Work related disorders of the upper limb.
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Arm Injuries↗
Biomedical subjects
D Thompson
Publications and source records attributed to D Thompson.
Oesophageal reflex responses: abnormalities of the enteric nervous system in patients with oesophageal symptoms.
An intraluminal balloon was used to study the peristaltic reflex, which is mediated by the intrinsic nerves of the oesophagus. Serial balloon distension was performed in nine asymptomatic volunteers and 133 patients with oesophageal symptoms. Eight of the volunteers had a normal response with proximal stimulation and distal inhibition of motility. Only 42 patients (31.6 per cent) had a normal response. The commonest abnormal response (39.1 per cent) was some form of failure of the distal inhibitory reflex. Other patterns of abnormality were an unresponsive oesophagus (15.8 per cent) with no motility change during balloon inflation, or spasm (13.5 per cent) proximal to the balloon. These alterations of secondary peristaltic activity suggest that there are abnormalities of the intrinsic (enteric) nerves of the oesophagus. Different abnormalities were found in patients with similar symptoms. Awareness of this difference might allow a more rational approach to treatment. This hypothesis was tested in a small pilot study treating functional dysphagia with cisapride. Three of nine patients had marked symptomatic improvement within 4 weeks and all three had an unresponsive oesophagus. The remaining six patients, who had failure of distal inhibition or a normal response, did not improve.
Adult↗
Flow patterns of blood cells in the retinal capillaries. Retinal capillary flow patterns.
We present a new technique for retinal blood cell angiography which was used to investigate flow patterns of blood cells in the retinal capillary net of normal cats. Capillary paths were defined to be the path taken by the labelled blood cells from the terminal arteriole to the entry point into a collecting venule. We were able to define two types of capillary paths. The 'simple' paths were minimally coiled and had a high blood cell flux. The 'complex' paths were coiled, structurally complex and had a low blood cell flux in comparison to the simple paths of the same eye. A simultaneous fluorescein angiogram was performed to reveal the complete anatomy of the capillary net in which the functional paths exist. The possibility that such flow patterns exist in the human retina should be considered.
Animals↗
Habituation to zipeprol hydrochloride during pregnancy.
Zipeprol hydrochloride is a synthetic antitussive agent that has shown little evidence of addictive potential in animal studies. Despite this, several reports of abuse and abuse-related over-dosage have been published. Abuse of this drug has now become a problem in the United States-Mexico border region. We report the specific case of a pregnant woman habituated to zipeprol without evidence of other drug abuse and an abstinence syndrome observed in her newborn infant.
Adult↗
Enhancement of erythropoiesis by recombinant human erythropoietin in low birth weight infants: a pilot study.
We randomly assigned eight concurrently symptom-free premature infants (birth weight less than or equal to 1250 gm) at high risk of requiring erythrocyte transfusions for anemia of prematurity to 6 weeks of intensive treatment with either subcutaneous recombinant human erythropoietin (r-HuEPO group) or a placebo (control group). Treatment with r-HuEPO was initiated at a dose of 100 units/kg per day 5 days a week, and was increased to 200 units/kg per day after 2 or 3 weeks if target reticulocyte counts were not achieved. All patients were given supplemental oral iron therapy at a dose of 6 mg/kg per day, as tolerated. Mean reticulocyte counts in r-HuEPO-treated and control infants were 64,600 versus 67,500 cells/mm3 at entry; were 245,600 versus 78,000 cells/mm3 after 1 week; and averaged 262,600 versus 136,400 cells/mm3 during the study. Mean reticulocyte counts in r-HuEPO-treated infants were 251,200 cells/mm3 during the week when r-HuEPO, 100 units/kg per day, was given, and were 269,500 cells/mm3 after the dose was increased to 200 units/kg per day. Mean hematocrit values at entry were 33.4% in babies who received r-HuEPO versus 33.6% in the control subjects, and were 31.4% in r-HuEPO-treated and 25.2% in the control subjects at the end of treatment. One r-HuEPO-treated and three control babies received transfusions during the study; the total volume of blood given was 17 ml in the r-HuEPO group and 101 ml in the control subjects. The percentage of hemoglobin F increased in infants not given transfusions. We conclude that r-HuEPO stimulates endogenous erythropoiesis in small premature babies who are receiving supplemental oral iron therapy. A controlled multicenter trial has been undertaken to confirm these promising preliminary observations.
Anemia, Neonatal↗
Construction of the knowledge file for an image understanding system.
To enable an image understanding system to provide an automated interpretation of diagnostic imagery it must have access to all of the concepts, procedures and methods used by human experts. The paper describes information elicitation from experts of different domains and the construction of a knowledge file. Uncertainty management is based on Bayesian belief network methods.
Bayes Theorem↗
Acute phase reactants in predicting disease outcome.
From the studies which are reviewed above, it is generally apparent that in terms of the acute phase response, the initial findings in early inflammatory arthritis (particularly rheumatoid arthritis, with which the majority of such studies are concerned) have little predictive value for either the functional outcome or mortality. The wide interindividual variability in these measurements is also likely to limit their clinical usefulness as predictors of disease outcome. The trend in certain acute phase reactants may be more useful in indicating disease activity, although the number of satisfactory studies in this area is very limited.
Acute-Phase Proteins↗
A model for evaluating the cost-effectiveness of cholesterol-lowering treatment.
We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness of alternative cholesterol-lowering treatments. We combine standard incidence-based techniques for measuring the cost of illness with logistic risk functions from the Framingham Heart Study to project, for persons with known coronary risk characteristics, the likelihood of developing coronary heart disease (CHD) over a lifetime as well as a number of related outcomes, including the expected loss of years of life due to CHD, the expected lifetime direct and indirect costs of CHD, and the changes in these outcomes that would result from cholesterol-lowering treatment.
Adult↗
Measurement of severity for nonhospitalized injuries in the pediatric age group.
To better classify minor injuries in the pediatric outpatient population, we empirically developed a scale to predict functional impairment, one week and one month postinjury, based on data available at the time of care. A sample of 857 injured children aged five to 19 years was randomly split into two subsamples. Using logistic regression techniques, predictive models were developed and confirmed on the subsamples and then applied to the full sample. Age, location of injury, and type of injury were predictive of impairment one week post-injury; however, type of injury was the only consistently significant predictor. Type of injury, specifically fracture, dislocation, and sprain, and location of injury (lower extremity) were significant predictors of functional impairment one month postinjury; however, once again, the type of injury was the only variable consistently significant across all models. Other than the type of injury, the variables available at the time of care were too uniform between disabled and nondisabled patients to be useful in developing a severity scale for minor injuries. We conclude that other outcome measurements or scale development techniques should be explored to develop a useful classification scheme for minor injuries.
Adolescent↗
Recombinant human erythropoietin and the treatment of anemia in patients with AIDS or advanced ARC not receiving ZDV.
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AIDS-Related Complex↗
Effects of cetirizine, loratadine and terfenadine on histamine weal and flare reactions.
This randomised double-blind, placebo-controlled, cross-over study compared the effects of single oral doses of terfenadine 120 mg, cetirizine 10 mg, and loratadine 10 mg on experimentally induced weal and flare reactions. The areas of weal and flare induced by intracutaneous injections of histamine were measured using planimetry, weal thickness by A-scan pulsed ultrasound and erythema index by a device which measures the relative reflectance of red and green light. All three antihistamines suppressed the weal and flare area and weal thickness 3, 6, 12 and 24 h after dosing. At the usual currently recommended doses terfenadine and cetririzine were most effective after 6 h and were more potent than loratadine for the first 6 h of the study.
Administration, Oral↗
The value of acute phase protein measurements in clinical practice.
There is clearly a role for the measurement of acute phase proteins and other indices of the acute phase reaction but it is equally clear that no one laboratory test is suitable for use in all clinical situations. The choice of acute phase protein measurement depends on the diagnostic sensitivity and specificity of the measurement in the particular clinical situation. The choice of measurement must also include a decision on time of sampling and whether single or serial sampling would be more appropriate. In most situations where acute phase measurement is useful CRP is the assay of choice with alpha 1-antichymotrypsin also being useful in inflammatory bowel disease and other situations where a wider time window is required. The ESR or plasma viscosity can be useful to screen for disease. Cytokine and enzyme-inhibitor complex measurements may be important assays in the future.
Acute-Phase Proteins↗
Outcomes of cefazolin versus ceftriaxone therapy in treating lower respiratory tract infections in adults.
OBJECTIVE: To determine whether choice of a first- versus third-generation cephalosporin as initial therapy for lower respiratory tract infections in hospitalized adults affects the course and duration of care, both of which may influence antimicrobial treatment cost. DESIGN: Retrospective analysis of discharge abstracts and hospital pharmacy records. SETTING: Forty-eight US acute-care hospitals. PATIENTS: One thousand ninety-two hospitalized adults (aged > 17 y) with principal diagnoses of lower respiratory tract infections (DRGs 79-80, 89-90). INTERVENTIONS: Cefazolin or ceftriaxone, given as sole antimicrobial therapy for at least one day. MAIN OUTCOME MEASURES: (1) The number of patients who received another parenteral antibiotic anytime prior to hospital discharge; (2) the number of days during which patients received any parenteral antibiotic while in the hospital; and (3) the number of days patients remained hospitalized following the start of antibiotic therapy. RESULTS: Patients treated with cefazolin (n = 763) were more likely to receive another parenteral antibiotic while in the hospital (30.3 vs. 20.7 percent; p < 0.001) and received more total days of therapy (7.2 vs. 6.7 d; p < 0.05) than those treated with ceftriaxone (n = 329). Although the time to hospital discharge did not differ in the full sample (9.2 d for both groups), it was greater among those receiving cefazolin (8.6 vs. 8.0 d; p < 0.05) when patients with lengths of stay exceeding 24 days were excluded from both groups. CONCLUSIONS: In addition to acquisition cost, differences in course and duration of care should be considered when determining the most cost-effective choice for antimicrobial therapy.
Adolescent↗
Bayesian belief networks in quantitative histopathology.
Bayesian belief networks have a dynamic range and numeric response characteristics that make them uniquely suitable for descriptive classification schemes. Features showing considerable overlap of tolerance regions may be used, in a cumulative manner, to derive unequivocal classification decisions. The numeric response characteristics of Bayesian belief networks are analyzed, and their application as control modules in automated scene segmentation in histopathology is demonstrated.
Bayes Theorem↗
Western blots using stained protein gels.
A general method is described for the electrophoretic transfer of proteins from stained gels to membranes and subsequent Western detection of specific proteins on the stained membranes. Proteins are separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis, and the gels are stained using either of two different methods followed by electrophoretic transfer to nitrocellulose or Immobilon-P membranes. The transferred proteins remain stained during immunodetection, providing a set of background markers for protein location and size determination.
Blotting, Western↗
Expert systems in histopathology. V. DS theory, certainty factors and possibility theory.
Uncertainty management for the evaluation of evidence based on linguistic and conceptual data is taking advantage of developments in the Dempster-Shafer (DS) theory of evidence, possibility theory and fuzzy logic. The DS theory offers the capability to assess the uncertainty of different subsets of assertions in a domain and the way in which uncertainty is affected by accumulating evidence. The DS theory goes beyond probability theory in its ability to represent ignorance about certain aspects of a situation. However, the theory is very sensitive to the numerical assessments provided by users and can lead to intuitively unexpected and even undesirable results. Certainty factors are widely used in various expert systems. Their definition and updating may follow either a probabilistic model or fuzzy set theoretic concept.
Data Interpretation, Statistical↗
Expert systems in histopathology. IV. The management of uncertainty.
Expert systems deal with data that are categorical and conceptual, that represent elements of fuzzy sets and that often, by themselves, do not allow an unequivocal decision. The management of uncertainty in expert systems thus becomes a crucial issue. It involves defining measures of uncertainty and procedures for combining accumulating evidence in a manner that properly considers the dependence structure of diagnostic clues. Probability theory offers valuable procedures for uncertainty assessment; however, their practical application in the domain of quantitative histopathology and histopathologic diagnosis can be problematic.
Diagnosis, Computer-Assisted↗
Intranasal administration of a beta adrenergic amine: an alternative to metered-dose inhalers.
In anesthetized, artificially ventilated guinea pigs, intranasal and intravenous administration of albuterol produced the same maximum degree of protection against bronchoconstriction induced by bilateral electrical stimulation of the cervical vagal nerves. Intranasal albuterol showed a slower onset of action than intravenous albuterol and exhibited equivalent cardiovascular side effects for the same level of bronchoprotection. Accordingly, intranasal albuterol may represent an alternative to metered-dose inhalation for prophylaxis and treatment of bronchoconstriction in humans.
Administration, Inhalation↗