An interview with Kay Clark. Interview by Barbara J. Barnum.
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Forecasting↗
Biomedical subjects
K Clark
Publications and source records attributed to K Clark.
Supply, demand, and salaries.
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Health Services Needs and Demand↗
Establishment and preliminary characterization of a new myeloma cell line, C23/11.
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Cell Fusion↗
Testicular ischemia and infarction following herniorrhaphy or varicocelectomy: evaluation by radionuclide imaging.
The postoperative use of testicular imaging to evaluate the preservation of testicular circulation has been reported after orchiopexy, excision of a hematocele, and repair of a traumatized tunica albuginea. The authors discuss the previously unreported use of testicular imaging in patients who have undergone recent herniorrhaphy or varicocelectomy. The scan of a patient with intact testicular perfusion following herniorrhaphy is compared to the scans of two patients with absence of perfusion of a testicle five to seven days following respective herniorrhaphy and varicocelectomy surgeries.
Adult↗
Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair.
In four patients with ruptured abdominal aortic aneurysms increased intra-abdominal pressure developed after repair. It was manifested by increased ventilatory pressure, increased central venous pressure, and decreased urinary output associated with massive abdominal distension not due to bleeding. This set of findings constitutes an intra-abdominal compartment syndrome caused by massive interstitial and retroperitoneal swelling. The purpose of this report is to establish criteria for this syndrome and suggest a method of treatment. The syndrome developed within 24 hours; in one patient within 5 hours postoperatively. All four patients received more than 25 liters of fluid resuscitation (electrolyte and blood) during and within 16 hours after operation and had massive abdominal distension. Decompressive laparotomies were performed in the Intensive Care Unit with placement of Marlex (Bard Corp., Billerica, MA) mesh. In two additional patients, at the completion of the aneurysmectomy the abdominal incision was left open with interposition Marlex mesh. Opening the abdominal incision was associated with dramatic improvements in central venous pressure, urinary output, ventilatory pressure, arterial carbon dioxide tension, and oxygenation. The authors conclude that some patients with ruptured abdominal aortic aneurysm do not tolerate the closure of the abdominal wall, as manifested by increased ventilatory pressures, decreased oxygenation, and decreased urinary output. Opening the abdominal wound or delayed closure may reverse the oliguria and improve oxygenation. Recognition and treatment of this condition by opening the abdominal wound or delayed closure may affect outcome in some cases.
Abdomen↗
Aspects of women's health care in Finland.
The article is drawn from experience gained on a management study trip to Finland, and begins with a general explanation of the Finnish health care system, which is based on local government. Planning progress over the last fifty years is outlined, culminating in the present emphasis on primary care. There is a short section on family planning, followed by a description of abortion legislation and its effects on the birth rate. Antenatal care is also considered, particularly the important role of public health nurses and the lack of contact during pregnancy with the hospital staff who will attend the delivery. Finally the generous Finnish system of maternity leave is described.
Female↗
Case management service provision and client change.
The present study examines the relationship between case management service provision to the chronically mentally ill and consequent client change. Subjects were clients who had been in the Mississippi case management system for at least six months. It was predicted that the services of linkage/referral and advocacy would account for the most change in the number of problems and severity of problems on the part of the client. However, less than three percent of the variance in overall client change was explained by all five services combined. Results are discussed in light of certain constraints within the system.
Adolescent↗
The relationship between heart rate, heart rate variability and depression in patients with coronary artery disease.
Seventy-seven patients undergoing elective cardiac catheterization were administered a diagnostic psychiatric interview and their mean heart rates and heart rate variability were determined from the results of a 24 hr ambulatory ECG. The mean heart rate for depressed patients with coronary artery disease (CAD) was significantly higher than for nondepressed CAD patients, independent of the patient's age, smoking status, and beta blocker therapy. Heart rate variability was lower in depressed patients but did not achieve significance. With the exception of smoking, which was more common in depressed patients, there were no significant differences between the depressed and nondepressed patients on any other medical or demographic variable assessed. It is concluded that elevated heart rate may represent increased sympathetic tone in depressed CAD patients, and may help to explain the increased morbidity and mortality reported in these patients.
Arousal↗
Interferon alfa-n1 (Wellferon) in juvenile onset recurrent respiratory papillomatosis: results of a randomized study in twelve collaborative institutions.
Sixty-six patients with clinically severe juvenile-onset recurrent respiratory papillomatosis (RRP) were entered into a 12-month randomized crossover study to evaluate interferon alpha-n1 Wellferon (WFN) as an adjuvant to CO2 laser surgical excision. Eligibility required disease onset to be before age 16, and an endoscopic excision requirement of at least three operations in the 6 months immediately prior to entry. Patients were randomized to Observation versus WFN at a dose of 5 MU/m2 daily for 28 days and three times weekly for 5 months. The patient groups were comparable in extent of disease at entry. Total extent of disease was determined by a composite score derived from the number of diseased anatomic sites and extent of surface area and lumen encroachment present at each site. Standard endoscopic excisions were performed every 2 months and clinical courses compared on a basis of composite scores determined at each endoscopy. Statistically significant improvement occurred in the patient group which received WFN. We conclude that interferon alpha n-1 is an effective adjuvant to surgery in RRP management.
Adolescent↗
Effect of tamoxifen on oestrogen binding, lipid and lipoprotein concentrations and blood clotting parameters in premenopausal women with breast pain.
As part of a controlled trial of the use of tamoxifen for the treatment of mastalgia, some of the metabolic and haematological effects of this agent were measured. A panel of haemostatic variables including prothrombin time, kaolin cephalin clotting time, fibrinogen, euglobulin lysis time, factor VII, factor VIII, protein C and anti-thrombin III were determined. In addition, levels of sex hormone-binding globulin and both total and free oestradiol were estimated. No alteration in clotting function was found during the administration of tamoxifen, although hepatic function did alter during this period with an increase in concentration of sex hormone-binding globulin. There was a significant increase in total oestradiol and free oestradiol although the percentage of biologically available free oestradiol fell slightly during the course of tamoxifen treatment. There was a slight reduction in low-density lipoprotein cholesterol with an increase in HDL2, a subclass of high-density lipoprotein (HDL) cholesterol, consistent with an oestrogen-agonist effect. These data suggest that tamoxifen administration does not adversely influence haemostatic mechanisms or lipoprotein metabolism in the short term.
Adult↗
Pharmacological treatments of tardive dyskinesia in the 1980s.
The studies of tardive dyskinesia treatment published in the 1980s were generally superior to earlier work in terms of methods (more double-blind trials using standardized rating scales), but relatively small sample sizes and short durations of studies were still the main deficiencies. The results continue to suggest an absence of an overall satisfactory treatment. Individual patients seem to respond to different drugs such as noradrenergic antagonists and GABAergic agents. Withdrawal of neuroleptics and antiparkinsonian agents is a useful strategy. Future work should concentrate on defining clinicopharmacological subtypes of tardive dyskinesia.
Dyskinesia, Drug-Induced↗
Major depressive disorder in coronary artery disease.
Depression has been reported to be common in patients with coronary artery disease (CAD), using a variety of criteria for the diagnosis of depression. However, many studies have relied solely on the presence of symptoms such as a dysphoric mood and fatigue in making a diagnosis of depression. Both fatigue and dysphoric mood are also associated with medical illnesses, and psychiatric diagnoses based on such nonspecific symptoms may lack the specificity necessary to predict the need for psychiatric treatment. To assess the incidence of depression likely to require and respond to psychiatric treatment, 50 patients documented to have CAD by coronary angiography underwent psychiatric diagnostic interviews. Current research-based criteria (DSM-III) were used to make diagnoses of major depressive disorder. In addition, the applicability of a brief screening inventory the (Beck depression inventory) for detecting the presence of depression in these patients was tested. Nine patients (18%) met criteria (DSM-III) for major depressive episode. Depression was not related to the extent of CAD, age or use of beta blockers. There was a relation between depression and smoking. Only 2 of the 9 depressed patients had been diagnosed previously and were being treated for depression. When a score of greater than or equal to 10 on the Beck depression inventory was used to distinguish patients with depression, it had moderate sensitivity (78%) and specificity (90%) for the identification of depression.
Aged↗
Non-phosphorylated and phosphorylated neurofilaments in hypothyroid rat cerebellum.
Purkinje cell baskets in hypothyroid rat cerebellum were studied with antibodies reacting with phosphorylated or non-phosphorylated neurofilament epitopes. Compared to normal rats, Purkinje cell baskets were fewer in number and less developed in hypothyroid rat cerebellum. However, no differences were observed as to their immunoreactivity with monoclonal antibodies reacting with phosphorylated or non-phosphorylated neurofilament epitopes.
Animals↗
Prevalence of major depressive disorder in patients receiving beta-blocker therapy versus other medications.
Depression is believed to be a common side effect in patients receiving beta-blocker therapy. However, diagnoses of depression defined by current diagnostic criteria may not be more common in patients receiving beta-blockers than in patients with the same medical disorder receiving other medications. Seventy-seven patients undergoing elective cardiac catheterization for evaluation of chest pain received a semi-structured diagnostic psychiatric interview. Twenty-one percent of the patients receiving beta-blockers and 33 percent of the patients receiving medications other than beta-blockers met the current American Psychiatric Association criteria for major depressive disorder (DSM-III) (p = NS). The mean heart rate and state anxiety scores for patients taking beta-blockers were significantly lower than those measured in patients taking medications other than beta-blockers. No other medical or demographic differences were observed between the two groups. Despite the methodologic limitations of the study, there does not appear to be a difference in the point prevalence of depression between patients receiving beta-blockers and those receiving other medications.
Adrenergic beta-Antagonists↗
Pelvic infection and the pathogenesis of tubal ectopic pregnancy.
All ectopic pregnancies occurring in a defined New Zealand urban area from the years 1970 and 1984 were studied (232 cases in total). The medical records and histological preparations were reviewed. A 38% increase in the incidence of ectopic pregnancy over this 15-year period is documented. The percentage of patients with histological evidence of past tubal infection increased from 40.6% in 1970 to 61.2% in 1984. Significant increases in the number of patients with histories of infertility or past pelvic infection and of patients with operative evidence of past infection were also noted. These results support the postulate that the increase in incidence of ectopic pregnancies over recent decades is strongly associated with the increase in prevalence of pelvic infection. Tubal damage secondary to previous pelvic infection is probably the major, although certainly not the only, aetiological factor in the development of tubal pregnancies.
Adolescent↗
Demonstration of antigenic variation among rabies virus isolates by using monoclonal antibodies to nucleocapsid proteins.
Rabies virus isolates from terrestrial animals in six areas of the United States were examined with a panel of monoclonal antibodies to nucleocapsid proteins. Characteristic differences in immunofluorescence reactions permitted the formation of four antigenically distinct reaction groups from the 231 isolates tested. The geographic distribution of these groups corresponded well with separate rabies enzootic areas recognized by surveillance of sylvatic rabies in the United States. Distinctive reaction patterns were also identified for viral proteins from four infected bat species, and identical patterns were found in eight isolated cases of rabies in terrestrial animals. These findings suggest that monoclonal antibodies can be used to study the prevalence, distribution, and transmission of rabies among wildlife species.
Animals↗
Peripheral airways function and nonspecific airways reactivity in cigarette smokers.
Increasing concentrations of inhaled aerosolized histamine acid phosphate were administered to 31 heavy cigarette smokers from a smoking cessation clinic. Nineteen of 31 smokers (mean age +/- ISD: 39.6 +/- 11.5 yrs; pack years 25.5 +/- 13.5) failed to reduce forced expired volume in one second (FEV1) while inhaling histamine and were labelled nonresponders. In 12 of 31 smokers (age 38.4 +/- 9.4 yrs; pack years 23.0 +/- 10.5), extrapolated provocation concentration of inhaled histamine required to reduce forced expired volume in one second (FEV1) by 10 percent (PC10) could be determined and these smokers were labelled responders. We also measured maximum expiratory flow volume curves with air and also a mixture of 80 percent helium and 20 percent oxygen (HeO2) to determine the percentage of increase in maximal flow at 50 percent vital capacity breathing HeO2 as compared to air (delta Vmax50), and the slope of phase III of the single breath oxygen test (delta N2/L). In the responders, PC10 ranged from 1.4 mg/ml to 10.2 mg/ml (mean 5.5 +/- 3.3 mg/ml) and delta Vmax50 ranged from 7.1 percent to 68.4 percent (mean 39.6 +/- 18.3 percent). There was a significant positive correlation between PC10 and delta Vmax50 (r = 0.77, p less than 0.01), and a significant negative correlation between PC20 and delta N2/L (r = -.61, p less than 0.01). There was no difference between responders and nonresponders in mean values for lung function tests, allergy skin tests, or symptoms. These results suggest that there may be two fundamentally different groups of smokers with peripheral airways dysfunction: one group in which dysfunction is associated with, or related to, airways reactivity, and one group in which dysfunction is related to other factors.
Adult↗
Psychosocial aspects of prolonged ventilator dependency.
Placement of the ventilator-dependent patient must take into consideration the psychosocial aspects of the situation. These include the patient's age, level of emotional and cognitive function, financial status, insurance benefits, cultural and personal-experience influences regarding life-threatening illness and institutionalization, and the availability of suitable caregivers. The hospital provides the greatest physical security but is expensive and allows minimal patient autonomy and family involvement. A nursing home is homier and less expensive, but it must have a staff well trained in the complex care of these patients and someone to oversee execution of the care plan, and its cost may not be adequately reimbursed by private insurance. Home care usually provides the best conditions for the patient, but it requires trained and available health professionals; a committed physician; education of the patient, family, and attendants; a suitable residence; a system for delivery and maintenance of supplies and equipment; and dependable financing; and it must allow the patient increased independence, socialization, and activities of daily living. Ventilator-dependent patients commonly experience fear, feelings of total dependency, and even degradation. Caregivers can relieve these feelings by reassuring the patient about safety measures, by keeping him informed about medical procedures, and by establishing communication.
Home Care Services↗