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Biomedical subjects

J F Robertson

Publications and source records attributed to J F Robertson.

At least 181 records · Page 10Linked to original sources
PubMed1987

Facial paralysis in acute parotitis.

We report on a 12-year-old boy who developed facial paralysis secondary to acute parotitis. Awareness of this rare complication is emphasised. Lower motor neuron lesion of the facial nerve due to parotid enlargement is extremely rare in the absence of underlying neoplasia.

Acute Disease↗
PubMed1984

Treating the intoxicated adolescent. A need for comprehensive services.

Intoxicated adolescents seen in hospital emergency departments are frequently treated for their immediate complaints, but fail to have follow-up assessments for underlying alcohol/drug abuse and/or psychosocial problems. We undertook a prospective study of 171 acutely intoxicated adolescents (12 to 18 years of age) admitted to the emergency department of the University of Wisconsin Hospital and Clinics, Madison. A comparison group randomly selected from the community demonstrated that the emergency department patients were at a significantly higher risk for alcohol and polydrug abuse and psychological dependency. To adequately serve this potentially high-risk group, follow-up assessment must be done, including the gathering of in-depth information regarding legal, psychosocial, and alcohol/drug use status. This study indicates that the general hospital, with its 24-hour emergency department services and other resources, can play a vital role not only in the crisis management of intoxicated adolescents, but in their follow-up, assessment, and, when indicated, appropriate referral for treatment.

Adolescent↗
PubMed1981

Evaluation of M-mode echographic estimates of left ventricle function: relationship of selected ultrasonic and hemodynamic parameters.

We examined the relationship between echocardiographic and hemodynamic parameters in 48 patients with left ventricular ejection fractions less than 50% without primary valvular disease. Pulmonary wedge pressure (PWP) correlated with the PR-AC interval (r = -0.62) and with left atrial dimension (r = 0.64) but not with left ventricular diastolic dimension. A PR-AC interval less than or equal to 60 msec was observed in 26 of 29 (90%) patients with a PWP greater than or equal to 14 mm Hg versus 1 of 10 (10%) patients with a PWP less than 14 mm Hg. The correlation between PWP and the PR-AC interval was substantially better in patients with a PR interval less than or equal to 200 msec (r = -0.79) than in patients with a PR interval greater than 200 msec (r = -0.55). The PR-AC interval also correlated with the ejection fraction (r = 0.47). A left atrial dimension greater than or equal to 4.0 cm was observed in 29 of 35 (83%) patients with a PWP greater than or equal to 14 mm Hg versus 0 of 9 (0%) patients with a PWP less than 14 mm Hg. Stroke volume (SV) correlated with aortic root excursion (r = 0.71) and with SV calculated from formulas based on mitral valve motion (r = 0.76) or aortic valve motion (r = 0.62). However, no echo formula provided valid estimates of cardiac output. We conclude that M-mode echocardiography provides a relatively useful noninvasive method of assessing left ventricular filling pressure in patients with reduced ejection fraction and no valvular disease.

Adult↗
PubMed1981

Anatomic and electrophysiologic correlates of ventricular tachycardia requiring left ventricular stimulation.

In 108 patients with reproducible initiation of ventricular tachycardia by programmed ventricular stimulation, the ventricular tachycardia was initiated only by left ventricular stimulation in 12 (11 percent). Programmed ventricular stimulation included single and double extrastimuli extrastimuli at three cycle lengths and bursts of rapid pacing to cycle lengths of 250 ms. Clinical, electrocardiographic, angiographic, hemodynamic and electrophysiologic data were available in 74 of 96 patients with ventricular tachycardia initiated by right ventricular stimulation (Group A) and in all 12 patients with ventricular tachycardia initiated only by left ventricular stimulation (Group B). there were no significant differences between Groups A and B in clinical characteristics, hemodynamics or presence and site of infarction or aneurysm. Comparison of electrophysiologic variables revealed no significant differences between Groups A and B mean A-H interval (92 +/- 22 versus 89 +/- 15 ms, respectively), H-V interval (59 +/- 15 versus 59 +/- 15 ms) or right ventricular (241 +/- 38 versus 260 +/- 40 ms) or left ventricular (232 +/- 28 versus 251 +/- 42 ms) effective refractory period. Ventricular tachycardia with right bundle branch block and superior axis was more prevalent in Group B (92 percent versus 31 percent, p less than 0.001) but was observed in 32 patients in Group A. It is concluded that 11 percent of patients with clinically documented sustained ventricular tachycardia will require left ventricular programmed stimulation to reproducibly initiate the tachycardia. No clinical, anatomic, electrocardiographic or electrophysiologic features can predict whether left ventricular programmed stimulation will be required. Because initiation of ventricular tachycardia by programmed ventricular stimulation has important prognostic and therapeutic implications in such patients, stimulation should be performed from the left ventricle when the tachycardia is not initiated by stimulation from the right ventricle.

Adolescent↗
PubMed1975

Interaction in three generation families, parents as mediators: toward a theoretical perspective.

This paper focuses on the development of a theoretical perspective within which it is possible to empirically define parental mediation in interactions between grandparents and grandchildren. Using socialization theory and studies conducted by the writer and a colleague, eight independent dimensions of parental mediation have been identified. This makes it possible to develop measurement indices for testing the postulate that parents act as mediators between the grandparent and grandchild generations in socializing both into their respective roles and thereby influencing the nature of their relationship.

Adolescent↗
PubMedDate not supplied

A library instruction module.

The authors describe a modular instruction method to teach nursing students important library skills and provide an example of the instructional module. A pilot study demonstrated the value of this approach in facilitating use of the library. Nurse educators can use this method to assist their students in accessing reference materials quickly and successfully.

Curriculum↗
PubMedDate not supplied

Comparison of mastectomy with tamoxifen for treating elderly patients with operable breast cancer.

STUDY OBJECTIVE: Comparison of tamoxifen and mastectomy in treatment of breast cancer in elderly patients. DESIGN: Randomised trial of treatment of operable breast cancer by wedge mastectomy or tamoxifen, with median follow up 24 and 25 months respectively (range 1-63). SETTING: University hospital; most patients from primary catchment area. PATIENTS: 135 consecutive patients with breast cancer aged over 70 with operable tumours (less than 5 cm maximum diameter); 68 were allocated to tamoxifen group and 67 to mastectomy group. Histological diagnosis by biopsy. Two incorrect randomisations in each group. Patient characteristics similar in the two groups and all under care of one surgical team. INTERVENTIONS: Mastectomy group received wedge mastectomy plus excision of symptomatic axillary lymph nodes. Tamoxifen group received continuous treatment with tamoxifen 20 mg twice daily. Patients in tamoxifen group received wedge mastectomy if there was sign of local progression. Those in mastectomy group received further excision or radiotherapy for locoregional recurrence and when local treatments had been exhausted or metastatic disease diagnosed they received tamoxifen. END POINT: Treatment efficacy was assessed by local control of disease and by survival. MAIN RESULTS: Mortality from metastatic cancer in tamoxifen group was 7 (10.6%) and in mastectomy group 10 (15.3%) (NS). There was no difference in survival between the two groups. In mastectomy group 70% remained alive and free of local recurrence at 24 months; in tamoxifen group only 47% remained alive and free of local progression. In mastectomy group locoregional recurrence occurred in 16 patients and metastatic disease in 13; in tamoxifen group locoregional progression occurred in 29 patients and metastatic disease in seven. CONCLUSIONS: As a high proportion of patients treated with tamoxifen eventually required surgery treatment of elderly patients with breast cancer should include mastectomy. Optimum treatment may include both mastectomy and tamoxifen.

Aged↗
PubMedDate not supplied

Intravenous nutrition and hepatic dysfunction.

Abnormalities in biochemical liver function tests in 127 general surgical patients who had a course of intravenous nutrition have been reviewed. Only 26 patients had liver function tests considered to be normal on commencing intravenous nutrition and they were included in this retrospective study. During intravenous nutrition the most sensitive biochemical test of liver dysfunction was gamma-glutamyl transpeptidase--all patients having an elevated gamma-glutamyl transpeptidase level by week 4. Most abnormalities were transient whereas the elevation of alkaline phosphatase was prolonged beyond week 9. Patients with major sepsis were found to have almost double the incidence of abnormal liver function test values compared with patients with no evidence of sepsis. Only patients who were transfused more than 8 units of blood showed a significant rise in bilirubin. Liver function tests in patients who received smaller transfusions showed no difference from patients who did not receive any blood. Patients with below normal anthropometric measurements on commencing intravenous nutrition were more likely to develop abnormalities in aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and gamma-glutamyl transpeptidase.

Alanine Transaminase↗