Management of spontaneous pneumothorax.
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Chest Tubes↗
Biomedical subjects
G Simpson
Publications and source records attributed to G Simpson.
Scale and corrosion control with combined dolomite/calcite filter.
Water quality is a major operational issue for boiler operation and control. If the water is hard scale control is required and if it is soft then corrosion control is an issue. Here a two stream boiler test rig has been used to test the effect a fixed bed filter has on the scaling and corrosion properties of both hard and soft waters. The filter effectively controlled the pH, hardness and alkalinity of both waters leading to significant decreases in scale formation and effective control of corrosion.
Calcium Carbonate↗
Successful treatment of empyema thoracis with human recombinant deoxyribonuclease.
Fibrinolytic enzymes, particularly streptokinase, are now widely used to treat empyema thoracis. Recent in vitro evidence suggests that streptokinase has no effect on pus viscosity but that deoxyribonuclease (DNase) reduces the viscosity of pus. We report the first use of human recombinant DNase given intrapleurally to treat an empyema which had not resolved after standard treatment with streptokinase.
Aged↗
Management of chronic obstructive pulmonary disease in the twenty-first century.
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Anti-Inflammatory Agents↗
Anaphylactoid reactions associated with menstruation affecting two sisters.
Cyclical anaphylactoid reactions associated with menstruation are exceedingly rare. We report two sisters who were both affected, one severely and one mildly. Treatment involved suppression of menstruation and use of a cyclooxygenase-2 (COX-2) inhibitor. An abnormal reaction to prostaglandins, perhaps produced by COX-2 enzyme activity in the endometrium, is a possible mechanism.
Adult↗
A probabilistic atlas and reference system for the human brain: International Consortium for Brain Mapping (ICBM).
Motivated by the vast amount of information that is rapidly accumulating about the human brain in digital form, we embarked upon a program in 1992 to develop a four-dimensional probabilistic atlas and reference system for the human brain. Through an International Consortium for Brain Mapping (ICBM) a dataset is being collected that includes 7000 subjects between the ages of eighteen and ninety years and including 342 mono- and dizygotic twins. Data on each subject includes detailed demographic, clinical, behavioural and imaging information. DNA has been collected for genotyping from 5800 subjects. A component of the programme uses post-mortem tissue to determine the probabilistic distribution of microscopic cyto- and chemoarchitectural regions in the human brain. This, combined with macroscopic information about structure and function derived from subjects in vivo, provides the first large scale opportunity to gain meaningful insights into the concordance or discordance in micro- and macroscopic structure and function. The philosophy, strategy, algorithm development, data acquisition techniques and validation methods are described in this report along with database structures. Examples of results are described for the normal adult human brain as well as examples in patients with Alzheimer's disease and multiple sclerosis. The ability to quantify the variance of the human brain as a function of age in a large population of subjects for whom data is also available about their genetic composition and behaviour will allow for the first assessment of cerebral genotype-phenotype-behavioural correlations in humans to take place in a population this large. This approach and its application should provide new insights and opportunities for investigators interested in basic neuroscience, clinical diagnostics and the evaluation of neuropsychiatric disorders in patients.
Adult↗
Social, neuroradiologic, medical, and neuropsychologic correlates of sexually aberrant behavior after traumatic brain injury: a controlled study.
OBJECTIVE: To identify social, neuroradiological, medical, and neuropsychological correlates of sexually aberrant behavior (SAB) after traumatic brain injury (TBI). DESIGN: A controlled study using a retrospective file review. SETTING: A brain injury unit providing inpatient and outpatient rehabilitation services. PARTICIPANTS: A sample of males (n = 25) exhibiting SABs and a control group (n = 25) matched for gender, severity of injury, age at injury, and time after injury. MAIN OUTCOME MEASURES: A protocol that recorded data on demographic, injury, radiological, medical, and neuropsychological variables. RESULTS: The SAB group had a significantly higher incidence of postinjury psychosocial disturbance in areas of nonsexual crime and failure to return to work than the matched TBI group. There were no significant differences between the two groups in the incidence of premorbid psychosocial disturbance or postinjury radiological, medical, or neuropsychological variables. CONCLUSIONS: The study results caution against simplistic explanations of SAB as the product of damage to the frontal-lobe systems or premorbid psychosocial disturbance. Furthermore, the results suggest that a wide-ranging assessment of people with TBI who exhibit SABs is required, because results of neuropsychological examination alone cannot be considered conclusive. Future research into the etiology of SABs could examine additional factors such as lack of insight, lack of empathy, and premorbid history of family dysfunction.
Adult↗
Modeling the interactions between a prosthetic socket, polyurethane liners and the residual limb in transtibial amputees using non-linear finite element analysis.
Continuing earlier studies into the relationship between the residual limb, liner and socket in transtibial amputees, we describe a geometrically accurate non-linear model simulating the donning of a liner and then a socket. The socket is rigid and rectified and the liner is a polyurethane geltype which is accurately described using non-linear (Mooney-Rivlin) material properties. The soft tissue of the residual limb is modelled as homogeneous, non-linear and hyperelastic and the bone structure within the residual limb is taken as rigid. The work gives an indication of how the stress induced by the process of donning the rigid socket is redistributed by the liner. Ultimately we hope to understand how the liner design might be modified to reduce discomfort. The ANSYS finite element code, version 5.6 is used.
Amputation Stumps↗
The Rapid Syndrome Validation Project (RSVP).
The Rapid Syndrome Validation Project (RSVP) is a collaboration of several institutions: Sandia and Los Alamos National Laboratories, the University of New Mexico Department of Emergency Medicine, and the NM Department of Health Office of Epidemiology. RSVP is a system that operates at the intersection of individual health care providers, public health and bioterrorism. Physicians quickly enter clinical and demographic information on patients exhibiting symptoms and signs of the syndromes of interest. It provides early warning and response to emerging biological threats, as well as emerging epidemics and diseases. RSVP provides real time clinical information to the provider and any other potential user such as the DOH, about current symptoms, disease prevalence and location. The system also serves as a mechanism for the Department of Health to inform health care providers of health alerts and to facilitate the process of collecting data on reportable diseases. We describe here the purpose an the architecture of a network-based surveillance system that is currently implemented in an Emergency Department.
Bioterrorism↗
Cultural variations in the understanding of traumatic brain injury and brain injury rehabilitation.
Little is known about how people from different cultures experience and understand traumatic brain injury (TBI) and the process of brain injury rehabilitation. The Brain Injury Rehabilitation Unit (BIRU) undertook a qualitative project to research cultural variations in the understanding of TBI and the rehabilitation process, interviewing 39 people with TBI and family members from Italian, Lebanese and Vietnamese backgrounds. The focus was on the reporting of sequelae of the TBI; valued qualities of service providers; barriers to effective communication; the role of the families in the rehabilitation process; and the experience of social stigma. Findings suggest there is a universal experience of TBI that transcends individual cultures. Study participants valued attentiveness, friendliness and guidance from rehabilitation staff. Family support was not always available to the person with TBI due to family conflict. Generally, people with TBI and family members valued the assistance of health interpreters facilitating their communication with rehabilitation staff. People with TBI from all three cultures experienced problems of stigma and social isolation. The findings have a number of implications for how brain injury rehabilitation staff can approach service provision to people from diverse cultural backgrounds.
Adaptation, Psychological↗
Effects of streptokinase and deoxyribonuclease on viscosity of human surgical and empyema pus.
STUDY OBJECTIVE: To investigate the effects of streptokinase and deoxyribonuclease (DNase) on the viscosity of pus to assess whether the DNase in the old preparation of streptokinase-streptodornase used intrapleurally to treat empyema was contributing to easier drainage of pus compared with purified streptokinase. DESIGN: In vitro measurement of pus viscosity. PATIENTS: Pus from three patients with surgically drained soft tissue abscesses and from six patients with empyema thoracis of varying etiology was studied. INTERVENTIONS: Pus samples were incubated with saline solution as control and with streptokinase, streptokinase-streptodornase, human recombinant DNase, and a mixture of streptokinase and DNase in concentrations approximating those achieved in clinical practice. RESULTS: Purified streptokinase had little effect on pus viscosity, with a mean reduction of 11.1% in the surgical specimens and 1.7% in the empyema samples. Streptokinase-streptodornase reduced viscosity by a mean of 52.8% in the surgical samples and 94.8% in the empyema samples. Human recombinant DNase reduced viscosity by a mean of 32. 79% in surgical samples and 93.4% in empyema samples. Adding streptokinase to human recombinant DNase produced no further reduction in viscosity. Final viscosities in samples treated with DNase were very similar whatever the starting viscosity. CONCLUSIONS: DNase significantly reduces pus viscosity, whereas streptokinase has little or no effect, and in empyema may work simply by breaking down loculations. Clinical studies should be undertaken to see if these in vitro changes produce clinical benefits. The simple viscometer devised for these experiments may also prove useful in other contexts.
Deoxyribonucleases↗
A systematic approach to evaluate the modification of lens proteins by glycation-induced crosslinking.
To systematically evaluate the modification of lens proteins by aldose and dicarbonyl sugars during the glycation process, the sugar-dependent incorporation of Lys and Arg, SDS-PAGE profile, amino acid analysis, and fluorophore formation (excitation 370 nm/emission 440 nm) were determined. Reaction mixtures with glycolaldehyde, glyceraldehyde, threose and 3-deoxythreosone showed the greatest extent of Lys crosslinking and fluorescence formation. An increase in fluorescence intensity, but a decrease in Lys and Arg crosslinking, was found with glyoxal, methylglyoxal, hydroxypyruvaldehyde and threosone. In addition glyoxal, methylglyoxal and hydroxypyruvaldehyde caused the specific loss of Arg residues in lens proteins. Reaction mixtures with xylose, xylosone, glucose, glucosone and 3-deoxyglucosone exhibited the least protein modifications; however, incubation with 3-deoxyxylosone resulted in extensive loss of Lys and Arg residues, a higher extent of Lys or Arg crosslinking and significant fluorophore formation. Each sugar exhibited unique characteristics in the modification of lens proteins by glycation. To validly compare the protein modifications occurring during glycation reactions, a systematic approach was employed to evaluate the potential role of aldose and dicarbonyl sugars in protein modification.
Arginine↗
Sex offending as a psychosocial sequela of traumatic brain injury.
OBJECTIVE: To describe the nature and extent of sexual offending after traumatic brain injury (TBI). DESIGN: Retrospective file review. SETTING: A brain injury unit providing inpatient and outpatient rehabilitation services. PARTICIPANTS: A review of five years of admissions to the Brain Injury Rehabilitation Unit (N = 477) identified a sample of 29 males who committed 128 incidents of sex offending. MAIN OUTCOME MEASURES: A protocol to record data on demographic, injury, radiological, and psychosocial variables and offending behaviors. RESULTS: Of the total population of 445 clients with TBI, 6.5% (n = 29) were identified as having committed some form of sexual offense. Alcohol was a factor in only three (2.3%) of the incidents, and only two clients had a preinjury history of sexual offending. The most common offenses were the "touching" offenses, followed by exhibitionism and overt sexual aggression. Staff members were the most common targets of the offenses, followed by members of the general public, other people with TBI, and family members. CONCLUSIONS: Sex offending is a significant clinical problem among a small minority of men after TBI. The absence of alcohol and preinjury histories of sexual offending suggest that the brain injury and contingent sequelae were a significant etiological factor underlying the offenses. A number of implications for the clinical management of clients with sexually aberrant behaviors is identified and discussed.
Adolescent↗
Investigation and management of persistent dry cough.
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Adolescent↗
Tuberculosis in Far North Queensland, Australia.
SETTING: Regional thoracic clinic in tropical Australia. OBJECTIVE: To document recent experience with tuberculosis in Far North Queensland, Australia, with particular reference to tuberculosis in indigenous people. METHODS: Retrospective survey of all cases of tuberculosis in Far North Queensland between January 1993 and December 1997. RESULTS: There were 87 cases of tuberculosis; 54 were pulmonary, of which 67% were sputum smear-positive. Crude annual incidence of tuberculosis in indigenous people was 35.9/100,000 population compared to 2.32/ 100,000 in non indigenous people. There were 15 deaths, seven of which were felt to be avoidable. Nine of 11 relapses of previously treated disease occurred in Aboriginals. There were six cases of initial drug resistance, of which four were imported from overseas. Contact tracing identified four active cases of tuberculosis and 102 recently infected contacts. Preventive treatment in infected contacts was completed in only 41%, largely because of poor compliance related to alcohol consumption. CONCLUSION: Tuberculosis remains common in Far North Queensland, with excess cases observed mainly in the indigenous population. Aboriginals are at high risk of both death from and relapse of tuberculosis. Tuberculosis control in indigenous people scattered over such a vast area remains challenging, and the results at present are sub-optimal.
Adolescent↗
Development of a finite element model of a transtibial socket liner--an initial study.
A number of computer models of limb loading by lower limb prostheses have been developed to date, however their accuracy and clinical usefulness is somewhat debatable. This paper is the first in a series describing investigations into the behaviour of a transtibial socket under compressive loading. The work focuses upon the socket liner and its role in reducing and redistributing stresses within the socket. This initial study used non-linear finite element analysis to replicate the effect of pressure loading on a polyurethane socket liner in the region of a bony prominence. It is a first step in understanding the load transfer between the residual limb, socket liner and socket of a transtibial prosthesis. The Mooney Rivlin material model [1] was used to simulate the polyurethane socket liner and compression tests in accordance with BS903 [2] were performed to gain the necessary data to calculate the Mooney Rivlin constants. Experimental validation showed that a very accurate, large-strain representation of the material was achieved. Future work will model more complex, three-dimensional geometries.
Artificial Limbs↗
A phase II/III trial of antimicrobial therapy with or without amikacin in the treatment of disseminated Mycobacterium avium infection in HIV-infected individuals. AIDS Clinical Trials Group Protocol 135 Study Team.
OBJECTIVE: To determine the clinical and microbiologic benefit of adding amikacin to a four-drug oral regimen for treatment of disseminated Mycobacterium avium infection in HIV-infected patients. DESIGN: A randomized, open-labeled, comparative trial. SETTING: Outpatient clinics. PATIENTS: Seventy-four patients with HIV and symptomatic bacteremic M. avium infection. INTERVENTIONS: Rifampin 10 mg/kg daily, ciprofloxacin 500 mg twice daily, clofazimine 100 mg every day, and ethambutol 15 mg/kg orally daily for 24 weeks, with or without amikacin 10 mg/kg intravenously or intramuscularly 5 days weekly for the first 4 weeks. MAIN OUTCOME MEASURE: Clinical and microbiologic response at 4 weeks; quantitative level of bacteremia with M. avium. RESULTS: No difference in clinical response was noted with the addition of amikacin to the four-drug oral regimen, and only 25% in either group had a complete or partial response at 4 weeks. A comparable quantitative decrease in bacteremia was noted in both treatment groups, with 16% of patients being culture-negative at 4 weeks and 38% at 12 weeks. Toxicities were mainly gastrointestinal. Amikacin was well tolerated. Median survival was 30 weeks in both groups. CONCLUSIONS: The addition of amikacin to a four-drug oral regimen of rifampin, ciprofloxacin, clofazimine, and ethambutol did not provide clinical or microbiologic benefit.
AIDS-Related Opportunistic Infections↗
Differential sensitivities to risperidone and olanzapine in a human immunodeficiency virus patient.
BACKGROUND: Neuroleptic sensitivity presents a considerable problem for the treatment of psychosis in the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV)-positive patient population. As yet, there are few data on the response of these patients to newer atypical antipsychotic medications. METHODS: We present the detailed medication history of a 33-year-old man with AIDS, who had a prior history of extrapyramidal symptoms (EPS) with both typical antipsychotics and risperidone, and was treated with olanzapine for major depression with psychotic features. RESULTS: The patient developed akathisia in a dose-dependent manner at dosages between 10 and 15 mg daily of olanzapine, but no EPS. Akathisia responded to dose reduction and use of beta-adrenergic blockade. CONCLUSIONS: The AIDS patient may exhibit sensitivity even to newer atypical antipsychotics. The lack of EPS and response to a beta-blocker underscore the different mechanisms causing akathisia and EPS.
Adult↗