Biomedical subjects
Publications and source records attributed to J Cleary.
Because injury to the brain stem is usually associated with diffuse brain damage, recovery is rare and mortality high. A non-fatal penetrating injury involving the brain stem is described from a crossbow bolt. The diagnosis and management of such injuries are discussed.
A case of an extra-renal malignant rhabdoid tumour of the gluteal muscles in a 12-year-old boy is presented. Such a site has not been reported previously. The literature about this uncommon and aggressive tumour is reviewed.
The purpose of the present study was to examine the effects of haloperidol (0.3-10 mg/kg), molindone (0.3-5.6 mg/kg), mesoridazine (0.3-10) and thioridazine (0.3-25 mg/kg) on the behavior of pigeons exposed to a repeated acquisition procedure. At sufficiently high doses, each of these neuroleptics increased error rates (interfered with learning) and reduced rate of responding. When the drugs were compared on the basis of absolute doses administered, haloperidol disrupted behavior at doses considerably lower than the other drugs. If, however, chlorpromazine equivalent doses were examined, haloperidol was the least disruptive of the four drugs. Comparing the degree of behavioral disruption produced by the four drugs with their relative neuroreceptor affinities for dopamine D-2, cholinergic muscarinic, histamine H1, alpha-1 adrenergic and alpha-2 adrenergic receptors suggests that behavioral disruption cannot be attributed in any simple way to dopamine or acetylcholine receptor blockade. The relationship between the behavioral effects of neuroleptics and their simple neuropharmacological actions must be considered as highly tentative.
Langerhans' cell histiocytosis (LCH) is an extremely heterogeneous disorder which is uncommon, making therapeutic guidelines difficult. The malignant features seen in this case have been described presenting in the skin but not in the bone. Although pathological fractures through bone affected by eosinophilic granuloma have been described, this is the first reported case of LCH with malignant features presenting in such a way.
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Three studies examined gamma-butyrolactone (Gbl) for benzodiazepine-like effects on low rates of food reinforced lever pressing by rats. A fourth study established Gbl's discriminative properties. Additionally, d-amphetamine or naloxone was administered with Gbl to test hypotheses of Gbl's neurochemical mechanisms of action. In Experiment 1, Gbl caused a dose-related decrease in lever pressing during a fixed-interval reinforcement schedule. Contrary to previous reports, neither d-amphetamine nor naloxone reversed the depressive effects of a high dose of Gbl on behavior. In Experiment 2, Gbl increased lever pressing which had been suppressed in the presence of a tone correlated with response-independent foot-shock (conditioned suppression). These results are consistent with, and extend, previous findings of benzodiazepine-like antipunishment effects of Gbl. However, in Experiment 3, when brief electric shocks were presented after each lever press, Gbl did not increase lever pressing. These results show the limited generality of Gbl's antipunishment effect compared to broad spectrum anxiolytics. Experiment 4, a drug discrimination study, showed rats readily discriminated 150 and 125 mg/kg Gbl from saline. However, neither d-amphetamine nor naloxone generalized to the Gbl lever. Amphetamine partially blocked the discriminative properties of 150 mg/kg Gbl, whereas naloxone had little effect on Gbl's discriminative properties. Thus, there is some support for a direct catecholaminergic role in Gbl-related seizures and little support for opioid receptor participation. The results of Experiments 1 and 4 indicate that Gbl's effects on behavior are complex, and are not accounted for by hypotheses involving only catecholamine and/or opioid mechanisms of action.
Play in hospitals has developed alongside of changes toward a more family-centered model of care. The recreational and educational role of play has been significantly extended toward a therapeutic purpose. This article considers the relationships between play workers and teachers, nurses and parents, and presents some European examples of the use of play in hospitals. Finally, problems encountered in the operation of play programs are discussed in the context of ensuring the viability of play in the hospital.
Buprenorphine, methadone and naloxone were administered to pigeons key pecking under a repeated acquisition procedure. Under this procedure subjects are required to emit a new sequence of responses each session to receive access to food. All three drugs reduced overall key pecking rates although naloxone's rate-reducing effect was limited to the highest dose (30 mg/kg). The dose-effect curves for overall key pecking rate under buprenorphine and methadone were similar though the effective dose range for buprenorphine appeared wider. Methadone increased percentage of total errors at the highest doses, but neither buprenorphine nor naloxone affected total error levels very much. Within-session errors were increased early in the session under high methadone doses. Low buprenorphine doses also showed some tendency to increase errors early in the session. Buprenorphine and methadone reduced the number of chains completed in a dose-dependent manner. Buprenorphine was also administered daily at the most behaviorally disruptive dose (10 mg/kg/day). Under this dosing schedule, the behavior-suppressing effects of buprenorphine returned to base-line levels within 4 days. Error rates were unaffected by daily buprenorphine administration.
Two cynomolgous macaques categorized six colors into two groups of three after conditional discrimination training (zero-delay symbolic match-to-sample). The procedures resulted in the establishment of relations among the elements of each set-relations that were not specifically trained and that can be characterized by the properties of reflexivity, symmetry, and transitivity. Each set of colors was related to a characteristic pattern of responding: One response pattern involved temporal duration (press and hold the response keys); the second response pattern entailed repeated pressing and releasing of the response keys (fixed ratio 8). Six combinations of two colors were trained, three combinations from each set. After discriminative performance stabilized for each monkey, they were tested with 10 additional color combinations, all of which differed from the training combinations. The conditional relations established between test combinations can be characterized as stimulus equivalence. The training procedures were analogous to the procedure of using category names, and have implications for understanding the function of language in the formation of equivalence classes.
Interactions between methadone and acute and chronic imipramine were studied in pigeons key pecking under a multiple variable interval 15-sec variable interval 150-sec schedule of food presentation. Both drugs decreased response rates at the highest doses. The VI 15-sec schedule was slightly more sensitive to acute drug administration than was the variable interval 150-sec schedule. Acute combinations of the two drugs neither ameliorated nor exacerbated the effects of either drug alone. Chronic imipramine alone had no lasting effect on responding. Unlike acute combinations, chronic imipramine lessened the rate reducing effect of methadone.
Supraventricular tachyarrhythmias are a frequent complication encountered after coronary artery bypass grafting. A retrospective survey of 102 consecutive patients undergoing exclusive bypass grafting at St. Mary's Hospital supplemented by a review of 16 published reports over a period of 10 years revealed a mean incidence of post-operative tachyarrhythmia of 33.4% in 1344 patients (range 11.4-100%). One hundred and thirty two patients undergoing exclusive bypass surgery, were randomised prospectively in double blind fashion to receive either oral timolol or matched placebo approximately 24 hours after surgery. In the 66 patients receiving timolol, there was a significant reduction of post-operative arrhythmias compared to the 66 patients receiving placebo: from 19.7 to 7.5% (P less than 0.05). Of all arrhythmias, two thirds appeared under 48 hours after surgery. In the timolol group, 4 patients developed systemic hypotension. This was readily reversed by withdrawing the drug. No other side effects were noted. The use of oral timolol after coronary artery surgery significantly lowers the incidence of post-operative supraventricular arrhythmias.
A care by parent option was introduced into a general paediatric ward without any additional finance or facilities. Most parents coped successfully and were grateful for the opportunity of caring for their children. All believed that their children benefited from their active involvement. The nurses believed that their role was enhanced and their job satisfaction increased. This system offers advantages and could become more generally used in paediatric wards in Britain.
A care by parent scheme was established in the children's department of a university hospital. It was seen as the natural extension of the increased involvement of parents in the care of their children in hospital. A structured observational study was carried out to monitor its effect on the lives of child patients. Children in the scheme spent far less time awake alone, cried less, and slept less than those nursed unaccompanied. They had far more social interaction with a smaller number of adults, most of their contacts being with family members rather than hospital staff. Children with a resident parent but outside the scheme were generally in an intermediate position on these factors.
In a population of 473 inpatients, a profile of nutritional status from obesity to marasmic-kwashiokor was observed. Thirty-two per cent of the population were overweight or obese (n = 153), forty-five per cent were of normal weight (n = 211), 8% were at risk of protein-energy malnutrition (n = 39), and 15% (n = 70) had grades of protein-energy malnutrition from marasmus to marasmic-kwashiokor. The implications for improved nutritional support services for hospitalised patients are discussed.
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