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Sane N, Bloom A. Diagnostic dilemma: a patient with diarrhoea. Gut 2023; 73:46-104. [PMID: 36868845 DOI: 10.1136/gutjnl-2022-328854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Nikhita Sane
- Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Ashley Bloom
- Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Gastroenterology, Monash Gastroenterology, Monash Health, Clayton, Victoria, Australia
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Patwala K, Prince DS, Celermajer Y, Alam W, Paul E, Strasser SI, McCaughan GW, Gow P, Sood S, Murphy E, Roberts S, Freeman E, Stratton E, Davison SA, Levy MT, Clark-Dickson M, Nguyen V, Bell S, Nicoll A, Bloom A, Lee AU, Ryan M, Howell J, Valaydon Z, Mack A, Liu K, Dev A. Lenvatinib for the treatment of hepatocellular carcinoma-a real-world multicenter Australian cohort study. Hepatol Int 2022; 16:1170-1178. [PMID: 36006547 PMCID: PMC9525325 DOI: 10.1007/s12072-022-10398-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Abstract
Introduction Hepatocellular carcinoma (HCC) is a serious complication of chronic liver disease. Lenvatinib is an oral multikinase inhibitor registered to treat advanced HCC. This study evaluates the real-world experience with lenvatinib in Australia. Methods We conducted a retrospective cohort study of patients treated with lenvatinib for advanced HCC between July 2018 and November 2020 at 11 Australian tertiary care hospitals. Baseline demographic data, tumor characteristics, lenvatinib dosing, adverse events (AEs) and clinical outcomes were collected. Overall survival (OS) was the primary outcome. Progression free survival (PFS) and AEs were secondary outcomes. Results A total of 155 patients were included and were predominantly male (90.7%) with a median age of 65 years (interquartile range [IQR]: 59–75). The main causes of chronic liver disease were hepatitis C infection (40.0%) and alcohol-related liver disease (34.2). Median OS and PFS were 7.7 (95% confidence interval [CI]: 5.8–14.0) and 5.3 months (95% CI: 2.8–9.2) respectively. Multivariate predictors of mortality were the need for dose reduction due to AEs (Hazard ratio [HR] 0.41, p < 0.01), new or worsening hypertension (HR 0.42, p < 0.01), diarrhoea (HR 0.47, p = 0.04) and more advanced BCLC stage (HR 2.50, p = 0.04). Multivariable predictors of disease progression were higher Child–Pugh score (HR 1.25, p = 0.04), the need for a dose reduction (HR 0.45, p < 0.01) and age (HR 0.96, p < 0.001). AEs occurred in 83.9% of patients with most being mild (71.6%). Conclusions Lenvatinib remains safe and effective in real-world use. Treatment emergent diarrhoea and hypertension, and the need for dose reduction appear to predict better OS. Supplementary Information The online version contains supplementary material available at 10.1007/s12072-022-10398-5.
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Affiliation(s)
- Kurvi Patwala
- Department of Gastroenterology, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.
| | - David Stephen Prince
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia. .,Department of Gastroenterology, Liverpool Hospital, 75 Elizabeth Street, Liverpool, NSW, 2170, Australia.
| | - Yael Celermajer
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Waafiqa Alam
- Department of Gastroenterology, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Eldho Paul
- Department of Medicine, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Simone Irene Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Geoffrey William McCaughan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Paul Gow
- Department of Gastroenterology and Liver Transplant, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Siddharth Sood
- Department of Gastroenterology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Elise Murphy
- Department of Gastroenterology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Stuart Roberts
- Department of Medicine, Monash University, Wellington Road, Clayton, VIC, 3800, Australia.,Department of Gastroenterology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Elliot Freeman
- Department of Gastroenterology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Elizabeth Stratton
- Department of Gastroenterology, Liverpool Hospital, 75 Elizabeth Street, Liverpool, NSW, 2170, Australia
| | - Scott Anthony Davison
- Department of Gastroenterology, Liverpool Hospital, 75 Elizabeth Street, Liverpool, NSW, 2170, Australia
| | - Miriam Tania Levy
- Department of Gastroenterology, Liverpool Hospital, 75 Elizabeth Street, Liverpool, NSW, 2170, Australia
| | - McCawley Clark-Dickson
- Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonard's, NSW, 2065, Australia
| | - Vi Nguyen
- Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonard's, NSW, 2065, Australia
| | - Sally Bell
- Department of Gastroenterology, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, 8 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Ashley Bloom
- Department of Gastroenterology, Eastern Health, 8 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Alice Unah Lee
- Department of Gastroenterology, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia
| | - Marno Ryan
- Department of Gastroenterology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jessica Howell
- Department of Gastroenterology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, 3010, Australia.,Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Zina Valaydon
- Department of Gastroenterology, Western Health, 160 Gordon Street, Footscray, VIC, 3011, Australia
| | - Alexandra Mack
- Department of Gastroenterology, Western Health, 160 Gordon Street, Footscray, VIC, 3011, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Anouk Dev
- Department of Gastroenterology, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
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Bloom A, Bloom S, Silva H, Nicoll AJ, Sawhney R. Zinc supplementation and its benefits in the management of chronic liver disease: An in-depth literature review. Ann Hepatol 2022; 25:100549. [PMID: 34614431 DOI: 10.1016/j.aohep.2021.100549] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 02/04/2023]
Abstract
Malnutrition among patients with chronic liver disease (CLD) is a common complication with significant prognostic implications for patients with liver cirrhosis. Micronutrient deficiency has been associated with an increased risk of hepatic decompensation and is an independent risk factor for mortality among cirrhotic patients. Micronutrient deficiencies in patients with CLD include zinc, vitamin A, vitamin D and selenium. This review article aims to evaluate the literature to date on the complications of zinc deficiency in patients with CLD. A management algorithm for zinc replacement has also been proposed.
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Affiliation(s)
- Ashley Bloom
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Hannah Silva
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Nutrition and Dietetics, Eastern Health, Melbourne, Victoria, Australia
| | - Amanda J Nicoll
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Nutrition and Dietetics, Eastern Health, Melbourne, Victoria, Australia
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
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Worland T, Bloom A, Robertson M. An Unusual Case of Small Bowel Obstruction. Gastroenterology 2021; 160:e12-e13. [PMID: 33039463 DOI: 10.1053/j.gastro.2020.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Thomas Worland
- Monash Health, Department of Gastroenterology, Melbourne, Australia.
| | - Ashley Bloom
- Monash Health, Department of Gastroenterology, Melbourne, Australia
| | - Marcus Robertson
- Monash Health, Department of Gastroenterology, Melbourne, Australia
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Paz T, Bloom A, Roth B, Kalish Y, Rottenstreich A, Elchalal U. Pharmacomechanical Catheter Thrombolysis for Pregnancy-Related Proximal Deep Venous Thrombosis: Prevention of Post-Thrombotic Syndrome. J Vasc Surg Venous Lymphat Disord 2020. [DOI: 10.1016/j.jvsv.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Anderson S, Snyder N, Bloom A, Brasile D, Gocial B, Orris J, Glassner M. Cumulus cell acetyl-CoA enrichment from acetate found to decrease with maternal age using a novel approach to measure metabolism in individual cumulus cell complexes. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bloom A, Shen E, Browne W, Wong V, Rawlin A. SUN-PP153: High Salt Intake and its Effects on Non-Hypertensive Complications in Geriatric Patients with Type 2 Diabetes Mellitus. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Farkas A, Kalish Y, Spectre G, Elchalal U, Bloom A. Catheter directed thrombolysis for proximal deep venous thrombosis during early pregnancy and the post-partum period. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bloom A. Studies of the mode of action of metrifonate and DDVP in schistosomes - cholinesterase activity and the hepatic shift. Acta Pharmacol Toxicol (Copenh) 2009; 49 Suppl 5:109-13. [PMID: 7344403 DOI: 10.1111/j.1600-0773.1981.tb03260.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Rubinstein C, Al-Husseini R, Anner H, Berlatzky Y, Klimov A, Akopnick I, Rivkind A, Bloom A. Abstract No. 10: Medium Term Follow Up of Emergent Endovascular and Surgical Repair of Acute Subclavian Artery Injuries. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tsirigotis P, Sella T, Shapira MY, Bitan M, Bloom A, Kiselgoff D, Levin M, Libster D, Abdul Hai A, Gesundheit B, Or R, Slavin S, Resnick I. Peliosis hepatis following treatment with androgen-steroids in patients with bone marrow failure syndromes. Haematologica 2007; 92:e106-10. [PMID: 18024386 DOI: 10.3324/haematol.11343] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Androgens widely used in the treatment of bone marrow failure syndromes can in rare cases cause hepatic peliosis, a pathological entity characterized by multiple blood-filled cavities in the liver parenchyma. Bone marrow failure syndromes per se are associated with a low coagulation status, which is further magnified by bone marrow transplantation for aplastic anaemia due to deep thrombocytopenia. Both these conditions can cause bleeding; their combination is especially dangerous. We describe two cases of aplastic anaemia due to paroxysmal nocturnal hemoglobinuria and Fanconi syndrome, in which patients developed peliosis hepatis after prolonged treatment with androgens. One patient developed severe subcapsular bleeding, successfully treated with catheterization of the right hepatic artery and embolization of the bleeding site. The second patient bridged over deep post-transplant aplasia with high frequency platelet transfusions, and demonstrated an uncomplicated post-BMT course. We suggest avoiding or interrupting treatment with androgens in patients preparing for BMT.
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Affiliation(s)
- P Tsirigotis
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah University Hospital, Jerusalem, Israel
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Laserson KF, Binkin NJ, Thorpe LE, Laing R, Iademarco MF, Bloom A, Agerton TB, Nelson L, Cegielski JP, Ferroussier O, Holtz T, Vitek E, Gammino V, Tan K, Finlay A, Dewan P, Miranda A, Aquino G, Weyer K, Sy DN, Vernon A, Becerra J, Ershova J, Wells CD. Capacity building for international tuberculosis control through operations research training. Int J Tuberc Lung Dis 2005; 9:145-50. [PMID: 15732732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
SETTING In resource-poor countries, few tuberculosis (TB) program staff at the national, provincial, and even district levels have the basic analytical and epidemiological skills necessary for collecting and analyzing quality data pertaining to national TB control program (NTP) improvements. This includes setting program priorities, operations planning, and implementing and evaluating program activities. OBJECTIVES To present a model course for building capacity in basic epidemiology and operations research (OR). DESIGN A combination of didactic lectures and applied field exercises were used to achieve the main objectives of the 6-day OR course. These were to increase the understanding of quantitative and qualitative research concepts, study design, and analytic methods, and to increase awareness of how these methods apply to the epidemiology and control of TB; and to demonstrate the potential uses of OR in answering practical questions on NTP effectiveness. As a final outcome, course participants develop OR proposals that are funded and later implemented. RESULTS Since 1997, this OR course has been conducted nine times in five countries; 149 key NTP and laboratory staff have been trained in OR methods, and 44 OR protocols have been completed or are underway. CONCLUSION This low-cost model course can be adapted to a wide range of public health issues.
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Affiliation(s)
- K F Laserson
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia 30333, USA
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Goldschmidt N, Libson E, Bloom A, Amir G, Paltiel O. Clinical utility of computed tomography-guided core needle biopsy in the diagnostic re-evaluation of patients with lymphoproliferative disorders and suspected disease progression. Ann Oncol 2003; 14:1438-41. [PMID: 12954585 DOI: 10.1093/annonc/mdg372] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Histological transformation is a common clinical event in patients with lymphoproliferative diseases, often requiring a modification in therapy. Minimally invasive biopsy techniques have been used for initial diagnosis of these disorders but their role has not been systematically evaluated in disease progression. The purpose of this study was to evaluate the yield of computed tomography (CT)-guided core needle biopsy in patients with lymphoproliferative disorders and suspected disease progression. PATIENTS AND METHODS We performed a retrospective analysis of the records of patients with known lymphoproliferative disorders who underwent CT-guided core needle biopsy during the course of their disease, between 1990 and 2002. RESULTS A total of 130 patients with lymphoproliferative disorders (91 patients with non-Hodgkin's lymphoma, 21 with Hodgkin's disease, 10 with chronic lymphocytic leukemia, six with combined malignancies and two with Castleman's disease) underwent CT-guided core needle biopsy 4.7 +/- 5.1 (standard deviation) (range 0-40) years after initial diagnosis. The procedure was diagnostic in 98 cases (75.4%). In 22 patients (17%) a subsequent open biopsy was performed, and in 10 (7.6%) the final diagnosis remained unconfirmed. Histological transformation was found in 20 cases (15.4%), of which 19 were suspected clinically. A new diagnosis (malignant and non-malignant) was apparent in 18 cases (13.9%) and relapsed or ongoing evidence of the original disease was found in 82 (63%). CONCLUSIONS CT-guided core needle biopsy is a reliable procedure in patients with suspected histological transformation of lymphoproliferative disorders, and should be used as the initial tool for pathological re-evaluation.
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Affiliation(s)
- N Goldschmidt
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
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Chapman OL, Eian GL, Bloom A, Clardy J. Photochemical transormations. XXXVIII. Nonoxidative photocyclization of N-aryl enamines. A facile synthetic entry to trans-hexahydrocarbazoles. J Am Chem Soc 2002. [DOI: 10.1021/ja00741a017] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Niederl V, Siconolfi CA, Bloom A, Meter CTV. Synthetic Estrogens. I. 3,4-bis-(m-Methyl-p-hydroxyphenyl)-2,4-hexadiene, 3,4-bis-(m-Methyl-p-hydroxyphenyl)-hexane and Some of their Organic Esters. J Am Chem Soc 2002; 70:508-11. [DOI: 10.1021/ja01182a023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bloom A. Shades of citizenship: race and the census in modern politics. [Review of: Nobles, M. Shades of citizenship: race and the census in modern politics. Stanford: Stanford U. Pr., 2000]. J Interdiscip Hist 2001; 32:327-8. [PMID: 16845771 DOI: 10.1162/002219501750442729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Garavan H, Pankiewicz J, Bloom A, Cho JK, Sperry L, Ross TJ, Salmeron BJ, Risinger R, Kelley D, Stein EA. Cue-induced cocaine craving: neuroanatomical specificity for drug users and drug stimuli. Am J Psychiatry 2000; 157:1789-98. [PMID: 11058476 DOI: 10.1176/appi.ajp.157.11.1789] [Citation(s) in RCA: 658] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cocaine-related cues have been hypothesized to perpetuate drug abuse by inducing a craving response that prompts drug-seeking behavior. However, the mechanisms, underlying neuroanatomy, and specificity of this neuroanatomy are not yet fully understood. METHOD To address these issues, experienced cocaine users (N=17) and comparison subjects (N=14) underwent functional magnetic resonance imaging while viewing three separate films that portrayed 1 ) individuals smoking crack cocaine, 2) outdoor nature scenes, and 3) explicit sexual content. Candidate craving sites were identified as those that showed significant activation in the cocaine users when viewing the cocaine film. These sites were then required to show significantly greater activation when contrasted with comparison subjects viewing the cocaine film (population specificity) and cocaine users viewing the nature film (content specificity). RESULTS Brain regions that satisfied these criteria were largely left lateralized and included the frontal lobe (medial and middle frontal gyri, bilateral inferior frontal gyrus), parietal lobe (bilateral inferior parietal lobule), insula, and limbic lobe (anterior and posterior cingulate gyrus). Of the 13 regions identified as putative craving sites, just three (anterior cingulate, right inferior parietal lobule, and the caudate/lateral dorsal nucleus) showed significantly greater activation during the cocaine film than during the sex film in the cocaine users, which suggests that cocaine cues activated similar neuroanatomical substrates as naturally evocative stimuli in the cocaine users. Finally, contrary to the effects of the cocaine film, cocaine users showed a smaller response than the comparison subjects to the sex film. CONCLUSIONS These data suggest that cocaine craving is not associated with a dedicated and unique neuroanatomical circuitry; instead, unique to the cocaine user is the ability of learned, drug-related cues to produce brain activation comparable to that seen with nondrug evocative stimuli in healthy comparison subjects.
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Affiliation(s)
- H Garavan
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee 53226, USA
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Poliafico FJ, Bloom A. Emergency! Are you prepared? RN 2000; 63:suppl 1-4, 7. [PMID: 10983183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Winocur E, Gavish A, Halachmi M, Bloom A, Gazit E. Generalized joint laxity and its relation with oral habits and temporomandibular disorders in adolescent girls. J Oral Rehabil 2000; 27:614-22. [PMID: 10931255 DOI: 10.1046/j.1365-2842.2000.00546.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A group of 248 girls, aged 15-16 years, were randomly selected and examined both clinically and by questionnaire with regard to the signs and symptoms of temporomandibular disorders (TMD), generalized joint laxity (GJL), range of mandibular opening, temporomandibular joint (TMJ) hypermobility and presence of oral parafunctions. The prevalence of GJL was 43% and that of TMJ hypermobility (TMJH) was 27.3%. A significant, albeit weak, correlation was found between the two. In the presence of joint click, both active and passive opening were significantly larger. When either muscle or joint sensitivity to palpation was present, the difference between the active and passive range of mouth opening increased significantly. The presence of reported clicks was negatively associated with GJL. This association was not valid in the presence of parafunction. Some of the signs and symptoms of TMD affected the range of mouth opening. In the presence of joint clicks, the mean active and passive mandibular opening were significantly larger. In the presence of joint and muscle sensitivity to palpation, the difference between passive and active mouth opening was larger. This was possibly because of the effect of pain on the full active range of opening, which was invalid in the registration of the passive mandibular opening. GJL, when present, did not seem to jeopardize the health of the stomatognathic system as expressed in the signs and symptoms of TMD. There was a negative association between GJL and the presence of reported joint clicks and catch. When a parafunction was present in addition to GJL, this association was invalid but not reversed, as has been previously reported.
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Affiliation(s)
- E Winocur
- Department of Occlusion and Behavioral Sciences, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Jarnagin K, Grunberger D, Mulkins M, Wong B, Hemmerich S, Paavola C, Bloom A, Bhakta S, Diehl F, Freedman R, McCarley D, Polsky I, Ping-Tsou A, Kosaka A, Handel TM. Identification of surface residues of the monocyte chemotactic protein 1 that affect signaling through the receptor CCR2. Biochemistry 1999; 38:16167-77. [PMID: 10587439 DOI: 10.1021/bi9912239] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The CC chemokine, monocyte chemotactic protein, 1 (MCP-1) functions as a major chemoattractant for T-cells and monocytes by interacting with the seven-transmembrane G protein-coupled receptor CCR2. To identify which residues of MCP-1 contribute to signaling though CCR2, we mutated all the surface-exposed residues to alanine and other amino acids and made some selective large changes at the amino terminus. We then characterized the impact of these mutations on three postreceptor pathways involving inhibition of cAMP synthesis, stimulation of cytosolic calcium influx, and chemotaxis. The results highlight several important features of the signaling process and the correlation between binding and signaling: The amino terminus of MCP-1 is essential as truncation of residues 2-8 ([1+9-76]hMCP-1) results in a protein that cannot stimulate chemotaxis. However, the exact peptide sequence may be unimportant as individual alanine mutations or simultaneous replacement of residues 3-6 with alanine had little effect. Y13 is also important and must be a large nonpolar residue for chemotaxis to occur. Interestingly, both Y13 and [1+9-76]hMCP-1 are high-affinity binders and thus affinity of these mutants is not correlated with ability to promote chemotaxis. For the other surface residues there is a strong correlation between binding affinity and agonist potency in all three signaling pathways. Perhaps the most interesting observation is that although Y13A and [1+9-76]hMCP are antagonists of chemotaxis, they are agonists of pathways involving inhibition of cAMP synthesis and, in the case of Y13A, calcium influx. These results demonstrate that these two well-known signaling events are not sufficient to drive chemotaxis. Furthermore, it suggests that specific molecular features of MCP-1 induce different conformations in CCR2 that are coupled to separate postreceptor pathways. Therefore, by judicious design of antagonists, it should be possible to trap CCR2 in conformational states that are unable to stimulate all of the pathways required for chemotaxis.
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Affiliation(s)
- K Jarnagin
- Department of Molecular and Cell Biology, University of California at Berkeley 94720, USA.
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Hemmerich S, Paavola C, Bloom A, Bhakta S, Freedman R, Grunberger D, Krstenansky J, Lee S, McCarley D, Mulkins M, Wong B, Pease J, Mizoue L, Mirzadegan T, Polsky I, Thompson K, Handel TM, Jarnagin K. Identification of residues in the monocyte chemotactic protein-1 that contact the MCP-1 receptor, CCR2. Biochemistry 1999; 38:13013-25. [PMID: 10529171 DOI: 10.1021/bi991029m] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The CC chemokine, MCP-1, has been identified as a major chemoattractant for T cells and monocytes, and plays a significant role in the pathology of inflammatory diseases. To identify the regions of MCP-1 that contact its receptor, CCR2, we substituted all surface-exposed residues with alanine. Some residues were also mutated to other amino acids to identify the importance of charge, hydrophobicity, or aromaticity at specific positions. The binding affinity of each mutant for CCR2 was assayed with THP-1 and CCR2-transfected CHL cells. The majority of point mutations had no effect. Residues at the N-terminus of the protein, known to be crucial for signaling, contribute less than a factor of 10 to the binding affinity. However, two clusters of primarily basic residues (R24, K35, K38, K49, and Y13), separated by a 35 A hydrophobic groove, reduced the level of binding by 15-100-fold. A peptide fragment encompassing residues 13-35 recapitulated some of the mutational data derived from the intact protein. It exhibited modest binding as a linear peptide and dramatically improved affinity when the region which adopts a single turn of a 3(10)-helix in the protein, which includes R24, was constrained by a disulfide bond. Additional constraints at the ends of the peptide, corresponding to the disulfide between the first and third cysteines in MCP-1, yielded further improvements in affinity. Together, these data suggest a model in which a large surface area of MCP-1 contacts the receptor, and the accumulation of a number of weak interactions results in the 35 pM affinity observed for the wild-type (WT) protein. The receptor binding site of MCP-1 also is significantly different from the binding sites of RANTES and IL-8, providing insight into the issue of receptor specificity. It was previously shown that the N-terminus of CCR2 is critical for binding MCP-1 [Monteclaro, F. S., and Charo, I. F. (1996) J. Biol. Chem. 271, 19084-92; Monteclaro, F. S., and Charo, I. F. (1997) J. Biol. Chem. 272, 23186-90]. Point mutations of six acidic residues in this region of the receptor were made to test their role in ligand binding. This identified D25 and D27 of the DYDY motif as being important. On the basis of our data, we propose a model in which the receptor N-terminus lies along the hydrophobic groove in an extended fashion, placing the DYDY motif near the basic cluster involving R24 and K49 of MCP-1. This in turn orients the signaling residues (Y13 and the N-terminus) for productive interaction with the receptor.
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Affiliation(s)
- S Hemmerich
- Department of Molecular and Cell Biology, University of California at Berkeley 94720, USA
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24
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Choi Y, Putti T, Win K, Hu Y, Remy P, Bloom A. Correlation of viral RNA, alanine aminotransferase, and histopathology in hepatitis C virus-associated hepatitis. Mol Diagn 1999; 4:251-4. [PMID: 10553026 DOI: 10.1016/s1084-8592(99)80029-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is usually monitored by the level of alanine aminotransferase (ALT) and histopathological changes in liver biopsy specimens. However, accumulating data indicate these parameters are not always correlated with disease progression or the response of HCV infection to therapy. MATERIALS AND METHODS Using the Amplicor PCR Monitor Test Kit (Roche Diagnostic Systems, Branchburg, NJ), HCV RNA level was measured in 38 patients with positive anti-HCV antibodies and in 21 of those patients after interferon treatment. The grade and stage of histological changes on hematoxylin and eosin-stained sections of liver biopsy specimens were evaluated on a scale of 1 to 4. In each case, the HCV RNA level was compared with the histological grade or stage and level of ALT and statistically analyzed by Student's t-test. RESULTS ALT level did not correlate with pretreatment and posttreatment levels of HCV RNA or histopathological changes. However, there was a statistically significant correlation between HCV RNA and histological grade (P,.05). CONCLUSION HCV RNA measurement is a better means of determining and monitoring HCV infection than either ALT level or histopathological characteristics and may provide insight into hepatic injury caused by HCV infection even without an invasive liver biopsy.
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Affiliation(s)
- Y Choi
- Department of Pathology, Bronx-Lebanon Hospital Center, Bronx, New York, USA
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25
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Paavola CD, Hemmerich S, Grunberger D, Polsky I, Bloom A, Freedman R, Mulkins M, Bhakta S, McCarley D, Wiesent L, Wong B, Jarnagin K, Handel TM. Monomeric monocyte chemoattractant protein-1 (MCP-1) binds and activates the MCP-1 receptor CCR2B. J Biol Chem 1998; 273:33157-65. [PMID: 9837883 DOI: 10.1074/jbc.273.50.33157] [Citation(s) in RCA: 163] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To address the role of dimerization in the function of the monocyte chemoattractant protein-1, MCP-1, we mutated residues that comprise the core of the dimerization interface and characterized the ability of these mutants to dimerize and to bind and activate the MCP-1 receptor, CCR2b. One mutant, P8A*, does not dimerize. However, it has wild type binding affinity, stimulates chemotaxis, inhibits adenylate cyclase, and stimulates calcium influx with wild type potency and efficacy. These data suggest that MCP-1 binds and activates its receptor as a monomer. In contrast, Y13A*, another monomeric mutant, has a 100-fold weaker binding affinity, is a much less potent inhibitor of adenylate cyclase and stimulator of calcium influx, and is unable to stimulate chemotaxis. Thus Tyr13 may make important contacts with the receptor that are required for high affinity binding and signal transduction. We also explored whether a mutant, [1+9-76]MCP-1 (MCP-1 lacking residues 2-8), antagonizes wild type MCP-1 by competitive inhibition, or by a dominant negative mechanism wherein heterodimers of MCP-1 and [1+9-76]MCP-1 bind to the receptor but are signaling incompetent. Consistent with the finding that MCP-1 can bind and activate the receptor as a monomer, we demonstrate that binding of MCP-1 in the presence of [1+9-76]MCP-1 over a range of concentrations of both ligands fits well to a simple model in which monomeric [1+9-76]MCP-1 functions as a competitive inhibitor of monomeric MCP-1. These results are crucial for elucidating the molecular details of receptor binding and activation, for interpreting mutagenesis data, for understanding how antagonistic chemokine variants function, and for the design of receptor antagonists.
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Affiliation(s)
- C D Paavola
- Department of Molecular and Cell Biology, University of California at Berkeley, Berkeley, California 94720, USA
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Abstract
BACKGROUND Studies of condom efficacy rely on self-reported behavior. Objective markers of exposure to semen may provide a more valid assessment of condom failure and failure to use condoms. GOALS OF THIS STUDY To compare three semen biomarkers: acid phosphatase (AP) activity, prostate specific antigen (PSA), and the human seminal plasma antigen (MHS-5). STUDY DESIGN Twenty women were intravaginally inoculated with six measured, increasingly larger amounts of their partners' semen. Vaginal fluid was collected by the participant using swabs and tested. RESULTS Background levels of PSA were low (0.00-1.25 ng/ml), background levels of AP were variable (0-350 U/l), and all preinoculation samples were negative for MHS-5. All postinoculation samples were positive for PSA, 64 of 117 (55%) for AP, and 14 of 120 (12%) for MHS-5. CONCLUSION The PSA immunoassay was the best semen biomarker under these sampling and testing conditions.
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Affiliation(s)
- M L Lawson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham 35294-2170, USA
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Killam AL, Greener Y, McFerran BA, Maniquis J, Bloom A, Widder KJ, Dittrich HC. Lack of bioeffects of ultrasound energy after intravenous administration of FS069 (Optison) in the anesthetized rabbit. J Ultrasound Med 1998; 17:349-356. [PMID: 9623471 DOI: 10.7863/jum.1998.17.6.349] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The current study was designed to provide a sensitive in vivo model to maximize the potential bioeffects (measured by hemolysis) of B-mode ultrasound energy in combination with FS069 (Optison). B-mode ultrasound energy was delivered to anesthetized male New Zealand white rabbits with a phased array 5 MHz transducer on a Hewlett-Packard Sonos 1500 ultrasonograph, with transmit level set to maximum (40 dB, approx 135 W/cm2). FS069 (Optison), latex particles in human albumin, or human albumin alone (vehicle) was infused via an ear vein at 0.6 mL/kg. No statistically significant changes were noted in serum free hemoglobin or lactate dehydrogenase either over time or between groups.
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Affiliation(s)
- A L Killam
- Molecular Biosystems, Inc., San Diego, California 92121, USA
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Bloom A. Positive changes. Nurs Times 1997; 93:48-9. [PMID: 9095932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Bloom
- Park Road Nursing Home, north London
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Li S, Hart ME, Bloom A, Miller J. The impact of ultraviolet B-irradiated leukocyte transfusion and cyclosporine in rat kidney transplantation. Transplantation 1996; 61:320-1. [PMID: 8600643 DOI: 10.1097/00007890-199601270-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- S Li
- Department of Surgery, University of California, San Diego, USA
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Affiliation(s)
- A B Fiorini
- Hadassah University Hospital, Gastrointestinal Unit, Jerusalem, Israel
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Reissman P, Perry Y, Cuenca A, Bloom A, Eid A, Shiloni E, Rivkind A, Durst A. Pancreaticojejunostomy versus controlled pancreaticocutaneous fistula in pancreaticoduodenectomy for periampullary carcinoma. Am J Surg 1995; 169:585-8. [PMID: 7771621 DOI: 10.1016/s0002-9610(99)80226-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anastomotic leak of the pancreaticojejunostomy is a major cause of morbidity and mortality following pancreaticoduodenectomy. Reports have described a large variety of techniques for performing this anastomosis and managing the pancreatic stump. In an attempt to obviate the pancreaticojejunostomy, we prospectively studied the technique of ligating the pancreatic duct and using external drains to create a temporary controlled pancreaticocutaneous fistula. PATIENTS AND METHODS Thirty-five consecutive patients who were to undergo pancreaticoduodenectomy for periampullary carcinoma were prospectively randomized to one of two groups: pancreaticojejunostomy (PJ) (n = 18) or controlled pancreaticocutaneous fistula (CPF) (n = 17). The groups were well matched for age, sex, coexisting medical illnesses, type of tumor, and preoperative condition. Except for the management of the pancreatic remnant, all patients in both groups underwent an identical procedure. Major morbidity, length of hospitalization, duration of the controlled pancreatic fistula, and mortality were analyzed over a mean follow-up interval of 26 months (range 5 months to 7.5 years). RESULTS The CPF group experienced lower overall operative morbidity rates than the PJ group (24% versus 56%, P < 0.01). Two patients (11%) in the PJ group and none in the CPF group died (P = NS). Half the morbidity in the PJ group and both mortalities were related to anastomotic leak. The CPF and PJ groups left the hospital after mean stays of 26.4 and 42.2 days respectively (< 0.01). CONCLUSIONS Compared to pancreaticojejunal anastomosis, creation of a temporary controlled pancreaticocutaneous fistula in patients who undergo pancreaticoduodenectomy for periampullary malignancy has no appreciable risk. It is associated with reduced morbidity and shorter length of hospitalization.
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Affiliation(s)
- P Reissman
- Department of General Surgery, Hadassah University Hospital, Jerusalem, Israel
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33
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Affiliation(s)
- N Berkman
- Institute of Pulmonology, Hadassah University Hospital, Jerusalem, Israel
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34
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Bloom A. Human health and the environment in eastern and central Europe. Report of the conference Prague, Czech Republic, 12-15 April 1993. Cent Eur J Public Health 1994; 2:27-31. [PMID: 7812241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A group of 46 leading environmental health scientists from 15 nations unanimously agreed to join forces in a new scientific effort to protect human health around the world from the potentially harmful effects of environmental chemicals and radioactive materials. The scientists agreed to establish a non-political European-based, not-for-profit organization whose objectives will be to promote, coordinate and fund environmental health research in order to provide a scientific basis for environmental remediation. The organization will be affiliated with the Conte Institute. The research priorities decided upon for Eastern and Central Europe were as follows: 1. Research into the effects of toxic metals, such as lead, cadmium, arsenic, and beryllium. 2. Research in the populations of the region on cancer, birth defects, and other diseases, with emphasis on data sharing across national boundaries, on quality control, and on use of biomarkers of reproductive and other effects. 3. Studies on the molecular, biochemical, and chromosomal bases for varying genetic susceptibilities to environmentally-induced diseases. 4. Coordination of research on radiation effects, especially on radiation-exposures resulting from nuclear power and weapons plants. 5. Research on approaches to bioremediation. 6. Education and training of professionals and nonprofessionals in environmental health issues, on an international basis. These and other issues will be taken up over time by this new, cooperative scientific research organization, as decided at the Prague Conference.
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Affiliation(s)
- A Bloom
- Conte Institute for Environmental Health, Pittsfield
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35
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Reissman P, Ligumsky M, Bloom A, Durst AL. Laparoscopic adhesiolysis - a treatment for recurrent intestinal obstruction due to adhesions. MINIM INVASIV THER 1994. [DOI: 10.3109/13645709409153007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bowen D, Dasani H, Yung B, Bloom A. Deep venous thrombosis and pulmonary embolism in a patient with type III von Willebrand's disease, protein C and antithrombin III deficiency. Br J Haematol 1992; 81:446-7. [PMID: 1390220 DOI: 10.1111/j.1365-2141.1992.tb08255.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- D Bowen
- Department of Haematology, University of Wales College of Medicine, Heath Park, Cardiff
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Bloom A. Physician credentialing in managed care. Ann Health Law 1991; 1:93-106. [PMID: 10141604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The managed care industry is increasingly using physician credentialing when seeking health care providers. The credentialing process must be conducted in a manner that meets the goals of the managed care program.
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Affiliation(s)
- A Bloom
- Maxicare Health Plans, Inc., Los Angeles, CA
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38
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Burstein M, Bloom A, Heyman A. Nonthrombocytopenic purpura induced by cefoxitin. DICP 1990; 24:206. [PMID: 2309515 DOI: 10.1177/106002809002400217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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39
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Bloom A. The Discovery of Insulin. Postgrad Med J 1988. [DOI: 10.1136/pgmj.64.754.646-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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40
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Aguilera JA, Aguilera J, Baumeister P, Bloom A, Coursen D, Dobrowolski JA, Goldstein FT, Gustafson DE, Kemp RA. Antireflection coatings for germanium IR optics: a comparison of numerical design methods. Appl Opt 1988; 27:2832-2840. [PMID: 20531847 DOI: 10.1364/ao.27.002832] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Refinement and thin film synthesis methods were used by members of six different institutions to design antireflection coatings for germanium substrates. The solutions are based on the use of zinc sulfide and germanium layers only. Several systems were found with an average reflectance that is less than 1% in the 7.7 to 12.3 microm spectral region.
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Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) are now causing severe clinical infection on a worldwide basis. Pulmonary infection due to MRSA although widely reported is poorly documented. We report the predisposing factors, underlying diseases, treatment and outcome in 4 patients with pneumonia, 3 patients with empyema thoracis, 1 patient with pneumonia and empyema thoracis, 1 patient with pneumonia plus lobectomy wound infection and 2 patients with lung abscess. Vancomycin was highly effective in treatment, a finding compatible with experience treating other severe MRSA infections.
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Affiliation(s)
- M T Cafferkey
- Department of Medicine, Royal City of Dublin Hospital, Ireland
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Gebel HM, Bloom A, McErlean J, Leifheit AK, Economou S. Prolonged survival of endocrine allografts with preoperative cyclosporine A. Transplant Proc 1987; 19:946-9. [PMID: 3103290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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43
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Topinka C, Wilkerson S, Reese A, Bloom A. Cognitive and motor development in under 1000 gram infants. Infant Behav Dev 1986. [DOI: 10.1016/s0163-6383(86)80386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Defective platelet thromboxane synthesis has been described in uraemia and attributed to a 'functional cyclooxygenase defect'. We have studied platelet aggregation and generation of immunoreactive thromboxane B2 (TXB2) in 11 subjects on a chronic haemodialysis programme. The platelet function abnormality of uraemia was confirmed, maximal aggregation in response to collagen (2 and 4 micrograms/ml) and sodium arachidonate (1.5 and 3.0 mM) being significantly depressed. However, increased platelet aggregation in response to sodium arachidonate 0.75 mM was noted. Due to the reduced haematocrit, the platelet concentration in platelet-rich plasma (PRP) of uraemic subjects was significantly lower than that of controls; when TXB2 generation in PRP adjusted to 200 X 10(9) platelets/l was assessed, no evidence for a defect of cyclooxygenase was found, although reduced synthesis of TXB2 in response to thrombin was noted. Furthermore, increased thromboxane generation by uraemic PRP in response to sodium arachidonate 0.75 mM was detected. We conclude that the mild platelet abnormality in uraemic subjects treated by haemodialysis is not explained by a 'functional cyclooxygenase defect', although an abnormality of thrombin-induced thromboxane synthesis may be present. Furthermore, the tendency to increased aggregation and thromboxane synthesis in response to a low concentration of arachidonic acid may contribute to the thrombotic tendency which is also described in such subjects.
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45
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Bloom A. Diabetes and Metformin: a Research and Clinical Update. Postgrad Med J 1986. [DOI: 10.1136/pgmj.62.723.72-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
We report a patient with hemoperitoneum from rupture of intraperitoneal varices. Hemoperitoneum is rare. Nevertheless, it should be easily recognized in a patient with abdominal pain and distension, a falling hematocrit in the absence of external blood loss, and gross blood in the abdominal fluid. The syndrome is another justification for early paracentesis in patients with abdominal fluid. Mortality remains high despite surgical correction of the bleeding and reflects the severity of the underlying liver disorder.
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Abstract
A method is described to produce radiographs of thin sections of human teeth and periodontal structures. These high resolution contact x-rays allow for visualization of the microscopic details of the mineralized components of these tissues in a dimension heretofore not examined. Twenty-five blocks of human jaws containing teeth affected by periodontal disease were obtained from cadavers. Sagittal, transverse and cross-sectional serial slices were cut using a rotary instrument (1500 rpm) with a water-cooled 3-inch jewelers slot saw. Five hundred-micron sections were made of jaw specimens containing 2 or 3 teeth. The radiographs were taken with a Faxitron low voltage x-ray machine on Kodak-Ortho, Type 3 film. Films were exposed at a distance of 12 inches from the x-ray source at 35 kVp and 1.0 mA for 3 minutes with the specimen in direct contact with the film. Spatial representation of the internal structure of the alveolar bone was obtained using this technique and the detailed anatomy of the vascular channels within the cancellous and cortical compartments of the jaws was studied. Mineralization patterns of plaque and calculus, calcifications in the periodontal ligament, pulp calcifications, accessory root canals, caries and detailed structural changes in the enamel and cementum were also viewed on these films with the aid of microscopy. Magnifications of up to 30 times were used without excessive image distortion resulting from film grain.
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49
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Bloom A, Hannaford PA, Greaves M, Preston FE, Brown CB. Hemolytic-uremic syndrome: demonstration of abnormalities of platelet reactivity and insensitivity to prostaglandin I2. Clin Nephrol 1985; 23:85-8. [PMID: 3886228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Platelet aggregation and thromboxane synthesis and platelet sensitivity to the antiaggregatory action of prostaglandin I2 were studied serially in a subject suffering from adult hemolytic-uremic syndrome. Platelet aggregation in vitro was defective during the acute phase of the disease and recovered during the convalescent phase. Defective aggregation was not associated with a failure of thromboxane synthesis although it was related to an intrinsic platelet defect rather than an inhibitor in the plasma. The platelets were insensitive to prostaglandin I2, even in the recovery phase of the disease. Furthermore, plasma from the patient rendered normal platelets insensitive to prostaglandin I2 and more sensitive to aggregating agents. It is concluded that the platelet abnormality in hemolytic-uremic syndrome is complex and it combines both an intrinsic platelet abnormality and a plasma component.
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