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Biomedical subjects

A Kolker

Publications and source records attributed to A Kolker.

15 recordsLinked to original sources
PubMed2000

Tuberous breast deformity: principles and practice.

The tuberous breast deformity is one of the most challenging congenital breast anomalies. The nomenclature, classification, and treatment of this pathological condition have varied considerably. In this study, 16 patients with 23 tuberous breast deformities are evaluated. The breast deformities are classified according to the three-tier classification system used at the authors' institution. The treatment pattern is evaluated and a flexible algorithm is discussed for the treatment of the tuberous breast deformity.

Breast↗
PubMed1998

Dermal autografts for fascial repair after TRAM flap harvest.

To find an alternative to synthetic mesh closure of abdominal fascial defects after transverse rectus abdominis musculocutaneous (TRAM) flap harvest, dermal autografts were removed from tissue to be discarded and used for fascial closure. Dermal grafts have been used for herniorrhaphy and fascial repair after TRAM harvest previously, but have never been systematically studied. The dermal autograft technique was used in 24 patients to repair or reinforce anterior rectus sheath or external oblique fascia after TRAM harvest for breast reconstruction. During the same period, 25 other patients underwent TRAM breast reconstruction with abdominal wall closure by other methods. All patients were followed by serial physical examinations given by the operating surgeon. Average follow-up in the dermal autograft group was 12.6 versus 12.0 months in the second group. In the dermal autograft group, two patients complained of bulging of the anterior abdominal wall; one developed a true hernia, away from the location of the dermal autograft. In the second group, two patients experienced bulging. Wounds and infectious complications were similar in both groups. Dermal autografts are a useful alternative to mesh repair or direct closure of fascial defects after TRAM flap harvest.

Adult↗
PubMed1993

Deciding about the unknown: perceptions of risk of women who have prenatal diagnosis.

This paper examines the risk perceptions of women who undergo two prenatal diagnostic procedures, amniocentesis and CVS (chorionic villus sampling). Data were collected from a survey of clinic patients in suburban Washington, D.C. and in San Diego (N = 120). The survey was supplemented by in-depth interviews with prenatal diagnosis users and genetic counselors. Women with more education, as well as those who had CVS rather than amniocentesis, were more likely to view their risk as low. This contradicts the accepted view that users are aware of the higher risks of CVS. Rather, it seems that risk perceptions are socially constructed to achieve cognitive consistency with the action undertaken. Qualitative data suggest that perceptions of risk appear to be influenced not only by the users' demographic characteristics but by the salience and severity of the event in question and by the user's perceived control over it.

Amniocentesis↗
PubMed1989

Advances in prenatal diagnosis. Social-psychological and policy issues.

Chorionic villus sampling (CVS), a new technique for prenatally diagnosing chromosomal and genetic disorders, may soon replace amniocentesis. This procedure, performed by inserting a catheter through the pregnant woman's cervix or through the abdomen and removing cells from the placenta, has the advantages of being available earlier in the pregnancy than amniocentesis (at 9 to 11 weeks gestational age) and of yielding results in a shorter time. Although the medical aspects of the procedure are being investigated, its psychosocial and policy implications have not been studied systematically. These issues include the subjective assessment of risk that prompts women to choose or to reject CVS, the implications of earlier diagnosis for feelings about abortion, the potential of negative findings (i.e., the absence of the designated disorder) for well-being during the remainder of the pregnancy, the ramifications of first trimester identification of fetal sex, equity of access to prenatal diagnosis, and the possible over-utilization of these procedures. Drawing on previous research regarding amniocentesis and more recent research concerning CVS, this article discusses the potential implications of CVS.

Chorionic Villi Sampling↗
PubMedDate not supplied

Clients undergoing chorionic villus sampling versus amniocentesis: contrasting attitudes toward pregnancy.

We analyzed interview data from 44 primarily white, middle-class women who had used the prenatal diagnostic technique of chorionic villus sampling (CVS: n = 24) or amniocentesis (n = 20). CVS provides earlier results but carries a somewhat higher risk of miscarriage. Amniocentesis clients were highly committed to the pregnancy and expressed considerable anxiety over the possibility of having to terminate it should an abnormality be diagnosed. CVS clients seemed less bonded to the fetus and less concerned about losing a pregnancy several termed "replaceable." Thus, with its first-trimester abortion decision, CVS redefines prenatal diagnostic issues for women.

Abortion, Therapeutic↗
PubMedDate not supplied

Grieving the wanted child: ramifications of abortion after prenatal diagnosis of abnormality.

Prenatal diagnosis is increasingly common. Whereas amniocentesis is typically performed in the second trimester, chorionic villus sampling (CVS) is a first-trimester procedure, which makes an earlier, safer abortion possible. However, CVS carries a slightly higher risk of miscarriage and other complications. In choosing a procedure, couples (with the aid of genetic counseling) must weigh the risks of miscarriage against the odds and implications of an abnormal diagnosis. Interviews with women who decided on abortions after amniocentesis or CVS and meetings with genetic counselors indicate that both types of abortion are more traumatic than is commonly realized. Both dash dreams and hopes. Termination after amniocentesis also forces the mother to take an active part in the life and death of a nearly viable fetus. Yet, because abortions for fetal abnormality are statistically rare, there is little societal understanding and minimal support for those who experience them. This is true of health care workers as well as for the couple's primary support group.

Abortion, Therapeutic↗