Nursing Mirror clinical forum. 8. Stoma care: towards a health body image.
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Biomedical subjects
Publications and source records attributed to M Salter.
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Therapy for acute leukemia in children has improved dramatically in recent years so that early death is rare. A subset of patients with extreme elevation of the WBC at diagnosis have been noted to have a higher rate of early death. We reviewed our experience with acute leukemia in children retrospectively over a 10 year period to assess the incidence and outcome of this problem. Nine early deaths occurred in a total of 185 cases (4.9%). One hundred and sixty patients presented with WBC less than 100,000/mm3 at diagnosis and four (2.5%) early deaths occurred. Twenty-five patients presented with WBC greater than 100,000/mm3 at diagnosis and five (20%) early deaths occurred (p less than 0.001). While early death in acute leukemia in children is uncommon (4.9%), patients with extremely elevated WBC at diagnosis have a significantly higher risk of early death.
It was assumed that patients with temporo-mandibular pain and dysfunction syndrome (TMPDS) would represent a population whose pain resulted from their emotional state. It was anticipated in the light of existing reports in the literature that they would score like patients with anxiety neurosis or other psychiatric illness on the General Health Questionnaire (GHQ) and the Crown-Crisp Experiential Index (CCEI: a measure of anxiety and other emotional characteristics). It was also anticipated that patients with facial pain associated with lesions would show evidence of similar emotional disturbance secondary to their pain. It was postulated, however, that the TMPDS patients would be separated from the others by a scale which measured their attitudes to parents and childhood experience, namely, the Parental Bonding Instrument (PBI). The actual comparison of TMPDS patients and patients with facial pain and lesions or pathophysiological disorders showed little evidence of neuroticism in either group; nor were the parental bonding attitudes found to be abnormal. It is questioned whether TMPDS is primarily psychological in origin.
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A 4-month-old male infant with Stage I rhabdoid tumor of the kidney at presentation subsequently developed pulmonary metastatic disease shortly after diagnosis and initiation of Vincristine and Actinomycin D chemotherapy. The patient was then treated with cis-platinum and Adriamycin. Within 28 days he achieved a complete remission which was maintained for 5 months. Subsequent recurrent pulmonary lesions failed to regress with radiotherapy and high-dose cyclophosphamide when used as single sequential agents. Further clinical trials with cis-platinum and Adriamycin seem warranted since prognosis with this tumor is poor and successful chemotherapy after metastatic dissemination has not been previously reported.
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Technique for re-educating sensory function after median nerve lesions at the wrist is described. Results of re-education of Twenty-three patients are presented. The functional results are good and belie the traditional view of sensory function after nerve suture. Recent advances in sensory neuro-physiology are discussed which may explain the successes of this technique.
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Because microorganisms are easily dispersed, display physiologic diversity, and tolerate extreme conditions, they are ubiquitous and may contaminate and grow in many food products. The behavior of microbial populations in foods (growth, survival, or death) is determined by the properties of the food (e.g., water activity and pH) and the storage conditions (e.g., temperature, relative humidity, and atmosphere). The effect of these properties can be predicted by mathematical models derived from quantitative studies on microbial populations. Temperature abuse is a major factor contributing to foodborne disease; monitoring temperature history during food processing, distribution, and storage is a simple, effective means to reduce the incidence of food poisoning. Interpretation of temperature profiles by computer programs based on predictive models allows informed decisions on the shelf life and safety of foods. In- or on-package temperature indicators require further development to accurately predict microbial behavior. We suggest a basis for a "universal" temperature indicator. This article emphasizes the need to combine kinetic and probability approaches to modeling and suggests a method to define the bacterial growth/no growth interface. Advances in controlling foodborne pathogens depend on understanding the pathogens' physiologic responses to growth constraints, including constraints conferring increased survival capacity.
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