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Biomedical subjects

R Ferguson

Publications and source records attributed to R Ferguson.

At least 37 records · Page 2Linked to original sources
PubMed1993

Listeria-associated pericarditis in an AIDS patient.

Listeria monocytogenes is a pathogenic, facultative intracellular gram-positive rod, generally seen in cell-mediated immunocompromised states. In acquired immunodeficiency syndrome (AIDS), it most commonly presents as bacteremia or meningitis. An association with pericarditis has not been described previously in this group of patients. This article describes a case of pericarditis secondary to listeriosis involving a focal pancarditis and necrosis of the A-V node with subsequent refractory ventricular tachyarrhythmias in an immunodeficient patient presenting with altered mental status. Infectious etiologies should be considered for "benign" appearing pericardial effusions in AIDS patients and the diagnosis of listeriosis excluded in the presence of "diphtheroid-like" organisms.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Determinants of clean surgical wound infections for breast procedures at an oncology center.

OBJECTIVE: To determine the clean surgical wound infection rate for breast procedures and the risk factors predisposing patients to these infections. DESIGN: A survey study. SETTING: Oncology center. PATIENTS: A consecutive sample of adult female patients who underwent surgical breast procedures for suspected carcinoma of the breast. Patients undergoing excisional biopsy, lumpectomy, or mastectomy from January 1985 to January 1987 were included in the study. INTERVENTION: Clean surgical wound infection rates were derived overall and for each procedure type. The medical records of all patients were then reviewed to extract data on patient characteristics and operative information in order to assess the risk factors for infection. RESULTS: Among the breast procedures performed on 448 patients, the overall clean surgical wound infection rate was 8.7% (39/448). The clean surgical wound infection rate for each procedure type was as follows: biopsy 2.3%, lumpectomy 6.6%, and mastectomy 19%. In addition to the type of procedure, factors significantly (p less than .05) associated with the development of clean surgical wound infection in the univariate analysis included: presence of surgical drains (p less than .01); closed suction drainage (odds ratio [OR] = 16.5, 95% confidence interval [CI95] = 5.0-54.7); location of the drain (OR = 3.3, CI95 = 1.7-6.6); prolonged preoperative stay (OR = 1.2, CI95 = 1.0-1.5); length of surgery (OR = 2.2, CI95 = 1.7-3.0); and greater mean age (OR = 1.6, CI95 = 1.2-2.1). CONCLUSION: Clean surgical wound infections are not uncommon in patients undergoing breast procedures. Factors relating to both the patient and operative techniques contribute to the clean surgical wound infection rate. Further consideration should be given to perioperative antibiotic prophylaxis for selected breast procedures, and the role of surgical drains should be reassessed.

Biopsy↗
PubMed1992

Venous occlusion: a rare complication of transvenous cardiac pacing.

Venous occlusion is an uncommon complication of transvenous cardiac pacing. Fibrotic occlusion of the right subclavian and innominate veins and stenosis of the left innominate vein, after the insertion of transvenous pacing wire, was corrected surgically with an external iliac vein graft.

Adult↗
PubMed1991

Phase I/II trial of superselective arterial 5-FU infusion with concomitant external beam radiation for patients with either anaplastic astrocytoma or glioblastoma multiforme.

From August 1987 through September 1989, 25 patients with either anaplastic astrocytoma (8 patients) or glioblastoma multiforme (17 patients) were entered into a Phase I trial of combined intra-arterial 5-fluorouracil (5-FU) and external beam radiation therapy. The intra-arterial 5-FU was given in a superselective, supraopthalmic fashion, in escalating doses from 200 mg to 600 mg on a weekly basis during the radiotherapy. Each patient received from 1-4 courses of 5-FU. Radiotherapy consisted of 5,000 rads in 25 fractions given to partial brain fields including the mass and surrounding edema plus a 3-cm margin as defined by computed tomography scan. There were a total of 4 significant acute complications out of a total of 70 infusions. These included 3 ischemic events of which 2 were transient. In addition, 1 patient experienced a cerebral bleed. No patients developed ocular complications. Electroencephalograms (EEGs) were performed immediately before and during 21 intra-arterial infusions. Two patients developed significant EEG changes during intra-arterial infusion, and both of these patients experienced untoward reactions. The remaining patients showed no EEG changes during their infusions. The median survival for patients with glioblastoma multiforme was 15 months. We believe the toxicity of superselective intra-arterial 5-FU infusion combined with external beam radiotherapy is acceptable. This type of treatment deserves further study.

Adult↗
PubMed1991

End-stage renal disease and race: an overview and perspective.

The epidemiology of end-stage renal disease (ESRD) in the United States is reviewed. Hypertension and diabetes as etiologic factors in ESRD in minorities are discussed, as is the question of a familial ESRD. It is hypothesized that diuretics as sole antihypertensive therapy in blacks may in the long term result in chronic volume contraction, increased sympathetic stimulation, and therefore, decreased renal function. As such, a rational basis for the long-term use of diuretics as the sole antihypertensive therapeutic in blacks becomes questionable at best.

Black People↗
PubMed1990

The effect of race on the relationship between fetal death and altered fetal growth.

This population study examines racial differences in the relationship between birth weight and fetal death. An earlier report showed that a birth weight that results in a fourfold increased risk of stillbirth is not a constant birth weight percentile (2nd percentile at 25 weeks, 17th percentile at 42 weeks). This analysis was applied to 782,430 white and black births in Illinois from 1980 to 1984. Mean and 10th percentile growth for white and black infants is identical before 34 weeks' gestation and growth diverges by 250 gm at term, with white infants being larger. Race-specific birth weights resulting in quadrupling of the stillbirth rate were determined with an exponential regression analysis of the relationship between birth weight and fetal death rate for each gestational age. The data indicate (1) that the birth weights resulting in quadrupling the stillbirth rate are substantially above the Denver 10th percentile and the previously unpublished race-specific Illinois 10th percentiles and (2) that at term white infants demonstrate this constant risk at the 12th percentile, whereas black infants exhibit the risk at the 18th percentile. From these data we conclude that black fetuses are more sensitive than white fetuses to factors that adversely affect growth and that continued use of "race-neutral" data for clinical management in racially heterogenous populations will not accurately predict the risk of stillbirth.

Black or African American↗
PubMed1990

A model for the prospective analysis of perinatal deaths in a perinatal network.

This prospective study assesses factors that contribute to perinatal mortality. The study population includes the 1362 perinatal deaths that occurred among 85,402 live births between 1983 and 1987 at hospitals of the University of Chicago Perinatal Network. After peer review of demographic, clinical, and pathologic data, each perinatal death was classified in one of the following categories: (1) the result of congenital malformation incompatible with life, (2) unavoidable, (3) potentially avoidable by patient, by health provider, or by both, or (4) of undetermined responsibility. Of 1362 deaths, 12.3% involved congenital malformations incompatible with life, 56.9% were classified as unavoidable, 28.1% were judged potentially avoidable, and 2.7% due to undetermined causes. Of potentially avoidable deaths, 36% were due to patient factors (primarily noncompliance), 59% to health provider factors, and 15% to combined patient and provider factors. There was a significant reduction in the potentially avoidable cases during the study period. The maximum attainable reduction in perinatal mortality under optimal conditions is calculated. Intervention plans to achieve this goal are discussed.

Chicago↗
PubMed1989

Tympanic ECochG and conventional ABR: a combined approach for the identification of wave I and the I-V interwave interval.

Identification of wave I and measurement of the I-V interwave interval (IWI) are important parameters of the auditory brain stem response (ABR). However, at low stimulus sensation levels, wave I may be absent in the presence of wave V when the ABR is recorded conventionally with scalp electrodes. Several studies have shown that the amplitude and detectability of wave I (or N1) can be enhanced via extratympanic electrocochleography (ECochG), and even more so with tympanic ECochG. In the present study, tympanic ECochG was combined with conventional ABR to compare the amplitude and sensitivity of N1, wave I, and wave V in normally hearing subjects, and to identify the N1-V IWI in hearing impaired subjects whose conventional ABRs did not contain a reliable wave I. For the normally hearing subjects, the amplitude of the N1 was considerably larger than the amplitudes of waves I and V of the conventional ABR and there was no significant difference between N1 and wave V thresholds. For the hearing impaired group, the combined ECochG-ABR approach allowed for the identification of N1 and measurement of the N1-V IWI in all subjects. Our results support the use of tympanic ECochG in combination with conventional ABR for certain audiological and neurological applications.

Audiometry, Evoked Response↗
PubMed1989

A population study of the relationship between fetal death and altered fetal growth.

In order to describe the relationship between fetal death rate and impaired fetal growth, we examined over 850,000 births in Illinois between 1980-1984 (using the state computer data file) and assessed the mean/modal birth weights at each gestational age and the relationship between birth weight and fetal death rate at each gestational age. We were interested in the following questions: 1) Is the relationship between impaired fetal growth and fetal death rate the same at each gestational age? and 2) What birth weight would result in a quadrupling of the fetal death rate at each gestational age? Using exponential regression analysis, we determined for each gestational age the fetal death rate at the modal birth weight and similarly, the birth weight expected to result in a quadrupling of the fetal death rate. As gestational age advanced, the birth weight percentile resulting in the constant outcome also increased (second percentile at 25 weeks; 17th percentile at 42 weeks). We also compared these data with similar data from Denver. The findings indicate the following: 1) Fetal death rate increases exponentially as birth weight decreases at each gestational age; 2) the birth weight percentile that results in a constant outcome is not consistent at each gestational age; and 3) if assessment of risk is to be inferred based on the relationship between birth weight and gestational age, the tenth percentile (whether Denver, Illinois, or elsewhere) does not predict stillbirth accurately. The implications point to the use of outcome-oriented risk assessments to predict fetal death when examining the relationship between birth weight and gestational age.

Birth Weight↗
PubMed1988

Predicting problems in school performance from preschool health, developmental and behavioural assessments.

To determine the accuracy of various predictors of school problems, we conducted a 3-year prospective study of 1999 children who began school in the Niagara region of Ontario in 1980. During the year before school entry the parents gave a health, developmental and behavioural history during an interview with a community health nurse, and the children underwent vision and hearing screening tests and the Denver Developmental Screening Test (DDST). At the end of the 1980-81 school year the kindergarten teachers rated the children's learning problems. At the end of the 1982-83 school year the presence of school problems was ascertained, and the predictive accuracy of items from the preschool history and examination and of the kindergarten teachers' ratings was calculated. The health, developmental and behavioural history with or without the DDST was found to predict later school problems with acceptable accuracy. The kindergarten teachers' ratings gave slightly more accurate predictions. We conclude that in communities where prompt diagnostic evaluation and effective therapeutic or preventive help can be provided to children identified as being at high risk, health professionals may play a useful role in screening for future school problems.

Age Factors↗
PubMed1988

A familial risk of chronic renal failure among blacks on dialysis?

End-stage renal disease (ESRD) is strongly associated with both hypertension and diabetes. As both diabetes and hypertension tend to be familial, we hypothesized a familial clustering of ESRD cases. Using 114 cases from three dialysis centers and 99 controls, the exposure odds ratio was determined. Mantel-Haenszel analysis demonstrated that individual history of hypertension (ORmh = 5.14; 95% Cl = 2.29-11.56) and history of chronic renal failure in a first or second degree relative (chi 2mh = 5.12; p less than 0.05) were significant "risk" factors for being dialysed for ESRD, while family history of hypertension posed a more questionable risk (ORmh = 1.92 95% Cl 0.96-3.86). In fact, when the subset of patients identified with hypertensive renal disease was considered independently, the risk due to family history of hypertension increased 14-fold which suggests a role as a confounder for hypertensive renal disease. The effect of chronic renal failure in a relative was independent of family history of diabetes.

Black People↗
PubMed1987

Evaluation of public health preschool child developmental screening: the process and outcomes of a community program.

We conducted a randomized controlled trial of a public health and education screening program aimed at all 4,797 four to five year old children registering for kindergarten in three school districts of southern Ontario, Canada. Children received either the Denver Developmental Screening Test (DDST) with a community health intervention program for positive screeness; the DDST with no intervention for positive screenees; or no screening test. The intervention program consisted of referral to the child's physician for assessment; a review conference between the child's teacher and the school health nurse; parent counseling; and monitoring of the child in school by the school health nurse. At the end of the third school year, no differences were found between positive screenees in the community health intervention group and the "no intervention" groups using individual academic achievement, cognitive, and developmental tests. Parents' reports revealed no differences between groups in children's mental, social, and behavioral well-being. However, parents of intervention program children had more worry about their child's school progress suggesting a potentially harmful labeling effect. In comparison to a random sample of children with normal DDST results, or a random sample of children who had randomly not been screened, the children with positive preschool DDSTs had substantially more school problems three years after screening.

Child Development↗
PubMed1987

The epidemiology of end-state renal disease: the six-year South-Central Los Angeles experience, 1980-85.

Using the End-Stage Renal Disease Medical Information System and 1980 census information, the crude cumulative incidence among Blacks, Hispanics, and Whites in south central Los Angeles was determined to be 160.1, 49.28, and 55.3 per 100,000 respectively. Sex-specific rates were slightly greater in males. Among Blacks, nephrosclerosis and diabetes represented 41.5 and 30.2 per cent of the cases respectively and increased during the period 1980-85.

Adolescent↗