weeks, there was no difference between pravastatin 20 mg and pravastatin 10 mg in lowering TC and LDL-C. The frequency of overall side effects, including central nervous system-related symptoms and headache, was similar and low in all groups.
Adolescent↗
Conscious sedation for minor gynecologic surgery in the ambulatory patient. A pilot study.
A conscious sedation regimen consisting of alphaprodine, hydroxyzine, and methohexital together with intensive behavior modification was evaluated in an open pilot study for patients undergoing minor gynecologic surgery. This combination was found to result in hemodynamic stability, satisfactory patient compliance, and patient and surgeon acceptance. Patients were unable to recognize words taught to them just after drugs were administered.Electroencephalogram (EEG) changes seen in general anesthesia or deep sedation were not found in the EEG records of a subset of patients. These findings suggest that conscious sedation can provide adequate relief of pain and anxiety for minor gynecologic procedures when local anesthesia can achieve only partial pain relief.
Adult↗