Managing acute cardiac patients in and out of the hospital setting.
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Allied Health Personnel↗
Biomedical subjects
J Boulton
Publications and source records attributed to J Boulton.
Enthusiasm and teamwork--the basis for increase in laparoscopic surgery for ectopic pregnancy: an Inner London district hospital experience.
Laparoscopic surgery is the gold standard in the surgical management of ectopic pregnancy. It results in lower morbidity, less impact on reproductive health and faster return to normal activity. However, laparoscopic management is not available to all women. Between April 2001 and March 2002 a prospective audit of surgical management of ectopic pregnancy was carried out; 88.7% were performed laparoscopically, most due to concerted consultant input to the care of women with ectopic pregnancy.
Adult↗
Bed wetters: not just wet blankets.
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Enuresis↗
Does vitamin C cause hemolysis in premature newborn infants? Results of a multicenter double-blind, randomized, controlled trial.
OBJECTIVE: We tested the hypothesis that vitamin C supplementation of premature neonates is associated with hemolysis. STUDY DESIGN: A double-blind, randomized, controlled trial of vitamin C supplementation (50 mg/day) was undertaken in premature neonates (birth weight, 1000 to 1500 gm). Infants were randomly assigned to receive vitamin C (Ce-Vi-Sol) (n = 32) or placebo (n = 24) for 14 days. Twenty-three subjects per group were required to detect a difference of 1 SD in corrected carboxyhemoglobin values (alpha = 0.05, beta = 0.10). RESULTS: Day 14 vitamin C levels were lower in control subjects than in supplemented neonates (62 +/- 24 vs 125 +/- 62 micromol/L, p = 0.005). There was no difference in corrected blood carboxyhemoglogin concentrations (0.72 +/- 0.44 vs 0.72 +/- 0.23%; p = 0.95), other parameters of hemolysis, weight gain, blood sampled, presumed septic episodes, necrotizing enterocolitis, feeding intolerance, or transfusion. On day 14, bilirubin values were higher in control subjects than in the supplemented group (77 +/- 37 vs 55 +/- 33 micromol/L; p = 0.04). When a distant outlier in the nonsupplemented group was excluded (163 micromol/L), statistical significance was lost (73 +/- 32 vs 55 +/- 33 micromol/L; p = 0.09). CONCLUSION: Oral supplementation of premature infants with vitamin C is not associated with evidence of increased erythrocyte destruction, hyperbilirubinemia, or other morbidity.
Anemia, Hemolytic↗
Visual evoked potentials for prediction of neurodevelopmental outcome in preterm infants.
Visual evoked potentials (VEPs) have proved to be accurate predictors of outcome in term infants with hypoxic-ischemic encephalopathy. Parallels between term asphyxia and hypoxic-ischemic injury in the preterm brain suggested the hypothesis that VEPs may predict the development of periventricular leukomalacia (PVL) and later cerebral palsy. 123 infants less than 32 weeks' gestational age were enrolled in the study. VEPs were done in the first 3 weeks of life (usually first week). VEPs did show a statistically significant association with PVL (p < 0.04) although false-positive recordings were twice as frequent as true-positive recordings. VEPs were not associated with grade III-IV intraventricular hemorrhage (p = 1.0). Unlike asphyxiated term infants, VEPs were not predictive of abnormal neurodevelopmental outcome in the preterm population.
Aging↗
Locked-in syndrome in fulminant demyelinating disease.
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Brain↗
MRI in schistosomiasis of conus medullaris and lumbar spinal cord.
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Adult↗
Reduction of ischemic heart disease risk markers in the teenage children of heart attack patients.
BACKGROUND: Families of people with ischemic heart disease (IHD) are likely to share high levels of risk markers and to have similar lifestyle patterns. Teenage children in such families were the focus of a behavioral intervention program. METHODS: Families were randomly allocated to either an "early" or a "late" advice group. The late group and a third "control" group (consisting of families with no cardiovascular disease) received the intervention only after baseline measurements were repeated in all three groups at the end of 12 months. Pedigree analysis was used to compare changes across groups. RESULTS: The decrease in self-reported total fat intake was greater among teenagers in the early group (mean = -3.38, SE = 1.00) than among those in the late group (mean = -0.58, SE = 1.06), as was the decrease in saturated fat intake (mean = -2.46, SE = 0.56; mean = -0.54, SE = 0.60, respectively). These differences were statistically significant (P < 0.05). There were no differences between these groups for changes in total or high-density lipoprotein cholesterol levels. There was a statistically significant difference between the change in total cholesterol levels in the control group (mean = +0.08, SE = 0.07) and that in the late group (mean = -0.14, SE = 0.11). CONCLUSIONS: The intervention program appears to have made the teenagers aware of high-fat foods, as stated fat intake was significantly lowered, but it was not successful in decreasing blood cholesterol levels. Having a parent with IHD did, however, influence the teenagers' risk-related behavior, leading to a significant reduction in blood cholesterol levels.
Adolescent↗
Differential motion thresholds to sinusoidal gratings at two eccentricities.
Differential motion thresholds were measured at eccentricities of 9 degrees and 16.6 degrees using computer-generated sinusoidal gratings. Three spatial frequencies (0.51, 0.25, and 0.13 cycles/deg) were examined at reference velocities of 2, 4, 8, 16, 32, and 48 deg/sec. Minimum differential velocity thresholds were between 20 and 30% of the reference velocities for the three spatial frequencies at both eccentricities. Increasing eccentricity produced an increase in the velocity at which minimum velocity discrimination occurred. Temporal frequency tuning was between 4 and 8 Hz, regardless of eccentricity.
Acceleration↗
Survival after neonatal myocardial infarction.
These are case reports of two children with structurally normal hearts and with normal coronary arteries, who survived myocardial infarction in the early neonatal period. They are only the third and fourth reported survivors of neonatal myocardial infarction and the first in which hypercholesterolemia is postulated to have played an important role. The most likely cause of the myocardial infarction was thrombosis or thromboembolism. Changes in hemostatic function associated with hypercholesterolemia may be relevant.
Coronary Angiography↗
Effect of gamma aminobutyric acid on the carbon dioxide rebreathing response of normal subjects: a study using vigabatrin.
Animal studies suggest that gamma aminobutyric acid (GABA) may be an important neurotransmitter in the control of respiration. Vigabatrin, a new drug for the treatment of epilepsy, is thought to exert its effect by increasing GABA concentrations in the brain. To assess the effect of increased GABA concentrations in the brain on human respiration we measured the ventilatory response to carbon dioxide in seven normal subjects after they had taken vigabatrin or placebo for three days in a double blind crossover study. There was no change in either the slope or the intercept of the curve of the ventilatory response to carbon dioxide after vigabatrin by comparison with placebo. This study suggests that GABA does not have an important role in the control of respiration in normal individuals.
4-Aminobutyrate Transaminase↗
Treatment of metastatic prostate carcinoma with the depot LRH analog Zoladex.
A long-acting LRH agonist (ICI 118630, Zoladex) was given by monthly subcutaneous injection to 25 patients with previously untreated symptomatic advanced prostatic carcinoma. The medication was well tolerated with the only side effect being hot flushes in 15 patients. Subjective improvement occurred in 22 patients, and disease remission or stabilization judged by objective criteria was seen in 21 and 18 patients from the total group at 3 and 6 months of treatment, respectively. Twelve of 18 patients followed for 1 year were still in objective remission/stabilization. Prostate volume measured by ultrasound decreased by a mean value of 75% and urine flow increased significantly. There were significant falls in serum testosterone and gonadotrophin levels and significant although lesser reductions in serum androstenedione and dehydroepiandrosterone. These changes were accompanied by significant reductions in serum acid and alkaline phosphatase and a rise in serum osteocalcin. Four patients (16%) experienced an initial tumor flare. Although only a small number of patients were studied, Zoladex appeared to be a well-tolerated agent for treatment of prostatic carcinoma, with an initial clinical response similar to that seen with standard endocrine therapy.
Adult↗
Zoladex treatment of symptomatic prostatic carcinoma.
The depot LH-RH agonist Zoladex was used to treat 38 patients with previously untreated symptomatic stage D2 prostate carcinoma. Side effects were minimal and patient acceptability excellent, although temporary tumor flare occurred in 11% of patients. Eighty-four percent experienced subjective improvement and 87% had objective evidence of initial disease stabilization or remission lasting 3 months. Serum levels of gonadotrophin and free testosterone as well as androgens of adrenal origin fell significantly with treatment. Long-term survival to date appears at least as good as that described for conventional endocrine therapy.
Buserelin↗
Food intake at age 8. 1. Energy, macro- and micronutrients.
The food energy, macro-, and micronutrient intake of 78 boys and 63 girls aged 8 years who have been studied since birth is reported. Nutrient intake was calculated from 4 day weighed records using the CSIRONET data bank based on British tables of food composition. The mean values for daily intake for girls and boys, respectively, for energy (MJ), protein, fat, carbohydrate and fibre (g) were 7.4 and 6.5; 64 and 57; 71 and 62; 232 and 206; and 15 and 12 g. Half the food energy came from carbohydrate, divided equally between starch and simple sugars, 15% from protein, and 35% from fat. This comprised 41% saturated (S), 33% mono- and 16% polyunsaturated (P). The mean P:S ratio for girls was 0.46, and 0.41 for boys. Overall sweets and soft drinks contributed 4-5% to energy intake, with large individual differences. Mineral and vitamin intakes were satisfactory in relation to theoretical optimal population needs. Vitamin and/or mineral supplements were taken by 8.5% of the sample. These results are discussed in relation to the Nutritional Guidelines.
Australia↗
Food intake at age 8. 2. Frequency, company and place of meals.
In a sample of 141 healthy 8 year old children, over 95% had three main meals on each of the 4 days of the food record. Two-thirds had an afternoon snack and nearly one-half a morning snack on each of the 4 days, but only one-quarter had supper on each day. Seventy-one per cent of all meals were eaten at home with the family, 20% at school with friends, and less than 1% of meals were eaten at a restaurant or fast food outlet. These data show that amongst children of primary school age, take away sources of food make a very small contribution to the diet, and that eating habits at home are of greatest importance to the child's diet.
Child↗
Food intake at age 8. 3. Distribution and food density by meal.
This report describes how nutrient intake was distributed throughout the day, and the nutrient density according to meal, in 78 boys and 63 girls who have been studied from birth. The food intake was calculated from 4 day weighed records using the CSIRONET data bank based on British tables of food composition. The percentages of total energy from breakfast, lunch, evening meal, and snacks were 20, 26, 31, 23%. There was a very wide range of individual nutrient intake for each meal. The evening meal made the largest contribution to fat and protein intake. Most starch came from lunch (30%) and least from snacks (16%). Snacks contained a large portion of the simple sugars (39%). Breakfast was an important source of calcium and B vitamins, but with wide ranges of micronutrients occurring for each meal. This analysis of nutrient density and distribution contributes towards the formulation of practical recommendations about beneficial dietary changes.
Child↗
Energy and nutrient intake at age 6 and its relationship to body size and fatness.
The values for macro- and micronutrients and food energy intake are reported from a sample of 154 healthy children aged 6 years who have been prospectively studied since birth. The daily food energy intake in absolute terms and adjusted for body mass was lower than reported previously, and lower than the current recommended daily intake (RDl) but consistent with values derived from predictive equations based on other studies of preschool children. The carbohydrate intake was similar, but the protein intake was slightly lower and the fat intake also less than that reported in previous studies of children of a similar age. Micronutrient intake was greater than the RDl for each. The intake of potassium was adequate, but that of sodium was high in relation to the recommended K:Na ratio of greater than 1, resulting in a value of 0.66. Stature was positively correlated with energy and fat intake, but there was an inverse correlation between fatness and energy intake, and intake of unrefined carbohydrate. These results are discussed in relation to the effect of different nutritional planes on growth rate.
Age Factors↗