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Biomedical subjects

J F Nolan

Publications and source records attributed to J F Nolan.

At least 19 recordsLinked to original sources
PubMed2000

Who gets priority? Waiting list assessment using a scoring system.

This study examines the relationship between clinical priority and duration on the waiting list. Patients' priority is also compared from three different perspectives: the consultant at out-patients (clinical urgency), the general practitioner who later sends a letter requesting expedition of admission (clinical urgency) and the 18-month waiters. Clinical priority in 222 patients awaiting primary hip or knee arthroplasty was assessed using a modification of the New Zealand priority criteria scoring system, administered by postal questionnaire. There was no correlation between time on waiting list and clinical score (r = 0.0). The hip and knee patient scores were not significantly different. The mean scores in the consultant and GP groups were higher (greater pain and disability) than in the 18-month waiters. The Kappa inter-rater agreement method demonstrated that both groups of clinician's assessment of clinical urgency had a 'fair' strength of agreement with scoring system, but the agreement of the 18-month waiter group was 'very poor'. Time on a waiting list should not be a decisive factor in establishing priority for primary hip or knee arthroplasty. Scoring systems can aid in assigning clinical priority for operation and indeed for the initial out-patient referral.

Arthroplasty, Replacement, Hip↗
PubMed1992

Transurethral surgery using intravesical bupivacaine and intravenous sedation.

We report our experience using intravesical 0.5% bupivacaine as a topical anesthetic along with intravenous fentanyl and midazolam sedation to perform a variety of transurethral procedures in 78 patients. We achieved adequate pain control in all patients and observed no anesthetic complications. Use of this combination of intravesical topical anesthesia and intravenous sedation provided safe, adequate anesthesia to our patients undergoing various transurethral procedures in an outpatient clinic setting.

Administration, Intravesical↗
PubMed1992

Fracture of the femoral stem of the Ring TCH hip prosthesis.

We report the clinical and operative details of seven cases of fracture of the femoral stem of the Ring TiMESH cementless hip prosthesis (two were cemented and five uncemented). Six fractures occurred in the proximal one-third of the stem and one at mid-stem. The failures are attributed mainly to two defects in stem design, the narrowness of the anteroposterior dimensions and the depth of the recess for the titanium mesh pads. Great difficulty was experienced in removing the osseo-integrated distal fragments of the broken stems.

Biomechanical Phenomena↗
PubMed1991

Urethrovaginal reconstruction using a perineal artery axial flap.

A 19-year-old woman was born with a cloacal malformation and a common urogenital sinus. We describe a method of urethral and vaginal reconstruction to correct these anomalous problems. A neourethra was constructed from tubularized anterior vaginal epithelium. A perineal artery based axial flap was used to cover the neourethra plus widen the vaginal orifice.

Adult↗
PubMed1983

Superficially invasive vulvar cancer with nodal metastases.

Seven patients with superficially invasive vulvar cancer and lymph node metastases are reported. Histology of the primary tumor does not seem to correlate reliably with its metastatic potential in any individual case, though "spray," pseudoglandular, and small cell carcinomas may be particularly aggressive lesions. While wide local excision seems to be adequate treatment for the primary lesion, it is recommended that for lesions with greater than 1 mm of stromal invasion, bilateral inguinal-femoral lymphadenectomy should be performed for midline lesions, and at least ipsilateral inguinal-femoral lymphadenectomy should be performed for lateralized lesions.

Adult↗
PubMed1980

Carcinoma in situ of the vagina: past and present management.

The experience of the Southern California Cancer Center with carcinoma in situ of the vagina has been analyzed. Thirty-five patients were treated over 22 years. Patients with carcinoma in situ of the vagina are usually asymptomatic and most often have no visible or palpable lesions; diagnosis therefore depends upon directed biopsy in patients with abnormal routine vaginal cytology. Local radium application was the most frequent modality of treatment in this study group of patients, and excellent results were obtained. The need for cytologic evaluation after hysterectomy is emphasized. Colposcopy is a valuable aid in the diagnosis and follow-up of these patients.

Adult↗
PubMed1978

Stage II endometrial carcinoma: two modalities of treatment.

Forty-five cases of Stage II endometrial cancer are analyzed with regard to histologic grade, therapy, site of recurrence, survival, and cause of death. This group represents 5% of all endometrial cancer patients registered at the Southern California Cancer Center from 1954 to 1974. Thirty-two (71.2%) were classified as poorly differentiated tumors. A significant analysis of survival data comparing the 26 patients treated by RT alone, and 17 patients managed by surgery and RT, could not be obtained because of the small number of patients. However, the frequency of residual tumor in the uterus and intraperitoneal recurrence in the RT only group suggests that RT plus surgery should provide a better survival than RT alone.

Adenocarcinoma↗
PubMed1976

Stage I carcinoma of the uterine cervix in patients under 40 years of age.

A retrospective analysis was made 94 patients, 39 years of age or younger, who were treated for Stage I carcinoma of the uterine cervix from 1942 through 1972 at the Los Angeles Tumor Institute and the Southern California Cancer Center. Comparisons were made between the frequency of Stage I and other stages of carcinoma of the uterine cervix, as well as the frequency of Stage I carcinoma in young and older individuals. Survival rates for the younger group were compared to those for the same stage of disease for all ages of patients. There is discussion of the treatment modalities used in light of recommendations for future plans of therapy for these young patients. Tumor recurrences are discussed, with special reference to 43 patients who survived over 10 years. Eight of these patients were found to show new or recurrent tumors after this period of time. The importance of careful, long-term follow-up and early secondary treatment for recurrent lesions is emphasized, since subsequent radical surgery may salvage a number of these individuals.

Adult↗