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Biomedical subjects

E P Gall

Publications and source records attributed to E P Gall.

At least 19 recordsLinked to original sources
PubMed1992

AI/Learn/Rheumatology. A computer-assisted educational system for teaching about rheumatic diseases.

Education of health professionals about the rheumatic diseases is in need of improvement. The computer is an instrument that can be used efficiently to educate large numbers of users. With specific educational principles in mind, we developed AI/Learn/Rheumatology, a computer-assisted interactive videodisc system for teaching the rheumatic diseases. While interacting with the user, it conveys knowledge using visual and problem-solving techniques. The system is efficient, enjoyable to use, and useful for small groups and independent study. It is applicable for teaching medical and allied health professional students, postgraduate trainees, and primary care physicians.

Computer-Assisted Instruction↗
PubMed1991

Pharmacokinetics of the R(-) and S(+) enantiomers of ibuprofen in the serum and synovial fluid of arthritis patients.

Eight patients with arthritis and knee effusions received 13 doses of a single 800-mg ibuprofen tablet every 8 hours. Serum and synovial fluid samples were obtained after the first and last doses and assayed for the R(-) and S(+) enantiomers of ibuprofen by a stereospecific assay. Since only S(+)-ibuprofen inhibits cyclo-oxygenase, a description of the time course of this isomer in synovial fluid is needed for the development of suitable pharmacodynamic models. The isomers were significantly different with respect to peak concentrations and areas under the concentration-time curves (AUC) in synovial fluid levels. No significant accumulation of either isomer was observed in serum or synovial fluid levels between the first and the last doses. The steady-state concentration of both isomers fluctuated less in synovial fluid than in plasma, and the synovial fluid concentrations of the S(+) isomer were about twice that of the R(-) isomer. The mean synovial albumin concentration was about 60% of the serum albumin concentration, and the steady-state isomer AUC values in synovial fluid were significantly correlated with the corresponding serum values after the differences between the two fluids with respect to albumin concentration were corrected. The authors conclude that binding of the isomers to albumin and the serum-synovial fluid albumin ratio controls the steady-state distribution of the ibuprofen isomers into synovial fluid. The ramifications of these findings in the development of satisfactory concentration-response relationships are discussed.

Adult↗
PubMed1987

Lethal midline granuloma with a novel T-cell phenotype as found in peripheral T-cell lymphoma.

Lethal midline granuloma (LMG), initially a clinical description, includes an uncommon group of disorders characterized by a relentless, destructive process involving the upper respiratory structures. Its etiology and pathogenesis are uncertain, probably varied, and the distinction between inflammatory and malignant processes is difficult despite extensive clinical and histopathologic evaluation. The need for new techniques for rapid diagnosis has important therapeutic implications. Using an extensive panel of T- and B-cell monoclonal antibodies the authors describe a patient with clinically and pathologically typical LMG demonstrating an "activated" T-cell phenotype with a "novel" pattern characteristic of peripheral T-cell lymphoma, strongly implying that some cases of LMG are more closely related to neoplastic T-cell lymphoproliferative disorders than to inflammatory conditions. Further studies using these immunotyping techniques may help clarify the pathogenesis of LMG, and may uncover specific diagnostic and prognostic phenotypic patterns.

Adult↗
PubMed1986

Ibuprofen kinetics in plasma and synovial fluid of arthritic patients.

After administration of a single dose and at steady state, ibuprofen concentrations were measured simultaneously in plasma and synovial fluid obtained from eight patients with rheumatoid arthritis. By seven hours after a dose at steady state, the mean synovial fluid: plasma ibuprofen concentration ratios were constant, and the synovial fluid levels were, on average, greater than those in plasma. The extent to which ibuprofen was bound to protein was somewhat greater in plasma than in synovial fluid. As a result, the mean synovial fluid:plasma free concentration ratio for seven-hour and later specimens was greater than that based on total concentrations. The degree of accumulation of ibuprofen in each fluid was minimal, consistent with its short half-life.

Adult↗
PubMed1986

Family practice and internal medicine clinical judgment in a university setting.

There were no significant differences between family practice and internal medicine residents in the proportion of total diagnoses that were reasonable (72 percent and 77 percent, respectively) and unreasonable (14 percent and 15 percent, respectively) or average number of consultations requested per examination (.15 and .16, respectively). There was a significant difference between the two types of physicians in the average number of laboratory tests requested per examination (1.42 per family practice and 1.88 per internal medicine) and average number of x-ray examinations requested per examination (0.35 for family practice and 1.02 for internal medicine). The average length of examination for internal medicine tended to be longer than for family practice. Although generalizability of this study is limited, the results suggest that there may be important differences in the practice patterns of family practice and internal medicine with implications for training programs.

Clinical Laboratory Techniques↗
PubMed1985

Treatment of hemophilic arthritis with D-penicillamine: a preliminary report.

Current medical management programs for established joint diseases in hemophiliacs are unsatisfactory and do not modify the eventual outcome. D-penicillamine, a drug effective in the proliferative synovitis of rheumatoid arthritis, was evaluated in a rabbit model of hemarthroses-induced arthritis and in four hemophiliacs with chronic synovitis. The animals had intra-articular injections of citrate (left knees) and autologous citrated whole blood (right knees). Eight weeks later, the rabbits were divided into two groups: no treatment and D-penicillamine (50 mg/kg/day, IM) until sacrificed at 6 months. The saline-injected joints showed no inflammation and no iron deposition. The blood-injected knees showed iron deposition in both groups, the D-penicillamine animals had marked suppression of chronic inflammation. Of the four patients treated, three had clinical responses (reduction in synovial thickness, reduction in number of bleeds in the affected joint). One patient, who did not respond, developed mild-moderate proteinuria. Those patients who responded received between 5.3 and 7.1 mg/kg/day of the drug. Mild abnormalities in platelet aggregation were seen in the responders. This preliminary study suggests that D-penicillamine is beneficial in the chronic synovitis/arthritis induced by hemarthroses. Further trials are recommended.

Animals↗
PubMed1985

Assessing clinical judgment with standardized patients.

Family physicians and general practitioners see the majority of patients with uncomplicated rheumatic disease, yet information on database collection and clinical judgment in such practices is limited. Trained patients with uncomplicated rheumatic disease (standardized patients) were used to evaluate these abilities in 26 family physicians at the University of Arizona College of Medicine in blinded, but previously consented to, brief new encounters. Ability to formulate an assessment and to plan was evaluated as well as ability to collect diagnostic information. Few physicians explored the psychosocial impact of the illness (4 percent) or the role of depression (0 percent). In the brief encounter with a localized complaint, little inquiry was directed to systemic disease (46 percent). Physicians more uniformly asked about the chief complaint (96 percent) and time of onset (88 percent). Physical examination items most commonly omitted were evaluation of systemic joint involvement (69 percent) and muscle wasting in the involved area (59 percent). Referral occurred on 15 percent of encounters and patient education occurred in 62 percent. Three quarters of physicians developed an adequate assessment and virtually all developed an adequate patient care plan.

Arizona↗
PubMed1979

Hyperuricemia and gout. A modern approach to diagnosis and treatment.

Diagnosis of gout by crystal identification in synovial fluid is simple and definitive. To treat gout effectively, the physician must determine whether overproduction or underexcretion of uric acid is the underlying mechanism. The acute attack is treated initially with antiinflammatory agents. After the acute phase is controlled, lifelong definitive therapy for hyperuricemia is begun.

Allopurinol↗
PubMed1979

The zeta sedimentation ration (ZSR) as the routine monitor of disease activity in a general hospital.

Nine hundred eighty-one requests for sedimentation rates in a clinical laboratory were received and the zeta sedimentation ratio (ZSR) test was performed. The results were correlated with the patients' diagnoses and disease activity. This test was found to be a useful monitor of disease activity in a clinical setting. Substitution of the ZSR for the standard erythrocyte sedimentation rates (ESR) appears to be acceptable. The test is simple, rapidly performed, and reproducible.

Blood Sedimentation↗
PubMed1978

Psoriatic spondylitis. Association with advanced nongranulomatous upper lobe pulmonary fibrosis.

We describe the case of a patient with psoriasis, peripheral and axial arthropathy, and upper lobe fibrosis. This association of findings has not, to the best of our knowledge, been described in the past. Pulmonary fibrosis is not found to be more common in people with psoriasis than would be expected in a control Veterans Administration population and, while this association may be coincidental, pulmonary fibrosis in psoriatic spondylitis should be searched for in other patients.

Adult↗
PubMed1978

Automated rheumatoid factor assay in a population of patients with rheumatic disease.

Rheumatoid factor has been measured in 128 patients having rheumatic disease to compare the Singer-Plotz assay with an automated particle size assay. Correlation coefficient between the two methods using regression analysis revealed r = 0.89, P less than 0.00001 when two different commercial sources of sensitized latex particles were used. Thus rheumatoid factor may be quantitated electronically and represented in arbitrary units (MPRF) without altering clinical interpretation. This methodology may be applicable to many other immunologic assays.

Autoanalysis↗