"Futility" as a criterion in limiting treatment.
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Attitude of Health Personnel↗
Biomedical subjects
M Solomon
Publications and source records attributed to M Solomon.
Public opinion, the NHS, and the media: changing patterns and perspectives.
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Attitude to Health↗
A scoring system to determine radiological loosening in cemented total hip arthroplasty.
A radiological scoring system was developed to identify grades of loosening of the components of a cemented hip replacement. In grade 1, there are mild changes, usually of minor significance; in grade 2 moderate changes which need regular observation, and in grade 3 severe changes which indicate impending failure. Three parameters are used for the socket, giving a score of 10 points, and 5 for the stem, with a score of 15 points. This method can be used to provide a comparison between different series with a long-term follow up.
Evaluation Studies as Topic↗
Unilateral leg edema caused by abdominoscrotal hydrocele: elegant diagnosis by MRI.
A 5-month-old boy presented with bilateral hydroceles since birth and right leg edema. An ultrasound of the pelvis showed a 4-cm cystic mass that was diagnosed as a teratoma or cystic hygroma. Magnetic resonance imaging was performed, which showed a dumbbell shaped contiguous, fluid filled mass extending intraabdominally through the inguinal canal from the scrotum. The cystic portion in the right iliac fossa was lying on the right iliac vessels, which were patent. A bilateral hydrocelectomy was performed, and the intraperitoneal sac was completely excised through the inguinal incision. The edema of the right leg disappeared a few days after surgery.
Humans↗
Partial trisomy 19p: case report and natural history.
Partial trisomy 19p was noted in an infant delivered at 39 weeks gestation with intrauterine growth retardation (IUGR), bilateral club feet, renal abnormalities, hearing deficit, and multiple dysmorphic features. Chromosomes obtained following amniocentesis at 32 weeks gestation revealed that the fetus was partially trisomic for 19p and partially monosomic for a portion of the terminal band of 3q, having inherited a derivative chromosome 3 from her father [46,XX,-3,+der(3)t(3;19)(q29;p13.2)pat]. The father was found to be the carrier of a balanced translocation between chromosomes 3 and 19 [46,XY,t(3;19)(q29;p13.2)]. The only other case of partial trisomy 19p previously reported was an infant with partial trisomy 19p and partial monosomy 13q who died at 59 days of age. This report by Byrne et al. [(Am J Hum Genet 1980: 32:64A] is similar to our case with respect to IUGR, small palpebral fissures, and ear anomalies.
Adult↗
Long-term results of Charnley low-friction arthroplasty of the hip.
The long-term results of 488 Charnley low-friction arthroplasties, performed by one surgeon, were analysed. Radiological changes were assessed using the CART nomenclature. If sepsis (1.4%) is excluded, the mechanical failure rate of one or both components requiring revision surgery was 6.5%. The incidence of radiological loosening of components was 4.7%. Kaplan-Meier survival analysis predicts an 88% mechanical survival of components at 10-12 years.
Adult↗
Quinolone antibacterials: preparation and activity of bridged bicyclic analogues of the C7-piperazine.
A series of quinolone and naphthyridine antibacterial agents possessing as the C7-heterocycle bicyclic 2,5-diazabicyclo[n.2.m]alkanes, where n = 2, 3 and m = 1, 2, and a series including 4-aminopiperidine and 3-amino-8-azabicyclo[3.2.1]octanes have been prepared and evaluated in vitro and in vivo for antibacterial activity against a variety of Gram-negative and Gram-positive organisms. These compounds were also tested against the target enzyme bacterial DNA gyrase. All the examples investigated are nearly equipotent with the parent 7-piperazinyl analogues. Only endo-7-(3-amino-8-azabicyclo[3.2.1]oct-8-yl)-1-cyclopropyl-6,8-difluoro- 1,4- dihydro-4-oxo-3-quinolinecarboxylic acid displays activity that surpasses that of the piperazine parent.
4-Quinolones↗
Long term effects of smoke inhalation in survivors of the King's Cross underground station fire.
BACKGROUND: In most accidents causing smoke inhalation only a few victims actually inhale the smoke. The fire at King's Cross provided an opportunity to assess the long term effects of smoke inhalation in a larger number of patients. METHODS: Fourteen survivors from the King's Cross underground station fire were assessed for respiratory disability six months after the disaster and 10 were reassessed at two years. All had inhaled substantial quantities of smoke and 10 had skin burns of differing severity. RESULTS: Six months after the fire nine survivors admitted to one or more symptoms, which included hoarseness (two cases), cough (five cases), and breathlessness (six cases); and a survivor with asthma noted a worsening of his symptoms. The remaining five denied new symptoms. Peak expiratory flow, spirometric indices, and transfer factor for carbon monoxide were within the predicted normal ranges. The mean residual volume, however, was greater than the predicted value and the mean maximum expiratory flow at 25% of vital capacity (V25) less than predicted, with no significant differences between smokers (n = 7) and non-smokers (n = 7). At least one of these ventilatory defects, suggesting small airways obstruction, was present in 11 survivors at six months and they had persisted in the seven patients who were reassessed at two years. CONCLUSION: Smoke inhalation may be associated with injury to the small airways.
Adult↗
Long-duration polyphasic motor unit potentials in myopathies: a quantitative study with pathological correlation.
In most myopathies, the duration of motor unit action potentials (MUAPs) is shorter than normal. However, polyphasic MUAPs of duration longer than 20% of the control mean, (long-duration polyphasic potentials, or LDPPs) may be seen. We therefore analyzed the incidence and meaning of LDPPs using quantitative MUAP analysis in 41 patients with different myopathies. The mean duration of all potentials was reduced in only 64% of patients because LDPPs increased the mean. When only simple potentials were considered, however, the mean duration was decreased in 95% of patients. This observation confirms the need to exclude LDPPs when calculating the mean duration of MUAPs for diagnosis. We found LDPPs most often in chronic polymyositis and in one patient with Becker Muscular Dystrophy. LDPPs are attributed to desynchronization of single-fiber potentials within the MUAP and may be due to slow conduction in regenerating muscle fibers.
Action Potentials↗
New quinolone antibacterial agents. Synthesis and biological activity of 7-(3,3- or 3,4-disubstituted-1-pyrrolidinyl)quinoline-3-carboxylic acids.
A series of 7-(3-amino- or 3-aminomethyl-1-pyrrolidinyl)-1-cyclopropyl-6,8-difluoro-1,4-dihydro-4-o xo-3-quinolinecarboxylic acids was synthesized and tested for antibacterial activity. Unique to these quinolones was the presence of a methyl or phenyl group in the pyrrolidine ring. Although the in vitro activity of these agents was usually equal to or less than that of their unsubstituted counterparts, one quinolone, 7-[3-(aminomethyl)-3-methyl-1-pyrrolidinyl]-1-cyclopropyl-6,8-difluoro-1 ,4-dihydro-4-oxo-3-quinolinecarboxylic acid, displayed exceptional potency both in vitro and in vivo, particularly against Gram-positive organisms.
Animals↗
Intracranial ependymoma and subependymoma: MR manifestations.
In order to provide a detailed description of the MR appearance of intracranial ependymoma, the MR examinations of 12 patients (10 with ependymomas and two with subependymomas) were reviewed and correlated with operative and pathologic reports. Three of 10 ependymomas were intraventricular, two were intraparenchymal, and five were transependymal, extending from CSF spaces into parenchyma. Both subependymomas were intraventricular. Solid ependymomas and subependymomas were iso- to hypointense relative to normal white matter on T1-weighted images and hyperintense on proton-density- and T2-weighted images. Foci of signal heterogeneity within solid neoplasms represented methemoglobin, hemosiderin, necrosis, calcification, and encased native vessels or tumor vascularity. Gd-DTPA-enhanced images in two patients differentiated enhancing tumor from surrounding nonenhancing edema and from surrounding normal brain parenchyma. Cystic neoplasms had sharply defined, round or oval margins and uniform signal intensity equivalent to or slightly hyperintense relative to CSF. Tumor-associated calcification was not demonstrated readily by MR. Sagittal and coronal images were valuable in assessing the amount of intraventricular tumor and route of extension. We conclude that the MR differentiation of ependymomas and subependymomas from other gliomas is provided most reliably by the location and morphology of the tumor and not by differences in signal intensity. The typical ependymoma arises within the fourth ventricle as a solid mass with heterogeneous signal intensity. A propensity for spread is seen along the CSF pathways via the foramina of Magendie and Luschka and the aqueduct of Sylvius. Supratentorial ependymomas may be periventricular in location and have cystic components. The two subependymomas in our series were solid, intraventricular tumors with relatively homogeneous signal intensities.
Adolescent↗
Reactions of 1-bromo-2-[14C]pinacolone with acetylcholinesterase from Torpedo nobiliana. Effects of 5-trimethylammonio-2-pentanone and diisopropyl fluorophosphate.
1-Bromo-2-[14C]pinacolone, (CH3)3C14COCH2Br [( 14C]BrPin), was prepared from [1-14C]acetyl chloride and tert-butylmagnesium chloride with cuprous chloride catalyst, followed by bromination. It was examined as an active-site directed label for acetylcholinesterase (acetylcholine acetylhydrolase, EC 3.1.1.7) (AcChE). AcChE, isolated from Torpedo nobiliana, has k(cat) = (4.00 +/- 0.04).10(3) s-1, Km = 0.055 +/- 0.008 mM in hydrolysis of acetylthiocholine, and k(cat) = (5.6 +/- 0.2).10(3) s-1, Km = 0.051 +/- 0.003 mM in hydrolysis of acetylcholine. BrPin, binding in the trimethyl cavity, acts initially as a reversible competitive inhibitor, Ki = 0.20 +/- 0.09 mM, and, with time, as an irreversible covalently bound inactivator. Introduction of 14C from [14C]BrPin into Torpedo AcChE at pH 7.0 was followed by SDS-PAGE, autoradiography and scintillation counting, in the absence and presence of 5-trimethylammonio-2-pentanone (TAP), a competitive inhibitor (Ki = 0.075 +/- 0.001 mM) isosteric with acetylcholine; 1.8-1.9 14C was incorporated per inactivated enzyme unit at 50% inactivation. TAP retarded inactivation by [14C]BrPin, and prevented introduction of 0.9-1.1 14C per unit of enzyme protected. Prior inactivation of AcChE by BrPin prevents reaction with [3H]diisopropyl fluorophosphate [( 3H]DFP). Prior inactivation by DFP or [3H]DFP does not prevent reaction with [14C]BrPin, and this subsequent reaction with BrPin does not displace the [3H] moiety. [14C]BrPin alkylates a nucleophile in the active site, and this reaction does not alkylate or utilize the serine-hydroxyl.
Acetylcholine↗
Vitreoperfusion. A new approach to ocular ischemia.
No satisfactory treatment is available to supply the metabolic needs of the retina in vascular occlusion. Consequently, necrosis occurs. We devised vitreoperfusion, a technique of perfusing the vitreous cavity after vitrectomy-lensectomy with selected fluids containing glucose and oxygen. We tested whether vitreoperfusion could protect the retina from severe combined retinal and choroidal ischemia. An intraocular pressure of 170 mm Hg was induced in each eye of nine cats for up to four hours, and simultaneously one eye of each cat underwent vitreoperfusion. After one week, histopathologic examination revealed retinal atrophy and dissolution in untreated eyes but not in eyes treated with vitreoperfusion. To our knowledge, such severe ischemia has never been treated successfully before. Vitreoperfusion is a potential treatment modality in various forms of ocular ischemia. Additional studies are warranted to refine the technique and determine any clinical applicability.
Animals↗
Ring finger testing in carpal tunnel syndrome: a comparative study of diagnostic utility.
Because digit 4 (D4) has dual innervation, median and ulnar sensory latencies can be determined over identical distances. To determine if D4 testing is more sensitive than other commonly used techniques to diagnose carpal tunnel syndrome (CTS), we examined 42 hands with clinical evidence of carpal tunnel syndrome and 43 control hands. D4 latency was significantly longer than controls more often than digit 2 (D2) in patients with CTS. Comparing median to ulnar latencies from D4 was the most sensitive method to make the diagnosis of CTS. In mild CTS, a characteristic double peak potential was seen in recordings from the median nerve after stimulating D4. This potential provided immediate visual confirmation of the diagnosis of CTS. Comparing D4 latency along median and ulnar nerves is useful for detecting mild CTS and should be used whenever there are clinical signs and symptoms of CTS but electrodiagnostic studies are normal or borderline.
Adolescent↗
Assessing Arab-American health care needs.
A health needs assessment was conducted with Arab-American immigrants in northern California. Data were obtained from community forums, key informants, the U.S. Census, and from a survey of 47 Arab immigrants. In the community forums, parenting difficulties, marital conflicts, and health risks were identified. Key informants (clergy, community leaders, health professionals) identified mental health problems related to child rearing, referrals for appropriate services, education to assist Arab women interface with the health and education systems, and translation and cultural interpretation for Arab patients and health care providers. Arab patients requesting health care identified referrals for appropriate care, advocacy, education about the medical regimen, and technical assistance obtaining care. Social indicators indicated potential needs for health services for those of lower income. A survey of 47 Arab-Americans indicated that predominant illnesses experienced in the past year were upper respiratory infections, cardiovascular and hypertension, diabetes, and family and social stress. Health-related problems reported most frequently were family stress, adjusting to the U.S., managing acute illness, coping with adolescents, and marital stress. For the most part, this group was satisfied with medical care received and stated that their most important health services were health education, availability of Arab speaking health providers, and referrals for appropriate treatment.
Attitude to Health↗
Stress, satisfaction, and coping: a study of women clerical workers.
Increasing numbers of women in the work force have prompted researchers to study the health impact of their work satisfactions and stressors. In this study, we examined the quality of the work role as perceived by women who hold clerical jobs. Qualitative data were collected through structured interviews with 87 female clerical workers employed in four organizational settings. All were mothers with one or more children living at home. Work satisfaction, work stressors, coping strategies, and resources were discussed in the interviews. Categories were developed for each of these areas. The Ethnograph computer program was used after content analysis to code and retrieve the responses for each category.
Adaptation, Psychological↗
Dream frequency in psychoanalysis and psychoanalytic psychotherapy.
The authors examine data on dream frequency from 50 patients, half of whom were seen in psychoanalysis and half in psychoanalytic psychotherapy. Frequency, defined as the proportion of sessions where at least one dream is related, is analyzed statistically as a function of sex, age, and type of treatment. Also, treatment outcome is examined as a function of sex, type of treatment, diagnosis, and dream frequency. Psychoanalytic patients are found to have higher dream frequency than the patients in the psychotherapy group. Higher average dream frequency is correlated with a better treatment outcome in both patient groups.
Adult↗