Biomedical subjects
Publications and source records attributed to J A Cunningham.
Diffuse cavernous rectal hemangioma is described through a case history. Presentation, diagnostic work up, pathophysiology, and therapy for this condition are reviewed. Emphasis is placed on rectal sparing surgical techniques in the management of this disease process that affects young, otherwise healthy individuals.
Blast injury remains an important source of trauma in both civilian and military settings. We have studied a recently developed blast wave generator to evaluate its effectiveness for laboratory study of blast injury. In order to determine the reliability of the device and the pathology of the lesions caused by the short duration (0.5-1.0 msec), and high intensity (60-375 psi) pressure wave, laboratory rats were exposed to the pressure waves generated by the machine. The animals were divided into three groups: the first exposed to midthoracic blasts, the second to abdominal blasts, and a group of controls exposed to a gentle stream of gas. Group I showed gross and microscopic evidence of lung blast injury of "rib imprint" hemorrhages, intra-alveolar hemorrhage, marked increase in lung weight, prolonged apnea, and bradycardia. Group II showed typical blunt abdominal trauma at the closest ranges, but characteristic submucosal hemorrhages up to 4.0 cm from the blast nozzle. In both groups, a protective effect was seen in heavier animals. The blast wave generator permits reproducible blast injury in the laboratory that is safer and faster than current methods. The lung and bowel lesions induced are grossly and microscopically similar to injuries of blast exposure seen in clinical patients.
Auranofin (SKF-D 39162) is an oral gold preparation for the treatment of rheumatoid arthritis. One of its major side effects is diarrhoea. To determine one possible mechanism for this we compared the effects of auranofin and myochrysine on intestinal water and solute transport in the rat. Jejunal perfusion with 2 mM auranofin (n = 5) induced fluid and electrolyte secretion and inhibited glucose absorption (p less than 0.01). Auranofin (0.2 mM) induced fluid secretion in the jejunum (n = 5; p less than 0.01) and colon (n = 6; p less than 0.01). In contrast, 2 mM myochrysine enhanced jejunal water and electrolyte absorption (n = 6; p less than 0.02). Both compounds enhanced absorption of mannitol (p less than 0.01). Perfusion of 0.2 mM auranofin for two hours had no significant effect on mucosal c-AMP levels (n = 4). After perfusion for two hours with 2 mM auranofin the jejunal mucosa showed severe injury by light and scanning electronmicroscopy while myochrysine had no apparent effect. The damage after perfusion with 0.2 mM auranofin for two hours was less severe. Auranofin was more rapidly absorbed than myochrysine (p less than 0.05). These effects provide an explanation for the diarrhoea associated with auranofin therapy.
Hierarchically structured thesauri--including MeSH--were studied to test the assumption of an inverse relationship between term specificity and the number of postings in online databases. It was suggested that this assumption holds only for peripheral terms and that the opposite is true for the central terms of a discipline. The Environment tree structure of MeSH was used to test the "peripheral" hypothesis, which was supported at a .05 level of significance, but the scattergram on the Endocrine Diseases tree, which was run to test the "central" hypothesis, had an even better level, .02. The commonly held belief that specific terms are added to a thesaurus when more general ones get too many postings was also tested. The relationship between specificity and dates was supported in MeSH (.015). The corollary--that terms with later dates have fewer postings--was supported at a .001 level of significance. The results for MeSH were much more significant than for other hierarchically structured thesauri, which indicates that thesaurus development at NLM involves interaction with MEDLINE to preclude an excessive number of postings to any one term.
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Reasons for delaying or not seeking treatment were compared between outpatient alcohol and drug abusers, and between alcohol abusers who had either resolved their problem without treatment, were currently not resolved, or were in an outpatient treatment program. Outpatient alcohol and drug abusers exhibited few differences in their endorsed reasons for delaying seeking treatment. There were, however, several differences between resolved and nonresolved alcohol abusers who had never sought treatment and alcohol abusers in treatment (e.g., endorsing items such as "wanted to handle problem on own," "didn't think I had a problem"). Such differences may explain why some problem drinkers do not seek treatment. Treatment implications of these findings are discussed.
Clients at two different treatment facilities were asked at assessment how influential each of 10 possible reasons were in their decision to change their alcohol or drug use. Clients at both facilities most often endorsed "weighing the pros and cons of drinking or drug use" and a "warning from spouse." Client's reasons for seeking treatment were also examined in relation to treatment compliance. Three reasons--"weighing the pros and cons," "hitting rock bottom," and experiencing a "major lifestyle change"--were predictive of treatment compliance. Clients who rated any of these reasons as influential were more likely to enter and complete treatment. Although more research is needed, knowledge of clients' reasons for seeking treatment might be useful in treatment matching.
This paper describes the rationale and design for a recently implemented study involving a community-based intervention designed to foster self-change for individuals who otherwise would be unlikely to seek formal help or treatment for their alcohol problem. The study is based on research examining natural recovery processes with alcohol abusers and on clinical trials using a Guided Self-Change model of treatment with problem drinkers. Advertisements and mailed pamphlets are used to solicit individuals who wanted to change their drinking on their own using self-help materials. Respondents are screened and, if eligible, are randomly assigned to two conditions: Guided Self-Change (GSC) or Educational Materials Control (EMC) (projected N = 788): All subjects complete and mail in several brief assessment forms. Subjects in the GSC group receive advice and personalized feedback based on their assessment answers. Subjects in the EMC group receive educational pamphlets prepared for general medical and mental health settings. Subject characteristics and drinking-related history variables for the first 10% of the sample are presented. Subjects will be followed up at 12 months following the intervention.
Results from several recent studies, particularly general population surveys, reveal that self-change (recovery from alcohol problems without treatment) is a major pathway to recovery from alcohol problems. Results from five different groups of subjects, however, suggest that most people are unaware of this fact. Reasons for this lack of awareness are discussed, and suggestions are made as to the implications of increasing the public's awareness about self-changes as a way of recovering from alcohol problems.
Prior research has indicated that the majority of people who resolve an alcohol problem or from smoking cigarettes do so without treatment. However, no similar data have been available for other drug resolutions. This article explores the service use of former drug users employing data from the 1994 Canadian Alcohol and Drug survey. It is concluded that, as for alcohol and smoking, the majority of individuals stop their drug use without treatment.
This paper describes an epidemiologic-based sample of individuals who remitted from alcohol abuse or alcohol dependence, both with and without treatment, to abstinence or moderate drinking. Inspection of the severity, onset, and duration of alcohol problems experienced by these individuals suggests that there may be two primary categories of drinkers with distinct pathways to remission. The first is a population of individuals who experience significant problems for an extended period of time who then resolve to abstinence through the use of treatment services. The second is a population of individuals who drink heavily at some point in their lives, experience some problems, and then "mature out" of this stage in their life as they age and take on other life roles.
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