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Yeo JJY, Stewart K, Maniam P, Arman S, Srinivasan D, Wall L, MacNeill M, Strachan M, Nixon I. Neoadjuvant tyrosine kinase inhibitor therapy in locally advanced differentiated thyroid cancer: a single centre case series. J Laryngol Otol 2023; 137:1237-1243. [PMID: 36946096 DOI: 10.1017/s0022215123000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Primary surgical resection remains the mainstay of management in locally advanced differentiated thyroid cancer. Tyrosine kinase inhibitors have recently shown promising results in patients with recurrent locally advanced differentiated thyroid cancer. This study discussed four patients with locally advanced differentiated thyroid cancer managed with tyrosine kinase inhibitors used prior to surgery in the 'neoadjuvant' setting. METHOD Prospective data collection through a local thyroid database from February 2016 identified four patients with locally advanced differentiated thyroid cancer unsuitable for primary surgical resection commenced on neoadjuvant tyrosine kinase inhibitor therapy. RESULTS All cases had T4a disease at presentation. Three cases tolerated tyrosine kinase inhibitor therapy for more than 14 months while the last case failed to tolerate treatment at 1 month. All patients subsequently underwent total thyroidectomy to facilitate adjuvant radioactive iodine treatment. Disease-specific survival remains at 100 per cent currently (range, 29-75 months). CONCLUSION Neoadjuvant tyrosine kinase inhibitors in locally advanced differentiated thyroid cancer can be effective in reducing primary tumour extent to potentially facilitate a more limited surgical resection for local disease control.
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Affiliation(s)
- J J Y Yeo
- Department of Head and Neck Surgery, St John's Hospital at Howden, Livingston, UK
| | - K Stewart
- Department of Head and Neck Surgery, St John's Hospital at Howden, Livingston, UK
| | - P Maniam
- Department of Head and Neck Surgery, St John's Hospital at Howden, Livingston, UK
| | - S Arman
- Department of Head and Neck Surgery, St John's Hospital at Howden, Livingston, UK
| | - D Srinivasan
- Department of Oncology, Western General Hospital, Edinburgh, UK
| | - L Wall
- Department of Oncology, Western General Hospital, Edinburgh, UK
| | - M MacNeill
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Strachan
- Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - I Nixon
- Department of Head and Neck Surgery, St John's Hospital at Howden, Livingston, UK
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McKnight JA, Ochs A, Mair C, McKnight O, Wright R, Gibb FW, Cunningham SG, Strachan M, Ritchie S, McGurnaghan SJ, Colhoun HM. The effect of DAFNE education, continuous subcutaneous insulin infusion, or both in a population with type 1 diabetes in Scotland. Diabet Med 2020; 37:1016-1022. [PMID: 31872473 DOI: 10.1111/dme.14223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 11/29/2022]
Abstract
AIM To investigate the effect of DAFNE and continuous subcutaneous insulin infusion in clinical practice. METHODS Within NHS Lothian, continuous subcutaneous insulin infusion started in 2004 and DAFNE education began in 2006. We extracted anonymized data from the national database for all those aged > 18 years with type 1 diabetes having a Dose Adjustment For Normal Eating course or continuous subcutaneous insulin infusion start date (n = 4617). RESULTS In total, 956 persons received DAFNE education, and 505 had received an insulin pump, 208 of whom had DAFNE education followed by insulin pump. Mean (SD) HbA1c before DAFNE education was 68 (15) mmol/mol (8.4% [1.4%]) and 66 (13) mmol/mol (8.2% [1.2%]) before continuous subcutaneous insulin infusion. In the year following DAFNE education, the mean fall in within-person HbA1c was 3.8 mmol/mol (95% CI 4.0 to 3.4; 0.3% [0.4% to 0.3%]). Those with the poorest control (HbA1c ≥ 85 mmol/mol [9.9%]) experienced the largest decline (15.7 mmol/mol [1.4%]). Those in the lowest HbA1c band at initiation (< 53 mmol/mmol [7.0%]) experienced a rise. In the year following continuous subcutaneous insulin infusion initiation there was a mean fall in within-person HbA1c of 6.6 mmol/mol (6.8 to 6.4; 0.6% [0.6% to 0.6%]). In those with the poorest control (HbA1c ≥ 85 mmol/mol [9.9%]), the mean fall in HbA1c was 22.2 mmol/mol (23 to 21; 2.0% [2.1% to 1.9%]). Continuous subcutaneous insulin infusion effectiveness was not different with or without DAFNE education. The effects of both interventions were sustained over 5 years. CONCLUSIONS Both DAFNE education and insulin pump therapy had the greatest effect on HbA1c in those with higher baseline values. There was little difference to attained HbA1c when Dose Adjustment For Normal Eating education was introduced before insulin pump therapy.
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Affiliation(s)
- J A McKnight
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - A Ochs
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Mair
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - O McKnight
- Forth Valley Royal Hospital, NHS Forth Valley, Scotland
| | - R Wright
- Department of Diabetes, St John's Hospital, Livingston, UK
| | - F W Gibb
- Edinburgh Centre for Diabetes and Endocrinology, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S G Cunningham
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - M Strachan
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - S Ritchie
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - S J McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - H M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Department of Public Health, NHS Fife, Kirkcaldy, UK
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Reed N, Glen H, Gerrard G, Good J, Lei M, Lyon AR, Strachan M, Wadsley J, Newbold K. Expert Consensus on the Management of Adverse Events During Treatment with Lenvatinib for Thyroid Cancer. Clin Oncol (R Coll Radiol) 2019; 32:e145-e153. [PMID: 31843241 DOI: 10.1016/j.clon.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 12/23/2022]
Abstract
AIMS Lenvatinib is an oral multi-kinase inhibitor approved for the treatment of adults with progressive, locally advanced or metastatic, differentiated thyroid carcinoma refractory to radioactive iodine. MATERIALS AND METHODS A literature review was undertaken to inform the development of consensus-based guidance for the routine management of adverse events associated with lenvatinib. PubMed was searched on 24 October 2017; the search terms were 'lenvatinib' and 'thyroid cancer'. RESULTS Hypertension, diarrhoea, weight loss, skin toxicities and cardiovascular adverse events were considered. For grade 1/2 diarrhoea, initial treatment should be loperamide with a 1-week treatment interruption if diarrhoea persists and dose reduction if diarrhoea recurs on reinitiation of lenvatinib. Blood pressure should be monitored daily in patients with pre-existing hypertension, otherwise from 1 week after the initiation of lenvatinib and weekly for the first 2 months. For patients with systolic blood pressure ≥135 mmHg to <160 mmHg or diastolic blood pressure ≥85 mmHg to <100 mmHg, lenvatinib should be continued but antihypertensive therapy initiated/intensified. For patients who remain hypertensive, a treatment break can be considered with lenvatinib reinitiated at a reduced dose once the patient's blood pressure has stabilised for at least 48 h. Weight loss of 10% of baseline body weight or the onset of anorexia should be managed with a 1-week treatment break; patients should maintain a healthy, active lifestyle. For patients with grade 2 proteinuria, lenvatinib may be continued, but an angiotensin II receptor blocker or angiotensin converting enzyme inhibitor should be commenced. For grade >3 proteinuria, lenvatinib should be interrupted until proteinuria returns to 1+. For chronic proteinuria, lenvatinib should be stopped. Skin toxicities should be managed with moisturisers or emollients and soap substitutes. CONCLUSIONS Prophylaxis, regular monitoring and symptomatic management with appropriate short treatment breaks and, for persistent adverse events, dose reductions, are recommended to enable patients to remain on the optimal dose regimen.
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Affiliation(s)
- N Reed
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - H Glen
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - J Good
- QE Hospital, Birmingham, UK
| | - M Lei
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A R Lyon
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, London, UK
| | | | | | - K Newbold
- Royal Marsden NHS Foundation Trust, London, UK
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Ma J, Igata S, Wong D, Strachan M, Raisinghani A, Demaria A. P4213Predictive factors for progression of mitral regurgitation in asymptomatic mitral valve prolapse patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Ma
- University of California San Diego, San Diego, United States of America
| | - S Igata
- University of California San Diego, San Diego, United States of America
| | - D Wong
- University of California San Diego, San Diego, United States of America
| | - M Strachan
- University of California San Diego, San Diego, United States of America
| | - A Raisinghani
- University of California San Diego, San Diego, United States of America
| | - A Demaria
- University of California San Diego, San Diego, United States of America
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Bowen J, Southgate R, Ali A, Little S, Liakos A, Greaves F, Strachan J, Baraco A, Adem G, Abdillahi M, Handuleh J, Reed K, Walker F, Zeron J, Strachan M, Bowen S, Hellyer T, Hersheson J, Whitwell S, Fyfe M, Phillips J, Trim C, Johnson O, Leather A, Al-Hadithy N, Finlayson A. Can UK healthcare workers remotely support medical education in the developing world?: Focus group evaluation. JRSM Short Rep 2012; 3:47. [PMID: 22908028 PMCID: PMC3422851 DOI: 10.1258/shorts.2012.011171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objectives To evaluate the feasibility of providing regular, live, text-based teaching to medical students and junior doctors in Somaliland using a dedicated case-based medical education website (www.MedicineAfrica.com). Design Review of MedicineAfrica database for details of teaching sessions held in Somaliland from December 2008-October 2010 and evaluation of user experiences through focus groups. Setting King's College Hospital, London, UK and Ahmoud University, Borama, Somaliland. Participants Final year medical students, newly graduated interns and second year interns at Ahmoud University, Borama, Somaliland. Main outcome measures Qualitative and quantitative user rating of online case-based tutorials in the context of pre-existing educational opportunities available to them. Results Regular online teaching sessions are received enthusiastically by students and junior doctors and are reported to improve their clinical practice. Conclusions Despite technological limitations in Somaliland, a live text-based teaching service can be delivered effectively and streamlined with local curricula. This represents an alternative to traditional static teaching methodologies currently used in international medical education.
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Affiliation(s)
- Jst Bowen
- Geriatrics Department, Royal Berkshire Hospital , Reading , UK
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Morling J, Williamson R, Strachan M, Price J, Glancy S, Nee L. P2-201 Changes in aminotransferases indicate changes in hepatosteatosis in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.34] [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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Morling J, Williamson R, Strachan M, Price J, Nee L, Glancy S. P2-202 Thiazolidinediones are associated with regression of hepatosteatosis in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.35] [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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Przybojewski SJ, Griffith-Richards SB, Strachan M, Vadachia Y, Kathan DL. 'Migrating' intraventricular neurocysticercus cyst. SA J Radiol 2007. [DOI: 10.4102/sajr.v11i1.58] [Citation(s) in RCA: 3] [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: 11/01/2022] Open
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9
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Ellard S, Thomas K, Edghill EL, Owens M, Ambye L, Cropper J, Little J, Strachan M, Stride A, Ersoy B, Eiberg H, Pedersen O, Shepherd MH, Hansen T, Harries LW, Hattersley AT. Partial and whole gene deletion mutations of the GCK and HNF1A genes in maturity-onset diabetes of the young. Diabetologia 2007; 50:2313-7. [PMID: 17828387 DOI: 10.1007/s00125-007-0798-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 07/02/2007] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS Heterozygous mutations of glucokinase (GCK) and hepatocyte nuclear factor-1 alpha (HNF1A; also known as hepatic transcription factor 1 [TCF1]) genes are the most common cause of MODY. Genomic deletions of the HNF1B (also known as TCF2) gene have recently been shown to account for one third of mutations causing renal cysts and diabetes syndrome. We investigated the prevalence of partial and whole gene deletions in UK patients meeting clinical criteria for GCK or HNF-1alpha/-4alpha MODY and in whom no mutation had been identified by sequence analysis. METHODS A multiplex ligation-dependent probe amplification (MLPA) assay was developed using synthetic oligonucleotide probes for 30 exons of the GCK, HNF1A and HNF4A genes. RESULTS Partial or whole gene deletions were identified in 1/29 (3.5%) probands using the GCK MLPA assay and 4/60 (6.7%) of probands using the HNF1A/-4A MLPA assay. Four different deletions were detected: GCK exon 2, HNF1A exon 1, HNF1A exons 2 to 10 and HNF1A exons 1 to 10. An additional Danish pedigree with evidence of linkage to HNF1A had a deletion of exons 2 to 10. Testing other family members confirmed co-segregation of the deletion mutations with diabetes in the pedigrees. CONCLUSIONS/INTERPRETATION Large deletions encompassing whole exons can cause GCK or HNF-1alpha MODY and will not be detected by sequencing. Gene dosage assays, such as MLPA, are a useful adjunct to sequence analysis when a diagnosis of MODY is strongly suspected.
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Affiliation(s)
- S Ellard
- Institute of Biomedical Science and Clinical Medicine, Peninsula Medical School, Exeter, UK.
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Vadachia Y, Strachan M, Griffith-Richards SB, Przybojewski SJ, Kathan DL. Emphysematous pyelonephritis in a patient with polycystic kidney disease. SA J Radiol 2006. [DOI: 10.4102/sajr.v10i3.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kathan DL, Griffith-Richards SC, Przybojewski SJ, Strachan M, Vadachia Y, Von Bezing H. Encysted peritoneal hydatidosis with a hepatic hydatic cyst. SA J Radiol 2006. [DOI: 10.4102/sajr.v10i3.169] [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: 11/01/2022] Open
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Strachan M, Vadachia Y, Przbojewski S. The meandering inferior mesenteric artery. SA J Radiol 2006. [DOI: 10.4102/sajr.v10i3.170] [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: 11/01/2022] Open
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Abstract
Quality of life is often thought to be poor before and after intensive care unit admission. The aim of this study was to investigate changes in quality of life before and after intensive care. A prospective cohort study of 300 consecutive patients admitted to intensive care was performed in a Scottish Teaching Hospital. Quality of life was assessed premorbidly and 3, 6 and 12 months after intensive care admission for surviving patients using SF-36 as well as EQ-5D scores at 12 months. The median value for age was 60.5 years and for APACHE II score, 18. The mean length of stay was 6.7 days. SF-36 physical component scores decreased from premorbid values at 3 months (p = 0.05) and then returned to premorbid values at 12 months (p < 0.001). The mean physical scores were below the population norm at all time points but the mean mental scores were similar or higher than these population norms. Patients who died after intensive care discharge had lower quality of life scores than did survivors (all p < 0.01). Poor premorbid quality of life was demonstrated and appears to reduce after ICU discharge. For survivors there was a slow increase in physical quality of life to premorbid levels by the end of the first year but these remained lower than in the general population. ICU patients experience a considerable longer-term burden of ill health.
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Affiliation(s)
- B H Cuthbertson
- Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.
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Lafitte S, Masugata H, Peters B, Togni M, Strachan M, Yao B, Kwan OL, DeMaria AN. Accuracy and reproducibility of coronary flow rate assessment by real-time contrast echocardiography: in vitro and in vivo studies. J Am Soc Echocardiogr 2001; 14:1010-9. [PMID: 11593206 DOI: 10.1067/mje.2001.112908] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Real-time myocardial contrast echo (MCE) provides the potential to assess myocardial blood flow from time-intensity refilling curves after high-energy bubble destruction. This study validated the accuracy of this approach and the effect of specific examination variables and instrument settings on results. The effects of examination depth and angle as well as dynamic range, pulse repetition frequency, and line density were assessed with the use of in vitro incremental flow rates produced in an in vitro tissue phantom. In vivo recordings of real-time imaging with an infusion of a contrast agent (Optison) were obtained in 7 open-chest dogs with graded left anterior descending artery stenosis at baseline and during adenosine hyperemia, and were compared with flow probe measurements. After bubble destruction, time-intensity data were fitted to an exponential function, and the rate of intensity increase (b) and peak plateau intensity (A) were derived from refilling curves. In vivo real-time values for b, but not A, correlated closely with flow probe measures (r = 0.93). A similar correlation for b was observed in vitro (r = 0.98). The correlation between flow rate and b was influenced by several examination variables, including depth, angle, and instrument settings. Real-time MCE provides accurate quantification of coronary flow by assessing the rate of microbubble refilling. However, this parameter may be affected by several examination and instrument variables. Therefore, real-time MCE refilling measures are best applied by comparing baseline values with those of stress studies.
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Affiliation(s)
- S Lafitte
- Cardiovascular Division, University of California at San Diego, USA
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Lafitte S, Matsugata H, Peters B, Togni M, Strachan M, Kwan OL, DeMaria AN. Comparative value of dobutamine and adenosine stress in the detection of coronary stenosis with myocardial contrast echocardiography. Circulation 2001; 103:2724-30. [PMID: 11390344 DOI: 10.1161/01.cir.103.22.2724] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Controversy continues as to whether adenosine or dobutamine is the superior pharmacological stress agent for myocardial contrast echocardiography (MCE). METHODS AND RESULTS We compared real-time MCE refilling curves and wall thickening during adenosine and dobutamine stress in 14 open-chest dogs with left anterior descending and left circumflex coronary artery stenoses that reduced hyperemia by 40% to 60% and 70% to 90% (mild and severe non-flow-limiting stenosis, NFLS) and resting flow by 10% to 30% and 35% to 50% (mild and severe flow-limiting stenosis, FLS). MCE was performed with low-energy imaging during Optison infusion. After high-energy bubble destruction, time-intensity data from risk beds were fitted for an exponential function as y=A(1-e(-)(bt)), from which the rate of intensity increase (b) and maximal plateau intensity (A) were derived. Although severe NFLS and greater stenoses decreased b with both dobutamine and adenosine, with mild NFLS it was reduced in 58% of animals with dobutamine versus 8% with adenosine. The absolute decrease in b, however, was greater for adenosine than dobutamine with FLS. The A parameter was decreased with both adenosine and dobutamine only with the most severe FLS. Wall thickening was decreased with dobutamine in 33% of animals with severe NFLS and in all animals with any FLS; with adenosine, in all with severe FLS. CONCLUSIONS Both dobutamine and adenosine significantly reduce MCE refilling rates in the setting of severe stenosis and in the absence of contractile abnormalities. Dobutamine decreases refilling rate and wall thickening at a less reduced flow grade than adenosine, but adenosine produces a greater magnitude of change than dobutamine.
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Affiliation(s)
- S Lafitte
- Cardiovascular Division, University of California at San Diego, USA
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Abstract
Numerous studies have yielded small, negative correlations between measures of paranormal and "traditional religious beliefs". This may partly reflect opinions of Christians in the samples who take biblical sanctions against many "paranormal" activities seriously. To test this, 391 college students (270 women and 121 men) rated their beliefs in various paranormal phenomena and were classified as Believers, Nominal Believers, and Nonbelievers on the strength of their self-rated commitment to key biblical (particularly Protestant) doctrines. As predicted, Believers were significantly less likely than Nominal Believers or Nonbelievers to endorse reincarnation, contact with the dead, UFOs, telepathy, prophecy, psychokinesis, or healing, while the beliefs of Nominal Believers were similar to those of Nonbelievers. Substantial percentages of Nominal and Nonbelievers (30-50%) indicated at least moderate acceptance of the paranormal phenomena surveyed.
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Affiliation(s)
- E L Hillstrom
- Department of Psychology, Wheaton College, IL 60187, USA.
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Abstract
Real-time three-dimensional echocardiography acquires data as a volume rather than as a series of planar images, thereby obviating cardiac or respiratory gating and limiting artifacts generated by random motion. This study was undertaken to evaluate the feasibility of using real-time three-dimensional echocardiography to evaluate fetal cardiac anatomy and function. Ten human fetuses were evaluated in utero, four of whom had congenital heart disease. Freehand transabdominal scanning was performed on each pregnant woman using a real-time three-dimensional echocardiography system. Four volume clips at 20 volumes/s of duration 1.5 s each were obtained on each fetal heart and stored for off-line analysis. Data were displayed immediately as a series of four simultaneous planes, with the ability for the observer to manipulate the position of each plane within the acquired volume data set. Cardiac motion could be slowed, stopped, or viewed at its original speed. Most structures and views, as well as cardiac function, could be visualized consistently. Abnormal structures could be detected readily. Off-line analysis was rapid and easy. We conclude that fetal real-time three-dimensional echocardiography is a feasible, facile, and rapid new technique.
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Affiliation(s)
- M S Sklansky
- Division of Pediatric Cardiology, University of California, San Diego 92103-8445, USA
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Karmali MA, Arbus GS, Ish-Shalom N, Fleming PC, Malkin D, Petric M, Cheung R, Louie S, Humphreys GR, Strachan M. A family outbreak of hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli serotype O157:H7. Pediatr Nephrol 1988; 2:409-14. [PMID: 3153052 DOI: 10.1007/bf00853433] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
All five siblings (three boys and two girls, aged 1.5-9 years) in a family developed hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli O157:H7 at a lakeside vacation cottage during the fall of 1985. All five were hospitalized and made a full recovery. Both parents remained asymptomatic, and neither had evidence of this infection. In four children who were investigated prospectively, free verotoxin was still detectable in the stools for between 3 and 7 weeks. The prodromal diarrheal illness in the children occurred over a 10-day period. The epidemic curve was consistent with a point-source outbreak, but continuous exposure or person-to-person transmission could not be ruled out. The source of the infection was not identified.
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Affiliation(s)
- M A Karmali
- Department of Bacteriology, Hospital for Sick Children, Toronto, Ontario, Canada
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Strachan M. International cooperation in family planning. Nurs Outlook 1971; 19:103. [PMID: 5203646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Abstract
In December, 1965, a patient was admitted to the wards at Parkside Hospital, Macclesfield, with a Korsakoff syndrome which had appeared following a suicidal hanging attempt. Strangulation as a cause of the Korsakoff syndrome appears in all surveys of the numerous causes of the disorder, from Bonhoeffer (1904) to Lewis (1961), but only one case (Whiteley, 1958) has been described in the English literature and this only briefly. Indeed, the whole subject of the neuropsychiatric sequelae of attempted hanging has received scant attention in the English literature, yet according to statistics of the Registrar-General (Stengel, 1964), hanging is the second commonest method of suicide in males in this country. Moreover, Bokonjic (1963) has collected 19 cases admitted to hospitals in Aarhus and Copenhagen between 1948–1958 suffering from the anoxic effects of attempted hanging, whilst Berczeller and Nowotny (1935) claimed to have dealt with 100 hanging survivors in the Vienna University Clinic over a ten-year period. Possibly of greater importance in justifying a review of this subject is the fact that the neuropsychiatric sequelae of attempted hanging are really those of cerebral anoxia. In this age, when surgical techniques involving interruption of the cerebral circulation are growing more frequent and when methods of anaesthesia and particularly dental anaesthesia are evoking a good deal of attention and contention, it is important that the psychiatrist should have some acquaintance with the psychological and neurological symptoms and signs that are caused by cerebral anoxia.
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Strachan M. Identification of major needs in the care of mother and infant throughout the maternity cycle. Bull Am Coll Nurse Midwifery 1966; 10:103-10. [PMID: 5177017 DOI: 10.1111/j.1542-2011.1966.tb00202.x] [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: 01/14/2023]
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