Biomedical subjects
Publications and source records attributed to G Thompson.
Brachyolmia is a form of spondylodysplasia that has not to the authors' knowledge been described in the UK. It may be a cause of short stature that is currently unrecognised. A case of an 11 year old boy with clinical, radiographic, and eye findings consistent with Toledo type brachyolmia is reported.
Access to medical care is an important goal of health care reform. In West Virginia, access to care has been defined in terms of insurance coverage and the availability of health care professionals, especially primary care practitioners. In recent years, three surveys have attempted to measure access to care. These surveys show that approximately 200,000 to 230,000 West Virginians needed medical care but were not able to obtain it because they could not afford it. A much larger number, about 540,000 West Virginians, put off or postponed seeking care they felt they needed because they could not afford it.
BACKGROUND: Given the trend toward early discharge of patients after surgery and the inherent adverse effects of opioid analgesics, we compared a new nonsteroidal antiinflammatory drug, ketorolac tromethamine, given intravenously (iv) and then orally, with two commonly prescribed opioid analgesics in ambulatory patients for up to 1 week after surgery. METHODS: In this study incorporating a double-blind, multi-dose design, 221 patients who had moderate or severe pain after surgery were randomized to one of three treatment groups: group K30 received 30 mg iv ketorolac twice, then 10 mg iv every 30 min as required to control pain, up to six doses, followed by 10 mg oral ketorolac every 4-6 h; group F50 received 50 micrograms iv fentanyl at the same time intervals as in group K30, followed by 60 mg codeine plus 600 mg acetaminophen (C+A) orally every 4-6 h; and group F10 received the same combination as did group F50, but only 10 micrograms fentanyl per dose. RESULTS: Compared with 50 micrograms fentanyl iv, 30 mg iv ketorolac provided delayed but otherwise equivalent analgesic effects and was associated with similar side effects. Compared with C+A, 10 mg oral ketorolac was associated with a lower incidence of nausea and somnolence and earlier return of bowel function but not better pain relief, drug tolerability, quality of life, or psychologic well-being. CONCLUSIONS: Ketorolac, when used in an iv and then oral sequence, is a safe and effective analgesic in the ambulatory surgery setting. It has a slower onset than fentanyl, but causes fewer side effects than C+A.
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A survey of Victorian surgeons performing laparoscopic cholecystectomy was carried out. This report discusses the bile duct injuries identified in the survey. Twelve injuries were recorded, a rate of 0.2%. Three of the 12 required formal repair, the other 9 being treated by T-tube alone. Possible mechanisms of these injuries, the experience of the surgeon, the role of operative cholangiography and delays in recognition of the injury are discussed.
In 1990, as part of a major health status assessment, a dental survey was carried out on a 20 per cent random sample of the adult population in the Keewatin region of the Northwest Territories. A 73 per cent response rate was obtained. Of the 397 people examined, 334 (88 per cent) identified themselves as Inuit. More than 20 per cent of the respondents were edentulous, including 10 per cent of those 18 to 34 years old. The median DMFT was 24 for all respondents and 21 for dentulous respondents. There was a significant difference between Inuit and non-Inuit respondents, which was most marked in the 18 to 34 year old age group (mean DMFT 22.1 versus 15.6, p < .001). The proportion of filled to decayed and filled surfaces (F/DF) was 50 per cent. Periodontal disease was common and increased with age. More than 73 per cent of the dentate individuals had gingival bleeding at one or more sites. Very few were free of calculus. Mean pocket depth increased with age (1.3 mm at 18-34 years of age, rising to 2.3 at 55 plus, p < .001). Sixty per cent of adults needed at least one restorative procedure, 68 per cent needed prophylaxis, and 45 per cent needed periodontal treatment. Men required more treatment of all types than women. The results of this study confirm the clinical impression that dental disease is rampant among the Inuit population. There are major needs for both preventive and treatment services.(ABSTRACT TRUNCATED AT 250 WORDS)
13 patients with minimal residual disease following platinum-based systemic therapy for epithelial ovarian cancer were treated with intraperitoneal iproplatin. A total of three cycles were given at monthly intervals. All patients had minimal residual disease (defined as less than 2 cm in diameter) or positive cytology documented at second look laparotomy following systemic chemotherapy. Iproplatin was administered via a temporary dialysis catheter (n = 11) or a semi permanent Tenckhoff peritoneal dialysis catheter (n = 2). The dose of iproplatin ranged from 150 to 450 mg/m2. No responses to therapy were documented. In this trial the major toxic side effects of iproplatin were thrombocytopenia, diarrhoea, nausea and vomiting. The maximum tolerated dose was 300 mg/m2.
The purpose of this investigation was to study the relationship between visual reinforcement audiometry (VRA) performance and age (i.e., corrected and mental) with 60 premature infants. VRA performance was classified as unacceptable, marginal, or acceptable based on conditionability and number of responses obtained before habituation to the task. The results indicated that mental age and corrected age were significantly related to VRA performance. It was found that a corrected age of 8 mo and/or a mental age of 6 mo is typically required for acceptable performance using VRA. A lack of responsiveness to the VRA procedure at these ages would most likely be due to hearing loss as opposed to a general developmental delay. The data from this study would not support a large scale behavioral hearing screening program for premature infants below 8 mo corrected age or 6 mo mental age.
This study investigated strategies for increasing the number of responses that can be obtained from young children during visual reinforcement audiometry. Subjects included normal 1- and 2-yr-old children. Responses before habituation were studied as a function of age, reinforcer conditions, and test sessions. It was found that: (1) using two reinforcers led to more responses before habituation than use of a single reinforcer; (2) after habituation in test session 1 and a 10-min break, most 1-yr-olds demonstrated a minimum of five additional responses in test session 2; and (3) 2-yr-olds habituated more rapidly than 1-yr-olds.
The purpose of this study was to conduct a direct comparison of two dose regimens of minocycline to determine 1) whether they achieved crevicular fluid concentrations in a therapeutic range; and 2) the frequency of side effects. In a double-blind design, 30 patients divided into 2 groups were given either 100 mg minocycline or 200 mg minocycline per day for an 8-day period. The concentration of minocycline in the gingival clevicular fluid (GCF) at 8 days was 4.77 micrograms/ml for the 100 mg a day group and 5.97 micrograms/ml for the 200 mg a day group and at 15 days was 4.30 micrograms/ml for the 100 mg a day group and 4.17 micrograms/ml for the 200 mg a day group. There was no significant difference in the antibiotic concentration in the gingival crevicular fluid between the 2 groups. Reported adverse experiences to the minocycline were greater in the 200 mg a day group. Short-term changes in periodontal health as measured by plaque index, gingival index, pocket depth, and bleeding upon probing showed improvements in all parameters over the 15 day period. There were no significant differences in these parameters between the 100 mg a day and 200 mg a day group. At 8 days reduced levels of Porphyromonas gingivalis and Prevotella intermedia were achieved but they were not eliminated from infected subgingival sites in either group. Achieving bacteriostatic concentrations of GCF, fewer side effects, and the potential for better compliance suggests that a single daily dose of 100 mg minocycline should now be investigated for its efficacy in managing periodontal infections manifesting as periodontitis.
This paper describes a five week initiative, which aimed to reduce the waiting list for new referrals to an ophthalmic department. A cohort of 317 patients was examined qualitatively to help determine the future direction of ophthalmic resources. Cataract was the most frequent diagnosis, and one in five new patients were referred for surgery. A third of all referral letters contained inaccurate diagnoses, suggesting that grading waiting times on the basis of referral letters is unsatisfactory. Ten per cent of referrals suffered from conditions that could potentially lead to irreversible visual loss. There was no significant difference between the non-attenders (19%) and attenders in relation to their diagnoses or subsequent management. This initiative effectively reduced the outpatient waiting time from 28 weeks to two weeks, thereby maintaining the outpatient waiting time at eight weeks over the following year.
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Families of 49 hearing-impaired children responded to a questionnaire requesting information about the identification of their child's hearing loss. Parents were the first to suspect the hearing loss in 48 cases but more often than not were told that the child would outgrow it or was too young to test. When professionals agreed with the parents and attended to their concerns, confirmation of the hearing loss occurred significantly more rapidly than when they disagreed with parents and ignored their concerns. A child whose hearing loss is not clearly identified and whose communication is inadequate or nonexistent, causes frustration and stress within the family and prevents the child from receiving the maximum benefit from early language input and amplification. It would benefit both the child and family if professionals would listen to parental concerns regarding their child and assist in the early identification process.
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The Radiographic Vertebral Index (RVI) was assessed as a possible outcome measure for bone disease in myeloma by evaluating within and between reader reproducibility. Four readers (2 radiologists and 2 clinical hematologists) independently scored, on two separate occasions, the RVI on 40 radiographs from patients with myeloma. Each vertebra from third thoracic (T3) to fifth lumbar (L5) received a score of "1" if normal, "2" if biconcave and "4" if crushed or fractured. RVI global scores, therefore, could vary from a minimum of 15, for no damage, to a potential maximum of 60 in which all vertebrae are collapsed. Agreement was determined for each vertebra using crude percentage agreement and the kappa statistic (which corrects for chance-expected agreement) for categorical data, and for global score using analysis of variance and calculating intra-class correlation. With increasing mean abnormality score on individual vertebrae there was a corresponding increase in kappa and reduction in crude percentage agreement. Within readers, the mean percentage agreement across all vertebrae varied from 85.6 to 90.3% and the observed differences just reach statistical significance (p = 0.048). Mean kappa values ranged from 0.48 to 0.63 and were similar across readers. Differences in intra-reader agreement were not related to subspecialty. When between reader percentage agreement and kappa scores were assessed for radiologists and non-radiologist clinicians, no difference could be detected. Agreement with respect to intra-reader mean global RVI scores was excellent as illustrated by the intra-class correlation coefficient which varied from 0.89 to 0.94. The mean intra-class correlation for radiologists was 0.92, compared with 0.91 for non-radiologists.(ABSTRACT TRUNCATED AT 250 WORDS)
Six Friesian cows were milked daily, and arterial and mammary venous blood samples were taken between day 266 of gestation and day 6 after parturition. Samples of blood plasma were analysed for their content of acetate and progesterone, and mammary secretion for potassium, isocitrate, 2-oxoglutarate and triglyceride fatty acids. The onset of secretion of medium-chain triglyceride fatty acids was preceded by, or coincided with, increases of potassium and isocitrate concentration in the secretion. The onset of fatty acid secretion was not accompanied by any change in the gland's extraction of acetate from the circulation, and did not occur at a consistent time relative to parturition or changes in plasma progesterone concentration.
The evaluation of fetal well-being by fetal heart rate monitoring at preterm gestational ages remains a difficult and important area for investigation. While the nonstress test has achieved widespread usage, a role for the contraction stress test remains uncertain. This study describes the outcome of 113 contraction stress tests which were performed for persistent fetal heart rate nonreactivity in 78 pregnancies of less than 37 completed weeks' gestation. There were no fetal deaths and no obstetric complications which could be attributed to these tests. The finding of a negative contraction stress test provided reassurance which facilitated significant prolongation of pregnancy. Contraction stress test appear to be a safe and effective method of investigating further the clinical dilemma of persistent fetal heart rate nonreactivity in high risk pregnancies at preterm gestational ages.