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Biomedical subjects

J Barrett

Publications and source records attributed to J Barrett.

At least 415 records · Page 23Linked to original sources
PubMedDate not supplied

Mail consultations in ophthalmology. The Tenth Richard E. Hoover Lecture.

BACKGROUND: Although a number of diagnostic and therapeutic methods are available to assist the ophthalmologist, relatively little attention has been given to mail consultations. By this method, a clinical summary and photographs, fluorescein angiograms, ultrasonograms, and/or other relevant materials are mailed to a consultant who then renders an opinion by telephone and/or return mail. MATERIALS AND METHODS: The records of all mail consultations that were sent to the senior author and his colleagues during a 20 year period were reviewed to determine the total number of mail consultations, the reasons for the consultations, and the diagnoses and therapeutic recommendations that were made by the consultant. RESULTS: A total of 1357 mail consultations were received during the 20 year period, with a progressively increasing number of consultations each year. Consultations were received from 757 physicians representing all 50 states in the United States and 32 other countries. Because of the authors' subspecialty in ocular oncology and medical retinal diseases, the majority of the consultations received were related to those topics. In many cases, the initial diagnosis and treatment plan were altered based on our opinion through mail consultation. Based on the material received, the recommendations that we made included observation in 635 cases, enucleation in 152, surgical excision of a lesion in 120, plaque radiotherapy in 102, laser photocoagulation in 81, systemic evaluation in 40, external beam irradiation in 36, fine needle aspiration biopsy in 33, orbital exenteration in 25, chemotherapy in 21, and cryotherapy in 14. CONCLUSION: Although not as ideal as direct patient examination, mail consultation can be an effective method of making or confirming a diagnosis and obtaining a therapeutic opinion. Although the authors have received mail consultations related to ocular oncology, this method may be applicable to other subspecialties in ophthalmology and to general medicine.

Adult↗
PubMedDate not supplied

Recognition of depression by internists in primary care: a comparison of internist and "gold standard" psychiatric assessments.

In an effort to elucidate the process of internists' recognition of depression in primary care settings, a comparison of internist and "gold standard" psychiatric assessments of patients was undertaken in a rural primary care practice over a 15-month period. Clinical characteristics and diagnoses, global assessments of psychosocial stress, and two aspects of chief-complaint presentation style, clarity and somatization, were recorded by the internists for each patient, who was independently assessed by a psychiatrist for the presence of any specific depressive disorder by structured interview. Internists correctly labeled 57% of the interview-assessed depressives as depressed; 13% of patients with "no psychiatric disorder" were assessed as depressed by internists. Clinical and demographic characteristics of the "false-negative" and "false-positive" internists' diagnoses were examined to clarify how internists think of "depression" in the primary care context.

Adult↗
PubMedDate not supplied

Endovascular embolization of varicoceles: resorption of tungsten coils in the spermatic vein.

PURPOSE: To investigate whether resorption of tungsten coils occurs in patients with varicoceles treated by endovascular embolization of the spermatic vein. METHODS: Patients who had previously had varicocele embolization were requested by letter to attend the radiology department. Blood levels of tungsten were compared with a group of controls. Fluoroscopic images of the coils were taken and compared with those obtained during the original procedures. RESULTS: Nineteen patients attended, whose procedure had been done 19-57 months previously (mean 40 months). Blood levels of tungsten were raised in 18 patients compared with the controls. Radiographic evidence of loss of substance of the coils was seen in four patients. CONCLUSION: Tungsten coil resorption occurs in varicocele embolization. In view of the unknown long-term effects of raised blood tungsten levels and the availability of alternative embolization agents, we feel that it is unwise to persist in the use of tungsten coils in this application.

Adult↗
PubMedDate not supplied

Prevalence of depression and its correlates in a general medical practice.

A screening scale for depression, based on HSCL depression scale items, was used during a one-year period in a rural general medical practice. The estimated prevalence of depression was 8.8% for severe (probable depressive disorder) depression, 18.3% for moderate (depressive syndrome) depression, and 28.3% for mild depression. For all three levels of depression, there were significant relationships to sex and to marital status. For the higher level of depression, probable depressive disorder, there were significant relationships to age and to retirement status; these relationships were not evident at the moderate or the mild levels of depression.

Adolescent↗
PubMedDate not supplied

Strategies for detoxification of aldehydic products of lipid peroxidation in helminths.

Crude extracts from a number of helminths including Schistosoma intercalatum and Fasciola hepatica were able to detoxify known aldehydic products of lipid peroxidation. A major route for alk-2-enal and alka-2,4-dienal detoxification in parasitic helminths was via glutathione conjugation and glutathione transferase appeared to be responsible for the activity. As yet uncharacterised NADPH-linked systems may provide an important secondary pathway for detoxification of alk-2-enals and alka-2,4-dienals in parasitic helminths. The free-living nematode Panagrellus redivivus had higher active NADH/NADPH-linked aldehyde reduction systems compared to parasitic helminths. The NADH linked and NADPH linked reductions in P. redivivus were mitochondrial and cytosolic activities respectively. NADH/NADPH-linked systems may be responsible for alkanal reduction in helminths as there is no evidence of conjugation of alkanals with glutathione. P. redivivus and Haemonchus contortus were also able to oxidise aldehydes via NAD/NADP-linked systems.

Aldehyde Dehydrogenase↗
PubMedDate not supplied

Abnormal heart rate response during newborn sucking behavior study: subsequent sudden infant death syndrome with cardiac conduction abnormality.

This report concerns a four-month-old white female infant who exhibited abnormal feeding behavior and EKG irregularities during a newborn sucking behavior study. The immediate post-birth history showed an irregular heart rate on two occasions, but a cardiac consultation elicited no unusual findings. During sucrose sucking conditions, the heart rate increased with a beat-to-beat variation of 50 beats per minute, noted to be due to premature atrial beats. At 39 days, an EKG showed a marked sinus tachycardia of 156, a PR interval of 0.08, QRS of 0.05 and a QT of 0.26. The infant was diagnosed as a sudden infant death syndrome (SIDS) following an unexpected death at home. Subsequent cardiac pathology revealed an anomalous tract between the right atrium and the atrioventricular (AV) bundle which formed an extensive bypass of the AV node (atrio-His tract), and two accessory AV connections between the left atrium and posterior left ventricle. These findings are consistent with the Wolff-Parkinson-White syndrome type A. Only further studies can determine whether such abnormal feeding behavior with EKG irregularities can be used to identify infants who are at high risk for sudden death.

Arrhythmias, Cardiac↗
PubMedDate not supplied

The MacArthur Foundation Depression Education Program for Primary Care Physicians: background and rationale.

In order to improve the assessment and management of depression in general medical care, the John D. and Catherine T. MacArthur Foundation supported the development, evaluation, and dissemination of an eight-hour depression education program (DEP) for primary care physicians. This publication includes a paper describing the background and educational rationale for the program structure, the complete participant's workbook, and a facilitator's guide for teaching the program. Given in two separate four-hour workshops by a psychiatrist and a primary care physician, DEP is delivered to small groups of learners (about 12) using an interactive adult learning model and multiple teaching techniques including targeted yet flexible objectives, two lectures, videotape demonstration and discussion, role-play exercises, a focused monograph on depression, an interview checklist, structured assessment and outcomes tools, clinical case studies, and audiotape review of actual patient interviews. DEP has been shown in a prospective randomized trial to improve physicians' interview-ing skills as well as simulated-patient satisfaction scores. Over 150 PCPs in four states have taken DEP in more than 30 separate programs given by 24 trained facilitators. Participants, despite a wide diversity of background knowledge and skills, have uniformly reported remarkably positive learner satisfaction with all dimensions of the Program.

Depression↗
PubMedDate not supplied

Iselin's disease: a case presentation of nonunion and review of the differential diagnosis.

The confusing pathology of the proximal fifth metatarsal can make Iselin's disease difficult to distinguish from Jones', avulsion, or stress fractures, or os vesalianum. While lselin's disease appears to be rare due to the scarcity of cases in the medical literature, this may be due to misdiagnosis. The case report discusses the course of treatment for a young male with Iselin's disease that developed into a nonunion. The differentiating factors of the above-mentioned fractures are discussed.

Adolescent↗
PubMedDate not supplied

Chondrosarcoma of the proximal phalanx.

An 87-year-old male presented with a painless, large mass on the dorsum of the left foot. He reported that the mass had first appeared 10 years ago and now had become so large that he could no longer tie his shoe. The mass originated from the proximal aspect of the second digit, encompassing the second web space and distal one third of the second and third metatarsals. Surgical excision of the mass was performed and pathologic diagnosis of the specimen confirmed a grade 1 chondrosarcoma. As expected with a lower grade chondrosarcoma, the patient did not have metastasis and fully recovered. While the occurrence of chondrosarcoma is not uncommon, it rarely affects the foot. This appears to be the third case of chondrosarcoma appearing in the proximal phalanx second digit of the foot.

Aged↗
PubMedDate not supplied

A comparison of the psychological resources of adolescents at low and high risk of mistreating their children.

OBJECTIVE: Our objective was to compare the psychological resources of pregnant teenagers who are at low and high risk for mistreating their children. METHOD: We studied 71 participants in a comprehensive, adolescent-oriented maternity program. During the prenatal period, the Family Stress Checklist was used to quantify child abuse potential, with scores > or =25 defining high risk. Information about the social context of the pregnancy and maternal psychological resources was obtained with self-administered questionnaires. A composite psychological resource variable was computed by summing the z scores for intelligence, mental health, and mastery, with scores < or =0 defining the low-resource group. RESULTS: Of the 71 teenagers, 26 (36.6%) were classified as high risk for child abuse and neglect. Compared with low-risk teens, high-risk teens had more behavioral problems, lower psychological resource scores (mean +/- SD of z score: -0.98 +/- 2.02 compared with 0.39 +/- 1.79; P =.004), and were more likely to have low psychological resources (69.2% compared with 44.4%; P =.04). CONCLUSIONS: Pregnant teenagers who are at risk for child abuse and neglect exhibit fewer psychological resources than their low-risk peers do, and may therefore benefit preferentially from intensive, in-home intervention.

Adaptation, Psychological↗
PubMedDate not supplied

Quantification of the control of carbohydrate catabolism in the tapeworm Hymenolepis diminuta.

The elasticities for the different steps of carbohydrate catabolism in the tapeworm Hymenolepis diminuta were estimated from perturbation experiments. These data were then used to calculate flux and metabolite control coefficients. Enzyme elasticities were also calculated from the rate equations and an independent estimate of the flux control coefficients for phosphoenolpyruvate carboxykinase was made by inhibitor titration. The values obtained for the flux control coefficients for carbohydrate breakdown in H. diminuta are consistent with how the pathway is thought to be controlled in vivo. A sensitivity analysis of the flux control coefficients of the important regulatory enzymes in the pathway shows that for hexokinase, phosphofructokinase, pyruvate kinase, and phosphoenolpyruvate carboxykinase there are three or four key elasticities which have a significant effect on the coefficient. For glycogen synthase, the major factor in determining the magnitude of the flux control coefficient is the relative flux through the branch.

Adenosine Triphosphate↗
PubMedDate not supplied

Early enteral nutrition after brain injury by percutaneous endoscopic gastrojejunostomy.

Twenty-seven patients in a series of 52 patients with severe brain injury (Glasgow Coma Scale score less than or equal to 8) underwent insertion of intestinal feeding tubes at the bedside. The technique required endoscopy with externalization of gastric and intestinal ports through the abdominal wall. Feedings were begun through the intestinal tube with Vital HN within 4 hours of its insertion with simultaneous gastric decompression via the gastric tube. Tubes were placed 2.3 (range 0-5) days after injury. Full caloric intake (3020 kcal/24 h) was achieved by 6.8 (range 2-8) days after injury to 4.2 (range 2-8) days after placement of the feeding tube. Only 1 patient failed to tolerate feedings immediately after tube insertion. Technical inability to insert the tubes occurred in 3 patients and the intestinal tube migrated into the stomach in 2 patients; diarrhea occurred in only 1 patient. With this technique, it was possible to deliver an average daily intake of 1.2 g/kg of protein in 8-day balance periods beginning at the time of tube insertion. These data included 3- to 4-day periods in which feedings were steadily increased. In 16 patients in whom nitrogen balance was measured for 8-day balance periods, average nitrogen balance was -5.7 (range -11.3 to +3.5) g/24 h. The reduction in nitrogen loss by this technique appears equal to or superior to either gastric feeding or TPN. This technique provides the ability to enterally feed a high proportion of brain-injured patients (except those in barbiturate coma) very early after injury using a bedside procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Australian bat lyssavirus infection in a captive juvenile black flying fox.

The newly emerging Australian bat lyssavirus causes rabieslike disease in bats and humans. A captive juvenile black flying fox exhibited progressive neurologic signs, including sudden aggression, vocalization, dysphagia, and paresis over 9 days and then died. At necropsy, lyssavirus infection was diagnosed by fluorescent antibody test, immunoperoxidase staining, polymerase chain reaction, and virus isolation. Eight human contacts received postexposure vaccination.

Animals↗
PubMedDate not supplied

Potential exposure to Australian bat lyssavirus, Queensland, 1996-1999.

Two human deaths caused by Australian bat lyssavirus (ABL) infection have been reported since 1996. Information was obtained from 205 persons (mostly adults from south Brisbane and the South Coast of Queensland), who reported potential ABL exposure to the Brisbane Southside Public Health Unit from November 1,1996, to January 31, 1999. Volunteer animal handlers accounted for 39% of potential exposures, their family members for 12%, professional animal handlers for 14%, community members who intentionally handled bats for 31%, and community members with contacts initiated by bats for 4%. The prevalence of Lyssavirus detected by fluorescent antibody test in 366 sick, injured, or orphaned bats from the area was 6%. Sequelae of exposure, including the requirement for expensive postexposure prophylaxis, may be reduced by educating bat handlers and the public of the risks involved in handling Australian bats.

Adolescent↗