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Biomedical subjects

M Rankin

Publications and source records attributed to M Rankin.

At least 19 recordsLinked to original sources
PubMed2003

Effects on climacteric symptoms, bone and lipoprotein metabolism of hormone replacement therapy delivered by estradiol-releasing intravaginal rings: a pilot study.

OBJECTIVE: To assess the efficacy and tolerability of intravaginal rings (IVRs) delivering estradiol. DESIGN: This was a dose-escalating, continuous-dosing, pilot study. METHODS: Sixteen women post surgical menopause were recruited at a hospital-based menopause clinic. Over 20 weeks, each patient had IVR devices releasing 50, 75, 100, 150 and 200 mug/day of estradiol inserted consecutively at 4-weekly intervals. MAIN OUTCOME MEASURES: Climacteric symptoms were assessed, and levels of serum estradiol, lipoproteins and biochemical indices of bone turnover were estimated prior to insertion of the first IVR and at each monthly visit, when the IVR was changed to one of a higher dose. The susceptibility of low-density lipoprotein (LDL) to oxidation was assessed at 0, 12 and 20 weeks. RESULTS: Twelve women completed the study. The rings were well tolerated and serum estradiol levels increased in parallel with each increasing dose. Vasomotor and psychological symptoms and loss of libido were reduced by 76% (p < 0.001), 44% (p < 0.001) and 44% (p < 0.05), respectively, by the end of the study. There were no significant changes in levels of serum lipoproteins, although the ratio of LDL cholesterol to high-density lipoprotein cholesterol decreased by 7.2% (p = 0.01) after 20 weeks. The susceptibility of LDL to oxidation did not change. Urinary excretion of both calcium and deoxypyridinoline cross-links decreased significantly (p < 0.001), indicating a reduction in bone resorption. CONCLUSIONS: The rings were effective in controlling climacteric symptoms and had beneficial effects on bone metabolism, but no significant effects on lipoprotein levels or the susceptibility of LDL to oxidation.

Administration, Intravaginal↗
PubMed2001

National plastic surgery survey: brow lifting techniques and complications.

The purpose of this survey was to assess trends in brow lifting philosophy, techniques, and complications. This is the second of a three-part survey; the first part reported on complications with face lift techniques, and the final report will address practice management issues, including facility and ancillary procedures. Surveys were sent to 3800 members of the American Society of Plastic Surgeons; the response rate was 15 percent. This survey represents data on 6951 brow lifts, of which approximately 50 percent were performed endoscopically and 50 percent with a coronal incision. Several conclusions about the practice of the respondents were reached: (1) Both brow lift techniques were considered to be effective. (2) Surgeons considered coronal brow lifting to be more effective for the three basic goals of brow lifting: brow elevation, reduction of transverse lines, and reduction of glabellar lines. (3) Reported complication rates for both techniques were low, and the most frequent complication was alopecia (varying from 2.9 percent to 4 percent). (4) Patient satisfaction varied from 98.2 percent to 99.2 percent. (5) Major complications were rarely reported.

Data Collection↗
PubMed2000

National plastic surgery survey: face lift techniques and complications.

The purpose of this study was to assess trends in technique and philosophy of face lifting, associated procedures, and the incidence and management of complications. Surveys were sent to 3800 members of the American Society of Plastic and Reconstructive Surgeons (ASPRS); 570 surveys (15 percent) were returned. Numerous very specific technique and philosophy questions were asked. Details of demographics, techniques, incidence of complications, management of complications, and basic philosophy are presented. Three basic conclusions can be gleaned from this study: (1) Surgeons perform more tried and true methods of aesthetic surgery, rather than the many new methods that seem to get the most attention in the media and at the meetings. (2) It seems that less-experienced surgeons tend to be generally more conservative in their approach to aesthetic surgery. (3) Complication rates reported by the plastic surgery community at large coincide with previous complication rates, as outlined in other nonsurvey studies. The authors expect to report additional data from the survey--on brow surgery (part II) and facility and ancillary procedures (part III)--in forthcoming publications.

Data Collection↗
PubMed2000

Haemochromatosis: work and social implications.

Hereditary haemochromatosis is prevalent in our society and requires vigorous and lifelong treatment. Diagnosis of the disorder may be delayed or missed due to its nonspecific symptoms and diverse manifestations. This can have lifelong consequences for the sufferer. Early diagnosis prevents severe organ damage and premature death and leads to a normal productive life. Screening family members will enable early diagnosis of those with the HFE gene mutation. The stigma attached to having a genetic condition may have consequences for job opportunities and for life and health insurance. Education of the community (including workplaces and employers) as well as health service providers will not only increase the likelihood of early diagnosis of haemochromatosis but will ease the social consequences of suffering from this disorder.

Employment↗
PubMed1999

Psychological complications in 281 plastic surgery practices.

Surgery is a high-stakes stressor with possible consequences that include death, pain, disfigurement, economic losses, and alterations in social roles. Often, the most disturbing complications to surgeons and patients are psychological rather than physical. Ineffective management of psychological complications of surgery can have profound consequences, resulting in delayed recuperative times, delayed return to work, poor patient compliance, dissatisfaction with the surgical outcome, hostility toward surgeons, and anxiety. The purpose of this study was to investigate in a large randomized group of plastic surgery practices the relative incidence of negative psychological outcomes and to compare these with the incidence of adverse physical outcomes to gain a greater appreciation of the relative magnitude of each type of perioperative complication. The study design was a descriptive, correlational survey that assessed psychological complications reported by plastic surgeons. The Plastic Surgery Questionnaire was sent to 702 randomly selected board-certified plastic surgeons. The sample consisted of 281 board-certified plastic surgeons (40 percent response rate). The study instrument was found to be highly reliable, with inter-item Cronbach's alpha r = 0.85. The demographics were representative of the specialty as a whole. It was found in general that psychological complications were much more prevalent than physical problems such as hematoma or infection. Anxiety reactions were commonly encountered by 95.4 percent of surgeons; disappointment (96.8 percent), depression (95.0 percent), nonspecific physical complaints (92.2 percent), and sleep disorders (88.5 percent) were the next most commonly reported complications. Most surgeons (75.8 percent) reported that screening for depression was important, but only 18.8 percent identified screening for post-traumatic stress disorder as important, even though 86 percent had diagnosed post-traumatic stress disorder in their postoperative patients. Psychological complications occur at rates equal to or greater than those of physical complications in the plastic surgery practice. Patients who experience physical complications are much more likely to simultaneously experience psychological complications. Patients with preexisting psychological conditions are more at risk for postoperative psychological complications. Disappointment, anxiety, and depression were the most frequently seen psychological complications. Nursing personnel are perceived by plastic surgeons to have the primary role in screening patients for pertinent psychological history. Directed research should be undertaken to determine which treatment regimens are most effective in reducing preoperative psychological complications. Controlled clinical trials of pharmaceuticals and alternative therapies must be designed and carried out in a prospective manner to establish the optimum treatment for alleviation of adverse emotional consequences of surgery. The next frontier for the specialty is to actively and consciously investigate and improve our patients' emotional and psychological results from surgery.

Anxiety↗
PubMed1999

Lidocaine is not necessary in liposuction.

Lidocaine is an integral part of most wetting solutions used in liposuction. Although the Physician's Desk Reference states that the permissible dose of lidocaine is 7 mg/kg, doses as high as 75 mg/kg have been used in liposuction. Lidocaine is used in the wetting solution even when the procedure is performed under epidural or general anesthesia. The justification for this is a reduction in postoperative pain. This study compared the pain between paired, mirrored sides of 10 patients when lidocaine was used on only one side. There was no statistically significant difference between the postoperative pain at 5, 30, 60, and 120 minutes and on the first postoperative day. Because there was no difference in pain whether or not lidocaine was used, and because lidocaine is potentially toxic and lethal, this study concludes that lidocaine is not necessary in liposuction.

Anesthesia, Epidural↗
PubMed1998

Optimal pH for simple cold storage or machine perfusion of dog kidneys with UW solution.

Metabolic suppression by temperature is a key to successful organ preservation. Additional methods for inducing metabolic suppression may further improve organ preservation. Extracellular acidosis has been shown to suppress warm anoxic injury to various isolated cells. Acidosis may suppress enzymes with a pH optimum at the pH of the cytosol (pH 7.3). In this study, the combination of hypothermia and acidosis was used to determine if it would improve renal preservation. Dog kidneys were cold-stored (CS) for 48 h in University of Wisconsin (UW) solution with the pH adjusted to 6.4, 6.8, 7.4, or 7.8. Kidneys were also machine-perfused (MP) for 3 days with the gluconate perfusion solution (Belzer's machine perfusion solution, MPS) at pHs similar to those tested for CS. Renal function (serum creatinine, SCr) and survival were recorded in immediate contralateral nephrectomized recipients. On the basis of maximum SCr values, kidneys preserved by CS or MP were best preserved at pHs of 7.4 or 7.8. At a pH of 6.8, SCr values were elevated and returned to normal at a slower rate than in those preserved at higher pHs. This study shows that acidosis is not cytoprotective to cold-stored dog kidneys and causes preservation/reperfusion injury.

Adenosine↗
PubMed1998

Research priorities and concerns of plastic surgical nurses.

The advancement of nursing knowledge to improve clinical plastic surgical nursing practice was identified as a priority for the American Society of Plastic and Reconstructive Surgical Nurses (ASPRSN). The purpose of this investigation was to determine the specific research priorities and perspectives of practicing plastic surgical nurses. In addition, nurses were asked to rank their current concerns for the future of plastic surgical nursing.

Attitude of Health Personnel↗
PubMed1998

Reevaluating the need for routine drainage in reduction mammaplasty.

The incidence of complications after reduction mammaplasty without drains was reviewed by analysis of 50 bilateral reduction mammaplasty procedures. Patients ranged in age from 14 to 65 years; the average combined volume removed was 953 g. Eighty-four percent of the patients underwent a Pitanguy technique, and the remaining patients underwent an inferior pedicle or amputative technique with free nipple grafts. Three patients had six complications; one of these patients had three of the complications. Complications included two cases of fat necrosis and one case of wound disruption. One patient had a hematoma with wound disruption and partial nipple loss. There were no cases of infection. The purpose of this study was to determine the rate of complications in reduction mammaplasty performed without drains. Incidentally, statistical analysis using the chi-squared test revealed that this series without drains compared favorably with previously published data for reduction mammaplasty using drains. It is concluded that routine closed suction drainage after reduction mammaplasty is unnecessary and should be reconsidered.

Adolescent↗
PubMed1998

Quality-of-life outcomes after cosmetic surgery.

Cosmetic surgery is an increasingly common medical procedure whose benefits to patients have not been quantified objectively. The purpose of this study was to prospectively examine long-term quality-of-life outcomes for patients undergoing elective cosmetic surgery. In this prospective, correlational study of 105 consecutive patients undergoing elective cosmetic surgery, the parameters of quality-of-life index, depression, social support, and coping were determined preoperatively and at 1- and 6-month intervals postoperatively. The data from the four study instruments were analyzed using Pearson correlation and repeated measures of multivariate analysis of variance for differences in each variable over time. The multivariate analysis of variance quality-of-life index scores for patients improved from baseline preoperative mean levels of 3.24 to a mean of 2.56 at 1 month, and then to 2.11 (f = 518.5, p = < 0.0001) at 6 months postsurgery. Mean scores for depression [determined by using the Center for Epidemiologic Studies Depression Scale (CESD)], improved from 11.2 preoperatively to 6.5 at 1 month, and to 6.3 (f= 79.3, p = < .0001) at 6 months after surgery. Surgical intervention produced no significant differences between preoperative and postoperative ways of coping and social support scores. Cosmetic surgery produces positive psychological benefits by significantly improving quality-of-life outcomes that persist long term, without adversely affecting social support and ways of coping.

Adaptation, Psychological↗
PubMed1997

Anxiety disorders in plastic surgery.

Surgery is a stressful event, with the potential for profound disturbance to the patient's psychological and physiologic homeostasis. Cosmetic surgery is a particularly intense psychological experience because, in addition to the usual concerns about surgical side effects, cosmetic patients bring their hopes and expectations for improved self-image, putting them at risk for the added anxiety of disappointment. High levels of anxiety coupled with the perception of vulnerability or threat to self can cause significant psychological reactions complicating care for the plastic surgical patient. This paper outlines the diagnostic features of the common types of anxiety disorders seen in plastic surgical patients, and it offers treatment strategies for the practitioner, delineating when referral to a mental health expert is advised. Specific clinical case studies of panic attack, posttraumatic stress disorder, and acute stress disorder are presented to illustrate the variety of abnormal anxiety responses that may be encountered in the perioperative setting. Interventions for the anxious patient are part science and part art. Careful questioning and psychosocial assessment can identify those patients who are at greater risk for psychological problems after surgery. However, some patients may mask or keep secret their concerns, which can be manifested with resulting anger and hostility. Plastic surgeons must use appropriate indicators of psychological anxiety and measure a specific patient's reactions to surgery to make the diagnosis of abnormal anxiety. Close follow-up by the plastic surgical team is an essential part of the anxiety disorder patient's psychological treatment, but it is imperative that these problematic patients be referred promptly to a qualified mental health professional to limit their adverse experience and promote their well-being. Patients who are less anxious during the perioperative period report less emotional distress and fewer defensive behaviors and are likely to be more satisfied with the outcome of their surgery.

Adult↗
PubMed1996

Donor nutritional status--a determinant of liver preservation injury.

In liver transplantation, the quality of the liver is determined by a number of factors including donor nutritional status. Livers from fasted donors appear to tolerate long-term preservation better than livers from fed donors. In this study we repeated earlier results and obtained 31% (4/13) survival after 40-hr preservation of livers from fed donor Brown Norway rats and 67% (8/12) survivors with donor livers from 4-day-fasted rats (P = 0.154). The explanation for this improvement is not known but may be due to inactivation of Kupffer cells due to nutritional depletion of the liver. Kupffer cell activation has been one explanation advanced to explain how cold storage injuries livers during reperfusion (transplantation). In this study, we have measured how donor fasting affects Kupffer cell function (phagocytosis of colloidal carbon) after preservation of the rat liver. In addition, we measured how enhancing liver glycogen by feeding glucose to the rat donors affected outcome and liver functions tested by isolated perfusion after 24- and 40-hr cold storage of the liver. Preservation did not cause inactivation or activation of Kupffer cell phagocytosis of colloidal carbon. In livers with 0-hr preservation, colloidal carbon uptake was 3.1 +/- 0.2 mg/g/hr, after 40-hr preservation uptake was 3.8 mg/g/hr (P < 0.05 vs. 0 hr) (fed) and 2.7 +/- 0.3 mg/g/hr (fasted, P, 0.05 vs. 0-hr and 40-hr-fed). Thus, the improved survival obtained with livers from fasted donors does not appear related to inactivation of Kupffer cell phagocytosis. Although livers from fasted donors showed improved survival, there was extensive hepatocellular injury as indicated by large LDH release from the livers after 40-hr cold storage as tested by isolated perfusion. LDH released into the perfusate increased from 35.8 +/- 10.1 U/L (fed, 40-hr CS) to 301 +/- 65 U/L (fasted, 40-hr CS) after 1-hr reperfusion. AST release showed a similar pattern and bile production was suppressed more in livers from fasted donors than fed donors. Feeding rats glucose elevated liver glycogen and significantly reduced hepatocellular injury as measured by LDH release and AST release in the isolated perfused liver after 40-hr cold storage. Feeding rats glucose (40% in drinking water for 4 days) also improved survival: fed+glucose = 85% survival versus 31% survival with no glucose and fasted+glucose = 92% survival versus 67% survival with no glucose. These results show that both extensive donor fasting and glucose feeding enhanced outcome in orthotopic liver transplantation. This dilemma (both fasting and feeding improved survival) are discussed in terms of how the interactions between Kupffer cells and hepatocytes affect liver viability. Donor fasting is probably impractical clinically as a method to improve the donor liver, but elevating liver glycogen by glucose supplementation is possible and may lead to improved preservation and outcome in liver transplantation.

Animals↗
PubMed1993

Prolongation of canine intestinal allograft survival with RS-61443, cyclosporine, and prednisone.

The efficacy of RS-61443 and cyclosporine utilized either alone or in combination was assessed in both a segmental heterotopic and total orthotopic canine intestinal transplant model. Twenty-eight dogs underwent segmental (150-cm) heterotopic intestinal transplants and five dogs total orthotopic transplants. Five heterotopic groups were compared: group 1, no immunosuppression; group 2, cyclosporine and prednisone; group 3, RS-61443, cyclosporine and prednisone; group 4, RS-61443 and prednisone; and group 5, RS-61443 and subtherapeutic cyclosporine. Group 3 animals achieved a median survival of 136 days, while the median survivals of groups 1, 2, 4, and 5 were < or = 10 days (P < .001). Twenty deaths in groups 1 through 5 were secondary to allograft rejection, two were due to infection, and two were unexplained. Four animals in group 3 were sacrificed, one at 83 days due to diarrhea and weight loss and three at the termination of the study. The median survival of five dogs undergoing total orthotopic transplantation (group 6) was 27.0 days and was significantly longer than groups 1, 4, and 5 (P < .01). No dog in this group had intestinal rejection--however, four were sacrificed due to weight loss and one died of malnutrition. The combination of RS-61443 and cyclosporine significantly prolonged intestinal allograft survival in both the heterotopic and orthotopic transplant models. Clinically, this combination may be promising for both combined liver-intestinal and isolated intestinal transplantation.

Animals↗
PubMed1992

Immunological and feeding studies on antigens derived from the biting fly, Stomoxys calcitrans.

Pairs of rabbits were immunised with three antigenic preparations derived from Stomoxys calcitrans gut, abdominal section and whole flies. Immunoblotting studies demonstrated that a humoral response was mounted against eight antigens from the gut preparation and 12 each from the abdominal and whole fly preparations. In vitro feeding experiments showed higher mortality between Days 4 and 7 in the group of flies which had fed upon blood from rabbits inoculated with the gut derived antigen. This group also produced the lowest percentage of viable eggs (15.5%).

Animals↗