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Biomedical subjects

S Stewart

Publications and source records attributed to S Stewart.

At least 397 records · Page 22Linked to original sources
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Changes in body protein, body potassium, and lean body mass during total parenteral nutrition.

Lean body mass by anthropometry (AMLBM), total body potassium (TBK), and total body nitrogen (TBN) by prompt gamma analysis, are reported in 38 malnourished patients during total parenteral nutrition. Over long periods (greater than 2 months) TBN increased 32% while AMLBM and TBK rose only by 9.2 and 9.5%, respectively. Changes in AMLBM and in K were significantly correlated, but changes in nitrogen were not correlated with either. From short-term studies, the same conclusions can be obtained; although there are changes in lean body mass and in potassium, there is no correlation with such changes in nitrogen. With repletion, changes in body protein are not necessarily related to changes in AMLBM or to TBK: the latter two reflecting total and intracellular water, respectively, but not protein content.

Anthropometry↗
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Does Cybex testing increase knee laxity after anterior cruciate ligament reconstructions?

Long-term stability of the knee after anterior cruciate ligament reconstruction is imperative. Testing protocols that use isokinetic systems are commonly performed despite controversies as to their safety. The purpose of this study was to test whether one episode of isokinetic testing would cause an increase in anterior tibial translation. Twenty-four subjects who had anterior cruciate ligament reconstructions 153 to 300 days earlier volunteered for the study. Initially, subjects walked on a treadmill at 5 km/hr for 10 minutes to test the effect of exercise on displacement measurements. One week later, subjects performed a maximal knee flexion-extension test on the Cybex dynamometer at 60, 150, and 240 deg/sec. Anterior tibial displacement at 133.5 N was obtained from force-displacement curves produced by KT-2000 arthrometer testing at nine intervals: before exercise on the treadmill, at four intervals after treadmill exercise, and at four intervals after Cybex testing. Repeated measures analysis of variance did not show a significant exercise effect, interaction between type of exercise and time interval, or change after Cybex testing for the reconstructed knee displacement, the contralateral knee displacement, or side-to-side difference. The average difference before and after Cybex testing was 0.1 mm for the reconstructed knee. In conclusion, a single Cybex test, performed at least 6 months after surgery, did not affect anterior tibial displacement in this study sample.

Adolescent↗
PubMedDate not supplied

The psychosocial impact of human papillomavirus infection: implications for health care providers.

The American Social Health Association (ASHA) surveyed people with human papillomavirus (HPV) about their experiences with the disease and its effect on their lives. A sample of 837 was chosen from the subscribers to HPV News, ASHA's quarterly journal for people with HPV. Of the sample, 489 returned completed surveys, which addressed medical history, health care experiences, personal impact, and demographic information. Data analysis was descriptive. Data illustrated that the psychosocial impact of HPV can be serious. More than three-quarters of respondents reported feelings of depression and anger, and two-thirds feelings of shame. Sexual enjoyment and activity were also negatively affected by HPV. Additionally, respondents expressed dissatisfaction with the diagnosing health care providers' counselling on emotional and sexual issues. These results may be instructive to those delivering health services by providing insight into the significant personal impact of HPV on those infected.

Adult↗
PubMedDate not supplied

Beyond three: MCH nurses' assessment leads to early interventions.

This study reports the results of a one year trial of a comprehensive developmental assessment, including vision and hearing screening, of three to four year olds in one municipality. Initial results indicated that over 50% of the 790 children assessed had no identifiable problems, this increased a further 15% after retesting. One hundred and eighty-seven children were referred to a variety of agencies, mainly for vision and audiological reassessment. One hundred and thirty-five referrals for further investigation were for children whose problems were confirmed and appropriately managed.

Child, Preschool↗
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Natural history of chronic rejection in heart-lung transplant recipients.

Chronic rejection is the major cause of death of long-term survivors of heart-lung transplantation. Of our 61 patients who have received heart-lung transplants, 29 have been followed up for a year or longer. Seven patients had clinical evidence of chronic rejection within 15 months of transplantations of these seven, four died with postmortem confirmation of extensive obliterative bronchiolitis, interstitial and pleural fibrosis, and vascular sclerosis in the heart and lungs. All seven patients had evidence on transbronchial biopsy specimens of submucosal fibrosis and vascular sclerosis. Twelve of our remaining patients have shown similar areas of lung fibrosis on transbronchial biopsy specimens, and the other 10 are well and without fibrosis seen on transbronchial biopsy specimens. Studies of the 201 biopsy specimens obtained from 29 patients confirmed rejection on 130 occasions, with more frequent, more persistent, and more severe rejection in the chronic-rejection group than in the without-fibrosis or lung-fibrosis group. Opportunistic infections resulted in pneumonia on 19 occasions, and these were most commonly found in patients with lung fibrosis. We conclude that chronic lung rejection is the likely outcome in patients with early, poorly controlled, severe rejection.

Adult↗
PubMedDate not supplied

Histologic prognostic indicators for the lung allografts of heart-lung transplants.

The histologic changes in transbronchial lung biopsy specimens of heart-lung transplant patients were graded during episodes of acute rejection and when patients were well. Infection was strictly excluded from all episodes studied. Grade of severity of rejection was determined by the magnitude and extent of the inflammatory infiltrate. Biopsy specimens, obtained 1 year after the initial biopsies, were examined for histologic evidence of airway submucosal fibrosis, and each patient's clinical status at this time was recorded. The biopsy material from 22 long-term survivors was studied. On 16 occasions the specimens showed no evidence of rejection (grade 0). Twelve of these sets of specimens were from clinically well patients, and four were from the patients who had clinical evidence of rejection. The other six sets of specimens, from clinically well patients, showed evidence of rejection: three grade 1 and three grade 2. One year later, the clinically well patients had normal biopsy histology without fibrosis and normal lung function. Bronchiolitis obliterans had not developed in any patient. There were 27 episodes of rejection in the 22 patients, of which 23 were confirmed histologically. Eleven sets of specimens had grade 1 acute rejection, eight grade 2, and four grade 3. Three of these patients died, and bronchiolitis obliterans was confirmed at necropsy. Lung fibrosis was more common in specimens taken after 1 year, and lung function was depressed in these patients. The histologic grading of transbronchial lung biopsy material, although still in the early stages of development, provides some predictive value to the long-term outcome of the lung transplant patient, in development of both bronchiolitis obliterans and lesser fibrotic changes.

Biopsy↗
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High dose chemotherapy with autologous bone marrow rescue in small cell lung cancer.

Twenty five patients diagnosed as having small cell lung cancer (SCLC) were treated with etoposide and cisplatinum. After assessment for tumour response, autologous bone marrow (ABM) was collected from five patients in good clinical state who had shown a partial response (PR) and no bone marrow involvement with tumour. These patients were treated with high dose cisplatinum, etoposide and melphalan and then by ABM infusion. Although all patients (3 with extensive and 2 with limited disease) responded (4 CR and 1 PR), 3 patients with extensive disease relapsed and died of their disease. One patient with limited disease died of infection while pancytopaenic; one patient is alive but has relapsed at eighteen months. Although patient numbers are small, our data support the conclusion that high dose chemotherapy and autologous bone marrow rescue has a very small role or none at all in the management of patients with extensive or limited stage SCLC.

Antineoplastic Combined Chemotherapy Protocols↗
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Transbronchial biopsy has eliminated the need for endomyocardial biopsy in heart-lung recipients.

Between April 1984 and August 1987, 27 patients have received heart-lung transplantations at Papworth Hospital. In the first 17 patients endomyocardial biopsies were performed routinely in accordance with the practice for heart transplant recipients. It became apparent that in contrast to heart transplant recipients, heart-lung transplant recipients show little evidence of cardiac rejection. As routine endomyocardial biopsies did not contribute therefore to patient management, they were stopped. Conversely, pulmonary rejection was diagnosed either clinically by a decrease in forced expired volume in 1 second (FEV1) in the absence of lung infection or by transbronchial biopsy, which determined when immunosuppression needed to be augmented. The presence of lung rejection was confirmed by resolution of the lung histopathology or improvement in FEV1.

Adult↗
PubMedDate not supplied

Histologic changes in heart-lung transplant recipients during rejection episodes and at routine biopsy.

In our experience a lung biopsy specimen taken by means of a fiberoptic bronchoscope is a useful, safe technique for the diagnosis of rejection in heart-lung transplant recipients. To determine that the histologic features associated with rejection can be identified in transbronchial biopsy specimens, 35 biopsy specimens (group A) taken when retrospective review confirmed a clinical diagnosis of rejection without evidence of infection were identified from a total of 107 biopsy specimens. These were compared with 14 biopsy specimens (group B) taken when the patients were well. Several foci of dense perivascular mononuclear cell infiltration with pyroninophilic lymphocytes and plasma cells were seen in 79% of group A biopsy specimens. Fewer foci of non-pyroninophilic cells were seen in group B biopsy specimens (p = 0.005). There was also a difference in the histologic features of the mucosa and interstitial lung tissue. We believe that the early confirmation of rejection followed by adequate augmentation of immunosuppression may prove to be an important factor in reducing the incidence of obliterative bronchiolitis in heart-lung transplant recipients.

Biopsy↗
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A happy return.

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Adult↗