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Biomedical subjects

J A Clark

Publications and source records attributed to J A Clark.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Married couples' perspectives on prostate cancer diagnosis and treatment decision-making.

Prostate cancer is a disease of men. But for married men, it is commonly and quite reasonably expected that their wives will be significantly involved in dealing with the disease and its treatment. Yet, there are few data on how wives perceive the diagnosis and their role in responding to it. This study explores men's and their wives' perceptions of the prostate cancer diagnosis and their role in treatment decision-making. We conducted separate focus group interviews with seven married men with metastatic prostate cancer and their wives. The accounts of receiving the diagnosis and deciding on treatment that were told by the men differed in significant ways from the stories told in the wives' groups. We found that many men do not share their prostate-related health problems with their wives and some men choose their treatment without much spousal consideration. Our findings suggest that physicians may be in a position to influence how men and their wives interact in reaching a treatment decision.

Aged↗
PubMedDate not supplied

Radiologic peroral gastrostomy.

PURPOSE: To develop an improved percutaneous technique for the insertion of large-bore gastrostomy tubes. MATERIALS AND METHODS: With use of fluoroscopic guidance, the stomach is punctured and the esophagus is catheterized in a retrograde fashion. A guide wire is passed from the gastrostomy site, up the esophagus, and out of the patient's mouth. A large-bore (20-24 F) endoscopic push-type gastrostomy tube is advanced over the wire, through the mouth, down the esophagus, and out of the gastrostomy site. RESULTS: Thirty-one successful tube placements were performed in 32 attempts (97% success rate). There were no major procedural or postprocedure complications. Minor complications included one lip laceration (one of 31 = 3%), one minor exit site infection (one of 31 = 3%), and two inadvertent tube dislodgements (two of 31 = 6%). CONCLUSIONS: Radiologic placement of large-bore endoscopic gastrostomy tubes is possible without endoscopy. The procedure is rapid, easy to perform, and safe.

Enteral Nutrition↗
PubMedDate not supplied

Viscoelastic behaviour of deformed spines under correction with halo pelvic distraction.

The applied tensile tractive force between skull and pelvis of the Halo Pelvic Distraction appliance has been measured using a simple compression spring device. Details of these external force measurements with daily distraction and correction of spinal deformity are illustrated for 10 patients which include tuberculous kyphoses, paralytic scolioses, and congenital and idiopathic scolioses. The relationships between applied load, time, amount of distraction, and extent of spinal curvature were studied in terms of the biomechanical proerties of elasticity and plasticity. A linear relationship exists between the total distraction distance and the reduction in the angle of the spinal deformity. For this correction procedure the rates of distraction, the total distraction amount, the total duration of the distractional period, and the maximum load depend on each individual spinal deformity with its particular peculiarities.

Adolescent↗
PubMedDate not supplied

Microcirculation in hypertrophic scars after burn injury.

Hypertrophic scar formation is a common complication after burn injury. Early active scars show hyperemic appearances that change as the scar matures. This is a report on microcirculation in hypertrophic scars after burn injury among 50 Chinese patients with a laser Doppler flowmeter. The average period of follow-up for the patients was 20 months. The microcirculatory response in scars to vasodilation (heat) stimulus was studied. Significant differences (p less than 0.0001) were demonstrated between scars of different clinical grades of maturity when compared with normal skin. The qualitative and quantitative differences in microcirculatory blood flow were correlated with site variations and different physiologic demands from different grades of scars. The study showed that laser Doppler flowmetry was useful in the clinical grading assessment of or for scar maturity.

Adolescent↗
PubMedDate not supplied

Glutamine supplementation of enteral nutrition: impact on whole body protein kinetics and glucose metabolism in critically ill patients.

BACKGROUND: Glutamine-supplemented parenteral nutrition has been reported to attenuate the early postoperative reduction in intracellular glutamine and improve protein synthesis and nitrogen balance. We investigated the effect of an enteral formula or protein and glucose kinetics and nitrogen balance in trauma patients. METHODS: The enteral formula (AlitraQ) provided a mean intake of 0.35 g of glutamine/kg body weight per day to 16 trauma patients and was compared with an isonitrogenous formula that provided a mean of 0.05 g of glutamine/kg body weight per day in 14 trauma patients. After 3 days of feeding, protein kinetics were measured using a 4-hour prime-continuous infusion of L-[1-13C]leucine. Glucose kinetics were measured during the same time interval using prime-continuous infusion of [U-14C]- and [6-3H]glucose. RESULTS: Nitrogen balance was not significantly different in the two groups. There were no significant differences in protein turnover, synthesis, and breakdown between the two groups. There were no significant differences in glucose turnover, oxidation, recycling, and percent of VCO2 from glucose oxidation between the two groups. CONCLUSIONS: Glutamine-enriched enteral formulas are well tolerated by the severely injured patient but provide no additional nutritional advantage compared with standard enteral formulas during the first 3 days of feeding immediately after trauma.

Adult↗
PubMedDate not supplied

Serial magnetic resonance imaging of hamstring anterior cruciate ligament autografts during the first year of implantation. A preliminary study.

A prospective, observational study was performed to document the serial changes in the magnetic resonance signal of devascularized, hamstring ACL autografts during the 1st year of implantation. Twenty-one ACL deficient knees (14 chronic, 7 acute) were reconstructed. Instability developed in five knees within the first 6 months of graft implantation (24%). Magnetic resonance examinations were performed at 1, 6, 12, 24, 36, and greater than 48 weeks postoperatively (repetition time 1500, echo delay time = 50). A total of 104 scans were reviewed (average, five per knee). The ACL graft was divided into four unequal size zones for analysis. The proximal, middle, and distal thirds of the intraarticular portion of the graft and the portion of the graft within the tibial tunnel were independently analyzed. The magnetic resonance signal in each portion of the graft was graded on a scale with (I) being a normal signal, (II) greater than 50% of the total volume of the graft having a normal signal, (III) less than 50% of the graft having a normal signal, and (IV) 100% of the graft having an increased signal. The increased magnetic resonance signal of the ACL graft was observed to be regionalized and confined to the distal two-thirds of the intraarticular portion of the graft. The portion of the graft exiting the femoral tunnel and within the tibial tunnel retained a normal magnetic resonance signal. The increases in magnetic resonance graft signal were time-dependent, became well established by 3 months, and remained unchanged at 1 year. The clinical outcome could not be predicted based on the magnetic resonance signal of the graft.

Adolescent↗
PubMedDate not supplied

A rationale for predicting anterior cruciate graft impingement by the intercondylar roof. A magnetic resonance imaging study.

This study was designed to analyze how anterior tibial tunnel placement can result in graft impingement by the intercondylar roof. The relationship of the ACL to the intercondylar roof was studied using magnetic resonance scans. An attempt was made to predict the amount of bone that may need to be removed from the intercondylar roof to prevent impingement on a 10 mm thick ACL graft. Magnetic resonance scans of 19 normal ACLs were analyzed. The amount of bone removal required to correct roof impingement was determined for a graft placed either eccentrically or centrally within the ACL insertion, and within the bulk of the normal ACL fibers. An eccentric tibial tunnel placement required approximately 5 to 6 mm and a central placement required 2 to 3 mm of bone removal from the intercondylar roof to prevent impingement. Placing the graft within the bulk of the ACL fibers, just 3 mm posterior to the center of the ACL insertion, required little bone resection to prevent impingement. To prevent ACL graft impingement, roofplasties need to be performed in both acute and chronic ACL reconstructions if the presently accepted locations for positioning the tibial tunnel are used. A more anteriorly placed tibial tunnel requires more bone removal to prevent roof impingement than a more posteriorly positioned tibial tunnel.

Adolescent↗