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Biomedical subjects

N Robinson

Publications and source records attributed to N Robinson.

At least 19 recordsLinked to original sources
PubMed1992

Medical complications of substance abuse.

Substance abuse is involved in many instances of intentional and unintentional injury. It can also cause medical complications that affect various organ systems--among them, the cardiac, vascular, neurologic, pulmonary, gastrointestinal, immunologic, and reproductive systems. Even though there is pressure to create a new medical specialty to specifically address substance-abuse issues, the truth is that any physician, regardless of specialty, may encounter patients with substance-abuse problems. Alcoholism and drug abuse, with their associated psychosocial and clinical ramifications and complications, cut across all specialty fields. Consequently, all physicians need to be familiar with the spectrum of clinical problems associated with substance abuse and comfortable with addressing these problems prudently and promptly.

Cardiovascular Diseases↗
PubMed1992

Mechanical ventilation in preterm infants: neurosonographic and developmental studies.

Surviving preterm infants of less than 34 weeks' gestation who were selected on the basis of serial cranial ultrasonographic findings during their nursery course had repeated neurologic and developmental examinations during late infancy and early childhood that established the presence (n = 46) or absence (n = 205) of spastic forms of cerebral palsy. Of the 205 infants without cerebral palsy, 22 scored abnormally low on standardized developmental testing during early childhood. The need for mechanical ventilation beginning on the first day of life (n = 92) was significantly related to gestational age, birth weight, Apgar scores, patent ductus arteriosus, grade III/IV intracranial hemorrhage, large periventricular cysts, and the development of cerebral palsy. In the 192 mechanically ventilated infants, vaginal bleeding during the third trimester, low Apgar scores, and maximally low PCO2 values during the first 3 days of life were significantly related to large periventricular cysts (n = 41) and cerebral palsy (n = 43), but not to developmental delay in the absence of cerebral palsy (n = 18). The severity of intracranial hemorrhage in mechanically ventilated infants was significantly associated with gestational age and maximally low measurements of PCO2 and pH, but not with Apgar scores or maximally low measurements of PO2. Logistic regression analyses controlling for possible confounding variables disclosed that PCO2 values of less than 17 mm Hg during the first 3 days of life in mechanically ventilated infants were associated with a significantly increased risk of moderate to severe periventricular echodensity, large periventricular cysts, grade III/IV intracranial hemorrhage, and cerebral palsy. Neurosonographic abnormalities were highly predictive of cerebral palsy independent of PCO2 measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Diseases↗
PubMed1992

Epilepsy in pregnancy: developmental outcome of offspring at 12 months.

Women were enrolled in our prospective cohort study of epilepsy and pregnancy to determine the developmental outcome of offspring and the immediate outcome of pregnancy. Women with epilepsy (case group) were enrolled before conception or during the first trimester, and women without epilepsy or chronic illness (control group) were recruited during pregnancy. We have now completed 12-month evaluation for 43 children in the case group and 41 in the control group. We found no difference in growth parameters between the groups. The children in the case group had a higher mean number of minor anomalies than did those in the control group, and their features were consistent with those previously reported for children exposed to AEDs in utero. Developmental differences between the two groups varied, with some differences reaching statistical significance. The findings reported here are preliminary, since the children will be evaluated through 3 years of age.

Abnormalities, Drug-Induced↗
PubMed1991

Commercial levels of chymosin production by Aspergillus.

We have increased the production of bovine chymosin in Aspergillus niger var. awamori to more than one gram per liter of secreted authentic enzyme by combining a mutagenesis protocol with a novel robotic screening program. Analysis of the superior chymosin producing strains indicated that they have enhanced capabilities to secrete extracellular proteins.

Aspergillus niger↗
PubMed1990

Do retroverted uteri adversely affect insertions and performance of IUDs?

A large international multi-center IUD data set (N = 5520) coordinated by Family Health International was analysed to determine if the uterine position of a woman (anteverted, mid-positioned or retroverted) affects the ease of IUD insertion and if knowledge of uterine position would diminish insertion-related problems and improve IUD performance. Findings showed that insertion-related events were rare irrespective of uterine position. Women with retroverted uteri were not associated with higher termination rates for accidental pregnancy, expulsion or removal for bleeding and/or pain after 12 months of IUD use, as compared to the other two uterine position groups. All insertions in this data set were performed by experienced obstetricians/gynecologists, and our findings suggest that women with retroverted uteri should be equally good candidates for IUD contraception.

Adult↗
PubMed1990

The diagnostic impact of prehospital 12-lead electrocardiography.

STUDY HYPOTHESIS: It is feasible to apply prehospital 12-lead electrocardiography to most stable prehospital chest pain patients. Prehospital diagnostic accuracy is improved compared with single-lead telemetry. POPULATION: One-hundred sixty-six stable adult patients who sought paramedic evaluation for a chief complaint of nontraumatic chest pain. METHODS: One-hundred fifty-one prehospital 12-lead ECGs of diagnostic quality were obtained by paramedics on 166 adult patients presenting with nontraumatic chest pain. Paramedics and base station physicians were blinded to the information on acquired prehospital 12-lead ECGs and treated patients according to current standard of care-clinical diagnosis and single-lead telemetry. Final hospital diagnoses were classified into three groups: acute myocardial infarction (24); suspected angina or ischemia (61); and nonischemic chest pain (66). Paramedics and base station physicians' clinical diagnoses and prehospital and emergency department ECGs were similarly classified and compared. Prehospital and ED 12-lead ECGs were read retrospectively by two cardiologists. RESULTS: Paramedics achieved a high success rate (98.7%) in obtaining diagnostic quality prehospital 12-lead ECGs in 94.6% of eligible prehospital patients. For patients with acute myocardial infarction, prehospital ECG alone had significantly higher specificity than did the paramedic clinical diagnosis (99.2% vs 70.9%; P less than .001), and significantly higher positive predictive value (92.9% vs 32.7%; P less than .001). For patients with angina, combining the paramedic clinical diagnosis and the prehospital ECG significantly improved sensitivity (90.2% vs 62.3%; P less than .001) and increased negative predictive value (88.9% vs 71.3%; P less than .02) compared with paramedic clinical diagnosis alone. There was a high concordance between prehospital and ED ECG diagnosis (99.3% for acute myocardial infarction and 92.8% for angina). Furthermore, ten patients whose prehospital ECGs demonstrated ischemia and who had final hospital diagnoses of angina or acute myocardial infarction were mistriaged by paramedics and/or received no base station physician-directed therapy. CONCLUSION: It is feasible to apply prehospital 12-lead electrocardiography to most stable prehospital chest pain patients. Prehospital 12-lead ECGs have the potential to significantly increase the diagnostic accuracy in chest pain patients, approach congruity with ED 12-lead ECG diagnoses, and may allow for consideration of altering and improving prehospital and hospital-based management in this patient population.

Aged↗
PubMed1990

Employment problems and diabetes.

A survey of employment problems in a random sample of diabetic patients and a group of control subjects aged 17-65 years was carried out in eight centres in the UK. Data were linked to information collected from patients' diabetic clinic notes relating to the presence and treatment of any diabetic complications and quality of diabetic control. Difficulties in obtaining employment because of diabetes were reported by 13% of diabetic patients, and because of illness by 2% of control subjects (p less than 0.001). Nine percent of diabetic patients and 2% of control subjects reported having to change their job because of their illness (p less than 0.001), and 7% of people with diabetes and 2% of people without diabetes reported losing a job because of their illness (p less than 0.001). Diabetic shift workers were twice as likely as control subjects working shifts to experience problems with their job (18 vs 8%, p = 0.045). Reports of any sickness absence in the last 12 months were not significantly different for people with and without diabetes (49 vs 45%). Sickness absence in excess of 20 days in the last 12 months was more common among diabetic patients than control subjects (29 vs 16%, p less than 0.001). People with diabetes are more likely to experience problems in obtaining employment and staying employed than people without diabetes.

Adolescent↗
PubMed1990

Diagnosis and management of cleft larynx. Literature review and case report.

Laryngeal cleft is a rare congenital laryngeal anomaly that has been recognized more frequently in recent years. It can be a serious problem, consisting of separation of the arytenoids with a fissure resulting from a defect in the fusion of the posterior cricoid cartilage lamina. Dysphagia with aspiration of food is commonly seen with resultant bouts of pneumonia. Surgical repair has been successful in a handful of cases. This communication will review our institution's recent handling of a case successfully treated. The epidemiology, embryology, classification, diagnosis, and suggested treatment regimen for laryngeal cleft will also be outlined.

Humans↗
PubMed1990

Malignant external otitis and mastoiditis associated with an IgG4 subclass deficiency in a child.

We have presented the first child in Delaware with malignant external otitis associated with IgG4 deficiency. Our patient needed three courses of intravenous antibiotics and twice required mastoidectomy, but has recovered completely following the restoration of the natural barrier between the internal and external ear, using a fascial graft from the large temporalis muscle. Some hearing deficit remains.

Child, Preschool↗
PubMed1990

Effect of oral N-acetylcysteine (NAC) on volume and albumin content of respiratory tract fluid but not on epithelial secretory cell number in "smoking" rats.

This study was designed to look at the effect of N-acetylcysteine (NAC) on epithelial secretory cells and the respiratory tract fluid volume and albumin content from the lower airways of "bronchitic" rats. Rats were exposed either to tobacco smoke (TS), TS and NAC, or NAC alone. TS caused a significant increase in epithelial secretory cell number which was not reduced by concomitant NAC administration; NAC alone had no effect on cell numbers. TS increased respiratory tract fluid volume and albumin content by a small but non-significant amount, whereas TS and NAC increased the volume and albumin content by a greater and significant amount; NAC alone was also shown to significantly increase both fluid volume and albumin content.

Administration, Oral↗
PubMed1989

Cervical laceration at IUD insertion--incidence and risk factors.

Incidence and risk factors of cervical laceration at IUD insertion are studied as the one remaining IUD insertion-related rare event using the multi-center IUD database developed by Family Health International. Two-hundred-ten lacerations were reported from 11,646 insertions (1.8 per 100 insertions) performed between 1977 and 1987. The incidence was twice as high in insertions with the copper devices and the multiload devices as in those with the Loop devices. Nulliparous women were found to be at an increased risk compared to multiparous women. Use of a tenaculum at insertion may also be a risk factor for laceration, but this finding needs to be confirmed by future studies. Data were not adequate to examine the effect of insertor's experience on the incidence of cervical lacerations at insertion.

Adult↗
PubMed1989

Employers' attitudes to diabetes.

In order to examine the knowledge and attitude of employers to diabetes and diabetic employees, a questionnaire was sent to a random sample of approximately 2500 businesses and industries in eight different areas of the United Kingdom. Information was collected on the employment of people with diabetes, such as sickness absence, suitability of types of job for the diabetic person, the proportion of people with diabetes registered as disabled, and the provision of pension schemes. Only 1% of firms claimed that they would not consider a person with diabetes for employment within the firm. Nearly a third of employers did not know whether they employed anyone with diabetes. Over a quarter of the manufacturing industries reported some jobs that were unsuitable and 8% reported certain unfavourable job conditions for a diabetic employee such as shift work, working at heights, strenuous work, etc. A total of 7% of those firms with a diabetic employee reported that diabetic workers were more often absent from work due to sickness and 16% of firms employing a diabetic person did not allow paid time off for clinic visits. The attitude of the majority of employers seemed to indicate that diabetes in itself does not limit employment prospects since most people with diabetes have few problems arising from their condition and can make good employees in a range of occupations.

Absenteeism↗
PubMed1989

Unemployment and diabetes.

Unemployment was examined in a random sample of diabetic clinic attenders and a group of non-diabetic control subjects aged 17-65 years, selected from eight different centres in Great Britain. Data on employment were obtained using a postal questionnaire and medical details were collected from diabetic clinic notes. Out of a 61% response rate, 22% of males and 12% of females with diabetes were unemployed compared with 8 and 5% of the control group (both p less than 0.001). A greater percentage of people with diabetes were economically inactive, that is retired, unable to work, ill or housewives compared with the control group (29 vs 14%, p less than 0.001). Young people with diabetes (16-25 years) had the highest rates of unemployment. A matched pairs analysis confirmed that diabetic men had higher unemployment rates than their controls (14 vs 7%, p less than 0.001). Comparisons were made between unemployment rates for the eight geographical areas and published unemployment statistics; unemployment rates were significantly higher for men with diabetes except at one centre. A stepwise multiple logistic regression analysis indicated that variables which were predictive of unemployment were similar to those expected for people without diabetes. Unemployment is apparently a problem for the person with diabetes, especially for the young.

Adolescent↗
PubMed1989

Infrequency of blacks among patients having carotid endarterectomy.

We reviewed demographic data on patients having 2,256 carotid endarterectomies in eight large hospitals in North Carolina to determine the frequency of blacks among these patients. Blacks comprised only 4.6% of the patients having carotid endarterectomy even though they comprised 26% of all patients discharged and 22% of the general population of the state. Data from the National Inpatient Profile of the Commission on Professional and Hospital Activities, which represents patients discharged from short-term, nonfederal hospitals throughout the United States, show that nationwide, blacks comprise only 2.7% of the patients having carotid endarterectomy, whereas they comprise 12.0% of all patients discharged, 12.1% of the general population, and 10.7% of patients discharged following Class I surgical procedures. Blacks have only 67 carotid endarterectomies per 100,000 patients discharged; this rate is five or more times higher in whites. Among black patients having carotid endarterectomy, women predominate, whereas men predominate among white patients having carotid endarterectomy (p = 0.006). The underrepresentation of blacks among patients having carotid endarterectomy lends support to the concept that carotid vascular disease in blacks is distributed intracranially rather than extracranially as opposed to the extracranial rather than intracranial distribution in whites.

Adult↗