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Biomedical subjects

R Curless

Publications and source records attributed to R Curless.

17 recordsLinked to original sources
PubMed2000

Prevalence of lower gastrointestinal symptoms and associated consultation behaviour in a British elderly population determined by face-to-face interview.

BACKGROUND: The incidence of organic lower gastrointestinal disease increases with age. However, the prevalence of lower gastrointestinal symptoms in a British elderly population is unclear, with previous epidemiological studies focusing on younger populations. Furthermore, there is little information about consultation behaviour associated with lower gastrointestinal symptoms. AIM: To determine the prevalence of lower gastrointestinal symptoms reported by randomly selected, elderly community subjects. METHODS: An age- and sex-stratified random sample of patients aged 65 years and over was drawn from a general practice register (n = 842). Those who had not refused to participate in an initial postal survey were invited to participate in a semi-structured physician interview at their own home to assess lower gastrointestinal symptomatology (n = 745). Non-participation bias and service use of all subjects were assessed from practice records. RESULTS: Five hundred and ninety-six (71%) patients were interviewed. Fifty-seven per cent of all participants had at least one lower gastrointestinal symptom. Individual symptoms and symptom complexes were common, affecting up to 32% of subjects. Only 24% of subjects with lower gastrointestinal symptoms consulted their general practitioner (GP) with such symptoms in the previous year. As few as 31% of subjects with new onset of the significant symptoms of rectal bleeding, abdominal pain, and a change in bowel habit consulted their GP. CONCLUSION: Lower gastrointestinal symptoms are common in a British elderly population and an important reason for GP consultation.

Abdominal Pain↗
PubMed1999

Randomized controlled trial of a comprehensive stroke education program for patients and caregivers.

BACKGROUND AND PURPOSE: We report the findings of a randomized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program (SEP) for patients and their informal carers. METHODS: Two hundred four patients admitted with acute stroke and their 176 informal carers were randomized to receive an invitation to the SEP or to receive conventional stroke unit care. The SEP consisted of one 1-hour small group educational session for inpatients followed by six 1-hour sessions after discharge. The primary outcome measure was patient- and carer-perceived health status (SF-36) at 6 months after stroke. Knowledge of stroke, satisfaction with services, emotional outcome, disability, and handicap and were secondary outcome measures. RESULTS: Only 51 of 108 (47%) surviving patients randomized to the SEP completed the program, as did 20 of 93 (22%) informal carers of surviving patients. Perceived health status (Short Form 36 [SF-36] health survey) scores were similar for SEP patients and controls. Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group (P=0.04). Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls (patients, P=0.02; carers, P=0. 01). Patients in the SEP group were more satisfied with the information that they had received about stroke (P=0.004). There were no differences in emotional or functional outcomes between groups. CONCLUSIONS: Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services, this was not associated with an improvement in their perceived health status. Indeed, the social functioning of informal carers randomized to the SEP was less than in the control group.

Adult↗
PubMed1998

Cerebral aneurysmal arteriopathy in childhood AIDS.

OBJECTIVE: To identify cerebral aneurysmal arteriopathy in children with longstanding AIDS. BACKGROUND: Five cases are described from the authors' experience, and eight additional cases are reviewed from the literature. Details are presented in regard to the clinical picture as well as brain imaging with cerebral angiography and magnetic resonance angiography in some cases. Autopsy information is available in four cases, including one of the authors' patients. RESULTS: Seven patients acquired HIV infection perinatally, five patients were infected by blood transfusions, and one patient had both risk factors. In the four postmortem patients, the vascular pathology was similar, showing ectasia and aneurysmal dilatation confined to the large arteries of the circle of Willis. Medial fibrosis and loss of muscularis with destruction of the internal elastic lamina and intimal hyperplasia was common. The latency period following infection varied from 2 to 11 years. Once a diagnosis of aneurysmal arteriopathy was made, the patients deteriorated rapidly, with death occurring in less than 6 months. CONCLUSIONS: The development of cerebral aneurysmal arteriopathy in childhood AIDS tends to occur after a prolonged delay and is usually followed by death in a short period of time. The etiology for the vasculitis is unknown. Varicella zoster virus may be the etiology in some of the cases because of its potential to cause this pathology and the striking unilateral arterial involvement found in Case 5. HIV vasculitis is also a possibility, as suggested by the detection of HIV protein or genomic material in two of the four autopsy cases.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Does alcohol contribute to accident and emergency department attendance in elderly people?

OBJECTIVE: To evaluate the possible contribution of alcohol to presentation of elderly subjects at a hospital accident and emergency (A&E) department. METHODS: 105 patients aged 70 years and over who attended the department were interviewed by a single observer using a structured questionnaire based on previously validated general population surveys. Details of alcohol consumption within the previous 24 hours were recorded. Usual consumption of alcohol in the preceding 12 months was estimated by the quantity frequency method. Alcohol dependence was screened for by the CAGE questionnaire. An assessment of disability was made using the Barthel index. Breath alcohol was measured. RESULTS: In only 2% of attenders was alcohol thought to be a contributory factor. Breath alcohol measurements were technically unsatisfactory in this age group. Regular drinkers were functionally and socially more independent than non-regular drinkers. Drinking patterns in this age group may partly be determined by the physical ability to obtain alcohol. CONCLUSIONS: Alcohol was not found to be a major factor in A&E attendance in elderly people.

Activities of Daily Living↗
PubMed1994

Clinical features and prognosis of hepatocellular carcinoma in Britain in relation to age.

A retrospective review of 110 cases of hepatocellular carcinoma (HCC) from the North East of England was undertaken to examine clinical features and prognosis in the 52 patients 65 years of age or more at presentation in comparison with 58 patients under 65. Symptoms and signs at the time of presentation were similar in the two age groups. Only 25% of patients were known to be cirrhotic at the time of presentation, but this increased to 75% after investigation. Although tumour stage at diagnosis was no worse in the elderly group, these patients received less intensive investigation and were significantly more likely to receive conservative therapy (p = 0.03). Although median survival was significantly worse in those aged > or = 65 years than in those < 65 years (10.5 and 18.5 weeks respectively; p = 0.02) this adverse effect disappeared when adjusted for the effects of treatment.

Adolescent↗
PubMed1994

Colorectal carcinoma: do elderly patients present differently?

A cohort of patients with a histological diagnosis of colorectal carcinoma was enrolled prospectively. All subjects were interviewed by one observer using a structured questionnaire. One hundred and fifty 'young' (under 70 years) and 123 'elderly' (70 years or more) subjects formed the study sample. The elderly patients did not present more frequently as emergencies than the young, but were more often referred to medical or geriatric rather than surgical units (p < 0.01). There was no difference in median overall delay from symptom onset to histological diagnosis between the age groups (19.5 weeks in each). Symptomatic anaemia and nonspecific symptoms were more often the presenting complaint in the elderly subjects (p < 0.05). On direct questioning, there were no differences in symptom reporting with respect to age group for subjects with colonic cancer. For rectal cancer the following symptoms were more common in the young group: tenesmus (odds ratio 4.2; 95% confidence intervals 2.0-10.0), abdominal or rectal pain (4.0; 1.9-10.6), change in flatus production (2.6; 1.3-5.8), passage of mucus per rectum (2.2; 1.1-4.8). Anorexia was more common in the elderly patients (0.4; 0.1-0.8). This study suggests that symptomatic presentation of rectal cancer is different in the elderly but does not necessarily lead to greater delays in diagnosis nor higher rates of non-elective presentation.

Adenocarcinoma↗
PubMed1994

Comparison of gastrointestinal symptoms in colorectal carcinoma patients and community controls with respect to age.

Early diagnosis of colorectal cancer may be delayed by the wide prevalence of gastrointestinal symptoms in the general population. This study assessed, with respect to age, the frequency of gastro-intestinal symptoms in patients with colorectal carcinoma in comparison with community controls and also compared the frequency of such symptoms between 'young' (under 70 years) and 'old' (70 year or over) subjects. Two hundred and seventy three consecutive unselected colorectal cancer patients and 273 age and sex matched community controls were interviewed in a structured manner. Among controls, the 'old' group compared with the 'young' reported abdominal pain (p < 0.05), mucous discharge (p < 0.01), faecal incontinence (p < 0.05), change in flatus production (p < 0.05) significantly more often. There were no significant differences in regularity and frequency of bowel habit by age group. All the symptoms considered were significantly more common in colorectal cancer cases than controls (except abdominal bloating), but the association was less strong in the 'old' group. This study confirms that symptoms attributable to the lower gastrointestinal tract are reported by a clinically important number of community subjects and by a significantly higher proportion of elderly people.

Abdominal Pain↗
PubMed1993

Is caffeine a factor in subjective insomnia of elderly people?

Subjective insomnia is more prevalent in elderly than in young populations. In order to examine the relationship between caffeine and sleep quality we studied 181 community-dwelling subjects over a wide age range and 53 elderly patients receiving continuing hospital care. Subjects completed a sleep questionnaire and data concerning smoking, alcohol, use of hypnotics and caffeine-containing substances were recorded. Late afternoon plasma caffeine concentrations were measured in a sub-group of 87 of the community-dwelling subjects and in the hospitalized patients. For the group as a whole, there was a significant negative correlation between age and coffee but not tea consumption (p < 0.001). A global score of sleep quality was significantly inversely related to age (p < 0.001). For the community-dwelling population, the median plasma caffeine concentration was 1.71 micrograms/ml (range 0.10-6.74) and showed a significant correlation with sleep quality (p < 0.05). In contrast, for the hospital dwelling population, median caffeine concentration was higher in patients reporting sleep problems than in those without (p < 0.05). Self-reported consumption of coffee and tea did not correlate with plasma caffeine concentrations. It is possible that people with poor sleep quality, residing in the community, are aware of the stimulatory effects of caffeine and lower their intake accordingly, whereas hospitalized elderly patients, who have less control over their environment, do not.

Adult↗
PubMed1990

Monosomy 7 syndrome. Clinical heterogeneity in children and adolescents.

Bone marrow monosomy 7 is the most frequent karyotypic abnormality found in patients with chronic myeloproliferative disorders. To a review of 46 previously reported pediatric patients we add three additional cases. Clinical presentation is usually dependent upon which cell lines are most perturbed in this pluripotent stem cell disorder. Sixteen (35%) children presented by their first birthday and 35 (76%) by their sixth birthday. Distinctive differences in presentation exist between infants, children, and adolescents. Younger patients were more symptomatic and had greater degree of hepatosplenomegaly and leukocytosis. The prognosis is very poor and death usually occurs within two years from complications attributable to cytopenias, cellular dysfunction, or transformation to acute nonlymphocytic leukemia. Implications for therapy are discussed.

Adolescent↗
PubMed1988

Severe protein C deficiency in a newborn.

An infant presented at birth with a cutaneous lesion that developed the characteristics of purpura fulminans. He sustained a cerebral infarction during the first 4 days of life, which was initially misinterpreted to be cerebral hemorrhage resulting from thrombocytopenia and hypofibrinogenemia. After the diagnosis of Protein C deficiency was made and effective replacement therapy begun, no further cutaneous lesions occurred. Although there was no evidence of further cerebral infarction, the initial insult progressed to severe encephalomalacia and cerebral atrophy. This disorder should be considered in infants with purpura fulminans or those with cerebral infarction, as prompt institution of transfusion therapy to replace the missing protein may prevent further damage.

Humans↗
PubMed1987

Encephalomyelitis associated with leukemia in a child.

A case of an encephalomyelitis in a child with acute lymphoblastic leukemia is reported. The patient was a 5-year-old boy who developed seizures, progressive confusion, and coma after radiation and intrathecal methotrexate therapy. Computed tomography (CT) of the brain showed bilateral hypodensities in the posterior parietal and temporal regions. At autopsy, perivascular inflammation, microglial nodules without intranuclear viral inclusions, and bilateral necrosis of the temporoparietal and hippocampal regions were seen in the brain and spinal cord. Paraneoplastic encephalomyelitis is generally recognized in adult patients with underlying malignancy but, to our knowledge, has not been reported in children with leukemia. This report should alert the clinicians to an entity that must be included in the differential diagnosis of leukemic children with progressive neurologic disorder.

Brain↗