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Biomedical subjects

S Gallagher

Publications and source records attributed to S Gallagher.

At least 19 recordsLinked to original sources
PubMed1996

Coronary restenosis.

Return of angina within 6 months of a catheter-based treatment of coronary artery disease usually reflects restenosis due to an overly aggressive local healing response to the procedure-related arterial injury. The restenotic lesion should be treated aggressively. Patients with preexisting diabetes mellitus, renal failure requiring hemodialysis, and left anterior descending artery lesions should be considered to be at exceedingly high risk for clinically significant restenosis. Exercise testing is indicated for all patients who experience a return of their angina within 6 months of an interventional procedure. Nurse practitioners in the primary care setting may be the first clinicians to hear of the return of angina. Patients should always be reassured that repeat intervention is almost always possible and is generally effective in providing long-term relief. New devices (in particular the Palmaz-Schatz stent) may help reduce the likelihood of restenosis, to the extent that they provide a large acute post-treatment lumen diameter that is more tolerant of intimal hyperplasia without producing significant narrowing. Until adjunctive drug therapy is found that effectively reduces the local tissue response to interventional therapy, all clinicians involved in caring for patients following such procedures will need to be vigilant and knowledgeable about recognizing and treating restenosis.

Angioplasty, Balloon, Coronary↗
PubMed1995

Marketing a hospital-based specialty program.

The 1980s were a time of growth and opportunity for hospital-based specialty programs. ET nurses developed a variety of highly valued clinics and services. Because of current trends toward downsizing, otherwise strong programs and services are undergoing unusual scrutiny. The purpose of this article is to offer the ET nurse ideas for strengthening hospital-based specialty programs through a marketing approach.

Enterostomy↗
PubMed1994

Retroperitoneal hematoma after cardiac catheterization: prevalence, risk factors, and optimal management.

PURPOSE: Retroperitoneal hematoma is an unusual, but potentially serious, complication after cardiac catheterization. The predisposing factors, typical presentation, and clinical course of this iatrogenic complication are identified, and the role of surgery in its treatment is defined. METHODS: A retrospective review of 9585 femoral artery catheterizations over a 5-year period allowed identification and evaluation of all patients with retroperitoneal hemorrhage. RESULTS: Retroperitoneal hematoma developed in 45 patients (overall prevalence 0.5%), with the highest frequency after coronary artery stenting (3%). In the group of patients who underwent coronary artery stenting, statistically significant predictors of this complication included protocol for sheath removal, female sex, nadir platelet count, and excessive anticoagulation. Signs and symptoms included suprainguinal tenderness and fullness in 100%, severe back and lower quadrant pain in 64%, and femoral neuropathy in 36%. Most patients were treated successfully with transfusion alone. Seven patients (16%) required operation; in four, hypotension unresponsive to volume resuscitation developed early after catheterization; and, in three, a progressive fall in hematocrit level led to surgery 24 to 72 hours after catheterization. CONCLUSIONS: Retroperitoneal hematoma after cardiac catheterization can usually be treated by transfusion alone. A small subset of patients who have development of hypotension unresponsive to volume resuscitation require urgent operation.

Aged↗
PubMed1994

Dynamic biomechanical modelling of symmetric and asymmetric lifting tasks in restricted postures.

This article describes investigations of dynamic biomechanical stresses associated with lifting in stooping and kneeling postures. Twelve subjects volunteered to participate in two lifting experiments each having two levels of posture (stooped or kneeling), two levels of lifting height (350 or 700 mm), and three levels of weight (15, 20, or 25 kg). One study examined sagitally symmetric lifting, the other examined an asymmetric task. In each study, subjects lifted and lowered a box every 10 s for a period of 2 min in each treatment combination. Electromyography (EMG) of eight trunk muscles was collected during a specified lift. The EMG data, normalized to maximum extension and flexion exertions in each posture, was used to predict compression and shear forces at the L3 level of the lumbar spine. A comparison of symmetric and asymmetric lifting indicated that the average lumbar compression was greater in sagittal plane tasks; however, both anterior-posterior and lateral shear forces acting on the lumbar spine were increased with asymmetric lifts. Analysis of muscle recruitment indicated that the demands of lifting asymmetrically are shifted to ancillary muscles possessing smaller cross-sectional areas, which may be at greater risk of injury during manual materials handling (MMH) tasks. Model estimates indicated increased compression when kneeling, but increased shear forces when stooping. Increasing box weight and lifting height both significantly increased compressive and shear loading on the lumbar spine. A multivariate analysis of variance (MANOVA) indicated complex muscle recruitment schemes--each treatment combination elicited a unique pattern of muscle recruitment. The results of this investigation will help to evaluate safe loads for lifting in these restricted postures.

Adult↗
PubMed1992

Acceptable workloads for three common mining materials.

A series of psychophysical lifting studies was conducted to establish maximum acceptable weights of lift (MAWL) for three supply items commonly handled in underground coal mines (rock dust bags, ventilation stopping blocks, and crib blocks). Each study utilized 12 subjects, all of whom had considerable experience working in underground coal mines. Effects of lifting in four postures (standing, stooping under a 1.5 m ceiling, stooping under a 1.2 m ceiling, and kneeling) were investigated together with four lifting conditions (combinations of lifting symmetry and lifting height). The frequency of lifting was set at four per min, and the task duration was 15 min. Posture significantly affected the MAWL for the rock dust bag (standing MAWL was 7% greater than restricted postures and kneeling MAWL was 6.4% less than stopped); however, posture interacted with lifting conditions for both of the other materials. Physiological costs were found to be significantly greater in the stooped postures compared with kneeling for all materials. Other contrasts (standing versus restricted postures, stooping under 1.5 m ceiling versus stopping under 1.2 m ceiling) did not exhibit significantly different levels of energy expenditure. Energy expenditure was significantly affected by vertical lifting height; however, the plane of lifting had little influence on metabolic cost. Recommended acceptable workloads for the three materials are 20.0 kg for the rock dust bag, 16.5 kg for the ventilation stopping block, and 14.7 kg for the crib block. These results suggest that miners are often required to lift supplies that are substantially heavier than psychophysically acceptable lifting limits.

Accidents, Occupational↗
PubMed1991

Application of the murine anti-Gd-2 antibody 14.Gd-2a for diagnosis and therapy of neuroblastoma.

We have tested the sialoganglioside monoclonal antibody Gd-2a for scintigraphic diagnostic and for immunotherapy in children with neuroblastoma stage IV. We could confirm tumor sites with Gd-2a scans in 1/2 children. Doses of 20-60 mg/m2 were administered daily for 5-10 days. 2/2 children with multiple tumor sites showed significant tumor regression. Four children, treated preventively, are still in clinical remission. One child showed tumor progression despite Gd-2a treatment. Adverse effects included itching, rashes, and pain.

Adolescent↗
PubMed1991

Acceptable weights and physiological costs of performing combined manual handling tasks in restricted postures.

Eight healthy, male underground coal miners (mean age = 36.9 yrs +/- 4.5 SD) participated in a study examining psychophysically acceptable weights and physiological costs of performing combined lifting and lowering tasks in restricted head-room conditions. Independent variables included posture (stooping or kneeling on two knees), task symmetry (symmetric or asymmetric), and vertical lift distance (35 cm or 60 cm). All tasks were 10 min in duration and were performed under a 1.22 m ceiling to restrict the subject's posture. Subjects were required to raise and lower a lifting box every 10s, and asked to adjust the box weight to the maximum amount they could handle without undue strain or fatigue. During the final 5 min of each test, data were collected to determine the energy expenditure requirements of the task. Results of this study demonstrated that psychophysical lifting capacity averaged 11.3% lower when kneeling as compared to stooping. Subjects selected 3.5% more weight in asymmetric tasks, and lifted 5.0% less weight to the 60 cm shelf compared to the 35 cm shelf. Heart rate was not significantly affected by posture, but was increased an average of 4 beats/min in asymmetric conditions, and by 3.5 beats/min while lifting/lowering to/from the high shelf. Oxygen uptake was increased by 9% when stooped, by 10% when lifting/lowering asymmetrically, and by 8.2% when performing the task to the high shelf. Results of this study indicate that, wherever possible, materials that must be lifted manually in low-seam coal mines be designed in accordance with the decreased lifting capacity exhibited in the kneeling posture.

Adult↗
PubMed1989

Symmetric and asymmetric manual materials handling. Part 1: Physiology and psychophysics.

To study the physiological and psychophysical costs of symmetric and asymmetric manual materials handling, two tasks were performed by 30 industrial subjects. In both tasks, box weight and handle position were varied. The symmetric task, lifting and lowering between floor and conveyor, showed handles to be beneficial. The asymmetric task was palletizing and depalletizing 36 boxes between a pallet and a conveyor. Both palletizing and depalletizing proved strenuous for females with heart rates exceeding 140b/min. All handle positions were better than No Handles, but the best handle position changed from asymmetric for 9 kg boxes to symmetric for 13 kg boxes. The effect of handles was equivalent to a weight change of 1-2 kg for Heart Rate and Rated Perceived Exertion, but much higher (2-14 kg) for Body Part Discomfort measures.

Adult↗
PubMed1989

Symmetric and asymmetric manual materials handling, Part 2: Biomechanics.

Earlier studies of the biomechanics of handle placement and angles on boxes in Manual Materials Handling have been limited to sagittally symmetric tasks. This study extends the results to a palletization/depalletization task with considerable asymmetric movement. Part 2 shows how body posture, hand/handle interface, and disc compressive force change in this asymmetric task. The results were not too different from the earlier studies of symmetric tasks, except that a 'traditional' handle position in the upper part of each lateral face (the 2/2 position) proved more effective than had been anticipated.

Adult↗
PubMed1987

Multiple microsample analysis of intratumor estrogen receptor distribution in breast cancers by a combined biochemical/immunohistochemical method.

A multiple microsample analysis of estrogen receptors (ER) was performed on 81 samples obtained from 21 human breast cancers using a biochemical (BC) and immunohistochemical (IHC) method. Qualitative agreement occurred in 96% of the cases. Using both the percentage of cells staining specifically for ER as well as the intensity of staining (Histoscore) a semiquantitative correlation between the two analyses was obtained. Large variations in cellularity and the percentage of cells that stained specifically for ER existed within individual tumors. In most cases the variation in intensity of staining was minimal. Both the level and distribution of ER in different areas of individual tumors were calculated using a correction for differences in cellularity amongst samples. Heterogeneity in ER level as well as distribution was found in some tumors. In addition, a "checkerboard" type of staining with intermixed ER positive and ER negative cells was observed. This combined BC/IHC method may provide specific information about intratumor ER heterogeneity not available from either method alone.

Adult↗
PubMed1987

Influence on patient management of general practitioner direct access to radiological services.

We have looked at the effect of open radiological access on patient management during a 2-year prospective study in the radiology department of a teaching hospital and two general practices. Five hundred and thirty consecutive requests for radiological examination were studied. Chest radiographs (29.8%) and barium meals (17.4%) were the investigations most commonly requested. At the time of referral general practitioners indicated that if open radiological access had not been available, 78% of the patients would have been referred to specialist clinics. They also indicated that with a normal initial radiological examination only 12% would need referral to a specialist department. Open access appears to save outpatient consultations.

Ambulatory Care↗
PubMed1987

Peripartal changes in serum alkaline phosphatase activity and lactate dehydrogenase activity in dairy cows.

Peripartal serum alkaline phosphatase activity and lactate dehydrogenase activity were measured in 30 dairy cows in order to examine the association between retained fetal membranes and enzyme activity. Daily blood samples were obtained from pregnant cows, starting 15 days before the expected day of calving until eight days after parturition. Sera from 15 cows which retained fetal membranes longer than 24 hours and 15 cows which shed fetal membranes within six hours after parturition were analyzed for alkaline phosphatase and lactate dehydrogenase enzyme activities. Mean alkaline phosphatase enzyme activities ranged from 15.93 to 32.6 U/L in retained and nonretained placenta cows. There was a trend towards higher serum alkaline phosphatase activities in retained placenta cows but the differences were not significant among the groups (P greater than 0.05). Mean lactate dehydrogenase activities ranged from 307.2 to 438.86 U/L in nonretained and retained placenta cows. Lactate dehydrogenase enzyme activities in nonretained and retained placenta cows were similar (P greater than 0.05). The alkaline phosphatase and lactate dehydrogenase enzyme activities peaked at the time of parturition in both groups. However, the differences in alkaline phosphatase and lactate dehydrogenase activities on different days within non-retained and retained placenta cows were significant (P less than 0.05). Results indicate that prepartal changes in alkaline phosphatase and lactate dehydrogenase enzyme activities are not predictive of placental retention postpartum.

Alkaline Phosphatase↗
PubMed1986

Oxalate degradation by gastrointestinal bacteria from humans.

Anaerobic bacteria that metabolize oxalic acid have only recently been isolated from the rumen and from other gastrointestinal habitats. They constitute a new genus and species, Oxalobacter formigenes. This report presents the first comparison of cultural counts of these organisms from human feces and indicates that numbers as high as 10(7)/g may be present in feces from normal humans. Rates of oxalate degradation by mixed bacterial populations in feces from seven normal humans ranged from 0.1 to 4.8 mumol/(g X h). With fecal samples from eight patients that had undergone jejunoileal bypass surgery, rates were much lower [0-0.006 mumol/(g X h)]. We propose that oxalic acid degradation by Oxalobacter formigenes may influence absorption of oxalate from the intestine and that lower rates or lack of oxalate degradation in the colons of jejunoileal bypass patients may contribute to the increased absorption of dietary oxalate and the hyperoxaluria commonly associated with such patients.

Adult↗