Intravenous fetal transfusion of immunoglobulin for alloimmune thrombocytopenia.
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Blood Transfusion, Intrauterine↗
Biomedical subjects
J Bowman
Publications and source records attributed to J Bowman.
Impact of the diagnostic procedure on outcome measures of swallowing rehabilitation in head and neck cancer patients.
This study was designed to determine whether swallow rehabilitation outcomes were affected by the type of evaluation procedure utilized by the clinician. The two evaluation techniques compared were the bedside examination and videofluoroscopy (the modified barium swallow). Ten institutions participated in this study, enrolling a total of 103 partial laryngectomized patients, 21 in the bedside arm and 82 in the videofluoroscopy arm. Data on recovery of oral intake were collected weekly. All patients received an X-ray study of swallow at 3 months after the operation. Mean time to oral intake of food was significantly lower in patients assessed with bedside examination. Overall swallow measures of transit times and swallow efficiencies after 3 months revealed significantly better function in the videofluoroscopy group. Results are discussed in terms of the visibility of swallow physiology with the two assessment techniques, the accuracy of therapy planning with the bedside examination versus videofluoroscopy and the ability of head and neck cancer patients to tolerate some aspiration without developing aspiration pneumonia.
Deglutition↗
Effects of dietary fish oil on myocardial ischemic/reperfusion injury of Wistar Kyoto and stroke-prone spontaneously hypertensive rats.
The purpose of the present study was to determine whether 15 weeks of dietary fish oil supplementation to Wistar Kyoto (WKY) and stroke-prone spontaneously hypertensive rats (SP-SHR) would alter cardiac contractile performance. Isolated perfused working hearts were used to determine the effects of varying left atrial filling pressures on cardiac pump output and pressure development. In addition, the ability of these hearts to recover cardiac output after a 60-minute period of low-flow ischemia followed by 30 minutes of reperfusion was assessed. Myocardial high-energy phosphate levels and long-chain acylcarnitine content were measured. Fish oil supplementation had no effect on indirect tail-cuff systolic blood pressure of WKY rats, but produced a small decrease in systolic blood pressure of SP-SHR. In response to varying left atrial filling pressures, hearts from WKY rats and SP-SHR exhibited no major differences in aortic flow, left intraventricular diastolic pressure, systolic pressure, positive and negative rate of pressure change per unit of time (dP/dt), or relaxation time; however, coronary flow values were lower in SP-SHR groups relative to respective WKY groups. Fish oil supplementation had no effect on these cardiac parameters. When these hearts were subjected to ischemia and reperfusion, the recovery of cardiac contractile performance was significantly improved in fish oil-fed WKY and SP-SHR groups, compared with their corn oil-fed counterparts. There were no differences in the recovery of the above cardiac hemodynamic parameters between corn oil-fed WKY and SP-SHR. These results provide further support to the hypothesis that dietary fish oil can significantly reduce the mortality risk from cardiovascular disease.
Animals↗
Metabolic effects of treadmill exercise training on the diabetic heart.
This study determined whether exercise training in rats would prevent the accumulation of lipids and depressed glucose utilization found in hearts from diabetic rats. Diabetes was induced by intravenous streptozotocin (60 mg/kg). Trained diabetic rats were run on a treadmill for 60 min, 27 m/min, 10% grade, 6 days/wk for 10 wk. Training of diabetic rats had no effect on glycemic control but decreased plasma lipids. In vivo myocardial long-chain acylcarnitine, acyl-CoA, and high-energy phosphate levels were similar in sedentary control, sedentary diabetic, and trained diabetic groups. The levels of myocardial triacylglycerol were similar in sedentary control and diabetic rats but decreased in trained diabetic rats. Hearts were perfused with buffer containing diabetic concentrations of glucose (22 mM) and palmitate (1.2 mM). D-[U-14C] glucose oxidation rates (14CO2 production) were depressed in hearts from sedentary diabetic rats relative to sedentary control rats. Hearts from trained diabetic rats exhibited increased glucose oxidation relative to those of sedentary diabetic rats, but this improvement was below that of the sedentary control rats. [9,10(-3)H]palmitate oxidation rates (3H2O production) were identical in all three groups. These findings suggest that exercise training resulted in a partial normalization of myocardial glucose utilization in diabetic rats.
Animals↗
Functional results after total or near total glossectomy with laryngeal preservation.
Locally advanced tongue cancer is a devastating disease for which there are limited therapeutic options that will result in a high rate of cure while preserving function. To determine the oncologic effectiveness of total or near total glossectomy with laryngeal preservation and the possibility of speech and swallowing rehabilitation following treatment, we reviewed our experience with 27 patients treated between 1982 and 1989. Twenty-four patients were eligible for 2-year follow-up and their disease-specific survival was 51%. Swallowing was achieved initially in 18 patients (67%), while 12 had successful long-term deglutition (44%). Oral communication was accomplished in 25 patients (92%). Significant aspiration occurred in three patients and was severe enough to require interval laryngectomy in two patients. The role of laryngeal suspension, palatal augmentation prosthesis, and videofluoroscopy as rehabilitation adjuncts for the total glossectomy patient are described.
Adult↗
Light reflection rheography: an effective non-invasive technique for screening patients with suspected deep venous thrombosis.
Light reflection rheography is a simple non-invasive technique for assessing venous function in the leg. One hundred and twenty-four patients referred for venography with a clinically suspected deep venous thrombosis were investigated by light reflection rheography to determine the accuracy of the technique in diagnosing acute thrombosis. In half of the patients venography confirmed a deep venous thrombosis. Light reflection rheography had a sensitivity of 92 per cent and a specificity of 84 per cent in detecting acute thrombosis. The technique had a negative predictive value of 92 per cent in selecting those patients with no thrombosis. Light reflection rheography can be performed at the bedside or in the radiography department which makes it a suitable technique for screening patients with suspected deep venous thrombosis.
Female↗
Intravenous drug abuse causes Rh immunization.
Intravenous drug abuse causes many health problems. From March 1989 to January 1990 of 27 Rh-negative women (28 pregnancies) referred to our centre, 4 women (5 pregnancies) were Rh immunized due to the sharing of needles and blood with their Rh-positive partners. Severe hydrops was present in 4 of their 5 fetuses when they were first seen at 17-35 weeks of gestation. Only the fetus first seen at 35 weeks survived. That infant was moribund at birth and now has evidence of leukomalacia and porencephaly. The fifth fetus, not hydropic, required two intravascular fetal transfusions in order to survive. A fifth woman, immunized in a similar manner, had a spontaneous abortion. These fetuses represent some of the earliest and severest examples of hydrops fetalis ever seen at our centre. The severity of their fetal hemolytic disease is probably due to the fact that their mothers' exposure to Rh(D) antigen by blood sharing was continuous and ongoing. Because of their aberrant behaviour, these women have suffered irreversible reproductive damage.
Abortion, Spontaneous↗
Diarrheal disease due to Clostridium difficile in general practice.
A total of 288 stool samples from patients attending their general practitioners was examined for the presence of Clostridium difficile. C. difficile or its cytotoxin was found in 16 patients (5.5%) and was the most common enteric pathogen detected. Most patients had only mild to moderate diarrhea but in the majority of patients the diarrhea was protracted. Eleven of the 16 patients had received antimicrobial agents in the 3 mths preceding onset of diarrhea and there was good circumstantial evidence that 2 other patients had also been exposed. None of the patients had a history of any inflammatory bowel disease or possible occupational exposure. The prescribing habits of general practitioners with regard to antimicrobial agents were monitored for a 1 yr period. Tetracyclines and amoxycillin accounted for approximately 25% each of all prescriptions dispensed. Ten of the 16 patients were treated with antimicrobials (mainly metronidazole) and in most cases the diarrhea resolved. We conclude that C. difficile may be a significant cause of community-acquired diarrhea.
Adult↗
Childbearing after liver transplantation.
Seventeen female patients who underwent orthotopic liver transplantation between June 1973 and June 1987 became pregnant 5 months to 11 years after transplantation. Immunosuppression was maintained with combinations of prednisone, cyclosporine, and azathioprine prior to and during pregnancy. One patient discontinued immunosuppression after knowledge of pregnancy, taking only azathioprine sporadically. Mean age at time of delivery was 26 years. Twelve patients had no alteration in liver function studies; 7 patients demonstrated mild or moderate enzyme elevations prior to delivery, with one case of rejection confirmed by percutaneous liver biopsy. Major problems related to pregnancy were hypertension, anemia, and hyperbilirubinemia. Twenty live births occurred (2 patients had 2 separate pregnancies, one patient had a set of twins); 13 were by cesarean section, 7 by vaginal delivery. Eleven of the 13 cesarean births were premature by gestational age. All vaginal births were term. Toxemia of pregnancy and early rupture of membranes were the principal indications for cesarean section. There were no congenital abnormalities or birth defects and all the children are surviving well. Fifteen of 16 children older than one year all have normal physical and mental development, with one child manifesting immature speech development. Four children are under one year, all with normal milestones thus far. Sixteen of the 17 mothers are alive from 2-18 years after transplantation; the only death was from a lymphoma, almost 4 years after transplantation and 2 1/2 years after delivery. This experience suggests that women undergoing liver transplantation can safely bear children despite an increased risk of premature cesarean births. The effect of chronic immunosuppression of female pediatric patients on their reproductive potential later in adulthood remains to be fully evaluated but the results so far are favorable.
Adult↗
Liver transplantation for malignant tumors.
As reviewed herein, the current results of liver transplantation for malignant tumors are suboptimal. Progress depends on development of other modalities of adjunctive therapy.
Biliary Tract Neoplasms↗
Surgical technique of orthotopic liver transplantation.
Although significant strides have been made in the surgical technique of orthotopic liver transplantation, numerous problems and nuisances are still encountered. Further surgical refinements will certainly evolve. The development of better preservation techniques, the use of intraoperative flowmeters, and the availability of new technologies, such as an artificial liver, should impact and advance the techniques of liver transplantation significantly and improve the overall results even further.
Adult↗
Postoperative surgical complications.
Results of liver transplantation have dramatically improved since the introduction of cyclosporine. Most deaths occur within the first 3 postoperative months. Morbidity and mortality can be minimized by early diagnosis and aggressive management of postoperative surgical complications.
Biliary Tract Diseases↗
Functional analysis of treatment of oral cavity cancer.
There are few studies that have addressed themselves to measuring the speech, swallowing results, and quality of life that patients are left with after the treatment of oral cavity cancer. We developed a test series to assess the oral cavity function and the general health of patients treated for oral cavity cancer. The results of 51 patients treated for oral cavity cancer were compared by site and stage of the lesion as well as by treatment modality. In addition, the functional results achieved by different reconstructive techniques in the oral cavity were evaluated. The series also identified site-specific speech and swallowing problems.
Combined Modality Therapy↗
The effect of vinblastine on spermiogenesis in Drosophila melanogaster: evidence for two functional classes of cytoplasmic microtubules.
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Animals↗
Hemoglobin E, an oxidatively unstable mutation.
When bloods from 3,159 individuals from the United States, Iran, Ethiopia, and South Vietnam were examined for erythrocytic enzyme deficiencies with a new test utilizing the visible reduction of 2,6-dichlorophenolindophenol by glutathione, gross turbidity was observed in 81 samples. All were from Southeast Asia and 78 contained hemoglobin E. The precipitation rates of various hemoglogins in hemolysates incubated with dichlorophenolindophenol were: Hb EE greater than Hb AE greater than other hemoglobins (A, S, C, D, A2, F, O-Arabia, Rush). Hemoglobin E is an oxidatively unstable hemoglobin, possibly with weakened alpha 1 beta 1 contact; it may result in increased susceptibility to oxidative hemolysis and can be simply detected and differentiated from both Hb C and Hb O-Arabia.
Blood Protein Electrophoresis↗
New test series for the functional evaluation of oral cavity cancer.
There are few studies that have addressed themselves to measuring speech, swallowing function and the "quality of life" of patients that have been treated for oral cavity cancer. The goal of this study was to develop a test series to assess the oral cavity function and the general health of patients treated for oral cavity cancer. The results of 51 patients treated for oral cavity cancer will be compared by the site and stage of the lesion, as well as by treatment mode. In addition, the functional results achieved by different reconstructive techniques in the oral cavity will be presented. Radiotherapy patients as a group have the best speech and swallowing function while the patients treated with combined therapy have the worst function. In the surgical group, those patients treated with intraoral skin grafts had the best speech results and those with primary closures had the best swallowing performance.
Adult↗
Factors affecting nonadherence with antibiotics.
Nonadherence with antibiotic therapy has profound implications both for patient health and the health care system that bears the financial costs incurred. Significant levels of nonadherence with antibiotic prescriptions have been demonstrated. Of the many proposed variables involved, those that are potentially modifiable relate to aspects of the doctor-patient interaction and drug regimen. Despite the potential for intervention with these variables, there have been very few methodologically sound studies examining their effect on adherence with either medications generally or antibiotics specifically. Only two studies were located that had tested the effectiveness of reduced complexity of antibiotic dosage schedules. The results suggest that the less complex the schedule, the greater is the adherence. Both practitioners and patients must be encouraged to use and accept simpler dosage schedules, preferably once-daily schedules wherever possible. The paucity of well-controlled studies to date highlights the need for further research evaluating intervention strategies that utilize variations in dosage schedule and elements of the doctor-patient interaction to improve adherence with antibiotic medications.
Anti-Bacterial Agents↗