RESUMEN
During operations in subtropical areas over the summer months of 2001 and 2003 the authors audited 80 patients with heat-related illness, with the intention of defining the nature and distribution of the underlying pathophysiology. Haematological, biochemical and clinical data were gathered prospectively and patients allocated to diagnostic categories on the basis of the combination of clinical findings and investigations. Four basic types of heat-related illness could be distinguished: (1) excessive salt loss with hyponatraemic dehydration, (2) hypokalaemic alkalosis with low serum bicarbonate, (3) haemodilution associated with excessive water intake in stressed individuals, and (4) loss of normal thermoregulation, characterised by high core temperature and paradoxical cessation of sweating. Most of the patients fell clearly into a single distinct category, but there was a degree of overlap. Reduction of extracellular fluid volume was a common central mechanism. Common provoking factors identified were: gastrointestinal upset, history of previous heat intolerance (35%) environmental temperatures exceeding 45 degrees C, short period of acclimatisation (55%), travel, sleep loss, hard physical work especially if directly preceded by a period of sleep, work in confined humid spaces (45%), and lack of additional salt intake. When several of these factors were present together admission rate over one 24-hour period reached 3% of persons at risk per day. Patients are often more ill than they appear. To reduce the incidence of heat illness during future operations the following measures are proposed: 1. Avoidance of physical exertion during the heat of the day for the first 7-10 days. 2. Progressive gentle exercise in the early morning or late evening over the same period. 3. Increase in daily salt intake to 15-20gm for the first 2-3 weeks. 4. Only sufficient water intake to relieve thirst and to ensure the flow of abundant dilute urine.
Asunto(s)
Alcalosis/complicaciones , Deshidratación/complicaciones , Hemodilución , Hipopotasemia/complicaciones , Hiponatremia/complicaciones , Clima Tropical/efectos adversos , Aclimatación , Alcalosis/diagnóstico , Regulación de la Temperatura Corporal , Estudios de Casos y Controles , Áreas de Influencia de Salud , Deshidratación/diagnóstico , Conducta de Ingestión de Líquido , Líquido Extracelular , Agotamiento por Calor/complicaciones , Agotamiento por Calor/diagnóstico , Humanos , Humedad/efectos adversos , Hipopotasemia/diagnóstico , Hiponatremia/diagnóstico , Irak , Omán , Esfuerzo Físico , Privación de Sueño , Viaje , AguaRESUMEN
With the advent of evidence-based medicine and the Calman-Hine Report, more and more surgical trainees are undertaking a period of research, either before entering or during their Specialist Registrar training. Many will encounter concepts in science uncommon in daily clinical settings. This paper will elucidate the techniques of genetic amplification available today with their potential for usage in clinical research.
Asunto(s)
Técnicas de Amplificación de Ácido Nucleico , Reacción en Cadena de la Polimerasa , Medicina Basada en la Evidencia , Cirugía General/educación , Humanos , Técnicas de Amplificación de Ácido Nucleico/normas , Técnicas de Amplificación de Ácido Nucleico/tendencias , Reacción en Cadena de la Polimerasa/normas , Reacción en Cadena de la Polimerasa/tendencias , Estados UnidosRESUMEN
PURPOSE: Hepatocyte growth factor/scatter factor (HGF/SF), via its receptor c-MET, has been implicated to play a pivotal role in breast cancer development and progression. This study examined a transgene-consisting of a combination of U1snRNA, hammerhead ribozyme, and antisense, designed to inhibit c-met expression-and its impact on the migration and in vitro invasion of breast cancer cells. EXPERIMENTAL DESIGN: A hammerhead ribozyme targeting human c-MET was cloned into a modified pZeoU1EcoSpe vector and transfected into breast cancer cells MDA MB 231 and MCF-7 by electroporation. Expression of MET mRNA and protein was determined. Migration and in vitro invasiveness of transfected cells were also analyzed. RESULTS: Breast cancer cells were transfected with the ribozyme-containing plasmids. Stable transfectants manifested an almost complete loss of MET mRNA and protein, as shown by reverse transcription-PCR, Northern blotting, and Western blotting, respectively, whereas the wild-type plasmid had no effects. Met-ribozyme transfected cells exhibited reduced migration and in vitro invasiveness through extracellular matrix (Matrigel), compared with the wild-type cells and cells transfected with empty plasmid. CONCLUSIONS: These data show that targeting c-MET by way of a hammerhead ribozyme encoding antisense to c-MET is an effective approach in reducing the invasiveness of breast cancer cells.
Asunto(s)
Neoplasias de la Mama/patología , Proteínas Proto-Oncogénicas c-met/genética , ARN Catalítico/genética , Secuencia de Bases , Neoplasias de la Mama/genética , Neoplasias de la Mama/terapia , Movimiento Celular/genética , ADN sin Sentido/genética , Regulación Neoplásica de la Expresión Génica , Humanos , Datos de Secuencia Molecular , Invasividad Neoplásica/genética , Invasividad Neoplásica/prevención & control , Plásmidos/genética , Proteínas Proto-Oncogénicas c-met/metabolismo , ARN Catalítico/metabolismo , ARN Mensajero/genética , ARN Mensajero/metabolismo , ARN Nuclear Pequeño/genética , ARN Nuclear Pequeño/metabolismo , Factores de Tiempo , Transfección , Células Tumorales CultivadasRESUMEN
This article reviews current literature on the role of manual medicine in the diagnosis and treatment of cervicogenic headache. Manual diagnostic procedures and treatment procedures are described for the cervical spine. Emphasis is placed on accurate diagnosis using a biomechanical model and precise localization of forces. Muscle energy technique is suggested as a safe and effective treatment when somatic dysfunction of the cervical spine is found in association with the diagnostic criteria for cervicogenic headache. Lastly, a suggested clinical approach to this problem from a manual medicine perspective is given.
Asunto(s)
Trastornos de Cefalalgia/terapia , Manipulación Ortopédica , Vértebras Cervicales/fisiopatología , Trastornos de Cefalalgia/fisiopatología , Humanos , Movimiento/fisiología , Músculos del Cuello/fisiopatologíaRESUMEN
Following the observation that relatives of cystic fibrosis (CF) patients have an increased mortality due to leukaemia, a study was initiated to determine whether leukaemia patients had an increased prevalence of the delta F508 CF mutation. No increase in carriers were found among leukaemias; however the carrier frequency of the delta F508 mutation appeared to be reduced in patients with malignant melanoma analysed as a control group compared to the normal population. This paper extends our previous study and investigates several other common human tumours, including those of the colon, breast, and lymphoma tissue. Fewer than expected carriers remained among the melanoma group from South Wales. There were fewer than expected carriers among patients with colon cancer compared to the normal population. The prevalence of the delta F508 mutation was normal in lymphomas and leukaemias.
Asunto(s)
Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Fibrosis Quística/genética , Leucemia/genética , Mutación , Neoplasias/genética , Alelos , Neoplasias de la Mama/genética , Neoplasias del Colon/genética , Electroforesis en Gel de Poliacrilamida , Heterocigoto , Humanos , Linfoma/genética , Melanoma/genética , Reacción en Cadena de la Polimerasa , Eliminación de Secuencia , GalesRESUMEN
We report on the use of a subcutaneous infusion of diamorphine, hyoscine and midazolam in the terminal care of a child with a neurodegenerative disease. The technique was safe and effective, and provided good symptom relief including control of previously intractable seizures.
Asunto(s)
Heroína/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Midazolam/uso terapéutico , Antagonistas Muscarínicos/uso terapéutico , Narcóticos/uso terapéutico , Cuidados Paliativos , Escopolamina/uso terapéutico , Convulsiones/prevención & control , Resultado Fatal , Femenino , Humanos , LactanteRESUMEN
A mixture of synthetic L-amino acids (Aminoplex 14) was infused intravenously over 4 hours in five dogs each prepared with a gastric fistula and a denervated fundic pouch. Acid and pepsin outputs from the innervated fundic pouch. Acid and pepsin outputs from the innervated gastric mucosa (gastric fistula) increased significantly after 90 minutes' infusion of amino acid. Acid output from the denervated fundic mucosa (Heidenhain pouch) was estimated by a method of intragastric titration and increased significantly only in response to intravenous amino acid infusion when the pouch was subjected to distention with 100 ml of perfusate. Blood glucose, serum gastrin, hematocrit and serum osmolality levels did not change throughout the experiments. Bolus intravenous injection of either atropine (0.15 mg/kg) or cimetidine (10 mg/kg) blocked the acid secretory response to intravenous amino acids. It is concluded that intravenous amino acids stimulate the innervated gastric mucosa to secrete both acid and pepsin. The secretory response from denervated mucosa in only obtained in the presence of fundic pouch distention. The gastric secretory response is susceptible to both atropine and histamine H2 antagonist blockade.