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Biomedical subjects

G Bond

Publications and source records attributed to G Bond.

At least 37 records · Page 2Linked to original sources
PubMed1997

Laparoscopic cholecystectomy: the missed diagnosis.

BACKGROUND: All 534 laparoscopic cholecystectomies performed by five surgeons at a single institution over a 3-year period were reviewed as part of a quality assurance process. The aim of the review, which has previously been published in this journal, was to identify and quantify complications of the procedure. Five cases in this series were recognized where major intra-abdominal pathology not identified at the time of laparoscopic cholecystectomy required laparotomy shortly thereafter. These five cases are reported here because there has been little discussion in the literature of this problem associated with laparoscopic cholecystectomy. METHODS: The records of all 534 patients having a laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed and entered into a computer database (Microsoft Access). This data collection and recording have subsequently become an ongoing process of quality assurance. RESULTS: Five of 534 patients treated by laparoscopic cholecystectomy failed to have resolution of their symptoms postoperatively. A laparotomy was subsequently required within 3-12 months which demonstrated causative pathology present, but not detected at, the time of laparoscopic cholecystectomy. Where possible, treatment of these laparotomy findings resolved the initial presenting symptoms of colicky epigastric pain. CONCLUSIONS: The rate of 'missed diagnosis' is found to be < 1%. Laparoscopic cholecystectomy is a therapeutic, rather than diagnostic, procedure, and pre-operative discussion should include the possibility of further procedures being required subsequently, particularly when symptoms and signs are atypical.

Adult↗
PubMed1997

Managing for quality in a nursing home: a resident-directed approach.

As the population ages, the need for nursing care services will increase. Consumer focus on quality of life as well as reduction of expenditures poses a major challenge to the traditional nursing home, which often reinforces dependent resident behavior. The authors propose various strategies for improving life satisfaction and functional status of residents as well as efficiency and productivity of staff.

Long-Term Care↗
PubMed1996

Laparoscopic cholecystectomy: the experience of community hospital.

BACKGROUND: The practice of laparoscopic cholecystectomy in a community hospital is presented. The morbidity of the procedure is analysed and recommendations for improvement are made. Laparoscopic cholecystectomy was introduced into this 200 bed community hospital in October 1990. All five general surgeons accredited to the hospital agreed to participate in a quality assurance programme to determine the incidence of complications and to make recommendations for improvement. METHODS: The records of all 534 patients having laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed, and all complications recorded. RESULTS: Of the 534 cases reviewed in the study 470 were considered uncomplicated and 64 patients experienced a total of 85 postoperative complications. The death of one patient was caused by a pulmonary embolus and another patient experienced a myocardial infarction. Twenty patients has postoperative atelectasis or pneumonia and urinary infection or retention occurred in seven. Complications of laparoscopic cholecystectomy requiring a conversion to open cholecystectomy occurred in eight patients, biliary complications occurred in 18 and 11 required re-operation. CONCLUSIONS: Three areas of concern were identified. They were the incidence of major biliary injury (0.37% of all cases) and its management, the role of cholangiography, and the incidence and prophylaxis of deep venous thrombosis and pulmonary embolism. Recommendations for improvement in these areas were made.

Australia↗
PubMed1993

Carotid artery intimal-medial wall thickening and plasma homocyst(e)ine in asymptomatic adults. The Atherosclerosis Risk in Communities Study.

BACKGROUND: Plasma levels of homocyst(e)ine are elevated in certain patients with occlusive arterial diseases. We extended these findings to asymptomatic adults. METHODS AND RESULTS: We determined plasma homocyst(e)ine levels in 287 pairs of asymptomatic adults. Cases and controls were defined on the basis of intimal-medial thickness of the carotid wall as measured by B-mode ultrasound. Study subjects had no history of atherosclerotic disease and were selected from a probability sample of 15,800 men and women between 45 and 64 years old. Subjects with thickened intimal-medial carotid walls (cases) had higher plasma homocyst(e)ine levels than controls (p < 0.001). The odds ratio for having a thickened carotid artery wall was 3.15 (p < 0.001) for subjects in the top quintile of plasma homocyst(e)ine levels (> 10.5 mumol/L) compared with those in the bottom quintile (< 5.88 mumol/L). CONCLUSIONS: The present study as well as observations on the common occurrence of elevated plasma homocyst(e)ine levels in patients with occlusive arterial diseases suggest that clinical trials should be conducted to determine whether normalization of hyperhomocyst(e)inemia may prevent progression of atherosclerosis.

Arteriosclerosis↗
PubMed1992

Irradiation-induced atherosclerosis: a factor in therapeutic planning.

Early primary head and neck cancers (stages I and II) and occult metastatic neck disease have caused debate regarding the choice between surgery and irradiation. The arguments for each are reviewed with a new consideration: the acceleration and/or induction of carotid atherosclerosis in irradiated patients. We present clinical case reports (n = 9), a retrospective clinical evaluation for the occurrence of carotid atherosclerosis in irradiated head and neck cancer patients (n = 57) and a comparison study of the extent and distribution of atherosclerosis in irradiated (n = 29) and nonirradiated head and neck cancer patients controlled for age, blood pressure, and tobacco use. The results show that carotid atherosclerosis is found in a wider anatomic distribution and to a greater extent in irradiated than in nonirradiated patients. We conclude that carotid atherosclerosis is induced and/or accelerated by neck irradiation. The implications as they relate to choice of treatment, to pretreatment evaluations, and to long-term follow-up are discussed.

Aged↗
PubMed1991

The Psychosocial Levels System. A new rating scale to identify and assess emotional difficulties during bone marrow transplantation.

The "Psychosocial Levels System" assesses patients on three gradations of intensity: Level 1 (mild/minimal); Level 2 (moderate); and Level 3 (severe), taking into account past psychiatric history, quality of family and social support, prior coping history, coping with disease and treatment, quality of affect, proneness to anticipatory problems, and mental status. Based on initial psychiatric interviews, 42 BMT patients were rated by the authors. Results showed strong and significant concordance amongst raters. Retrospective global "level" ratings assigned by each patient's liaison therapist were highly concordant with the record-review generated ratings by the authors, emphasizing the significant convergent validity of the system.

Adaptation, Psychological↗
PubMed1990

Asymmetrical nature of the muscular anatomy of the infantile pylorus: a possible consideration in pyloromyotomy.

Post-mortem studies of the normal infantile pylorus have demonstrated an asymmetrical structure with the mucosa protruding under the circular muscle at the lesser curve but not on the anterior surface. In addition the circular muscle was often discontinuous at the pyloroduodenal junction with only longitudinal fibres or even fibrous tissue separating the mucosa from the serosa. In a further specimen in which a pyloromyotomy had been performed 10 weeks previously, this asymmetry was more pronounced. This anatomy suggests that in pyloric stenosis it may be safer to site the caudal part of the pyloromyotomy incision on the anterior surface, rather than on the anterosuperior surface as most authors recommend. Perforation of the mucosa is predicted to be less likely.

Humans↗
PubMed1990

A comparison of antihypertensive drug effects on the progression of extracranial carotid atherosclerosis. The Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS).

Hypertension is a major risk factor for coronary heart disease (CHD) and is the primary risk factor for stroke. Drug trials lowering blood pressure by pharmacological means have demonstrated impressive reduction in both fatal and nonfatal stroke (33 to 50%) that are virtually identical to the predicted stroke reduction, considering the observed diastolic blood pressure change (5 to 6mm Hg). On the other hand, reduction of CHD risk has been less impressive in these same trials. Although statistically significant, the reduction in CHD risk is roughly one-half (14%) of that predicted (25%) when results from these drug trials are analysed in aggregate. Most trials have used moderate to high dosages of thiazide diuretics or beta-blockers as therapies. Several factors may account for the disappointing results in CHD risk reduction. These drugs may induce metabolic disturbances in lipids, increased glucose tolerance, insulin resistance, or cause inadequate regression of left ventricular hypertrophy, thus attenuating the predicted reduction in CHD risk associated with pharmacological blood pressure lowering. Isradipine is a new dihydropyridine calcium antagonist that is highly effective in lowering blood pressure. Isradipine also has antiatherogenic properties in animal models of atherosclerosis. The effect of isradipine on atherosclerosis in humans is unknown. The Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS) is a 3-year double-blind, randomised trial in over 800 men and women with hypertension, aged 40 years or older. The primary aim of MIDAS is to compare the efficacy of isradipine 2.5 to 5.0mg twice daily vs hydrochlorothiazide 12.5 to 25mg twice daily in retarding the progression of extracranial carotid atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Copper metabolism in growing sheep given kale (Brassica oleracea) and ryegrass (Lolium perenne)-clover (Trifolium repens) fresh forage diets.

Kale (Brassica oleracea) and ryegrass (Lolium perenne)-clover (Trifolium repens) pasture grown under similar soil conditions were grazed in the vegetative state by growing lambs of 23.6 kg initial live weight for 24 weeks. Forty-eight lambs grazed each forage. The kale and pasture contained respectively 4 and 14 mg copper/kg dry matter (DM), 7.2 and 3.1 g total sulphur/kg DM and 0.4 and 1.1 mg molybdenum/kg DM. Subcutaneous injections of Cu (12 mg) were given to half the animals grazing each forage during weeks 1, 6, 12 and 18. All ninety-six animals were slaughtered at the end of the experiment and an additional group of twelve animals was slaughtered when the experiment commenced. Liver Cu was determined on all slaughtered animals and heart muscle cytochrome oxidase (EC 1.9.3.1) activity on those slaughtered at week 24. Blood samples removed at 6-week intervals were assayed for activity of superoxide dismutase (EC 1.15.1.1; SOD) and serum Cu concentration determined. Wool growth, live-weight gain and cytochrome oxidase activity of biopsied hind-limb muscle were also measured at 6-week intervals. Control animals grazing pasture showed an accumulation of total liver Cu during the experiment. Animals grazing this diet and given Cu injections showed an additional accumulation of liver Cu equivalent to the supplementary Cu administered, but Cu supplementation did not affect the activity of any of the Cu-containing enzymes measured and did not affect live-weight gain or wool growth. Control animals grazing kale showed a depletion of total liver Cu and reductions in serum Cu concentrations during weeks 18 and 24.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗
PubMed1981

Influence of arsenic exposure and smoking on lung cancer among smelter workers: a pilot study.

A pilot study of 300 smelter workers from the cohort reported by Lee and Fraumeni [1969] has been studied: 150 men from their heavy exposure group and 150 men from the rest of the cohort randomly selected. Usable smoking habits were obtained from 86% of the sample. Estimates of the total lifetime work exposure were made from available measurements. A very high risk of lung cancer (SMR 1429) was observed among the most heavily exposed workers. Excess risks, though still present, were much less in those with lower exposures. There was a lower proportion of nonsmokers among the heavily exposed arsenic workers than among the other workers. This suggests that there may be some interaction between smoking and arsenic exposure. Moreover, comparison of smoking habits reported by smelter workers suggested that, as a group, they smoked more heavily than average for the United States population. A small study of proxy smoking histories suggested that these were valid and unbiased. The work continues on an enlarged sample.

Arsenic↗
PubMed1979

A correlation between a spectrophotometric quantitation of rabbit spermatozoan motility and velocity.

Rabbit sperm motility was measured spectrophotometrically and a sperm motility index (SMI) was obtained. A comparative analysis between the SMI values and the velocity of motile sperm (obtained by time lapse photography of sperm tracks) was performed. The SMI specifically was compared to the mean velocity of the first 300 sperm cells observed and to the mean velocity of just the first 300 progressively motile sperm cells. In both comparisons, the SMI was highly correlated to the sperm track length (sperm velocity). In addition, a modification of the spectrophotometric procedure is described which allows measurements of the SMI to be made on semen extended into egg-yolk glycerine cryopreservation agents.

Animals↗
PubMed1978

Alcoholics in interactional group therapy: an outcome study.

Three interactional therapy groups of alcoholic patients (N = 20) were formed, and treatment outcome after eight months and again after 12 months of therapy was compared with the outcome of 17 neurotic patients in comparable therapy. Outcome assessment was obtained from three sources: patient, therapist, and independent judge, using both nomothetic and ideographic measures. The results indicated that although more alcoholic than neurotic patients terminated therapy within the first six sessions, a higher percentage of alcoholic patients remained in therapy for 12 months. At the end of 12 months, both samples had improved along a wide variety of variables, and there were no significant differences between the alcoholic and neurotic population in degree of improvement.

Adult↗