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Biomedical subjects

M D Smith

Publications and source records attributed to M D Smith.

At least 451 records · Page 25Linked to original sources
PubMed1987

The incidence and prevalence of woman abuse in Toronto.

A telephone survey on the physical abuse of women by a male intimate was conducted with a representative sample of 604 Toronto women. Results showed an annual incidence rate of 14.4% and a prevalence rate of 25.0%, based on the Conflict Tactics Scales as the measure of abuse. Several additional measures increased the prevalence rate to 36.4%. These estimates, which are much higher than those obtained in a similar survey conducted two years earlier in Toronto, appear to be the result mainly of improved methodological procedures in the present study.

Adult↗
PubMed1987

Measurement of immune complexes with the liquid phase C1q binding assay: ten years experience in a routine diagnostic laboratory.

We describe our 10 years experience in assaying over 15,000 clinical specimens for immune complexes (IC) using the C1q binding assay. Normal ranges were initially established using a large panel of blood donor sera and precision of the assay was optimized by inclusion of heat aggregated IgG (HAGG) as standards. Nevertheless some variability was observed due to variation in C1q binding from batch to batch and with aging of this reagent. In an empirically selected 2 year period involving over 3,000 clinical specimens, 25% had elevated concentrations of IC. Of these the majority were from patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), other connective tissue disorders, infective endocarditis (IE), diffuse interstitial lung disease (DILD) and vasculitis (VASC). In RA, IE and VASC, significant correlations were observed between concentrations of IC and rheumatoid factor (RF) and the addition of a purified monoclonal RF to normal serum caused increased C1q binding. Longitudinal studies in RA and IE demonstrated a striking decline in IC in response to effective treatment. We conclude that the measurement of IC provides little additional useful diagnostic information in those diseases associated with high levels of RF but appears more useful in disorders such as SLE, IE and DILD in which RF is absent or present in low concentration. Sequential monitoring of IC in RA and IE reflects response to treatment.

Antigen-Antibody Complex↗
PubMed1986

Clonidine protection from soman and echothiophate toxicity in mice.

The influence of clonidine on the toxicity produced by two irreversible, organophosphate cholinesterase inhibitors, soman and echothiophate, was studied in mice. At lethal doses, soman produced whole body tremor but no muscle fasciculation; at lethal doses, echothiophate produced muscle fasciculations but no whole body tremor. Pretreatment with clonidine protected against several toxic manifestations of soman, but had little effect on echothiophate toxicity. In addition to its documented effects on acetylcholine metabolism, clonidine was found to be a weak inhibitor of acetylcholinesterase. At certain concentrations, clonidine protected the enzyme from permanent inactivation by soman. These findings indicate that the toxicity of soman and echothiophate reflect primarily central and peripheral actions, respectively, and that clonidine has a much greater protective effect versus the centrally-acting agent. Moreover, direct interactions with acetylcholinesterase may contribute to clonidine protection from cholinesterase inhibitor toxicity.

Acetylcholinesterase↗
PubMed1986

Methylprednisolone infusion therapy in rheumatoid arthritis patients. The effect on synovial fluid lymphocyte subsets and inflammatory indices.

Paired samples of synovial fluid (SF) and blood were obtained prior to and at 4 and 24 hours following high-dose methylprednisolone infusion therapy in a group of patients with refractory rheumatoid arthritis. After therapy there was a significant decrease in numbers of polymorphonuclear leukocytes, lymphocytes, immune complexes, and C-reactive protein in the SF. Measurement of lymphocyte subsets, using monoclonal antibodies, revealed that at 4 hours postinfusion, there was a disproportionate decrease in the percentage of SF lymphocytes expressing class II antigens (HLA-DR or Ia-like). These data suggest that glucocorticoids induce rapid changes in SF indices of disease activity and may directly influence T cell activation within the rheumatoid joint.

Aged↗
PubMed1986

Managing the behavior of adults with autism in the job setting.

The purpose of the study was to facilitate the adjustment of adults who are severely disabled by autism to the job setting. Three cases are presented that illustrate the use of on-the-job training procedures to manage behavior problems of adults with autism. In two cases aggressive and oppositional behavior were eliminated or reduced in frequency, and in a third case production rate was increased. The feasibility of on-the-job training of adults with autism is discussed, and expanded research into vocational training programs is recommended.

Adult↗
PubMed1986

Systematic correlation of continuous-wave Doppler and hemodynamic measurements in patients with aortic stenosis.

The purpose of this study was to compare estimates of pressure gradients obtained from continuous-wave (CW) Doppler recordings with direct pressure measurements derived from cardiac catheterization in patients with aortic stenosis. Forty patients who underwent cardiac catheterization for evaluation of aortic stenosis were prospectively studied with CW Doppler spectral recordings of the aortic valve prior to catheterization. Thirty-three patients underwent a second Doppler examination simultaneously with pressure recordings in the catheterization laboratory. Nineteen of the patients had catheterization pressures measured using high-fidelity, micromanometer-tip catheters. Doppler and pressure tracings were digitized using a microprocessor-based computer with a software program which allowed for calculation of maximal instantaneous, mean, and peak-to-peak gradients, plus ejection and acceleration times. Maximal instantaneous gradient by CW Doppler showed an excellent correlation with maximal instantaneous catheterization gradient (r = 0.93, SEE = 9 mm Hg). The correlation of maximal instantaneous Doppler gradient with peak-to-peak catheterization gradient was also linear (r = 0.85, SEE = 12 mm Hg), but there was a consistent overestimation of peak-to-peak gradient in 38 of 40 cases (mean = 17 mm Hg). Mean gradient as calculated by the two techniques correlated best of all measurements performed (r = 0.95, SEE = 6 mm Hg). When patients were grouped into subsets of mild (0 to 25 mm Hg), moderate (25 to 50 mm Hg), and severe (greater than 50 mm Hg) levels of stenosis, the correlation of maximal instantaneous Doppler and peak-to-peak catheterization gradients were r = 0.22, 0.44, and 0.77, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Use of similar sensory stimuli in the community-based treatment of self-stimulatory behavior in an adult disabled by autism.

The suppressive effects of frequent access to olfactory stimulation on the olfactory self-stimulatory behavior of a woman severely disabled by autism were investigated in a noninstitutional community setting. The results indicated that a reduction in self-stimulation could be achieved by frequent presentation of alternative olfactory stimulation, and that direct care staff in a group home setting could successfully apply the strategy. Fourteen months after the onset of treatment the target behavior remained suppressed.

Adult↗
PubMed1986

Similarities and distinctions between murine natural killer cells and lymphokine-activated killer cells.

Pretreatment of mice with rabbit anti-asialo GM1 removes both natural killer (NK) effector cells and NK cells responsive to interleukin 2 (IL-2). Spleen cells from these mice do possess normal lymphokine-activated killer (LAK) activity. Young mice (less than 3 weeks of age) do not have NK activity and do not possess IL-2-inducible NK effector cells. Similarly to anti-asialo GM1-treated mice, LAK cells can be generated from these mice. While these experiments indicate clear distinctions between a certain level of NK and LAK precursors, the distinctions are not as clear when analyzing mice congenitally deficient in NK cells. Beige mice which lack NK effector cells and IL-2-inducible NK cells also lack the ability to generate LAK cells. The relationships and differences between NK- and LAK-cell precursors and effectors are discussed.

Animals↗
PubMed1986

Living-related kidney donors: a multicenter study of donor education, socioeconomic adjustment, and rehabilitation.

To determine the consequences of living-related kidney donation, a study was conducted of 536 donors whose nephrectomies had been performed at nine geographically dispersed centers during the past 12 years. The data demonstrated that greater than 84.0% of the donors thought they had been adequately informed regarding all aspects of donation, and less than 15.0% reported being pressured in their decision. Only two serious medical complications were directly attributable to the surgery, greater than 92.0% of the donors believed their health had not been adversely affected by donation, and 96.8% reaffirmed their decision regardless of the graft's success or the financial distress they experienced (P greater than .05). However, greater than 14.0% experienced direct pressure, particularly not to donate. Donation also appeared to stress previously troubled marriages, especially among donors without a religious affiliation, who were pressured to donate by their families, or who borrowed from family members (P less than .05). Substantial unreimbursed expenses (greater than or equal to $1,000) were incurred by 43 donors, and 23.2% of all donors reported that donation caused a financial hardship.

Adolescent↗
PubMed1986

Gastric neurofibroma in an adolescent.

A 14-year-old white girl with a large, bleeding, ulcerated mass of the stomach was treated with surgical excision. Histologically, the mass was a plexiform neurofibroma. These tumors are uncommon, especially in the pediatric age group, and are best treated by surgical resection.

Adolescent↗
PubMed1986

Serological investigations in the diagnosis and management of infective endocarditis.

In a retrospective study of 39 patients with infective endocarditis (IE) all had elevated concentrations of C reactive protein (CRP) at presentation, patients with the acute variety having significantly higher values than patients with the subacute variety. In addition, the majority of patients with subacute bacterial endocarditis had elevated concentrations of circulating immune complexes (CICs) and rheumatoid factor (RF), both of which were absent in all but one of nine patients with acute bacterial endocarditis. Two patients with subacute and one with acute bacterial endocarditis had low values of C3 and C4. Measurement of CRP, CICs, and RF did not distinguish between patients with and without extracardiac manifestations. Sequential analysis of patients revealed that a successful response to antimicrobial treatment was indicated by a striking and rapid decline in CRP, with less striking declines in CICs, RF, and IgM. Antibiotic failure was indicated by the persistence of high concentrations of CRP and CICs. We conclude that the measurement of C reactive protein is of some value in the diagnosis and management of infective endocarditis. A normal CRP concentration excludes this diagnosis. The measurement of CRP alone appears sufficient for monitoring most cases of infective endocarditis with the sequential measurement of rheumatoid factor and circulating immune complexes adding no useful information except where the CRP remains elevated despite treatment. In this latter instance, persisting high levels of CRP and circulating immune complexes together herald an ominous course.

Acute Disease↗
PubMed1986

Adult onset Still's disease or coxsackie polyarthritis?

The clinical manifestations and laboratory findings of two patients with a presumptive diagnosis of coxsackie B4 virus infection are described. A striking feature was the similarity with adult onset Still's disease, with spiking fever, evanescent macular rash, and severe polyarthritis. This latter feature persisted for many weeks and required steroids to control the symptoms. Review of the literature has supported the proposition that many cases of adult onset Still's disease may be due to coxsackie B4 or other viral infection and it is suggested that these agents should be actively sought in future cases.

Adult↗