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Biomedical subjects

R Gates

Publications and source records attributed to R Gates.

At least 19 recordsLinked to original sources
PubMed2000

A simpler, less expensive technique for delayed primary closure of fasciotomies.

A variety of techniques have recently been advanced for delayed primary closure of wounds following emergent fasciotomy for compartment syndrome. We introduce a very simple, effective method for gradual reapproximation of margins using daily reapplication of Steri-strips (3M Surgical Products, St. Paul, Minnesota). This method allows final closure of fasciotomy wounds with simple suture in 5-8 days without scar contractures, marginal necrosis, infection, or significant pain. Moreover, because it requires no specialized equipment and can be applied in skilled nursing centers or at home by trained nurses, this technique could reduce the cost of caring for fasciotomy patients.

Aged↗
PubMed2000

Nonoperative management of bile leaks following liver transplantation.

UNLABELLED: The biliary anastomosis has been called 'the Achilles heel' of liver transplantation (RABKIN JM, ORLOFF SL, REED MH. Transplantation 1998: 65 [2]: 193; DAVIDSON BR, RAI R, KURZAWINSKI TR. Br J Surg 1999: 86 [4]: 447). Biliary complications after liver transplantation reportedly occur at an incidence of 20-30%, 10-15% as bile leaks. The management of bile leaks, especially early bile leaks, is controversial. In the present study, we report our experience with the management of bile leaks after liver transplantation. In this retrospective study, we reviewed 85 liver transplants over a 3-yr period. In 79, the biliary anastomosis was choledochocholedochostomy (CDCD) over a small-caliber T-tube, while choledochojejunostomy (CDJ) was used in 7. Over a mean follow up period of 13.5 months (median 10 months), 10 patients (12%) experienced a clinically significant bile leak within the first 3 months after liver transplantation. The early leaks, occurring within 1 month of transplant, were successfully managed by observation (DAVIDSON BR, RAI R, KURZAWINSKI TR. Br J Surg 1999: 86 [4]: 447) or endoscopic retrograde cholangiopancreatography (ERCP) and the placement of a biliary stent for a duration of 6-12 wk (RANDALL HB, WACHS ME, SOMBERG KA. Transplantation 1996: 61 [2]: 258). One of these resulted from accidental dislodgement of the T-tube on postoperative day 1; one resulted from necrosis at the CDCD anastomosis and required CDJ; the remaining four resulted from leaks along the T-tube track. One of the late leaks occurred following the planned removal of the T-tube at 3 months after liver transplantation; the other two were leaks along the T-tube track. All were successfully treated by ERCP and stent placement, though in one case, ERCP was initially unsuccessful because of the inability to advance a guidewire, necessitating a fluoroscopically aided guide wire placement during a mini laparotomy. ERCP was then successfully performed with the placement of a stent. [See table in text] CONCLUSIONS: Our experience indicates that most bile leaks after liver transplantation, including early leaks, can be successfully managed nonoperatively. Most will require intervention, but ERCP and stent placement are usually sufficient.

Adolescent↗
PubMed1998

Out of plan. Certain HMO characteristics affect physicians' satisfaction and influence their decision to reenroll.

The authors examine the issue of continuity, which is directly associated with patient satisfaction, from the perspective of the physician. They attempt to determine which factors are most important in determining physician satisfaction with an HMO and the link between satisfaction with an HMO and intent to remain affiliated with that HMO. Their study reveals that 11 factors explain 71% of the variation in overall physician satisfaction and that a physician's satisfaction with a plan is closely linked to intentions to reenroll. Implications for HMOs, physicians, employers, and public policy makers are explored.

Attitude of Health Personnel↗
PubMed1996

Australian registered nurses and sex-based harassment in the health care industry.

This paper discusses sex-based harassment in the nursing profession in Australia. The paper generates industry-specific hypotheses which may provide insights into sex-based harassment in the Australian context. A good understanding of sex-based harassment in health care is essential for reducing and eliminating the problem and its toxic sequelae.

Australia↗
PubMed1995

Contrasting in vivo effects on T helper cell functions induced by mitogenic (intact) versus nonmitogenic (F(ab')2) anti-CD3 monoclonal antibody.

Anti-CD3 mAbs are potent inhibitors of T cell function; however, administration of mitogenic mAb can cause significant morbidity secondary to T cell activation and cytokine release. Nonmitogenic anti-CD3 mAb is immunosuppressive in mice without inducing detectable morbidity, and may thus be preferable for in vivo T cell immunosuppression. The precise mechanisms of action of these two forms of mAb have not been fully defined. To further characterize and compare the in vivo functional effects of mitogenic and nonmitogenic anti-CD3 mAbs, mice were treated with the intact (mitogenic) form of the anti-murine CD3 mAb, 2C11, or with F(ab')2 fragments (nonmitogenic). Effects on T cell phenotypes and the secretion of Th1-derived cytokines were compared. Nonmitogenic mAb induced a prolonged downregulation of secretion of interleukin (IL)-2 and interferon (IFN)-gamma from CD4+ T cells, and of IL-2 secretion from CD8+ T cells, and preferential depletion of CD4+ T cells. In marked contrast, mitogenic mAb induced a prolonged upregulation of IL-2 and IFN-gamma secretion from both CD4+ and CD8+ cells, and preferential depletion of CD8+ T cells. Both forms of mAb induced a shift in the T cell populations from a naive to a memory phenotype; however, this shift was not responsible for the observed changes in cytokine secretion. These results demonstrate that mitogenic and nonmitogenic forms of 2C11, while binding to the identical epitope, differentially affect T cell functions, and have implications for the use of anti-CD3 mAbs in the clinical setting.

Animals↗
PubMed1994

Use of bi-level biotinylation for concurrent measurement of in vivo recovery and survival in two rabbit platelet populations.

BACKGROUND: The objectives of this research were 1) to determine whether two populations of platelets may be labeled with different levels of biotin and followed concurrently in vivo by flow cytometry and 2) to determine whether the level of biotinylation affects the in vivo platelet recovery and survival. STUDY DESIGN AND METHODS: Two platelet aliquots were biotinylated under conditions that resulted in either a lower or a higher number of biotin molecules per platelet. After transfusion, the two populations were distinguished and quantitated by flow cytometry. RESULTS: In five animals, recoveries were 69.8 +/- 27.0 percent for low-biotin platelets and 72.6 +/- 26.7 percent for high-biotin platelets. For each animal, the recoveries agreed closely. Life span, determined by the multiple-hit method, was 2.68 +/- 0.63 days for low-biotin platelets and 2.58 +/- 0.69 days for high-biotin platelets. These values for recovery and life span are consistent with those measured in rabbits by using radioisotope labels. CONCLUSION: Platelet biotinylation offers a nonisotopic method for direct comparison of alternative harvest and storage conditions. It also offers the potential for simultaneous evaluation of the in vivo characteristics of platelets from at least two donors.

Animals↗
PubMed1992

Studies with biotinylated RBC: (1) use of flow cytometry to determine posttransfusion survival and (2) isolation using streptavidin conjugated magnetic beads.

Methods are reported for the quantitation and isolation of biotinylated red blood cells (B- RBC). The first method is for determination of posttransfusional survival of rabbit RBC by flow cytometry. The survival of B-RBC was measured using both fresh and paraformaldehyde-fixed cells with similar results. The posttransfusion survival of rabbit RBC measured in this way was normal. There was no indication of increased cell destruction due to antibodies directed against B-RBC and no evidence for loss of biotin from circulating cells. The second methodology is for the isolation of B-RBC from blood with streptavidin-coated magnetic beads. At least eighty percent of positive cells were recovered with very few false positives. Both methods may be helpful in the study of resealed erythrocytes.

Animals↗
PubMed1992

Complications from intra-aortic balloon counterpulsation: a review of 303 cardiac surgical patients.

From January 1980 to January 1990 all patients undergoing cardiac surgery at the Royal North Shore Hospital, Sydney, and requiring intra-aortic balloon counterpulsation (IABCP) were retrospectively reviewed. A total of 99 patients (32.6%) developed complications. Vascular/haemorrhagic complications occurred in 46 patients (15.2%); 79 patients (26%) required platelet transfusions. We have found that only a history of hypertension was predictive of an increased incidence of developing vascular complications. Surgical intervention was required in 17 patients (5.6%), or 47% of the patients who developed a vascular complication. The mortality among patients requiring IABCP was 36.6%. Intra-aortic balloon pump-related deaths occurred in 6 patients (2%). Use of the intra-aortic balloon pump can be a life-saving procedure, but it carries a significant morbidity and mortality rate. This makes it imperative to temper our indications to those patients who demonstrate a need for it.

Adult↗
PubMed1992

Who leaves the service area? Profiling the hospital outshopper.

Rural hospitals are facing a crisis of major proportions. Declining patient loads, revenues, and profits are the norm. The authors find that in rural communities, the likelihood of going to the local hospital increases with age and may decrease with income.

Adolescent↗
PubMed1990

Disseminated cutaneous and synovial Mycobacterium marinum infection in a patient with systemic lupus erythematosus.

A patient with systemic lupus erythematosus had a protracted skin infection with Mycobacterium marinum after a puffer fish sting. Disseminated cutaneous and synovial disease was associated with clinically active systemic lupus erythematosus two years after the initial infection. The infection was poorly responsive to multiple antituberculous regimens. Hematogenous spread of infection was the likely route of dissemination.

Adult↗
PubMed1990

Comparison of chromosome analysis to DNA content by flow cytometry for pediatric tumors.

Chromosome analyses in a series of 50 pediatric tumor samples showed abnormal chromosome number, ranging from hypodiploid to tetraploid. Aliquots of the same solid tumor samples were analyzed by flow cytometry (FCM). Material from spontaneous abortions and 12 tumor samples with normal chromosomes were also compared in a control series of 83 samples. Tumors or abortuses with 44-48 chromosomes could not be differentiated from material with normal diploid complement by FCM. However, greater than or equal to 3-4 extra chromosomes produced detectable differences in mean DNA index. Triploidy and tetraploidy were readily identified by FCM. It is concluded that FCM could identify an important group of hyperdiploid pediatric tumors, as well as 3N and 4N tumor complements.

Child↗
PubMed1989

Documenting safe treatment of the medical-risk patient.

An easily mastered safe treatment documentation system is presented. The routine consists of two parts, a comprehensive yet manageable medical history and a treatment modification record. Millions of medically compromised patients may now receive comprehensive care in safety.

Anesthesia, Dental↗
PubMed1987

Folacin status in adolescent females.

The folacin status of 103 adolescent females aged 12, 14, and 16 y was evaluated. In the third year, longitudinal data regarding folacin status was obtained from 50 girls aged 14 and 16 y who had participated in the first year. In the first year, 11.7% and 47.6% of the girls had serum and erythrocyte folacin levels less than 3 ng/mL (6.8 nmol/L) and 140 ng/mL (317 nmol/L), respectively. Serum folacin levels and dietary folacin intake decreased with increasing age but not significantly. During the first year, 75% and 66% of the subjects that were folacin deficient based upon serum and erythrocyte folacin values, respectively, were the same subjects considered to be deficient during the third year. Folacin status, as indicated by serum and erythrocyte folacin values, was not related to per capita income. These findings demonstrate that folacin status is less than adequate in females during the adolescent years.

Adolescent↗
PubMed1987

Effects of premilking stimulation on complete lactation milk yield and milking performance.

Effects of premilking preparation on complete lactation performance were measured with two groups of multiparous Holstein cows; 1) 17 cows received full stimulation, a 60-s routine, and 2) 16 cows received minimum stimulation, a 15-s routine, before machine attachment. Actual unadjusted average lactation milk yield for cows receiving full stimulation was 5.4% less than that for cows receiving minimum stimulation. When postpeak persistencies were compared by linear regression of either 1) daily milk weights or 2) 3.5% FCM from DHI records of milk yield and milk fat percent and fitted to lactation curves using an incomplete gamma function, cows receiving full stimulation produced 1) 2.8 or 2) 2.5% more milk per lactation than did cows receiving minimal stimulation. However, none of the treatment differences in mean milk yield was significant statistically. Milk flow rates, strip yields, and machine on-times were measured at 8-wk intervals throughout lactation. Cows receiving full stimulation had significantly higher average milk flow rates and shorter machine on-times starting at wk 32. There were no significant differences in strip yields or percent residual milk between cows receiving full and minimum stimulation.

Animals↗
PubMed1984

Comparison of cognitive ability, personality profile, and school success in epileptic children with pure right versus left temporal lobe EEG foci.

By reviewing electroencephalographic reports compiled over five years and checking clinical details, we identified and studied 27 children with apparently pure left or pure right temporal lobe epilepsy. The children underwent neurological examination and neuropsychological testing (Halstead-Reitan Battery, Wechsler Intelligence Scale for Children [WISC] and Wide Range Achievement Test), and parents completed the Personality Inventory for Children (PIC). Of 15 boys and 12 girls with a mean age of 12.7 years, 14 had right and 13 left temporal lobe epilepsy. Seizure control was excellent in 17. Five (2 with left, 3 with right temporal lobe epilepsy) had received professional emotional help, 6 (3 with left, 3 with right focus) received special help at school, and 5 (3 with left, 2 with right focus) had failed a grade in school. No significant left-right differences were seen in WISC full scale, verbal, or performance IQ scores, neuropsychological test battery findings, or clinical scale scores on the PIC. Most of the children with unilateral temporal lobe epilepsy had no measurable cognitive or emotional difficulties. Cognitive, personality, and school problems were equally distributed between left and right temporal lobe epilepsy groups. When the two groups were combined, however, 10 patients (5 with left, 5 with right focus) were identified by the PIC as maladjusted, and as a group showed significantly lower neuropsychological test functioning than did the normally adjusted children.

Achievement↗