Biomedical subjects
Publications and source records attributed to W J Kane.
Scoliosis is a lateral curvature of the spine, which may require treatment; this brief analysis details those factors weighed in the basic decision-making process. Additional technical details are presented in subsequent sections.
Therapy directed against the toxic effects of reactive oxygen species may reduce the final extent of ischemic injury in otherwise viable tissue irreversibly injured by the abrupt reoxygenation of reperfusion. In four groups of dogs, superoxide dismutase plus catalase (groups I-III) or saline (controls) (group IV) was infused into the left atrium. Group I received the infusion for 2 hours, beginning 15 minutes before occlusion of the left circumflex coronary artery (90 minutes) and ending 15 minutes after reperfusion. Group II received the infusion for 1 hour starting 15 minutes before reperfusion. Group III received the infusion for 1 hour beginning 40 minutes after reperfusion. Dogs were killed the next day, and infarct size was determined by dissection and weighing, and confirmed histologically. Infarct size expressed as percent of the anatomic area at risk was: group I, 19.4 +/- 5.0; group II, 21.8 +/- 3.3; group III, 47.6 +/- 10.3; group IV, 43.6 +/- 3.5 (mean +/- SEM). Analysis of variance followed by Duncan's multiple range test showed that ultimate infarct size as assessed in groups I and II differed significantly (P less than 0.05) from that observed in the control animals in group IV, whereas infarct size between groups III and IV did not differ significantly (P greater than 0.05). The percent of left ventricle at risk did not differ between the four groups. The beneficial effects of superoxide dismutase plus catalase could not be explained by hemodynamic differences. Similar protection of jeopardized myocardium in groups I and II suggest that potentially viable tissue is salvaged by scavenging free radicals during early reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Little documentation exists concerning the extent of functional disability in the hospitalized elderly and the impact of this disability on the care of these patients. A physician-led survey was conducted in a 400-bed community hospital of 279 patients aged 70 or more years. Considerable age-correlated disability was documented. Fifty-four percent of the patients aged 85 years or older were moderately or severely disoriented. Thirty-four percent had impaired hearing, 40% had impaired vision, and 25% had speech impairments. More than half of the patients 75 years or older needed assistance with activities of daily living. Modern hospital design and services may interfere with functional recovery. Evaluation of special care units to minimize the hazards of hospitalizing the elderly is recommended.
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During the past three years, the Duke-Watts Family Medicine Program and the Duke University Center for the Study of Aging and Human Development have developed training in geriatric medicine as an integral part of the family medicine residency program. This paper traces the following steps in the development of this program: a survey of resident and faculty interest, institution of a conference series, identification of potential training sites, development of elective rotations, and use of consultants. Principles found helpful in establishing training in geriatrics for family medicine residents include the following: involve residents in planning, start with modest goals, make the program relevant and practical, build on local strengths, include other health care professional trainees, and use ambulatory, acute hospital, and long-term care sites in the training rpogram.
Problems in the provision of health care to rural areas in the United States include the distribution of health workers, health care facilities, preventive services, quality of care, and economics. The problems must be clearly identified and defined if solutions are to be effective, and the cooperation of several sectors of the community is required. Community organization and political activity are often necessary to convince legislators and medical schools to assist rural communities in a solution of their major problems.
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The onset of "idiopathic" scoliosis is gradual. It goes unnoticed by parent and child alike. The problem is often not detected until the curvature has progressed. Severe scoliosis has serious long-term systemic, cosmetic and psychologic effects. School-based screening programs are very effective in reducing the number of operations required. These programs can be carried out by school nurses, physical education teachers and volunteers who are trained by a knowledgeable physician. Brace treatment is successful when scoliosis is detected only.
The broad topic of metabolic liver disease may be divided into three pathophysiologic groups -- storage diseases, cholestatic syndromes, and metabolic defects contributing to hepatocellular necrosis. The important disease entities in each group have been discussed in terms of incidence, clinical course, inheritance, diagnostic criteria, pathogenesis, hepatic pathology, and therapy. An approach to the evaluation of metabolic liver disease has been proposed. It is hoped that this review will be helpful to the clinician who is engaged in the primary care of children.
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