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Biomedical subjects

R S Wilson

Publications and source records attributed to R S Wilson.

At least 127 records · Page 7Linked to original sources
PubMed1991

Cessation of driving and unsafe motor vehicle operation by dementia patients.

We surveyed 522 consecutive patients from a dementia clinic to assess duration of driving after disease onset and instances of unsafe motor vehicle operation in the preceding 6 months. Among the 333 patients licensed to drive at the onset of dementia, the median duration of driving after onset was 28.6 months. Patients with a clinical diagnosis of Alzheimer's disease drove significantly longer than those with other dementia syndromes. Of the 93 patients still driving at the time of the survey, approximately one third were reported to have had at least one form of unsafe motor vehicle operation in the past 6 months, including 21 patients with motor vehicle accidents. Motor vehicle accidents were associated with use of prescription medications with sedative properties and with lower subjective ratings of the patient's driving ability by the informant.

Accidents, Traffic↗
PubMed1990

Preserved word-stem-completion priming of semantically encoded information in Alzheimer's disease.

Alzheimer's disease (AD) patients and normal elderly control subjects completed 80 standardized sentence frames with single words, yielding a measure of semantic memory. Memory for best fit sentence endings was then tested either explicitly, with a forced-choice recognition task, or implicitly, with a word-stem-completion task. The patients completed fewer sentences with best fit word endings than did the control subjects. Explicit retention was markedly defective in the AD group, but word-stem completion was normal. The preserved word-stem completion in AD is discussed in terms of encoding operations and transfer-appropriate processing.

Aged↗
PubMed1990

Adrenocorticotrophin-induced hypertension in the rat: haemodynamic, metabolic and morphological characteristics.

Adrenocorticotrophin (ACTH) administration has been systematically studied in man and sheep. It raises systolic blood pressure (SBP) in the rat, but this has been little studied. ACTH was injected once daily at 0.5 mg/kg for 12 days in male Sprague-Dawley rats (n = 19). Sham-injected animals were studied in parallel (n = 15). ACTH increased SBP from 94 +/- 4 to 121 +/- 4 mmHg (P less than 0.001), significantly greater (P less than 0.02) than sham injection. The SBP of ACTH-treated rats was significantly higher than that of sham-injected rats when the same animals were measured by both the tail-cuff method (ACTH, 126 +/- 3 mmHg; sham, 99 +/- 3 mmHg) and direct arterial cannulation (ACTH, 137 +/- 2 mmHg; sham, 123 +/- 3 mmHg): P less than 0.005 and P less than 0.001, respectively. There was a loss of body weight, and increased water intake and urine output in ACTH-treated animals compared with both control (P less than 0.001) and sham treatments (P less than 0.02). ACTH increased plasma [Na] (sham, 140 +/- 1 mmol/l; ACTH, 145 +/- 1 mmol/l; P less than 0.001) and urinary Na excretion compared with control (P less than 0.01) and sham injection (P less than 0.05), and also decreased plasma [K] (sham, 4.6 +/- 0.2 mmol/l; ACTH, 3.3 +/- 0.8 mmol/l; P less than 0.01) and increased urinary K excretion (P less than 0.01) compared with control. SBP in adrenalectomized animals (n = 10) was unchanged by ACTH. ACTH increased adrenal, renal, cardiac and brain weights compared with sham injection (P less than 0.05). There were no significant changes in vascular morphology, although ACTH treatment increased glomerular epithelial cell droplets and abolished the adrenal zona glomerulosa.

Adrenal Glands↗
PubMed1990

Clinical diagnosis of Binswanger's disease.

To aid in the prospective study of Binswanger's disease, a poorly understood form of vascular dementia, a standardised criteria for its antemortem diagnosis was proposed. These criteria include dementia, bilateral radiological abnormalities on computed tomography (CT) or magnetic resonance imaging (MRI), and at least two of the following three clinical findings: A) a vascular risk factor or evidence of systemic vascular disease; B) evidence of focal cerebrovascular disease; and C) evidence of "subcortical" cerebral dysfunction. These criteria were validated in two ways. First, by retrospectively applying them to a series of 30 demented patients with various pathological diagnoses. Second, by prospectively applying them to a series of 184 patients with clinically typical Alzheimer's disease. The sensitivity and specificity of the criteria appear adequate for use in clinical research.

Alzheimer Disease↗
PubMed1990

Adrenal medullary transplant to the striatum of patients with advanced Parkinson's disease: 1-year motor and psychomotor data.

We studied motor and psychomotor changes over 1 year after surgery in 7 patients with severe idiopathic Parkinson's disease (PD) who underwent intrastriatal autologous adrenal medulla transplant. Significant clinical improvements were present 1 year after surgery and primarily involved increased quantity of "on" time and increased quality of "off" time: "on" time increased from a mean 60.7% of the waking day to 82.7%, and "off" function improved. In contrast, although "on" function also improved, statistically significant improvement occurred in only 1 measure, the Unified Parkinson's Disease Rating Scale activities of daily living subscale. Medications did not change, and motor fluctuations persisted. Improvement began several weeks after surgery, was maximal at 4 to 6 months, and was sustained thereafter. There was significant group improvement in quality of life measures of sleep and rest, social isolation, and ambulation. One patient had severe, recurrent depression postoperatively. The efficacy of adrenal transplant surgery is not transient, and specific functional improvements can be prolonged.

Activities of Daily Living↗
PubMed1990

Involuntary smoking in Savannah's restaurants.

A survey of Savannah area restaurants was conducted to determine the frequency with which nonsmoking sections are provided. Only one in five restaurants in Savannah provide nonsmoking sections, and only one in 10 tables available for dining out are reserved for nonsmokers. Restaurants associated with a national corporation are more than four times as likely to reserve space for nonsmokers than those strictly locally owned. Pertinent attitudes of restaurant personnel are presented, as is a brief discussion of the issue of involuntary smoking.

Data Collection↗
PubMed1989

Psychogenic dysphagia and globus: reevaluation of 23 patients.

Despite warnings against attributing dysphagia to psychological causes, the diagnoses of "psychogenic dysphagia" or "globus hystericus" have been previously applied to 13% of patients referred to the Johns Hopkins Swallowing Center. This paper reports the results of reevaluation of 23 patients previously diagnosed as having symptoms of psychogenic origin. The Swallowing Center evaluation documented an explanation for symptoms in 15 (65%). No cause of dysphagia could be documented in eight patients. All five patients with the "globus sensation" had a documentable abnormality of swallowing. Overall, nine patients had esophageal pathology, while six had pharyngeal disease. Five had structural lesions constricting the lumen, while 10 had motor dysfunction of either the pharynx or esophagus. Review of the referral records of these patients indicates the quality of prior evaluation for patients previously labeled as having a swallowing disorder of psychogenic origin is variable, and that once attribution of symptoms to psychogenic causes is made, the diagnosis is rarely reconsidered. We conclude that attribution of the diagnosis of psychogenic dysphagia should be made with caution, and only after thorough evaluation. Any change or progression of symptoms should prompt a careful re-evaluation.

Adolescent↗
PubMed1989

Effect of digoxin and vasodilators on left ventricular function in aortic regurgitation.

In order to assess the relative value of digoxin, nifedipine and hydralazine on left ventricular performance at rest and during exercise, we studied 10 men with moderately severe chronic aortic regurgitation using two-dimensional echocardiography. Digoxin after one month at therapeutic serum levels increased resting ejection fraction as compared to control [0.54 +/- 0.08 (SD) vs 0.47 +/- 0.08, respectively, P less than 0.03]. Ejection fraction decreased during exercise but the difference between digoxin and control was maintained. Stroke volume also was higher on digoxin than control at rest (93 +/- 15 vs 83 +/- 17 ml, P less than 0.02) and the larger stroke volume on digoxin was maintained during exercise. By contrast, stroke volume was reduced by one month of therapy with maximally tolerated nifedipine doses compared to control (74 +/- 8 vs 83 +/- 17 ml, P = 0.03) and this difference was maintained during exercise. Hydralazine in doses up to 225 mg/day for one month produced no significant changes in left ventricular performance compared to control at rest or during exercise. However, compared to digoxin ejection fraction at peak exercise was significantly less on hydralazine (0.39 +/- 0.9 vs 0.52 +/- 10, P less than 0.02). These data suggest that digoxin improved left ventricular performance and may be of benefit in the treatment of patients with chronic aortic regurgitation.

Adult↗
PubMed1988

Ambulatory pH monitoring of gastro-oesophageal reflux in "morning dipper" asthmatics.

A causal relation between gastro-oesophageal reflux and nocturnal asthma has been postulated. Forty four adult asthmatics underwent ambulatory monitoring of their oesophageal pH over 24 hours to find out if there was such a relation. Of these 21 showed significant "morning dipping" in which the peak expiratory flow falls during the night. Asthmatics with morning dipping had a history of nocturnal wheeze and a higher incidence of reflux symptoms, but measurement of oesophageal pH showed no significant difference in the amount or pattern of reflux when compared with "non-dippers." Overall, 15 asthmatics had gastro-oesophageal reflux, and these participated in a randomised, double blind crossover trial of ranitidine versus placebo. No significant difference was found in the peak expiratory flow rates or subjective evaluation of well being of the patients.

Adult↗
PubMed1988

Nebuhaler or nebulizer for high dose bronchodilator therapy in chronic bronchitis: a comparison.

We have compared the clinical efficacy of high dose terbutaline sulphate (10 mg four times daily) delivered by either a Nebuhaler or jet nebulizer in 13 patients with chronic bronchitis in a 2-week, open, crossover study. Both treatment regimens improved run-in symptom scores but no significant changes were recorded in peak flow and spirometry. Side-effects were more common with the Nebuhaler and more patients preferred the nebulizer. However, the Nebuhaler is an alternative therapeutic option for delivery of high doses of bronchodilators in patients with chronic bronchitis.

Aged↗
PubMed1988

Right upper lobe obstruction with right-sided double-lumen endobronchial tubes: a comparison of two tube types.

Twenty-nine patients undergoing left thoracotomy consecutively were intubated with right-sided double-lumen endotracheal tubes in the conventional "blind" fashion. The first 20 received Leyland red-rubber double-lumen tubes, and the subsequent nine received Mallinckrodt polyvinylchloride double-lumen tubes. The patency of the right upper lobe bronchial orifice was then assessed by flexible fiberoptic bronchoscopy. Right upper lobe obstruction occurred in 89% of the polyvinylchloride tube intubations and in 10% of the red-rubber tube intubations.

Bronchoscopy↗