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Biomedical subjects

B J Stephens

Publications and source records attributed to B J Stephens.

13 recordsLinked to original sources
PubMed1997

Elective laparoscopic splenectomy for hematologic disorders.

Laparoscopic splenectomy has been reported to be the procedure of choice in selected patients with hematologic disorders. The purpose of this study is to review our experience with laparoscopic splenectomy in this patient population. The charts of all patients with hematologic disorders who presented for laparoscopic splenectomy over a 17-month period were reviewed. Fifteen patients, nine males and six females, aged 12 to 80 years (mean, 49 years) presented for laparoscopic splenectomy. Surgical indications included 13 cases of idiopathic thrombocytopenic purpura and one each of hemolytic anemia and Hodgkin's disease. Splenectomy was performed utilizing a four- or five-puncture laparoscopic technique. For completed laparoscopic splenectomies, the mean operative time was 129 minutes, and the mean estimated blood loss was 232 cc. Mean splenic weight was 210 g. There were no operative deaths. There was a single intraoperative complication, a 1700-cc hemorrhage, and two postoperative complications: pneumonitis and deep venous thrombosis. Overall morbidity was 20 per cent. A single patient (7%) required conversion to laparotomy for completion due to hemorrhage. For patients completed laparoscopically, the mean hospitalization was 1.5 days, and none required parenteral narcotics for pain control after the first 36 hours. Laparoscopic splenectomy for patients with hematologic disorders is a safe and technically feasible procedure. Decreased hospitalization and discomfort are the primary benefits. This technique should be added to the repertoire of surgeons treating patients with hematologic disorders.

Adolescent↗
PubMed1995

The consequences of disclosure: one hospital's response to the presence of an HIV-positive physician.

Health care administrators are having to confront the many and complex problems associated with patient fears about the transmissibility of the HIV virus. Particularly acute are concerns that are raised when the physicians are HIV-positive or have AIDS. This article presents a case history of how one hospital handled the problems created by the announcement by one of its emergency room physicians that he was HIV-positive. The hospital's response--which included disclosure to the community, the full cooperation of the physician, provision of free counseling, and HIV testing--and the aftermath of this AIDS-related event are described. This case is discussed in relationship to the ongoing debate about the ethics and consequences of disclosure of the HIV status of health care workers.

Centers for Disease Control and Prevention, U.S.↗
PubMed1993

Fournier's gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance.

Experience with 11 cases of Fournier's gangrene during the decade 1979-1988, prompted this review of the English language literature to determine whether there have been changes in demography, etiology, and outcome, as compared to cases dating to 1763. All cases were evaluated according to age, sex, bacteriology, etiology, and outcome. In the decade 1979-1988, 449 cases were reported. The average age of the patients was 49.8 years; with 14 per cent occurring in females. Synergistic polymicrobial infections were present in all cases. The most commonly reported etiologies were colorectal (33%), idiopathic (26%), and genitourinary (21%). Mortality associated with colorectal etiology was highest (33%, p < 0.05). Female mortality (49%) was not significantly greater than male mortality (17%), when obstetrical etiology was excluded. Overall mortality was 22%. Comparison with 386 cases of Fournier's gangrene reported between 1763 and 1978 reveals that the mean age of patients remains relatively low, and males continue to predominate. The pathophysiologic aspects of this disease appear similar in both sexes. The mortality rate from colorectal sources is significantly greater than from other common causes. Neither the introduction of antibiotics nor the development of newer ones has reduced mortality significantly. In spite of newer diagnostic techniques, the etiology remains unclear in over one-fourth of cases.

Fasciitis↗
PubMed1987

Cheap thrills and humble pie: the adolescence of female suicide attempters.

The purpose of this study was to identify and describe characteristic social and psychological patterns of the adolescence of females who become suicide attempters during adulthood. To accomplish this retrospective study, life histories of 50 adult female suicide attempters were obtained; these were supplemented by a content analysis of personal documents written by the subjects during their adolescence. Two disparate social and psychological patterns were identified: "Cheap Thrills" and "Humble Pie." Cheap Thrills was a pattern of defiance, rebelliousness, acting-out behaviors, drug involvement, and indiscriminate sexuality. Humble Pie was in polar contrast and involved overconformity, docility, passivity, and emotional submergence. The significance of these findings lies in the identification of the second pattern, Humble Pie; this pattern is a stark contrast to the prevalent image in the suicide literature. More generally, the present study may contribute to an understanding of the long-term and processual nature of the suicidal careers of females.

Acting Out↗
PubMed1985

Suicidal women and their relationships with husbands, boyfriends, and lovers.

This study describes the specific conflicts which suicidal women experience in their intimate relationships with men. Fifty women who had made suicide attempts were studied with a focus on the contributing role of their relationships with men to the genesis of the suicidal acts. Four major themes were found in the relationships: "smothering love", infidelity, battering, and denial of affection. The women experienced these conflicts as major precipitants in their suicidal behaviors. Examples of the four themes are described and analyzed.

Adolescent↗
PubMed1984

Vocabularies of motive and suicide.

This paper presents a brief review of the vocabulary of motives tradition in sociology and argues for its applicability to the study of suicidal motivation. A comparison of motive statements in the notes of suicides and motive statements elicited from a nonsuicidal group reveals a measure of motive standardization. The findings promote viewing suicide motives as social constructions learned in interaction which permit the individual and others to assign meaning and acceptability to the suicidal act.

Culture↗
PubMed1976

Human pulmonary dirofilariasis associated with pleural effusion.

Tuberculosis, untreated pneumonia and other chest infections were excluded as possible causes of histological features observed in patient who had been discovered in a chest X-ray survey. Pleural effusion was eventually attributed to a dirofilarial granuloma found in a small pulmonary artery.

Adult↗
PubMedDate not supplied

Optimal timing of elective indirect inguinal hernia repair in healthy children: clinical considerations for improved outcome.

Experience with several incarcerations that resulted in emergent surgery for children with known indirect inguinal hernias prompted this review to determine if there is an optimal time after hernia diagnosis during which elective repair should be undertaken to avoid incarceration. Over a 30 month period, 228 children less than 10 years of age underwent 303 indirect inguinal hernia repairs. They were analyzed for age, sex, interval between diagnosis and repair, predisposing conditions, major complications, and length of hospitalization. Excluded were 21 children who presented with incarceration of a previously undiagnosed indirect inguinal hernia that required operative reduction, 13 children with conditions predisposing to indirect inguinal hernia, and 53 children for whom the interval between diagnosis and repair was unknown, leaving a study group of 141 children who underwent 190 indirect inguinal hernia repairs. Nearly 13% (18 of 141) of the children developed incarcerated hernia prior to elective repair. Compared to children who underwent repair of a reducible indirect inguinal hernia, those with incarceration were more likely (p less than 0.05): 1) to have major complications (11% vs 0.6%), 2) to have a shorter interval between diagnosis and repair (26 vs 49 days), 3) to be younger (7.5 vs 25.6 mos), and 4) to require greater than 24 hours of hospitalization. Had children with reducible incarcerated indirect inguinal hernia been hospitalized and undergone repair 24 to 48 hours later, 83% of subsequent incarcerations would have been prevented. Furthermore, this experience supports the recommendation that for healthy children less than 10 years of age, indirect inguinal hernia repair should be performed on a semi-elective basis within 7 days of diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗