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Biomedical subjects

J Jordan

Publications and source records attributed to J Jordan.

At least 127 records · Page 7Linked to original sources
PubMed1995

Family medicine in a tertiary care hospital. Obstetrical outcomes and interventions.

OBJECTIVE: To examine the rates of obstetrical complications and interventions among patients managed or comanaged by family physicians. DESIGN: Case series. Retrospective review of hospital records. SETTING: Victoria Hospital, a tertiary care centre affiliated with the University of Western Ontario in London, Ont. PARTICIPANTS: Five hundred forty-two women in labour admitted consecutively by family physicians from October 1, 1990, to September 31, 1991. There were no exclusions based on antenatal risk. MAIN OUTCOME MEASURES: Degree of risk on admission, and rates of cesarean sections, inductions, epidurals, forceps deliveries, episiotomies, perineal tears, postpartum hemorrhages, and postpartum fever for mothers. For newborns, Apgar scores and rate of need for a pediatric critical care unit or special observation nursery. RESULTS: Except for rates of inductions and episiotomies, which were lower than those reported elsewhere, results were all comparable to those in previous North American studies of low-risk family medicine obstetric patients. CONCLUSION: Family physicians care for women with a range of antenatal risks. Even when practising in tertiary care environments, family physicians can minimize many obstetrical interventions while maintaining good maternal and neonatal outcomes.

Adult↗
PubMed1995

[Patients in (post)modern society--does psychosomatic medicine still have concrete foundations?].

The paper describes the scientific development psychosomatic medicine has undergone in the last decades, as well as the politically induced changes in the German Health Care system. In three future scenarios the dangers of a) biological and b) voluntaristic schools of thought are presented along with the c) consequences of ecological destruction and economic power. The increasing trend for psychosomatic medicine to use salutogenetic models is discussed as a feasible approach for the prevention of fear-provoking perspectives.

Forecasting↗
PubMed1995

Comparative yield of endocervical and metaplastic cells. Two sampling techniques: wooden spatula and cytology brush.

OBJECTIVE: To compare two sampling techniques in their ability to obtain endocervical and metaplastic cells from the Papanicolaou smear. DESIGN: Prospective clinical trial comparing the criterion standard of a wooden spatula to a cytology brush. SETTING: Community-based family medicine clinic in London, Ont. PATIENTS: Consecutive sample of 102 women aged 15 to 58 years requiring a Pap smear between October 1992 and October 1993 who presented to the office of their family physician and were assessed by one resident or one faculty physician. INTERVENTIONS: A Pap smear was obtained from each participant using first the wooden spatula and then the cytology brush. MAIN OUTCOME MEASURES: The number of Pap smears done in the study population that contained endocervical or metaplastic cells. RESULTS: Endocervical cell yield was significantly greater using the cytology brush (93.1%) than using the spatula (61.8%) (P < 0.001). There was no significant difference in metaplastic cell yield between the cytology brush (71.6%) and the spatula (63.7%). At least one of these cell types was identified on 95.1% of cytology brush samples and on 79.4% of spatula samples (P < 0.001). The resident and faculty physician were not significantly different in their rate of detecting endocervical or metaplastic cells. CONCLUSIONS: Adding a cytology brush sample to the Pap smear resulted in a significant increase in the rate of Pap smears that detected cells. The cytology brush was significantly better than the spatula for detecting endocervical cells (P < 0.001), but not significantly better for detecting metaplastic cells.

Adolescent↗
PubMed1995

[The usage of light density heparin (fraxiparin) in the treatment of orbital phlegmonous cellulitis with orbital veins and thrombophlebitis of the cavernous sinus].

A case of 72 years old man, diabetic, suffering from phlegmonous cellulitis with orbital veins and sinus cavernous thrombophlebitis as a nasal vestibule furuncle complication is presented. Apart from the application of antibiotics and surgical procedure, the patient was treated from beginning with thrombolytics specimen, fraxiparine. The methods of treatment of cavernous sinus thrombosis with thrombolytic specimens evoke in the literature controversial opinions. In the author's opinion the early application of fraxiparine in presented case could be regarded as responsible for stopping the process orbital veins and sinus cavernous thrombosis and even causing it to recess. The complete cure without complications (e.g. blindness) is attributed by the authors to the anticoagulation treatment. The authors also stress that fraxiparine may by used for treatment of cavernous sinus thrombophlebitis even when the surgical procedure is planned.

Aged↗
PubMed1995

[Laryngeal edema after radiotherapy--radiation reaction or a property of the neoplasm (recurrence, residual neoplasm)].

The authors discuss occurrence of post-radiation laryngeal oedema in the cases of patients with laryngeal cancer. The examination was carried out in 69 cases of patients on whom laryngectomy had been performed after failure of radiotherapy. In 65 out of these cases patients suffered from oedema of larynx with 57 cases classified as persistent or progressive post-radiation oedema (lasting for over three months inspite of application of pharmacological treatment), and 8 cases identified as fluctuating (receding after application of treatment and periodically reoccuring). Analysing the microscopic material of the specimens of the post-radiation oedema, the authors differentiated the stasis, inflammatory oedema and that causes by the presence of cancer infiltration. Basing on their own research data and the contemporary literature, the authors conclude, that the occurrence of persistent post-radiation oedema of the larynx lasting for the three months without reaction to the applied pharmacotherapy should be regarded as an important symptom signalling the presence or the recurrence of tumour after radiotherapy.

Biopsy↗
PubMed1995

[Regarding assessment of changes in the larynx after radiation according to RTOG/EORTC classification].

The authors discuss the classification of changes in reactions occurring during and after radiotherapy of the laryngeal cancer adopted in 1987 by Radiation Therapy Oncology Group and European Organisation for Research and Treatment of Cancer (RTOG/EORTC). The above classification is not based on uniform criteria. The authors express the opinion that is extremely difficult to distinguish between chondritis, chondronecrosis of high intensity and necrosis without microscopic examination and limiting oneselves to the subjective symptoms only. In they opinion the classification of the post-radiation reaction should take into account the clinical assessment of the state of the larynx as well as the subjective elements of the examination. The authors have their findings on their own clinical and microscopic research as well as on the date accessible in the relevant literature.

Humans↗
PubMed1995

[Bleeding from the esophagus in a patient after laryngectomy].

The report present a study of a case of a 38 year old man, suffering from massive haemorrhage from esophagus on the 21st day after performed laryngectomy. Serious difficulties occurred at first in specifying the exact sources of haemorrhage (cervical vessel, gastric ulcer?). The surgical assessment of the neck vessels and laparotomy were performed without finding any sources of bleeding. The haemorrhage was eventually stopped by the application of Sengstaken's tubene, but it reoccurred when a trial to remove was undertaken. Thoracotomy to assess the mediastinal vessels did not reveal the sources of bleeding. 22 units of blood were administered in transfusion. This patient died 10 days after the beginning of the haemorrhage. In autopsy the diffuse inflammatory process of the oesophageal wall, multiple corrosive points in the mucous and deep, large ulceration (2.5 x 1 cm in diameter) within posterior oesophageal wall located in the middle stenosis were found. Discussing the possible causes of the bleeding the authors point out to the fact that the presence of the naso-oesophageal catheter could have been one of them. The authors also express the opinion, that persisting hiccups can be regarded ad a characteristic symptom of developing oesophagitis which actually was observed in the presented case.

Adult↗
PubMed1994

Luteal phase defect: the sensitivity and specificity of diagnostic methods in common clinical use.

OBJECTIVE: To assess the sensitivity and specificity of common clinical tests used for the diagnosis of luteal phase defect (LPD). DESIGN: The sensitivity and specificity of these tests for predicting low integrated P levels over the luteal phase were calculated. SETTING: Outpatient reproductive endocrinology and infertility clinic at a university medical center. PATIENTS: Fifty-eight strictly defined normal women were used to determine normal integrated luteal phase P levels. The study population was a separate 34 women who either were normal (n = 15) or were being evaluated for infertility or recurrent abortion (n = 19). These 34 study subjects all had the following tests performed in the same menstrual cycle: daily reproductive hormone levels, daily assessment of preovulatory follicle size, late luteal endometrial biopsies, and BBT charts. MAIN OUTCOME MEASURES: Basal body temperature, maximum preovulatory follicle size, dated endometrial biopsies, and serum P levels (single and multiple) were used in an attempt to predict which patients had low integrated P levels. RESULTS: Unacceptably low sensitivity and/or specificity levels were found for the following tests: appearance of BBT charts, luteal phase length, and preovulatory follicle diameter. Timed endometrial biopsy was found to have marginally acceptable sensitivity and specificity levels whether dated by next menstrual period or midcycle events. The best test for the prediction of low integrated P was a single serum P level from the midluteal phase that was < 10 ng/mL (31.8 nmol/L) or a sum of three random serum P measurements that was < 30 ng/mL (95.4 nmol/L) (also obtained in the midluteal phase). CONCLUSIONS: Luteal phase defect is a relatively uncommon but important cause of infertility and/or habitual abortion. The recommended test for the determination of LPD is a midluteal phase single serum P level < 10 ng/mL or the sum of three serum P levels that is < 30 ng/mL. The endometrial biopsy is a second line test that is only recommended when LPD needs to be evaluated in a treated cycle (ovulation induction or supplemental P).

Abortion, Habitual↗
PubMed1994

[Change in self-object differentiation in an eating disordered patient during inpatient therapy].

This paper is intended as a contribution to qualitative-quantitative research on the psychotherapeutic process. It reports on the course of a three-month inpatient psychosomatic treatment of a female patient with an eating disorder from the preferred point of view of psychoanalytically oriented individual therapy. Given the central role of the self-object relationship in women with eating disorders, changes that occur with regard to this aspect over the course of the therapy are recorded and described. In addition to the clinical perspective, the selected approach is based on a combination of methods, with an emphasis on the analysis of linguistic content using the Gottschalk-Gleser method, the Core Conflictual Relationship Theme method according to Luborsky and the projective procedure of Object Relations Technique according to Phillipson. In the course of treatment reveals changes in terms of reducing shame-anxiety and inwardly-directed aggressiveness as well as in the patient's object repproachement and to a more positive way of dealing with herself, all of which, on the whole, can be considered indicative of an increasing degree of self-object differentiation.

Adult↗
PubMed1994

[Multiple lymphatic cervical cysts].

Authors described a case of 60 year old woman with multiple lateral neck cysts. Four cysts, 5 x 4 x 3 cm and 3 x 2 x 2 cm in diameter, were located in the supraclavicular region of lateral neck triangle. During histopathological studies of postoperative specimens a cystic hygroma diagnosis was established. The fact, that cystic lymphangioma occurred in an adult woman, was interesting. The authors stress the necessity of preoperative evaluation of tumor size in view of the possibility of its penetration into the thorax. The CT examination may be useful in these cases.

Cervical Vertebrae↗
PubMed1994

Use of a revised version of the psychotropic medication efficacy graph.

A medication efficacy graph developed by Spirrison and Grosskopf (1991) was revised and applied in a case study to effectively monitor a client's progress. The revision combined several aspects of client behavior into one graph that could aid clinicians in assessing a client under psychiatric care. Revised applications of the graph should also enable clinicians to measure and display not just incidents of maladaptive behaviors but weighted maladaptive behaviors, adaptive behaviors, potency of medication, and side effects, all of which provide a better overall picture of the client's behavior.

Adult↗
PubMed1994

[Clinical indications for laryngectomy in the patients with carcinoma of the larynx after failed radiotherapy].

The authors present 22 patients with carcinoma of the larynx after radiotherapy in which laryngectomy was performed basing on the clinical view, without repeated histological confirmation of the tumour. In this material there were 14 patients without any biopsies after radiotherapy, and 8, in whom biopsies were performed once or twice, but no evidence of tumour was found. During microscopic studies of postoperative specimens the tumour was found in 21 cases-in one case pre-operative changes were caused by postradition injuries (inflammation, necrosis). The authors discuss clinical signs, which can be helpful to recognize the presence of tumour with postradiation changes and which gives a reason for laryngectomy following radiotherapy. This signs were: persisting or progressive post-radiation oedema of the larynx, laryngeal wall swelling (especially dissimmetrical), vocal cord fixation after radiotherapy, mucosal ulceration of the laryngeal wall and lymph nodes palpability on the neck after radiotherapy.

Carcinoma↗
PubMed1993

[Perception of and psychological coping with medical technology. How does the patient perceive percutaneous transluminal coronary angioplasty?].

BASIC REMARKS: Since, as a result of technological progress, ever more interventions are being carried out in the conscious patient without anesthesia or sedation, psychological coping is an important aspect. METHODS: Over a period of one year, all patients undergoing coronary artery dilatation at the University Hospital, Frankfurt, were admitted to the study in which the patients and their spouses, as well as the physicians involved were questioned (individual questioning, questionnaires, interviews). In addition, a catamnestic follow-up examination was performed. RESULTS: In addition to numerous other results, the following major points can be made: most patients coped with the stressful situation by adopting an optimistic attitude, which was combined with trust in the physician and the procedure employed. A very small group of patients can be considered to suffer from appreciable depressivity/anxiety and requires psychotherapeutic support. Days and weeks after the procedure there is a delayed phase of "late coping". In the patients with no major persisting symptoms, there is an increasing tendency in this period to play down the situation, with the result that there may be a lack of readiness to admit the need to change possibly dangerous habits and adopt a different life style.

Adaptation, Psychological↗
PubMed1993

Effects of intermodality change on electrodermal orienting and on the allocation of processing resources.

Two experiments studied the effects of intermodality change on electrodermal responses and on reaction time to a secondary task probe stimulus after 24 habituation training trials with either a tone or a vibrotactile stimulus. The probe was a visual stimulus of 500 ms duration, and within-stimulus probes occurred 300 ms following stimulus onset. Experiment 1 crossed change versus no change with modality of the training stimulus. Skin conductance responses (SCRs) were larger in the experimental group than in the control on the test trial, and in the experimental group, test trial responses were larger than those on the first training trial. Probe reaction time was slower on the test trial in the experimental group than in the control, and within-stimulus probe reaction time was slower than interstimulus interval reaction time early in the habituation series. Experiment 2 crossed change versus no change with the presence of a secondary task. Test trial SCRs were larger in the experimental group than in the control, regardless of whether or not the secondary task was present. In addition, test trial responses in the experimental group were larger than those on the first training trial in both the task and no-task conditions. Within the task condition, reaction time was slower in the experimental condition than in the control on the test trial. In addition, reaction time in the experimental condition was slower during the change trial than during the first training stimulus. The data provide difficulties for noncomparator theories of habituation and seem to be most easily explained by theories of habituation that emphasize the importance of an extrapolatory process.

Acoustic Stimulation↗
PubMed1993

Characterization of Centers for Disease Control group NO-1, a fastidious, nonoxidative, gram-negative organism associated with dog and cat bites.

Seventeen strains of fastidious, nonoxidative, gram-negative rods, isolated from human wounds resulting primarily from dog or cat bites, formed a distinct group, which was designated Centers for Disease Control (CDC) group nonoxidizer 1 (NO-1). The phenotypic characteristics of CDC group NO-1 were most similar to non-acid-producing Acinetobacter species, with the major difference being a negative reaction in the transformation assay test for Acinetobacter spp. The cellular fatty acid composition of CDC group NO-1 was different from those of Acinetobacter species and all other bacteria tested to date. The isolates were susceptible to a variety of antimicrobial agents including the aminoglycosides, beta-lactam antibiotics, tetracyclines, quinolones, and sulfonamides. Fifty percent of the isolates were resistant to trimethoprim. Ubiquinone-8 was present as the major isoprenoid quinone in CDC group NO-1.

Acinetobacter↗