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Biomedical subjects

B Palmer

Publications and source records attributed to B Palmer.

At least 37 records · Page 2Linked to original sources
PubMed1998

Primary reconstructive surgery with a sliding flap for carcinoma of the Bartholin gland.

Bartholin gland tumours are rare and therefore recommendations concerning management have been based on small series. Although there is a tendency today to perform less radical surgery, meaning hemivulvectomy or a wide local excision, the anatomical position of these tumours often leads to a large postoperative defect. The objective of this report is to present data on three patients but mainly to describe our surgical technique where a sliding flap obtained from the gluteal region is used for primary closure. This surgical procedure offers a functional and cosmetically acceptable vulva which is of importance considering the relative young age of patients with Bartholin gland tumours.

Bartholin's Glands↗
PubMed1997

Modifying repetitive verbalizations of community-dwelling patients with AD.

Seven caregivers of a home-dwelling spouse with Alzheimer's disease were trained during 12 weekly home visits to implement behavior management programs including written cuing procedures in response to repetitive verbalizations. Data from 7 trained caregivers and 7 matched control caregivers who only tracked repetitive behavior were compared. Results revealed that trained caregivers were successful at decreasing patient repetitions using written cues. Patients of control subjects showed no systematic changes in behavioral disturbances due to behavior tracking. In addition, intervention effects lasted for 16 weeks or longer and several caregivers reported applying the cuing intervention to other, nontargeted behaviors. Trained caregivers' perceptions of their efficacy in managing difficult patient behavior improved significantly at the 3-month follow-up assessment when program staff were no longer visiting them weekly.

Aged↗
PubMed1997

Regional glucose uptake within hypoperfused swine myocardium as measured by positron emission tomography.

Chronic myocardial ischemia and 2-[18F]fluoro-2-deoxy-D-glucose (FDG) uptake were studied with positron emission tomography in 12 swine instrumented with an external constrictor on the left anterior descending coronary artery (LAD). Serial changes in function (by echocardiography), blood flow (with H215O) and FDG were determined weekly. At 1 wk, function was normal and FDG uptake in the LAD and non-LAD regions was 0.43 +/- 0.12 and 0.45 +/- 0.11 mumol. min-1.g-1, respectively (not significant). At approximately 5 wk, LAD wall thickening decreased to 18 +/- 5 from 27 +/- 8% (P < 0.05), whereas LAD and non-LAD blood flows were 0.68 +/- 0.28 and 1.03 +/- 0.25 ml.min-1.g-1, respectively (P < 0.05). At that time, FDG uptake in LAD and non-LAD regions was 0.60 +/- 0.43 and 0.49 +/- 0.30 mumol.min-1.g-1, respectively (P < 0.05). By the use of transmural biopsies (n = 6), ATP and creatine phosphate in the LAD region were 3.62 +/- 0.73 and 5.91 +/- 1.44 mumol/g wet wt, respectively, and neither differed from values in remote regions. In this model of chronic ischemia, hypoperfused dysfunctional regions were characterized by enhanced glucose uptake and preserved bioenergetics. This supports the concept that the myocardium adapts to chronic ischemia.

Adenosine Triphosphate↗
PubMed1997

Quality assurance in plastic surgery: reduction mammaplasty.

Continuous quality assessment is essential to keep the quality of health care high as well as being a powerful educational tool. Good surgical and aesthetic results and high levels of patient satisfaction are clinical indicators of good quality plastic surgery. Breast surgery, particularly reduction mammaplasty, makes up a considerable part of plastic surgery. We have developed quality indicators of this procedure for objective evaluation of the surgical results in general, the different techniques, and the different surgeons. Consideration was taken of the patient's subjective assessment. Data were collected on the "Reduction mammaplasty quality assurance sheet." We find this form sufficient and easy to handle and we can recommend it for use by other plastic surgeons.

Adolescent↗
PubMed1996

Risk factors for orofacial and limbtruncal tardive dyskinesia in older patients: a prospective longitudinal study.

Although there is a consensus that orofacial and limbtruncal subtypes of tardive dyskinesia (TD) exist and may represent distinct pathophysiologic entities, few studies have examined the incidence of and risk factors associated with the development of these TD subtypes. Two hundred and sixty-six middle-aged and elderly outpatients with a median duration of 21 days of total lifetime neuroleptic exposure at study entry were evaluated at 1- to 3-month intervals. Using "mild" dyskinesia in any part of the body for diagnosis of TD, the cumulative incidence of orofacial TD was 38.5 and 65.7% after 1 and 2 years, respectively, whereas that of limbtruncal TD was 18.6 and 32.6% after 1 and 2 years. Preclinical dyskinesia was predictive of both orofacial and limbtruncal TD. History of alcohol abuse or dependence was a significant predictor of orofacial TD only whereas tremor was a significant predictor of limbtruncal TD only. Findings support suggestions that orofacial and limbtruncal TD may represent specific subsyndromes with different risk factors.

Aged↗
PubMed1996

Comparison of vascular effects of calcitonin gene-related peptide and lidocaine on human veins.

Arterial and venous constriction during microsurgery are among the leading causes of flap failure. So far, pharmacologic tools have been proposed only for arterial constriction, and local anesthetics are commonly used to counteract the vascular spasm. The purpose of this study was to investigate the vascular effects of two known arterial vasodilators on human veins, in order to evaluate the possibility of their potential use during microsurgery. In vitro experiments were performed on 31 greater saphenous vein (SV) rings obtained from 20 patients and on 12 cephalic vein (CV) rings from 7 patients. The rings were mounted in organ baths and their isometric contractile activity was measured. Experiments were conducted by cumulatively adding calcitonin gene-related peptide (CGRP) or lidocaine to the organ baths. The endothelium was mechanically removed in 18 SV rings and in 6 CV rings. Results demonstrated that in vitro CGRP produced vasodilation only; no constrictive effects were seen. Lidocaine produced a biphasic response with contraction at low concentrations (1.5 x 10(-5) M, 1.5 x 10(-3) M) and release of the maximal contraction at higher concentrations, similar to that observed in arteries. Removal of the endothelium did not significantly affect contractile activity in either CGRP- or lidocaine-treated vessels. The data supported the conclusion that CGRP could be used to relieve venous constriction, and it is suggested that further studies on the clinical use of CGRP in microsurgery is warranted.

Calcitonin Gene-Related Peptide↗
PubMed1996

Calcitonin gene-related peptide in experimental ischemia. Implication of an endogenous anti-ischemic effect.

Ischemia resulting from flap harvesting and vascular manipulation during microsurgery may be responsible for flap ischemic sufferance and, ultimately, necrosis. Recently, the regulatory role of the sensory nervous system in ischemia has attracted much interest. Calcitonin gene-related peptide (CGRP), a neuropeptide, is a naturally occurring vasodilator with no constrictive effects. In the present study, we developed a model of partial, chronic ischemia in the rat epigastric flap and investigated the effects of ischemia on concentrations of CGRP-like immunoreactivity (-LI) in ischemic skin and in different regions of the rat brain (striatum, hippocampus, pituitary, hypothalamus, and frontal and occipital cortex). A neurovascular island flap based on the superficial epigastric vessels was raised in 10 animals. Ischemia of the flap was obtained by ligating the feeding artery so that the blood flow was reduced to 25% of the normal circulation. An electromagnetic Doppler positioned on the artery was used to monitor the blood flow reduction. Ten nonoperated animals were used as controls. Ten days after the operation, CGRP-LI was significantly increased in five of six brain regions analyzed (striatum excepted). Significantly decreased concentrations of CGRP-LI were found in seven ischemic flaps, as opposed to the control group. In the remaining three flaps, no significant changes in CGRP concentration were observed. The highest blood flux values (detected using a laser Doppler) in the flaps correlated positively with the highest concentrations of CGRP-LI in the flap tissue. The results of the present study suggest that endogenous CGRP may be involved in the adaptive response to ischemia.

Animals↗
PubMed1995

Myocardial blood flow and FDG retention in acutely stunned porcine myocardium.

UNLABELLED: This study assesses regional differences in myocardial blood flow and 18F-fluorodeoxyglucose (FDG) retention in acutely stunned porcine myocardium. METHODS: Two groups of swine were used for these studies. In Group 1, 15 animals underwent stunning induced by 20 min of myocardial ischemia followed by reperfusion. Regional function was measured with ultrasonic crystals and myocardial blood flows were quantitated with radiolabeled microspheres. Within 2 hr postischemia, myocardial blood flow images were obtained with 15O-water, and FDG uptake was estimated with dynamic scanning. In a second group of five animals, PET scanning was performed 2 hr poststunning and repeated 24 hr later. RESULTS: In Group 1 animals, postischemic reductions were noted in both regional shortening and myocardial oxygen consumption. Myocardial blood flows at baseline were 0.72 +/- 0.05 ml/min/g in the LAD region and 0.83 +/- 0.07 ml/min/g in the non-LAD region; following reperfusion they were 0.70 +/- 0.07 ml/min/g and 0.89 +/- 0.08 ml/min/g, respectively. Within 2 hr of reperfusion, FDG retention was significantly lower in the LAD region compared with remote myocardium. As with Group 1, Group 2 also showed a reduction in FDG uptake in acutely reperfused myocardium relative to remote regions. Twenty-four hours later, FDG uptake within reperfused regions increased to 0.31 +/- 0.04 mumole/min/g and did not differ from remote myocardium. CONCLUSION: FDG uptake in acutely stunned swine myocardium is lower than remote regions at a time when regional myocardial blood flows are not dissimilar. This differs from 24 hr following reperfusion in which enhanced FDG uptake may be observed relative to perfusion. Therefore, the time course of metabolic changes following reperfusion needs to be considered in patients undergoing viability studies with PET.

Animals↗
PubMed1994

Task decision difficulty: effects on ERPs in a same-different letter classification task.

A "same-different" letter pair choice reaction time task was used to compare reaction time, performance accuracy, and P3 amplitude and latency at three levels of task difficulty. Stimulus set was held constant across tasks, and task difficulty was manipulated by instructions to the subject. Subjects delivered a button-press response to designate whether members of each letter pair matched or mismatched on the basis of their physical identity (low difficulty), name identity (medium difficulty), or category identity (vowels/consonants, high difficulty). Task decision difficulty was confirmed by slower reaction times and reduced response accuracy. P3 amplitude was inversely related to task decision difficulty; relatively larger P3s were associated with matched (vs. mismatched) letter pairs. These findings evidence direct effects of task difficulty on P3 amplitude, possibly as the result of "equivocation" related to more difficult task judgments.

Adult↗
PubMed1994

Effects of dobutamine stimulation on regional myocardial glucose uptake poststunning as measured by positron emission tomography.

OBJECTIVES: The aim was to determine whether dobutamine stimulation of energy expenditure within the postischaemic myocardium would affect regional differences in glucose uptake as measured by positron emission tomography (PET). METHODS: The metabolic rate of glucose uptake within the myocardium can be assessed with the glucose analog 18F-fluorodeoxyglucose (FDG). Stunning was induced in 14 anaesthetised pigs by partially occluding the left anterior descending coronary artery (LAD) for 20 min (> 80% flow reduction). The metabolic rate of glucose uptake was determined 2 h after reperfusion in the LAD and non-LAD regions in two groups: without (group 1; n = 7) and during (group 2; n = 7) a constant intravenous infusion of dobutamine (4 micrograms.kg-1.min-1). RESULTS: In all pigs, stunning reduced systolic shortening from 16(SD 4)% to 5(5)% (p < 0.05) and slightly lowered myocardial oxygen consumption, from 3.18(1.21) to 2.67(0.93) mumol.min-1.g-1 (p = 0.08). In the postischaemic LAD region of group 1, the metabolic rate of glucose uptake was significantly lower than the non-LAD region (0.11(0.08) and 0.43(0.33) mumol.min-1.g-1 respectively). In group 2, dobutamine induced a sustained increase in both fractional shortening (7(4)% to 16(5)%; p < 0.05) and oxygen consumption (2.34(0.94) to 4.53(1.52) mumol.min-1.g-1; p < 0.05) within the postischaemic LAD region. Despite recruitment of function and oxygen consumption in group 2, the metabolic rate of glucose uptake was similar to that of group 1 (0.11(0.09) and 0.40(0.28) mumol.min-1.g-1 in LAD and remote regions respectively). CONCLUSIONS: In this pig model of stunning, uptake of FDG was lower in stunned compared with remote myocardium and was independent of postischaemic changes in oxygen consumption and wall thinning. This supports the contention that after stunning, non-glucose substrates play an important part in maintaining energy expenditure during catecholamine stimulation.

Animals↗
PubMed1994

Cognitive functioning in a mildly to moderately depressed geriatric sample: relationship to chronological age.

The neuropsychological performance of three age cohorts of depressed patients (46-59, 60-69, and 70-85) was compared with the performance of age-matched control subjects to determine whether advancing age potentiates the effect of depression on cognition. Depression and increasing age did not interact to produce more pronounced cognitive deterioration in our unmedicated, medically healthy, well-educated outpatients diagnosed with mild to moderate major depression. Test findings suggest that presence of mild to moderate depression may result in premature "aging" of specific cognitive abilities (such as nonverbal memory, word generation, and categorization), but once the seventh decade is reached, cognition in depressed and nondepressed individuals appears to be comparable.

Age Factors↗
PubMed1994

Intradermal lignocaine injections increase blood cell flux but not flap survival in rats.

In four groups of six rats a random dorsal flap was raised, and 5, 20, or 200 mg/ml lignocaine or 0.9% sodium chloride, were injected intradermally. Cutaneous laser Doppler blood cell flux was measured at 12 time points over 130 minutes. In six other groups 5, 20, 100, 200, or 400 mg/ml lignocaine concentrations, or sodium chloride were tested. Blood cell flux was measured at the time that the flap was raised and 30 minutes after the injections. The area of the flap that survived was measured on day 10. Raising of the flaps resulted in a significant reduction in blood cell flux, which was followed by a significant increase at 10 minutes (p < 0.05) after the injections with all lignocaine concentrations tested. Injections of 5, 20 and 100 mg/ml lignocaine elicited a significant increase (p < 0.05) in blood cell flux compared with baseline values. There was no reduction in blood cell flux values at any concentration of lignocaine tested. Compared with sodium chloride, injections of lignocaine had no significant effect on flap survival. We conclude that, despite an increase in blood cell flux, lignocaine had no effect on flap survival in this model.

Animals↗
PubMed1993

Role of infection control practitioners in human immunodeficiency virus testing. APIC Bloodborne Pathogens Committee.

BACKGROUND: As a result of the HIV epidemic, the role of the ICP has changed; acute care settings have developed a variety of policies regarding patient and health care worker (HCW) HIV testing and issues related to the HIV-infected HCW. APIC conducted a survey to determine the extent to which ICPs were involved in HCW and patient HIV testing and counseling, the prevalence of routine HIV testing for patients, institutional policies on HIV testing of patients and HCWs, and the management of HIV infected HCWs. METHODS: In 1990, a questionnaire was sent to ICPs in a simple random sample of 1300 acute care hospitals (approximately 20%) in the United States. RESULTS: Response rate was 52.8%. Of the 686 respondents, 54.8% provided counseling to the HCW after an exposure incident. ICPs were involved not only in HIV testing and counseling for patients and HCWs but also in institutional policy development for HIV-related issues. Most facilities (73.8%) obtained written consent for testing from the patient after an employee exposure. When a direct care giver was known to be HIV positive, 61.5% of the respondents evaluated each case individually. CONCLUSIONS: The ICP has a significant role in the development and implementation of institutional policies on HIV testing and counseling and on the management of HIV-infected workers. These findings affirm the need for APIC to provide educational opportunities on the issues related to HIV testing and counseling.

AIDS Serodiagnosis↗