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Biomedical subjects

W G Thompson

Publications and source records attributed to W G Thompson.

At least 73 records · Page 4Linked to original sources
PubMed1989

Hypersegmented neutrophils and vitamin B12 deficiency. Hypersegmentation in B12 deficiency.

The sensitivities and specificities of the mean cell volume (MCV), the red cell distribution width (RDW), and blood smear hypersegmentation for B12 deficiency were reviewed in 515 patients whose B12 levels were determined. 61 patients had B12 levels less than 200 pg/ml. 43 patients were defined as B12 deficient (n = 13) or non-B12 deficient (n = 30). Hypersegmentation was more sensitive (91%) than MCV greater than 95 fl (62%) or RDW greater than 15% (54%) in detecting B12 deficiency. The MCV and the RDW should not be relied on when screening for B12 deficiency; examination of the blood smear for hypersegmentation is essential.

Anemia↗
PubMed1988

Value of necropsy in acquired immunodeficiency syndrome.

Necropsy findings in 101 adult patients with the acquired immunodeficiency syndrome (AIDS) from two metropolitan hospitals were compared retrospectively with the antemortem clinical diagnoses. 94% of the patients were male and 68% were homosexual or bisexual. 75 (74%) patients had AIDS-related diseases at necropsy that were not suspected clinically. The commonest of the unsuspected AIDS-related diseases were cytomegalovirus infection (49% of all cases), systemic fungal infection (20%), systemic Kaposi's sarcoma (14%), Mycobacterium avium intracellulare infection (11%), and systemic herpes infection (9%). Cryptococcal infection and cytomegalovirus retinitis were always diagnosed antemortem; and Pneumocystis carinii pneumonia went undiagnosed in only 5 of 58 (9%) patients who had proven infection either clinically or at necropsy. 8 patients who died with fungal pneumonia had undergone bronchoscopy; however, in only 1 patient was it diagnosed antemortem. Tuberculosis was undiagnosed in 4 patients. 4 cases of central nervous system lymphoma diagnosed only at necropsy had been treated empirically for toxoplasmosis. Bacterial pneumonias contributed considerably to mortality in 30% of the patients.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Comparison of tests for diagnosis of iron depletion in pregnancy.

The serum ferritin level was used to diagnose iron depletion in 137 pregnant patients who came to an inner-city hospital outpatient clinic. Seventy-three patients (53.3%) had ferritin levels less than 20 micrograms/L, indicating iron depletion. The prevalence of iron depletion was 29% in the first trimester, 64% in the second trimester, and 71% in the third trimester (p less than 0.001). The sensitivities of serum iron (2.8%), transferrin saturation (12.5%), mean corpuscular volume (6.8%), and red cell distribution width (16.4%) were too low for screening or diagnosing iron depletion and deficiency. Serum ferritin level should be used to screen for and diagnose iron depletion and deficiency in pregnancy.

Adolescent↗
PubMed1988

Red cell distribution width, mean corpuscular volume, and transferrin saturation in the diagnosis of iron deficiency.

The usefulness of the red cell distribution width, mean corpuscular volume, and the transferrin saturation in diagnosing iron deficiency anemia were evaluated in a retrospective study of 247 anemic hospitalized patients, many of whom had chronic liver disease. A red cell distribution width greater than 15% had a sensitivity of 71% and a specificity of 54% for iron deficiency as diagnosed by a low serum ferritin or bone marrow examination. A mean corpuscular volume less than 80 femtoliters had a sensitivity of 53% and a specificity of 84%. Transferrin saturation less than 16% had a sensitivity of 61% and a specificity of 86%. Because the sensitivities and specificities of these tests are less than reported in studies of healthier populations, they cannot be relied on for screening for iron deficiency in sick hospitalized patients.

Anemia, Hypochromic↗
PubMed1988

Use of creatine kinase MB isoenzyme for diagnosing myocardial infarction when total creatine kinase activity is high.

The usefulness of measuring creatine kinase MB isoenzyme for diagnosing myocardial infarction when activities of total creatine kinase are very high is unclear. We conducted a retrospective study in an urban hospital that serves a largely indigent population. We concentrated on 146 patients whose creatine kinase activity was greater than 1000 U/L (upper limit of normal: 165 U/L for women and 225 U/L for men), with MB isoenzyme greater than 10 U/L and less than 5% of total creatine kinase. The positive predictive value of MB isoenzyme (isoimmune method) values greater than 10 U/L was between 11.6% and 56.8% when the value for total creatine kinase exceeded 1000 U/L. Using different values (MB greater than 4% of total creatine kinase) as positive for myocardial infarction would have resulted in far fewer false-positives, but 10 cases of myocardial infarction would have been missed. The most appropriate cutoff value for MB isoenzyme in this population (total creatine kinase greater than 1000 U/L) was found to be greater than 2% of total creatine kinase.

Adolescent↗
PubMed1987

Evaluation of current criteria used to measure vitamin B12 levels.

Because of recent improvements in the serum vitamin B12 assay, literature criteria based on prior assay methods used in measuring B12 levels were evaluated. Of 1,708 B12 levels measured at Bellevue Hospital in a six-month period, 137 in 124 patients were below 200 pg/ml. Contrary to expectations, 81.6 percent of patients with low B12 levels had a mean corpuscular volume (MCV) below 95 fl. Literature-derived criteria missed 30 percent of patients with low B12 levels. Only three of 12 patients with megaloblastic bone marrow or an abnormal Schilling result had B12 levels that were low (below 100 pg/ml), and nine had values in an intermediate range (100 to 200 pg/ml). This suggests that the use of an MCV below 95 fl and a B12 level below 100 pg/ml as abnormal values may not detect clinically important B12 deficiency.

Adolescent↗
PubMed1986

A strategy for management of the irritable bowel.

The irritable bowel is one of the most common complaints facing clinicians. Its management is difficult but a strategy is proposed that is useful in most instances. It is well to remember that most people with these symptoms do not complain to a doctor. The reason for the visit to the physician may, therefore, hold a clue as to the best course of management. The physician must first establish his credibility through a careful history, physical examination, and sigmoidoscopy. He needs to identify the precipitating factors such as dysentery, drugs, diet, emotion, or an important life event. In accordance with the patient's needs, the physician should comfort and reassure. Bran appears to be a safe method of treatment and many are satisfied with it. A follow-up visit is important to ensure compliance and comprehension. The biggest risk of the IBS lies in uncertainty, which generates needless anxiety, costly investigation, fruitless drug side effects, and even the hazards of surgery. If the patient is unimproved at the second visit, one must consider diagnostic alternatives while resisting the temptation to order irrevelant investigative procedures. Continued empathy with the patient is important and certain drugs might be considered either for their placebo effect or because of their effect on a specific complaint such as diarrhea. In the patient who continues to be dissatisfied, the physician must offer continued support and reassurance. Certain referral options may be considered but if possible, the physician should retain the initiative.

Amitriptyline↗
PubMed1986

Clinical picture of diverticular disease of the colon.

Uncomplicated diverticular disease is usually asymptomatic. When abdominal pain or discomfort related to defecation, altered bowel habit, and flatulence occur, they are likely a result of a coexistent irritable bowel. Nonetheless, diverticula are subject to serious complications. Diverticular hemorrhage may be massive and require emergency angiography and segmental resection. Peridiverticulitis occurs when a diverticulum ruptures, perhaps because of inspissated fecal material. This occurs usually in the sigmoid, resulting in a peridiverticular abscess localized by the adjacent fat and mesentery. If the infection extends beyond this, abscess, fistula, or free perforation may occur. These complications require antibiotics, intravenous therapy, and, in the case of uncontrollable abscess or perforation, urgent surgery. Obstruction of the colon, sometimes associated with ileus, may occur and in this case one may find a carcinoma among extensive diverticular disease. Although there is insufficient evidence to justify a high-fiber diet for the general population, the notion of a low-residue diet in the management of uncomplicated diverticular disease should be laid to rest.

Colonic Diseases, Functional↗
PubMed1985

Gluten in pills: a hazard for patients with celiac disease.

It has recently been recognized that many pharmaceutical products contain gluten. Patients with celiac disease are at risk of acute illness if they are treated with such products. This paper lists the products available in Canada, according to the "Compendium of Pharmaceuticals and Specialties, 1985", that contain gluten and the Canadian manufacturers who stated that they do not use gluten as an excipient.

Canada↗
PubMed1985

Students' ratings of instructors in a multidiscipline course.

Multidiscipline courses employing small group bedside teaching techniques are difficult to evaluate. At the University of Ottawa School of Medicine, a simple rating system by the students was employed to monitor a 180-hour clinical methods course that involved lectures, laboratories, and small group teaching at the bedside. This monitoring system allowed course organizers to evaluate over 3,000 hours of teaching provided by nearly 250 instructors in 20 different divisions and departments. Examples are reported in this article which demonstrate how the rating system was used to detect unsatisfactory areas in the course. Analysis of the ratings allowed the course organizers to understand the difficulties better than without it and in most cases to correct them.

Curriculum↗
PubMed1984

Nonulcer dyspepsia.

One third to one half of cases of dyspepsia remain unexplained. The cause of nonulcer dyspepsia is unknown, but aerophagia, esophageal dysfunction, pyloroduodenal dysmotility and the irritable bowel syndrome may be important factors in some patients. The symptoms are often affected by diet and emotion. History-taking and endoscopy are the most discriminating diagnostic tests. Unexplained dyspepsia tends to be a lifelong disease with few, if any, sequelae. Nevertheless, reassurance and treatment with a placebo, such as an antacid or simethicone, provide effective and safe relief for many patients.

Aerophagy↗
PubMed1984

Gastrointestinal symptoms in the irritable bowel compared with peptic ulcer and inflammatory bowel disease.

Symptoms of 50 patients with the irritable bowel syndrome were compared with those of 49 with endoscopically proven peptic ulcer disease and 49 with radiologically or endoscopically proven inflammatory bowel disease using a questionnaire which was administered after the diagnosis was made. Symptoms of bowel dysfunction including pain related to bowel movements were more likely to occur in the irritable bowel syndrome than peptic ulcer disease. Only abdominal distension, straining at stool and scybala, however, were significantly more likely in the irritable bowel syndrome than inflammatory bowel disease. Four symptoms previously shown to be more common in irritable bowel syndrome than in organic abdominal disease were combined. The more of these symptoms that were present, the more likely were the patients to have the irritable bowel syndrome than peptic ulcer disease. Symptoms of gut dysfunction are highly discriminating between irritable bowel syndrome and peptic ulcer disease but less so between irritable bowel syndrome and inflammatory bowel disease.

Adolescent↗