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Biomedical subjects

J Evans

Publications and source records attributed to J Evans.

At least 271 records · Page 15Linked to original sources
PubMed1995

The study of the effect of intensity of blood pressure management on the progression of type 1 diabetic nephropathy: study design and baseline patient characteristics. Collaborative Study Group.

A randomized, prospective, clinical trial has been initiated to continue follow-up in a subset of the patients previously enrolled in the recently completed Study of Angiotensin-Converting Enzyme Inhibition (ACEi) in Type 1 Diabetic Nephropathy. In that study, the use of captopril was associated with a 48% reduction in the risk of doubling the serum creatinine and a 50% reduction in the risk of experiencing dialysis, transplantation, or death, compared with the use of placebo. These effects were independent of captopril's effect on the blood pressure. This study is designed to determine whether the level of mean arterial blood pressure (MAP), using the ACE inhibitor ramipril as the primary therapy, is associated with an improved prognosis of diabetic nephropathy with respect to (1) the rate of decline in renal function; (2) the rate of progression to end-stage renal failure; (3) the clinical course of proteinuria; (4) morbidity; and (5) mortality. Patients are randomized into one of two distinct blood pressure control groups, an Intensive Group #1, MAP < or = 92 mm Hg; and a Moderate Group #2, MAP 100 to 107 mm Hg. Patients previously enrolled in the "Study of ACEi in Type 1 Diabetic Nephropathy" whose serum creatinine was less than 4.0 mg/dL (354 mumol/L) were eligible for randomization into this study. All patients will receive ramipril (2.5 to 10.0 mg/day) as the primary therapy, with the addition or removal of other antihypertensive agents as needed to achieve the assigned blood pressure goal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Shwachman-Diamond syndrome and matched unrelated donor BMT.

A 5 year old with Shwachman-Diamond syndrome (SDS) developed acute monoblastic leukaemia following a period of myelodysplasia associated with a clonal cytogenetic abnormality involving chromosome 7. Matched unrelated BMT was carried out using standard CY/TBI conditioning and GVHD prophylaxis protocols. The patient experienced no toxicity, had temporary committed progenitor cell engraftment but eventually died from bone marrow failure 1 year post-transplant. This report, to our knowledge, documents the first reported case of matched unrelated donor BMT for SDS/AML and we speculate that standard conditioning regimens are probably safe in this group of patients.

Bone Marrow Diseases↗
PubMed1995

Induction of immune tolerance in a 7-year-old hemophiliac with an anaphylactoid inhibitor.

BACKGROUND: Anaphylactic reactions were a rare complication of low purity VIII concentrates, but not with high purity VIII concentrates. CASE: 7 y/o WM with severe hemophilia A, received only cryoprecipitate and monoclonally purified VIII concentrates; developed post-infusional urticaria. A 2-Bethesda-unit inhibitor was detected. Generalized urticaria and bronchospasm following factor developed as the titer increased. Skin tests demonstrated reactivity to plasma derived VIII, but not recombinant VIII (rhVIII). Attempts at desensitization using rhVIII failed. ELISA revealed an anti-VIII IgE antibody. He was treated with a modified tolerance regimen using rhVIII starting at 500 U/day with aggressive premedication. The dosage increased by 200 U weekly as tolerated to a maximum of 100 U/kg/d without symptoms. RESULTS: His antibody titer decreased rapidly once he started 100 U/kg/d. Six months later, the inhibitor was < 1 Bethesda unit. CONCLUSION: Immune tolerance induction using a graduated dosage of rhVIII was successful.

Anaphylaxis↗
PubMed1995

Networking a need: a cost-effective approach to statewide health information delivery.

VTMEDNET is the health information network for the state of Vermont. In response to a needs assessment of rural health care providers, it supports e-mail, access to knowledge-bases, and the ability to request library services for health care providers across the state, regardless of their location or affiliation. For Fletcher Allen Health Care affiliates, it also supports access to in-patient hospital records. Two thirds of the state's physicians are using the network as well as many other health care providers, and, with minimal cost, it has begun to meet its goal of improving health care delivery to many of Vermont's citizens.

Attitude to Computers↗
PubMed1994

Secondary chronic myelomonocytic leukemia with t(9;11) in a child.

Chronic myelomonocytic leukemia (CMMol) developed in a 10-year-old girl after treatment of non-Hodgkin's lymphoma with a regimen which did not contain epipodophyllotoxins. t(9;11)(p22;q23) was found in the leukemic cells. This case highlights the fact that secondary hemopoietic malignancies with 11q23 abnormalities are not restricted to patients treated with epipodophyllotoxins, expands the number of documented cases of secondary myelodysplasia in children, and adds CMMoL to the spectrum of hemopoietic malignancies associated with t(9;11).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

An audit of non-accidental injury in burned children.

The incidence of non-accidental injury in burned children and the repeat injury rate following non-accidental injury is very high according to some reports. A retrospective follow-up review was undertaken for all patients admitted to the Plymouth Paediatric Burns Unit over a 47-month period. Hospital records, general practitioners' records and the Social Services Department were used to gain follow-up information. The incidence of confirmed abuse was about 3 per cent and this included intentional injury as well as other forms of abuse such as neglect. The repeat injury rate was very low indeed. These figures are very much lower than many of the published figures. This may be due to differences in the definition of non-accidental injury, differences in the population make-up or simply that a burn injury is a relatively uncommon form of non-accidental injury in Devon and Cornwall.

Burns↗
PubMed1994

The dialysis debate: acute renal failure in burns patients.

Acute renal failure is an uncommon occurrence in burns patients, although the mortality of this condition remains high. We review briefly the literature on the incidence and management of acute renal failure in burns patients. We discuss the results of a questionnaire sent to all units in the UK examining this problem. Our findings suggest that acute renal failure is usually part of a complex multiorgan failure. However, an aggressive approach in the management of these patients can result in a significant improvement in prognosis, in the absence of a greater understanding of prevention of the condition. We have suggested measures that could be taken to aid the care of burns patients with renal failure.

Acute Kidney Injury↗
PubMed1994

Ivermectin and onchocercal optic neuritis: short-term effects.

In 1982 the macrocyclic lactone, ivermectin, was first tested in human patients with onchocerciasis. It has since undergone phase I to IV trials and is now being widely distributed in onchocercal areas. The previous microfilaricide, diethylcarbamazine citrate (DEC), is known to precipitate or exacerbate active optic neuritis in some onchocercal patients, as part of a wider inflammatory response (the Mazzotti reaction). Ivermectin may also cause a mild reaction, especially in people with high microfilarial loads. Few data are available concerning the effect of ivermectin on active optic neuritis. A large, randomised, double-masked, phase IV trial is reported. Individuals were screened for evidence of optic nerve disease (OND), and those identified as possible cases of OND underwent detailed ophthalmic examination, including fluorescein angiography, before being dosed with ivermectin or placebo. A total of 6831 persons were screened of whom 856 (13%) underwent angiography prior to dosing. At 7-14 days after dosing an attempt was made to re-examine 50% of adults over the age of 20 years, including all those with OND. Six hundred and eighty-eight repeat or new angiograms were performed. During this period, 5 new cases of active optic neuritis and one case of exacerbation of existing optic neuritis were identified. Five of these individuals had received placebo and one ivermectin. Two individuals with optic neuritis before dosing had improved after 7-14 days. One had received placebo, the other ivermectin. Ivermectin does not appear to precipitate or exacerbate optic neuritis at a period of 7-14 days.

Adolescent↗
PubMed1994

An investigation into sick building syndrome among local authority employees.

Self-administered questionnaires were used to find out the prevalence among employees working in the three local authority premises in a Health District of self-reported illness which could be associated with sick building syndrome. Eye symptoms were found to be more common among employees working in a typing centre using VDUs. The symptoms tiredness, lethargy and influenza-like ('flu-like) illness, including aches in the limbs, were reported in significantly higher numbers by employees working in areas where there was evidence of increased pressure of work and worries over job losses. Dry throat and blocked or stuffy nose were symptoms reported in significantly higher proportions by employees working in certain buildings, where anecdotal evidence suggested that there could be problems with temperature regulation. This study also confirmed findings by other studies that for some symptoms women complain in significantly higher numbers than men. It was concluded that the type of work people do, in addition to the type of building they work in, play an important role in self-reported illnesses. Causation of sick building syndrome is complex and probably of multifactorial origin.

Administrative Personnel↗
PubMed1994

Lyme disease.

In the United States, Lyme disease is the most common arthropod-borne infection. The majority of cases occur in the Northeast, the Midwest, and California, which are areas with established foci of Borrelia burgdorferi. Phenotypic and genotypic diversity of B. burgdorferi has resulted in its classification into three separate genospecies and may account for differences in disease expression. Clinical features of Lyme disease have expanded to include a flulike illness without erythema migrans and the persistence of intrathecal antibody responses after successful antibiotic therapy in neuroborreliosis. Better understanding of the pathogenic mechanisms of Lyme arthritis will help guide future treatment decisions, and recent progress made in assessing the risk of infection from tick bites and vaccine development may help calm public anxiety about Lyme disease.

Arthritis, Infectious↗
PubMed1994

Spontaneous intramural haematoma of the oesophagus: a report of three cases and review of the literature.

Spontaneous intramural haematoma of the oesophagus is an uncommon condition which may follow rapid increases in intra-oesophageal pressure and is predisposed to by coagulation disorders. The characteristic clinical presentation and findings at radiology and endoscopy frequently result in misdiagnosis and confusion with more sinister pathology. Awareness of the condition and conservative treatment with correction of coagulation abnormalities, when present, are the mainstays of management. Spontaneous resolution invariably occurs, and the condition is rarely fatal unless surgical treatment is attempted.

Aged↗
PubMed1994

Distribution and aetiology of blindness and visual impairment in mesoendemic onchocercal communities, Kaduna State, Nigeria. Kaduna Collaboration for Research on Onchocerciasis.

During a field trial of ivermectin in Kaduna State, 6831 people age 5 years and above, living in 34 mesoendemic onchocercal communities in Kaduna State, northern Nigeria, were examined for ocular disease. Visual function assessments included tests of visual acuity and visual fields. A total of 185 individuals (2.7%) were bilaterally blind by acuity criteria with a further 28 blind by field constriction. The overall prevalence of blindness was 3.1%. A further 118 individuals were visually impaired by WHO criteria. Examination for the cause of blindness revealed that 43% of eyes in bilaterally blind patients were blind due to onchocerciasis. A further 11% were blind from optic atrophy much of which was probably onchocercal in origin. Glaucoma was the next most common cause of blindness in the bilaterally blind (11%). Only 6% of eyes were blind from cataract as the primary cause. In the visually impaired population cataract was the most common primary cause of impaired/blind eyes (31%), followed by onchocerciasis (19%) [corrected].

Adolescent↗