Education and QA: a model for continuous improvement in skin integrity.
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Biomedical subjects
Publications and source records attributed to R Abbott.
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The use of sensory rhizotomy has long been used for the treatment of spasticity. This review outlines the historical development of this treatment, the current surgical technique, and its physiologic rationale. Patient selection, postoperative treatment, and complications are also discussed.
Hormonal, haemodynamic and subjective psychological responses to the intravenous infusion of clonidine were investigated in nine male alcoholics who had been abstinent for 5 weeks, and were compared with those of nine healthy controls. The growth hormone response to clonidine was significantly blunted in the abstinent alcoholics. Both baseline cortisol levels and the clonidine-induced cortisol decrease were significantly greater in the alcoholics than in controls. Blood pressure, pulse rate and psychological responses to clonidine were similar in both groups. These results indicate that some aspects of alpha-2-adrenoceptor sensitivity are persistently abnormal in alcoholics at least 5 weeks into abstinence.
The clinical value of serum brain specific creatine kinase (CK-BB) was assessed in head injured patients (group A) using a new enzyme-linked immunosorbent assay (ELISA). The results were compared to healthy controls (group B) and patients post-myocardial infarction (group C). None of the head injured patients had undergone a surgical procedure or ventricular puncture. CK-BB was significantly higher in group A than in controls. The level of CK-BB in group A was inversely proportional to the Glasgow Coma Scale on admission. All patients with a CK-BB greater than 100 micrograms/l died. The ELISA technique is a simple and reliable assay with prognostic significance in patients with head injury and has wider clinical application than the previously described radioimmunoassay methods.
Immunotherapy using monoclonal antibody 17-1A has been performed on 22 patients with metastatic gastrointestinal cancer. Criteria for treatment included objective evidence of advanced colon, gastric, or pancreatic cancer (positive CAT scan or x-rays, elevated tumor markers, and/or abnormal liver function tests). The tumor tissue was antigenically positive in all cases. Performance status ranged from 50 to 100%. No adverse reactions were noted. Of the 22 cases treated, 4 (18%) have died, none have rapidly progressive disease, 4 (18%) have slowly progressive disease, 10 (45%) are considered stable with disease, and none are considered partial or complete responses. It is too early to classify the response in 4 cases. In 6 of 8 patients where anti-idiotypic data was available, death or progressive disease was correlated to negative anti-idiotypic response, and clinical stability to a positive anti-idiotypic response. In the patients considered to be stable, the percent change from pre-treatment serum 19-9 concentrations to current values ranged from -10% to +353%. In the patients who have died or have been classified as slowly progressive the serum 19-9 changes ranged from +13% to +707%.
Forty-five patients with metastatic germ cell tumour were treated with chemotherapy. Complete remission was achieved in 63% of all cases and in 65% of patients whose primary tumour arose in the testis or ovary. Surgical resection of abdominal masses persisting after chemotherapy was performed in seven patients, two of whom were found to have persistent tumours. Twenty-seven of the 33 patients with teratoma originating in the gonads remain in complete remission. Total serum LDH activity was elevated in 28 of the patients with measurable disease. The increased LDH was not accompanied by significant alteration in other hepatic enzymes nor were hepatic metastases demonstrable in these patients. Fractionation of the LDH demonstrated that the increased LDH in these patients was located in either iso-enzymes 1 or fractions 1 + 2. Alteration of the serum LDH activity correlated with the response to therapy and warrants further study.
A study involving the determination of total fibrinogen and high molecular weight (HMW) fibrinogen was performed with the glycine precipitation method. Ninety patients in different trimesters of pregnancy and 37 non-pregnant controls participated in the study. Total fibrinogen was found to increase during pregnancy until delivery, after which it declined gradually, peaking once more on the 3rd day of puerperium. HMW fibrinogen showed a similar pattern during pregnancy and puerperium, but markedly increased at the time of delivery. These elevated values during pregnancy indicate a significant change in the fibrinolytic system, which is believed to be depressed during pregnancy, enhanced during the postpartum period, and stabilized after the 3rd day of puerperium.
Presented is the case of an elderly woman who developed severe hyponatremia while taking tricyclic antidepressants. She met the criteria for the syndrome of inappropriate antidiuretic hormone secretion induced by drugs. Her symptoms of lethargy, weakness, and gastrointestinal disturbances developed insidiously, allowing the hyponatremia to reach severe levels before a diagnosis was made. A variety of psychoactive drugs, most prominently tricyclic antidepressants, have been reported to produce hyponatremia idiosyncratically in elderly persons.
Twenty-eight patients with inoperable or metastatic gastric cancer were treated with combination chemotherapy using 5-fluorouracil, adriamycin and mitomycin-C (FAM). Twenty-one patients had measurable disease parameters and 57 per cent of these experienced a major regression of disease following chemotherapy. The median survival of the responding patients was 13.2 months compared with 6.8 months in the group who did not achieve a major response. These results demonstrate the sensitivity of gastric carcinoma to this drug combination.
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Metabolic profiles of urine extracts of humans with viral infections, as well as of media of virus-infected human tissue cultures, have been analyzed by non-fragmenting mass spectrometry and compared with corresponding controls. The spectra were then subjected to several alternative computerized statistical procedures to detect diagnostic biochemical profiles. Controlled longitudinal studies on fully informed, consenting volunteers who received sandfly fever virus demonstrate the onset of a characteristic metabolic pattern that precedes the onset of symptoms and subsides when the patients overcome the infection. Longitudinal studies of human tissue cultures infected with poliomyelitis virus demonstrate characteristic metabolic patterns within a few hours after infection. Non-fragmenting mass spectrometry may thus provide the clinical laboratory with a sensitive, reliable test for viral infections significantly faster than attainable by current techniques.
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BACKGROUND: Computers that collect data from patients and provide both patients and practitioners with printed feedback on a range of health risks are a tool for assisting general practitioners with preventive care. This study assessed the impact of computer-generated printed feedback on cervical screening among women who were underscreened for cervical cancer. METHOD: Female attenders at two Australian general practices were randomly allocated to Experimental or Control groups. Women in both groups completed a health risk survey on a touch screen computer prior to their consultation. Those in the Experimental group received printed pages summarizing their results, including their eligibility for cervical screening and last Pap test, for themselves and their doctor. The number and proportion of underscreened women who had a Pap test in the 6 months after completing the computer survey, as determined by pathology records, were examined. RESULTS: Of the 679 participants, 139 were classified as underscreened on the basis of self-report (74 Experimental, 65 Control) and 272 on the basis of their pathology records (148 Experimental, 124 Control). Overall about one-third of women had a test in the 6-month period, and the differences between the groups were not significant for women overall (18-70 years) or for women 18-49 years. Among women 50-70 who were underscreened based on self-report, those receiving the printout were more likely to have a Pap test in the next 6 months (P < 0.05). This pattern was also evident, but did not reach statistical significance, for older women who were underscreened based on pathology records. CONCLUSIONS: We are unable to draw conclusions regarding the effectiveness of the computer system due to the modest proportions of women screened, the small numbers, and the fact that the computer survey may have created an intervention effect in the Control group. As the study suggests the computer system is acceptable to women and may be effective for encouraging screening among older women, further exploration of the system is desirable.
Studies of urban-rural differences in prevalence of non-psychotic mental disorder have not given consistent findings. Such differences have received relatively little study in Great Britain. Data from 9777 subjects in the Household Survey of the National Morbidity Survey of Great Britain were analysed for differences between urban, semi-rural, and rural areas. Psychiatric morbidity was assessed by scores on the Revised Clinical Interview Schedule (CIS-R), together with alcohol dependence, drug dependence, and receipt of treatment from general practitioners. Associations with other characteristics were examined by logistic regression. Urban subjects had higher rates than rural of CIS-R morbidity, alcohol dependence, and drug dependence, with semi-rural subjects intermediate. Urban subjects also tended to be members of more deprived social groups, with more adverse living circumstances and greater life stress--factors themselves associated with disorder. Urban-rural differences in alcohol and drug dependence were no longer significant after adjustment for these factors by logistic regression, and differences on CIS-R morbidity were considerably reduced. There were no differences in treatment. There are considerable British urban-rural differences in mental health, which may largely be attributable to more adverse urban social environments.
Two cases of aplasia cutis congenita with associated bony defects are presented to highlight the dangers of delayed coverage of exposed dura. Management of one case was complicated by repeated local and systemic sepsis and the other by repeated, life-threatening hemorrhage. Early, definitive coverage of these defects using full thickness skin flaps avoids the risks of hemorrhage and should, if the recipient bed is clean, lessen the incidence of complicating sepsis.
Intrinsic focal tumor of the medulla oblongata is an uncommon entity. Of the 51 cases presenting for treatment of a brainstem glioma between 1984 and 1990, only 7 were confined to the medulla. Radical excision was performed on each patient. Four of the first 5 patients who were extubated in the recovery room had CO2 retention, with associated respiratory arrest and hypoxia. Three suffered permanent cranial nerve deficits as a result. It is the purpose of this report to describe the serious complications of medullary surgery and to make recommendations as to how they may be avoided.