Computer database for palliative care.
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Biomedical subjects
Publications and source records attributed to F Murphy.
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Colorectal leiomyosarcoma (CLM) is an uncommon tumour. Reports of its occurrence have been published mostly as single cases or small series. This study documents 12 cases of CLM that were seen over a 28-year period in Saskatchewan. The annual incidence of CLM was 0.45 per million people and constituted 0.12% of all colorectal malignant tumours seen during the study period. CLMs had a predilection for the rectum and sigmoid and commonly were associated with rectal bleeding or abdominal pain. More than half the tumours were detected by sigmoidoscopy. A correct preoperative or intraoperative histologic diagnosis of leiomyosarcoma was made in only two out of six cases. A potentially curative surgical procedure was done in 10 of the 12 patients. The mean follow-up was 6.9 years. Eight patients had tumour recurrence or metastasis, or both. From the findings of this study the authors recommend wide excision of colorectal smooth-muscle tumours whenever there is a suggestion of malignancy.
Tourette's Syndrome was first described by Gilles de la Tourette in 1885. Previously thought to be a rare neuropsychiatric disorder, its prevalence is now estimated at 0.05%. In Canada, this would mean approximately 12,000 people are affected. The rapid growth of knowledge in the neurosciences has led to better understanding and treatment of this disorder. Tourette's Syndrome is characterized by motor tics, usually beginning in the face and progressing to other areas, and by vocal tics, such as hissing, snorting, and barking. Fifty percent also develop copralalia. The age of onset is between 2 and 15 years of age but its complex symptomatology and its waxing and waning course delays diagnosis. This paper will describe the disease process including etiology, signs and symptoms, and treatment. The main focus will be on a case study which will depict how this syndrome affected the life of one woman. The multidisciplinary approach required to assist the severely affected individual to return to her family following successful treatment will be described.
OBJECTIVE: To assess the role of aminophylline in the treatment of acute exacerbations of bronchospastic disease when used in addition to inhaled beta-agonists and intravenous corticosteroids. DESIGN: Randomized, double-blind, placebo-controlled intervention study. PATIENTS: One hundred thirty-three adult patients with either asthma or chronic obstructive pulmonary disease who presented to the emergency department with asthma or wheezing. INTERVENTIONS: All patients received therapy with both aerosolized metaproterenol and intravenous methyl-prednisolone. Patients were randomly assigned to receive either a loading dose of aminophylline followed by a routine infusion (n = 65) or an equal volume of placebo as a loading dose and infusion (n = 68). MEASUREMENTS AND MAIN RESULTS: At discharge from the emergency department, the median serum theophylline concentration for the aminophylline group was 54 mumol/L (9.7 mg/L). The two groups showed no differences (P greater than 0.2) in measurements of forced expiratory volume at 1 second (FEV1), forced vital capacity (FVC), or peak expiratory flow rate (PEFR) at baseline or at 60 or 120 minutes after aminophylline administration. Neither patient satisfaction nor physician assessment of response to therapy differed between the two groups. There was no difference (P greater than 0.2) in the frequency of side effects, except for a trend toward a higher frequency of nausea (P = 0.13) in the aminophylline group. There was, however, a threefold decrease in the hospital admission rate for patients treated with aminophylline (6%) compared with placebo recipients (21%) (P = 0.016). CONCLUSION: Aminophylline, in doses producing levels just below the commonly accepted therapeutic range, appears to decrease hospital admissions in patients with acute exacerbation of asthma or chronic obstructive pulmonary disease. This finding, if confirmed in larger studies, may represent a substantial cost savings.
A 7-year-old girl had a 4 X 3 X 3 cm nodule on the left wrist with axillary lymphadenopathy. Acid-fast bacilli were seen on a smear from a biopsy specimen of this granulomatous skin lesion. A Rhodococcus species grew on culture. Skin infections caused by Rhodococcus may be more common than the few prior case reports suggest.
The effect of calcium and selected calcium antagonists on the lung phospholipid secretion associated with lung distension was examined in newborn rabbits. Lung distension was produced by saline lavage or air inflation in freshly killed pups. Calcium or calcium antagonists were added to the lavage solution. The fractional stimulation of secretion with 1.0 mM calcium was 1.94 +/- 0.28 (p less than 0.01), but ethylene diamine tetraacetic acid (EDTA) did not have the expected inhibitory effect. There was dose-related inhibition of phospholipid secretion induced by the calcium antagonist, lanthanum, the fractional recovery decreasing from 1.0 +/- 0.23 at 10(-5) molar, to 0.43 +/- 0.19 at 0.5 x 10(-4) molar, to 0.22 +/- 0.03 at 10(-4) molar and 0.19 +/- 0.05 at 10(-3) molar (p less than 0.001). This inhibition was significantly reversed by the addition of 10 mM calcium. Although nifedipine and verapamil had no effect, nickel and cadmium also inhibited secretion. Therefore, it is likely that lanthanum acted as a calcium channel blocker, suggesting the importance of extracellular calcium. The observation that intense calcium chelation with ethylene glycol bis-aminoethylether tetraacetic acid-bis-aminophenoxyethane tetraacetic acid (EGTA-BAPTA) had a significant inhibitory effect, supports the conclusion that a superficial calcium pool in the plasma membrane may be an important stimulus for phospholipid secretion during lung distension. The inhibitory effect of neomycin, a drug known to displace superficial calcium, was consistent with this conclusion.
The community organization and development process is not new and has its roots in social action ideology from the 1960s. The difference between the 1960s and the 1990s is in bringing together of target community consumers with representatives of private and public sector resources (with consumers in the majority), to form a community coalition board. This community coalition board must make policy decisions. Combining these community organizers and development techniques with the mission of health promotion is a viable methodology for addressing the needs of medically underserved and unserved communities. The approach is a multifactorial one, as illustrated in Figure 1. The Health Promotion Resource Center at Morehouse School of Medicine seeks to combine the ideology of community organization and development with culturally sensitive and linguistically appropriate health promotion curriculum materials and intervention strategies. Within the HPRC lies the Statewide Coordinating Center for Georgia which has been funded by the Henry J. Kaiser Family Foundation. Its mandate is to assist minority and poor communities in Georgia in developing community-based health promotion initiatives which address the areas of cancer, cardiovascular disease, adolescent pregnancy, substance abuse, and violence and unintentional injury. Our strategy in carrying out this mandate is the community organization and development model described in this article.
Liver abnormalities were found in three patients with fetal alcohol syndrome. The histological appearance was different in each case. Thick, sclerotic central veins were seen in two of the three cases. One patient had features typical of congenital hepatic fibrosis and cystic disease of the kidneys. Findings in these patients indicate that some cases of congenital hepatic fibrosis might be caused by high maternal alcohol ingestion in pregnancy.
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Oxygen uptake and effects of pro- and antioxidants have been compared at 80 C in lyophilized red blood cell (RBC) bilayer membranes (ghosts). In this dry and relatively immobile system, catalytic metals have pronounced effects. When ghosts are prepared in the usual manner, in phosphate buffer, hypotonic saline, or deionized water (DI), oxygen uptake is extremely slow and limited unless: (a) catalytic metal, e.g. cobaltous ion, is supplied in the absence of metal-complexing buffers and (b) residual phosphate buffer is removed by repeated deionized water or hypotonic saline washes. Ghosts adsorb d-alpha-tocopherol strongly from 1% alcohol emulsion in buffer in amounts far above normal RBC concentrations, whereas synthetic antioxidant uptake seldom exceeds the normal tocopherol level. Uptake and effectiveness of antioxidants introduced by either perfusion or in the vapor phase, and resistance of ghosts to autoxidation introduced by either perfusion or in the vapor phase, and resistance of ghosts to autoxidation are discussed as they relate to protection of lyophilized membranes and freeze-dried foods.
Before the introduction of endoscopy, four out of 720 cases of gastric cancer were diagnosed before the cancer had breached the muscularis propia, an incidence of 0.5%. Using endoscopy and endoscopic biopsy, 10 out of 101 cases of gastric cancer were diagnosed at this "early" stage, an incidence of 10%. Their clinical, morphological, and histological characteristics are compared with those of Japanese "early gastric cancers" and reveal a remarkable similarity. The results of this study suggest that a higher proportion of British gastric cancers could be diagnosed at an "early" stage by more intensive investigation of dyspeptic patients using up to date radiological techniques, fibreoptic endoscopy, and endoscopic biopsy.
Squamous cell papilloma of the esophagus is rare. Seven well-documented cases have been reported in the English literature. Three further cases are presented, in one of which symptoms were related to the tumour. Although there is no proof that this lesion is premalignant, coincident cancer must be excluded. In each of the authors' cases, endoscopic removal of the tumour was possible. The etiology of esophageal squamous cell papilloma has not been established.
An investigation of noise levels in a hospital ward, a cubicle off the ward, and an intensive therapy unit (ITU) showed that the noise levels in all three areas were higher than internationally recommended levels at all times of day. Loud noises above 70 dB(A) were common in all areas but especially the ITU. The noise pollution levels reached annoying values during the day in the ward and cubicle and during both the day and the night in the ITU. Equipment and conversations among the staff were the main causes of noise in the ITU. These noisy environments are unlikely to help patients recover. Although measures designed to eliminate noisy surfaces will help, making staff aware of the noise they create and the effects it has may be much more effective in reducing noise pollution.
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Orungo virus was studied in cell culture and mice by light and electron microscopy. The virus developed in the cytoplasm of infected cells in mouse brain and cell culture in association with a specific viral granular matrix and accompanying filaments. Virus particle size was 63 nm with a core diameter of 34 nm. Most particles were released from infected cells by lysis, but some budded through membranes and assumed a "pseudoenvelope". In its morphology and mode of morphogenesis, Orungo virus was indistinguishable from other described orbiviruses.
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