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Biomedical subjects

I Robertson

Publications and source records attributed to I Robertson.

At least 91 records · Page 5Linked to original sources
PubMed1986

Plasma cholinesterase changes during the puerperium.

Changes in plasma cholinesterase activity during the puerperium were studied in 16 women who received epidural analgesia for labour followed by vaginal delivery, and in five women who underwent elective Caesarean section under epidural analgesia. A consistent fall in cholinesterase activity was demonstrated during the first 2 to 3 days post partum, followed by a rise to approximately normal nonpregnant values by the end of the puerperium. An additional patient who manifested prolonged paralysis following an emergency Caesarean section under general anaesthesia, including a suxamethonium infusion, was also studied. Possible mechanisms by which the transient decrease in cholinesterase activity is produced, and its clinical significance, are discussed.

Anesthesia, Epidural↗
PubMed1986

Evaluation of a self-help manual for media-recruited problem drinkers: six-month follow-up results.

A total of 785 individuals responded to a newspaper advertisement offering free help to cut down drinking and were sent alternately either a self-help manual based on behavioural principles or a general information and advice booklet. Of these, 247 (31.3 per cent) returned assessment questionnaires or agreed to be interviewed by telephone and 132 of these respondents (53.4 per cent) were successfully contacted at six-month follow-up. Those lost to follow-up were more 'socially stable' on initial measures than those successfully contacted. Results showed a greater reduction in previous week's consumption in the group receiving the manual than in the control group. In addition, respondents interviewed by telephone showed a greater reduction on a measure of alcohol-related problems and a higher proportion reducing drinking than those contacted only by post. There was no evidence that reductions in consumption were confined to relatively low consumers or to those showing only early signs of dependence on alcohol, irrespective of which type of material was received.

Adolescent↗
PubMed1986

A comparison of minimal versus intensive controlled drinking treatment interventions for problem drinkers.

Thirty-seven problem drinkers with problems of low to moderate severity were randomly allocated to two groups, one receiving 'minimal' treatment of three or four sessions' assessment and advice, and the other 'intensive' treatment of one or more of a selection of individually tailored, cognitive-behavioural therapies lasting an average of 9.1 sessions. The two groups were followed up an average of 15.5 months after termination of treatment. Analysis of covariance revealed that the intensive group reduced consumption significantly more than the minimal group. Also, the intensive group showed a significantly greater increase in the number of days abstinent in the month prior to follow-up. Analysis of covariance also showed that, in spite of their small numbers (n = 7), women increased their days abstinent by a significantly greater amount and reported a significantly greater reduction in number of days drinking between 10 and 20 units. Overall, successful outcome was associated with higher pre-treatment employment and higher alcohol consumption although, given the large numbers of measures, these findings could have occurred by chance.

Adult↗
PubMed1986

Effects of unemployment on drinking behavior: a review of the relevant evidence.

Although it is often asserted that drinking and drinking problems are likely to increase as a consequence of unemployment, there is little evidence at present to support such a view. However, reasons why such a relationship might be expected may be derived from the literature on the social, psychological, and health effects of unemployment and also from the relationship between drinking behavior and occupation. It is argued that any competent investigation must consider the stages of unemployment and a number of psychological and demographic variables which may moderate the effects of unemployment on drinking. Finally, two specific hypotheses are identified and requirements for future research suggested.

Adult↗
PubMed1985

Total body and serum electrolyte composition in heart failure: the effects of captopril.

We compared the long-term effects of captopril and placebo on patients with heart failure in a double blind crossover fashion. Serum and total body electrolytes were measured and the response to 6 week periods of treatment with captopril determined. During the placebo phase of the study, total body potassium was low at 92 +/- 14% of predicted normal (P less than 0.05) and total body sodium was high at 104 + 7% of predicted normal (P less than 0.05). Total body chlorine did not differ from predicted normal (99 + 12%). In those patients with active plasma renin concentrations above the normal range (greater than 50 microU ml-1) total body potassium was even more markedly deplete (85 + 13% of predicted normal). This group was also characterized by lower serum potassium and sodium concentrations and lower blood pressure. Total body potassium increased significantly on captopril, and the rise was greatest in those with the highest plasma renin concentrations during the placebo phase of the study. However, captopril had no significant effect on total body sodium and chlorine or weight indicating that no long-term natriuresis had occurred.

Aged↗
PubMed1985

Melanocytic dysplasia and melanoma.

A review of a series of 226 melanomas, representing 95% of the melanomas presenting in one year, has shown that 34% are associated with atypical melanocytic proliferation or melanocytic dysplasia in the adjacent skin. The dysplasia may be lentiginous, predominantly spindle-celled or non-lentiginous in pattern. These variants appear to correspond to the previously reported lesions, lentiginous and epithelioid melanocytic dysplasia and atypical melanocytic hyperplasia respectively. Some of these are referred to as dysplastic naevi. All these variants were seen in a review of 325 cases of melanocytic dysplasia. The variations are commonly seen within the same lesion and it is argued that they are variants of a single premalignant process which might best be termed melanocytic dysplasia. Melanocytic dysplasia is seen in white races, on non-exposed and exposed skin. They may be solitary as well as multiple and the majority are non-familial. Although melanocytic dysplasia may be a precursor of a large proportion of malignant melanomas it is suggested that most lesions mature into a benign intradermal melanonaevus. The behaviour of the lesions in any single patient appears to be proportional to the number and cellularity of the lesions and the strength of the family history. A diffuse mottled pattern of melanocytic dysplasia appears to have a particularly unfavourable prognosis.

Female↗
PubMed1985

Effects of enalapril in heart failure: a double blind study of effects on exercise performance, renal function, hormones, and metabolic state.

Several studies have shown symptomatic and haemodynamic improvement after the introduction of angiotensin converting enzyme inhibitors in patients with heart failure treated with diuretics. The concomitant long term effects of the new orally effective long acting angiotensin converting enzyme inhibitor, enalapril, on symptoms, exercise performance, cardiac function, arrhythmias, hormones, electrolytes, body composition, and renal function have been further assessed in a placebo controlled double blind cross over trial with treatment periods of eight weeks. Twenty patients with New York Heart Association functional class II to IV heart failure who were clinically stable on digoxin and diuretic therapy were studied. Apart from the introduction of enalapril, regular treatment was not changed over the study period; no order or period effects were noted. Enalapril treatment significantly improved functional class, symptom score for breathlessness, and exercise tolerance. Systolic blood pressure was significantly lower on enalapril treatment. Echocardiographic assessment indicated a reduction in left ventricular dimensions and an improvement in systolic time intervals. In response to enalapril, the plasma concentration of angiotensin II was reduced and that of active renin rose; plasma concentrations of aldosterone, vasopressin, and noradrenaline fell. There were significant increases in serum potassium and serum magnesium on enalapril. Glomerular filtration rate measured both by isotopic techniques and by creatinine clearance declined on enalapril while serum urea and creatinine rose and effective renal plasma flow increased. Body weight and total body sodium were unchanged indicating that there was no overall diuresis. There was a statistically insignificant rise in total body potassium, though the increase was related directly to pretreatment plasma renin (r = 0.5). On enalapril the improvement in symptoms, exercise performance, fall in plasma noradrenaline, and rise in serum potassium coincided with a decline in the frequency of ventricular extrasystoles recorded during ambulatory monitoring. Adverse effects were few. In patients with heart failure, enalapril had a beneficial effect on symptoms and functional capacity. The decline in glomerular filtration rate on enalapril may not be beneficial in early heart failure.

Angiotensin II↗
PubMed1984

Untreated Hansen's disease of the eye: a clinicopathological report.

A Maltese immigrant presented with intermittent bilateral anterior uveitis for which no cause could be found. The inflammation did not respond to topical treatment and ultimately the left eye developed a hypopyon and was enucleated. Histological examination revealed granulomatous inflammation and large numbers of Mycobacterium leprae throughout the anterior segment. Occasional foci of inflammation containing Mycobacterium leprae were found in the vitreous extending to the retina at the posterior pole. These findings in the posterior segment have rarely been reported. Eye infection in Hansen's disease is frequent and delays in diagnosis are common.

Adult↗
PubMed1984

Social skills training with mentally handicapped people: a review.

Four questions are asked about the use of social skills training procedures with mentally handicapped people. The first is, 'What are social skills in the context of mental handicap?', and it is suggested that they involve a complex array of perceptual, cognitive, motor and motivational processes, all of which can be disrupted due to various problems common among mentally handicapped people. The second question, 'What changes do social skills training programmes aim to achieve?', leads to the conclusion that most programmes have concentrated on motor, and to some extent on motivational processes, at the expense of perceptuo-cognitive ones. In asking, 'Have the programmes been successful in achieving these changes?', the answer is a guarded 'yes', given the limited aims of most investigators. Generalization to the natural environment has only occasionally been established, though it is often not measured. The fourth question is, 'What is the clinical significance of the changes obtained by such programmes and how can future ones be made more clinically relevant?'. The answer to the first part of the question is that, in general, their clinical utility has not been established. Future programmes could be made more clinically relevant if they were integrated with strategies for producing more benign and stimulating environments for mentally handicapped people.

Adolescent↗
PubMed1984

Captopril in heart failure. A double blind controlled trial.

The effect of the converting enzyme inhibitor captopril as long term treatment was investigated in 14 patients with severe congestive heart failure in a double blind trial. Captopril reduced plasma concentrations of angiotensin II and noradrenaline, with a converse increase in active renin concentration. Effective renal plasma flow increased and renal vascular resistance fell; glomerular filtration rate did not change. Serum urea and creatinine concentrations rose. Both serum and total body potassium contents increased; there were no long term changes in serum concentration or total body content of sodium. Exercise tolerance was appreciably improved, and dyspnoea and fatigue lessened. Left ventricular end systolic and end diastolic dimensions were reduced. There was an appreciable reduction in complex ventricular ectopic rhythms. Adverse effects were few: weight gain and fluid retention were evident in five patients when captopril was introduced and two patients initially experienced mild postural dizziness; rashes in two patients did not recur when the drug was reintroduced at a lower dose; there was a significant reduction in white cell count overall, but the lowest individual white cell count was 4000 X 10(6)/l. Captopril thus seemed to be of considerable value in the long term treatment of severe cardiac failure.

Captopril↗
PubMed1983

Enalapril in the treatment of hypertension with renal artery stenosis.

The converting enzyme inhibitor enalapril, in single daily doses of 10-40 mg, was given to 20 hypertensive patients with renal artery stenosis. The blood pressure fall six hours after the first dose of enalapril was significantly related to the pretreatment plasma concentrations of active renin and angiotensin II and to the concurrent fall in angiotensin II. Blood pressure fell further with continued treatment; the long term fall was not significantly related to pretreatment plasma renin or angiotensin II concentrations. At three months, 24 hours after the last dose of enalapril, blood pressure, plasma angiotensin II, and converting enzyme activity remained low and active renin and angiotensin I high; six hours after dosing, angiotensin II had, however, fallen further. The rise in active renin during long term treatment was proportionally greater than the rise in angiotensin I; this probably reflects the fall in renin substrate that occurs with converting enzyme inhibition. Enalapril alone caused reduction in exchangeable sodium, with distinct increases in serum potassium, creatinine, and urea. Enalapril was well tolerated and controlled hypertension effectively long term; only two of the 20 patients required concomitant diuretic treatment.

Adolescent↗
PubMed1983

Malignant Schwannoma of cranial nerves.

The clinical presentation and histopathological features of 5 cases of malignant Schwannoma of cranial nerves are described. The ultrastructural appearances of one case and the pattern of nerve sheath cell differentiation of these tumours are also discussed. These uncommon tumours often are not diagnosed at initial presentation. Since the cases provide evidence that early diagnosis and surgical treatment are vital in the management of patients with this tumour criteria for its diagnosis are suggested.

Adult↗
PubMed1983

The intermuscular septum of the inferior oblique muscle: revised concepts.

The classical anatomical descriptions of the inferior oblique muscle give little or no account of its intermuscular fascial septum. Operative and cadaver dissections show that a definite and constant fascial septum exists between the sheaths of the inferior oblique and the lateral and inferior recti. The clinical significance of this fascia is realised when it is pulled laterally, as its inner surface provides a guide to the inferior oblique sheath; also, when a muscle hook is placed under the lateral rectus muscle it may snag the septum and kink the inferior oblique and cause its overaction. The fascia forms a sling for the inferior oblique sheath and helps to maintain its line of action. For these reasons the intermuscular septum of the inferior oblique should be included in anatomical accounts of the ocular fascia and should be remembered during operations on the inferior oblique or lateral rectus muscles.

Eye↗