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Biomedical subjects

J Lloyd

Publications and source records attributed to J Lloyd.

191 records · Page 11Linked to original sources
PubMedDate not supplied

Neuroendocrine concomitants of reproductive aging.

Depletion of ovarian follicles is often thought to be the determining factor in female reproductive aging. However, increasing evidence suggests that neural and neuroendocrine changes play important causative roles in the decline of regular reproductive cycles leading to the menopause. A blunting or suppression in the daily pattern of secretion of several neuroendocrine hormones has been documented in aging laboratory animals and humans. Investigators have designed experiments to test whether these changes reflect multiple unrelated changes in the regulation of each of these hormones, or whether these alterations result from a fundamental change in the time-keeping mechanism that underlie these patterns of hormone secretion. Oscillations that occur approximately every 24 h are a hallmark of most living organisms. These cycles provide the organism with the capability of coordinating events that occur at higher (hourly) and lower (weekly or monthly) frequencies within an individual organism, and with the capability of synchronizing these events with the external environment. In mammals, the hypothalamic suprachiasmatic nucleus is thought to be a master oscillator that regulates most circadian rhythms in mammals. Perturbations in temporal organization occur during aging and influence multiple physiological systems, including reproductive cyclicity in females. Thus, the question for neuroendocrinologists is: Do changes in the cyclic pattern of hormone secretion reflect a change in the master oscillator, and do these changes play a role in female reproductive aging? Data from our laboratory demonstrate that the timing of the preovulatory and steroid-induced luteinizing hormone (LH) surge changes during middle-age in rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMedDate not supplied

Fiberoptic intubation in the emergency department: a case series.

A prospective descriptive study was conducted to evaluate the feasibility of using fiberoptic bronchoscopy to replace blind nasotracheal intubation. The study was performed from November 1989 to August 1991 at a university teaching tertiary care hospital. Intubations were performed by three senior emergency physicians with no prior clinical experience in emergency fiberoptic intubation. Training in fiberoptic intubation was carried out on anesthetized patients, intubation manikins, and cadavers. All patients coming to the emergency department who would have been intubated in the blind nasotracheal manner were eligible for fiberoptic intubation, except for apneic patients and those intubated by residents learning other techniques. An independent observer collected the data. Forty-two patients were entered into the study, 22 males and 20 females, with an average age of 64 years. The success rate was 72% (30/42), with one of the investigators performing most of the intubations (22, 52%). His success rate was 82%. The other two investigators' success rates were 64% and 56%. Most failures were ascribed to coping with secretions. In conclusion, intubation with the fiberoptic bronchoscope can be a useful alternative to blind nasotracheal intubation. Success with this technique is dependent on the airway being free of secretions and blood.

Aged↗
PubMedDate not supplied

Emergency department use and misuse.

We conducted a 14-day survey of the emergency department (ED) at a university tertiary care teaching hospital to examine appropriate and inappropriate use of the ED. The results are based on a convenience sample of 849 patients, selected to represent a 1-week period. Three categories (CAT) of patients were defined. CAT I: patients had a medical condition that could only be assessed in the ED. CAT II: patients had a medical condition that required evaluation either in the ED or elsewhere within 6 hours of triage. CAT III: patients could wait to be evaluated 6 or more hours from time of triage. Patients in CAT II were matched with outpatient facilities (OPF), based on the time of presentation, the presenting complaint, investigative tests, and treatments required. Overall, it was found that 69% of the patients were appropriate users and could have been seen only in the ED. Fifteen percent of the patients were classified as inappropriate users and should have been seen at an OPF. The remaining 15.8% represented "gray zone" cases. An interview conducted on a subset of ambulatory patients revealed the main reasons for choosing to visit the ED were lack of awareness of other facilities, perceived seriousness of condition, trust in the ED staff, or proximity of the ED. It was concluded that misusers represent a small portion of our ED caseload.

Adolescent↗
PubMedDate not supplied

Ketorolac penetration into the cerebrospinal fluid of humans.

STUDY OBJECTIVE: To determine the cerebrospinal fluid (CSF): total plasma concentration ratio of ketorolac tromethamine following a single intramuscular (IM) dose. DESIGN: Open, single-dose, IM-administration study. SETTING: General operating theaters of a medical school hospital. PATIENTS: 29 ASA physical status I and II patients scheduled to undergo elective surgery with spinal anesthesia. INTERVENTIONS: Patients were premedicated with ketorolac 90 mg IM formulated as 3 ml of a 3% solution. Between 1 and 4 1/2 hours later, an intravenous infusion of 500 ml of compound sodium lactate was begun. Lumbar puncture was then performed, and 2 ml of CSF was collected prior to administration of the spinal anesthetic. In addition, a 5 ml sample of venous blood was taken within 5 minutes of the CSF sample. MEASUREMENTS AND MAIN RESULTS: Simultaneous plasma and CSF concentrations of ketorolac were measured between 62 and 277 minutes following IM administration in 29 patients undergoing spinal anesthesia. The CSF concentrations were on the order of 1,000 times less than the total plasma concentrations; free concentrations of ketorolac in plasma were estimated to be about 10 times more than those in CSF. There appeared to be no constant time factor relating the appearance of ketorolac in the CSF to its plasma concentration following IM administration. CONCLUSION: Although the sensitivity of central prostaglandin synthetase systems to inhibition is unknown, it is unlikely from this pharmacokinetic data that there is a major central mechanism of analgesia for ketorolac.

Adult↗
PubMedDate not supplied

Practical and psychological problems for parents of children with epidermolysis bullosa.

Parents of children with epidermolysis bullosa were sent a questionnaire seeking information on problems associated with the condition; 45% replied and their responses are discussed in terms of reported needs. Epidermolysis bullosa (EB) is the name given to a group of distinct, inherited disorders which are manifest as an exceptional liability of the skin to blister and ulcerate following mechanical trauma. There are three principal groups: EB simplex, dystrophic EB and junctional EB. All forms of EB simplex are inherited as autosomal dominant traits. These diseases are generally relatively mild but some patients are sufficiently disabled to prevent their walking more than 200 yards at a time. Dystrophic EB is of variable severity; not unknown are problems such as fusion of the fingers, fixation of the tongue, shrinkage of the mouth and oesophageal stenosis. When severe this is an exceptionally disabling disorder associated with a significant reduction in life expectancy. Junctional EB is always serious and death within the first few years of life, often within the first few weeks, is usual. DEBRA, the Dystrophic Epidermolysis Bullosa Research Association, is a self-help group of sufferers and their families. A questionnaire aimed at eliciting problems associated with this condition was sent to 138 members and their replies form the basis of this paper.

Adolescent↗
PubMedDate not supplied

Facial deformity in childhood: severity and psychological adjustment.

This study examines the hypothesis that severe facial deformities may be less of a psychological burden than those that are more mild. Twenty-seven experimental children and 12 controls, plus 26 siblings of the experimental group and 12 control siblings, were assessed using tests of intelligence, self-concept and ratings of behaviour. The results provided some support for the hypothesis being considered.

Child↗
PubMedDate not supplied

Growth in medical director numbers continues.

A recent survey shows that nearly two-thirds of all hospitals have or are considering a medical director position. Comparative data show that the average bed size of hospitals with a medical director continues to decline as more and more institutions add the position. The reasons for the growth, according to the survey, are the increasing demands of administering a medical staff and responding to regulatory agencies.

Data Collection↗
PubMedDate not supplied

Ultrasonographic evaluation of birth injury to the shoulder.

Injuries of the proximal humerus in infants are often missed or misinterpreted because the humeral epiphysis is frequently nonossified. Ultrasonography enables direct visualization of the proximal humeral epiphysis, metaphysis, joint space, and relationship of the epiphysis with the glenoid cavity. We describe an infant with unexplained agitation and ventilatory difficulty related to a fracture of the proximal right humerus that was not appreciable on plain film radiographs. Sonographic imaging of the shoulder, with use of the opposite side for comparison, clearly demonstrated a Salter I proximal humeral fracture with marked metaphyseal displacement and preservation of the normal epiphyseal-glenoid relationship.

Birth Injuries↗