Biomedical subjects
Publications and source records attributed to D Fowler.
The presentation and management of a patient with a symptomatic hepatic artery aneurysm is detailed. The aneurysm occurred secondary to fibromuscular hyperplasia of the hepatic artery and was associated with a limited area of dissection. This patient represents the second reported case of this type of aneurysm of the hepatic artery,
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Data was compiled from 126 morphine-involved cases investigated by the Office of the Chief Medical Examiner, State of Maryland, USA. An investigation was conducted into whether comparison of morphine concentrations from a central and peripheral site could be used to determine whether a morphine death was acute or delayed. Fifty cases were identified as 'acute' because the urine free morphine concentration by radioimmunoassay (RIA) was less than 25 ng/mL; 76 cases were classified as 'random' because they had a urine morphine concentration greater than 25 ng/mL by RIA. The average heart blood to peripheral blood morphine concentration ratio in the acute deaths was 1.40. The average heart blood to peripheral blood morphine concentration ratio in the random deaths was 1.18. Because there was considerable overlap between the two groups of data, the authors conclude that it was not possible to predict 'acute' opiate intoxication deaths versus 'delayed' deaths when the only information available is heart and peripheral blood free morphine concentrations.
The ability to form intent to commit a particular act is often a significant issue in criminal litigation. Often, a complicating factor in the resolution of this issue is the presence of ethanol and drugs in the individual whose motives are to be ascertained. To determine whether an intoxicating blood ethanol concentration (BAC) in the absence of other information is sufficient to establish intent, we reviewed cases investigated by the Office of the Chief Medical Examiner, State of Maryland over a two-year period. Specifically, we identified cases of suicide with a suicide note, the presence of ethanol and the absence of other psychoactive drugs. The BACs ranged from 0.01 to 0.37 g/dL. The average BAC was 0.14 g/dL and the median BAC was 0.13 g/dL. Twenty-five of the 37 cases had a BAC greater than 0.08 g/dL. We conclude that a BAC alone is not sufficient to determine the capability of an individual to form intent to commit a particular act.
OBJECTIVE: To describe a preliminary evaluation of a group CBT approach which has been fully integrated into the routine care for acute psychotic inpatients, admitted to a typically overburdened inner-city psychiatric general hospital unit. DESIGN: The design is pre-post. A comparison of some indicators between the years preceding (1997) and following the beginning of the group therapy (1998) has been carried out. SETTING: Psychiatric ward of S. Filippo Neri in Rome, in 1998. METHOD: The study compared the rate of rehospitalization, the rate of compulsory admission, the use of physical restraints, the episodes of violent behaviour and the escape from the ward. During the last three months of 1998 patients' satisfaction was also measured. RESULTS: Overall 385 patients attended the group therapy, 79% of all inpatients in the period, with an average number of 4 sessions per patient. 59% of participants in the group in 1998 had a diagnosis of schizophrenia or paranoid disorder. The total compulsory admissions declined by 1/3 (p < 0.001), the "revolving door" patients declined by 1/3 (p < 0.05), compulsory admissions in "revolving door" patients declined by 3/4 (p < 0.005), violent episodes by almost half (p < 0.001), physical restraints and patients escape from the ward almost disappeared. Patients' opinion about the participation to the group was excellent. CONCLUSIONS: It is likely, but not sure, that the improvements were directly attributable to the introduction of the group treatment. Moreover, the group was clearly found to be useful by the majority of the participants. Some asked for further help of this type on discharge. These preliminary results are promising and make us confident they will act as stimuli for other colleagues to implement and evaluate this approach in other settings.
Pregnancies with fetal trisomy 18 suffer from severe intrauterine growth restriction from the first trimester. This cross-sectional study of chorionic villi obtained from ongoing singleton pregnancies at 10-14 weeks of gestation, semiquantitatively examines chorionic villus stromal and trophoblastic cell proliferation rates in ongoing chromosomally normal and trisomy 18 pregnancies. Chorionic villi were stained using a standard immunohistochemistry protocol with a monoclonal antibody to the Ki-67 antigen and the number of Ki-67 positive trophoblastic and stromal cells per villous cross-section was compared between groups. The number of Ki-67 positive trophoblastic and stromal cells was significantly higher in the group (n=10) with trisomy 18 compared to the chromosomally normal group (n=25;t=2.1, P=0.03 and t=5.3, P<0.001 respectively). Abnormalities in control of cell turnover during development may be important in the pathogenesis of the clinical features of trisomic pregnancies.
This study retrospectively examines the spectrum of sacrococcygeal tumors reported in a tertiary paediatric pathology department during a 15-year period. There were 85 sacrococcygeal tumors identified in total, including 79 (93%) sacrococcygeal germ cell tumors, of which 62 (78%) were benign, whereas 17 (22%) contained malignant yolk sac tumor elements. The median age at examination in cases with malignant elements present was significantly greater than in those with benign sacrococcygeal teratoma only (median 2 years, range birth--3 years versus median 1 week, range birth--10 years, respectively; p < .01). Of the 85 cases of total sacrococcygeal lesions 6 (7%) represented pathologies other than sacrococcygeal teratoma, including one case each of neuroblastoma, ganglioneuroma, myxopapillary ependymoma, primitive neuroectodermal tumor, lipomatous tumor, and unclassifiable inflammatory tumor. Of these 6 cases 3 were malignant (50%) compared with 17 of the 79 cases of sacrococcygeal germ cell tumors (22%; Z =1.59, p = .08). The median age in the group of non-germ-cell sacrococcygeal masses was 3 years (range 5 months to 13 years).
The anatomy of the canine distal ulna was evaluated to determine its potential as a free vascularized bone graft. Twelve cadavers were studied by gross dissection and nonselective and selective angiography. The caudal interosseous artery consistently served as a source artery to the distal ulnar periosteal vasculature in all dogs. The diameters of the caudal interosseous artery and venae comitantes were large enough to permit microvascular anastomoses. Nonselective perfusions of the brachial artery demonstrated large barium-filled vessels within soft tissues surrounding the ulna with anastomotic connections between medullary and periosteal vasculature. Grafts selectively perfused through the caudal interosseous artery (periosteal circulation only) had barium-filled vessels within the muscular cuff, periosteum, cortical bone, and medullary canal of the ulna. A surgical approach to remove the distal ulna along with an intact musculoperiosteal cuff and its associated vasculature is described.
An autogenous free vascular bone graft of the canine distal ulna was evaluated. The vascularity of the graft was based on a musculoperiosteal sheath supplied solely by the caudal interosseous artery and vein. Four autogenous heterotopic (ulna to tibia) vascular transfers were performed. Two avascular transfers were performed to provide baseline criteria from which the success of vascularized transfers could be assessed. Clinical lameness evaluation, serial radiographs, bone scintigraphy, and sequential fluorochrome bone labeling were performed after surgery in both vascular and avascular transfers. All dogs were free of lameness in the donor limb by the 26th postoperative day. Serial radiographs revealed rapid graft incorporation and hypertrophy in all vascularized grafts and severe bone resorption in nonvascularized grafts. Histology, microangiography, and evaluation of fluorochrome bone labels were performed 90 days after surgery to determine graft viability, incorporation and temporal remodeling patterns. Microangiography and fluorochrome assessment complemented the histological findings. Based on these findings the distal ulnar bone graft was determined to be both viable and structurally adequate for selected cases of long bone reconstruction.
Twenty-seven dogs with naturally occurring mast cell tumors were treated with weekly i.v. injections of vincristine (0.75 mg/m2) for 4 treatments. Two dogs (7%) had a partial response. Nine dogs (32%) had treatment stopped prematurely because of toxicity or a perceived deterioration in their quality of life. We conclude that vincristine is ineffective as a sole treatment for measurable mast cell tumors in dogs and produces an undesirable number of adverse reactions.
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PURPOSE: To assess the potential impact of early post birth discharge in Canada. METHODS: Neonatal readmission was examined, based on hospital discharge data from the Canadian Institute for Health Information, with a total of 2,144,205 infants from fiscal year 1989/90 to fiscal year 1996/97. RESULTS: Neonatal readmission rates increased from 27.3 per 1,000 in 1989/90 to 38.0 per 1,000 in 1996/97, while mean length of hospital stay at birth decreased from 4.2 days to 2.7 days during the same period. The increase in readmission rate was more evident for dehydration and jaundice. The provinces and territories with decreased length of hospital stay at birth usually had increased neonatal readmission rate and earlier age at readmission. Between 1994/95 and 1996/97, compared with Newfoundland, the risks for neonatal readmission for dehydration were 5.7 and 5.5, and for jaundice were 4.5 and 2.7, respectively, for Alberta and Ontario. CONCLUSION: Neonatal readmission rates for several conditions have increased substantially, associated with early post birth discharge policies adopted in Canada.
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Needle-stick injuries are one of the most severe hazards faced by nurses today. The most physically and emotionally devastating type of injury is from a needle contaminated with human immunodeficiency virus (HIV), but far more likely to occur is infection with other blood-borne pathogens, especially hepatitis B. The daily threat of needle-stick injuries adds yet another dimension of concern to the stresses inherent in working in a health care facility. Health care workers at greatest risk are those who manipulate needles and draw blood samples on a regular basis. With this concern in mind, a study was launched to evaluate a needle-free I.V. access system with respect to the following research objectives: 1) to assess the prevention/reduction of needle-stick risks and injuries; 2) to identify associated reduction in expenses; 3) to implement product and ease of use; and 4) to assess nursing satisfaction levels. This article describes the methodology used and the results of the study.
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PURPOSE: To analyze spatio-temporal variations of neonatal length of in-hospital stay in Canada. METHOD: The length of in-hospital stay of 1,469,761 newborns in Canadian hospitals from April 1, 1984 to March 31, 1995 recorded by the Canadian Institute for Health Information was analyzed. RESULTS: Neonatal length of in-hospital stay decreased from an average of 5.0 days in 1984 to 2.9 days in 1994. In 1994, the average neonatal length of in-hospital stay in Alberta was 2.5 days, which was 0.2 to 1.5 days shorter than other provinces. The spatio-temporal variations in neonatal length of in-hospital stay could not be explained by corresponding variations in birthweight and other neonatal disorders. CONCLUSIONS: Neonatal length of in-hospital stay has been substantially reduced in Canada in recent years but there remain important interprovincial variations. These variations are unlikely to be the results of changes or differences in patient-specific factors; policy played an important role.