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Biomedical subjects

R W Armstrong

Publications and source records attributed to R W Armstrong.

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

Brainstem encephalitis (rhombencephalitis) due to Listeria monocytogenes: case report and review.

Listerial brainstem encephalitis is a rare disease. Only 62 cases have been reported previously; all were in adults, only 8% of whom were immunosuppressed. The disease has a characteristic biphasic course: a nonspecific prodrome of headache, nausea or vomiting, and fever lasting for several days is followed by progressive asymmetrical cranial-nerve palsies, cerebellar signs, hemiparesis or hypesthesia, and impairment of consciousness. Neck stiffness was initially present in only 55% of the cases described thus far. Studies of cerebrospinal fluid often revealed only mild abnormalities. Cultures of cerebrospinal fluid and blood were positive in 41% and 61% of cases, respectively. Respiratory failure occurred in 41% of cases. Initial computed tomography of the brain often gave normal results; magnetic resonance imaging better demonstrated brainstem abnormalities. Overall mortality was 51%. All untreated patients died. When treatment with ampicillin or penicillin was initiated early, the rate of survival was > 70%; however, neurological sequelae developed in 61% of survivors.

Adult↗
PubMed1993

The determination of ionic bonding interactions of N-phenyl glycine and N-(2-hydroxy-3-methacryloxypropyl)-N-phenyl glycine as measured by carbon-13 NMR analysis.

The purpose of the present investigation was to determine whether high-resolution carbon-13 nuclear magnetic resonance could be utilized for detection of ionic bonding interactions of NPG and NPG-GMA with selected inorganic cations. The C1-carbonyl carbon of NPG and NPG-GMA were labeled with 13C to help magnify the spectral response signal. The labeled monomers were allowed to react with Ca(OH)2 and LiOH. The C-13 carbonyl resonance was observed by solution- and solid-state NMR. The interaction of the cations in solution and on a powered glass support resulted in a downfield chemical shift of about 2-5 ppm, indicating the presence of a chemical interaction between the monomer and the cations. The reaction of the monomers with the solid substrates of hydroxyapatite, and bovine dentin did not result in a significant downfield shift in the carbonyl resonance. The results provide evidence that high-resolution nuclear magnetic resonance can be used for evaluation of chemical bonding interactions of dental adhesives with inorganic ions.

Carbon Isotopes↗
PubMed1992

Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors.

During a 4-year study of 4,256 knee arthroscopies, eighteen patients became infected (infection rate 0.42%). Occurrence of infection was strongly associated with use of long-acting intraarticular intraoperative corticosteroids. Infection was more common among patients with longer surgery operating times, increased numbers of procedures during surgery, prior procedures, and performance of chondroplasty or soft tissue debridement. Subsequent to the study, the infection rate fell to 0.1%. Twenty-four infections were studied (our eighteen plus six other concurrent community cases); twelve were due to Staphylococcus aureus, eleven to coagulase-negative staphylococci, and one to Enterobacter cloacae. Seventy percent of the patients had onset of symptoms within 3 days of surgery. Most patients with coagulase-negative staphylococcal infections had fevers less than 38.3 degrees C (101 degrees F), negative Gram stains on synovial fluid, normal peripheral leukocyte counts, and somewhat indolent, mild clinical syndromes, while most patients with S. aureus infections had higher fevers, positive synovial Gram stains, peripheral leukocytosis, and more acute and severe clinical syndromes. Knee pain, swelling, and warmth always occurred, but erythema was noted in only 30% of patients. Treatment with 2 weeks of intravenous antibiotics was successful in all but one patient. Long-term results were excellent in sixteen of twenty-two patients.

Adolescent↗
PubMed1992

Continuous intrathecal baclofen treatment of severe spasms in two children with spinal-cord injury.

This study reports the use of intrathecal baclofen in two ventilator-dependent children with severe spasms secondary to spinal-cord injury. Baclofen was delivered via a subcutaneously implanted, programmable pump. The children were followed for 12 and 24 months. Baclofen dramatically reduced spasms, resulting in more stable ventilation, improved ease of care, reduced distress and better integration into the community. Although effective, intrathecal baclofen represents a significant intervention; careful consideration must be given to potential complications and the need for long-term management. Full effectiveness was dependent on free CSF flow.

Adolescent↗
PubMed1992

Self-perceived social function among disabled children in regular classrooms.

Disabled children represent an important "at-risk" group for emotional and behavioral problems. This study determined how they assess their own social function in regular classrooms and compared them with their able-bodied peers. School principals identified 60 visibly disabled children who were integrated into regular classes for at least 50% of the time. A comparison group of 56 randomly selected, same-gender classmates was identified. Children completed the Perceived Competence Scale and a classroom sociometric scale. Parents and teachers were asked to rate each child's social function. Disabled children rated themselves lower on physical competence (mean = 2.53 vs 2.92, p = .002) but not on social or cognitive competence. However, disabled children had fewer friends and scored lower on the classroom sociometric measure than did their able-bodied classmates (mean = 2.06 vs 2.39, p = .01). There was no difference between disabled and control children when social function was assessed by parents or teachers. For all children two variables were significantly associated with the child's self-perceived social competence: the child's self-perceived physical competence (R2 = .27) and the peer sociometric rating (R2 = .13). Teacher perception (R2 = .35) and self-perception (R2 = .10) of social function were most strongly associated with the perception of peers. In both cases whether the child was disabled contributed little to the observed association. These findings support the importance of peers in the successful social function of children and suggest that teachers can have an impact on how children are perceived by other children.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1991

Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome.

Increased intracranial pressure has been a noteworthy problem in some of our patients with cryptococcal meningitis and acquired immunodeficiency syndrome (AIDS), and this appears to be a feature observed in patients with cryptococcal meningitis reported in the literature. Whereas most attention of clinicians is presently focused on optimizing the antifungal regimen, so as to improve on high failure rates in cryptococcal meningitis in AIDS, little attention has been paid to the problem of intracranial hypertension. We argue that visual loss and some of the cases of death early after the onset of chemotherapy may be related to high cerebrospinal fluid (CSF) pressure, regardless of antifungal therapy. The possible pathophysiologic mechanisms are discussed, and we postulate that the mechanism is reduced CSF outflow possibly due to increased outflow resistance, not necessarily accompanied by prominent cerebral edema. Optimal therapy of this complication is not yet established, but some measures that may be helpful are ventricular shunting, frequent high-volume lumbar punctures, and possibly glucocorticoids.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Complications after intravesical instillation of bacillus Calmette-Guerin: rhabdomyolysis and metastatic infection.

Two cases of adverse reaction to bacillus Calmette-Guerin (BCG) bladder instillations are reported. In both cases transient fevers and systemic symptoms developed following the instillations. After an additional instillation 1 patient had high fevers, severe myalgias and profound weakness followed by rhabdomyolysis and anuric renal failure, which required 3 weeks of hemodialysis before recovery. Extensive evaluation revealed no cause other than the BCG instillations. In the other patient a firm subcutaneous nodule gradually developed on the chest wall, which contained nonviable acid fast bacilli.

Abscess↗
PubMed1991

Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities.

The primary purposes of this article are to review the literature on seating assessment and to describe the development of a clinical evaluation scale, the Seated Postural Control Measure (SPCM), for use with children requiring adaptive seating systems. The SPCM is an observational scale of 22 seated postural alignment items and 12 functional movement items, each scored on a four-point, criterion-referenced scale. A secondary purpose of this article is to report the reliability of the seven-point Level of Sitting Scale (LSS). Interrater and test-retest reliability of the SPCM items and the one-item LSS were evaluated on a sample of 40 children with developmental disabilities who sat with and without their seating systems. Kappa values of .75 or higher were considered excellent, .40 to .74 as fair to good, and less than .40 as poor. The interrater reliability tests for the two seated conditions and the two test sessions conducted 3 weeks apart yielded overall item Kappa coefficient means of .45 for the alignment section and .85 for the function section. Test-retest results for the SPCM items were less satisfactory, with item Kappa coefficient means for the two seating conditions and raters of .35 and .29 for alignment and function, respectively. Reliability results did not appear to be consistently better among seating conditions, raters, or test sessions. Kappa coefficients for the LSS were fair to good for both interrater and test-retest reliability. Plans for future development of the SPCM and LSS are discussed.

Adolescent↗
PubMed1991

New Zealand Maori women's health: status and self-help action in the 1980s.

The indigenous Maori population of New Zealand has experienced improvements in health in recent decades but vis-à-vis the non-Maori segment of the population, Maori, and Maori women in particular, continue to be disadvantaged. The situation became the focus of attention during the 1980s. Among efforts to improve it, a broad-based self-help campaign initiated by Maori leaders, organizations and health professionals emerged as important. This paper documents the current status of Maori women's health and examines health-related self-help activities on the part of the Maori Women's Welfare League, the leading Maori women's organization. The League has taken a leading role in the self-help campaign, declared a Decade of Health for 1985-1995, and adopted a program of action that could help to significantly improve the status of Maori health.

Age Factors↗
PubMed1989

Infection following breast reconstruction.

Of 33 patients who underwent 49 breast implantations for reconstructive surgery, 8 (24%) patients developed implant infections. All 8 of these patients were among a subgroup of 15 having immediate breast reconstructions with tissue expander implants after simple or modified radical mastectomy (a 53% infection rate). The infection rate increased substantially when bilateral procedures involving implants were performed as opposed to unilateral implants. Nine implants were removed (an overall implant loss rate of 18%). Patients who underwent other breast reconstruction techniques (i.e., including immediate reconstruction with permanent implants or delayed reconstruction with or without tissue expanders) did not develop infection unless they had had simultaneous immediate reconstruction with a tissue expander in the contralateral breast. The most frequently isolated organism was the coagulase-negative staphylococcus. The study concludes that neither the tissue expander nor immediate reconstruction is a risk factor, but the combination may lead to an unacceptable infection rate, especially in the face of bilateral breast procedures.

Bacterial Infections↗
PubMed1989

An epidemiological study of children's attitudes toward disability.

In this epidemiological study the authors recorded the attitudes of children in Hamilton, Ontario, to physically disabled and mentally handicapped children. Univariate analyses confirmed the importance of female gender, friendship and contact with handicapped persons as determinants of more accepting attitudes. Type of disability and the presence or absence of disabled children in respondents' schools were not found to influence attitudes in a systematic manner. Correlations between attitudes and children's self-esteem or sociometric ratings were not significant, nor were parent-child attitude correlations. Maternal language of origin was found to influence children's attitudes, in favour of children of English-speaking mothers. These results are discussed with reference to their practical applications by community and educational systems seeking to foster integration of disabled children.

Attitude↗
PubMed1987

A randomized controlled trial of a 'buddy' programme to improve children's attitudes toward the disabled.

Children's attitudes to their disabled peers exert a powerful influence on the process of integration of the disabled. This study reports a randomized controlled trial of a 'buddy' interaction programme in which gender-matched able-bodied and disabled schoolmates were paired over a three-month period. 43 per cent of the buddy children had a significant improvement in attitudes, compared with 18 per cent of the controls. Buddies also got to know significantly more disabled schoolmates than did the control children. There was a secondary effect on parents, with both fathers and mothers of buddy children having significant improvements in attitude. The implications of these results for the social success of disabled children are discussed.

Adolescent↗
PubMed1987

Parental attitudes toward children with handicaps: new perspectives with a new measure.

Research on attitudes toward the disabled generally has focused on adult perceptions of disabled adults, or children's attitudes toward peers. In view of changing social practices, such as mainstreaming in education and community integration of children with special needs, measures of adults' attitudes toward disabled children are needed. This paper reports on the development and validation of a 30-item self-report questionnaire assessing parental attitudes toward children with handicaps, and presents information concerning several determinants of parental attitudes. The measure is easy to use, reliable, and shows good evidence of construct validity. It detects differences among parents by gender, by parental education and occupational status, by cultural background of parents, by parental familiarity with a handicapped person, and by stimulus (physically disabled vs. mentally retarded child referent). Results are discussed in relation to determinants of parental attitudes toward handicaps. Potential applications of this measure for evaluation of teacher attitudes are suggested.

Attitude↗
PubMed1986

Improving attitudes toward the disabled: a randomized controlled trial of direct contact versus Kids-on-the-Block.

Social interaction between able-bodied and disabled children (as in a "buddy" program) is known to improve children's attitudes toward handicapped peers. This randomized-factorial-design study evaluated the relative impact of two interventions--a buddy program and the Kids-on-the-Block (KOB) puppet program--singly and in combination. Outcomes included measures of attitudes, familiarity with disabled schoolmates, self-esteem, and parental attitude. The buddy program appeared to be a successful intervention. The KOB program alone had no measurable impact on any outcomes, compared with control children. Surprisingly, the combination of KOB and buddy programs produced a significantly smaller impact than the buddy program alone. The combination was also marginally significantly poorer than the change experienced by the control group. These results are discussed in relation to the probable dissonance between real disabled children and the puppets. Suggestions are advanced for possible strategies to enhance interventions to teach social interactional skills to able-bodied children.

Adolescent↗