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Biomedical subjects

T K Jones

Publications and source records attributed to T K Jones.

At least 55 records · Page 3Linked to original sources
PubMed1992

A simplified intraoral surveying device.

This article describes an easily made and used intraoral surveying device that can aid the dentist in transferring needed preparation information from the diagnostic cast. This device also allows checking of the preparations as they are progressing. The device consists of a Proxabrush handle and a drafting lead.

Dental Cavity Preparation↗
PubMed1992

Phase II trial of combination chemotherapy and irradiation in non-small-cell lung cancer, Radiation Therapy Oncology Group 88-04.

Encouraging results of several clinical trials utilizing combination chemotherapy and irradiation in unresectable non-small-cell lung cancer have been reported. A recent report from a cooperative group study suggested that preirradiation vinblastine and cisplatin improved survival over irradiation alone. In an attempt to enhance the possible effectiveness of combination chemotherapy and irradiation, the Radiation Therapy Oncology Group embarked on a Phase II trial utilizing preirradiation vinblastine (5 mg/m2 weekly x 5) and cisplatin (100 mg/m2) on days 1 and 29 prior to irradiation and on days 50, 71, and 92 during irradiation. The irradiation began on day 50 and consisted of 6300 cGy in 7 weeks. Between May 20, 1988 and May 1, 1989, 30 patients were entered on study. Seventy-two percent of patients had Karnofsky status greater than 90, and 76% had weight loss less than 5%. Forty-eight percent of the patients were younger than 60 years of age. Forty-five percent of the patients had Stage IIIA disease. Eighty-three percent of the patients received at least four courses of vinblastine, and 59% received at least four courses of cisplatin. Seventy-eight percent of the patients received at least 95% of the prescribed irradiation. The major toxicity was hematologic, and there were two fatal complications in the study group. The preliminary survival figures are encouraging. This combination of chemotherapy and irradiation appears to be tolerable and may merit further investigation.

Aged↗
PubMed1987

Cardiopulmonary arrest following penetrating trauma: guidelines for emergency hospital management of presumed exsanguination.

Exsanguination may be presumed in pale, mottled, unresponsive trauma victims with no palpable pulse nor spontaneous respirations with noncranial penetrating wounds. Under ideal circumstances, those victims initially witnessed to have some signs of life can be successfully revived in 5 to 25% of cases. The chance for a successful outcome influences the decision to initiate resuscitation and depends on the mode of injury, anatomic location of the wound, and elapsed time until presentation as well as the organization of the available facilities and personnel. The resuscitative algorithm for presumed exsanguination is markedly different from the ACLS guidelines for cardiogenic arrest and requires some degree of surgical expertise. After confirming the witnessed cardiopulmonary arrest from presumed exsanguination, the four phases of resuscitation are restoring central oxygenation, controlling internal hemorrhage, re-establishing spontaneous cardiac function, and definitively repairing the injury. Regardless of the type or location of the noncranial penetrating injury, these phases must be accomplished sequentially to minimize the risks of cerebral and cardiac anoxia.

Algorithms↗
PubMed1986

Greenfield vena caval filter: rationale and current indications.

Prevention is the best therapy for deep venous thrombosis, but when this fails, prompt diagnosis and appropriate treatment can usually avoid lethal pulmonary embolism. Anticoagulation is the preferred treatment for thromboembolic disease because it prevents lethal pulmonary embolism and also arrests the underlying thrombotic process. However, in specific patients with documented pulmonary embolism or deep venous thrombosis, or who are at high risk that either of these will develop, anticoagulation therapy may be contraindicated, may fail to control the thrombotic process, or may offer inadequate protection from lethal pulmonary embolism. In these instances, or when a previous mechanical attempt has failed to prevent pulmonary embolism from a caval source, a Greenfield filter should be considered. The available information on the natural history of patients in these specific categories and subcategories is reviewed, and the indications for and timing of Greenfield filter placement are explained.

Filtration↗
PubMed1986

Normalization of cardiopulmonary endurance in severely asthmatic children after bicycle ergometry therapy.

Sixty-five children with severe asthma were tested on a bicycle ergometer to determine their cardiopulmonary endurance and to determine whether they could achieve normal levels of endurance after a physical rehabilitation program. Workloads on entry into the study ranged from 12% to 222% (median 70%) of predicted. Abnormalities in cardiopulmonary endurance did not correlate with historical features commonly used to define severe asthma or degree of airways obstruction. Forty (58%) patients required further bicycle ergometry training two to five times per week: 32 had scores less than 2 SD below the mean, and eight had scores between 1 and 2 SD below the mean. No adverse side effects were encountered during either testing or training. Of the children with scores less than 2 SD below the mean, 84% achieved normal workloads within 2 to 17 weeks of hospitalization. Rates of improvement were similar in the 27 children who subsequently passed and the five children who did not pass, suggesting that duration of program participation was the most important variable in determining success. Thus severely asthmatic children with abnormal fitness levels can achieve normal cardiopulmonary fitness after training on the bicycle ergometer.

Adolescent↗
PubMed1985

Tetralogy of Fallot: selective staged management.

One hundred twenty-four patients with tetralogy of Fallot have undergone either primary total repair (61), shunt and later repair (30), or an initial shunt (33). The mean ratio of pulmonary anulus to descending thoracic aorta increased from 0.80 +/- 0.25 before the shunt to 1.22 +/- 0.26 before the repair (p less than 0.0001). The mean ratio in the primary repair group was 1.23 +/- 0.25. A transannular patch was necessary in only six of 91 patients (6.6%). Postrepair right ventricular/left ventricular pressure ratio averaged 0.50 +/- 0.11 in the shunt plus repair group and 0.43 +/- 0.12 in the primary repair group. Only four patients had a right ventricular/left ventricular pressure ratio less than 0.65. A significant inverse linear relationship existed between this ratio and the pulmonary anulus size measured at operation and normalized for the patient's height (p less than 0.01). Postoperative complications occurred in 21% of patients after a shunt and 20% of patients after open heart repair. The early mortality was 0.8% (1/124). An initial shunt in patients with a small pulmonary anulus can result in an increased anulus size and better hemodynamic result with frequent avoidance of a transannular patch. Staged repair may result in improved overall mortality rates.

Child, Preschool↗
PubMed1984

Coma scale for use in brain-injured children.

The association between admission coma score and eventual outcome was assessed using a coma scale developed for children with a variety of central nervous system injuries. As opposed to the Glasgow coma scale, this scale does not demand assessment of verbalization, and thus can be applied to the preverbal or previously intubated child. Cortical function is graded from 6 (purposeful, spontaneous movements) to 0 (flaccid), and brainstem function is graded from 3 (intact) to 0 (absent and apneic). Maximum total score is 9. In 91 children treated for intracranial hypertension, the association was moderately good. The scale was better in predicting the outcome of patients with hypoxic encephalopathy and head trauma than that of patients with Reye's syndrome, meningitis, or encephalitis. No child with a score of less than 3 survived in spite of intensive therapy. Most of these children were flaccid with depressed or absent brainstem reflexes. No child with flaccidity on admission survived.

Brain Injuries↗
PubMed1983

Diagnostic imaging in blunt trauma of the abdomen.

Diagnostic imaging is a useful adjunct in evaluating the stable patient with blunt trauma to the abdomen who is not in need of emergent celiotomy. Plain and contrast roentgenography, sonography, scintigraphy, CT and angiography have unique applications in identifying injuries caused by blunt forces. Roentgenograms of the cervical spine, upright chest and pelvis with intravenous pyelography are indicated early to identify injuries that may jeopardize the patient's outcome. Upper gastrointestinal series, with water-soluble contrast medium, are useful in confirming suspected diaphragmatic and duodenal abnormalities. Urethral, bladder and ureteric injuries are readily diagnosed with the results of retrograde urethrography, cystography and pyelography, respectively. Ultrasound is particularly useful in diagnosing and following post-traumatic complications by identifying and localizing hematomas and other fluid collections. Radionuclide scintigraphy is a reliable screening method for injuries to the spleen, liver and kidneys but most importantly, scans are useful in observing patients treated without an operation. Because of the unsurpassed sensitivity and specificity of the recently introduced CT scanners, CT is the roentgenologic screening method of choice in the stable multi-trauma patient with blunt abdominal injury. However, angiography is still the most informative method of assessing vascular injury and, at times, may be both diagnostic and therapeutic. Although, it should be reserved for selected instances when noninvasive studies are inconclusive or performed incidental to necessary pelvic or thoracic aortography. The type and extent of suspected injury usually dictates the nature of the roentgenologic evaluation. Studies that duplicate previous findings or interfere with the ability to pursue needed additional investigative studies should be avoided. Finally, it is crucial that celiotomy should not be delayed by time-consuming studies in the unstable patient.

Abdominal Injuries↗
PubMed1981

Pineal and ectopic pineal tumors: the role of radiation therapy.

Seventeen patients wih pineal tumors and one ectopic (suprasellar) germinoma were treated with radiation therapy. Surgery was restricted to decompression in 16 patients, and only two patients had resection of the tumor. Thirteen of 18 patients are alive without evidence for disease with a ten-year survival rate of 88%. The tumor dose ranged from 4000 rads to 6000 rads. No age or dose dependence in survival was noted, but patients with whole brain irradiation or generous volume to include ventricular system had better survival. No case of spinal metastasis was noted. The possibility of increased incidence of meningeal seeding following surgical intervention is considered. From their data, the authors feel that radiation therapy with or without surgical decompression should be the primary treatment for pinealoma. Surgery can be used for diagnosis and/or treatment of patients who show delayed response to radiation. Recommendation is made for the use of whole brain irradiation to 4000 rads followed by a boost to the tumor area to 5000 rads.

Adolescent↗
PubMed1981

Probability models in the analysis of radiation-related complications: utility and limitations.

In order to predict radiation-related enteric damage, 92 women were studied who had received identical radiation doses for cancer of the ovary from 1970 through 1977. A logistic model was used to predict the probability of complication as a function of number of laparotomies, hypertension, and thin physique. The utility and limitations of such probability models are presented.

Body Composition↗
PubMed1980

Sequential surgery, radiation therapy, and Alkeran in the management of epithelial carcinoma of the ovary.

In 1970, a prospective multidisciplinary protocol was initiated for Stages I through III obviously malignant ovarian epithelial carcinomas. The planned sequential therapy included 1) surgery, 2) radiotherapy (2000 rads to whole abdomen, 3000 rad boost to pelvis), 3) chemotherapy (ten cycles of Alkeran), and 4) a "second-look" surgical procedure. Ninety-six patients were enrolled in this program through 1976. Median follow-up of the survivors was greater than 44 months. Adjusted disease-free survival was 90 percent for Stage I, 64 percent for Stages IIB--IIC, and 16 percent for Stage III. Stage III patients with no palpable tumor at time of initiation of radiation therapy had a survival of 37 percent. No Stage III patient with palpable tumor at time of initiation of radiation therapy was cured. Eight percent of patients developed small bowel obstruction requiring surgical intervention. Three percent of all patients died of hematologic causes; of the 30-month-plus survivors, 5 percent (2 of 37) developed acute myelogenous leukemia. Cure and toxicity will be examined in detail and compared with the literature.

Adenocarcinoma↗