Biomedical subjects

B Payne

Publications and source records attributed to B Payne.

At least 19 recordsLinked to original sources

PubMed2002

[Treatment of proximal ulnar comminuted fractures--a challenge].

INTRODUCTION: Comminuted fractures of the proximal ulna are severe injuries often complicated by involvement of the elbow joint and damaged soft tissues. The treatment of these fractures is very demanding and the results often mediocre due to of ancillary injuries (Dislocation in the humero-ulnar joint and associated radial head fractures). We analyzed the results of the treatment of these fractures and investigated whether other factors than the severity of fracture type influenced the final outcome. METHOD: Retrospective analysis of 18 patients with comminuted proximal ulna fractures. These comminuted ulna fractures included not only C-fractures according the the AO classification but also A1, A3, B1 and B3 fractures. Postoperative clinical and radiological examinations were routinely performed at 1/2-1 year intervals following treatment according to bone healing and work begin. This was done up to 48 months following treatment. Elbow function was recorded one year after the accident using the Morrey score. RESULTS: According the the AO classification, of the total of 18 patients, four suffered from an A-fracture, four from a B-fracture and 10 from a C-fracture. Eight of the 18 patients had an open fracture. 10/18 of the patients also had a fractured radial head and 9/18 of the cases had a dislocation of the humero-ulnar joint. The average range of motion based on a postoperative examination after one year was extension/flexion 0 degree/20 degrees/120 degrees and pronation/supination 70 degrees/0 degree/70 degrees. The assessment based on the Morrey-score indicated excellent to good results for 10 patients, average results for four patients and poor results for four patients. CONCLUSION: Despite correct diagnosis of the severity of injury and adequate treatment the results are only mediocre due to associated injuries (dislocation, radial head fractures). The goal is a stable anatomic reconstruction to allow early functional treatment.

Adult↗

PubMed2002

Quality improvement for patients with hip fracture: experience from a multi-site audit.

PROBLEM: The first East Anglian audit of hip fracture was conducted in eight hospitals during 1992. There were significant differences between hospitals in 90-day mortality, development of pressure sores, median lengths of hospital stay, and in most other process measures. Only about half the survivors recovered their pre-fracture physical function. A marked decrease in physical function (for 31%) was associated with postoperative complications. DESIGN: A re-audit was conducted in 1997 as part of a process of continuing quality improvement. This was an interview and record based prospective audit of process and outcome of care with 3 month follow up. Seven hospitals with trauma orthopaedic departments took part in both audits. Results from the 1992 audit and indicator standards for re-audit were circulated to all orthopaedic consultants, care of the elderly consultants, and lead audit facilitators at each hospital. KEY MEASURES FOR IMPROVEMENT: Processes likely to reduce postoperative complications and improve patient outcomes at 90 days. STRATEGY FOR CHANGE: As this was a multi-site audit, the project group had no direct power to bring about changes within individual NHS hospital trusts. RESULTS: Significant increases were seen in pharmaceutical thromboembolic prophylaxis (from 45% to 81%) and early mobilisation (from 56% to 70%) between 1992 and 1997. There were reduced levels of pneumonia, wound infection, pressure sores, and fatal pulmonary embolism, but no change was recorded in 3 month functional outcomes or mortality. LESSONS LEARNT: While some hospitals had made improvements in care by 1997, others were failing to maintain their level of good practice. This highlights the need for continuous quality improvement by repeating the audit cycle in order to reach and then improve standards. Rehabilitation and long term support to improve functional outcomes are key areas for future audit and research.

Aged↗

PubMed2001

Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly.

OBJECTIVES: This paper compares the performance of the GOHAI and the OHIP-14 as measures of the oral health-related quality of life of the compromised elderly. METHODS: Data were obtained from a cross-sectional survey of 225 participants, most of whom lived in a large geriatric care centre. RESULTS: The mean age of subjects was 83 years and the majority had one or more chronic medical conditions and physical disabilities. Their main oral problems were high rates of tooth loss and xerostomia. Additive and simple count methods were used to derive GOHAI and OHIP-14 scores. Using the additive method, 8.4% had a GOHAI score of zero and 30.3% an OHIP-14 score of zero. Using the simple count method the percentage with a score of zero was 15.1% and 45.8%. Both measures discriminated between dentate subjects with and without one or more dentures, with and without a chewing problem and with and without dry mouth. Both also showed significant associations with self-rated oral health and satisfaction with oral health status. Associations tended to be stronger between GOHAI scores and these variables. The measures were equally good at predicting overall psychological well-being and life satisfaction. Although the GOHAI identified more oral functional and psychosocial impacts than the OHIP-14, neither was markedly superior to the other when used as discriminatory measures. However, the high prevalence of subjects with zero scores may compromise the ability of the OHIP-14 to detect within-subject change.

Aged↗

PubMed2000

Manifold manifestations of ergotism.

Vasospastic side effects leading to organic manifestations are rare in ergotamine therapy. To our knowledge, combinations of more than two signs of ergotism have rarely been described in the literature so far. We present a 65-year-old male patient who as a consequence of severe migraine had developed ergotamine abuse. He was admitted to our hospital after one week of increasing abdominal pain. During laparotomy, necrotic areas of the small intestine and the sigmoid colon were resected, which on histopathologic examination revealed severe hypertrophy of the smooth musculature of mesenteric arteries, resulting from chronic vasospasms. Postoperatively, the patient developed ischaemia of the limbs which was confirmed by angiography. Before death, the patient also showed ischaemic signs in the acrae and necrosis of the tongue.

Aged↗

PubMed2000

[Traumatic paraplegia: surgical measures].

Reduction and fixation of unstable spine injuries in patients with neurological deficit are the prerequisites for early rehabilitation. Diagnostic procedures and surgery in patients with para-/tetraplegia must be performed urgently to avoid further neurological damage and ensure recovery. In parallel administration, high-dose steroids are initiated immediately after admission. In general, unstable spine fractures are reduced in a closed or open manner and stabilised. Bony fragments occluding the spinal channel are removed and, if necessary, the anterior column is reconstructed. Unstable fractures of the cervical spine are operated on either from the back and/or anteriorly, although the techniques used in the upper cervical spine are quite different from those used in the lower cervical spine. Instabilities of the thoraco-lumbar junction are reduced and stabilised via a dorsal and/or anterior-lateral approach (transthoracic or retroperitoneal). Exact preoperative planning is necessary due to the proximity of large vessels and organs, as well as the narrow space for positioning of the implants. With early operative stabilisation of the spine paretic/paralysed patients can be mobilised immediately and personal care is facilitated. In this article the operative techniques are described on the basis of examples chosen from 606 patients treated at the Division of Trauma Surgery, University Hospital of Zurich from 1992 to 1997. 119 patients (19%) were diagnosed with incomplete/complete para-/tetraplegia and 51 with various degrees of neurological deficit.

Decompression, Surgical↗

PubMed2000

Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population.

Numerous studies have demonstrated that many older adults have problems chewing, pain, difficulties in eating, and problems in social relationships because of oral disorders. However, it is not clear if these functional and psychosocial outcomes affect broader psychological well-being and life satisfaction. Consequently, this paper begins to address the question, 'Does poor oral health compromise the quality of life?'. Initial cross-sectional analyses used data derived from the seven-year follow-up of the Ontario Study of the Oral Health of Older Adults. As at baseline and three-year follow-up, oral health was measured by self-ratings of oral health and five oral health indices. Psychological well-being and life satisfaction were assessed according to the Morale Index, the Perceived Life Stress Questionnaire, The Life Satisfaction Scale, and the General Health Questionnaire. All oral health variables were significantly associated with scores from the first three of these measures in the expected direction. These associations remained after we controlled for other potential influences on the quality of life. In addition, prospective analysis indicated that self-perceived oral health at three years had a significant independent effect on psychological well-being and life satisfaction at seven years. These results suggest that poor self-perceived oral health and relatively poor quality of life co-exist in the same subgroup of older adults.

Aged↗

PubMed2000

Medical students' and doctors' perceptions about Medicaid: a content analysis.

This research investigates the similarities and differences in medical students' and doctors' perceptions about Medicaid. One hundred, ninety-seven medical students and doctors were asked to answer 4 three open-ended questions about Medicaid. Their responses were content analyzed using standard rules of manifest and content analysis. Results indicate important differences between the groups. Implications are provided.

Adult↗

PubMed1997

Life circumstances, lifestyles and oral health among older Canadians.

OBJECTIVE: To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians. DESIGN: Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined. PARTICIPANTS: Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada. MEASURES: Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score. RESULTS: In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age. CONCLUSIONS: These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question.

Age Factors↗

PubMed1994

Partners in clinical teaching.

This article describes the importance of preparing the clinical environment to facilitate clinical instruction of undergraduate nursing students. Clinical competence of the faculty member, respect for the judgement and skills of nursing staff and the expectation that students, faculty and staff collaborate to enhance quality patient care all are important in developing positive learning experiences for students.

Clinical Competence↗

PubMed1993

Differential sparing of depth perception, orienting, and optokinetic nystagmus after neonatal versus adult lesions of cortical areas 17, 18, and 19 in the cat.

Performance by cats with lesions of the visual cortex made in infancy or adulthood was examined on tasks of visually guided behavior that do not require specific training. Cats with lesions confined to areas 17, 18, and 19 made during the 1st postnatal week showed more sparing of function on a visual cliff, at orienting to targets suddenly appearing in the visual field, and at optokinetic nystagmus than did cats with equivalent damage incurred as adults. Cats with lesions that included areas 17, 18, 19 and most of the contiguous visual areas were severely impaired at all tasks whether the lesions were incurred neonatally or in adulthood. These findings suggest that sparing of vision after neonatal lesions of cortical areas 17, 18, and 19 is not confined to pattern learning tasks and that remaining lateral cortical visual areas are importantly involved in such sparing.

Aging↗

PubMed1990

Melengestrol acetate and megestrol acetate are prostatic tumor inhibiting agents.

We had previously reported that 6-methylene progesterone, an inhibitor of 5 alpha-reductase, the enzyme which converts testosterone to dihydrotestosterone, markedly inhibited growth of the androgen-dependent Dunning R3327-H rat prostatic tumors. We now find that the progesterone derivatives melengestrol acetate (MGA) and megestrol acetate (MA) inhibit both the androgen-dependent (Dunning R3327-H) and the androgen-independent (Dunning R3327-AT3) prostatic tumors. Growth of the AT3 tumors was suppressed by approximately 53% after 9 days of daily s.c. injections with MGA at 10 mg/kg body weight. MGA also caused a 54% weight reduction of the ventral prostate and a 53% reduction of the seminal vesicles. Adrenal weights were reduced by 42%. A 24-day oral treatment with MGA (at approximately 15-17 mg/(kg.day)) inhibited AT3 tumor growth by 59% and caused a weight reduction in the following tissues: prostate (46%), seminal vesicles (19%), testes (12%), and adrenals (52%). Under the same protocol, MA inhibited AT3 tumor growth by 32% and reduced the weight of the ventral prostate by 49% and the weight of the adrenals by 18%, but had no effect on the seminal vesicles and testes. The extent of the MGA-induced prostatic regression was accompanied by cytological changes similar to those effected by 6-methylene progesterone, i.e., shrinking of the acinar epithelium. The AT3 tumors in MGA-treated rats displayed a limited degree of apoptosis. Atrophy of the adrenal cortex and lowered plasma levels of corticosterone and dihydroepiandrosterone were also observed. A therapeutic role for MGA and MA against androgen-independent prostatic neoplasms in man is forecast by these observations.

Adrenal Glands↗

PubMed1989

Selective sparing after lesions of visual cortex in newborn kittens.

Previous findings are discordant regarding the effects of perinatal lesions of Cortical Areas 17 and 18 on visual discrimination learning in cats. Three potential determinants of such sparing were investigated: age at lesion (4 or 181 days), age at testing (3 or 9 months), and stimulus complexity. Age at testing was not significant, but performance varied with stimulus complexity and cortical damage, and there was an interaction between stimulus complexity and age at lesion. Both operated groups were transiently impaired in discriminating objects and subsequently learned to discriminate simple 2-dimensional patterns as well as done by controls, but the lesion groups were permanently impaired in discriminating similar patterns circumscribed by irrelevant lines. The age-at-lesion groups differed, however, in discriminating patterns masked by superimposed lines. The group lesioned at 181 days was severely impaired at both acquisition and subsequent intercurrent performance; the group lesioned at 4 days was impaired only at intercurrent performance. This study suggests that sparing after early postnatal damage of Areas 17 and 18 occurs only under limited circumstances.

Animals↗

PubMed1989

Visual discrimination by cats given lesions of visual cortex in one or two stages in infancy or in one stage in adulthood.

Sparing of visual function was studied in cats with bilateral cortical damage to Areas 17 and 18 and most of Area 19. Cats with lesions made in 2 stages, on Postnatal (P) Days 3 and 6, in 1 stage on P6, or in 1 stage in adulthood were compared with sham-operated controls on 10 visual discrimination tasks. On some tasks, both groups of cats that underwent surgery as infants showed considerable sparing of function compared with cats that had surgery as adults; the latter group showed a marked impairment. However, on several of the discriminations, 2-stage lesions permitted almost total sparing of pattern vision, whereas 1-stage lesions made neonatally were almost as debilitating as those incurred in adulthood. The findings suggest that differential behavioral consequences can follow physiological or anatomical changes, or both, that occur within a 4-day neonatal interoperative period.

Aging↗

PubMed1986

Plasma catecholamine levels during water immersion in man.

In ten normal subjects thermoneutral neck-out water immersion produced a highly significant natriuresis and diuresis mediated via an induced central hypervolaemia. During immersion suppression of plasma noradrenaline and adrenaline was observed but no change occurred in plasma dopamine levels. No correlation was found between the suppression of noradrenaline and the diuresis and natriuresis. The reduction in plasma noradrenaline observed may reflect a widespread diminution of sympatho-adrenal activity during water immersion. This reduction could be a consequence of the cardiovascular changes of immersion and may not be directly involved in the mechanism of the renal response.

Adult↗

PubMed1984

Extrinsic visual and auditory cortical connections in the 4-day-old kitten.

The major extrinsic projections to and from the visual and auditory cortical areas were examined in 4-day-old kittens using axonal transport of horseradish peroxidase (HRP) and/or tritiated proline. Six different afferent and seven different efferent systems were studied; all 13 were present by postnatal day 4 as revealed by either HRP, or autoradiography alone, or these two techniques combined. Topographical projections were found for the corticopetal pathways from the thalamus and claustrum and for the corticofugal pathways to the thalamus, claustrum, striatum, and tectum, as well as for the inter- and intrahemispheric pathways. No topographical relations were seen in projections to the cortex from the basal ganglia or the lower brainstem. The results of the present study indicate that most or all of the major extrinsic connections of the kitten's visual and auditory cortical areas are present neonatally, and that both the cells of origin and the axonal targets are arranged topographically much like those of adult cats. However, the origins of callosal projections from visual cortex are more widespread in newborn kittens than in adult cats. In addition, the laminar arrangements of the kitten's corticocortical connections differ from those of adult cats in a number of details. The results suggest that the sparing of some visual and auditory functions after neonatal lesions occurs despite the fact that the cortical areas removed have formed extrinsic connections.

Age Factors↗

PubMed1983

Effect of gestational age on ductus arteriosus response to circulating prostaglandin E2.

Premature newborn lambs with a patent ductus arteriosus have higher plasma prostaglandin E2 concentrations than near-term newborn lambs with a contricted ductus arteriosus. To see whether these concentrations of PGE2 could produce patency of the ductus arteriosus, we studied eight near-term lambs (with constricted ductuses) delivered by cesarean section, paralyzed, and mechanically ventilated. After ductus arteriosus resistance and plasma PGE2 concentrations had stabilized, a continuous PGE2 infusion into the superior vena cava was started to determine threshold concentrations needed to dilate the ductus in vivo. By two hours after birth, circulating PGE2 concentrations in near-term lambs were considerably less then the threshold concentration, and the ductuses were constricted. In five premature newborn lambs, significantly lower concentrations of PGE2 were required to dilate the ductus: threshold and ED50 concentrations were one sixth and one third, respectively. In these premature lambs during the first two hours after birth, circulating PGE2 concentrations were twice as high as the calculated in vivo threshold level. Therefore, circulating PGE2 concentrations probably played a significant role in the patency of the ductus arteriosus in these premature lambs.

Animals↗

PubMed1983

Factors determining the loss of ductus arteriosus responsiveness to prostaglandin E.

The ductus arteriosus of the newborn infant varies in its ability to dilate when doses of prostaglandin E (PGE) are administered. We infused PGE2 into 15 late-gestation newborn lambs to determine which factors regulate the ability of the ductus arteriosus to respond to PGE. PGE2 dilated the ductus in 10 lambs (responders); in five other lambs, despite similar PGE2 concentrations, there was no effect (nonresponders). The measured ductus resistance after the PGE2 infusion was directly related to the ductus resistance before the infusion. Responders had a larger left-to-right shunt through the ductus before the PGE infusion than nonresponders. Ductus that were isolated and studied in vitro from lambs that were nonresponsive to PGE2 (in vivo) were limited in their ability to relax with PGE2 as well as to actively contract with oxygen and indomethacin. This generalized loss of ductus responsiveness was directly related to the amount of the left-to-right shunt through the lumen of the ductus. These observations are consistent with the hypothesis that the constriction of the ductus arteriosus after birth limits the ability of the ductus to respond to PGE therapy.

Animals↗

PubMed1982

Iodine-125-labeled triiodothyronine in rat brain: evidence for localization in discrete neural systems.

Autoradiograms prepared from adult rat brains demonstrate that nerve cells and neuropil in different brain regions selectively concentrate and retain intravenously administered triiodothyronine, by mechanisms susceptible to saturation with excess triiodothyronine. A neuroregulatory role for thyroid hormones, strongly supported by the observations, may account for their marked effects on behavior and the activity of the autonomic nervous system.

Animals↗