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Biomedical subjects

J Flowers

Publications and source records attributed to J Flowers.

At least 19 recordsLinked to original sources
PubMed2006

Sick individuals and sick populations: 20 years later.

Twenty years after Geoffrey Rose published his classic paper, the central messages remain highly relevant to modern public health policy and practice. The individual and population approaches are fundamentally different but both are needed. Recent examples of powerful population approaches prove Rose's point that norms can change benefiting the most deprived. Individual approaches have also succeeded but their protection of the most deprived communities is limited. Consumerism in health and over-reliance on individual approaches risk widening health inequalities.

Health Promotion↗
PubMed2001

Development of an ultrasonically activated trocar system.

BACKGROUND: Although rare, visceral and vascular injuries related to the insertion of conventional laparoscopic trocars may have disastrous consequences. Most of these injuries are due to the high puncture force applied to the trocar. We present the results of an animal laboratory evaluation of a newly developed ultrasonically activated trocar. METHODS: A total of 40 punctures were made in four pigs with an average weight of 53 kg. An 11-mmHg pneumoperitoneum was created through a Veress needle. A 10-mm diameter trocar was inserted in the midline for a laparoscope. A series of five trocars were then inserted on each lateral wall under laparoscopic control. Twenty punctures were made with a conventional reusable 11-mm trocar (CT) whose tip was sharp and conical. Twenty punctures were made with an 11-mm ultrasonically activated trocar (UT), whose fequency was 23.5 KHz and amplitude 150 mm. The cutaneous incision was made large enough so that the skin did not interfere with the trocar insertion. The force applied to the trocar was measured with a push-pull gauge connected to a computer. The following data were recorded: maximal force applied to the trocar to obtain insertion of the tip through the abdominal wall, maximum abdominal pressure increase during trocar insertion, and time for abdominal penetration. RESULTS: The average time needed for trocar penetration was 12.8 s with CT and 4.5 s with UT (p < 0.001). The average maximal force was 6.8 kgF with CT and 0.4 kgF with UT (p < 0.001). The average abdominal pressure increase was 7.6 mmHg with CT and 0.8 mmHg with UT (p < 0.001). At 30 days, no necrosis was found. Pathological findings were similar in both groups. CONCLUSION: Ultrasonically activated trocars required less time and much less force to be inserted. This may be a breakthrough in the safety of trocar insertion.

Animals↗
PubMed1999

A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy.

BACKGROUND: Laparoscopic donor nephrectomy (laparoNx) has the potential to increase living kidney donation rates by reducing the pain and suffering of the donor. However, renal function outcomes of a large series of recipients of laparoNx have not been studied. METHODS: We retrospectively reviewed the records of 132 recipients of laparoNx done at our center between 3/96 and 11/97 and compared them to 99 recipients of kidneys procured by the open technique (openNx) done between 10/93 and 3/96. RESULTS: Significantly more patients in the laparoNx group (25.2%) were taking tacrolimus within the first month than those in the openNx group (2.1%). Mean serum creatinine was higher in laparoNx compared with openNx at 1 week (2.8+/-0.3 and 1.8+/-0.2 mg/dl, respectively; P=0.005) and at 1 month (2.0+/-0.1 and 1.6+/-0.1 mg/dl, P=0.05) after transplant. However, by 3 and 6 months, the mean serum creatinine was similar in the two groups (1.7+/-0.1 versus 1.5+/-0.05 mg/dl, and 1.7+/-0.1 versus 1.7+/-0.1, respectively). By 1 year posttransplant, the mean serum creatinine for laparoNx was actually less than that for openNx (1.4+/-0.1 and 1.7+/-0.1 mg/dl, P=0.03). Although patients in the laparoNx compared to the openNx group were more likely to have delayed graft function (7.6 versus 2.0%) and ureteral complications (4.5 versus 1.0%), the rate of other complications, as well as hospital length of stay, patient and graft survival rates were similar in the two groups. CONCLUSION: Although laparoNx allografts have slower initial function compared with openNx, there was no significant difference in longer term renal function.

Adult↗
PubMed1998

Iron deficiency anemia due to a Brunner's gland hamartoma.

Brunner's gland hamartomas are rare benign duodenal tumors often discovered incidentally during endoscopy or on an upper gastrointestinal series. These tumors arise mainly in the duodenal bulb and can present with gastrointestinal bleeding or symptoms of intestinal obstruction. When symptomatic, surgical or endoscopic removal can be safely performed and the prognosis is very good. We describe a 63-year-old man presenting with iron deficiency anemia due to a large Brunner's gland hamartoma and review the endoscopic, radiologic, surgical, and pathologic findings.

Anemia, Iron-Deficiency↗
PubMed1997

Sex differences on the MMPI-1 and MMPI-2.

This study compared sex differences on the MMPI-2 to those previously found on the MMPI-1. Statistically significant differences were found with men (n = 66) showing higher mean raw scale scores on antisocial (men = 10.00, women = 7.15), authority problems (men = 4.58, women = 3.14), admission of addiction (men = 3.58, women = 2.74), amorality (men = 2.30, women = 1.61), and Type A (men = 8.24, women = 7.71). Women (n = 132) showed higher mean raw scale scores on Hypochondriasis. Depression, Hysteria, Paranoia. Depression subscale, N affection, Health Concerns, and Somatic Complaints. With a few exceptions, these general patterns are consistent with previous research.

Adult↗
PubMed1995

Sleep disturbance in mid-life women.

A correlational field survey was used to describe sleep disturbance and explore the relationship of that sleep disturbance to the psychological and menopausal status of 23 mid-life women. Subjects were 40-55 years of age and had self-reported sleep problems. Instruments included the sleep disturbance questionnaire (SDQ), Centre for Epidemiologic Studies depression scale (CES-D), Speilberger state-trait anxiety scale (STAI), a demographic form, 4 cc blood sample for follicle stimulating hormone analysis, and a 7-night sleep diary ('self report of sleep', or SRS). Ten of the 23 subjects reported periodic limb movement on the SDQ. Sleep diaries (SRS) revealed a characteristic sleep disturbance among 13 of the 23 subjects, which paralleled in some respects the changes in sleep efficiency observed with advancing age, but was more pronounced and was present at an earlier age. There was no statistically significant relationship between sleep disturbance and menopausal status or symptoms, or anxiety and depression among subjects, as shown by correlational coefficient and chi-square statistical tests. Results suggest that a characteristic sleep disorder accompanied by periodic limb movement may be responsible for sleep disturbance in mid-life women. What remains unclear is whether this sleep disturbance is related to aspects of the perimenopause not addressed in this study or to other aspects of ageing.

Adult↗
PubMed1993

Thoracoscopic sympathectomy.

With the advent of advanced video and laparoscopic techniques, new applications have been found for thoracoscopy's expanding role in thoracic surgery. Described herein are three cases of thoracoscopic sympathectomy for three different indications. The evaluation and surgical technique are described in detail. Thoracoscopic sympathectomy is an excellent alternative to open transthoracic approach.

Adult↗
PubMed1992

Laparoscopic management of acute and chronic cholecystitis.

Contrary to earlier predictions, it appears that acute cholecystitis should be considered a relative rather than an absolute contraindication to laparoscopic surgery. The most important parameter in determining the feasibility of attempting laparoscopic cholecystectomy in the setting of acute inflammation appears to be the experience of the surgeon. This also appears to be true when encountering individuals with elements of long-standing chronic cholecystitis. Although laparoscopic intervention in such patients is associated with a greater likelihood of conversion to open laparotomy, the incidence of major biliary and nonbiliary complications appears to be low. In addition, these patients enjoy the same benefits of laparoscopic surgery as those undergoing elective surgery.

Acute Disease↗
PubMed1988

Experimental repair of ventricular septal defects using autologous right ventricular muscle flaps: preliminary report.

Survival after repair of postinfarction ventricular septal defects remains poor, often due to extensive loss of contractile muscle in the septum or left ventricle. We evaluated whether a contractile flap of right ventricular muscle could be used to repair a similar ventricular septal defect to augment left ventricular performance in 7 fully instrumented mongrel dogs (weight, 23 to 28 kg). By using hypothermic bypass and cold fibrillatory arrest, a trapezoidal right ventricle flap was fashioned from the free wall of the mid to lower right ventricle, basing its widest portion anteriorly on the septum and left ventricle. A large, 2-cm-diameter core of septum was excised beneath this flap to simulate a postinfarct ventricular septal defect. The right ventricular flap was then invaginated through the defect and sewn to the left ventricular side of the septum with pledgeted sutures taken full thickness through the flap and septum in a "vest-over-pants" fashion. Contraction of the right ventricular flap was confirmed visually and by postbypass multiple gated acquisition scans. The right ventricular defect was closed with fascia lata. All dogs were weaned from bypass without inotropes. Precardiac and postcardiac outputs of 2.5 +/- 0.5 versus 2.3 +/- 0.4 L/min and left ventricular end-diastolic pressures of 4 +/- 2 versus 4 +/- 3 mm Hg were identical. No shunts were detected by oxygen saturation. Autopsies confirmed the integrity of the repair. We conclude that septal defects can be repaired by using contractile right ventricular muscle, thus preserving left ventricular function. This technique offers promise for repair of postinfarction ventricular septal defects by using autologous, already conditioned to contract, cardiac muscle, but its application in humans must await long-term testing.

Animals↗
PubMed1987

Mood, depressive illness and gait patterns.

This study measures the ground force patterns of 87 normal, older adults. It tests the hypothesis that there is a relation between a subject's mood as measured by the Beck Inventory, and the ground reaction forces as measured by a force plate during normal gait. Results showed that the push-off force in the posterior and downward directions was correlated with the expression of mood state. Lower mood individuals demonstrated a smaller push-off force and these ground force patterns of low mood state subjects resembled the patterns found in a previous study of clinically depressed patients. It is suggested that gait measurement could provide a sensitive index of level of depression in a clinical population.

Aged↗
PubMed1980

The epidemiology of poisoning from drug products.

On the basis of 24,487 telephone calls to a poison control center during a one-year period, the 12 most commonly ingested drugs (accounting for 2,417 calls) were selected for study. Each agent was analyzed on the basis of (1) age of the individuals involved, (2) frequency of overdose, and (3) signs, and symptoms, and severity. These findings have implications for the diagnosis and prevention of drug overdose.

Adolescent↗