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Biomedical subjects

L Thompson

Publications and source records attributed to L Thompson.

At least 37 records · Page 2Linked to original sources
PubMed1991

Current status of coronary artery operation in septuagenarians.

Previous reports of elderly patients undergoing coronary artery bypass grafting have not addressed the current era of aggressive percutaneous angioplasty and frequent urgent or emergent operation. To investigate this important subgroup of patients, we analyzed our recent coronary artery bypass grafting experience with patients 70 years of age or older. From January 1984 to January 1989, 121 consecutive patients in this age range underwent surgical revascularization at our institution. Overall in-hospital operative mortality (OM) was 7.4% (9/121), with 77.8% (7/9) of deaths due to cardiac causes. Serious postoperative morbidity occurred in 71.1% (86/121). Surgical priority was significantly correlated with operative mortality: for elective cases, the OM was 2.9% (2/68), but it was 8.6% (3/35) for urgent cases (p less than 0.05) and 22.2% (4/18) for emergency cases (p less than 0.05). Univariate analysis isolated the need for inotropic support, intraaortic balloon pump, reoperation, cardiopulmonary resuscitation, and emergency status as significant risk factors for OM (p less than 0.05). Multivariate stepwise logistic regression analysis identified the need for inotropic support, intravenous nitroglycerin, reoperative coronary artery bypass grafting, and hypertension as independently significant risk factors. A logistic risk equation developed from this population accurately modeled OM at the extremes of operative risk. Three (3.1%) of the 97 patients predicted to have less than 5% OM died, whereas all patients predicted by the model to have greater than 90% OM died. These results indicate that in spite of relatively high morbidity and mortality rates, elderly patients have a very acceptable operative risk in the current era of high-risk coronary artery bypass grafting. This is particularly true if elective revascularization is possible.

Aged↗
PubMed1991

Development of a dietary model for the study of mild zinc deficiency in humans and evaluation of some biochemical and functional indices of zinc status.

After a 1-wk baseline period, a dietary regimen was developed to induce mild zinc deficiency in 15 males (aged 25.3 +/- 3.3 y, mean +/- SD). The regimen consisted of 1 wk on a liquid diet containing 0.6 mg Zn/d and molar ratios of phytate to zinc (phy:Zn) and of phytate X calcium to zinc [(phy X Ca): Zn] of 209 and 4116, respectively, followed by 6 wk on a diet based on soy protein and egg albumin containing 4 mg Zn/d and with phy:Zn and (Ca X phy):Zn of 70 and 2000, respectively. Subjects were then repleted with 30 mg Zn/d for 2 wk. Fasting blood and urine samples were taken weekly. Changes were observed in mean plasma (mumol/L) and urinary zinc (mumol/d): baseline 97.0 +/- 10.9 and 8.0 +/- 2.7, depletion 80.1 +/- 13.4 and 4.3 +/- 2.3, and repletion 100.8 +/- 13.6 and 8.2 +/- 3.1, respectively (P less than 0.05); taste acuity (0.05 less than P less than 0.10); and cellular immune responses (P less than 0.05). Activities of plasma angiotensin-1-converting enzyme and acidic alpha-D-mannosidase were unchanged. Mild zinc deficiency was induced by the dietary regimen.

Adult↗
PubMed1991

Perceptions of self and short stature: effects of two years of growth hormone treatment.

A cohort study was carried out to determine whether childrens' perception of the problem of short stature changed over 2 years of growth hormone (GH) therapy. A total of 66 children (age range, 5-15 years; mean 10.2 years) were selected on the basis of height below the 3rd centile for chronological age, height velocity below the 25th centile for bone age, prepubertal status, and absence of any organic condition causing growth failure or likely to interfere with GH action. The children were taking part in a 2-year multicentre trial to assess the effect of authentic recombinant GH on short, slowly growing children without GH deficiency (GHD). The childrens' and parents' attitudes and emotional adjustment to shortness were assessed before GH therapy commenced, and at 6 months and 2 years, using a growth-specific psychological instrument, the Attitude to Growth scale (ATG). The children were also assessed using the Piers Harris Childrens Self Concept Scale at 2 years. The mean ATG scores increased from 34.2 (95% confidence interval, 33.2-35.2) at intake to 37.2 (95% confidence interval, 36.2-38.2) at 2 years. Younger subjects had a greater increase (p less than 0.05). No sex differences occurred. Two separate factors were identified in the childrens' attitudes: emotional preoccupation with stature and a concrete focus on practical aspects. No differences were present between childrens' and parents' mean scores, though parents' estimates differed on selected items. The mean Piers Harris score at 2 years was within the normal range, and was positively correlated to the ATG but was unrelated to height. It is concluded that GH treatment may have a beneficial effect on childrens' attitudes to being short, particularly in the younger child.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Preschool vision screening.

Although a good case for preschool screening for vision defects can be made there is very little evidence that existing programmes are effective in practice. A comparative trial of three different methods of preschool vision screening is described. Some 7000 children initially aged 5 months (younger cohorts) and 30 months (older cohorts) in three matched areas entered the trial during 1987. During 18 months of follow up new visual and ocular defects among these children were ascertained through ophthalmology outpatients and from optician records. Screening at 35 months by an orthoptist based in the community is superior to conventional health visitor surveillance at 30 months and to an agreed programme of primary care screening for squint at 30-36 months as judged by screening sensitivity (100% v 50% v 50%) and the incidence of treated target conditions (17 v 3 v 5 per 1000 person years). A notable feature in the area served by the orthoptist is that 13 children received treatment for straight eyed visual acuity loss from among 1000 children whereas there were no such cases among 2500 in the comparison areas. In the younger cohorts (that is, screening at age 5-9 months) all three programmes showed equally poor results, only one of the eight treated target conditions arising from all 3500 younger children being screen detected.

Amblyopia↗
PubMed1991

Effect of pregnancy on endothelium and smooth muscle: their role in reduced adrenergic sensitivity.

During pregnancy, vascular reactivity of the uterine artery is characterized by decreased contraction to norepinephrine and increased relaxation to acetylcholine. We investigated whether 1) relaxation to A23187 is increased during pregnancy and 2) endothelium-derived relaxing factor (EDRF) and/or prostaglandins are responsible for the decreased uterine artery sensitivity to norepinephrine during pregnancy. Isolated rings of uterine and carotid arteries were obtained from pregnant and nonpregnant guinea pigs. Relaxation to sodium nitroprusside in uterine but not carotid artery was reduced during pregnancy. Relaxation of both uterine and carotid arteries to the calcium ionophore A23187 was unaffected by pregnancy. During pregnancy, contractions to norepinephrine were reduced in the uterine artery compared with arteries from nonpregnant animals. Indomethacin slightly enhanced the contractions of uterine artery to norepinephrine during pregnancy. However, indomethacin-treated uterine arteries from pregnant animals were still less responsive to norepinephrine than control uterine arteries from nonpregnant animals. Methylene blue enhanced the efficacy of norepinephrine in uterine arteries of nonpregnant animals as well as carotid arteries of pregnant and nonpregnant animals but not in uterine arteries of pregnant animals. In contrast, N-monomethyl-L-arginine, a specific inhibitor of EDRF synthesis, not only enhanced uterine and carotid artery responses to norepinephrine in both pregnant and nonpregnant animals but fully reversed the blunted potency of norepinephrine on uterine arteries of pregnant to that of nonpregnant animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Acute retroviral syndrome].

A 37 year old male developed fever for 20 days, along with headache, anorexia, malaise, sweating, pharyngitis, lymphadenopathy and splenomegaly. At this stage, Ag p24 was positive and anti HIV was negative. The patient recovered fully but 6 months later positive HIV titers were demonstrated by immunofluorescence and Western-blot. A retrospective diagnosis of acute retroviral syndrome was made. The difficult differential diagnosis with infectious mononucleosis, cytomegalovirus, measles, rubella, toxoplasmosis and influenza is discussed. Thus, anti HIV antigenemia should be investigated in any patient with a mononucleosis like syndrome belonging in a high risk group for AIDS, even if Paul-Bunnell-Davidson or IgG anti VCA-EB reactions are positive.

Acute Disease↗
PubMed1991

[Bacterial overgrowth in small intestine in patients with liver cirrhosis].

Hepatic encephalopathy, bacterial infections and endotoxemia in cirrhotic patients have been related to colonic flora. However, an abnormal small bowel bacterial content could also be implied. We investigated small bowel bacterial overgrowth (SIBO) by jejunal cultures in 14 cirrhotic patients and 5 control subjects, and indirectly by the lactulose H2 breath test in 22 patients with cirrhosis and 12 controls. SIBO was demonstrated by cultures in 64% of cirrhotic patients and 1 of 5 controls. The breath test was positive for SIBO in 45% of patients with cirrhosis and 8% of controls. No differences were noted between patients with alcoholic and non-alcoholic liver disease. According to fasting H2 breath levels, SIBO was significantly correlated with the Child-Pugh score for hepatic function (r = 0.45; p < 0.05). Also, patients with positive criteria for SIBO in jejunal cultures had worse hepatic function in comparison to cirrhotics with normal jejunal bacterial counts (p < 0.05). Thus SIBO is frequent in patients with hepatic cirrhosis and is associated with impairment in hepatic function.

Bacteria↗
PubMed1991

[Treatment of uncomplicated urinary tract infections: cefuroxime vs cotrimoxazole].

Forty females (ages 15-74) with community-acquired, uncomplicated urinary tract infections were studied. Clinical and microbiological efficacy of cefuroxime (250 mg td) and trimethoprim sulfamethoxazole (160/800 mg td) used for 7 days were evaluated. The microorganisms found in the pre-treatment urinary cultures were: Escherichia Coli (85%), Klebsiella Pneumoniae (12.5%), and E. Agglomerans (2.5%). They were all susceptible to cefuroxime, and 42.5% were resistant to trimethoprim sulfamethoxazole (Kirby-Bauer). These findings show that trimethoprim sulfamethoxazole should not be used empirically while waiting for the results of urinary cultures, and that cefuroxime is a good alternative in these cases. Clinical cure was observed in all, and bacteriological cure in 75% of the pts treated with both antimicrobial agents. Relapses and reinfections were detected during follow-up emphasizing the importance of intra and post-treatment urinary cultures.

Adolescent↗
PubMed1991

A critical appraisal of the research literature investigating fatigue in the individual with cancer.

Fatigue is a commonly experienced symptom, which may be a component of virtually any disease and can have a psychological, physical, or mixed origin. Nurses need to understand the onset, duration, and progression of fatigue to intervene successfully with the cancer patient adapting to diagnosis and treatment. While the literature is an important source of information, results of research studies must be critically interpreted before proceeding with practice guidelines based on research findings. A critical appraisal of the research literature investigating the problem of fatigue in individuals with cancer was conducted. There is strong evidence to suggest that fatigue is a prevalent problem among cancer patients receiving chemotherapy and radiation therapy. However past research has been limited by methodological problems. Typically, studies fail to include a control group, do not control for possible confounding variables, and have restricted measurement to unidimensional scales with limited reliability and validity. While several correlates of fatigue have been postulated, research to date has found no consistent relationships among such correlates as weight loss, anemia, or psychological distress. This article reviews what is currently known about fatigue in the cancer patient and how future research could be designed to improve on past measurement and sampling problems.

Fatigue↗
PubMed1991

Survival after neonatal myocardial infarction.

These are case reports of two children with structurally normal hearts and with normal coronary arteries, who survived myocardial infarction in the early neonatal period. They are only the third and fourth reported survivors of neonatal myocardial infarction and the first in which hypercholesterolemia is postulated to have played an important role. The most likely cause of the myocardial infarction was thrombosis or thromboembolism. Changes in hemostatic function associated with hypercholesterolemia may be relevant.

Coronary Angiography↗
PubMed1990

True emergency coronary artery bypass surgery.

Previous reports of emergency coronary artery bypass grafting often included cases that were not true surgical emergencies, thereby creating inappropriately favorable results. To accurately investigate this important subgroup of patients, we analyzed our recent experience with truly emergent coronary artery bypass grafting. From January 1984 to January 1989, 117 patients underwent true emergency bypass grafting for acute refractory coronary artery ischemia. Clinical deterioration was associated with failure of percutaneous angioplasty in 37 patients and instability during diagnostic catheterization in 13 patients. Refractory ischemia developed in the remaining patients while on the ward or in the intensive care unit. All operations were performed within four hours of surgical consultation, most within one hour. Overall in-hospital operative mortality was 14.5% (17/117), and 76.5% of deaths (13/17) were due to cardiac-related causes. Major morbidity occurred in 35.9% (42/117). Univariate analysis isolated ejection fraction, extent of coronary artery disease, previous myocardial infarction, hypertension, need for inotropic support, use of an intraaortic balloon pump, and cardiopulmonary resuscitation as risk factors for operative mortality. Stepwise multivariate analysis confirmed that previous myocardial infarction, hypertension, cardiopulmonary resuscitation, and reoperation were independently significant risk factors. Age, sex, diabetes, left main disease, and peripheral vascular disease had no significant impact on the prognosis. The 4% operative mortality (2/50) for patients taken directly to the operating room from the catheterization suite was significantly lower than the 22.4% mortality (15/67) associated with emergencies arising on the ward or intensive care unit (p less than 0.01). A logistic risk equation developed from this population accurately modeled operative mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Thoracic irradiation in Hodgkin's disease: disease control and long-term complications.

A total of 590 patients with Stage IA-IIIB Hodgkin's disease received mantle irradiation at the Joint Center for Radiation Therapy between April 1969 and December 1984 as part of their initial treatment. Recurrence patterns as well as pulmonary, cardiac and thyroid complications were analyzed. Pulmonary recurrence was more frequently seen in patients with large mediastinal adenopathy (LMA); 11% of patients with LMA recurred in the lung in contrast to 3.1% with small or no mediastinal disease, p = 0.003. Hilar involvement, when corrected for size of mediastinal involvement, was not predictive of lung relapse. Patients with LMA also had a high rate of nodal relapse above the diaphragm (40%) following radiation therapy (RT) alone as compared to similarly treated patients with small or no mediastinal adenopathy (6.5%), p less than 0.0001. This risk of nodal recurrence was greatly reduced (4.7%) for LMA patients receiving combined radiation therapy and chemotherapy (CMT), p less than 0.0001. Sixty-seven patients (11%) with hilar or large mediastinal involvement received prophylactic, low dose, whole lung irradiation. No decrease in the frequency of lung recurrence was seen with the use of whole lung irradiation. Radiation pneumonitis was seen in 3% of patients receiving radiation therapy alone. In contrast, the use of whole lung irradiation was associated with a 15% risk of pneumonitis, p = 0.006. The risk of pneumonitis was also significantly increased with the use of chemotherapy (11%), p = 0.0001. Cardiac complications were uncommon with pericarditis being the most common complication (2.2%). Thyroid dysfunction was seen in 25% of patients and appeared to be age-related. These data suggest that the long-term complications of mantle irradiation are uncommon with the use of modern radiotherapeutic techniques. The use of prophylactic whole lung irradiation is no longer recommended since its use did not reduce pulmonary relapse but did increase the risk of pneumonitis. Chemotherapy is also associated with an increased risk of pneumonitis, however, its use in patients with large mediastinal adenopathy appears justified.

Adolescent↗
PubMed1990

Histoplasmosis duboisii (African histoplasmosis). An African case reported from Chile with ultrastructural study.

A case of histoplasmosis duboisii in a 30 year-old engineer is presented. The diagnosis was made with the help of light microscopy, electron microscopy and cultures. Although diagnosed in Chile, the patient probably acquired the disease in the endemic African area, more precisely in the Ivory Coast. Differential diagnosis between Histoplasma capsulatum var. capsulatum and Histoplasma capsulatum var. duboisii is based primarily on the larger in-vivo yeast form size of the latter. Electron microscopy study, the first done on the duboisii variety of Histoplasma capsulatum in human material to our knowledge, was not essential for this purpose. Differential diagnosis between Histoplasma capsulatum var. duboisii and Blastomyces dermatitidis is based on morphological tissue changes and mycologic characteristics. Once more, a case of an "exotic" or geographically restricted disease is detected far from its endemic area, thanks to easier means of transportation. Earth is a shrinking planet.

Adult↗