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Biomedical subjects

D M Quinlan

Publications and source records attributed to D M Quinlan.

At least 19 recordsLinked to original sources
PubMed1992

A quantitative histological analysis of the dilated ureter of childhood.

A quantitative histological study of the dilated ureter of childhood was performed on 26 ureters. The specimens were from 15 male and 11 female patients 10 days to 12 years old (mean age 2.0 years). A color image analysis system was used to examine and compare collagen and smooth muscle components of the muscularis layers to normal control ureters of similar age. In comparing primary obstructed (12) to primary refluxing (14) megaureters and control ureters (6), there was a statistically different collagen-to-smooth muscle ratio (p < 0.001) between the primary obstructed and primary refluxing megaureter groups. For patients with primary refluxing megaureter there was a 2-fold increase in the tissue matrix ratio of collagen-to-smooth muscle when compared to patients with primary obstructed megaureter. In the primary obstructed megaureters the amount of collagen and smooth muscle was not statistically different from controls (p > 0.01). The increased tissue matrix ratio of 2.0 +/- 0.35 (collagen-to-smooth muscle) in the refluxing megaureter group compared to 0.78 +/- 0.22 in the obstructed megaureter group and 0.52 +/- 0.12 in controls was found to be due not only to a marked increase in collagen but also a significant decrease in the smooth muscle component of the tissue. Primary obstructed and normal control ureters had similar quantitative amounts of smooth muscle with 60 +/- 5% and 61 +/- 6%, respectively, while refluxing megaureters had only 40 +/- 5% smooth muscle. The percentage collagen was 36 +/- 5 in the obstructed megaureter group and 30 +/- 5 in controls, with refluxing megaureters having 58 +/- 5% collagen on analysis. Our findings emphasize the significant differences in the structural components (collagen and smooth muscle) of the dilated ureter of childhood, and provide us with further insight into the pathological nature of these dilated ureters and their surgical repair.

Child↗
PubMed1992

Application of argon beam coagulation in urological surgery.

Argon beam coagulation is a new form of electrocautery that has proved useful to control diffuse bleeding in other surgical specialties. We report its application to urology. Three cases are presented in which argon beam coagulation provided excellent hemostasis in situations that are often difficult to control, such as partial nephrectomy for penetrating trauma, hemorrhagic cystitis refractory to other forms of treatment and after anterior exenteration for bladder cancer. The basis, technique and advantages of argon beam coagulation are discussed, as well as other instances in urological surgery in which it may have application. Argon beam coagulation is an alternative to conventional methods of hemostasis whenever there is a diffusely bleeding operative site.

Adult↗
PubMed1992

Late massive hematuria as a complication of conservative management of blunt renal trauma in children.

The conservative management of blunt renal trauma in children is well accepted and well documented in the medical literature. The majority of children who sustain blunt renal trauma do well with such an approach. However, the complications of conservative management are also well documented. We present 2 patients with blunt renal trauma who were treated conservatively and suffered massive life threatening hemorrhage several weeks after the initial injury. Angiography was not performed until late and in both cases it identified the cause of bleeding. Percutaneous transcatheter embolization provided immediate definitive treatment in both patients.

Adolescent↗
PubMed1992

Perceived-competence deficit in anorexia nervosa.

Anorexia nervosa patients are portrayed as competent and accomplished and yet they feel ineffective and diffident. The assessment of this aspect of their self-esteem presents methodological problems. The Interests and Abilities Questionnaire was designed to measure interests and perceived abilities in typical adolescent activities. The disparity between interests and perceived abilities--perceived-competence deficit (PCD)--was hypothesized to be characteristic of anorexics. Three groups of females, aged 14 to 24, were studied: 13 anorexic inpatients, 13 psychiatric inpatients without an eating disorder but of similar severity of illness, and 48 nonclinical subjects. Similar to the nonclinical controls, anorexics were interested in a variety of activities; similar to control patients, anorexics rated their abilities lower than nonclinical subjects. In PCD, anorexics scored significantly higher than both control groups; this difference was not related to level of depression.

Achievement↗
PubMed1992

Psychometric properties of the Depressive Experiences Questionnaire for adolescents.

Items of the Depressive Experiences Questionnaire (DEQ) were rephrased and simplified to make them appropriate for younger subjects. This adolescent form of the DEQ (DEQ-A) was administered to high school students; a factor analysis revealed three factors that were highly congruent in female and male students and with the three factors of the original DEQ. Internal consistency as well as short- and long-term reliability for each of the 3 DEQ-A factors were at acceptable levels. Each factor correlated highly with its counterpart factor in the original DEQ, especially the Dependency and Self-Criticism factors. Correlations of the DEQ-A factors with other measures of depression essentially replicate relationships found between these measures of depression and the original DEQ for adults. The reliability, internal consistency, and validity of the DEQ-A indicate that it could be useful in studying depressive experiences in younger adolescents.

Adolescent↗
PubMed1991

Nerve growth factor, nerve grafts and amniotic membrane grafts restore erectile function in rats.

In an effort to reduce complications arising from radical pelvic surgery, an improved technique for restoration of autonomic innervation has been developed. The ability of nerve growth factor (NGF) alone or in combination with interposition nerve grafts, as well as the use of fetal amniotic membrane as an alternative growth matrix to enhance regeneration of ablated cavernous nerves were investigated in rats. Rats with ablated cavernous nerve displayed little or no penile erection, either in response to direct electrical stimulation or to an estrous female rat. A step wise improvement in electrically induced erections was observed by NGF alone, nerve graft alone, and the combination of NGF and nerve graft. Restoration of sexual behavior followed the same pattern obtained with electrical stimulation. Furthermore, the use of neonatal amniotic membrane as an alternative nerve growth matrix enhanced both electrically stimulated erection and mating behavior. These results suggest that the use of NGF and appropriate grafting materials can facilitate autonomic nerve regrowth and potentially reduce the morbidity of surgically induced nerve injuries.

Amnion↗
PubMed1991

Cavernous nerve grafts restore erectile function in denervated rats.

Although potency can be preserved in most men following radical prostatectomy, in some patients one or both cavernous nerves must be sacrificed in order to excise all tumor. For these patients we have considered nerve reconstruction at the time of surgery using an interposition nerve graft. This possibility has been tested in a rat model. Animals were divided into three groups. In the sham control group, a pelvic exploration was conducted without division of the cavernous nerves. In the nerve ablation group, a five mm. segment of cavernous nerve was excised. In the graft group, five mm. of cavernous nerve was excised bilaterally and replaced with an interposition graft of genito-femoral nerve. At one month intervals postoperatively animals from each group underwent mating tests to determine potency; the ratio of vaginal intromission to unsuccessful mounts (I/M ratio) was determined. Following the mating tests the animals were re-explored and attempts were made to stimulate erections electrically via the pelvic nerve. Results at two months show the I/M ratio of the rats with grafts (0.05) and the nerve ablations (0.14) are low compared with the sham operated animals (1.0). By month four the graft group (0.89) has approached the sham group (0.91) while the ablation group (0.18) remains unchanged (p less than .05). Electrical stimulation at month two produced no erections in the nerve ablated or the grafted rats and 100% erections in the sham-operated animals. At month four, 50% of the rats with grafts, 10% of the nerve ablated animals, and 100% of the intact animals produced erections upon electrical stimulation (p less than .05). These results suggest that cavernous nerve grafting in rats can be successful in restoring potency after surgical injury. Application of these techniques to man may be indicated.

Animals↗
PubMed1991

Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles.

The influence of preservation or excision of the neurovascular bundles on return of sexual function is analyzed. Between 1982 and 1988, 600 men 34 to 72 years old underwent radical retropubic prostatectomy for prostate cancer. Of the 503 patients who were potent preoperatively and followed for a minimum of 18 months 342 (68%) are potent postoperatively. Three factors were identified that correlated with the return of sexual function: 1) age, 2) clinical and pathological stage, and 3) surgical technique (preservation or excision of the neurovascular bundle). In men less than 50 years old potency was similar in patients who had both neurovascular bundles preserved (90%) and patients who had 1 neurovascular bundle widely excised (91%). With advancing age of more than 50 years sexual function was better in patients in whom both neurovascular bundles were preserved than in patients in whom 1 neurovascular bundle was excised (p less than 0.05). When the relative risk of postoperative impotence was adjusted for age the risk of postoperative impotence was 2-fold greater if there was capsular penetration or seminal vesicle invasion, or if 1 neurovascular bundle was excised (p less than 0.05). These data indicate that the return of sexual function postoperatively in men more than 50 years old is quantitatively related to preservation of autonomic innervation. In these men when it is necessary to excise the neurovascular bundle on 1 side, consideration in the future should be given to approaches that may restore autonomic function through nerve regeneration, for example partial excision of the bundle or cavernous nerve grafts.

Age Factors↗
PubMed1991

Use of the Benchekroun hydraulic valve as a catheterizable continence mechanism.

Problems with continence and access for catheterization with previous continent stoma techniques have led us to search for an alternate method. We report our initial experience with the Benchekroun hydraulic valve in 9 patients. Five patients underwent creation of an ileocolic bladder: for myelodysplasia in 1, after cystectomy for bladder cancer in 2 and for exstrophy in 2. Two patients underwent conversion from an uncatheterizable Indiana pouch because of exstrophy (1) and interstitial cystitis (1). Two patients underwent small bowel augmentation of a small, poorly compliant bladder with an abdominal Benchekroun stoma: 1 had exstrophy and 1 had myelodysplasia. Patient age ranged from 7 to 63 years. Two patients had de novo creation of an ileocolic bladder, whereas 7 had bladder or previous bowel conduits incorporated in the continent reservoirs. At up to 20 months of followup all patients had diurnal and nocturnal continence, and none had experienced serious long-term complications. Problems were encountered in 5 patients. One patient had a valve fistula that was surgically revised. One patient experienced transient difficulty with catheterization when the reservoir was overdistended and a false passage developed. Three patients had stomal stenosis and require periodic dilation. We believe the Benchekroun hydraulic valve to be a useful adjunct in the construction of a continent urinary reservoir. It is easy to construct, provides reliable continence and is easy to catheterize. Furthermore, it may be applied to standard ileocolic bladders either de novo or as a salvage procedure for failed efferent limbs.

Adolescent↗
PubMed1991

The Benchekroun ileal valve.

In our hands, the Benchekroun hydraulic ileal valve has proved to be a very reliable continence mechanism. The patient is provided with a cosmetically acceptable stoma that creates diurnal and nocturnal continence and ease of catheterization. Stomal stenosis has occurred in several patients in our series and has been managed successfully with dilatation or minor surgical revision. The efferent limbs are readily accessed by endoscopic equipment, permitting treatment of stones and surveillance for malignancy. The need for surgical revision is moderate, as only 5 of 15 patients have required such intervention, compared with the revision rate of 58% with plicated ileal efferent limbs in our hands. The in situ Benchekroun technique represents an economy of time and energy, especially as a salvage procedure for failed plicated ileal limbs. Currently, the Benchekroun hydraulic ileal valve is our continence mechanism of choice.

Adolescent↗
PubMed1979

Plasma cortisol levels in depression and other psychiatric disorders: a study of newly admitted psychiatric patients.

Morning and evening plasma cortisol levels were checked in 123 consecutively newly admitted psychiatric patients with a variety of diagnoses. Questions asked were whether there were differences among groups with more severe illness, type of depression, alcohol abuse, or particular symptoms. Morning cortisol elevation was found in 33% of patients and was not associated with any particular diagnostic category. Evening cortisol elevation occurred in 85% of the subjects. It was significantly higher in those with unipolar depression and organic brain syndrome, also in those patients who abused alcohol regardless of diagnosis. Evening cortisol elevation was twice as common in patients with diagnoses of more severe psychiatric illness than in those with minor disorders. Further study is suggested to see if these patterns of cortisol elevation are sustained beyond the stress-of-admission period.

Adjustment Disorders↗
PubMed1979

Clinical responses of A and B practising psychotherapists to schizoid and neurotic patient prototypes.

Eighty-three male psychotherapists varying on A-B type and experience orally responded to tape-recordings of simulated schizoid and neurotic patients in the privacy of their own offices. Five dimensions of therapist response were studied: accurate empathy, positive social-emotional reactions, negative social-emotional reactions, length of response and proportion of declarative statements. Although the simple A-B interaction effect was not found, significant second-order interactions were found for both accurate empathy and positive reactions which indicated that the predicted interaction effect tends to be upheld for inexperienced therapists but attenuated or reversed for experienced therapists. A significantly reversed interaction for experienced therapists' response length was also found. Examination of the results from this study and previous studies suggested a revision of the A-B interaction hypothesis: for inexperienced therapists, As will be more effective with schizoids/schizophrenics than Bs, whereas Bs will surpass As with neurotics; for experienced therapists, however, this interaction will be attenuated or reversed. Speculations about underlying processes in A-B interaction phenomena were offered.

Communication↗
PubMed1978

Overinclusion and transactional thinking on the Object Sorting Test of schizophrenic and nonschizophrenic patients.

Two aspects of "disordered thinking", overinclusion and transactional thinking were studied on the Object Sorting Test responses of 20 young schizophrenic patients and 20 comparable nonschizophrenic patients. Patients' parents were also studied for comparison. In addition, idiosyncratic responses from WAIS Comprehension items were assessed for comparison of another measure on another test. Transactional thinking and idiosyncratic responses were greater in schizophrenic patients. Conceptual overinclusion and bizarre responses also tended to be more frequent in schizophrenics, but behavioral overinclusion showed no differences. Conceptual overinclusion was consistently correlated with transactional thinking and idiosyncratic responses, while behavioral overinclusion showed an inconsistent pattern. The differences were attributed to the differences in the specificity of measures of disordered thinking.

Acute Disease↗