Biomedical subjects

F Jamil

Publications and source records attributed to F Jamil.

6 recordsLinked to original sources

PubMed2002

Management of immature heterotopic ossification (HO) of the hip.

A case of extensive heterotopic ossification involving the left hip in a 16 year old girl who sustained non traumatic spinal paralysis at T4 ASIA scale A. This case demonstrates the practical difficulties facing clinicians involved in the rehabilitation of this paraplegic patient who required intervention before full maturation of her left hip heterotopic ossification (HO). The patient was developing a rapidly progressive fixed scoliosis and severe difficulty in achieving a proper seating posture. In addition there was difficulty with the application of a suitable orthosis to try and limit the progression of scoliosis as a result of the HO. Discussants will comment on heterotopic ossification in general and the course of action in this particular case.

Adolescent↗

PubMed2001

Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI).

STUDY DESIGN: Review. OBJECTIVES: To assess current available options for bladder management in SCI patients the post-acute phase. METHODS: Relevant articles were extracted from medline and Cinahl between 1966--1999. In addition, references earlier than 1966 that were listed in these articles were identified and extracted. RESULTS: Catheterisation (indwelling or self intermittent) is still carried out by the majority of SCI patients with more morbidity for indwelling catheterisation. Other methods include condom drainage, suprapubic tapping and supreapubic pressure are used and are associated with less complications. Complicated procedures like sacral anterior root stimulator and entero-cystoplasty are carried out with the onset of or impending complications. CONCLUSION: Several methods of bladder management are available in the post-acute phase of SCI. The method used has to be based on urodynamic characteristics with the aim of producing a continent bladder with adequate low pressure storage capacity. Modern management of the bladder in SCI has successfully reduced renal related mortality in SCI from 95% in the first half of the 20th century to the present 3%.

Catheters, Indwelling↗

PubMed2001

CD9 immunohistochemical staining of breast carcinoma: unlikely to provide useful prognostic information for routine use.

AIMS: CD9, a cell membrane glycoprotein, is found in a variety of tumour cells and is believed to regulate cell motility and possibly cell growth. It has been reported that the absence of CD9 is associated with increased aggressiveness of breast carcinoma, but no detailed studies of the distribution of CD9 in normal and abnormal breast tissue are available. This investigation was aimed at studying the distribution of CD9 in a wide variety of breast biopsies including normal, benign, and malignant cases, and assessing its usefulness as a prognostic marker in breast cancer. METHODS AND RESULTS: Sections of 113 breast biopsies from female and male patients including 10 normal, 23 benign, and 80 malignant cases were examined. The monoclonal antibody CD9 (Novacastra Ltd, Newcastle-upon-Tyne, UK) was used with the avidin-biotin complex immunoperoxidase technique. The results were assessed semiquantitatively using a four scale system of 3+, 2+, 1+ and negative. All normal and benign epithelial cells were strongly stained (3+). In female breast carcinomas, 40% were 3+, 49% were 2+, and 11% were 1+. Both cases of male breast carcinomas scored 3+. For female breast cancers, the results were then correlated to tumour grade, the presence or absence of lymph node metastases, and oestrogen and progesterone receptor status. No significant statistical correlation was found with any of these parameters. We then examined 11 axillary lymph nodes with metastases from some of the above cases. Three of these cases had a CD9 score of 3+, seven were 2+, and one was 1+. The metastatic tumours in all 11 cases were strongly stained (3+). CONCLUSIONS: Immunostaining for CD9 is unlikely to provide any useful additional prognostic information for clinical purposes.

Antigens, CD↗

PubMed2000

Consistency of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.

OBJECTIVES: To investigate the consistency of physician judgments of treatment consent capacity (competency) for patients with Alzheimer's disease (AD) when specific legal standards (LS) for competency are used, and to identify the LS most clinically relevant to experienced physicians. DESIGN: Control and AD patient participants were videotaped being administered a measure of capacity to consent to medical treatment. Study physicians viewed videotapes of these assessments individually and made competency judgments for each participant under different LS followed by their own personal judgment of competency. SETTING: A university medical center. PARTICIPANTS: Participants were 10 older controls and 21 patients with AD (10 with mild and 11 with moderate AD). Five physicians with experience assessing the competency of AD patients were recruited from the geriatric psychiatry, geriatric medicine, and neurology services of a university medical center. MEASUREMENTS: The 31 participants were videotaped performing on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI). The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Vignette A and B assessments were videotaped separately for each participant (total videotapes for sample = 62). Each study physician viewed each videotaped vignette individually, made judgments under each of the LS (competent or incompetent), and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis. Within participant group, consistency of physician judgments was evaluated across LS and personal judgments using percentage agreement and kappa. Agreement between personal and LS judgments for the AD group was evaluated for each physician using logistic regression. RESULTS: As expected, physicians as a group generally demonstrated very high percentage agreement in their LS and personal competency judgments for the control group. For the AD group, mean percentage judgment agreement among physicians ranged from a high of 84% (LS1) (evidencing a treatment choice) to a low of 67% (LS3) (appreciating consequences of treatment choice). Mean percentage agreement for personal competency judgments was 76%. For the AD sample, kappa analyses for physicians as a group demonstrated significant agreement not attributable to chance for LS5 (understanding treatment situation/choices) (k = 0.57, P = .001), LS4 (providing rational reasons for treatment choice) (k = 0.39, P = .04), and also for personal judgments (k = 0.48, P = .009). Analysis of LS judgment agreement within physician indicated that physicians applied the LS as discrete standards. Within-physician and for the AD sample, personal competency judgments were associated significantly with judgments on LS5 (P = .001), LS4 (P = .004), and LS3 (P < .04). CONCLUSIONS: Experienced physicians demonstrated significant agreement assessing competency in AD patients when judgments were based upon specific legal standards. Personal competency judgments of physicians showed a substantially higher level of agreement than found in a previous study, where specific LS were not used. These results suggest that consistency of physician competency judgments can be enhanced if they are guided by knowledge of specific LS. Physicians' personal competency judgments were most closely associated with comprehension and reasoning LS, the most conservative and clinically appropriate standards for deciding competency.

Alzheimer Disease↗

PubMed1999

Subjective versus objective memory change after temporal lobe epilepsy surgery.

OBJECTIVE: To examine subjective versus objective memory change after anterior temporal lobectomy (ATL). METHODS: A prospective, controlled study. Controls included 39 unoperated patients with intractable temporal lobe epilepsy (TLE) who were administered a series of cognitive and health-related quality of life measures at baseline and at 12-month follow-up intervals. The surgery sample included 65 patients with intractable, focal TLE who had undergone either a right or left ATL. These patients were tested preoperatively and at 6-month follow-up intervals. Subjective and objective memory change was quantified using a newly developed methodology to control for practice effect and regression to the mean. RESULTS: Measures of subjective and objective memory change were not significantly related in the surgery sample. Prevalence of significant subjective memory decline 1 year after surgery ranged from 3 to 7%, whereas prevalence of significant objective memory decline ranged from 26 to 55%. Postoperative levels of emotional distress significantly predicted self-reported memory decline 1 year after ATL. Postoperative medication side effect and seizure outcome were also related significantly to subjective memory change in patients who had undergone left ATL. CONCLUSIONS: Subjective and objective memory change after temporal lobectomy are not related. Complaints of significant memory decline after ATL are infrequent and may serve as a marker for depression or other mood disorder rather than organically based memory decline.

Adult↗

PubMed1999

Natural-fill urodynamics in chronically catheterized patients with spinal-cord injury.

OBJECTIVE: To determine whether an indwelling catheter on free drainage provides a constantly low intravesical pressure in patients with a neuropathic bladder. PATIENTS AND METHODS: Thirty patients with complete spinal-cord injury (SCI) whose bladders were managed exclusively with an indwelling catheter were assessed urodynamically using natural-fill urodynamics (ambulatory monitoring) while their catheters were left on free drainage. Their upper urinary tracts were assessed using plain X-rays and ultrasonography. RESULTS: Detrusor contractions causing intravesical pressure rises of >40 cmH2O for up to 4.5 min were observed in 11 patients. Renal scarring was observed in nine patients; of these, six were in the group with contractions of > 40 cmH2O, whereas only five of 21 patients with normal kidneys had such pressure rises. CONCLUSION: An indwelling catheter on free drainage is no guarantee of a constantly low intravesical pressure. This study provides evidence to suggest that there is an association between phasic bladder contractions which occur despite catheter drainage and upper urinary tract damage in permanently catheterized patients with SCI.

Adult↗