Unsupervised surgical training: questionnaire study.
Explore the source record for details and available documents.
General Surgery↗
Biomedical subjects
J A Wilson
Publications and source records attributed to J A Wilson.
Direct and indirect measures of intentional forgetting in children and adults: evidence for retrieval inhibition and reinstatement.
In two experiments children in grades 3 and 4 and college students were given an item-by-item cued intentional forgetting task (i.e., instructions were to remember some words and to forget others), either a direct (cued recall word-stem completion) or an indirect (repetition priming word-stem completion) test of memory for the words, and a final free recall test for both remember- and forget-cued words. In both age groups, direct and indirect assessments produced better memory for remember- than for forget-cued words, even in Experiment 2 where the opportunity to selectively rehearse had been reduced by having subjects count aloud with each cue. These results suggest that retrieval inhibition plays a role in item-cued intentional forgetting, albeit one that is similar across ages. Furthermore, again in both age groups, performance on the word-stem completion tasks was enhanced in comparison with an immediate free-recall group, but only for material thought to be irrelevant (the forget-cued words). The facilitation on the priming tasks, however, did not carry over to a final free-recall task. These results on the effects of an intervening experience are discussed in terms of their implications for children's eyewitness testimony.
Adolescent↗
Bronchial carcinoid--twenty years' experience defines a selective surgical approach.
BACKGROUND: The purpose of this study was to look at the clinical behavior of bronchial carcinoids and clarify a surgical approach. METHODS: Eighty-four patients resected for bronchial carcinoids were retrospectively reviewed for clinicopathologic variables, surgical management, and outcome. Tumors were considered "typical" or "atypical" based on histologic features. "Conservative" surgery signified lung parenchyma-sparing procedures. Survival analysis was performed using standard statistical methods. RESULTS: Most patients presented with an abnormal routine chest x-ray. One patient had the carcinoid syndrome. Computed tomography scan reliably predicted lymph node status and bronchoscopic biopsy diagnosed carcinoids with 70% success. Fifteen "conservative" procedures were performed. Fifteen percent of patients had atypical carcinoids, 12% presented with lymph node metastases, and 6 patients had tumorlets associated with the primary tumor. Overall survival rates were 93% and 82% at 5 and 10 years, respectively. Significantly decreased disease-free survival was found with atypical histology (p < 0.0001) and the presence of tumorlets (p = 0.02); lymph node involvement strongly tended toward poorer outcome. CONCLUSIONS: Bronchial carcinoids have a definite malignant potential predicted by atypical histology, presence of tumorlets, and lymph node involvement. These features can be identified with routine bronchoscopic biopsy, computed tomography scanning, and intraoperative assessment including frozen section. In the select group of patients without negative features, strong consideration should be given to performing a conservative resection.
Adult↗
Cavernous lymphangioma in the adult parotid.
Cavernous lymphangioma is a benign congenital lesion that usually appears in childhood. It rarely presents in the adult but may be diagnosed at this late stage due to the slow growing nature of the tumour. It is rarely found in the salivary glands and when it does occur, the gland is usually incorporated by lymphangioma of surrounding tissue. We present and discuss the case of a cavernous lymphangioma in the parotid gland of an adult male.
Adult↗
Decreased levels of the cell-cycle inhibitor p27Kip1 protein: prognostic implications in primary breast cancer.
Breast cancer is the second leading cause of cancer death in North American women. There is considerable need for reliable prognostic markers to assist clinicians in making management decisions. Although a variety of factors have been tested, only tumor stage, grade, size, hormone receptor status, and S-phase fraction are used on a routine basis. The cell cycle is governed by a family of cyclin-dependent kinases (cdks), which are regulated by associated cyclins and by phosphorylation. p27Kip1, a cyclin-dependent kinase inhibitor, regulates progression from G1 into S phase by binding and inhibiting cyclin/cdks. p27Kip1 protein levels and/or activity are upregulated by growth inhibitory cytokines including transforming growth factor-beta (TGF-beta) and, thus, provide an important link between extracellular regulators and the cell cycle. Loss of p27Kip1, a negative cell-cycle regulator, may contribute to oncogenesis and tumor progression. However, p27Kip1 mutations in human tumors are extremely rare. We have demonstrated by immunohistochemistry that p27Kip1 protein levels are reduced in primary breast cancers and that this is associated with tumor progression in both in situ and invasive lesions. This was confirmed by western analysis, reflected in increased G1/S-phase cyclin-dependent kinase activities and shown to be regulated posttranscriptionally by in situ hybridization. Furthermore, on multivariate analysis, low p27Kip1 is a predictor of reduced disease-free survival. This simple and reliable immunohistochemical assay may become a routine part of breast cancer evaluation and may influence patient management.
Biomarkers, Tumor↗
Expression of MUC2 and MUC5AC by human nasal mucosa.
Explore the source record for details and available documents.
Animals↗
Patient-reported problems associated with dysphonia.
In the UK there has been little assessment of the efficacy of therapy for patients with dysphonia. Current objective assessment methods (e.g. acoustical analysis) do not correlate well with patient symptoms. Existing subjective measures are based on clinical impression. To date, no measure has been based on the patient's experience and the aim of this study was to explore the difficulties that patients encounter as a consequence of their illness or disability. One hundred and thirty-three dysphonic patients completed an open-ended questionnaire where they were asked to make a list of the problems they experienced due to their voice disorder. Responses were categorized using the WHO International Classification of Impairments, Disabilities and Handicaps. A total number of 467 problems were listed: 60% impairments, 26% disabilities and 14% were handicap related. The six major impairments related to altered voice and throat symptoms. Although the majority of disabilities resulted from lack of projection and clarity, the most frequently reported was singing. Reported handicaps encompassed psychological, emotional and employment-related difficulties and effects on family and friends. People with dysphonia experience social, lifestyle and employment difficulties as a consequence of their voice disorder. Responses to the open-ended questionnaire have considerable practical applications in targeting more comprehensive treatment strategies.
Adolescent↗
A preliminary investigation into resistance to synthetic pyrethroids by the sheep biting louse (Bovicola ovis) in New Zealand.
Increasing reports of failure of synthetic pyrethroids for the control of Bovicola ovis on sheep lead to a preliminary investigation into the insecticide resistance status of this pest during 1994. Eighteen strains of lice from North and South Island flocks experiencing failure of synthetic pyrethroid treatments to control lice were exposed to cypermethrin (high-cis) in a treated surface (contact) bioassay. Lice from a group of hermit sheep were chosen as a reference susceptible strain against which resistance of field strains was measured and resistance factors (RFs) calculated. Low to moderate resistance to cypermethrin (high-cis) was demonstrated, with RFs ranging from 1.0 to 12.4.
Journal Article↗
Magnetic resonance spectroscopy of isoflurane kinetics in humans. Part I: Elimination from the head.
We describe the first human experiments to demonstrate wash-out of isoflurane using fluorine magnetic resonance spectroscopy. Using a surface receive coil, we found two-compartment kinetics within the head with decay half-times of 9.5 and 130 min, but the signal was too weak to localize the compartments. If the fast compartment is assumed to be the brain then our results match the predictions of the classical perfusion-limited pharmacokinetic model of inhalation anaesthesia.
Adult↗
Magnetic resonance spectroscopy of isoflurane kinetics in humans. Part II: Functional localization.
We describe the first experiments to relate the cerebral kinetics of isoflurane (determined by fluorine magnetic resonance spectroscopy) to cerebral function. Using a surface receive coil we found two-compartment kinetics within the head with equilibrium half-times of 3.5 min and approximately 1 h with respect to expired isoflurane concentrations. Using critical fusion flicker frequency as an objective measure of the cerebral effect of isoflurane, we found evidence to identify the fast component as the brain. Responsiveness to command was lost at a brain partial pressure of 0.3% isoflurane. We conclude that the measured cerebral kinetics of isoflurane exactly matched the predictions of the classical perfusion-limited model.
Anesthetics, Inhalation↗
Dose response, recovery, and cost of doxacurium as a continuous infusion in neurosurgical intensive care unit patients.
OBJECTIVES: To determine the optimal dosing of doxacurium as a continuous infusion in neurosurgical patients with traumatic brain injury; to determine the effects of bolus administration of doxacurium on heart rate (HR), blood pressure (BP), and intracranial pressure (ICP); to monitor neuromuscular recovery after discontinuation of prolonged doxacurium infusion; and to compare the cost of doxacurium with other current neuromuscular blocking drugs. DESIGN: Prospective, open-label study. SETTING: Neurosurgical intensive care unit (ICU) of a university-affiliated teaching hospital. PATIENTS: Eight critically ill, mechanically ventilated patients with traumatic head injury and normal renal and hepatic function. Patients had ICP monitoring. INTERVENTIONS: A bolus injection of doxacurium (0.05 mg/kg) followed by a continuous infusion (0.015 mg/kg/hr), adjusted to maintain one twitch during Train-of-Four nerve stimulation of the adductor pollicis muscle. MEASUREMENTS AND MAIN RESULTS: Bolus injections of doxacurium did not alter the HR, BP, or ICP. Patients were paralyzed 66 +/- 12 (SEM) hrs, with recovery of the fourth twitch occurring 118 +/- 19 mins after infusion of the doxacurium was discontined. There were no incidences of prolonged weakness, myopathy, or other adverse events. CONCLUSIONS: Continuous infusion of doxacurium provides stable neuromuscular blockade for neurosurgical patients with traumatic brain injury. Doxacurium is devoid of clinically important interactions with HR, BP, or ICP and is less costly than other neuromuscular blockers used in the ICU.
Adult↗
Fluoroscopy-assisted intubation of a child with an unstable subluxation of C1/C2.
Patients presenting with unstable cervical spine injuries are at risk for additional neurological injury as a consequence of airway manipulation. Techniques of awake intubation may not always be desirable or practical, particularly in the pediatric patient. We describe the use of fluoroscopy during the induction of anesthesia and intubation of a child with an unstable C1/C2 spinal subluxation. Fluoroscopy is readily available and noninvasive. This technique allows for rapid establishment and maintenance of optimal head and neck positioning during induction of general anesthesia and performance of laryngoscopy and tracheal intubation.
Accidents, Traffic↗
Analysis of p74, a PDV envelope protein of Autographa californica nucleopolyhedrovirus required for occlusion body infectivity in vivo.
In nature, nuclear polyhedrosis viruses (NPV) are transmitted when susceptible insect larvae ingest viral occlusion bodies (OB). These dissociate in the alkaline environment of the midgut and release encapsulated virions (PDV) which bind to midgut epithelial cells and initiate an infection. A previous study showed that expression of the Autographa californica NPV (AcMNPV) p74 gene during replication is essential for the production of infectious OB. A set of p74 deletion and overexpression recombinants was used for the production and screening of monoclonal antibodies, and for an investigation of gross cytopathology and localization of p74. No differences in virus structure or morphogenesis were observed in infected cells when the p74 gene of AcMNPV was deleted, even though the infectivity of OB harvested from the cells was abolished when they were fed to Trichoplusia ni larvae. Mutant OB released virus particles and degraded insect peritrophic membrane as in infections with wild-type virus; in addition, virions purified from mutant OB were infectious when injected into the haemocoel of T. ni larvae. Western blot analysis confirmed that p74 was associated with the PDV and could not be detected in the budded form virion phenotype. The polypeptide was readily degraded by treatment of purified PDV with proteinase K, in the presence and absence of detergent, and could be extracted from PDV by a non-ionic detergent treatment. The data are consistent with p74 being a structural polypeptide of the PDV phenotype, most probably as a component associated with the outside surface of the virion envelope. Its presence is shown to be essential for primary infection of midgut cells of insect larvae.
Animals↗
Intranasal diamorphine for paediatric analgesia: assessment of safety and efficacy.
OBJECTIVE: To evaluate the safety and efficacy of intranasal diamorphine as an analgesic for use in children in accident and emergency (A&E). METHODS: A prospective, randomised clinical trial with consecutive recruitment of patients aged between 3 and 16 years with clinically suspected limb fractures. One group received 0.1 mg/kg intranasal diamorphine, and the other group received 0.2 mg/kg intramuscular morphine. At 0, 5, 10, 20, and 30 minutes pain scores, Glasgow coma score, and peripheral oxygen saturations were recorded; parental acceptability was assessed at 30 minutes. RESULTS: 58 children were recruited, with complete data collection in 51 (88%); the median summed decrease in pain score was better for intranasal diamorphine than intramuscular morphine (9 v 8), though this was not significant (P = 0.4, Mann-Whitney U test). The episode was recorded as "acceptable" in all parents whose child received intranasal diamorphine, compared with only 55% of parents in the intramuscular morphine group (P < 0.0001, Fisher's exact test). There was no incidence of decreased peripheral oxygen saturation or depression in the level of consciousness in any patient. CONCLUSIONS: Intranasal diamorphine is an effective, safe, and acceptable method of analgesia for children requiring opiates in the A & E department.
Administration, Intranasal↗
AMPA-preferring receptors mediate excitatory synaptic inputs to retinal ganglion cells.
Pharmacological studies were performed to determine whether alpha-amino-3-hydroxy-5-methyl-4-isoazoleprionic acid (AMPA)- and/or kainate (KA)-preferring receptors mediate excitatory synaptic inputs to tiger salamander retinal ganglion cells. Excitatory postsynaptic currents (EPSCs), evoked either by light or by stimulating bipolar cells with puffs of K+, were measured using whole cell recording techniques in the tiger salamander retinal slice. The AMPA/KA component of the EPSCs was isolated by including antagonists of glycine-, gamma-aminobutyric acid (GABA)- and NMDA-receptors in the bath. The AMPA-preferring receptor antagonists, 1-(4-aminophenyl)-4-methyl-7,8-methylenedioxy-5H-2,3-benzodiazepine hydrochloride (GYKI-52466) and 1-(4-aminophenyl)-3-methylcarbamyl-4-methyl-7,8-methylenedioxy-3,4 - dihydro-5H-2,3-benzodiazepine (GYKI-53665), reduced light-evoked EPSCs and K+ puff-evoked EPSCs amplitudes in a concentration-dependent manner. The IC50 values for GYKI-52466 were 3.6 and 4.2 microM for the light- and puff-evoked responses, respectively. The more potent GYKI-53665 had IC50 values of 0.7 microM for both the light- and puff evoked responses. KA activates both KA- and AMPA-preferring receptors. KA-evoked currents were completely blocked by 10-40 microM GYKI-53665, indicating that little or no excitatory synaptic current was mediated by KA-preferring receptors. Concanavalin A, a compound that preferentially potentiates responses mediated by KA-preferring receptors, did not enhance either EPSCs or glutamate-evoked responses. By contrast, cyclothiazide, which selectively enhances AMPA-preferring receptor mediated responses, was found to enhance both EPSCs and glutamate-evoked currents. Our results indicate that the non-NMDA component of ganglion cell EPSCs is mediated by AMPA-preferring receptors and not significantly by KA-preferring receptors.
Ambystoma↗
Targeting medical students to promote women in surgery.
The under-representation of women in surgical subspecialities is a well-aired topic. Most efforts to redress the surgical gender balance have, to date, been directed at opportunities for women in surgical training. We report on a one-day symposium organized by the Royal College of Surgeons of Edinburgh to promote interest in taking up a surgical career, aimed at senior women medical students and newly qualified doctors. Although 130 of the attendees who were surveyed did not change their opinion about the four most off-putting aspects of a surgical career, the symposium succeeded in increasing the appeal of a surgical career in 50%, apparently by the intensive exposure to a large and varied sample of female surgical role models.
Career Choice↗
Psychiatric disturbance and personality traits in dysphonic patients.
A study of 68 consecutive attendees at a voice clinic revealed that 51 (75%) were female. Personality characteristics and the incidence of minor psychiatric disturbances were studied in the 51 female patients with dysphonia and in 42 female ENT outpatient control subjects. Personality was assessed by use of the Eysenck Personality Questionnaire (EPQ) and the Hysteroid-Obsessoid Questionnaire (HOQ), and psychiatric disturbance was assessed by use of the General Health Questionnaire (GHQ), 60-item version. Whereas the 18 patients who were diagnosed as having psychogenic dysphonia had, overall, a greater degree of mild psychiatric disturbance, the 33 patients whose dysphonia was associated with structural laryngeal abnormality were also significantly more disturbed than control subjects (p < 0.01). There were no significant differences in personality traits among the three groups. Ten of the 18 patients with psychogenic dysphonia had evidence of significant psychiatric symptomatology on GHQ testing. More unexpectedly, one in three of the women with structural laryngeal changes showed similar psychiatric disturbance. Such psychological distress cannot therefore be detected solely on laryngeal appearances and voice characteristics. We propose the GHQ to be a quick, simple screening tool to identify those patients who might benefit from a more psychologically based approach to therapy.
Adolescent↗
Voice therapy for dysphonia--still more art than science?
Before evaluation of the efficacy of voice therapy is possible it is necessary to define established practice. The aim of this study therefore was to assess the prevailing treatment strategies among UK voice therapists for commonly presenting causes of dysphonia.
Humans↗