Biomedical subjects
M Coles
Publications and source records attributed to M Coles.
Extraversion-introversion and the EEG.
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Diagnostic laparoscopy of the liver and peritoneum using conscious sedation.
Laparoscopic study of the liver is now common in many U.S. medical centers. With proper preparation, the procedure can be performed safely in the endoscopy suite using conscious sedation. Multiple sites in the liver can be biopsied in a directed and rapid sequence. Postbiopsy bleeding can be detected early and stopped effectively should it occur. Restrictions after the procedure are similar to those for other outpatient surgical procedures along with the typical post-liver biopsy instructions. A successful laparoscopy requires careful nursing evaluation, monitoring, and assistance. In this article, the authors discuss the practical aspects of diagnostic laparoscopy performed in the endoscopy suite, the nurse's role during and after the procedure, and management of the instruments.
Management of disturbed and aggressive behaviour in psychopaths.
In order to maximize the benefits of a multimodal therapeutic regime, a therapeutic group milieu setting is needed as a catalyst, followed by mandatory community care. Therefore, the treatment of choice for the psychopath seems to be the integrated comprehensive approach on a long term basis. However, should therapy be ineffective, the structure will be maintained while the elapse of time decreases the psychopathic behaviour to a virtual non-existent entity as a result of aging. In either case, society will be protected.
Bridgeport Hospital autologous blood donation experience from 1992 to 1996.
The safety of the blood supply, an issue in the 1970s and 1980s, created an increased need to screen the blood supply for HIV-1 and hepatitis C virus infections. The possibility exists that other contamination could again affect the blood supply. This has resulted in the increased use of strategies to minimize the transfusion of allogeneic blood, such as autologous blood predeposit for elective surgical procedures. Many studies indicate, however, that autologous blood donation is overutilized so that half of the blood withdrawn for autologous use is discarded. Cost-effectiveness studies have indicated that autologous blood donation has little benefit compared with many medical procedures, from which one might conclude that the procedure could be eliminated. Alternatively, the benefit could be improved by reducing the wastage of autologous donated blood. This wastage must occur only because of a premise that autologous blood is obtained to ensure avoidance of a homologous transfusion. This results in an amount of blood withdrawn that is more than is used in an uncomplicated procedure. We examined the transfusion requirements in surgical procedures for which there is autologous blood donation to establish the optimum amount of blood to be taken based on expected blood use. The transfusion records of 493 patients who donated blood preoperatively (340 orthopedic, 69 urological and 83 gynecological, in the years 1992 and 1993) were audited to determine the characteristics of the transfusion practices associated with the surgical procedures. The study sample underwent 182 total knee and 123 total hip arthroplasties, 33 laminectomies with fusion and three without, 83 hysterectomies and myomectomies, 59 radical retropubic prostatectomies and 10 nephrectomies and lymph node resections. Data used for evaluation were age, sex, units donated and transfused, predonation hemoglobin concentration, initial and final hemoglobin concentration, surgical procedure and surgical blood loss. The study suggests that autologous predeposit is not indicated for hysterectomies because of the low likelihood of transfusion. Even when a transfusion is likely according to the surgical blood order schedule, predonation is greater than actual use. Use of predonation hemoglobin could facilitate better efficiency of use for procedures where use is anticipated, thereby significantly reducing a wastage near 50 percent.
Treatment of pathologic fracture and surgical value of prognostic factors in multiple myeloma.
Fifty-eight cases diagnosed as multiple myeloma were reviewed to assess the surgical treatment and prognostic factors which had been recently advocated to predict the survival. The following data in these cases were investigated: age, sex, surgical modalities and prognostic factors such as beta 2-microglobulin, LDH, hemoglobin, etc. In our study, surgical significance based on these laboratory findings was discussed. There was significant difference (p < 0.05) in hemoglobin level between pathologic fracture group and non-fracture group. The albumin in the fracture group was lower than the albumin in the non-fracture group. These data were consistent with increased activity of myeloma cells that might cause bone destruction and fracture. Multiple myeloma has a peak incidence during the 7th decade, younger patients (< or = 40 yrs.o.) were rare. One 39-year-old man was successfully treated with surgery, chemotherapy and radiation therapy. Operative intervention seems to be quite important to improve the quality of life if longer survival is expected.