What do patients want?
Explore the source record for details and available documents.
Attitude to Health↗
Biomedical subjects
D Armstrong
Publications and source records attributed to D Armstrong.
Doctors' perceptions of pressure from patients for referral.
OBJECTIVE: To assess the effect of pressure from patients on patterns of general practitioners' outpatient referrals. DESIGN: Survey of general practitioners' referrals to hospital outpatient departments during one week. SETTING: One health district. SUBJECTS: All (160) general practitioners in the health district. MAIN OUTCOME MEASURES: Specialty of the referral, the reason for it, and its status (NHS or private) and the general practitioner's assessment of the degree of pressure exerted by the patient for the referral (much, little, or none). RESULTS: 122 (76%) general practitioners completed the survey. Younger general practitioners (aged less than or equal to 45) and those qualifying in the United Kingdom and Republic of Ireland reported greater pressure from patients to refer (p less than 0.03, p less than 0.001 respectively). Pressure was also greater for patients referred privately (p less than 0.001), for those referred for reassurance (p less than 0.05), and for those referred to clinics in psychiatry, rheumatology, dermatology, and orthopaedics. General practitioners with a higher referral rate (with total consultations in the week as the denominator) were more likely to report pressure (p less than 0.01). CONCLUSIONS: The pressure from patients to refer reported by general practitioners is related both to general practitioners' characteristics and to the nature of the referral. Pressure to refer seems to explain some of the variation in referral rates among general practitioners.
Adult↗
Comparison of liver cancer and nodules induced in rats by deoxycholic acid diet with or without prior initiation.
The neoplastic responses of liver to prolonged continuous exposures of deoxycholic acid (DCA) in the diet with or without prior initiation was examined in Fischer 344 (F-344) and Sprague-Dawley (SD) male rats. In both rat strains, 7 months of continuous feeding of 0.5% (F-344 rats) or 1.0% (SD rats) of deoxycholic acid in chow diet generated hepatic nodules which persisted up to 8 months after deoxycholic acid was stopped. In one group of Sprague-Dawley male rats, 7 months of deoxycholic acid was preceded by an initiating dose of diethylnitrosamine. In 10 out of 15 of these rats, not only persistent nodules but also 26 liver cancers (large, multifocal, invasive, lung metastases) become evident by 8 months after cessation of deoxycholic acid.
Animals↗
Pneumothorax in AIDS.
OBJECTIVE: To determine risk factors for the development of pneumothorax in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Prospective cohort study. SETTING: Tertiary care center. PATIENTS: Of 1030 patients with AIDS who were followed at Memorial Sloan-Kettering Cancer Center between 1 January 1980 and 30 September 1989, 20 (2%) developed pneumothorax that was unrelated to trauma or a pulmonary procedure. RESULTS: Of 20 patients with AIDS who presented with pneumothorax, 19 had compelling evidence of concurrent Pneumocystis carinii pneumonia. Using bivariate analysis, patients receiving aerosol pentamidine prophylaxis (relative risk, 17.6) and those with a history of P. carinii pneumonia (relative risk, 14.5) were more likely to develop pneumothorax. By Mantel-Haenszel stratified analysis, aerosol pentamidine use was a statistically significant risk factor independent of a history of P. carinii pneumonia. The pneumothorax-related mortality rate was 10% and there was considerable morbidity. CONCLUSIONS: Patients with AIDS at the highest risk for developing pneumothorax are those with a history of P. carinii pneumonia who are receiving aerosol pentamidine prophylaxis but who nevertheless develop P. carinii pneumonia. The benefits of aerosol pentamidine prophylaxis in these patients far outweigh this risk. Pneumocystis carinii pneumonia should be considered as the most likely diagnosis in any patient with AIDS who develops a pneumothorax.
Acquired Immunodeficiency Syndrome↗
Effect of a general practitioner's consulting style.
Explore the source record for details and available documents.
Family Practice↗
Tissue peroxidase in the normal and neoplastic salivary gland.
Peroxidase activity was measured by two colorimetric methods in six neoplastic tumors of the parotid salivary gland. When p-phenylenediamine was used as the hydrogen donor co-substrate, peroxidase activity was absent or reduced from 6 to 22% of normal in these tumors. Cross reactivity with normal peroxidase antibody could not be demonstrated in tumors exhibiting negative activity. Two neoplastic salivary glands had well-described, encapsulated tumors which showed reduced peroxidase activity when compared with the normal uninvolved portion. However, when guaiacol was substituted for p-phenylenediamine, normal activity was recorded. After dialysis, peroxidase activity was not enhanced. Mixing experiments showed no effect of the tumor extract on the peroxidase activity of normal saliva, nor on salivary gland supernatant. Normal salivary gland peroxidase was inhibited 90% by 10(-2) g/L amino-triazole, but neoplastic tumors were inhibited less (13 and 73%). It is suggested that peroxidase is a simple marker for the detection of neoplasia and can be of value in the differentiation of benign tumors.
Adenoma↗
Diclofenac delays healing of gastroduodenal mucosal lesions. Double-blind, placebo-controlled endoscopic study in healthy volunteers.
The effects of the water-soluble and delayed-release formulations of a nonsteroidal antiinflammatory drug, diclofenac, on the healing of gastroduodenal mucosal lesions were compared in a double-blind, double cross-over, placebo-controlled endoscopic study conducted in 14 healthy volunteers. Severe endoscopic lesions (petechiae, erosions, ulcers, and esophageal candidiasis) were found only in the group taking the soluble formulation of diclofenac (P less than 0.05 vs placebo). The endoscopic healing of biopsies at one week was delayed by both preparations in comparison to placebo (P less than 0.05 vs placebo). Neither formulation produced significantly more histological inflammation or minor endoscopic lesions (erythema, red striae) than placebo. Both formulations were equally well tolerated and produced no more symptoms than placebo. This study suggests that soluble diclofenac acts topically to delay gastroduodenal healing and produce gastroduodenal injury; it thus provides a model for future studies of the production, perpetuation, and healing of peptic lesions.
Adult↗
Traumatic aortic rupture in the pediatric population. Role of plain film, CT and angiography in the diagnosis.
A retrospective review was undertaken to determine the incidence of, and radiologic findings associated with aortic rupture resulting from blunt chest trauma in children. Records and imaging data of 54 consecutive pediatric patients admitted over a 2 year period to a pediatric trauma center after sustaining blunt chest trauma were reviewed. Four of 54 (7.4%) had a documented aortic tear. Plain films were evaluated for 7 radiographic signs described in the adult literature as sensitive indicators of aortic rupture, including abnormal aortic contour and mediastinal widening. Two groups of patients were defined: Group 1 (n = 4) had aortic rupture confirmed by angiography or operation and Group 2 (n = 50) with no angiographic investigation. All patients in Group 1 demonstrated mediastinal widening and abnormal aortic contour; however, 50 percent of patients in Group 2 had similar findings. Computed tomograms of the thorax where obtained were reviewed, including 1 patient from Group 1 and 6 patients from Group 2. The aortic tear was well demonstrated in the one patient from Group 1; however, the remaining computed tomograms were deemed inadequate for reliable exclusion of significant aortic injury. Plain chest radiographic findings in 5 consecutive children who underwent aortography in the two years subsequent to this series, including 2 additional patients with aortic rupture, were also reviewed, with similar results. In conclusion, traumatic aortic rupture in the pediatric population may be more common than previously reported. Plain film findings of aortic rupture in children are similar to those in adults, and are sensitive but non-specific. Currently, at least in our institution, this injury may be underinvestigated. Angiography remains the modality of choice in the diagnosis of aortic tears in children.(ABSTRACT TRUNCATED AT 400 WORDS)
Angiography↗
Differential modulation of the CD-2 and CD-3 T cell activation pathways by a monoclonal antibody to Leu-13.
MAb anti-Leu-13 reacts with a 16-kDa-interferon-responsive lymphocyte-endothelial cell surface antigen and has been demonstrated to induce lymphocyte aggregation by an undefined adhesion pathway. While anti-Leu-13 inhibits proliferation triggered by CD3 antibodies it was found to consistently augment proliferation induced by a pair of CD2 antibodies at suboptimally mitogenic concentrations. The latter mechanism of T cell activation may represent an antigen-nonspecific activation pathway requiring extensive cell-cell interaction. Proliferation induced via the CD2 pathway was very sensitive to the presence of monocytes whose inhibitory effect was reversed by indomethacin. While the potent inhibitory effect of PGE2 on proliferation induced via the CD2 pathway was weakly antagonized by anti-Leu-13, the combined effects of anti-Leu-13 and PGE2 on the CD3 pathway were additive and very inhibitory. The possibility that the Leu-13 signal reflects a mechanism by which a monocyte/macrophage-sensitive T cell activation pathway might be selectively amplified in vivo is discussed.
Antibodies, Monoclonal↗
Reproducibility of long-term ambulatory esophageal combined pH/manometry.
Long-term ambulatory esophageal manometry is used increasingly, but normal values and data on the reproducibility of the method are not available. Thus, studies were conducted using paired 24-hour recordings, separated by 1-4 weeks, in 24 healthy volunteers (aged 19-50). Computerized analysis of each two-channel pressure recording (5 and 15 cm above lower esophageal sphincter) determined mean contraction amplitude, duration, area under the curve, contractility and propagation velocity, and the proportion of propagated contractions during day and night periods. A combined glass pH electrode (5 cm above lower esophageal sphincter) was used to register acid reflux. Visual analysis of the 24-hour contractility patterns showed marked intraindividual reproducibility but, although most subjects showed similar meal-associated increases and sleep-associated decreases in contraction frequency and amplitude, considerable interindividual variation was observed. This was confirmed by comparing the variation between subjects in the first and second recordings with the variation between recordings in the same subject; for all pH and manometry variables, the coefficient of variation was two to three times greater between subjects than between recordings in the same subject. The recordings were highly reproducible within subjects (nighttime contraction duration, P less than 0.05; all other variables, P less than 0.01). Thus, computerized ambulatory pH manometry is reproducible and because healthy volunteers have a characteristic individual pattern of esophageal motility, the method is perfectly suitable for repeated-measure design physiological and pharmacological studies. However, generally applicable normal values are difficult to define.
Adult↗
A modified broth dilution assay for antibiotic sensitivity testing of Mycobacterium avium-intracellulare using paraffin slide cultures.
Mycobacterium avium-intracellulare (MAI) can utilize paraffin wax as the sole carbon source in basal media. Paraffin slide culture (Para SL/C) has been employed for isolation and speciation of MAI derived from clinical sources. We have evaluated an adaptation of this method for antimicrobial sensitivity testing. Sixteen clinical isolates of MAI were tested against ciprofloxacin amikacin, and azithromycin by Para SL/C and compared with sensitivities obtained with a conventional broth microtiter procedure. The system can be performed rapidly over a median time interval of 6-8 days. The MIC was defined as the lowest concentration of antimicrobial agent necessary to inhibit growth on paraffin wax coated slides. With Para SL/C, the MIC values were determined at the time when the corresponding control tubes showed confluent growth. The procedure was reproducible with all of the agents tested. The MIC50 and MIC90 values obtained from the Para SL/C assay and from serial broth microtiter dilutions correlated well for ciprofloxacin and amikacin. However, results of the MIC50 and MIC90 for azithromycin did not correlate.
Amikacin↗
Lipid peroxidation and retinopathy in streptozotocin-induced diabetes.
Using the streptozotocin (STZ)-induced diabetic rat model, we have established a time-related curve for lipid hydroperoxides (LHP) in plasma and have correlated the period corresponding to maximal increase with histologic changes in the outer retina. Measurement of thiobarbituric acid reacting substances (TBARS) provides a convenient assessment of LHP concentration in plasma. Our results demonstrate a seven-fold elevation of TBARS at 10 days post-induction which increased to fifteen times above normal at 22 days and then fell dramatically to below baseline values at 39 days. Structural damage to the retina consisted of a reduction in cell number throughout the inner and outer nuclear layers, disorganization and loss of photoreceptor segments, and dilation of the basal region of the retinal pigment epithelium. The present observations establish a correlation between LHP concentration and retinal structure and function. Taken together with other reports in the literature showing alterations of protective enzymes and antioxidants, it appears that free radicals and lipid peroxidation are involved in the etiology of diabetic retinopathy in the STZ rat model. The TBARS assay is a simple, sensitive and inexpensive method to monitor changes in oxidative status and may prove useful in diagnosis and monitoring of patients with diabetes.
Animals↗
Fluorinated sugar analogues of potential anti-HIV-1 nucleosides.
In order to obtain agents with therapeutic indices superior to those of AZT, FLT, or D4T, several analogues of anti-HIV-1 nucleosides were synthesized. These include 2',3'-dideoxy-2',3' -difluoro-5-methyluridine (13), its arabino analogue 19, arabino-5-methylcytosine analogue 21, 3'-deoxy-2',3'-didehydro-2' -fluorothymidine (25), 3'-azido-2',3'-dideoxy-2'-fluoro-5-methyluridine (29), 2'-azido-3'-fluoro-2',3'-dideoxy-5-methyluridine (31), and 2'3'-dideoxy-2' -fluoro-5-methyluridine (37). These new nucleosides were screened for their activity against HIV and feline TLV in vitro. None of the compounds showed significant activity. It is interesting to note that such a small modification in the sugar moiety of active anti-HIV nucleosides (i.e., displacement of hydrogen by fluorine) almost completely inactivate the agents.
Animals↗
Beta-endorphin time course response to intensity of exercise: effect of training status.
The concentration of beta-endorphin (B-EP) was measured in 6 trained and 6 untrained cyclists during three intensities of exercise to determine the time course changes of B-EP. B-EP was determined by radioimmunoassay with less than 5% cross reactivity with beta-lipotrophin. A counter-balanced design was used to avoid an order effect from exercise intensity. Resting B-EP values were similar across visits. There were no differences in resting B-EP values comparing the trained (4.61 +/- 0.25 pmol.l-1) to the untrained (4.03 +/- 0.23 pmol.l-1) group. Cycling at 60% VO2max did not increase B-EP in either group at any time measured. Cycling at 70% VO2max increased B-EP by 10 min in both groups p less than 0.05. The rate and magnitude of increase of B-EP were similar for both groups. B-EP changes at 80% VO2max were significantly greater that at 70% VO2max and were identical for the two groups. Both groups demonstrated increases by 5 min and further increases at 30 min of exercise p less than 0.01. These changes occurred despite the fact that lactate levels were lower in the trained group at both 70 and 80% VO2max intensities. It is concluded that the time course change for B-EP is similar for trained and untrained individuals working at the same relative intensity of exercise and does not seem to be related to plasma lactate concentrations.
Adult↗
Utilization of circulating glutathione by nodular and cancerous intact rat liver.
The relationship of the rate of extraction of circulating glutathione (GSH) to the level of activity of gamma-glutamyltransferase (GGT) of hepatocytes of nodular and of cancer-bearing livers was studied in rats perfused in situ via the portal vein. Fischer adult male rats with many nodules (10 rats) or few (nine rats) liver nodules and four rats with hepatomas were compared as to their ability to remove GSH (10 microM) from the perfusate. The rate of extraction of infused GSH was directly proportional to the numbers of GGT(+)-hepatocytes in the liver tissue, inhibitable completely by adding the GGT inhibitor serine borate at 6-8 mM in the perfusate, and significantly enhanced in all rats by adding the gamma-glutamyl acceptor glycyl-glycine to the perfusate. These results suggest that nodules and cancers are able to remove GSH much more efficiently from the circulation than the surrounding liver tissue and that their enhanced GSH utilization is directly dependent on their GGT activity, which is present at much higher levels than in the surrounding tissues. The increases in GGT activity in nodule hepatocytes and enhanced ability to utilize GSH could be critical factors in the response to resistance selection of chemical hepatocarcinogenesis.
Animals↗
Diploid growth pattern of hepatocellular tumours induced by various carcinogenic treatments.
Hepatocellular carcinomas from rats of different strains, subjected to a variety of carcinogenic treatment regimens in different laboratories (initiation by diethylnitrosamine or dimethylhydrazine, promotion by phenobarbital, 2-acetylaminofluorene, nafenopin, orotic acid or deoxycholic acid, growth stimulation by partial hepatectomy or necrogenic CCl4 treatment), were all found to be predominantly diploid by flow cytometric analysis, in contrast to normal liver tissue in which polyploid nuclei were predominant. A switch from polyploidization to diploid growth would thus seem to be a common property of malignant liver tumours. Benign neoplastic liver nodules were likewise predominantly diploid, with the exception of nodules induced by long-term deoxycholic acid treatment in Fischer rats. In addition to containing a majority of polyploid cells, the latter nodules failed to progress to the carcinoma stage.
Animals↗
Differences in human immunodeficiency virus type 1 (HIV-1) anti-p24 reactivities in serum of HIV-1-infected and uninfected subjects: analysis of indeterminate western blot reactions.
Anti-p24 reactions in sera from 42 human immunodeficiency virus type 1 (HIV-1)-infected and 36 uninfected people with indeterminate Western blot antibody tests for HIV-1 were studied. Anti-p24 reactivity in HIV-1-infected people was completely blocked by HIV-1 recombinant p24 antigen, whereas the reaction in uninfected individuals with indeterminate patterns was inhibited partly or not at all. In contrast to infected individuals, anti-p24 reactivity from uninfected individuals could not be detected by an inhibition ELISA for HIV-1 p24 antibody. These results suggest a practical way to distinguish anti-p24 reactivity in sera from patients with HIV-1 infection from that seen in uninfected patients with indeterminate Western blot reactions.
Adult↗
Progressive disseminated infection with Mycobacterium avium complex after intravenous and oral challenge in cyclosporine-treated rats.
Male Sprague-Dawley rats, immunosuppressed with cyclosporine (CsA), developed disseminated infection after intravenous or oral challenge with Mycobacterium avium complex (MAC). Disseminated infection leading to bacillemia could be established after intravenous inoculation with as few as 5 x 10(3) organisms. When CsA was not given or when CsA was stopped 1 month after infection, animals cleared the bacilli from blood and tissue. Animals developed disseminated infection after oral challenge with as few as 10(6) organisms. Persistent bacillemia occurred when organisms in the spleen exceeded 10(7). Differences in virulence among strains were observed. Infected tissues showed histopathologic changes similar to those seen in patients with AIDS. The CsA-treated rat is a new model that appears useful for studies of the virulence of MAC strains and the pathogenesis of disseminated MAC infection.
Acquired Immunodeficiency Syndrome↗