Giant Meckel's diverticulum with enterolith formation.
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Aged↗
Biomedical subjects
E Donaldson
Publications and source records attributed to E Donaldson.
Novel WT1 exon 9 mutation (D396Y) in a patient with early onset Denys Drash syndrome.
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Amino Acid Substitution↗
Cutaneous histiocytic lymphangitis: an unusual manifestation of rheumatoid arthritis.
Two cases are presented of unusual cutaneous lesions associated with rheumatoid arthritis in underlying joints. The lesions were evanescent, erythematous and violaceous partly macular and partly indurated plaques, with a livedo-like pattern of erythema at the edge in one case. Histological changes were identical in the two cases. The major features were dilated, dermal lymphatics containing aggregates of inflammatory cells, mainly histiocytes, with adjacent perivascular lymphoid aggregates. An appropriate name for this reaction would appear to be cutaneous histiocytic lymphangitis.
Arthritis, Rheumatoid↗
An airline cardiac arrest program.
BACKGROUND: As many as 1000 lives are lost annually from cardiac arrest in commercial aircraft. Ventricular fibrillation (VF), the most common mechanism, can be treated effectively only with prompt defibrillation, whereas the current policy of most airlines is to continue cardiopulmonary resuscitation pending aircraft diversion. The objective of this study was to assess the impact of making semiautomatic external defibrillators (AEDs) available for use on airline passengers with cardiac arrest. METHODS AND RESULTS: AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation. Supervision was provided by medical volunteers or (remotely) by airline physicians. During a 64-month period, AEDs were used on 109 occasions: 63 times for monitoring an acutely ill passenger and 46 times for cardiac arrest. Twenty-seven episodes of cardiac arrest occurred in aircraft, often (11 of 27 [41%]) unwitnessed, and they were usually (21 of 27 [78%]) associated with asystole or pulseless idioventricular rhythm. All 19 arrests in terminals were witnessed; VF was present in 17 (89%). Overall, defibrillation was initially successful in 21 of 23 cases (91%). Long-term survival from VF was achieved in 26% (2 of 6 in aircraft and 4 of 17 in terminals). The ability to monitor cardiac rhythm aided decisions on diversion, which was avoided in most passengers with asystole or idioventricular rhythm. CONCLUSIONS: AEDs in aircraft and terminals, with appropriate crew training, are helpful in the management of cardiac emergencies. Survival from VF is practicable and is comparable with the most effective prehospital ambulance emergency services. Costly aircraft diversions can be avoided in clearly futile situations, enhancing the cost-effectiveness of the program.
Aircraft↗
First aid in the air.
BACKGROUND: First aid is commonly required during commercial aircraft flights, especially during international flights. An intimidating and sometimes threatening array of in-flight medical emergencies challenge the doctor, flight attendants and other passengers in such medical emergencies. Cramped conditions, difficulties of access to the victim, lack of privacy, cultural and language differences and noise and vibration all compound to increase the difficulties of the normal first aid drills which are required in the management of in-cabin emergencies. Doctors who fly as passengers are liable to be called upon to render first aid in the air. We provide an analysis of the types of medical emergencies encountered during commercial air travel. METHODS: We have reviewed all consecutive in-flight medical incident reports for QANTAS international flights for 1993. All incidents requiring the attention of a doctor were included. RESULTS: A total of 454 significant medical incidents occurred. These included, in rank order, syncope (35%), angina and cardiac emergencies (23%), gastrointestinal conditions (13%), respiratory tract infections and asthma (9%) and anxiety and panic reactions warranting medical intervention (5%). CONCLUSIONS: Syncope, the management of gastrointestinal symptoms and problems of angina comprise over half (58%) of the presenting symptoms which confront a fellow traveller who may coincidentally be a medical practitioner. Problems of anxiety, sleeplessness, airport bustle, immobility, barotrauma, alcohol abuse and mild hypoxia are discussed in the context of precipitating factors which may trigger an in-flight emergency. Psychological problems are very common and challenge the first aider, whether or not he or she is medically trained. We emphasize the necessity for doctors and nurses to be trained in first aid, as a distinct profession in its own right and a series of drills and skills which are distinctive from those of surgery-based health care. The 5% annual increase in air-passenger traffic, predicted for the next two decades, highlights the importance of special training for "first aid in the air'.
Aerospace Medicine↗
Management of ventricular fibrillation in commercial airliners.
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Aerospace Medicine↗
Helicobacter pylori in patients undergoing upper endoscopy in Jamaica.
One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55%) were positive for H. pylori. Of male patients, 36 (60%) and of female patients, 20 (48%) tested positive. Sixty-eight per cent of patients with antral gastritis, 65% with duodenal ulcer and 60% with gastric ulcer had H. pylori. Thirty-nine patients (70%) positive for H. pylori were from major urban areas, and 17 (30%) were from rural areas of Jamaica. In patients without H. pylori, 61% and 39% were from urban and rural areas, respectively. Forty-four patients (79%) with H. pylori and 40 (87%) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88% had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection.
Duodenitis↗
Pancreatic cytology and adenosquamous carcinoma of the pancreas.
Primary carcinoma of the pancreas exhibiting squamous differentiation is unusual. We present such a case which was diagnosed by percutaneous fine needle aspiration biopsy. A cytological diagnosis of squamous cell carcinoma lead to the question: was the tumour primary or secondary? Subsequent post-mortem examination confirmed a primary carcinoma of the head of the pancreas with predominantly squamous differentiation and a small component of glandular differentiation. Cytologic diagnosis of squamous cell carcinoma should prompt a review of clinical and radiologic data. Evidence of a malignant glandular component should also be sought.
Aged↗
Defibrillators on Qantas aircraft.
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Aircraft↗
Predictive value of specimen histology after preoperative radiotherapy in the treatment of bulky/barrel carcinoma of the cervix.
One hundred thirty-four patients with bulky and barrel-shaped cervix cancers were treated with preoperative radiation to 40-45 Gy, intracavitary therapy using Cs-137 or Cf-252 and extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) 4-6 weeks after radiotherapy. Outcome of therapy was traced for patients with residual tumor (positive) in the hysterectomy specimen and those who had no residual tumor (negative) in the specimens. All specimens were studied by a set protocol to carefully evaluate the TAHBSO specimen for gross or residual tumor. Ninety-two percent of the patients with negative specimens survived 5 years, but this dropped to 71% if the specimen was positive. These findings were observed in both the Cs-137- and Cf-252-treated patients. Patients with negative specimens failed mainly in distant sites, whereas those with positive specimens failed locally and distantly. Patient survival was less in patients with positive specimens. There was no difference in outcomes for adenocarcinoma and squamous cell carcinomas. The specimen histological findings have predictive value in patients treated with preoperative radiation and surgery.
Actuarial Analysis↗
Specimen findings and survival after preoperative 252Cf neutron brachytherapy for stage II cervical carcinoma.
Twenty-seven patients with operable Stage II cervical cancer with a mean diameter tumor of 8.0 cm were studied in a feasibility study using preoperative 252Cf implants plus whole-pelvis radiation to 45 Gy followed by extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy 4 to 6 weeks later. Hysterectomy specimens were studied by a set protocol. With the protocol used, 13/27 (51%) specimens and abdominal stagings were negative for residual tumor. The survival rate for the patients with negative findings was 93% at 5 years. In 14/27 (49%) patients the specimens were positive for residual tumor. In contrast, the 5-year survival rate for this group was 46% (P less than 0.001). In these patients several interrelated factors were determined to be of importance, i.e., (1) tumor size greater than 8 cm in maximum diameter, (2) positive or negative residual tumor status, and (3) total dose of radiation given. Survival was lower for larger tumors and specimens were more likely to show residual tumor. A lower treatment dose led to more positive specimens, as well as to poorer survival. While the patients with Stage II disease fared very well when negative specimens were found, further prospective studies of the appropriate treatment for those with positive tumor specimens are needed.
Brachytherapy↗
Effects of temazepam on sleep, performance, and rhythmic 6-sulphatoxymelatonin and cortisol excretion after transmeridian travel.
The effects of 20-mg doses of the short-acting benzodiazepine, temazepam, on sleep, performance and pineal, adrenal and temperature rhythms were investigated in a placebo-controlled, double-blind crossover study. Ten healthy males were studied 4 d prior to flying from Sydney to London via Tokyo and Anchorage (11 time zones). Temazepam or placebo were administered at 2300 hours (local time) during the flight and for 4 d after arrival. After a 7-d recreation break in London, the subjects returned to Sydney via Moscow and Tokyo and again took five doses of temazepam or placebo. During the 5 d following their arrival in London or Sydney, the subjects collected urine, had rectal temperature monitored, performed a battery of performance tests and filled out questionnaires. Temazepam significantly improved various subjective sleep characteristics, particularly on the first few nights. Performance (choice reaction time, critical flicker fusion threshold and pencil and paper tests) was not impaired by temazepam treatment. The pineal rhythm was assessed by urinary 6-sulphatoxymelatonin excretion rate determinations. The time of peak 6-sulphatoxymelatonin excretion (acrophase) occurred progressively later each day after arrival in London and Sydney, however the rate of adjustment of the rhythm was not affected by temazepam. Similarly, the urinary cortisol and temperature rhythms adjusted to the new environments by progressive delay with no drug effect being evident. Administration of temazepam clearly had a beneficial effect on sleep and alertness following transmeridian travel, without detrimental effects on performance. There was no evidence to suggest that temazepam altered the rates of entrainment of physiological rhythms to the new environments.
Adult↗
Group C streptococcal meningitis.
Group C streptococci have been infrequently described as human pathogens. A case of meningitis caused by Streptococcus dysgalactiae, in a 73-year-old man with alcoholic liver disease, was treated successfully with penicillin and chloramphenicol.
Aged↗
Dose-response and failure pattern for bulky or barrel-shaped stage IB cervical cancer treated by combined photon irradiation and extrafascial hysterectomy.
From 1975 to 1987, 80 patients with bulky or barrel-shaped Stage IB cervical cancer were treated with preoperative irradiation and Cs-137 intracavitary implant therapy, before a planned extrafascial abdominal hysterectomy, using a consistent treatment policy. Of the hysterectomy specimens obtained, 37% were positive histologically at 89 +/- 2.3 days after the start of radiotherapy and at 4 to 6 weeks after the completion of radiation therapy. Sixty-three percent were negative after a total external and internal cervix irradiation dose of 9642 cGy at point T. The average point A dose contributed by intracavitary therapy was 2104 cGy. The survival rate at 5 years was 84%: At 10 years the survival rate was 78%. The failure pattern was analyzed for patients who had positive and negative specimens. The patients with positive specimens failed pelvically or pelvically and distantly. Patients with negative specimens failed in extrapelvic or distant metastatic sites. Preoperative radiotherapy led to excellent local and pelvic control of tumor, and the failures became predominantly distant metastases. The combined radiosurgical therapy was tolerated well and allowed surgical staging of disease. This permitted earlier and selective consideration of adjunctive therapy (i.e., paraaortic irradiation, chemotherapy, or chemoradiotherapy). The dose-response data give insight into the effects of photon radiotherapy on bulky or barrel Stage IB cervical cancers and correlate histologic status with failure pattern, outcome, and long-term survival.
Adult↗
Detection of temporal gaps in sinusoids by normally hearing and hearing-impaired subjects.
A two-alternative forced-choice task was used to measure psychometric functions for the detection of temporal gaps in a 1-kHz, 400-ms sinusoidal signal. The signal always started and finished at a positive-going zero crossing, and the gap duration was varied from 0.5 to 6.0 ms in 0.5-ms steps. The signal level was 80 dB SPL, and a spectrally shaped noise was used to mask splatter associated with the abrupt onset and offset of the signal. Two subjects with normal hearing, two subjects with unilateral cochlear hearing loss, and two subjects with bilateral cochlear hearing loss were tested. The impaired ears had confirmed reductions in frequency selectivity at 1 kHz. For the normal ears, the psychometric functions were nonmonotonic, showing minima for gap durations corresponding to integer multiples of the signal period (n ms, where n is a positive integer) and maxima for durations corresponding to (n - 0.5) ms. For the impaired ears, the psychometric functions showed only small (nonsignificant) nonmonotonicities. Performance overall was slightly worse for the impaired than for the normal ears. The main features of the results could be accounted for using a model consisting of a bandpass filter (the auditory filter), a square-law device, and a sliding temporal integrator. Consistent with the data, the model demonstrates that, although a broader auditory filter has a faster transient response, this does not necessarily lead to improved performance in a gap detection task. The model also indicates that gap thresholds do not provide a direct measure of temporal resolution, since they depend at least partly on intensity resolution.
Aged↗
Feasibility study of Californium-252 for the therapy of stage IV cervical cancer.
Twenty patients with Stage IVA and IVB cervic cancers were treated with Californium-252 (Cf) neutron brachytherapy (NT) in a feasibility trial between 1976 and 1986. Eleven patients had Stage IVA disease; nine patients had Stage IVB disease. Patient compliance with therapy was poor in four of nine patients with Stage IVB disease, and the 50% survival time was 6 months. In Stage IVA disease there were 18% 3-year survivals. For those that failed, the 50% survival time was 7.5 months. Because of the frequency of disseminated metastases, effective adjuvant therapy needs to be developed to use after the tumor debulking therapy, especially for Stage IVB disease. A single early Cf-NT implant followed by 6000 cGy of whole-pelvis fractionated radiation would accomplish this adequately for local tumor control and palliation.
Adult↗
Efficacy of brachytherapy with californium-252 neutrons versus cesium-137 photons for eradication of bulky localized cervical cancer: single-institution study.
A fast-neutron-emitting radioisotope, 252Cf, is being tested in clinical trials of neutron brachytherapy for cervical cancer. The efficacy for histological eradication of bulky stage IB cervical tumors (mean diameter, approximately 6 cm) using combined radiation and surgery was studied in 65 patients treated with 137Cs or 252Cf before surgery during 1983-1986. Forty-four patients were treated with 137Cs and 21 were treated with 252Cf at equivalent doses of radiation. Fifteen of the 44 specimens (34%) were positive after 137Cs therapy. Only one of the 21 specimens was positive after 252Cf therapy (P = .025), and that patient was treated in a delayed schedule 21 days after the start of external-beam irradiation rather than early in the course. 252Cf therapy required a much lower radiation dose and shorter treatment time. The study compared tumor destruction of an identically staged human cervical tumor in situ by direct histological means, using 252Cf neutron therapy or conventional photon therapy at an identical and equivalent dose adjusted by a relative biological effectiveness of 6.0 for 252Cf.
Adult↗
Patient-controlled analgesia using butorphanol for postoperative pain relief: an open-label study.
Patient-controlled analgesia (PCA) has been studied extensively for the treatment of postoperative pain using narcotic analgesics. Butorphanol, a nonnarcotic injectable analgesic, has not previously been investigated using this drug delivery mechanism. Twenty-five patients undergoing general abdominal surgery and general anesthesia used a PCA device with butorphanol as the analgesic agent. Most patients (84%) were able to obtain excellent postoperative pain relief. The role of butorphanol in the management of postoperative pain should be expanded to include patient-controlled drug delivery.
Adult↗