Search PubMed⌕ Search

Biomedical subjects

R Marshall

Publications and source records attributed to R Marshall.

At least 127 records · Page 7Linked to original sources
PubMed1988

Interprofessional collaboration: who is doing it? Who isn't?

A questionnaire about practice in the area of physician-educator collaboration and behavioral-developmental pediatrics was obtained from 239 California primary care pediatricians. The survey examined the characteristics of physicians who do and do not collaborate, as well as their perceptions of the advantages of and barriers to interprofessional collaborations. The results indicated that, whereas most (88%) respondents indicate that communication among educators and physicians is sometimes or frequently useful when patients have behavioral, developmental, and chronic health disorders, only 17% actually communicate frequently by telephone or meeting with educators. The characteristics of physicians who collaborate the most frequently include factors such as small groups or solo practices in rural areas, use of routine developmental screening, training in working with teachers, training in behavioral and developmental pediatrics, and higher estimates of the number of patients with behavioral and developmental disorders in their practice. The relationship between physician characteristics and frequency of collaboration is analyzed and discussed. Physicians' perceptions of the collaboration process and suggestions for improving collaboration are discussed.

Attitude of Health Personnel↗
PubMed1987

Positron emission tomography studies of cerebral glucose metabolism in chronic partial epilepsy.

Positron emission tomography (PET) performed with [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG) was used to measure local cerebral metabolic rate for glucose (lCMRGlc) interictally in 31 patients with chronic partial epilepsy and 16 age-matched normal subjects. Hypometabolic zones were visualized in 25 patients (81%). Cortical lCMRGlc in hypometabolic zones was within 2 standard deviations of the mean for normal temporal cortex in all but 8 patients. However, in 24 patients asymmetry between the hypometabolic cortex and homologous contralateral cortex was more than 2 standard deviations above the mean cortical asymmetry for normals. There was good correlation between hypometabolic zones and electroencephalogram (EEG) foci in patients with unilateral well-defined EEG foci. Diffuse or shifting EEG abnormalities were often associated with normal PET scans. Of 28 patients who underwent magnetic resonance imaging, 10 showed focal temporal lobe abnormalities corresponding to focal hypometabolism. While the [18F]FDG PET scan cannot currently localize an epileptogenic zone independently, the absence of focal hypometabolism or its presence contralateral to a presumed EEG focus suggests the need for additional electrophysiological data.

Adolescent↗
PubMed1987

Serological evaluation of the outer membrane protein complexes of five saccharolytic intestinal Bacteroides species.

The purpose of this investigation was to develop a serological procedure for rapid identification of the following five Bacteroides species: Bacteroides distasonis, Bacteroides fragilis, Bacteroides ovatus, Bacteroides uniformis, and Bacteroides vulgatus. The outer membrane fractions were assayed using SDS-polyacrylamide slab gel electrophoretic techniques. The species-specific protein band from each species as well as the group-specific protein were purified and used to develop an indirect enzyme-linked immunosorbent assay to detect the species-specific and group-specific protein from the outer membrane of five reference species. The sensitivity and specificity of the procedure were evaluated by indirect ELISA methodology using 506 clinical isolates of organisms in this group, ten other species of anaerobic gram-negative bacilli, and three species of aerobic gram-negative bacilli. Each species evaluated yielded unique outer membrane protein patterns, suggesting the potential for development of a rapid, species-specific diagnostic procedure.

Animals↗
PubMed1987

Nephropathic cystinosis with central nervous system involvement.

Nephropathic cystinosis is associated with end-stage renal failure, retinal damage, and hypothyroidism. Patients may now survive past the first decade of life with the use of dialysis and renal transplantation. Examination of a 24-year-old woman with this disorder revealed ovarian failure, mildly abnormal results on a glucose tolerance test, intermittent confusion, short-term memory loss, and cerebral atrophy on computerized axial tomography. Autopsy examination at age 25 years revealed cystine storage in multiple tissues including the atrophic ovaries, pancreatic islet cells, the aorta, and the brain. Dysfunction of multiple organ systems may develop in patients with cystinosis who survive into adulthood. This emphasizes the need for a systemic therapy for cystinosis.

Adult↗
PubMed1987

Positive groin lymph nodes in superficial squamous cell vulvar cancer. A Gynecologic Oncology Group Study.

The term microinvasive carcinoma is inappropriate when applied to all vulvar cancers less than or equal to 5 mm thick because approximately 50% of vulvar carcinomas are no thicker than 5 mm and 20% of those superficial tumors metastasize to the lymph nodes. The significant predictors of groin node metastases in patients with superficial vulvar cancer are tumor thickness, histologic grade (proportion of undifferentiated tumor pattern), capillary-like space involvement with the tumor, clitoral or perineal location, and clinically suspicious nodes, according to the linear logistic model analysis of clinicopathologic data in 272 women. No lymph node metastases occurred in approximately one fourth of patients with a combination of low-risk factors: no clinically suspicious nodes, negative capillary-like space, and nonmidline vulvar cancers that were either grade 1 and 1 to 5 mm thick or grade 2 and 1 to 2 mm thick. In contrast, all 10 patients with clinically suspicious nodes and grade 4 tumors had positive groin nodes. The risk of lymph node metastases is best determined by simultaneous evaluation of all risk factors rather than a single factor such as tumor thickness.

Carcinoma, Squamous Cell↗
PubMed1987

A community model for physician, educator, and parent collaboration for management of children with developmental and behavioral disorders.

This article describes a model for physician, educator, and parent collaboration in the management of children with developmental and behavioral disorders. The results of implementing the model with 256 professionals and parents of developmentally disabled children are described and discussed. The benefits of using the model in school districts and/or communities seeking to improve interprofessional collaboration and work with families are presented. The model has been demonstrated to be effective in producing practical solutions for improving collaboration that is relevant to local community barriers and based on input from physicians, educators, and parents.

Child↗
PubMed1986

Reversibility of cardiac wall-motion abnormalities predicted by positron tomography.

Positron emission tomography (PET) can be used with nitrogen-13-ammonia (13NH3) to estimate regional myocardial blood flow, and with fluorine-18-deoxyglucose (18FDG) to measure exogenous glucose uptake by the myocardium. We used PET to predict whether preoperative abnormalities in left ventricular wall motion in 17 patients who underwent coronary-artery bypass surgery were reversible. The abnormalities were quantified by radionuclide or contrast angiography or both, before and after grafting. PET images were obtained preoperatively. Abnormal wall motion in regions in which PET images showed preserved glucose uptake was predicted to be reversible, whereas abnormal motion in regions with depressed glucose uptake was predicted to be irreversible. According to these criteria, abnormal contraction in 35 of 41 segments was correctly predicted to be reversible (85 percent predictive accuracy), and abnormal contraction in 4 of 26 regions was correctly predicted to be irreversible (92 percent predictive accuracy). In contrast, electrocardiograms showing pathological Q waves in the region of asynergy predicted irreversibility in only 43 percent of regions. We conclude that PET imaging with 13NH3 to assess blood flow and 18FDG to assess the metabolic viability of the myocardium is an accurate method of predicting potential reversibility of wall-motion abnormalities after surgical revascularization.

Ammonia↗
PubMed1986

Avian paramyxovirus type 1 infections of racing pigeons: 4 laboratory assessment of vaccination.

The immune response and protection from challenge afforded to adult pigeons by four different vaccination schedules were assessed. Intravenous challenge with a field pigeon isolate was done four weeks after the second of two doses of vaccine given four weeks apart. Little difference in protection was seen between two 0.25 ml and two 0.5 ml doses of oil emulsion vaccine, although the latter produced a slightly higher immune response. In both cases one of 10 challenged pigeons became sick and died. One dose of Newcastle disease virus B1 live vaccine followed four weeks later by 0.5 ml oil emulsion vaccine gave a comparable immune response to two 0.25 ml doses of oil emulsion but only six birds survived challenge. Two doses of Newcastle disease virus B1 vaccine gave a poor immune response and little protection from challenge; all 10 birds became sick and eight died. Assessment of the onset of protection following one dose of either 0.5 ml oil emulsion vaccine or Newcastle disease virus B1 indicated some partial protection in the latter group as early as five days after vaccination. Both groups showed protection at 10 days but by 21 days, although protection was sustained in the oil emulsion group, birds receiving live vaccine were fully susceptible. Measurement of the duration of protection in pigeons given two 0.5 ml doses of oil emulsion vaccine indicated that protection had begun to wane by 40 weeks after the first dose.

Animals↗
PubMed1986

Sclerosing encapsulating peritonitis: report of a case with small bowel obstruction managed by long-term home parenteral hyperalimentation, and a review of the literature.

Sclerosing peritonitis has recently emerged as a complication of peritoneal dialysis associated with a high morbidity and mortality. These patients experience the characteristic syndrome of nausea, vomiting, abdominal pain, partial small bowel obstruction, and impaired ultrafiltration. A pathologic finding is the replacement of mesothelial cells with a thick layer of nondistensible fibroconnective tissue. We report here a 58-year-old white woman who developed peritoneal sclerosis after 4 years of peritoneal dialysis, including 3 years of continuous ambulatory peritoneal dialysis. Risk factors included peritoneal exposure to low concentrations of formaldehyde and a 1-week exposure to long-dwell acetate dialysate. Laparotomy for partial small bowel obstruction with resection of the involved segment was complicated by enterocutaneous fistulae, which improved only on cessation of oral intake and treatment with home parenteral nutrition. We have reviewed the literature to find 20 cases of sclerosing peritonitis in patients on peritoneal dialysis. A 78% mortality rate is reported in cases that had surgical intervention. We conclude that the use of long-term parenteral nutrition with cessation of oral intake may be necessary in the management of sclerosing encapsulating peritonitis.

Female↗
PubMed1986

Sensitivity patterns of coagulase-negative staphylococci from neonates.

Coagulase-negative staphylococci from neonates on two special care baby units were collected and the sensitivity patterns to 18 antibiotics were compared. The two units had different antibiotic policies and this correlated with different sensitivity profiles for the isolates. Netilmicin was shown to be the most active aminoglycoside and cefamandole the most active cephalosporin.

Aminoglycosides↗
PubMed1986

Regional perfusion, glucose metabolism, and wall motion in patients with chronic electrocardiographic Q wave infarctions: evidence for persistence of viable tissue in some infarct regions by positron emission tomography.

Positron-emission tomography with 13N-ammonia and 18F-2-deoxyglucose was used to assess regional perfusion and glucose utilization in 31 chronic electrocardiographic Q wave regions in 20 patients. With previously published criteria, regions of infarction were identified by a concordant reduction in regional perfusion and glucose utilization, and regions of ischemia were identified by preservation of glucose utilization in regions of diminished perfusion. Only 10 of the 31 regions (32%) exhibited myocardial infarction tomographically. In contrast, positron tomography revealed ischemia in six regions (20%) and was normal in 15 regions (48%). Even when Q wave regions were reassigned and consolidated to enhance the specificity of the electrocardiogram, uptake of 18F-2-deoxyglucose was noted in the majority (54%) of the regions. Neither electrocardiographic ST-T changes nor severity of associated wall motion abnormality reliably distinguished tomographically identified regions of ischemia from infarction. Thus positron tomography reveals evidence of persistent tissue metabolism in a high proportion of chronic electrocardiographic Q wave regions, and commonly used clinical tests do not reliably distinguish hypoperfused but viable regions from tomographically defined regions of myocardial infarction.

Adult↗
PubMed1985

Relationship of flow cytometry results to clinical and steroid receptor status in human breast cancer.

Flow cytometry (FC), estrogen receptor (ER), and progesterone receptor (PR) analyses were performed on 226 breast cancers. The presence of steroid receptors was inversely proportional to proliferative index and percent aneuploidy. Within the two ER (+ and -) groups, the presence of PR did not add significantly to the comparison. The mean proliferative index for the diploid tumors was 17.5 +/- 6.8 compared to 27.8 +/- 9.8 for aneuploid tumors (p less than .001). The degree of aneuploidy, or DNA index, was not related to cell cycle kinetics or steroid receptor status. In 163 tissues analyzed for percent tumor present, a correlation between the relative number of aneuploid cells and percent tumor in the histologic review was observed. A study of the diploid tumors indicated greater than 75% had at least 10% tumor cells by histologic review. Since with FC one can observe at least 10% aneuploid cells in a tumor sample, it is our opinion that the percent aneuploidy in this study is not artifactually low due to sampling error. There was no significant relationship between nodal status or number of positive nodes and proliferative index, aneuploidy, or steroid receptor status. Metastatic tumors had a higher mean proliferative index, but this was not statistically significant. There was a relationship between age and proliferative index but not between age and ploidy status. In a small group of patients there was a trend for proliferative index and percent aneuploidy to be higher in the poorly differentiated and larger tumors when compared to the well differentiated and smaller tumors.

Age Factors↗
PubMed1985

In vitro activity of cefbuperazone, a new cephamycin, against anaerobic bacteria.

The 90% MIC of cefbuperazone (BMY 25182) was 32 micrograms/ml for Bacteroides fragilis and Bacteroides spp., 128 micrograms/ml for Fusobacterium and Clostridium spp., 64 micrograms/ml for Eubacterium and Peptococcus spp., 8 micrograms/ml for Actinomyces spp., and 32 micrograms/ml for Peptostreptococcus spp. The level of activity of cefbuperazone was higher against B. fragilis and lower against anaerobic cocci than those of related cephalosporins, i.e., cefoxitin, cefoperazone, cefotaxime, ceftizoxime, and cefmenoxime. However, the activity of cefbuperazone was comparable to that of moxalactam against all groups tested. Size of inoculum and type of media used did not alter the MICs of cefbuperazone for B. fragilis. Cefbuperazone showed synergistic activity when combined with cefoxitin against resistant strains of B. fragilis.

Anti-Bacterial Agents↗
PubMed1984

Is coagulase-negative staphylococcal bacteraemia in neonates a consequence of mechanical ventilation?

The clinical symptoms associated with coagulase-negative staphylococcal bacteraemia in infants on a Special Care Baby Unit were investigated. They were compared with those of blood culture-negative controls matched for age and weight. Infants with positive cultures were further sub-divided by judging the isolate to be a contaminant or a pathogen. There was a high incidence of respiratory symptoms in the latter patients, particularly in infants of less than 37 weeks gestation. These symptoms often responded to antimicrobial chemotherapy, particularly in infants given correct antibiotics, as demonstrated by laboratory sensitivity testing. Bacteraemia was usually detected shortly after starting mechanical ventilation, and may be its consequence in premature infants. Gentamicin-resistance occurred in over 50 per cent of blood culture isolates of coagulase-negative staphylococci. We postulate that coagulase-negative staphylococci can be a neonatal pathogen requiring appropriate antimicrobial chemotherapy.

Coagulase↗