Biomedical subjects
Publications and source records attributed to L G Walker.
Although there is a disproportionately high accident rate among adolescent drivers due to inexperience, alcohol appears to play a significant role in this number one killer for the age group. To assess this, the level of blood alcohol was measured in adolescents admitted to a trauma center following vehicular injuries.
Explore the source record for details and available documents.
Bilateral spontaneous quadriceps ruptures are rare and have been reported most often in association with chronic disease states. A case report and review of the literature are presented. Two-thirds of reported cases occur in healthy individuals, although chronic disease states enhance susceptibility to this injury in a significantly younger patient population. Routine laboratory screening for rheumatologic, endocrine, and renal disease is therefore advocated for all presenting patients. Diagnosis is clinical; review of the literature documents the efficacy of early repair followed by appropriate immobilization and aggressive physical therapy.
Controversy persists regarding the role of intraoperative biopsy in the treatment of resectable pancreatic and periampullary masses. The authors report their experience with intraoperative biopsy in 37 patients in whom preoperative diagnosis was unsuccessful. Tru-cut needle biopsy was positive in 86 per cent of patients with carcinoma of the pancreas, but was negative in all patients having periampullary neoplasms. Incisional biopsy was positive in 75 per cent of all patients, its accuracy being approximately equal in both groups of patients. Duodenotomy with open biopsy was performed in eight patients having periampullary lesions and was accurate in 88 per cent. Biopsy of lymph nodes not contraindicating resection was performed in 11 patients and was positive in only 18 per cent. Resections based on clinical findings suspicious of malignancy with either a negative biopsy or no biopsy attempted resulted in a 13 percent resection rate of patients having benign disease. These results indicate that while histologic determination of malignancy can be obtained in most resectable pancreatic and periampullary lesions, at least 12 per cent of such tumors remain undiagnosed by standard operative biopsy techniques. Pancreatoduodenectomy should proceed in these patients based on their clinical status and the surgeon's degree of experience with the procedure.
Explore the source record for details and available documents.
A simple, inexpensive skin retractor can be easily constructed using an 18- or 20-gauge needle combined with a hemostat, needle holder, or cotton-tipped applicator. This device is particularly useful for small operations on the hand, if a standard skin hook is not available.
The number of patients undergoing definitive duodenal ulcer operation at Charlotte Memorial Hospital and Medical Center declined by 75 percent from 1971 to 1985. The percentage of women making up the total study population increased to 40 percent in the period from 1981 through 1985. Average patient age also increased. Fewer gastric resections are now being performed and emergency operations are becoming more frequent, with bleeding being the most common indication. Splenic lacerations requiring splenectomy in patients undergoing vagotomy occurred in 3.1 percent of the study population during the 15 year study. The overall mortality rate for elective operations was 1.5 percent and for emergency operations, 17.2 percent. The incidence of acute duodenal ulcer perforation increased during this 15 year study. Duodenal ulcer operations have changed in number and in type as the manifestations of the disease have become altered by trends that began in the mid 1950s and became exaggerated by more effective ulcer therapy.
Explore the source record for details and available documents.
A community sample of elderly married couples completed the 60-item General Health Questionnaire and the Leeds General Scales for the Self-Assessment of Depression and Anxiety. Significant concordance was demonstrated between the spouses' scores on these scales. Concordance was higher for depression than for anxiety. There was little to support previous findings that wives are more likely than husbands to be concordant with an ill spouse. The spouse concordance rates for psychiatric morbidity were similar to those found in studies of younger married couples.
Ratings of behaviour and family relationships were made on the basis of (a) a non-schedule standardised interview, (b) direct observation of family interaction during a meal time and (c) direct observation of mother-child interaction during free play. A number of scales met a battery of reliability and other criteria, and possible generalisation of these ratings across methods (interview versus direct observation) and settings (meal time versus free play) was assessed. For the vast majority of scales this was low. Reasons for this, together with some clinical implications, are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Seventy-five students, at the end of their final year, responded to a postal questionnaire designed to assess their views on their medical curriculum. The responses of those intending to enter general practice were compared with those of intending hospital doctors and comparison were also made between respondents who had enrolled for a 6-year course and those who had enrolled for the newer 5-year course.
Five experimental incentive conditions were compared with a control condition in terms of their effect on work performance. Each of the six groups studied had a standard four-week baseline period (Block 1) consisting of an attendance payment, followed by a four-week experimental period (Block 2). Whereas all patients in the Control and Feedback groups produced less during Block 2, only two patients in the remaining four groups failed to improve. An analysis of variance indicated that Social Reinforcement, Piece Rate, Piece Rate plus Social Reinforcement, and Pay Increase plus Social Reinforcement were significantly superior to the Control and Feedback conditions.
I have found the POMR to be a valuable tool in both the office and hospital practice of general surgery.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.