Molded acrylic mouthguard to control bleeding at the hard palate graft site after eyelid reconstruction.
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Adolescent↗
Biomedical subjects
L Robinson
Publications and source records attributed to L Robinson.
Ultrasonic and computed tomographic appearances of paraganglioma simulating pancreatic mass.
We report two cases of paraganglioma in which the tumour was situated adjacent to the head of the pancreas simulating a pancreatic mass lesion. The absence of biliary or pancreatic duct dilatation on ultrasound in the presence of a large mass suggested a retroperitoneal tumour rather than a pancreatic adenocarcinoma. Functional activity in these tumours is common and should be excluded before biopsy.
Diagnosis, Differential↗
Contrast enhancing lymph nodes in bladder cancer: a potential pitfall on CT.
We report three cases of bladder cancer in which contrast enhanced computed tomography (CT) demonstrated minimally enlarged lymph nodes. These showed uniform uptake of contrast medium to a similar degree as adjacent venous structures, making the distinction between vessels and lymph nodes difficult. Magnetic resonance imaging (MRI) examination resolved the problem in two of the three patients.
Carcinoma, Transitional Cell↗
Mammary hamartoma--a review of 35 cases.
Mammary hamartomas are macroscopically well-delineated tumours composed of a variable mixture of epithelial elements, fat and fibrous tissue. Such lesions are an under-recognized entity and, as they can be visualized by mammography, may be seen more frequently with the advent of the UK National Breast Screening Programme. The clinical and pathological features of 35 cases of mammary hamartoma seen at the Imperial Cancer Research Fund Clinical Oncology Unit at Guy's Hospital between 1979 and 1990 have been reviewed. Hormone receptor analysis on nine cases gave high progesterone with low oestrogen levels, probably reflecting their premenopausal status. Immunohistochemistry showed that the positive receptor staining was confined to the epithelial elements. In 25 cases pseudo-angiomatous hyperplasia was evident in the stroma of the lesion. The importance of distinguishing the inter-anastomosing stromal spaces seen in the latter condition from low-grade angiosarcoma is emphasized; the relationship between pseudo-angiomatous hyperplasia and mammary hamartoma is discussed; and the possibility that the former represents a permanently dilated form of the lymphatic labyrinth suggested.
Adolescent↗
Cognitive-behavioural treatment of panic disorder during pregnancy and lactation.
The treatment of panic disorder during pregnancy and lactation poses special problems. It is important that both the practitioner and patient consider a number of issues to find the most appropriate treatment for the patient. New cognitive-behavioural treatment options often circumvent the problems of pharmacotherapy for pregnant or lactating women while providing therapeutic benefits which are at least equivalent.
Adult↗
Registration and display of the combined bone scan and radiograph in the diagnosis and management of wrist injuries.
A system has been developed for the registration and combined display of the X-ray image and isotope bone scan. This system has been evaluated by prospectively studying 23 patients who were referred for suspected injury of the wrist. The registration system has an inherent precision for registration of about 1 mm. When patient positioning errors are included, this increases to about 4 mm. Two observers evaluated the sets of images prior to registration and after registration and combined display. They judged that in 16 out of 17 cases judged abnormal (observer 1) and 12 out of 18 cases judged abnormal (observer 2), the registration technique improved localization of a lesion. One case was rejected as registration was not possible due to incorrect positioning of the hand.
Carpal Bones↗
Risks associated with an elevated maternal serum alpha-fetoprotein level.
Among 58,187 women tested, 1002 had a maternal serum alpha-fetoprotein measuring greater than or equal to 2.5 multiples of the median after correction for race, weight, and insulin-dependent diabetes. They were stratified into three groups: group 1, 2.5 to 2.9; group 2, 3.0 to 5.0; group 3, greater than or equal to 5.0 multiples of the median. The initial risk of a serious abnormality detected by ultrasonography or amniocentesis was 17% (5%, 12% and 65% in groups 1, 2, and 3, respectively). After correction for twins and dates, this risk became 23% (7%, 18%, and 71% in groups, 1, 2, and 3, respectively). Among the women with high maternal serum alpha-fetoprotein levels, 556 (77%) had normal ultrasonographic and amniocentesis studies, and the risk of adverse pregnancy outcome ws 27% (19%, 29%, and 70% in groups 1, 2, and 3, respectively). There was a statistically significant increase in late fetal and perinatal death, prematurity and growth retardation, oligohydramnios, abruptio placentae, preeclampsia, and congenital abnormalities. The overall risk for abnormality or adverse outcome was 24% in group 1, 41% in group 2, and 91% in group 3.
Congenital Abnormalities↗
Familial Hirschsprung's disease: report of autosomal dominant and probable recessive X-linked kindreds.
Multifactorial sex-modified inheritance has been proposed as the model of transmission in familial Hirschsprung's disease (HD). A review of two separate kindreds suggests that aganglionosis may be inherited as an X-linked recessive or an autosomal dominant trait. Chromosomal anomalies and other syndromes, including G6PD deficiency, may occur with familial HD. Recurrence risk counseling for family members depends on accurate pedigree analysis and a comprehensive understanding of the genetic factors involved.
Female↗
Renal artery stenosis in children.
In a large paediatric renal unit over the last 14 years, 19 children (10 male and 9 female, aged 1 week to 16 years, mean 7 years) with renal artery stenosis (RAS) were evaluated. Transplant RAS cases were not included. All 19 children were hypertensive. In 10 this was an incidental finding. Based on clinical findings and arteriography, the causes of RAS included a middle aortic syndrome (MAS) (n = 5), neurofibromatosis (n = 3), William's syndrome (n = 3), fibromuscular hyperplasia (FMH) (n = 4), idiopathic RAS (n = 2) and isolated branch artery stenosis (n = 2). Previous studies have suggested FMH is the commonest cause of RAS in the paediatric population. In our study the largest subgroup are MAS/William's syndrome children, in whom the angiographic appearances were indistinguishable. Where possible, management, both surgical and radiological, and eventual outcomes have been described.
Adolescent↗
A field trial to evaluate a whole cell vaccine for the prevention of caseous lymphadenitis in sheep and goat flocks.
A field trial to evaluate a whole cell vaccine for the prevention of caseous lymphadenitis (CLA) in sheep and goats was performed in one goat herd and one sheep flock over a period of three years. In goats, there was a nonstatistically significant trend for fewer cases of CLA in the vaccinated animals compared to the controls. In sheep, from six months to 36 months postinitial vaccination, the proportion of vaccinated sheep that developed CLA was significantly less (p less than 0.05) than in the control sheep. The antibody titers to Corynebacterium pseudotuberculosis as detected by microagglutination assay were significantly different (p less than 0.0001) at all times except at the initial vaccination. Swellings occurred at the vaccination site at an incidence level of 29.6% in goats and 34.1% in sheep. The vaccine appeared to be efficacious in reducing the proportion of sheep that developed CLA when challenged naturally in a field situation.
Agglutination Tests↗
Roots of urban violence.
Alcohol consumption and dependence, employment status, social and family history and history of previous violence in 49 patients injured in city-centre violence were compared with that in 49 paired, age and sex matched control individuals in a major accident and emergency department. All control individuals had been in the same locations as the patients at the time of injury. Alcohol consumption was recorded in units and dependence was assessed by means of the CAGE questionnaire. Patients had consumed significantly more alcohol in the 6 h before injury (mean consumption: 9 units/controls 7.1 units) and had been involved in more previous violence (mean number of incidents in previous 5 years: 4.3/controls: 1.5 incidents). In comparison with controls, male patients tended to be single rather than married (P = 0.051), to have lost a parent (P = 0.058) and to feel guilty about their alcohol consumption (P = 0.068). These results indicate that in relation to young adults, injury in urban violence was associated with excessive binge-alcohol consumption, but not with alcohol dependence, unemployment at the time of violence or socio-economic group.
Adolescent↗
Nager's acrofacial dysostosis. Case report and review of the literature.
Nager's acrofacial dysostosis is a rare congenital anomaly in which mandibulofacial dysostosis is seen in combination with limb deformities, particularly hypoplasia of the radial aspect of the hand. A boy with a severe manifestation of this syndrome is presented. Deformities include severe bilateral mandibular hypoplasia with trismus, malar hypoplasia, downward sloping palpebral fissures, high-arched hard palate, absent soft palate, external auditory and middle ear abnormalities and bilateral hand deformities. The diagnosis and treatment difficulties in this patient are discussed in light of those reported in the literature. An interdisciplinary team approach to the management of patients with Nager syndrome is emphasized.
Fingers↗
Syringomyelia and syringobulbia: pathophysiology, surgical treatment and nursing implications.
Syringomyelia (central cavitation of the spinal cord) and syringobulbia (cavitation of the medulla) are relatively rare disorders. These conditions are often found in association with congenital abnormalities such as Chiari malformations, with neoplasms or as sequelae to spinal cord trauma. The pathology progresses from minor sensory changes to weakness and wasting and, in the case of syringobulbia, to respiratory compromise and even death. Surgical treatment involves drainage or decompression of the syrinx cavity with diversion of fluid to the subarachnoid space or peritoneal cavity. Posterior fossa decompression may also be used. These procedures attempt to halt destruction of the nervous system, but will not reverse damage that has already occurred. A case presentation and associated nursing diagnoses are discussed to illustrate current medical and nursing interventions.
Adult↗
Precipitants of violence in a psychiatric inpatient setting.
Data gathered from the medical record and in interviews with staff and patients in an inpatient psychiatric setting at a Veterans Affairs medical center were used to examine events preceding 73 episodes in which patients were placed in four-point restraints. The behaviors leading to restraint included physical aggression, verbal threats, and threats with an object as a weapon. These behaviors were more likely to relate to external situations than to the patient's internal psychiatric symptoms. Staff were most frequently the target of patients' aggression, and patients were more likely to view the events leading to restraint as conflict with staff. No differences in the subsequent number of restraint episodes or hours in restraints were found between patients with positive and negative responses to the index restraint episode.
Adult↗
Elevated maternal serum alpha-fetoprotein and amniotic fluid alpha-fetoprotein after multifetal pregnancy reduction.
Forty patients underwent fetal reduction at approximately 12 weeks' gestation for multiple pregnancy. Twenty-two had maternal serum alpha-fetoprotein (MSAFP) determinations and all but one was elevated, with a mean value of 9.41 multiples of the median (MOM). A total of 53 amniotic fluid specimens were evaluated for AFP; 25% were elevated above 2.0 MOM and one sample was positive for acetylcholinesterase. None of these elevations were associated with a neural tube defect, although two neural tube defects were detected by other means. Routine MSAFP is not recommended for patients with multifetal pregnancy reduction.
Abortion, Induced↗
Stress and anxiety.
Anxiety is the psychophysiologic signal that the stress response has been initiated. The stress response's by-product, stress, is difficult to define. The response has multiple dimensions that have yielded research with many foci. Most salient to nursing are investigations of psychobiologic variables, the influence of life events, and the interactional model of the stress response. The stress response can be viewed as an interactional process that causes psychophysiologic reactions that are immediate and can occur up to and including physiologic events 3 weeks after confrontation with the stressor. The literature suggests that neuroendocrine alterations in response to confrontation with a stressor may influence immunocompetence. Intervention and prevention studies of stress focus on pharmacotherapy, psychotherapy, behavioral techniques, personality engineering, relaxation training, and biofeedback. Nursing research on stress has proliferated in the 1980s. Implications for nursing intervention include coping strategies that fall into four categories: behavioral, physical, cognitive, and emotional.
Anxiety↗
Nursing abroad. Passage to Nepal.
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Cross-Cultural Comparison↗
Purification of human basophils. Their response to anti-IgE.
Although usually the least prevalent blood leukocyte, the basophil can release potent soluble factors in response to multiple triggers. We purified basophils from normal volunteers by means of isopycnic centrifugation and affinity binding of mononuclear cells. The majority of the basophils from most subjects were recovered in a band formed between Percoll layers with densities of 1.070 and 1.080; at this stage basophils represented a mean of 22% of total leukocytes. These cells were reacted with monoclonal antibodies to T (OKT-11) and B (anti-HLA-DR) lymphocytes; B and T cells were removed by adsorption to insoluble antibodies against mouse immunoglobulin resulting in a mean purity of 75% basophils with a yield of 54%. These highly enriched basophils resembled unpurified basophils in terms of (1) intracellular histamine content, (2) spontaneous release of histamine in buffer, and (3) percentage of histamine released by anti-IgE. These findings suggest that the techniques used to purify the basophils do not affect the functional integrity of human basophils.
Basophils↗