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Biomedical subjects

J Young

Publications and source records attributed to J Young.

At least 559 records · Page 31Linked to original sources
PubMedDate not supplied

Endoscopic skull base surgery I: a new animal model for pituitary surgery.

Endoscopy has emerged as a new means to perform minimally invasive surgery of the skull base. Specifically, endoscopic techniques and instruments can be used to safely and effectively approach and resect tumors of the pituitary gland in humans. No animal model currently exists to serve as a template upon which to refine and develop endoscopic surgical technique in this region of the anatomy. We operated on two purpose-bred Hampshire-Yorkshire-Duroc hybrid swine to demonstrate the application of endoscopy to pituitary surgery. Based upon similar anatomical relationships in humans and swine between the oropharynx, nasopharynx, and skull base, we used a transoral, transpalatal approach to access the vomer of the swine. Under endoscopic exposure, we resected the vomer, entered the sphenoid sinus, and then resected the sphenoid septum, sella turcica, and adenohypophysis. Clear visualization of the pituitary, hypophyseal stalk, cavernous sinuses, and carotid prominences was achieved and documented with digital photography. Benefits and limitations of the technique were noted. These results have pertinent implications both for the study of the surgical anatomy of the swine craniofacial skeleton, and for future development of endoscopic surgical manipulation of the skull base.

Animals↗
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Rotator cuff repairs in individuals with paraplegia.

Shoulder pain and dysfunction are common problems among those individuals with a spinal cord injury (SCI). Among individuals with SCI who have shoulder pain, the prevalence of rotator cuff tears is 65 TO 71%. To date, there has been little discussion as to the efficacy of various treatments for shoulder pain used in the SCI population. The purpose of this retrospective study was to evaluate the outcome of rotator cuff repairs at the Spinal Cord Injury Center (Veterans Administration Puget Sound Health Care System). Five patients (six shoulders) were identified who had undergone shoulder surgery for rotator cuff tear since 1987. Four individuals (five shoulders) had large rotator cuff tears, and following surgery, none of these repairs resulted in improvement of shoulder function or improvement in active range of motion. The one patient with a smaller tear limited to the supraspinatus had a successful surgical outcome in that he had decreased pain, increased strength, and increased range of motion. There is a general lack of epidemiologic information about shoulder pain in individuals with paraplegia. There is also a remarkable lack of research as to the functional impact of shoulder pain and the outcome of nonsurgical and surgical treatments. This case series, drawn from a population of 511 individuals with spinal cord injury, demonstrates that poor outcome was more likely in those with supraspinatus atrophy, those with upward displacement of the humeral head on x-ray, and in those with tears involving more than one muscle. There is a need for further study of conservative treatment and development of selection criteria for those individuals who are being considered for surgery.

Aged↗
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Lorazepam given the night before surgery reduces preoperative anxiety in children undergoing reconstructive burn surgery.

A high level of preoperative anxiety frequently occurs in children undergoing reconstructive burn surgery. Reduction of this anxiety may have a number of physiological and psychological benefits. Various pharmaceutical and nonpharmaceutical regimens to reduce preoperative anxiety have been devised; however, most regimens are not initiated until the period immediately before surgery. Many of the children in our institution report high levels of anxiety beginning the night before surgery. Therefore we hypothesized that sedation the night before surgery would be beneficial. Oral lorazepam 0.025 mg/kg or placebo was given the night before surgery to 45 patients in a prospective, randomized, double-blind fashion; in addition, all patients received preoperative sedation per protocol on the day of surgery. Immediately before induction of anesthesia, all patients (mean age 12.5 +/- 0.9 years, range 6 to 18 years) performed an anxiety self-rating with the use of a validated visual analog scale (VAS). Patient anxiety and quality of anesthesia induction was also rated by one of the investigators. Postoperatively, patients rated their recall of anxiety with the use of the VAS. When queried preoperatively, patients who received lorazepam the night before surgery self-reported significantly less anxiety than those receiving placebo. Investigator observations did not detect this difference; this reinforces the assertion that patient self-rating of anxiety may be the best tool for rating anxiety.

Adolescent↗
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Pharmacokinetics and pharmacodynamics of enalapril in patients with congestive heart failure and patients with hypertension.

The clinical pharmacokinetics and pharmacodynamics of enalapril and its de-esterified active metabolite, MK 422, were determined in eight patients with congestive cardiomyopathy and five patients with hypertension. After administration of single doses of 2.5, 5, and 10 mg enalapril in the congestive heart failure patients and 20 or 40 mg in the hypertensive patients, serum levels and urine elimination of enalapril and MK 422 were determined. Standing and supine heart rate and blood pressure were measured as was ejection fraction in the congestive heart failure group and renin activity, aldosterone levels, and converting enzyme activity in the hypertensive group. Apparent oral clearance after administration of 5 and 10 mg enalapril was lower in the congestive heart failure patients (0.6 +/- 0.2 and 0.7 +/- 0.4 L/min) than after 20 and 40 mg given to hypertensive patients (2.5 +/- 1.3 and 2.7 +/- 2.7 L/min). The elimination of MK 422 was also slower in the congestive heart failure patients (7.8 +/- 5.0 and 6.8 +/- 2.5 h after 5 and 10 mg enalapril, respectively, vs. 4.6 +/- 2.0 and 5.3 +/- 1.1 h after 20 and 40 mg, respectively, in the hypertension group). The enalapril area under the concentration-time curve increased disproportionately to dose increments in both groups, but was more pronounced in congestive heart failure. Twenty and 40 mg enalapril lowered the blood pressure by 2 h after dosing in the hypertension group, and peak effects were seen 4-5 h after dosing. Peak effects correlated with peak serum MK 422 concentrations but not with enalapril (MK 421) levels. Supine heart rates were unchanged after 20 mg, but increased after 40 mg; standing heart rates were transiently increased after 20 and 40 mg enalapril. Blood pressure was not significantly changed in the congestive heart failure group, and cardiac ejection fraction was unchanged. In the hypertension group, renin stimulation and converting enzyme activity inhibition were seen at 4 h and persisted for at least 24 h after administration of 40 mg enalapril. In summary, the clearance of enalapril and elimination of MK 422 was slower in congestive heart failure patients versus hypertensive patients. Therefore, slower onset and longer duration of drug effect might be anticipated in patients with congestive heart failure versus patients with hypertension during enalapril administration.

Adult↗
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Self-report evaluation of health behavior, stress vulnerability, and medical outcome of heart transplant recipients.

OBJECTIVE: The purpose of this study was to explore the value of patient self-report assessment in heart transplant candidacy evaluation, utilizing the Millon Behavioral Health Inventory (MBHI). Patient's MBHI measures were related to important pretransplant patient characteristics and posttransplant measures of health behavior, medical morbidity, and mortality. METHOD: Ninety heart patients with end-stage cardiac disease completed the MBHI during pretransplant candidacy evaluations, and also were interviewed concerning their coping effectiveness, support resources, and compliance history. Postransplant follow-up of 61 living and 29 deceased patients included measures of survival time, postsurgical medical care, rejection and infection episodes, and nurse ratings of medication compliance and problematic interpersonal health behaviors. RESULTS: The MBHI coping scales were found to significantly discriminate good and poor pretransplant compliance, and interview judgments of good and poor coping and support resources, with modest accuracy. The MBHI also was superior to these interview judgments in predicting posttransplant survival time and medical care used. Certain scales were also positively associated with physical parameters of pretransplant and posttransplant status. CONCLUSIONS: Patient self-report with the MBHI can contribute to identification of patients at risk for a problematic outcome with transplant, by providing information pertinent to clinical decision making and outcome management analysis with this special population of cardiac patients.

Adult↗
PubMedDate not supplied

Subtrochanteric fracture after fixation of slipped capital femoral epiphysis: a complication of unused drill holes.

Subtrochanteric fracture of the femur has been infrequently reported after in situ fixation of slipped capital femoral epiphysis, and this occurred in only 1.4% of our patients over a 10-year period. As this technique is used more frequently, however, the incidence of this complication is likely to rise. All four subtrochanteric fractures occurred through unused drill holes, and avoiding extraneous screw holes seems to be the best way to prevent postoperative subtrochanteric fracture. Once subtrochanteric fracture occurs, immediate open reduction and internal fixation with a compression hip screw device is the recommended treatment.

Adolescent↗
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Instrumented testing of functional knee braces.

The ability of seven functional knee braces to control anterior tibial displacement in three severely lax ACL deficient knees using two instrumented testing devices was studied. Some braces were statistically shown to be much better in this regard than others, but not all data obtained was statistically significant. This material should aid one in determining which braces offer the greatest degree of control of anterior tibial displacement in patients with ACL insufficiency.

Analysis of Variance↗
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Day hospital and stroke patients.

Geriatric day hospitals are commonly used in the rehabilitation of stroke. However, there is little objective evidence about its effect for this condition. The potential advantages and disadvantages are finely balanced and further research, including cost-effectiveness analysis, is needed to define more clearly the role of this expensive facility.

Activities of Daily Living↗
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Hantavirus transmission in the United States.

In 1996, investigation of a hantavirus pulmonary syndrome (HPS) outbreak in southern Argentina found evidence of person-to-person transmission of a hantavirus. The infection control ramifications of this finding led to this review of hantavirus epidemiology in the United States; the review suggests that Sin Nombre virus infection is rarely, if ever, transmitted from person to person and that existing guidelines for prevention of HPS remain appropriate for North America.

Adult↗
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Survey of newborn security in British Columbia hospitals. Review Committee on Newborn Security. Provincial Ministry of Health.

The abduction of a newborn from Kelowna General Hospital, Kelowna, BC, in September 1996 resulted in the formation of a newborn security review team by the province's Ministry of Health and the British Columbia Health Association. Part of the duties of the review team was the surveying of 87 hospitals in British Columbia that provide maternity services on current security protocols in each facility. Results of the survey are presented in this article, along with the subsequent recommendations of the review committee.

British Columbia↗
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[Lacrimal gland hypertrophy: revealing sarcoidosis].

We present a case of systemic sarcoidosis in a 34-year-old woman initially presenting with bilateral and symmetric proptosis caused by lacrimal gland enlargement. Based upon clinical, biological and radiological findings, sarcoidosis was suspected with lacrymal gland, parotid and pulmonary lesions. Biopsy of enlarged lacrimal gland for histological examination revealed a non caseating granuloma compatible with the diagnosis of sarcoidosis. Sarcoid lesions regressed with corticosteroid therapy.

Adult↗
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Integrating special-needs adoption with residential treatment.

Current estimates indicate that 76% of Iowa children whose parents' rights have been terminated and who are listed on the adoption exchange are older children with emotional/behavioral disabilities. Residential treatment can play a significant role in preparing difficult-to-place children (e.g., seven- to 14-year-olds with moderate to severe emotional or behavioral problems) for adoptive placement [Powers and Powell 1982]. The SATT model offers the opportunity to effectively manage the risks in adoptive placement for these children.

Adoption↗
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I dare you.

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Humans↗
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Synthetic amphipathic sequences of surfactant protein-B mimic several physicochemical and in vivo properties of native pulmonary surfactant proteins.

A mixture of lipids and proteins unique to the lung lines the airspaces of all mammalian species. This mixture, termed pulmonary surfactant, is essential for normal lung function. We have synthesized selected amino acid sequences of one of the major low molecular weight surfactant proteins to find whether these peptides can duplicate effects of native protein. Peptide/lipid mixtures approximate results found with native surfactant proteins both in vitro and in vivo. Effects found with native proteins or synthetic peptides include association with, and ordering of, surfactant lipid; changes in surface tension with surface compression; rapid adsorption of lipids from subphase to surface; and improvements in oxygenation of surfactant-deficient rats.

Amino Acid Sequence↗
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Körner statistics.

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Humans↗