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Skunk and psychosis in South East London
- M. Di Forti, C. Morgan, V. Mondelli, L. Gittens, R. Handley, N. Hepgul, S. Luzi, T. Marques, M. Aas, S. Masson, C. Prescott, M. Russo, P. Sood, B. Wiffen, P. Papili, P. Dazzan, C. Pariante, K. Aitchison, J. Powell, R. Murray
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- Journal:
- European Psychiatry / Volume 24 / Issue S1 / January 2009
- Published online by Cambridge University Press:
- 16 April 2020, 24-E34
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Background:
Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007).
Hypothesis:We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.
Methods:We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. All were recruited as part of the Genetic and Psychosis (GAP) study which studied all patients who presented to the South London and Maudsley Trust.
Results:There was no significant difference in the life-time prevalence of cannabis use or age at first use between cases and controls. However, cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls. The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).
Conclusions:Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.
P.075 Clinical spectrum of POLR3-related leukodystrophy caused by biallelic POLR1C pathogenic variants
- L Gauquelin, FK Cayami, L Sztriha, G Yoon, LT Tran, K Guerrero, F Hocke, RM van Spaendonk, EL Fung, S D’Arrigo, G Vasco, I Thiffault, DM Niyazov, R Person, KS Lewis, E Wassmer, T Prescott, P Fallon, M McEntagart, J Rankin, R Webster, H Philippi, B van de Warrenburg, D Timmann, A Dixit, C Searle, N Thakur, MC Kruer, S Sharma, A Vanderver, D Tonduti, MS van der Knaap, E Bertini, C Goizet, S Fribourg, NI Wolf, G Bernard, DDD Study
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 46 / Issue s1 / June 2019
- Published online by Cambridge University Press:
- 05 June 2019, p. S34
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Background: Biallelic variants in POLR1C are associated with POLR3-related leukodystrophy (POLR3-HLD), or 4H leukodystrophy (Hypomyelination, Hypodontia, Hypogonadotropic Hypogonadism), and Treacher Collins syndrome (TCS). The clinical spectrum of POLR3-HLD caused by variants in this gene has not been described. Methods: A cross-sectional observational study involving 25 centers worldwide was conducted between 2016 and 2018. The clinical, radiologic and molecular features of 23 unreported and previously reported cases of POLR3-HLD caused by POLR1C variants were reviewed. Results: Most participants presented between birth and age 6 years with motor difficulties. Neurological deterioration was seen during childhood, suggesting a more severe phenotype than previously described. The dental, ocular and endocrine features often seen in POLR3-HLD were not invariably present. Five patients (22%) had a combination of hypomyelinating leukodystrophy and abnormal craniofacial development, including one individual with clear TCS features. Several cases did not exhibit all the typical radiologic characteristics of POLR3-HLD. A total of 29 different pathogenic variants in POLR1C were identified, including 13 new disease-causing variants. Conclusions: Based on the largest cohort of patients to date, these results suggest novel characteristics of POLR1C-related disorder, with a spectrum of clinical involvement characterized by hypomyelinating leukodystrophy with or without abnormal craniofacial development reminiscent of TCS.
The establishment of DOHaD working groups in Australia and New Zealand
- Part of
- S. L. Prescott, K. Allen, K. Armstrong, C. Collins, H. Dickinson, K. Gardiner, F. Jacka, C. Jasoni, T. Moore, K. M. Moritz, B. Muhlhausler, W. Siero, K. Sim, R. Nanan, R. Saffery, G. Singh, M. H Vickers, J. M. Craig
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- Journal:
- Journal of Developmental Origins of Health and Disease / Volume 7 / Issue 5 / October 2016
- Published online by Cambridge University Press:
- 27 April 2016, pp. 433-439
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The evidence underpinning the developmental origins of health and disease (DOHaD) is overwhelming. As the emphasis shifts more towards interventions and the translational strategies for disease prevention, it is important to capitalize on collaboration and knowledge sharing to maximize opportunities for discovery and replication. DOHaD meetings are facilitating this interaction. However, strategies to perpetuate focussed discussions and collaborations around and between conferences are more likely to facilitate the development of DOHaD research. For this reason, the DOHaD Society of Australia and New Zealand (DOHaD ANZ) has initiated themed Working Groups, which convened at the 2014–2015 conferences. This report introduces the DOHaD ANZ Working Groups and summarizes their plans and activities. One of the first Working Groups to form was the ActEarly birth cohort group, which is moving towards more translational goals. Reflecting growing emphasis on the impact of early life biodiversity – even before birth – we also have a Working Group titled Infection, inflammation and the microbiome. We have several Working Groups exploring other major non-cancerous disease outcomes over the lifespan, including Brain, behaviour and development and Obesity, cardiovascular and metabolic health. The Epigenetics and Animal Models Working Groups cut across all these areas and seeks to ensure interaction between researchers. Finally, we have a group focussed on ‘Translation, policy and communication’ which focusses on how we can best take the evidence we produce into the community to effect change. By coordinating and perpetuating DOHaD discussions in this way we aim to enhance DOHaD research in our region.
Chapter 32 - Disorders of calcium metabolism
- from Section 9 - Endocrinology
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 366-372
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Summary
Calcium is an abundant mineral and has diffuse cellular functions in bone metabolism, cell division, coagulation, enzyme regulation, glycogen metabolism, muscle contraction, neurotransmission, protein synthesis, and degradation. Calcium is ingested in the diet and absorbed in the small intestine. It is distributed throughout the body, but 99% appears in the bone [1–3]. Adult humans contain more than 1 kg of calcium, of which over 99% is skeletal and dental and only 0.1% is in extracellular fluids. About half the calcium in serum is bound to protein, primarily of which is albumin. Decreases in serum albumin are accompanied by decreases in calcium (a drop of 1 g/dL of albumin lowers the calcium by about 0.8 mg/dL). Several calcium determinations and measurement of ionized (physiologically active) calcium levels may be needed to accurately assess calcium status..
Calcium is maintained in a very narrow range by a redundant system of parathyroid hormone (PTH), vitamin D, and calcitonin; all acting at multiple target organs, including bone, kidneys, and the gastrointestinal tract. As ionized (free, metabolically active) calcium levels decrease, the parathyroid glands secrete PTH, which raises calcium levels by stimulating bone resorption, renal calcium reabsorption, phosphate excretion, and renal 1,25-dihydroxycholecalciferol (1,25-[OH]2D3) synthesis. Vitamin D, in turn, promotes bone resorption, increases intestinal absorption of dietary calcium and phosphate, and inhibits PTH secretion [1,4–14]. Finally, calcitonin, released by parafollicular cells of the thyroid in response to hypercalcemia, has been shown to transiently inhibit bone resorption [5].
Chapter 30 - Disorders of the thyroid
- from Section 9 - Endocrinology
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 350-357
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Summary
Because thyroid hormones exert regulatory effects on multiple organ systems, thyroid function should be aggressively evaluated and abnormal function treated in patients who require surgery. Thyroid hormones also significantly affect the metabolism of many drugs, and dose adjustments may be required when function is abnormal. Medical consultants performing preoperative evaluations should include clinical assessments of thyroid function and perform confirmatory tests when indicated.
The adult thyroid gland weighs 15–20 g, typically consists of two lobes connected by an isthmus, and is located just below the cricoid cartilage. A remnant of the thyroglossal duct, the pyramidal lobe may be noted arising superiorly from the isthmus or medial side of a lobe. Enlargement of the pyramidal lobe indicates a diffuse thyroidal abnormality. The thyroid gland consists of follicles, which are spheres lined by a single layer of cuboidal cells and are filled with a colloid that is composed primarily of thyroglobulin. A rich capillary network surrounds the follicles, explaining why a bruit is sometimes heard over hyperactive, enlarged thyroid glands. Scattered throughout the thyroid are calcitonin-secreting perifollicular cells. Hyperplasic or malignant transformation of these cells does not result in abnormalities of thyroid function [1–3].
Chapter 29 - Diabetes mellitus
- from Section 9 - Endocrinology
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 343-349
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Summary
Surgery has major effects on carbohydrate metabolism and thus presents special risks for patients with diabetes. Surgical mortality rates for patients with diabetes have declined but the successful perioperative care of these patients requires close cooperation between surgeons, anesthesiologists, and primary physicians to prevent complications. There are 25.8 million children and adults in the USA with diabetes – 8.3% of the population [1]. Diabetes is listed as a diagnosis on 23% of hospital discharges [2]. At least half of these patients will require surgery at some point in their lives. In addition to surgical conditions typical of the general population, patients with diabetes have an increased incidence of occlusive vascular disease; cholelithiasis; ophthalmic disease (i.e., cataract extraction, vitrectomy); renal disease; and infection. Three of four patients with diabetes are older than 40 years and are approaching a time of life when surgical indications increase. The presence of diabetes typically is known prior to surgery, although a new diagnosis of diabetes is made in the perioperative period in as many as 12% of cases [3].
Hyperglycemia in the hospital is common and may result from stress, infection, effect of procedures, or is iatrogenic [4]. Previously, glucose levels between 100 and 200 mg/dL were not treated in the perioperative period. This practice was challenged by studies suggesting that more aggressive treatment of elevated glucose levels with insulin reduces infectious complications, decreases mortality, and decreases length of hospital stay [5–7]. Many hospitals developed programs, and started treating both medical and surgical patients with intensive insulin therapy to maintain blood glucose at or below 110 mg/dL, particularly in ICU settings. But, following studies performed in other ICUs, particularly medical ones, failed to reproduce the beneficial effects of intensive insulin therapy. In fact, intensive insulin therapy increased the risk of death [8–11]. One study demonstrated a 2.6% absolute increase in 90-day mortality in patients randomized to tight glucose control [10]. This may have been related to the increased risk for hypoglycemia in the intensive insulin group [12].
Chapter 31 - Disorders of the adrenal cortex
- from Section 9 - Endocrinology
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 358-365
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Summary
During surgery there is a coordinated response to stress that includes the nervous, endocrine, and immune systems. Inappropriately low response or inappropriately excessive response to stress may lead to disease and possible premature death [1,2]. The hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system react to stress by releasing hypothalamic CRH and vasopressin (AVP). These hormones synergistically stimulate systemic ACTH secretion, which, in turn, stimulates the adrenal cortexes to secrete glucocorticoids. Central activation of the sympathetic neurons leads to activation of both the systemic sympathetic nervous system and the adrenal medullae [2,3]. The immune system through inflammatory mediators, especially cytokines, stimulates the release of corticotropin-releasing factor from hypothalamic neurons. This central activation of the HPA axis and the direct stimulation of the adrenal glands by the sympathetic system may be a regulatory mechanism for preventing an excessive immune reaction [4,5].
Adrenocorticotropic hormone (ACTH) is released in quick, pulsatile bursts followed by a slower, more sustained rise in cortisol and metabolites [6,7]. Free cortisol is the active hormone and acts directly on tissues [6]. Normal ACTH release and production of cortisol follows a circadian rhythm and is connected to light. It is the highest on awakening in the morning (peaking about 8 hours after the onset of sleep), declines over the day, and is lowest in the middle of the night [7]. The cortisol secretory pattern is usually resistant to acute change. Prolonged bed rest, continuous feeding, or 5 days of fasting, do not alter the rhythm [8]. Occasionally, abrupt time changes of the sleep–awake cycle, as during shift work rotations and jet lag, may have some effect on the 24-hour cortisol patterns [9–11]. Critical illness, chronic inflammatory conditions, chronic insomnia, coronary artery disease, and severe stress often alter the daily rhythm [12–14]. These conditions exert their effect by cytokines, interleukins, and tumor necrosis factors. Circulating interleukin-6 is a potent activator of the HPA axis. By stimulating pituitary ACTH and therefore cortisol, response to inflammation can enhance resistance to inflammatory disease, while a decreased or defective response can increase susceptibility [4,5,13].
Chapter 33 - Pheochromocytoma
- from Section 9 - Endocrinology
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 373-376
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Summary
Pheochromocytomas are not a common medical/surgical problem. They are estimated to cause only 0.1–0.5% of all cases of hypertension [1,2], and are seen in 4–7% of patients with incidentally found adrenal adenomas [2,3]. That being said, at some time in their careers medical consultants are likely to be asked to evaluate a patient with a suspected pheochromocytoma. Because catecholamines have major regulatory effects on many different body systems, it is vital that these be anticipated and properly managed in the perioperative period. Pheochromocytomas are associated with an increased risk of adverse reactions to many commonly prescribed drugs and clinicians must also be aware of this potential hazard. The removal of a pheochromocytoma has great potential for complications, both during and after surgery because of the release of catecholamines during manipulation or stimulation of the tumor.
Pathophysiology
Pheochromocytomas arise from chromaffin cells of the neural crest that migrate to form the adult adrenal medulla and sympathetic ganglia. These cells synthesize catecholamines through a series of enzymatically controlled steps, starting with the conversion of tyrosine to dihydroxyphenylalanine (dopa) by tyrosine hydroxylase. This is the rate-limiting step in catecholamine synthesis. Dopa is then converted to dopamine, which is subsequently decarboxylated to norepinephrine. The methylation of norepinephrine to epinephrine is accomplished through the action of phenylethanolamine-N-methyl transferase, an enzyme that is induced by glucocorticoids that reach the adrenal medulla in high concentrations through the corticomedullary venous sinuses from the adrenal cortex. Norepinephrine and epinephrine are the major products of most pheochromocytomas [4]. Epinephrine is produced mainly in the adrenal medulla; thus, a pheochromocytoma that produces epinephrine is nearly always located in the adrenal gland. Norepinephrine is produced and secreted in the central nervous system and the sympathetic post-ganglionic nerve endings as well as in the adrenal medulla. Dopamine is also produced and secreted by some pheochromocytomas. The metabolism of catecholamines takes place mostly in the same cells where the catecholamines are synthesized [4]. Once catecholamines reach the plasma, they have a half-life of only 1–2 minutes before they are taken up by cells or enzymatically degraded [5]. Metanephrine, normetanephrine, and vanillylmandelic acid are the major metabolites.
Galaxy and Mass Assembly (GAMA): Optimal Tiling of Dense Surveys with a Multi-Object Spectrograph
- A. Robotham, S. P. Driver, P. Norberg, I. K. Baldry, S. P. Bamford, A. M. Hopkins, J. Liske, J. Loveday, J. A. Peacock, E. Cameron, S. M. Croom, I. F. Doyle, C. S. Frenk, D. T. Hill, D. H. Jones, E. van Kampen, L. S. Kelvin, K. Kuijken, R. C. Nichol, H. R. Parkinson, C. C. Popescu, M. Prescott, R. G. Sharp, W. J. Sutherland, D. Thomas, R. J. Tuffs
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- Journal:
- Publications of the Astronomical Society of Australia / Volume 27 / Issue 1 / 2010
- Published online by Cambridge University Press:
- 02 January 2013, pp. 76-90
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A heuristic greedy algorithm is developed for efficiently tiling spatially dense redshift surveys. In its first application to the Galaxy and MassAssembly (GAMA) redshift survey we find it rapidly improves the spatial uniformity of our data, and naturally corrects for any spatial bias introduced by the 2dF multi-object spectrograph. We make conservative predictions for the final state of the GAMA redshift survey after our final allocation of time, and can be confident that even if worse than typical weather affects our observations, all of our main survey requirements will be met.
30 - Pheochromocytoma
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- By Pamela T. Prescott, University of California at Davis Division of Epidemiology, Sacramento, CA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 383-386
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Summary
Although pheochromocytomas are not a common medical/surgical problem (they are estimated to cause only 0.1% to 0.5% of all cases of hypertension, and are operated on only once or twice per year in most centers), medical consultants are likely to be asked to evaluate and prepare for surgery patients with suspected pheochromocytomas at some time during their careers. Because catecholamines have major regulatory effects on many different body systems, it is vital that these be anticipated and properly managed in the perioperative period. Pheochromocytomas are associated with an increased risk of adverse reactions to many commonly prescribed drugs and clinicians must also be aware of this potential hazard. The surgical removal of a pheochromocytoma has great potential for intra- and postoperative complications because of the release of catecholamines during manipulation or stimulation of the tumor.
Pathophysiology
Pheochromocytomas arise from chromaffin cells of the neural crest that migrate to form the adult adrenal medulla and sympathetic ganglia. These cells synthesize catecholamines through a series of enzymatically controlled steps, starting with the conversion of tyrosine to dihydroxyphenylalanine (dopa) by tyrosine hydroxylase. This is the rate-limiting step in catecholamine synthesis. Dopa is then converted to dopamine, which is subsequently decarboxylated to norepinephrine. The methylation of norepinephrine to epinephrine is accomplished through the action of phenylethanilamine-N-methyl transferase, an enzyme that is induced by glucocorticoids that reach the adrenal medulla in high concentrations through the corticomedullary venous sinuses from the adrenal cortex. Norepinephrine and epinephrine are the major products of most pheochromocytomas.
27 - Disorders of the thyroid
-
- By Pamela T. Prescott, University of California at Davis Division of Endocrinology, Sacramento, CA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 367-373
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Summary
Because thyroid hormones exert regulatory effects on multiple organ systems, thyroid function should be aggressively evaluated and abnormal function treated in patients who require surgery. Thyroid hormones also significantly affect the metabolism of many drugs, and dose adjustments may be required when function is abnormal. Medical consultants performing preoperative evaluations should include clinical assessments of thyroid function and perform confirmatory tests when indicated.
The adult thyroid gland weighs 15 to 20 g, typically consists of two lobes connected by an isthmus, and is located just below the cricoid cartilage. A remnant of the thyroglossal duct, the pyramidal lobe may be noted arising superiorly from the isthmus or medial side of a lobe. Enlargement of the pyramidal lobe indicates a diffuse thyroidal abnormality. The thyroid gland consists of follicles, which are spheres lined by a single layer of cuboidal cells and are filled with a colloid that is composed primarily of thyroglobulin. A rich capillary network surrounds the follicles, explaining why a bruit is sometimes heard over hyperactive, enlarged thyroid glands. Scattered throughout the thyroid are calcitonin-secreting perifollicular cells. Hyperplasic or malignant transformation of these cells does not result in abnormalities of thyroid function.
Inorganic iodide is actively transported from the blood into the follicular cells, immediately oxidized by perioxidase, and is rapidly incorporated into the tyrosine residues of thyroglobulin. These monoiodotyrosine and diiodotyrosine residues couple to form the iodothyronines thyroxine (T4) and triiodothyronine (T3), which are stored in the follicles.
26 - Diabetes mellitus
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- By Pamela T. Prescott, University of California at Davis Division of Endocrinology, Sacramento, CA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 361-366
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Summary
Surgery has major effects on carbohydrate metabolism and thus presents special risks for patients with diabetes. Surgical mortality rates for patients with diabetes have declined but the successful perioperative care of these patients requires close cooperation between surgeons, anesthesiologists, and primary physicians to prevent complications. More than 20 million people in the USA have diabetes and at least half of them will require surgery at some point in their lives. In addition to surgical conditions typical of the general population, patients with diabetes experience increased intervention for occlusive vascular disease; cholelithiasis; ophthalmic disease (i.e., cataract extraction, vitrectomy); renal disease; and infection. Three of four patients with diabetes are older than 40 years and are approaching a time of life when surgical indications increase. The presence of diabetes typically is known before operation, although a new diagnosis of diabetes is made in the perioperative period in as many as 20% of cases.
Pathophysiology
The endocrine pancreas, which consists of the islets of Langerhans, accounts for less than 3% of the total pancreatic mass in adults. The islets are unevenly distributed through the pancreas and contain four cell types: A (α) cells, which secrete glucagons; B (β) cells, which secrete insulin; D (δ) cells, which secrete somatostatin; and F cells, which secrete pancreatic polypeptide. Insulin, the major secretory product, is synthesized as a precursor molecule, preproinsulin, in the endoplasmic reticulum and is cleaved by microsomal enzymes to proinsulin. Proinsulin is then converted by proteolysis to insulin and an amino acid residue, c-peptide.
29 - Disorders of calcium metabolism
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- By Pamela T. Prescott, University of California at Davis Division of Endocrinology, Sacramento, CA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 379-382
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Summary
Both hypercalcemia and hypocalcemia may be associated with life-threatening cardiac arrhythmias as well as morbidity affecting other organ systems. Effective treatment is available and clinicians should be alert to abnormalities in serum calcium, which are present in more than 2% of hospitalized patients. Furthermore, both hypercalcemia and hypocalcemia suggest significant underlying pathology, and efforts to diagnose and treat these conditions should be instituted.
Adult humans contain more than 1 kg of calcium, of which over 99% is skeletal and dental and only 0.1% is in extracellular fluids. About half the calcium in serum is bound to protein, primarily albumin. Decreases in serum albumin are accompanied by decreases in calcium (a drop of 1 g/dl of albumin lowers the calcium by about 0.8 mg/dl). Several calcium determinations and measurement of ionized (physiologically active) calcium levels may be needed to accurately assess calcium status.
Serum ionized calcium levels are tightly controlled by the interplay of parathyroid hormone, calcitonin, and 1,25-dihydroxycholecalciferol (1,25-[OH]2D3). Parathyroid hormone is synthesized in the parathyroid glands and, after cleavage of precursor molecules, is released into the circulation as an 84-amino-acid polypeptide and small fragments.
The amino-terminal 1–34 amino acids compose the biologically active portion of the molecule. Highly specific immunoradiometric assays are available that measure the intact hormone, permitting accurate diagnosis. Parathyroid hormone release is primarily controlled by serum calcium levels, although modest hypomagnesemia also evokes a parathyroid hormone response, whereas severe hypomagnesemia impairs release.
28 - Disorders of the adrenal cortex
-
- By Pamela T. Prescott, University of California at Davis Division of Endocrinology, Sacramento, CA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 374-378
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Summary
Serum cortisol levels rise within 30 minutes of the induction of anesthesia and remain elevated for hours to days in the face of postoperative stress. Because of cortisol's critical role in the successful handling of stress, a careful clinical assessment of adrenal function is necessary before surgery. Either deficiency or excess of cortisol can adversely affect surgical outcome. The physiology and metabolism of the adrenal cortex are briefly reviewed in this chapter to help clarify the appropriate selection of tests to verify a clinical diagnosis of adrenal cortex disorder. The adrenal medulla is discussed in Chapter 30.
Human adult adrenal glands weigh 4 to 5 g each and reside in the retroperitoneal space supermedial to the kidneys. The cortex, of mesodermal origin, occupies the outer 90% of the gland. It consists of three concentric histologic zones, two of which have apparently identical function. The outermost zona glomerulosa produces aldosterone but, because it lacks 17 α-hydroxylase activity, is unable to synthesize cortisol or androgens. The middle zona fasciculate is the largest area of the adrenal cortex, and the small innermost zona reticularis encircles the medulla. These two zonae produce cortisol, androgens, and small amounts of estrogen but lack the 18-hydroxysteriod dehydrogenase required for aldosterone synthesis. Histologic evidence suggests that the zona fasciculata responds to acute adrenocorticotropic hormone (ACTH) stimulation, whereas the zona reticularis responds to prolonged stimulation.
Adrenal steroid synthesis is controlled by the hypothalamic–pituitary–adrenal (HPA) axis.
Risperidona en la esquizofrenia crónica: un estudio de cambio al descubierto con verificación detallada y seguimiento de dos años de pacientes en medicación depot
- L. Conlon, T. J Fahy, R. O'Toole, J. Gilligan, P. Prescott
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- Journal:
- European Psychiatry (Ed.Española) / Volume 10 / Issue 5 / June 2003
- Published online by Cambridge University Press:
- 12 May 2020, pp. 303-310
- Print publication:
- June 2003
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Existe poca información sobre la evolución a medio y a largo plazo de cambiar a los pacientes con esquizofrenia del depot tradicional a agentes antipsicóticos orales atípicos. Por una verificación clínica detallada, identificamos un grupo representativo de 102 pacientes de un servicio psiquiátrico irlandés con esquizofrenia crónica segiin DSM-IV y neurolépticos depot durante una media de 15 años. De los 69 elegibles para participar, 33 entraron en un estudio de cambio de 6 meses de risperidona, con seguimiento limitado de los pacientes que consintieron y los que no consintieron al año y a los dos años. A los 6 meses, 23 de los 33 estaban todavía con risperidona y tenían pequefias mejorías significativas en los efectos secundarios clínicos y extrapiramidales, la calidad de vida y la medicación auxiliar medi-dos con respecto a la línea de base. Al año, 19 de los 33 estaban todavía con risperidona, reduciéndo-se a 13 de los 33 a los 2 años. A los 2 años, de los 32 supervivientes que consintieron el cambio, 19 habían sufrido acontecimientos perjudiciales clínicamente y no estaban ya con risperidona, comparado con ninguno de los 33 supervivientes que no consintieron, que estaban todavía con el depot. Estos hallazgos indican que cambiar del depot a risperidona puede encontrar tasas altas de rechazo y reducción posteriores al cambio. Mientras que una mayoría de los pacientes cambiados pueden mejorar des-pués de 6 meses al menos, la verificación más el cambio pueden tener efectos clínicamente desfavora-bles en otros durante un período de seguimiento de 2 años.
Fatigue in a community sample of twins
- P. F. SULLIVAN, P. KOVALENKO, T. P. YORK, C. A. PRESCOTT, K. S. KENDLER
-
- Journal:
- Psychological Medicine / Volume 33 / Issue 2 / February 2003
- Published online by Cambridge University Press:
- 14 February 2003, pp. 263-281
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Background. Fatigue is a complex symptom associated with many physiological, psychological and pathological processes. Its correlates and typology remain inadequately understood.
Method. These data were from two large, longitudinal twin studies. Trained interviewers enquired as to the presence of a [ges ]5 day period in the previous year of fatigue or tiredness that interfered with daily activities. A range of potential correlates was assessed in a structured interview: demography; health beliefs; the presence of nine physical disorders; mood, anxiety and addictive disorders; neuroticism and extraversion; recollections of parental rearing; and nine stressful life events. Statistical analyses included logistic regression, CART, MARS, latent class analysis and univariate twin modelling.
Results. Data were available for interfering fatigue (IF) on 7740 individual twins (prevalence 9·9% in the previous year). IF was significantly associated with 42 of 52 correlates (most strongly with major depression, generalized anxiety disorder, reported major health problems and neuroticism). Multivariate analyses demonstrated that IF is a highly complex construct with different sets of correlates in its subtypes. There were two broad clusters of correlates of IF: (a) major depression, generalized anxiety disorder and neuroticism; and (b) beliefs of ill health coexisting with alcoholism and stressful life events. Twin analyses were consistent with aetiological heterogeneity – genetic effects may be particularly important in women and shared environmental effects in men.
Conclusions. IF is a complex and common human symptom that is highly heterogeneous. More precise understanding of the determinants of IF may lead to a fuller understanding of more extreme conditions like chronic fatigue syndrome.
Effect of food type and location on the attendance to an automatic milking system by daily cows and the effect of feeding during milking on their behaviour and milking characteristics
- N. B. Prescott, T. T. Mottram, A. J. F. Webster
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- Journal:
- Animal Science / Volume 67 / Issue 2 / October 1998
- Published online by Cambridge University Press:
- 02 September 2010, pp. 183-193
- Print publication:
- October 1998
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Food can be used in an automatic milking system (AMS) to encourage frequent attendance to, and modify behaviour in, an AMS. An AMS was designed such that a cow had to pass from a bedded area through the AMS to enter the feeding area. A visit resulted in milking if the interval since the last milking was greater than 4 h.
Fourteen Holstein-Friesian dairy cows were allowed to attend voluntarily an AMS for 15 h/day for three 8-day periods. In period 1 the cows were given forage in the feeding area and concentrates in the bedded area but in period 2 this was reversed. Period 3 repeated period 1. The cows were also divided into two groups of seven, only one of which was given 1 kg of concentrates when milked in each period in a cross-over design.
Visits per cow per day increased when the cows were given forage in the feeding area (6·0 v. 4·1 (s.e.d. 0·08) P < 0·05) but milkings per cow per day were only slightly different (2·6 v. 2·4 (s.e.d. = 0·02) P = 0·052). Feeding forage in the feeding area modified forage-eating behaviour by reducing the number of bouts (4·9 v. 7·6 bouts per cow per day, P < 0·05) and total forage eating time (209 v. 289 min per cow per day (s.e.d. = 33·6), P < 0·05). The cows also tended to spend less time lying (529 v. 620 min per cow per day (s.e.d. = 43·2) P = 0·051).
There was no effect of feeding/not feeding concentrates in the milking stall on visits per cow per day or milkings per cow per day. However, feeding tended to create more shuffling behaviour during the automatic teat cup attachment process (3·4 v. 6·7 shuffling bouts per milking (s.e.d. 2·07) P = 0·053) but there were no effects on the levels of kicking, successful teat cup attachment rate, vocalization, elimination, hesitations in mounting a step or poor rear leg positions. The cows tended to adjust to a more accessible stance during both the automatic attachment process (from 17% of milkings exhibiting poor leg positions at the start of attachment, to 10% at the end, P < 0·01) and over the course of the experiment (from 26% to 10%, P < 0·02). There was a trend for cows who were not fed to milk out quicker than those who were fed for all milkings per day combined (733 s v. 811 (s.e.d. 43·3) s P = 0·074) but there were no other effects on yield, milk flow rate from the udder or time taken to milk out for all milkings through the day combined or just the first milking of the day.
Feeding concentrates in the feeding area can be used as an alternative to feeding forage in the feeding area, but there is no need to feed concentrates in the milking stall. Feeding cows while they were being milked did not improve their behaviour or milking characteristics.
Relative motivations of dairy cows to attend a voluntary automatic milking system
- N. B. Prescott, T. T. Mottram, A. J. F. Webster
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- Journal:
- BSAP Occasional Publication / Volume 20 / 1997
- Published online by Cambridge University Press:
- 27 February 2018, pp. 80-83
- Print publication:
- 1997
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Voluntary automatic milking is proposed as a system whereby dairy cows can choose to be milked when they want. The aim is to develop a system that can milk and perform all the associated tasks without requiring routine human intervention. (Details of the design and operation can be found in Street et al., 1992.) The system may not be viable unless the cows visit at an appropriate frequency, high enough to generate the 0·10 to 0·15 proportional increase of milk yield from cows milked three or more times per day (e.g. Knight and Wilde, 1993) but not so high as to result in some cows over-using the system. Understanding why cows may want to visit the system is therefore important. The two most important reasons why a cow may attend are likely to be motivation to be milked and motivation to eat. Motivation to be milked may change as lactation progresses. Late lactation cows have been shown to enter a milking parlour later than high yielding cows in one experiment (Rathore, 1982) but not in another (Winter, 1993). Rathore (1982) suggested that motivation to be milked may be generated by the discomfort of a large and distended udder. Motivation to be milked may also be linked to some inherent desire of the cow to suckle and subsequently wean her calf. This may be independent of the amount of milk in her udder and decline during lactation. Therefore motivation to be milked could be generated either from the discomfort of a large and distended udder or by some psychological desire by the cow to suckle a calf generalized to a milking machine. Either way, the strength of motivation to be milked may have implications for how an automatic milking system (AMS) is designed. For example, if cows were highly motivated to be milked and attended at an appropriate frequency, there would be no requirement to provide additional incentives, such as food, to attract cows into the AMS. In addition, if cows choose to be milked more frequently than they are milked in conventional systems (generally twice per day), then this may be a method by which choices can be engineered into an animal’s environment.
Authors' reply
- D. O'Rourke, T. J. Fahy, P. Prescott
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- Journal:
- The British Journal of Psychiatry / Volume 170 / Issue 1 / January 1997
- Published online by Cambridge University Press:
- 02 January 2018, pp. 89-90
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- January 1997
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The Galway Study of Panic Disorder IV: Temporal Stability of Diagnosis by Present State Examination Test–Retest
- D. O'Rourke, T. J. Fahy, P. Prescott
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- Journal:
- The British Journal of Psychiatry / Volume 169 / Issue 1 / July 1996
- Published online by Cambridge University Press:
- 02 January 2018, pp. 98-100
- Print publication:
- July 1996
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Background
A long-term outcome study of DSM–III–R panic disorder included the Present State Examination (PSE) at baseline and follow up five to six years later.
MethodPSE test–retest and individual within-patient change scores on various PSE syndromes were assessed for consistency with either a categorical view of panic disorder as a stable clinical entity or panic disorder as one facet only of a ‘general neurotic syndrome’.
ResultsPSE profile at baseline was virtually identical with that at follow up. Few patients had ‘changed’ in PSE syndrome diagnosis after five to six years.
ConclusionThese data, although not conclusive, are supportive of the concept of DSM–III–R panic disorder as a stable clinical entity and are correspondingly difficult to reconcile with the view that panic disorder is but one facet only of a general neurotic syndrome.