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E Dillon

Publications and source records attributed to E Dillon.

30 records · Page 2Linked to original sources

Does reactivity testing in the laboratory reflect blood pressure changes elsewhere?

This study examines whether reactivity testing in a laboratory setting might identify individuals whose blood pressure (BP) fluctuates excessively outside of the laboratory. Eighty-eight normotensive and untreated hypertensive patients were studied. Patients' BPs were obtained repeatedly on two separate screening occasions. They were subsequently admitted to a research ward, and 4 days later their BPs were measured at resting baseline and in response to a series of stressful tasks. Blood pressure declined by 14/11 mm Hg +/- 1.2/1.1 mm Hg (SE) from screening to the in-patient resting baseline. The four stressful tasks all led to increases in BP over the in-patient resting baseline level. Individuals with increased amounts of task-induced reactivity in the laboratory were also more likely to be those whose BP declined the most from out-patient screening to hospitalized baseline. The average correlation between the drop in BP associated with hospitalization and the BP reactivity to each stressor task was r = 0.33 for systolic BP (p < 0.01) and r = 0.24 for diastolic BP (p < 0.05). Reactivity responses in a laboratory setting may convey information about blood pressure fluctuation in the real world.

Adult↗

Noise-induced stress as a predictor of burnout in critical care nurses.

In this study we found that, for 100 critical care nurses, noise-induced occupational stress was positively related to burnout as measured by Jones's Staff Burnout Scale for Health Professionals (r = 0.369, p less than 0.001) and the emotional exhaustion subscale of Maslach's Burnout Inventory (r = 0.300, p less than 0.01). Hierarchical multiple regressions confirmed these results once variance in burnout linked with life stressors and other occupational stressors was accounted for. Furthermore, an interaction term, noise-induced stress X intrinsic sensitivity to noise in the person, did not account for significant variance in burnout once independent variance linked with noise-induced stress was identified. That is, nurses with intrinsic sensitivity to noise were no more at risk for burnout linked with noise-induced stress than were less sensitive nurses. This result is discussed as evidence that there are exceptionally high levels of noise in critical care units. The critical care unit noises that are most distressing to nurses are identified and discussed in terms of stress theory.

Adult↗

Ultrasonography, HIDA scintigraphy or both in the diagnosis of acute cholecystitis?

The benefit of early surgery for patients with acute cholecystitis is now accepted but rapid accurate pre-operative diagnosis is important and the single best investigation has not yet been clearly established. All 47 patients with suspected acute cholecystitis admitted to a district general hospital during a 6 month period underwent ultrasonic examination and scintigraphy with HIDA within 48 h of admission. In 23 patients acute cholecystitis was proven. Ultrasound correctly diagnosed this in 21 patients but in 2, changes attributed to chronic cholecystitis only were detected. Two false positive ultrasound results also occurred, one in a patient with adenomyomatosis and acute pancreatitis, the other in a case of duodenitis. HIDA scan was diagnostic in 19 patients but in the remaining 4 the presence of abnormal liver function tests accounted for non-visualization of the biliary tree (a non-diagnostic result). In the absence of jaundice a HIDA scan is the more specific test for confirming acute cholecystitis.

Acute Disease↗

Low-frequency voltage noise in a mammalian bone cell clone.

Measurements were made of plasma membrane voltage noise in cells of a bone cell clone. The measurements were made under conditions intended to approximate in vivo conditions more closely than in previous electrical measurements on small mammalian cells. Mononucleate cells of normal size, imbedded in a collagen matrix, were used. The electrical state of the cell membrane under normal conditions was characterized by low-frequency random fluctuations (noise) of high magnitude. Hyperpolarizing spikes were observed in some cells. Power spectrum analysis revealed that the random fluctuations were actually a sum of incoherent spike patterns, with spikes of the same time width as those seen in the clearly spiking patterns. This analysis, combined with similar measurements in a high [K+], low [Na+] medium, showed that the fluctuation/spiking phenomenon resulted from modulation of K+ and Na+ transport by a control process at a level higher than that of the individual channels. This process persisted when the membrane potential was depolarized. These results indicate that the membrane potential is not part of the feedback loop producing the fluctuation/spiking phenomenon.

Animals↗

High bile duct cancer: incidence and pattern of investigation in the General Hospital setting.

Between 1 April 1977 and 30 November 1979, 16 cases of high bile duct carcinoma presented at North Tees District Hospital, giving an incidence of one per 40000 population per annum for Teesside. Results of this prospective study emphasize the potential accuracy of preoperative assessment using techniques which should be available in a district general hospital. Ultrasound revealed the site of obstruction in every patient in whom it was used (n = 13), and often indicated a neoplastic aetiology (n = 10). Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiography (ERC) correctly demonstrated the site of obstruction in each patient and suggested a primary bile duct carcinoma in 12 patients. Although intraoperative cholangiography gave additional information in some patients, it was not sufficiently reliable to dispense with either PTC or ERC. Histological proof of a primary bile duct carcinoma was obtained in 15 patients. In the 10 patients without obvious metastatic disease frozen section analysis was positive in 7, but was negative in 3 patients with multiple strictures where malignant cells were relatively infrequent and were found in the perineural lymphatics on paraffin sections. In this difficult group of patients the approach described eliminates the possibility of a false negative laparotomy, enables careful planning of the necessary surgical technique and also the consideration of nonoperative management.

Adult↗

The diagnosis of primary bile duct carcinoma (cholangiocarcinoma) in the jaundiced patient.

One hundred and ten patients with obstructive jaundice were investigated in the established manner; an initial abdominal ultrasonic B scan was followed by fine needles percutaneous transhepatic cholangiography (PTC) and/or endoscopic retrograde cholangiography (ERC). This yielded 15 cases of histologically proven primary bile duct carcinoma (cholangiocarcinoma), which is an incidence of 13.6%. Primary bile duct carcinoma is suggested on ultrasonic examination by: (i) Attenuation of the ultrasound beam in the bile duct area especially if the shadowing is multiple and/or from the intrahepatic ducts. (ii) Delineation of a mass associated with the bile ducts. (iii) A high level of duct obstruction with a normal pancreatic appearance. On direct cholangiography a stricture of the duct system which is branched, short, multiple or tapering also suggests primary bile duct malignancy. It is possible to diagnose primary bile duct carcinoma on ultrasonic examination alone once this condition is recognised as occurring with significant frequency. PTC and ERC aid delineation of the extent of the tumour and exclude biliary duct stone as the cause of jaundice.

Adenoma, Bile Duct↗

The role of upper abdominal ultrasonography in suspected acute cholecystitis.

Ultrasonic investigation of the upper abdomen was performed as an initial imaging procedure in 117 consecutive patients regarded on clinical examination as probably suffering from acute cholecystitis. All patients were studied within 72 h and the majority within 48 h of admission. All were followed up for a minimum of 12 months and the ultimate clinical diagnosis recorded and compared with the initial ultrasonic diagnosis. Despite the clinical suspicion at referral, only about half were ultimately found to have biliary tract or closely related pathology. In a further 10% totally unexpected and unrelated causes for the symptoms were detected. 87% of gallstones were detected on the initial ultrasonic examination, which compares well with previously reported series. In all cases where there was a right upper quadrant mass at presentation, the organ from which this arose was demonstrated. The results of this initial study indicate that upper abdominal ultrasonic examination is a valuable inital screening procedure in patients presenting with acute right upper abdominal symptoms.

Abdomen↗

The role of diagnostic radiology in the diagnosis and management of rhabdomyosarcoma in young persons.

Rhabdomyosarcoma is a rare tumour of mesenchyme-like tissue in which differentiation of rhabdomyoblasts has occurred. It is found mainly in infants and children. The prognosis, until recent years very grave, has been improved by a combination of chemotherapy and radiotherapy occasionally with surgery. Survival depends on the extent of the disease at the time of diagnosis. Diagnostic radiology has an important role to play in the demonstration of this, illustrations of which are given from a series of seven cases. The primary tumour has no pathognomonic appearances and is demonstrated essentially as a soft tissue mass lesion which displaces adjacent soft tissue structures such as arteries, veins, bladder and colon, or erodes adjacent bones whether in the extremities or the skull. The main role of diagnostic radiology is the detection of metastases. Chest radiography and skeletal survey are mandatory. Lymphangiography may reveal filling defects in regional lymph nodes but these are indistinguishable from any other metastases. Arteriography as well as revealing displacement of larger vessels, may show typical tumour neovascularity in the lesion. Serial skeletal radiographs are of help in assessing response of metastases to therapy.

Adolescent↗

Race and sex differences in cardiovascular recovery from acute stress.

To evaluate the effects of race and gender on recovery, i.e. the relative return to baseline after a stress challenge, cardiovascular and catecholamine measures were examined before, during and after two standardized laboratory stressors (a speaking and a mirror tracing task) in a group of 85 Black and White men and women (mean age 35.6 years, range 20 to 52). For the speech task, White men showed the least systolic (p < 0.025) and diastolic (p < 0.05) blood pressure recovery as compared to Black men and women. For the mirror star tracing task, total peripheral resistance (p < 0.03) recovery was least for Whites as compared to Blacks and heart rate (p < 0.04) recovery was least for White women as compared to Black women and men. There were no significant group effects in terms of catecholamine recovery from either task. The findings extend prior studies on race and gender by suggesting that these same characteristics affect recovery from stressors.

Acute Disease↗

The stress interview as a tool for examining physiological reactivity.

Most studies of cardiovascular reactivity utilize tasks that are highly standardized and controlled. However, there is some concern whether the information obtained from these tasks is relevant to understanding the cardiovascular responses to behavioral stimuli encountered in real life. Historically, various forms of a stress interview have been used to examine physiological concomitants of emotional arousal. However, these tools fell into disuse because of ethical concerns, their intensive time requirements, and the perception that the interviews could not be standardized. We have developed a short (16-minute) interview that is not aversive or threatening. In studies on 24 normotensives and 19 hypertensives, the interview elicited greater blood pressure elevations than those elicited by mathematical calculations or cold pressor (p less than 0.0001). The interview increased systolic and diastolic pressures by 38/32 mm Hg in hypertensives and 31/24 mm Hg in normotensives. The variance in BP elicited by this interview is not appreciably greater than that found in highly structured tasks such as mathematical calculations. The test-retest stability of the interview is comparable to that of resting baseline blood pressure and is superior to that of mathematical calculations or cold pressor. Techniques such as the interview may be at least as useful as highly standardized tasks and possibly more valid as models for examining cardiovascular reactivity.

Adult↗

Effects of chronic stress on beta-adrenergic receptors in the homeless.

This study examined the role of chronic life stress (homelessness), coping style, and hypertension on beta-adrenergic receptors in a sample of homeless men. Sixteen healthy normotensive subjects and nine untreated hypertensive subjects were studied. Life stress was measured with the Brown and Harris categorization; coping style was measured with the Ways of Coping Scale. Lymphocyte beta-adrenergic receptors were characterized in terms of receptor density (Bmax). Individuals with high life stress had lower Bmax (p < .005). In multiple regression analyses, 50% of the variance in Bmax was accounted for by life stress and coping style (p = .01). Receptor measures may be useful for characterizing the physiological response to continuing life adversity.

Adaptation, Psychological↗