Biomedical subjects

J W Shaffer

Publications and source records attributed to J W Shaffer.

At least 55 records · Page 3Linked to original sources

PubMed1984

Patency of anastomosed arteries and veins subjected to reapplication of microvascular clamps.

One hundred and two rat femoral vessels, both vein and artery, were transected and repaired with a standard technique. After a 30-minute observation period, vessel clamps were reapplied in a standardized manner. The repairs were reexplored at 2 weeks. The results demonstrated no serious reduction in vessel patency in the first period or at the 2 week exploration. Reapplication of vessel clamps after an initial flow period post anastomosis does not have a significant effect on vessel patency.

Animals↗

PubMed1984

Severe fracture complications in myelodysplasia.

Prevention of fractures in the patient with myelodysplasia is aided by minimizing disuse osteoporosis by continuing weight-bearing whenever possible. The presentation and treatment of lower extremity fractures in the postoperative myelodysplasic patient have been reviewed. After these fractures severe systemic dysfunction can occur. A clinical situation involving hypovolemia and suggestive of fat embolism has responded well to immobilization in the posterior half of the spica cast and to fluid replacement.

Casts, Surgical↗

PubMed1984

A comparison of three methods for scoring figure drawings.

Figure drawings obtained from 758 white male medical students were scored using three different methods. Method I involved 16 different physical size measurements; Method II involved six separate sophistication of body concept ratings; and Method III involved 42 separate aspects of the drawings weighted in direct proportion to their relative frequency of occurrence in the sample studied (conventionality scoring). Separate factor analyses of the scores derived from each method revealed that Methods I and II each reflect only a single underlying factor, and that these factors are uncorrelated in the population studied. Method III yielded eight meaningful factors, each of which may be construed as an independent area of conventionality/deviancy. An overall conventionality/deviancy score was also derived. It is believed that these three methods of scoring capture most of the variance inherent in existing figure drawing scoring systems, but that use of all three is necessary for a comprehensive analysis.

Factor Analysis, Statistical↗

PubMed1984

Trends in the commission of crime among narcotic addicts over successive periods of addiction and nonaddiction.

Although several studies have documented high levels of criminal activity among narcotic addicts, especially during periods of active addiction, few studies have delineated the types of criminal activities involved or have attempted to uncover trends in such activities over successive periods of addiction and nonaddiction in addicts' careers. In the present series of analyses, the criminal activities of 354 male narcotic addicts were categorized and traced individually over time using five, standardized, crime-days-per-year-at-risk measures in the areas of theft, violence, drug sales, deception/forgery, and other crimes. In addition, a sixth composite measure was also employed. Although large differences among addicts in patterns of criminal activity over time were much in evidence and may be useful as a basis for a criminal typology, this same heterogeneity tends to preclude definitive statements concerning addicts as a group. This caveat notwithstanding, there does appear to be a general tendency for criminal activity to diminish over successive periods of nonaddiction and to increase irregularly over successive periods of addiction. The agreement of these findings with those of earlier group analyses by the authors is discussed.

Adult↗

PubMed1984

An ecological analysis of the interrelationships among drug abuse and other indices of social pathology.

In a study of the interrelationships among 12 separate indices of social pathology, including drug abuse, in which census tracts were the units of analysis, moderate to high intercorrelations among all indices were observed. A subsequent components-types factor analysis revealed only a single eigenvalue greater than unity, suggesting that the interrelationships among the several indices may be most parsimoniously explained in terms of a single underlying construct-generalized social pathology. Exact factor scores on this construct were computed for each tract, and those may be viewed as estimates of the degree of social upheaval present.

Crime↗

PubMed1984

A staged Papineau protocol for chronic osteomyelitis.

A three-stage Papineau protocol for the management of chronic pyogenic osteomyelitis was critically investigated in 13 prospectively treated patients with draining osteomyelitis. Stage I involved removal of nonviable tissue and retained metal. Stage II involved grafting of cancellous iliac bone. In Stage III skin coverage was accomplished. Infection was eradicated in all but one patient, and the osseous defect filled in all patients. Five patients attained skin coverage after split-thickness grafting. In seven patients epithelialization occurred, while one patient underwent a soleus muscle transposition with skin grafting. The prospective protocol could have been improved by prolonged hospitalization with repeated surgical debridements. Rather than demonstrating absolute cure of all kinds of osteomyelitis, the present results reveal factors that help to ensure successful treatment.

Adolescent↗

PubMed1984

Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring.

We retrospectively analyzed the postoperative neurological complications in 137 patients who underwent a posterior spine fusion for scoliosis and had concomitant somatosensory cortical evoked-potential spinal-cord monitoring. The patients were divided into three specific operative groups: group 1, forty-nine patients who had a Harrington rod with segmental wiring (segmental spinal instrumentation); group 2, twenty patients who had Luque segmental spinal instrumentation; and group 3, sixty-eight patients who had a Harrington rod without segmental spinal instrumentation. There were neurological complications in twelve (17 per cent) of the sixty-nine patients in groups 1 and 2. Three patients (4 per cent) had a major injury to the spinal cord and nine patients (13 per cent) had only transient sensory changes. No difference was apparent between group 1 and group 2 in the degree of operative correction of curves or in the incidence of neurological complications. The one neurological complication (1.5 per cent) that occurred in the sixty-eight patients in group 3 was a Brown-Séquard syndrome. The factors related to increased risk for spinal cord injury in groups 1 and 2 included: (1) the passage of sublaminar wires in the thoracic and thoracolumbar spine, (2) intraoperative correction exceeding the preoperative bending correction, and (3) the surgeon's lack of adequate experience with the technique. With spinal cord monitoring we were able to predict the impending major neurological deficits, but the transient (sensory) changes that may be associated with segmental wiring were less reliably predicted.

Adolescent↗

PubMed1983

A multivariate analysis of circulatory data and their relationship to later disease.

Measurements on 21 separate variables involving blood pressure and heart rate were obtained under casual, resting, and controlled conditions as part of the baseline evaluation of 1087 white males participating in a prospective investigation of possible precursors of premature disease and death. These measurements were subjected to a components-type factor analysis with orthogonal rotation of component vectors in an effort to construct statistically independent composites of greater predictive power and generality as well as to minimize problems in interpretation introduced by partially redundant variables. Multivariate and univariate techniques were afterwards used to test differences between groups of subjects who developed specific major disorders and those who remained in good health. Comparison of factor scores with original circulatory measures in a series of prospective analyses revealed that the former had the greater predictive power. Although only the hypertension group could be unequivocally differentiated from all others, a number of nominally-significant findings may provide leads for further research.

Adult↗

PubMed1983

The day-to-day criminality of heroin addicts in Baltimore--a study in the continuity of offence rates.

A representative sample of 354 male heroin addicts living in the Baltimore metropolitan area was traced from onset of opiate use to time of interview to ascertain any changes in the frequency or type of offences committed during their years at risk. Five basic measures of criminality were employed: crime-day theft, crime-day violence, crime-day dealing, crime-day con games and crime-day other offences. A sixth measure -- composite crime day -- incorporated all five crime-day measures. Crime rates per year were derived from these six measures. It was found that the start of addiction was associated with a high level of criminality (255 composite crime-days per year), and that this high rate continued over numerous subsequent periods of addiction. Theft of property was the most common type of crime, followed by drug sales, other offences, con games, and violent offences. In contrast to the addiction periods, criminality decreased over successive non-addiction periods. Thus, the composite crime rate (82 composite crime-days per year) for the first non-addiction period was only 32% of the rate of the first addiction period and this lower rate of criminality decreased markedly thereafter.

Crime↗

PubMed1983

An empirical typology of narcotic addicts.

On the basis of structured interview data concerning their life-styles, behaviors, circumstances, and activities during their most recent periods of addiction, 460 male narcotic addicts (230 Black and 230 White) were empirically classified, or "typed," using factor and cluster analytic techniques in a multistage process. Mean factor score profiles for each of the eight types derived are presented, along with provisional labels and verbal descriptions. It is believed that this classification is descriptive of the major addict types to be encountered in a large urban population.

Adult↗

PubMed1983

Failure of treatment of ununited fractures of the carpal scaphoid. The role of non-compliance.

We studied the results in thirty patients who had grafting of an ununited fracture of the carpal scaphoid bone. Psychiatric evaluations revealed that the thirteen patients who had a non-union of the initial scaphoid bone graft had significant psychiatric problems, whereas the seventeen patients in whom the non-union had healed after initial bone-grafting of the scaphoid did not have psychiatric abnormalities. Technically successful surgical revisions in the first group of patients did not result in significant clinical improvement. We concluded that most failures of the bone grafts were related to non-compliance on the part of the patient and that some of the operations could have been avoided if the underlying psychiatric problems had been recognized preoperatively.

Bone Transplantation↗

PubMed1982

Factor structure of the MMPI-168 in male narcotic addicts.

Factor analyses of abbreviated clinical and validating scales derived from the MMPI-168 yielded essentially the same solutions reported for full-length versions of the inventory. However, previously derived item-level factor scales did not emerge as distinct factors. Although the factor structures associated with black and white narcotic addict samples (N = 460) were highly similar, significant mean differences between the racial groups on many of the scales suggested the presence of greater psychopathology among white addicts.

Adult↗

PubMed1982

Youthful habits of work and recreation and later cancer among physicians.

Scores on seven factors derived from a Habits of Work and Recreation Survey administered to 1,038 white male medical students 17 to 35 years ago were used to compare students who subsequently developed some form of major cancer with those who did not. With the Type I error rate controlled through use of multivariate analysis of variance and age and smoking ruled out as possible confounding variables, the two groups were significantly differentiated, primarily in terms of intellectual interests--cancer cases having fewer. Students at or below the overall mean on the intellectual interests measure were more than three times as likely to develop cancer as were students with scores above the mean. In this population, the results appear interpretable in terms of the stamina concept, in which few intellectual interests may reflect an absence of stamina and spontaneity and/or failure to meet subcultural expectations--factors possibly associated with increased cancer risk.

Adolescent↗

PubMed1982

Family attitudes in youth as a possible precursor of cancer among physicians: a search for explanatory mechanisms.

A measure of youthful family attitudes, the Closeness to Parents Scale, has continued to be predictive of cancer among physicians in a prospective study of medical students. Nonetheless, questions have remained concerning the meaning and reliability of this measure and whether its predictive value is diminishing over time. Perhaps more important, it is necessary to ascertain whether the relationship is the result of some methodological artifact or whether it is mediated by an association with known risk factors, such as smoking, drinking, and radiation exposure. Each of these issues was examined in turn, using a variety of statistical techniques to refine the scale and to equate cancer and control groups with respect to risk factors as well as possible artifacts. In a group of 913 men, it was found that the scale is primarily a function of good father-son relationships and that its association with later cancer persists even after the influence of possible mediating and artifactual variables is statistically controlled. Several possible explanations for these findings are discussed.

Alcohol Drinking↗

PubMed1982

A comparison of nine systems to diagnose schizophrenia.

The files of 283 hospitalized patients discharged with a diagnosis of schizophrenia, schizoaffective schizophrenia, or paranoid state were examined without knowledge of the patient's subsequent history. These patients, most of whom had originally been diagnosed by DSM-I criteria, were retrospectively diagnosed by New York Research Diagnostic Criteria (RDC), the New Have Schizophrenia Index (NHSI), the St. Louis criteria, Taylor-Abrams 1978 criteria, Schneider's first-rank symptoms (FRS), the Washington IPSS 12-Point Flexible System, Astrup's process/nonprocess distinction, and DSM-III. Kappa values measuring pairwise diagnostic agreement amont the nine systems were typically low except among RDC, DSM-III, and St. Louis criteria. Long-term followup status was not significantly predicted by the FRS, NHSI, or Taylor-Abrams criteria. Diagnosis by means of the other systems, especially the Astrup process/nonprocess distinction, was significantly correlated with followup. However, Astrup's "process" schizophrenia is not operationally defined and could not be expected to be used with the degree of interrater reliability desired by researchers. On the other hand, of the operationally defined systems, DSM-III schizophrenia has the highest correlation with followup and is thus suggested for use by researchers desiring a highly homogeneous, although narrowly defined, population. Investigators wishing to cast a wider net could use a less restrictive system such as the RDC, with or without schizoaffectives included.

Adult↗

PubMed1982

Types and characteristics of addicts in the community.

This study examines both the status and behavior while addicted of 230 White and 230 Black male narcotic addicts. Following a presentation of antecedent behaviors and characteristics, an addict typology is developed based on illicit income, perception of adequacy of income to meet needs, and employment. The resulting six types are then described in terms of treatment experiences, criminality, social activities, and psychopathology. The discussion includes suggestions of a treatment perspective for each type.

Adult↗

PubMed1982

Reactive psychoses.

Scandinavian psychiatrists have been pre-eminent in elucidating the concept of reactive psychoses. This diagnosis has never found much acceptance except in Scandinavia, and the new Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition category of brief reactive psychosis is quite different from reactive psychosis as described by most Scandinavian clinicians and researchers. The concept of psychogenic psychoses is, however, not new. Indeed, many psychiatrists of the early 20th century stressed the psychogenic factors in psychotic mental disturbances. Reactive psychoses have generally been considered illnesses distinct not only from schizophrenia but also from manic-depressive psychosis with a distinctive genetic component. Of 283 hospitalized patients at Johns Hopkins for whom long-term follow-ups were available and of whom all were first admissions, Astrup retrospectively diagnosed 91 as reactive psychoses. A contrasting group of 78 "systematic schizophrenics" by Leonhardt's criteria were identified. Stephens found that these two groups differed significantly in that the reactive patients had a) a more acute onset, b) more precipitating stress, c) more affective symptoms, d) more confusion, e) less affective blunting, f) a better premorbid adjustment, g) less premorbid schizoid traits, h) fewer schizophrenic relatives, and i) a much more favorable long term outcome.

Adult↗

PubMed1982

Cholesterol levels in young adulthood and subsequent cancer: a preliminary note.

In a study of the serum cholesterol of 30 male medical students who later developed major cancer, no consistent relationship between baseline cholesterol level and cancer was found during follow-up studies extending for up to 33 years. However, different cancer types seemed to have different cholesterol profiles: subjects who developed melanoma or lung cancer had relatively low initial levels, while subjects who developed cancer of the digestive system, brain or urinary bladder tended to have high initial values. Sequential cholesterol measurements made on two men with cancer of the colon are presented. It is suggested that such sequential cholesterol studies combined with knowledge of the types of cancers involved would help to clarify such complex interrelationships as may exist. The implications of a two-population hypothesis are discussed.

Adult↗