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Biomedical subjects

J Rees

Publications and source records attributed to J Rees.

At least 73 records · Page 4Linked to original sources
PubMed1995

Where medical science and human behaviour meet.

Although we may be wrong about the details, we should try to imagine what the future holds for hospital consultants. The days of the independent consultant in the same post for 30 years are over, and there will be a change from "the" consultant to a few tiers of senior staff. Patients will increasingly demand to see specialists, so more specialists will be needed. As patients and their advocates become better informed the traditional rationing of clinical care to patients in Britain, such as restricting access to specialists, cannot continue. There is a current trend for evidence based health care, but the idea that each element of medical practice can be dictated by systematic evidence based research will prove to be naïve--such research informs practice rather than dictates it. Science will continue to act as the guide to medical practice but specialists will not be turned into a set of logical operators running programs designed by health planners.

Behavior↗
PubMed1995

Guillain-Barré syndrome. Clinical manifestations and directions for treatment.

Guillain-Barré syndrome (GBS) is the commonest cause of acute neuromuscular paralysis in the developed world today. Patients present most commonly with a rapidly ascending paralysis together with sensory symptoms and variable autonomic involvement. The diagnosis is clinical, but lumbar puncture and nerve conduction studies are helpful in excluding other conditions. The improvement in prognosis in recent years is largely due to advances in respiratory intensive care management. Careful monitoring of cardiorespiratory function and in particular regular measurements of the vital capacity will help to predict which patients will require elective ventilation to prevent impending neuromuscular respiratory failure. The paralysed patient is susceptible to all the complications of immobility, in particular venous thromboembolism and hypostatic pneumonia, and good nursing care and physiotherapy are therefore mandatory. Autonomic involvement may predispose to cardiac arrhythmias and labile blood pressure. The prolonged nature of the illness predisposes to psychiatric complications, particularly depression, and this should be treated appropriately. Specific treatment is aimed at reducing the period of maximum disability. Both plasma exchange (PE) and intravenous immune globulin (IVIg) have been shown to be effective in randomised controlled trials. A multicentre trial is currently under way to determine whether PE or IVIg or PE followed by IVIg is the most effective treatment for this condition. Steroids alone have not been shown to be of value, although a trial is under way comparing the combination of IVIg and methylprednisolone with IVIg alone. The prognosis of GBS is generally good, with about 80% of patients making a full recovery, although about 5% die of complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗
PubMed1994

Genetic alterations in non-melanoma skin cancer.

Non-melanoma skin cancer is common and offers unrivaled opportunities to relate genetic changes to clinical and biologic behavior. Recent technical advances in molecular biology render genetic analysis of even the smallest skin cancers possible. In this review I will discuss the role of p53 gene in skin carcinogenesis, the relation between p53 immunostaining and p53 mutation, and recent evidence for the involvement of putative tumor suppressor genes both on chromosome 9 and other chromosomes in non-melanoma skin cancer.

Basal Cell Nevus Syndrome↗
PubMed1994

Waxy keratoses of childhood.

Three cases of waxy keratoses of childhood occurring in two families are described. The disorder seen in these three cases appears to be clinically and histopathologically distinct from previously described familial disorders of keratinization, which also feature multiple discrete papules.

Child↗
PubMed1993

Relief of sickle cell priapism by hydralazine. Report of a case.

We report a 16-year-old Tanner IV male with homozygous hemoglobin S who presented with recurrent episodes of priapism unresponsive to standard therapy with hydration, analgesia, and exchange transfusion. He had a complete resolution of his symptoms with hydralazine therapy. We therefore suggest a trial of vasodilator therapy for recurrent sickle cell priapism before attempting surgical therapy.

Adolescent↗
PubMed1993

Assessment of area of involvement in skin disease: a study using schematic figure outlines.

The ability to assess the severity of dermatoses by measurement of area of involvement is important in both clinical practice and research. Using schematic figure outlines we have shown that physicians, nurses and other groups are unable to assess area accurately, and that the degree of error is partially dependent on absolute area, but also on other factors. The pattern and magnitude of the errors varied between the groups examined, but overall was such that it calls in question the use of area indices such as the PASI (psoriasis area and severity index) score in the assessment of inflammatory dermatoses.

Dermatology↗
PubMed1992

The molecular biology of retinoic acid receptors: orphan from good family seeks home.

A variety of c-DNAs coding for nuclear retinoic acid receptors (RARs) have recently been cloned. These receptors are members of the steroid/thyroid receptor superfamily and are believed to act as ligand-inducible transactivating factors; retinoic acid induces changes in receptor configuration that allows DNA binding and increased gene transcription from specific genes to occur. The retinoic acid receptor family itself may consist of up to 20 separate receptors each with a specific distribution and ligand binding characteristics. The RAR-gamma in the adult is found almost exclusively in the skin but other receptors which are found in a variety of other tissues are also present in skin. Associations of cutaneous disease states with receptor mutants have not yet been reported although some cases of leukaemia may be secondary to retinoic acid receptor gene rearrangements. A variety of approaches to identify the biological function of these receptors based on recombinant DNA technology are already underway.

Animals↗
PubMed1992

Surgical approaches to the sphenoid sinus.

The sphenoid sinus can be approached through the ethmoid, nasal or septal zones of the anterior wall. Case studies, fresh/fixed cadaver material and radiologic examinations, including three-dimensional CT reconstructions, were used to define the anatomic conditions governing the safest penetration of each zone. The ethmoid zone was often associated with anatomic variations such as posterior and superior placement of ethmoid cells which dictated caution. The transnasal route was best used for isolated sphenoid disease since nasal disease caused significant bleeding. A detailed description of the vomer-ethmoid relationship outlines the advantages of using the septal zone. The actual zone used to enter the sphenoid sinus must be determined by the nature of the disease process to be treated and therefore a detailed knowledge of the normal and aberrant anatomy of each zone, as elaborated by the radiological road map, is required to prevent complication.

Endoscopy↗
PubMed1991

Snoring.

Explore the source record for details and available documents.

Alcohol Drinking↗