Biomedical subjects

G Somes

Publications and source records attributed to G Somes.

At least 19 recordsLinked to original sources

PubMed2006

Pamidronate infusion in patients with systemic sclerosis results in changes in blood mononuclear cell cytokine profiles.

A single infusion of pamidronate was given to patients with systemic sclerosis (scleroderma, SSc) to assess effects on cytokine production by peripheral blood mononuclear cells (PBMC) and lymphocyte subsets. Eighteen patients with SSc received a single intravenous dose of 60 mg of pamidronate and were followed for 6 months. Assessment of cytokine production [interferon (IFN)-gamma, interleukin (IL)-10, transforming growth factor (TGF)-beta1, tumour necrosis factor (TNF)-alpha and IL-4] by PBMC and lymphocyte subsets by flow cytometry was carried out before and after the pamidronate infusion. Unstimulated PBMC produced increased amounts of IFN-gamma and TNF-alpha and reduced levels of TGF-beta1 for up to 24 weeks after the infusion. gammadelta T cells from patients with SSc were activated in vitro and produced increased IFN-gamma. The effects of pamidronate on modulation of cytokine profiles in patients with SSc may merit future study.

Aged↗

PubMed1998

Injuries and deaths due to firearms in the home.

OBJECTIVE: Determine the relative frequency with which guns in the home are used to injure or kill in self-defense, compared with the number of times these weapons are involved in an unintentional injury, suicide attempt, or criminal assault or homicide. METHODS: We reviewed the police, medical examiner, emergency medical service, emergency department, and hospital records of all fatal and nonfatal shootings in three U.S. cities: Memphis, Tennessee; Seattle, Washington; and Galveston, Texas. RESULTS: During the study interval (12 months in Memphis, 18 months in Seattle, and Galveston) 626 shootings occurred in or around a residence. This total included 54 unintentional shootings, 118 attempted or completed suicides, and 438 assaults/homicides. Thirteen shootings were legally justifiable or an act of self-defense, including three that involved law enforcement officers acting in the line of duty. For every time a gun in the home was used in a self-defense or legally justifiable shooting, there were four unintentional shootings, seven criminal assaults or homicides, and 11 attempted or completed suicides. CONCLUSIONS: Guns kept in homes are more likely to be involved in a fatal or nonfatal accidental shooting, criminal assault, or suicide attempt than to be used to injure or kill in self-defense.

Accidents, Home↗

PubMed1997

Alcohol and illicit drug abuse and the risk of violent death in the home.

CONTEXT: While acute alcohol and illicit drug use are common in homicide and suicide victims, the role of chronic substance use in violent death is unclear. OBJECTIVE: To measure the magnitude of risk of violent death in the home associated with alcohol use or chronic abuse and use of illicit drugs. DATA SOURCES: Data obtained from a case-control study of risk factors for homicide and suicide in 3 large metropolitan areas of the United States. DESIGN: Matched case-control study including 388 homicide cases, 438 suicide cases, and equal numbers of controls matched for age, sex, race, neighborhood, and county. Data were analyzed by means of conditional logistic regressions in which other potential risk factors for violent death were also considered. OUTCOME AND EXPOSURE MEASURES: Homicide and suicide victims were identified from medical examiner reports in Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio. Structured interviews were conducted with proxy respondents close to the decedents to obtain information about alcohol or illicit drug use, and history of alcohol-related hospitalization or trouble at work because of drinking by the subject. Data about alcohol use by others living in the same house as the subject were also obtained. RESULTS: The risks of homicide and suicide associated with alcohol or illicit drug use were elevated, as were the risks of violent death associated with several indicators of chronic alcohol abuse. In addition, nondrinkers living in a home with alcohol users were at increased risk of homicide (odds ratio, 1.7; 95% confidence interval, 0.98-3.0), and non-drug-using individuals residing in homes with illicit drug users were at greatly increased risk of homicide (odds ratio, 11.3; 95% confidence interval, 4.4-28.8). CONCLUSIONS: Alcohol and illicit drug use appear to be associated with an increased risk of violent death. The risk of homicide was increased for non-substance-abusing individuals living in households in which other members abused alcohol or drugs. The concept of the individual at risk of homicide should be broadened to include not only the abuser but also those who may be at risk because of their exposure to others.

Adolescent↗

PubMed1996

Injuries due to firearms in three cities.

BACKGROUND: To describe the incidence and outcome of injuries due to firearms, we conducted a population-based study of fatal and nonfatal gunshot wounds in three cities: Memphis, Tennessee; Seattle; and Galveston, Texas. METHODS: Records of the police, medical examiners, ambulance crews, and hospital emergency departments and hospital admissions were monitored to identify all injuries caused by firearms that were severe enough to prompt emergency medical treatment. These records were linked to generate a complete picture of each event. Census data were used to calculate rates of injury for various population groups. RESULTS: A total of 1915 cases of injury due to firearms were identified between November 16, 1992, and May 15, 1994. The crude rate of firearm injury per 100,000 person-years was 222.6 in Memphis, 143.6 in Galveston, and 54.1 in Seattle. Approximately 88 percent of the injuries were incurred during confirmed or probable assaults; 7 percent were sustained in the course of suicide or attempted suicide; unintentional injuries accounted for 4 percent of the cases. Handguns were used in 88 percent of the cases in which the type of weapon was recorded. Five percent of the 1677 victims who were brought to a hospital emergency department could not be resuscitated; 53 percent were hospitalized, and 42 percent were treated and released. Ninety-seven percent of the deaths occurred within 24 hours of the injury. Emergency department and inpatient charges exceeded $16.5 million. CONCLUSIONS: Injuries due to firearms, most involving handguns, are a major cause of morbidity and mortality in U.S. urban areas. The incidence varies greatly from city to city.

Adolescent↗

PubMed1995

Extent of medial temporal resection on outcome from anterior temporal lobectomy: a randomized prospective study.

WE REPORT A prospective, randomized, blinded clinical trial comparing seizure and neuropsychological outcomes from anterior temporal lobectomies between two groups of patients. One group (n = 34) underwent hippocampal resection posteriorly to the anterior edge of the cerebral peduncle (partial hippocampectomy). In the other group (n = 36), the hippocampus was removed further to the level of the superior colliculus (total hippocampectomy). The amount of lateral cortical resection was the same between groups. Patients were and neuropsychological morbidity. At 1 year postoperatively, the total hippocampectomy group had a statistically superior seizure outcome compared with the partial hippocampectomy group (69 versus 38% seizure-free), and examination of time to first seizure (survival analysis) revealed significantly superior outcomes associated with total hippocampectomy. There was no increased neuropsychological morbidity associated with the more extensive hippocampal resection.

Adolescent↗

PubMed1994

Patterns of academic competence in adults with epilepsy: a cluster analytic study.

Cluster analysis was used in the attempt to derive a meaningful taxonomy of academic competence in 117 adults with temporal lobe epilepsy. Reading, spelling and arithmetic achievement scores from the Wide Range Achievement Test-Revised were subjected to hierarchical complete linkage cluster analysis, and the stability of the obtained solution was examined by the application of two additional clustering procedures. A six cluster solution was obtained, and tests of internal validity showed membership in four of the clusters to be extremely stable (Moderate and Marked Reading/Spelling Underachievement, Above Average Achievement, Reading/Arithmetic Underachievement), while the remaining two clusters showed some exchange of cases (Arithmetic Underachievement, Average Achievement). Modest evidence of external validity was found through the comparison of specific clusters to the Average Achievement group on measures of neuropsychological function, neurological and demographic characteristics. It is concluded that cluster analysis may be helpful in developing taxonomies of psychosocial impairment in epilepsy, and may facilitate an understanding of the determinants of variable quality of life outcomes associated with epilepsy.

Adult↗

PubMed1994

Do blacks get bystander cardiopulmonary resuscitation as often as whites?

STUDY OBJECTIVE: To determine whether there is an association between the race of a victim of out-of-hospital cardiac arrest and the provision of bystander-initiated CPR. DESIGN: Record review of 1,068 consecutive cases of nontraumatic out-of-hospital cardiac arrest. SETTING: Memphis, Tennessee, a city of more than 600,000 with roughly equal numbers of white and black residents. PARTICIPANTS: Every adult who was seen by municipal emergency medical services personnel for nontraumatic cardiac arrest between March 1, 1989, and June 5, 1992. INTERVENTION: None. RESULTS: Although black and white cardiac arrest victims were similar in many respects, black victims received bystander CPR substantially less frequently than whites (9.8% versus 21.4%; odds ratio, 0.46; 95% confidence interval, 0.34 to 0.61). This difference was slightly more pronounced when the victim collapsed in a public place. In addition to race of the victim, location of the arrest outside the home and having the arrest witnessed were independent determinants of whether a victim was given bystander CPR. Multiple logistic regression analysis showed that the effect of race was independent of the other variables studied. CONCLUSION: Black victims of out-of-hospital cardiac arrest receive bystander CPR less frequently than white victims. Targeted training programs may be needed to improve the rates of bystander CPR among certain groups.

Black or African American↗

PubMed1994

Declarative memory following anterior temporal lobectomy in humans.

This study hypothesized that verbal memory decline following anterior temporal lobectomy (ATL) is associated with a lack of significant neuropathology in resected left, but not right, hippocampus and is limited to measures of episodic memory only. Tests of immediate (digit span), semantic (visual naming), and episodic memory as measured by the California Verbal Learning Test (CVLT) were administered before and 6 months after resection of the anterior left (n = 36) or right (n = 26) temporal lobe. There were no effects of hippocampal pathology on measures of immediate or semantic memory for either ATL group or for episodic memory for the right ATL group. Left ATL patients who demonstrated no/mild hippocampal sclerosis exhibited significantly greater postoperative decline in episodic memory compared with those with moderate/marked hippocampal sclerosis on multiple CVLT indices (recall measures, learning characteristics, and contrast measures).

Adult↗

PubMed1994

Dysnomia after left anterior temporal lobectomy without functional mapping: frequency and correlates.

The integrity of language function after a left (dominant) anterior temporal lobectomy performed without the use of functional mapping remains controversial. Much of the controversy concerns the degree to which analyses of group data obscure the identification of surgically induced dysnomia in individual patients. This study investigated postoperative language outcome in our entire series (n = 162) of nonretarded, left hemisphere speech dominant patients with intractable nonlesional epilepsy who underwent a left (n = 85) or right (n = 77) anterior temporal lobectomy without functional mapping. A comparison of preoperative to (6 mo) postoperative performance on a standardized test of nominal speech revealed the following: 1) a statistically significant but clinically modest difference in outcome between left and right anterior temporal lobectomy groups; 2) a subgroup (7%) of left anterior temporal lobectomy patients exhibited a postoperative dysnomia (a decline in nominal speech that exceeded the worst performance in the right anterior temporal lobectomy group); and 3) a postoperative decline in nominal speech after left anterior temporal lobectomy was specifically associated with a later age at the onset of epilepsy. Within the context of group data suggesting minimal risk to language function when functional mapping is not used, a small subgroup of individuals characterized by a later onset of epilepsy can be identified who exhibit a surgically induced dysnomia after a standard left anterior temporal lobectomy. Whether these results differ from the outcome of functional mapping remains to be determined.

Adult↗

PubMed1993

Impact of first-responder defibrillation in an urban emergency medical services system.

OBJECTIVE: To evaluate the impact of adding first-responder defibrillation by fire-fighters to an existing advanced life-support emergency medical services system. DESIGN: Nonrandomized, controlled clinical trial with periodic crossover. SETTING: Memphis, Tenn, a city of 610,337 people, which is served by a fire department-based emergency medical services system. All city ambulances provide advanced life support. PATIENTS: Adult victims of out-of-hospital cardiac arrest due to heart disease. INTERVENTION: Twenty of 40 participating engine companies were equipped with an automated external defibrillator and ordered to apply it immediately in all cases of cardiac arrest. The other 20 companies were ordered to start cardiopulmonary resuscitation (CPR) immediately and wait for paramedics to arrive. Every 75 days, group roles were reversed. Care otherwise proceeded according to 1986 American Heart Association guidelines. MAIN OUTCOME MEASURES: Return of spontaneous circulation in the field, survival to hospital admission, survival to hospital discharge, and neurological status at discharge. RESULTS: During the 39-month study interval, 879 patients were treated by a project engine company. Four hundred thirty-one (49%) of these were found in ventricular fibrillation. Bystander CPR was started in only 12% of cases. Overall, firefighters reached the scene a mean of 2.5 minutes faster than simultaneously dispatched paramedics. Although our automated external defibrillators proved to be reliable and efficacious for terminating ventricular fibrillation and pulseless ventricular tachycardia, patients treated by an automated external defibrillator-equipped engine company were no more likely than CPR-treated controls to be resuscitated (32% vs 34%, respectively), to survive to hospital admission (31% vs 29%), or to survive to hospital discharge (14% vs 10%). Neurological outcomes were also similar in the two treatment groups. CONCLUSIONS: In a fast-response, urban emergency medical services system served by paramedics, the impact of adding first-responder defibrillation appears to be small. Early defibrillation alone cannot overcome low community rates of bystander CPR. Careful attention to every link in the "chain of survival" is needed to achieve optimal rates of survival after cardiac arrest.

Aged↗

PubMed1993

Gun ownership as a risk factor for homicide in the home.

BACKGROUND: It is unknown whether keeping a firearm in the home confers protection against crime or, instead, increases the risk of violent crime in the home. To study risk factors for homicide in the home, we identified homicides occurring in the homes of victims in three metropolitan counties. METHODS: After each homicide, we obtained data from the police or medical examiner and interviewed a proxy for the victim. The proxies' answers were compared with those of control subjects who were matched to the victims according to neighborhood, sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. RESULTS: During the study period, 1860 homicides occurred in the three counties, 444 of them (23.9 percent) in the home of the victim. After excluding 24 cases for various reasons, we interviewed proxy respondents for 93 percent of the victims. Controls were identified for 99 percent of these, yielding 388 matched pairs. As compared with the controls, the victims more often lived alone or rented their residence. Also, case households more commonly contained an illicit-drug user, a person with prior arrests, or someone who had been hit or hurt in a fight in the home. After controlling for these characteristics, we found that keeping a gun in the home was strongly and independently associated with an increased risk of homicide (adjusted odds ratio, 2.7; 95 percent confidence interval, 1.6 to 4.4). Virtually all of this risk involved homicide by a family member or intimate acquaintance. CONCLUSIONS: The use of illicit drugs and a history of physical fights in the home are important risk factors for homicide in the home. Rather than confer protection, guns kept in the home are associated with an increase in the risk of homicide by a family member or intimate acquaintance.

Adolescent↗

PubMed1992

Suicide in the home in relation to gun ownership.

BACKGROUND: It has been suggested that limiting access to firearms could prevent many suicides, but this belief is controversial. To assess the strength of the association between the availability of firearms and suicide, we studied all suicides that took place in the homes of victims in Shelby County, Tennessee, and King County, Washington, over a 32-month period. METHODS: For each suicide victim (case subject), we obtained data from police or the medical examiner and interviewed a proxy. Their answers were compared with those of control subjects from the same neighborhood, matched with the victim according to sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. RESULTS: During the study period, 803 suicides occurred in the two counties, 565 of which (70 percent) took place in the home of the victim. Fifty-eight percent (326) of these suicides were committed with a firearm. After excluding 11 case subjects for various reasons, we were able to interview 80 percent (442) of the proxies for the case subjects. Matching controls were identified for 99 percent of these subjects, producing 438 matched pairs. Univariate analyses revealed that the case subjects were more likely than the controls to have lived alone, taken prescribed psychotropic medication, been arrested, abused drugs or alcohol, or not graduated from high school. After we controlled for these characteristics through conditional logistic regression, the presence of one or more guns in the home was found to be associated with an increased risk of suicide (adjusted odds ratio, 4.8; 95 percent confidence interval, 2.7 to 8.5). CONCLUSIONS: Ready availability of firearms is associated with an increased risk of suicide in the home. Owners of firearms should weigh their reasons for keeping a gun in the home against the possibility that it might someday be used in a suicide.

Adult↗

PubMed1992

Preoperative psychological adjustment and surgical outcome are determinants of psychosocial status after anterior temporal lobectomy.

This investigation evaluated the role of preoperative psychological adjustment, degree of postoperative seizure reduction, and other relevant variables (age, education, IQ, age at onset of epilepsy, laterality of resection) in determining emotional/psychosocial outcome following anterior temporal lobectomy. Ninety seven patients with complex partial seizures of temporal lobe origin were administered the Minnesota Multiphasic Personality Inventory (MMPI), Washington Psychosocial Seizure Inventory (WPSI), and the General Health Questionnaire (GHQ) both before and six to eight months after anterior temporal lobectomy. The data were subjected to a nonparametric rank sum technique (O'Brien's procedure) which combined the test scores to form a single outcome index (TOTAL PSYCHOSOCIAL OUTCOME) that was analysed by multiple regression procedures. Results indicated that the most powerful predictors of patients' overall postoperative psychosocial outcome were: 1) The adequacy of their preoperative psychosocial adjustment, and 2) A totally seizure-free outcome. Additional analyses were carried out separately on the MMPI, WPSI, and GHQ to determine whether findings varied as a function of the specific outcome measure. These results were related to the larger literature concerned with the psychological outcome of anterior temporal lobectomy.

Adaptation, Psychological↗

PubMed1992

Pathological status of the mesial temporal lobe predicts memory outcome from left anterior temporal lobectomy.

This investigation tested the hypothesis that the degree of impairment to memory function caused by an anterior temporal lobectomy (ATL) is inversely related to the pathological status of the resected hippocampus. Specifically, the greatest risk to postoperative memory function should be to patients with no or minimal hippocampal sclerosis, i.e., those with a functional hippocampus. Forty patients who underwent a partial resection of the left (n = 21) or right (n = 19) anterior temporal lobe were administered tests of immediate and delayed verbal and figural memory, both preoperatively and 6 months postoperatively. The degree of postoperative impairment in memory function was then investigated as a function of the degree of hippocampal sclerosis, as determined by a standardized procedure. For a left ATL, an absence or mild degree of hippocampal sclerosis was associated with significantly greater postoperative impairment of both verbal and figural memory, compared with patients with moderate or marked sclerosis. No statistically significant relationship was noted for patients who underwent a right ATL, but the findings were in the same direction for five of six memory measures. It may be possible to predict and avoid surgically induced impairment of memory function among patients who undergo left ATL through the use of preoperative hippocampal volumetric magnetic resonance imaging. Better clinical tests of right hippocampal function are needed to predict the outcome for patients who undergo a right ATL.

Adult↗

PubMed1991

Aorta and Iliac Arterial Sizes in Pre-operative Morbidly Obese Patients: a preliminary report.

Central blood flow and cardiac output are increased in most morbidly obese patients. This may be reflected in abnormal vessel sizes. Other influences such as smoking, age, weight, vertebral size, hypertension and age at onset of obesity may also be operative. Abnormal aorta and common iliac artery diameters were retrospectively measured on abnormal computer-assisted axial tomography scans of 44 morbidly obese, vascular disease-free females prior to their bariatric surgery. They were compared at standardized aortic and ileac levels with normal weight, similar age, control patients. There was no correlation between patient body weight, body mass index, percent excess body weight or age at onset of obesity versus any of the aortic or iliac diameters. Pearson's correlation analysis of smoking, age and hypertension each showed a significant positive relationship with aorto-iliac diameters (p < 0.05). Vertebral coronal body widths revealed a significant correlation with age (p < 0.05) but not with body weight, aortic or iliac diameters at any level. We conclude that the aortic and iliac arterial diameters of morbidly obese patients are significantly enlarged relative to normal weight controls. Smoking, age and hypertension also appear to have some degree of influence on aorto-iliac diameters in morbidly obese middle-aged women.

Journal Article↗

PubMed1991

Language function following anterior temporal lobectomy.

The authors report the results of a prospective investigation that evaluated postoperative changes in language function after dominant (29 cases) or nondominant (35 cases) anterior temporal lobectomy for treatment of complex partial seizures. These patients received conservative resection of lateral temporal cortex but aggressive resection of medial temporal cortex. None of the patients underwent functional mapping of cortical language ability. All patients were assessed with a standardized aphasia battery (Multilingual Aphasia Examination) before and 6 months after surgery. Postoperatively, the dominant anterior temporal lobectomy group did not show any significant losses in language function compared to patients who underwent nondominant anterior temporal lobectomy. In addition, the dominant temporal lobectomy group showed significant postoperative improvement in complex receptive language comprehension compared to the nondominant group. These results suggest that patients with complex partial seizures of medial temporal lobe onset can undergo a conservative resection of lateral temporal cortex without language mapping. Such surgery carries little risk to language function and provides an excellent postoperative surgical outcome.

Adolescent↗

PubMed1991

Seizure outcome from anterior and complete corpus callosotomy.

Eighty patients underwent anterior corpus callosotomy for treatment of generalized seizures. The patients' mean age was 18.3 years (range 4 to 53 years); the mean age at seizure onset was 5.27 years (range 0.1 to 27 years). The mean intelligence quotient (IQ) of 41 testable patients was 71.12 (range less than 30 to 114). The seizure outcome was as follows: 13% were seizure-free, 65% were significantly improved, and 22% were unchanged. Ten patients subsequently underwent a second operation to complete the callosal sectioning which resulted in additional seizure improvement in only five of them. Five complications resulted from 90 operations: two epidural hematomas, one delayed subdural hematoma, one bone-flap infection, and one postcallosotomy disconnection syndrome; two patients died. A younger age at onset of seizures, a higher IQ, and generalized tonic-clonic, atonic, complex-partial, and mixed seizure types were associated with improved seizure outcome.

Adolescent↗

PubMed1991

The morbidity of long-term seizure monitoring using subdural strip electrodes.

The authors report a prospective study of morbidity associated with long-term seizure monitoring using subdural strip electrodes. Three hundred fifty patients were divided into two groups: 175 patients received antibiotics intravenously during the entire period that the electrodes were implanted, and 175 patients received one dose of antibiotics on the morning of surgery. In the group given continuous antibiotic coverage there were two cases of meningitis, both treated without sequelae. In the group receiving one dose of antibiotics, one patient had a brain abscess and three had superficial wound infections. There were no other instances of major morbidity or mortality in either group of patients. The total morbidity rate for both serious and minor complications was 0.85%.

Adult↗