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Biomedical subjects

D J Curtis

Publications and source records attributed to D J Curtis.

At least 19 recordsLinked to original sources
PubMed1995

Functional anatomy of the trunk musculature in the slow loris (Nycticebus coucang).

Lorisid locomotor and postural behaviour exhibits a number of features that distinguish it clearly from other primates. The comparative myological study of the trunk in the slow loris (Nycticebus coucang) and the squirrel monkey (Saimiri sp.) presented here reveals differences that are related to unique aspects of lorisid positional behaviour. While quadrupedal running and leaping requires flexion and extension of the spine, slow climbing quadrupedalism in lorisids depends on spinal lateral flexion and rotation. The contrasting development of the epaxial musculature in the two species dissected reflects these different requirements. Bipedal suspension is a common posture in the lorisids during which rotation and dorsiflexion of the head is made possible by the robustly developed deep, dorsal, cervical musculature. The long lower lever arm in the M. rectus abdominis may play a significant role in the ventroflexion required to regain a quadrupedal stance.

Abdominal Muscles↗
PubMed1995

Chronic airflow obstruction in long-term survivors of allogeneic bone marrow transplantation.

Prospective pulmonary function tests (PFTs) of 49 long-term survivors of identical sibling bone marrow transplants (BMT) were analysed. Eight (16%) developed a persistent pulmonary syndrome characterised by a late onset, cough and dyspnoea, hyperinflation or patchy infiltrates on plain radiography and episodic bacterial infections. The predominant PFT pattern was obstructive (reduced forced expiratory ratio, FER) with a variable restrictive component (reduced vital capacity, VC). When compared with the other 41 patients (controls), mean FER (53% absolute) and VC (73% predicted) were significantly lower at 12 months (P = 0.005). Graft-versus-host disease (GVHD) was the only identifiable risk factor (odds ration 7.1). Five of 7 patients compared with 4 of 31 controls tested at 3 months had an abnormal FER or maximum mid-expiratory flow rate (MMFR), but not VC, prior to the onset of symptoms (P = 0.015). Patients with mild to moderate disease (FER 50-70%) had stable pulmonary function while severe cases progressed despite immunosuppressive agents. Earlier recognition of this syndrome by a reduced FER or MMFR may allow the initiation of therapy at a potentially reversible stage.

Adult↗
PubMed1994

Positional behaviour in captive aye-ayes (Daubentonia madagascariensis).

The aye-aye shows numerous special features in its postcranial skeleton, partly in association with its unusual feeding habits and partly in association with locomotor specialisation connected with the possession of claws. This study examined the positional behaviour of 3 captive adult aye-ayes in order to throw light on these morphological specialisations. Locomotion was dominated by quadrupedal walking and climbing. Given the relatively large body size of aye-ayes, an unexpectedly high frequency of head-first descent was observed. This may provide an explanation for two characteristics of aye-ayes: robusticity of the shoulder girdle and high compressive and bending strengths of the humerus. Agile leaping was also observed, contrasting with previous reports that this species is characterised by slow, cautious movement. Specific morphological features that are shared with slow-moving lorisids may be attributable to a combination of frequent head-first descent and postural suspension.

Animals↗
PubMed1991

Radiologic recommendation for breast biopsy on screening mammography reports.

Radiologic reports on screening mammography findings often obligate breast biopsy. Ready recommendation for biopsy of nonpalpable lesions imaged by x ray is a conservative radiologic policy but is unsettling for patients and creates an imperative bind for surgeons. Like the decision to send the patient with right lower quadrant abdominal pain home rather than to the operating room, the diagnosis that requires clinical confidence and precision is nonappendicitis. Noncancer of the breast is a similar diagnosis that can usually be made on clinical and mammographic findings rather than passing such patients through to invasive diagnosis. A series of 84 patients was referred for needle localization of nonpalpable mammographically detected lesions called suspicious on screening examination. Of these 84 patients, new radiographic reports reinterpreting the findings without biopsy were written on the original mammogram in 15 patients. This is a cancellation rate of 21 per cent. In 69 patients needle localization was carried out with the finding of cancer in 28 per cent, compared with the national average of 15 per cent. This higher than average yield caused concern whether any unbiopsied cancers had been followed, and a review of these patients was undertaken. In the log of patients referred for needle localization, the prereading by the mammographer performing the needle localization was recorded in advance of biopsy confirmation, and specificity proved to be 94 per cent and sensitivity 96 per cent. Of the cancers that were detected, 39 per cent were proven in patients older than 50 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗
PubMed1989

Selecting radiology resident candidates.

Radiology resident candidate selection has become a burdensome, subjective, and somewhat arbitrary process. Because the luxury of many well-qualified candidates exists, there is an obligation to select them as honestly, equitably, and objectively as possible. Two years were spent in revising and modifying the resident selection process to make it more uniform and more efficacious. An application scoring form was devised to extract uniform pertinent information from the original application form. Candidates could then be ranked according to a numerical score derived from the form. This allowed easy selection of top candidates to be interviewed. A new interviewing scoring form was developed to include desirable characteristics of resident candidate performance. This form was also devised in such a way as to be easily scored and to allow selection of the top 20 to 25 candidates. These candidates were then ranked by participating faculty members while reviewing their application score forms and their interview forms. Positions for the residency training program were offered according to the ranking. The usefulness of both new forms was evaluated and confirmed by correlating form scores with faculty ranking of academic performance of current residents in the training program.

District of Columbia↗
PubMed1988

Physician assessments of practice patterns in emergency department radiograph interpretation.

Emergency and radiology department directors at 517 acute-care US teaching hospitals were sent identical questionnaires surveying practice patterns of ED plain film radiograph interpretation. Fifty-seven percent of ED directors and 51% of radiology department (RD) directors responded. Both groups reported that the most common practice pattern (60%) was alternating responsibility for immediate interpretation between emergency physicians and radiologists during a 168-hour week. Remaining hospitals were nearly equally divided between systems in which radiologists always provided immediate interpretation and those in which the emergency physicians always provided the initial interpretation. In all systems in which emergency physicians provided some immediate radiograph interpretation, radiologists provided subsequent review. Institutions varied as to the level of training of the physician in both the ED and RD who provided immediate radiograph interpretation; at least 30% of the institutions responding were reported to have either emergency physicians or radiologists of resident level providing immediate interpretation at least part of the 24-hour day. Interpretation discrepancy rates between emergency physicians and radiologists were estimated to be 4% to 6%. The large amount of variation among hospitals in ED radiograph interpretation systems suggests that these systems were not designed with quality of care concerns as their primary criterion. As a consequence, objective patient outcome and process measures need to be developed and measured to ensure that a particular internal system for ED radiograph interpretation is providing an acceptably high standard of patient care.

Emergency Service, Hospital↗
PubMed1988

Testing as a teaching tool.

More than four years ago, the authors initiated testing as a means of obtaining data for evaluating residents. The testing process has evolved now and is used for its teaching value and as a means of objective resident self-evaluation. Testing is designed to provide 10 cases an hour, with characteristics allowing a single diagnosis as a unique answer. No history is provided because a common topic and anatomic area provide a context for each examination. Answers are given during the examination after each question, and discussion follows. All answers are written, and answer sheets are collected. Attendance is high. Test scores are routinely lower than in other forms of evaluation. Testing integrates all aspects of radiology training from cognitive through deductive, simulates written consultations, and provides a means of self-evaluation through rapid feedback. Testing is a viable form of teaching that blends self-evaluation with faculty and peer feedback.

Educational Measurement↗
PubMed1988

Ranking: a year three follow-up in a different institution.

Ranking residents as a means of semiobjective evaluation of their overall performance was described in 1985. The predictive nature of pooled faculty ranking of residents was stressed. Ranking of resident total scores on The American College In-training Examination and American Board of Radiology written examination was noted to be statistically related to the pooled faculty ranking. Similarly, the faculty ranking was predictive of itself in subsequent rankings. A cohesiveness of faculty consensus was present such that small numbers (five minimum) were predictive of larger groups of participating faculty. All reported observations persist in the new institution. Exceptions to expected residency level of training stratification (eg, third-year residents ranking in the midst of first-year residents, second-year residents ranking above many third-year residents) continue to be the most useful observation in counseling residents. Additional information reported includes sensitivity of the ranking to improvement or nonimprovement of probated residents.

Achievement↗
PubMed1987

An isodicentric X chromosome with short arm fusion in a woman without somatic features of Turner's syndrome.

A 25 year old woman with gonadal dysgenesis but no other somatic features of Turner's syndrome was found to have a 45,X/46,XidicX(p22.3) karyotype. It is postulated that because her stature is within the normal range there has been no loss of genetic material in the fusion of the two Xs. Her mother, who also had a history of menstrual problems, was found to be a 46,XX/47,XXX mosaic.

Adult↗
PubMed1987

Barrett's esophagus. A prevalent, occult complication of gastroesophageal reflux disease.

A prospective study of patients with symptoms of gastroesophageal reflux was undertaken to determine the prevalence of Barrett's esophagus and reevaluate the diagnostic approach necessary to detect this complication. Endoscopy with mucosal biopsy was performed in 97 subjects. Twelve (12.4%) were found to have Barrett's esophagus. The sensitivity and specificity of the endoscopic and radiologic examinations for Barrett's esophagus were prospectively evaluated. Endoscopy (92%) was significantly more sensitive than radiology (24%) in detecting Barrett's esophagus (p less than 0.001). The frequency and severity of reflux symptoms among patients determined to have Barrett's esophagus, reflux esophagitis, or normal esophageal biopsies were quantitatively similar in all three groups, except for significantly greater daytime heartburn in those with reflux esophagitis (p less than 0.01). These data indicate that Barrett's esophagus complicates gastroesophageal reflux more often than previously believed.

Barrett Esophagus↗
PubMed1986

Radiology of the nutcracker esophagus.

We prospectively evaluated 22 patients with manometrically proven "nutcracker esophagus" (high amplitude peristaltic contractions). All patients were symptomatic with angina-like chest pain, dysphagia, or both. Patients underwent barium esophagram with video-recording of the images. Video tapes were reviewed independently by a gastrointestinal radiologist who was unaware of the patients' manometric diagnoses. The video-esophagram was normal in 12 of 22 (55%) patients. Eight of 22 (36%) had dysmotility: either diffuse spasm (9%) or tertiary contractions (27%) (Fig. 2). A hiatal hernia was the only abnormality in two patients. Although the presence of diffuse spasm or tertiary contractions may suggest the presence of the underlying motor disorder in patients with nutcracker esophagus, we conclude that the "barium swallow" lacks sufficient sensitivity to screen adequately for this disorder in patients with atypical angina or dysphagia.

Adult↗