Biomedical subjects
Publications and source records attributed to A M Thomas.
Multiple rice body formation is an unusual complication of chronic bursitis. Clinically and macroscopically, it can resemble synovial osteochondromatosis. Radiographic and MR appearances, however, may allow an accurate pre-operative diagnosis. The imaging features of two middle-aged women with multiple subacromial/subdeltoid bursa rice bodies are described.
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We describe a patient who developed palatal tremor and presented with ear clicks that appeared to originate from activity of the levator veli palatini and not the tensor veli palatini. This was treated with botulinum toxin. We discuss the motor innervation of the palate in the context of our case, our findings in terms of classification, and how the lower cranial nerve nuclei are involved in the etiology of palatal tremor.
Four patients with haemangioendothelioma of the spine which was treated surgically are presented. Two were male and two female, mean age 30 years (range 5-60). All tumours were sited in the thoracic spine between T5 and T10; three were primary and one metastatic from a hepatic haemangioendothelioma. Each patient had a significant neurological deficit at presentation; three were paraplegic. A diagnosis of vertebral neoplastic disease was suggested on plain radiographs, and in three cases this was supported by computed tomography or magnetic resonance imaging. Two patients underwent anterior decompression and posterior instrumented stabilisation, one anterior decompression alone and one posterior decompression followed by tumour vessel embolisation and then anterior decompression. Intra-operative blood loss was a significant feature despite the use of hypotensive anaesthetic techniques and local haemostatic agents. Three of the tumours were tested for Factor VIII (a tumour for vascular tumours), and all proved positive. In these, sufficient histological material was available to grade the tumours according to the classification of Campanacci et al. [1]. All were grade II. Three patients recovered completely from paraglegia; one had residual mild spasticity which required the use of a walking aid. The mean improvement in Frankel grade was 2.5 (range 1-4). In two the tumour recurred outside the spine within 18 months; one had subsequently died. The presentation, investigation and results of surgery for haemangioendothelioma of the spine are presented. Particular attention is drawn to the neurological status at presentation, the effect of pre-operative tumour embolisation and the dramatic recovery that can be achieved in these patients following surgery.
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There is substantial evidence of the relationship between maternal depressive mood and problematic child functioning. The vast majority of studies in this area concentrate on cross-sectional designs and depressive mood at one point in time. In contrast to the existing literature, the goal of this study was to investigate the relation of change in maternal depressed mood across time and adolescent functioning, including the possible moderating effects of gender of the adolescent and the marital status of parents. Regression analyses indicated that increased depressed mood across one year predicted teacher report of higher levels of externalizing and internalizing problems and lower levels of social competence, above that which could be predicted from the initial assessment of depressed mood. With one exception, neither gender nor parental marital status qualified the findings. The results suggest that static levels of maternal depressive mood are not sufficient for forecasting adolescent functioning. Future research needs also to consider change in such mood.
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A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) and central demyelinating disease is described in whom striking nodular filling defects on multiple lumbar-sacral nerve roots, mimicking neurofibromata, were observed at myelography and magnetic resonance imaging. We suggest that these lesions are secondary to recurrent segmental demyelination and remyelination and that the differential diagnosis of this radiological feature should include CIDP.
This study was conducted to retain the pulp-involved deciduous teeth in dental arches and were restored to function by elimination of infection in pulpectomized deciduous teeth using iodoform paste. Clinically the teeth were evaluated for pain, mobility, and presence or absence of sinus for 3 months. We concluded that the iodoform paste is a suitable root canal filling material for single-visit pulp canal treatment in chronic pulp-infected deciduous teeth.
The predictability of adolescent adjustment, based on teacher reports, in divorced and married families was examined in relationship to four variables: paternal mood, spouse-ex-spouse relationship, father-adolescent relationship, and parental visitation. Analyses indicated that the father-adolescent relationship was predictive of adolescent functioning in divorced families, and the spousal relationship and paternal mood were similarly predictive in married families.
Strategic planning identifies a department's environmental factors while establishing its purpose, mission, philosophy and goals and developing a long-range plan and objectives. This hospital's practical approach mirrors the nursing process related to assessment, diagnosis and planning, implementation and evaluation.
Patients with non-fear panic disorder (NFPD) meet DSM-III-R criteria for panic disorder, but do not report subjective fear or anxiety. Although apparently common in medical settings, this controversial group is in need of further diagnostic validation. This study assessed family history of panic disorder in patients with chest pain and normal coronary arteries (CP/NCA) and either NFPD, panic disorder with fear, or no panic. It was hypothesized that the two panic disorder groups would have similar, elevated rates of panic disorder in their first-degree relatives, compared to patients without panic. The results support the hypothesis; about 17% of the first-degree relatives of both NFPD and panic disorder patients were diagnosable with panic disorder according to proband interviews, whereas only 4.6% of the first-degree relatives of patients without panic were so diagnosable. These results support the diagnostic validity of NFPD in CP/NCA patients, because such patients had a family history of panic disorder similar to patients with a more classical panic disorder presentation. The lack of fear symptoms and behavior in NFPD may cause panic disorder to be overlooked as a potential cause of somatic symptoms in patients with no medical explanation for their condition.
OBJECTIVE: The authors evaluated the diagnostic validity of an interview-based panic disorder diagnosis in cardiology chest pain patients with angiographically normal coronary arteries. METHOD: Patient probands with normal coronary arteries (N = 65) were first contracted immediately after their normal angiogram and were given a structured diagnostic interview. On the basis of the results of the interview, probands were grouped as having panic disorder (N = 19), panic attacks that did not meet frequency criteria for panic disorder (N = 17), or no panic (N = 29). At a later time, patient probands were recontacted and given a structured family history interview that inquired about psychopathology in their first-degree biological relatives (N = 544). RESULTS: As predicted, panic disorder was significantly more prevalent among the first-degree relatives of probands with normal coronary arteries diagnosed with panic disorder or panic attacks than among the family members of probands with normal coronary arteries without panic (17.4% versus 15.7% versus 4.0%). Family members of probands with panic attacks were significantly more likely to be diagnosed with major depression than were the family members of probands with no panic; however, differences did not reach significance for family members of the panic disorder proband group. Groups did not differ significantly in familial alcoholism. CONCLUSIONS: These data support the construct validity of an interview-based panic disorder diagnosis among patients with chest pain and normal coronary arteries and suggest that these patients could benefit from treatment for panic disorder.
OBJECTIVES: Several interview studies have suggested that panic disorder (PD) exists in patients with angiographically normal coronary arteries (NCA). Interview studies require corroboration by other studies in order to validate them. The purpose of this study is to test whether response to the inhalation of 35% CO2 reliably discriminates between PD and non-panic disorder patients in this population. METHOD: Three groups were studied: six with NCA and PD, five with NCA and no PD, and ten in the control group. All subjects breathed room air, then 35% CO2 in a single-blind fashion. Each completed the Acute Panic Inventory (API) before and during the procedure. RESULTS: The NCA-panic group scored significantly higher than the other two groups on the Acute Panic Inventory from baseline to post-inhalation. CONCLUSION: Despite several methodological limitations including a relatively small number people in each cells, 35% CO2 was shown to trigger more intense responses in panic patients, thus helping to validate the interview findings.
The purposes of this study were to examine young adolescent functioning over a 2-year period after divorce and to assess the role of two family factors, interpersonal conflict and the parent-adolescent relationship, in predicting such functioning. One hundred and twelve young adolescents, their mothers, and their social studies teachers served as participants. One-half of the adolescent were from recently divorced families and one-half were from married families. Mothers completed measures concerning interparental conflict and the parent-adolescent relationship, adolescents completed a measure of the relationship, and teachers completed measures assessing four areas of adolescent functioning. The results indicated that adolescents from divorced families were functioning less well than those from married families. There were no changes in adolescent functioning and the parent-adolescent relationship from the first to second year postdivorce. High levels of interparental conflict in divorced families were associated with more parent-adolescent relationship problems. In turn parent-adolescent relationships problems served as the best predictor of concurrent and subsequent difficulty in adolescent functioning.
The kinetic behavior and pH-stability of recombinant human renin was analyzed using a new fluorogenic substrate based on the normal P6-P3' renin cleavage sequence in human angiotensinogen. The design of this fluorogenic substrate makes possible, for the first time, direct monitoring of the kinetics of proteolytic conversion of prorenin to renin. The pH-stability profile for renin, measured with the substrate at 25 degrees C, indicated a broad plateau of stability between pH 6.0 and 10.0. Analysis of the pH-activity profile of renin for the substrate indicated a minimum Km (approximately 1.8 microM) at pH approximately 7.4 and a maximum Vm between pH 7.4 and 8.0. The thermodynamics of the binding of a novel, soluble, peptidomimetic inhibitor to renin indicated it is possible to retain the tight-binding characteristics and enthalpy contributions to binding of larger peptide-derived inhibitors, while reducing inhibitor size and entropic contributions to binding. A novel derivative of the fluorogenic substrate, containing a 3-methyl histidine substitution at the P2 site, was used to test the recent hypothesis that renin functions by virtue of substrate-directed catalysis.
The effect of mechanical vibration in the frequency range 0-500 Hz on the cadaveric human femur was assessed. It was found that when the bone was fixed at both ends, its resonant frequency was markedly affected by end loading and damping. If the conditions of the experiment were designed to simulate the condition of the femur when prepared for a total hip replacement, it was found that the bone did not resonate but behaved in a mass-like mode. The significance of this observation is that in the event of vibration being applied to enhance the penetration of bone cement, the movement induced in the bone will be proportional to the force applied regardless of frequency. This also demonstrates that the concept of designing a prosthesis so that it is isoelastic with the femur is complex and potentially flawed, since the stiffness of the femur will vary during the walking cycle.
This article describes validating studies for diagnosing panic disorder in some patients with angiographically normal coronary arteries (NCA) and chest pain. Psychiatric interviews of 94 such patients showed that 34% met the diagnostic criteria for panic disorder. Further studies showed that NCA patients with panic disorder were more disabled at 3.5-year follow-up, had more relatives with panic disorder, were more likely to suffer from major depression, and were more likely to respond to 35% CO2 challenge with panic symptoms. Because panic disorder is highly disabling but responds well to psychological and pharmacologic treatments, screening NCA patients in the cardiology population for this disorder is recommended.