Angiokeratoma corporis diffusum in fucosidosis.
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Angiokeratoma↗
Biomedical subjects
S George
Publications and source records attributed to S George.
Do formal controls always achieve control? The case of triage in accident and emergency departments.
Triage is the term used to describe the formal process of assigning urgency categories to patients arriving in a hospital accident and emergency department. This paper uses insights from literature on management control, medical sociology and nursing to illuminate the results of a research study comparing formal triage with an informal prioritisation process carried out by nurses. Topics discussed include whether triage is a bureaucratic process, whether it allows nurses' intuition to be expressed, whether it masks the urgency of the condition of the small number of seriously injured or ill patients, and whether responsibility for decisions on urgency should be separated from responsibility to act on those decisions. It is concluded that managers must consider these questions in the light of arrangements in their own hospital; departmental layout as well as the nursing staff's experience and commitment need to be taken into account.
Decision Making, Organizational↗
Detection of pituitary microadenomas: comparison of dynamic keyhole fast spin-echo, unenhanced, and conventional contrast-enhanced MR imaging.
OBJECTIVE: Pituitary microadenomas may not be detected on conventional MR images. We supplemented conventional unenhanced and contrast-enhanced MR imaging with a dynamic keyhole fast spin-echo (kFSE) method in order to compare how frequently a microadenoma could be detected with the three different methods. SUBJECTS AND METHODS: Eighteen consecutive patients with clinical and laboratory evidence of pituitary microadenomas had unenhanced, dynamic kFSE, and conventional contrast-enhanced MR imaging of the pituitary gland. A control group of 13 subjects without pituitary disease also had dynamic kFSE MR imaging. Hard copies of all the studies were obtained in an identical fashion, and then the MR images of the patients and control subjects were randomly mixed. The studies were reviewed by a neuroradiologist who had no knowledge of the clinical status of the subjects. The presence or absence of any pituitary focal hypointensity consistent with the appearance of a microadenoma was noted. RESULTS: A pituitary lesion consistent in appearance with a microadenoma was detected on dynamic kFSE images in 13 of the 18 patients, on unenhanced images in nine patients, and on conventional contrast-enhanced images in 10 patients. In four patients, a microadenoma was detected on dynamic kFSE images only. Dynamic kFSE images showed a lesion in four of the 13 control subjects. CONCLUSION: Dynamic kFSE MR imaging is a useful supplemental sequence in patients undergoing MR imaging because of pituitary endocrinopathy. It may show lesions that would otherwise escape detection.
Adenoma↗
Correlation of colony-forming cells, long-term culture initiating cells and CD34+ cells in apheresis products from patients mobilized for peripheral blood progenitors with different regimens.
Peripheral blood progenitor cell (PBPC) populations used for transplantation were analyzed for the presence of CD34+ cells, colony-forming cells (initial CFC), and long-term culture initiating cells (LTC-IC) cultured on irradiated stroma for 5 weeks. Thirty-eight leukapheresis products were studied from 11 patients with breast cancer, 2 with non-Hodgkin's lymphoma and 1 with ovarian cancer harvested during recovery from either cyclophosphamide (CY) chemotherapy or cyclophosphamide-VP16 with G-CSF (CY-VP-G). CY-VP-G products had a threefold higher median number of mononuclear cells collected, a fivefold higher median concentration of CD34 and LTC-IC and a threefold higher concentration of initial-CFC when compared with CY products. CY-VP-G products had a significantly higher ratio of CFU-GM to BFU-E than the CY-mobilized products. Significant correlations of r = 0.89 and r = 0.68 were observed when comparing CD34 and CFC in products from CY or CY-VP-G patients, respectively. Analysis of the regression lines indicated that slopes of these regression lines were significantly different with a ratio of CD34 to initial CFC of 15:1 in the CY-VP-G products versus 5.2:1 with the CY products. These data indicate a higher cloning efficiency of the CD34+ population in the products from CY-mobilized patients. Significant correlations of r = 0.9 (CY) and r = 0.53 (CY-VP-G) were observed when the initial CD34 concentration and the LTC-IC were compared. Comparison of initial CFC with LTC-IC also showed significant correlations (r = 0.94, CY; r = 0.58, CY-VP-G) in samples from both patient groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Pituitary gland MR: a comparative study of healthy volunteers and patients with microadenomas.
PURPOSE: To compare the MR appearance of the pituitary glands of healthy volunteers with that of patients with microadenomas. METHODS: Unenhanced coronal T1-weighted MR of the pituitary gland was performed on 52 healthy adult volunteers and 14 consecutive patients with evidence of pituitary adenomas. The MRs were interpreted in a randomized, blinded fashion. Notation was made of pituitary gland size, symmetry, stalk position, and the gland's signal uniformity. RESULTS: Focal pituitary gland hypointensities were seen in 20 of 52 volunteers and in all 14 patients. In the volunteers, on average the areas of low signal were smaller and not as dark as in the patient group, but there was some overlap between the two groups. Pituitary gland size, symmetry, and stalk position did not differ between the two groups. CONCLUSIONS: Focal hypointensities are common incidental MR findings in the healthy population. On average they appear smaller and not as dark as microadenomas.
Adenoma↗
A double-blind, randomized, prospective trial to evaluate topical vitamin C solution for the prevention of radiation dermatitis. CNS Cancer Consortium.
PURPOSE: The object of this study was to ascertain the value of topical ascorbic acid in the prevention of radiation dermatitis. METHODS AND MATERIALS: Patients with primary or metastatic brain tumors were eligible. Patients applied a topical solution, twice per day prior to and throughout the course of radiotherapy, to the left and right sides of the head. The radiotherapist and the patient were blinded as to the contents of the solutions. The bottle for one side of the head contained topical ascorbic acid solution. The bottle for the other side of the head contained only vehicle. During and after the course of treatment the radiotherapist scored the skin reaction on both the left and right sides of the irradiated head using a skin reaction scale. The data were analyzed with a matched pair analysis. Since each patient received both treatments (ascorbic acid and control solutions) the statistical analysis concentrated on the paired difference in scores based on the probability of a "preference" for the treatment or control. RESULTS: Eighty-four patients entered the study. Sixty-five were suitable for analysis. In 10 patients there was a preference for ascorbic acid solution (15%), in 20 patients there was a preference for placebo (31%), and there was a preference for neither in 35 patients (54%). Ascorbic acid solution could be considered to have an effect if the percentage of preferences favoring ascorbic acid over placebo, among those subjects with a preference, significantly exceeded the 50% expected by chance. The observed percentage of preferences for ascorbic acid was only 33% (10 of 30 with a preference; p = .10, two-sided sign test). Patient age, race, sex, and total dose of irradiation had no detectable influence on the comparative skin toxicity scores. CONCLUSION: There is no discernible benefit to ascorbic acid lotion, in the manner in which we used it in this trial, for the prevention of radiation dermatitis.
Adolescent↗
The needs of high and low expressed emotion families: a normative approach.
Comparison of the needs and characteristics of relatives classified as high and low expressed emotion (EE) across a range of measures including social functioning and indices of stress and family burden revealed that high EE relatives reported higher levels of disturbed behaviour, subjective burden, and perceived themselves as coping less effectively. Individuals from high-EE households were more impaired in terms of social functioning, particularly in terms of independence and interpersonal functioning. No difference in overall knowledge about schizophrenia was observed between high and low EE relatives, although high EE relatives possessed more information about hospital procedures. Analysis of needs assessment data, based on a normative approach to need, revealed that two-thirds of high EE relatives, as against one-third of low EE relatives had high needs in at least one or more of the following five areas: knowledge about schizophrenia, subjective burden, personal stress, behavioural disturbance and perceived coping. No low EE relative had high needs on all five criteria. The implications of the results for the meaning and genesis of EE and for service provision are considered.
Adaptation, Psychological↗
Rheumatoid arthritis in a population sample in the Gulf: clinical observations.
In our practice we had constantly been under the impression that most Arab patients with RA tend to have a non-aggressive and rather nondisabling disease. Therefore, the spectrum of RA was studied in 42 hospital patients with classic or definite forms. Their mean age was 41.2 years and the mean duration of illness was 5.25 years. F:M ratio was 3.6:1. Seropositivity and radiological findings were observed in 59.5% and 45.2% of the patients respectively. They showed a marked lack of nonarticular manifestations with insignificant functional incapacity. The over-all assessment appeared to be in agreement with the initial clinical impression.
Adult↗
Congenital internal carotid artery aneurysm.
Congenital carotid aneurysms are frequently found in the intracranial arteries but rarely seen in extracranial part of the internal carotid artery. A case of a congenital internal carotid artery aneurysm at the skull base was treated in a 13-year-old female child. This case is being presented for its rarity and also to highlight the ease of exposing the upper end of the aneurysm via lateral skull base approach. Infratemporal fossa approach was adopted in this case. The carotid canal was drilled off and the upper end of the aneurysm in the intrapetrous part was mobilized and vascular clip applied before dissection of the aneurysm. Relevant literatures pertaining to this case are also reviewed.
Adolescent↗
Effect of phototherapy and urocanic acid isomers on natural killer cell function.
Ultraviolet (UV) radiation suppresses a variety of immune responses but it is uncertain whether this action contributes to the effectiveness of phototherapy. Urocanic acid (UCA) has been proposed as a mediator of the immunologic effects of UV. On exposure the naturally occurring trans-isomer of UCA in the skin changes into the cis-isomer, which has been demonstrated to mimic many of the immunomodulatory effects of UV irradiation. Natural killer (NK) cells play an important role in several immunologic processes and published evidence indicates that their activity is altered by UV irradiation. To ascertain the effect on NK cells of phototherapy used in the treatment of psoriasis, modulation of NK activity in psoriatic patients undergoing broad-band UVB, narrow-band UVB, or psoralen plus (PUVA) regimens was examined. This was compared with NK cell activity in psoriatic patients treated with topical coal tar and in normal subjects receiving broad band UVB. The NK cell activity of psoriatic and normal subjects was the same over a wide range of effector to target cell ratios. Almost all patients undergoing phototherapy exhibited depressed NK cell activity during or after irradiation, although the timing of the depression varied between the lamps used and may be related to dose. However, patients treated with topical coal tar showed unchanged NK cell activity throughout the therapy. The effect of UCA isomers on NK cell activity in vitro was also determined. It was found that cis-UCA induced a dose-dependent suppression of NK cell activity in both patients and normal subjects, whereas trans-UCA had hardly any effect in either group. Thus it is possible that there may be a correlation between cis-UCA formation in the epidermis and the modulation of NK cell activity that occurs during phototherapy.
Adult↗
Phototoxicity at unusual sites during photochemotherapy.
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Blister↗
A trial of accelerated PUVA in psoriasis.
Ten psoriatic patients were treated with an accelerated PUVA regimen. Nine patients cleared in an average of 13.7 treatments (range 4-24) after an average total UVA dose of 83 J/cm2 (range 18-186). One patient had to withdraw due to pruritus and burning and six others had burning problems. The high incidence of burning may limit the routine use of this irradiation regimen.
Female↗
Nodular fasciitis: a case with unusual clinical presentation initially diagnosed by aspiration cytology.
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Adult↗
Nurse triage in theory and in practice.
'Nurse Triage' refers to the formal process of early assessment of patients attending an accident and emergency (A&E) department by a trained nurse, to ensure that they receive appropriate attention, in a suitable location, with the requisite degree of urgency. The benefits claimed for nurse triage include better patient outcomes, through clinical management reaching those in greatest need of it first. A recent study of nurse triage in a British A&E department failed to demonstrate the benefits claimed: patients undergoing triage were delayed, especially those in the most urgent groups. No differences were noted between the two study groups in levels of satisfaction with the A&E process. The results brought forth criticism from all quarters. In this paper the points made by the critics are considered, and an attempt to answer them is made.
Clinical Nursing Research↗
Differences in priorities assigned to patients by triage nurses and by consultant physicians in accident and emergency departments.
STUDY OBJECTIVES: To investigate whether the greater urgency assigned to accident and emergency patients by triage nurses than by accident and emergency doctors was uniform across all patient groups. DESIGN: Patients attending an accident and emergency department between 8.00 am and 9.00 pm over a six week period were assessed prospectively for degree of urgency by triage nurses, and retrospectively for urgency by one of two consultant accident and emergency doctors. Patients were grouped according to their clinical mode of presentation. SETTING: An accident and emergency department of a district general hospital in the Midlands, UK, in 1990. PATIENTS: 1213 patients who presented over six weeks. MEASUREMENTS AND MAIN RESULTS: As might be expected, patients' conditions were assessed as being more urgent prospectively than retrospectively. This finding, however, was not uniform across all patient groups. Nurses' assessments of urgency tended to favour children and patients who presented with eye complaints and gave less priority to medical cases, particularly those with cardiorespiratory symptoms. CONCLUSIONS: These findings have implications for all those involved in the organisation of triage systems and in the training of nurses in accident and emergency departments. It is essential that judgements on how urgently patients need to be seen are made in a completely objective manner.
Age Factors↗
Toxic strep syndrome.
Group A beta-hemolytic streptococci are known to produce infections with protean manifestations. We report here a case of toxic streptococcal syndrome in a patient who presented with a multisystemic disease. Serological and bacteriological evidence strongly suggested an infection by Group A beta hemolytic streptococci.
Cefazolin↗
Stable isotopic tracers as metabolic probes in exercise.
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Amino Acids↗