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Biomedical subjects

J Toner

Publications and source records attributed to J Toner.

At least 55 records · Page 3Linked to original sources
PubMed1990

Strategies in the treatment of major tissue loss and gangrene: results of 100 consecutive vascular reconstructions.

To determine the features of a successful clinical strategy, we analyzed the results of 100 consecutive lower extremity vascular reconstructions performed exclusively for tissue loss and gangrene of the legs and feet. Eighty patients underwent 100 procedures on 80 limbs. Follow-up was 95% complete (every six months, mean 2.2 years). Forty inflow procedures to the femoral artery were performed with 13 simultaneous infrainguinal bypasses. Sixty bypasses were performed from the femoral artery to the popliteal (25) or tibial arteries (35). Sixty-eight percent of the identified ulcerations healed, and limb salvage was achieved in 70% of patients by life-table analysis. The cumulative patency for all reconstructions was 48% (five years), for tibial bypasses 60% (four years). Femoropopliteal bypasses had the poorest patency and healing rates (less than 40%), while combined inflow-outflow procedures and femorotibial bypasses had the highest rates of healing (77%, 66%). There were two operative deaths, three graft infections, seven wound infections, and 12 acute graft thromboses. Vascular reconstructions for extensive tissue loss or gangrene can be performed with a morbidity and mortality comparable to procedures performed for less severe disease with a high rate of limb salvage. The long term success of surgical therapy depends primarily on the most direct revascularization of ischemic, infected tissues, using autologous conduits whenever possible.

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PubMed1990

[The GnRH precursor is present in the anterior pituitary gland and an important increase of its content precedes serum LH surge induced by estradiol-17 beta in female primates].

Estradiol-17 beta (E2 17 beta) is well known to evoke a preovulatory-like LH surge in ovariectomized monkeys even in the absence of the integrity of the hypothalamo-pituitary connections. LH release from the anterior pituitary (AP) is reliant on stimulation by hypothalamic GnRH which is derived from proteolytic cleavage of a precursor (designated Pro-GnRH-GAP) which also results in the production of an associated peptide (GAP). The present study examined the effects of E2 17 beta on the hypothalamic content of Pro-GnRH-GAP, GnRH and GAP while incidental observations revealed the presence of Pro-GnRH-GAP and its products in the AP. Changes in GnRH and GAP were closely related at all times after E2 17 beta treatment. However, the pattern of change in the hypothalamus and AP was inversely related. Pro-GnRH-GAP levels remained unchanged in the hypothalamus whereas in the AP the peptide increased markedly (48 hrs. post E2 17 beta) prior to the LH surge and declined to low levels (72 hrs. post E2 17 beta) at the time of the LH surge. The increase in Pro-GnRH-GAP in the AP that precedes the rise in GnRH and accompanying LH surge by 24 hrs. strongly indicates that AP GnRH is more important than hypothalamic GnRH for the mediation of the E2 17 beta-induced LH surge in female primate.

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PubMed1988

Comparison of self-administered and rater-administered methods of assessing levels of severity of depression in elderly patients.

Eighty consecutive attenders (M age = 75 years) in a primary care group practice associated with a teaching hospital in New York were assessed for depression using a self-administered questionnaire, the Zung Self-Rating Depression Scale (SDS), and a rater-administered interview, the Short-CARE. The sample was 75% female and 85% black or Hispanic. The response rate of completed interviews was 65% for the Zung SDS and 100% for the Short-CARE. Among the reasons indicated by subjects for not filling out the Zung SDS were visual problems (n = 13, 28%), illiteracy (n = 4, 9%), and lack of motivation/wanted it read to them (n = 16, 34%). Additionally, using the Primary Care Physicians' Questionnaire (PCPQ), results from the Short-CARE and the Zung SDS were compared to primary care physicians' judgments regarding the presence of depression in these patients. The convergent validity coefficient for the Zung SDS with the PCPQ was .65 (kappa = .29); the comparable coefficients for the PCPQ and the Short-CARE Depression Scale were .73 and .46 respectively.

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