Internists
33 years of experience

1751 E Gardner Way
Suite D
Wasilla, AK 99654
907-373-5950
Locations and availability (1)

Education ?

Medical School Score Rankings
Oregon Health & Science University (1977)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Associations
American Board of Internal Medicine

Affiliations ?

Dr. Hunter is affiliated with 1 hospitals.

Hospital Affilations

  • Mat Su Regional Medical Center
  • Publications & Research

    Dr. Hunter has contributed to 59 publications.
    Title Projective Clustering Using Neural Networks with Adaptive Delay and Signal Transmission Loss.
    Date September 2011
    Journal Neural Computation
    Excerpt

    We develop a new neural network architecture for projective clustering of data sets that incorporates adaptive transmission delays and signal transmission information loss. The resultant selective output signaling mechanism does not require the addition of multiple hidden layers but instead is based on the assumption that the signal transmission velocity between input processing neurons and clustering neurons is proportional to the similarity between the input pattern and the feature vector (the top-down weights) of the clustering neuron. The mathematical model governing the evolution of the signal transmission delay, the short-term memory traces, and the long-term memory traces represents a new class of large-scale delay differential equations where the evolution of the delay is described by a nonlinear differential equation involving the similarity measure already noted. We give a complete description of the computational performance of the network for a wide range of parameter values.

    Title A Survey of Intensive Care Unit Visiting Policies in the United Kingdom.
    Date November 2010
    Journal Anaesthesia
    Excerpt

    Admission to an intensive care unit is a highly stressful event for both patients and their relatives. Feelings of anxiety, pain, fear and a sense of isolation are often reported by survivors of a critical illness, whilst the majority of relatives report symptoms of anxiety or depression while their relative was in the intensive care unit. Traditionally, infection control concerns and a belief that liberal visiting by patients' relatives interferes with the provision of patient care have led many units to impose restricted visiting policies. However, recent studies suggest that an open visiting policy with unrestricted visiting hours improve visitors' satisfaction and reduces anxiety. In order to determine current visiting practice and provision for relatives within intensive care units, a questionnaire was sent to the principal nurse in all units within the United Kingdom. A total of 206 hospitals out of 271 completed the survey (76%). We found that 165 (80.1%) of responding units still impose restricted visiting policies, with wide variations in the facilities available to patients' relatives.

    Title Primum Non Nocere.
    Date June 2010
    Journal Canadian Medical Association Journal
    Title Intratumor Heterogeneity and Precision of Microarray-based Predictors of Breast Cancer Biology and Clinical Outcome.
    Date May 2010
    Journal Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    Excerpt

    Identifying sources of variation in expression microarray data and the effect of variance in gene expression measurements on complex predictive and diagnostic models is essential when translating microarray-based experimental approaches into clinical assays. The technical reproducibility of microarray platforms is well established. Here, we investigate the additional impact of intratumor heterogeneity, a largely unstudied component of variance, on the performance of several microarray-based assays in breast cancer.

    Title Watching Them Wash: Description of a Hand Hygiene Observation Program.
    Date March 2010
    Journal Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America
    Title Sepsis and the Heart.
    Date January 2010
    Journal British Journal of Anaesthesia
    Excerpt

    Septic shock, the most severe complication of sepsis, accounts for approximately 10% of all admissions to intensive care. Our understanding of its complex pathophysiology remains incomplete but clearly involves stimulation of the immune system with subsequent inflammation and microvascular dysfunction. Cardiovascular dysfunction is pronounced and characterized by elements of hypovolaemic, cytotoxic, and distributive shock. In addition, significant myocardial depression is commonly observed. This septic cardiomyopathy is characterized by biventricular impairment of intrinsic myocardial contractility, with a subsequent reduction in left ventricular (LV) ejection fraction and LV stroke work index. This review details the myocardial dysfunction observed in adult septic shock, and discusses the underlying pathophysiology. The utility of using the regulatory protein troponin for the detection of myocardial dysfunction is also considered. Finally, options for the management of sepsis-induced LV hypokinesia are discussed, including the use of levosimendan.

    Title Maternal Congenital Diaphragmatic Hernia Causing Cardiovascular Collapse During Pregnancy.
    Date June 2009
    Journal British Journal of Hospital Medicine (london, England : 2005)
    Title Abdominal Compartment Syndrome: an Under-diagnosed Contributory Factor to Morbidity and Mortality in the Critically Ill.
    Date November 2008
    Journal Postgraduate Medical Journal
    Excerpt

    As the abdomen is a closed cavity, it follows that any increase in abdominal contents will inexorably lead to a rise in the intra-abdominal pressure. Normally this is less than 7 mm Hg, but when it persistently exceeds 12 mm Hg, renal, intestinal, pulmonary, cardiovascular and central nervous system dysfunction arises. A wide range of conditions encountered in both medical and surgical intensive care units are associated with a rise in intra-abdominal pressure. When this pressure is continually above 20 mm Hg, organ system failure can occur, a condition known as abdominal compartment syndrome. Failure to recognise and treat this syndrome is associated with a high morbidity and mortality.

    Title Xenon As an Anaesthetic Gas.
    Date June 2007
    Journal British Journal of Hospital Medicine (london, England : 2005)
    Title Frequency Domain Analysis of Human Subdural Recordings.
    Date June 2007
    Journal Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
    Excerpt

    SUMMARY: It is possible to localize many aspects of cortical function and dysfunction without the use of direct electrical stimulation of cortex. This study explores the degree to which information can be obtained about functional cortical organization relative to epileptogenic regions through analysis of electrocorticographic recordings in the frequency domain. Information about the extent of seizure regions and the location of the normal sensory and motor homunculus and some higher language and memory related areas can be obtained through the analysis of task-related power spectrum changes and changes in lateral interelectrode coherence patterns calculated from interictal and ictal recordings.

    Title Mutually Suppressive Interrelations of Symmetric Epileptic Foci in Bitemporal Epilepsy and Their Inhibitory Stimulation.
    Date March 2007
    Journal Clinical Neurology and Neurosurgery
    Excerpt

    OBJECTIVES: The goal of this study is to analyze the suppressive interaction of symmetric temporal lobe epileptic foci, assess some failures of epilepsy surgery, and evaluate the possibility of terminating focal seizures with stimulation of symmetric epileptic foci. MATERIALS AND METHODS: One hundred and twenty-nine intractable epilepsy patients (age range 6-53 years) with bitemporal epileptiform abnormalities in multiple scalp EEGs were evaluated with chronically implanted depth and subdural electrodes. Interelectrode coherence and power spectra were studied using internally developed software. RESULTS: Bitemporal epileptic foci were found in 85/129 (66%) patients with reciprocal relations between these foci in 57/85 (67%) patients. Temporal lobectomy was performed for 67/85 patients. 12/67 patients became free of seizures (Engel's Class I), 32/67 improved (Classes II and III), and 23/67 did not improve. 14/23 patients demonstrated post-surgical activation of the contralateral temporal lobe epileptic focus. For 8/14 of these patients, the stereotactic cryoamygdalatomy was performed in the temporal lobe contralateral to the first surgery. 5/8 patients became free of seizures. It was found that stimulation of temporal lobe deep epileptic focus may terminate focal seizures in the contralateral symmetric structures. CONCLUSION: A mutually suppressive relationship is one of variants of the interaction of symmetric epileptic foci. Some epilepsy surgery failures may be a result of post-surgical activation of the intact focus. The increase of coherence between both temporal lobes before the seizure onset of the seizure suggests the establishment of functional interrelations between two epileptic foci at an early, "hidden" phase of seizures, and may predict the direction of seizure spread. Mutually suppressive interrelations of symmetric epileptic foci might be employed for chronic therapeutic stimulation.

    Title Ventilator Associated Pneumonia.
    Date November 2006
    Journal Postgraduate Medical Journal
    Excerpt

    Hospital acquired or nosocomial infections continue to be an important cause of morbidity and mortality. The critically ill patient is at particular risk of developing intensive care unit acquired infection, with the lungs being especially vulnerable. Nosocomial bacterial pneumonia occurring after two days of mechanical ventilation is referred to as ventilator associated pneumonia, and is the most common nosocomial infection seen in the intensive care unit. Intubation of the trachea and mechanical ventilation is associated with a 7-fold to 21-fold increase in the incidence of pneumonia and up to 28% of patients receiving mechanical ventilation will develop this complication. Its development is associated with an attributable increase in morbidity and mortality. The establishment of an accurate diagnosis of ventilator associated pneumonia remains problematic and as yet there is still no accepted "gold standard" for diagnosis. The responsible pathogens vary according to case mix, local resistance patterns, and methodology of sampling. However, there is general agreement that rapid initiation of appropriate antimicrobial therapy improves outcome.

    Title Locating Chronically Implanted Subdural Electrodes Using Surface Reconstruction.
    Date September 2005
    Journal Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
    Excerpt

    OBJECTIVE: To determine the accuracy of locating subdural electrodes by means of 3-D surface rendering of CT scans. METHODS: Open source software has been developed and posted on the web which segments the electrodes into 3-D surfaces and allows their 3-D locations to be exported to other EEG analysis programs. The accuracy of the technique was determined by studying 410 subdural electrodes implanted in four epilepsy patients. Accuracy was determined by comparing the locations from the rendering analysis to the locations of the same electrodes determined by conventional analysis of their appearance on individual CT slices. RESULTS: The average accuracy of a study of 410 electrodes imaged in four patients repeated two times by three observers was 0.91 (+/- 0.41) mm, with a maximum error of 3.3 mm, about half of the diameter of an electrode. CONCLUSIONS: The location of subdural electrodes can easily and quickly be determined within high-resolution CT scans through the use of 3-D rendering. SIGNIFICANCE: This relatively fast and easy method for determining the location of subdural electrodes should facilitate their use in both clinical and research investigations.

    Title Intra-abdominal Hypertension and the Abdominal Compartment Syndrome.
    Date September 2004
    Journal Anaesthesia
    Excerpt

    The pressure within the abdominal cavity is normally little more than atmospheric pressure. However, even small increases in intra-abdominal pressure can have adverse effects on renal function, cardiac output, hepatic blood flow, respiratory mechanics, splanchnic perfusion and intracranial pressure. Although intra-abdominal pressure can be measured directly, this is invasive and bedside measurement of intra-abdominal pressure is usually achieved via the urinary bladder. This cheap, easy approach has been shown to produce results that correlate closely with directly measured abdominal pressures. Significant increases in intra-abdominal pressure are seen in a wide variety of conditions commonly encountered in the intensive care unit, such as ruptured aortic aneurysm, abdominal trauma and acute pancreatitis. Abdominal compartment syndrome describes the combination of increased intra-abdominal pressure and end-organ dysfunction. This syndrome has a high mortality, most deaths resulting from sepsis and multi-organ failure. Detection of abdominal compartment syndrome requires close surveillance of intra-abdominal pressure in patients thought to be at risk of developing intra-abdominal hypertension. The only available treatment for established abdominal compartment syndrome is decompressive laparotomy. Prevention of abdominal compartment syndrome after laparotomy by adoption of an open abdomen approach may be preferable in the patient at significant risk of developing intra-abdominal hypertension, but this has not been demonstrated in any large trials. Most surgeons prefer to adopt a 'wait and see' policy, only intervening when clinical deterioration is associated with a significant increase in intra-abdominal pressure.

    Title Amplitude and Frequency Dependence of Spike Timing: Implications for Dynamic Regulation.
    Date September 2003
    Journal Journal of Neurophysiology
    Excerpt

    The spike-time reliability of motoneurons in the Aplysia buccal motor ganglion was studied as a function of the frequency content and the relative amplitude of the fluctuations in the neuronal input, calculated as the coefficient of variation (CV). Measurements of spike-time reliability to sinusoidal and aperiodic inputs, as well as simulations of a noisy leaky integrate-and-fire neuron stimulated by spike trains drawn from a periodically modulated process, demonstrate that there are three qualitatively different CV-dependent mechanisms that determine reliability: noise-dominated (CV < 0.05 for Aplysia motoneurons) where spike timing is unreliable regardless of frequency content; resonance-dominated (CV approximately 0.05-0.25) where reliability is reduced by removal of input frequencies equal to motoneuron firing rate; and amplitude-dominated (CV >0.35) where reliability depends on input frequencies greater than motoneuron firing rate. In the resonance-dominated regime, changes in the activity of the presynaptic inhibitory interneuron B4/5 alter motoneuron spike-time reliability. The increases or decreases in reliability occur coincident with small changes in motoneuron spiking rate due to changes in interneuron activity. Injection of a hyperpolarizing current into the motoneuron reproduces the interneuron-induced changes in reliability. The rate-dependent changes in reliability can be understood from the phase-locking properties of regularly spiking motoneurons to periodic inputs. Our observations demonstrate that the ability of a neuron to support a spike-time code can be actively controlled by varying the properties of the neuron and its input.

    Title Synaptic Heterogeneity and Stimulus-induced Modulation of Depression in Central Synapses.
    Date August 2001
    Journal The Journal of Neuroscience : the Official Journal of the Society for Neuroscience
    Excerpt

    Short-term plasticity is a pervasive feature of synapses. Synapses exhibit many forms of plasticity operating over a range of time scales. We develop an optimization method that allows rapid characterization of synapses with multiple time scales of facilitation and depression. Investigation of paired neurons that are postsynaptic to the same identified interneuron in the buccal ganglion of Aplysia reveals that the responses of the two neurons differ in the magnitude of synaptic depression. Also, for single neurons, prolonged stimulation of the presynaptic neuron causes stimulus-induced increases in the early phase of synaptic depression. These observations can be described by a model that incorporates two availability factors, e.g., depletable vesicle pools or desensitizing receptor populations, with different time courses of recovery, and a single facilitation component. This model accurately predicts the responses to novel stimuli. The source of synaptic heterogeneity is identified with variations in the relative sizes of the two availability factors, and the stimulus-induced decrement in the early synaptic response is explained by a slowing of the recovery rate of one of the availability factors. The synaptic heterogeneity and stimulus-induced modifications in synaptic depression observed here emphasize that synaptic efficacy depends on both the individual properties of synapses and their past history.

    Title Air Injection During Fna-ultrasound and Mammographic Appearances.
    Date July 2000
    Journal Clinical Radiology
    Title Spontaneous Fluctuations in Pupil Size Are Not Triggered by Lens Accommodation.
    Date June 2000
    Journal Vision Research
    Excerpt

    Fluctuations in pupil size and lens accommodation are measured concurrently under open loop conditions, constant illumination and far fixation. In 12/17 trials no correlation was measured between the fluctuations in pupil size and lens accommodation. For the remaining 5/17 trials no lag was observed between the changes in pupil size and lens accommodation indicating that this correlation does not arise as a consequence of a near response. These observations suggest that under conditions of constant illumination and far fixation, the supranuclear centers controlling the near response are not active.

    Title Effects of Anaesthesia on the Human Immune System.
    Date January 2000
    Journal Hospital Medicine (london, England : 1998)
    Excerpt

    The ability of certain anaesthetic agents to influence the immune response has been recognized for almost 30 years. The purpose of this review is to briefly describe the different components of the immune system and examine the way in which surgery and anaesthesia influence these.

    Title Resonance Effect for Neural Spike Time Reliability.
    Date December 1998
    Journal Journal of Neurophysiology
    Excerpt

    The spike timing reliability of Aplysia motoneurons stimulated by repeated presentation of periodic or aperiodic input currents is investigated. Two properties of the input are varied, the frequency content and the relative amplitude of the fluctuations to the mean (expressed as the coefficient of variation: CV). It is shown that, for small relative amplitude fluctuations (CV approximately 0.05-0.15), the reliability of spike timing is enhanced if the input contains a resonant frequency equal to the firing rate of the neuron in response to the DC component of the input. This resonance-related enhancement in reliability decreases as the relative amplitude of the fluctuations increases (CV-->1). Similar results were obtained for a leaky integrate-and-fire neuronal model, suggesting that these effects are a general property of encoders that combine a threshold with a leaky integrator. These observations suggest that, when the magnitude of input fluctuations is small, changes in the power spectrum of the current fluctuations or in the spike discharge rate can have a pronounced effect on the ability of the neuron to encode a time-varying input with reliably timed spikes.

    Title Minor Morbidity After Day-case Surgery.
    Date November 1998
    Journal Scottish Medical Journal
    Excerpt

    The number of patients and procedures considered suitable for day-case anaesthesia and surgery continues to grow and it is hoped that 50-60% of all operations in the UK will eventually be performed on a day-patient basis. However, minor but troublesome post-operative side effects remain common. We have examined the incidence of the most common causes of minor morbidity, namely headache, nausea/vomiting and pain occurring after a wide variety of day-case surgical and diagnostic procedures. Patient satisfaction with treatment and the impact of day case surgery on the workload of the general practitioner was also assessed. The anaesthetic records of the patients involved were reviewed in an attempt to determine if there was any association between the anaesthetic technique and an adverse outcome. A simple postal questionnaire completed on the morning after surgery was returned by 553 patients (response rate over 87%). More than 50% of respondents complained of some morbidity, with 40% complaining of pain, 19% of headache and 9% of nausea and vomiting. One third self-medicated to modify their symptoms, and in most cases (81%) this was effective. However, 6% of patients called their GP for advice and 2% received a home visit. No patient required readmission. A total of 92 patients (17%) would have preferred treatment as an in-patient. Analysis of the anaesthetic drugs and techniques suggested that the commonly used anti-emetics droperidol and metoclopramide had little effect on the incidence of postoperative nausea and vomiting. Intubation was associated with a significantly higher incidence of minor morbidity although this may be related to surgical factors.

    Title Anaesthetic Management of the Morbidly Obese Patient.
    Date November 1998
    Journal Hospital Medicine (london, England : 1998)
    Excerpt

    Morbidly obese patients are prone to many clinical conditions that can effect anaesthesia. Of major concern to the anaesthetist are difficulties with airway management and abnormalities of cardiorespiratory function. Safe anaesthesia requires an appreciation of potential problems and a thorough understanding of the pathophysiological changes that accompany morbid obesity.

    Title Cortical Activation States in Sleep and Anesthesia. I: Cardio-respiratory Effects.
    Date October 1998
    Journal Respiration Physiology
    Excerpt

    Under light urethane anesthesia, animals cycle through patterns of EEG activity which superficially appear like waking, light sleep and slow-wave sleep patterns (States I, II and III, respectively) in unanesthetized animals. The present study questioned whether similar cortical activity patterns in anesthetized and unanesthetized golden mantled ground squirrels represented analogous states in terms of cardiorespiratory function. Sleep exerted a strong negative influence on breathing frequency and ventilation, but had less consistent effects on tidal volume. Urethane-anesthetized animals demonstrated exactly the same alterations in respiratory variables when switching between states with similar cortical activity. Cardiovascular function was also affected by arousal state; heart rate decreased and variation increased significantly as animals moved from wake into sleep. Although urethane anesthesia greatly increased heart rate and abolished respiratory sinus arrhythmia, state-dependent changes in heart rate were still evident. Overall, the states observed under urethane anesthesia mimicked sleep/wake in terms of their effect on cardio-respiratory function.

    Title Cortical Activation States in Sleep and Anesthesia. Ii: Respiratory Reflexes.
    Date October 1998
    Journal Respiration Physiology
    Excerpt

    Under urethane anesthesia, animals exhibit patterns of cortical activity similar to those seen in wake, drowsiness and slow-wave sleep in unanesthetized animals. In the present study, hypoxic and hypercapnic ventilatory reflexes were examined in unanesthetized and urethane-anesthetized golden mantled ground squirrels in states with similar EEG profiles. Synchronized EEG patterns occurred less frequently in both unanesthetized and anesthetized animals during hypoxic (10% O2) and hypercapnic (5% CO2) exposure. Breathing frequency fell significantly during sleep in animals breathing all gas mixtures, while the relative ventilatory sensitivity to hypoxia and hypercapnia increased during sleep. Urethane-anesthetized animals also showed significant falls in breathing frequency and ventilation and increases in relative ventilatory sensitivity to hypoxia and hypercapnia as they moved into states with synchronized EEG patterns. These data suggest that the brain activity states observed under urethane anesthesia mimic sleep/wake in terms of their effect on respiratory function and that changes in breathing pattern and the enhancement of ventilatory responses in states with a synchronized EEG is not due solely to changes in levels of behavioural stimuli.

    Title The Otago Medical School Revisited.
    Date September 1998
    Journal The New Zealand Medical Journal
    Title The Ultrasound Diagnosis of Posterior Shoulder Dislocation Associated with Erb's Palsy.
    Date September 1998
    Journal Pediatric Radiology
    Excerpt

    A case is presented of an infant with Erb's palsy whose posterior dislocation of the humeral head was identified using high-resolution ultrasound following non-diagnostic plain radiographs. Posterior dislocation is associated with Erb's palsy but the diagnosis can be delayed. We suggest the early use of ultrasound in patients with Erb's palsy, as this technique is a safe, quick and reliable method of excluding posterior dislocation.

    Title Conservative Management of Gastric Rupture Following Scuba Diving.
    Date July 1998
    Journal Journal of Accident & Emergency Medicine
    Excerpt

    Gastric rupture is an uncommon surgical problem which normally presents with an acute abdomen and peritonism. An unusual case following underwater ascent and its conservative management is presented.

    Title Fibular Fracture: Detection with High Resolution Diagnostic Ultrasound.
    Date July 1998
    Journal Journal of Accident & Emergency Medicine
    Title Case of the Month. Double and Nothing.
    Date April 1998
    Journal The British Journal of Radiology
    Title A Survey of Homeobox Genes in Chaetopterus Variopedatus and Analysis of Polychaete Homeodomains.
    Date July 1997
    Journal Molecular Phylogenetics and Evolution
    Excerpt

    A survey of genomic DNA from the polychaete Chaetopterus variopedatus was conducted using the polymerase chain reaction. Twelve unique homeobox-containing gene fragments were recovered. Phylogenetic analysis indicates that seven of the fragments are from genes belonging to Hox homeobox classes. Other fragments show orthology with Xlox, caudal, and Prh homeobox classes, with two fragments not definitely assignable to a homeobox class by our analysis. Orthology with gene sequences reported for the polychaete Ctenodrilus serratus, by Dick and Buss (1994), was calculated and indicated that at least eight of the C. variopedatus fragments are homologous to these previously reported sequences. Tabulation of the Hox gene relationships suggest that polychaetes have representative genes of each of the Hox cognate groups except Abd-B. This conclusion further suggests that the Hox cluster in the basal protostome ancestor had already undergone the gene duplications leading to the complete complement of homeotic genes known in Drosophila, with the possible loss of Abd-B in the polychaete lineage.

    Title Magnetic Resonance Imaging in Macromelia and Macrodactyly.
    Date September 1996
    Journal The British Journal of Radiology
    Excerpt

    We report five cases presenting with soft tissue and bone overgrowth that demonstrate the ability of MRI to establish a diagnosis in the absence of specific clinical features. Disorders included macrodystrophia lipomatosa, angiolipomatosis, Klippel-Trenaunay-Weber syndrome, blue rubber bleb naevus syndrome and one case of segmental limited hypertrophy. The MRI appearances, and other radiological features of these conditions are discussed. MRI is recommended in all cases of macrodystrophy when the clinical features and plain film findings are indeterminate.

    Title Thyroid Function in the Critically Ill.
    Date August 1996
    Journal Anaesthesia
    Title The Radiological Appearances of Small Cell (oat Cell) Carcinoma of the Oesophagus.
    Date March 1996
    Journal Clinical Oncology (royal College of Radiologists (great Britain))
    Excerpt

    We present three patients with primary small cell (oat cell) carcinoma of the oesophagus from a clinical and radiological point of view and review the radiological appearances of previously reported cases. The features of this rate neoplasm are variable, but extensive circumferential oesophageal wall thickening associated with luminal widening should raise the possibility of this diagnosis.

    Title Hepatic Venous Doppler Waveforms: Changes in Pregnancy.
    Date January 1996
    Journal Journal of Clinical Ultrasound : Jcu
    Excerpt

    A total of 75 fasted healthy normal volunteers were examined during various stages of pregnancy. Examinations were performed in a supine position using an Acuson 128 ultrasound scanner with a 3.5 MHz transducer. Doppler interrogation of the middle hepatic vein was made during quiet respiration by one of three examiners. The Doppler waveforms were subsequently assessed blindly by one of the authors and categorized as normal, damped, or flat. Between 12 and 20 weeks, the majority of patients had normal hepatic pulsatility (64%) with 20% damped and 16% flat. Between 20 and 30 weeks there was a significant change (p > 0.001) with 68% being flat, 20% damped, and only 12% normal. In the last 10 weeks of pregnancy the changes were more marked: 80% were flat, 12% dampened, and 8% normal. There was a profound change in hepatic venous pulsatility during pregnancy. Hepatic waveforms changed from their normal pulsatile nature to become completely flat with increasing gestation. These changes were more frequent and more marked the further gestation progressed.

    Title Spinal Cord Injury in Youth.
    Date May 1995
    Journal Clinical Pediatrics
    Excerpt

    To identify special characteristics of the pediatric spinal cord-injured (SCI) population, we analyzed a database of 1,770 traumatic SCI patients; 88 (5%) fell into the two pediatric subgroups: 0-12 years (n = 26) and 13-15 years (n = 62) at time of injury. Differences between age groups were identified with regard to demographics, neurologic characteristics, associated injuries and complications, and management. Mode level of bony injury was C2 in preteens, C4 in teens, and C4-C5 in adults. Scoliosis developed far more frequently in children, particularly preteens (23%), than in adults (5%). Violent etiologies, predominantly gunshots, accounted for a disproportionate share of injuries to preteens (19%) and African-Americans (28%), as compared with adults (12%) and Caucasians (7%). This last finding underscores the urgent need to mount a response to the nationwide proliferation of gunshot-related SCI in children and minorities.

    Title The Diagnosis of Fatal Gas Embolism: Detection by Plain Film Radiography.
    Date December 1994
    Journal Clinical Radiology
    Excerpt

    Two recent deaths from massive air embolism occurring while scuba diving off the South coast of Britain are reported. In each case the circumstances of death were uncertain. In both instances the cause of death, that is massive gas embolism, was determined by plain radiography and findings were confirmed at post-mortem. These cases illustrate that in unexplained deaths that occur after exposure to, or change in hyper- or hypobaric conditions, investigation should include pain radiographs of the chest, abdomen and skull.

    Title What Americans Really Think About Abortion.
    Date March 1993
    Journal First Things (new York, N.y.)
    Title Circadian Variation in Alloxan Sensitivity of Mice As Indicated by Mortality and Blood Glucose Alteration.
    Date June 1992
    Journal Chronobiology International
    Excerpt

    The objective of this study was to determine in mice if a time-dependent pancreatic beta-cell susceptibility to alloxan could be correlated to daily changes in blood glucose levels and to monitor the pattern of blood glucose at various times of day as mice became diabetic. Food was removed from mice standardized to a 12-h light:dark cycle (lights on at 0600 h CST, during the month of June) at 12 h before subcutaneous injection with 0.27 mg/g of alloxan. Six groups of 30 fasted mice were injected at 4-h intervals. Blood glucose levels were measured from each group immediately prior to injection, and at 2, 4, 8, 12, 24, 48, and 216 h after treatment. Animals receiving alloxan during the early- to middark period had an increase in blood glucose after 2 h, followed by a decline to hypoglycemic levels between 4 and 8 h, and recovery to hyperglycemic levels 48 h after alloxan exposure. Three and 30% of these animals were dead at 8 and 48 h, respectively. Mice treated during the midlight span had decreased blood glucose levels 2 h after alloxan treatment followed by an increase to diabetic hyperglycemia within 48 h. Twenty-three and 70% of the animals treated at 1430 h were dead at 8 and 48 h, respectively. At 216 h, total mortality was 45.6% and 81 of the 98 surviving mice were hyperglycemic. These data suggest a greater sensitivity to alloxan during the midlight resting period of the mice. This may be the result of increased sensitivity to the insulin released from the beta cells when alloxan was given during the light span.

    Title Chronobiology of Exercise: the Influence of Scheduling Upon Glycemic Responses of Control and of Subjects with Diabetes Mellitus.
    Date November 1990
    Journal Progress in Clinical and Biological Research
    Excerpt

    Exercise programs contribute significantly to: a) improve cardiovascular fitness; b) lower blood pressure in hypertension; and c) facilitate glycemic control in subjects with Diabetes Mellitus (DM). The mechanisms involved in promoting the above responses remain undetermined. Circadian phases at which exercise is applied could play a major role in optimizing the individual's physiological responses to exercise. In a pilot study, controls and a subject with Insulin Dependent Diabetes Mellitus (IDDM) were exercised at 0800 and 2000 hours: pedaling on an exercycle for 30 minutes at rates that maintained tachycardia at 70% of maximum reserve heart rates (Karvomen et al., 1957). All subjects were on "standard" rest-activity schedules (rest 2300-2400 to 0600-0700) and were allowed a single 360 ml Sustacal meal either at 2400 hours or at 1200 hours; i.e., 8 hours preceding the exercise program. Blood samples were obtained for determinations of glucose (finger tip) just before exercise (0 time) and at 10, 20, 30, 40 and 60 minutes of exercise/post exercise periods. The results suggest that non-diabetics experience a rapid decrease in blood glucose levels which does not recover during the 60 minute sampling time when exercise was in the morning. However, when these individuals exercised during the evening, glucose levels did not fall as much on a percentage basis and full recovery was obtained within 40-60 minutes. In the case of the diabetic patient, after morning exercise, glucose levels did not decline and after 40 minutes had risen above resting glucose levels.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Circadian Stage Dependent 125i-insulin Binding in the Liver and Epididymal Fat of the Mouse.
    Date November 1990
    Journal Progress in Clinical and Biological Research
    Title Hereditary Angioedema As a Cause for the Non-surgical Acute Abdomen.
    Date December 1984
    Journal North Carolina Medical Journal
    Title Comparative Cervical Microflora Shifts After Cefoxitin or Cefazolin Prophylaxis Against Infection Following Cesarean Section.
    Date August 1984
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    The aerobic and anaerobic cervical microflora was determined before operation and on day 4 after operation in groups of women undergoing a clinical trial of prophylaxis with three doses of cefoxitin, cefazolin, or placebo for infectious complications of nonelective cesarean section. Floral shifts occurred post partum, with return of Escherichia coli and Bacteroides fragilis and a decrease in Candida colonization. No significant differences in flora existed preoperatively among patients receiving cefoxitin, cefazolin, or placebo, but by day 4, both antibiotic groups had greater enterococcal colonization. This difference was more marked with cefoxitin than with cefazolin. No difference in E. coli or B. fragilis colonization was noted by day 4 in placebo and antibiotic groups. Resistance developing in isolates in the antibiotic groups was mainly a result of enterococcal colonization. Results of this study indicate that a three-dose cephalosporin prophylactic regimen resulted in a significant selection of resistant enterococcal colonization but there was no increase in nosocomial infection in the antibiotic groups compared to the placebo group. There did not appear to be significant differences in either species selection or antibiotic resistance of aerobic or anerobic microflora between the cefoxitin and cefazolin groups.

    Title Universities and Continuing Medical Education.
    Date March 1984
    Journal The Medical Journal of Australia
    Title Multicenter Comparison of Cefoxitin Versus Cefazolin for Prevention of Infectious Morbidity After Nonelective Cesarean Section.
    Date February 1983
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    A randomized double-blind placebo-controlled comparison of prophylactic cefoxitin, an antibiotic with good activity against anaerobic bacteria, with cefazolin, an agent effective predominantly against aerobes, was undertaken in 354 women who underwent nonelective cesarean section (124 receiving cefoxitin, 119 cefazolin, and 111 placebo). Among the placebo group, 24.3% developed genital tract-related infection, in comparison to 5.6% of the cefoxitin patients and 6.7% of the cefazolin patients (P less than 0.001). Standard febrile morbidity, fever index, and duration of postoperative hospital stay were also significantly less in the antibiotic prophylactic groups. For patients with febrile morbidity, the mean fever index was less in the cefoxitin group (24.8 degree-hours) than that in the cefazolin group (42.7 degree-hours), and this difference approached statistical significance (P less than 0.1, greater than 0.05). Postoperative hospital stay longer than 1 week for infectious morbidity occurred in 26% of cefoxitin patients, a significantly lower incidence compared to the 66% rate for patients who received cefazolin, and the 57% incidence for patients in the placebo group (P less than 0.05).

    Title Autoimmune Neutropenia in Hodgkin's Disease.
    Date April 1982
    Journal Archives of Internal Medicine
    Excerpt

    A patient was profoundly neutropenic at the time of diagnosis of stage IIIB Hodgkin's disease. The neutropenia was not due to infection or bone marrow involvement by tumor. It did not respond to discontinuation of medication or to splenectomy, done for pathologic staging of Hodgkin's disease. The patient's serum contained abnormally increased granulocyte-binding antibody, which reacted with his own cells. The neutropenia resolved with high-dose prednisone therapy, and has not recurred after chemotherapy. Thus, immune neutropenia--as well as autoimmune hemolytic anemia and immune thrombocytopenic purpura--can be associated with Hodgkin's disease. Recognition and treatment of such immune processes assume major importance in planning cytotoxic therapy for the underlying malignancy.

    Title Continued Learning for the Professional.
    Date January 1982
    Journal The New Zealand Medical Journal
    Title Histiocytosis X: Late Manifestations in a Long-term Survivor of Letterer-siwe Disease.
    Date January 1977
    Journal The Journal of Pediatrics
    Title Single-strand Nuclease Action on Heat-denatured Spermiogenic Chromatin.
    Date October 1976
    Journal The Journal of Histochemistry and Cytochemistry : Official Journal of the Histochemistry Society
    Excerpt

    The aim of this study was to compare the sensitivity of chromatin from representative cellular stages of spermiogenesis to a single-strandeded nuclease after heat denaturation. Thermal denaturation of chromatin was assayed in situ in fixed round, elongating and elongated spermatids and in testicular sperm from mice. Production of single-stranded deoxyribonucleic acid (DNA) at elevated temperatures was monitored by digesting chromatin with endonuclease specific for single-stranded DNA (S1 nuclease), staining the residual DNA with gallocyanin-chrome alum (GAC) and measuring the stain content by absorption cytophotometry. Changes in GCA staining were minimal over the temperature range of 22-90 degrees C in each cell type not exposed to nuclease. Staining of undigested cells decreased progressively with advancing cell maturity. Nuclease had no effect on the GCA content of round spermatids below 60 degrees C, but above this temperature there was a progressive decrease in GCA-stainable chromatin. Both round and elongating spermatid stages showed a significantly greater sensitivity to nuclease digestion than did more mature stages; sperm showed no effects of nuclease action below 80 degrees C. Progressive chromatin condensation and a concomitant decrease in the number of available DNA phosphate groups during spermiogenic cell maturation may be responsible for the observed decline in sensitivity to nuclease and decreased GCA staining. Thermal denaturation of round spermatids labeled with 3H-thymidine produced no change in autoradiographic mean nuclear grain counts, indicating no loss of thymidine-labeled DNA from the slides during denaturation. When round spermatids and sperm were hydrolyzed with hot tricholoroacetic acid before staining, both nuclear GCA content and autoradiograph grain count were partially reduced, indicating incomplete DNA removal. Almost complete loss of Feulgen-stainable material occurred in these cells and may be due to depurination and elimination of Feulgren-reactant aldehyde groups.

    Title Differences in Bile Acid Excretion in Subjects with Hypercholesterolaemia, Hypertriglyceridaemia and Overweight.
    Date June 1975
    Journal Australian and New Zealand Journal of Medicine
    Title Autoradiographic Detection of Diamine Inhibition of Mammalian Sperm Maturation.
    Date January 1974
    Journal Journal of Reproduction and Fertility
    Title Autoradiographic Studies of Gonadotrophin Action on Germ Cell Maturation Rate.
    Date October 1973
    Journal The Journal of Endocrinology
    Title An Electrocardiogram Radiotelemetry Monitoring System for Hospital Patients.
    Date October 1973
    Journal The New Zealand Medical Journal
    Title Treatment of Hypercholesterolaemia with Colestipol: a Bile Sequestrating Agent.
    Date January 1973
    Journal The New Zealand Medical Journal
    Title The Department of Medicine University of Otago Medical School, Dunedin, New Zealand.
    Date February 1972
    Journal Journal of the Royal College of Physicians of London
    Title The Mobilization of Free Fatty Acids in Relation to Adipose Tissue Triglyceride Fatty Acids in the Rat.
    Date June 1970
    Journal Journal of Lipid Research
    Excerpt

    Three diets, consisting respectively of formulations high in oleic and stearic acid, linolenic acid, and lauric acid, were fed to rats until the adipose tissue TGFA largely reflected the dietary pattern of fatty acids. The composition of the serum FFA under basal conditions and following noradrenaline-stimulated lipolysis, were examined in relation to the respective adipose tissue TGFA. It was found in both in vivo and in vitro studies that lauric acid appeared to be less easily mobilized than longer chain acids. The in vitro studies indicated that this could not be explained either by positional preference of the shorter chain acids for the alpha-position of esterification or by increased reesterification of the shorter chain acids. The possibility remains that the difference is due to some specificity of tissue lipases for certain ester linkages.

    Title Peripheral Localization of Dna Synthesis in the Seminiferous Epithelium.
    Date September 1969
    Journal Nature
    Title Results of Acute Coronary Care in a Medical Ward.
    Date July 1968
    Journal The New Zealand Medical Journal
    Title Middle-aged Men on a Twenty-week Jogging Programme. 2. Changes in Weight, Fatness, Blood Pressure and Serum Lipids.
    Date July 1968
    Journal The New Zealand Medical Journal
    Title Air Injection During Fna-ultrasound and Mammographic Appearances
    Date
    Journal Clinical Radiology

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