Doctor-patient relationship in Ontario has deteriorated: college.
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Biomedical subjects
Publications and source records attributed to P Sullivan.
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A method to determine the extent of active inflammatory bowel disease using selective labelling of autologous neutrophils and monocytes by phagocytosis of a technetium-99m (99mTc) stannous oxide colloid is described. Unlike leucocyte scanning techniques using Indium-III (IIIIn), the 99mTc colloid scan uses a cheap, readily available isotope, which specifically labels phagocytes. Scan results in 20 patients with inflammatory bowel disease were compared with barium examinations and colonoscopic appearances. There was close agreement in 15 of 20 patients as to the extent of mucosal disease. In four cases the scan showed more extensive disease than was suggested by barium examination. The scan showed terminal ileal Crohn's disease in three patients in whom the barium studies of the ileum had been reported as normal. In four patients with inactive disease and normal barium examinations no activity was seen on the scans. The 99mTc phagocyte scan is a sensitive, reliable means of determining the extent of active inflammatory bowel disease and can be used to quantify disease activity.
This report compares the clinical and microbiological status of 2 groups of subjects with treated periodontis on different maintenance schedules. 43 control (C) subjects were given prophylaxes every 3 months. 40 test (T) subjects were given this service on a flexible schedule according to the proportions of spirochetes and/or motile rods in fresh smears of subgingival scrapings. Both groups were examined every 6 months clinically and microbiologically. This report presents base line, 1- and 2-year data. Generally, mean values for both groups did not differ significantly from one another. Both groups exhibited comparable increases in GI and PLI scores during the first 2 years of this study. No change in probing depth was noted between base line and the 2-year examination. However, a slight increase in attachment level, as determined by probing, was noted in both groups. Both groups also exhibited similar proportions of bacterial morphotypes at base line and subsequent examinations. Disease recurrence, defined as an increase in probing depth of 3 mm or more from base line on any tooth surface during the 2-year period, tended to be more prevalent in the C than in the T group (15/43 C and 9/40 T subjects). However, the proportional difference between the groups was not statistically significant. Subjects with disease recurrence in the T group had greater proportions of spirochetes at base line than subjects in the same group without disease recurrence (20.2% versus 9.8%, p less than 0.01). This difference in proportions persisted if both groups were examined jointly, but was only of borderline significance (16.0% versus 10.5%, p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of this study was to evaluate the reliability of differential dark-field microscopy (DDFM) of subgingival bacteria to correctly predict the recurrence of periodontitis in treated patients on 2 different recall schemes. The results are based on data from 51 patients on 3-month recalls (C group) and 39 patients (T group) who received periodontal prophylaxes according to a customized regimen based on DDFM of subgingival bacterial morphotypes. No significant differences were detected in the rate of recurrence of periodontitis between the 2 groups, although the incidence of disease recurrence tended to be greater in the C group. The proportions of spirochetes and motile rods observed at base line, or the average of the values observed at base line, 3 months and 6 months, were compared between subjects with and without disease recurrences. Significantly elevated proportions of these bacterial morphotypes were observed in patients of the T group who demonstrated evidence of disease recurrence during the first year as compared to subjects without disease recurrence. No significant differences could be detected in bacterial morphotypes between patients resistant to disease recurrence and those who developed recurrences at some time during the 3-year period covered by this report. The ability of DDFM of subgingival bacterial morphotypes to predict future disease occurrence was tested for 1- and 3-year periods, in both the C and T groups. The test appears to be reliable only for subjects on the experimental maintenance regimen (group T) and for prediction of disease recurrence for the initial 1-year period.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors studied the effects of age, liver function, mean corpuscular volume, and major depression on cortisol concentrations following the dexamethasone suppression test in 31 alcoholics. Only age was significantly correlated with cortisol levels, and it appeared to be an independent effect.
As a primary physician for most deaf children, the otolaryngologist must be able to identify signs and symptoms of sexual abuse. Child sexual abuse is a topic of national concern as epidemiologic data indicate more than 100,000 American children become victims annually. This paper provides an overview of the incidence, demographic characteristics, risk factors, and dynamics of child sexual abuse within both the general handicapped and, specifically, the hearing imparied populations. Strategies for identifying the sexually abused hearing impaired child are delineated including the physical appearance and behavioral manifestations of child victims, as well as the characteristics of abusive caretakers and perpetrators. Case summaries are presented which illustrate these characteristics. A national center specializing in the evaluation and treatment of abused handicapped children is described.
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Twenty three patients with essential hypertension who were uncontrolled on diuretic and/or beta-receptor antagonist therapy were treated additionally with the vasodilator, pinacidil, in an open study. Significant reduction in mean blood pressure was achieved. Supine and erect systolic and diastolic blood pressure fell by 44/25 mmHg and 37/24 mmHg respectively over the study period of 12 weeks. Side-effects such as dizziness, headache, facial flushing and mild oedema were experienced by 10 patients during the study, all of which were mild and transient and did not require withdrawal from pinacidil therapy. Pinacidil is an effective and well tolerated agent in the treatment of essential hypertension.
It has been reported that the first-dose response to prazosin is more common in patients who are salt-depleted or already receiving beta blockers. The relationship between the first-dose blood pressure and plasma renin responses to oral administration of 1 mg prazosin in 13 (seven male, six female) patients with essential hypertension (average blood pressure = 150/100 +/- 5/2 mm Hg) was studied. Eight of 13 patients experienced marked orthostatic decreases in blood pressure associated with nausea and dizziness. The degree of the orthostatic depressor response was inversely correlated with the baseline plasma renin activity (p less than 0.005). This unique sensitivity of low-renin essential hypertension to prazosin may reflect an underlying increased alpha tone and/or an attendant blunted renin reactivity in this form of human essential hypertension.
A household health survey of residents living near two hazardous waste disposal sites in Calcasieu Parish, Louisiana was conducted in 1981-1982 as part of a comprehensive study of the effects of those sites on the environment and on the health of nearby residents. An unexposed community was included in the health survey for comparison. Due to media coverage and public concern about the sites, two potential indices of reporting bias, hypochondriasis and respondent's opinion about the environmental effects of waste sites, were included in the survey. Because air and water quality data showed little evidence that hazardous concentrations of chemicals were being released from the sites, questions were raised about the interpretation of the health survey data. The data were analyzed, therefore, for the association between symptom reports and the potential indices of reporting bias. Hypochondriasis scores were associated with symptom reports regardless of location of residence while an individual's opinion showed a different pattern by area of residence. Respondents living near one of the waste disposal sites who answered "yes" to the opinion question were 2-3 times more likely to report some types of symptoms than residents of the comparison community. In contrast, there was little difference in symptom reports between the exposed and comparison communities for those answering "no" to the opinion question. The usefulness of self-reported symptom data in studies of communities near hazardous waste disposal sites is discussed, and attention is called to the need to develop measures sensitive to reporting bias in epidemiologic studies.
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Serum aldosterone and cortisol responses to dexamethasone were studied in 17 patients with major depressive disorder, 16 nondepressed hospitalized patients and seven healthy controls. Serum aldosterone was neither blunted nor stimulated following dexamethasone in any of these three groups. Cortisol nonsuppression following dexamethasone, based on a criterion greater than 5 micrograms/dl, was noted in five depressed patients and two nondepressed patients. None of the seven patients with cortisol nonsuppression revealed any apparent abnormalities in their serum aldosterone secretory responses following dexamethasone. Thus, the incorporation of aldosterone measurements was not a useful extension of the dexamethasone test under the clinical conditions of this study.
We prospectively evaluated excretion of Giardia lamblia in children in day care centers in Houston by conducting two prevalence studies of 600 children enrolled in 30 DCC, day care centers, and an 18-month longitudinal study in 82 children in one center. In the two prevalence surveys, Giardia cysts were identified in 72 (21%) and 67 (26%) children, respectively, who provided stool specimens. Trophozoites were found in 15 (4%) and 8 (3%), respectively. There was no correlation between the frequency of recent diarrheal episodes and the finding of Giardia. Stool specimens containing cysts were significantly (P less than 0.0001) more frequent in the 13- to 30-month-old children than in children younger than 12 months. Children attending day care centers for more than 3 months were more likely to be excreting Giardia than those attending for less than 3 months. In the longitudinal study, cysts were detected in stool specimens from 27 (33%) of the 82 children at least once during the survey. Twelve children had Giardia cysts in weekly stool specimens for a mean of 6.2 +/- 1.2 months and trophozoites for 3.3 +/- 1.2 months. The number of enteric symptoms observed in children and the classification of nutritional status based on monthly height and weekly weight measurements did not differ significantly when infected and noninfected children were compared. Asymptomatic Giardia excretion in children younger than 36 months is common and appears to be well tolerated.
Ninety-two subjects with a history of treatment for chronic periodontitis were monitored on a regular basis for an average period of 10.7 months. During this monitoring period, in spite of their participation in a preventive maintenance program, 19 subjects out of 92 showed evidence of significantly increased probing depth (greater than or equal to 3 mm from base line measurements) on at least one tooth surface, or approximately 1% of the dental units at risk in this population. A comparison of differential microscopic counts of subgingival bacteria from the affected tooth surfaces with a pooled sample of 6 other surfaces with the greatest probing depth, in the same mouth, taken at the same appointment, revealed no significant differences between proportions of coccoid cells, spirochetes, motile rods or other cell types. These findings suggest that disease recurrence, as measured by a comparatively rapid increase in probing depth, might be accounted for on the basis of the following hypotheses: an alteration in the host response without a detectable change in the composition of the subgingival microbiota, a qualitative change in the microbial flora not detectable by a microscopic assay, relatively brief episodes of disease activity which may be accompanied by brief, transient, qualitative changes in the local microbiota that cannot be readily detected by biannual examinations.
Sixty day care centers (DCC) randomly selected from 736 licensed child care facilities in Harris County (Houston), Texas were surveyed for the incidence of diarrhea by periodic visits and weekly telephone calls over two years. A total of 2,708 episodes of diarrhea were reported in 3,800 children under 6 years of age, and 84 cases occurred in center staff. Overall incidence was 0.44 episodes/person/year among children and 0.14 among staff. Attack rates among the 60 DCC ranged from none to 3.64 cases/year in each child. The incidence for children under 36 months of age was 17 times higher than for the older group. Characteristics of DCC associated with higher rates of disease among children were the presence of young, non-bowel trained children, staff who both diapered infants and prepared food on a regular basis, DCC for profit management, and DCC whose only guidelines were provided by the State. The socioeconomic burden associated with DCC disease, its transmission, and control is considerable and needs to be further addressed.
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The records of seventy-four patients who had had cervical cerclage procedures were surveyed. Without suture placement, these patients would have had a fetal salvage rate of 23%. The Shirodkar method was performed in 67 cases and the McDonald in 7. Spontaneous abortions occurred in ten women (13.5%). Four pregnancies terminated between the 20th and 26th week of gestation; two of these losses were due to chorioamnionitis and two to immature labor. No congenital anomalies were noted. In the remaining 60 patients, 6 pregnancies terminated between the 28th and the 36th week of gestation, and 54 pregnancies were carried beyond the 36th week; all of these infants survived. The salvage rate after the cerclage procedure was 81.8%. The average length of labor in the patients who delivered vaginally was 9 hours, 18 minutes. The incidence of cervical lacerations was 3%. Eight cesarean sections were performed (13.3%) for various reasons.