Jugular bulb saturation: which side to measure?
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Brain↗
Biomedical subjects
A Inglis
Publications and source records attributed to A Inglis.
Hyperventilation with increased intracranial pressure.
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Brain Ischemia↗
Maternal position during induction of spinal anaesthesia for caesarean section. A comparison of right lateral and sitting positions.
Forty women presenting for elective Caesarean section under spinal anaesthesia were randomly assigned to have anaesthesia induced in either the sitting or right lateral positions; 2.5 ml 0.5% hyperbaric bupivacaine was injected over 10 s before the mother was placed in a supine position with a 20 degree lateral tilt. The onset time and height of the subsequent analgesic and anaesthetic block was measured. It took longer to site spinal needles in the lateral position (240 vs 115 s, p < 0.001). There was a faster onset of sensory block to the sixth thoracic dermatomal level (8 vs 10 min, p < 0.001), in the lateral group, although onset time to T4 was comparable. There was no difference in maximum block height or degree of motor block. Mothers in the lateral group required more ephedrine in the first 10 m after siting the spinal (13.5 vs 10.5 mg, p < 0.05).
Adult↗
Screening for colorectal cancer: reasons for refusal of faecal occult blood testing in a general practice in England.
STUDY OBJECTIVE: To ascertain reasons for non-compliance with faecal occult blood tests in colorectal cancer screening programmes. DESIGN: A standard interview by a trained nurse of a random sample of those who declined screening. SETTING: The Leicestershire town of Market Harborough, where most of the 25,000 population are served by a single general practice of 10 partners. PARTICIPANTS: Altogether 4185 residents aged 51 to 70 years were invited to receive a free faecal occult blood test (Haemoccult). Eighty one subjects from a sample of 351 who wrote declining the offer were interviewed. MAIN RESULTS: Non-compliers were divided into those who did not request a test kit and those who returned an unused kit. In the former group the commonest reasons given were intercurrent illness (39%), fear of further tests and surgery (24%), and feeling well (22%). For those who returned unused kits the commonest reasons were the unpleasantness of the stool collection procedure (65%), feeling well (30%), intercurrent illness (23%), and fear of further tests and surgery (20%). In both groups the main concern of those who did not comply were fear of further diagnostic tests and surgery rather than concern at the lack of effective treatment for cancer. CONCLUSIONS: To increase compliance, education and publicity must explain the concept of asymptomatic illness and allay people's fear of hospital investigation and treatment. The benefits of screening should be particularly emphasised to those who return kits so they may overcome their reservations.
Aged↗
The hospital admissions study in England: are there alternatives to emergency hospital admission?
STUDY OBJECTIVE: To assess the potential for substituting alternative forms of care for admission to an acute hospital in particular groups of patients. DESIGN: A screening tool, the intensity-severity-discharge review system with adult criteria (ISD-A), developed for hospital utilisation review in the USA, was used in a cohort of hospital admissions to identify a group of patients who could potentially have been treated outside the acute hospital. These patients were further assessed by a panel of general practitioners (GPs) to determine the most appropriate alternative form of care. A cost analysis was performed on the results obtained. SETTING: General medicine and geriatric specialties in one acute hospital in the south western region. PATIENTS: Patients comprised a sample of 701 admitted to general medical and geriatric specialties. MAIN RESULTS: The screening tool identified 19.7% of admissions for whom there was potential for treatment outside the acute hospital. Assessment by the GP panel reduced this potential to between 9.8% and 15.0% of emergency admissions. The alternatives most frequently identified as "most appropriate" were the community hospital/GP bed and the urgent outpatient assessment (within either 24 or 48 hours). Potential resource savings based on the average cost were relatively small. This potential seemed to be greater for the alternative of the urgent outpatient assessment. CONCLUSIONS: Potential exists for treating a proportion of patients in lower intensity alternatives to the acute hospital. If this potential were exploited few resource savings would occur.
Cohort Studies↗
Use of cardiopulmonary bypass during bronchoscopy following sand aspiration. A case report.
A 6-year-old boy with massive sand aspiration was effectively treated with femoral vein to femoral artery cardiopulmonary bypass (CPB), saline bronchial lavage, and exogenous surfactant. The patient was discharged the 9th hospital day without apparent sequelae. CPB should be considered for cases of sand or gravel aspiration when gas exchange is compromised.
Bronchoscopy↗
A survey of information supplied to day-case patients.
The communication of information to day-case patients regarding post-anaesthetic precautions was reviewed. Deficiencies in the existing provision of information were identified and a proposal to improve on this is developed.
Adult↗
Neuropeptide Y analog with selective antagonism of effects mediated by postjunctional Y1 receptors.
Neuropeptide, a 36 amino acid peptide, is one of the most ubiquitous neuropeptides in the nervous system. It is released during stimulation of sympathetic nerves and is implicated as an important neurotransmitter regulating cardiovascular activity. Administration of neuropeptide Y results in vasoconstriction and inhibition of neurotransmitter release. However, the absence of any effective inhibitors of neuropeptide Y action have precluded the examination of its possible role in hypertension. Here we describe a synthetic hexapeptide (BRC 672), corresponding to residues 22-27 of neuropeptide Y. Following the administration of BRC 672 (6.7 mumol/kg), neuropeptide Y-induced pressor responses were reduced by 32-48% in a dose-dependent fashion. The inhibition was specific for neuropeptide Y, as the pressor response to phenylephrine, an alpha-adrenoceptor agonist, was unchanged. It was selective for the postsynaptic (neuropeptide Y Y1 receptor-mediated) vasoconstrictor activity, because the presynaptic (neuropeptide Y Y2 receptor-mediated) cardiac vagal inhibition evoked by injection of neuropeptide Y to rats was not affected. The hexapeptide inhibited the neuropeptide Y-induced increase in cytosolic free Ca2+ in mammalian cells expressing the cloned human neuropeptide Y Y1 receptor. Injections of BRC 672 significantly reduced blood pressure in anaesthetised rats and in conscious spontaneously hypertensive rats. Resting arterial blood pressure decreased from 136 +/- 4 mm Hg to 122 +/- 3 mm Hg and remained depressed 2 h after the administration of the hexapeptide in anaesthetised rats. In spontaneously hypertensive rats blood pressure was decreased for up to 4 h.
Animals↗
Plumboporphyria (ALAD deficiency) in a lead worker: a scenario for potential diagnostic confusion.
A lead worker developed bilateral wrist drop. At first this seemed to be a lead neuropathy but all his screening tests for blood and urine toxicity had been within the accepted safety limit during employment. Detailed investigation showed that he had plumboporphyria (ALAD deficiency) which had been symptom free until he was exposed to lead. Details of his porphyrin metabolism are presented.
Adult↗
Familial transmission of speech and language impairment: a preliminary investigation.
The familial transmission of speech and language disorders was investigated using a community sample of five year old children with speech and/or language impairment and a control group with normal language skills. The results indicated a significantly higher prevalence rate of language-related problems in families of speech and language impaired children than in normal language controls. Girls with speech/language impairments had more affected relatives than boys, suggesting that girls with this type of family history are at a greater risk of developing speech or language related problems. The pattern of transmission of speech and language disorders was also compared with published reports of the family histories of stuttering and reading disabilities, and with reports of cognitive and linguistic deficits among families of autistic individuals. The findings are discussed in relation to the theory of an underlying neurolinguistic diathesis common to these various disabilities.
Child of Impaired Parents↗
Child psychiatry and early intervention: I. The aggregate burden of suffering.
This paper discusses the need to estimate the costs of an illness to properly allocate intervention resources for the various psychiatric disorders of childhood. Disorders that require the most community resources should be given the highest priority for early intervention programs. Factors to consider for estimating disorders which are most costly are discussed here: the incidence of the disorder, its severity, whether it is episodic or stable, and its impact on the individual family and the community. These factors contribute to the aggregate burden of suffering caused by a disorder.
Adolescent↗
Child psychiatry and early intervention: II. The internalizing disorders.
This paper uses the concepts introduced in the paper Child Psychiatry and Early Intervention: I. The Aggregate Burden of Suffering to review the internalizing disorders of childhood. This review surveys the internalizing disorders from the point of view of early intervention, for their prevalence, course, risk, early indicators, associated impairment, and responses to intervention. In general, the internalizing disorders have little effect on the community. When coupled with other disorders such as conduct disorder, or when dealing with suicide, the community's concern for these disorders increases and allocation of resources to target populations who are at risk becomes an important public health goal.
Anxiety Disorders↗
Child psychiatry and early intervention: IV. The externalizing disorders.
This paper is the last in a series of four using the concept of the aggregate burden of suffering to review the major psychiatric disorders of childhood. This paper reviews the externalizing disorders of childhood to prioritize early intervention programs. The paper discusses the prevalence, course, risk and early indicators, associated impairments, and responses to intervention. The externalizing disorders affect the individual, family and community and are thought to result in the greatest aggregate burden of suffering of all the childhood mental disorders. Early intervention is advocated and will likely need to be intense and long term for this group of children. The need for research into efficient and effective programs is emphasized.
Adolescent↗
Child psychiatry and early intervention: III. The developmental disorders.
This paper is the third in a series of four using the concepts introduced in the paper Child Psychiatry and Early Intervention: I. The Aggregate Burden of Suffering. This paper reviews the developmental disorders of childhood to set priorities for early intervention programs. This review discusses the prevalence, course, risk, early indicators, associated impairments, and responses to intervention. The specific developmental disorders, especially learning disabilities, have a significant impact on community resources. Since the developmental disorders are easily recognized among preschool children, early intervention is feasible. However, successful interventions have yet to be demonstrated. Priority should be given to the development of effective interventions. There is a great need for research studies on the effects and effectiveness of early intervention with these individuals.
Adolescent↗
The continuum of linguistic dysfunction from pervasive developmental disorders to dyslexia.
This article examines speech and language impairment in relation to several common childhood psychiatric disorders. Similarities among disorders can be found in the associated language impairments, family histories, and certain language outcomes. The article describes prevalence surveys of speech and language disorders and the correlates of language impairment, such as IQ, socioeconomic status, and birth order. The association between language impairment and childhood psychiatric disorders (i.e., hyperactivity, autism) is investigated, and the outcomes of language impairment are discussed. Finally, the hypothesis that a common underlying neurolinguistic diathesis may be present for certain subgroups of psychiatrically disordered children is presented. In some groups, psychiatric disorder (i.e., hyperactivity) and linguistic impairment may develop in parallel as a function of an underlying neurodevelopmental immaturity. The relation between the linguistic impairment and neurodevelopmental immaturity requires clarification so as to disentangle their specific associations with the various disorders discussed.
Autistic Disorder↗
Psychiatric risk in children with speech and language disorders.
Based on an initial community sample of 1,655 5-year-old children, this report utilized the risk statistic to estimate a child's risk for developing a psychiatric disturbance depending on his or her status as speech/language-impaired. Results showed that risk estimates varied as a function of gender and source of information (teacher, parent, psychiatric reports). Overall, speech- and language-impaired children had a higher risk for developing a psychiatric disturbance compared with normal language controls, with speech/language-impaired girls being at greater risk than boys.
Adaptation, Psychological↗
The children's self-report questionnaire: factor score age trends and gender differences.
Age trends and gender differences in a normative sample of 1,676 children (6- to 13-years) were explored with the use of scores obtained from the Children's Self-Report Questionnaire (SRQ). Several interesting trends emerged. Boys scored higher than girls on Conduct Problems, and girls scored higher than boys on dimensions labeled Worry and Sensitive-Emotional. Scores on other SRQ factors exhibited orderly increases or decreases across age groups. These trends are discussed in an attempt to clarify behavioral cognitive and affective age appropriate norms and are cautiously interpreted within a developmental framework. The identification of age and gender trends are a necessary step in the development of a diagnostic instrument intended for use with children. The age and gender trends observed lend additional support to the validity of the SRQ.
Affective Symptoms↗
Minor congenital laryngeal clefts: diagnosis and classification.
Cleft larynx is a rare congenital anomaly. Detection of an unsuspected minor cleft may be difficult, but the pediatric laryngologist should suspect the possibility of cleft larynx from the clinical features. Four minor clefts are reported, three cases of supraglottic interarytenoid cleft and one of partial cricoid cleft. The technique for endoscopic diagnosis and the distinctive features are described and a classification into four types is proposed.
Abnormalities, Multiple↗