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Biomedical subjects

R J Young

Publications and source records attributed to R J Young.

At least 37 records · Page 2Linked to original sources
PubMed2001

Allergic disorders of the gastrointestinal tract.

Allergic disorders of the gastrointestinal tract were once thought of as primarily dermatological manifestations of common food allergens such as peanuts. Recently, greater attention to these products has arisen as complex mechanisms of action have been more clearly delineated. Specific disease states have recently been recognized associated with gastrointestinal reactions to foods, such as celiac disease, infantile formula protein intolerance, and eosinophilic gastroenteritis have been well described. More recently, eosinophilic esophagitis and allergic constipation have been described. This article will review current information regarding the commonly identified gastrointestinal allergic states, and more detailed information regarding two new allergic entities will also be described.

Allergens↗
PubMed2001

Complementary medicine in intensive care: ethical and legal perspectives.

Complementary medicine continues to increase in popularity in the general community. As a result it is likely that requests for the administration of complementary medicine to intensive care patients will be more frequent in the future. It is therefore prudent for intensive care clinicians to address this issue and develop an approach that is consistent. Complementary medicine has not been subjected to well conducted trials to determine its efficacy and risks. Consequently decisions about its use cannot be based on risk/benefit analyses and genuine informed consent cannot be achieved. Therefore complementary medicine should not be incorporated into intensive care practice. Strict adherence to a policy of negating requests for administration of complementary medicine in intensive care patients may result in significant conflicts between intensive care clinicians, patients and families. On occasions the patient or family may insist on the use of complementary medicine and it may be seen as important to their psychological wellbeing to accede to the request. The intensive care clinician is still legally responsible for any treatment administered to the patient, even if it is against medical advice. Nevertheless if there is no demonstrable risk to the patient, complementary medicine can be administered following appropriate counselling and documentation. This review addresses the legal and ethical difficulties that may arise and an approach that may be followed when requests are made for complementary medicine in intensive care patients.

Complementary Therapies↗
PubMed2001

Plantar tissue thickness is related to peak plantar pressure in the high-risk diabetic foot.

OBJECTIVE: To investigate the relationship among plantar foot pressure, plantar subcutaneous tissue thickness, severity of neuropathy (vibration perception threshold [VPT]), callus, and BMI in a large group of neuropathic diabetic patients at risk of foot ulceration. RESEARCH DESIGN AND METHODS: A total of 157 diabetic neuropathic patients (VPT >25 V) without either peripheral vascular or ulcer history were studied. Plantar foot pressure and plantar tissue thickness were measured at each metatarsal head (MTH) using an optical pedobarograph and an ultrasound scanning platform, respectively. RESULTS: A significant association was observed between peak plantar pressure and plantar tissue thickness at all MTHs (-0.26 < r < -0.61, P < 0.0001), with the least pronounced association at the first MTH. In addition, the pressure time integral was significantly associated with plantar tissue thickness (-0.24 < r < -0.57, P < 0.0001). BMI was significantly related to plantar tissue thickness (0.18 < r < 0.45, P < 0.05), but not to peak forefoot pressures. Subjects with callus had significantly reduced plantar tissue thickness at all MTHs except the first MTH and increased peak pressures at all MTHs (P < 0.001). CONCLUSIONS: This study confirms a strong inverse relationship between plantar tissue thickness and dynamic foot pressure measurements. Long-term follow-up of this patient population will confirm whether reduced plantar tissue thickness predicts the development of diabetic foot ulcers.

Body Mass Index↗
PubMed2001

Solitary nodule of the great toe.

We describe a 21-year-old woman with a subungual exostosis exhibiting both skin and nail findings. The patient presented with a firm, flesh-colored, nontender, subungual nodule in the distal nail bed of the great toe. Radiographic examination revealed focal calcification of the nodule, with direct communication to the underlying phalanx. Subungual exostosis should be considered in the differential diagnosis of any digital mass. Surgical excision, followed by curettage of the base, is the treatment of choice.

Adult↗
PubMed2000

Quantitative analysis of the developing rat kidney: absolute and relative volumes and growth curves.

The development of the permanent kidney, or metanephros, is a complex process. In the present study, stereological methods were used at the light microscopic level to estimate the absolute volumes and volume densities of seven compartments in the developing rat metanephros, from embryonic day 14 (E14) to E21. Metanephroi from time-mated Sprague-Dawley rats were embedded whole in glycolmethacrylate, exhaustively sectioned at 2 microm and stained with PAS. The left metanephros from three embryos from each of three mothers were analysed at each of the ages (a total of 72 metanephroi). Relative volumes were multiplied by total metanephric volume to obtain absolute volumes. Total metanephric volume increased approximately 300-fold during the 7-day period studied. At E14, 92% of the metanephros was composed of undifferentiated mesenchyme, whilst the ureteric epithelium made up approximately 5% of the volume. By E21 the undifferentiated mesenchyme comprised 47% of the kidney, while the ureteric epithelium comprised 9% and the various components of developing nephrons (epithelial vesicles, comma-shaped bodies, S-shaped bodies, glomeruli, tubules) comprised 43%. Equations with prediction intervals describing the growth of the whole kidney as well as the absolute and relative growth of the seven kidney compartments were generated. These data provide a baseline for future studies on the roles of specific molecules in renal development.

Animals↗
PubMed2000

Measuring clinical performance and outcomes from diabetes information systems: an observational study.

AIMS/HYPOTHESIS: To examine changes in diabetes care provision after the introduction of a district diabetes information system. METHODS: All patients with diabetes registered on the system between 1993 and 1998 (n = 6544) were included in the analysis. Drop-out cohort analysis was used to handle population changes, logistic regression models with general estimating equations were used to examine changes in clinical performance over time. RESULTS: After the introduction of the system, care processes improved appreciably, in both primary and secondary care. The proportion of patients receiving a preventative care review within the calendar year rose from 56% in 1993 to 67% in 1998. The proportion of these in whom each process was completed improved in all categories from 1993 to 1998: blood pressure 96% to 98%; glycaemic check 67% to 93%; lipid check 31% to 68%; renal check 46% to 87%; fundoscopy 79% to 92%; foot screen 87% to 87%. Similarly there was an increase in the proportion of patients achieving intermediate outcome treatment targets (HbA1c < or = 9.0% from 29% to 43%; cholesterol < or = 5.5 mmol/1 5% to 19%; blood pressure < or = 160/90 37% to 46%). CONCLUSION/INTERPRETATION: Our results suggest appreciable improvements in diabetes care between 1993 and 1998. These changes apply to an entire population of patients across primary and shared care. We believe that these improvements could, in part, be attributable to the way in which the district diabetes information system has facilitated the structured cascade of diabetes care.

Cohort Studies↗
PubMed2000

Glomerular size and glomerulosclerosis in Australian aborigines.

We have previously described the prevalence of glomerulomegaly in biopsy specimens from Australian Aborigines with renal disease, a phenomenon documented in a number of other indigenous populations. Many of the biopsy specimens showed variable degrees of focal and segmental glomerulosclerosis (FSGS). Correlations between glomerular size and FSGS have been described in various animal models, as well as studies of humans. The aim of this study is to determine whether a relation exists between glomerular volume and severity of FSGS in biopsy specimens from Australian Aboriginals in the Northern Territory and Aboriginal inhabitants of the Tiwi Islands (Bathurst Island and Melville Island, Northern Territory, Australia). Consecutive clinical biopsy specimens were obtained from 78 non-Tiwi and 72 Tiwi Aboriginals. Glomerular volume was estimated using the stereological method of Weibel and Gomez. FSGS was graded from 0 to 4; 0 indicates no sclerosis and 4 indicates severe sclerosis. A biphasic relationship between glomerular size and severity of FSGS was identified. As the severity of FSGS increased from grade 0 to grade 3, glomerular size also increased. For both populations studied, glomeruli scored as grades 1, 2, and 3 were approximately 50% (P< 0.001), 65% (P< 0.001), and 100% (P< 0.001) larger than normal glomeruli, respectively. However, in glomeruli with grade 4 FSGS, glomerular size decreased to the size of normal glomeruli. These results show a biphasic relationship between severity of FSGS and glomerular size in Australian Aborigines.

Biopsy↗
PubMed2000

Acral lipoblastoma.

Lipoblastomas are rare, benign childhood tumors. We report a case of lipoblastoma on the heel of a 5-year-old girl who presented with a progressively enlarging, xanthoerythematous plaque. Surgical excision with follow-up for possible recurrence is the treatment of choice.

Child, Preschool↗
PubMed1999

Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children.

OBJECTIVE: The objective of this study was to determine the efficacy of Lactobacillus casei sps. rhamnosus (Lactobacillus GG) (LGG) in reducing the incidence of antibiotic-associated diarrhea when coadministered with an oral antibiotic in children with acute infectious disorders. STUDY DESIGN: Two hundred two children between 6 months and 10 years of age were enrolled; 188 completed all phases of the protocol. LGG, 1 x 10(10) - 2 x 10(10) colony forming units per day, or comparable placebo was administered in a double-blind randomized trial to children receiving oral antibiotic therapy in an outpatient setting. The primary caregiver was questioned every 3 days regarding the incidence of gastrointestinal symptoms, predominantly stool frequency and consistency, through telephone contact by blinded investigators. RESULTS: Twenty-five placebo-treated but only 7 LGG-treated patients had diarrhea as defined by liquid stools numbering 2 or greater per day. Lactobacillus GG overall significantly reduced stool frequency and increased stool consistency during antibiotic therapy by the tenth day compared with the placebo group. CONCLUSION: Lactobacillus GG reduces the incidence of antibiotic-associated diarrhea in children treated with oral antibiotics for common childhood infections.

Anti-Bacterial Agents↗
PubMed1999

A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. I: prevention.

AIM: To evaluate the role of preventative strategies in reducing foot ulcers in patients with Type 2 diabetes mellitus, both in the general population and those identified to be at a raised risk. METHOD: A systematic review of interventions to prevent diabetic foot ulcers. RESULTS: Available studies are generally unsatisfactory in their ability to answer the important questions relating to prevention. However, where people with diabetes receive well-organized and regular care with rapid referral to appropriate specialist multidisciplinary teams when problems (or their precursors) occur, ulcer morbidity can be substantially reduced. CONCLUSION: Foot ulcers are common in people with diabetes and are costly in terms of both patient morbidity and the use of healthcare resources. Although it is nearly a decade since the St Vincent Declaration called for a marked reduction in morbidity to be achieved through better patient management, available evidence suggests that the process of care in Britain is still very variable in quality. Foot care for people with diabetes must be organized to provide monitoring, education and referral in a manner acceptable to patients and realistic for local healthcare providers.

Diabetes Mellitus, Type 2↗