Search PubMed⌕ Search

Biomedical subjects

J Fowler

Publications and source records attributed to J Fowler.

At least 73 records · Page 4Linked to original sources
PubMed1994

A study of chromium induced allergic contact dermatitis with 54 volunteers: implications for environmental risk assessment.

Over the past 60 years, dose-response patch test studies by various methods have been conducted in an attempt to identify the minimum elicitation threshold (MET) concentration of hexavalent chromium (Cr(VI)) that produces an allergic response in Cr(VI) sensitive subjects. These data are not adequate, however, to provide an accurate estimate of the MET because of the variability in the patch testing techniques and the variability in diagnostic criteria used. Furthermore, the data were not reported in terms of mass of allergen per surface area of skin (mg Cr/cm2-skin), which is necessary for conducting occupational or environmental health risk assessments. Thus the purpose of this study was to determine the MET (mg allergen/cm2) for Cr(VI) and trivalent chromium (Cr(III)) by patch testing techniques. A patch test method that delivers a controlled amount of allergen per surface area of skin was used. A group of 54 Cr(VI) sensitised volunteers were patch tested with serial dilutions of Cr(VI) and Cr(III) to determine the cumulative response rate at several concentrations. The results indicate that the 10% MET for Cr(VI) based on the cumulative response was 0.089 micrograms Cr(VI)/cm2-skin. Only one of the 54 volunteers may have responded to 33 micrograms Cr(III)/cm2-skin, otherwise Cr(III) was unable to produce allergic contact dermatitis in these highly sensitive volunteers. Two supplemental studies were also conducted to assess whether the surface area of the patch and the concentration of Cr(VI) in the patch (related to patch thickness) were likely to influence the results. The data from these studies were used to assess the risk of developing allergic contact dermatitis due to contact with Cr(VI) and Cr(III) in soil. The findings indicated that soil concentrations at least as high as 450 ppm Cr(VI) and 165,000 ppm Cr(III) should not pose an allergic contact dermatitis hazard for at least 99.99% of the people in the community who might be exposed.

Adult↗
PubMed1994

In vitro adsorption of dichlorvos and parathion by activated charcoal.

Accidental and suicidal ingestions of organophosphate compounds continue to be a common occurrence in Turkey. Activated charcoal administration without gastric emptying has been advocated as primary therapy in most acute poisoning cases, although some references do not recommend activated charcoal use in organophosphate poisoning. This study was performed to determine the in vitro adsorption of dimethyl dichlorovinyl phosphate (dichlorvos) and parathion by activated charcoal over a wide range of charcoal:organophosphate ratios (1:1, 2.5:1, 5:1, 10:1 and 20:1, g:g). The charcoal binding ability of dichlorvos and parathion were studied in both pH 1.2 and pH 7 environments. The supernatant was extracted with n-hexane and then analyzed by gas chromatography. Each incremental increase in charcoal dose increased the percent adsorption of dichlorvos and parathion. At the 20:1 ratio, 82.8 +/- 2.0/87.3 +/- 2.9% (pH 1.2/7.0) of dichlorvos and 59.3 +/- 4.5/64.5 +/- 6.1% (pH 1.2/7.0) of parathion were bound by activated charcoal. There were no significant differences in amounts of compound bound in the acid and neutral solutions. Large doses of activated charcoal effectively bind dichlorvos and parathion in vitro. In vivo research should be performed to determine activated charcoal's role in organophosphate poisoning cases.

Adsorption↗
PubMed1994

A welcome focus on a key relationship. Using Peplau's model in palliative care.

1. Nurses involved in an area of nursing where the nurse-patient relationship is significant would be well advised to review Peplau's work. 2. Peplau sees this relationship as a dynamic one and identifies four phases which interlock and overlap. 3. A significant similarity between the writings of Peplau, Murray Parks and Kubler Ross is the acceptance that the patient/relatives go through a process which has recognisable parts and that nurses can have a significant influence on whether it is a positive or negative experience.

Humans↗
PubMed1994

Modeling past, current, and future time in medical databases.

Recent research has focused on increasing the power of medical information systems by incorporating time into the database system. A problem with much of this research is that it fails to differentiate between historical time and future time. The concept of bitemporal lifespan presented in this paper overcomes this deficiency. Bitemporal lifespan supports the concepts of valid time and transaction time and allows the integration of past, current, and future information in a unified model. The concept of bitemporal lifespan is presented within the framework of the Extended Entity-Relationship model. This model permits the characterization of temporal properties of entities, relationships, and attributes. Bitemporal constraints are defined that must hold between entities forming "isa" hierarchies and between entities and relationships. Finally, bitemporal extensions are presented for database query languages in order to provide natural high-level operators for bitemporal query expressions.

Information Systems↗
PubMed1994

Collaborative Social and Medical Service System.

This paper describes the Collaborative Social and Medical Services System, a robust information infrastructure for integrated social and medical care. The Collaborative Social and Medical Services System design and architecture address the primary goals of creating a readily extensible social and ambulatory care system. Our initial step toward reaching this goal is the delivery of an application supporting the operations of the Baylor Teen Health Clinics. This paper discusses our prototype experiences, system architecture, components, and the standards we are addressing.

Adolescent↗
PubMed1994

How accurate is the pelvic examination as compared to transvaginal sonography? A prospective, comparative study.

Findings at pelvic examination in 120 patients were compared to those obtained by transvaginal sonography (TVS). Overall, 102 of 472 (22%) pelvic examination assessments did not agree with the TVS findings. Twenty-nine (36%) uterine assessments differed, while 46 (32%) ovarian assessments differed. Among 37 pelvic masses assessed in 20 cases (54%) the pelvic examination differed from the findings obtained by TVS. Only 4 (29%) cases assessed by pelvic examination were in agreement with the laparotomy findings as compared with 10 (71%) cases assessed by TVS.

Adolescent↗
PubMed1994

Flow characteristics in benign and malignant gynecologic tumors using transvaginal color flow Doppler.

OBJECTIVE: To assess flow characteristics of benign and malignant gynecologic tumors by transvaginal color flow Doppler. METHODS: Records of the Ultrasound Laboratory, Women's Cancer Center, University of Minnesota were analyzed retrospectively. Gray scale findings were recorded as either "diagnostic" or "nondiagnostic." Color flow assessment was performed on intratumor vessels or ovarian and/or uterine arteries. Flow was recorded as either "absent" or "present." Spectral analysis allowed determination of the systolic, diastolic, and mean velocities and calculation of the pulsatility and resistance indices. Malignancy was then predicted based upon color flow findings alone, with malignant tumors demonstrating increased color flow and a pulsatility index of at most 1.0 or a resistance index of at most 0.4. Color flow Doppler findings were then recorded as "giving additional useful information" that either confirmed questionable gray scale findings or changed the gray scale sonographic diagnosis, or as "not giving additional information" over the gray scale diagnosis. RESULTS: Two hundred thirty-one patients had gray scale sonography, and 167 also had color flow Doppler performed. Gray scale sonographic findings were sufficient to make a diagnosis in 156 (93%) of the scans. Color flow Doppler findings added useful information in 49 scans (30%). Increased color flow was highly significant (P < .0001), as was the calculated pulsatility index (P < .02) and resistance index (P < .008), in distinguishing benign from malignant tumors. Ovarian and uterine artery and intratumor assessments of the systolic, diastolic, and mean velocities were not significantly different between the benign and malignant tumors. Regression analysis confirmed the presence or absence of color flow as an independent predictor of malignancy or benignity (P < .0001). CONCLUSIONS: Our large study confirms the overall accuracy of gray scale scanning. When used alone, color flow Doppler--although specific--lacks sensitivity and predictive value as an independent predictor of malignancy. When findings were combined with those obtained from gray scale scanning, sensitivity, specificity, and predictive value were improved to acceptable levels. Significant differences existed between benign and malignant tumors for calculated pulsatility index and resistance index, but neither was sufficiently sensitive, specific, or predictive to be used alone as sole criteria of malignancy prediction. Other flow indices studied (systolic, diastolic, and mean velocities) in general did not differ significantly between groups. Physicians should be cautioned against using color flow findings alone for clinical decision making. We recommend a multi-institutional study to investigate the multiple vascular assessments to determine the role of color flow Doppler in the preoperative prediction of pelvic tumors and in screening for gynecologic abnormality.

Adult↗
PubMed1993

Invasive vulvar tumors in young women--a disease of the immunosuppressed?

Twenty-seven patients under the age of 40 years were treated for invasive vulvar cancer at the Women's Cancer Center, University of Minnesota. Seventeen patients had Stage I, five patients had Stage II, two patients had Stage III, and two patients had Stage IV disease. Twenty patients (80%) gave a history of smoking. Associated medical and immunosuppressive conditions present in these patients included vulval HPV (N = 3), diabetes mellitus (N = 3), pregnancy (N = 2), autoimmune connective tissue disease (N = 2), renal transplant (N = 2), previous chemotherapy for invasive malignancies at other sites (N = 1), chronic hepatitis (N = 1), schizophrenia (N = 1), and one patient on Imuran for herpes zoster and multiple sclerosis. Two of the nonsmokers were in this group of immunosuppressed patients. Three patients have died of intercurrent disease while another is currently alive with invasive disease. All others are alive without evidence of disease. The mean duration of follow-up is 45.2 months (range, 1-158 months). Invasive vulvar tumors are uncommon in young women. Smoking and a history of an immunosuppressive medical illness is common in this patient population.

Adult↗
PubMed1993

The use of video cameras in one college of nursing.

The use of video cameras in nurse education is reviewed and a small scale investigation into the usage of video cameras in one medium-sized college of nursing and midwifery is described. It was found that only 3% of staff had used a video camera more than six times a year. On these occasions the camera was used primarily to record student role play. Analysis and discussion of the respondents' use and suggested use of the video camera is included.

Education, Nursing, Baccalaureate↗
PubMed1993

Two vascular complications of the Ehlers-Danlos syndrome.

Patients with Ehlers-Danlos syndrome type IV have thin walled, friable arteries and veins and are prone to spontaneous arterial rupture. We present a patient who suffered severe damage to the common femoral vein during surgery for varicose veins and who subsequently suffered a spontaneous rupture of the right external carotid artery, treated by ligation and oversewing. Intraarterial radiology and surgery in such patients are hazardous and should be avoided if possible. Where operation is essential, the simplest available procedure should be performed. Patients should be counselled to inform every doctor they consult that they have the Ehlers-Danlos syndrome.

Adult↗
PubMed1993

Age-related digoxin-alprazolam interaction.

A case report of dramatic increases in serum digoxin levels after alprazolam administration prompted our investigation. Twelve inpatients receiving long-term digoxin (0.25 mg daily) randomly received oral administration of either 1.0 or 0.5 mg alprazolam per day for 7 days. In each dosage group, three patients were older than and three were younger than 65 years of age. The area under the concentration-time curve for serum digoxin increased significantly in patients receiving 1 mg alprazolam daily, and this increase was more pronounced in patients older than 65 years of age. Clinical digoxin toxicity developed in one elderly patient who was receiving 1 mg/day alprazolam.

Aged↗
PubMed1993

Screening for cervical cancer. Current terminology, classification, and technique.

The Pap smear is one of the most successful of the screening tools for cancer. However, refinements are continually being made in the terminology used to define the gradations of disease, in the classifications used to describe test results, and in the appropriate technique for performing the test. Dr Fowler offers these guidelines to keep you up to date on the current state of cervical cancer screening methods.

Colposcopy↗
PubMed1993

Persistent postmolar gestational trophoblastic disease: use of transvaginal sonography and colour flow Doppler.

Invasive moles have been difficult to diagnose except at hysterectomy. Many patients with persistent gestational trophoblastic disease (GTD) have been treated without ever demonstrating the site of the persistent trophoblastic focus. High resolution transvaginal sonography (TVS) has provided a technique of demonstrating very small uterine lesions, previously unsuspected by transabdominal sonography. The addition of colour flow Doppler further increased diagnostic sensitivity and provides another means of monitoring response to therapy. Three patients with persistent GTD, scanned by TVS and CFD (colour flow Doppler) performed as part of their metastatic work-up are presented. The only abnormalities detected were foci demonstrated within the myometrium that demonstrated increased flow on CFD. Single agent chemotherapy was commenced and the patients were monitored periodically through their course with repeat ultrasonography. After an initial lag period, the lesions decreased in size as the beta-HCG titres fell. An unsuspected adnexal mass was diagnosed on 1 patient, later proving to be a mature ovarian teratoma.

Adult↗
PubMed1993

Detection of significant abnormalities on lumbar spine radiographs.

The purpose of this study was to determine the proportion of significant abnormalities detected on anteroposterior (AP) and lateral radiographs of the lumbar spine when viewed separately, in a series of cases where the prevalence of abnormalities had been artificially increased. Five radiologists of varying experience were required to report separately on the AP and lateral films of 300 cases in which randomly included were 30 cases with metastatic disease, a disc infection or an inflammatory spondylitis. At a later date, unaware of their initial observations, the radiologists repeated the exercise reviewing all the films together. As might be expected the false positive rate was relatively high, particularly in the least experienced radiologists' responses. Nevertheless the overall results indicate that the majority of early inflammatory spondylitis cases will be missed on a solitary lateral film as will many of the metastases. Conversely, fractionally more of the disc infections were observed on the lateral film than on the AP. Further analyses in terms of sensitivity, specificity, positive and negative predictive values are presented. The authors conclude that it is preferable to reduce the overall number of lumbar spine examinations performed, by adherence to accepted guidelines, than to prejudice the detection of significant, albeit rare, abnormalities by restricting the routine series of radiographs.

Discitis↗
PubMed1993

Acute poisoning in Izmir, Turkey--a pilot epidemiologic study.

Epidemiologic data on poisonings in Turkey are extremely limited. This is a retrospective chart review to describe the prevalence of poisoning in both adults and children, the presenting clinical features, morbidity and mortality to identify how poisoning in Izmir follows the pattern of other countries and how it is unique. Three hundred sixty-five poisoned patients presented to the Dokuz Eylül University Hospital, Ismir in 1989 to 1990. The distribution frequency of substances ingested reflects that of substances available in the home. Poisoning episodes in small children were most likely to involve hydrocarbons, analgesic, caustics or pesticides (55%). Ethanol, anticonvulsants, tricyclic antidepressants, and pesticides (55%). Ethanol, anticonvulsants, tricyclic antidepressants, and pesticides were the most common toxins seen in adults. A significant number of patients presented late in the course of their poisoning. Of those ingesting pharmaceuticals, mushrooms or plants, emesis, but no other modes of decontamination, was reported for 21%. Toxin "antidotes", gastrointestinal decontamination and enhanced drug removal techniques used in other parts of the world were rarely utilized. Nonetheless, only three patients (0.8%) died. This pilot study supports the need for a Regional Poison Information Center offering poison management advice to the general public as well as to members of the health care professions, the initiation of a public education campaign, and regional treatment by physicians trained in medical toxicology.

Adolescent↗
PubMed1993

Transvaginal color flow Doppler sonography in the assessment of gestational trophoblastic disease.

The aim of this study was to evaluate the blood flow characteristics of the uterine artery and intratumoral vessels in patients with GTD. Twelve patients with GTD were evaluated with TVS, and 11 also had CFD sonography performed. Spectral analysis of both uterine artery and samples intratumoral and intramyometrial vessels revealed systolic frequencies and PI that were significantly higher in the uterine artery than in sampled intratumoral vessels (P < 0.05). Uterine artery PI correlated significantly with age (P = 0.043), uterine size (P = 0.003), and beta-HCG titer (P = 0.03). Intratumoral PI correlated significantly with uterine size (P = 0.05). Intratumoral PI did not correlate with patient age, the shape or orientation of the uterus, presence or absence of subendometrial halo, endometrial thickness or echogenicity, or impression of myometrial invasion. Regression analysis of beta-HCG titers on uterine artery and intratumoral PI revealed a linear association. TVS and color flow Doppler sonography are useful in the assessment of patients with GTD. The PI is strongly associated with prognosis and correlates with beta-HCG titers.

Adult↗