Biomedical subjects
R E Brennan
Publications and source records attributed to R E Brennan.
Malpractice and negligence.
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Acute rheumatic fever and rheumatic heart disease in a rural central Australian aboriginal community.
A retrospective study of clinical case records was conducted at the health centre of a rural central Australian Aboriginal community to determine the frequency of acute rheumatic fever and of rheumatic heart disease between 1978 and 1987. The case records of 976 residents over 5 years of age were examined for evidence of the clinical indicators of acute rheumatic fever or rheumatic heart disease; together they contributed 8015 person-years of study. During the 10-year study period, 18 patients developed acute rheumatic fever and 12 patients had rheumatic heart disease. The annual incidence of acute rheumatic fever (first and recurrent attacks) for children aged 5-14 years was 815 per 100,000 person-years. For the residents aged 5 years and over, the point prevalence for rheumatic heart disease at the end of 1987 was between 7.9 and 12.3 per 1000 persons, according to health clinic records and the official population census, respectively. These rates are similar to those reported for Third World countries. Preventive measures must include efforts by health professionals to help to alleviate the adverse living conditions in Aboriginal communities.
Legal implications of routine screening for asymptomatic silent myocardial ischemia.
A recent case in California raises legitimate concern about the risks of a lawsuit arising out of a routine physical examination. This ruling has an ominous portent for many physicians who either are not current or are not comfortable with the available testing procedures for screening asymptomatic patients for silent myocardial ischemia.
Resistive training can reduce coronary risk factors without altering VO2max or percent body fat.
Eleven healthy, untrained males (age = 44 +/- 1 yr; range = 40 to 55 yr) were studied to determine the effects of 16 wk of high-intensity resistive training on risk factors for coronary artery disease. Lipoprotein-lipid profiles, plasma glucose and insulin responses during an oral glucose tolerance test, and blood pressure at rest were determined before and after training. The training program resulted in a 13% increase in high-density lipoprotein-cholesterol (39 +/- 2 vs 44 +/- 3 mg.dl-1, P less than 0.05), a 43% increase in high-density lipoprotein-cholesterol (7 +/- 2 vs 10 +/- 2 mg.dl-1, P less than 0.05), a 5% reduction in low-density lipoprotein cholesterol (129 +/- 5 vs 122 +/- 5 mg.dl-1, P less than 0.05), and an 8% decrease in the total cholesterol/high-density lipoprotein-cholesterol ratio (5.1 +/- 0.3 vs 4.7 +/- 0.3, P less than 0.01), despite no changes in VO2max, body weight, or percent body fat. Glucose-stimulated plasma insulin concentrations during oral glucose tolerance testing were significantly lower, and supine diastolic blood pressure was reduced (P less than 0.05) as a result of the training program. No changes in any of these variables occurred in a sedentary control group. These findings indicate that resistive training can lower risk factors for coronary artery disease independent of changes in VO2max, body weight, or body composition.
Legal ramifications of the development of an AIDS vaccine.
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Metastatic malignant melanoma mimicking renal cell carcinoma.
Large renal parenchymal masses are a rare manifestation of metastatic malignant melanoma. We report the second and third such cases to be noted on excretory urography.
Computed tomography of the iliopsoas muscle.
Computed tomography (CT) is an ideal method for the imaging of the psoas muscle. The authors present 13 cases of patients with psoas abnormalities diagnosed by CT. The CT features of the different pathologic entities and comparison of CT with other imaging modalities are discussed.
CT diagnosis of a splenic artery pseudoaneurysm: a complication of chronic pancreatitis and pseudocyst formation.
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Composition of diets of low-income pregnant women: comparison of analyzed with calculated values.
Nutrient composition of diets of low-income pregnant women was determined by laboratory analysis and by calculation from food tables. Twenty-two diet composites, each representing a subject's 24-hour intake, were so evaluated. Findings from use of the two methods were compared. Mean analyzed and calculated values compared favorably for food energy, protein, fat, carbohydrate, potassium, magnesium, and zinc, although large differences in values as determined by the two methods were found in some single diet composites. Analyzed values compared less favorably with calculated values for calcium, phosphorus, iron, sodium, and the six vitamins studied.
Nutrient intake of low-income pregnant women: laboratory analysis of foods consumed.
Nutrient intake of a group of 22 young, mainly black, low-income pregnant women was evaluated by use of data resulting from laboratory analysis of foods prepared and consumed in the home over a 24-hour period. Magnesium, zinc, and folacin were the nutrients least well supplied in the foods consumed. Analyzed values for daily intake of the three were below 50% of the RDAs. Mean energy intake was considerably lower than recommended allowances, even though mean gain in weight was somewhat greater than that recommended for normal pregnancy, a finding like that of other investigators. The wide range in daily intake of energy and various nutrients among subjects is comparable with that found in a number of other studies, which showed that many individuals have marked deviations in intake from day to day. Analyzed diets also were examined in terms of nutrient density. Mean nutrient density for protein, calcium, phosphorus, vitamin A, thiamin, riboflavin, niacin, and ascorbic acid compared favorably with that of the RDAs, in contrast with the poor nutrient density for zinc, magnesium, and folacin. Laboratory analysis of the diets had the advantage of providing information about nutrient content of foods as prepared and consumed in the home. The analysis had particular advantage in the evaluation of content of zinc, magnesium, and folacin, as data for the three nutrients in food composition tables are limited.
Fibrous dysplasia of the facial bones and mandible.
Five cases of fibrous dysplasia isolated to the facial bones and mandible are presented. A review of the clinical and roentgen features of facial fibrous dysplasia are described.
Computed tomography of stress fracture.
An athletic young female developed gradual onset of pain in the right leg. Plain radiographs demonstrated solid periosteal reaction in the tibia compatible with stress fracture. She stopped sport activities but her pain continued. Follow-up radiographs of the tibia revealed changes suspicious for osteoid osteoma. Computed tomography (CT) scan demonstrated periosteal reaction, but in addition, lucent fracture lines in the tibial cortex were evident. CT obviated the need for more invasive diagnostic procedures in this patient. In selected cases CT may be useful to confirm the diagnosis of stress fracture when plain radiographic or routine tomographic studies are not diagnostic.
Left renal vein obstruction associated with nonrenal malignancy. Detection by computed tomography and ultrasonography.
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Acute renal failure secondary to ureteral obstruction by a gravid uterus.
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Teardrop bladder: additional considerations.
Nine cases of teardrop bladder (TDB) seen at excretory urography are presented. In some of these patients, the iliopsoas muscles were at the upper limit of normal in size, and additional evaluation of the perivesical structures with computed tomography (CT) was necessary. CT demonstrated only hypertrophied muscles with or without perivesical fat. The psoas muscles and pelvic width were measured in 8 patients and compared with the measurements of a control group of males without TDB. Patients with TDB had large iliopsoas muscles and narrow pelves compared with the control group. The psoas muscle width/pelvic width ratio was significantly greater (p less than 0.0005) in patients with TDB than in the control group, with values of 1.04 +/- 0.05 and 0.82 +/- 0.09, respectively. It is concluded that TDB is a not uncommon normal variant in black males. Both iliopsoas muscle hypertrophy and a narrow pelvis are factors that predispose a patient to TDB.
Bifid blind-ending ureter.
Six patients with bifid blind-ending ureter diagnosed at excretory urography are presented. In four of six patients the blind ureter was an incidental discovery. All had a characteristic appearance on urography consisting of an elongated contrast-filled tubular structure which usually terminated in a bulbous proximal tip. Demonstration of the rounded tip at excretory urography is important as it indicates the entire blind ureter has been opacified, obviating the need for retrograde pyelography.
Nutrition education in medical schools.
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