Tasmanian inter-practice visit study.
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Education, Medical, Continuing↗
Biomedical subjects
R Barnes
Publications and source records attributed to R Barnes.
Screening for large bowel cancer.
Is there a need for yet another screening process to be applied in general practice with all the consequent costs in terms of materials, doctors' time and patient anxieties? What is the evidence for and against screening for colorectal cancer?
Adolescent↗
The polycystic ovary syndrome: pathogenesis and treatment.
PURPOSE: To propose a theory for the pathogenesis of the polycystic ovary syndrome that explains the endocrinologic abnormalities of the syndrome and provides a rational approach to therapy. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1975 to 1988) and extensive bibliographic reviews of identified articles. STUDY SELECTION: We reviewed the literature and selected 169 articles considered most relevant for the definition of the endocrinologic abnormalities, elucidation of pathogenic mechanisms, or delineation of therapeutic interventions. DATA EXTRACTION: The authors independently assessed study quality and data concerning endocrinologic abnormalities, pathogenic mechanisms, and therapy of the polycystic ovary syndrome. RESULTS OF DATA SYNTHESIS: The polycystic ovary syndrome may be best defined as functional, gonadotropin-dependent ovarian hyperandrogenism. The polycystic ovary syndrome results when a primary defect increases one of three variables: the ratio of the serum concentrations of luteinizing hormone to follicle stimulating hormone, the ratio of the intraovarian concentrations of androgen to estrogen, or follicular atresia. An increase in one of these variables can then induce successive abnormalities in one or more of the remaining two variables in a to-and-fro manner. CONCLUSIONS: Evidence suggests that several causes exist, each of which can produce the clinical syndrome by a to-and-fro interaction among pathogenic mechanisms. Treatment objectives for the syndrome include amelioration of hirsutism, induction of ovulation, and weight reduction.
Androgens↗
How much soil do young children ingest: an epidemiologic study.
Sixty-four children aged 1-4 years were evaluated for the extent to which they ingest soil. The study followed the soil tracer methodology of S. Binder, D. Sokal, and D. Maughan (1986, Arch. Environ. Health, 41, 341-345). However, the present study included a number of modifications from the Binder et al. study. The principal new features were (1) increasing the tracer elements from three to eight; (2) using a mass-balance approach so that the contribution of food and medicine ingestion would be considered; (3) extending the period of observation from 3 days to 8 days; and (4) validating the methodology by having adult volunteers ingest known amounts of soil in a mass-balance validation study. The principal findings reveal the following. (1) The adult study confirmed the validity of the tracer methodology to estimate soil ingestion. (2) Of the eight tracers employed in the adult study, only Al, Si, and Y provided sufficient recovery data that was directly acceptably stable and reliable. (3) If food ingestion determinations were taken into consideration, the median estimates of soil ingestion from the eight tracers ranged from a low of 9 mg/day (Y) to a high of 96 mg/day (V); the median values of Al, Si, and Y, the three most reliable tracers, ranged from 9 mg/day to 40 mg/day. (4) One child had soil ingestion values ranging from 5 to 8 g/day, depending on the tracer. (5) If food ingestion had not been considered, the estimates of soil ingestion would have increased about two- to sixfold, depending on the tracer with Ti and Y being most affected by food intake. (6) Since soil and dust samples did not significantly differ in their levels of tracer elements, no reliable differentiation between the contribution of ingestion of dust and soil could be made. (7) These findings are generally consistent with the previously reported findings of Binder et al. (1986) and P. Clausing, B. Brunekreff, and J.H. van Wijnen (1987, Int. Arch. Occup. Med., 59, 73) if these latter studies are corrected for ingestion of tracers in food and medicine. The findings also account for the apparent discrepancy between the estimates from Al and Si and estimates based on Ti in previous studies. Thus the elevated estimates of soil ingestion by Ti were substantially reduced when food ingestion is considered.
Adult↗
Lymphogranuloma venereum: 27 cases in Paris.
Twenty-seven men with laboratory-confirmed lymphogranuloma venereum (LGV) were identified among 211 patients tested for LGV or chancroid during a 6-y period. The patients with LGV ranged in age from 17 to 73 y; most were from countries other than France. Twenty-five sought care because of inguinal adenopathy (with spontaneous draining fistulae in two patients) and two because of proctitis. Chlamydia trachomatis was isolated from nine patients; all isolates were the LGV biovar as demonstrated by biologic characterization and monoclonal antibody reactivity. In patients without isolation of C. trachomatis, the diagnosis was based on chlamydial complement fixation antibody titers greater than or equal to 1:32 (mean titer, 1:128). Genital herpes was an associated diagnosis in one patient and syphilis in two patients. Serologic evidence of exposure to human immunodeficiency virus (HIV) type 1 was present in five patients and to HIV-2 in one patient.
Adolescent↗
Evaluation of the 7-h membrane filter test for quantitation of fecal coliforms in water.
The 7-h fecal coliform (FC) test for detection of FC organisms in water was evaluated to establish its validity and usefulness for emergency and disaster situations. The waters tested consisted of routine samples collected for public health surveillance and enforcement purposes. A total of 984 water samples from throughout California were assayed. These included samples from coastal salt waters, rivers, canals, and reservoirs, in addition to potable and miscellaneous freshwater sources. A portion of each sample was tested concurrently by both the 7-h FC test and the most-probable-number FC five-tube test. The 7-h FC test samples were incubated for 7 to 7.25 h at 41.5 degrees C. Overall, greater than 90% agreement was obtained between the methods in determining whether the water quality was acceptable or unacceptable. Statistical analysis of the 984 samples confirmed that the 7-h FC method was a suitable alternative to the most-probable-number FC method for evaluation of freshwater samples. During emergencies or disasters, the 7-h FC test could provide a means for detection of fecal contamination of water with results available in less than 1 day.
Disasters↗
Double-blind trial of imipramine in Alzheimer's disease patients with and without depression.
The authors divided 61 subjects with primary degenerative dementia of the Alzheimer's type into a group who also met DSM-III criteria for depression (N = 28) and a group who did not (N = 33). Both groups were randomly assigned to an 8-week double-blind trial of imipramine or placebo. Scores on the Hamilton Rating Scale for Depression, administered at baseline and weeks 2, 4, 6, and 8, indicated significant improvement in both groups. Two measures of cognitive function yielded differing results. The results suggest that moderate depression is a treatable condition in patients with Alzheimer's disease.
Aged↗
Notification of malignant mesotheliomas.
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Asbestos↗
Space Station atmospheric monitoring systems.
A technology assessment study on atmospheric monitoring systems was performed by Battelle Columbus Division for the National Aeronautics and Space Administration's John F. Kennedy Space Center under Contract No. NAS 10-11033. In this assessment, the objective was to identify, analyze, and recommend systems to sample and measure Space Station atmospheric contaminants and identify where additional research and technology advancements were required. To achieve this objective, it was necessary to define atmospheric monitoring requirements and to assess the state of the art and advanced technology and systems for technical and operational compatibility with monitoring goals. Three technical tasks were defined to support these needs: Definition of Monitoring Requirements, Assessment of Sampling and Analytical Technology, and Technology Screening and Recommendations. Based on the analysis, the principal candidates recommended for development at the Space Station's initial operational capability were: (1) long-path Fourier transform infrared for rapid detection of high-risk contamination incidences, and (2) gas chromatography/mass spectrometry utilizing mass selective detection (or ion-trap) technologies for detailed monitoring of extended crew exposure to low level (ppbv) contamination. The development of a gas chromatography/mass spectrometry/matrix isolation-Fourier transform infrared system was recommended as part of the long range program of upgrading Space Station trace-contaminant monitoring needs.
Air Conditioning↗
Quinine-induced thrombocytopenia. A case report.
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Adult↗
Seminoma of the testis at Groote Schuur Hospital, 1973-1984.
The clinical records of 47 patients with testicular seminoma treated between 1973 and 1984 were reviewed. The mean age was 41 years. There were relatively few blacks and patients of mixed race--4% and 17% respectively. The incidence of associated testicular maldescent was statistically significantly higher among the black and mixed-race patients (40%) than among the white patients (8%). Forty-three patients underwent retroperitoneal irradiation after orchidectomy, with a 5-year survival rate of 87% at a median follow-up of 52 months. There were no relapses at follow-up in 27 stage I patients; 1 of 8 patients with stage IIA and B (non-bulky) disease relapsed after 12 years, and relapses occurred in all 5 patients with stage IIC (bulky) seminoma. Retroperitoneal and mediastinal irradiation has controlled disease in 2 patients with stage III disease without bulky metastases. One patient with stage IV seminoma treated with irradiation relapsed. One of the patients with stage I disease has developed a major bowel complication following 3,000 cGy fractionated irradiation. Our experience with cis-platinum-based chemotherapy includes noting its effectiveness in a patient with unresectable locally advanced testicular seminoma. We recommend retroperitoneal irradiation after orchidectomy for patients with stage I and IIA/B disease and cis-platinum combination chemotherapy after orchidectomy for those with more advanced disease.
Adolescent↗
An outbreak of hepatitis B and D in butchers.
This report documents an outbreak of hepatitis B (HB) and hepatitis D (HD) in a group of butcher shop employees. During the 13-month period from September 1983 to October 1984, 8 employees from 2 establishments developed acute HB. Epidemiological investigation suggested that the first case, who was also an intravenous drug user, was the source of infection for other employees. This person and 2 others were found to have concurrent HD. In November 1984 the wife of one of the infected butchers also developed HB.
Disease Outbreaks↗
Noonan's syndrome. With carcinoma of undescended testis.
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Adult↗
Evaluation of a new dressing in the treatment of sports-related skin lesions.
Twenty-seven players with superficial wounds (abrasions, turf burns, and blisters) were treated with a new Hydroactive dressing. We conclude that this dressing provides an excellent alternative to other forms of treatment since it is easy to use, comfortable, hypoallergenic, and provides impressive healing results.
Adult↗
Progression of radiographic changes in asbestos workers and ex-workers.
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Asbestos↗
Pharmacologic treatment of agitation associated with dementia.
Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo-controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long-term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial.
Affective Symptoms↗