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Biomedical subjects

N Whitley

Publications and source records attributed to N Whitley.

At least 19 recordsLinked to original sources

Evidence-based periodontal regenerative therapy.

Periodontal health care has progressed into a new era. It is distinguished by a rapidly expanding volume of literature, rapid influx of new technologies, and need for new skills to perform increasingly complex procedures. Correspondingly, practice management changes are required to adapt to the extensive follow-up care associated with some of these new treatments. This must be accomplished while also acknowledging the deepening concern for escalating costs and increased attention to the quality of care provided. As with most change, clinicians can fight it by continuing to rely on old ways of doing things and hope to keep these issues at bay, but history would say they are unlikely to succeed. Instead, clinicians can embrace these changes and adapt to them by adding new tools, such as evidence-based methodology, to their armamentarium. The evidence-based approach offers a "bridge" from science to clinical practice. It can strengthen the foundation by providing a framework for integrating patient preferences, scientific knowledge, clinical judgment, and personal experience. By adapting the way treatment decisions are made in daily practice to an evidence-based approach, clinicians can deliver the highest quality care to their patients and be in better control of their own destiny. These new challenges can be perceived as problems or as opportunities--it is a choice!

Bibliographies as Topic↗

Pancreatic enlargement in alcoholic pancreatitis: prevalence and natural history.

We determined the prevalence and natural history of pancreatic enlargement by abdominal ultrasonography or computed tomography in 72 patients with alcoholic pancreatitis. Pancreatic enlargement was observed in 54 patients (75%); it was diffuse in 28 (52%) and focal in 26 (48%). The focal enlargement was frequently cystic (50%), while the diffuse enlargement was only occasionally cystic (7%). Sequential imaging of the pancreas in 29 patients demonstrated partial to total resolution of pancreatic enlargement in greater than 50% during 6 months of follow-up. Determination of serum amylase and p-isoamylase activity was neither sensitive nor specific for pancreatic enlargement in alcoholic pancreatitis.

Acute Disease↗

Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure.

The mortality rate from hepatic failure after extensive resection should be negligible in the presence of normal results from preoperative liver function tests in patients without pre-existing hepatitis and cirrhosis. Despite conventionally acceptable results from preoperative hepatic function tests in 56 patients undergoing extensive hepatic resection for tumours (47 metastatic, six hepatomas and three adenomas), however, five patients died of hepatic failure. Among the many preoperative and intraoperative risk factors studied, the important factors in the group with hepatic failure were very high levels of serum alkaline phosphatase (p less than 0.05) in the presence of normal levels of bilirubin and large tumor, preoperative administration of chemotherapy, the presence of hepatomas rather than metastatic carcinoma (p = 0.083) and intraoperative blood loss of greater than 5,000 milliliters (p = 0.03). The patients receiving preoperative chemotherapy or those with hepatoma showed a minimal rise of alkaline phosphatase (p less than 0.03) and a minimal regeneration of liver on computed tomographic (CT) scan after hepatic resection. In the group with hepatic failure, a consistent postoperative pattern of increasing bilirubin with normal or subnormal alkaline phosphatase levels corresponded with lack of regeneration of liver on repeated CT scans. Conversely, the pattern of decreasing bilirubin with reciprocal increase in alkaline phosphatase corresponded with hepatic regeneration on CT scan in the group of survivors. Thus, we observe that alkaline phosphatase is a good indicator of hepatic regeneration in the absence of jaundice in patients after hepatectomy. To avoid postoperative hepatic failure, we recommend more discriminant tests than conventional hepatic function tests in patients with large tumors associated with high alkaline phosphatase levels, preoperative chemotherapy and hepatoma even without pre-existing cirrhosis or hepatitis.

Adult↗

Multicystic dysplasia and crossed renal ectopia.

Multicystic renal dysplasia in a crossed fused or nonfused ectopic kidney is a rare occurrence that produces unusual imaging findings. In four such cases in neonates, three presented with a palpable abdominal mass and one was discovered in utero with maternal sonography. In three cases, sonography showed a multicystic mass, contiguous with the lower pole of the orthotopic kidney. In the fourth infant, a crossed, tiny dysplastic kidney was not visualized, but its markedly dilated ectopic ureter was seen traversing the spine on CT. Ureteropelvic junction obstruction was present in the three fused orthotopic kidneys. The characteristic imaging findings of multicystic dysplasia and crossed renal ectopia include a multicystic mass of variable size that is contiguous with the lower pole of a hydronephrotic, malrotated kidney; ureteral displacement and/or dilatation; and contralateral absence of the kidney and its renal artery.

Abnormalities, Multiple↗

Use of computed axial tomography to diagnose vascular ring in an infant.

Computed axial tomography was performed in an infant with severe respiratory distress. A right aortic arch and paratracheal density was visualized, suggesting a vascular ring. Angiography confirmed a right aortic arch, mirror-image branching, and a left patent ductus arteriosus.

Journal Article↗

Use of the computed tomographic whole body scanner to stage and follow patients with advanced ovarian carcinoma.

Advanced ovarian carcinoma continues to be a difficult tumor to evaluate noninvasively. Recent developments in chemotherapy have enhanced response rates in this disease, thus improving the likelihood of tumor regression. Computed Tomography (CT) allows the noninvasive estimation of tumor extent in patients with ovarian carcinoma. Seventeen patients with epithelial ovarian carcinoma had 22 whole body CT scans performed either just prior to or following laparotomy. For determination of tumor involvement, when the CT was positive, a high pathologic correlation was found at liver, ascitic, peritoneal, mesenteric, and omental sites (sensitivity). When the cT was negative, high pathologic correlation was found at ascitic and mesenteric sites (specificity). Lower and negative correlation at other disease sites is attributed to difficulty of CT detection of small (1 cm) tumor nodules on visceral surfaces. Eighteen patients with advanced ovarian carcinoma were followed prospectively during treatment with repetitive CT scans. CT results were compared with physical examination, other radiologic studies, and clinical status. In 83% (15/18) of patients and 88% (59/67) of CT scans performed, CT was found to contribute useful management information. Clinical decisions were made on the basis of CT alone in 43% (29/67) of scans performed. These data suggest that CT scanning is very useful in the staging and follow-up of patients with ovarian carcinoma and can replace other radiologic procedures, but it is not completely accurate and needs to be correlated with physical examination and in cases without tumors visible with CT, with laparotomy.

Female↗

Preparation for breastfeeding: a one-year followup of 34 nursing mothers.

A retrospective survey of 34 breastfeeding mothers was undertaken. From the data the following hypotheses have been suggested for further study: 1) Class preparation for breastfeeding favors a longer duration of nursing. 2) Nipple rolling and breast massage with manual expression of colostrum during pregnancy are not associated with a longer duration of nursing, nor do they prevent sore nipples or breast engorgement postpartum. 3) Mothers with multiple complications are at high risk for lactation failure. 4) Limiting nursing time for the first few days postpartum does not prevent sore nipples.

Breast↗

The first coital experience of one hundred women.

A retrospective survey of the first coital experience of 100 women, with emphasis on the incidence of bleeding and pain, is reported. Eleven of the women interviewed had vaginismus on pelvic examination. The article includes a discussion of the etiology and treatment of vaginismus, as well as possible applications of survey findings in teaching and counseling patients.

Adolescent↗

Cesarean births.

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Anesthesia, Obstetrical↗

Prenatal classes.

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Female↗

Breastfeeding risks.

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Breast Feeding↗