Pseudomembranous colitis complicating chemotherapy.
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Adult↗
Biomedical subjects
A Chan
Publications and source records attributed to A Chan.
The association of low socio-economic status in metropolitan Adelaide with maternal demographic and obstetric characteristics and pregnancy outcome.
The South Australian perinatal statistics collection for 1988 was used to consider the association of low socio-economic status in metropolitan Adelaide (South Australia) with maternal demographic and obstetric characteristics and pregnancy outcome in 12047 singleton births. Socio-economic status--low, middle or high--was inferred from the socio-economic rating of the postcode of residence. Chi-squared analyses were carried out to test for significant trends in proportions of pregnancy and pregnancy outcome variables across the socio-economic groupings. There was trend for the proportions of adverse obstetric and perinatal outcomes to decrease with increasing level of socio-economic status. Logistic regression analysis, adjusted for maternal age, marital status, race, parity and gestational age, confirmed the findings of the trend analyses, namely that mothers from the poor socio-economic areas were at a greater risk for poor pregnancy outcome. These poor outcomes included Apgar scores of less that 7 at both 1 and 5 minutes after birth, delay in onset of regular breathing of 5 minutes or longer; the need for intubation; the use of narcotic antagonists; low birthweight of under 2500 g; the need for special nursey care; and neonatal death.
Adult↗
Microalbuminuria and other cardiovascular risk factors in nondiabetic subjects.
The association between urinary albumin:creatinine ratio and other cardiovascular risk factors such as age, blood pressure, obesity, glycemic indices, insulin and lipid profile was examined in a population in a Chinese community consisting of 795 men (mean age 35.8 +/- 8.8 yr) and 538 women (mean age 37.9 +/- 8.9 yr) with a normal glucose tolerance defined by WHO criteria. Men with a urinary albumin:creatinine ratio above the 90th percentile had higher systolic and diastolic blood pressures, fasting plasma glucose, 2-h glucose after a 75 g oral glucose load, and fasting serum insulin. Women with high urinary albumin:creatinine values had higher systolic and diastolic blood pressures, body mass index, waist-hip ratio, fasting insulin and triglycerides. Multivariate analysis showed that only systolic blood pressure and fasting glucose in men, and diastolic blood pressure and fasting insulin in women, independently contributed to urinary albumin:creatinine. When the effect of blood pressure was eliminated by excluding subjects with systolic blood pressure > 140 and diastolic > 90 mm Hg, only fasting insulin was associated with urinary albumin:creatinine in women. No associations were found for men. We conclude that microalbuminuria may be a marker for cardiovascular disease only because of its association with blood pressure in men, while in women, there is an additional independent association with fasting serum insulin.
Adult↗
Ventricular tachycardia after surgical repair of tetralogy of Fallot: results of intraoperative mapping studies.
OBJECTIVES: Four patients with previous repair of tetralogy of Fallot and ventricular tachycardia underwent map-guided surgery to ablate the arrhythmias. BACKGROUND: Although patients with repaired tetralogy of Fallot are at increased risk of sudden death due to ventricular tachycardia, little is known of the origin and mechanism of this arrhythmia. METHODS: A customized right ventricular balloon with 112 electrodes was used to record endocardial activation and, where possible, simultaneous epicardial recordings were obtained with a sock electrode array. Three patients had an aneurysm of the right ventricular outflow tract and one had a septal aneurysm. All had moderate to severe pulmonary valve insufficiency. Preoperative electrophysiologic study demonstrated inducible rapid (cycle length 180 to 300 ms) hemodynamically unstable monoform ventricular tachycardias. RESULTS: Intraoperatively, five different tachycardias (two in one patient) were induced and mapped. The sites of earliest activation were located in the subendocardium of the right ventricular outflow tract in all, but they varied widely among the septum, free wall and parietal band and could not be identified by visible scar. All were due to a macroreentrant circuit initiated by a critical delay in activation beyond a functional arc of block. Two patients treated by cryoablation while the heart was beating and perfused at normal temperature had inducible ventricular tachycardia postoperatively. In the two subsequent patients, the application of cryoablation under anoxic cardiac arrest resulted in noninducibility of arrhythmia. CONCLUSIONS: Ventricular tachycardia in tetralogy of Fallot in these four patients was caused by macroreentry in the right ventricular outflow tract. Surgical success depends on detailed mapping and cryoablation under anoxic cardiac arrest. In patients at risk of sudden death, map-directed surgery may offer distinct advantages over either implantable devices or drug therapy.
Child↗
Intestinal obstruction in patients with widespread intraabdominal malignancy.
The clinical course of 28 patients with surgically documented widespread intraabdominal malignancy who developed intestinal obstruction was reviewed. Of 26 patients, 13 responded to initial conservative management. In the ten patients treated surgically, there was significant morbidity in 80% and a postoperative mortality of 40%. Reobstruction occurred in 11 patients, responded poorly to therapy, and was associated with a short life expectancy. These results support the use of conservative therapy in the management of intestinal obstruction due to widespread intraabdominal malignancy, with emphasis on the palliation of symptoms and maintenance of quality of life.
Abdominal Neoplasms↗
Onychomycosis of the toenails caused by Chaetomium globosum.
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Aged↗
Calcification of arterial arcade of colon in a patient with ischaemic colitis.
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Aged↗
Complications and failure of anticoagulation therapy in the treatment of venous thromboembolism in patients with disseminated malignancy.
Thirty-one patients with malignancy, anticoagulated for the treatment of venous thromboembolism (VTE) are reported. Complications of treatment included major bleeding (35%), redevelopment of VTE whilst on therapeutic levels of anticoagulants (13%) and recurrent VTE following cessation of anticoagulant (42%). Forty-two per cent of patients died within three months of initiating anticoagulant therapy. The cause of death was progressive malignancy, except in one patient who died of anticoagulant-related bleeding. The high incidence of bleeding is frequently associated with over-anticoagulation and indicates the need for improved monitoring. The frequent recurrence of VTE is associated with chronic disseminated intravascular coagulation, for which warfarin is ineffective and heparin is indicated.
Adult↗
The association of maternal and socioeconomic characteristics in metropolitan Adelaide with medical, obstetric and labour complications and pregnancy outcomes.
Multiple regression analysis was used to measure associations of maternal age, race, gravidity, marital status and socioeconomic status with medical problems and pregnancy outcomes. The study population comprised all singleton births to residents of metropolitan Adelaide (in South Australia) during 1988 that were included in the State's perinatal statistics collection. The results indicate that in metropolitan Adelaide, low socioeconomic status is related to a higher risk profile of mothers and babies. It also highlights that there is a strong association of divorce and separation with medical problems and an adverse pregnancy outcome. Poorer outcomes are also seen in never married women, teenage women, older women, non-Caucasian women and primigravid women. These poorer outcomes in older women and primigravidas include higher risks of low birth-weight and prematurity of their babies. The study also demonstrates that groups that are less likely to have choice of obstetric care, eg. teenage women, non-Caucasian women, and women of low socioeconomic status, have a lower odds of obstetric intervention as characterized by nonspontaneous labour and elective Caesarean section.
Adult↗
Tumorigenicity of the met proto-oncogene and the gene for hepatocyte growth factor.
The met proto-oncogene is the tyrosine kinase growth factor receptor for hepatocyte growth factor/scatter factor (HGF/SF). It was previously shown that, like the oncogenic tpr-met, the mouse met proto-oncogene transforms NIH 3T3 cells. We have established NIH 3T3 cells stably expressing both human (Methu) and mouse (Metmu) met proto-oncogene products. The protein products are properly processed and appear on the cell surface. NIH 3T3 cells express endogenous mouse HGF/SF mRNA, suggesting an autocrine activation mechanism for transformation by Metmu. However, the tumor-forming activity of Methu in NIH 3T3 cells is very low compared with that of Metmu, but efficient tumorigenesis occurs when Methu and HGF/SFhu are coexpressed. These results are consistent with an autocrine transformation mechanism and suggest further that the endogenous murine factor inefficiently activates the tumorigenic potential of Methu. The tumorigenicity observed with reciprocal chimeric human and mouse receptors that exchange external ligand-binding domains supports this conclusion. We also show that HGF/SFhu expressed in NIH 3T3 cells produces tumors in nude mice.
3T3 Cells↗
Neonatal Campylobacter fetus meningitis: a report of an unusual case.
Campylobacter fetus is a rare cause of meningitis in the pediatric age group and, in particular, among neonates. The clinical presentation of campylobacter meningitis in high-risk neonates is not well-described. A review of campylobacter meningitis by Lee et al in 1985 reported nine cases occurring in neonates, of which only one case was caused by C. fetus. In the ensuing six years only three more confirmed cases of neonatal meningitis caused by C. fetus have been reported. We here report another confirmed case of C. fetus meningitis in a neonate.
Campylobacter Infections↗
Met and hepatocyte growth factor/scatter factor signal transduction in normal melanocytes and melanoma cells.
The proto-oncogene c-MET encodes a transmembrane tyrosine kinase receptor for hepatocyte growth factor/scatter factor (HGF/SF). HGF/SF stimulates the proliferation and motility of various cell types. Because HGF/SF is also a melanocyte mitogen, we investigated the biological role of HGF/SF, including c-Met expression, activation and signal transduction, in normal and malignant human melanocytes. We show that HGF/SF is mitogenic in the presence of synergistic factors, such as basic fibroblast growth factor (bFGF) and mast cell growth factor (MGF) and that, by itself, it stimulates the motility of normal human melanocytes. The ligand also maintained high levels of tyrosinase activity and melanin content in theses cells. Signal transduction by HGF/SF included phosphorylation of tyrosyl residues on c-Met, a cascade of tyrosine phosphorylations on several other proteins and activation of microtubule-associated protein kinase/extracellular signal-regulated kinase. Met expression and activity are normal in human melanomas, and constitutive activity of HGF/SF in retrovirally infected autonomously proliferative mouse melanocytes is insufficient to confer the malignant phenotype. Our findings suggest that activation of Met in response to HGF/SF may contribute to malignant progression synergistically with the aberrant expression of bFGF in malignant melanocytes and that, in addition, the peptide may promote dispersion of factor-dependent melanocytes from early stages of primary melanomas to ectopic sites.
Animals↗
Influence of obesity on plasma fructosamine concentration.
The influence of obesity on plasma fructosamine concentration was studied in 68 diabetic and 1335 nondiabetic subjects from a Chinese community. Obese nondiabetic men (body mass index > 25 kg/m2) had lower fructosamine concentrations than nonobese nondiabetic men (body mass index < or = 25 kg/m2); the pattern was similar for diabetic women. Stepwise multiple-regression analysis showed that, apart from known factors (total protein, albumin, and indices of glycemic control), fructosamine was also associated with body mass index and plasma fasting triglycerides. However, the contribution of these were small except in diabetic women. We conclude that the effect of obesity on fructosamine is small.
Adult↗
Blood pressure and urinary cations in a Chinese population.
The prevalence of hypertension and the relationship between blood pressure, age, body mass index (BMI) and urinary cations from casual urine specimens were examined in 1,513 Chinese employees of a public utility company and non-medical personnel of a district hospital. The prevalence of hypertension, defined as systolic blood pressure greater than or equal to 140 or a diastolic blood pressure greater than or equal to 90 mmHg, or a past history of hypertension, was 17% in men and 5% in women. After excluding subjects who were on antihypertensive medication, age, body mass index, and urinary sodium/potassium ratio were independently and positively associated with blood pressure, while urinary potassium/creatinine ratio was inversely related to blood pressure. No association with urinary sodium or sodium/creatinine ratio was found. Higher mean blood pressure in men was accompanied by lower urinary potassium/creatinine and potassium concentration and higher sodium/potassium ratio, even though men had the same mean BMI when compared with women. A difference in potassium intake between the sexes may partly account for this finding. We conclude that in this Chinese population, whose dietary intake is more influenced by the West compared with Chinese in the Peoples' Republic of China, age and BMI are important determinants of blood pressure, together with potassium intake as reflected by urinary potassium excretion. No association of blood pressure with sodium excretion was demonstrated.
Adolescent↗
Association between insulin and blood pressure in a community population with normal glucose tolerance.
The purpose of this study was to examine the relationship between insulin and BP in patients with normal glucose tolerance. The associations between systolic and diastolic BP, age, body mass index, waist/hip ratio, fasting glucose, insulin, fructosamine, glycosylated haemoglobin, lipid profile, and glucose and insulin two hours after 75 g oral glucose were examined in 1,520 employees of a public utility company and non-medical staff of a district hospital. Patients with impaired glucose tolerance or diabetes mellitus (using WHO criteria) were excluded. In men (mean age 35.6 +/- 8.7 years, n = 769), both systolic and diastolic BP were positively associated with age, body mass index, waist/hip ratio, fasting and 2h glucose and insulin, triglycerides and apolipoprotein B, and were negatively associated with glucose/insulin ration, and high density lipoprotein and cholesterol and its subfractions. However, in multivariate analysis only body mass index, age, fasting glucose and insulin were independent predictors of systolic BP, while only body mass index and age predicted diastolic BP. In women, age, glycosylated haemoglobin, 2h glucose/insulin ratio, 2h glucose, fructosamine and triglycerides were predictors of systolic BP. Fasting or 2h insulin, and glucose/insulin ratios did not predict diastolic BP. The results are compatible with the hypothesis that systolic hypertension may reflect a hyper-insulinaemic state even in those with normal glucose tolerance, independent of age and obesity. The association between plasma lipids and blood pressure is probably mediated by insulin and obesity.
Adult↗
Free triiodothyronine in sera of acutely ill general medical patients: a prognostic indicator?
We measured free triiodothyronine (FT3), thyrotropin (TSH), and C-reactive protein (CRP) in sera of 39 acutely ill medical patients who died within three months of admission and 39 age- and sex-matched control patients selected at random from a total of 294 acute medical admissions. Serum FT3 in nonsurvivors (1.91 +/- 1.51 pmol/L) was significantly lower than that in survivors (3.01 +/- 1.3 pmol/L, P less than 0.01) and the CRP in nonsurvivors (54.6 +/- 59.2 mg/L) was significantly higher than in survivors (43.6 +/- 59.5 mg/L, P less than 0.05). There was no difference in plasma TSH between the two groups. The estimated odds ratio relating death to a plasma FT3 value less than 1.0 pmol/L on admission was 17 (highly significant: P less than 0.001). We conclude that plasma FT3 may be a useful prognostic indicator in acutely ill patients.
Acute Disease↗
Palliative care in a general teaching hospital. 2. Establishment of a service.
OBJECTIVE: To assess the first year of operation of a palliative care service in a general teaching hospital. DESIGN, SETTING, PATIENTS: A retrospective analysis of 241 terminally ill patients referred to the Austin Hospital Palliative Care Service during its first year of operation. MAIN OUTCOME MEASURES: The occurrence and relief of pain, the occurrence and management of social and psychological problems, involvement of allied health services and the place of death. MAIN RESULTS: Unrelieved pain was the most frequent medical problem but, with appropriate medical management as well as input from other members of the multidisciplinary team, all patients achieved satisfactory pain control. The occurrence and severity of social and psychological problems was greater than expected. Most of the patients were discharged home and referred to domiciliary palliative care services; one-quarter of patients were able to die at home, one-third died in an inpatient hospice, and the remainder died in hospital. CONCLUSIONS: The Service was able to achieve most of its stated aims and has generated a much improved appreciation of the palliative care needs of patients with terminal illness and their families within the Hospital. A multidisciplinary approach to the management of terminally ill patients is crucial, and this Service has been successful despite limited staffing because of the willing involvement of other Units and Services in the Hospital. The difficulties inherent in the evaluation of a palliative care program (quality of life, cost-effectiveness) are discussed.
Hospital Departments↗
Palliative care in a general teaching hospital. 1. Assessment of needs.
OBJECTIVE: To assess the palliative care needs and the results of treatment of patients with terminal cancer admitted to a general teaching hospital. DESIGN, SETTING, PATIENTS: A retrospective analysis of 110 consecutive patients with terminal cancer admitted to the Austin Hospital. MAIN OUTCOME MEASURES: The occurrence and relief of pain, the use of allied health services and the place of death. MAIN RESULTS: Pain was the most common symptom and was satisfactorily improved in only two-thirds of the patients. Allied health services were used sporadically and appeared to be underused. Psychological problems were documented in very few patients. Only seven patients died at home, the remainder dying in hospital (82) or in a hospice (21). CONCLUSIONS: One-third of patients with terminal cancer in a general teaching hospital received inadequate pain relief; the reasons for this included lack of medical expertise in the use of analgesics for chronic cancer pain and the frequent use of analgesia given only "as required". The underuse of allied health services, the infrequent documentation of psychological issues and the observation that only a small proportion of patients were able to die outside hospital all underline the need for a coordinated multidisciplinary approach to the management of patients with terminal cancer.
Adult↗