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Biomedical subjects

M Donaldson

Publications and source records attributed to M Donaldson.

At least 55 records · Page 3Linked to original sources
PubMed1985

Career aspirations of geriatric medicine trainees.

The views of trainees in geriatric medicine on preferred career styles were studied by questionnaire. As expected, the majority of respondents did not intend a career in geriatric medicine upon graduation. Whilst a majority would prefer a post wholly dedicated to the care of elderly patients, half the sample would prefer their service to be integrated with general medical services. The majority are optimistic for the future of geriatric medicine in the United Kingdom.

Age Factors↗
PubMed1984

Characterization of Ross River viruses isolated from patients with polyarthritis in New Caledonia and Wallis and Futuna Islands.

Viruses isolated during 1979 and 1980 from patients with polyarthritis in New Caledonia and Wallis and Futuna Islands have been found to be more closely related to Ross River virus than any other regional Alphavirus. On the basis of virulence in suckling mice the majority of these isolates were found to be more closely related to the NB5092 strain of Ross River virus than to the prototype T48 strain.

Alphavirus↗
PubMed1984

Early experience with in situ saphenous vein grafts for severe ischemia of the lower extremity.

Based upon this group of 35 patients with a variety of vascular lesions, it would appear that the in situ saphenous vein technique is certainly, at least, a viable alternative to standard bypass techniques. It has been applied with equally encouraging results by several surgeons in a variety of clinical settings, all using the procedure for the first time in a learning phase. This technique may become the procedure of choice for the treatment of occlusive disease of the lower extremity in this difficult and challenging group of patients.

Blood Vessel Prosthesis↗
PubMed1982

Extremity lesions in the Intergroup Rhabdomyosarcoma Study (IRS-I): a preliminary report.

The sites in which rhabdomyosarcoma occurs most frequently in children and young adults are the head and neck, genitourinary tract, and the extremities. Among these three sites, tumors of the extremities have been associated with the highest relapse rate and lowest survival rate in patients treated by protocols of the Intergroup Rhabdomyosarcoma Study (IRS). In five of six patients treated by primary extremity amputation, tumor recurred. Seven of 21 patients in Clinical Group I (completely resected tumors), and 9 of 27 patients in Clinical Group II (patients with gross tumor excision but positive lymph nodes, "microscopic residual" disease, or extension beyond the muscle of origin) had relapse. Thirteen of 18 patients (72%) in Clinical Group III (gross residual disease) responded to a chemotherapy-radiotherapy regimen, but ten have subsequently had relapses; and 13 of 18 are dead. Of 30 patients in Clinical Group IV (disseminated disease on entry), 15 initially responded to chemotherapy, but 25 of 30 are dead. The period of surveillance is 2 1/2 to 7 1/2 years, with a mean of 46.3 months at least examination. Increased rates of relapse were seen in patients with extremity tumors, as opposed to tumors in other sites, irrespective of the specific IRS chemotherapy-radiotherapy regimen employed. In Clinical Group I (nonamputation), relapse rates by histologic subtype of rhabdomyosarcoma were alveolar subtype, 5/8; embryonal, 1/7; and all other subtypes, 1/6. Clinical Group II, relapse rates were alveolar, 6/12; embryonal, 5/11; all other subtypes, 3/10.

Amputation, Surgical↗
PubMed1982

Sanctuary therapy: a randomized trial of 724 children with previously untreated acute lymphoblastic leukemia: A Report from Children's Cancer Study Group.

Between 1972 and 1974, Childrens Cancer Study Group enrolled 724 children with newly diagnosed acute lymphoblastic leukemia on a single randomized clinical trial. Study CCG-101 was designed to test four types of presymptomatic central nervous system and sanctuary therapies consisting of (a) 2400-rad craniospinal radiation therapy (RT) plus 1200-rad extended-field RT, which included the liver, spleen, kidneys, lower abdomen, and gonads; (b) 2400-rad craniospinal RT; (c) 2400-rad cranial RT plus intrathecal methotrexate (i.t. MTX); and (d) i.t. MTX alone. Patients all received a 28-day induction course of vincristine, prednisone, and L-asparaginase and were maintained subsequently on a regimen consisting of daily 6-mercaptopurine, weekly MTX, and monthly pulses of vincristine and prednisone. Patients treated with six doses of i.t. MTX alone had a significantly higher incidence of central nervous system relapse than did patients treated with 2400-rad craniospinal RT plus 1200-rad abdominal RT, 2400-rad craniospinal RT, or 2400-rad cranial RT plus i.t. MTX. There was no significant differences in marrow remission duration or survival of the treatment groups. There appears to be a benefit with regard to length of bone marrow remission and survival for patients with initial white blood counts greater than or equal to 20,000/cu mm treated with cranial RT plus i.t. MTX. The majority of the patients remaining on study have now discontinued maintenance therapy. The 8-year overall estimated survival rate on this study is 56%, and the disease-free survival rate is 52%.

Antineoplastic Agents↗
PubMed1980

An alternative to antepartum fetal heart rate testing.

The high-risk pregnancies of 203 patients were prospectively studied to test the hypothesis that the maternal perception of fetal movement is as useful as antepartum fetal heart rate testing (AFHRT) in assessing fetal welfare. Evidence for an active fetus (186 cases, 92%) was usually followed by a normal AFHRT result (320/330 results, 97%). Furthermore, a favorable perinatal outcome was equally predicted by an active fetus (168/186 cases, 90%) and a normal AFHRT result (173/190 cases, 91%). Evidence for an inactive fetus was less sensitive but not significantly different from an abnormal AFHRT in predicting an unfavorable perinatal outcome (10/17 cases versus 11/13 cases, p > 0.05). However, an abnormal AFHRT result coincident with fetal inactivity was highly predictive of an unfavorable neonatal outcome in nine of 10 cases. In conclusion, the data reveal that a record of fetal activity by the compliant patient is a reliable alternative to AFHRT for the initial screening of fetal well-being.

Female↗
PubMed1980

Testicular relapse in childhood acute lymphoblastic leukemia: association with pretreatment patient characteristics and treatment. A report for Childrens Cancer Study Group.

Of 395 male pediatric patients with previously untreated acute lymphoblastic leukemia, 20 (5%) exhibited testicular infiltration prior to or concurrent with their first bone marrow relapse. Fourteen occurred as an isolated relapse and six occurred concomitant with bone marrow and/or central nervous system relapse. Nine of the 20 relapses were in patients who had discontinued therapy after completing three years of continuous complete remission. Factors found to be independently associated with an increased risk of testicular relapse during maintained remission included pretreatment lymphadenopathy, and to a lesser extent, initial hemoglobin level and initial platelet count. Pretreatment splenomegaly and lymphadenopathy appear to imply an increased risk of testicular relapse for those patients who have their maintenance therapy discontinued. Time from testicular relapse to bone marrow relapse or death was significantly shorter for patients with testicular involvement while receiving chemotherapy when compared to patients with testicular relapse after discontinuing therapy. In those patients achieving three years of continuous complete remission, subsequent testicular relapse occurred significantly more often in patients who discontinued therapy than a similar group who continued therapy. In a group of 76 males who received presymptomatic gonadal radiation immediately after achieving an initial marrow remission, protection appears to have been provided against the manifestation of testicular leukemia during maintained remission.

Age Factors↗
PubMed1980

The cost of medical student instruction in the practice setting.

Using an incremental cost approach, the cost of instruction for medical students participating in a variety of ambulatory-care, chiefly family-practice, experiences in several clinical practice sites was examined. The costs ranged from $5 per student per day for a first-year observational experience to $112 per student per day for a second-year preceptorship with direct patient care involvement by the students. Factors such as the previous experience of the student, the baseline productivity of the site, the number of examining rooms, the income source of the preceptor (salary vs fee-for-service), and the clarity of preceptor role definition are discussed in relation to cost. The lack of defined, stable income to offset costs is noted. In view of the substantial costs of instruction in ambulatory family practice clerkships, clearly defined ongoing sources of income must be provided to ensure the continuation or expansion of these vital experiences.

Ambulatory Care↗
PubMed1980

Nonstress testing and perinatal outcome.

The clinical value of nonstress testing (NST) in assessing fetal well-being is controversial. This study reviews the monitored tracings and subsequent perinatal outcome of 561 high-risk clinic patients who had undergone NST within one week prior to delivery. Two or more adequate accelerations of the fetal heart rate baseline with sufficient fetal activity over a 20-minute period were associated with a low risk of fetal jeopardy and were classified as a reactive test result. The corrected perinatal mortality of patients with reactive NSTs (1/509) was comparable to that of patients with no apparent antepartum complications (6/1,408) and was significantly lower (p less than 0.05) than those of high-risk patients with either nonreactive NSTs (2/22) or no testing (20/1,000). The incidence of subsequent perinatal jeopardy was significantly lower (p less than 0.001) among those high-risk pregnancies with recent reactive NST results (4%) than in those with recent nonreactive NST results (36%) and those without recent testing (13%). Perinatal morbidity among those pregnancies with recent reactive NSTs usually arose in the intrapartum period, and no reason to explain this jeopardy predominated. A reactive NST can be safely repeated in seven days, regardless of the adequately treated maternal risk factor. The only stillbirth following a reactive NST (1/509) probably arose from a cord accident.

Adult↗
PubMed1979

Familial pheochromocytoma, hypercalcemia, and von Hippel-Lindau disease. A ten year study of a large family.

Long-term epidemiological and laboratory studies were carried out in a kindred with familial pheochromocytoma associated with von Hippel-Lindau disease. Thirteen members were affected by the syndrome and the trait appears to be transmitted in an autosomal dominant fashion. Of 13 patients, 7 had pheochromocytoma alone. Of the remaining six patients, one had pheochromocytoma combined with von Hippel-Lindau disease, four had pheochromocytoma with retinal disease only, and a single patient had a retinal lesion without pheochromocytoma. In four patients, pheochromocytoma antedated the development of retinal lesions. Ten members also had mild hypercalcemia without accompanying elevations of PTH in the 4 patients in whom this was determined. In all, hypercalcemia was corrected with removal of tumors, and no patient had a return of hypercalcemia in the absence of recurrent increases in urinary catecholamines. The clinical presentations in 12 patients varied markedly, as did their urinary excretion rates of norepinephrine, epinephrine and their metabolites. However, an analysis of the data revealed significant correlations not previously described between the urinary excretion of free catecholamines (norepinephrine plus epinephrine), blood pressure, the free catecholamine content of the tumor and the age of the patient. Urinary excretion of free norepinephrine plus epinephrine appear to be decreased with advancing age (p less than 0.001). Both systolic and diastolic blood pressures and the age of the patient were inversely correlated (p less than 0.01). A significant inverse relationship between the tumor content of free catecholamines and the age of the patients was, although to a lesser degree, also present (p less than 0.05). As a whole, the size of the tumors and their norepinephrine content were not correlated. We present a concept that, in familial pheochromocytoma, the metabolism of catecholamines is altered by the process of aging, and that this change modifies the clinical presentations of the disease.

Adolescent↗