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Biomedical subjects

A W Nichols

Publications and source records attributed to A W Nichols.

8 recordsLinked to original sources
PubMed1992

Exercise-induced anaphylaxis and urticaria.

Physical exercise is a stimulus capable of provoking urticaria and anaphylaxis in certain individuals. The cutaneous manifestations of EIA include erythema, pruritus, and urticarial whealing. Symptoms may also progress to angioedema, laryngeal edema, bronchospasm, and hypotension. Attacks are consistently associated with increases in serum histamine levels, and atopic individuals are more commonly affected. At least two distinct diseases cause EIA, including CU and classic EIA. A variant form of EIA may also exist. CU episodes are induced by increases in body temperature occurring secondary to physical exercise or passive body warming. Classic EIA episodes are induced only by exercise. Further differences between these two disorders include the size of skin lesions and the high frequency of progression to upper airway distress and shock in classic EIA. The manifestations of EIA occur as a result of mast cell degranulation that releases histamine and other mediators into the circulation. An exaggerated cholinergic response to body warming seems to provoke mast cell degranulation in individuals with CU. In classic EIA, exercise acts as a physical stimulus, which through an unknown mechanism provokes mast cell degranulation. The treatment of acute episodes of EIA includes administration of epinephrine and antihistamines, airway maintenance, and cardiovascular support. Prophylactic treatment includes exercise avoidance, abstention from coprecipitating foods and medications, pretreatment with antihistamines and cromolyn, and the induction of tolerance through regular exercise.

Anaphylaxis↗
PubMed1988

Management of elevated serum cholesterol in a university-based family practice.

Hypercholesterolemia is a well-known risk factor of coronary heart disease. This study was designed to determine whether a group of family physicians in an academic medical center followed recent recommendations in the recognition and treatment of young patients with elevated cholesterol levels. Patient charts were reviewed retrospectively in 94.1 percent of the 1,129 patients aged between 30 and 39 years seen in the University of California at Los Angeles (UCLA) Family Health Center over a one-year period. Only 346, or 32.6 percent, of the charts reviewed contained the patient's cholesterol values. Ninety-nine patients had serum cholesterol levels greater than the recommended treatment level of 5.70 mmol/L (220 mg/dL). Of patients with elevated cholesterol levels, only 34.1 percent were treated. There was no difference in the treatment rates of faculty members' patients as compared with residents' patients. The incidence of treatment increased linearly with respect to rising cholesterol values. This study identified the relative infrequency with which cholesterol levels appear in the charts of patients aged 30 to 39 years. It also illustrated that significantly more physician effort is required to meet suggested treatment guidelines for patients with elevated cholesterol levels. The cholesterol "normal ranges" that are reported on laboratory result sheets, which are not age-specific, may be misleading, and consequently affect patient care.

Adult↗
PubMed1978

Counselor effectiveness in a methadone maintenance program.

Counselor effectiveness for 253 heroin addicts in a methadone maintenance program was studied. The results of patient urinalysis for heroin use was chosen to assess counselor effectiveness. No significant differences in heroin use were found for the following groups of patients: 1. Those with multiple ex-addict (EA) counselors. 2. Those with multiple nonaddict (NA) counselors. 3. Patients with time periods with EA counselors followed by time periods with NA counselors, or vice versa. 4. Those with a single NA counselor. 5. Those with a single EA counselor. Patients with no counselor for one-third or more of each study period were found to have a significantly greater percent of urines positive for heroin.

Adult↗
PubMed1977

Evaluation of the Arizona Medical Student Exchange Program.

In this article the authors describe and present an evaluation of the Arizona Medical Student Exchange Program of the Western Interstate Commission for Higher Education. The program is designed to help defray the cost that an Arizona student faces in attending an out-of-state medical school by paying, in the student's behalf, the difference between the resident and nonresident tuition at the out-of-state school. Furthermore, the accepting medical school is paid an additional sum as an inducement to accepts more Arizona students in the future. The program's goal is to increase the number of graduating physicians who will return to practice in Arizona, especially in areas of medical need. While the program apparently has been successful in increasing the number of Arizona students studying medicine and the number of physicians returning to the state--both to metropolitan areas and to areas of medical need--these increases have not kept pace with Arizona's growing population.

Arizona↗
PubMedDate not supplied

Frequency, associated factors, and treatment of breaststroker's knee in competitive swimmers.

Thirty-six competitive breaststroke swimmers were interviewed and examined for knee pain specifically related to the breaststroke kick. Eighty-six percent of the subjects had a history of at least one episode of breaststroke knee pain, while 47.2% had breaststroke knee pain that occurred at least once a week. There was a significant relationship between more frequent knee pain and increasing swimmer's age, increasing years of competitive swimming, increasing breaststroke training distance, and decreasing warm-up distance. The subjects with frequent knee pain were found to have less internal rotation at the hip joint. The most common site of breaststroke knee pain was the medial portion of the knee, with specific sites differing among the individuals. The medial synovial plica syndrome may be a cause of breaststroke knee pain, since 47% of subjects with weekly knee pain had tender, thickened medial plicae. Palpation of those plicae produced pain similar to that experienced with the breaststroke kick. The findings in this study suggest that reducing or eliminating breaststroke training distance should be an initial measure in treatment. Applications of ice, changes in kick technique, stretching exercises to increase hip rotation, and administration of aspirin may also be effective. The breaststroke training distance should be increased very gradually in the early season, and warm-up distance should be adequate to help prevent the symptoms of breaststroker's knee.

Adolescent↗
PubMedDate not supplied

Achilles tendinitis in running athletes.

Achilles tendinitis is an injury that commonly affects athletes in the running and jumping sports. It results from repetitive eccentric load-induced microtrauma that stresses the peritendinous structures causing inflammation. Achilles tendinitis may be classified histologically as peritendinitis, tendinosis, or partial tendon rupture. Training errors are frequently responsible for the onset of Achilles tendinitis. These include excessive running mileage and training intensity, hill running, running on hard or uneven surfaces, and wearing poorly designed running shoes. Biomechanical abnormalities that predispose to Achilles tendinitis include gastrocnemius-soleus muscle weakness or inflexibility and hindfoot malalignment with foot hyperpronation. The initial treatment should be conservative with relative rest, gastrocnemius-soleus rehabilitation, cryotherapy, heel lifts, nonsteroidal anti-inflammatory drugs, and correction of biomechanical abnormalities. Surgery is recommended only for persons with chronic symptoms who wish to continue running and have not benefited from conservative therapy.

Achilles Tendon↗
PubMedDate not supplied

Financing medical care for the underserved in an era of Federal retrenchment: the health service district.

Federal funding programs have, since the 1960s, been available in a variety of forms to deal with problems of access to medical care for the medically underserved. Certain programs, such as the National Health Service Corps, have recently pulled back from their points of maximal impact in terms of numbers of obligated physicians in the field. This change leaves a need for greater contributions by State and local entities in the face of Federal retrenchment. The health service district (HSD) is one such mechanism for filling the gap. It has been available under this name in Arizona law since 1977, but the first such district in the State in only now under development in a small copper mining community. Similar to school districts in concept, the HSDs allow residents in their catchment areas to tax themselves for the purpose of delivering primary health care. Two successful HSDs--or similar entities--in other States are described. One program is in Stickney, IL, and other in Condon, OR. The political success and financial viability of the Condon program are documented.

Arizona↗