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Biomedical subjects

E Dawson

Publications and source records attributed to E Dawson.

68 records · Page 4Linked to original sources
PubMed1982

Serum aluminum levels in dialysis dementia.

Serum aluminum concentrations were measured in 7 normal persons, 47 chronic hemodialysis patients and in 10 patients with the dialysis dementia syndrome. The concentrations were (mean +/- 1 SEM): 35 +/- 3.7, 109.3 +/- 10.6, and 369 +/- 51.6 micrograms/l, respectively. These results are consistent with the theory that aluminum is involved in the pathogenesis of this syndrome. In contrast to most previous reports dialysate contaminated with aluminum could not be implicated in our patients.

Aluminum↗
PubMed1980

Emotional disturbance and chronic low back pain.

Treated chronic low back pain patients (N = 102) in a university hospital clinic. Ss were given the EPI, the Recent LIfe Changes Questionnaire, and the Locus of Control Scale in order to isolate the principal dimensions of emotional disturbance in such patients and to see whether derived dimensions were related to response to conservative treatment for back pain. Self-report ratings of current pain intensity were obtained approximately 1 year after the start of treatment. Factor analysis revealed five factors: Distrust and alienation, somatic concern, vulnerability, extraversion, and social desirability; these accounted for 71% of the total variance among patients. Patients with above-average pretreatment distrust and alienation scores more frequently failed to return the follow-up form than patients with below-average scores. Low scores on somatic concern were related to good outcome. Results suggest that patients in alienation and distrust may be prone to be poor compliers. Because only the somatic concern dimension predicted outcome, a single scale that measures this characteristic may be sufficient for effective identification of the potential good vs. poor responders to conservative treatment of low back pain.

Adult↗
PubMed1979

The MMPI as a predictor of response to conservative treatment for low back pain.

Studies that used the MMPI to predict the response of chronic low back pain patients to standard medical treatment have not produced definitive results. Patients seen in a university hospital orthopedic back pain clinic were given the MMPI before treatment, and 6 to 12 months later 76 patients completed follow-up forms that indicated their level of intensity during the previous week and their ratings of the success of treatment in relieving their pain as well as in enabling them to return to normal activities. Predictions of poor response were made in terms of either single MMPI scales or code types. Patients with poor outcome on two of the three criteria (level of pain intensity and ability to return to normal activities) had significantly higher scores on the Hs scale. The predicted high risk code types very accurately identified patients with poor response on the same two criteria; however, the code-type procedure overpredicted poor response in the good outcome group.

Back Pain↗
PubMed1975

Metastatic carcinoid presenting as a spinal tumor.

A case of carcinoid tumor metastatic to the thoracic spine with associated myelopathy is described. Multiple posterior explorations were singularly unsuccessful in locating and indentifying the metastasis, but an anterior transthoracic exposure allowed identification of the tumor, removal of the osteoblastic epidural mass, and fusion of the spine with a rib graft. The patient's myelopathy improved steadily following surgery without evidence of tumor recurrence or regression of neurologic status. The reasons for the relative absence of central nervous system carcinoid metastases are not known.

Carcinoid Tumor↗
PubMedDate not supplied

Evaluation and analysis of patient outcomes with an intrasegmental fixation system in lumbar spinal fusion.

BACKGROUND CONTEXT: A new spinal fixation system with polydirectional screws and modular links with interconnecting radial serrations has been developed. The system allows the linking of multiple points of fixation, two points at a time (intrasegmental fixation), thus eliminating the need for intraoperative contouring of rods or plates. PURPOSE: Evaluation of this new type of spine system was done through biomechanical studies, analysis of lumbar lordosis preservation postoperatively, and multicenter review of patient outcomes with a minimum of 1 year follow-up. STUDY DESIGN/SETTING: Biomechanical studies of the spine system were performed according to American Society for Testing and Materials (ASTM) standards. To evaluate the maintenance of lordosis, radiographs from the first 119 patients were reviewed by the authors. Analysis of patient outcomes consisted of a review of the first 259 patients who underwent spinal fusion surgery with the new spine system. PATIENT SAMPLE: Evaluation of patient outcomes consisted of 122 men and 137 women with an average age of 50+/-13 years (range, 22-96 years) and a mean follow-up of 20+/-6 months (range, 12-54 months). The patient population was at high risk for fusion failure, with 127 smokers (49%), 141 who had previous spine surgery (54%), 22 with osteoporosis (8%), 63 were obese (24%), and 32 with diabetes (12%). One hundred two patients (39%) had a one-level fusion, 105 patients (41%) had two levels fused, and 52 patients (20%) had three or more levels fused. The majority of patients (66%) were covered under workers' compensation. OUTCOME MEASURES/METHODS: Radiographic fusion was deemed successful when the presence of trabecular bridging bone from transverse process to transverse process was observed, as well as no fixation failure nor radiographic evidence of screw loosening. Clinical success was rated excellent, good, fair, or poor depending on the patients pain level, function, and pain medication intake. RESULTS: Biomechanical studies of this intrasegmental fixation system have shown it to be strong under both static and fatigue testing, with exceptional strength in compression bending. In evaluating preservation of lumbar lordosis, no statistically significant loss of lordosis was observed. Overall, radiographic fusion was noted in 229 of 259 patients (88%) and did not differ significantly (p>.10) by the number of levels fused. Clinically, 69 patients (27%) had an excellent result, 111 patients (43%) had a good result, 50 patients (19%) had a fair result, and 29 patients (11%) had a poor result. The high rate of successful patient outcomes did not differ significantly (p>.10) by the number of levels fused, or other patient or surgical variables, except for the satisfaction level of workers' compensation versus nonworkers' compensation. One hundred of 118 patients (85%) who were working before surgery returned to work at an average 9+/-4 months postoperatively (range, 2-20 months). The use of direct current (DC) stimulation in this population was reserved for patients with one or more risk factors for fusion failure and was noted to be of benefit. There were no recorded intraoperative complications, but postoperatively 5 device and 19 non-device-related complications (9%) were noted, which is comparable to other lumbar fusion series. CONCLUSIONS: The results of these analyses show consistent patient outcomes regardless of the number of levels fused with an intrasegmental system. This may be attributable to the increased biomechanical strength of the system at each segment, coupled with the ability of intrasegmental fixation to maintain sagittal plane balance through preservation of the patient's lordotic curve.

Adult↗
PubMedDate not supplied

Health care administrator: heal thy organizational self.

Many problems in today's group practice marketplace exist because organizations are confused about what constitutes the "business" side of health care in relationship to its philanthropic past. Eugene Dawson Jr., Ph.D., examines some of these problem conditions and offers suggestions on coping with the changing environment.

Administrative Personnel↗
PubMedDate not supplied

Potency preservation following conformal radiotherapy for localized prostate cancer: impact of neoadjuvant androgen blockade, treatment technique, and patient-related factors.

PURPOSE: Impotence is a familiar sequela of both definitive external-beam radiotherapy (EBRT) and radical prostatectomy for localized prostate cancer. Among surgical options, nerve-sparing radical prostatectomy (NSRP) offers the highest potency preservation rate of 70%. We report the change in potency over time in an EBRT-treated population, determine the significantly predisposing health and treatment factors affecting post-EBRT potency, and compare age- and stage-matched potency rates with those of NSRP-treated patients. PATIENTS AND METHODS: Our results are from a retrospective study of 287 patients diagnosed with prostate cancer in clinical stages A to C and treated with conformal techniques to 6200 to 7380 cGy. Information regarding preradiotherapy potency, medical and surgical history, neoadjuvant antiandrogen use, and post-EBRT potency was documented for each patient. The median follow-up time was 34 months. RESULTS: At months 1, 20, 40, and 60, actuarial potency rates were 96%, 75%, 59%, and 53%, respectively. Factors identified as significant predictors of post-EBRT impotence include pre-EBRT partial potency, diabetes, coronary artery disease, and anti-androgen medication usage. Among treatment factors, a trend toward potency preservation was noted for the six-field versus the four-field technique. Finally, age- and stage-matched comparisons of potency rates for our population and NSRP-treated patients were performed. For patients older than 70 years, 60.9% of EBRT patients and 32.9% of NSRP patients remained potent after treatment. Overall, EBRT patient potency preservation was 71.3%, versus 66.2% for NSRP patients. DISCUSSION: Pre-EBRT partial potency, diabetes, coronary artery disease, and anti-androgen medication usage are significant predispositions to impotence in EBRT-treated prostate cancer patients. In comparing EBRT with NSRP for various age and stage groups, EBRT offers notably higher potency preservation rates than NSRP for patients older than 70 years.

Aged↗
PubMedDate not supplied

Beta-tricalcium phosphate delivery system for bone morphogenetic protein.

An aggregate of biodegradable beta-tricalcium phosphate and bone morphogenetic protein (BMP/TCP) induces the differentiation of cartilage within eight days, cartilage and woven bone within 12 days, and lamellar bone, including bone marrow, within 21 days. The yield of new bone from a 1-mg dose was more than 12 times greater from the TCP/BMP than from the BMP alone. Whether TCP acts as a slow-release delivery system, potentiates the activity of BMP, or serves to distribute BMP in a favorable three-dimensional pattern requires further investigation.

Animals↗
PubMedDate not supplied

Intertransverse process fusion with the aid of chemosterilized autolyzed antigen-extracted allogeneic (AAA) bone.

Forty intertransverse process spinal fusions were performed across two to three vertebrae in four cases of fracture-dislocations of the dorsolumbar region and 36 cases of degenerative joint and disk disease, including spinal stenosis and spondylolisthesis of lumbosacral segments. In all cases, arthrodesis was performed with a composite of AAA cortical bone strips and local autologous spongiosa, including lamellar bone chips. The iliac crest was not used as a donor site in any case. The apophyseal joints were erased, packed with autologous bone slivers, and transfixed with AAA bone pegs. In selected cases, AAA cortical bone "H-blocks" were also placed between the spinous process as in a routine posterior lateral arthrodesis. In cases of bilateral total laminectomy for fractures or spinal stenosis, the excised cancellous bone chips were cleaned of soft parts and transplanted across the transverse processes beneath and around the AAA cortical bone implants. In the above-described operations, graded by the Anatomic-Functional Economic (AEF) system, the long-term excellent and good results were: 4/4 in fracture dislocations; 23/28 in degenerative arthritis and spinal stenosis; 5/8 in spondylolisthesis. Overall, there were over 80% excellent and good results; the pseudarthrosis rate was 12%. In a comparable surgical procedure with autologous iliac bone in 58 control cases, reported in the foregoing article in this volume, the minimum pseudarthrosis rate was 8%. Raw band bone, either frozen or freeze-dried, is now either so infrequently considered or unavailable for lumbar spinal operations or unavailable for lumbar spinal operations that further investigations of AAA bone grafts are warranted in a statistically significant number of patients. Although autologous bone is the ideal bone for a graft, the most important incentive for further investigations of AAA bone is the avoidance of complications of excision of massive bone grafts from iliac crests.

Adolescent↗
PubMedDate not supplied

Giant-cell tumor of the second cervical vertebra treated by cryosurgery and irradiation.

A 17-year-old female presented with a large, destructive, giant-cell tumor of the second cervical vertebra. The lesion was obviously life-threatening. Owing to its proximity to the spinal cord and the danger of a pathologic fracture with cord transection and because of the effectiveness of cryosurgical methods in treating giant cell tumors of long bones, we decided to attempt local freezing of the lesion using a cryoprobe via a transoral approach. To further ensure tumor destruction, we followed cryosurgery with a course of radiotherapy (4600 rads). At this writing, 30 months later, healing has been excellent with no signs of recurrence, pain, tenderness or neurologic problems. To the best of our knowledge, this represents the first time a vertebral body bone tumor has been treated by cryosurgery.

Adolescent↗