Biomedical subjects
P G Dyment
Publications and source records attributed to P G Dyment.
The pediatrician, sports medicine, and managed care.
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Increasing use of "Ecstasy" (MDMA) and other hallucinogens on a college campus.
We conducted a random survey of illicit drug use by undergraduate students at a private southern university in 1990 and compared the results with results from a similar 1986 survey of that college's student population. During the 4 years since the first study, the prevalence of cocaine use declined from 39% to 21%, and use of traditional amphetamines declined from 22% to 12%. No significant differences were found in the use of marijuana--68% in 1986, 64% in 1990--or in use of LSD (lysergic acid diethylamide)--14% in 1986, 17% in 1990. The use of mescaline/psilocybin increased from 8% to 24% and the use of MDMA, known as "Ecstasy" (3,4-methylenedioxymethamphetamine), increased from 16% to 24%. Mescaline/psilocybin and Ecstasy were more likely than the other drugs to have been used first during the students' college years, according to the 1990 study.
The orthopedic component of the preparticipation examination.
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Low back pain in adolescents.
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Steroids: breakfast of champions.
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Initial management of minor acute soft-tissue injuries.
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The adolescent athlete and ergogenic aids.
Amphetamines and anabolic/androgenic steroids are the ergogenic aids with the most serious side effects that adolescents are likely to misuse, although adolescents are more frequently lured into taking expensive and worthless vitamin and protein supplements. Physicians performing preparticipation physical examinations should address the issue of ergogenic aids when they offer anticipatory guidance to adolescent athletes.
Another look at the sports preparticipation examination of the adolescent athlete.
The sports preparticipation examination can be worthwhile if the musculoskeletal system is examined carefully, with particular regard for the residual disabilities from previous injuries; this can be accomplished in a two-minute orthopedic examination done in addition to the usual physical examination. As many as 10% of young people may have abnormalities such as patellofemoral syndrome, incompletely rehabilitated ankle sprains, or tight hamstring muscles, which may result in further injury unless a rehabilitation exercise program is instituted.
Management of minor soft tissue trauma in adolescent athletes.
Rest, ice therapy, compression, and elevation (RICE) are important components of the initial management of acute soft-tissue injuries such as contusions, strains, and sprains. Cryotherapy should be used, in the form of an ice pack, as soon as possible after the injury, and then several times a day for 20 minutes for several days. The use of ice has a theoretical, clinical, and experimental basis. Mild pain due to an injury should be treated with acetaminophen rather than aspirin because of the latter's effect on blood coagulation.
Impact of the timing of triple intrathecal therapy on remission induction in childhood acute lymphoblastic leukemia: a Pediatric Oncology Group study.
Five weekly doses of triple intrathecal (IT) chemotherapy (methotrexate, hydrocortisone, cytosine arabinoside) starting on day 1 of treatment were added to systemic induction therapy in a regimen (Arm 3) that was compared to three other regimens (Arms 1, 2, and 4) in which central nervous system (CNS) prophylaxis was initiated after complete marrow remission (CR) was attained. The CR rate for Arm 3 was only 83% as compared to 91-92% for other Arms. The lower CR rate was the result of a significantly higher death rate during induction for patients receiving early CNS prophylaxis (10.6 vs 0.9-3.5%). These differences were only observed in high risk patients as defined in the study. The early death rate was especially high (30%) in Arm 3 for children who were less than 2 years of age. Infection was the primary cause of morbidity and mortality. Severe infection following the initiation of induction therapy was found in 16.7% of patients on Arm 3 vs 1.8-6% on other regimens. Immediate triple IT chemoprophylaxis during induction therapy of acute lymphoblastic leukemia as used in this study appears to be associated with increased susceptibility to infection and this form of CNS prophylaxis has increased hazards of morbidity and mortality in infants and other high risk patients.
Drugs and the adolescent athlete.
The pediatrician performing a preparticipation physical examination on an adolescent athlete should discuss the use of ergogenic aids. This could be with all of the athletes present in the case of the mass screening examination, or in private during the preferred office-based physical examination, whether preparticipation or health maintenance. Knowing which sport the youth is active in can lead to the drugs most likely being misused being emphasized by the physician; ie, androgens in the case of weightlifting and football, and amphetamines in competitive events like swimming, football, and track. Not only should the risks be discussed (an unsuccessful way to influence adolescents' behavior), but the drugs' degree of ineffectiveness should be stressed. Finally, and possibly at least as importantly, the moral question of a competitor attempting to gain an "illegal edge" should be addressed.
Prognosis for adolescents with Hodgkin's disease.
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Acute lymphocytic leukemia with microblastosis and near haploidy (26 chromosomes): a case report.
A three-year-old acute lymphocytic leukemia (ALL) patient had a modal chromosome count of 26 in her bone marrow metaphases. The leukemia was "common" ALL by cytochemical and immunologic studies. Five other cases had been reported previously, and all have had a near haploidy varying from 26 to 32 chromosomes. Disomy of chromosomes 18 and 21 is a consistent feature of this disease. Severe hypodiploidy correlates with microblastosis requiring morphologic separation from non-neoplastic small lymphocytes.
Drug misuse by adolescent athletes.
The substances described have little or no ergogenic capacity, and even if they did, the dangers associated with taking many of them far outweigh the advantage of their giving an athlete an "illegal edge." Using these drugs for this purpose is cheating and a violation of the ethics of fair play in sports. The use of alleged ergogenic aids by the adolescent athlete is a possibility that should be considered by the physician whenever he performs either a routine health maintenance examination or a preparticipation physical examination on the adolescent athlete. This subject should be routinely mentioned then by the physician, and the risks and alleged benefits fully discussed.
E rosetting by leukemic monoblasts. A possible mechanism.
Occasional cases of acute monoblastic leukemia have been reported to have unusual immunologic properties such as the capacity to form heat stable E-rosettes, a marker usually associated with T-cell acute leukemia. This case report describes such a patient and postulates a possible mechanism for the anomalous E rosetting.