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Biomedical subjects

K Heller

Publications and source records attributed to K Heller.

At least 19 recordsLinked to original sources
PubMed1992

Clonidine for patients with rapid atrial fibrillation.

OBJECTIVE: To determine whether clonidine can slow ventricular rate in patients with rapid atrial fibrillation. DESIGN: Randomized, controlled trial, with a 4-hour follow-up period. SETTING: Emergency room of a university hospital. PATIENTS: A consecutive sample of 18 hemodynamically stable patients who were evaluated or treated for rapid atrial fibrillation. Exclusion criteria included acute or terminal illness; current use of antiarrhythmic agents, calcium-channel blockers, or beta-blockers; excessive hypertension; pulmonary, valvular, or pericardial disease; and electrolyte imbalance. INTERVENTIONS: Patients were randomly assigned to receive either "no treatment" (control group) or clonidine, 0.075 mg orally, at baseline and after 2 hours if heart rate did not decrease by at least 20%. MEASUREMENTS: Blood pressure was measured by the same nurse in the same arm for 4 consecutive hours, and a full 12-lead electrocardiographic evaluation was done. MAIN RESULTS: Heart rate decreased to below 100 beats/min in eight of nine patients receiving clonidine compared with two of nine patients in the control group. The difference in the mean decreases in heart rate was 38 beats/min (95% CI, 20 to 56 beats/min). Six patients who were treated with clonidine and one patient in the control group reverted to normal sinus rhythm. Systolic blood pressure decreased slightly in both groups, without significant differences. Clinical follow-up was uneventful. CONCLUSION: Low-dose clonidine was an easy, efficient, and effective treatment for patients with rapid atrial fibrillation who were hemodynamically stable.

Adrenergic alpha-Agonists↗
PubMed1992

Morphometric comparisons of optic nerve axon loss in acquired immunodeficiency syndrome.

Axonal degeneration and diminution of the axonal population in the optic nerve have been documented in aging and in various neuro-ophthalmic conditions. We applied morphometric techniques to the postmortem examination of optic nerves obtained from patients with acquired immunodeficiency syndrome. Twelve optic nerves (eight from patients with AIDS and four from age-matched control eyes) were stained with paraphenylenediamine and morphometrically analyzed with a computer-assisted image and measurement system. Degeneration was often severe and was scattered throughout all of the AIDS-affected optic nerves. In the AIDS-affected optic nerves, the mean axonal population was markedly lower than the mean obtained from normal optic nerves (880,000 vs 1,507,000). Despite the approximate 40% loss of axons, mean axonal diameters were not markedly different, suggesting that no particular class of axon was especially susceptible to AIDS-associated degeneration. The extent and pattern of axonal loss in optic nerves of patients with AIDS suggest that the changes may not only be secondary to damage at the retina, but may reflect an AIDS-associated primary optic neuropathy.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Central hamartoma of the liver in a child.

A two-year-old girl was found to have a hamartoma of the liver located centrally in the hilar region. Despite the benign character of this lesion severe biliary obstruction developed rapidly and made surgical therapy necessary. The surgical approach, with reference to the literature, is discussed.

Child, Preschool↗
PubMed1991

[Endoscopy, shockwave lithotripsy and local lysis in complicated pigmentary calculi of extra- and intrahepatic bile ducts].

Endoscopy, extracorporeal shockwave lithotripsy (ESWL) and local lysis with alkaline solution of EDTA and bile salts in water were applied in combination in four patients with extra- and intrahepatic pigment stones as well as calcium bilirubinate covered concrements of the biliary tract. In the first patient (a man aged 80 years) a giant concrement of the bile duct was broken up after ESWL by three weeks of local chemical lysis and the fragments were removed by endoscopy. In the second case (man, aged 72), a nonextractable pigment stone was at first reduced in size by four-day local lysis and then removed endoscopically. Intrahepatic pigment stones were completely removed in the other two patients (boy of 12, man of 62) by local lysis only in 3 and 15 weeks, respectively. Even long-term use of the alkaline solution may not cause any serious side effects. Breaking up of stones after size reduction with ESWL of giant stones, size reduction of intact stones and contact lysis of intrahepatic stones are three important indications for chemical dissolution of biliary tract stones, respectively.

Adolescent↗
PubMed1991

Peer support telephone dyads for elderly women: was this the wrong intervention?

Tested a preventive intervention in which peer telephone dyads were developed for low-income, community-living, elderly women with low perceived social support. After an initial assessment, respondents were randomly assigned to either an assessment-only control or received 10 weeks of friendly staff telephone contact. After a second assessment, participants receiving the staff contact were randomly assigned to continue that contact or were paired in dyads to continue phone contact with one another. Dependent variables were measures of perceived social support, morale, depression, and loneliness. All groups, particularly the staff contact group, showed some improvement in mental health scores over time, but there were no significant differences between intervention groups, or between intervention and assessment-only control groups. The results suggest that participation in the study and in personal assessment interviews at home were probably morale enhancing, and that additional telephone contact did not significantly add to that effect. Evidence also indicates that, in this sample, low perceived family support was significantly related to poor mental health, so it is possible that a program designed to increase friend support may have been the wrong intervention.

Aged↗
PubMed1991

Support interventions for older adults: confidante relationships, perceived family support, and meaningful role activity.

The rationale and problems encountered in implementing a peer-support telephone intervention are described. The research conducted by Heller, Thompson, Trueba, Hogg, and Vlachos-Weber (1991) was based on epidemiological literature documenting the moral enhancing value of confidante relationships. However, that literature may be insufficiently precise to form the basis for an intervention without prior ethnographic study of the local target population. Furthermore, the positive effects of peer friendships may refer to long established relationships rather than to newly formed social ties. It is concluded that future support intervention research with older adults should concentrate on reinforcing meaningful role activities, and that greater attention should be given to strengthening indigenous ties before attempting to create new ones. While prior process research and formative evaluation are of value, we also emphasize the importance of well-controlled field studies in the ultimate test of intervention hypotheses.

Aged↗
PubMed1990

Surgical techniques in short bowel syndrome.

An operation according to Bianchi in a 2-year-old girl is described and indications as well as technical procedure are discussed. The girl was born with a gastroschisis. There was a jejunal perforation 10 cm below the ligament of Treitz caused by a volvulus. Only 20 cm of the jejunum remained. Moreover, only the left part of the colon was present. Total parenteral nutrition for 2 years was necessary. The principle of the operation is based on a longitudinal division of the remaining bowel and a creation of two separate bowel tubes out of the divided bowel halves, thus effecting an isoperistaltic serial connection by means of two anastomoses. This is technically possible since each half of the bowel wall has its own blood supply. The vessels originating from the mesenterium branch off before they reach the bowel wall so that the mesenteric dissection line can be anastomosed longitudinally with the antimesenteric border. This results in doubling of the bowel length, narrowing of the preoperatively dilated bowel diameter, closer contact of bowel contents with the mucosa, prolonged transit time and a Bacteroides colonization which is reduced by more effective peristalsis. Indications, time of operation and our own experiences are discussed and three cases are described. All children are alive and show marked improvement in nutrition.

Anastomosis, Surgical↗
PubMed1990

Attributional style in aggressive adolescent boys.

Past research suggests that aggressive children misattribute hostile intentions to peers during ambiguous provocative interactions. This study sought to extend the analysis of attributional differences between aggressive and nonaggressive boys to a sample of court-involved adolescents and their perceptions of interactions involving both peers and adults. Three groups of youngsters (nonoffenders, nonaggressive offenders, and aggressive offenders) participated in a structured interview and provided causal attributions for interpersonal problems commonly faced by teenagers. Results indicated that offenders were more likely than nonoffenders to attribute blame to others in ambiguous problem situations. Among offenders, external, person-centered blame attributions were significantly related to aggressiveness. This relationship was found only in ambiguous situations, and the correlation between such person-centered attributions and aggressiveness was higher in adult-oriented interactions than in peer-oriented ones. Overall, the results suggest that aggressiveness among offenders is associated with an attributional style that is characterized by the tendency to attribute blame for problems in ambiguous interactions to global, dispositional characteristics of others.

Adolescent↗
PubMed1990

Facets of support related to well-being: quantitative social isolation and perceived family support in a sample of elderly women.

The purpose of this study was to examine the independent and interactive relationships of measures of network embeddedness and perceived social support with mental and physical health measures from responses of a sample of 271 community-dwelling elderly women. Quantitative social isolation was measured as the co-occurrence of low network embeddedness with family and with friends. There was a threshold effect such that quantitatively isolated participants had poorer psychological well-being and functional health than did nonisolated participants. This effect was independent of perceived support levels. The pattern was different for perceived social support. Elderly women with low perceived family support had poorer psychological well-being regardless of perceived support from friends or network embeddedness. Implications are discussed for several unanswered questions in the social support literature, including possible interventions for the quantitatively isolated and for those with low levels of perceived support.

Aged↗
PubMed1990

A measure of relational competence for community-dwelling elderly.

A measure of relational competence was developed to assess the skills necessary for peer friendship development among the elderly. Participants were required to respond to a series of social problem vignettes that were constructed to tap empathy, assertion, and role-taking skills. Validation data were collected as part of a larger project designed to establish indigenous, elderly peer-support telephone dyads among low-income, community-dwelling elderly women. Results indicated that the measure of relational competence was related to initial friendship formation, telephone conversational skills, and rated social competence as determined by judges' ratings of 2 telephone conversations between participants and staff members. The research illustrates the usefulness of moving away from trait conceptions of social competence to a more focused consideration of particular task demands and the skills needed to solve age-linked social problems.

Activities of Daily Living↗
PubMed1990

[Effect and correlation of various risk factors in the development of retinopathy of prematurity. A retrospective study of 338 premature infants].

The statistical significance of ophthalmological and pediatric findings in the development of retinopathy of prematurity (ROP) was evaluated in a retrospective study of 338 premature infants. Short gestation time, frequent hypoxia, and low birthweight were strongly correlated with advanced stages of ROP. The influence of Vitamin E treatment, duration of oxygen therapy, and need for transfusions was less significant. Neither multiple births nor the infant's sex had any influence on the development of ROP. Cryotherapy appears to reduce ROP, but the number of cases in the present study was too small to permit statistical analysis.

Birth Weight↗
PubMed1989

Ethical dilemmas in community intervention.

Ethics code books provide only general guidelines and are inadequate in resolving explicit ethical dilemmas that frequently occur in community intervention. Ethical choices often reflect personal values as well as professional role proscriptions and are difficult to resolve for a number of reasons. It often is not clear to whom the interventionist should be accountable, or what the long-range impact may be of specific programs that seem to have short-term benefit. Value clashes can occur between consultants and consultees, even when both groups believe that they represent the best interests of vulnerable client groups. Since personal values are important determinants of ethical choices, whenever possible, they should be communicated openly so community groups can understand the interventionist's values before community projects begin. It also is important to share ethical dilemmas with professional colleagues in order to provide community psychologists with constructive feedback from their professional peers, and to help others anticipate similar value conflicts in their own work. These points are illustrated by discussion of the vignettes presented by O'Neill (1989) and by additional examples drawn from my own experience.

Adolescent↗
PubMed1989

[Short bowl syndrome and quality of life in childhood].

From 1985 to 1988, six patients suffered from short gut syndrome due to congenital malformations. The children were aged 4-24 months at the time of the operation in which the gut was doubled in length by a Bianchi procedure. It is necessary to interview the parents about their own and the child's psychological and physical stress during the pre- and postoperative periods. Collective reactions were found which must be considered for indication and time of operation.

Adaptation, Psychological↗
PubMed1988

Social support from a friend, perceived support, and social problem solving.

This research combined experimental and correlational methods to investigate the effects of social support on social problem-solving effectiveness and perceived stress. During a wait period, college students were given the opportunity to work on practice items from a mildly stressful social problem-solving task, either alone or in the company of a close friend. Participants and friends were allowed to talk about the practice items but were not required to do so, and supportive transactions were tape recorded and content analyzed. All students then completed social problem-solving and perceived stress items alone. Participants who waited with friends did not show superior problem-solving effectiveness unless companions provided particular supportive behaviors. Participants with high perceived support scores rated the experiment as less stressful than those with low scores, but perceived support was not related to companions' actual supportive behaviors. The results were discussed in terms of implications for understanding the mechanisms of social support.

Depression↗