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Biomedical subjects

A Thomas

Publications and source records attributed to A Thomas.

At least 433 records · Page 24Linked to original sources
PubMed1990

The Gospel Oak Project: the use of health and social services by dependent elderly people in the community.

The Gospel Oak Project surveyed a community sample of elderly people. Prevalence rates of depression and dementia were determined. Cases were assessed in detail and subject to long-term follow-up. Demographic information and morbidity data identified details of health service, social service and informal service contact. This paper reports the findings of the first survey of this population completed in 1987. It examines the effect of the increase in the very elderly on the need for health and social services, including contact with general practitioners. Duplication of service contacts are explored and the dependent elderly people not in receipt of services are identified. Finally, the survey investigates the effect of informal care on the level of service contact. Results confirm that contact increases with age, especially multiple service contact, implying a need for an expansion in future services. Although most depressed residents do not usually complain of depression, they have increased contact with health services but are not treated with anti-depressant medication. Few dependent elderly people receive no services; conversely there is no evidence of service duplication. Finally, receipt of informal care affected attendance at a day centre but no other service provision.

Aged↗
PubMed1990

[Malignant maxillofacial extra-nodal lymphoma].

64 patients with extra-nodal maxillo-facial NHL were seen between 1969 and 1989. These rare tumours (1 to 4% of stomatological tumours) tended to occur more often in men (60% of cases) between the ages of 40 and 70. Bony involvement was common (maxillary and mandibular involvement), though more rarely the salivary glands or mucosa were involved, presenting as a swelling with lysis of underlying bone. Highly malignant varieties (85% of cases) were most commonly encountered. The treatment remains medical, involving chemotherapy (C.H.O.P. or high dose methotrexate) and gives an actuarial survival rate of 50% at 3 years.

Adult↗
PubMed1990

Controlled clinical trial of two multidrug regimens with and without rifampin in highly bacilliferous BL/LL south Indian patients: a five-year report.

A controlled clinical trial of two multidrug regimens in multibacillary lepromatous and near-lepromatous patients with a bacterial index (BI) of 2.5 or more was conducted. Patients were randomly allocated to either a two-drug regimen of dapsone plus clofazimine for 60 months or a four-drug regimen of rifampin, isoniazid, dapsone, and clofazimine for the first 3 months and clofazimine plus dapsone for the next 57 months. There was no difference between the rifampin and nonrifampin regimens with respect to the clinical improvement or bacteriological status of the patients at 60 months. Reactive states and neuritis were observed to be equal in the two patient groups.

Adolescent↗
PubMed1990

A modified cancer education program. Effect on cancer knowledge and beliefs of the elderly.

This pilot study examines the effect of a cancer education program on the knowledge and beliefs of elderly adults. The program, developed for this age group, was based on principles of adult education and on an understanding of changes related to aging. It focused on cancer risks and early diagnosis of cancer for older adults. The sample included 21 elderly adults from three retirement centers. The questionnaire used to determine knowledge and beliefs about cancer included seven scales based on the Health Beliefs Model: knowledge, severity, susceptibility, utility, barriers, behavioral intentions, and cues to action. A week following administration of the questionnaire, a program was presented: the modified cancer education program, a conventional cancer education program, or a program not related to cancer. The questionnaire was then readministered as a posttest. Findings were insignificant except that the group receiving the modified cancer program had increased scores on the knowledge scale from pretest to posttest; and the level of education accounted for 25% of the variability of posttest utility scores. The pilot study was useful for identifying problems with the questionnaire, the testing procedure, and the educational program that need to be corrected before a larger study can be undertaken.

Aged↗
PubMed1989

Hydrophobic cluster analysis (HCA) of the hormone-binding domain of receptor proteins.

A new technique of protein sequence analysis, namely, Hydrophobic Cluster Analysis (HCA), has been used to align and compare the sequences of proteins belonging to the receptor superfamily (steroid, thyroid hormone and retinoic acid receptors) and serpin superfamily (corticosteroid binding globulin (CBG) and alpha 1-antitrypsin (alpha 1-AT]. By matching up clusters of hydrophobic amino-acids that oftenmost correspond to identifiable secondary structures (alpha-helices, beta-strands etc.), it has been possible to deduce the following information on the secondary structures of these proteins: CBG is structurally related to alpha 1-AT (HCA score greater than 80%), the structures of the hormone-binding domains of the steroid receptors that bind 3-keto-delta 4-steroids are closely interrelated (greater than 80%) but less closely related to that of the estrogen receptor (ER) (approximately 75%), vitamin D, retinoic acid and thyroid hormone receptors are structurally closely related (greater than or equal to 80%). Their secondary structures are, however, also related to that of the steroid receptors (approximately 70%), and a high degree of analogy exists between the structures of serpins and of the hormone-binding domains of members of the steroid superfamily (60-70%). HCA has clearly shown that a previous local sequence alignment of the estrogen receptor with other steroid receptors and cytochromes P450 has to be reconsidered. The published consensus steroid binding sequence previously identified in cytochromes is in fact 80 amino-acids upstream from its previously defined position. Other regions of contiguous sequence identity have also been identified which may be involved in the hydrophobic core of the protein or in steroid binding. Their positions have been indicated using the crystal structure of alpha 1-AT as a model.

Amino Acid Sequence↗
PubMed1989

Predicting pregnancy outcome after in vitro fertilization and embryo transfer using estradiol, progesterone, and human chorionic gonadotropin beta-subunit.

Two hundred twenty consecutive in vitro fertilization (IVF) conception cycles were studied prospectively in order to examine the predictive value of serum human chorionic gonadotropin beta-subunit (beta-hCG), estradiol (E2), and progesterone (P) in predicting pregnancy outcome between 2 and 4 weeks after oocyte collection. To examine the predictive value of each hormone in predicting clinical pregnancy outcome, each patient's result at each week was assigned a scoring system based on the 25th percentile value of the concentration of beta-hCG, E2, and P in ongoing singleton IVF pregnancies for each week of the study. All but one ectopic pregnancies had scores of 0 or 1 points between 2 and 4 weeks after oocyte collection. The scores in successful pregnancies were significantly higher than in unsuccessful pregnancies 2 weeks after oocyte collection. Ninety percent of women scoring 3 points 2 weeks after oocyte collection had ongoing IVF pregnancies. The authors conclude that determination of serum beta-hCG, E2, and P concentrations between 2 and 4 weeks after oocyte collection provides clinically useful information not only in the prediction of ectopic IVF pregnancy, but also, conversely, in the identification of IVF pregnancies that are destined to be ongoing.

Chorionic Gonadotropin↗
PubMed1989

Do raised serum luteinizing hormone levels during stimulation for in-vitro fertilization predict outcome?

Previous reports associating raised LH concentrations with reduced fertilization and pregnancy rates in women undergoing in-vitro fertilization (IVF) have assumed a Gaussian distribution of LH values with IVF treatment. We have determined the serum LH range during ovarian stimulation for IVF with a single regimen of clomiphene citrate/hMG from 102 consecutive IVF conception cycles. The results show a non-Gaussian distribution of LH values. Application of this LH range to a consecutive series of 596 women undergoing IVF treated with this single regimen showed no difference in pregnancy rates, fertilization rates, median number of oocytes fertilized or retrieved when analysed with respect to serum LH concentrations above the 75th or 95th centile for greater than or equal to 3 days of an IVF treatment cycle. We conclude that follicular-phase LH concentrations do not predict IVF fertilization rates or clinical outcome and are not clinically useful in individual patient management.

Clomiphene↗
PubMed1989

Cystosarcoma phyllodes: a review of surgical options.

The unpredictable behavior of histologic types and the disputable results of particular surgical procedures have contributed to the controversies surrounding phyllode tumors. The therapeutic issue is further compounded by an imprecise preoperative diagnosis. This is illustrated in our series of 106 patients, in whom 71.7% were mistakenly operated on for fibroadenoma. Since only 15.8% of this group developed local recurrence, it may be acceptable to adopt a watchful policy, unless detailed microscopic assessment of tumor margins provides evidence of inadvertent transection. Reoperation would then be logical advice, as with one of our patients. In patients clinically suspected of having phyllode tumors, tissue diagnosis is preferable to investigative procedures, which are seldom definitive. Our experience has been with frozen-section diagnosis, although trucut core biopsy is certainly an attractive procedure. In 18 patients only 50% were positively identified as having phyllode tumors. The logistic and therapeutic issues related to use of frozen-section diagnosis are discussed. Wide excision has been recommended by many investigators as an appropriate measure, as long as it is technically possible to remove the lesion with an adequate rim of normal breast tissue. This applies especially to young female patients (less than 20 years), in whom conservation of the breast is particularly desirable and whose tumors behave in a more benign manner. On the other hand, mastectomy is necessary if the phyllode tumor is large compared with breast morphologic size,when histologic transformation has taken place, or when clinical behavior takes a more aggressive course. In this retrospective study, conservative surgery is generally practiced for both primary and recurrent tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Treatment of Horton's disease].

716 cases collected from 9 recent studies published between 1981 and 1985 served as a basis for a general review of the current treatment of temporal arteritis. Steroid therapy was instituted as first intention in 652 cases, high dose treatment was continued for between 8 days and 3 months but the majority of authors started a reduction in the dosage from the 4th or 5th week. There was no overall agreement regarding the duration of maintenance therapy nor the criteria allowing its discontinuation, and withdrawal was not possible before the 25th month on average. The ideal initial dosage, in the absence of randomized studies, remains to be defined: generally around 0.5 mg/kg/d in milder forms, the dosage may be increased to 1 mg/kg/d in the presence of complicated temporal arteritis. Besides cortico steroid therapy, other treatments are successively envisaged: synthetic anti-malarials (SAM), non steroidal anti-inflammatories (NSAI), dapsone... while these are generally used as back-up treatment, David-Chausse used SAM as first intention, combined in 17 cases with NSAI in 61 of his 66 patients, with very promising results which require confirmation in other studies. In this review the cure rate was around 25% and the relapse rate 38%; complications related to the disease occurred in 19%, while almost one patient in two--47%--developed iatrogenic complications. Blindness dominates the prognosis, and occurred in 15% of cases, most often as an inaugural event, it very rarely regressed on steroid treatment. Although death occurred in 18% of cases, the prognosis of temporal arteritis generally remains favorable, with a 5 year survival curve identical to a control population.

Giant Cell Arteritis↗
PubMed1988

Ajoene inhibition of platelet aggregation: possible mediation by a hemoprotein.

Ajoene, an organosulfur compound derived from garlic, was found by spectral measurements, to interact, cooperatively, with a purified hemoprotein implicated, previously, in platelet activation. It modified the binding interactions of the protein with ligands, deemed to be physiologically relevant as effectors. The characteristics of the modifications were found to parallel those of ajoene induced modifications of agonist-induced aggregation kinetics of gel-filtered calf platelets.

Adenosine Diphosphate↗
PubMed1988

HLA-D region alpha-chain monoclonal antibodies: cross-reaction between an anti-DP alpha-chain antibody and smooth muscle.

Two monoclonal antibodies, Tal 3C3 and Tal 1B5, raised against purified plasma membrane extract of the Bristol 8 B lymphoblastoid cell line and previously shown to recognize epitopes on denatured HLA-D alpha-chains revealed several differences in staining patterns when screened by immunocytochemical techniques on pre-fixed paraffin-embedded sections of human tissues. Although Tal 3C3 staining was weaker and more restricted than Tal 1B5 on immunoregulatory cells expected to express class II antigens, this monoclonal antibody showed additional strong activity on normal smooth muscle. Biochemical studies show that whereas Tal 1B5 reacts with DR alpha-chains, Tal 3C3 predominantly defines DP alpha-chain subunits and a high molecular weight (200-250 kD) actin binding protein known as filamin. In view of several recent reports that the cellular distribution of class II antigens may be more widespread than hitherto thought and may be expressed by cells not normally involved in specific immune functions, these findings emphasize that unexpected monoclonal antibody reactions must be interpreted with caution. It is clearly important to include both immunohistological tissue section and biochemical studies in the initial screening procedures for monoclonal antibodies in order to distinguish between specific target antigen activity and cross-reactions with unrelated molecules.

Antibodies, Monoclonal↗
PubMed1988

Antioxidants to treat chronic pancreatitis in childhood? Case report and possible implications for pathogenesis.

The case history of a 10-yr old boy with calcific chronic pancreatitis is reported. His theophylline clearance of 450 ml/kg/h was several times higher than normal, indicating induction of cytochromes P450. Painful attacks disappeared concurrently with administration of antioxidants. The possible relevance of these findings is discussed in the context of chronic pancreatitis in childhood.

Antioxidants↗
PubMed1988

Percutaneous transtracheal high frequency jet ventilation as an aid to difficult intubation.

A case is described where prophylactic high frequency jet ventilation through a percutaneous transtracheal cannula was performed. This guaranteed adequate ventilation of a patient who was known to be difficult to intubate, enabling a paralyzing dose of succinylcholine to be given and intubation to be performed safely in a well oxygenated patient scheduled for coronary artery bypass grafting.

Catheterization, Peripheral↗
PubMed1988

Drawing pedigrees.

The problem of drawing a pedigree in a clear and concise manner is discussed and a case is made for the adoption of the marriage node graph as the most appropriate format in which to depict highly looped pedigrees. A method for assigning suitable coordinates to marriages and individuals is then described. This involves use of simulated annealing to search for the clearest picture. The method is illustrated by two examples: the pedigree of Przewalski's Horse and that of the European Bison.

Animals↗