Biomedical subjects
C Evans
Publications and source records attributed to C Evans.
Ondansetron in intractable nausea and vomiting.
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Intramedullary spinal cord metastases from epithelial ovarian carcinoma.
A patient with poorly differentiated serous cystadenocarcinoma of both ovaries who had undergone extensive medical treatment presented with nonspecific neurologic complaints. With the aid of magnetic resonance imaging, a metastatic lesion in the intramedullary area of the spinal cord was diagnosed. Rapidly instituted high-dose steroids and radiotherapy resulted in resolution of her symptoms. Intramedullary spinal cord metastasis is an unusual metastatic site. This is the first reported case of epithelial ovarian carcinoma metastatic to the intramedullary spinal cord.
The Separation-Individuation Inventory. Association with borderline phenomena.
The Separation Individuation Inventory (SII; Christenson and Wilson, J. Nerv. Ment. Dis., 173:561-565, 1985) was designed to assess adult psychopathology construed in terms of the concepts of separation and individuation (Mahler, Pine, and Bergman, The Psychological Birth of the Human Infant: Symbiosis and Individuation, 1975). Its reported use is confined to the original authors' paper, which compared scores of 20 subjects with borderline personality disorder with the scores of staff control subjects. We report the association of the SII with two self-report measures of borderline personality diagnosis and phenomenology. Our British samples, from the staff and residents in a therapeutic community for severely personality-disordered clients, thus complement the original American work. The SII was found to have good internal consistency, respectable screening parameters, and high correlations with indications of trait psychopathology. We suggest a slight modification to the scoring of the inventory and two main areas for additional research.
Could 'objective, experimental' analysis of human motivation really improve psychotherapy?
Cattell is a founding father of modern, multivariate psychological method and his paper is a fine introduction to his views on motivation which have perhaps received less attention in Britain than they deserve. However, it was the unanimous opinion of three referees that it needed to be followed by a dissenting voice. In this counterargument I suggest that Cattell's presentation is: (1) ingenuously confident of the power of multivariate statistical methods; (2) naïve about the interactive nature of the clinical relationship.
Human immunodeficiency virus type 1 envelope gene structure and diversity in vivo and after cocultivation in vitro.
Nested-primer polymerase chain reaction (PCR) has been applied to the molecular cloning of 4.6-kb half-genome fragments of human immunodeficiency virus type 1 (HIV-1) taken directly from the peripheral blood mononuclear cells (PBMC) of an individual with neurological symptoms of HIV-1 infection. In a similar manner, gp120-coding portions of the envelope gene were cloned after PBMC from the same blood sample were cocultivated with uninfected PBMC for 28 days. The complete 1.6-kb nucleotide sequence of the gp120 gene was determined from each of 35 clones examined. Two of 13 (15%) PBMC-derived gp120 genes and 3 of 22 (14%) coculture-derived gp120 genes were defective as a result of frameshifts and an in-frame stop codon(s). Mean diversity between individual gp120-coding sequences in PBMC was fivefold greater (3.24%) than after coculture (0.65%). A predominant sequence of "strain" was found after coculture that was distinct from the diverse viral genotypes detected in vivo and therefore was selectively amplified during in vitro propagation. Multiple distinct third variable (V3) regions encoding the principal neutralizing domain of the envelope protein were detected in PBMC-derived genes, suggesting the presence of immunologic diversity of HIV env genes in vivo not reflected in the cocultured virus sample. The large size of the HIV fragments generated in this study will permit analysis of the diversity of immunologic reactivity, gene function, and pathogenicity of HIV genomes present within infected individuals, including the functional significance of the loss of diversity that occurs upon coculture.
Therapeutic community treatment for personality disordered adults: changes in neurotic symptomatology on follow-up.
Personality disordered patients are important as they place high continuing demands on services and are often refractory to traditional treatments. Often personality disorders may co-exist with neurotic symptomatology, worsening prognosis of the latter. This paper reports change in neurotic symptomatology following intensive, long term, therapeutic community treatment for such patients. Sixty two subjects with personality disorder were followed up for eight months after discharge (response rate 65%). Results showed a highly significant reduction in symptomatic distress as measured by the SCL-90R questionnaire. Investigation of the reliability and clinical importance of the change in individual subjects demonstrated that 55% of subjects had improved reliably, and in 32% this change was also clinically significant, whilst only 6.5% of subjects had deteriorated reliably.
Reports of the death of factor analysis are greatly exaggerated.
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Multiple self-damaging behaviour among alcoholic women. A prevalence study.
Among patients being treated for specific behaviour-control problems, there exists an important subgroup of 'multi-impulsive' patients whose treatment might be facilitated if the full range of their problems were recognised and dealt with as one general issue of impulse control. In women in particular, loss of control of eating may be prevalent and easily concealed from staff, and may thwart treatment. This survey of 50 women attending an alcoholic-treatment unit explored the prevalence of behavioural-control problems other than those of alcohol. Three-quarters of the women also had other behavioural problems. Over half the sample had thought of taking an overdose and just under half had actually taken one; about a quarter had cut themselves deliberately; half described impulsive physical violence; half acknowledged a period of 'promiscuity'; and at least 16% had had a clinically diagnosable eating disorder. More research is needed but we believe that all self-damaging behaviour should be addressed simultaneously to prevent 'revolving door' relapses as emotional distress is transferred from one behaviour to another.
Barry University School of Podiatric Medicine. The first seven years and beyond.
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Evaluation of surgical procedures. Changing patterns of patient selection and costs in heart transplantation.
During the past 4 years we have observed a marked increase in costs of heart transplantation in our center. This trend coincides with a shift in our recipient population toward the more severely ill patients. The percentage of patients bound for the intensive care unit has doubled. In analyzing the components of cost, we find that the length of stay, both in special care and regular nursing units, accounts for most of the cost increase. In our study of outcomes we find no significant difference in survival, at 1 month and 1 year, between recipients operated on from the intensive care unit and those not in intensive care. We find that at 1 year after transplantation, approximately 80% of patients are rehabilitated, which we define as the ability to work or to go to school. Only 20% of patients are off disability rolls, however, primarily because of problems related to insurance and the cost of continuing care, including drugs. We conclude that the comprehensive evaluation of surgical procedures requires an approach that balances costs with results on a continuing and long-term basis.
Synthesis of a gene for rat liver fatty-acid-binding protein and its expression in Escherichia coli.
A gene coding for rat liver fatty-acid-binding protein (FABP) has been constructed by the single-step ligation of ten synthetic oligonucleotides. The gene has been cloned into the bacterial expression vector pKK223-3. Induction of protein synthesis from this gene results in over expression of an FABP that is indistinguishable in its structure and binding properties with that isolated from rat liver.
Kindling-induced potentiation in the piriform cortex.
At intensities sufficient to induce epileptiform afterdischarges, repeated electrical stimulation of limbic structures can lead to the development of permanent increases in the strength of the epileptiform response (kindling). Field potentials evoked by pulse stimulation are also increased in amplitude in a number of forebrain pathways following kindling. This kindling-induced potentiation effect is similar in many respects to the 'long-term potentiation' (LTP) effect which is produced by non-epileptogenic stimulation. There are, however, some interesting differences. For example, kindling-induced potentiation can far outlast LTP. In these experiments, we attempted to determine the longevity of the kindling-induced potentiation of the response evoked in the piriform cortex by olfactory bulb stimulation, following olfactory bulb kindling. This system was targeted because both the olfactory bulb and the piriform cortex are highly reactive kindling sites. In addition, we used the paired pulse technique to monitor facilitation and inhibition in this system. Kindling was found to induce a potentiation in the piriform field potential that lasted for at least 3 months (the period of the experiment) with little or no decay. Kindling also produced a decrease in paired pulse facilitation. In some animals the net facilitation was changed to a net depression. These results are consistent with the interpretation that kindling produces an increase in recurrent inhibition in the piriform cortex. The paired pulse measures, however, returned to near baseline levels over the 3-month test period.
Infertility and eating disorders.
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Comparison of ondansetron with dexamethasone and domperidone in the prophylaxis of non-cisplatin chemotherapy induced emesis refractory to dexamethasone.
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Case report: hepatic and splenic calcification due to amyloid.
A case of marked hepatic and splenic calcification due to primary amyloidosis is presented. Although the patient had been treated with continuous ambulatory peritoneal dialysis, there was no evidence of a causal relationship with the calcification. Amyloid is known to have an affinity for calcium, but this radiographic manifestation has not been previously reported.
Severe urticarial reaction to rubber: complication of a barium enema.
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Imaging after renal transplantation.
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