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Biomedical subjects

A McLean

Publications and source records attributed to A McLean.

At least 91 records · Page 5Linked to original sources
PubMed1991

Use of phenytoin to treat horses with Australian stringhalt.

Five horses with Australian stringhalt were treated with 15 mg/kg phenytoin orally for 2 weeks. During the second week of the trial, 3 of the horses were given an additional dose of 10 mg/kg phenytoin. The response to treatment was clinically assessed by grading the severity of the gait abnormality at the walk, trot, turning and backing twice daily. There was a significant (P less than 0.05) improvement in the gait abnormality when pre-treatment values were compared with the mean of the last 3 assessments before treatment stopped. When reassessed 2 weeks after treatment ceased, there remained a significant (P less than 0.05) improvement compared with pre-treatment values at the trot and on backing, but not at the walk or turning. Surface electromyographic recordings were made weekly from the long digital extensor muscle, and there was a change to a near normal recording by the end of treatment. Plasma phenytoin concentrations were monitored during the trial, and the dose rates used achieved a steady state with a mean plasma level of 37 +/- 7 mumol/l. There was wide variability between plasma concentrations in different horses, although there was no difference in absorption between administration of the phenytoin as a paste, or when it was mixed in the feed. Although mild tranquilization was seen after treatment, there were no clinical, haematological or biochemical signs of toxicity from the phenytoin therapy.

Administration, Oral↗
PubMed1991

Relative effects of brain and non-brain injuries on neuropsychological and psychosocial outcome.

Based on the 242 consecutive surviving head injury cases and 132 general trauma cases, this study examined the contribution of brain and non-brain injuries to cognitive and psychosocial outcome 1 month postinjury. The study also examined the relationships among various head injury severity indices. The head injury severity indices were all correlated but patients with Glasgow Coma Scale scores in the mild range had broadly ranging scores on the other head injury severity indices (Abbreviated Injury Scale and time to follow commands). Neuropsychological outcome was related to brain injury severity, but was not independently influenced by severity of other systems injuries. Psychosocial outcome related to both brain and non-brain injuries independently. When evaluating trauma outcome, it is important to consider the contributions of both brain and other system injuries.

Abbreviated Injury Scale↗
PubMed1991

Fatigue and depression in brain-injured patients correlated with quadriceps strength and endurance.

Many brain-injured (BI) patients complain of persistent fatigue that may alter their lifestyles. In order to assess muscular strength and endurance after brain injury, 22 BI men, greater than 9 months postinjury and aged 20 to 51 years, were separated into two groups based on a complaint of fatigue (fatigue n = 13, nonfatigue n = 9); each performed one maximal isometric knee extension at 60 degrees and 20 maximal isokinetic contractions at 20 rpm using a Cybex II dynamometer. A third group of age-matched, able-bodied men (n = 10) were used as controls. A battery of tests assessing the presence of fatigue (using a symptom checklist and two rating scales), depression, anxiety, and health status were given at the time of isokinetic/isometric testing. The mean fatigue rating, a subjective score, for the fatigue group of BI subjects was significantly worse than the other groups (p less than .01). There was a positive correlation between clinically significant Zung depression scores and fatigue rating (r = .46) and between Zung anxiety scores and fatigue rating. The depression scores for those who complained of fatigue were significantly higher than the other groups (p less than .005). Maximal isometric contractions were no different among the three groups. The mean maximal isokinetic torque during the 20 repetitions was greater in controls than in the BI groups, but did not reach statistical significance (p less than .25). There were no significant declines in isokinetic torque in the 20 repetitions for any of the groups, and the fatigue index was nearly equal for all three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Contradictions in the social production of clinical knowledge: the case of schizophrenia.

This paper is divided into two parts. In Part I, I contend that the current thrust to synthesize clinical and critical medical anthropology is misdirected and may serve to further fragment, rather than unify their concerns. I then suggest that instead of focusing on their differences, either in levels of analysis ('micro-' versus 'macro-') or in objects for analysis, we should emphasize instead the perspective that they share--one drawn from the common task their work assumes as a critical, emancipatory science of mankind. In Part II, keeping in mind this short prolegomenon, I utilize data regarding the National Alliance for the Mentally Ill (NAMI) to illustrate that medical knowledge is reducible to neither natural nor social forces; it is instead produced by living actors who are constrained by their social and historical conditions and the exigencies of the mode of production in which these actors produce. I show how NAMI members have succeeded in changing 'blame-the-family' ideologies about schizophrenia etiology and treatment, but I also explain how the medicalized alternative they produced in redefining schizophrenia as a disease of the brain is itself limited and fraught with contradictions (e.g. reinforcing a depersonalizing mind/body separation that inhibits healing). These contradictions highlight the difficulty of transcending the assumptions implicit in medical categories since they are tied to the dominant epistemology of the mode of production in which they are produced--one that binds our world views and limits the options we can generate. Anthropologists must draw attention to these constraints as an initial step to transcending them.

Anthropology↗
PubMed1990

Diaphragmatic (Bochdalek) hernias simulating pulmonary metastases on computed tomography.

Three patients with known primary malignancy and a normal chest radiograph are presented. Computed tomographic scans viewed on 'lung' settings showed a solitary mass lesion simulating a neoplastic mass in the posterior costophrenic recess in each patient. These lesions in fact were small herniations of abdominal fat into the chest through diaphragmatic defects.

Aged↗
PubMed1990

Neuropsychological recovery in patients with moderate to severe head injury: 2 year follow-up.

Neuropsychological outcome and recovery of a group of 31 consecutive adult patients with moderate to severe head injuries were prospectively investigated over a 2-year period. A friend control group was used for comparison purposes. Based on the results we conclude: (1) there is marked impairment of a broad spectrum of neuropsychological functions at 1, 12, and 24 months postinjury; (2) coma length is significantly related to neuropsychological status at all three time periods, although the relationship is weaker at 12 and 24 months; (3) marked improvement in all functions occurs in the first year, while recovery in the second year appears more specific and may depend on the severity of the injury and type of function; (4) practice effects and variability over repeated measures cause difficulties in determining recovery and need to be addressed with larger samples.

Adult↗
PubMed1990

Thin malignant melanomas (less than 1.5 mm) with metastasis: a histological study and survival analysis.

It is known that not all thin malignant melanomas have an excellent prognosis and that the specific features identifying the patients at risk of metastasis have not been fully elucidated. We have looked at thin malignant melanomas (less than 1.5 mm) in the East of Scotland that had proven metastasis and death, and compared the clinical and histological features with a similar group (less than 1.5 mm) that have had no further recurrence after a minimum of 6-year follow-up. We identified 26 patients with thin melanomas who had developed histologically proven metastasis and/or died following adequate surgical treatment of their primary lesion. When compared with the control group, factors found to be significantly different between the two groups and present in the group that did badly were (a) histological regression, (b) lesion size, (c) Clark level IV and (d) depth of the uninvolved dermis.

Adult↗
PubMed1990

Alcohol use as a situational influence on young women's pregnancy risk-taking behaviors.

Recent studies have found that many young women just beginning their sexual lives use alcohol prior to intercourse. A large number appear to drink heavily enough prior to sex to compromise their ability to use contraceptives. The question emerges whether there is a relationship between drinking before intercourse, the nonuse of birth control methods, and unplanned pregnancies. The present research describes 43 instances of intercourse which resulted in unplanned pregnancies in 14- to 21-year-olds. Variables examined included alcohol use prior to sex, amount of alcohol consumed, the use of other drugs, the planning of intercourse, respondents' stated reasons for nonuse of contraceptives, and other general demographic data.

Adolescent↗
PubMed1989

Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer.

STUDY OBJECTIVE: To determine the utility of the serologic marker CA19-9 in the diagnosis of pancreatic cancer in patients suspected of having a pancreatic disorder. DESIGN: Blinded study of frozen pedigreed serum samples collected at time of diagnostic evaluation with follow-up review at a mean of 8 years. SETTING: A general university teaching hospital serving both primary and referral patient populations. MEASUREMENTS AND MAIN RESULTS: Sera collected prospectively from 1978 to 1980 from 261 patients undergoing imaging studies of the pancreas (ultrasound, computed tomography, endoscopic retrograde cholangiopancreatography) for a variety of symptoms were assayed for CA19-9 levels, and the results were compared with earlier determinations of other potential markers for pancreatic cancer. In 54 patients ultimately shown to have pancreatic cancer, the CA19-9 assay showed a sensitivity of 70% with a median value of 349 u/mL (normal less than 70 u/mL) and range, 7.3 to 2,859,964 u/mL, whereas specificity of the marker in this population was 87%. The positive predictive value was 59%, and the negative predictive value was 92%. Results of CA19-9 testing in the small group of patients with definitive staging information showed no difference in sensitivity between patients with local/regional disease (n = 6) and those with distant metastases (n = 14), 50% compared with 71% (P = 0.613). CONCLUSION: CA19-9 was found to be a more sensitive and specific marker of pancreatic cancer than other serologic markers and should be a useful test in the patient with suspected pancreatic disease.

Adenocarcinoma↗
PubMed1989

Ultrasonography shows no abnormality of pelvic structures in women with severe idiopathic constipation.

Patients with severe idiopathic constipation are almost exclusively women. Common presenting features include lower abdominal pain, irregular and painful menstruation, and a past history of gynaecological surgery. Pelvic ultrasonography was undertaken in 26 patients with severe idiopathic constipation and 21 age matched control women to detect any gynaecological abnormality. No difference was found in ovarian, uterine or pelvic vein morphology or size. The abdominal pain in these patients is related to the bowel disorder, and minor abnormalities of pelvic morphology on ultrasound are probably incidental findings.

Adolescent↗
PubMed1989

Role of computed tomography in evaluating asbestos related lung disease.

To find how computed tomography (CT) may be effectively used in individuals with suspected asbestos related lung disease 30 men with a history of exposure to asbestos were studied. All subjects underwent high kilovoltage posteroanterior and left lateral chest radiographs and chest CT. Eighteen were randomly selected asbestos workers referred for routine surveillance. The remaining 12 were patients who had been referred for investigation of respiratory symptoms or abnormal routine chest radiograph, or both, and found to have chest radiographic changes compatible with asbestos related lung disease. In the group referred for routine surveillance both pleural shadowing and pulmonary shadowing were shown on CT but not chest radiographs in only one case. Five were thought to have pleural shadowing on chest radiographs but this was confirmed on CT in only one case. All 12 patients referred for investigation showed pleural shadowing on chest radiographs; this was confirmed in all cases on CT which also showed unsuspected pulmonary shadowing in five cases. These findings suggest that it is not appropriate to use chest CT routinely in all asbestos workers referred for routine surveillance. When CT is used selectively in those with pleural shadowing on plain chest radiography, however, it is helpful in refuting or confirming the presence of pleural disease and may show unsuspected pulmonary shadowing.

Adolescent↗
PubMed1989

Comparison of paragraph comprehension test scores with reading versus listening-reading and multiple-choice versus nominal recall administration techniques: justification for the bypass approach.

Eight groups of learning disabled children (N = 100), categorized by the clinical Lexical Paradigm as good readers or poor readers, were individually administered the Gilmore Oral Reading Test, Form D, by one of four input/retrieval methods: (1) the standardized method of administration in which the child reads each paragraph aloud and then answers five questions relating to the paragraph [read/recall method]; (2) the child reads each paragraph aloud and then for each question selects the correct answer from among three choices read by the examiner [read/choice method]; (3) the examiner reads each paragraph aloud and reads each of the five questions to the child to answer [listen/recall method]; and (4) the examiner reads each paragraph aloud and then for each question reads three multiple-choice answers from which the child selects the correct answer [listen/choice method]. The major difference in scores was between the groups tested by the recall versus the orally read multiple-choice methods. This study indicated that poor readers who listened to the material and were tested by orally read multiple-choice format could perform as well as good readers. The performance of good readers was not affected by listening or by the method of testing. The multiple-choice testing improved the performance of poor readers independent of the input method. This supports the arguments made previously that a "bypass approach" to education of poor readers in which testing is accomplished using an orally read multiple-choice format can enhance the child's school performance on reading-related tasks. Using a listening while reading input method may further enhance performance.

Achievement↗
PubMed1989

Depression, learning disability, and school behavior problems.

It is possible that recurrent depression (primary affective illness) is the most significant variable related to school problems of a behavioral nature in children manifesting developmental specific learning disabilities. The association of school problems and depression was investigated at a private school for children with developmental specific learning disabilities. These children were of normal intelligence and were free of primary conduct or thought disturbances. Prior to entering school, 95% of the students fulfilled criteria for developmental specific learning disabilities and 64% for depression with or without hyperactivity. Students manifesting no diagnosable behavioral condition prior to entrance continued to be relatively free of behavioral problems during their stay at school. Students with both depression and hyperactivity showed the most problematic behavior followed by students with depression without hyperactivity.

Adolescent↗
PubMed1989

Comparison of nominal recall (standard) and multiple-choice methods for administration of WISC-R information subtest: a preliminary study indicating a learning effect of multiple-choice testing.

The Wechsler Intelligence Scale for Children--Revised (WISC--R) Information subtest was administered to learning disabled children using two methods of administration, the standard (recall) method and a multiple-choice format. Those children who were tested first with the multiple-choice format and subsequently with the standard format did better on the standard format than expected. This preliminary study suggests a learning effect of such multiple-choice testing and the desirability of further research being undertaken.

Child↗
PubMed1989

Medical students' early expectations and later opinions of aspects of their first year.

A survey of medical students on their first day of medical school and again near the end of their first year measured the discrepancy between their expectations of various aspects of the first year and their retrospective opinions about these aspects. The entering students had specific, detailed expectations about numerous aspects, many of which were not confirmed by their subsequent experience. The same students were reminded, one year later, of their unfulfilled expectations about the first year and were asked to describe any effects these expectations had had on class emotional climate and morale. They recalled both serious disappointments and pleasant surprises but no general change of class morale. A serendipitous finding was the profound indifference of the second-year students to their first-year emotional responses. Our results challenge the general practice of basing curriculum renewal programs on cross-sectional student surveys with no consideration of baseline expectations, and of relying on students to initiate improvements in educational programs.

Attitude↗