Biomedical subjects
Publications and source records attributed to J Gilliam.
A patient with a large Zenker's diverticulum and narrow, angulated passageway successfully underwent transesophageal echocardiography using a pediatric endoscope, short esophageal overtube, and a pediatric transesophageal echocardiographic probe.
OBJECTIVE: In contrast to the well-recognized Schatzki's ring, the lower esophageal muscular ring remains a poorly defined entity. The purpose of this study is to report on the clinical features of three patients with lower esophageal muscular rings and review the literature on this disorder, to better understand its importance as a cause of dysphagia. METHODS: Three patients presenting to the West Roxbury VA Medical Center were identified as having a contractile, focal narrowing in the distal esophagus by upper GI series. Clinical histories were obtained and endoscopic and manometric evaluations were performed. RESULTS: The three patients had symptoms consisting of chronic, intermittent dysphagia for both liquids and solids. The results of barium swallows and upper endoscopic examinations were similar and revealed a focal, thick constriction of variable luminal diameter located a few centimeters above the squamocolumnar junction. Esophageal motility testing revealed peristaltic, high-amplitude, long-duration, and multiple peaked contractions. Lower esophageal sphincter function was normal. The patients derived partial or only temporary relief of dysphagia with esophageal dilation with rigid dilators. All three patients had significant symptomatic responses to anticholinergic agents. CONCLUSIONS: Lower esophageal muscular rings are an uncommon but important cause of dysphagia. Significant esophageal motility abnormalities can be found in symptomatic patients. Distinguishing the lower esophageal muscular ring from the Schatzki's ring is important because of differences in the treatment and outcome of the two conditions.
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There is a need to better document the reliability and validity of assessment measures used in physical therapy. Studies documenting the reliability of measurement of the pelvic angle and its relationship to sacral motion are presently inconclusive. The purpose of this study was twofold. First, we wanted to determine the reliability and validity of a goniometric measurement of the pelvic angle. We also wanted to test the hypothesis that there is a relationship between the pelvic angle and the sacral angle. Intertester and intratester reliability of goniometric pelvic angle measurements of 23 healthy young adults were examined using three different raters. Radiographic measurements of the pelvic and sacral angle using two raters and goniometric measurement of the pelvic angle using a single rater were taken from 15 patients with low back pain who had been referred for X-rays. Intraclass correlation coefficients (ICCs) of intratester reliability for goniometric measurements of the pelvic angle were .93, .96, and .96. The intertester reliability was .95. The ICCs for intratester reliability for radiological measurements were .92 and .95 for the sacral angle and .98 for both measurements of the pelvic angle. Intertester reliability coefficients were .86 and .88, respectively. The Pearson correlation coefficients for the goniometric and radiological measurements of the pelvic angle were .85 and .68. A comparison of the radiological and goniometric measurements of the pelvic angle with the sacral angle demonstrated low average correlations of .43 and .58, respectively. The results indicate a high level of correlation between and within testers for goniometric measurements of the pelvic angle but only a fair correlation between goniometric and radiological measurements of the pelvic angle.(ABSTRACT TRUNCATED AT 250 WORDS)
Every nurse executive is responsible for maintaining compliance to current externally established standards. As standards change, the nurse executive must evaluate the organization, making sure it continues to demonstrate compliance. This article describes how one organization used the Joint Commission on Accreditation of Healthcare Organizations' Agenda for Change as an opportunity to examine its nursing practice. The process included: 1) analyzing compliance to the 1991 standards; 2) developing an action plan to address deficiencies; and 3) developing and conducting a mock survey to monitor and evaluate effectiveness of the action plan. Increased staff comfort with the survey process, monitoring tools, and data regarding compliance to standards were the primary outcomes of this process. Leadership development, team building, and networking were also outcomes.
Adult Reye's syndrome (ARS) is an infrequently diagnosed condition that typically affects patients younger than age 35 years. We describe a 61-year-old man with ARS occurring after influenza B-USSR infection and aspirin use. The diagnosis of ARS was confirmed by oil-red-O stain of liver biopsy tissue and subsequent electron microscopy. We review the literature on ARS and compare the clinical features and management of ARS with pediatric Rye's syndrome. This case is of interest to practitioners treating adult patients because it demonstrates that the patient population at risk for Reye's syndrome is broader than generally believed.
Multi-modality evoked potentials and computed cranial tomography (CT) were performed in ten patients with Wilson's disease to determine if any of these studies would correlate reliably with neurologic status. While all four patients with CT abnormality had neurologic signs, two additional patients with neurologic findings had normal scans. Evoked responses were normal in nine patients. The remaining patient displayed abnormal visual, brainstem, and somatosensory evoked potentials, and follow-up studies after clinical deterioration revealed worsening of the brainstem and visual evoked potentials. This patient died unexpectedly from a subdural hematoma, and postmortem examination confirmed the radiographic findings of cortical atrophy of the cerebrum and cerebellum and bilateral cystic degeneration of the basal ganglia. However, localized demyelination in the visual, auditory, and sensory pathways was not present. We conclude that the clinical neurologic status of patients with Wilson's disease cannot be reliably predicted by either CT or multi-modality evoked potentials.
A physical phenomenon known as elastic jump occurs downstream of an elastic constriction applied to a collapsible tube. This flow anomaly is analogous to the hydraulic jump that occurs in surface flows. Some investigators have predicted that an elastic jump could occur in the male urethra (during voiding) in the cavernous segment between constrictions at the membranous and meatal regions. To identify and understand this flow anomaly, and to obtain clinical correlations in human male subjects we have attempted several radiological and urodynamic studies in normal and abnormal subjects. The studies were retrograde urethrography, voiding cystourethrography, static pressure recordings during voiding and uroflowmetry. Retrograde urethrography was believed to delineate accurately the anatomy of the bulbous urethra. Voiding cystourethrography showed the geometry of the functional bulb. Our observations in 43 male subjects suggest that the site and degree of elastic jump depend on the severity of bladder neck or prostatic obstruction, magnitude of detrusor pressure (energy) during voiding, degree of distal constriction and position in which the subject voids. The animal studies (23 dogs) confirmed our clinical urodynamic impression.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The natural history of the cells which participate in the repair of defects in articular cartilage was studied in the chick-quail chimeric system. This system involves interspecific grafting of quail limb rudiments onto the vascularized chick embryo chorioallantoic membrane (CAM) where the grafts revascularized and grow. Differences in cell morphology make it possible to clearly differentiate cells which subsequently arise from the grafted elements, from those which subsequently originate in the host (chick) tissues and migrate into the grafts. Herein, lesions were produced in quail femurs just prior to the time they were grafted to the chick CAM. The lesions were of two types: those restricted to the proliferative and hypertrophic zones of the cartilaginous epiphyses, and those which penetrated through the cartilage into the subchrondral marrow space. Epiphyses cut transversely at the level of the proliferative and hypertrophic cells failed to resurface with hyaline cartilage or fibrocartilage. Cavities produced in these areas also failed to repair. However, lesions which penetrated through the epiphyses into the medullary spaces filled with calcified bone trabeculae, and all the osteoblasts and osteocytes in the repair bone had nuclei of the graft (quail) type. The observations suggested that the cells resident in articular cartilage have little ability to effect healing, and that the new bone was derived from osteoprogenitor cells in the quail marrow stroma which moved with capillaries into the lesions. Indirect evidence is presented to support the concept that chondrocytes surviving ossification of the epiphyses can also contribute to the osteoprogenitor cell pool. A fibrocartilage metaplasia was not observed at the joint surface in this system, presumably due to the absence of biomechanical influences.