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Biomedical subjects

A Hopkins

Publications and source records attributed to A Hopkins.

At least 73 records · Page 4Linked to original sources
PubMed1990

Who asks permission for an autopsy?

A survey was undertaken of all hospitals with more than 400 beds in North East Thames Region to ascertain the way in which permission for an autopsy was obtained, in an attempt to explore reasons for declining autopsy rates. We found that there was a considerable variation in autopsy rates, and in the systems within hospitals whereby permission for autopsy is sought. The responsibility for requesting an autopsy is often delegated to younger doctors who have not received any training in how it should be done. A sensitive lay person can achieve high rates of permission for autopsy. Most consultants interviewed stated that they requested less autopsies now than 5 or 10 years ago. They seldom attended autopsies, and one-third of pathologists have given up contacting the clinician before an autopsy.

Autopsy↗
PubMed1989

Effect of physical activity on lumbar spine and femoral neck bone densities.

The lumbar spine and femoral neck densities of 123 and 141 normal adult women (50 +/- 10 years), respectively, measured by dual photon absorptiometry, were correlated with the number of hours of walking per day associated with their regular daily activities. This measure of exercise, obtained by detailed questionnaire and interview, was analyzed because it is regular, seasonally stable, and quantifiable. Both lumbar spine and femoral neck densities were significantly correlated with walking, with 0.8% and 1.9% increases in average bone density per hour of daily walking, respectively. This increase in density is substantial, considering that the age-related rate of bone loss in the same population is 0.7% and 0.5% per year of lumbar spine and femoral neck, respectively. This means that, on the average, a woman walking one additional hour per day has a femoral neck bone density comparable to that of a women 4 years younger who does not pursue this additional activity. This physical activity-associated enhancement of bone density may be critical at old age when osteoporosis is clinically manifested.

Adult↗
PubMed1989

Normal and abnormal features of the lumbar spine observed in dual photon absorptiometry scans.

Dual photon absorptiometry (DPA) is an extensively used technique for measuring the density of the lumbar spine. The presence of vertebral and extra-vertebral pathologies can lead to increased scatter of data and artifactual bias when constructing diagnostic reference value curves. The bone density of patients with such abnormalities cannot be compared with those of normals because it will appear artificially high. Furthermore, little effort has been made to identify and evaluate spinal abnormalities using the pictograms produced in this method. We have analyzed 60 DPA scans for morphologic changes, using x-rays for comparison, and have found practically complete concurrence between these two radiologic methods on features, though only the former is capable of accurately quantifying bone density. Examples of DPA presentation of anatomical morphology are shown to aid the user in interpreting DPA findings.

Adult↗
PubMed1989

Lessons for neurologists from the United Kingdom Third National Morbidity Survey.

The Third National Morbidity Survey lists data about the primary care consultations for more than 300,000 person-years at risk. Data of interest to neurologists have been extracted from the complex tables of the Survey, many of which are on micro-fiche. Assuming that any one subject has only one neurological symptom, 9.5% of the population will consult their general practitioner about a neurological symptom each year. The five most common groups of disorders for which advice is sought are headache/migraine, dizziness, syndromes related to the cervical or lumbar spine, faints or fits, and symptoms due to cerebrovascular disease. About 7% of all patients seen with neurological symptoms are referred to hospital clinics for further advice.

Adolescent↗
PubMed1989

A record of patient encounters in neurological practice in the United Kingdom.

Thirteen consultant neurologists working in ten different towns or cities in the United Kingdom were asked to log all their encounters with patients in 1 week. The median number of encounters was 79 (range 33-144). Forty-one per cent were new patients; 85% of all new patient encounters were with National Health Service patients. In more than four-fifths of all encounters, the neurologist felt that the consultation was a justified use of his experience. Consultations for headache/migraine and epilepsy together accounted for over a quarter of all encounters.

Cross-Sectional Studies↗
PubMed1989

The development of a novel immunoassay amplification system and its use in viral detection.

A novel amplification system has been developed for the detection of free or antibody-conjugated alkaline phosphatase. The amplification system provides a 100 fold enhancement in the detection of the enzyme, compared to direct detection with chromogenic substrates. The key to the amplification system is the dephosphorylation of a potent phosphorylated inhibitor, and the visualization of this inhibitor using a second, indicator, reaction. This system is shown to provide increased sensitivity for immunoassays detecting either herpes simplex virus or respiratory syncytial virus in clinical samples. In addition, this general concept for amplification may be applicable to a variety of other hydrolytic enzymes, and is demonstrated for the enhanced detection of beta-galactosidase.

Alkaline Phosphatase↗
PubMed1989

Pseudoseizures.

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1988

Monitoring of hemostasis parameters during coronary thrombolysis with recombinant tissue-type plasminogen activator.

The monitoring of changes in the blood coagulation and fibrinolytic systems during thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) may be complicated by artifacts due to in vitro activation after blood collection and to interference of other agents (e.g., heparin) in the assays. In 106 patients with early acute myocardial infarction, infused with 150 mg of rt-PA (G11044) intravenously over 5 to 8 hours, blood samples were collected into liquid citrate supplemented with the plasmin inhibitor aprotinin (200 KIU/ml plasma) or on a lyophilized mixture of acidified citrate and the synthetic t-PA inhibitor D-Phe-Pro-Arg-CH2Cl (PPACK). A good correlation between precipitable (sulphite) and functional (clotting rate) fibrinogen levels was observed in plasma collected on citrate before therapy (r = 0.76) and in samples collected after 3 hours on either aprotinin (r = 0.87) or PPACK (r = 0.82). Precipitable fibrinogen levels were approximately 10% higher than functional level, in baseline samples collected on citrate alone and approximately 20% higher in 3 hour samples collected on either PPACK or aprotinin. Fibrinogen levels measured with both assays correlated well, but were somewhat higher in samples collected on PPACK than on aprotinin. rt-PA antigen levels assayed in plasma collected in either inhibitor correlated well (r = 0.90) but were 10-20% higher in PPACK containing samples. Addition of heparin up to 9 units/ml to plasma had no effect on the functional fibrinogen assay.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Chloromethyl Ketones↗
PubMed1988

The first seizure in adult life. Value of clinical features, electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence.

408 adults (age 16 and over) were followed up after their initial seizure. The actuarial risk of recurrence was highest in the early weeks. For those seen within the first week, the risk of recurrence was 52% by the end of 3 years. In univariate analysis, the only clinical variable that was associated with recurrence was the time of day at which the initial seizure occurred. There was a tendency, that did not reach statistical significance, for younger age (less than 50 years) and a family history of seizures of any type, including febrile convulsions, to be associated with recurrence. Such risk factors appear to be additive, so that the risk of recurrence at 1 year for a subject with all three factors is about three times that of a subject with none of them. Sex, type of seizure, and features of the electroencephalogram were not of predictive value. Computerised tomographic scanning revealed tumours in 3% of subjects, and these individuals were particularly likely to have recurrent seizures.

Adolescent↗
PubMed1988

Norms of care in British and American neurologic practice.

At a Consensus Development Conference on the Scope of Neurological Practice in the United Kingdom, 26 British specialists in the field of neurology constructed norms of care for patients with 11 neurologic disorders. For each disorder, these specialists specified the percentage of all patients who should see a physician, as well as the percentage who should see a consultant neurologist, the appropriate duration of the initial patient encounter, and the appropriate frequency of follow-up visits per annum. When compared with American estimates used in health manpower planning, British neurologists generally make a far greater allowance for patient self-care, as well as care by nonphysician health care providers, allow less time for patient encounters, and see a need for follow-up care less frequently. These marked differences in the perceptions of specialists of a normative character may determine, in part, the different "practice styles" of physicians in different regions that cannot be explained in economic terms. Results suggest that the practice style concept should be broadened to include the use of health personnel of many types, the scope of specialty medicine, and the role definition of primary care.

Central Nervous System Diseases↗
PubMed1988

Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck bone densities.

The relationships between parity, breast-feeding, and the use of birth control pills and the bone densities of the lumbar spine and the femoral neck, measured by dual-photon densitometry, were studied in normal women. Femoral neck density was found to decrease by 1.1% per live-birth, whereas lumbar spine density showed no significant association with parity. Breast-feeding was found to increase lumbar spine density by 1.5% per breast-fed child, whereas femoral neck density was not significantly correlated. No significant relationships between the use of birth control pills and the bone densities were found.

Adult↗
PubMed1988

The therapeutic efficacy of misoprostol in peptic ulcer disease.

Misoprostol, a synthetic methyl ester analogue of prostaglandin E1 (PGE1) is both a powerful inhibitor of gastric secretion and is able to protect the gastroduodenal mucosa from damage produced by alcohol, aspirin, naproxen and tolmetin. The results of 12 double-blind, randomized, placebo- and cimetidine-controlled trials involving 4000 patients have been reviewed here and show that misoprostol, given in a dosage of 800 micrograms daily in two or four divided doses, is able to produce rates of complete ulcer healing and pain relief in both gastric and duodenal ulcer which are significantly superior to placebo therapy and comparable to those achieved with high or conventional doses of cimetidine. One further large trial has shown that misoprostol is able to heal a significant proportion of duodenal ulcers refractory to treatment with H2 receptor antagonists. In the compromised patient, two trials have suggested that misoprostol is able to abolish the adverse effects of smoking on duodenal ulcer, although this effect was not apparent in the gastric ulcer trials or in other duodenal ulcer trials. Similarly, while in volunteers pretreatment with misoprostol is able to protect the gastric mucosa from alcohol damage, there is little clinical evidence to support improved ulcer healing in the patient who abuses alcohol. Further studies in these areas should be conducted. Misoprostol could well have an important role to play in the protection of the gastroduodenal mucosa from damage produced by non-steroidal anti-inflammatory drugs (NSAIDs) in arthritic patients compelled to take these drugs for long periods. A series of double-blind placebo-controlled trials in healthy volunteers have shown that pretreatment with, or simultaneous administration of, 800 micrograms daily of misoprostol, reduces significantly mucosal damage produced by aspirin, tolmetin and naproxen. Two controlled clinical trials in a large number of arthritic patients have shown firstly, that misoprostol 800 micrograms daily is able to reduce significantly aspirin-induced mucosal bleeding as compared with placebo and secondly, in an endoscopically, placebo-controlled trial that it reduced significantly the frequency and severity of aspirin-induced mucosal lesions, accelerated the healing of erosions and ulcers and in other patients was able to protect the undamaged mucosa from injury. Misoprostol is well tolerated--a dose related, usually self limiting, diarrhoea occurred in a small proportion of patients but only rarely enforced withdrawal. Because of its uterotropic effects misoprostol should not be given to women of child bearing age unless they are taking adequate contraceptive measures. It has no other systemic effects and no clinically significant adverse haematology or biochemical abnormalities, or drug interactions have been reported. It does not seem to induce hypergastrinaemia. Misoprostol is, therefore, a safe and effective drug in the treatment of chronic peptic ulcer and could have a beneficial action in duodenal ulcers refractory to treatment with H2-receptor antagonists. It could benefit compromised groups of ulcer patients who are smokers or alcohol users amd certainly has been shown to protect the gastroduodenal mucosa against damage induced by NSAIDs in healthy volunteers and arthritic patients.

Alprostadil↗
PubMed1988

Effects of natural menopause, hysterectomy, and oophorectomy on lumbar spine and femoral neck bone densities.

Lumbar spine and femoral neck bone densities of women, aged 35-65, were measured by dual photon bone densitometry. After exclusion of women with spinal and other abnormalities, this study included 233 subjects: 60 menstruant, 91 who underwent natural menopause (56 more than 2 years post-menopause), 45 bilaterally oophorectomized, and 37 hysterectomized without bilateral oophorectomy. No significant differences were found between the age-normalized average bone densities of the menstruant, early postmenopausal, and late postmenopausal women; nor was there a difference between the rates of their bone loss. The bone densities of the hysterectomized women were significantly lower than those of the normals. The bone densities of the oophorectomized women were significantly lower than those of the hysterectomized patients. The rates of bone loss, however, were comparable in all groups studied. The use of estrogen without progestin was associated with significantly higher lumbar spine densities in the oophorectomized women, but showed no significant effect in any of the other groups.

Adult↗