PURPOSE: Current sonographic technology has enhanced imaging. This study analyzes the sonographic findings in a large series of patients with pancreatic ductal adenocarcinoma. METHODS: The sonograms of 62 patients with pathologically confirmed pancreatic ductal adenocarcinoma were retrospectively analyzed. RESULTS: Tumors were an average of 4.5 x 3.5 cm in cross section. The largest lesion was 14.0 x 9.0 cm, and the smallest was 1.8 x 1.1 cm. Forty-three tumors (69%) were located in the head of the pancreas, 1 (2%) at the junction of the head and body, and 16 (26%) in the body or tail; 2 lesions (3%) were diffuse. Tumors were ovoid or spherical in 37 patients (60%) and irregular in 25 (40%). Forty tumors (65%) markedly deformed the shape of the gland. Six lesions (10%) caused no glandular contour abnormality and were visualized only because tumor echogenicity differed from that of the normal pancreas. Thirty-four tumors (55%) were homogeneously hypoechoic compared with the normal pancreas, 2 (3%) were homogeneously hyperechoic, 1 (2%) was isoechoic, and 25 (40%) had heterogeneous echotextures. Many of the heterogeneous tumors were predominantly hypoechoic with areas of varied echogenicity. Calcifications were noted in 4 patients (6%) and small intratumoral cystic areas in 9 patients (15%). Postobstructive pseudocysts were found in 4 patients (6%). Color Doppler flow information was available for 19 patients; internal flow was detected in only 1 tumor (5%). Vascular occlusion was found in 3 patients and circumferential vascular encasement in 8; the tumors in these patients were unresectable. Tumors were noted to touch vessels in another 6 patients. CONCLUSIONS: Current sonographic equipment allows the demonstration of new findings in pancreatic carcinoma. Color Doppler sonography can define tumor involvement of blood vessels and potentially affect clinical staging and treatment decisions.

Blood Flow Velocity↗

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Relationships among medical and nonmedical uses of pharmacologically active agents.

Explore the source record for details and available documents.

Adolescent↗

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The nursing outcomes classification: validation by rehabilitation nurses.

Measuring patient outcomes is important to rehabilitation nurses and the patients they serve. This article describes research conducted at the University of Iowa College of Nursing to develop the Nursing Outcomes Classification (NOC) and the validation of this research by surveys conducted through specialty nursing organizations, particularly the Association of Rehabilitation Nurses. Nurses responded to surveys designed to validate (a) the importance of outcome indicators to the achievement of an outcome and (b) nursing's contribution to the achievement of the indicators. The results of the surveys indicated that rehabilitation nurses believe that nursing makes a substantial contribution to most outcomes and indicators.

Activities of Daily Living↗

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The early identification of anticonvulsant activity: role of the maximal electroshock and subcutaneous pentylenetetrazol seizure models.

A number of widely different animal seizure models have been employed in the search for new and novel anticonvulsant drugs useful for the treatment of human epilepsy. At present, no single laboratory test will, in itself, establish the presence or absence of anticonvulsant activity or fully predict the clinical potential of a test substance. Of the many available animal models, the maximal electroshock (MES) and subcutaneous pentylenetetrazol (scPTZ) tests still represent the most commonly employed models for the routine screening and identification of new anticonvulsant drugs. This chapter will briefly describe how these two tests are conducted, their limitations and how they have contributed in the past and to the present day anticonvulsant drug discovery process.

Animals↗

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The effect of aging and pressure on the specific hydraulic conductivity of the aortic wall.

We measured the specific hydraulic conductivity (K) of the human and bovine aortic wall, two tissues for which K has not been previously reported in the literature, and examined the effects of aging (human) and development (bovine) on K. As part of the study, we also examined the effects of mounting the tissue in a flat or cylindrical configuration and the effects of perfusion pressure. With aging, in the human, we found a modest increase of K with age in a flat geometry; this trend was not apparent in a limited number of measurements in a cylindrical geometry. No significant dependence of K on developmental stage was found in the bovine aortic wall perfused in either a flat or cylindrical geometry. Our results indicate that aging and developmental changes of the aortic extracellular matrix have minimal effects on its hydrodynamic transport properties as measured. Mounting geometry for the aorta has been a concern reported in the literature since Yamartino et al. (1974) reported that K in the rabbit was 10-fold lower when measured in a flat geometry than in a cylindrical geometry. We found mounting geometry to make only a small difference in the calf and the cow, (Kflat approximately 2/3 of Kcylindrical), and in the human, we found K to be somewhat higher in the flat geometry than in the cylindrical geometry. Higher perfusion pressures decreased K of bovine tissue in the flat geometry, but pressure was not found to have a significant effect on K in the cylindrical geometry. An analytical model demonstrated that the anisotropic nature of the aortic wall allows it to be compressible (water-expressing) and yet remain at nearly constant tissue volume as the aorta is pressurized in a cylindrical geometry.

Aging↗

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Reading the medical record. II. Design of a human-computer interface for basic reading of computerized medical records.

A user interface for reading the medical record was designed and implemented on a workstation with a 19-inch colour screen. The text is presented on imitations of paper-pages. The pages are organized in bundles which are dynamically connected to scrollable index lists. The turning of pages on the screen is the fundamental concept of the interface. A page can be turned by a mouse-click or by a circular mouse-movement. Elaborated feedback is given to the user in order to provide effortless orientation and navigation. The interface supports the basic ways of use identified in our analyses of reading habits. It also enables human perceptual and cognitive skills to be used. It seems very easy to learn and efficient in use.

Cues↗

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Convergent cholinergic activities in aging and Alzheimer's disease.

Choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) activities have been examined postmortem in a series of 66 individuals with no evidence of CNS disease, ranging in age from 24 gestational weeks to 95 years and in 33 cases of Alzheimer's disease (AD) aged 57-89 years. In the normal human hippocampus a striking and highly significant age-related decline in ChAT occurred from middle to old age (between 40 and 100 years); a trend apparent at a later stage and to a lesser extent in the hippocampal gyrus. In both areas enzyme activity in AD was inversely related to age at death; reductions compared with the normal were on average 70-80% in the 60-70 year old groups compared with 30-40% in the 80-90 year old group. A similar trend was apparent with respect to acetylcholinesterase (AchE) histochemical activity associated with fibers and terminals (predominantly cholinergic and concentrated in CA3 and 4 of the hippocampus) but not with reactive perikarya (considered to be noncholinergic) present in both hippocampus and cortex. These data indicate that the normal aging human hippocampus may constitute a useful model for investigating the dysfunction or degeneration of basal forebrain cholinergic neurons in AD.

Acetylcholinesterase↗

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Glutamate receptor binding in the human hippocampus and adjacent cortex during development and aging.

Distinct patterns of age-related alterations in NMDA (MK801 binding) and non-NMDA, AMPA (CNQX), and kainate binding have been identified in human hippocampus and parahippocampal gyrus in normal individuals with no evidence of degenerative brain disease ranging in age from 24 gestational weeks to 94 years. Whereas MK801 binding did not alter substantially over this age range, CNQX binding rose from low levels in the fetus to maximum levels between neonate and middle age, and kainate binding declined extensively from the perinatal to adult stage. Following maturity, there were no significant changes in kainate binding, although MK801 binding increased in CA1 and CA3 and CNQX binding declined in several regions, particularly CA2 and subiculum. For each receptor binding the timing of these fluctuations ocurring during development and aging varied within different regions of the dentate gyrus, hippocampus proper, subicular complex, and entorhinal cortex examined. The transient peaks of receptor binding are likely to reflect processes of synaptogenesis and pruning and may provide clues regarding the role of the different glutamate receptor subtypes in various pathologies of the hippocampus and adjacent cortex associated with developmental disorders (of genetic origin or due to perinatal trauma or insult). The absence of substantial changes in any subtype examined from middle to old age suggests alterations in transmitter binding to these glutamate receptors are not involved in senescent neurodegeneration.

Adolescent↗

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Autoradiographic distribution of [3H]nicotine binding in human cortex: relative abundance in subicular complex.

Distinct patterns of [3H]nicotine (3 nM) binding were apparent in various regions of adult human neo- and archicortex. Receptor binding was greatest in the subicular complex--particularly presubiculum--and entorhinal cortex, where it was prominent in the characteristic parvo- and magnocellular islands of these regions and in middle layers of entorhinal cortex. In somatosensory cortex (Brodmann areas 3, 1 and 2) and occipital (area 17) cortex binding was highest in the upper and lower layers, and relatively sparse in the sensory input, layer IV. In primary motor (area 4) and temporal (area 21) cortex, binding in the outer half of the cortical ribbon was denser than that in the inner half and a distinct band was apparent in temporal and cingulate (area 32) in the lower portion of layer III. In prefrontal association cortex the pattern of binding was less distinct although slightly higher in the lower architectonic layers. There was generally little binding in the hippocampus (areas CA1-4) and dentate gyrus with the exception of the stratum lacunosum moleculare in CA2-3 and, to a lesser extent, supra- and subgranule zones of the dentate. These patterns of reactivity, which are distinct from that of the major cortical cholinergic innervation, suggest that the nicotinic receptor, detected using nanomolar concentrations of [3H]nicotine, may primarily be associated with intracortical circuitry in the neocortex. The relatively high density in entorhinal and subicular regions may be related to the extensive phylogenetic development of these regions which has occurred in conjunction with the development of multimodal association circuitry in the human cortex.

Adolescent↗

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Knowledge and presence: accountability as described by nurses and surgical patients.

Accountability was an integral part of phenomenological descriptions of 24 patients' experience of having surgery and 24 nurses' understanding of their experiences. Patients and nurses discussed two major elements, knowledge and presence, although the emphasis on categories within these elements differed. Within the element of knowledge, nurses emphasized lacking knowledge, using professional knowledge, teaching, and leadership. Patients talked most about receiving teaching and individualized knowledge. Nurses also emphasized structure and process, and patients emphasized outcomes. Within the element of presence, nurses talked most about environmental barriers and interaction, and patients emphasized attentive attitude. This view of accountability may help restructure work environments to allow nurses to meet the needs that patients perceive themselves as having.

Adult↗

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The Medical Outcomes Study: a nursing perspective.

The authors analyze the Medical Outcomes Study framework as a means of measuring the effectiveness of a multidimensional, interdisciplinary health care delivery system. The potential for this model to measure outcomes resulting from the interventions of nurses is demonstrated. The similarities between variables in the Medical Outcomes Study (MOS) framework and in research in nursing are presented. Modifications in the framework are suggested that would represent the collaboration among physicians, nurses, and allied health practitioners and the influence of their interaction on patient outcomes. The authors also suggest adding the domain of societal outcomes to include such outcome variables as cost. These modifications will enhance future health outcomes research based on the MOS conceptual framework and will encourage investigations of the interactive effects of health care providers on patient outcomes.

Cross-Sectional Studies↗

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The complexities of nursing research with men.

There has been a proliferation of nursing and other research on women's health over the last thirty years but a similar interest in men's health has not materialised. Within this paper we seek to explore the issues that need to be taken into consideration when conducting research with (or on) men. It outlines the current thinking on men and masculinity and the social development of stereotypes of men. The position of men with regard to the development of feminist thinking is also explored. The paper develops the argument by an examination of the different stages of the research process in nursing. The effect of gender on the setting of the research question; the choice of methodology; obtaining the data; analysis; discussion and dissemination of the findings of research conducted upon men are considered. We suggest that there is a requirement to consider the gender of both researched and researcher during the research process.

Data Collection↗

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Two regimes of the Arctic's circulation from ocean models with ice and contaminants.

A two-dimensional barotropic, coupled, ocean-ice model with a space resolution of 55.5 km and driven by atmospheric forces, river run-off, and sea-level slope between the Pacific and the Arctic Oceans, has been used to simulate the vertically averaged currents and ice drift in the Arctic Ocean. Results from 43 years of numerical simulations of water and ice motions demonstrate that two wind-driven circulation regimes are possible in the Arctic, a cyclonic and an anti-cyclonic circulation. These two regimes appear to alternate at 5-7 year intervals with the 10-15 year period. It is important to pollution studies to understand which circulation regime prevails at any time. It is anticipated that 1995 is a year with a cyclonic regime, and during this cyclonic phase and possibly during past cyclonic regimes as well, pollutants may reach the Alaskan shelf. The regime shifts demonstrated in this paper are fundamentally important to understanding the Arctic's general circulation and particularly important for estimating pollution transport.

Arctic Regions↗