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Biomedical subjects

L Thompson

Publications and source records attributed to L Thompson.

At least 127 records · Page 7Linked to original sources
PubMed1992

The role of social supports in the bereavement process of surviving spouses of suicide and natural deaths.

This report examines the changing role of social supports in the bereavement of spouses of elderly suicide and natural deaths, focusing on differences and similarities in relation to gender, time, and mode of death. Measurements were obtained 4 times after death (within 2 months, at 6 months, at 12 months, and at 2 to 2 1/2 years) on 79% of the 108 survivors of elderly suicide, 89% of the 199 natural death survivors, and 79% of the nonbereaved controls. The results indicated that the suicide survivors received significantly less emotional support for their feelings of depression and grief than the natural death survivors, and that they did not confide in the persons in their network any more than the nonbereaved controls did. Women report receiving more support overall than men. A low spot in social supports occurred at the 6-month point after loss for both bereaved groups, but primarily in practical help received by natural death survivors. By the end of the second year, both practical and emotional supports had increased to at least the same level as immediately after death.

Aged↗
PubMed1992

Geriatric acute myocardial infarction: a challenge to recognition, prompt diagnosis, and appropriate care.

The presentation of an AMI in the older person is often atypical, with a lower incidence of classic chest discomfort but increasing incidence of dyspnea, syncope, stroke, and acute confusion. Atypical presentation is especially common in those 85 years and older. The altered pattern of symptoms predisposes the elderly to a delayed or missed diagnosis. Delay in diagnosis may also occur when the ECG is nondiagnostic. In addition, enzyme elevations may be lower and fail to reflect the extent of myocardial damage. Thus, among the greatest challenges confronting critical care nurses is that of caring for elderly patients presenting with atypical AMI and concomitant polypathology. Nurses who are well informed about the normal age-related changes in the cardiovascular system contribute to more accurate and timely diagnosis and treatment of AMI in the elderly.

Age Factors↗
PubMed1991

Clinical pharmacology, metabolism, and tissue distribution of 90Y-labeled monoclonal antibody B72.3 after intraperitoneal administration.

B72.3 is a murine monoclonal antibody that recognizes a high-molecular-weight tumor-associated glycoprotein (TAG-72). Nine patients with TAG-72-positive ovarian carcinoma or papillary serous carcinoma of the peritoneum received an intraperitoneal infusion of 2, 4, or 10 mg B72.3 labeled with 0.5-1.2 (mean, 0.8) mCi 90Y. All patients had laparotomy, with multiple tissue and tumor samples removed 3-7 days later. The concentration of the total 90Y label in peritoneal fluid cleared with an extrapolated half-life of 68.6 +/- 4.5 hours. A low-molecular-weight 90Y-labeled species of metabolite was identified by high-performance liquid chromatography. The concentration of this low-molecular-weight species initially increased in the peritoneal fluid, with a half-life of 0.9 hour, and was rapidly cleared from the peritoneal cavity, with a half-life of 23.1 hours. Both the 90Y-labeled metabolite and the 90Y-labeled B72.3 were absorbed into the plasma, with half-lives of 16 +/- 2.2 hours and 25 +/- 5 hours, respectively. The clearance half-lives for these agents in plasma were 25 +/- 3 hours for the metabolite and 42 +/- 17 hours for B72.3. Approximately 8%-11% of the total injected 90Y label appeared in urine over 72 hours. Most of the label (about 70%) was present as the 90Y-labeled metabolite, but about 30% of the 90Y label in urine appeared identical to the authentic 90Y-labeled B72.3 standard when assayed by chromatography. Tissue distribution studies showed that normal tumor tissue and omentum contained the highest content of 90Y (about 0.017% of the injected dose per gram), followed in descending order by liver, normal lymph nodes, peritoneum, bone, and fascia. The lowest concentrations of 90Y were found in rectus abdominis muscle, bone marrow, and fat. There was substantial heterogeneity in the uptake of the 90Y label into tumor sites among patients and among different sites within the same patient. No correlation could be demonstrated between the TAG-72 content and the amount of 90Y label found in tumor sites. Preliminary radiation dosimetry estimates suggest that the tumor sites received about 82.8 cGy for each millicurie of 90Y administered. Thus, if an adequate total radiation dose can be achieved, 90Y-labeled B72.3 should be therapeutically useful for treating diffuse intraperitoneal disease.

Adult↗
PubMed1991

Dietary phytate x calcium/zinc millimolar ratios and zinc nutriture in some Ontario preschool children.

Millimolar ratios of phytate/Zn, Ca x phytate/Zn, and Ca x phytate/Zn per 4.2 MJ were calculated from 3-d weighed-food records collected from 62 male (M) (mean age: 58 +/- 7 mo [mean +/- SD]) and 44 female (F) (mean age: 58 +/- 6 mo) preschool children from Southern Ontario. Food-composition values for phytate were based on laboratory analysis and the literature. No gender differences existed for median millimolar ratios of phytate/Zn (median: M, 5.3; F, 5.3), and Ca x phytate/Zn per 4.2 MJ (M, 68.1; F, 59.5), but median intakes of phytate (M, 399; F, 333 mg/d) and median millimolar ratios of Ca x phytate/Zn (median: M, 102.1; F, 72.3; p less than 0.01) were higher for boys than for girls. Of the children, only two (1M, 1F) and 22 (17 M, 5F) had millimolar ratios of phytate/Zn and Ca x phytate/Zn per 4.2 MJ, respectively, that were above critical values. Millimolar ratios of Ca x phytate/Zn (p = 0.06) and Ca x phytate/Zn per 4.2 MJ (p = 0.05) were higher in boys with hair zinc less than 1.07 mumol/g v greater than or equal to 1.07 mumol/g. Analysis of variance showed that height was influenced by an interaction between millimolar ratios of Ca x phytate/Zn per 4.2 MJ and sex (p = 0.0007), when age and midparent height were treated as covariates. Results suggest that dietary Ca x phytate/Zn millimolar ratios, when expressed per 4.2 MJ, influenced the zinc nutriture of these Southern Ontario boys.

Calcium, Dietary↗
PubMed1991

Primary cysts and tumors of the mediastinum.

A retrospective analysis was performed on 230 patients with primary cysts and tumors of the mediastinum seen at our institution from January 1944 to April 1989. We divided these patients into two groups. Group 1 was seen before 1970 and group 2 was seen from January 1970 to April 1989. There was a significant increase in the prevalence of malignancy in group 2 (47.2% versus 17.1%; p less than 0.0001) due to an increase in the number of lymphomas (22.6% versus 3.5%; p less than 0.001) and malignant neurogenic tumors (6.8% versus 1.1%; p = 0.0528). There was a significant increase in the number of malignant tumors in the anterior (59.5% versus 30.9%; p = 0.0022) and paravertebral (28.5% versus 2.8%; p = 0.0027) compartments in group 2. More patients with these tumors were symptomatic in group 2 (63.6% versus 5%; p = 0.0422). There was an increase of ancillary diagnostic studies performed to evaluate these tumors (76.0% versus 34.5%; p = 0.0422). Logistic regression analysis identified date of presentation (p less than 0.005), symptoms (p less than 0.01), size (p less than 0.005), and the anterior mediastinal compartment (p less than 0.005) as preoperative predictors of malignancy. The surgical approach to these tumors included more median sternotomy (30.1% versus 10.7%; p = 0.0008), anterior mediastinotomy, and cervical mediastinoscopy in group 2 (1.1% versus 17.5%; p = 0.0002). Long-term results support surgical resection in benign lesions and an aggressive multimodality approach to malignant lesions.

Adolescent↗
PubMed1991

Primary cardiac valve tumors.

To investigate the characteristics of primary cardiac valve tumors, we retrospectively analyzed our multiinstitutional experience from 1932 through 1990. We encountered 56 valvular tumors in 53 patients. The average age of these patients was 52 years (range, 2 to 88 years) and 79% (42/53) were male. Symptoms were present in 38% (20/53) and were neurological in 15% (8/53). Four patients experienced sudden death. Each of the four valves was affected with approximately equal frequency: 16 aortic, 15 mitral, 13 pulmonary, and 12 tricuspid. All but four tumors were benign. The most common histological type was papillary fibroelastoma (41), followed by myxomas (5), fibromas (4), sarcomas (2), hamartoma (1), hemangioma (1), histiocytoma (1), and undifferentiated (1). Average tumor size was 1.15 cm (range, 3 mm to 7 cm), and the average size of fibroelastomas was 8 mm (range, 3 to 15 mm). Mitral valve tumors were more likely than aortic valve tumors to produce serious neurological symptoms or sudden death (8/15 versus 3/16; p less than 0.05). Six patients underwent echocardiography, and results were positive in each. All 6 underwent uncomplicated valve repair or replacement. Compared with a series of 407 nonvalvular tumors, cardiac valve tumors are more likely to occur in male patients (p less than 0.001) and adults (p less than 0.001). Valve tumors are also more commonly benign (p less than 0.001) and asymptomatic (p less than 0.001). These tumors demonstrate somewhat less aggressive behavior compared with non-valvular tumors, but their distinct propensity to produce serious clinical sequelae argues in favor of surgical resection for all cardiac valve tumors.

Female↗
PubMed1991

Current status of coronary artery operation in septuagenarians.

Previous reports of elderly patients undergoing coronary artery bypass grafting have not addressed the current era of aggressive percutaneous angioplasty and frequent urgent or emergent operation. To investigate this important subgroup of patients, we analyzed our recent coronary artery bypass grafting experience with patients 70 years of age or older. From January 1984 to January 1989, 121 consecutive patients in this age range underwent surgical revascularization at our institution. Overall in-hospital operative mortality (OM) was 7.4% (9/121), with 77.8% (7/9) of deaths due to cardiac causes. Serious postoperative morbidity occurred in 71.1% (86/121). Surgical priority was significantly correlated with operative mortality: for elective cases, the OM was 2.9% (2/68), but it was 8.6% (3/35) for urgent cases (p less than 0.05) and 22.2% (4/18) for emergency cases (p less than 0.05). Univariate analysis isolated the need for inotropic support, intraaortic balloon pump, reoperation, cardiopulmonary resuscitation, and emergency status as significant risk factors for OM (p less than 0.05). Multivariate stepwise logistic regression analysis identified the need for inotropic support, intravenous nitroglycerin, reoperative coronary artery bypass grafting, and hypertension as independently significant risk factors. A logistic risk equation developed from this population accurately modeled OM at the extremes of operative risk. Three (3.1%) of the 97 patients predicted to have less than 5% OM died, whereas all patients predicted by the model to have greater than 90% OM died. These results indicate that in spite of relatively high morbidity and mortality rates, elderly patients have a very acceptable operative risk in the current era of high-risk coronary artery bypass grafting. This is particularly true if elective revascularization is possible.

Aged↗
PubMed1991

Development of a dietary model for the study of mild zinc deficiency in humans and evaluation of some biochemical and functional indices of zinc status.

After a 1-wk baseline period, a dietary regimen was developed to induce mild zinc deficiency in 15 males (aged 25.3 +/- 3.3 y, mean +/- SD). The regimen consisted of 1 wk on a liquid diet containing 0.6 mg Zn/d and molar ratios of phytate to zinc (phy:Zn) and of phytate X calcium to zinc [(phy X Ca): Zn] of 209 and 4116, respectively, followed by 6 wk on a diet based on soy protein and egg albumin containing 4 mg Zn/d and with phy:Zn and (Ca X phy):Zn of 70 and 2000, respectively. Subjects were then repleted with 30 mg Zn/d for 2 wk. Fasting blood and urine samples were taken weekly. Changes were observed in mean plasma (mumol/L) and urinary zinc (mumol/d): baseline 97.0 +/- 10.9 and 8.0 +/- 2.7, depletion 80.1 +/- 13.4 and 4.3 +/- 2.3, and repletion 100.8 +/- 13.6 and 8.2 +/- 3.1, respectively (P less than 0.05); taste acuity (0.05 less than P less than 0.10); and cellular immune responses (P less than 0.05). Activities of plasma angiotensin-1-converting enzyme and acidic alpha-D-mannosidase were unchanged. Mild zinc deficiency was induced by the dietary regimen.

Adult↗
PubMed1991

Perceptions of self and short stature: effects of two years of growth hormone treatment.

A cohort study was carried out to determine whether childrens' perception of the problem of short stature changed over 2 years of growth hormone (GH) therapy. A total of 66 children (age range, 5-15 years; mean 10.2 years) were selected on the basis of height below the 3rd centile for chronological age, height velocity below the 25th centile for bone age, prepubertal status, and absence of any organic condition causing growth failure or likely to interfere with GH action. The children were taking part in a 2-year multicentre trial to assess the effect of authentic recombinant GH on short, slowly growing children without GH deficiency (GHD). The childrens' and parents' attitudes and emotional adjustment to shortness were assessed before GH therapy commenced, and at 6 months and 2 years, using a growth-specific psychological instrument, the Attitude to Growth scale (ATG). The children were also assessed using the Piers Harris Childrens Self Concept Scale at 2 years. The mean ATG scores increased from 34.2 (95% confidence interval, 33.2-35.2) at intake to 37.2 (95% confidence interval, 36.2-38.2) at 2 years. Younger subjects had a greater increase (p less than 0.05). No sex differences occurred. Two separate factors were identified in the childrens' attitudes: emotional preoccupation with stature and a concrete focus on practical aspects. No differences were present between childrens' and parents' mean scores, though parents' estimates differed on selected items. The mean Piers Harris score at 2 years was within the normal range, and was positively correlated to the ATG but was unrelated to height. It is concluded that GH treatment may have a beneficial effect on childrens' attitudes to being short, particularly in the younger child.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Preschool vision screening.

Although a good case for preschool screening for vision defects can be made there is very little evidence that existing programmes are effective in practice. A comparative trial of three different methods of preschool vision screening is described. Some 7000 children initially aged 5 months (younger cohorts) and 30 months (older cohorts) in three matched areas entered the trial during 1987. During 18 months of follow up new visual and ocular defects among these children were ascertained through ophthalmology outpatients and from optician records. Screening at 35 months by an orthoptist based in the community is superior to conventional health visitor surveillance at 30 months and to an agreed programme of primary care screening for squint at 30-36 months as judged by screening sensitivity (100% v 50% v 50%) and the incidence of treated target conditions (17 v 3 v 5 per 1000 person years). A notable feature in the area served by the orthoptist is that 13 children received treatment for straight eyed visual acuity loss from among 1000 children whereas there were no such cases among 2500 in the comparison areas. In the younger cohorts (that is, screening at age 5-9 months) all three programmes showed equally poor results, only one of the eight treated target conditions arising from all 3500 younger children being screen detected.

Amblyopia↗
PubMed1991

Effect of pregnancy on endothelium and smooth muscle: their role in reduced adrenergic sensitivity.

During pregnancy, vascular reactivity of the uterine artery is characterized by decreased contraction to norepinephrine and increased relaxation to acetylcholine. We investigated whether 1) relaxation to A23187 is increased during pregnancy and 2) endothelium-derived relaxing factor (EDRF) and/or prostaglandins are responsible for the decreased uterine artery sensitivity to norepinephrine during pregnancy. Isolated rings of uterine and carotid arteries were obtained from pregnant and nonpregnant guinea pigs. Relaxation to sodium nitroprusside in uterine but not carotid artery was reduced during pregnancy. Relaxation of both uterine and carotid arteries to the calcium ionophore A23187 was unaffected by pregnancy. During pregnancy, contractions to norepinephrine were reduced in the uterine artery compared with arteries from nonpregnant animals. Indomethacin slightly enhanced the contractions of uterine artery to norepinephrine during pregnancy. However, indomethacin-treated uterine arteries from pregnant animals were still less responsive to norepinephrine than control uterine arteries from nonpregnant animals. Methylene blue enhanced the efficacy of norepinephrine in uterine arteries of nonpregnant animals as well as carotid arteries of pregnant and nonpregnant animals but not in uterine arteries of pregnant animals. In contrast, N-monomethyl-L-arginine, a specific inhibitor of EDRF synthesis, not only enhanced uterine and carotid artery responses to norepinephrine in both pregnant and nonpregnant animals but fully reversed the blunted potency of norepinephrine on uterine arteries of pregnant to that of nonpregnant animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Acute retroviral syndrome].

A 37 year old male developed fever for 20 days, along with headache, anorexia, malaise, sweating, pharyngitis, lymphadenopathy and splenomegaly. At this stage, Ag p24 was positive and anti HIV was negative. The patient recovered fully but 6 months later positive HIV titers were demonstrated by immunofluorescence and Western-blot. A retrospective diagnosis of acute retroviral syndrome was made. The difficult differential diagnosis with infectious mononucleosis, cytomegalovirus, measles, rubella, toxoplasmosis and influenza is discussed. Thus, anti HIV antigenemia should be investigated in any patient with a mononucleosis like syndrome belonging in a high risk group for AIDS, even if Paul-Bunnell-Davidson or IgG anti VCA-EB reactions are positive.

Acute Disease↗
PubMed1991

[Bacterial overgrowth in small intestine in patients with liver cirrhosis].

Hepatic encephalopathy, bacterial infections and endotoxemia in cirrhotic patients have been related to colonic flora. However, an abnormal small bowel bacterial content could also be implied. We investigated small bowel bacterial overgrowth (SIBO) by jejunal cultures in 14 cirrhotic patients and 5 control subjects, and indirectly by the lactulose H2 breath test in 22 patients with cirrhosis and 12 controls. SIBO was demonstrated by cultures in 64% of cirrhotic patients and 1 of 5 controls. The breath test was positive for SIBO in 45% of patients with cirrhosis and 8% of controls. No differences were noted between patients with alcoholic and non-alcoholic liver disease. According to fasting H2 breath levels, SIBO was significantly correlated with the Child-Pugh score for hepatic function (r = 0.45; p < 0.05). Also, patients with positive criteria for SIBO in jejunal cultures had worse hepatic function in comparison to cirrhotics with normal jejunal bacterial counts (p < 0.05). Thus SIBO is frequent in patients with hepatic cirrhosis and is associated with impairment in hepatic function.

Bacteria↗
PubMed1991

[Treatment of uncomplicated urinary tract infections: cefuroxime vs cotrimoxazole].

Forty females (ages 15-74) with community-acquired, uncomplicated urinary tract infections were studied. Clinical and microbiological efficacy of cefuroxime (250 mg td) and trimethoprim sulfamethoxazole (160/800 mg td) used for 7 days were evaluated. The microorganisms found in the pre-treatment urinary cultures were: Escherichia Coli (85%), Klebsiella Pneumoniae (12.5%), and E. Agglomerans (2.5%). They were all susceptible to cefuroxime, and 42.5% were resistant to trimethoprim sulfamethoxazole (Kirby-Bauer). These findings show that trimethoprim sulfamethoxazole should not be used empirically while waiting for the results of urinary cultures, and that cefuroxime is a good alternative in these cases. Clinical cure was observed in all, and bacteriological cure in 75% of the pts treated with both antimicrobial agents. Relapses and reinfections were detected during follow-up emphasizing the importance of intra and post-treatment urinary cultures.

Adolescent↗
PubMed1991

A critical appraisal of the research literature investigating fatigue in the individual with cancer.

Fatigue is a commonly experienced symptom, which may be a component of virtually any disease and can have a psychological, physical, or mixed origin. Nurses need to understand the onset, duration, and progression of fatigue to intervene successfully with the cancer patient adapting to diagnosis and treatment. While the literature is an important source of information, results of research studies must be critically interpreted before proceeding with practice guidelines based on research findings. A critical appraisal of the research literature investigating the problem of fatigue in individuals with cancer was conducted. There is strong evidence to suggest that fatigue is a prevalent problem among cancer patients receiving chemotherapy and radiation therapy. However past research has been limited by methodological problems. Typically, studies fail to include a control group, do not control for possible confounding variables, and have restricted measurement to unidimensional scales with limited reliability and validity. While several correlates of fatigue have been postulated, research to date has found no consistent relationships among such correlates as weight loss, anemia, or psychological distress. This article reviews what is currently known about fatigue in the cancer patient and how future research could be designed to improve on past measurement and sampling problems.

Fatigue↗