Implants in children: the first two years of the South Australian Program.
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Adolescent↗
Biomedical subjects
J C Rice
Publications and source records attributed to J C Rice.
Preferential rejection of the kidney in a simultaneous kidney-pancreas transplant.
A case of selective kidney allograft rejection with stable pancreas function in a patient who received simultaneous kidney-pancreas allograft from the same donor is reported. Pancreas function was shown to be normal within the first month posttransplant by both a glucose tolerance test (despite a high corticosteroid dose) and stable urinary amylase values during biopsy-proven acute renal allograft rejection. This patient subsequently rejected his kidney allograft as documented by histopathologic evidence of severe chronic vascular rejection and acute tubulointerstitial rejection, yet his pancreas function remained intact. He subsequently received a six-antigen-matched kidney, continues to have normal fasting glucose and normal glucose tolerance by oral glucose tolerance test, and is without evidence of glucosuria. He has never had a clinical rejection of his pancreas, as evidenced by either a decline in urinary amylase or hyperglycemia, and has not required insulin except in the perioperative period of his second kidney transplant, at which time he was receiving high doses of both corticosteroids and cyclosporin. It is suggested that preferential rejection and subsequent loss of the kidney, although infrequent, do occur in combined renal-pancreas allografts and that maintenance of immunosuppression is justified until retransplant of kidney is available.
Adult↗
Myelomeningocele at the sacral level. Long-term outcomes in adults.
We reviewed the long-term outcome of thirty-six patients who had a myelomeningocele at the sacral level and whose average age was twenty-nine years (range, nineteen to fifty-one years). The patients were followed at our institution for an average of ten years (range, one to thirty-three years); however, the medical records from birth on were available for all of the patients. Instead of the expected outcome that function had been maintained in this group of patients, we found a decline in the ability to walk of eleven of the thirty-five patients who had been community ambulators initially. At the time of the most recent follow-up examination, five had become household ambulators, two were non-functional ambulators, and four were non-ambulators. The one patient who initially had been a household ambulator was a non-ambulator at the time of the most recent follow-up examination. A decrease in plantar flexion was found in fourteen patients and a decrease in plantar sensation, in fifteen. Breakdown of the skin and soft-tissue infections on the plantar surface of the metatarsal heads and of the heel were seen in twenty-seven and twenty-three patients, respectively, and were related to the absence of plantar sensation. Fifteen patients had osteomyelitis involving the lower extremity. Eleven patients had had a total of fourteen amputations: five involved one toe or more, four involved one ray or more, two were Syme amputations, and three were below-the-knee amputations. By the most recent follow-up examination, thirty-three patients had had a total of 371 orthopaedic procedures. The procedures included tendinous procedures; osteotomies; soft-tissue releases, transfers, and débridements; amputations; and arthrodeses of the lower extremities or spine.
Adult↗
Fasciotomy in vascular trauma: is it too much, too often?
Fasciotomy has been used as a prophylactic measure against development of compartment syndrome and as a treatment modality when the syndrome has developed in patients suffering vascular trauma. The hospital records of 36 patients who underwent surgical repair of their traumatic vascular injuries were reviewed. All 36 patients had at least one indication for fasciotomy at the time of repair; i.e., ischemic time of more than 6 hours or combined arterial and venous injury. Prophylactic fasciotomies were performed in 18 of the patients at the time of vascular repair; 18 did not have fasciotomies performed at the time of initial repair. The decision to perform a fasciotomy was made by the operating surgeon based on well-defined criteria. Hospital stay was significantly longer for the fasciotomy group. Four of the fasciotomy-related complications were infective in nature. Only one patient who did not undergo fasciotomy at the time of original repair developed a compartment syndrome during the postoperative period. Selective fasciotomy based on well-defined criteria instead of serial physical examinations or measurement of compartment pressures will effectively save limbs; there is an increased hospital stay.
Adolescent↗
The cochlear implant and the deaf community.
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Attitude to Health↗
Survey of fish and shellfish consumption by residents of the greater New Orleans area.
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Animals↗
Moonlighting in a university surgical training program.
The impact of house officer moonlighting on training performance was assessed through a faculty questionnaire and house officer survey distributed in the Department of Surgery at Tulane University School of Medicine. Responses were obtained from 30 house officers and 15 faculty members. Most house officers who moonlighted did so one or two times each month; most were employed in emergency departments. Yearly earnings from moonlighting averaged approximately $10,000. Although many house officers were in debt from medical school, debt was not the primary reason for moonlighting. Many faculty members disapproved of moonlighting, but agreed to monitoring by clinical performance and American Board of Surgery In-Training Examination. A statistically significant relationship was found between yearly income from moonlighting and decreasing scores on the American Board of Surgery In-Training Examination.
Attitude of Health Personnel↗
Venous insufficiency: a late sequelae of four-compartment fasciotomy in the lower extremity?
Four-compartment fasciotomies used to relieve abnormally high compartment pressures necessitate interruption of the ensheathing fascial membrane. In the calf, this is considered an important component in maintaining a viable musculovenous pump and preventing venous hypertension, a leading cause of venous insufficiency. Through postoperative physical examination and photoplethysmography evaluation of 47 patients who underwent this procedure, no indication exists that division of the fascial component leads to calf pump dysfunction and chronic venous insufficiency. Of the patients studied, 92 per cent had unchanged musculovenous pump function upon photoplethysmography reevaluation at 19 weeks compared with the initial values recorded 6 weeks postoperatively; 6 per cent had improved venous flow, while only one of the 47 (2%) had venous recovery measurements consistent with diminished venous flow.
Adolescent↗
Structural requirements for galanin inhibition of pentagastrin-stimulated gastric acid secretion in conscious rats.
The effects of rat galanin, together with a number of its N- and C-terminal fragments, on pentagastrin-stimulated gastric acid secretion were studied in conscious rats equipped with chronic gastric fistulas. Similarly to its porcine counterpart studied previously, at a dose of 3 nmol/kg per h rat galanin was a potent inhibitor of gastric acid secretion. The N-terminal fragments, rat galanin-(1-10) and -(1-15), retained about 60% of the inhibitory potency of the whole galanin sequence whilst the C-terminal fragments, rat galanin-(2-29), -(3-29) and -(9-29), were unable to produce significant inhibition over comparable dose ranges. Surprisingly, however, simply acetylating the alpha-amino group in position 9 of rat galanin-(9-29) restored almost full gastric acid inhibitory activity in a homologous rat model. We speculate that this could be due to a favorable conformational effect on the C-terminal region produced by alpha-acetylation. These results also suggest that structural features within either the N-terminal or C-terminal regions of rat galanin are able to elicit this particular biological response. One possible explanation for this could be the involvement of more than one rat galanin receptor having different ligand recognition requirements.
Animals↗
The effect of sex education on teenagers in St. Kitts and Nevis.
Knowledge of sexual matters is one of several key factors capable of influencing teenage reproductive behavior. This article reports the results of initial and followup surveys designed to test such knowledge among adolescent students in St. Kitts and Nevis before and after they received a family life/sex education course in the mid-1980s. This course provided information about fundamentals of human reproduction and contraception, human growth and development, emotional development, and issues of adolescent sexuality.
Adolescent↗
Infrainguinal revascularization for limb salvage in patients with end-stage renal disease.
We studied the efficacy of infrainguinal bypass for limb salvage in patients with end-stage renal disease. The patency of 42 femoropopliteal and femorodistal bypasses, performed for limb salvage in 37 patients with end-stage renal disease, was assessed with Doppler ultrasonography and dye tests. Patency rates and limb salvage were determined by life-table analysis. Average age was 45 years (range, 28 to 61 years); 23 of the 37 were men. Twenty-three patients had diabetes mellitus, and 16 were smokers. Bypass procedures were done in 32 instances while the patients were maintained with chronic hemodialysis and in five instances with peritoneal dialysis; in five instances the patients had had successful renal transplantation. Indications for revascularization included pain at rest, nonhealing ulcer, or distal gangrene. Femoropopliteal bypass was done in 32 limbs; 10 were more distal procedures. Reversed saphenous vein was the conduit in 30 cases; prosthetic material was used in the remainder. Autogenous material was used in all distal bypasses. Four patients required graft revision during the initial hospitalization, but none thereafter. Two patients died within the operative period, nine within 18 months of operation. Nine major operations were required. Three-month cumulative graft patency was achieved in 41 cases and corresponding limb salvage in 33 cases; 18-month patency was achieved in 34 cases and overall limb salvage in 33 cases. Success of limb salvage most closely correlated with preoperative ankle-brachial ratio and level of bypass required.
Adult↗
Distribution and elimination of [2-14C]amino-3,8-dimethylimidazo [4, 5-f] quinoxaline in mice. Analysis by whole animal autoradiography.
1. 2-Amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) is a potent bacterial promutagen and carcinogen, formed when beef is cooked. In mammals, MeIQx is metabolized and activated by liver enzymes, but induces tumours in both hepatic and extrahepatic tissues. 2. Intravenous administration of [14C]MeIQx and whole animal autoradiography has been employed to examine the disposition of MeIQx. Within 10 min, radiolabel was distributed throughout body tissue. Liver levels of radioactivity rapidly rose and remained elevated in comparison to other tissues, throughout the period of study (4 d). 3. At early time points radioactivity accumulated in the stomach, kidney and salivary glands then later in the intestine. Radioactivity was rapidly eliminated from the majority of tissues although did persist in liver and intestines throughout the duration of the study, probably due to covalently bound material. No radioactivity could be detected in the central nervous system, thus neither MeIQx nor its metabolites cross the blood-brain barrier to any significant extent. 4. The rapid elimination of radioactivity from the tissues is in good agreement with the time course of excretion of MeIQx. Irrespective of the route of administration (i.v., i.p., p.o.), a substantial proportion of the labelled material is excreted within 24 h and is present in both urine and faeces in similar quantities. 5. Thus MeIQx is extensively bioavailable, is distributed throughout body tissue and, although the majority is quickly cleared, some remains bound to liver and intestine.
Animals↗
The fabric dependence of the orthotropic elastic constants of cancellous bone.
It has been proposed that the orthotropic elastic constants of cancellous bone depend upon a tensorial measure of anisotropy called fabric as well as the tissue's structural density. Cowin (1985, Mechanics Mater, 4, 137-147; 1986, J. biomech. Engng 108, 83-88) developed explicit relationships for the elastic constant, structural density and fabric relationship. In this study the orthotropic elastic moduli, structural density, and fabric components were measured for 11 cancellous bone specimens from five bovine femora and for 75 specimens from three human proximal tibiae and fitted to these relationships using a least squares analysis. The relationships explained between 72 and 94% of the variance in the elastic constants. The relationships between the elastic constants and squared or cubed power functions of structural density had better predictive value over the entire distribution of the data than did expressions with linear functions of structural density.
Aged↗
Efficacy of home health care in patients with peripheral vascular disease.
This investigation was designed to study the effects of home health care (HHC) on patients who have been hospitalized with peripheral vascular disease. For a patient to have HHC, the patient had to have a defined wound, educational needs, or both. Sixty patients, 30 with HHC and 30 without, were contacted approximately 30 days after their last hospital discharge. The 30 patients with HHC were deemed to be at increased risk because of multisystem disease with multiple medications, infirmity, early senility, and often complex wounds. In a prospective fashion, each patient was interviewed by either a registered nurse or medical student using a standardized data collection form. The following issues were assessed: incidence of postoperative complications, knowledge of the patient of his or her disease, compliance with medication (knowledge of, regular use), incidence of readmission, and unscheduled clinic or emergency department visits. Upon statistical analysis using the two-sample t-test and Pearson chi-square test, no significant differences were found between the two groups in terms of complications, compliance, or patient education. HHC, therefore, was found to be helpful to patients with peripheral vascular disease. In our study, the use of HHC made the risk of complications in a group of patients with defined teaching needs and wound care needs equal to that in a group with no such defined needs on discharge from the hospital.
Chi-Square Distribution↗
Factors important to students in selecting a residency program.
A 22-item questionnaire, designed to assess the factors students considered important when they ranked residency programs, was distributed to the 1988 senior class of Tulane University School of Medicine just before the submission deadline of the National Residency Matching Program. Completed surveys were obtained from 111 of the 157 graduating students (approximately 71%) and were representative of the entire class in terms of sex, age, race, marital status, and anticipated field of specialization. Results of this investigation suggest that the satisfaction of a program's house officers and the seniors' general impression at the interview were the most important selection factors of the matriculating seniors surveyed. Diversity of the training experience and geographic location were also important selection factors. House officer benefits and salary were low-priority factors in the seniors' program selections.
Career Choice↗
Asymmetries of sleep spindles and beta activity in pediatric EEG.
Unilateral suppression of beta activity, unilateral suppression of sleep spindles, and unilateral delta slowing on EEG have not been previously compared regarding accompanying neuroradiological (NR) and clinical neurological (CN) findings in children. We studied EEGs in children under age 10 years with unilateral beta suppression (n = 80), spindle suppression (n = 51) or unilateral delta slowing (n = 49). There were no significant differences between the three groups of abnormal EEGs in their relationships with NR and CN. Unilateral suppression of sleep spindles and beta activity are at least as accurate as focal slowing in lateralizing NR and CN findings.
Beta Rhythm↗
Patient compliance with fitted compression hosiery monitored by photoplethysmography.
This study assessed the compliance useage and impact by monitoring of graded compression hosiery in chronic venous disease. Diagnostic methods, such as qualitative photoplethysmography (PPG), have enabled the physician to assess deep-vein valvular incompetence earlier and begin specific treatment measures to slow the progression of symptoms. This study group, comprised of 100 patients, was diagnosed initially with deep-venous thrombophlebitis and evaluated by phleborrheography and PPG at three-month intervals for one year. The patients were instructed to wear fitted, graded compression hosiery after hospital discharge; compliance was 37% at one year. The primary reason for noncompliance was socioeconomic. The price of the ideal graded compression hosiery was not easily within reach of this population and insurance reimbursement was difficult or impossible to obtain. Complaint patients felt better while wearing the compression hosiery. Increasing deterioration of qualitative PPG values of deep-valve assessment was found in both compliant and noncompliant patients at each testing interval. The PPG value deteriorated as time increased with or without the compression hose, although symptoms lessened when the prescribed hosiery was worn. The long-term sequelae of wearing or not wearing the hosiery are yet to be determined, but PPG assessment is normalized with the hosiery in place.
Adult↗
Primary repair vs. colostomy for the treatment of penetrating colon injuries.
The charts of 81 consecutive patients with penetrating colonic trauma were reviewed. Sixty-five patients were considered for evaluation. Penetrating abdominal trauma index, associated injuries, length of operative procedure, wounding agent, length of hospital stay, method of treatment, and septic complications were evaluated. Twenty-eight patients were treated with colostomy at the site of injury: five with diverting colostomy proximal to repair, 30 with primary repair (either single or multiple injuries), and two with exteriorization and early drop back. Overall septic morbidity was 15 of 65 (23 percent) patients. No statistically significant difference was found in morbidity between colostomy, 9 of 33 (27 percent), and primary repair, 6 of 30 (20 percent). The two patients with exteriorized repairs had no morbidity. No deaths were reported among the 65 patients studied. Thirty-two of the 33 (97 percent) colostomies were later closed with morbidity in 7 of 32 (22 percent). The mean length of stay for primary repair patients was 10.3 +/- 2.8 days and for colostomy patients, 25.7 +/- 3.8 days, counting days for both initial and colostomy closure admissions (P less than .05). Colostomy was not mandated by anatomic location or number of colonic injuries, circumference of colonic wall involved, presence of fecal contamination, or involvement of mesenteric blood supply. This study indicates that primary repair does not carry an increased risk of septic complications and saves the patient the significant risk and increased hospital stay of colostomy closure. Prospective studies addressing this area are indicated.
Adult↗