Biomedical subjects
K Stewart
Publications and source records attributed to K Stewart.
An audit of rectal examination on general/geriatric wards in a district general hospital.
A study of 187 in-patients on designated medical/geriatric wards revealed that rectal examination was performed as part of physical examination in only 25% of patients. In the elderly (118 patients) it was performed in 36%. A prospective analysis of 100 elderly patients, in whom digital rectal examination was performed, revealed that 46 patients had significant findings. In only 33 of these were there any gastrointestinal or genitourinary symptoms or signs. As a result of these findings it is recommended that digital rectal examination be considered mandatory in the elderly admitted into hospital.
Resuscitation decisions in a general hospital.
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Effect of alteration in loading conditions on both normal and abnormal patterns of left ventricular filling in healthy individuals.
Doppler analysis of mitral flow provides a means of analyzing left ventricular (LV) diastolic function. While experimental studies have suggested that changes in left atrial pressure may affect the normal pattern of early diastolic filling, the effect of such changes on abnormal patterns of filling is unknown. Accordingly, the Doppler pattern of LV filling was analyzed in 20 subjects with LV hypertrophy (mean age 59 +/- 13 years, +/- standard deviation), in 25 healthy normal subjects (29 +/- 6 years) and in 11 elderly subjects (68 +/- 5 years). All underwent Doppler examination of LV inflow at rest and immediately after postural changes. In all 3 groups, head-down positioning increased early diastolic flow velocity (E) (p less than 0.001), and raised the E to late diastolic flow velocity (A) ratio (p less than 0.01). However, an abnormal E/A ratio never approached a normal resting value. Likewise, although E and the E/A ratio decreased significantly in normal subjects with head-up positioning, it did not become abnormal. The magnitude of change in E, A and E/A ratio did not differ among the 3 groups in response to postural changes. Thus, alterations of LV loading conditions alter the pattern of LV filling, whether normal or abnormal at baseline. The magnitude of change appears to be independent of the resting flow pattern. Although loading conditions may affect the Doppler pattern of filling, simple changes in venous return do not "normalize" an abnormal pattern, nor do they "abnormalize" a normal pattern.
Neutrophilic myelofibrosis presenting as Philadelphia chromosome negative BCR non-rearranged chronic myeloid leukemia.
Chronic myeloid leukemia consists of Philadelphia chromosome positive disease in 90% of cases, and a further 5%, although Philadelphia chromosome negative, exhibit bcr gene rearrangements consistent with the disease. The remaining 5% of cases have a heterogeneous clinical picture with a course unlike that of classical chronic myeloid leukemia, and may belong to different pathologic entities. We report five cases belonging to the latter group, initially identified as Philadelphia chromosome negative, bcr non-rearranged chronic myeloid leukemia, that developed progressive leucocytosis, absolute monocytosis, myelodysplasia, extramedullary hematopoiesis, and had evidence of myelofibrosis. These cases may represent a distinct clinical entity characterized by neutrophilic myelofibrosis, which can be identified prospectively by clinical and pathologic criteria. Standard therapy for treating chronic myeloid leukemia or idiopathic myelofibrosis may not be appropriate for this group.
New shapes in HIV protease inhibitors.
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Protocol for prevention of unintentional extubation.
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Alcohol use and the appearance of alcohol problems among first offender drunk drivers.
Drinking patterns among first offender drunk drivers are described using two quantitative dimensions, drinking frequency (the number of occasions on which alcohol was consumed) and continuation (the probability that the drinker will go on to drink several drinks once one drink has been consumed). The two independent dimensions of drinking patterns are shown to be differentially related to demographic characteristics of the subject population. Further, the patterns of drinking described by the two dimensions predict the appearance of alcohol related problems. It is demonstrated that demographic characteristics of the sample are also related to reports of alcohol problems independent of drinking frequency and continuation.
DNR in nursing homes: the U.K. and N.Y.
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Assessment of anomalous sentences repetition test.
Use of Anomalous Sentences Repetition Test (ASRT) in 16 patients with diagnosis of dementia of Alzheimer's type, 16 normal elderly and 18 patients with depression revealed no difference in the age adjusted scores between the three groups, suggesting that it is not a good test for diagnosing dementia or differentiating dementia from depression.
Caring for the unwanted patient.
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Do not resuscitate orders.
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Hypothyroidism in polymyalgia rheumatica and giant cell arteritis.
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Linkage analysis of multiple endocrine neoplasia type 1 with INT2 and other markers on chromosome 11.
We evaluated linkage between the locus for multiple endocrine neoplasia type 1 (MEN1) and several polymorphic DNA markers on chromosome 11 in a single large pedigree. On the basis of the finding of a basic fibroblast growth factor (bFGF)-like substance circulating in plasma of MEN1 patients, we chose a bFGF-related gene known to be localized to 11q13 as one of the markers. This gene locus, INT2, was found to be closely linked to the MEN1 gene. Pairwise and multipoint analyses with INT2 confirm the recent finding by C. Larsson et al. (1988, Nature (London) 332: 85-87) of MEN1 linkage to another marker, skeletal muscle glycogen phosphorylase, at 11q13.
Dynamic inversion of the forefoot and dorsiflexion of the big toe treated by transfer of extensor hallucis longus.
Dynamic hyperextension of the big toe and supination of the forefoot may occur in the swing phase of walking in children with various neurological disorders. Symptoms arising from this have been successfully corrected in 13 feet of 11 children by transfer of extensor hallucis longus to the insertion of peroneus brevis.
A modified technique for subtalar arthrodesis.
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Rett syndrome: a literature review and survey of parents and therapists.
A survey of 25 parents of girls with Rett Syndrome and 33 physical and occupational therapists treating those girls was conducted to gain a better understanding of the medical, developmental and therapy issues critical to this population. Twenty-two (92%) of the parent questionnaires and twenty-seven (82%) of the therapist questionnaires were returned. Questionnaire items judged to be critical to the daily management and therapeutic intervention of these girls were selected and analyzed. Descriptive statistics were employed for data analysis. The survey results are discussed in light of the current literature, and implications for pediatric physical and occupational therapy practice are offered.
Structure of the gene encoding rat thyrotropin releasing hormone.
The gene encoding the hypothalamic peptide thyrotropin releasing hormone (TRH) was isolated from two rat genomic bacteriophage libraries. Southern blot analysis indicates that the gene is present as a single copy in the rat genome. The transcriptional unit is 2.6 kilobases in size and contains three exons interrupted by two introns of approximately 750 and 450 base pairs. Exon 1 encodes the 5'-untranslated region of the mRNA, exon 2 encodes the signal sequence and the majority of the amino-terminal peptide, and exon 3 encodes the remainder of the amino-terminal peptide, five copies of the TRH sequence, the carboxyl-terminal peptide, and the 3'-untranslated region of the mRNA. The general structure of the TRH gene resembles that of three other polypeptide hormone genes, preproopiomelanocortin, preproenkephalin A, and preproenkephalin B. Further sequence analysis revealed that characteristic promoter elements are present in the 5'-flanking region of the TRH gene. In addition, sequence homologies with the glucocorticoid receptor binding site, the GC box hexanucleotide, and a portion of the flanking region of the thyroid stimulating hormone beta-subunit gene were also identified. These upstream sequences may be important for the regulation of TRH gene expression.