Joseph Rogers and the reform of workhouse medicine.
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History, 19th Century↗
Biomedical subjects
R Richardson
Publications and source records attributed to R Richardson.
Emergence of conditioned cardiac responses to an olfactory CS paired with an acoustic startle UCS during development: form and autonomic origins.
Pairing an olfactory conditioned stimulus (CS) with an acoustic startle unconditioned stimulus (UCS) produced conditioned bradycardia in rats ranging from 12 days of age to adulthood but failed to produce conditioning in 10-day-olds (Experiment 1). The second experiment compared the effects of two different UCSs, acoustic startle and electric shock. The startle UCS produced conditioned bradycardia accompanied by immobility. In contrast, the shock UCS produced conditioned tachycardia accompanied by behavioral activation. Pharmacological analysis revealed that activation of the parasympathetic nervous system (PNS) produced the conditioned bradycardia (Experiment 3) and that activation of the sympathetic nervous system (SNS) produced the conditioned tachycardia (Hunt, Hess, & Campbell, 1994). Further comparisons revealed that the startle UCS established conditioning several days earlier in development than the shock UCS. The ability of the PNS to respond to phasic stimulation earlier in development than the SNS was discussed as a possible mechanism for the early development of conditioned bradycardia.
Acoustic Stimulation↗
Celebrating New Year in Bart's dissecting room.
This paper presents a condensed version of a Victorian story concerning a surreal New Year's social gathering in the dissecting room at St. Bartholomew's Hospital Medical School, London. The story focuses upon the relationship between a medical student and a community of cadavers who come to life for the evening. The ethos of the dissecting room in the nineteenth century as revealed by the tale differs markedly from that of the present day. The story offers a persuasive narrative about the ethical treatment of the dead, and could prove a useful teaching tool. An introduction, discussion, and footnotes accompany the text, to draw out the cultural and moral significance of the original.
Anatomy↗
Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls.
The management of petroclival and foramen magnum meningiomas has been revolutionized by the techniques of cranial base surgery. However, these tumors are still among the most difficult cranial base lesions to treat. In this report, we discuss the classification, presenting symptoms, preoperative investigation, treatment indications, operative approaches and technique, postoperative complications and care, and results of surgery of petroclival and foramen magnum meningiomas. Careful analysis of tumor- and patient-related factors has helped us to predict which features can lead to postoperative problems in patients allowing surgeons to appropriately modify their behavior. The application of cranial base techniques-combined with new knowledge about the limitations of microsurgical resection-can greatly reduce postoperative morbidity in these patients.
Cranial Fossa, Posterior↗
Comparison of carbon dioxide and normal saline for uterine distension in outpatient hysteroscopy.
OBJECTIVE: To evaluate patient acceptance and the clinical feasibility of carbon dioxide compared with normal saline for uterine distension in outpatient hysteroscopy. DESIGN: Prospective, randomized clinical trial. SETTING: Outpatient hysteroscopy clinic in a university hospital. PATIENTS: One hundred fifty-seven patients undergoing outpatient hysteroscopy. INTERVENTIONS: Outpatient hysteroscopy was performed with carbon dioxide or normal saline with endometrial biopsy when indicated. MAIN OUTCOME MEASURES: Need for local anesthesia, cervical dilatation, view of uterine cavity, need to change from carbon dioxide to normal saline distension, procedure time, patient discomfort (lower abdominal pain, shoulder tip pain, nausea) and complications. RESULTS: Carbon dioxide was used for uterine distension in 79 women and normal saline was used in 78. Cervical dilatation was required more often with carbon dioxide hysteroscopy, although there was no increased requirement for local anesthesia. Hysteroscopic vision was similar between the two media, but eight carbon dioxide cases had to be converted to liquid distension. Procedure times were significantly longer for carbon dioxide hysteroscopy as was the occurrence of bubbles during the procedure. Lower abdominal pain and shoulder tip pain were significantly worse with carbon dioxide distension. Although the incidence of nausea and vomiting was higher with the use of carbon dioxide, the differences did not achieve statistical significance. CONCLUSION: The use of normal saline for uterine distension had no adverse affects on the hysteroscopic view. It provided a shorter operating time and was well accepted by patients. Because of its easy availability and low cost, normal saline is an excellent alternative to carbon dioxide in women undergoing outpatient hysteroscopy.
Adult↗
Management and long-term outcome of adenoid cystic carcinoma with intracranial extension: a neurosurgical perspective.
Adenoid cystic carcinoma is a tumor of minor and major salivary glands that often invades the cranial base and intracranial cavity via local and perineural spread. In the past, the role of neurosurgeons in managing these tumors has been limited. The growth of interdisciplinary cranial base surgical approaches has now increased the involvement of neurosurgeons in the management of these tumors. We present a series of 16 patients with adenoid cystic carcinomas with cranial base and intracranial extension, the largest series reported in the neurosurgical literature. We have focused our approach on a neurosurgical perspective and made recommendations for the treatment of these tumors in relation to the following specific aspects of this disease. 1) The management of the carotid artery: In our experience, when the carotid artery is involved by tumor, a preliminary cerebral revascularization procedure with a cervical carotid to middle cerebral artery vein bypass graft should be performed before tumor resection. 2) The management of the cavernous sinus and orbit: Cavernous sinus tumor should be removed as fully as possible, but every effort should be made to preserve the IIIrd and IVth cranial nerves to achieve optimal functional and cosmetic results. The orbit should be exenterated when there is intraconal involvement; otherwise, intraorbital tumor can be removed with orbital preservation. 3) The use of palliative surgery: We have found that the use of palliative surgery can be considered even in patients whose extent of local disease precludes a surgical cure. The slow progression of the disease allows for long-term survival of many patients with advanced local disease and even of those with metastatic disease. 4) The long-term survival of these patients: In our series, six patients had no evidence of local disease and a mean survival of 72 months, one living patient had evidence of local disease and has survived 56 months, eight patients died of disease, with a mean survival of 137 months, and one patient died of complications after surviving for 63 months.
Adult↗
Developmental and pharmacological analysis of the cardiac response to an acoustic startle stimulus.
The purpose of this research was to study the cardiac response of preweanling and adult rats to 10 presentations of an acoustic startle stimulus (0 ms rise time, 100 ms, 130 dB, white noise stimulus). The first presentation of the startle stimulus produced a decrease in heart rate (HR) at both ages. With continued stimulus presentations, the response shifted to tachycardia in the adults but remained bradycardia in the preweanlings. Pharmacological analysis revealed that the startle stimulus activated only the parasympathetic system in the preweanling rats on all 10 trials. In contrast, the startle stimulus produced coactivation of the parasympathetic and sympathetic systems in the adults on the first trial, with the parasympathetic system predominating, and solely sympathetic activation on later trials. These results are discussed in terms of current psychophysiological models of (a) the cardiac response to startle stimuli and (b) autonomic space.
Acoustic Stimulation↗
Assessing abuse and neglect and dental fear in women.
Little is known about how specific life stressors, such as sexual, physical and emotional abuse and neglect, might be factors in the establishment or maintenance of dental fears or might affect routine dental treatment. The authors collected data from 462 female members of a large urban health maintenance organization about their dental fear and histories of childhood and adult traumas. According to these data, a history of trauma appears to be significantly associated with elevated dental fear, although multiple factors play a major role in the establishment and maintenance of these phobias.
Adolescent↗
Donors' attitudes towards body donation for dissection.
We report a survey in the UK of potential whole-body donors for dissection. 218 people (age range 19-97 years) answered a postal questionnaire, giving information about themselves, their reasons for donation, attitudes towards the dead body, funeral preferences and medical giving and receiving. In addition to altruism, motives included the wish to avoid funeral ceremonies, to avoid waste, and in a few cases, to evade the expense of a funeral. 44% understood that their bodies would be used as teaching material, 42% for experiments. Whilst 69% believed in one or more supernatural phenomena, only 39% said they were religious. 69% requested cremation after dissection; 2% wanted to be buried. The notion of money incentives to promote donation was overwhelmingly rejected.
Adult↗
Cheating in medical school. Medical students cheated in the past too.
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England↗
Delayed development of conditioned heart rate responses to auditory stimuli in the rat.
This study examined heart rate responses to an auditory conditioned stimulus during development in the rat. The unconditioned stimulus (US) in all experiments was an acoustic startle stimulus. The conditioned stimulus elicited a monophasic bradycardia in animals 21 days of age and older, but no response in younger animals. These results are strikingly similar to an earlier study that used shock as the US (Campbell & Ampuero, 1985). Further, the conditioned cardiac response in adults was found to be mediated entirely through activation of the parasympathetic division of the autonomic nervous system (ANS) even though the US unconditionally activates the sympathetic system at that age. The delayed development of several different forms of conditioned fear is discussed.
Acoustic Stimulation↗
Humpty Dumpty: reflection and reflective nursing practice.
The recent increase in the amount of published work relating reflection and reflective practice to nurses and nursing practice suggests that nurses value the opportunities which this approach is believed to provide. There also appears to be an underlying assumption that we all share the same concepts, hence the association with Humpty Dumpty. Indications of attempts to mechanize the processes and to endow the perceived skills with an élitism are becoming evident. In contrast, there are other attempts to foster the notion of accepting uncertainty, unpredictability and the opportunity for increased understanding to emerge. In this paper, the roots of some of these concepts are traced. The appropriateness of traditional values and assumptions, based on natural science perspectives, in relation to reflective processes and the practice of nursing is questioned. The development of a multi-faceted approach which takes account of differing contexts and the factors which influence them is suggested.
Humans↗
Therapeutic methods for cerebral palsy.
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Cerebral Palsy↗
A series of 1000 consecutive out-patient diagnostic hysteroscopies.
OBJECTIVE: To review the success of out-patient diagnostic hysteroscopy. METHOD: Retrospective review of 1000 consecutive out-patient hysteroscopies. RESULTS: Hysteroscopy was successfully performed in 96%. Cervical dilatation was required in 15.0% and local anaesthesia was administered in 31.4%; 77.3% of those requiring cervical dilatation received local anaesthesia. Intrauterine pathology was noted in 49.3%. The procedure failed in 40 (4%) patients for the following reasons: pain or anxiety in 23, cervical stenosis in 11, equipment failure in 4, and extreme uterine retroversion and inadvertent false cavity formation in one case each. CONCLUSION: Out-patient diagnostic hysteroscopy is a safe, well tolerated and successful investigation procedure in the majority of patients and should be the procedure of choice for suspected intrauterine pathology.
Adult↗
Premature atherosclerosis with photomyoclonic epilepsy, deafness, diabetes mellitus, nephropathy, and neurodegenerative disorder in two brothers: a new syndrome?
We describe two brothers with sensorineural deafness, diabetes mellitus, progressive neurological deterioration with photomyoclonic epilepsy, and progressive deterioration in renal function, resulting in death in the third decade of life. Autopsy showed diffuse atherosclerosis and arteriolosclerosis of the systemic vasculature. There was no evidence of these abnormalities in the patients' 2 sisters or either parent. Mitochondrial enzyme analysis documented partial deficiencies of Complex III and IV of the respiratory chain. This deficiency was expressed in skin fibroblasts, kidney and liver but not in muscle. This suggests that the disease-causing mutation is either in the mitochondrial or nuclear DNA. Various modes of inheritance are considered, including maternal, autosomal recessive, or X-linked recessive. We suggest this is a new genetic syndrome characterized by an underlying metabolic disease and premature atherosclerosis, possibly of mitochondrial origin.
Adult↗
The orienting response to brief auditory stimuli in preweanling and adult rats.
The cardiac orienting response to brief auditory stimuli was measured in preweanling and adult rats. The eliciting stimulus varied in duration (2 or 10 s) and complexity (continuous or pulsing). Stimulus complexity affected response magnitude with the pulsing stimulus eliciting a larger response than the continuous stimulus. Stimulus duration affected response persistence but only when a pulsing stimulus was used. In contrast to recent research with stimuli of much longer duration, age did not significantly affect any aspect of the cardiac response to the novel auditory stimuli in the present study. These results are discussed in terms of (1) the effects of stimulus duration on the heart-rate component of the orienting response and (2) two-stage models of attention.
Aging↗
Has laparoscopy a role in the treatment of early ovarian cancer?
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Female↗
Delayed development of fear-potentiated startle in rats.
The developmental emergence of fear-potentiated startle was examined in rats ranging in age from 16 to 75 days. In Experiment 1, a pure tone served as the conditioned stimulus (CS) and an acoustic startle pulse served as the unconditioned stimulus (US) for fear conditioning. Fear-potentiated startle by the tone CS was observed in rats 23 days of age and older but not in rats 16 days of age. In Experiment 2, a light served as the CS. Rats 30 days of age and older showed fear-potentiated startle, whereas 23-day-old rats did not. The final experiment demonstrated that another behavioral index of fear, stimulus-elicited freezing, was observed earlier in development than fear-potentiated startle, confirming the effectiveness of the training procedure for conditioning fear. The results suggest that fear-potentiated startle is a relatively late-emerging response system, paralleling the development of conditioned autonomic changes (e.g., heart rate) rather than that of freezing.
Aging↗