Biomedical subjects
Publications and source records attributed to R Morton.
For the patient with cancer, bad news can occur several times between diagnosis and death. Patients expect honesty from professionals. Patients may choose to face up to bad news or actively deny what is happening. Nurses need to be able to deal with the patient's emotional response to bad news.
We assessed the outcome of the use of an enuretic alarm and desmopressin according to conventional guidelines and investigated the reasons for resistance to desmopressin. Children were given a 4 month course using an enuretic alarm if they had not previously used one; 12 out of 21 were dry (57%) after 4 months and one relapsed 1 month later. Those who had previously failed with an alarm or were considered poorly motivated to use it, were given a 4 month course of intranasal desmopressin. Of these 26 children, 10 (38%) were dry at the end of 4 months but only two (7%) remained dry after this was withdrawn. After the initial treatment with alarm or desmopressin, 27 children were still enuretic and attending the clinic. They were shown how to use the alarm and eight also used the dry bed training technique: 15 had become dry after a further 6 months. Of the 12 children who made no response to intranasal desmopressin, nine were given this medication under supervision in hospital; seven of these children still wet the bed despite producing small amounts of concentrated urine overnight. They also had small measured diurnal bladder capacities. We conclude that if a 4 month course with an enuretic alarm is unsuccessful, rather than using desmopressin, the alarm should be continued with relearning and consideration given to additional use of the dry bed training technique. The major factor causing nocturnal enuresis in children is likely to be a small nocturnal bladder capacity.
Following concerns that a considerable extra workload would be involved in sending a copy of the GP outpatient letter to parents following a medical consultation, 100 consecutive letters from the CDC were analysed to see if they could be sent to parents. Changes would have been necessary in 11, of which 6 would need an extra letter to the GP conveying additional specific information. Letters were generally intelligible, but it was recommended that they could be written in a more simple way for parents. Following these recommendations, copies of letters to the GP were sent to parents and the practice reviewed 2 years later. GP letters from 100 consecutive patients who had just visited the Centre were analysed and found to have been sent in 94. Of the remaining six, five were not sent because they contained information specific to the GP. It was felt that this could be rectified fairly easily. An anonymous questionnaire, sent to those receiving a copy of the letter, indicated that it had been very well received. It was felt that this policy was most helpful to the parents and justified a small additional workload.
OBJECTIVES AND METHODS: To assess its clinicopathological and diagnostic significance, interleukin-8 (IL-8) was measured by radioimmunoassay in fasting urine specimens and in gastric mucosal incubates taken from 54 patients with dyspepsia. The presence of Helicobacter pylori, the activity of gastritis, and urine creatinine levels were also assessed. RESULTS: The median urinary IL-8/creatinine ratio was 0.1 x 10(-6) in patients with current peptic ulcers (n = 13) and 0.2 x 10(-6) in patients with a history of ulcers (n = 8), compared with 0.4 x 10(-6) (p < 0.0001) in patients without ulcers who were infected with H. pylori (n = 20) or not infected (n = 13). The activity of gastritis had a positive correlation with gastric IL-8 (r = 0.5870, p < 0.01) and a negative correlation with urinary IL-8/creatinine ratio (r = -0.6447, p < 0.005). The improvement in the activity of gastritis in 20 patients given anti-H. pylori triple therapy was associated with a significant fall in gastric mucosal IL-8 and a rise in urinary IL-8/creatinine ratio. CONCLUSIONS: An inverse relationship seems to exist between urinary IL-8 and the activity of gastritis and gastric IL-8. This may represent another concept in the pathogenesis of peptic ulcers and can assist in the noninvasive diagnosis of peptic ulcer disease.
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AIM: To determine whether, in a susceptible population, dosing with 10 mg famotidine 1 h before an evening meal could decrease the interference with sleep caused by heartburn. METHODS: Patients with a history of frequent heartburn (n = 309) were randomized to receive 10 mg famotidine or placebo 1 h before an evening meal likely to induce symptoms. Patients assessed the efficacy of the treatment in preventing heartburn after the meal, at bedtime and during the night. The number of awakenings due to heartburn and the consumption of antacid tablets taken to alleviate symptoms were also recorded. RESULTS: Treatment groups were well matched and data from 302 patients were available for analysis. Compared to placebo, famotidine treated patients had: less heartburn after the meal (P < 0.0001 mean global scores), less interference with getting to sleep (P = 0.0156 mean global scores), fewer awakenings (P = 0.0001 difference in mean number) and better control of heartburn during the night (P < 0.0001 mean global scores). They were also almost three times less likely to need antacid treatment than the placebo group during the night (relative odds for no antacid 2.78 (95% CI: 1.29-5.96). Only four patients in each group suffered adverse events. CONCLUSION: Taking a 10 mg dose of famotidine 1 h before an evening meal appears to be a successful and well tolerated strategy for preventing post-prandial heartburn and avoiding the associated interference with sleep.
Dispersal of the Old World screw-worm fly, Chrysomya bezziana Villeneuve, was studied in Papua New Guinea by releasing radio-isotope labelled, laboratory-reared flies and collecting their labelled egg masses from sentinel cattle. A log-linear model was developed to describe recapture rate. Distance was found to dominate the model and was represented by a bilinear ('broken-stick') term as log-distance. Further terms in the model such as attractiveness of the site (estimated from the number of non-labelled egg masses), the season of the year and a time trend were statistically significant but of minor importance. From the model, the median distance females dispersed before depositing an egg mass was 10.8 km. The maximum distance from the release site that egg masses were recovered was 100 km. The dispersal ability of C. bezziana is discussed in terms of its impact on the prospects of eradicating this species using SIRM if an outbreak occurred in Australia.
The future of the biomedical communications unit is seen by many to be under threat but there are also good reasons to be optimistic. The ability to diversify will help ensure a secure future as will the maintenance of the highest professional standards. Above all, a willingness to harness new technology effectively to the communication needs of the medical community will mean that the skills of the biomedical communicator could become more valued than ever before.
OBJECTIVE: To determine whether there is a difference in the allocation of types of dialysis to male and female patients with end-stage renal disease (ESRD). DESIGN: Descriptive study. SETTING: Canada. PATIENTS: All patients registered with the Canadian Organ Replacement Register (CORR) whose treatment began between 1981 and 1991. Data were obtained for 19,732 patients, of whom 18,010 had sufficiently complete data and were being treated with either peritoneal dialysis or hemodialysis 3 months after the diagnosis of ESRD. OUTCOME MEASURES: Proportions of patients receiving peritoneal dialysis and hemodialysis according to sex. RESULTS: Significantly more male (58.1%) than female (50.8%) patients were receiving hemodialysis 3 months after diagnosis (p < 0.00001). Multivariate analysis to control for the possible confounding effects of age, province of treatment, diagnosis, concurrent illness and year of diagnosis did not explain the difference. CONCLUSIONS: In Canada from 1981 to 1991 male patients were more likely than female patients to receive hemodialysis for the treatment of ESRD. Additional research is needed to explain this finding.
A 30 year old woman with recurrent anaemia due to folate deficiency had evidence of sarcoid granuloma on small bowel biopsy but was presumed to have Crohn's disease. The diagnosis of small bowel sarcoidosis was not seriously considered until she developed systemic manifestations of sarcoidosis (cutaneous and pulmonary lesions) over the following 20 years. Sarcoidosis of the gastrointestinal tract, particularly the small bowel, is rare and this case is unusual because bowel pathology preceded more generalised lesions. As far as is known it is also the first case to be described presenting with malabsorption of folic acid.
Information technology offers important new ways of using pictures for teaching in medicine. Methods for storing and delivering high quality images for computer-based learning systems are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
This paper describes the results of a survey in 1990 which examined the practice of general anaesthesia in Accident and Emergency Departments. Data were obtained concerning the anaesthetics induced during the previous year, specifically the number of procedures undertaken, the equipment, the facilities and the personnel involved, including any complications. These findings are discussed in relation to recommendations for minimum standards in anaesthetic practice.
Using a quantitative sensitive HPLC fluorometric assay for the measurement of plasma and urine porphyrins, we have calculated the renal clearance of uro- and coproporphyrin in normal volunteers and in patients with congenital erythropoietic porphyria and hereditary coproporphyria (HCP). In patients with porphyria cutanea tarda (PCT), only uroporphyrin clearance was calculated. Plasma porphyrin concentrations were measured in patients with chronic renal failure (CRF). All our CRF patients on haemodialysis (10) had raised plasma uroporphyrin, 4 had raised plasma heptacarboxyporphyrins and 2 had raised plasma coproporphyrin, unchanged by haemodialysis. CRF patients with raised uroporphyrins and 7-carboxyporphyrins could be distinguished from PCT in patients with normal renal function, by their higher uro/7-carboxyporphyrin ratio (8.0 vs. 1.7). Renal clearance of coproporphyrin was much greater in HCP than in any of the other groups studied. Since coproporphyrin clearance was less than creatinine clearance in most normal subjects, and because 2 patients with CRF had raised plasma coproporphyrin concentrations, we argue that the kidney is probably not a major source of coproporphyrin, as previously reported. Furthermore, the variability and degree of abnormality in plasma porphyrins in CRF would suggest caution in diagnosing chronic porphyria in patients with renal impairment.
Successful therapy of atrial fibrillation (AF) has been reportedly influenced by a variety of factors including patient age, type of underlying heart disease, duration of arrhythmia, left ventricular function and left atrial (LA) size. To determine which of these factors are associated with maintenance of sinus rhythm after conversion, 43 patients with symptomatic chronic AF in the setting of a dilated left atrium (greater than or equal to 45 mm, range 45 to 78) were followed for at least 6 months after the return of sinus rhythm. Class IA drugs, IC drugs or amiodarone were used for therapy. Life table analysis showed sinus rhythm to be maintained in 81% for 6 months, 79% for 12 months and 60% for 24 months. Factors positively associated with success were conversion with drug therapy alone, duration of chronic AF less than or equal to 1 year, absence of mitral valve disease and LA dimension less than or equal to 60 mm (all p less than 0.05). Patient age, left ventricular function and presence of coronary disease were not associated with outcome. Thus, patients with moderate LA dilatation (45 to 60 mm) and a short duration of chronic AF can often be maintained in sinus rhythm, especially if they convert with pharmacologic intervention alone.
Depth perception is given by binocular vision and it can be reproduced photographically by taking left and right pictures. However, the optimum separation between the views may not always correspond to the distance between our eyes, particularly in close-up work. Important applications of stereophotography in medicine are examined in this article as well as some of the fundamental principles and techniques for taking 3-D pictures and viewing the results.