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Biomedical subjects

M Tobin

Publications and source records attributed to M Tobin.

At least 19 recordsLinked to original sources
PubMed1996

Normal saline i.v. fluid load decreases uterine activity in active labour.

This study was designed to observe the effects of i.v. fluid infusion on uterine activity during normal labour in women receiving an extradural block. Thirty-four women in spontaneous labour at term gestation were allocated randomly and prospectively to one of three i.v. pre-extradural fluid load groups: group A, no fluid load; group B, normal saline 500 ml; and group C, normal saline 1000 ml. Continuous internal measurement of uterine activity was observed before, during and after fluid infusion and extradural block. In groups A and B, uterine activity did not change. In group C, uterine activity decreased after infusion of saline (P < 0.01) and returned to baseline over the next 20 min. Extradural block was not associated with a change in uterine activity. Hypotension was not increased in the group that received no fluid preload.

Adolescent↗
PubMed1996

Psychosocial problems faced during absorption of Russian-speaking new immigrants into Israel: a systematic approach.

The problems faced by immigrants during the absorption process are multidimensional and require a systematic approach. According to the authors' theoretical perspective and clinical experience, two main principles determine the "facets" of absorption: search activity and self-esteem. The paper begins with a definition of search activity and its relationship to self-esteem and then discusses intrapsychic and environmental blocks to search activity and their effect on self-esteem. The paper concludes with a therapeutic approach toward restoration of search activity and self-esteem.

Acculturation↗
PubMed1995

When does palliative care begin? A needs assessment of cancer patients with recurrent disease.

This cross-sectional study compared the prevalence and intensity of needs expressed by cancer patients at the time of first recurrence (n = 75) with those of patients at the time of disease progression (n = 75). On a 72-item Likert-type scale participants rated from "none" to "very much" the severity of physical symptoms; emotional, psychological, and social problems; and difficulties with activities of daily living. The progressive disease group reported more problems than the first recurrence group in 11 of 24 (47%, p < 0.05) symptom-related questions. The progressive disease group also expressed greater needs in 19% of the function-related questions. There were no differences in reported psychological problems, responses to recurrence, or greatest concern between the two groups. These results support the need for palliative care throughout the entire course of illness.

Adult↗
PubMed1995

The psychosocial morbidity of breast cancer patients with lymphoedema.

Lymphoedema is a problem for many women after treatment for breast cancer, leading to physical, psychosocial, and psychological problems, which have been acknowledged but are poorly understood. This article discusses the findings of two studies that used the Psychosocial Adjustment to Illness Scale to examine the psychosocial morbidity of patients with breast cancer with lymphoedema. Women with lymphoedema were found to experience increased psychosocial maladjustment and psychological morbidity to their disease and lymphoedema when compared with a group of patients with breast cancer who did not have lymphoedema. These difficulties were not related to the degree of swelling present and persisted after 6 months of specialised treatment to the swollen arm. The findings indicate that the development of lymphoedema in patients with breast cancer carries psychosocial and psychological implications that should be acknowledged and addressed at an early stage by a trained health-care professional.

Adaptation, Psychological↗
PubMed1994

Safety and diagnostic yield of noninvasive ventricular stimulation performed via tiered therapy implantable defibrillators.

Extensive electrophysiological testing is critical for the effective utilization of sophisticated tachycardia detection and termination algorithms available in tiered therapy ICDs. To evaluate the safety and diagnostic yield of electrophysiological testing via noninvasive ventricular stimulation, we performed 294 electrophysiological studies in 154 patients (age 65 +/- 10; left ventricular ejection fraction 0.36 +/- 0.15) with tiered therapy ICDs. Stimulation was performed under methohexital anesthesia. A total of 918 sustained ventricular tachyarrhythmias were induced (3.1 +/- 2.5 per procedure): monomorphic VT, 550; ventricular flutter, 74; and VF, 246. The results of invasive and noninvasive programmed stimulation were compared for 79 patients who had both studies under similar treatment. Overall concordance was 83%, and did not differ significantly between patients who had the noninvasive stimulation via epicardial or endocardial pacing leads. VF could be induced in 206 of 257 studies (82%), and it was less likely to be induced in patients on amiodarone (74% vs 85%; P = 0.02), or beta blockers (55% vs 83%; P = 0.017). No patient presented a serious complication. Minor complications occurred during 39 studies: transient laryngospasm in 1, unintended delivery of an ICD shock to a conscious patient in 4; induction of sustained atrial fibrillation in 8; need for external rescue defibrillation shocks in 13; and delivery of inappropriate shocks for supraventricular rhythms in 14 studies. Noninvasive ventricular stimulation performed under methohexital anesthesia is safe. Its diagnostic yield compares favorably with that of conventional electrophysiological studies. VF can be induced in a majority of patients. There is good correlation between invasive and noninvasive programmed stimulation for induction of VT. Noninvasive ventricular stimulation may emerge as standard procedure for the initial programming and follow-up of ICDs.

Aged↗
PubMed1994

Anesthetic considerations for the pediatric plastic surgical patient.

An understanding of the anesthesiologist's concerns during pediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Prior to surgery, the child's history is obtained and physical examination is performed. The condition of the airway is the primary concern. Preoperative medication is usually given by oral routes to avoid injections. Induction intubation, maintenance, and emergence are discussed. Specific postanesthesia care is described. Special precautions are given for children having surgical repair of craniofacial anomalies. Cleft lip and palate and mandibular advancement are described.

Age Factors↗
PubMed1993

Doppler echocardiographic evidence of left ventricular diastolic dysfunction in ankylosing spondylitis.

Although cardiac involvement in the form of conduction abnormalities or aortic regurgitation occurs in 5 to 10% of patients with ankylosing spondylitis, few studies have assessed left ventricular (LV) function. This study assesses the prevalence of both systolic and diastolic LV dysfunction and other cardiac abnormalities in patients with ankylosing spondylitis who have no clinical cardiac manifestations. Fifty-nine patients (49 men and 10 women, mean age 42 +/- 10 years) underwent full clinical examination, electrocardiography, 24-hour Holter monitoring and 2-dimensional, M-mode and Doppler echocardiography. Mean disease duration was 17 +/- 9 years (range 1 to 42). Seventeen patients had evidence of noncardiac extraarticular manifestations. Precordial examination was normal in all. An age- and sex-matched control group of 44 healthy subjects was also studied. On echocardiography, abnormal LV diastolic function was detected in 12 patients (20%). Prolonged isovolumic relaxation time, prolonged deceleration time, reduced rate of descent of flow velocity in early diastole (EF slope) and reversal of the early and late peak transmitral diastolic flow velocities (E/A ratio) were noted in 9 patients. In 3 patients there was an increased E/A ratio, reduced deceleration time and increased EF slope. Mild aortic regurgitation and mitral regurgitation was seen in 1 and 3 patients, respectively. No abnormalities of left atrial size, LV systolic or diastolic dimensions or wall thicknesses were noted. There was no correlation between the presence of LV diastolic dysfunction and age, disease severity, disease duration, or the presence of extraarticular manifestations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Fair hearing testimony.

Realizing the competitive environment of medicine, the gold standard for credentials must remain training, experience, ability, and/or competence. These two doctors have met this standard. Family physicians have cesarean privileges in Memphis, Tenn.; Wichita, Kan.; Kansas City, Mo.; Rochester, Minn.; and numerous other cities across our state and nation. With access to perinatal care of critical importance, all physicians must practice medicine to their fullest capabilities. This hospital will greatly benefit from its support of fair privileging for family physicians. And the AAFP will vigorously defend each family physician's right to practice obstetrics on both a state and national level.

Cesarean Section↗
PubMed1991

Synthesis and characterization of magnetically responsive albumin microspheres containing cis-hydroxyproline for scar inhibition.

Magnetically responsive albumin microspheres containing the proline analog, cis-hydroxyproline, were synthesized and their in-vitro physical properties were characterized. These microspheres have an average size of 1.1 +/- 0.3 microns with 94% of the microspheres less than 2.0 microns. They are uniformly spherical and contain 67% albumin, 22% magnetite, and 8% cis-hydroxyproline. The cis-hydroxyproline is releasable during a 72-h period and demonstrates a slow, releasable pool that constitutes approximately 50% of the incorporated drug. cis-Hydroxyproline is neither chemically nor biologically altered during its incorporation into the microsphere. cis-Hydroxyproline release from microspheres results in the in vitro inhibition of collagen secretion, which is indistinguishable from unincorporated cis-hydroxyproline. In a rat-tail animal model these microspheres were selectively targeted using an external magnetic field applied to a 1.5-2.0-cm target site. Fifty to 80% of the infused microspheres were localized to this site, whereas without a magnetic field only 15-20% of the microspheres are localized to this site. cis-Hydroxyproline microspheres resulted in a 16% decrease in collagen content in a scar model when compared with untreated animals (p less than 0.05). With further refinement of this method of drug delivery, clinically useful inhibition of scar formation may result.

Animals↗
PubMed1990

Cerebral blood flow variations in CNS lupus.

We studied the patterns of cerebral blood flow (CBF), over time, in patients with systemic lupus erythematosus and varying neurologic manifestations including headache, stroke, psychosis, and encephalopathy. For 20 paired xenon-133 CBF measurements, CBF was normal during CNS remissions, regardless of the symptoms. CBF was significantly depressed during CNS exacerbations. The magnitude of change in CBF varied with the neurologic syndrome. CBF was least affected in patients with nonspecific symptoms such as headache or malaise, whereas patients with encephalopathy or psychosis exhibited the greatest reductions in CBF. In 1 patient with affective psychosis, without clinical or CT evidence of cerebral ischemia, serial SPECT studies showed resolution of multifocal cerebral perfusion defects which paralleled clinical recovery.

Adult↗
PubMed1989

Nonthromboembolic causes of high-probability lung scans.

Three cases of high-probability lung scans because of nonthromboembolic causes (dissecting thoracic aortic aneurysm, sarcoid with venous occlusion, and subclavian catheter misplacement) are presented along with a review of the literature.

Adult↗
PubMed1987

The cholescintigraphic pattern of small bowel obstruction.

An elderly patient presenting with acute abdominal pain, nausea, and vomiting underwent a hepatobiliary scan. This demonstrated normal filling of the gallbladder but dilatation of the small bowel, which was found to correspond radiographically to partial small bowel obstruction.

Aged↗
PubMed1987

Cerebellar glucose consumption in normal and pathologic states using fluorine-FDG and PET.

We studied cerebellar metabolism in 118 subjects including young and elderly controls and patients suffering from stroke, supratentorial brain tumor and Alzheimer's disease using fluorine-18 fluorodeoxyglucose ([18F]FDG) and position emission tomography (PET). Alzheimer's disease and normal aging did not alter mean cerebellar metabolism. In stroke and tumor mean cerebellar metabolism was lower in the hemisphere contralateral to the supratentorial lesion. In tumor bilaterally significant reductions in absolute cerebellar metabolism also were noted, unlike stroke. Primary sensory stimulation did not alter absolute or relative cerebellar metabolism. These results show that absolute and relative values for cerebellar metabolism vary depending on the process under study. Thus analysis schemes employing normalization of regional metabolic data to cerebellar values may be subject to error.

Adult↗