The sad state of Indian health.
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Delivery of Health Care↗
Biomedical subjects
R D Walker
Publications and source records attributed to R D Walker.
Absent factor VIII response to synthetic vasopressin analogue (DDAVP) in nephrogenic diabetes insipidus.
To study the effect of 1-deamino-8D-arginine vasopressin (DDAVP) on the factor VIII response in nephrogenic diabetes insipidus (NDI), 0.30 microgram/kg DDAVP was given to 2 unrelated NDI patients, 3 obligate carriers, and 20 controls. Factor VIII coagulant activity (FVIIIC) and factor VIII related antigen (FVIIIR:Ag) responses were absent in both NDI patients and were decreased by approximately 50% in the carriers by comparison with controls. These results show that the vasopressin receptor defect in NDI is not confined to the kidney but is equally expressed in other tissues including the vascular endothelium and hepatic sinusoids, the respective sites of FVIIIR:Ag and FVIIIC production. A decreased factor VIII response may help in identifying carriers in families at risk.
Adolescent↗
The child with solitary hydronephrotic kidney.
The child with solitary hydronephrotic kidney has a prognosis different from that of the child with hydronephrosis and a normal contralateral kidney. We have reviewed a decade of experience with 31 children with solitary hydronephrotic kidney and have identified characteristics that point to either a favorable or unfavorable prognosis in these children.
Acid-Base Equilibrium↗
A comparison of the Mustardé and Horton-Devine flip-flap techniques of hypospadias repair.
We compared the results and complications of the Horton-Devine flip-flap and Mustardé techniques for 1-stage repair of distal hypospadias. Followup has been for at least 1 year so that long-term complications could be included. Urethral fistulas occurred in 6 of 20 patients treated with the Horton-Devine flip-flap and 3 of 20 who underwent the Mustardé repair. No strictures were noted with either procedure. In our opinion the meatus had a better configuration after the Mustardé repair. We conclude that the Mustardé procedure provides a more satisfying cosmetic and clinical result.
Adolescent↗
The growing rabbit with a solitary, partially-obstructed kidney. Analysis of an experimental model with reference to the renal concentrating ability.
The systemic and renal effects of high partial ureteral obstruction were investigated in a new model of experimental hydronephrosis. The test group comprised 12 contralaterally nephrectomized growing male New Zealand rabbits. As compared to the pyelographic findings in 6 unilaterally nephrectomized control animals, the test group could be divided into partially obstructed but non-hydronephrotic and obstructed-hydronephrotic subgroups. Animals of all 3 groups were capable of increasing their weight during the first 2 postoperative months. The mean plasma creatinine concentration remained normal in the obstructed group and even hydronephrosis was compatible with a normal serum creatinine level. As studied during forced hypotonic expansion, the renal response to a vasopressin analogue was significantly different in all 3 animal groups. Reciprocal but less marked differences were noted in the animals' ability to retain water during this test. We conclude that in this experimental model the magnitude of the antidiuretic response is inversely related to the radiologically defined degree of obstruction.
Animals↗
Detoxification recidivism among urban American Indian alcoholics.
Fifty urban American Indians were interviewed during admission to a free-standing medical detoxification unit. From the year before the interview through 2 years of follow-up, this sample averaged 44.6 detoxification admissions and 64.1 days in other inpatient treatment and had no significant change in the number of annual detoxification admissions. At follow-up all but three subjects reported recent alcohol dependence symptoms or episodic alcohol abuse. these patients continued to experience serious alcohol-related problems despite repeated treatment in both medical detoxification and inpatient rehabilitation settings. These findings emphasize the need for more innovative and effective alternatives to the existing revolving door process.
Adult↗
Derivation and validation of neuropsychological clusters among men alcoholics.
Scores from 13 cognitive-neuropsychological tests administered to 245 men alcoholics were subjected to an average linkage cluster analysis. Six subtypes were derived but three were eliminated from further analyses because they had samples of less than 10. The remaining clusters appeared to reflect differing levels and patterns of neuropsychological functioning. Subsequent analyses indicated that the clusters were related to age but were independent of most other demographic and pretreatment alcohol-related variables. Significant associations were found between cluster membership and the likelihood of abstinence, completion of aftercare therapy and employment status over a 9-month follow-up period. Although this relationship to outcome is encouraging, neuropsychological status accounted for only a limited amount of the variance. The findings suggest the need to broaden the base of assessment, using multiple domains, in future attempts to derive meaningful subtypes within an alcoholic population.
Adult↗
Changes in leukocyte populations in pulmonary lavage fluids of calves after inhalation of Pasteurella haemolytica.
The distribution of leukocytes in bovine bronchoalveolar lavage fluids was determined in 15 calves at various times after aerosol exposure to Pasteurella haemolytica. For comparison, 10 calves were exposed to aerosols of phosphate-buffered saline solution; 15 calves, to Staphylococcus epidermidis; and 10 calves, to Salmonella typhimurium endotoxin. At 10 minutes after inhalation exposure for each group, the predominant cell type was the macrophage. Macrophages remained the predominant cell type throughout each lavage interval for calves exposed to phosphate-buffered saline solution and Staph epidermidis. For calves exposed to P haemolytica, there was a decrease in the percentage of macrophages detectable by 30 minutes after exposure, with a corresponding increase in the percentage of neutrophils. Sixty minutes after the inhalation exposure to P haemolytica, the percentages of macrophages and neutrophils in the lavage fluid were equal. By 240 minutes after exposure to P haemolytica, greater than 90% of the cells in the lavage fluids was neutrophils. The increase in the percentage of neutrophils in lavage fluids from calves exposed to S typhimurium endotoxin was similar to that seen for the calves exposed to P haemolytica.
Animals↗
Sports injuries: rugby league may be less dangerous than union.
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Athletic Injuries↗
Antileukotoxin antibody produced in the bovine lung after aerosol exposure to viable Pasteurella haemolytica.
Experiments were performed to determine the in vivo immunogenicity of Pasteurella haemolytica leukotoxin. Calves were exposed twice to aerosol mists of viable P haemolytica, using a treatment regimen previously shown to induce a resistant state. Pulmonary lavage fluids and serum samples from these calves were assayed for leukotoxin-neutralizing antibodies. Before aerosol exposure, neutralizing antibody titers were routinely found in serum samples, but were not detectable in pulmonary lavage concentrates before exposure. After aerosol exposure, titers of toxin-neutralizing immunoglobulin (Ig)A and IgG antibodies were found in pulmonary lavage concentrates and were accompanied by increased serum toxin neutralization titers.
Aerosols↗
Study of out-of-hours visits to children.
Out-of-hours calls made to children by an urban practice were studied over a 12-month period. Out of a total of 1463 out-of-hours visits, 336 were to children, of whom 17 were admitted to hospital. The proportion of the out-of-hours calls which were to children is less than had been expected. This unexpectedly low level of out-of-hours visits to children and the type of conditions encountered should be taken into account when planning vocational training programmes.
Adolescent↗
Growth in children with various therapies for end-stage renal disease.
The growth of children undergoing continuous ambulatory peritoneal dialysis (CAPD) therapy for end-stage renal disease (ESRD) was compared with the growth of children undergoing hemodialysis and that of children after successful kidney transplantation. The bone ages of the children were used to predict expected growth velocities. The actual growth velocities observed were then expressed as percentages of the predicted rates. Children receiving CAPD therapy grew better than those treated by hemodialysis and as well as the children who received a kidney transplant. There was some correlation between growth and allograft function in the transplant recipients. Children receiving CAPD were less acidotic and were more likely to exhibit improvement in renal osteodystrophy than children treated by ongoing hemodialysis. There were no significant differences in reported caloric intake between the two groups.
Adolescent↗
Management of thermal injuries in large animals.
The pathophysiology and histopathology of thermal burns in large animals is very similar to that in humans. Burns are classified as first degree, superficial and deep second degree, third degree, and fourth degree, depending upon the depth of thermal injury. Most severe burns will produce a local and a systemic response--both of which must be properly treated to increase the patient's chances for survival. The systemic response is mainly characterized by hypovolemia, fluid and electrolyte loss, protein loss, pulmonary edema, increased caloric requirements, and depressed immune responses. The local response is one of inflammation, vasospasm fluid accumulation, and electrolyte shifts depending upon the extent of the thermal injury. In all burn cases, the total patient should be evaluated. There is a tendency to focus on the wound, and systemic problems may be overlooked. In many cases, the thermal wound cannot be accurately evaluated for a few days, especially in large animals. An attempt should be made to estimate the depth of the burn, because treatment will vary accordingly. The treatment method must consider several problems. These include evaporative fluid and electrolyte loss, protection against mechanical injury, prevention of bacterial invasion and infection, maintenance of body temperature, and removal of nonviable tissue while leaving viable germinal tissue for healing. Thermal injuries in large animals present several additional problems. Many burns in large animals involve a large surface area, which increases the fluid, electrolyte, and caloric losses. Because most veterinary hospitals are not equipped to control the patient's surroundings, extensive bacterial contamination of the burn is of major concern. Patient restraint must also be a consideration to prevent further injury of the healing wound. Many patients are pruritic, and proper measures must be taken to prevent self-mutilation. There is also a lack of technically trained personnel to monitor and properly treat burn patients.
Animals↗
Experimental production of bovine respiratory tract disease with bovine viral diarrhea virus.
Five 6-month-old calves were inoculated with bovine viral diarrhea (BVD) virus (n = 3) or Pasteurella haemolytica (n = 2) endobronchially with a fiberoptic bronchoscope. Five additional calves were inoculated sequentially with BVD virus followed by P haemolytica at a 5-day interval. Blood samples were collected daily from the calves for bacterial isolation. Clinical signs of respiratory tract disease in calves were recorded daily. If the calves survived, they were killed for necropsy 3 or 4 days after inoculation with P haemolytica (or 8 days after inoculation with BVD virus). The extent and nature of pulmonary lesions in the calves were determined, and the lower portion of the respiratory tract (lungs and trachea) was examined for both these organisms. The 3 calves, inoculated with BVD virus only, developed mild clinical signs mainly manifested as fever, nasal discharge, and occasional cough. Approximately 2% to 7% of the total lung capacity of these calves was pneumonic. Mild clinical signs and localized lesions involving about 15% of the lung volume developed in the 2 calves exposed to P haemolytica only. However, severe fibrinopurulent bronchopneumonia and pleuritis involving 40% to 75% of lung volume developed in the 5 calves inoculated sequentially with BVD virus and P haemolytica. The possible role BVD virus may have in bovine respiratory tract disease is discussed.
Animals↗
Effect of bovine viral diarrhea virus infection on the distribution of infectious bovine rhinotracheitis virus in calves.
Four calves (control animals) were inoculated (by aerosol) with Cooper's strain of infectious bovine rhinotracheitis (IBR) virus given with an ultrasonic nebulizer. Seven other calves (principals) were inoculated (by aerosol) with a noncytopathic strain of bovine viral diarrhea (BVD) virus and 7 days later, with IBR virus. The calves were killed 3 to 8 days after the latter virus was inoculated. Various tissues were collected from the calves during necropsy and assayed for IBR virus. In the control calves, the IBR virus was recovered only from the cranial part of the respiratory tract and, in much lower concentrations, from the caudal part of the respiratory tract. In contrast, the same virus was widely disseminated in most tissues, usually in high concentrations, of the calves first inoculated with BVD virus (principals). These observations indicate that initial BVD virus infection may impair the ability of calves to clear IBR virus from the lungs and to contain the latter virus at the local infection site. The pathogenesis of various forms of IBR virus-induced diseases in calves is discussed.
Animals↗
Definitions, models, and methods in research on sociocultural factors in American Indian alcohol use.
This paper presents a critical discussion of the definitions, conceptual models, and methodological issues that researchers should consider in studies of sociocultural influences on drinking practices and problems. In particular, these concerns are related to studies of American Indian and Alaskan Native people. In an effort to avoid overgeneralized explanatory statements, it is recommended that efforts be made to study more specific aspects of such loosely defined terms as culture, alcoholism, and "Indianness." Research in this area might usefully be guided by parsimonious conceptual models developed and investigated in the dominant culture; however the extent to which relationships observed within one group generalized to another group remains an empirical question. While there may be a common set of operationalizing variables and collecting valid data cannot be assumed to have equal applicability with different subgroups. By remaining sensitive to the methodological implications of sociocultural differences, investigators can more accurately clarify the processes by which complex biological, psychological, and sociocultural factors influence alcohol use and misuse in any individual or group.
Acculturation↗
Concentrations of imipramine and its metabolites during enuresis therapy.
Plasma concentrations of imipramine and three of its metabolites were determined in children 6 to 15 years of age who received imipramine for treatment of nocturnal enuresis. In 14 patients with reliable data the reduction in wet nights after beginning drug therapy had no apparent relationship to either imipramine concentration alone or imipramine combined with its metabolites. This finding may be related to the relatively low drug concentrations in this group of patients, a high placebo response rate, or noncompliance with the prescribed dosage regimen. Determining plasma imipramine concentrations during treatment for enuresis has questionable value as an aid to improve clinical response. This practice may occasionally be justified when avoidance of toxicity is a major concern.
Adolescent↗
Use of fiberoptic bronchoscopy in experimental production of bovine respiratory tract disease.
Fourteen 6-month-old calves were infected with Pasteurella haemolytica or infectious bovine rhinotracheitis (IBR) virus. Four calves were inoculated sequentially with IBR virus followed by P haemolytica at a 5-day interval. Calves were inoculated by allowing them to inhale an aerosol of the organism or by placing an inoculum in the right lung, using fiberoptic bronchoscopy. Clinical signs of infection were recorded, and the calves, if they survived, were killed and necropsied 3 days after inoculation with P haemolytica (or 8 days after inoculation with IBR virus). The extent of pulmonary lesions was determined, and the lower respiratory tract (lungs and lower trachea) was examined for both organisms. Inoculation of the calves by aerosolization with IBR virus alone resulted in mild respiratory tract disease. Mild-to-moderately severe respiratory tract disease developed as a result of sequential inoculations by aerosolization with IBR virus and P haemolytica. However, respiratory tract disease did not develop in calves exposed by aerosol to P haemolytica alone. Large numbers of these organisms were recovered from the lower respiratory tract of the dually inoculated calves, only indicating delayed pulmonary clearance. Mild clinical signs of disease but substantial, though localized, pneumonic lesions developed in calves inoculated with P haemolytica by fiberoptic bronchoscopy. Calves inoculated with IBR virus by the latter procedure developed moderately severe respiratory tract disease involving 25% to 30% of the total lung volume. Lesions occurred mainly in the right lung, but the left lung also had marked lesions in these calves.(ABSTRACT TRUNCATED AT 250 WORDS)
Aerosols↗