Endoscopic adenoidectomy for relief of serous otitis media.
Explore the source record for details and available documents.
Adenoidectomy↗
Biomedical subjects
N Roberts
Publications and source records attributed to N Roberts.
Renal dysgenesis in a monozygotic twin: association with in utero exposure to indomethacin.
We report oligohydramnios and renal dysgenesis in one of identical twins, which might have resulted from in utero exposure to early, prolonged high-dose indomethacin. The proposita was the second of twin girls born at 36 weeks of gestation. Pregnancy was complicated initially by polyhydramnios in both amniotic sacs and premature uterine contractions. After administration of indomethacin and terbutaline from 16 to 30 weeks' gestation, serial prenatal ultrasound examinations ultimately showed oligohydramnios in twin B and resolution of polyhydramnios in twin A. On day 5 twin B developed hematuria, hypertension, renal failure, hyponatremia, hyperkalemia, metabolic acidosis, sodium wasting and severe, transient inability to excrete potassium. Renal sonography showed enlarged, hyperechoic kidneys with almost no corticomedullary differentiation. Renal biopsy revealed immature glomeruli, dilated Bowman's spaces, dilated tubules, and interstitial fibrosis. The liver was histologically normal. Indomethacin may induce oligohydramnios and transient renal insufficiency in humans and renal dysgenesis in fetal monkeys; it might have induced the abnormalities in this patient.
Adult↗
The application of total vertical projections for the unbiased estimation of the length of blood vessels and other structures by magnetic resonance imaging.
A new stereological method has recently been developed to estimate the total length of a bounded curve in 3D from a sample of projections about a vertical axis. Unlike other methods based on serial section reconstructions, the new method is unbiased (i.e., it has zero systematic error). A basic requirement, not difficult to fulfill in many cases, is that the masking of one structure by another is not appreciable. The application of the new method to real curvilinear structures using a clinical magnetic resonance (MR) imager is illustrated. The first structure measured was a twisted water-filled glass tube of known length. The accuracy of the method was assessed: With six vertical projections, the tube length was measured to within 2% of the true value. The second example was a living bonsai tree, and the third was a clinical application of MR angiography. The possibility of applying the method to other scientific disciplines, for example, the monitoring of plant root growth, is discussed.
Blood Vessels↗
Treatment of polyhydramnios with indomethacin.
Explore the source record for details and available documents.
Adult↗
Low-dose desferrioxamine test for the diagnosis of aluminium-related bone disease in patients on regular haemodialysis.
Bone biopsy in an invasive method of diagnosing aluminium related bone disease (ABD). Toxic side-effects have been reported with the currently used 'high-dose Desferrioxamine (DFO) tests.' A low-dose DFO test was evaluated for the diagnosis of ABD in 28 symptomatic patients (13 male) on regular haemodialysis treatment. DFO 0.5 g diluted in 100 ml of 0.9% sodium chloride was given intravenously during the first 2 h of dialysis. Aluminium estimation before (t1) and 48 h after DFO challenge (t2) were made by DC plasma emission spectrometry. Following the DFO test bone biopsy was performed and the specimen stained for aluminium using soluchrome zurine. The DFO test was considered positive if the t2 concentration was 150 micrograms/l or treble the amount of t1. Nineteen patients (8 male) fell into this group and all except two had ABD. Of the nine remaining patients (5 male) who had a negative DFO test none had ABD. We conclude that ABD can be diagnosed safely in the majority of patients using a low-dose DFO test, thereby avoiding toxic side-effects.
Adult↗
Marrow repopulation after bone marrow transplantation.
Explore the source record for details and available documents.
Bone Marrow↗
Ammoniated mercury ointment as a cause of peripheral neuropathy.
A 72-year-old Caucasian man with widespread psoriasis presented with a sensory-motor peripheral neuropathy following 40 years' use of an ammoniated mercury ointment. No clinical involvement of his central nervous system was noted and no other possible causative factors for his peripheral nerve disease were found. D-Penicillamine treatment induced mercuriuresis and blood levels of mercury fell to normal. His peripheral neuropathy improved slowly after normalisation of the serum mercury. It is believed that his condition was caused by percutaneous absorption of mercury. Ammoniated mercury ointments should have no role in the current management of skin disorders.
Administration, Topical↗
Pilot study of anxiety and depression in prepubertal children.
Early detection of anxiety and depression is important because of the relationship between these disorders, suicide and other problems (i.e. social, phobias, learning problems). This study screened prepubertal students in a school setting for symptoms of anxiety and depression using self-report measures (Revised Children's Manifest Anxiety Scale and the Children's Depression Inventory). Controls and children who scored high on measures of anxiety or depression or both were interviewed with their parents and were tested using the Diagnostic Interview for Children and Adolescents (computer version) and the Peabody Individual Achievement Test. Initial results indicated that anxiety is more prevalent in prepubertal children than depression. The correlation between different diagnostic measurements used in this project was calculated. A correlation was found between low scores of self-esteem and high scores of anxiety and depression on self-reports. It is concluded that self-report measures are good screening tools.
Anxiety↗
The quantitative study of lumbar vertebral bone marrow using T1 mapping and image analysis techniques: methodology and preliminary results.
A method of quantifying lumbar vertebral bone marrow using pixel by pixel T1 mapping of spin echo magnetic resonance images is described. The accuracy and precision of the relaxation time measurements is confirmed by studies with the EEC Concerted Research Project, test object no. 5. The T1 data from all the pixels sampled from lumbar vertebral marrow are displayed as a histogram. By "thresholding" relative to normal control data the spatial distribution of high or low T1 pixels can be demonstrated. The approach is superior to that of the conventional region of interest method for quantifying and analysing relaxation time data, and allows tissue heterogeneity to be studied. Studies in patients with aplastic anaemia and acute leukaemia have been performed.
Adult↗
Response to desipramine treatment in adolescent major depression.
Thirty adolescents (ages 15-20) who met DSM-III-R criteria for major depressive disorder completed a double-blind, placebo-controlled, 6-week, fixed-dose (200 mg daily) study of desipramine (DMI). Thirty-three percent of the placebo group and 50 percent of the DMI group improved (greater than or equal to 50% change on the Hamilton Rating Scale for Depression). Subjective reports of adverse effects did not significantly differentiate the two groups. Major adverse effects, necessitating study discontinuation, occurred solely in the DMI group.
Adolescent↗
Inflammation and cartilage metabolism in rheumatoid arthritis. Studies of the blood markers hyaluronic acid, orosomucoid, and keratan sulfate.
Single analyses of peripheral blood of rheumatoid arthritis (RA) patients showed a significant reduction in the mean value for keratan sulfate (KS) compared with that in control subjects, but the mean value for orosomucoid (OM) was elevated compared with that in control subjects. Some RA patients displayed highly elevated levels of hyaluronic acid (HA), while others exhibited normal levels. There was a significant inverse correlation between OM and KS content in RA patients, as well as a direct correlation between HA and OM. In longitudinal studies of RA patients, parallel changes in OM and HA and inverse changes between KS and OM or HA were commonly observed. Clinical analyses revealed that there was an inverse correlation between KS and morning stiffness, and direct correlations between the number of tender joints and HA, and between HA or the erythrocyte sedimentation rate and the number of joints with effusions. The reason(s) for the inverse correlation between KS and OM as an index of systemic inflammation remains to be established. Circulating HA represents an index of joint inflammation, for which a marker has not been previously available.
Adult↗
Bouffée délirante in Jamaican adolescent siblings.
The high incidence of brief schizophrenia-like psychosis in developing countries is well documented in the literature. This paper presents two cases of bouffée délirante found in Jamaican adolescent sibs who had recently immigrated to Canada and discusses the importance of accurate diagnosis, in view of prognosis and treatment, for this disorder.
Acculturation↗
Toward a national strategic plan for quality assurance and utilization review education.
This article discusses the need for a national plan for quality assurance and utilization review (QA/UR) education. Six points are addressed: the rationale for planning; the developments in quality assurance urging plan creation; external pressures on the QA field; internal interests in educational program development; a beginning vision of an educational future; and strategies for realizing the future. Additional planning and policy tasks are defined.
Curriculum↗
Effects of treatment on airway microvascular leakage.
Microvascular leakage, an essential component of inflammation, probably plays a critical role in asthma in producing plasma exudation and thickening of the bronchial mucosa which may underlie airway hyperresponsiveness. Several therapeutic approaches are possible to reduce this leakage, by blocking either the effects or the release of inflammatory mediators which induce the leakage. Drugs with these actions might be too specific to be of therapeutic value if many mediators are involved, as seems increasingly likely. Reduction of blood flow using selective vasoconstrictors is a more attractive approach and alpha 1-adrenoceptor agonists may be of value. Drugs that act directly on endothelial cells are probably the most useful, since they would be effective irrespective of the mechanism of leakage. Corticosteroids probably have this property, but whether beta-agonists or theophylline are clinically effective against airway microvascular leakage is not yet certain. The development of new drugs which can inhibit microvascular leakage is an important therapeutic approach for the future.
Adrenal Cortex Hormones↗
Intravascular exchange and bolus transfusion in the severely isoimmunized fetus.
Eight Rh-sensitized fetuses, between 21 weeks 2 days and 35 weeks of gestation, received 31 intravascular transfusions (13 exchange and 18 bolus) and one intraperitoneal transfusion under ultrasonographic guidance. The interval between transfusions was 13.4 +/- 4.7 days. Posttransfusion hematocrit dropped at a rate of 1.0% +/- 0.6% per day. Procedure time for the bolus transfusion was shorter than for the exchange transfusion (t test, p less than 0.001). Bleeding from the puncture site complicated 10 of the 31 intravascular transfusions, without apparent maternal or fetal consequences. Fetuses were delivered between 33 and 36 weeks of gestation, after lung maturity was achieved.
Adult↗
A percutaneous approach to cardiac haemodynamics in anaesthetised rats.
Established methods for evaluating cardiac function in small animals involve surgical manoeuvres. We describe a method for evaluating left ventricular volume (LVV) and pressure (LVP) in anaesthetised adult rats. Under fluoroscopic control a 23 G needle was inserted into the left ventricular cavity of anaesthetised normotensive WKY rats. LVV was determined by biplane angiography and LVP was measured directly. Surface electrocardiograms were recorded throughout the procedure. In 8 animals the study was repeated three times, one week apart. Animals were then sacrificed and tissues harvested for histological examination. In 8 rats, the technique was found to be reproducible and there was no evidence of functional (ECG) or pathological myocardial damage following repeated measurements. In conclusion this technique provides a reproducible method of measuring LVV and LVP, allowing longitudinal haemodynamic studies in anaesthetised rats.
Anesthesia, Intravenous↗
Cardiac responses to head up tilt during early extrauterine life: relevance of active acquisition of erect posture.
Mammals must adapt to gravity on passing from the intrauterine to the extrauterine environment. In order to evaluate the cardiovascular effects of gravity in the first phases of extrauterine life, the effects of passive orthostatism on the cardiac filling volume were investigated through longitudinal haemodynamic studies in 14 normal healthy males before (6 months) and after (18 months) acquiring the ability to stand. Left ventricular diameter (by echocardiographic measurement), arterial blood pressure (by sphygmomanometry) and heart rate were measured in the supine and upright position at both ages. At 6 months the left ventricular end diastolic volume was not modified by a change in posture [supine 6(SEM 3) ml, upright 6(3) ml], so heart rate was minimally altered [supine 128(9), upright 130(11) beats.min-1] and blood pressure remained stable [supine 74(6), upright 73(5) mm Hg]. After the acquisition of the erect posture (18 months) left ventricular end diastolic volume was reduced [supine 14(3), upright 8(2) ml], heart rate increased [supine 110(11), upright 127(12) beats.min-1] and blood pressure remained constant [supine 80(6), upright 79(7) mm Hg]. The assumption of the erect posture therefore represents a phase when, for the first time in the natural history of the cardiovascular system, translocation of intravascular volume from the cardiopulmonary area to the periphery stimulates nervous and humoral responses to control the dynamics of body fluids and arterial blood pressure in a gravitational environment.
Adaptation, Physiological↗
Measurement of anxiety and depression in children and adolescents.
In summary, symptom checklists and rating scales are a cost-effective means of deriving an extensive amount of clinical information in a relatively short period of time. Measures designed to assess affect in children have primarily been self-report inventories owing to the subjective nature of the constructs being assessed. However, subscales for the assessment of anxiety and depression by significant others (parent, teacher, clinician) can be found on more general measures of behavior such as the Conners' Parent and Teacher Rating Scales, the Achenbach Parent and Teacher Forms of the Child Behavior Checklist, and the Brief Psychiatric Rating Scale for Children. In choosing from the array of available measures, emphasis should be placed on an examination of the psychometric properties of the scales. Inventories with demonstrated reliability and validity will provide the clinician with a much more useful profile of a patient's symptoms than will instruments with undocumented or poor psychometric properties. A major concern for all structured interviews is the relative lack of detailed reliability or validity studies. In addition, there are important caveats for such research. A high internal reliability may only demonstrate that one narrow aspect of depression has been measured or a high test-retest reliability may indicate that the interview is measuring a stable trait rather than a current state. Research on the validity and efficiency of the interviews requires careful consideration and consensus regarding acceptable comparison standards. At this time, variants of the "best estimate diagnosis" methodology appear to have gained widest acceptance. In general, there remains much work to be done before the distinct capabilities of the structured interviews are established. It should be noted that in all cases these interviews are evolving instruments and continue to undergo revision and refinement. However, one difference has evolved and may be relevant to the choice of instrument in specific studies. The highly structured interviews, such as the DICA and the DISC, are amenable to epidemiologic screening. They cover a wide range of disorders and have a relatively low threshold for disorder or high sensitivity. In application, these instruments will tend to overdiagnose. It will be necessary to use good clinical judgment in ruling out those disorders that do not apply. In contrast the semistructured interviews, such as the K-SADS and the ISC, have a relatively high diagnostic threshold or relatively high specificity for a few disorders. These instruments are probably best used for the purpose for which they were designed; that is, the selection of depressed and or anxious subjects for research studies.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗