Biomedical subjects
Publications and source records attributed to S Buckingham.
Benign intratesticular lesions are rare. We describe the second reported case of an intratesticular lipoma and discuss the limitations of ultrasonography in differentiating benign from malignant conditions occurring within the testis.
An HIV-1 antibody positive black African man with plasma cell variant Castleman's disease and cutaneous Kaposi's sarcoma, despite receiving chemotherapy, had progressive disease. In addition, he developed pain and swelling behind the right knee. Histology of an ultrasound guided biopsy showed Kaposi's sarcoma infiltrating the head of gastrocnemius.
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BACKGROUND: Hypotension doubles the adverse outcome of severe brain injury (BI). This finding is thought to be due to secondary ischemia caused by cerebral hypoperfusion. Aggressive prehospital fluid resuscitation in BI is advocated to maintain mean arterial pressure (MAP). Increasing MAP by prehospital fluid resuscitation before control of hemorrhage is thought to increase blood loss and reduce survival. We hypothesized that vasoconstrictor treatment of uncontrolled hemorrhage would increase MAP, reduce hemorrhage volume, and decrease the extent of BI compared with delayed fluid resuscitation (DR) or resuscitation with Ringer's lactate (RL). METHODS: Swine were randomly assigned to a control group or an experimental group: splenic laceration (uncontrolled hemorrhage) and cryogenic BI. The experimental group received one of three prehospital resuscitation regimens: DR, RL, or phenylephrine (Phen) to maintain baseline MAP. Variables were measured at baseline and at 20, 50, and 120 minutes during the simulated "prehospital and early hospital" phases and at 2 and 8 hours after surgical control of the uncontrolled hemorrhage. After killing, biopsies of the brain, liver, kidney, and gut were evaluated for histologic evidence of ischemia and compared between groups. RESULTS: Hemorrhage volume was similar in the experimental groups. Mortality was lowest in the Phen group (11%) compared with DR (40%) and RL (33%) groups. Phen increased MAP and cerebral perfusion pressure. RL infusion increased cerebral blood flow and resulted in less secondary injury than either Phen or DR. CONCLUSION: Phen improves MAP and systemic and cerebral perfusion pressure in the prehospital phase but does not reduce secondary neuronal ischemia. RL restores cerebral blood flow earlier and is associated with less secondary ischemia than either Phen or DR in this model. These data suggest that prehospital infusion of RL in patients with BI and shock is warranted and decreases secondary ischemia.
Effective assessment of competency of student nurses in clinical practice is vital. Use of simulation rather than real life settings can be used to assess competency. Development of information technology and its use in teaching clinical skills offers opportunities for assessment. Clinical governance increases the need to scrutinize the assessment of practice. Ongoing assessment of clinical competency for qualified nurses is also important.
BACKGROUND: Recently acquired data suggest that prehospital fluid resuscitation may worsen outcome of patients with penetrating torso trauma. In patients with head injury, delayed resuscitation (DR) could lead to secondary cerebral ischemia. We hypothesized that standard prehospital resuscitation (SPR) with lactated Ringer's solution or diaspirin cross-linked hemoglobin would reduce secondary cerebral ischemia compared with DR. METHODS: Anesthetized swine were randomized to receive SPR, diaspirin cross-linked hemoglobin, or DR after cryogenic brain injury and uncontrolled hemorrhagic shock and studied for 70 minutes after the combined insults. RESULTS: Hemorrhage volume was lowest in the DR group (p<0.05). There were no significant differences between the groups in systemic or cerebral oxygen delivery. Intracranial pressure was lower and cerebral perfusion pressure higher in the diaspirin cross-linked hemoglobin group compared with SPR (p<0.05). Lesion size was greatest in the SPR group, but the difference was not significant. CONCLUSION: In this model, SPR leads to secondary cerebral ischemia. DR is no worse and may be superior to conventional prehospital resuscitation with lactated Ringer's solution.
When a group of student nurses embarked on an elective experience to Romania, they believed they'd be able to 'make a difference'. However, they quickly became disillusioned by a healthcare system still blighted by its past and staff that did not welcome their interest. Sylvia Buckingham's advice to others planning similar visits, is to go with realistic aims and plenty of time in which to achieve them
Thirty-five children <2 years of age mechanically ventilated for respiratory syncytial virus (RSV) infection were randomized to receive an intravenous infusion of 15 mg/kg MEDI-493 or placebo. RSV concentration was measured in tracheal secretions by plaque assay before and at 24-h intervals after treatment. The reduction in tracheal RSV concentration from day 0 to day 1 (-1.7+/-0.28 vs. -0. 6+/-0.21 log10 pfu/mL; P=.004) and from day 0 to day 2 (-2.5+/-0.26 vs. -1.0+/-0.41 log10 pfu/mL; P=.012) was significantly greater in the MEDI-493 group than in the placebo group. RSV concentration in nasal aspirates did not differ significantly between the groups. No significant differences were observed in the tracheal aspirate white blood cell count, or myeloperoxidase or eosinophilic cationic protein concentration, or in measures of disease severity between the groups. Thus, treatment with 15 mg/kg MEDI-493 intravenously was well-tolerated and significantly reduced RSV concentration in tracheal aspirates of children with respiratory failure due to RSV.
The neonicotinoid insecticide Imidacloprid acts at three pharmacologically distinct acetylcholine receptor (AChR) subtypes in the cockroach (Periplaneta americana) nervous system, but is ineffective on muscarinic receptors. Imidacloprid (3-100µmoll-1) induced dose-dependent depolarizations at cockroach cercal afferent/giant interneurone synapses. These responses were insensitive to 20µmoll-1 atropine but were completely blocked by the nicotinic antagonist mecamylamine (50µmoll-1). Similarly, Imidacloprid-induced depolarizations of cultured cockroach dorsal unpaired median (DUM) neurones dissociated from the same (terminal abdominal) ganglion were also completely blocked by 100µmoll-1 mecamylamine. However, two components of the response could be distinguished on the basis of their differential sensitivities to 0.1µmoll-1-bungarotoxin (-BTX), which selectively blocks AChRs with 'mixed' nicotinic/muscarinic pharmacology in this preparation. This indicates that Imidacloprid affects both AChRs sensitive to -BTX and -BTX-insensitive nicotinic acetylcholine receptors (nAChRs). Thus, in the cockroach, Imidacloprid activates -BTX-sensitive synaptic nAChRs in giant interneurones, -BTX-insensitive extrasynaptic nAChRs in DUM neurones, and a recently characterized DUM neurone 'mixed' AChR that is sensitive to both nicotinic and muscarinic ligands. Imidacloprid does not act on muscarinic acetylcholine receptors (mAChRs) present on DUM neurone cell bodies and at the cercal afferent/giant interneurone synapses. This study shows that Imidacloprid can act on pharmacologically diverse nAChR subtypes.
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Following an unrelated-donor bone marrow transplant a six-year-old child with severe aplastic anaemia developed Listeria monocytogenes septicaemia and meningitis. Cook-chill foods consumed during his stay in hospital were found to contain strains of L. monocytogenes and other Listeria species. Whole cell protein SDS-PAGE was performed on all isolates. No food isolates were found that were identical to the patient's strain by this technique or by serotyping. The usefulness of whole cell protein SDS electrophoresis for listeria strain differentiation is discussed.
The relationship between depression and neuropsychological test performance in HIV-1 seropositive individuals is unclear. The present study was conducted to determine whether different patterns of neuropsychological test performance would be present in depressed vs. nondepressed individuals infected by the Human Immunodeficiency Virus (HIV-1). It was hypothesized that subjects evidencing depressed mood would demonstrate greater difficulty on measures of neuropsychological function. The subjects were 54 mostly symptomatic HIV-1 seropositive homosexual/bisexual males aged 20 to 60. A neuropsychological test battery together with the Beck Depression Inventory (BDI) was administered to all subjects. Stepwise multiple regression analysis revealed a significant relationship only between scores on the BDI and the Grooved Pegboard test and Trial 6 of the RAVLT. Subjects were then dichotomized using the BDI into high-BDI (M = 28.9) and low-BDI (M = 6.3) groups. Analysis of variance failed to reveal significant group differences between the depressed vs. the non-depressed groups on the neuropsychological measures despite their marked separation on the BDI. Similarly, examination of individual neuropsychological outliers again failed to demonstrate an increased number of outliers in the high- and low-BDI groups. These results suggest that the presence of clinically significant levels of depression in a non-elderly HIV-1 seropositive sample does not necessarily lead to significant neuropsychological dysfunction.
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