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Biomedical subjects

J M Jordan

Publications and source records attributed to J M Jordan.

At least 37 records · Page 2Linked to original sources
PubMed1995

Family practice obstetrics in a teaching hospital. Does a tertiary care environment make a difference?

OBJECTIVE: To determine referral rates, to study the nature of consultations with obstetricians, and to examine how both patient and physician characteristics affect referrals. DESIGN: Case series. Retrospective review of hospital records. SETTING: Victoria Hospital, a tertiary care centre affiliated with the University of Western Ontario in London, Ont. PARTICIPANTS: Five hundred forty-two women admitted consecutively for delivery under the care of family physicians from October 1, 1990, to September 31, 1991. OUTCOME MEASURE: The number and types of obstetrical consultations obtained for the study population. RESULTS: Of the 50.7% of cases requiring consultation, half were delivered by obstetricians. The most common reasons for consultation were failure to progress in labour, induction of labour, posterior presentation, fetal distress, and pregnancy-induced hypertension. The most common reasons for obstetricians to attend delivery were to perform forceps rotations and cesarean sections. CONCLUSIONS: Parity and risk classification were the two most important factors for predicting whether consultation would occur. The high rate of consultation in this study might relate to ease of access to consultation in a tertiary care environment. More study is needed to examine the reasons for consultation because it seems that some of the situations for which obstetricians were consulted could have been safely managed by family physicians.

Family Practice↗
PubMed1994

Appraisal of and coping with arthritis-related problems in household activities, leisure activities, and pain management.

PURPOSE: We examined whether or not there are systematic differences in how people appraise different types of illness-related problems and in how they cope with these problems. METHODS: Two hundred thirty-five adults with recently diagnosed rheumatoid arthritis completed a mailed questionnaire followed by a telephone interview. A series of stress appraisal and coping variables were assessed in relation to three areas: household activities, leisure activities, and pain management. RESULTS: Pain differed significantly from household and leisure activities with regard to several appraisal and coping variables. Participants reported the least control over problems with pain, while attaching the most importance to pain control. Leisure activities also stood out as unique on several variables. Participants perceived greater ability and were more satisfied with their ability in relation to leisure activities. CONCLUSION: These findings show that, at least early in the disease, appraisal and coping strategies differ across the areas of household activities, leisure activities, and pain management.

Activities of Daily Living↗
PubMed1993

Errors in death certificate completion in a teaching hospital.

A retrospective chart review was conducted to determine the types and frequency of errors, other than those of diagnostic accuracy, made in recording information on death certificates and to assess factors that might affect those rates. The sample (n = 426) consisted of 50% of all deaths in a London, Ontario teaching hospital over one year. For each certificate reviewed, 6 questions were asked based on W.H.O. guidelines: 1) Was there an acceptable cause of death? 2) If mechanisms of death were recorded, were they adequately explained by an underlying cause of death? 3) Were there any sequencing errors? 4) Were there 2 competing causes of death listed? 5) Was there recorded any time interval between onset of the condition and death? 6) Was there any other inappropriate information recorded? The death certificates were filled out in an acceptable fashion 68.1% of the time. Comparing the 6 major departments in the hospital, there was significant difference in the error rates of the different departments (p = .0035). Error rates were not significantly better for certificates that had been signed by a coroner nor in those that had an autopsy performed. The majority of the death certificates (89.4%) were completed by house staff. More attention has to be devoted to raising physicians' awareness of the types of errors made in completing death certificates. Recurring educational sessions and feedback, if provided in teaching hospitals, could be helpful to increase the accuracy of these important documents.

Autopsy↗
PubMed1992

Psychological well-being among people with recently diagnosed rheumatoid arthritis. Do self-perceptions of abilities make a difference?

OBJECTIVE: Satisfaction with abilities and perceived importance of abilities are 2 factors involved in the process of self-evaluation. We examined the role that these factors play in adjustment to rheumatoid arthritis (RA). METHODS: Data were collected, via telephone interview and mailed questionnaire, from 234 individuals with recently diagnosed RA. Disease severity information was obtained from participants' physicians. RESULTS: Consistent with study hypotheses, satisfaction was associated with psychological well-being only among those who viewed as very important the abilities being evaluated. CONCLUSION: These findings increase understanding of the conditions under which low levels of satisfaction are likely to be associated with psychological distress.

Adaptation, Psychological↗
PubMed1991

The effects of hypnosis and of imagery on bleeding time: a brief communication.

2 studies are reported, one using hypnotized Ss selected on hypnotizability and one using Ss selected on imagery vividness, whose purpose is to examine whether non-patient Ss can control their bleeding in a laboratory setting. All Ss were cut on both arms with the "Surgicutt" device, an instrument that automatically makes a cut that will bleed from 2 to 10 minutes. Results suggest that Ss, who are instructed to reduce the bleeding time in one arm and to let the other arm bleed normally, are not able to control bleeding time.

Adult↗
PubMed1989

Effects of selenium deficiency on glutathione-induced protection from hyperbaric hyperoxia in rat.

Exposure of rats to 100% O2 at high pressure (greater than 2.0 ATA) results in generalized convulsions and death within several hours. The tripeptide, glutathione, has been shown to protect rats exposed to hyperbaric hyperoxia with delayed onset of seizures and prolonged survival. To investigate the hypothesis that glutathione exerts its protective effects via the glutathione redox cycle, we injected selenium-deficient rats and their selenium-supplemented controls with either glutathione (1 mmol/kg) or an equivolume of saline before exposure to 100% O2 at 4 ATA. Selenium-deficient rats exhibit marked reduction in liver glutathione peroxidase activity (GSH-Px). Glutathione administration significantly delayed both the onset of seizures and time to death in the control animals. In selenium-deficient rats, however, glutathione administration was not protective, having no significant effects on time to seizure or time to death. We also measured changes in glutathione concentrations in lung, liver, and brain of these same groups of animals exposed either to hyperbaric hyperoxia or to room air. In control rats, lung and brain glutathione concentrations did not change with the hyperbaric exposure regardless of glutathione pretreatment status, but hepatic glutathione concentration declined significantly during the exposure when glutathione was not supplied. If these animals were pretreated with glutathione, the decline in hepatic glutathione concentrations did not occur. In selenium-deficient rats, the hyperbaric exposure did not result in changes in lung, brain, or liver glutathione concentrations either in the glutathione-pretreated or in the saline-pretreated animals. Exogenous GSH administration does not protect selenium-deficient rats from hyperbaric hyperoxia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

BCNU-induced protection from hyperbaric hyperoxia: role of glutathione metabolism.

To explore the role of the glutathione oxidation-reduction cycle in altering the sensitivity of rats to the effects of hyperbaric hyperoxia, we administered N,N-bis(2-chloroethyl)-N-nitrosourea (BCNU) to decrease tissue glutathione reductase activity. We then exposed these animals and their matched vehicle-treated controls to 100% O2 at 4 ATA. Animals that received BCNU and were immediately exposed to hyperbaric O2 showed enhanced toxicity by seizing earlier in the exposure than controls. Animals that received BCNU 18 h before the hyperbaric O2 exposure were paradoxically protected from the effects of the exposure with a prolongation of their time to initial seizure and a marked increase in their survival time during the exposure. Tissue glutathione concentrations were also measured in the various groups and the hyperbaric O2 exposure produced marked decreases in hepatic glutathione levels in all control animals. In animals treated with BCNU 18 h before exposure, hepatic glutathione concentrations also decreased, but the concentrations had significantly increased during the 18-h waiting period, allowing these animals to maintain hepatic levels in the normal range even during their hyperbaric exposures. We conclude that treatment of rats with BCNU 18 h before exposure to hyperbaric hyperoxia results in enhanced protection of the animals during the exposure.

Animals↗
PubMed1988

Glutathione disulfide formation occurring during hypoxia and reoxygenation of rat lung.

To study changes in glutathione redox status as an indicator of oxidant stress during hypoxia and reoxygenation, we perfused isolated rat lungs with a high or low oxygen perfusate and measured the release of total glutathione and glutathione disulfide (GSSG) into the perfusate. Lungs were perfused for a 20-minute baseline period with a perfusate equilibrated with 95% O2 and 5% CO2 and ventilated with a 95% O2 and 5% CO2 gas mixture. Only very low amounts of oxygen were measurable in this hypoxic perfusate. The lungs were then perfused from a second reservoir containing perfusate equilibrated with 95% N2 and 5% CO2 and ventilated with a 95% N2 and 5% CO2 gas mixture. After the period of hypoxia, the lungs were reperfused with the 95% O2 and 5% CO2 equilibrated perfusate and ventilated with a 95% O2 and 5% CO2 gas mixture for the remainder of the experiment. Glutathione was measured in the perfusate serially throughout the experiment, and lactic dehydrogenase (LDH) was also measured to assess cell membrane rupture during the infusion. GSSG release remained stable in the baseline and hypoxic period but rose significantly in the reoxygenation period, to concentrations approximately two times basal release. Lung tissue concentrations of GSSC also rose in the reoxygenation period. Decreasing lung glutathione reductase activity by pretreating animals with 1,3-bis-2-chloroethyl)-1-nitrosourea (BCNU) increased GSSG release into the perfusate during reoxygenation. We conclude that GSSG formation and release is increased in the lung during the reoxygenation period after lung hypoxia, suggesting the presence of hydroperoxide and free radical metabolism. These data support the hypothesis that alterations in lung metabolism occur during hypoxia that allow free GSSG formation and release during the reintroduction of oxygen.

Animals↗
PubMed1987

Defective release of tissue plasminogen activator in systemic and cutaneous vasculitis.

The fibrinolytic system in a group of 23 patients with vasculitis and 10 patients with the cutaneous vasculitis atrophie blanche were studied. These patients were found to have markedly suppressed release of vascular tissue plasminogen activator (t-PA) stores whether the disease was active or in remission. The control group had releasable t-PA levels of 0.70 +/- 0.10 IU/ml of plasma. Levels of releasable t-PA in the patient population were 0.09 +/- 0.03 IU/ml for those with active vasculitis (p less than 0.0001 compared with the control group by the Student t test), 0.23 +/- 0.12 IU/ml for those with inactive vasculitis (p less than 0.001), and 0.03 +/- 0.01 IU/ml for those with atrophie blanche (p less than 0.0001). It is concluded that there is a generalized defect in plasminogen activator in a variety of vasculitides. Such a defect may contribute to the pathogenesis of lesions as well as the thromboembolic disease that may be observed in these patients.

Adult↗
PubMed1987

Wegener's granulomatosis involving the breast. Report of three cases and review of the literature.

Three cases of necrotizing granulomatous vasculitis of the Wegener's type involving the breast are described. In each, the presumed diagnosis was localized or metastatic carcinoma. The breast lesion and other manifestations of Wegener's granulomatosis developed concomitantly in one patient, and the breast lesion appeared several months before classic pulmonary symptoms in another. In the third patient, not only were her upper and lower airway symptoms explained only in retrospect, but even the significance of the breast biopsy findings was clarified only after other aspects of Wegener's granulomatosis developed. All patients ultimately demonstrated a good response to corticosteroids and cyclophosphamide therapy. Wegener's granulomatosis is a rare lesion affecting the breast but should nonetheless be considered in the evaluation of any breast mass.

Adult↗
PubMed1987

Pyomyositis and polyarticular septic arthritis from Hemophilus influenzae in a nonimmunocompromised adult.

We describe a healthy woman in whom pyomyositis of the left buttock, polyarticular septic arthritis, and meningitis due to Hemophilus influenzae type B developed after pneumonia. Systemic antibiotic therapy and local drainage provided a good result. This is the first case of pyomyositis and the 30th case of septic arthritis from Hemophilus influenzae described in an adult.

Arthritis, Infectious↗
PubMed1986

Multiple unusual manifestations of Wegener's granulomatosis: breast mass, microangiopathic hemolytic anemia, consumptive coagulopathy, and low erythrocyte sedimentation rate.

We describe a patient who presented with multiple unusual manifestations of Wegener's granulomatosis, including a breast mass, microangiopathic hemolytic anemia, and consumptive coagulopathy. Erythrocyte sedimentation rate (Westergren), usually elevated in the course of this disease, persistently remained low in this patient. We found that C-reactive protein levels were, in this case, a more sensitive gauge of disease activity.

Anemia, Hemolytic↗
PubMed1985

Juxtaglomerular apparatus tumor: a rare but curable cause of secondary hypertension.

We have reported our experience at Duke University Medical Center with juxtaglomerular apparatus tumor, a rare but remediable cause of significant hypertension. Our three cases illustrate markedly different clinical courses and diagnostic difficulties. Results of the usual diagnostic studies, including intravenous pyelogram and renal angiogram with selective renal vein renin assessment, may be normal, but abdominal CT with contrast can show even small lesions. Thus we propose the addition of CT in evaluating all cases of high-renin hypertension when renal artery stenosis has been excluded. Periodic reevaluation of these patients is mandatory to increase diagnostic accuracy and avoid unnecessary morbidity and mortality. Local resection, rather than total nephrectomy, should be considered because the tumors have low invasive potential.

Adult↗