Biomedical subjects
N Carr
Publications and source records attributed to N Carr.
Six second therapy.
Good general practice involves recognising the therapeutic power of the consultation itself. These simple acts are a way of enhancing that therapeutic power. Each takes around 2 seconds, so in 6 seconds we can achieve some useful therapy--that has to be fairly cost-effective!
Managing sore throats.
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'I just want some Valium, Doc'.
BACKGROUND: Consultations with drug seeking patients are common and often stressful. Conscientious general practitioners who prefer not to prescribe addictive drugs can experience awkward or unpleasant confrontations with patients. OBJECTIVE: This article describes a way of dealing with such consultations in order to minimise the difficulties, while maximising the opportunity for good patient care. Some of the common concerns about not prescribing for drug seekers are discussed. DISCUSSION: As with all situations in general practice, there is no single 'right' approach, but what follows may add to our armoury of available responses.
Quicker, better, cheaper.
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Referrals in minutes rather than days.
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Microvascular disease in the human large bowel.
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Immunohistochemical detection of O-acetylated sialomucins in intestinal metaplasia and carcinoma of the stomach.
Eighty-two selected gastric mucosal biopsy or resection specimens were stained both conventionally, to classify subtypes of intestinal metaplasia and carcinoma, and immunohistochemically with a mouse monoclonal antibody (MMM-17), raised against normal human colonic mucin, which has an affinity for di- and/or tri-O-acetylated sialomucin. The aims of the study were to reassess the prevalence of O-acetylated sialomucins in normal, metaplastic and carcinomatous gastric mucosa and to investigate whether the production of these mucins by intestinal metaplasia is related to its associated mucosal pathology. O-acetylated sialomucins were not seen in normal mucosa. They were, however, prevalent in all sub-types of metaplastic (64.8%) and carcinomatous (42.9%) mucosa. Type 1 intestinal metaplasia was significantly more likely to contain this type of mucin if Helicobacter pylori infection was identifiable in the adjacent gastric mucosa (81.0% v. 38.5%, P < 0.025). Type 3 showed a similar, albeit nonsignificant, relationship (100% v. 62.5%). O-acetylated sialomucins are, therefore, much more prevalent in gastric intestinal metaplasia and carcinoma than previously recognized by conventional staining techniques. The production of this type of mucin by intestinal metaplasia may reflect an adaptive response to alterations in the luminal environment such as an increase in bacterial content.
Master John of Arderne--surgeon of Newark.
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The role of implantology as an alternative to removable prostheses.
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Rectal necrosis after a phosphate enema.
We describe a patient who developed rectal ulceration after an apparently minor injury caused during the administration of a 130 ml 'disposable' phosphates enema. Treatment included parenteral antibiotics and a colostomy. Minor degrees of injury by rectal procedures are common. Rectal necrosis is a complication of injury during the administration of phosphates enemata which, although rare, deserves greater awareness. Painless rectal bleeding may be the only sign of injury and is an indication for thorough and repeated rectal examinations and early intervention.
Acute anal pain and a chicken bone.
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Rectal stricture due to actinomycosis.
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Vascular changes in radiation bowel disease.
A series of 20 cases of radiation bowel disease (RBD) was studied qualitatively and the arterial changes were studied quantitatively. A control series of 45 cases was studied. In the control cases there were positive correlations between the medial thickness of all vessels studied and the diastolic blood pressure as well as the incidence of intimal fibrosis in both intramural and extramural arteries. The medial thickness in all the arteries in cases of RBD was significantly higher than in the controls. This was probably due to the large number of fibrin thrombi which increased the vascular resistance. The degree of intimal fibrosis of the intramural arteries and arterioles was significantly greater than in the controls. Similarly the incidence of intimal fibrosis in all arterioles and intramural arteries was greater than the control group. The degree of intimal fibrosis was related to the dose of radiation received. The effect of radiation was an on-going process since the percentage of arterioles with intimal fibrosis increased with the time after radiotherapy. Blood pressure and age played no part in these correlations in RBD. The most consistently observed qualitative changes in RBD were in the arteries, arterioles and to a lesser extent the veins. These showed fibrin thrombi, fibrinoid necrosis, subendothelial oedema and fibrin. Various stages of healing were seen in the vessels. We believe that the blood vessels are the main site of injury in RBD and that the endothelial cell is the initial target for radiation damage.
Prophylactic metronidazole with and without cefuroxime in elective colorectal surgery. A prospective randomised double-blind study.
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A restriction map of plasmid pDC1 from the filamentous cyanobacterium Nostoc sp. MAC PCC 8009.
A plasmid designated pDC1 from the cyanobacterium Nostoc sp. MAC PCC 8009 was incubated with 16 different restriction enzymes, of which 8 cleaved pDC1. Plasmid pDC1 has a single site for ClaI, two sites for each of BglI, EcoRI, EcoRV, and MluI, three sites for HpaI, and four for HindIII. A restriction map of pDC1 for these 7 enzymes was constructed.
Inflammatory bowel disease in the older patient.
This paper presents a review of 64 patients in whom the first symptoms of inflammatory bowel disease occurred after the age of 60 years. Inflammatory bowel disease in older patients affects the large bowel much more commonly than the small bowel. The commonest variant is disease localized in the rectum and distal colon, and many of these patients have Crohn's disease (14 out of 28 patients). In 19 patients with localized left-sided colitis it was difficult to distinguish ischaemic colitis, acute diverticulitis and Crohn's disease. Patients with left-sided colitis or total colitis (15 patients) had a high incidence of acute complications, particularly colonic perforation. There should be an awareness of the risks associated with all types of colitis in the older patient.