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Biomedical subjects

J M Lawrence

Publications and source records attributed to J M Lawrence.

At least 19 recordsLinked to original sources
PubMed1997

Domestic violence in the Emergency Department: I. Two case-control studies of victims.

The object of this study was to compare the diagnoses and characteristics of self-reported domestic violence victims with a random sample of nonvictim controls who were selected from attendees at the Emergency Department (ED) of a major public hospital in Australia. Comparisons were made at index presentation and for the 5 years prior to index presentation. Subjects were drawn from two screening studies carried out 1 year apart which were conducted to assess the prevalence of domestic violence among attendees at the ED. From these groups, the medical records of all individuals who had disclosed domestic violence were examined and compared with the medical records of a random sample of nondisclosers, matched for age (+/- 10 years), sex, and type of entry into the ED (acute vs nonacute). The two case-control studies, conducted 12 months apart, showed that there were statistically significant differences between the diagnoses and characteristics of victims and nonvictims. Victims made more visits to the ED and Outpatients' Department than nonvictims; victims had more psychiatric index presentations; more victims had evidence of treatment of psychiatric conditions, both as inpatients and outpatients, in the previous 5 years than nonvictims; victims had greater rates of attempted suicide and alcohol problems than nonvictims at index presentation and for the previous 5 years. The findings indicate the need for the prevention and treatment of psychiatric conditions of domestic violence victims, including drug and alcohol problems and suicidal ideation. The findings form the basis of hypotheses for further studies to investigate the association between domestic violence and psychiatric illness.

Adult↗
PubMed1997

Domestic violence in the Emergency Department: 2. Detection by doctors and nurses.

This study was conducted in 1991 and 1992 to determine the detection rates of domestic violence victims by doctors and nurses at the Emergency Department (ED) of Royal Brisbane Hospital, a major public hospital in Australia. The objective was to determine the outcome of an education program about domestic violence conducted in 1991 for doctors and nurses in the ED. As part of two case-control studies, the self-reports of those who disclosed domestic violence on a screening questionnaire were compared with the recording of domestic violence on each individual medical record. Subjects were drawn from two screening studies carried out 1 year apart which were conducted to assess the prevalence of domestic violence among attendees at the ED. An education program about domestic violence was conducted for doctors and nurses in the ED between the two screening studies. The examination of the medical records showed that detection rates of victims of domestic violence were unchanged between the two case-control studies. Both studies found that 50.0% of those who reported the experience of domestic violence within the 24 hours prior to index presentation, on the screening questionnaire in the prevalence studies, were recorded as such in their medical records. The low detection rates indicate the requirement for doctors and nurses to receive appropriate training to identify and record the psychosocial aspects of domestic violence victims. As well as training, referral systems need to be set in place to address the psychosocial aspects of domestic violence victims.

Adult↗
PubMed1996

Prevalence study of domestic violence victims in an emergency department.

STUDY OBJECTIVE: In 1992, a study of the prevalence and predictors of domestic violence victims among individuals who presented to a major public hospital emergency department was conducted to replicate a study conducted by the authors in the same setting 12 months previously. The second study aimed to investigate more accurately the presentation of current victims of domestic violence to the ED. METHODS: In a retrospective, cross-sectional study, a screening questionnaire was administered to participants to establish the prevalence of a history and current presentation of domestic violence problems among patients who presented to the ED of a major public hospital. The study group comprised a representative sample of 670 male and 553 female adults (older than 16 years) who presented to all sections of a public hospital ED during 53 randomly selected 8-hour nursing shifts over an 8-week period in 1992. RESULTS: The results of the second prevalence study confirmed those of the first study. Of the 1,223 respondents in the study, 15.5% disclosed a history of adult domestic violence (8.5% of men, 23.9% of women). Women were at greater risk than men for abuse as adults (raw relative risk [RR], 3.27; 95% confidence interval [CI], 2.23 to 4.79; RR adjusted for age, history of child abuse, and country of birth, 4.13; CI, 2.86 to 5.95). Women were at greater risk than men for being doubly abused (as a child and as an adult)(raw RR, 2.17; CI, 1.33 to 3.53). The second prevalence study confirmed what had been indicated in the first study: that 2.0% of women who presented to the ED (11.6% of all women with a history of adult domestic violence) were current victims of domestic violence and that these women presented mainly between the hours of 5 pm and 8 am, when no social work services were available for referral of victims. CONCLUSION: These Australian studies support the findings of prevalence studies of domestic violence victims in ED in the United States. The prevalence and risk factors indicate the need for training of physicians and nurses in the ED about domestic violence and for provision of appropriate backup referral services such as after-hours social work services.

Adolescent↗
PubMed1996

Stress and the doctor's health.

Many among the medical profession and in society in general, still ascribe to the notion that doctors are not at risk from stress that doctors don't get sick and that if they do then help is readily available free of charge. This article explores and debunks these three myths with practical suggestions for dealing with the stresses of our profession.

Adaptation, Psychological↗
PubMed1995

Systemic lupus erythematosus in a child with sickle cell disease.

Although sickle cell disease (SCD) and systemic lupus erythematosus (SLE) are two distinct chronic diseases, many clinical features are common to both conditions. We describe a young patient who had a mild clinical course of SCD until SLE developed when he was 15 years old. His initial manifestations of SLE including fever, chest pain, and lung infiltration with pleural effusion were thought to be complications of SCD. However, a deteriorating clinical course, presence of facial and truncal rash, and persistent pleural effusion led to the diagnosis of SLE. We compare our case and the 10 previously reported cases and discuss the possible association of complement defects and the pathogenesis of SLE in patients with SCD. Our report illustrates the importance of considering other disease processes when clinical features are atypical of SCD.

Adolescent↗
PubMed1995

Voiding after neonatal circumcision.

OBJECTIVE: To determine whether it is necessary to delay discharge of newly circumcised male neonates to observe voiding. SUBJECTS AND METHODS: A prospective study was conducted in 1992 and 1993 of 51 healthy male, newly circumcised neonates between 0 and 10 days of age. The neonates were observed for the time of first voiding after circumcision was performed. RESULTS: All neonates voided after circumcision at a mean age of 5.3 +/- 2.5 hours, and there were no complications noted in the study population. CONCLUSION: Healthy male infants who are circumcised without obvious complications can be expected to void, and it is unnecessary to delay hospital discharge to make this observation.

Circumcision, Male↗
PubMed1994

Extrusion transplantation of Schwann cells into the adult rat thalamus induces directional host axon growth.

In a previous study we found that Schwann cells microtransplanted into the central nervous system rapidly dispersed from the transplantation site and became intimately associated with host grey and white matter. We have now investigated whether this migratory behavior of the donor Schwann cells is compatible with the production of stable, continuous anatomical cell tracks and whether such tracks can induce directional host axon growth. During the gradual withdrawal of a micropipette, highly purified suspensions of cultured adult peripheral nerve Schwann cells were continuously extruded to form a vertical column of cells extending for up to 4 mm through the thalamus and across the choroid fissure into the hippocampus of adult rat hosts. The donor Schwann cells were identified by immunohistochemistry for low-affinity nerve growth factor receptor, vimentin, and Rat 401. Although donor Schwann cells migrated into the host tissues, a large number remained along the axis of the injection track to form a column which was maintained for up to 3 weeks. From 4 days, increasing numbers of parallel, unbranching host RT97-positive axons entered the Schwann cell column in alignment with the long axis of the Schwann cells in the vertical tracks. The axons did not fasciculate directly with each other, but mingled diffusely with the Schwann cells. The Schwann cell tracks were able to convey host axons out of the dorsal thalamus, across the extracellular space of the choroid fissure, and into the ventral hippocampus. Thus, Schwann cells, transplanted in the form of elongated tracks, can establish bridges across boundary membranes in the brain and carry substantial numbers of nerve fibers from one area to another.

Animals↗
PubMed1994

Cardiovascular teratogenicity of terbutaline and ritodrine in the chick embryo.

OBJECTIVE: We determined the teratogenic effects of terbutaline and ritodrine, both beta 2-sympathomimetic agonists, on the stage 24 (4-day) chick embryo. STUDY DESIGN: We used a topical method of application of terbutaline or ritodrine to the stage 24 chick embryo in ovo. Doses of terbutaline ranged from 5.5 x 10(-10) to 6.5 x 10(-9) mol per embryo, and ritodrine doses ranged from 4.6 x 10(-11) to 4.6 x 10(-8) mol per embryo. To further determine the pharmacologic nature of the teratogenic potential of terbutaline or ritodrine, the experiments were repeated after pretreatment with butoxamine hydrochloride, a preferential beta 2-antagonist, or metoprolol tartrate, a preferential beta 1-antagonist, 4 hours before application of terbutaline or ritodrine. RESULTS: Terbutaline treatment was associated with significantly higher rates of anomalies than in controls at all dosages used, whereas ritodrine induced significantly more anomalies at or above doses of 4.6 x 10(-9) mol per embryo. At an equimolar dose pretreatment with butoxamine hydrochloride significantly reduced the cardiovascular teratogenic effects of terbutaline and ritodrine. Pretreatment with metoprolol tartrate at any dose did not significantly reduce terbutaline's potential. Metoprolol, at doses tenfold or 100-fold higher than ritodrine, was able to significantly reduce the teratogenic effects of ritodrine. CONCLUSIONS: Our data suggest that terbutaline and ritodrine are teratogenic in the chick and that these agents exert their teratogenic effects primarily through stimulation of the beta 2-adrenergic receptor.

Animals↗
PubMed1994

Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation.

From 1982 to 1988, 147 cemented acetabular components were revised with cementless hemispheric press-fit components, with an average follow-up period of 5.7 years (range, 3-9 years). Acetabular defects were typed from 1 to 3 and reconstructed with a bulk or support allograft. Type 1 defects had bone lysis around cement anchor sites and required particulate graft. Type 2A and B defects displayed progressive bone loss superiorly and required particulate graft, femoral head bulk graft, or cup superiorization. Type 2C defects required medial wall repair with wafer femoral head graft. Type 3A and B defects demonstrated progressive amounts of superior rim deficiencies and were treated with structural distal femur or proximal tibia allograft. Six of the 147 components (4.0%), all type 3B, were considered radiographically and clinically unstable, warranting revision. Three of the six were revised. Moderate lateral allograft resorption was noted on radiographs, but host-graft union was confirmed at revision. Size, orientation, and method of fixation of the allografts play an important role in the integrity of structural allografts, while adequate remaining host-bone must be present to ensure bone ingrowth.

Acetabulum↗
PubMed1994

Outcome of revision hip arthroplasty done without cement.

Between 1980 and 1986, ninety-three femoral revision arthroplasties without cement were performed on ninety-one patients who had symptomatic loosening of a stemmed femoral component of a total hip prosthesis. Eighty-one of these patients (eighty-three hips) were followed for at least five years (range, five to thirteen years; mean, nine years). Forty-three hips also had a revision of a cemented acetabular component with use of a hemispherical, porous-coated implant inserted without cement. The results are presented in a traditional manner in terms of implant survivorship, radiographic evaluation for stability of the implant, and standardized hip scores. Changes due to the treatment are presented as outcomes in terms of the physician's criteria for the success of the operation, the patient's criteria for the success of the operation, and the patient's economic status. No hips that needed additional operations were excluded, and we reported the outcome regardless of any interim operative procedures (including re-revisions). At the latest follow-up examination, nineteen (23 per cent) of the eighty-three hips had had an additional operation, including seventeen hips (20 per cent) for which re-revision had been necessary. In ten (12 per cent) of the eighty-three hips, the re-revision had involved an index implant. The rate of re-revision of the index femoral component was 10 per cent and the rate of mechanical loosening of that component was 11 per cent. The rate of re-revision of the index acetabular component was 7 per cent and the rate of mechanical loosening of that component was 11 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

Cytokine levels in serum and synovial fluid of patients with juvenile rheumatoid arthritis.

OBJECTIVE: Cytokines play an important role in mediating inflammation and in regulating the immune response of many rheumatological diseases. In patients with juvenile rheumatoid arthritis (JRA), levels of 6 cytokines, interleukin 1 alpha (IL-1 alpha), IL-1 beta (IL-1 beta), IL-2, IL-2 receptor (IL-2R), IL-6, and tumor necrosis factor alpha (TNF-alpha) were measured in serum and synovial fluid (SF) in an effort to evaluate their significance. METHODS: Serum concentrations of the 6 cytokines were measured in 62 patients with JRA including 22 pauciarticular onset, 26 polyarticular onset, and 14 systemic onset patients, and 29 disease and healthy controls using enzyme-linked immunoabsorbent assays (ELISA). Seventeen SF from patients with JRA were examined for cytokine levels. RESULTS: Elevated serum levels of IL-2R were found in patients with systemic onset and elevated IL-2 levels in pauciarticular and polyarticular onset JRA as compared to controls. Pauciarticular and polyarticular onset patients also had elevated IL-1 alpha and IL-6 levels. There were no statistical differences found between the groups for TNF-alpha and IL-1 beta. SF revealed elevated levels of IL-1 beta, IL-2R, and IL-6; however, correlation was noted between serum and SF levels only for IL-1 alpha, not for the other cytokines. Mean serum levels of IL-2R in all onset types with active disease and IL-6 levels in active polyarticular and pauciarticular onset were elevated when compared with mean inactive levels. CONCLUSION: Our studies indicate that (1) IL-1 alpha, IL-2, IL-2R, and IL-6 levels are increased in serum of patients with JRA with different onset types; (2) elevated levels of IL-1 beta, IL-2R, and IL-6 are found in their SF compared to serum levels; (3) a correlation exists between serum and SF levels only for IL-1 alpha; (4) mean IL-2R levels are elevated with active disease in all onset types and mean IL-6 levels with active polyarticular and pauciarticular onset disease are elevated compared to mean levels of inactive patients; and (5) cytokines may thus play a role as inflammatory mediators in JRA.

Adolescent↗
PubMed1994

Giardiasis in laboratory-housed squirrel monkeys: a retrospective study.

Giardia infection was diagnosed in a 1.5-year-old, group-housed, female squirrel monkey with diarrhea. A retrospective study was undertaken to evaluate the incidence of Giardia in the 190-member colony. Records were analyzed to determine whether any one of the following conditions applied: the animal had clinical signs referable to the gastrointestinal system; a fecal examination for ova and parasites was performed; gastrointestinal parasitism was revealed by necropsy; or a culture of samples from the gastrointestinal tract was performed. Analysis revealed a total of 19 monkeys, 68% (13/19) of which had gastrointestinal clinical signs. Giardia cysts were recovered from 33% (4/12) of monkeys with gastrointestinal signs in which fecal examinations were done. The yearly incidence of diarrhea in the colony was low at 0.61%; however, 33% (2/6) of the monkeys with diarrhea were positive for Giardia. Six animals had blood in the feces or rectal prolapse, in the absence of diarrhea, and 30% (2/6) of these animals were positive for Giardia. Of six animals without gastrointestinal clinical signs, 50% (3/6) had giardiasis, which was listed as an incidental finding. In light of these findings, an additional 16 healthy animals were examined for Giardia. Giardia cysts were recovered from 50% (3/6) of males and 70% (7/10) of females from which samples were obtained. Additionally, clean water consumed by the animals was negative for Giardia cysts, and facility waste water was positive. To our knowledge, this is the first report of giardiasis in squirrel monkeys.

Animals↗
PubMed1993

Domestic violence victims in a hospital emergency department.

OBJECTIVE: To determine the prevalence and predictors of domestic violence victims among attenders at the emergency department at Royal Brisbane Hospital in 1991. DESIGN: Cross-sectional study in which randomly selected nursing shifts were used to screen attenders. RESULTS: Of all attenders at the emergency department, 14.1% disclosed a history of domestic violence. Women were more likely than men to disclose domestic violence ("raw" relative risk, 2.31; 95% confidence interval [CI], 1.83-2.91; relative risk adjusted for age and history of child abuse, 4.50; 95% CI, 3.02-6.71). The greatest risks for being an adult victim of domestic violence were being female and having experienced abuse as a child. Most of those who had experienced domestic violence within the last 24 hours (1.1% of attenders) came to the department after-hours when social work staff were unavailable for referral. CONCLUSIONS: The prevalence and risk factors have implications for the training of doctors and nurses in domestic violence problems and for the provision of adequate resources to deal with the psychosocial aspects of domestic violence.

Adolescent↗
PubMed1993

Morphology and migration of cultured Schwann cells transplanted into the fimbria and hippocampus in adult rats.

Schwann cells cultured from neonatal rat peripheral nerve were injected into the fimbria and hippocampus of syngeneic adult rats by a microtransplantation technique which causes minimal disturbance to the host brain structure at the site of implantation, and thus allows the grafted cells to come into immediate contact with intact host tissue. Numerous Schwann cells could be identified for up to 6 weeks (and with decreasing frequency for up to 3 months) by intense immunoreactivity for low affinity nerve growth factor receptor. The transplanted cells adopted a distinctive elongated form, with a central, ovoid nucleus flanked by processes which were up to 300 microns long, and which ranged from swollen segments with a diameter as large as 12 microns down to thread-like fibres of 1 micron or less. This morphology is different from that of any of the host cells. The transplanted Schwann cells migrated freely into the host tissue along blood vessels and according to the position of the grafts, they either entered the hippocampal neuropil, or migrated (for distances of up to 2 mm) along the longitudinal axis of the fimbria, where they were interspersed in parallel with the interfascicular glial rows and axons. The host astrocytes did not appear to impede the migration of the donor Schwann cells. Although the host astrocytic processes became hypertrophic, with increased glial fibrillary acidic protein and vimentin expression, the predominant longitudinal orientation of the astrocytic tract processes was maintained. The transplanted Schwann cells did not form peripheral myelin (as detected by P0 immunoreactivity), and it is not clear whether they survive beyond the period at which we detect them.

Animals↗
PubMed1993

Autoantibody studies in juvenile rheumatoid arthritis.

Early studies showed few immunologic abnormalities in juvenile rheumatoid arthritis (JRA) patients. There were no specific laboratory markers useful for diagnosis and assessment of the course of disease in JRA. Previous work showed an association of antinuclear antibodies (ANA) with early-onset pauciarticular disease and iridocyclitis. Similarly, the presence of 19S immunoglobulin (Ig) M rheumatoid factors (RF) was associated with late-onset polyarticular disease in girls. More recent studies have detected many unique autoantibodies. Newer assays show 19S IgM RF in up to 35% of JRA patients, although still mainly in girls with late-onset polyarticular disease. Hidden 19S IgM RF can be shown in up to 75% of JRA patients using different procedures, primarily in those with active polyarticular-or pauciarticular-onset disease. Immune complexes have been detected in JRA patients by means of different techniques; their presence usually correlates with active disease. Studies on a specific ANA in JRA have shown no common extractable nuclear antigen, but antihistone antibodies have been found in up to 75% of cases, again mainly in those with pauciarticular onset and iritis. Finally, a variety of unusual immunologic proteins have also been detected, including anti-ocular, anti-cellular, anti-cardiolipin, anti-perinuclear factor, and anti-collagen antibodies. This review evaluates the significance of these antibodies that can now be found in JRA.

Antibodies, Antinuclear↗
PubMed1993

Schwann cells transplanted into the CNS.

A small volume of purified Schwann cells, cultured from early postnatal rat sciatic nerve, was injected into the hippocampus or fimbria of syngeneic adult hosts. The procedure caused minimal structural disturbance at the transplantation site, with close graft-host contact and maximal opportunity for integration. The donor Schwann cells were identified by a combination of light and electron microscopic features (which include characteristic deep and complex infoldings of a well marked nuclear envelope), antigenic profile (especially low affinity nerve growth factor receptor immunoreactivity), uptake of fluorescent latex microspheres and autoradiography of [3H]thymidine-labelled dividing cells. The donor Schwann cells adopted a distinctive elongated form, with a central, ovoid nucleus flanked by processes which were up to 300 microns long, and which ranged from swollen segments with a diameter as large as 12 microns down to thread-like fibres of 1 microns or less with growth cone-like expansions. Transplanted cells migrated from the graft, particularly along blood vessels and could permeate all cytoarchitectonic regions of the adjacent host hippocampal neuropil. Donor Schwann cells also migrated along the longitudinal axis of the fimbria, where they were interspersed in parallel with the interfascicular glial rows and axons. The grafted cells induced a transient but marked host astrocytic hypertrophy, which did not appear to impede the migration of the donor Schwann cells. The transplanted Schwann cells did not form peripheral myelin (as detected by P0 immunoreactivity), and it is not clear whether they survive beyond the period at which we detect them.

Animals↗