Biomedical subjects
Publications and source records attributed to G Browne.
Systemic amyloidosis is a rare but recognized complication of dystrophic epidermolysis bullosa. We report the cases of two siblings with recessive dystrophic epidermolysis bullosa who died of complications associated with systemic amyloidosis (AA type). This is the first report of systemic amyloidosis in siblings with dystrophic epidermolysis bullosa.
This study was designed to test the effectiveness of three computerized methods of record linkage, using minimal identifiers. The goal of the linkage was to determine the proportion of persons receiving Public Health Nursing Services (n = 5,749) who also receive income assistance from the region (n = 38,800) or the province (n = 16,741). The first linkage method was based on full agreement of a number of variables (deterministic matching) and the second was based on the likelihood of the match (probabilistic matching). The third method combined information from methods 1 and 2. Method 3 proved to be the most effective linkage technique, with a specificity of 0.98 and sensitivity of 0.94. The linkage showed that only 17% of the Public Health clientele received income assistance from the region or province, much lower than expected. Factors which have probably led to an underestimate are discussed.
We describe the anaesthetic management of an elderly woman who underwent thoracoscopically assisted trans-hiatal oesophagectomy. One-lung ventilation with insufflation of carbon dioxide was necessary for adequate surgical access. Potential intra-operative problems included hypoxaemia during one-lung ventilation, mediastinal shift and inadvertent damage to mediastinal structures.
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OBJECTIVE: To determine the prevalence of recognized and unrecognized health concerns and risks in an elderly population. DESIGN: Questionnaire survey. SETTING: Institutional primary care practice in a small southern Ontario city. PATIENTS: Volunteer sample of all patients older than 65 years (N = 1385) who were registered with the practice; were not demented, unstable, or residing in institutions at the time of contact; consented to participate; and completed a questionnaire (n = 674). MAIN OUTCOME MEASURES: Self-reported health concerns and health risks, including compliance with periodic health examinations; patient-generated concerns; and medical, lifestyle, and psychosocial issues. RESULTS: Most (92%) patients had at least one health concern or risk; 83% of these had one or more unreported or unrecognized health concerns or risks. The proportion with at least one concern or risk did not differ by sex or by age group. Many but not all complied with periodic health examinations. Loneliness was a meaningful psychosocial problem. Many patients had unreported medical concerns; the proportion rose slightly with age. Seniors with more concerns visited more frequently. CONCLUSIONS: Although most seniors had health concerns or risks, on average, each patient had only one or two concerns. These concerns are not concentrated in any particular area. Although non-attenders have fewer concerns, many have risk factors for diseases likely to progress without preventive measures, such as influenza vaccine and screening procedures for hypertension and breast, cervical, and prostate cancer.
Conventional solution-phase polymerase chain reaction (PCR) and in situ PCR/PCR in situ hybridization are powerful tools for retrospective analysis of fixed paraffin wax-embedded material. Amplification failure using these techniques is now encountered in some centres using archival fixed tissues. Such 'failures' may not only be due to absent target DNA sequences in the tissues, but may be a direct effect of the type of fixative, fixation time and/or fixation temperature used. The type of nucleic acid extraction procedure applied will also influence amplification results. This is particularly true with in situ PCR/PCR in situ hybridization. To examine these effects in solution-phase PCR, beta-globin gene was amplified in 100 mg pieces of tonsillar tissue fixed in Formal saline, 10% formalin, neutral buffered formaldehyde, Carnoy's Bouin's, buffered formaldehyde sublimate, Zenker's, Helly's and glutaraldehyde at 0 to 4 degrees C, room temperature and 37 degrees C fixation temperatures and for fixation periods of 6, 24, 48 and 72 hours and 1 week. DNA extraction procedures used were simple boiling and 5 days' proteinase K digestion at 37 degrees C. Amplified product was visible primarily yet variably from tissue fixed in neutral buffered formaldehyde and Carnoy's, whereas fixation in mercuric chloride-based fixatives produced consistently negative results. Room temperature and 37 degrees C fixation temperature appeared most conducive to yielding amplifiable DNA template. Fixation times of 24 and 48 hours in neutral buffered formaldehyde and Carnoy's again favoured amplification.(ABSTRACT TRUNCATED AT 250 WORDS)
AIMS: To investigate the feasibility of using fixed cells with the polymerase chain reaction (PCR) in situ hybridisation and to investigate possible reasons for reaction failure. METHODS: Fixed SiHa and CaSki cells were used in an experimental model of PCR in situ hybridisation for the detection of low and intermediate copy number viral infection in fixed cells. RESULTS: PCR in situ hybridisation was able to detect one to two copies of human papillomavirus (HPV) 16 in SiHa cells, using small fragment amplicons (120 base pairs), confirming the high detection sensitivity and flexibility of the technique. Problems were encountered with localisation of PCR amplified product in CaSki cells (200-300 copies of HPV 16 per cell) owing to diffusion of product post amplification. Overall, 40% of reactions were successful, which confirms the current unreliability of the technique. Within cell preparations, about 50% of cells contained amplified product. CONCLUSION: PCR in situ hybridisation represents the marriage of two revolutionary molecular pathological techniques. However, it is currently unreliable, with reaction failure common. Standardised, dedicated equipment is urgently required if the technique is to achieve universal acceptance. In the future, the technique may be used to detect chromosomal translocations in human tumours and to study cellular gene expression.
A questionnaire was sent to Canadian otolaryngologists to assess their continuing medical education interests. One hundred and eighty-seven completed questionnaires were returned, a response rate of 28.5%. The categories of highest interest were nose/sinus, otology/vestibular, and general otolaryngology. Lower overall ratings were found for head and neck surgery and facial plastic/reconstructive surgery topics.
The characteristics and use of respite services of 64 caregivers of severely cognitively impaired clients were correlated with the caregivers' purposes-in-life and burden outcome scores. Caregiver well-being was similar across users of a variety of respite service packages. Correlates of caregiver well-being, in spite of their burdens, were caregiver hardiness and favourable meaning given illness. Both of these cognitive variables exceeded the importance of perceived social support in explaining the variation in caregiver purpose-in-life.
Home-based traction is an alternative treatment to conventional hospital-based traction for children with orthopedic conditions such as congenital dislocated hip and Legg-Perthes disease. The application of a proposed theoretical model is used to describe the process of the home-based traction innovation. Creativity and innovation occasions a reconceptualization of stresses. The reconceptualization of stress, plus the operational support of coordinated in-home services, can help families and nurses in the community and in the hospital develop, implement, and evaluate this kind of innovative care. In applying the home-based traction professionals empower and legitimize parents as resourceful co-providers of care. The legitimizing of the alternative in-home service affords parents a more optimistic appraisal of their situation as manageable. Parents are free to develop a coordinated response to their overall circumstance, including the treatment of their one child's illness. The evaluation of this home-based traction example found the alternative to be acceptable, safe, effective in accomplishing treatment goals, and less expensive than conventional hospital-based traction.
In order to determine the accuracy of predictions made using Physician Impact Analysis (PIA), a comparison was undertaken of predicted versus actual resource use for 10 new physician specialists at a southern Ontario community hospital. The predictions were done from 1987 to 1989 using methodology recommended by the Ontario Hospital Association (OHA) and available at that time. This included (1) Hospital Medical Records Institute data and (2) a hospital service department survey. A comparison was made between PIA predictions and actual physician resource utilization data gathered in 1991. There was little agreement between the two. The usefulness of PIA rests largely on its ability to generate accurate predictions about a new physician recruit's number of cases and hospital resource use. However, because this research was undertaken in only one community hospital, further evaluation of the PIA process is recommended.
1. Although a range of factors can contribute to urinary incontinence in long-term care residents, it is more closely associated with a decline in both cognitive and functional status. 2. Although all subjects had to be cognitively impaired to participate in the study, the incontinent group had a significantly lower mean score on the mental status examination than did the continent group. 3. Incontinent subjects were more dependent in activities of daily living and took significantly longer to carry out functional tasks specifically related to toileting. 4. Urinary incontinence was strongly associated with a history of urinary tract infections, positive urine cultures, epididymitis, hematuria, and fecal incontinence. Medical diagnosis, medications, and affective status were not associated with the problem.
There is a plethora of studies investigating psychosocial adjustment in women with breast cancer, its correlates, clinical course, and prognosis. These studies have been conducted with varying degrees of methodologic rigor. An assessment has been made of the quality of this existing evidence to identify from the best evidence the factors which predict the adjustment status of women with breast cancer. Studies have been reviewed, using methodologic standards for the critical appraisal of studies on prognosis, developed by Sackett and colleagues in the Department of Clinical Epidemiology and Biostatistics at McMaster University (Hamilton, Ontario, Canada). Few of the studies investigating psychosocial adjustment of women with breast cancer meet all of the criteria for reviewing studies of clinical course and prognosis. This review focuses the direction and methodologic rigor required in future investigations. In particular, studies are needed that employ prospective designs and that deliberately measure or control for the extraneous prognostic variables that may affect adjustment. Future investigations need to incorporate adequate precision in measurement so that measures of the psychosocial variables are objective, reliable, and valid.
We made a retrospective study of 1770 infants with colic. Of these infants 206 were classified as having severe colic. Six of the infants with severe colic failed to respond to intensive behaviour management and were found to have urinary infection. Later investigation revealed that all six had significant renal disease. We recommend that all infants with colic who do not respond rapidly to conventional management be investigated for urinary tract infections.
Often, it is difficult to distinguish follicular lymphoma from reactive follicular hyperplasia histologically. Immunotypic evidence of monoclonality cannot be demonstrated routinely or reliably in routine paraffin-embedded sections. To determine whether a panel of monoclonal antibodies reactive with lymphoid cells in paraffin-embedded sections might be useful in distinguishing these confusing proliferations, the authors examined 45 follicular lymphomas and 30 follicular hyperplasia with the following antibodies; L26, B2, MT1, MT2, and UCHL-I. All sections were routine paraffin preparations from formalin- or B5-fixed tissue and were immunostained with the avidin-biotin immunoperoxidase technique. Ninety-two percent of the B5-fixed and 77% of the formalin-fixed lymphomas were MT2 positive. None of the reactive hyperplasias stained positively, and none of the other antibodies demonstrated consistent differences between these benign and malignant proliferations. MT2 marks interfollicular T cells and mantle-zone B cells in normal lymph nodes but does not mark normal germinal centers; this staining pattern is retained in reactive hyperplasia. However, paradoxically, in most follicular lymphomas the neoplastic germinal centers show aberrant MT2 positively. The authors conclude that MT2 may be useful in distinguishing follicular lymphoma from follicular hyperplasia in paraffin sections.
A Multidisciplinary Falls Consultation Service made possible a novel interdisciplinary approach to the patient as a faller. A team consisting of members from the medical, nursing, rehabilitation, administration, and activities departments reviewed epidemiological data on 323 falls and evaluated 24 patient referrals. Interventions at all clinical levels of staffing are being developed to reduce the risk of falling.
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The purpose of this study was to determine whether variables associated with psychosocial adjustment to a burn injury vary by gender. Male and female burned subjects (N = 260) were compared on their functional disability, disfigurement, coping responses, social resources, and psychosocial adjustment to a burn injury. Both men and women had adjusted psychosocially to their burn injury. Less functional disability (r = .57, p less than .001) for men and greater problem-solving (r = .57, p less than .001) for women were the most important variables in explaining psychosocial adjustment to a burn injury. In the future, researchers need to be cognizant of gender differences and consider men and women as separate populations.