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Biomedical subjects

J L Powell

Publications and source records attributed to J L Powell.

At least 19 recordsLinked to original sources
PubMed2006

Old age, vulnerability and sexual violence: implications for knowledge and practice.

AIM: This paper seeks to offer further analysis on the relationship between abuse of power, elder abuse and sexual violence. Importantly, current definitions are examined and the existing literature is reviewed to establish what the current level of debate is on sexual violence in its relationship to elderly women. METHODS: Through the analysis of available literature it is possible to observe which and how older people have been marginalized both in particular disciplines of study and policy spaces. FINDINGS: We conclude that marginalization results in inadequate redress to issues of violence and power that may manifest against the older person, and which leads to feelings of vulnerability. There are important implications for helping health professionals, especially nurses, for understanding the policy, theory and practice. The need for empirical research in this difficult area is paramount.

Aged↗
PubMed2004

An unexpectedly high incidence of Epstein-Barr virus lymphoproliferative disease after CD34+ selected autologous peripheral blood stem cell transplant in neuroblastoma.

The risk of Epstein-Barr virus lymphoproliferative disease (EBV-LPD) increases with the use of highly immunosuppressive therapies. Allogeneic BMT, especially supported by T-cell-depleted stem cell products, is a risk factor for EBV-LPD. Although the risk of EBV-LPD after autologous transplantation is low, case reports of this complication in the autologous setting exist. We report a higher incidence than previously described of EBV-LPD in children undergoing sequential high-dose chemotherapy supported with CD34 selected peripheral blood stem cells (CD34+ PBSC). The median time to LPD after tandem transplant was 3 months (range 1-5 months). Five patients out of 156 (3.5%) developed EBV-LPD while enrolled on two trials of tandem autologous SCT in high-risk pediatric malignancies. Both studies employed five cycles of induction therapy, followed by tandem autologous PBSC transplants. In all, 108 out of 156 patients received CD34+ PBSC; 48 received unselected PBSC. All patients contracting LPD were from the CD34 selected group. Treatment of EBV-LPD included rituximab in four out of five patients, i.v.Ig in two out of five patients, and gancyclovir in two out of five patients. EBV-LPD resolved in four out of five patients. We conclude that the combination of tandem SCT and CD34 selection may have increased immunosuppression in these patients to a point where there is an elevated risk of EBV-LPD.

Antigens, CD↗
PubMed2001

Resumption of driving after life-threatening ventricular tachyarrhythmia.

BACKGROUND: Although the privilege of driving must be respected, it may be necessary to restrict driving when it poses a threat to others. The risks associated with allowing patients with life-threatening ventricular tachyarrhythmias to drive have not been quantified. METHODS: The Antiarrhythmics versus Implantable Defibrillators (AVID) trial compared antiarrhythmic-drug therapy with the implantation of defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. In the current study, we sent patients who participated in the AVID trial a questionnaire, to be completed anonymously, requesting information about driving habits and experiences. RESULTS: The questionnaire was returned by 758 of 909 patients (83 percent). Of these, 627 patients drove during the year before their index episode of ventricular tachyarrhythmia. A total of 57 percent of these patients resumed driving within 3 months after randomization in the AVID trial, 78 percent within 6 months, and 88 percent within 12 months. While driving, 2 percent had a syncopal episode, 11 percent had dizziness or palpitations that necessitated stopping the vehicle, 22 percent had dizziness or palpitations that did not necessitate stopping the vehicle, and 8 percent of the 295 patients with an implantable cardioverter-defibrillator received a shock. Fifty patients reported having at least 1 accident, for a total of 55 accidents during 1619 patient-years of follow-up after the resumption of driving (3.4 percent per patient-year). Only 11 percent of these accidents were preceded by symptoms of possible arrhythmia (0.4 percent per patient-year). CONCLUSIONS: Most patients with ventricular tachyarrhythmias resume driving early. Although it is common for them to have symptoms of possible arrhythmia while driving, accidents are uncommon and occur with a frequency that is lower than the annual accident rate of 7.1 percent in the general driving population of the United States.

Accidents, Traffic↗
PubMed2001

Patients at lower risk of arrhythmia recurrence: a subgroup in whom implantable defibrillators may not offer benefit. Antiarrhythmics Versus Implantable Defibrillator (AVID) Trial Investigators.

OBJECTIVES: The goal of this study was to identify subgroups of arrhythmia patients who do not benefit from use of the implantable cardiac defibrillator (ICD). BACKGROUND: Treatment of serious ventricular arrhythmias has evolved toward more common use of the ICD. Since estimates of the cost per year of life saved by ICD therapy vary from $25,000 to perhaps $125,000, it is important to identify patient subgroups that do not benefit from the ICD. METHODS: Data for 491 ICD patients enrolled in the Antiarrhythmics Versus Implantable Defibrillators Study were used to create a hazards model relating baseline factors to time to first recurrent arrhythmia. The model was used to predict the hazard for recurrent arrhythmia among all trial patients. A priori cut points provided lower and higher recurrent arrhythmia risk strata. For each stratum the incremental years of life due to ICD versus antiarrhythmic drug therapy were calculated. RESULTS: Factors that predicted recurrent arrhythmia were: ventricular tachycardia as the index arrhythmia, history of cerebrovascular disease, lower left ventricular ejection fraction, a history of any tachyarrhythmia before the index event and the absence of revascularization after the index event. Survival times (over a follow-up of three years) were identical in each arm of the lowest risk sextile (survival advantage 0.03 +/- 0.12 [se] years), while the survival advantage for patients above the first sextile was 0.27 +/- 0.07 (se) years (two-sided p = 0.05). CONCLUSIONS: Patients presenting with an isolated episode of ventricular fibrillation in the absence of cerebrovascular disease or history of prior arrhythmia who have undergone revascularization or who have moderately preserved left ventricular function (left ventricular ejection fraction > 0.27) are not likely to benefit from ICD therapy compared with amiodarone therapy.

Aged↗
PubMed2001

Management of recurrent juvenile granulosa cell tumor of the ovary.

BACKGROUND: Juvenile granulosa cell tumors of the ovary are a rare form of neoplasm that makes up less than 5% of ovarian tumors in childhood and adolescence. About 90% are diagnosed in stage I with a favorable prognosis. More advanced stages (FIGO stages II--IV) have a poor prognosis. CASE: A patient was initially diagnosed at age 17 with FIGO stage IIIC disease and treated with a right salpingo-oophorectomy, debulking, and staging followed by six cycles of carboplatin and etoposide chemotherapy. Tumor recurrence in the liver and adjacent to the spleen occurred 13 months after completion of primary therapy. Aggressive surgical removal of tumor followed by six cycles of bleomycin and taxol as salvage chemotherapy resulted in 44 months of disease-free survival. On November 27, 2000, she had a cesarean delivery of a 2335-g normal male due to a breech presentation. Exploration revealed no evidence of tumor. CONCLUSION: This is the second case report of a patient with advanced juvenile granulosa cell tumor to become pregnant after apparently successful chemotherapy. These results are encouraging, but the best treatment for extensive and recurrent disease has yet to be determined.

Adolescent↗
PubMed2001

Identification of a group 1-like capsular polysaccharide operon for Vibrio vulnificus.

Virulence of Vibrio vulnificus correlates with changes in colony morphology that are indicative of a reversible phase variation for expression of capsular polysaccharide (CPS). Encapsulated variants are virulent with opaque colonies, whereas phase variants with reduced CPS expression are attenuated and are translucent. Using TnphoA mutagenesis, we identified a V. vulnificus CPS locus, which included an upstream ops element, a wza gene (wza(Vv)), and several open reading frames with homology to CPS biosynthetic genes. This genetic organization is characteristic of group 1 CPS operons. The wza gene product is required for transport of CPS to the cell surface in Escherichia coli. Polar transposon mutations in wza(Vv) eliminated expression of downstream biosynthetic genes, confirming operon structure. On the other hand, nonpolar inactivation of wza(Vv) was specific for CPS transport, did not alter CPS biosynthesis, and could be complemented in trans. Southern analysis of CPS phase variants revealed deletions or rearrangements at this locus. A survey of environmental isolates indicated a correlation between deletions in wza(Vv) and loss of virulent phenotype, suggesting a genetic mechanism for CPS phase variation. Full virulence in mice required surface expression of CPS and supported the essential role of capsule in the pathogenesis of V. vulnificus.

Amino Acid Sequence↗
PubMed2001

A Foucauldian analysis of old age and the power of social welfare.

It is argued that the question of social welfare is a key, if often overlooked, component in the construction of power relations and identities in later life that can take its place next to debates on bioethics and consumer lifestyle. Foucault's (1977) claim, that identities are kept in place through the deployment of integrated systems of power and knowledge and a routine operation of surveillance and assessment, is critically examined in this context. Trends in social welfare in the United Kingdom are used as a case example that sheds light on wider contemporary issues associated with old age. Finally, implications for the creation of particular narratives about later life are discussed and grounded through Foucault's (1988) notion of "technologies of self."

Aged↗
PubMed2001

Androgen-producing, atypically proliferating endometrioid tumor arising in endometriosis.

A case of androgen-secreting borderline endometrioid tumor arising in endometriosis of the rectovaginal septum is presented. It occurred 10 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy for extensive endometriosis of the fallopian tubes and ovaries, adenomyosis, and leiomyomas of the uterus. We believe 7 years of unopposed continuous oral estrogen replacement therapy contributed to the malignant transformation of the endometriosis.

Abdominal Pain↗
PubMed2000

Treatment of vaginal dysplasia: just a simple loop electrosurgical excision procedure?

We report a case of sigmoid perforation, peritonitis, and adult respiratory distress syndrome after a loop excision procedure for carcinoma in situ of the cervix and dysplasia of the vagina. Treatment of vaginal dysplasia with loop excision is potentially dangerous. Safer methods of management include carbon dioxide laser, topical 5-fluorouracil, and fulguration.

Adult↗
PubMed2000

Those who hesitate lose: the relationship between assertiveness and response latency.

Individuals who are low in assertiveness may take longer to sort out, process, and state their own perceptions, attitudes and priorities, which puts them at a disadvantage in getting their needs met. The reason for this may not be inhibition in social situations or cognitive ability, but a lack of clarity regarding their own attitudes, opinions, preferences, goals, and priorities. 101 undergraduate students (57% women and 43% men) completed a demographics questionnaire, the Wonderlic Personnel Test, a self-monitoring scale, the Marlowe-Crowne Social Desirability Scale, the Rosenberg Self-esteem Scale, the College Self-expression Scale, and a test of the false-consensus effect. Response latencies to questions were measured. Individuals with higher scores on the Wonderlic Personnel Test answered items more quickly but, even when cognitive ability was controlled, individuals low in assertiveness still took significantly longer to respond to questions about themselves, their opinions, and their preferences. If individuals fall behind at this early step in the process of asserting themselves, then they may be more likely to miss opportunities to be assertive.

Assertiveness↗
PubMed2000

Androgen-secreting steroid cell tumor of the ovary.

We present the case of a 93-year-old virilized woman with an androgen-secreting ovarian tumor. This rare ovarian sex cord stromal tumor behaved in a malignant fashion. Various aspects of the presentation, diagnosis, and treatment of these tumors are discussed.

Aged↗
PubMed1999

Panniculectomy to facilitate gynecologic surgery in morbidly obese women.

OBJECTIVE: To determine whether abdominal panniculectomy done in conjunction with pelvic surgery in morbidly obese women is safe and useful. METHODS: Twenty morbidly obese women had excision of large abdominal panniculi in conjunction with pelvic surgery at New Hanover Regional Medical Center between November 1994 and September 1998. Panniculectomy was to improve surgical exposure and to decrease the incidence of wound necrosis, infection, and dehiscence among those high-risk women who all had chronic intertrigo in the skin folds under their panni. RESULTS: The women were 38-65 years old (mean 51 years) and weighed 202-475 pounds (mean 305 pounds). Their body mass indices were 35-76 (mean 51.5). Three women had superficial partial wound dehiscence, which was treated successfully with office debridement. There were no pulmonary emboli or operative deaths. CONCLUSION: Abdominal panniculectomy is safe and useful in morbidly obese women.

Abdomen↗
PubMed1999

Differential expression of Vibrio vulnificus capsular polysaccharide.

Vibrio vulnificus is a human pathogen whose virulence has been associated with the expression of capsular polysaccharide (CPS). Multiple CPS types have been described; however, virulence does not appear to correlate with a particular CPS composition. Reversible-phase variation for opaque and translucent colony morphologies is characterized by changes in CPS expression, as suggested by electron microscopy of cells stained nonspecifically with ruthenium red. Isolates with opaque colony morphologies are virulent and appear to be more thickly encapsulated than naturally occurring translucent-phase variants, which have reduced, patchy, or absent CPS. Previously, we have shown that the virulence of translucent-phase variants was intermediate between opaque-phase variants and acapsular transposon mutants, suggesting a correlation between virulence and the amount of CPS expressed. In the present study, CPS expression of phase variants and genetically defined mutants of V. vulnificus M06-24/O was examined by using a CPS-specific monoclonal antibody with an enzyme-linked immunosorbent assay, flow cytometry, and immunoelectron microscopy. Semiquantitative analyses of CPS expression correlated well among these assays, confirming that the translucent-phase variant was intermediate in CPS expression and retained type I CPS-specific epitopes. Cell surface expression of CPS varied with the growth phase, increasing during logarithmic growth and declining in stationary culture. Significantly greater CPS expression (P = 0.026) was observed for cells grown at 30 degrees C than for those at 37 degrees C. These studies confirm that phase variation and virulence in V. vulnificus correlate with the amount of CPS expressed and demonstrate the fluidity of bacterial polysaccharide expression in response to environmental conditions.

Animals↗
PubMed1999

Vibrio species.

Vibrios are an important cause of human food-borne illness associated with the consumption of seafood worldwide, and contaminated food and drinking water in developing countries. Clinical syndromes induced by vibrios such as Vibrio cholerae, V. parahaemolyticus, V. vulnificus, and others range from mild, self-limiting gastroenteritis to life-threatening primary septicemia. As natural inhabitants of the aquatic environment, these bacteria pose a continual threat to food safety.

Animals↗