Spontaneous resolution of multifocal gastric enterochromaffin-like cell carcinoid tumours.
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Aged↗
Biomedical subjects
R F Harvey
Publications and source records attributed to R F Harvey.
Computerized tomography head scans as predictors of functional outcome of stroke patients.
Preadmission computerized tomography (CT) scans of the head were used to help develop a clinical method for the prediction of outcome of stroke patients. The functional gains and discharge outcomes of 100 stroke patients after inpatient rehabilitation were considered. Reports of preadmission (acute care hospital) CT scans of the head were analyzed and placed into six groups representing progressive anatomic involvement. Functional status was measured at admission and discharge using the patient evaluation and conference system (PECS) and placed into four functional groups. The groups ranged from normal to totally dependent in self-care activities, ambulation, and bladder and bowel functioning. Admission CT head scans reported in two categories--"normal" or "small superficial infarct"--were associated with return to independent functioning. Bihemispheric infarcts were associated with discharge to nursing home (71%), rather than to independent living. Of all patients with functional gain as measured with PECS, 79% returned home.
Adolescent↗
Effects of sleeping with the bed-head raised and of ranitidine in patients with severe peptic oesophagitis.
Sleeping with the bed-head raised is commonly recommended as treatment for patients with troublesome oesophagitis, but its effect has not been objectively tested. Ranitidine therapy is useful in oesophagitis, but it does not often produce complete relief of symptoms. The effects of each of these treatments alone and in combination have been studied in 71 patients with severe (grade III) peptic oesophagitis. Each treatment improved both symptoms and endoscopic appearances significantly more than placebo did. However, the combination of the two treatments was much better than either alone; the reduction in pain score and the area of ulceration healed were about twice those with either treatment alone. Smoking more than five cigarettes per day or drinking more than 30 g alcohol per day significantly reduced the effectiveness of ranitidine therapy, but age, sex, body weight, or the presence of a hiatus hernia had no detectable effect.
Adult↗
Prognosis in the irritable bowel syndrome: a 5-year prospective study.
To establish the short-term and long-term results of current treatment of irritable bowel syndrome (IBS), 104 patients were studied prospectively. All patients were treated similarly and the results were assessed after a few weeks and then after at least 5 years. IBS can be diagnosed more easily than has been suggested--72% of this series were correctly diagnosed by their referring doctor, and only 12% required radiological studies to exclude organic disease. The response to treatment was considerably better than expected, possibly because of the more aggressive use of high-fibre diets and bulking agents. Thus, 85% of patients were rendered virtually symptom-free in the short term, and 68% were still virtually symptom-free 5 years later. The response to treatment was better in men than in women, in those with constipation than with diarrhoea, when the symptoms had initially been triggered by an episode of acute diarrhoea, and in patients with a relatively short history. With a few simple investigations, sympathetic explanation, and appropriate treatment, most patients with IBS have a good prognosis.
Adolescent↗
Pathogenesis of the impaired gall bladder contraction of coeliac disease.
We have investigated the possibility that the abnormally decreased gall bladder contraction after meals in patients with coeliac disease might result in part from an abnormality in the gall bladder response to endogenous cholecystokinetic hormones--for example, cholecystokinin and motilin--rather than solely from decreased secretion of such hormones. Eight patients with untreated coeliac disease and nine controls received intravenous infusions of the pure synthetic cholecystokinin analogue caerulein, 2-16 ng/kg/hour. Gall bladder emptying was measured on a minute-by-minute basis using 99mTc-HIDA scans. In the patients with coeliac disease, gall bladder emptying was greatly decreased (34.6 +/- 9.9 v 61.5 +/- 7.5% at 60 minutes, p less than 0.02), and a much greater dose of caerulein was needed to initiate gall bladder contraction (3.80 +/- 1.08 v 1.49 +/- 0.56 ng/kg, p less than 0.02). These results suggest that the abnormal gall bladder contraction in coeliac disease is not simply because of impaired release of cholecystokinin. Although mechanical factors secondary to the increased gall bladder size in patients with coeliac disease might to some extent account for the findings, the alternative explanation is that the gall bladder muscle is for some reason resistant to the action of cholecystokinetic agents. A similar phenomenon affecting the pancreas might contribute to the abnormally decreased pancreatic secretion found in coeliac disease.
Adult↗
Computerized data bases: an integrated approach to monitoring quality of patient care.
Common information is shared by rehabilitation program evaluation, utilization review, and quality assurance. These administrative functions sometimes operate in isolation, not taking advantage of information sharing. This approach fails to recognize the potential for increased efficiency of integrating pertinent information to produce timely and useful reports. We report on a system design which addresses this concern by encouraging information sharing, reducing data duplication and creating a data base to produce needed statistical and management reports. Our discussion highlights the key elements of program evaluation, utilization review, and quality assurance. These elements are described as an integrated approach to meet the Commission on Accreditation of Rehabilitation Facilities and revised Joint Commission on Accreditation of Hospitals standards.
Database Management Systems↗
Rehabilitation team and family assessment of the initial home pass.
Brain-injured individuals may have neurologic damage resulting in physical, cognitive and personality sequelae. Rehabilitation promotes recovery for these patients by restoring cognitive and social functions and focusing attention on medical-physical and cognitive-social intervention. A major component in rehabilitation is to teach family members to understand the process of recovery and their role in teaching and reinforcing desired behaviors at home. To investigate the utility of the family's role, we studied the effects of allowing patients to return to the home/family environment for short stays (therapeutic pass). By comparing functional ratings obtained from family and rehabilitation team members, we found families rated brain-injured patients higher in medical-physical areas and more equally in cognitive-social areas. Although we do not control for the family's frame of reference regarding the patient's premorbid status, we conclude that impaired cognitive functioning has a profound impact on family members who, like the patient, must make adjustments because of the disability. We recommend therapeutic passes as a meaningful tool in the process of educating families about the disability, its scope and impact, as well as its accompanying effects on cognitive and social functioning.
Brain Injuries↗
Gallbladder emptying in celiac disease.
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Celiac Disease↗
Multifocal gastric carcinoid tumours, achlorhydria, and hypergastrinaemia.
Multiple polypoidal carcinoid tumours of the stomach were found in 5 patients with achlorhydria (4 of whom had pernicious anaemia) as a result of autoimmune atrophic gastritis. The tumours were small (nearly all less than 1 cm diameter) and appeared to grow very slowly, if at all; no significant enlargement or complications were seen during periods of observation of up to 6 years. No extragastric hormonal syndromes were identified. They differed from the carcinoid tumours usually found in the intestinal tract by being composed of argyrophil (not argentaffin) cells of the enterochromaffin-like (ECL) type. Fasting plasma levels of gastrin, which is believed to be trophic to ECL cells, were very high in all patients. Thus, chronic hyperplasia of gastric ECL cells (as a result of hypergastrinaemia) may have been responsible for development of the tumours. Long-term, uninterrupted achlorhydria produced by potent inhibitors of gastric acid secretion might therefore predispose to carcinoid tumours of the stomach.
Achlorhydria↗
Computerized tomography head scans as predictors of rehabilitation outcome.
This study explored the relationship between rehabilitation functional outcome, demographic characteristics, and predicted goal achievement for 30 patients with closed head injury according to characteristics of their computerized tomography (CT) head scans performed within 10 days of injury. Goals and outcome were measured according to levels of independent/dependent function at discharge from an interdisciplinary inpatient rehabilitation program by means of the Patient Evaluation Conference System (PECS). Patients were classified into the three following major subgroups according to CT findings: (1) normal; (2) 1 hemisphere lesion; and (3) bilateral lesion. Marked differences in patient outcome and in the team's ability to accurately predict outcome were found to match the subgroups so classified. The need to incorporate CT scan data into early team planning and goal setting is stressed.
Adult↗
Gut peptides and the control of food intake.
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Animals↗
Organic and functional disorders in 2000 gastroenterology outpatients.
To determine the relative frequency of different diseases and of functional gastrointestinal disorders among patients referred by general practitioners to a gastroenterology clinic, 2000 patients referred over a five-year period were studied. 980 had organic diseases, of which peptic ulcer, oesophagitis, and inflammatory bowel disease accounted for about half. 888 patients had functional disorders of the gastrointestinal tract, without any disease. Among these, various syndromes could be distinguished; abdominal pain with altered bowel habit (irritable bowel syndrome, spastic colon type) accounted for about half of these patients. More attention could profitably be directed towards understanding these common functional syndromes so that they can be more readily diagnosed and better managed.
Colonic Diseases, Functional↗
Lactoferrin concentration in the parotid saliva of patients with chronic pancreatitis.
Lactoferrin is present in pancreatic juice, and greatly increased concentrations are found in the pancreatic juice of patients with chronic pancreatitis. It is not known whether these high levels of lactoferrin represent a genetically determined defect predisposing to the later development of chronic pancreatitis or are simply a consequence of the disease. In view of the morphological and functional similarities between the pancreatic and parotid glands, we have measured the immunoreactive lactoferrin concentration in pure parotid saliva of 30 patients with chronic calcific pancreatitis, 26 controls, 5 patients with proven pancreatic cancer, 2 patients with Sjögren's disease and 2 patients with chronic recurrent parotitis. No difference in the lactoferrin concentration was detected between control subjects and patients with chronic pancreatitis or pancreatic cancer. Raised levels were found in the 4 patients with parotid gland disease. These findings suggest that increased lactoferrin secretion is confined to the exocrine pancreas in patients with chronic pancreatitis and is thus probably a phenomenon secondary to the disease.
Calcinosis↗
Chronic pancreatitis in Bristol.
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Adult↗
Patient profiles: utilization in functional performance assessment.
A computerized XY graphic plotted profile has been developed as a method of displaying patient progress and goals using the Patient Evaluation Conference System (PECS) as the data source. Each profile is a bar graph of functional status and goal scores for specific contact-evaluation points. Contacts are represented by different colors so that one color is superimposed on the other. Individual functional items are plotted on the X-axis at the appropriate level of independent or dependent function, as indicated by the 0 to 7 scale which appears on the Y-axis. The profile is used in goal-oriented team conferences, and provides a focus on particular problems of low status or discrepencies between status and goals. This visual aid can provide a display of rehabilitation progress useful to the patient, family, and staff.
Accidents↗
Cancer rehabilitation. An analysis of 36 program approaches.
Information about comprehensive rehabilitation for patients with cancer is limited. Only a few descriptions of existing models are found in the literature. A survey questionnaire concerning the description and operation of cancer rehabilitation programs was developed and mailed to identified programs in 95 facilities throughout the country. Thirty-six facilities responded with data appropriate for analysis of their method of organization, treatment approaches, team composition, program emphasis, evaluation procedures, and program results. A literature and survey analysis provide support for an interdisciplinary team approach for rehabilitation of cancer patients disabled by the disease or its treatment. In addition, the survey shows favorable acceptance and success of cancer rehabilitation programs, especially in community hospital settings.
Adaptation, Psychological↗
Changes in certain blood constituents during Ramadan.
Fasting serum cholesterol, triglycerides, thyroxine, triiodothyronine, uric acid, gastrin, and insulin were measured in a group of 24 Muslims at the beginning and end of Ramadan--the Muslim month of fasting. There was a significant increase in the levels of total serum cholesterol, thyroxine, and uric acid and a significant fall in body weight. There was no significant change in the levels of total serum triglycerides, triiodothyronine, gastrin, insulin (fasting), or in the rise in gastrin or insulin 1/2 h after food. These changes, although unlikely to affect normal people, may be significant in patients. Physicians working in Muslim countries should be aware that Ramadan may affect some laboratory findings.
Adult↗