Evidence-based learning in general practice.
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Evidence-Based Medicine↗
Biomedical subjects
C Fowler
Publications and source records attributed to C Fowler.
Metastasis of C1300 and TBJ murine neuroblastomas correlates with expression of matrix metalloproteinases.
Because metalloproteinases, specifically type IV collagenases, may mediate metastasis, 72- and 92-kDa collagenase activities were evaluated in two murine neuroblastoma cell lines: non-metastatic C1300 and metastatic TBJ. Zymogram analysis demonstrated that 72- and 92-kDa collagenases were associated only with metastatic TBJ. Three human neuroblastoma cell lines were then evaluated by zymogram and Western blot analyses: 72-kDa collagenase was found in metastatic SK-N-SH and IMR-32, but not in SK-N-MC, which may be a peripheral neuroectodermal tumor and not a neuroblastoma. Therefore, 72- and 92-kDa collagenases may be markers of metastasis in neuroblastoma and may aid in differentiation from other small blue cell tumors.
Animals↗
A taxonomy of Rorschach autisms with implications for differential diagnosis among thinking-disordered patients.
A tripartite taxonomy of perceptual-cognitive errors on the Rorschach, abbreviated TRAUT, was reviewed. TRAUT classifies "autisms" as stemming from either an arrant disregard for the blot shapes (HYPO), an inordinate attention to unusual blot areas (HYPER), or an endorsement of counterfactual relationships among blot areas (RELER) included among Exner's Unusual Verbalizations. The scoring of HYPOs and HYPERs and the frequency of their occurrence among thought-disordered groups were determined by examining Rorschachs of inpatient schizophrenics, outpatient schizophrenics, borderline personality disorders, and Cluster A personality disorders. Because HYPOs and HYPERs yielded better differential diagnoses than RELERs among these four groups, it was suggested that such percepts should be scored routinely as a screen for thought disorder.
Adult↗
A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate.
OBJECTIVES: To assess the safety and efficacy of endoscopic laser ablation of the prostate (ELAP), performed with the Urolase fiber and the neodymium:yttrium-aluminum-garnet laser, compared to transurethral resection of the prostate (TURP) in patients with bladder outflow obstruction secondary to benign prostatic hyperplasia (BPH). METHODS: In this multicenter, prospective, randomized study, a total of 151 patients were treated (ELAP, 76; TURP, 75) of whom 137 completed 1 year follow-up (ELAP, 67; TURP, 70). Safety parameters included measurement of preoperative and 24-hour postoperative sodium, hematocrit, and hemoglobin values and careful monitoring of adverse events. Efficacy was assessed with the American Urological Association symptom score (6), urinary flow rates, and residual urinary volume measurements. RESULTS: There was 1 death in each group during the study period unrelated to the treatment procedure. There was a clinically significant improvement in all efficacy parameters in both groups. Between group comparisons favored TURP in maximum flow rate, residual urinary volume, and symptom score. ELAP had a better safety profile than TURP in the defined safety parameters of drop in hemoglobin and hematocrit values. In 16% of patients, a blood transfusion was required after TURP compared with no transfusions in the ELAP group. Urinary tract infections and dysuria were more frequent in the ELAP group. CONCLUSIONS: ELAP performed with the Urolase fiber is a useful alternative therapy to TURP in patients presenting with bladder outflow obstruction secondary to BPH.
Aged↗
Factors related to the presence of head injury in bicycle-related pediatric trauma patients.
Using data from the National Pediatric Trauma Registry, this study examined the characteristics of bicycle-related head injury, factors related to the presence of head injury, and different outcomes of head injury up to the time of discharge. Of the 2,333 patients ages 0 to 14 years who were admitted to trauma centers because of bicycle-related injury during 1989 through 1992, more than one-half (54%) sustained head injury, predominantly concussions and skull fractures. With adjustment for age, sex, and motor vehicle involvement, children who had pre-existing mental disorders, who did not wear a helmet at the time of injury, or who were injured on roads had a significantly increased likelihood of sustaining head injuries. Patients with a head injury were four times as likely as patients with no head injury to be treated in intensive care units, and were almost twice as likely to develop complications. Head injury was associated with an increased risk of inhospital fatality and high prevalence rates of communication and behavior impairments at discharge. Although it is urgent to increase helmet use substantially by child bicyclists, special attention should be paid to high-risk groups, such as children with mental disorders and children who are likely to ride in traffic.
Adolescent↗
HLA class I variation in Australian aborigines: characterization of allele B*1521.
Traditional methods of serological typing have largely used antisera of Caucasoid origin, which can overlook HLA heterogeneity in non-Caucasoid populations. Therefore, we have used molecular techniques to evaluate potential polymorphism in HLA class I molecules of Aborigines from the central desert and northern coast of Australia. The DNA sequence of common Aboriginal HLA-A and B antigens were compared with serological reaction patterns which suggested new polymorphisms. Although serological data indicated that long and short variants of A34 may exist, regardless of the serological pattern, all individuals carried the A*3401 allele. Therefore, the variation in A34 reaction pattern observed serologically was not attributable to primary sequence variation in the HLA A*3401 allele. Similarly, there was no detectable polymorphism in the sequences of selected HLA-B alleles, even though some of these alleles showed unusual serological reaction patterns. However, a new allele of B15 (B*1521) was detected in two individuals carrying this serotype. The cells from both of these individuals showed ambiguous reaction patterns with monospecific B62 and B75 sera. cDNA sequencing of the HLA B15 gene from these cells revealed a B15 allele that differed from B*1502 by a single nucleotide change. This change occurred at position 272, resulting in a C to G substitution at residue 67 in the consensus B15 cDNA sequence. Hence, the Australian Aborigines as an ethnic group show very little primary sequence polymorphism within the class I loci, consistent with the results obtained from previous serological studies.
Amino Acid Sequence↗
Flow cytometric analysis of primary and metastatic squamous cell carcinoma of the oral cavity and oropharynx.
A retrospective analysis of formalin-fixed, paraffin-embedded tissue from patients with histologically confirmed metastatic squamous cell carcinoma was performed using flow cytometry. Ninety-eight sets of specimens from previously untreated patients with an oral cavity or oropharyngeal tumor and a simultaneous cervical metastatic deposit were analyzed. Normal mucosa and cervical lymph nodes were processed identically and run as controls. All patients underwent surgical resection at Wilford Hall USAF Medical Center or The Eye and Ear Hospital of Pittsburgh between 1980 and 1986. The specimens from 94 patients were technically adequate for interpretation. Diploid histograms in both the primary and metastatic tumors were present in 49 (52%) of 94 patients. Aneuploid histograms in either the primary and metastatic tumors were noted in 45 (47%) of 94 patients. In this group of 45 patients, the primary tumor and cervical metastasis were both aneuploid in 21 (46%), and aneuploid histograms occurred with equal incidence in either the primary or metastasis in the remaining 24 cases. No statistically significant prediction of survival could be made from any correlation with the histograms of either the primary or metastasis. The potential technical problems and limitations of flow cytometry in the determination of DNA content of formalin-fixed, paraffin-embedded tissue and the selection of patients with advanced disease warrant caution in the interpretation of results.
Carcinoma, Squamous Cell↗
The future of minimal access surgery.
It seems likely that the future of minimal access therapy will be driven in part by the forces which have shaped its early development. There will continue to be a movement of care from the hospital, where costs are relatively apparent, to the community, where they are hidden and difficult to determine. Hospital stays will be shorter and there will be fewer beds. Patients and their representatives will want more information about the procedures performed on them and their outcomes. Surgical operations will increasingly be performed by highly skilled experts with less and less service delivered by trainees. The duration and intensity of the work of theatre teams will tend to be reduced for health and safety reasons. New technologies, both predictable and unpredictable, will alter practice. These pressures and trends give us a hint of what the future might look like but the operation of chance means that any attempt at prediction contains a sizeable element of fantasy. What follows is a fantasy of a possible future.
Forecasting↗
Early memories: an exploration of theoretically derived queries and their clinical utility.
The authors take Mayman's (1968) procedure for gathering early memories as their point of departure by developing three theoretically and clinically relevant queries based on object relations theory. Two empirical studies were conducted to assess the projective potential and concurrent validity of these queries, while case vignettes illuminate their construct validity and clinical utility. The results of both studies and the case vignettes lend support to Mayman's theoretical conception of early memories as a unique and powerful projective tool.
Adult↗
Teaching laparoscopic surgery. Role of government centres.
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Curriculum↗
Pharmacokinetics and distribution in tissue of FK-037, a new parenteral cephalosporin.
A single 1-g or 2-g intravenous dose of the cephalosporin FK-037 was given over 30 min in a cross-over-designed study, to each of six healthy male volunteers, and the concentrations of the drug were measured in plasma and cantharides-induced blister fluid over the subsequent 12 h. Urine was collected over 24 h. After a washout period of 6 weeks, during which the blisters healed, the study was repeated at the other dose level. Following the 1-g dose, the mean peak concentration in plasma was 83.8 micrograms/ml, and after the 2-g dose it was 142.6 micrograms/ml. The mean peak concentrations in the inflammatory fluid were 37.9 and 63.3 micrograms/ml, respectively. The mean elimination half-lives from plasma and inflammatory fluid were 2.0 and 2.5 h, respectively, after 1 g and 2.0 h and 3.7 h, respectively, after 2 g. The amounts of penetration into inflammatory fluid (as assessed by ratios of areas under the concentration-time curves) were 109.9 and 110.5% following doses of 1 and 2 g, respectively. The proportions of the administered drug recovered in the urine by 24 h were 87.6 and 85.7%, respectively. Our results indicate that FK-037 should prove to be efficacious in the treatment of a wide range of systemic infections.
Adult↗
Concurrent and Discriminant Validity Between the Hand Test Pathology Score and the MMPI-2
Using an outpatient sample (N = 43), this study assessed the concurrent validity of the Hand Test pathology summary score (PATH) with an objective measure of psychopathology, the MMPI-2 clinical scales. The PATH score did exhibit several significant relations to the MMPI-2 clinical scales. In addition, there is support for divergent validity as none of the MMPI-2 validity scales (L, F, and K) were significantly related with PATH.
Journal Article↗
Head injuries incurred by children and young adults during informal recreation.
To examine injuries related to playground equipment, children's vehicles, roller skates, and skateboards, 1991 data on emergency room patients younger than 25 years in the Consumer Product Safety Commission's 91 surveillance hospitals were used. Head injury was the primary diagnosis for an estimated 58,480 patients, exceeding the total number of head injuries to bicyclists younger than 25 years. The head injury rate decreased with age. The large number and high rate of head injuries in children involved in a variety of recreational activities suggests the value of multipurpose helmets.
Adolescent↗
HLA DPB1 genotyping in Australian aborigines by amplified fragment length polymorphism analysis.
The HLA-DPB1 alleles in 93 Australian aborigines, from two geographically separate areas within Australia, were studied by AFLP analysis. There was a restricted range of DPB1 alleles seen in the aboriginal population, and the distribution of alleles varied between the two aboriginal groups. DPB1*0501 was the most common allele in the aborigines from the Central Desert, whereas DPB1*0401 was the most frequent allele in the Northern Coast aborigines. A new AFLP pattern was observed, and was found to correspond to the allele DPB1*2201, recently identified by SSO analysis. The DPB1 allele frequency distribution for both of the aboriginal groups was different from that seen for the Australian Caucasoid population.
Alleles↗
Simplified closed circuit television magnifier for the partially sighted.
Although the use of closed circuit television (CCTV) magnifiers is now well established, the instruments tend to be bulky, complex and expensive. A magnifier is described which consists of a miniature TV camera used as a hand-held scanner, which can be plugged into a wide variety of monitors and television sets.
Blindness↗
Inhaled histamine increases the rate of absorption of sodium cromoglycate from the lung.
Since many factors may alter lung epithelial permeability (LEP) to water soluble molecules, the effect of histamine on the absorption and clearance of inhaled sodium cromoglycate was examined in seven mildly asthmatic patients with hyperresponsive airways and eight normal subjects. The subjects underwent histamine challenge to determine the provocative concentration of histamine required to reduce the forced expiratory volume in one second (FEV1) by 20% (PC20) from baseline. On two further visits they inhaled either saline placebo or histamine and 5 min later inhaled an aerosol containing sodium cromoglycate. Measurements of FEV1 were made and blood samples taken for analysis of plasma sodium cromoglycate concentration at intervals for 3 h. In the asthmatic group histamine inhalation led to a 24 +/- 4% reduction in FEV1 but had no effect on the normal subjects. When compared with inhaled saline, histamine increased the initial pulmonary absorption of SCG without influencing the total amount of drug absorbed in both asthmatics and normals. These observations suggest that the pharmacokinetics of inhaled sodium cromoglycate may be altered significantly by inflammatory mediators present at the site of drug absorption from the airways.
Adolescent↗
A simple method for insertion of an intraprostatic coil.
A simplified method of insertion of a urethral coil for treatment of benign prostatic obstruction has been tested in 25 patients. The prostatic urethra is measured either by abdominal/transrectal ultrasound scanning or by rigid or flexible endoscopy. The coil is inserted into the prostatic urethra using simple measurements taken from a Foley catheter; 21 coils were correctly positioned at the first attempt using this new method--a success rate equivalent to that of ultrasound-guided insertion.
Aged↗
Familial Hirschsprung's disease: report of autosomal dominant and probable recessive X-linked kindreds.
Multifactorial sex-modified inheritance has been proposed as the model of transmission in familial Hirschsprung's disease (HD). A review of two separate kindreds suggests that aganglionosis may be inherited as an X-linked recessive or an autosomal dominant trait. Chromosomal anomalies and other syndromes, including G6PD deficiency, may occur with familial HD. Recurrence risk counseling for family members depends on accurate pedigree analysis and a comprehensive understanding of the genetic factors involved.
Female↗