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Biomedical subjects

S A Adams

Publications and source records attributed to S A Adams.

At least 19 recordsLinked to original sources
PubMed2005

Forward surgery on Operation Telic--Iraq 2003.

Two Air Assault Surgical Groups (AASGs) from 16 Close Support Medical Regiment deployed to Kuwait on Operation Telic in February 2003. Each AASG was comprised of a four-table resuscitation facility, a two table FST and a twin-bedded ITU facility. An A+E Consultant and nurse, an experienced radiographer and laboratory technician with two further RGNs and CMTs provided resuscitation support. Each FST had an orthopaedic and a general surgeon, two anaesthetists and eight operating department practitioners. Further equipment consisted of a Polymobil 111 X-ray unit, a Sonosite 180 ultrasound scanner and an ISTAT gas, haematocrit and electrolyte analyser. 100 units of mixed blood were carried by each AASG. Fifty-one surgical procedures were performed on thirty one patients. Twenty one of these patients were Iraqi prisoners of war or civilians. Seventeen wound debridements, five amputations, five laparotomies, four insertions of Denham pins with Thomas splintage for femoral fracture, three external fixations and one axillary artery repair formed the basis of the major cases undertaken. The first field use of activated factor VII by the British Army was successful in the resuscitation of a patient with exsanguinating haemorrhage after an open-book (APC-III) pelvic fracture and a ruptured intrapelvic haematoma. The other cases included eleven manipulations under anaesthetic/application of plaster and four finger terminalisations. Forward military surgery has a continued role to play on the modern fast moving battlefield. 16 Close Support Medical Regiment normally supports 16 Air Assault Brigade with its remit for expeditionary operations and SF support. Its experience on Op Telic should influence planning for future deployment.

Adolescent↗
PubMed2004

Reversal of glandular polarity in the lymphovascular compartment of breast cancer.

AIM: To investigate the polarity of breast invasive ductal carcinoma cells by comparing the polarity of the tumour located within lymphovascular spaces with that located in the extravascular compartment. METHODS: An immunohistochemical study identifying the apical HMFG-1, basolateral AUA-1, and basal laminin polarity markers of 11 cases of invasive ductal carcinoma (grades 1 or 2) metastatic to lymph nodes, all of which contained areas of tumour within and outside of lymphovascular spaces. RESULTS: Only one of 11 tumours had a focus of apparent reversed glandular polarity in the larger extravascular tumour compartment (with AUA-1 present internally and HMFG-1 expressed externally on tumour clumps), but six of the 11 tumours showed reversed glandular polarity (either with AUA-1, or HMFG-1, or both) within the very much smaller lymphovascular space tumour compartment. Laminin was not identified in association with lymphovascular tumour. CONCLUSIONS: Reversed glandular polarity in invasive ductal breast carcinomas was identified and was significantly more frequent within vessels than outside of them. Reversal of tumour glandular polarity within lymphovascular spaces allows direct interaction between apical domain-type molecules-which are then aberrantly expressed on the external surface of tumour clumps-and lymphovascular endothelium. Such interactions may affect the establishment of metastatic disease.

Animals↗
PubMed2003

Notions of reliability: considering the importance of difference in guiding patients to health care Web sites.

OBJECTIVES: This article analyzes the efforts of three organizations to provide a standard that guides Internet users to reliable health care sites. METHODS: Comparison of health Internet sites, interviews and document studies. RESULTS: In comparing these approaches, three different constructions of reliability are identified. CONCLUSIONS: The resulting possibilities and restrictions of these constructions for users that are searching for health information on the Internet are revealed.

Computer Security↗
PubMed2002

Perianal Hodgkin's lymphoma complicating Crohn's disease.

BACKGROUND: The perianal region is a very rare location for Hodgkin's lymphoma, and clinicians may often neglect the diagnosis in patients with inflammatory bowel disease. PATIENT PRESENTATION: We present a case of perianal Hodgkin's lymphoma in patient with Crohn's disease who was on long-term immunosuppression and whose symptoms would normally be attributed to Crohn's disease. Diagnosis was based on the morphological appearance of atypical cells in the lamina propria and the immunohistochemical profile of Reed Sternberg and Hodgkin's cells, showing co-expression of CD15 and CD30. CONCLUSION: Perianal complaints in patients with inflammatory bowel disease may be a manifestation of other pathology. Hodgkin's lymphoma could be a progression in the chronically inflamed tissue in this unusual location.

Aged↗
PubMed2002

Malignant mesothelioma: PAS-diastase positivity and inversion of polarity in intravascular tumour.

AIMS: Periodic acid-Schiff (PAS)-diastase-positive material was identified within pseudoglandular structures within the small intravascular component of two pleural malignant mesotheliomas. The aim of this study was to ascertain the nature of this material and to asses the polarity of the cells forming the pseudoglandular structure. METHODS AND RESULTS: Immunohistochemistry was performed using antibodies to laminin and type IV collagen and the antibody HBME-1. These demonstrated the material to be basement membrane rather than mucin. The apical polarity marker HBME-1 was not related to the internal pseudoglandular structure but stained the periphery of intravascular tumour clumps. CONCLUSIONS: Pseudoluminal PAS-diastase-positive material in malignant mesothelioma may easily be mistaken for epithelial mucin, leading to an erroneous diagnosis of adenocarcinoma. The presence of basement membrane material in pseudolumina, as defined by the presence of laminin and type IV collagen, surrounded by tumour cells whose external surface expresses the apical polarity marker HBME-1 implies inversion of polarity of tumour cells within vascular spaces.

Adenocarcinoma↗
PubMed2002

Challenges associated with creating a pharmaceutical stockpile to respond to a terrorist event.

The Centers for Disease Control and Prevention (CDC) was called into action to develop a National Pharmaceutical Stockpile (NPS). The NPS was created to respond to terrorism events involving blast, chemical and biological agents. There are many challenges associated with creating, managing and using such an asset. This paper provides a helpful background for clinicians and those planning to develop pharmaceutical and/or medical materiel stockpiles for national use. It also describes major challenges and offers suggestions for meeting those challenges.

Anti-Infective Agents↗
PubMed1999

The angiogenins: an emerging family of ribonuclease related proteins with diverse cellular functions.

Angiogenin is a member of the ribonuclease superfamily, which shows an ever expanding collection of molecules being identified and cloned. It was initially isolated from the conditioned medium of cultured tumour cells. Its angiogenic activity appears to be critical for the maintenance and support of tumour growth. Angiogenin also plays a role in a number of non-malignant vasculoproliferative pathological conditions. Along with other related molecules, it has been identified in a wide variety of somatic tissues in adult and embryonic stages of vertebrate development. This suggests that angiogenin and related molecules are likely to play a vital role in normal physiology. Angiogenin is detectable in serum and to date has been implicated as a mitogen for vascular endothelial cells, an immune modulator with suppressive effects on polymorphonuclear leukocytes, an activator of certain protease cascades such as matrix metalloproteases and plasminogen-activated plasmin pathways, as well as an adhesion molecule. However, the role of the angiogenin family in both normal and abnormal physiology and in development will only fully be realised by genetic approaches involving gene deletion.

Journal Article↗
PubMed1998

Digestion of 125I-labelled plasmin-derived fibrin degradation products by neutrophil lysosomal enzymes.

The cellular components of the blood, which become associated with fibrin through specific cellular adhesive processes, play a significant role in the breakdown of fibrin. Fibrinolysis by neutrophil elastase and cathepsin G occurs in a manner distinct from that produced by plasmin. This study demonstrates that neutrophil lysosomal enzyme activity further degrades the end products of plasmic fibrin degradation into low-molecular-weight material, followed by reassembly of higher-molecular-weight products in a process dependent on calcium and factor XIII. Although one of the reformed products has a similar molecular weight to D-dimer and is recognized by a monoclonal antibody raised against D-dimer, its isoelectric point indicates it to be distinctly different from plasmin-derived D-dimer. Processing of the end products of plasmic fibrin degradation by neutrophils may have the potential for modulating the immune response as well as compromising the predictive value of tests measuring D-dimer.

Antibodies, Monoclonal↗
PubMed1997

The scalability of the Rivermead Motor Assessment in acute stroke patients.

OBJECTIVE: To examine the scalability of the Rivermead Motor Assessment with hospitalized acute stroke patients. DESIGN: This was a prospective study of hospitalized stroke patients. SUBJECTS: Fifty-one selected stroke patients, including those over the age of 65, were assessed at one, three and six weeks post-stroke using the Rivermead Motor Assessment. Coefficients of scalability and reproducibility were calculated for each of the three sections of the Rivermead Motor Assessment at each assessment. RESULTS: The items in the gross function and arm sections met scaling criteria at all three assessments which meant that they were in appropriate order of difficulty. There was an overall increase in the proportion of subjects passing each item at successive assessments, suggesting that patients in the study were recovering. The leg and trunk section did not meet scale criteria with these acute stroke patients. CONCLUSIONS: We recommend that only the gross function and arm sections should be used as hierarchical scales with selected acute stroke patients. The leg and trunk section should only be used as an assessment checklist.

Activities of Daily Living↗
PubMed1997

The scalability of the Rivermead Motor Assessment in nonacute stroke patients.

OBJECTIVE: To examine the scalability of the Rivermead Motor Assessment (RMA) with nonacute stroke patients in the community. DESIGN: This was a prospective study of the patients after discharge from hospital. All subjects were assessed on the RMA at six and 12 months after discharge home from hospital. Coefficients of scalability and reproducibility were calculated for each of the three sections of the RMA at each assessment. SUBJECTS: Subjects were nonacute stroke patients aged 65 years and over, nonacute stroke patients aged under 65 years, and a selected group of those aged under 65 years. RESULTS: Only the items in the gross function section met scaling criteria with nonacute strokes in both age groups, which suggests that the items in this section were in appropriate order of difficulty. The items in the leg and trunk section were not in hierarchical order and were in fact closer to scaling if the present order were reversed. CONCLUSIONS: The clinical and research value of the RMA, as an ordered scale, are questioned. Changes in treatment styles and philosophies may mean that some of the items themselves are out-dated.

Activities of Daily Living↗
PubMed1995

Treatment of acute myocardial infarction with streptokinase does not appear to modulate circulating neutrophil function.

The administration of thrombolytic therapy is the most common method of achieving patency of the occluded coronary artery in patients with acute myocardial infarction (AMI). However, thrombolytic agents and the byproducts of fibrinolysis have the potential to affect neutrophil activation and thus function, thereby augmenting myocardial damage further. This study assessed the effect of streptokinase administration on the function of circulating neutrophils in patients with AMI. For this neutrophil adherence to human umbilical vein endothelial cells, homotypic neutrophil aggregation, and CD11b and L-selectin expression on the neutrophil membrane prior to and 1 h and 6 h after thrombolytic therapy was monitored. The study population included patients with AMI who received aspirin and streptokinase, and healthy laboratory workers who received aspirin only; all subjects acted as their own controls. Circulating fibrin degradation products and white cells were markedly raised following administration of streptokinase. No significant differences in neutrophil adherence to endothelium, homotypic neutrophil interactions, and CD11b or L-selectin expression were demonstrated between neutrophils, either pre- or post-thrombolytic therapy in the infarct group, or between neutrophils from the infarct group and from the control group. It was concluded that streptokinase produces an abrupt neutrophil leukocytosis together with a marked increase in circulating levels of fibrin degradation products. The assay systems used were unable to show significant sequential changes in circulating neutrophil adhesion and L-selectin or CD11b expression in patients with AMI following thrombolytic therapy or when these patients were compared with controls.

CD18 Antigens↗
PubMed1995

Role of neutrophil membrane proteases in fibrin degradation.

The cellular components of blood play a significant role in the breakdown of fibrin, with specific cellular adhesive processes allowing for accumulation of neutrophils within the fibrin clot. Fibrinolysis by elastase and cathepsin G, enzymes present within the azurophilic granules of the neutrophil, has previously been shown. Recent studies have demonstrated neutrophil-mediated fibrinogenolysis by a membrane-associated protease which suggests that proteases connected with the neutrophil membrane might also be capable of clot dissolution. Intact neutrophils were found to solubilize fibrin clots with the rate of fibrin solubilization being greater when the cells were incorporated into the clot than when the cells were added to preformed clots. Stimulation of intact neutrophils with phorbol ester upregulated this neutrophil-mediated fibrinolysis. Solubilization was detectable within 2 min of incubating the cells with fibrin clot, was always faster than that by neutrophil conditioned medium and lacked inhibition with lysosomal enzyme inhibitors. Neutrophil-mediated clot lysis was effected by membrane-associated serine proteases that migrated to apparent molecular weights of 501 kD, 398 kD, 316 kD, 245 kD and 209 kD on 3-13% SDS-PAGE. This degradation was distinct from that produced by plasmin, neutrophil lysosomal enzymes and purified human neutrophil elastase. The neutrophil membrane proteolytic systems were found to enhance the action of plasmin in clot solubilization. These results suggest neutrophil membrane proteolytic activity could assist thrombus dissolution and may be of particular value in assisting early clot dissolution by plasmin and when clot stabilization occurs through plasminogen activator inhibitor-1 (PAI-1) inhibition of plasminogen activation.

Cell Membrane↗
PubMed1994

Fibrinogenolysis by a neutrophil membrane protease generates an A alpha 1-21 fragment.

The 600 kDa neutrophil membrane neutral protease, which had been shown to generate bioactive peptides from the acute-phase reactant C-reactive protein, has now been shown to have fibrinogenolytic activity that is distinct from fibrinogenolysis by plasmin and neutrophil lysosomal enzymes. This protease gradually reduces the apparent molecular mass of fibrinogen (340 kDa) to non-clottable products and generates terminal products with apparent molecular mass values of 270 kDa, 200 kDa, 100 kDa and less than 40 kDa through cleavage of all three of the constituent chains. Characteristics of fibrinogenolysis by this neutrophil protease are cleavage of the bond between amino acids valine and glutamic acid at positions 21 and 22 respectively from the N-terminus of the A alpha chain to release an A alpha 1-21 peptide, digestion of the B beta chain at positions within the C-terminus, and proteolysis of the bond between amino acids isoleucine and glycine at positions 394 and 395 respectively from the N-terminus of the gamma chain. This generates products that lack anticoagulant activity. The thrombin clotting time of the product with an apparent molecular mass of 330 kDa was prolonged, although clot formation was still observed. Loss of coagulability and inability to clot was found with further degradation of fibrinogen to an apparent molecular mass of 290 kDa. Activity of this neutrophil membrane protease in vivo could be important for the regulation of fibrin deposition at sites of inflammation, and may contribute to the reported plasma levels of the A alpha 1-21 peptide.

Amino Acid Sequence↗
PubMed1994

Two- to five-year follow-up of 100 total hip arthroplasties using DF-80 implants.

In an uncontrolled prospective study, 100 primary total hip arthroplasties (THAs) using the DF-80 implant were followed up for a minimum of 2 years with rigorous clinical and radiographic examinations to define the natural history of this prosthetic system. Three groups were identified: (I) hips requiring revision because of failure (n = 3); (II) "impending" failures with radiographic indices of loosening (n = 8); and (III) clinically and radiographically benign, stable implants (n = 89). The preoperative Harris hip score was similar for all groups. Postoperatively, the failure group demonstrated early progressive clinical and radiographic deterioration with surgical revision at an average of 33 months. Male sex, increased weight, and greater intraoperative hemorrhage correlated positively with failure. The impending-failure group developed limited radiolucencies in the later postoperative period. Calcar resorption was noted in 26% of the total population and heterotopic ossification in 46%. We conclude that this series of THAs using DF-80 implants included a subset of patients demonstrating early clinical failure and widespread aggressive bone-cement radiolucencies that required early surgical revision.

Aged↗
PubMed1993

Immunological similarity between the 170 kD amoebic adherence glycoprotein and human beta 2 integrins.

Amoebiasis is an important cause of morbidity and mortality in developing countries. Virulence of Entamoeba histolytica depends on the trophozoite's being able to bind to colonic epithelium; binding is mediated by the 170 kD subunit of a 260 kD lectin. We found, by microcytofluorometry and western blotting studies, that this 170 kD subunit protein shares an epitope with human beta 2 integrins--a subfamily of cell-surface glycoproteins expressed exclusively on leucocytes and involved in many adhesive and signalling interactions. The immunological similarity between these proteins may explain the trophozoite's ability to bind to and invade colonic epithelium.

Amebiasis↗
PubMed1993

Use of the extended ADL scale with stroke patients.

The Extended ADL scale is a postal measure of Instrumental ADL ability, comprising sub-scales for mobility, household ability and leisure activity. Its validity was examined in 303 stroke patients who had participated in a rehabilitation study. Adequate Guttman scales were found in the mobility scale, an adjusted household scale and, in women, the leisure scale. Extended ADL scores at 6 months after discharge from hospital were independently predicted by the Barthel ADL score at discharge from hospital, the age of the patient, previous mobility, time spent in hospital for the stroke, the abbreviated mental test score at discharge and whether the patient was living alone or not. Extended ADL scores discriminated between patients in institutions and at home. In patients at home, the Extended ADL scores were lower in those who received social and nursing services than in those who did not. Death or institutionalization over the 6 months was uncommon in patients with high Extended ADL scores. These data support the validity of the Extended ADL scale and confirm it to be a useful measure of outcome in stroke research.

Activities of Daily Living↗