Biomedical subjects
Publications and source records attributed to S Thomas.
Keeping track of nursing resources consumed by each hospital inpatient does not have to be a cumbersome process. The authors present an inexpensive, straightforward approach to generate management information on nursing acuity by DRG, payor, hospital service, or physician.
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Persistent gastrointestinal symptoms are common postoperatively in children with intestinal malrotation. We investigated this problem in 14 children with intestinal malrotation who had a Ladd procedure (3 patients), gastroschisis repaired (6 patients), or omphalocele repaired (5 patients) between one month and 15 years prior to study. In 13 patients, gastric emptying was measured at 30 minutes (%GE30) and at 60 minutes (%GE60) following ingestion of 99m-Tc sulfur colloid in apple juice. We estimated the degree of gastric peristalsis using the %GE corrected for immediate postcibal gastroesophageal reflux (corrected %GE). Patients with vomiting exhibited slow gastric emptying compared to patients without vomiting (%GE30: 14.0 +/- 5.5 v 32.5 +/- 4.2, P less than .005). The slow gastric emptying was related to slow gastric peristalsis (corrected %GE30: 20.3 +/- 5.0 v 47.1 +/- 6.0, P less than .005). In all 5 patients with persistent bloating and diarrhea, gastric peristalsis was rapid at 30 minutes (corrected %GE30 = 56.7 +/- 4.2) and at 60 minutes (corrected %GE60 = 69.5 +/- 5.3). To assess the role of gastroesophageal reflux (GER) in persisting symptoms, all children had extended (18 to 24 hours) esophageal pH monitoring. Eleven (79%) of the 14 patients demonstrated GER by esophageal pH monitoring, including four of six patients without reflux symptoms. All ten children under two years of age demonstrated GER regardless of symptoms or congenital anatomic abnormality. In conclusion, GER is common in patients under two years of age with intestinal malrotation, but clinical symptoms seem related more to extreme variations in gastric peristalsis than to GER.
Of 108 renal transplant recipients (53 men and 55 women) treated with azathioprine (0.8-2.9 mg/kg/day) and prednisolone (10 mg daily), 10 men had actinic keratoses, and five of these had squamous cell carcinoma, on light-exposed areas of skin. The time from transplantation to diagnosis of these skin lesions varied from 1.2 to 9.0 (mean 5.1) years. The concentration of the active azathioprine metabolite 6-thioguanine nucleotide was 120-425 (mean 276) pmol per 8 X 10(8) red blood cells in the transplant patients who developed skin lesions and 54-203 (mean 130) pmol per 8 X 10(8) red blood cells in a matched control group of renal transplant recipients. This difference was statistically significant (P = 0.005). There was no statistically significant difference between patients and controls in azathioprine dosage, clinical features of immunosuppression, sunlight exposure or infection with human papilloma virus. The association of raised 6-thioguanine nucleotide concentrations in red blood cells with actinic keratoses and malignant skin tumours in these patients supports chemical carcinogenesis as a possible cause.
Scoliosis was produced experimentally in monkeys, by excision of ribs and costo-transverse ligaments. Unilateral excision of these structures produced mild reversible scoliosis, while bilateral excision caused a severe structural curve. We feel that scoliosis so produced is due to instability of the spine which is more pronounced in bilateral operations.
Oral cancer is the most common cancer seen in Papua New Guinea. Although there is a broad geographical correlation with betel chewing, there have been no analytical epidemiological studies and the aetiology remains poorly understood. A greater understanding of several putative risk factors and how they may interact is needed prior to any attempt to modify traditional customs. Although current strategies for primary prevention in India are based on the assumption that the risk of betel chewing is related to the tobacco in the quid, this cannot explain oral cancer in Papua New Guinea. In the latter, special epidemiological and laboratory investigations are needed to provide a scientific basis for future prevention.
An alternative method for assessing oral perceptual skills was developed to address some of the practical limitations of the standard form test. The alternate forms and standard NIH Oral Stereognostic Forms were administered to 182 children. Scores resulting from presentation of standard NIH forms and alternate edibles correlated .76. Suggestions for using the alternate forms for routine oral stereognostic testing are presented.
A battery of items testing oral stereognostic ability was individually presented to 168 children, 12 boys and 12 girls at each of seven age levels from 4-5 to 11-4. Age was significantly related to oral stereognostic scores; older subjects scored significantly higher than younger subjects. Sex was also significant; girls scored higher than boys. The interaction of age and sex was not significant.
Autoimmune diabetes mellitus occurs spontaneously in 40-60% of a colony of BioBreeding/Worcester rats. Pretreatment of susceptible animals for 10-day intervals prior to 70 days of age with Cyclosporin-A (CSA) significantly reduced the frequency and delayed the onset of diabetes. The relatively narrow time frame of successful treatment suggests that effector cells responsible for beta cell destruction in this model of Type I diabetes may be activated during this period of time prior to the onset of overt hyperglycemia. CSA administration did not protect against the occurrence of lymphocytic thyroiditis or autoantibodies directed against smooth muscle or thyroid colloid, suggesting that these BB immunologic phenomena may be controlled by a distinct series of immunologic events.
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The antibacterial activity of four new medicated tulle dressings was determined by a modified zone inhibition method. Six different test organisms were used and from the results of the investigation, it was concluded that although the dressings differed in their duration of action and the rate at which the medicaments were released from their individual formulations, they all possessed significant antimicrobial activity.
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A previously reported technique for the assessment of skin blood flow in the lower extremities of patients with ischemic lesions was evaluated using intracutaneous xenon clearance. The radioisotope was injected above and below both the ankle and the knee and flow was measured using a gamma camera with a low-energy collimator, 88-keV photopeak, and a 20% window. Healing was more frequent when skin blood flow was equal to or greater than 2.4 ml/min/100 g (38/39 patients) than when flow was less than 2.4 ml/min/100 g (4/7 patients). The authors conclude that this technique can be used to help determine the appropriate site for amputation in lower limb ischemic lesions.
Nine azotemic patients who developed a coagulopathy associated with the use of either cephalosporin or moxalactam antibiotics are reported. The acute renal failure patients had neoplastic disorders and were considered to be septic at the time that multiple antibiotics were administered. Four of 5 chronic hemo- or peritoneal dialysis patients also received multiple antibiotics. Nevertheless, the coagulopathy seemed to be most closely associated with the administration of the cephalosporin. One patient received moxalactam as part of the combination therapy for diffuse pulmonary infiltration during renal transplant rejection. Bleeding occurred into the gastrointestinal tract in four patients, into the kidney-urinary tract in three patients, into vascular surgical sites in two patients, and one each into the pulmonary-bronchial and cerebral-ventricular systems. Five operations were performed in four patients: a nephrectomy for massive subcapsular hemorrhage with a prothrombin time that exceeded 100 seconds; arteriovenous graft complicated by post-operative bleeding associated with prolongation of the prothrombin time; elective femoral-popliteal bypass complicated by a prolonged prothrombin time, bleeding into the graft site, hypotension, and a subendocardial myocardial infarction; elective cholecystectomy complicated by a two unit bleed associated with a slightly prolonged prothrombin time, followed by elective femoral-popliteal bypass complicated by a fatal intercerebral bleed associated with a more than twice normal prothrombin time. Cephalosporins are most likely associated with Vitamin K deficiency. Moxalactam is more likely to be associated with platelet dysfunction. Monitoring of the prothrombin time for cephalosporins or the bleeding time for moxalactam is the most reliable way to prevent what may be rapid emergence of clinical bleeding in patients with renal failure.
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