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Biomedical subjects

D King

Publications and source records attributed to D King.

At least 163 records · Page 9Linked to original sources
PubMed1995

Bilateral hippocampal atrophy in medial temporal lobe epilepsy.

Quantitative evidence of hippocampal atrophy has been correlated with site of seizure onset, hippocampal neuronal loss, and seizure relief after resection. Most studies have quantified hippocampal atrophy using ratios or differences between right and left hippocampal values. However, bilateral hippocampal atrophy may remain undetected by these techniques. To assess the frequency and implications of bilateral hippocampal atrophy, we studied absolute hippocampal volumes in 53 temporal lobectomy patients who had undergone intracranial electroencephalogram recordings preoperatively. Coronal images were constructed perpendicular to the longitudinal axis of the hippocampus. Atrophy was defined as > 2 SD below control values in the volume of the posterior 1.5 cm of the hippocampus. Five of 53 patients (9%) had bilateral hippocampal atrophy; four of these cases were undetected by ratios. Surgery was performed on the side of ictal onset in all five patients; four have been seizure-free for > 2 years. These results suggest that (a) mesial temporal sclerosis can be present bilaterally and may go undetected by hippocampal ratio or difference measures; (b) absolute hippocampal volume values as well as ratios are needed to detect all patients with bilateral hippocampal atrophy; and (c) temporal lobectomy is not contraindicated in patients with bilateral hippocampal atrophy, but success depends on electroencephalographic documentation of the side of predominant ictal onset.

Atrophy↗
PubMed1995

Comparison of four DNA-based methods for strain delineation of Candida lusitaniae.

Four methods for the accurate delineation of epidemiologically related and unrelated strains of Candida lusitaniae were compared. Three pulsed-field electrophoretic methods, including two contour-clamped homogeneous field gel electrophoresis methods (EKP-1 and EKP-2) yielding electrophoretic karyotype patterns of intact chromosomal DNA and a method in which the chromosomal DNA was macrodigested with the endonuclease SfiI prior to pulsed-field electrophoresis (MDP), and a random amplified polymorphic DNA (RAPD) assay were evaluated. A selected panel of 21 well-characterized isolated representing 13 strains of C. lusitaniae, including 7 epidemiologically related isolates of one strain (group I-A), 3 epidemiologically related isolates of another strain (group I-B), and 11 epidemiologically unrelated isolates (group II), were tested. All isolates were coded and tested in a blinded manner. All seven group I-A isolates were confirmed to be a single strain by the EKP-1 and MDP methods, and the three group I-B isolates were shown to be a single strain by the EKP-1, EKP-2, MDP, and RAPD methods. Subtle differences were noted with two of the group I-A isolates by the EKP-2 method, whereas three of these isolates were different by the RAPD method. Each group II isolate had distinct patterns by all four methods. These data support the fact that the three pulsed-field electrophoretic methods and the RAPD method can be used to delineate strains of C. lusitaniae. The EKP-1, EKP-2, and MDP gave results that correlated with the epidemiologic characteristics of the isolates tested in the study, whereas the RAPD method was perhaps too sensitive in detecting DNA changes for epidemiologic studies.

Candida↗
PubMed1995

Influenza vaccination: do the aged reap the benefit?

An audit of 100 elderly in-patients with appropriate medical conditions revealed that 63% had not been vaccinated this winter. 74% would have accepted vaccination if offered. A general practitioner questionnaire found that 42% relied on elderly patients coming forward and requesting vaccination. Unfortunately, many elderly patients are still missing out on influenza vaccination.

Aged↗
PubMed1995

The older driver--a review.

There are differences between elderly drivers and younger drivers in that the elderly are more likely to have cognitive, motor and sensoriperceptual deficits affecting their driving performance. The elderly driver is more likely to have a chronic illness and to be on medication, that might adversely affect driving. The elderly driver requires more study and help either by retraining or provision of adaptations to vehicles. Fitness to drive is of clinical importance to doctors in most specialities and recent studies would suggest that doctors need to be more aware of the current guidelines on driving and be prepared to offer advice.

Accidents, Traffic↗
PubMed1995

The prevalence of drivers in acute geriatric wards.

An audit of 150 patients on five acute geriatric wards found that 28 (19%) still drove. Forty-three (28%) used to drive but had given up, whilst 79 (53%) (76 of whom were female) had never driven. Former drivers gave the main reason for stopping as cost. No driver could recall being advised about driving by a doctor. Twenty-two drivers (79%) had a significant clinical condition that could affect driving, ranging from blackouts to arthritis. It is recommended that all elderly patients should be asked if they drive and any clinical conditions they might have that would adversely affect their driving be sought. Appropriate advice should be given by doctors to their elderly patients in order to safeguard them and the public from road traffic accidents.

Accidents, Traffic↗
PubMed1995

An audit of echocardiograms in acute left ventricular failure.

All patients with heart failure should have an echocardiogram to establish a diagnosis, both to aid treatment as well as for prognostic reasons. An audit of 100 case notes of patients admitted with acute left ventricular failure over a 12-month period found that 26 patients had not had an echocardiogram. Of the 74 who did have an echocardiogram 68 patients had reduced systolic function (mean ejection fraction 42%). Almost all (93%) were commenced on an angiotension-converting enzyme (ACE) inhibitor. Those who did not receive an ACE inhibitor had no contraindications to these drugs. Seventeen patients had a confirmed myocardial infarction. Of these, 11 had an echocardiogram and 10 were discharged home on an ACE inhibitor. Despite appropriate indications some patients are deprived of echocardiography as well as the benefits of ACE inhibitors.

Acute Disease↗
PubMed1995

Comparison of treatment regimens for pediatric lymphoblastic non-Hodgkin's lymphoma: a Childrens Cancer Group study.

PURPOSE: Patients with lymphoblastic non-Hodgkin's lymphoma (LB NHL) were randomized to treatment with either modified LSA2L2 or ADCOMP, which added daunorubicin (DAUN) and asparaginase (L-ASP) to the methotrexate (MTX), cyclophosphamide (CYT), vincristine (VCR), and prednisone (PRED) (COMP) regimen, in a clinical trial to determine the relative effectiveness and toxicity of the two regimens. PATIENTS AND METHODS: Patients with LB NHL were eligible for this randomized study if they were less than 22 years of age at diagnosis and had < or = 25% blasts in the bone marrow. Of 307 patients registered, 281 were fully eligible and assessable. Patients were stratified by extent of disease at diagnosis. RESULTS: The 5-year event-free survival (EFS) rate for patients with localized disease was 84%, and for patients with disseminated disease, 67%. There were four relapses in 28 patients with localized disease. Two hundred six patients had mediastinal primary tumors and despite local radiation, 34 of 63 failures in these patients involved the primary tumor site with or without other involvement. After adjusting for extent of disease at diagnosis, the regimens did not differ significantly with respect to risk for adverse events. The acute toxicity was primarily neutropenia and thrombocytopenia, with greater initial toxicity in patients on the LSA2L2 regimen. Three patients developed acute myelogenous leukemia. CONCLUSION: Long-term EFS in children with LB NHL can be achieved in the majority of patients. Disease progression, which includes recurrence at the primary tumor site, is a major cause of treatment failure in patients with mediastinal presentations. Addition of DAUN and L-ASP to the COMP regimen does not produce a more effective treatment than LSA2L2.

Adolescent↗
PubMed1995

Interobserver variation in the computed tomographic evaluation of mediastinal lymph node size in patients with potentially resectable lung cancer. Canadian Lung Oncology Group.

OBJECTIVE: To measure the reliability of the assessment of mediastinal lymph node size in computed tomographic (CT) scans of the thorax. DESIGN: Observer agreement study in which radiologists, blinded to one anothers' interpretation, were randomized to read 30 scans each. POPULATION: Sixty scans from patients with apparently operable non-small cell carcinoma of the lung were read by radiologists responsible for clinical interpretation (clinical radiologists) and four radiologists with a special interest in thoracic CT (study radiologists). MEASUREMENTS: Radiologists measured the size of left and right superior mediastinal nodes, aortic nodes, and the subcarinal nodes and, on the basis of whether any nodes accessible to mediastinoscopy were greater than 1 cm, recommended whether mediastinoscopy be undertaken. Agreement was quantified using kappa, a measure of chance-corrected agreement. RESULTS: Among all radiologists, agreement on whether there were any nodes larger than 1 cm for right superior mediastinal nodes was 0.68; for left superior mediastinal nodes it was 0.28; for aortic pulmonary nodes it was 0.62; for subcarinal nodes it was 0.58; and for any node greater than 1 cm and accessible to mediastinoscopy it was 0.61. The agreement was very similar when the analysis was restricted to the study radiologists. CONCLUSION: Although the good level of overall agreement suggests that CT provides useful information in the evaluation of mediastinal lymph node size, the disagreement was sufficient that it likely contributes to suboptimal sensitivity and specificity of CT in detecting tumor spread reported in previous studies.

Carcinoma, Non-Small-Cell Lung↗
PubMed1995

1995 student writing contest winner: glenohumeral joint impingement in swimmers.

The purpose of this paper is to look at the different motions swimmers produce while practicing their sport and how these different motions cause problems with glenohumeral joint impingement, or "swimmer's shoulder." All four competitive strokes were analyzed to determine their effect on shoulder pain. Reasons for swimmers' impingement problems include long and demanding training seasons, lack of strength and flexibility, hypovascularity in the rotator cuff tendons, and different bony configurations that may predispose athletes to shoulder pain. Current methods of prevention of glenohumeral joint impingement syndrome include strengthening and flexibility exercises and supervision of proper stroke mechanics. Treatment includes the use of modalities, such as ice, ultrasound, electrical muscle stimulation, NSAIDs, and pain-free exercises.

Journal Article↗
PubMed1995

Invasive electroencephalography in mesial temporal lobe epilepsy.

Invasive EEG recording of spontaneous seizures and correlations of findings with histopathology have defined a characteristic set of electrographic findings in medial temporal lobe epilepsy. The presence of periodic spikes before seizure onset has a significant correlation with reduced CA1 cell counts. This phenomenon is followed, in spontaneous seizures, by 13-25 Hz discharge in medial temporal lobe structures. Temporal neocortical seizure onsets have significantly faster frequencies than hippocampal onsets; hippocampal ictal onset frequencies also vary more often than neocortical onsets. Although hippocampus or entorhinal cortex are involved to a variable degree, the periodic spikes are more consistently seen in hippocampus. Sixty percent of mesial temporal ictal onsets initially propagate to the ipsilateral temporal neocortex. In another 30%, the initial area of propagation is the contralateral hippocampus, to which propagation occurs before involvement of the ipsilateral or contralateral temporal neocortex. Time to propagation of the seizure to the contralateral hippocampus is lengthened in direct proportion to CA4 cell loss, suggesting a role for CA4 in this process. Long interhemispheric propagation times are associated with good surgical outcomes and with the presence of mesial temporal sclerosis. This article also discusses correlation with hippocampal slice physiology, and significance of these findings in understanding the pathophysiology of medial temporal lobe epilepsy.

Electroencephalography↗
PubMed1994

Sequence of the sheep fetal beta globin gene and flanking region.

The sheep beta F globin gene has been sequenced completely, including 829 bases of 5' flanking region and 1368 bases 3' to the stop codon. In evolutionary terms, this gene is a homolog of the adult beta-like globin genes, including human beta. Over the course of evolution of Bovidae (comprised of sheep, goats, and cattle) the expression of beta F has become restricted to the fetal compartment of development. Comparisons between beta F and other closely related Bovidae beta globin genes indicate repetitive sequences that were inserted in these genes over the course of their divergence and a region which may be functionally significant to the developmentally regulated expression of beta F.

Animals↗
PubMed1994

Within-session changes in peak N160 amplitude of flash evoked potentials in rats.

The negative peak occurring approximately 160 ms after stimulation (peak N160) of flash evoked potentials (FEPs) of rats changes with repeated testing. Habituation, sensitization, and arousal have all been invoked to explain these changes, but few studies have directly tested these explanations. We examined within-session changes in peak N160 amplitude with repeated testing, and the modulatory effects of stimulus intensity and auditory white noise. Peak N160 amplitude increased with daily testing (between-session changes), and was larger at greater stimulus intensities. In contrast, peak N160 amplitude underwent within-session increases on early days and within-session decreases on later days. The within-session changes were not affected by stimulus intensity. In rats previously tested in a quiet environment, exposure to acoustic white noise increased motor activity and transiently decreased peak N160 amplitude, which then increased and subsequently decreased with continued photic and acoustic stimulation. Repeated testing in the presence of noise did not alter the within-session changes in peak N160 amplitude. Heart rate showed both within- and between-session decreases, but was unaffected by noise. The data suggest that the within-session changes in peak N160 amplitude may reflect a habituation-like response to the test environment.

Acoustic Stimulation↗
PubMed1994

A study of the nutritional status of elderly patients with Parkinson's disease.

Patients with Parkinson's disease tend to lose weight although the reasons are uncertain. Fifteen patients with stable Parkinson's disease who had lost at least 5 kg in weight, and 15 age- and sex-matched control subjects were studied. All subjects underwent physical examination, anthropometric measurements, biochemical and haematological screening, measurement of tumour necrosis factor and full dietary assessment. The Parkinson's disease patients who had lost a mean of 6.2 kg had significantly less body fat and a lower total peripheral lymphocyte count than the control subjects. Dietary analysis showed a higher daily intake of calories in the patients which was derived from an increased carbohydrate intake. Tumour necrosis factor was not detected in either the patients or control subjects. Parkinson's disease patients lose weight in spite of an increased calorie intake. This may reflect an increased metabolic rate.

Aged↗
PubMed1994

Soul on fire.

Explore the source record for details and available documents.

Adult↗
PubMed1994

Consultation patterns in a community survey of men with benign prostatic hyperplasia.

BACKGROUND: The Stirling benign prostatic hyperplasia natural history group have previously reported a prevalence of this condition of 255 per 1000 in a community study of 1610 men aged 40-79 years. AIM: It was decided to examine the consultation patterns of men with benign prostatic hyperplasia in greater detail. METHOD: All participating men were invited to complete a previously validated lifestyle questionnaire including questions on consultations with their general practitioner during the previous year and previous history of prostatic problems. The men who had a urinary symptom score greater than 11, or who had a urinary flow rate of less than 15 ml per second were examined by transurethral ultrasonography for prostate size. RESULTS: Of 364 men with benign prostatic hyperplasia, 89% had not consulted their doctor about urinary symptoms in the year prior to the study. Men with moderate to severe urinary symptoms were six times more likely to have consulted their doctor than those with mild symptoms. Moderate to severe symptoms and greater interference with daily living activities were both associated with a greater likelihood of consultation, independent of age. Of all the men in the study referred to the specialist clinic for assessment of prostate size by transurethral ultrasonography, two thirds were referred because of low urinary flow rate and one third because of high urinary symptom scores. The reported consultation data showed a reverse ratio of one third of those consulting having a low urinary flow rate and approximately two thirds having urinary symptoms. CONCLUSION: While mass screening is unjustified, there is a need for patient education about benign prostatic hyperplasia in general and the recognition of declining strength of urinary flow as a symptom of benign prostatic hyperplasia and not of ageing alone. Furthermore, evaluation of primary care use of urinary flowmeters and the development of local protocols are suggested as elements of a case finding strategy for benign prostatic hyperplasia based on patient led consultation.

Adult↗