General practice. Core values.
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Clinical Competence↗
Biomedical subjects
P Gordon
Publications and source records attributed to P Gordon.
Metabolic and perceptual responses during arm and leg ergometry in water and air.
This investigation determined metabolic (i.e., kcal.min-1) responses and ratings of perceived exertion (RPE) for varying pedal-crank rates (PCR) and power outputs (PO) during arm and leg exercise in thermoneutral air (TA) and water (TW). Nine males (age 28.2 yr; leg cycle VO2peak 3.4 l.min-1) undertook the 24 exercise trials. During the TW trials kcal.min-1 were less (P < 0.05): at 50 W for 40 (X +/- SE; 10.9 +/- 0.8) than 50 (8.2 +/- 0.2), 60 (8.2 +/- 0.6), or 70 (7.4 +/- 0.3) rev.min-1 and at 100 W for 40 (15.2 +/- 0.7), 50 (14.0 +/- 1.1), and 60 (13.8 +/- 0.7) than 70 (12.1 +/- 0.5) rev.min-1. All other comparisons of kcal.min-1 between PCR at the three PO were not significant. During the TA trials kcal.min-1 were less (P < 0.05): at 50 W for 40 (11.4 +/- 0.3) than 60 (9.7 +/- 0.4) and 70 (9.1 +/- 0.4) rev.min-1 and for 50 (11.0 +/- 0.5) than 70 rev.min-1. During the TW trials: RPE-Arms and RPE-Overall at 50 W were lower (P < 0.05) for 40 (8.1 +/- 0.5; 8.3 +/- 0.4) than 60 (9.6 +/- 0.5; 9.8 +/- 0.6) and 70 (9.3 +/- 0.5; 9.9 +/- 0.7) rev.min-1, RPE-Legs at 50 W was lower (P < 0.05) for 40 (8.3 +/- 0.4) than 70 (9.9 +/- 0.7) rev.min-1. All other comparisons of RPE between PCR at the three PO were not significant.
Adult↗
A cost-to-benefit analysis of blood products used during the initiation of an orthotopic liver transplantation programme.
Orthotopic transplantation is the treatment of choice for selected patients with end-stage post-necrotic and cholestatic liver diseases. These individuals typically have disturbed haemostasis, which reflects both impaired hepatic synthesis of clotting factors and disseminated intravascular coagulation compounded by large-volume transfusions of blood products occasionally required during surgery. The latter contribute significantly to the cost of this procedure, but may approximate the cumulative consumption of that required for the support of patients in liver failure. Perspective is provided by prospective analysis of data from the first 10 patients in the current programme. There were striking, if transient, intra-operative changes in standard laboratory parameters of coagulation and fibrinolysis; all patients were readily controlled with replacement therapy administered according to serial haemostatic measurements combined with clinical judgement. In most patients these values had stabilised within 24 hours of surgery. Those with post-necrotic liver cirrhosis had the most marked degrees of hepatic dysfunction, reflected in more profound haemostatic disturbances; these patients required the largest amounts of blood products. Inclusive median costs for the first year were estimated at R35,000 and for the first 5 years at R60,000, with 80% of the patients expected to be alive between 5 and 10 years later and enjoying an excellent quality of life. These figures contrast with those estimated for optimal medical and non-transplant surgical management following variceal bleeding as a major complication of liver disease (R30,000 for the first year and R70,000 at 3 years). In addition, the latter patients would usually be unable to work and have a poor quality of life with minimal likelihood of survival beyond this point. We conclude that with a multidisciplinary approach in an academic centre, surgical replacement of the irreversibly damaged liver in properly selected patients is no more expensive and has a better outcome than acceptable alternative approaches.
Adult↗
Case report 823: Fibro-osseous pseudotumor of the scapula.
A unique lesion discovered in the scapula of a 36-year-old woman is presented. The lesion has microscopic features resembling those of fibrous dysplasia and osteoid osteoma which we believe is identical to an entity previously only documented in the rib (fibro-osseous lesion of rib). We are of the opinion that the lesion probably represents a reactive response to trauma rather than a neoplasm and suggest the name of "fibro-osseous reparative pseudotumor" for this entity.
Adult↗
A direct comparison of the measurement of a random plasma glucose and a post-50 g glucose load glucose, in the detection of gestational diabetes.
We have compared the use of a random plasma glucose measured within 2 hours of a meal and a plasma glucose measured 1 hour after a 50 g glucose load to detect pregnant patients likely to have an abnormal 100 g glucose tolerance test at 28 weeks' gestation. The 50 g glucose load detected 24 of 28 women with gestational diabetes whereas the random plasma glucose detected only 13 of these patients. The 50 g glucose load gave fewer false positives, that is, patients who had an abnormal screening test but went on to have a normal glucose tolerance test (8.8% versus 13.4%). These data support the use of the 50 g glucose load to screen pregnant women for gestational diabetes as recommended by Australian authorities (1).
Blood Glucose↗
Strength training increases insulin action in healthy 50- to 65-yr-old men.
The insulin resistance associated with aging may be due, in part, to reduced levels of physical activity in the elderly. We hypothesized that strength training increases insulin action in older individuals. To test this hypothesis, 11 healthy men 50-63 yr old [mean 58 +/- 1 (SE) yr] underwent a two-step hyperinsulinemic-euglycemic glucose clamp with concurrent indirect calorimetry and an oral glucose tolerance test (OGTT) before and after 16 wk of strength training. The training program increased overall strength by 47% (P < 0.001). Fat-free mass (FFM; measured by hydrodensitometry) increased (62.4 +/- 2.1 vs. 63.6 +/- 2.1 kg; P < 0.05) and body fat decreased (27.2 +/- 1.8 vs. 25.6 +/- 1.9%; P < 0.001) with training. Fasting plasma glucose levels and glucose levels during the OGTT were not significantly lower after training. In contrast, fasting plasma insulin levels decreased (85 +/- 25 vs. 55 +/- 10 pmol/l; P < 0.05) and insulin levels decreased (P < 0.05, analysis of variance) during the OGTT. Glucose infusion rates during the hyperinsulinemic-euglycemic glucose clamp increased 24% (13.5 +/- 1.7 vs. 16.7 +/- 2.2 mumol.kg FFM-1.min-1; P < 0.05) during the low (20 mU.m-2.min-1) insulin infusion and increased 22% (55.7 +/- 3.3 vs. 67.7 +/- 3.9 mumol.kg FFM-1.min-1; P < 0.05) during the high (100 mU.m-2.min-1) insulin infusion. These increases were accompanied by a 40% increase (n = 7; P < 0.08) in nonoxidative glucose metabolism during the high insulin infusion. These results demonstrate that strength training increases insulin action and lowers plasma insulin levels in middle-aged and older men.
Aged↗
A study of frictional forces between orthodontic brackets and archwires.
The differences in magnitude of static and kinetic frictional forces generated by 0.022 x 0.030-inch stainless steel (Dentaurum) and polycrystalline ceramic (Transcend) brackets in combination with archwires of different sizes (0.018 inch and 0.019 x 0.025 inch) and materials (stainless steel, nickel-titanium, and beta-titanium) at a constant ligature force were investigated. A friction-testing assembly using the Instron machine was used. In all cases, the static frictional force was greater than the kinetic frictional force. There were no significant differences in the frictional forces generated by stainless steel and polycrystalline ceramic brackets. Beta-titanium archwires produced greater frictional forces than the other two materials. Increasing the archwire diameter increased the frictional force.
Analysis of Variance↗
A potentially dangerous design fault in an oxygen analyser.
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Anesthesiology↗
Contraindications and complications of laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is a commonly performed procedure for the removal of symptomatic gallstones. Compared with open cholecystectomy, laparoscopic cholecystectomy is associated with less postoperative pain, earlier discharge from the hospital and a more rapid recovery. However, there are specific contraindications to the procedure, including empyema of the gallbladder, gangrenous cholecystitis, coagulopathy, portal hypertension and peritonitis. Complications from laparoscopic cholecystectomy include common duct injury, bleeding, bile leakage and wound infection. An understanding of these issues allows the family physician to more appropriately select patients for laparoscopic removal of the gallbladder.
Cholecystectomy, Laparoscopic↗
Primary care development zones.
Most commentators on the Tomlinson report have agreed with its emphasis on improving primary and community care. The three elements of such a strategy are a remedial programme to bring primary care up to national standards, a programme to provide such services to people with non-standard needs such as mobile Londoners, ethnic minorities, and homeless people, and the development of an expanded model of primary care. No one model will be appropriate across all of London. The process should start with an audit of existing resources and services within each community, together with an analysis of needs. From this would develop a local programme with specific plans for investment in premises, staffing, training, and management. New contractual mechanisms may be needed to attract practitioners, improve their premises, secure out of hours services, and provide medical cover for community beds. There should also be incentives for closer working between primary and secondary services. No developments on the scale needed for London have been carried out in primary care within the lifetime of the NHS--but their success will be critical to the calibre of health services for Londoners into the next century.
Community Health Services↗
A multivariate analysis of choice criteria for hospitals.
This study determines the choice criteria used by consumers in selecting a hospital and provides information useful to hospital administrators in planning and implementing marketing efforts directed toward potential consumers. The findings suggest that physical plot, previous experience with the hospital, location of hospital, overall cost, and reputation of the hospital were important factors in selecting a hospital.
Adult↗
The effect of glucose on proteoglycans produced by cultured mesangial cells.
Altered proteoglycan metabolism may play a role in the development of diabetic glomerulopathy. This study was conducted to examine the effects of glucose on the production and physical characteristics of proteoglycans generated by rat mesangial cells in culture. Rat mesangial cells were exposed to elevated glucose media (500 mg/dl) or standard glucose media (200 mg/dl) for 8-10 days, and proteoglycan synthesis was determined using 35S-labeling in conjunction with anion exchange and sizing chromatography. Rat mesangial cells generated predominantly chondroitin/dermatan sulfate proteoglycans, with small amounts of heparan sulfate proteoglycans. High glucose did not alter the number of rat mesangial cells after 24 h or after 8-10 days, compared with cells grown under standard glucose conditions. The total amount of glycosaminoglycan generated and the sizes of the major proteoglycans were not different between cultures grown in standard and elevated glucose medium. Levels of mRNA for the proteoglycan, biglycan (as assessed by Northern blot analysis), also were comparable between the standard and elevated glucose conditions. Exposure to media high in glucose did not change the rate of secretion of proteoglycans from the cell layer to the medium, but did result in a greater quantity of radiolabeled proteoglycan deposited in the extracellular matrix. The cell, extracellular matrix and medium proteoglycans isolated from the elevated glucose cultures, consistently eluted from the anion exchange column at a lower [NaCl] compared with those generated under standard glucose conditions, indicating a loss of anionic charges.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
People need contraception because they have sex.
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Behavior↗
Safety of medical gas cylinders with finger control valves.
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Anesthesiology↗
Immediate results and long-term follow-up after repeat balloon aortic valvuloplasty.
Balloon aortic valvuloplasty (BAV) was performed in 219 elderly patients with aortic stenosis between December 1985 and April 1990. Forty-three patients underwent repeat BAV for symptomatic restenosis of the aortic valve 13 +/- 8 mo following initial BAV. To evaluate the outcome following initial and repeat BAV, hemodynamic results were analyzed according to the following subgroups: BAV 1--initial BAV for all patients (n = 219); BAV 1/1--initial BAV in those who had only one BAV (n = 176); BAV 1/2--the initial BAV in those who had repeat BAV (n = 43); and BAV 2--repeat BAV (n = 43). The mean age of patients undergoing BAV 2 was 82 +/- 6 yr compared to 78 +/- 10 yr for all patients undergoing BAV 1 (p = .01). At the time of BAV 1 there was no difference in baseline or post-valvuloplasty aortic valve area (AVA) or peak aortic valve gradient (AVG) for patients having BAV 1/1 compared to those having BAV 1/2. However, for patients having repeat BAV, although the magnitude of the hemodynamic improvement of BAV 1/2 (AVA increased from 0.6 to 0.9 cm2, AVG decreased from 68 to 34 mm Hg, p less than .001) was similar to the magnitude of the hemodynamic improvement of BAV 2 (AVA increased from 0.5 to 0.8 cm2, AVG decreased from 65 to 34 mm Hg, p less than .001), the baseline AVA (0.5 cm2 at BAV 2 vs. 0.6 at BAV 1/2) and the post-valvuloplasty AVA (0.8 cm2 at BAV 2 vs. 0.9 at BAV 1/2) were significantly smaller (p less than .004).(ABSTRACT TRUNCATED AT 250 WORDS)
Actuarial Analysis↗
Initiation of a liver transplant program in South Africa.
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Adult↗
Survey of colposcopy practices by obstetrician/gynecologists.
A statewide survey to characterize the colposcopy patterns of practicing obstetrician/gynecologists was undertaken. There was a 66.1% response rate, with 98.2% of respondents performing colposcopy. Of those performing colposcopy, nearly all perform biopsies, cryosurgery and conizations; 73.4% perform laser vaporization, 66.7% perform laser cone biopsy and 11% perform laser cone biopsies in their offices. The mean number of colposcopies performed by respondents in a six-month period was 55. Twenty percent performed less than one examination per week and an additional 60% performed two to three examinations per week. Further studies to assess the diagnostic accuracy of those performing greater and lesser numbers of examinations are needed.
Arizona↗
Orthotopic liver transplantation at Groote Schuur Hospital.
We present data on 10 patients (5 men and 5 women, aged 21-56 yrs) with end-stage liver disease or tumour who underwent orthotopic liver transplantation at Groote Schuur Hospital between October 1988 and June 1991. Standard surgical techniques were used for procuring the donor liver, the recipient hepatectomy and the implantation of the liver. The venovenous bypass method was used in all but 2 patients. Postoperative immunosuppression was usually achieved with cyclosporin, azathioprine and low-dose steroids. Six patients were treated with prophylactic OKT3. Rejection episodes were treated with bolus doses of intravenous steroids. The indications for liver transplantation included chronic active hepatitis progressing to cirrhosis (5), biliary cirrhosis in association with inflammatory bowel disease (1), sclerosing cholangitis (2), alpha 1-antitrypsin deficiency (1), and tumour (1). All patients with chronic liver disease had experienced at least one complication, examples of which included encephalopathy, bacterial peritonitis, ascites, variceal bleeding and septicaemia. Serious postoperative complications included acute rejection of the transplanted liver, renal and liver failure that responded to intensive care support and medical management. One patient died on the 11th postoperative day with complications of bleeding oesophageal ulcer, shock and fungaemia. The remaining patients are alive and well 1-31 months after transplantation.
Adult↗