Getting ready for change.
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Biomedical subjects
Publications and source records attributed to D Browning.
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A 20-year-old woman in status asthmaticus who failed to respond to conventional therapy and ventilation of the lungs with 0.5-2.0% halothane, was cooled to 30 degrees C for almost 5 days as the arterial carbon dioxide tension rose above 15 kPa. Halothane was not of immediate value, contrary to other reports. A reduction in carbon dioxide production by controlled hypothermia permitted more suitable ventilation parameters, but extensive muscle weakness caused by a steroid-induced myopathy complicated weaning from respiratory support. Prospective measurement of serum creatinine phosphokinase concentration in patients given high dose corticosteroids may herald the onset of a myopathy.
We describe a case of cytomegaloviral laryngitis and probable primary laryngeal malignant non-Hodgkin's lymphoma in a man with acquired immunodeficiency syndrome who presented to an otolaryngology clinic with odynophagia and hoarseness. While both of these disease processes have a known association with human immunodeficiency virus infection, laryngeal presentation is extremely rare. We stress the need for thorough clinical and pathologic otolaryngologic evaluation of patients with human immunodeficiency virus infection who have upper aerodigestive complaints.
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Free thyroxin (FT4) estimates by two immunoassays were compared with the concentrations of albumin in serum of apparently euthyroid subjects who either were (n = 99) or were not (n = 327) suffering from severe nonthyroidal illness (sNTI). In neither group was FT4 significantly correlated with albumin (P greater than 0.05), according to a "labeled antibody" radioassay (Amerlex-MAB). On amalgamating both groups, correlation with albumin was positive and significant (P less than 0.001). In the group with sNTI, both FT4 and albumin concentrations were decreased (mean FT4 to 77% and mean albumin to 61% of the respective reference means). For an analog radioimmunoassay (Amerlex-M), FT4 in all groups was significantly (P less than 0.001) correlated with albumin. Correlation coefficients were greater than with Amerlex-MAB for both sNTI and euthyroid groups, as well as for the joint panel. Mean FT4 in sNTI was only 44% of the reference mean. Lower radio-tracer "analog" values in sNTI are exaggerated by additional technical artefacts resulting from tracer binding to albumin.
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A chronic shortage of radiation therapy technologists exists in the United States. This report presents the data obtained in a 1987 survey of all radiation oncology facilities identified by the Patterns of Care master list. Of the 1,142 questionnaires mailed, 52% were returned. The survey identified 2,328 credentialed (ARRT) and 554 non-credentialed technologists employed in radiation therapy. Of this total of 2,882, 2,141 were identified as staff technologists. A total of 1,186 megavoltage units were identified, giving a ratio of 1.8 technologist/megavoltage unit. Two hundred sixty open funded positions and 230 unfunded positions for radiation therapy technologists were identified. The report compares the results of this 1987 Radiation Therapy Technology Manpower Survey with the results of the three previous surveys conducted in 1975, 1977, and 1981. Whereas this comparison demonstrates that progress has been made, current trends in allied health education are expected to have a negative impact on recruitment into radiation therapy technology. Program directors report that the number and quality of applicants to all allied health education programs is declining, and this trend in radiation therapy technology is substantiated by a drop in the number of students enrolled in programs, from 970 in 1986-87 to 777 in 1987-88. Our discussion addresses the areas of new program development, recruitment, retention, innovative programs, and overseas recruitment.
The postoperative use of testicular imaging to evaluate the preservation of testicular circulation has been reported after orchiopexy, excision of a hematocele, and repair of a traumatized tunica albuginea. The authors discuss the previously unreported use of testicular imaging in patients who have undergone recent herniorrhaphy or varicocelectomy. The scan of a patient with intact testicular perfusion following herniorrhaphy is compared to the scans of two patients with absence of perfusion of a testicle five to seven days following respective herniorrhaphy and varicocelectomy surgeries.
The effect of prolonged inhibition of gonadotrophin secretion was studied in 12 women with premature ovarian failure. All the patients had plasma concentrations of follicle-stimulating hormone (FSH) greater than 20 i.u./l, and in six, primordial follicles had been seen on ovarian biopsy. Goserelin (Zoladex, ICI), a depot synthetic analogue of luteinizing hormone-releasing hormone (LHRH) was administered by three consecutive 4-weekly injections. Plasma concentrations of luteinizing hormone (LH) fell from 34 (SD 11) i.u./l to 2.4 (SD 1.9) i.u./l, and plasma concentrations of FSH fell from 106 (SD 29) i.u./l to 4.5 (SD 2.6) i.u./l 4 weeks after the first injection. Plasma concentrations of gonadotrophins returned to pretreatment values in every patient within 9 weeks of the final injection of goserelin. Regular ultrasonography during the period following the final injection failed to demonstrate the development of ovarian follicles in any patient, and plasma concentrations of oestradiol remained below 100 pmol/l. This study has failed to show that suppression of gonadotrophin secretion reverses premature ovarian failure.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.