Re: Urinary continence following radical retropubic prostatectomy. J. Ramon et al. Br. J. Urol., 71, 47-51, 1993.
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Humans↗
Biomedical subjects
D M Quinlan
Publications and source records attributed to D M Quinlan.
Can the mental representations of paranoid schizophrenics be differentiated from those of normals?
The study of mental representations on projective tests such as the Rorschach has made substantial contributions to our understanding of psychopathology. It is not clear, however, whether the representations of paranoid schizophrenics can be differentiated from those of normals and whether the Rorschach is the best test for such comparison. Object representations on the Rorschach and a role-playing (Johnson & Quinlan, 1980, 1985) test were studied in groups of normal (n = 31) and schizophrenic subjects (divided into paranoid [n = 16], intermediate [n = 11], and nonparanoid groups [n = 16]). Developmental levels of representation on both tests were measured with the widely used system of Blatt, Brenneis, Schimek, and Glick (1976), derived from Werner's concepts of differentiation, articulation, and integration. Generally the groups were not differentiated on these measures on the Rorschach. The role-playing test showed greater discriminatory power than the Rorschach, possibly due to its explicit demand to produce representations of humans in interaction. Results of the role-playing test showed differentiation and integration scores were negatively correlated with measures of psychotic symptoms. Non-paranoids differed from the other three groups on differentiation measures, and paranoid and normal groups scored higher on integration measures than did the intermediate and nonparanoid groups. Paranoid subjects scored higher than nonparanoids on functional articulation and higher than intermediates on perceptual articulation; however, paranoid subjects were not differentiated from normals on any developmental measure. Differences between the schizophrenic sample and normals were explained entirely by the non-paranoid subgroup, supporting the paranoid-nonparanoid distinction and raising questions regarding the nature of the deficit in paranoid schizophrenia.
Adult↗
Normative implications of the relationship between reading vocabulary and Boston Naming Test performance.
The 60-item Boston Naming Test (BNT) was published in 1983 with norms described as provisional. One recent finding (Thompson & Heaton, 1989) suggests that verbal intelligence, and the Wechsler Adult Intelligence Scale (WA1S)-Revised Vocabulary subtest, in particular, is strongly correlated with BNT performance, and that education is moderately so. High false-positive rates for naming deficit may conceivably result from the application of the published norms with subjects of lower verbal abilities or limited educational backgrounds. To further explore the relationship of naming to other verbal abilities, analyses were undertaken of the correlations between Level 7-9 Gates-MacGinite Reading Vocabulary Test (G-MRVT) and BNT data from 97 schizophrenic, bipolar, and normal subjects. Reading vocabulary is strongly correlated with BNT performance, and the nature of this relationship is essentially the same across the three diagnostic groups. Application of the published norms would have resulted in a high false-positive rate for naming deficit in all groups among subjects with reading vocabularies equivalent to twelfth grade or less. As a word-recognition based reading exercise, the G-MRVT is likely to provide a brain-compromise-resistant index against which the adequacy of naming performances can be assessed. Accordingly, G-MRVT based BNT performance expectation guidelines are presented for use as a complement to the published norms. Other implications are discussed.
Journal Article↗
Ipecac abuse in a sample of eating disordered outpatients.
Eight hundred fifty-one consecutive outpatients presenting at a suburban eating disorder clinic were evaluated for current or past ipecac abuse. A percentage (7.6%) of all subjects reported some use or experimentation with ipecac for purging; 4.7% had experimented with it briefly; 3.1% (8.8% of subjects meeting criteria for bulimia) had chronically abused ipecac; and 1.1% (1.5% of subjects meeting criteria for bulimia) were regularly abusing ipecac at the time of intake. Chronic ipecac abusers were more likely to have been hospitalized. Subjects who experimented briefly with ipecac had a longer duration of illness. Both chronic ipecac abusers and experimenters were more prone to abuse other substances for purging and to report alcohol abuse in an immediate family member.
Adolescent↗
A quantitative histological analysis of the dilated ureter of childhood.
A quantitative histological study of the dilated ureter of childhood was performed on 26 ureters. The specimens were from 15 male and 11 female patients 10 days to 12 years old (mean age 2.0 years). A color image analysis system was used to examine and compare collagen and smooth muscle components of the muscularis layers to normal control ureters of similar age. In comparing primary obstructed (12) to primary refluxing (14) megaureters and control ureters (6), there was a statistically different collagen-to-smooth muscle ratio (p < 0.001) between the primary obstructed and primary refluxing megaureter groups. For patients with primary refluxing megaureter there was a 2-fold increase in the tissue matrix ratio of collagen-to-smooth muscle when compared to patients with primary obstructed megaureter. In the primary obstructed megaureters the amount of collagen and smooth muscle was not statistically different from controls (p > 0.01). The increased tissue matrix ratio of 2.0 +/- 0.35 (collagen-to-smooth muscle) in the refluxing megaureter group compared to 0.78 +/- 0.22 in the obstructed megaureter group and 0.52 +/- 0.12 in controls was found to be due not only to a marked increase in collagen but also a significant decrease in the smooth muscle component of the tissue. Primary obstructed and normal control ureters had similar quantitative amounts of smooth muscle with 60 +/- 5% and 61 +/- 6%, respectively, while refluxing megaureters had only 40 +/- 5% smooth muscle. The percentage collagen was 36 +/- 5 in the obstructed megaureter group and 30 +/- 5 in controls, with refluxing megaureters having 58 +/- 5% collagen on analysis. Our findings emphasize the significant differences in the structural components (collagen and smooth muscle) of the dilated ureter of childhood, and provide us with further insight into the pathological nature of these dilated ureters and their surgical repair.
Child↗
Application of argon beam coagulation in urological surgery.
Argon beam coagulation is a new form of electrocautery that has proved useful to control diffuse bleeding in other surgical specialties. We report its application to urology. Three cases are presented in which argon beam coagulation provided excellent hemostasis in situations that are often difficult to control, such as partial nephrectomy for penetrating trauma, hemorrhagic cystitis refractory to other forms of treatment and after anterior exenteration for bladder cancer. The basis, technique and advantages of argon beam coagulation are discussed, as well as other instances in urological surgery in which it may have application. Argon beam coagulation is an alternative to conventional methods of hemostasis whenever there is a diffusely bleeding operative site.
Adult↗
Late massive hematuria as a complication of conservative management of blunt renal trauma in children.
The conservative management of blunt renal trauma in children is well accepted and well documented in the medical literature. The majority of children who sustain blunt renal trauma do well with such an approach. However, the complications of conservative management are also well documented. We present 2 patients with blunt renal trauma who were treated conservatively and suffered massive life threatening hemorrhage several weeks after the initial injury. Angiography was not performed until late and in both cases it identified the cause of bleeding. Percutaneous transcatheter embolization provided immediate definitive treatment in both patients.
Adolescent↗
Perceived-competence deficit in anorexia nervosa.
Anorexia nervosa patients are portrayed as competent and accomplished and yet they feel ineffective and diffident. The assessment of this aspect of their self-esteem presents methodological problems. The Interests and Abilities Questionnaire was designed to measure interests and perceived abilities in typical adolescent activities. The disparity between interests and perceived abilities--perceived-competence deficit (PCD)--was hypothesized to be characteristic of anorexics. Three groups of females, aged 14 to 24, were studied: 13 anorexic inpatients, 13 psychiatric inpatients without an eating disorder but of similar severity of illness, and 48 nonclinical subjects. Similar to the nonclinical controls, anorexics were interested in a variety of activities; similar to control patients, anorexics rated their abilities lower than nonclinical subjects. In PCD, anorexics scored significantly higher than both control groups; this difference was not related to level of depression.
Achievement↗
Psychometric properties of the Depressive Experiences Questionnaire for adolescents.
Items of the Depressive Experiences Questionnaire (DEQ) were rephrased and simplified to make them appropriate for younger subjects. This adolescent form of the DEQ (DEQ-A) was administered to high school students; a factor analysis revealed three factors that were highly congruent in female and male students and with the three factors of the original DEQ. Internal consistency as well as short- and long-term reliability for each of the 3 DEQ-A factors were at acceptable levels. Each factor correlated highly with its counterpart factor in the original DEQ, especially the Dependency and Self-Criticism factors. Correlations of the DEQ-A factors with other measures of depression essentially replicate relationships found between these measures of depression and the original DEQ for adults. The reliability, internal consistency, and validity of the DEQ-A indicate that it could be useful in studying depressive experiences in younger adolescents.
Adolescent↗
The analysis of descriptions of parents: identification of a more differentiated factor structure.
The analysis of spontaneous descriptions of parents has proven to be a valuable procedure for assessing an individual's perceptions of caring experiences with their parents. The procedure has been useful in a number of research investigations. Blatt, Chevron, Quinlan, Schaffer, and Wein (1988) revised the scoring procedures in a new manual for this procedure. This study examined aspects of the reliability and validity of this new scoring system. The parental descriptions of 134 female and 79 male students from two universities were scored using the revised manual. An analysis of ratings from the new scoring procedures lead to a differentiation of negative punitive items from positive ambitious items. Three factors and a Length factor emerged; the four factors accounted for 71% of the variance. Three factors-Benevolent, Punitive, and Ambitious-were correlated in meaningful ways with relevant scales of the Semantic Differential, the Zung Self-Rating Depression Scale (Zung, 1972), and the Depressive Experiences Questionnaire (Blatt, D'Afflitti, & Quinlan, 1976). The results provide construct validity for this new factor solution for evaluating the descriptions given by individuals of significant figures in their lives.
Journal Article↗
Nerve growth factor, nerve grafts and amniotic membrane grafts restore erectile function in rats.
In an effort to reduce complications arising from radical pelvic surgery, an improved technique for restoration of autonomic innervation has been developed. The ability of nerve growth factor (NGF) alone or in combination with interposition nerve grafts, as well as the use of fetal amniotic membrane as an alternative growth matrix to enhance regeneration of ablated cavernous nerves were investigated in rats. Rats with ablated cavernous nerve displayed little or no penile erection, either in response to direct electrical stimulation or to an estrous female rat. A step wise improvement in electrically induced erections was observed by NGF alone, nerve graft alone, and the combination of NGF and nerve graft. Restoration of sexual behavior followed the same pattern obtained with electrical stimulation. Furthermore, the use of neonatal amniotic membrane as an alternative nerve growth matrix enhanced both electrically stimulated erection and mating behavior. These results suggest that the use of NGF and appropriate grafting materials can facilitate autonomic nerve regrowth and potentially reduce the morbidity of surgically induced nerve injuries.
Amnion↗
Cavernous nerve grafts restore erectile function in denervated rats.
Although potency can be preserved in most men following radical prostatectomy, in some patients one or both cavernous nerves must be sacrificed in order to excise all tumor. For these patients we have considered nerve reconstruction at the time of surgery using an interposition nerve graft. This possibility has been tested in a rat model. Animals were divided into three groups. In the sham control group, a pelvic exploration was conducted without division of the cavernous nerves. In the nerve ablation group, a five mm. segment of cavernous nerve was excised. In the graft group, five mm. of cavernous nerve was excised bilaterally and replaced with an interposition graft of genito-femoral nerve. At one month intervals postoperatively animals from each group underwent mating tests to determine potency; the ratio of vaginal intromission to unsuccessful mounts (I/M ratio) was determined. Following the mating tests the animals were re-explored and attempts were made to stimulate erections electrically via the pelvic nerve. Results at two months show the I/M ratio of the rats with grafts (0.05) and the nerve ablations (0.14) are low compared with the sham operated animals (1.0). By month four the graft group (0.89) has approached the sham group (0.91) while the ablation group (0.18) remains unchanged (p less than .05). Electrical stimulation at month two produced no erections in the nerve ablated or the grafted rats and 100% erections in the sham-operated animals. At month four, 50% of the rats with grafts, 10% of the nerve ablated animals, and 100% of the intact animals produced erections upon electrical stimulation (p less than .05). These results suggest that cavernous nerve grafting in rats can be successful in restoring potency after surgical injury. Application of these techniques to man may be indicated.
Animals↗
Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles.
The influence of preservation or excision of the neurovascular bundles on return of sexual function is analyzed. Between 1982 and 1988, 600 men 34 to 72 years old underwent radical retropubic prostatectomy for prostate cancer. Of the 503 patients who were potent preoperatively and followed for a minimum of 18 months 342 (68%) are potent postoperatively. Three factors were identified that correlated with the return of sexual function: 1) age, 2) clinical and pathological stage, and 3) surgical technique (preservation or excision of the neurovascular bundle). In men less than 50 years old potency was similar in patients who had both neurovascular bundles preserved (90%) and patients who had 1 neurovascular bundle widely excised (91%). With advancing age of more than 50 years sexual function was better in patients in whom both neurovascular bundles were preserved than in patients in whom 1 neurovascular bundle was excised (p less than 0.05). When the relative risk of postoperative impotence was adjusted for age the risk of postoperative impotence was 2-fold greater if there was capsular penetration or seminal vesicle invasion, or if 1 neurovascular bundle was excised (p less than 0.05). These data indicate that the return of sexual function postoperatively in men more than 50 years old is quantitatively related to preservation of autonomic innervation. In these men when it is necessary to excise the neurovascular bundle on 1 side, consideration in the future should be given to approaches that may restore autonomic function through nerve regeneration, for example partial excision of the bundle or cavernous nerve grafts.
Age Factors↗
Use of the Benchekroun hydraulic valve as a catheterizable continence mechanism.
Problems with continence and access for catheterization with previous continent stoma techniques have led us to search for an alternate method. We report our initial experience with the Benchekroun hydraulic valve in 9 patients. Five patients underwent creation of an ileocolic bladder: for myelodysplasia in 1, after cystectomy for bladder cancer in 2 and for exstrophy in 2. Two patients underwent conversion from an uncatheterizable Indiana pouch because of exstrophy (1) and interstitial cystitis (1). Two patients underwent small bowel augmentation of a small, poorly compliant bladder with an abdominal Benchekroun stoma: 1 had exstrophy and 1 had myelodysplasia. Patient age ranged from 7 to 63 years. Two patients had de novo creation of an ileocolic bladder, whereas 7 had bladder or previous bowel conduits incorporated in the continent reservoirs. At up to 20 months of followup all patients had diurnal and nocturnal continence, and none had experienced serious long-term complications. Problems were encountered in 5 patients. One patient had a valve fistula that was surgically revised. One patient experienced transient difficulty with catheterization when the reservoir was overdistended and a false passage developed. Three patients had stomal stenosis and require periodic dilation. We believe the Benchekroun hydraulic valve to be a useful adjunct in the construction of a continent urinary reservoir. It is easy to construct, provides reliable continence and is easy to catheterize. Furthermore, it may be applied to standard ileocolic bladders either de novo or as a salvage procedure for failed efferent limbs.
Adolescent↗
The Benchekroun ileal valve.
In our hands, the Benchekroun hydraulic ileal valve has proved to be a very reliable continence mechanism. The patient is provided with a cosmetically acceptable stoma that creates diurnal and nocturnal continence and ease of catheterization. Stomal stenosis has occurred in several patients in our series and has been managed successfully with dilatation or minor surgical revision. The efferent limbs are readily accessed by endoscopic equipment, permitting treatment of stones and surveillance for malignancy. The need for surgical revision is moderate, as only 5 of 15 patients have required such intervention, compared with the revision rate of 58% with plicated ileal efferent limbs in our hands. The in situ Benchekroun technique represents an economy of time and energy, especially as a salvage procedure for failed plicated ileal limbs. Currently, the Benchekroun hydraulic ileal valve is our continence mechanism of choice.
Adolescent↗
Grossly neglected hematuria: a rare cause of iron-deficiency anemia.
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Adult↗
Improved technique for creation of ileal conduit stoma.
Creation of a circumferentially protruding urinary intestinal stoma is an important aspect to prevent stomal regression, stenosis and parastomal herniation. Furthermore, an improperly fashioned stoma may make fitting of an ostomy appliance difficult, resulting in urinary leakage with secondary dermatitis and incrustation. The major difficulty in fashioning the stoma is everting the mucosa over the intestinal mesentery. We describe our method of stoma formation that creates a circumferentially symmetrical protruding stoma free of tension that has been used successfully even in obese patients. This technique has made the use of a Turnbull stoma unnecessary in our recent experience.
Humans↗
Psychometric properties of the Depressive Experiences Questionnaire in a college population.
The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) was developed to permit the study of the continuities between normal and pathological forms of depression. Since its publication over 10 years ago, the DEQ has been increasingly used in a wide range of investigations of depression in clinical and nonclinical samples and as a measure of two major personality dimensions in a number of studies of differential responsiveness to various life stressors. This study provides an analysis of the DEQ responses in a large sample of undergraduate subjects in an attempt to articulate more clearly the psychometric properties of the DEQ. The DEQ consists of 66 items describing experiences frequently reported by depressed individuals. In the original development of the DEQ, factor analyses using male and female undergraduate samples yielded three orthogonal factors, Dependency, Self-Criticism, and Efficacy (Blatt et al., 1976). Most subsequent studies have used the factor scoring coefficients from the female sample to score men and women's DEQs. The factor loadings in the new male and female samples were very similar to one another and to the original female factor loadings. Thus, the continued use of the scoring parameters from the original female sample is recommended. Factor scores for Dependency and Self-Criticism continue to be uncorrelated in both men and women. Normative data are presented from the new samples, with men scoring higher on Self-Criticism and women scoring higher on Dependency.
Adult↗