Biomedical subjects
Publications and source records attributed to M Evans.
Numerous case reports have elucidated the extent of radiation-induced injuries of the intrathoracic structures. An extensive radiation injury resulting from treatment of Hodgkin's disease is reported. This patient was successfully treated with multicoronary artery bypass grafting, aortic valve conduit and perioperative right ventricular inotropic support.
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This paper describes an automated medical record designed to allow providers to enter patient data at the point of care. The system runs on PCs and Macintoshes and uses a graphical user interface and object-oriented programming to take advantage of current mouse and pen technologies. The provider acquires all relevant patient data by pointing and clicking at selections on input screens, many of which contain anatomical drawings to help the provider quickly and accurately describe patient findings. The system also generates a grammatically correct progress note using the problem-oriented structure. Furthermore, items identified in the assessment and plans portion of the program can be ported to expert systems for medical decisions assistance or to billing systems. The system allows the provider to obtain the necessary information on a focused patient visit in less than 5 min or to enter a complete history and physical.
The relationship between superstitious beliefs and behaviors, and measures of obsessive-compulsive experiences was examined in this study. Both superstitious beliefs and superstitious behaviors were correlated with measures of compulsivity and obsessionality. Compulsive checking, but not compulsive cleaning (from the MOCI and the CAC-R) were correlated with superstitiousness. Both subscales from the Obsessional Thoughts Questionnaire were correlated with superstitiousness. The implications of these findings for the role of perceived control in obsessive-compulsive phenomena were discussed.
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The cofacilitator of a veteran's therapy group conducted by a Veterans Administration (VA) clinical nurse specialist uses his participant-observer role to analyze the theoretical constructs used in the group. A unique group psychotherapy model blending nursing triage techniques with "hot seat" client focus and interpersonal theory is presented and compared with similar models. Clinical issues arising from its use among combat veterans with post-traumatic stress disorder at a New Hampshire VA Medical Center are also discussed.
In the spring of 1989 the largest outbreak of acute Q fever recorded in the United Kingdom occurred in Solihull and surrounding areas of the West Midlands. The diagnosis was confirmed in 147 people, mainly males of working age. Windborne spread from farmland to the south of the urban area was the most likely route of infection. Fever was the commonest symptom, seen in 101/102 (99%) cases, followed by weight loss reported by 83/101 (82%). Headache, often severe, was experienced by 69/101 (68%). The commonest respiratory symptom was breathlessness, 65/102 (64%), followed by cough, 52/102 (51%), and chest pain, 46/102 (45%). Neurological features, seen in 23% of cases, were more prominent in this outbreak than is commonly recognized. Persisting ill health 6 months following the acute episode not due to chronic Q fever was also a prominent feature of this largely urban outbreak.
We have developed an experimental model in which pins, inserted into the seventh and ninth caudal vertebrae of 13-week-old rats, are used to load the eighth caudal vertebra in compression. Four groups of animals were used in the study: unpinned; animals with pins inserted, but non-loaded; animals loaded once, for 360 cycles at 0.5 Hz; and animals subjected to daily loading for 36 cycles at 0.5 Hz. Pins were immobilised by clamps when not undergoing loading. The animals were killed 9 days after pinning, and the eighth caudal vertebra was subjected to histomorphometric and histodynamic analysis. We found that vertebrae subjected to 36 daily loading cycles showed a 30-fold increase in bone formation compared to non-loaded controls. A single loading regime of 360 cycles was sufficient to increase bone formation 4-fold. Bone formation on trabecular surfaces was of lamellar rather than woven bone and was accompanied by a decrease in indices of bone resorption. Loaded vertebrae also showed substantial periosteal woven bone formation, although a minor degree of periosteal woven bone formation was also seen in one non-loaded pinned control vertebra. Our results suggest that in the rat, as in avian species, short loading regimes are capable of inducing bone formation. The model may assist an analysis of the interactions between bone resorption, bone formation and mechanical stimuli, and may enable identification of the molecular signals that mediate induction of lamellar bone formation on trabecular surfaces.
Twenty-seven long-term psychiatric inpatients maintained on neuroleptics with concomitant antiparkinsonian medication were entered into a study in which anticholinergic medication was gradually withdrawn in a randomized double-blind within-subjects design. The extrapyramidal symptoms of each patient were compared when taking their usual anticholinergic medication, when taking placebo and when taking no antiparkinsonian drug. The relapse rate on no medication was 14%, and if patients relapsed on no medication they also relapsed on placebo. The relapse rate was not significantly different on active medication. Nor were there significant differences in ratings of parkinsonism or dyskinesia. The lack of difference between double-blind and overt withdrawal does not mean that studies that find a much higher relapse rate are necessarily unaffected by nonspecific factors, as significant unblinding may occur in clinical trials.
Anti-idiotypic antibody and its F(ab')2 fragments prepared from pooled normal human IgG had a partial inhibitory effect on the spontaneous in vitro secretion of anti-DNA antibodies from blood mononuclear cells of lupus patients. The inhibitory effect was specific for anti-DNA secretion as the anti-idiotype failed to inhibit the spontaneous secretion of anti-tetanus toxoid in the same culture supernatants. Non-anti-DNA IgG or its F(ab')2 fragments from pooled normal human IgG had less inhibitory effect on anti-DNA secretion than the purified anti-Id. In vitro polyclonal IgG secretion by lupus blood mononuclear cells was equally inhibited by both the anti-idiotype and the non-anti-DNA IgG of pooled normal human IgG. There was no correlation between the in vitro suppression of anti-DNA and that of total IgG or of anti-tetanus toxoid antibody. Pooled normal human IgG could have a potential beneficial effect in the therapy of systemic lupus erythematosus by inhibiting anti-DNA production via an anti-idiotypic mechanism.
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Chemotherapy has been used clinically to mobilize hematopoietic progenitor cells into the peripheral blood so that they can be harvested for autologous transplantation. In humans, this is demonstrated by the presence of circulating granulocyte-macrophage colony-forming cells (CFU-GM) and CD34-positive cells, but it has not been possible to confirm the presence of marrow-repopulating stem cells. In this study, we treated mice with 200 mg/kg cyclophosphamide (CY) and measured the numbers of white blood cells, day 12 CFU-S (CFU-S12), and CFU-GM in the peripheral blood. There was a peak in the numbers of CFU-S12 and CFU-GM 8 days after treatment with cyclophosphamide. Peripheral blood cells taken at this time rescued lethally irradiated mice and engraftment of donor cells was confirmed after 140 days in sex mismatched recipients using a Y chromosome-specific probe. In vitro culture of the blood cells harvested after cyclophosphamide showed that they proliferated in suspension cultures for at least a year in the presence of interleukin-3. The cultured cells rapidly lost their abilities to rescue irradiated mice and to form colonies in vitro, but they did not become leukemic. Also, CY-treated mice were irradiated with a leukemogenic dose of x-rays to coincide with peak circulating cell numbers but these animals did not develop an excess of leukemias over mice given irradiation alone.
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The sensitivity of non-isotopic in situ hybridization (NISH), particularly on formalin-fixed, paraffin-embedded (FFPE) clinical tissues, has been the subject of controversy. Generally, NISH has been regarded as being less sensitive than radiolabelled procedures, although some reports have contradicted this. Accordingly, tissues from mice which were transgenic for variable amounts of the human alpha-1-antitrypsin gene were used to optimize the NISH procedure and to estimate the sensitivity. This approach showed that prolonged incubation of slides in final substrate resulted in high sensitivity--about 13 kb of target DNA. However, this prolonged incubation crucially depended on achieving minimal non-specific background staining. Many factors affected the degree of background staining, but five were particularly important. First, the method of mounting cut sections onto slides. Second, the length of the probe (ideally less than 400 bp). Third, the procedure for proteolytic digestion. Fourth, the denaturation technique, and fifth, the quality of the dextran sulphate used in the hybridization mix. The optimized protocol showed variable patterns of mRNA distribution in the transgenic mouse livers, while DNA distribution appeared uniform.
From February 1988 until August 1991, 28 patients with prior coronary artery bypass grafting (CABG) received implantable cardioverter defibrillator (ICD) therapy via a subxiphoid approach. Only one patient required conversion to a median sternotomy incision. The mean defibrillation threshold was 11.9 +/- 4.4 J. The mean R wave was 8.2 +/- 3.7 mV. One perioperative death occurred due to heart failure (mortality rate 1/28 [3.50%]). No patient required reexploration for bleeding. The subxiphoid method for ICD electrode implantation is safe and reliable in patients with prior CABG surgery.
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The increased risk of neoplasia following cytotoxic therapy for both malignant and nonmalignant disease is well known. Sister chromatid exchange (SCE) frequencies in patients receiving such chemotherapy are often elevated, and the persistence of high levels after treatment may provide an indicator for susceptibility to secondary neoplasia. The cytostatic drug razoxane has been used for the treatment of psoriasis, acute myeloid leukemia (AML), and colorectal carcinoma. Prolonged use of this drug, however, has been associated with the subsequent development of AML and, up to November 1987, 16 cases of acute leukemia following razoxane treatment have been reported. We report the SCE frequencies for 34 patients with colorectal carcinoma who were receiving or had previously been treated with razoxane. Our results show no significant increase in SCE levels in the razoxane group compared with either normal controls or untreated patients.