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Biomedical subjects

T Leonard

Publications and source records attributed to T Leonard.

46 records · Page 3Linked to original sources
PubMed1984

Oedipism reviewed: a case of bilateral ocular self-mutilation.

A 26-year-old Negro male schizophrenic is described with severe bilateral orbital injuries following attempted self-enucleation. Owing to his psychosis there was difficulty in obtaining a visual acuity and in establishing the cause of his fixed, dilated pupils. ACT scan showed bilateral orbital oedema, with surgical emphysema and haemorrhage. The visual evoked potential (VEP) was present in the right eye but absent in the left. High doses of systemic steroids effected rapid resolution of the orbital swelling and recovery of the vision in the right eye. The effects of self-inflicted injury to the orbital content and the value of sophisticated investigation in this unusual case are discussed.

Adult↗
PubMed1982

Critical evaluation of the persistent loop sign in necrotizing enterocolitis.

A review of the records and radiographs of 21 newborn infants with necrotizing enterocolitis and 10 control infants was performed to test the significance of the persistent loop sign in necrotizing enterocolitis. Twelve clinical and laboratory variables were compared with the persistent loop sign. None of the control infants and seven of the 21 study infants had a persistent loop sign. Four of the seven infants were proven to have necrotic bowel. All four died. Four of the 14 study patients without the persistent loop sign had necrotic bowel. Two of these four infants died. The findings of this study do not support the use of a persistent segmental loop of bowel as a single criterion for surgical intervention.

Enterocolitis, Pseudomembranous↗
PubMed1981

The probability of fetal metabolic acidosis during labor in a population at risk as determined by clinical factors.

The clinical data derived from 2,772 pregnancies managed in an intrapartum intensive care unit have been analyzed to establish which criteria will indicate in a more definite manner the probability that fetal metabolic acidosis will occur during labor and delivery. All antepartum and intrapartum clinical factors indicate a pregnancy and fetus with an increased probability of fetal metabolic acidosis. However, there is a remarkably consistent relationship between decreasing fetal weight in each week of gestational age and in increasing probability of fetal metabolic acidosis that will permit the magnitude of the risk to be determined with greater precision. The following clinical guidelines are proposed: (1) Current antepartum and intrapartum risk factors are appropriate for the selection of patients for intrapartum intensive care. (2) An accurate gestational age and an estimate of fetal weight within 200 gm will provide an indication of the probability of fetal metabolic acidosis in the individual fetus ranging from 15% to 50%. (3) The presence of meconium in the amniotic fluid increases the probability of metabolic acidosis as defined by fetal weight in relation to gestational age.

Acidosis↗
PubMedDate not supplied

The prevalence and detection of substance use disorders among inpatients ages 18 to 49: an opportunity for prevention.

BACKGROUND: Previous studies have found that substance use disorders are prevalent among inpatients of general medical hospitals. These studies were limited in the validity of their measures, their failure to distinguish between current and lifetime disorders, or their lack of attention to drugs other than alcohol. METHODS: The current study used validate diagnostic instruments to measure current and lifetime alcohol and other drugs abuse and dependence among patients ages 18 through 49. Additionally, this study assessed the sensitivity and specificity of four substance abuse screening questions. Patients were recruited from the general medical, general surgery, and orthopedics services of a university hospital in Madison, Wisconsin. The sample included 363 patients, or 86.4% of those recruited. RESULTS: The current and lifetime prevalence rates of substance use disorders were 21.8 and 49.6%, respectively. The prevalence rates of current problems were 16.3%, alcohol only; 2.5%, other drugs only; and 3.0%, alcohol and other drugs. Males had nearly a 30% current prevalence of current substance use disorders. The CAGE Questions Adapted to Include Drugs exhibited 70.9% sensitivity and 75.7% specificity. CONCLUSIONS: At one hospital, and perhaps at others, an alcohol and drug screening, assessment, and intervention program may have the potential to prevent future health and social problems.

Adolescent↗
PubMedDate not supplied

[A food cognition questionnaire].

BACKGROUND: Many authors evoke the role of cognition in the persistence of symptoms or in relapse. In pathology the cognitions produced by the patients are called dysfunctional or erroneous. The content of the cognitions are words or images issued from the treatment of information. In emotional disorders, the structure of thoughts named dysfunctional "schemata" involves a biased treatment of information and leads to erroneous cognitions. Several studies have attempted to elicit the most specific cognitions of different diseases. In this field, Hollon and Kendall found 36 cognitions specific to depression gathered in the automatic thoughts questionnaire (ATQ). In the same spirit, Beck et al. gathered 14 cognitions of anxiety and 12 depressed cognitions in the cognition check list (CCL). In the etiology and maintenance of eating disorders the cognitions take a large place. Around 1980 cognitive dysfunctioning was described and concerned food, interpersonal relationship and body shape. A few years later, some experimental studies explored these processes. The Stroop test, a categorization task, showed specific cognitive impairment in with patients eating disorders versus normal control subjects. It was then established that cognitive errors were based on food cognitions in restrictive patients, whereas they were based on body shape cognitions in bulimic patients. In several famous papers, Garner described typical cognitions of eating disorder patients and distinguished food-cognitions, eating-cognitions using case reports. As far as we know there is no clinical tool concerning such cognitions in France. That is the main motivation of the authors. AIM OF THE STUDY: The aim of this paper was to determine the characteristic cognitions of anorexic, anorexic-bulimic and bulimic patients and to compare them with those of normal control subjects. The goal of the study was to create a food cognition questionnaire. FIRST STEP METHODS: In the first step, food cognitions were collected among female eating disorder patients and normal female control subjects during systematic investigation. Ninety-two women were assessed and provided more than 3 000 food cognitions. Two independent psychologists identified the most frequent cognition per group and thus retained 115 food items. These items were randomly assigned. This provided the questionnaire. To illustrate the latter, here are the first five items: 1) Apricots are good for the health because they are rich in vitamins. 2) Pears are big fruit, difficult to digest. 3) Canned fruit is soaked with sugar. 4) Banana is a fruit which makes one put on weight. 5) White coloured food give the impression that it is not alive... The list of possible answers was: never, rarely, sometimes, often enough, often, always. SECOND STEP METHODS: In the second step, the food cognition questionnaire was proposed to 217 women including 131 eating disorder patients (53 anorexic, 50 anorexic bulimic, 28 bulimic) and 86 normal control subjects. The values of body mass index and the eating attitude test differed when we compared the two groups, and the mean age was close to 26 years in both groups. RESULTS: The statistic analysis highlighted six discriminative variables: two clinical criteria (weight and height) and four food-items given below: Q24: When I see food being fried, I feel the grease all over my body. Q76: When I start a cookie packet, I eat it up. Q102: When I feel anxious, I crave for food to fill my body. Q106: Eating pastry gives me heart-burn and makes me belch. The statistical model allowed us to differentiate eating disorder patients from normal control subjects. The content of the four food items is in agreement with experimental and clinical data. All these items included some aspects of the quality or quantity of food and also the negative consequences of food consumption on the body. CONCLUSION: To conclude, the model can help clinicians identify the patients and then initiate treatment. We also insist on the fact that this study is new and empirical, and should be extended by determining some food items for example, which would clarify the difference of behaviour between anorexics and bulimics.

Adult↗
PubMedDate not supplied

Reflex responses associated with activator treatment.

BACKGROUND: Previous studies have demonstrated the existence era reflex response, measurable by surface electromyography (sEMG), after manually delivered spinal manipulative therapy (SMT). This reflex response has been characterized as consistent, reproducible within individual subjects, and nonlocal because it extends beyond the site of manipulation. However, the nature and magnitude of possible reflex responses in the paraspinal and proximal limb muscles elicited by nonmanual SMT, such as with an adjusting instrument, remain unknown. OBJECTIVE: To characterize the reflex responses associated with SMT by using sEMG to record the responses of 16 muscles before, during, and after treatment. STUDY DESIGN: The eleetromyographic responses of 16 para-spinal and proximal limb muscles in 9 healthy, asymptomatic male volunteers were measured simultaneously by sEMG before, during, and after chiropractic SMT. METHODS: SMT thrusts were delivered to 9 asymptomatic volunteers at 6 bilateral sites (C3/4, T2/3, T6/8, T11/12, L2-4, and s1). Reflex responses were measured from 16 muscles with bipolar sEMG electrodes and collected at 2000 Hz per channel with data acquisition software. RESULTS: Approximately 68% of the SMT thrusts resulted in a detectable reflex response. The cervical spine resulted in a detectable response of 50%, thoracic spine 59%, lumbar spine 83%, and sacroiliac joints 94%. Treatments delivered to the thoracic spine elicited the largest peak-to-peak amplitude sEMG responses, whereas the lumbar spine demonstrated the most heterogeneous responses. When a reflex response was observed, it always occurred close to the treatment site ipsilaterally and was detected in muscles that had either their origin or insertion at the vertebral level that was adjusted. CONCLUSIONS: Based on the local nature, magnitude, and characteristic shape of all reflex responses observed, we hypothesized that they were likely generated by a single proprioceptor. Furthermore, the temporal properties of this reflex response suggest that they originated from the muscle spindles. In contrast to previous observations on reflex responses after manual SMT, these treatments elicited reflex responses that varied between subjects but were consistent within an individual and were local in nature. We conclude that SMT delivered in this manner results in a reflex response that is both quantitatively and qualitatively different from a manual SMT.

Adult↗
PubMedDate not supplied

A two-item conjoint screen for alcohol and other drug problems.

BACKGROUND: Although nonmedical use of illicit and prescription drugs is not uncommon among American adults, the currently recommended screens for substance use disorders focus only on alcohol. This study reports on the criterion validity of a two-item conjoint screen (TICS) for alcohol and other drug abuse or dependence for a split sample of primary care patients. METHODS: Two random samples of primary care patients aged 18 to 59 years responded to several screening items that emanated from a focus group process. The DSM-III-R criteria for substance use disorders, as codified by the Composite International Diagnostic Interview-Substance Abuse Module, served as the criterion standard. RESULTS: At least one positive response to the TICS (In the last year, have you ever drunk or used drugs more than you meant to? and Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?) detected current substance use disorders with nearly 80% sensitivity and specificity. The TICS was particularly sensitive to polysubstance use disorders. Respondents who gave 0, 1, and 2 positive responses had a 7.3%, 36.5%, and 72.4% chance of a current substance use disorder, respectively; likelihood ratios were 0.27, 1.93, and 8.77. The results were consistent across split samples of 434 and 702 participants. CONCLUSIONS: Current alcohol or other drug problems can be detected in nearly 80% of young and middle-aged patients by asking two questions that are easily integrated into a clinical interview.

Adolescent↗