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Biomedical subjects

E Blair

Publications and source records attributed to E Blair.

At least 19 recordsLinked to original sources
PubMed1992

Intrauterine growth and spastic cerebral palsy II. The association with morphology at birth.

This study tests the hypothesis that children with spastic cerebral palsy had different birth morphologies, defined in terms of their weight, length, head circumference, ponderal index and length to head circumference ratio, from that of the normal liveborn population. An earlier study showed a highly significant association of spastic cerebral palsy with low birthweight for gestational age in infants over 34 weeks gestation at delivery. This analysis defines morphological measurements as "abnormal" if not within the 10th-90th percentile ranges of appropriate total liveborn populations. The proportions with combinations of such measurements in 104 cases of spastic cerebral palsy from a population register of cerebral palsy are compared with those in a total liveborn population. Categories of 'abnormal' measurements associated with increased risk contained 44.4% of cases in excess of the proportion observed in the total population. More than half these excess cases were short for their gestation (suggesting size deficits originating before the 3rd trimester) and tended to have more severe forms of cerebral palsy. A further excess of 7.4% of cases had a head circumference above their 90th percentile: these generally developed mild cerebral palsy.

Birth Weight↗
PubMed1992

Detection of HIV in haemopoietic progenitors.

Peripheral blood cytopenias present a major problem in the management of patients with HIV infection. Their pathophysiology is likely to be multifactorial, although there is controversy as to whether haemopoietic progenitors are a target for HIV. In order to investigate the haemopoietic defect in HIV infection, we looked at bone marrow culture characteristics of marrow from eight HIV+ patients compared to normal controls. We performed long-term liquid culture (LTC) and colony forming assays for granulocyte-macrophage (CFU-GM) and granulocyte, erythroid, megakaryocyte, macrophage (CFU-GEMM). In LTC we found normal stromal appearance and haemopoietic focus formation. There was no difference in colony assays of CFU-GM and CFU-GEMM between HIV+ and normal controls. Colonies taken from CFU-GM and CFU-GEMM were analysed for HIV DNA sequences, and we were able to detect HIV DNA in colonies from all HIV+ patients. Our results indicate that despite infection of haemopoietic progenitor cells by HIV, bone marrow function is preserved. This suggests that HIV-related cytopenias may be due to alternative mechanisms not present in our in vitro system.

Adult↗
PubMed1991

Why have we failed to reduce the frequency of cerebral palsy?

OBJECTIVE: To review the data on children with cerebral palsy in relation to quality of obstetric care. DATA SOURCES AND STUDY SELECTION: In our Institute, a regular Medline print-out, certain key journals and Current Contents are perused to create an updated computerised file of publications on the epidemiological, aetiological and other aspects of cerebral palsy. For this study we reviewed data from the Western Australian Cerebral Palsy Register, more than 150 publications from which studies were chosen for sound methodology in countries with modern obstetric practices, and recent population data on cerebral palsy. DATA EXTRACTION AND SYNTHESIS: Three major areas were studied to see: (i) if the prevalence of cerebral palsy has fallen with increasing use of obstetric and neonatal interventions aimed at reducing birth asphyxia; (ii) if there is any evidence that cerebral palsy is caused by birth asphyxia; and (iii) if there is any evidence that intrapartum fetal monitoring or caesarean section reduces the prevalence of cerebral palsy. CONCLUSIONS: We concluded that: cerebral palsy proportions are not falling in spite of significant increases in obstetric and neonatal interventions aimed at reducing asphyxia; cerebral palsy proportions in low birthweight infants are rising in most developed countries, coincident with increases in the neonatal survival of low birthweight babies; few cases of cerebral palsy seem to be caused by birth asphyxia and those that are may not have been preventable by obstetric care; and parents will continue to sue if obstetricians keep promising perfection from obstetric care in the face of 2.0-2.5 cases of cerebral palsy per 1000 children born.

Asphyxia Neonatorum↗
PubMed1990

Intrauterine growth and spastic cerebral palsy. I. Association with birth weight for gestational age.

Birth weight, gestational age at delivery, and other factors were collected for 171 white children with spastic cerebral palsy. Their birth weights were compared with the birth weight distribution expected for a population of the same race, gestation, sex, maternal height, and parity, born in the same geographic area, and during the same time period. Birth weights of children with spastic cerebral palsy tended to be significantly lower than the median birth weight of their comparison population. Analysis stratified by gestation at delivery suggested that if the reduced birth weight were causally associated with the spastic cerebral palsy, 22% of cases were attributable to being below the 10th percentile of the comparison population birth weight distribution. The risk of spastic cerebral palsy associated with poor intrauterine growth was dependent on gestation at delivery; poorly grown infants delivered between 34 and 37 weeks' gestation were at highest risk. Some probable pathways by which growth retardation could result in brain damage (intrapartum hypoxia, hypoglycemia, and hypothermia) were investigated. Only intrapartum hypoxia may have played a causal role but probably accounted for less than 2% of all cases. These data suggest that spastic cerebral palsy is associated with poor intrauterine growth in infants of more than 33 weeks' gestation, but no important causal mechanism has yet been identified.

Birth Weight↗
PubMed1990

Deliberations on nursing administration practice.

Blair and O'Brien orient us to the conference where this issue's articles on nursing administration education originated. The authors stress the critical need for development of nursing administration theory.

Career Mobility↗
PubMed1989

Transvaginal ultrasonography in patients at risk for ectopic pregnancy.

Transvaginal ultrasonography was performed in 139 patients at risk for ectopic pregnancy. Among these patients, 22 ectopic pregnancies and 117 intrauterine pregnancies were eventually confirmed. Transvaginal ultrasonography definitively identified 18 of 22 (82%) ectopic pregnancies at initial evaluation by either direct visualization of an ectopically placed gestational sac (N = 14) or failure to visualize an intrauterine gestational sac combined with a level of the beta-subunit of human chorionic gonadotropin greater than 1300 mIU/ml (First International Reference Preparation) (N = 4). Transvaginal ultrasonography definitively diagnosed 103 of 117 (88%) intrauterine pregnancies at initial evaluation. Eighteen patients could not be definitively diagnosed by transvaginal ultrasonography at initial evaluation because nonvisualization of a gestational sac and a beta-subunit of human chorionic gonadotropin value less than 1300 mIU/ml. Evaluation of this group with serial measurements of beta-subunit of human chorionic gonadotropin, repeat ultrasonography, or both, revealed ectopic gestation (N = 4), early intrauterine pregnancy (N = 4), and complete abortion (N = 10).

Chorionic Gonadotropin↗
PubMed1989

Rapid detection of vaginal colonization with group B streptococci by means of latex agglutination.

Latex agglutination testing for colonization of the vagina with group B streptococci was carried out in 1100 patients. Samples underwent latex testing after 8 to 12 hours of preincubation in selective growth medium. This technique allowed a sensitivity of 91.8% and specificity of 97.6%. This study demonstrates the usefulness of latex agglutination testing in the detection of vaginal colonization with group B streptococci.

Female↗
PubMed1988

The effects of physical activity as maintenance for smoking cessation.

The effects of physical activity as a maintenance strategy for smoking cessation were evaluated. After a standard smoking cessation program, forty-two women were randomly assigned to one of three groups that received equal number of maintenance meetings: a physical activity program, smoking habit change information and contact control. Abstinence decreased from 83% at the end of treatment to 73% at 3 months, 49% at six months and 34% at 18 months. No differences were shown in cessation across groups. Group differences were shown for subjective levels of tension-anxiety, those who exercised showed increased tension anxiety levels compared to subjects in the no activity groups.

Adult↗
PubMed1988

Intrapartum asphyxia: a rare cause of cerebral palsy.

Data on all children with spastic cerebral palsy (N = 183) and on a matched group of control children (N = 549) born in Western Australia between 1975 and 1980 were compared to investigate the relationship between birth asphyxia and spastic cerebral palsy. Information on perinatal events for both the children with cerebral palsy and the control subjects was collected by means of epidemiologic methods to reduce bias. An association between clinically observed perinatal signs of birth asphyxia and spastic cerebral palsy was found (relative risk 2.84; 95% confidence interval 1.85 to 4.37). The population-attributable risk proportion was 14.1%. The likelihood of birth asphyxia's causing perinatal brain damage was assessed by two independent observers using defined criteria. It was estimated that in only about 8% (15/183) of all the children with spastic cerebral palsy was intrapartum asphyxia the possible cause of their brain damage. The contribution of intrapartum events and obstetric mismanagement to overall cerebral palsy rates is probably less than was previously thought.

Apgar Score↗
PubMed1985

Interobserver agreement in the classification of cerebral palsy.

Interobserver variation in diagnosis is thought to be an important source of bias in studies of cerebral palsy. Kappa (kappa) statistics were used as a measure of interobserver diagnostic agreement for two case series of 20 children attending an institution for the motor handicapped. kappa increased threefold after standardisation of diagnostic terms. Sources of diagnostic variation are discussed and possibilities and benefits of its further reduction explored.

Age Factors↗
PubMed1976

Autoxidation of polyunsaturated fatty acids: II. A suggested mechanism for the formation of TBA-reactive materials from prostaglandin-like endoperoxides.

The nature and mechanism of formation of the thiobarbituric acid (TBA)-reaction material produced in the autoxidation of polyunsaturated fatty acids (PUFA) or their esters has been studied. On the basis of chemical studies and spectroscopic evidence, it is concluded that the TBA test detects malonaldehyde which arises at least in part from the acid-catalyzed or thermal decomposition or endoperoxides (2,3-dioxanorbornane compounds). These endoperosides have structures related to those of the endoperoxides produced in the biosynthetic sequence leading to prostaglandins. A mechanism is proposed in which these endoperoxides are formed in a free radical cyclization process operating in competition with hydroperoxide formation during the autoxidation of PUFA or their esters containing three or more double bonds. When 20:3 or 20:4 PUFA undergo autoxidation, some of the natural, physiologically active prostaglandins would be produced, although in very low yield, along with many other stereo- and positional isomers. Thus, it is possible that some of the complex symptoms of lipid peroxidation in vivo could be due to nonenzymatically produced prostaglandins or their steroisomers.

Chemical Phenomena↗
PubMed1976

Significance of the electrocardiogram in heart contusion due to blunt trauma.

In a series of 24 patients with major blunt chest trauma, 11 presented evidence of heart injury upon re-examination of serial ECGs and four were confirmed at autopsy. The clinical diagnosis had been recorded in only one patient. In every case of closed chest trauma, regardless of the degree of visible injury, cardiac injury must be suspected. A presumptive diagnosis is then made, usually on the basis of ECG changes, which cannot be ruled out by any other cause. Even in some cases with normal ECGs the clinician's suspicion is the only guide. With a presumptive diagnosis made, the patient is treated as is any patient with an irritable myocardium; bedrest, avoidance of conditions which may precipitate arrhythmias, and of fluid overload, and treatment of these complications as they arise. Anticoagulants are usually avoided. Followup for long periods is indicated, because of the occasional emergence of chronic constrictive pericarditis or ventricular aneurysm.

Adult↗
PubMed1976

Pulmonary barriers to oxygen transport in chest trauma.

The pathodynamics of respiratory insufficiency are based upon the impairment of movement of O2 from the atmosphere to the pulmonary capillary blood. In blunt chest trauma the mechanisms can be clarified in terms of mechanical barrier phenomena. Two barriers are identified. The first is the mass or gross lung-thorax complex and is determined by integrity of the chest wall and ventilation of the lungs. Impairments are manifested by reduced PaO2. The second is the micro complex of the alveolocapillary membrane. The disturbance is a combination of VA/Q alterations and increased diffusion barrier block and is manifested by reduced PaO2 and increased A-aDO2. These are summarized in Table 5. The degree of alteration in PaO2, and especially in A-aDO2, can distinguish between flail (loss of chest wall integrity) and flail plus contusion (VA/Q and a-c block). Management of chest wall-lung gross problems is well established and relatively successful. The micro barrier disturbance is more complex and difficult.

Adult↗
PubMed1975

Primary mesenteric venous occlusive disease.

Primary mesenteric venous occlusive disease is a highly lethal disease. The only way to improve survival is early diagnosis and immediate laparotomy. The disease occurs in the older age group with a higher incidence in women and should be considered in the differential diagnosis of serious abdominal distress. The most helpful diagnostic tests are paracentesis and peritoneoscopy, but above all, the most important diagnostic tool is a high index of suspicion on the part of the examining physician.

Adult↗