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Biomedical subjects

R L James

Publications and source records attributed to R L James.

44 records · Page 3Linked to original sources

Hypophyseal metastatic renal cell carcinoma and pituitary adenoma. Case report and review of the literature.

A patient with a remote history of nephrectomy for renal cell carcinoma presented with a visual field defect. At surgery, a metastasis from the hypernephroma and an adenoma were found coexisting in the anterior pituitary gland. Although hypernephromas are known to act as "recipient" tumors in cases in which two primary neoplasms coexist, it is unusual for a renal cell carcinoma to metastasize into another tumor.

Adenocarcinoma↗

Diagnosing schizophrenia: Professor Kraepelin and the research diagnostic criteria.

The authors applied current diagnostic criteria (the Research Diagnostic Criteria developed by Spitzer and associates and DSM-III) to Kraepelin's descriptions of his own patients and compared Kraepelin's diagnoses of "functional" psychoses related to schizophrenia with those of today. Thirty-two case histories were selected from Kraepelin's textbook of psychiatry. Two psychiatrists screened out any comments from the case histories that might have revealed Kraepelin's original diagnoses.The screened case histories were then diagnosed by one of the authors. A high degree of agreement was found between Kraepelin's diagnoses and the diagnoses of present-day systems.

Austria↗

Effects of short term phosphorus deprivation on laying hens.

An experiment was conducted to determine the effects on laying hens of ingestion of a phosphorus deficient diet for 6, 9, or 21 days. Four experimental groups consisting of 3 replicates of 5 Leghorn pullets averaging 90 percent egg production were maintained in individual cages. A diet containing corn, soy, and meat and bone meal was formulated to contain 0.39 percent total P on a 90 percent dry matter basis (LP). A normal P diet (NP), 0.64 percent total P, was obtained by supplementation with an inorganic P source. Group 1 (Control) was fed the NP diet for 21 days. Groups 2, 3 and 4 were fed the LP diet for 6, 9, and 21 days respectively. Groups 2 and 3 resumed consumption of NP diet after 6 and 9 days. Individual egg production and egg weight were recorded daily. Individual hen determinations of serum P, g. shell/cm.2 surface area, and feed consumption by replicate were made at 3 or 4 day intervals. The serum P of Group 1 averaged 5.01 +/- 0.31 mg./100 ml. over the 21 days. Serum P was significantly reduced after 3 days of consuming the LP diet. Serum phosphorus of Groups 2,3, and 4 were 2.95 +/- 0.18, 3.03 +/- 0.24, 3.13 +/- 0.32 mg./100 ml. respectively after 6, 9, and 21 days of consuming the LP diet. Serum P returned to control levels within 4 days after resumption of the NP diet by Groups 2 and 3. There were no differences in feed consumption, egg production nor any detrimental effects on egg weight or shell calcification despite the low serum P. Body weight gain of the hens fed the phosphorus deficient diet for 21 days was significantly reduced. At the end of the experiment femur density was determined; the hens which had consumed the phosphorus deficient diet for 21 days had reduced femur density (osteoporous) compared to the control group or the hens fed the phosphorus deficient diet for only 9 days. It is concluded that pullets in 90 percent production can tolerate this low P diet for at least 9 days without apparent detrimental effects.

Animal Feed↗

Predicting the need for hospitalization of ambulatory patients with pneumonia.

OBJECTIVE: To develop clinical guidelines to identify patients with pneumonia who might be safely treated as outpatients. DESIGN: Retrospective chart review to derive guidelines, with subsequent prospective validation. SETTING: Initial review completed for patients seen in the emergency room (ER) of a university hospital and a community-based internal medicine practice. Validation conducted in the ERs of a university hospital and a community teaching hospital. PATIENTS/PARTICIPANTS: Individuals aged 16 years and older presenting with newly diagnosed pneumonia. Follow-up obtained through mail or telephone contact and chart review. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the initial retrospective review, 141 pneumonia patients without obvious reasons for hospital admission were identified and then classified as hospitalization necessary or unnecessary. Of these patients, 33 were classified as requiring admission. Multivariate analysis identified five variables that differentiated low-risk from high-risk study patients. These variables (and their relative weights) were: serious comorbid illness (3 points); preexisting lung disease (2 points); multilobar lung involvement by the disease by chest x-ray (2 points); observed or likely aspiration (2 points); and symptom duration of less than 7 or greater than 28 days (1 point). Risk scores were calculated using these variables. Patients with low scores (0-2 points) rarely had complications, and only one of 53 such patients (2%) was judged to require hospitalization. In contrast, patients with high scores (greater than or equal to 6 points) had frequent complications and 20 of 29 (69%) were felt to need hospitalization. Similar results were found during the validation phase. CONCLUSIONS: Clinical findings appear to help distinguish patients who need admission for treatment of pneumonia from those who do not. If validated in other settings, the clinical utility of these guidelines in assisting decision making about hospitalization should be determined.

Adolescent↗

NPO after midnight before elective surgery is no longer common practice for the majority of anesthesiologists.

One thousand three hundred thirty-seven anesthesiologists randomly selected from the current American Society of Anesthesiologists' directory were surveyed to discover if their attitudes toward the policy of allowing preoperative patients nothing by mouth (NPO) have changed. One thousand forty surveys were returned. For each response to a survey question, the percentage of respondents giving that response was calculated. The 95% confidence intervals for these percentages were calculated by using the normal approximation of a binomial distribution. Chi-square analyses were used to explore possible relationships between demographic factors and NPO orders. Nearly all anesthesiologists surveyed used less than an 8-hour fast for elective pediatric surgery. At least 50% of the anesthesiologists surveyed no longer use NPO after midnight as an order for elective surgery for adults. Of the demographic variables, only geography and the question of whether or not a hospital was a teaching institution were statistically related to NPO practice.

Adult↗