Background. Discordant physician-patient perceptions on health-related information have been related to less favourable health outcomes and increased use of health services. / Objectives. To develop a psychometrically-sound measure of physician-patient discordance that could be used by clinicians and researchers working with patients with various chronic diseases. To investigate the relationship between physician-patient discordance and patient adherence to self-care in inflammatory bowel disease. / Study design and population. A prospective cohort study with follow-ups at 2-weeks and 4-months was conducted between February and November 1999 at three gastroenterology clinics affiliated with the McGill University Health Centre. Ten physicians and 200 patients with inflammatory bowel disease participated in the study. / Methods. A 10-item visual analog scale questionnaire was developed which assessed perceptions of the patient's health status and of the clinical visit. Questionnaires were completed independently by physicians and patients following the index clinical visit. Discordance was calculated within physician-patient pairs. Demographic, clinical and psychosocial data were obtained prior to the visit. Patient adherence data were obtained at 2-weeks using a telephone interview and mail-back survey. General adherence was assessed with a visual analog scale; medication adherence was determined with a validated questionnaire. Medication data were obtained by chart review at 4-months. Multivariable generalized estimating equations models and mixed models for unbalanced repeated measures analysis of variance were used to determine associations between discordance and patient adherence. / Results. Satisfactory psychometric properties were obtained for discordance scores. Higher psychological distress was the most important determinant of higher discordance. Higher distress was correlated with active disease, less time since diagnosis, greater number and impact of negative life events. Higher satisfaction with social support reduced psychological distress by buffering the negative impact of perceived stress. Higher discordance on symptoms and treatment increased the risk of general nonadherence in patients with higher social support satisfaction. Medication adherence was associated with active disease, greater disease duration and scheduling another appointment. Higher discordance on well-being decreased the probability of medication adherence in non-distressed patients. / Conclusion. Preliminary evidence has been provided to support the validity of the new measure of physician-patient discordance. Higher discordance was associated with an increased risk of nonadherence in patients with healthy psychosocial characteristics.

Multiple Organ Dysfunction Syndrome (MODS) is the leading cause of mortality in Intensive Care Unit (ICU) patients. Although essential for host defense, the polymorphonuclear neutrophil (PMN) contributes to endothelial cell and end organ injury in disease states such as MODS. PMN chemotaxis and apoptosis are principally involved in neutrophil delivery and clearance, and their evaluation is performed with the goal of developing effective therapeutic intervention that would attenuate neutrophil mediated host injury. / To investigate the role of neutrophil membrane receptor expression in the regulation of neutrophil apoptosis and chemotaxis, human circulating PMN (venipuncture, healthy controls), exudate PMN (skin window skin blister) and septic PMN (venipuncture, patients with sepsis) were evaluated for apoptosis rates (flow cytometry), chemotactic function (Boyden chambers), and receptor expression (flow cytometry - Fas, FasL, TNFRI, TNFRII, IL-8RA, IL-8RB, C5aR). Experiments were coupled with a theoretical evaluation of the assumptions and clinical implications inherent to analytical research of the host response. / Following transmigration, exudate neutrophils demonstrate delayed constitutive and induced (TNF-alpha & Fas Ab) apoptosis. Decreased binding to TNF-alpha (not receptor expression) was found in association with decreased TNF-alpha induced apoptosis in exudate PMN. In contrast to circulating PMN, inhibition of protein synthesis in exudate PMN does not augment apoptosis; NF-kappaB does not mediate this effect as inhibition of NF-kappaB augments apoptosis in circulating and exudate PMN. Evaluation of chemoattractant receptors and chemotactic function revealed the following: exudate PMN displayed increased C5a receptors & C5a chemotaxis and reduced Interleukin-8 receptors (both IL-8RA & IL-8RB) & IL-8 chemotaxis. Septic PMN displayed reduced C5a & IL-8 receptors, and decreased C5a chemotaxis. These results suggest that alteration in chemoattractant receptor expression serves to regulate PMN chemotaxis in vivo, exudate PMN chemotaxis depends more on C5a than IL-8, and diminished chemoattractant receptors and chemotaxis in septic PMN may explain decreased PMN delivery in these patients. / Therapeutic interventions for patients with complex inflammatory disease states such as MODS remains elusive despite immense growth in understanding the mechanisms involved in the host response. To complement analytical research, the systemic host response to trauma, shock or sepsis may be evaluated as a complex system. (Abstract shortened by UMI.)

$ sp1$H NMR (1D and 2D) studies on human cerebrospinal fluid (CSF) are used to characterize normal CSF. Methyl malonic acid (MMA) is found (ca 154 $ mu$M) only in CSF from a vitamin B$ sb{12}$ deficient patient. / $ sp{31}$P NMR studies on the effects of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) on perfused SKI-1 glioma cells show a transient intracellular alkalosis of a similar magnitude, (0.13 $ pm$ 0.05) pH units, to that observed in vivo. This pH alteration may be related to Na$ sp+$ influx. / Multiple-quantum (MQ) filtered $ sp{23}$Na NMR experiments are described using the multipole formalism. A triple quantum filter (TQF;$ vert$3/2$>$ $ leftrightarrow$ $ vert-$3/2$>)$ is more selective for intracellular sodium (Na$ sp+ sb{ rm in})$ than the DQF$( vert$3/2$>$ $ leftrightarrow$ $ vert-$1/2$>$ and $ vert$1/2$>$ $ leftrightarrow$ $ vert-$3/2$>),$ under identical conditions, in human red blood cells. Studies on model solutions of bovine serum albumin (BSA) suggest that at constant ionic strength, the MQ filtered signal is directly proportional to the single quantum signal. Dysprosium tripolyphosphate, Dy(PPP$ sb{ rm i}) sb2 sp{7-},$ is used to discriminate between intracellular and extracellular Na$ sp+$ in neuroblastoma and human red blood cells.

No description available.

No description available.

No description available.

Adult articular cartilage of many species including humans has a limited capacity for repair following injury. The hypothesis that this might be related to a lack of responsiveness to growth factors involved in growth was investigated. Cartilage explants from 4 child and 5 adult human donors were cultured in the presence of various growth factors. Incorporation of $ sp{35}$SO$ sb4$ into proteoglycans and $ sp3$H-thymidine into deoxyribonucleic acid used as measures of the biosynthetic response of cartilage. / Young cartilage showed the ability to behave in an autocrine or paracrine manner to stimulate its basal biosynthetic rate. Immature chondrocytes respond well to somatomedin C (insulin-like growth factor, IGF-I) and insulin but there was no significant stimulation in old cartilage. This data suggests a specific loss of responsiveness to IGF-I in mature cartilage. However, adult cartilage was stimulated by IGF-I and insulin after prolonged incubation times. Adult cartilage could also be stimulated by the addition of fetal calf serum and to some degree by platelet derived growth factor, indicating that adult chondrocytes still have the capacity to respond to external stimuli. The relevance of these results is discussed.

Complications resulting in flap failure and tissue necrosis constitute a serious and frequent problem to the plastic surgeon. Oxygen derived free radicals have been implicated in a variety of pathological processes including the ischemia reperfusion injury (IRI) occurring in skin flaps. Previous work with experimental rat skin flaps has suggested that the xanthine oxidase (XO) enzymatic system may be the major source for these toxic radicals. Before the clinician and the patient can benefit from these experimental findings an animal model which closer resembles the clinical setting needs to be tested. In the laboratory I examined the role of XO and its potent inhibitor allopurinol in the IRI of skin and myocutaneous flaps. I have found negligible levels of XO enzyme in pig and human skin when compared to the rat. I have also found that no beneficial effect on survival could be observed by treating the flaps with several different dose regimens of allopurinol. Based on my results I conclude that it is unlikely that xanthine oxidase is of major importance in the IRI of skin flaps.

Dynamic muscle function was studied in human normal, pathological (rheumatoid arthritic, post-meniscectomy) and prosthetic knee joints. Function in the knee extensor and flexor muscles was defined from data derived from evaluations of joint motion, strength and electromyographic activity. Strength was measured during maximal voluntary isokinetic knee extension and flexion movements (torque-angle curves) at 30(DEGREES)/s, 90(DEGREES)/s, and 180(DEGREES)/s. Electromyograms (surface electrodes, rectified, time averaged) were recorded from five muscles of the lower extremity during knee movements in activities: gait, stair ascent and descent and chair rising and sitting. Analysis of the electromyographic activity emphasized the pattern, relative amplitude and coordination of activation in the different muscles. Using these methods of evaluation, characteristic deviations in functional dynamic capacity in the knee extensor and flexor muscles were described for the three patient groups. These data are applicable to the optimization of therapeutic approaches and to the improvement of prosthetic design.

There are many theories but little sound data available to explain cutaneous sensory mechanisms. The high frequency of traumatic peripheral nerve injuries and cutaneous reconstructive procedures offers the clinician a colorful spectrum of phenomena with altered sensibility; however, the processes underlying hyperpathic or paresthetic and false localization states still elude our understanding. This experimental work addresses the topic of cutaneous reinnervation subsequent to nerve injury at the trunk level or at the region of the skin receptors. For the first time, single afferent fiber recordings are utilized to study reinnervation in the glabrous skin of the primate following nerve crush and cut injury. Also for the first time processes of reinnervation of skin transplants are investigated by neurophysiological analysis. Finally, patterns of hairy skin reinnervation are addressed subsequent to nerve transection and repair.