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Biomedical subjects

J May

Publications and source records attributed to J May.

At least 199 records · Page 11Linked to original sources
PubMed1990

Canalicular laceration. An 11-year epidemiologic and clinical study.

From 1977 through 1987, a total of 222 patients (166 male and 56 female patients) underwent surgical repair of canalicular laceration at Wills Eye Hospital. Demographic and clinical information were collected from the medical records and by written questionnaire or telephone interview. Most injuries occurred in children or young adults (median age, 20 years). Overall, blows from fists was the most common cause of injury (52 patients, 23.4%). Dog bites or scratches were the most frequent causes among children. A total of 147 injuries (66.2%) involved the lower eyelid, 61 (27.5%) the upper eyelid, and 14 (6.3%) the upper and lower eyelids on the same side. Constant or stress epiphora occurred postoperatively significantly more often among patients with combined upper and lower canalicular injuries (61.5%) than among those with single canalicular laceration (19.7%) (p less than 0.01). Analysis with logistic regression showed epiphora to be more common among adults than children (p less than 0.05) when the pigtail probe had been used intraoperatively (p less than 0.05), or when no canalicular stent had been placed at the time of surgical repair (p less than 0.05). No statistically significant associations were found between sex, cause of injury, type of canalicular stent, or time interval from injury to surgical repair and presence of postoperative epiphora.

Adolescent↗
PubMed1989

Implicit and explicit memory bias in anxiety.

Previous investigations of recall and recognition for threatening information in clinically anxious subjects have yielded equivocal results. The present study contrasts implicit (word completion) with explicit (cued recall) memory and shows that indices of bias for emotional material derived from the two types of memory are independent of one another. The explicit measure was correlated with trait anxiety scores, but did not clearly distinguish between subjects with clinical anxiety states and normal control subjects. On the implicit memory measure, clinically anxious subjects produced more threat word completions, but only from a set to which they had recently been exposed. These results are taken as evidence that internal representations of threat words are more readily or more persistently activated in anxiety states, although they are not necessarily better elaborated.

Adult↗
PubMed1988

The living, related kidney donor: a follow-up study.

Thirty-eight children received 41 living-donor kidney transplants in an 11-year period; 73% of the grafts are functioning well. The parents of the recipients were the usual donors (60% of the donors were mothers and 25% of the donors were fathers); however, there were five donations from siblings and one donation from a donor who was related emotionally to the recipient. The most frequent perioperative complications were respiratory but these were not serious and did not cause any long-term sequelae. The principal long-term complications that related to--or were perceived by the donor as being related to--the procedure were incisional pain (20% of donors) and depression (25% of donors). These were not related to the success or otherwise of the transplantation. At follow-up, five (12%) donors had diastolic blood pressure levels of greater than 90 mmHg or were receiving antihypertensive therapy; this prevalence is similar to that which is found in the community. Two donors had urinary protein excretion rates of greater than 200 mg/24 h (210 mg/24 h and 350 mg/24 h, respectively). Creatinine clearance rates fell by 15% in women and by 5% in men. Serum creatinine levels had risen by 40% in men and by 35% in women after the nephrectomy; these levels had changed little at follow-up. All donors said that they would have proceeded with the donation even with fore-knowledge of what they would experience during and after the donation. Living-donor renal transplantation is a procedure with very low but definite operative risks which nevertheless provides a means for the early effective replacement of renal function in children with growth potential. The donors are enabled to make a major contribution to the life and well-being of the child, and they regard the perioperative complications as minimal. There do not appear to be any serious long-term complications of renal donation.

Adolescent↗
PubMed1988

Defects in cats.

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Animals↗
PubMed1988

Blunt trauma to the internal carotid artery.

Blunt injury of the internal carotid artery is rare and easily overlooked. The injury should be considered in a conscious patient with dense neurological deficit after blunt trauma to the head and neck. The diagnosis was established in 17 patients (9 men, 8 women) by arteriography. There was a median delay of 19 hours in the onset of neurologic deficit in 15 patients. Follow up arteriography was obtained in 16 of the 17 patients with a median interval of three months between arteriograms. On repeat arteriography, the internal carotid artery was patent in three of the nine patients with internal carotid arteries occluded on initial arteriography. Surgical repair was attempted in six patients. No significant difference in long term neurological deficit occurred between patients treated conservatively and those treated operatively. Of the 15 patients with hemiparesis on presentation, eight made a complete recovery and six improved. This study supports nonoperative management for blunt injuries of the internal carotid artery.

Adolescent↗
PubMed1988

Patency of femorofemoral venous crossover grafts assessed by duplex scanning and phlebography.

This study was undertaken to determine the accuracy of duplex imaging of femorofemoral venous crossover grafts (Palma-Dale operation) for postthrombotic unilateral occlusion of the iliac vein. Twenty-four patients, 14 men and 10 women with a mean age of 50 years (range 24 to 72 years), were subjected to duplex imaging and phlebography a mean of 5 years after surgery. Scanning was done with patients in an erect position. A graft was reported as patient if it met the following criteria: it could be imaged in continuity, it could be compressed by the scan probe, and blood flow varied with respiration and was augmented by thigh compression on the symptomatic side. Phlebography indicated that 20 grafts were patent and 17 of these were correctly identified with duplex scanning. Three scans were false negative in obese patients in whom the graft could not be imaged. Four grafts, not imaged, were confirmed by phlebography to be occluded. Compared with phlebography, duplex scanning had a sensitivity of 85%, specificity of 100%, and overall accuracy of 88%. Duplex scanning is safe and accurate way to determine patency after femorofemoral venous bypass if the criteria for patency are fulfilled. If not, the true status of the graft must still be established by phlebography.

Adult↗
PubMed1988

Infection rate for single lumen v triple lumen subclavian catheters.

An infection rate was calculated for all subclavian catheters inserted during a 12-month period. The overall, single lumen, and triple lumen infection rates were 1.7% (42/2,431), 0.4% (8/1,936), and 6.9% (34/495), respectively. After excluding single lumen catheters in patients in a surgical cardiovascular unit who appeared to have a decreased risk of infection, the overall, single lumen, and triple lumen rates were 3.7% (42/1,140), 1.2% (8/645), and 6.9% (34/495), respectively. Within this group, 11.8% (28/237) of the catheters used for total parenteral nutrition (TPN) were infected, whereas 1.6% (14/903) of the non-TPN catheters were infected. Of patients receiving total parental nutrition through a triple lumen catheter, 14.5% (25/172) became infected, whereas 4.6% (3/65) of the patients receiving total parental nutrition through a single lumen catheter became infected. Single and triple lumen patient groups appeared comparable based on average age, death rate, immunosuppression, underlying disease, and duration of catheterization, but the risk of infection was approximately three times greater for patients receiving total parental nutrition through a triple lumen catheter.

Aged↗
PubMed1988

Factors affecting the outcome of 463 femorotibial reconstructions.

Between 1973 and 1986, 463 infrapopliteal bypasses were performed on 408 limbs in 383 patients at Royal Prince Alfred Hospital. There were 265 males and 118 females. Their mean age was 69 years, 30% were diabetic, 71% smoked and 38% were hypertensive. The indication for surgery was threatened limb loss in 350 limbs and short distance claudication in 58 limbs. The peri-operative mortality rate was 5%. Cumulative graft patency was 58% (s.e.m. = 2.7) at 5 years. The limb salvage rate was 66% (s.e.m. = 2.5) at 5 years. Cumulative patency rate for autogenous grafts (n = 332) was 63% (s.e.m. = 3.2) at 5 years compared with the cumulative patency rate for synthetic grafts (n = 131) of only 38% (s.e.m. = 5) at 5 years (P less than 0.05). There was no significant difference between the cumulative patency of autogenous grafts originating from the common femoral artery (n = 195) and those from the superficial femoral artery (n = 111). Cumulative patency of autogenous grafts did not significantly differ with the site of distal anastomosis; posterior tibial (n = 79), anterior tibial (n = 98), peroneal artery (n = 138) with 5-year cumulative patency rates of 65% (s.e.m. = 6.4), 65% (s.e.m. = 6.1) and 70% (s.e.m. = 4.6) respectively (P greater than 0.05). Autogenous graft material is the most important determinant of a durable result from femorotibial bypass. Proximal and distal anastomotic sites should be chosen to allow maximal utilization of available autogenous vein.

Adult↗
PubMed1987

Intraoperative monitoring with somatosensory evoked potentials in neurosurgical operations on the spinal cord.

Our report deals with 24 patients who were treated neurosurgically for spinal space occupying lesions and in whom a noninvasive technique of intraoperative monitoring with somatosensory evoked potentials (SEP) was carried out. Reproducible potentials were obtained intraoperatively in each case, but only patients in whom potentials could be obtained preoperatively were included in the study. Using changes in amplitudes of up to 50% of the starting value as criteria, it was possible to make an accurate statement as to the expected postoperative neurological status in 22 patients (91.7%). We found false positive results in 2 cases (8.3%), but no false negative results were observed. In one patient, a postoperative complication caused by bleeding could be discovered in the early stages by means of postoperative SEP-monitoring. The results confirm the reliability and usefulness of this noninvasive technique when applied intraoperatively. Furthermore, the value of SEP-monitoring during the early postoperative phase in cases where the clinical judgment is limited due to anesthesia is emphasized. The secondary postoperative deterioration in the neurological status of one patient with a ventral space occupying lesion could not, however, be detected with the SEP monitoring. The use of the motor stimulation technique could be an advantageous adjunct in intraoperative and perioperative monitoring, particularly in cases where primarily motor pathways are at risk.

Adolescent↗
PubMed1987

Measuring the effects upon cognitive abilities of sleep loss during continuous operations.

One hundred and thirty-five soldiers attending a 10-week training course in the Brecon Beacons were divided into three groups, each of which sat a different kit of five tests taken from the Kit of Factor-Referenced Cognitive Tests (Ekstrom et al., 1976). The tests were given three times, with the first administration serving as a baseline, and the second and third administrations being completed after exercises involving either two nights' loss of sleep, or a physically fatiguing day. The experimental design allows the effects of practice and physical fatigue to be taken into account, and measures of the cognitive effects of sleep loss are obtained for each test. The results show that tests adversely affected by sleep loss are those that involve visual encoding and scanning, production of novel responses, as well as those in which lapses of attention critically affect performance. Performance on tests which involved logical thought and reasoning did not suffer, and in some cases improved.

Arousal↗
PubMed1987

Extraversion, neuroticism, obsessionality and the type A behaviour pattern.

A questionnaire consisting of a subset of questions from the Jenkins Activity Survey was given to 135 male military personnel aged between 18 and 25, together with the EPQ and the AI3, an obsessionality scale. A factor analysis of the answers revealed a four-factor structure - impatience, hard-driving competitiveness, speed and emotional unrepression. Neuroticism was found to correlate positively with impatience and speed, but negatively with hard-driving competitiveness, which together with emotional unrepression correlated positively with extraversion. Impatience, speed and emotional unrepression also correlated positively with obsessionality. Obsessionality was the only personality measure to correlate significantly with the total Type A score. The nature of the relationships between the Type A behaviour pattern and the Eysenckian personality measures are discussed.

Adolescent↗
PubMed1987

[The anxiolytic action of phenoxypropanolamine derivatives in comparison with propranolol, diazepam and placebo].

The hypothesis that the phenoxypropanolamine derivative CGP 361 A possesses anxiolytic activity was examined in 80 female healthy volunteers. Each volunteer received the treatment under double-blind conditions as part of a 1-way analysis of variance design. The medication factor had 4 levels (CGP 361 A, propranolol, diazepam and placebo). Stress was induced by asking subjects to deliver a free speech in front of a video camera. The anxiety was measured using adjectives list, state-trait-anxiety inventory and visual analogue scales. The physiological equivalents observed were pulse rate and skin resistance. The results support the hypothesis that a single dose of 10 mg CGP 361 A has a higher anxiolytic effect than 10 mg propranolol, 5 mg diazepam and placebo, with the peripheral beta-blocking effects (established by pulse rate) being no stronger than with propranolol. No subjective or objective sedation has been determined under the different drug conditions.

Adult↗
PubMed1987

Successful aortic surgery after renal transplantation without protection of the transplanted kidney.

When renal transplant recipients undergo aortic surgery, blood supply to the renal graft is interrupted while the aorta is clamped. Several innovative ways of using shunts have been described to preserve blood flow to the transplanted kidney during such surgery on the assumption that temporary warm ischemia of the renal transplant is poorly tolerated. We have performed aortic surgery in four renal transplant recipients without the use of any form of graft protection. One patient underwent urgent operation to treat an expanding aortic aneurysm and the other three had elective surgery for aortoiliac occlusive disease. Ischemic times ranged from 30 to 45 minutes. Two of the four patients had a temporary rise in serum creatinine levels. No patient required hemodialysis. We conclude that in selected renal transplant recipients, aortic surgery can be safely undertaken without graft protection.

Adult↗
PubMed1986

Early supradiaphragmatic Hodgkin's disease. High-dose gallium scanning obviates the need for staging laparotomy.

Experience with 16 sequential patients with Stage IA/IIA supradiaphragmatic Hodgkin's disease who had no evidence of intra-abdominal disease using high-dose gallium and computerized tomography scanning is reported. Subsequent staging laparotomy also was negative in all these patients and did not alter management decisions. It is suggested that high-dose, whole-body gallium scanning and other noninvasive staging procedures give reliable data for therapeutic decisions.

Adult↗
PubMed1986

Evaluation of a clinically useful length of 1 mm diameter PTFE as a microvascular graft.

Previous studies of 1 mm internal diameter polytetrafluoroethylene (PTFE) have investigated short graft lengths. The aim of this experiment was to assess a longer, clinically useful graft. Femoro-femoral crossover grafts 6 cm long were implanted into 20 rats and, after an initial observation period of 1 hour, were followed up for four weeks. Ten grafts failed within the first hour post-operatively, one was occluded at 2 weeks and nine were patent at 4 weeks (45% patency). Technical errors causing stasis within the prosthesis led to the early failures. When stasis was avoided patency was good and did not appear to be dependent upon development of a cellular lining within the graft.

Animals↗
PubMed1986

Skin blood flow measurement with xenon-133 to predict healing of lower extremity amputations.

Many techniques have been proposed to help the surgeon select the most distal amputation level that will heal. Skin blood flow measurement with xenon-133 (133Xe) is one of the best documented predictors of amputation healing, but the lowest flow consistent with healing has not been agreed upon. Our early experience with the method is reported. Skin blood flow was measured in 16 patients undergoing 17 lower extremity amputations. Twelve amputations healed (mean skin blood flow 3.69 +/- 2.73 ml/100 g of tissue/min) and five failed (mean skin blood flow 0.80 +/- 0.61 ml/100 g of tissue/min) (P less than 0.05). No amputation healed if the skin blood flow was less than 1.0 ml/100 g of tissue/min. A skin blood flow above 1 ml/100 g of tissue/min, measured with 133Xe, may be a useful guide to the level at which to amputate while minimizing unnecessary proximal amputation, but the method requires further prospective evaluation.

Aged↗
PubMed1986

Traumatic duodenal transection at the level of the ampulla of Vater: sphincteroplasty as a technical adjunct to primary repair.

Complete transection of the second part of the duodenum occurred as an isolated internal injury in a 20 year old female involved in a motor vehicle accident. Her terminal bile duct lay in the free edge of the proximal transected duodenum. A sphincteroplasty effectively shifted the termination of her bile and pancreatic drainage away from the free edge of the transected duodenum, simplifying repair of the injury. This avoided the more complex alternatives of duct reimplantation or pancreaticoduodenal resection.

Accidents, Traffic↗