Biomedical subjects

P Montgomery

Publications and source records attributed to P Montgomery.

At least 55 records · Page 3Linked to original sources

PubMed1996

The influence of bilateral orchiectomy on self-concept: a pilot study.

This pilot study was designed to explore self-concept alterations in a group of patients undergoing bilateral orchiectomy for treatment of advanced prostate cancer. The Tennessee Self-Concept Scale was used to measure pre- and postoperative self-concept group scores. Also, the group of orchiectomy patients was compared to a group of patients undergoing a transurethral resection of the prostate (TURP) for cancer and another group undergoing a TURP for benign prostatic hypertrophy (BPH). The results provide no evidence to suggest that surgical removal of both testicles in a group of males has a significant effect on self-concept or its indices when compared to a group of men who underwent a TURP, where both groups also were diagnosed with cancer. For the group of males who underwent bilateral orchiectomy, no significant differences were detected between the pre- and postoperative total self-concept scores. However, statistically significant differences did exist between the group's pre- and postoperative physical self scores and identity scores.

Humans↗

PubMed1996

Phase II study of high-dose busulfan, melphalan and thiotepa with autologous peripheral blood stem cell support in patients with malignant disease.

The purpose of this study was to determine the toxicities and potential effectiveness of high-dose busulfan, melphalan and thiotepa (Bu/Mel/TT) followed by autologous peripheral blood stem cell (PBSC) infusion in patients with a variety of diseases. A phase II clinical trial of Bu (12 mg/kg), Mel (100 mg/m2) and TT (500 mg/m2) followed by PBSC infusion in 104 patients with breast cancer (n = 48), malignant lymphoma (n = 25), ovarian cancer (n = 13), multiple myeloma (n = 7) and other malignancies (n = 11) was performed. Sixty-two patients were treated in an academic medical center and 42 in a community cancer center. Grade 3-4 regimen-related toxicities occurred in 14% of patients, causing regimen-related mortality in six (6%) patients with an overall transplant-related mortality of 9%. Transplant-related deaths occurred in 6/62 patients (10%) treated in an academic medical center and in 3/42 (7%) treated in a community cancer center. Complete remissions (CR) were achieved in 1/17 (6%) patients with refractory stage IV breast cancer, 4/4 patients with responsive stage IV breast cancer, 6/13 (46%) with more-advanced lymphoma and 4/4 with less-advanced lymphoma. These patients are alive and disease-free a median of 712, 279, 461 and 404 days after transplant, respectively. Nineteen of 22 patients with stage II-III breast cancer remain alive and disease-free a median of 365 days after transplant. Complete remissions were also seen in 4/9 patients with ovarian cancer and 3/7 with multiple myeloma. The Bu/Mel/TT regimen followed by autologous PBSC infusion is associated with acceptable morbidity and mortality, appears to have significant activity in patients with breast cancer and is well tolerated in the adjuvant setting of stage II-III breast cancer. Bu/Mel/TT also appears to have significant activity in patients with lymphoma, multiple myeloma and possibly ovarian cancer. Further phase II-III studies are warranted in patients with these and other malignancies.

Adolescent↗

PubMed1996

High-dose fractionated total-body irradiation, etoposide and cyclophosphamide for treatment of malignant lymphoma: comparison of autologous bone marrow and peripheral blood stem cells.

Consecutive patients with non-Hodgkin's lymphoma (NHL, n = 133) or Hodgkin's disease (HD, n = 20) were treated with 12.0 Gy of fractionated total body irradiation, etoposide 60 mg/kg, and CY 100 mg/kg followed by infusion of autologous hematopoietic stem cells. Seventy-nine patients received purged (n = 62) or unpurged BM (n = 17), and 74 received unpurged PBSCs alone (n = 56) or with BM (n = 18). The median day for achieving a sustained granulocyte count of 0.5 x 10(9)/I was 14 range (7-66) for BM recipients and 10 (7-30) for PBSC +/- BM recipients (P = 0.03). A platelet count of 20 x 10(9)/I was achieved at a median of day 24 (6-145) in BM recipients and day 11 (range, 7-56) in PBSC +/- BM recipients (P = 0.007). The median number of platelet units transfused was 86 (0-1432) for BM recipients and 30 (6-786) for PBSC +/- BM recipients (P = 0.001). The median number of hospital days was 36 (10-88) for BM recipients and 27 (14-76) for PBSC +/- BM recipients (P = 0.0001). The unadjusted Kaplan-Meier (KM) estimates of survival, event-free survival (EFS) and relapse at 2 years were 0.57, 0.45 and 0.43 for patients receiving BM and 0.55, 0.36 and 0.59 for patients receiving PBSC +/- BM. After adjusting for confounding variables, the estimated relative risk (RR) of death from any cause was 0.92 (P = 0.75), of relapse was 1.25 (P = 0.39), of non-relapse mortality was 0.71 (P = 0.42) and of mortality and/or relapse was 1.17 (P = 0.48) for patients receiving PBSC +/- BM as compared to BM. For 46 patients with NHL receiving unpurged PBSC alone, the unadjusted KM estimate of relapse was 0.61 compared with 0.48 for 52 comparable patients receiving purged BM, while the RR for relapse for patients receiving unpurged PBSCs was 1.37 (P = 0.33) after adjusting for other significant covariates. These data confirm previous observations that patients who receive PBSC +/- BM have faster engraftment, fewer transfusions and shorter hospital stays than patients who receive only BM. There were no statistically significant differences between the two groups in survival, relapse, death from causes other than relapse and event-free survival.

Adolescent↗

PubMed1995

ApoE genotypes in Australia: roles in early and late onset Alzheimer's disease and Down's syndrome.

We studied the apoE genotypes of 279 Australians in order to determine what relationships might exist in this group between apoE genotype and dementia associated with either early- or late-onset sporadic Alzheimer's disease (AD) or with Down's syndrome (DS). ApoE epsilon 4 allele frequency was increased in Australians with either early-onset sporadic AD (p < 0.002) or late-onset sporadic AD (p < 0.0001) and apoE epsilon 2 allele frequency was decreased in the late-onset sporadic AD group (p < 0.01). The apoE genotype distribution among patients with DS was not different from that of the control group. One individual with DS and an apoE epsilon 4/epsilon 4 genotype developed dementia at the earliest age of dementing DS patients, consistent with a role for apoE epsilon 4 in determining age of onset of dementia in AD and DS. Another DS patient with an apoE epsilon 2/epsilon 3 genotype developed dementia within an age range similar to that of four demented DS patients with an apoE epsilon 3/epsilon 3 genotype, an observation which would appear inconsistent with the proposed protective effect of apoE epsilon 2 to delay onset of dementia in DS. These results extend the evidence that the apoE genotype, particularly apoE epsilon 4, modulates dementia in early- and late-onset sporadic AD and DS. The protective role of apoE epsilon 2 in DS, however, may vary among different populations or ethnic groups.

Age of Onset↗

PubMed1995

The microbiology and antibiotic treatment of peritonsillar abscesses.

Pus from 53 peritonsillar abscesses was cultured and associations between the microbiological results and clinical data were investigated with the aim of developing a clinical protocol for treatment. A positive culture grew in 85% of quinsies and of these 16% produced aerobes and 84% anaerobes. Penicillin-resistant organisms were grown from 32% of patients and all but one of these organisms (Haemophilus influenzae) was sensitive to metronidazole. There was no association between clinical presentation and cultured organism which could guide treatment, hence we recommend penicillin and metronidazole as the antibiotic regimen of choice in the treatment of peritonsillar abscesses because of its effectiveness in 98% of patients.

Adolescent↗

PubMed1993

Spatial updating in Parkinson's disease.

We compared the ability of 48 patients with Parkinson's disease (PD) (24 mild, 24 moderate) and 35 controls to remain oriented to the starting position after being transported passively in a wheelchair in two conditions: visual and vestibular. The moderate PD group demonstrated the poorest performance in both sensory conditions. The visual condition discriminated between the mild PD group and the controls, but both groups had similar performance in the vestibular condition. Poor performance of the PD group in the visual condition and controls in the vestibular condition correlated significantly with poor performance on selected balance tests. Poor performance in the visual condition correlated significantly with poor performance on judgment of line orientation in the mild PD group. Spatial updating, or maintaining a sense of orientation while being moved in the environment, may be impaired in PD and should be investigated as a possible contributing factor to problems with spatial orientation noted clinically in some patients.

Aged↗

PubMed1993

Plasma amyloid precursor protein is decreased in Alzheimer's disease.

Alzheimer's disease is characterized by amyloid deposits whose major protein component is beta A4. beta A4 is a product of the amyloid precursor protein (APP). APP was assayed in partially purified plasma samples from 16 sporadic Alzheimer's disease patients, 12 age-matched controls, 15 Down's syndrome individuals aged 19-36 years and 8 young to middle-aged controls (22-51 years). 14 of the 16 Alzheimer's disease patients had decreased plasma APP when compared with age-matched controls. 14 of the 15 Down's syndrome individuals had similar levels of APP when compared with age-matched and elderly non-demented controls by immunoblotting, whereas one had levels of APP less than controls. Taken together with results from a previous report (Lancet 1992; 340: 453-454), the decreased plasma APP levels mirror the changes observed with cerebrospinal fluid APP levels in Alzheimer's disease.

Adult↗

PubMed1993

Predicting short-term survival for patients with advanced Alzheimer's disease.

OBJECTIVE: The purpose of this study was to develop a statistical model for predicting short term survival in patients with dementia of the Alzheimer type (DAT). DESIGN: A prospective cohort study. SETTING: Three 25-bed intermediate medical care units using a structured approach to patient care management including palliative care options and patients from a second, traditional long-term care setting. PARTICIPANTS: Of 104 patients with advanced DAT monitored for 34 months, 68 patients (97% white male) who had at least one fever episode were included in the model development phase. Data from 71 additional DAT patients with at least one fever episode were used to test the statistical model. MAIN OUTCOME MEASURES: Six-month survival following a fever episode. RESULTS: Older age and higher severity of DAT at the time of the fever episode, palliative care, and hospital admission for long-term care within 6 months prior to the fever were found to be positively associated with likelihood of mortality within 6 months of the fever onset. Adjusted odds ratios for each of these variables were statistically significant. The model performed well in subsequent testing on an independent sample of patients. CONCLUSION: Results provide a formula which can be used to predict likelihood of dying within 6 months following onset of a fever in DAT patients. This statistical prediction is recommended for use in combination with clinical judgment to certify DAT patients for Medicare hospice coverage.

Age Factors↗

PubMed1993

Starting a hospital-based home health agency: Part I. The service and its environment.

Alternative care services and delivery options can improve quality, access and institutional viability. When properly implemented, home healthcare--an important link in the continuum of the healthcare delivery system--provides this service. Part I of this three-part series describes the research, review and beginning implementation, defines populations, and evaluates environmental assessments which set the foundation to establish a hospital-based agency.

Delivery of Health Care↗

PubMed1993

Starting a hospital-based home health agency: Part II--Key success factors.

In Part II of a three-part series, the financial, technological and legislative issues of a hospital-based home health-agency are discussed. Beginning a home healthcare service requires intensive research to answer key environmental and operational questions--need, competition, financial projections, initial start-up costs and the impact of delayed depreciation. Assessments involving technology, staffing, legislative and regulatory issues can help project service volume, productivity and cost-control.

Cost Control↗

PubMed1993

Starting a hospital-based home health agency: Part III--Marketing.

Successfully marketing home healthcare involves not only community awareness, but the system's support as well--nurses, physicians, administration, social services. Working together with common goals and commitments is essential to the program's success. Addressing questions and concerns ensures a successful business start-up and ongoing implementation. A service benefit profile, target markets, and a feasibility analysis are provided in this final section of a three-part series on establishing a home health agency.

Ambulatory Care↗

PubMed1992

Thermal epiglottitis after swallowing hot tea.

Acute infectious epiglottitis in children is a well-recognized clinical entity. We report the development of acute thermal epiglottitis after ingestion of hot tea by a three-year-old patient. Clinical and radiographic findings in our patient and others reported in the literature resemble acute infectious epiglottitis. In all cases of burns around the mouth, the possibility of intraoral and respiratory damage must be considered. Because of the high risk of upper airway obstruction, children in whom thermal epiglottitis is suspected should be observed in the intensive care unit and have appropriate airway management.

Acute Disease↗

PubMed1992

The stress of marriage to an alcoholic.

1. Historically, wives of alcoholics have been described as having disturbed, pathological personalities that were instrumental in causing and maintaining their husbands' drinking. More recently, researchers have tended to support the view that the behavior of these women reflects their stressful circumstances. 2. The women in the study reported interpersonal, extrapersonal, and intrapersonal stressors. The most frequently reported and highest ranked stressor was their relationships with their husbands. 3. Sobriety does not necessarily mean that stressors disappear. 4. More research is needed for nurses to have the knowledge necessary to help wives of alcoholics to cope with their stressors.

Adaptation, Psychological↗

PubMed1991

Multidrug resistance in MCF-7 human breast cancer cells is associated with increased expression of nucleoside transporters and altered uptake of adenosine.

The rate of adenosine uptake and the corresponding expression of nucleoside transporters were studied in several MCF-7 human breast-cancer cell lines that express different levels of multidrug resistance (MDR). Kinetic studies of adenosine transport in these cell lines revealed that the mean apparent Km and Vmax values for the nucleoside transporters increased with increasing MDR. The apparent Km and the apparent Vmax of Adriamycin-resistant (ADR10) cell lines were respectively 3.2- and 1.8- fold those of Adriamycin-sensitive wild-type (WT) cells (P less than 0.001). A partially revertant cell line (ADR10rev) that was derived from the ADR10 line and was partially sensitive to Adriamycin exhibited apparent Km and Vmax parameters that lay between those of the ADR10 and WT cells (P less than 0.001 vs ADR10 cells; P less than 0.05 vs WT cells). ADR10 cell membranes bound greater than 4 times more of the nucleoside transporter blockers [3H]-nitrobenzylthioinosine [( 3H]-NBI) and [3H]-dipyridamole [( 3H]-DPR) than did WT cell membranes per unit protein (P less than 0.0001). Scatchard analysis revealed a 2-3 times greater density for nucleoside transporters in ADR10 membranes as compared with those in WT membranes. ADR10rev membranes bound less [3H]-NBI and [3H]-DPR than did ADR10 membranes (P less than 0.001), but they bound more of the blockers than did WT membranes (P less than 0.05). A 2.5-h exposure to 200 nM phorbol-12,13-dibutyrate (PDBu), which activates protein kinase C (PKC) and induces WT cells to exhibit a 4-fold increased transient MDR phenotype, increased the apparent Km of WT cells for adenosine transport by greater than 2 times (P less than 0.001) to a value close to that found for the ADR10 cells. An identical exposure of ADR10 cells to PDBu produced no significant effect. The apparent Km of ADR10rev cells was increased 1.4 times by a 2.5-h PDBu exposure. None of the cell lines were affected by a 2.5-h exposure to 200 nM phorbol-13,10-diacetate (PDA), a much less active phorbol, or vehicle. These results suggest that MDR in MCF-7 cells is associated with changes in nucleoside transport, including both the number of transporters and their rate of transport, and that such changes can be partially mimicked by stimulation of PKC.

Adenosine↗

PubMed1991

An unusual oronasal foreign body.

An unusual case of oronasal foreign body in a child is reported. A plain lateral X-ray of the head was carried out to show the shape and position of the foreign body; it was also useful in planning removal. Ribbon gauze impregnated with vaseline was packed around the sharp end of the metal in the nostril to protect the nasal mucosa from further trauma while removing it. We recommend this technique.

Child, Preschool↗

PubMed1991

Police response to wife assault in Northern Ireland.

To a large extent research on police response to wife assault had been dominated by the North American experience. Recent work in Britain has cast doubt on the extent to which these findings are applicable to the British context and drawn attention to the need for studies which explore the specific context in which policing occurs. It is argued that this approach has particular relevance in Northern Ireland where, in contrast to North America and Britain, the police operate in a context of political violence. Using data obtained from a series of semi-structured interviews with 67 women who defined themselves as victims of wife assault, the study examines police response in Northern Ireland. While the results indicate similar patterns of police response in Northern Ireland as those found elsewhere, the results also suggest that factors specific to the Northern Ireland context may influence women's use of the police, police procedures and police attitudes, and women's experience as victims.

Adolescent↗

PubMed1990

Glomerulocystic kidney disease: case report.

A newborn infant with abdominal masses was found to have Glomerulocystic Kidney Disease. Imaging showed markedly enlarged kidneys with multiple macroscopic cysts. Radiographic and clinical findings are discussed.

Humans↗

PubMed1989

Amyloid A4 protein and its precursor in Down's syndrome and Alzheimer's disease.

In patients with Alzheimer's disease, amyloid fibrils that are aggregates of A4 protein subunits are deposited in the brain. A similar process occurs at an earlier age in persons with Down's syndrome. To investigate the deposition of amyloid in these diseases, we used a radioimmunoassay to measure levels of the amyloid precursor (PreA4) in the serum of 17 patients with Down's syndrome, 15 patients with Alzheimer's disease, and 33 normal elderly controls. The mean (+/- SD) concentration of serum PreA4 was increased 1.5-fold in patients with Down's syndrome (2.49 +/- 1.13 nmol per liter) as compared with that in controls (1.68 +/- 0.49 nmol per liter; P less than 0.007); the levels in patients with Alzheimer's disease were similar to those in controls (1.83 +/- 0.78; P less than 0.98). We also found that the concentration of PreA4 in the brain tissue of two adults with Down's syndrome (100 and 190 pmol per gram) was higher than that in the brain tissue of either 26 patients with Alzheimer's disease (64.4 +/- 17.3 pmol per gram) or 17 elderly controls with neurologic disease (68.5 +/- 26.3 pmol per gram). Immunocytochemical studies of brain tissue from 26 patients with Down's syndrome showed that the deposition of A4 protein amyloid began in these patients approximately 50 years earlier than it began in 127 normal aging subjects studied previously, although the rate of deposition was the same. We conclude that, since the gene for PreA4 is on the long arm of chromosome 21, which is present in triplicate in Down's syndrome, overexpression of this gene may lead to increased levels of PreA4 and amyloid deposition in Down's syndrome. However, since increased levels of PreA4 are not present in Alzheimer's disease, additional factors must account for the amyloid deposition in that disorder.

Adolescent↗