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Biomedical subjects

P Johns

Publications and source records attributed to P Johns.

17 recordsLinked to original sources
PubMed1998

Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome.

STUDY OBJECTIVE: To compare the 1-year cosmetic outcome of wounds treated with octylcyanoacrylate tissue adhesive and monofilament sutures and to correlate the early, 3-month, and 1-year cosmetic outcomes. METHODS: We prospectively randomized 136 cases of traumatic laceration to repair with octylcyanoacrylate tissue adhesive or 5-0 or smaller monofilament suture. A wound score was assigned by a research nurse, and validated by a second nurse blinded to the treatment, at 5 to 10 days after injury (early), 3 months, and 1 year. Standardized photographs were taken at 3 months and 1 year and shown to a cosmetic surgeon blinded to the method of closure, who rated the wounds on a validated cosmesis scale. RESULTS: We were able to examine 77 lacerations at 1 year for follow-up. No differences were found in the demographic or clinical characteristics between groups. Likewise, at 1 year no difference was found in the optimal wound scores (73% versus 68%, P =.60) or in visual analog scale cosmesis scores (69 versus 69 mm, P =.95) for octylcyanoacrylate and sutures, respectively. Agreement was poor between early and 3-month wound scores (kappa=.34; 95% confidence interval [CI],.10 to.58) but a strong association existed between 3-month and 1-year wound scores (kappa=.71; 95% CI,.52 to.90). We noted a moderate correlation between 3-month and 1-year results on the visual analog cosmesis scale (intraclass correlation,.48; 95% CI, .30 to.63). CONCLUSION: One year after wound repair, no difference is noted in the cosmetic outcomes of traumatic lacerations treated with octylcyanoacrylate tissue adhesive and sutures. The assessment of wounds 3 months after injury and wound repair provides a good measure of long-term cosmetic outcome.

Adult↗
PubMed1998

Improving patient outcomes through CQI: vascular access planning.

This article reports the use of the continuous quality improvement (CQI) process to improve patient outcomes. The FADE method (focus, analyze, develop, and execute) was used to focus on vascular access planning, analyze data concerning intravenous (i.v.) therapy, develop a vascular access planning algorithm, and execute implementation of the algorithm. An evaluation study revealed that patients whose vascular access planning was consistent with the algorithm reported fewer i.v.s, less difficulty starting i.v.s, and less stress; waited significantly less time until central venous line (CVL) placement (for those who received CVLs); and had significantly shorter lengths of stay.

Algorithms↗
PubMed1997

A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations.

OBJECTIVE: To assess the effectiveness of a new tissue adhesive for laceration closure. DESIGN: A prospective, randomized controlled trial. SETTING: An adult teaching hospital. PARTICIPANTS: One hundred thirty patients with 136 lacerations who consented to enrollment during a 5-month period. The lacerations included all eligible nonmucosal facial lacerations, as well as selected extremity and torso lacerations (not on hands, feet, or joints). One hundred six lacerations were available for early follow-up, and 98 were available for 3-month evaluation. INTERVENTIONS: Lacerations were randomly allocated to have skin closure with octylcyanoacrylate adhesive or monofilament suture. MAIN OUTCOME MEASURE: A 3-month photograph of the wound was assigned a cosmesis score on a previously validated 100-mm visual analog cosmesis scale by a plastic surgeon who was unaware of the method of wound closure. RESULTS: There were no differences in the mean visual analog cosmesis scores (67 mm for octylcyanoacrylate vs 68 mm for sutures; P=.65). Similarly, there was no difference in the percentage of early (80% vs 82%; P=.80) or late (72% vs 75%; P=.74) optimal wound evaluation scores. The tissue adhesive was a faster method of wound repair (3.6 vs 12.4 minutes; P<.001) as well as being less painful (visual analog pain scores, 7.2 vs 18.0 mm; P<.001). CONCLUSIONS: Octylcyanoacrylate tissue adhesive effectively closes selected lacerations. This relatively painless and fast method of wound repair can replace the need for suturing several million lacerations each year.

Adult↗
PubMed1993

Bronchiectasis and rheumatoid arthritis: a clinical study.

OBJECTIVES: To examine the relation between rheumatoid arthritis (RA) and bronchiectasis (BR). METHODS: Disease activity, outcome, extra-articular manifestations, and laboratory features were compared in 32 patients with BR and RA (RA-BR group), 32 matched patients with RA without BR (RA group), and 31 patients with BR but without arthritis (BR group). RESULTS: In 30 of the 32 (94%) patients with RA-BR, BR preceded RA. There was no functional or radiological difference between the RA-BR and RA groups, and except for xerophthalmia, which was more common in patients with RA-BR than patients with RA, there was no difference in extra-articular or laboratory features. CONCLUSIONS: Bronchiectasis does not lead to a more aggressive disease course in RA and, despite the recognised association, BR is not an extra-articular manifestation of rheumatoid disease.

Adult↗
PubMed1984

The inferior alveolar and mylohyoid nerves: an anatomic study and relationship to local anesthesia of the anterior mandibular teeth.

The distance between the branching point of the mylohyoid nerve to the entrance of the inferior alveolar nerve into the mandibular canal was studied in 37 adult human cadavers. On the average, this branching distance was 14.7 mm, which is greater than previously reported. Also found was a 43% incidence of extension of the mylohyoid nerve beyond the muscle to foramina on the lingual aspect of the mandible. If the mylohyoid nerve mediates sensory information from the anterior incisors, then the factor of an increased branching distance may become important in terms of the dilution of the anesthetic agent during diffusion and the amount of nerve length exposed to the anesthetic agent. These findings may also account in part for the purported greater success of the so-called Gow-Gates type of injection technique compared with that of the conventional mandibular block.

Aged↗
PubMed1980

Effect of meconium on the strength of chorioamniotic membranes.

A population of 1320 patients was reviewed to assess the clinical significance of antepartum meconium staining on the occurrence of premature rupture of the membranes. Specimens of amniotic membranes were studied by tensile strength testing from 2 population groups. The results of the retrospective review showed no difference in the incidence of premature rupture of the membranes between the populations with clear amniotic fluid and those with meconium-stained fluid at time of amniorrhexis. The tensile strength testing demonstrated that the study population with antepartum meconium-stained fluid had significantly lower stress tolerance. This investigation demonstrated a significant decrease in stress tolerance of human chorioamniotic membranes associated with a meconium-stained fluid environment, but this loss of stress tolerance is not apparently significant in clinical practice.

Adult↗
PubMed1979

Production of IgE complexes by allergen challenge in atopic patients and the effect of sodium cromoglycate.

Specific IgE complexes and symptoms of asthma and eczema were produced in two allergic patients by oral challenge with food allergen. Both symptoms and IgE complexes could be prevented by pre-treatment with oral sodium cromoglycate. The IgE complexes can fix complement and may therefore provide the vehicle of the "late" responses seen in immediate hypersensitivity. The central role of gut sensitivity is emphasised by the protection afforded by sodium cromoglycate both when given acutely, against the effects of an oral challenge, and when given continuously for asthma and eczema due to food allergy.

Adult↗
PubMed1978

The structural requirements for immunoglobulin aggregates to localize in germinal centres.

The capacity of non-heat-aggregated monoclonal human immunoglobulins of different classes, to localize in murine splenic germinal centres within 24 h of intravenous injection has been investigated. It has been shown that at least trimerization of polyclonal IgG must occur before any germinal centre trapping is manifest. Studies of complement fixation by these IgG preparations in vivo, together with studies of the germinal centre trapping of various monoclonal immunoglobulins, have indicated that the sole structural requirement for germinal centre localization of immunoglobulin aggregates is the ability to fix complement. Results suggest that immunoglobulin aggregates are transported to germinal centres via membrane C3 receptors of mobile cells, and then are released with loss of complement to become fixed to dendritic macrophages by a separate mechanism.

Animals↗
PubMed1977

Complexed IgE in atopy.

Evidence of circulating high-molecular-weight forms of IgE was found in 16 patients with hayfever and/or atopic eczema. This finding of what appears to be complexed IgE in the serum of atopic patients may help to elucidate the aetiology of atopy.

Antigen-Antibody Complex↗
PubMed1976

Empirical and theoretical relationships between the sedimentation coefficient and molecular weight of various proteins, with particular reference to the immunoglobulins.

The empirical and theoretical relationships between the sedimentation coefficient and molecular weight of proteins of various conformational shapes have been investigated. In each case it was found that the relationship obeys the general formula log S020,W= a log molecular weight +b. The empirical values obtained for the slope and intercept for globular proteins (non-immunoglobulins) and immunoglobulins have been used to calculate the molecular weight from the sedimentation coefficients of other proteins belonging to these two groups. For most proteins and particularly the immunoglobulins the values obtained were found to be similar to those obtained using the classical experimental techniques. The application of this approach to the determination of molecular weights, of proteins and more particularly protein containing complexes is discussed.

Animals↗
PubMed1976

A simple numerical method for the construction of isokinetic sucrose density gradients, and their application to the characterisation of immunoglobulin complexes.

A simple numerical method for calculating the parameters required for the production of isokinetic sucrose density gradients is described. Calculation is based on tables of viscosity and density of sucrose solutions at various concentrations. When density gradients prepared according to this method were used for centrifugation of a number of well characterised proteins, it was shown that isokinetic behavior occurs, and that sedimentation coefficients obtained are comparable to those determined by conventional analytical ultracentrifugation. The method was used to characterise polymers of IgM and IgG, and results suggest that IgM polymers up to the tetramer can occur in Waldenstrom's macroglobulinaemic serum, and that IgG polymers up to the pentamer can occur in stored specimens of ethanol precipitated human IgG. The sedimentation behaviour of 125I-IgE was studied by fractionating the gradients and counting the fractions, and it was shown that degradation of the labelled IgE took place during storage. It was also found that labelled IgE induces rapid breakdown of IgG with which it was mixed prior to centrifugation. The method has also been used to study immunoglobulin-containing complexes found in the knee joint fluids of patients with rheumatoid arthritis. The high degree of resolution of this method is demonstrated by the fact that many more of these components were detectable by density gradient centrifugation than by conventional analytical ultracentrifugation.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Esophageal bezoar formation in a tube-fed patient receiving sucralfate and antacid therapy: a case report.

In this case report, the authors describe an esophageal bezoar found in a mechanically ventilated patient receiving sucralfate, antacid, and tube feeding via a nasogastric tube. The presence of a prosthetic device in the esophagus (such as a nasogastric or endotracheal tube) in conjunction with functional esophageal abnormalities is a common link in the development of esophageal bezoars. These bezoars form in the esophagus as a result of regurgitation of stomach contents. In addition, bezoars are a known complication of gastric motility disorders, such as gastric paresis of diabetes. Critically ill patients are frequently given antacid and sucralfate therapy while being enterally tube fed, often by nasogastric tubes. This combination of treatment modalities in patients with esophageal and/or neurological abnormalities warrants vigilant adherence to measures to prevent reflux and gastric pooling.

Aged↗