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Biomedical subjects

J Lindsay

Publications and source records attributed to J Lindsay.

18 recordsLinked to original sources
PubMed1992

Methicillin-resistant Staphylococcus aureus colonization in a long-term-care facility.

OBJECTIVE: To study the prevalence and risk factors for colonization with MRSA at a long-term-care facility. DESIGN: Cross-sectional surveillance culture survey. SETTING: A 233-bed university-affiliated long-term-care facility. MEASUREMENTS: Surveillance cultures for MRSA were performed on patients of two adjacent nursing units and on new admissions to the entire facility over a 4-month period. RESULTS: On the chronic medical unit, where patients known to be colonized had been cohorted, 20 of 38 (52.6%) were colonized vs 3 of 67 (4.5%) on the skilled/intermediate unit (P less than 0.001), suggesting that little intra-facility spread of MRSA occurs. Twenty-four of 55 (43.6%) chronic medical admissions were colonized vs 6 of 63 (9.5%) admitted to the other units (P less than 0.001). Thirteen of 30 (43.3%) admissions were not previously known to be colonized. By univariate analysis, colonized admissions were younger and more often male; had more listed diagnoses, including pressure sores, a previous positive MRSA culture, and urinary incontinence; were more often fed by feeding tube; and had longer durations of hospital stay prior to admission. Logistic regression analysis showed that the most powerful independent predictors of colonization at admission were: a prior positive culture for MRSA (OR 8.8, 95% CI 2.4, 32.4), male sex (OR 8.2, 95% CI 2.3, 29.7), urinary incontinence (OR 3.8, 95% CI 1.4, 10.4), and presence of pressure sores (OR 2.9, 95% CI 0.9, 9.2). CONCLUSIONS: Unrecognized colonization of nursing home residents with MRSA is common, and nursing homes are unwittingly repositories for patients colonized with MRSA following acute hospitalization. Gloving and careful attention to handwashing may limit spread of MRSA within nursing homes, and identification of colonized patients may be facilitated by targeted surveillance cultures of the most debilitated patients at admission.

Aged↗
PubMed1979

Isoniazid exposure in relation to cancer incidence and mortality in a cohort of tuberculosis patients.

41 226 isoniazid exposed and 22 811 non-exposed patients admitted to Canadian institutions for the treatment of tuberculosis from 1952 to 1960 were followed to 1973 by computerised record linkage to the National Death Index and, for 1969 to 1973, to the National Cancer Incidence Reporting System; The mortality for the total cohort compared to that expected from the mortality in the Canadian population, was greater than expected for tuberculosis, other chest diseases and certain cancer sites associated with cigarette smoking (except bladder cancer). There was, however, no difference between the isoniazid-exposed and non-exposed in mortality from all cancer and individual cancer sites, except for oesophageal cancer in males. Cancer incidence from 1969 to 1973 was also similar for the isoniazid- exposed and non-exposed groups. An elevated standardised incidence ratio was seen only for buccal cavity and pharynx in male exposed subjects. It is concluded that this study provides additional negative evidence on the carcinogenicity of isoniazid in man.

Adolescent↗
PubMed1979

Long-term outcome in children with temporal lobe seizures. I: Social outcome and childhood factors.

One-hundred children, diagnosed as having temporal lobe epilepsy and reported on in 1966, have been followed into adult life. In this 1977 survey they have been coded into four social outcome categories, A, B, C and D. A: 33 per cent are found to be seizure-free and independent; B: 21 per cent are socially and economically independent but are receiving anticonvulsant treatment and are not necessarily seizure-free; C: O9 per cent are dependent either on their parents or in institutions; D: 5 per cent died under the age of 15. Biological factors ascertained and coded in childhood are related to adult outcome. Eight adverse factors emerged: an IQ below 90, onset of seizures before 2 years 4 months, five or more grand mal attacks, temporal lobe seizure frequency of one per day or more, a left-sided focus, the hyperkinetic syndrome, catastrophic rage and special schooling. The presence of first-degree relatives with seizure disorders was a good prognostic sign. Disorderly homes in childhood did not significantly affect adult outcome. All but one of those achieving Group A status had received normal schooling. In general, the prognosis for children with limbic seizures is clear before the end of adolescence. A simple count of the number of childhood adverse factors predicts adult outcome at a high level of significance.

Adolescent↗
PubMed1979

Long-term outcome in children with temporal lobe seizures. II: Marriage, parenthood and sexual indifference.

One-hundred unselected children with clinical and EEG evidence of temporal lobe seizures were followed into adult life. Data related to marriage and reproduction are analysed. Female survivors, if not totally handicapped, are nearly all married; surviving males who are not totally handicapped more often remain single. Early remission of seizures in males is associated with marriage: seizures continuing through adolescence are associated with sexual appetitive indifference. The female probands have produced children at a rate three times greater than the male probands. The findings have implications for understanding the development of male secual appetite. The epidemiology and genetics of these forms of seizures must take account of much greater fitness on the distaff side of the pedigree. The likelihood of marriage and parenthood would appear to rest on a few biological factors usually recognisable before the end of childhood.

Adolescent↗
PubMed1979

Long-term outcome in children with temporal lobe seizures. III: Psychiatric aspects in childhood and adult life.

One hundred children with temporal lobe epilepsy were followed into adult life. 85 per cent had had psychiatric problems in childhood. The occurrence of overt psychiatric disorder in adult life was low: of those survivors who were not gravely mentally retarded, 70 per cent were regarded as psychiatrically healthy. Overt schizophreniform psychosis has developed in 10 per cent of survivors. Males with continuing epilepsy and left-sided foci were at special risk: 30 per cent of such patients had become psychotic. No patient coded as having a right-sided focus in 1964 had become psychotic by 1977. Though 26 patients had had grossly disordered childhood homes, this factor had no significant relation to adult psychiatric disorder. Antisocial conduct marked the adult life of 12 patients. Their childhood codes showed that male sex, a focus contralateral to the preferred hand, and unremittent epilepsy marked this group. Low intelligence and childhood rages were also prominent. Treated neurotic and depressive illness was quite uncommon. Only five survivors have fallen into this category. Those patients escaping psychiatric ill-health are often notably extraverted and successful.

Adult↗
PubMed1978

Traumatic coronary artery fistula.

We report certain diagnostic and therapeutic problems presented by patients with traumatic coronary arteriovenous or arteriocameral fistulas, based on our experience with one case and our review of cases which have previously been reported in detail.

Adult↗
PubMed1977

Arrhythmias in the post CCU phase of myocardial infarction: their correlation with the acute illness.

To estimate the frequency of potentially life-threatening arrhythmias in myocardial infarction following transfer from the coronary care unit (CCU) and to identify features of the acute illness which predict such events, 66 patients were monitored on-line by means of a computer assisted system. Premature ventricular contractions (PVCs) were detected following transfer from the CCU in 64 patients (97%). In 29 (44%) they fell in classes 2 to 4 of Lown. Accelerated ventricular rhythm was detected in five and ventricular tachycardia in three. The presence of these rhythm disturbances did not correlate with age, sex, infarct location, the occurrence of previous infarction, the level of serum cardiac enzymes, the presence of heart failure, atrial arrhythmias, heart block, or serious ventricular arrhythmia in the CCU. Use of procaine amide or quinidine for persistent ventricular arrhythmia in the CCU was correlated with detection of class 2, 3 or 4 PVCs. Thus, PVCs are nearly universal in the late phase of hospitalization for myocardial infarction. Frequent and complicated PVCs are common and occur most frequently in individuals in whom such events have been persistent in the CCU.

Acute Disease↗
PubMed1976

Mortality from cancer of the uterus in Canada and its relationship to screening for cancer of the cervix.

Age-standardized death rates at ages 30-64 from cancer of the uterus in the 10 provinces of Canada have been assessed in 1950-52, 1960-62 and 1970-72, and changes in rats over these periods related to screening for cancer of the cervix and variables derived from the censuses of 1961 and 1971. Death rates at the county and census division level have also been assessed for the provinces of Nova Scotia, Quebec, Ontario, Manitoba and Alberta for 1960-62 and 1970-72 and related to screening and census-derived variables. There is little indication of a contribution of screening to the fall in death rates that occurred in eight of the 10 provinces from 1950-52 to 1960-62. There is, however, evidence of an important and significant contribution of the intensity of screening (as indicated by the number of cervical cytology examinations conducted in 1966 expressed as a rate per 1,000 female population aged 20 or more) to the fall in death rates at both the provincial and county or census division levels from 1960-62 to 1970-72, and this effect is not abolished by taking the census-derived variables into account. It is concluded that a significant effect of intensity of screening on the reduction in mortality from cancer of the uterus in Canada in the age-group 30-64 over the period 1960-62 to 1970-72 has been demonstrated.

Adult↗
PubMed1976

Electrocardiographic radiotelemetry in the early recuperative period of acute myocardial infarction. Its value in detecting arrhythmias in the setting of a progressive coronary care unit.

One hundred seventeen consecutive patients with acute myocardial infarction transferred from the coronary care unit to a progressive coronary care unit were monitored by electrocardiographic radiotelemetry for a median of five days for arrhythmia detection. Eighty patients (68%) had arrhythmias; 37 patients (32%) had none. Almost all arrhythmias were detected by the sixth day of monitoring. Thirty-nine patients (33%) had premature ventricular contractions, two patients had primary ventricular tachycardia, one patient had primary ventricular fibrillation, and two patients had secondary ventricular fibrillation. An additional patient was successfully resuscitated after monitoring had been discontinued. Four (3%) of 117 patients had a potentially lethal arrhythmia treated successfully, three while being monitored. Twenty-five of the patients (21%) had 33 episodes of treatment intervention because of telemetrically detected events. Five patients (4%) died, all of unpreventable causes. No patient died because of an arrythmia. We conclude that telemetry is feasible and practical in detecting arrhythmias. It is clear that potentially fatal ventricular arrhythmias do occur following transfer from the coronary care unit and that monitoring is, therefore, desirable.

Acute Disease↗
PubMed1976

Hemopericardium, anticoagulation, and an endocardial pacemaker. A case report with description of new auscultatory and radiographic signs.

A case of organizing hemopericardium and cardiac tamponade in a patient with a permanent endocardial pacemaker who was maintained on anticoagulation is presented. The hemopericardium is concluded as solely due to the anticoagulation. A new auscultatory finding attributable to an endocardial pacemaker and a helpful radiographic sign of pericardial effusion in patients with these pacemakers is described.

Cardiac Tamponade↗
PubMed1975

Conventional coronary care unit monitoring. Nondetection of transient rhythm disturbances.

Conventional electrocardiographic monitoring techniques depend on human observation of an oscilloscopic display for detection of transient rhythm disturbances such as premature ventricular contractions (PVCs). It is not surprising that such events are often missed. We have found that transient events are regularly identified only when they occur with a frequency exceeding one per minute. Rhythm disturbances such as coupled PVCs or PVCs in which R waves interrupt the preceding T wave ("R on T"), which constitute indications for antiarrhythmic therapy, may go undetected if they occur less frequently than this.

Acute Disease↗
PubMed1975

Hemoglobin S-C disease presenting as acute pneumonitis with pulmonary angiographic findings in two patients.

Acute illness characterized by fever, cough, chest pain and pulmonary infiltrates on chest film is characteristic of patients witb sickle cell anemia and with sickle-C disease. The underlying hemoglobinopathy is usually recognized in the former, but because patients with sickle-C disease as a rule have less severe anemia and fewer, less severe crises their abnormal hemoglobin may not be detected until adolescence or adulthood. Acute pulmonary illness in such patients may therefore present a diagnostic dilemma for the unwary. Two cases are presented to highlight this point. Pulmonary angiographic findings in patients with sickle cell states might add information about the pathogenesis of this disorder since vascular occlusion appears to play a major role. Pulmonary angiograms in the two patients we describe documented the presence of localized abnormalities of perfusion. In one, the presence of filling defects in medium-sized arteries suggests intravascular thromboembolism.

Acute Disease↗
PubMed1975

Midsystolic clicks originiating from tricuspid valve structures: a sequela of heroin-induced endocarditis.

In two patients who had been heroin users, loud midsystolic clicks developed during infective endocarditis involving the tricuspid valve. The sounds were loudest along the left sternal border, exhibited an increase in intensity during inspiration and were associated with right atrial gallop sounds and with murmurs of tricuspid regurgitation. This constellation of clinical events suggests that the midstystolic clicks emanated from tricuspid valve structures as a result of disordered function of the chordae tendineae. Prolapse of the tricuspid valve has recently been demonstrated angiographically to accompany similar abnormalities of mitral valve motion in certain patients with the click-murmur syndrome. The participation of the tricuspid valve in the generation of the auscultatory finding is unclear, but the cases herein reported suggest that the tricuspid valve is capable of producing these findings.

Adult↗
PubMedDate not supplied

Acute vestibular paralysis in herpes zoster oticus.

A case of herpes zoster oticus is presented in which the lateral and superior semicircular canals of the labyrinth were affected unilaterally. The results of several electronystagmographic examinations are described and correlated with the patient's description of symptoms. This case study indicates that disease affecting the lateral semicircular canal is reliably detected by the conventional caloric test. However, the fact that the posterior semicircular canal remained intact could not be inferred from the results of the caloric test in this case. Also the appearance of nystagmus upon eye closure appears to have been a more sensitive index of the state of the disease process than was the caloric test.

Adult↗
PubMedDate not supplied

Aortic dissection.

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Aortic Dissection↗