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Biomedical subjects

C Fowler

Publications and source records attributed to C Fowler.

At least 37 records · Page 2Linked to original sources
PubMed1996

Factors associated with the intent of firearm-related injuries in pediatric trauma patients.

OBJECTIVE: To examine the characteristics of unintentional and assaultive firearm-related pediatric injuries treated in trauma centers. DESIGN: Comparative analysis of patients 14 years or younger who were admitted to the trauma centers because of unintentional firearm-related injuries (n = 292) vs assaultive firearm-related injuries (n = 457). SETTING: Sixty-eight trauma centers or children's hospitals in the continental United States and Canada that reported data to the National Pediatric Trauma Registry from January 1, 1990, through December 31, 1994. MAIN OUTCOME MEASURES: Frequency distributions of firearm-related injuries in relation to intent and injury circumstances, odds ratios (ORs) on the intent of injury being assaultive, injury severity scales, and in-hospital fatality rates. RESULTS: The frequency of unintentional firearm-related injuries rose in the afternoons peaking between 4 and 5 PM; they predominantly occurred at home (89%). Assaultive firearm-related injuries peaked sharply between 8 and 9 PM and usually occurred on roads or in other public places (63%). About 3 times as many boys as girls were harmed in firearm-related injuries. Given a firearm-related injury resulting in admission to a trauma center, the adjusted OR of it being assaultive was 2.8 (95% confidence interval [CI], 1.6-4.6) if the victim was a girl, 4.9 (95% CI, 3.1-7.8) if the shooting occurred at night, 2.6 (95% CI, 1.6-4.2) if the shooting occurred on a weekday, and 21.1 (95% CI, 9.1-49.4) if the shooting occurred on a road. Injury patterns and severity were similar between patients with unintentional and assaultive injuries. Overall, 19% of the patients sustained head injuries, which contributed to 90% of the in-hospital deaths. CONCLUSIONS: Marked differences in injury circumstances exist between unintentional and assaultive firearm-related injuries among children. The late afternoon hours when many children have come home from school but their parents may still be working have the highest frequency of unintentional firearm-related injuries. The evening peak of assaultive injuries may be related to drug-related and gang-related violence. While it is important to reduce the access of firearms to children, school-based extracurricular and community-based social services should be considered in developing intervention programs.

Adolescent↗
PubMed1996

Quantitative and qualitative differences in growth, invasion and lung colonization of an anaplastic and a papillary human thyroid cancer cell line in vitro and in vivo.

Invasion and metastasis remain major reasons for failure of anti-cancer therapy. Cell lines derived from human carcinomas are frequently used to investigate the molecular mechanisms that underlie invasion and metastasis. Unfortunately many of these cell lines do not retain the malignant characteristics of their parental tumors. We therefore conducted a series of experiments in vivo and in vitro to identify which aspects of malignancy of a papillary (NPA'87) and an anaplastic (DR090-1) thyroid carcinoma were consistent with the pathology of the parental tumor types. We evaluated tumor growth, invasion and metastasis of DRO90-1 and NPA'87 in vivo following inoculation of the tumor cells under the dermis, under the renal capsule and into the lateral tail vein of nude mice. This evaluation in vivo showed that the anaplastic carcinoma had a faster growth rate compared with the papillary carcinoma. Furthermore, the papillary carcinoma cells could destroy and infiltrate surrounding tissue but were not capable of extravasation and colonization of lung tissue. The anaplastic cells formed lung nodules following injection into the tail vein of nude mice. This lung colonizing capability of DRO90-1 correlated with their capacity to secrete an active 62 kDa gelatinase and to migrate through reconstituted basement membrane in vitro.

Animals↗
PubMed1996

Neuromodulation of detrusor hyper-reflexia by functional magnetic stimulation of the sacral roots.

OBJECTIVE: To investigate the acute effects of functional magnetic stimulation (FMS) on detrusor hyper-reflexia using a multi-pulse magnetic stimulator. PATIENTS AND METHODS: Seven male patients with established and intractable detrusor hyper-reflexia following spinal cord injury were studied. No patient was on medication and none had had previous surgery for detrusor hyper-reflexia. After optimization of magnetic stimulation of S2-S4 sacral anterior roots by recording toe flexor electromyograms, unstable detrusor activity was provoked during cystometry by rapid infusion of fluid into the bladder. The provocation test produced consistent and predictable detrusor hyper-reflexia. On some provocations, supramaximal FMS at 20 pulses/s for 5 s was applied at detrusor pressures which were > 15 cmH2O. RESULTS: Following FMS there was an obvious acute suppression of detrusor hyper-reflexia. There was a profound reduction in detrusor contraction, as assessed by the area under the curves of detrusor pressure with time. CONCLUSIONS: Functional magnetic stimulation applied over the sacrum can profoundly suppress detrusor hyper-reflexia in man. It may provide a non-invasive method of assessing patients for implantable electrical neuromodulation devices and as a therapeutic option in its own right.

Adult↗
PubMed1996

Absence of an effect of levofloxacin on warfarin pharmacokinetics and anticoagulation in male volunteers.

Some fluoroquinolone drug-drug interactions involving inhibition of the hepatic metabolism of agents such as theophylline and caffeine have been identified. This study was designed to investigate the potential interaction of the fluoroquinolone levofloxacin in a standard multiple-dose regimen with the oral anticoagulant warfarin. Sixteen healthy male volunteers were given a single oral dose of 30 mg warfarin sodium during a multiple-dose regimen of placebo or levofloxacin 500 mg twice daily, in a placebo-controlled, randomized, double-blind, two-way crossover design. Plasma R(+) and S(-) warfarin concentrations and prothrombin times were measured for 6 days after administration of each warfarin dose. The pharmacokinetic parameters of both enantiomers of warfarin were comparable in the absence and presence of levofloxacin, with no significant differences noted in warfarin peak plasma concentration, time to peak plasma concentration, apparent total body clearance, and terminal disposition half-life. Levofloxacin also had no significant effect on warfarin pharmacodynamics, as assessed by baseline-corrected maximum prothrombin time, time to maximum prothrombin time, and area under the prothrombin time-versus-time curve. The lack of pharmacokinetic or pharmacodynamic interaction observed in this study suggests that a clinically important effect of levofloxacin on warfarin is unlikely to occur during concurrent therapy.

Administration, Oral↗
PubMed1996

A multimethod approach to assessing dependency: the early memory dependency probe.

The construct validity and clinical utility of the early memory probe assessing aspects of dependency was investigated. Clinical patients' responses to the "feeding, being fed, or eating" probe were compared with Rorschach Oral Dependency (ROD) scale scores (Masling, Rabie, & Blondheim, 1967), as well as theoretically and empirically derived behavioral ratings. Sixty-five psychiatric patients and their therapists participated in the study. Results demonstrated moderate to strong correlations between the early memory scores and the ROD scores, thus demonstrating good concurrent validity. A moderate correlation between the early memory scores and therapists' ratings of key behavioral patterns in therapy support the predictive validity of the early memory probes. The early memory scores also demonstrated discriminant validity when compared with Rorschach object-relational content scales.

Adult↗
PubMed1995

Metastasis of C1300 and TBJ murine neuroblastomas correlates with expression of matrix metalloproteinases.

Because metalloproteinases, specifically type IV collagenases, may mediate metastasis, 72- and 92-kDa collagenase activities were evaluated in two murine neuroblastoma cell lines: non-metastatic C1300 and metastatic TBJ. Zymogram analysis demonstrated that 72- and 92-kDa collagenases were associated only with metastatic TBJ. Three human neuroblastoma cell lines were then evaluated by zymogram and Western blot analyses: 72-kDa collagenase was found in metastatic SK-N-SH and IMR-32, but not in SK-N-MC, which may be a peripheral neuroectodermal tumor and not a neuroblastoma. Therefore, 72- and 92-kDa collagenases may be markers of metastasis in neuroblastoma and may aid in differentiation from other small blue cell tumors.

Animals↗
PubMed1995

A taxonomy of Rorschach autisms with implications for differential diagnosis among thinking-disordered patients.

A tripartite taxonomy of perceptual-cognitive errors on the Rorschach, abbreviated TRAUT, was reviewed. TRAUT classifies "autisms" as stemming from either an arrant disregard for the blot shapes (HYPO), an inordinate attention to unusual blot areas (HYPER), or an endorsement of counterfactual relationships among blot areas (RELER) included among Exner's Unusual Verbalizations. The scoring of HYPOs and HYPERs and the frequency of their occurrence among thought-disordered groups were determined by examining Rorschachs of inpatient schizophrenics, outpatient schizophrenics, borderline personality disorders, and Cluster A personality disorders. Because HYPOs and HYPERs yielded better differential diagnoses than RELERs among these four groups, it was suggested that such percepts should be scored routinely as a screen for thought disorder.

Adult↗
PubMed1995

A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate.

OBJECTIVES: To assess the safety and efficacy of endoscopic laser ablation of the prostate (ELAP), performed with the Urolase fiber and the neodymium:yttrium-aluminum-garnet laser, compared to transurethral resection of the prostate (TURP) in patients with bladder outflow obstruction secondary to benign prostatic hyperplasia (BPH). METHODS: In this multicenter, prospective, randomized study, a total of 151 patients were treated (ELAP, 76; TURP, 75) of whom 137 completed 1 year follow-up (ELAP, 67; TURP, 70). Safety parameters included measurement of preoperative and 24-hour postoperative sodium, hematocrit, and hemoglobin values and careful monitoring of adverse events. Efficacy was assessed with the American Urological Association symptom score (6), urinary flow rates, and residual urinary volume measurements. RESULTS: There was 1 death in each group during the study period unrelated to the treatment procedure. There was a clinically significant improvement in all efficacy parameters in both groups. Between group comparisons favored TURP in maximum flow rate, residual urinary volume, and symptom score. ELAP had a better safety profile than TURP in the defined safety parameters of drop in hemoglobin and hematocrit values. In 16% of patients, a blood transfusion was required after TURP compared with no transfusions in the ELAP group. Urinary tract infections and dysuria were more frequent in the ELAP group. CONCLUSIONS: ELAP performed with the Urolase fiber is a useful alternative therapy to TURP in patients presenting with bladder outflow obstruction secondary to BPH.

Aged↗
PubMed1995

Factors related to the presence of head injury in bicycle-related pediatric trauma patients.

Using data from the National Pediatric Trauma Registry, this study examined the characteristics of bicycle-related head injury, factors related to the presence of head injury, and different outcomes of head injury up to the time of discharge. Of the 2,333 patients ages 0 to 14 years who were admitted to trauma centers because of bicycle-related injury during 1989 through 1992, more than one-half (54%) sustained head injury, predominantly concussions and skull fractures. With adjustment for age, sex, and motor vehicle involvement, children who had pre-existing mental disorders, who did not wear a helmet at the time of injury, or who were injured on roads had a significantly increased likelihood of sustaining head injuries. Patients with a head injury were four times as likely as patients with no head injury to be treated in intensive care units, and were almost twice as likely to develop complications. Head injury was associated with an increased risk of inhospital fatality and high prevalence rates of communication and behavior impairments at discharge. Although it is urgent to increase helmet use substantially by child bicyclists, special attention should be paid to high-risk groups, such as children with mental disorders and children who are likely to ride in traffic.

Adolescent↗
PubMed1995

HLA class I variation in Australian aborigines: characterization of allele B*1521.

Traditional methods of serological typing have largely used antisera of Caucasoid origin, which can overlook HLA heterogeneity in non-Caucasoid populations. Therefore, we have used molecular techniques to evaluate potential polymorphism in HLA class I molecules of Aborigines from the central desert and northern coast of Australia. The DNA sequence of common Aboriginal HLA-A and B antigens were compared with serological reaction patterns which suggested new polymorphisms. Although serological data indicated that long and short variants of A34 may exist, regardless of the serological pattern, all individuals carried the A*3401 allele. Therefore, the variation in A34 reaction pattern observed serologically was not attributable to primary sequence variation in the HLA A*3401 allele. Similarly, there was no detectable polymorphism in the sequences of selected HLA-B alleles, even though some of these alleles showed unusual serological reaction patterns. However, a new allele of B15 (B*1521) was detected in two individuals carrying this serotype. The cells from both of these individuals showed ambiguous reaction patterns with monospecific B62 and B75 sera. cDNA sequencing of the HLA B15 gene from these cells revealed a B15 allele that differed from B*1502 by a single nucleotide change. This change occurred at position 272, resulting in a C to G substitution at residue 67 in the consensus B15 cDNA sequence. Hence, the Australian Aborigines as an ethnic group show very little primary sequence polymorphism within the class I loci, consistent with the results obtained from previous serological studies.

Amino Acid Sequence↗
PubMed1995

Flow cytometric analysis of primary and metastatic squamous cell carcinoma of the oral cavity and oropharynx.

A retrospective analysis of formalin-fixed, paraffin-embedded tissue from patients with histologically confirmed metastatic squamous cell carcinoma was performed using flow cytometry. Ninety-eight sets of specimens from previously untreated patients with an oral cavity or oropharyngeal tumor and a simultaneous cervical metastatic deposit were analyzed. Normal mucosa and cervical lymph nodes were processed identically and run as controls. All patients underwent surgical resection at Wilford Hall USAF Medical Center or The Eye and Ear Hospital of Pittsburgh between 1980 and 1986. The specimens from 94 patients were technically adequate for interpretation. Diploid histograms in both the primary and metastatic tumors were present in 49 (52%) of 94 patients. Aneuploid histograms in either the primary and metastatic tumors were noted in 45 (47%) of 94 patients. In this group of 45 patients, the primary tumor and cervical metastasis were both aneuploid in 21 (46%), and aneuploid histograms occurred with equal incidence in either the primary or metastasis in the remaining 24 cases. No statistically significant prediction of survival could be made from any correlation with the histograms of either the primary or metastasis. The potential technical problems and limitations of flow cytometry in the determination of DNA content of formalin-fixed, paraffin-embedded tissue and the selection of patients with advanced disease warrant caution in the interpretation of results.

Carcinoma, Squamous Cell↗
PubMed1995

The future of minimal access surgery.

It seems likely that the future of minimal access therapy will be driven in part by the forces which have shaped its early development. There will continue to be a movement of care from the hospital, where costs are relatively apparent, to the community, where they are hidden and difficult to determine. Hospital stays will be shorter and there will be fewer beds. Patients and their representatives will want more information about the procedures performed on them and their outcomes. Surgical operations will increasingly be performed by highly skilled experts with less and less service delivered by trainees. The duration and intensity of the work of theatre teams will tend to be reduced for health and safety reasons. New technologies, both predictable and unpredictable, will alter practice. These pressures and trends give us a hint of what the future might look like but the operation of chance means that any attempt at prediction contains a sizeable element of fantasy. What follows is a fantasy of a possible future.

Forecasting↗
PubMed1995

Early memories: an exploration of theoretically derived queries and their clinical utility.

The authors take Mayman's (1968) procedure for gathering early memories as their point of departure by developing three theoretically and clinically relevant queries based on object relations theory. Two empirical studies were conducted to assess the projective potential and concurrent validity of these queries, while case vignettes illuminate their construct validity and clinical utility. The results of both studies and the case vignettes lend support to Mayman's theoretical conception of early memories as a unique and powerful projective tool.

Adult↗
PubMed1994

Pharmacokinetics and distribution in tissue of FK-037, a new parenteral cephalosporin.

A single 1-g or 2-g intravenous dose of the cephalosporin FK-037 was given over 30 min in a cross-over-designed study, to each of six healthy male volunteers, and the concentrations of the drug were measured in plasma and cantharides-induced blister fluid over the subsequent 12 h. Urine was collected over 24 h. After a washout period of 6 weeks, during which the blisters healed, the study was repeated at the other dose level. Following the 1-g dose, the mean peak concentration in plasma was 83.8 micrograms/ml, and after the 2-g dose it was 142.6 micrograms/ml. The mean peak concentrations in the inflammatory fluid were 37.9 and 63.3 micrograms/ml, respectively. The mean elimination half-lives from plasma and inflammatory fluid were 2.0 and 2.5 h, respectively, after 1 g and 2.0 h and 3.7 h, respectively, after 2 g. The amounts of penetration into inflammatory fluid (as assessed by ratios of areas under the concentration-time curves) were 109.9 and 110.5% following doses of 1 and 2 g, respectively. The proportions of the administered drug recovered in the urine by 24 h were 87.6 and 85.7%, respectively. Our results indicate that FK-037 should prove to be efficacious in the treatment of a wide range of systemic infections.

Adult↗
PubMed1994

Concurrent and Discriminant Validity Between the Hand Test Pathology Score and the MMPI-2

Using an outpatient sample (N = 43), this study assessed the concurrent validity of the Hand Test pathology summary score (PATH) with an objective measure of psychopathology, the MMPI-2 clinical scales. The PATH score did exhibit several significant relations to the MMPI-2 clinical scales. In addition, there is support for divergent validity as none of the MMPI-2 validity scales (L, F, and K) were significantly related with PATH.

Journal Article↗