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Biomedical subjects

M L Walker

Publications and source records attributed to M L Walker.

At least 55 records · Page 3Linked to original sources
PubMed1996

Power Doppler--a new tool for transcranial duplex assessment of intracranial vasculature.

The present study was undertaken to assess the clinical use of power Doppler (PD) as a new tool for transcranial vessel imaging. Power Doppler displays the integrated power of the Doppler signal instead of the Doppler frequency shift used in the conventional color flow Doppler (CFD) technique. Twenty-one patients were evaluated who had intracranial malformations or arterial stenoses [4 middle cerebral artery (MCA) stenoses, 2 intracranial carotid stenoses, 7 arteriovenous malformations (AVM), 5 intracranial carotid aneurysms, 3 Moya-Moya syndromes]. The PD results were compared with those obtained from CFD and digital subtraction angiography (DSA). Power Doppler was able to visualize 3 of 4 MCA stenoses with greater morphological detail than CFD, whereas PD and CFD were equally effective in diagnosing carotid stenoses. All AVMs were visualized using PD as well as CFD, but again PD revealed more morphological details, in a manner similar to DSA. Power Doppler was also superior to CFD in imaging intracerebral aneurysms and pathological collateralization associated with Moya-Moya syndromes. It is evident from these data that PD permits reliable and detailed transcranial imaging and therefore is a superior method for visualizing intracerebral vascular malformations and arterial stenoses.

Blood Flow Velocity↗
PubMed1995

Psychiatric comorbidity in adolescent inpatients with substance use disorders.

OBJECTIVE: To assess DSM-III-R Axis I and Axis II co-occurrence and comorbidity in adolescent inpatients with substance use disorders (SUD). METHOD: A consecutive series of 138 adolescent inpatients were reliably assessed with structured diagnostic interviews for Axis I disorders and Axis II personality disorders. To determine significant co-occurrence of diagnoses, comparisons were between 69 patients with SUD and 69 patients without SUD. RESULTS: Disruptive behavior disorders were diagnosed significantly more frequently in patients with SUD than in those without SUD. Conduct disorder was diagnosed more frequently and oppositional defiant disorder was diagnosed less frequently in the SUD patients than in the non-SUD patients. Anxiety disorders were diagnosed less frequently in the SUD group. Cluster B personality disorders and borderline personality disorder were diagnosed more frequently in the SUD group. CONCLUSIONS: The findings replicate previous research showing high rates of co-occurrence of other psychiatric disorders in adolescent inpatients with SUD. The use of a relevant psychiatric comparison group allows for finer distinctions regarding significant comorbidity and the psychopathological implications thereof.

Adolescent↗
PubMed1995

A comparison of the structured clinical interview for DSM-III-R and clinical diagnoses.

The relationship between diagnoses generated by the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID) and by nonstructured psychiatric interviews was examined. The purposes were to evaluate which DSM-III-R diagnoses were most reliably chosen, and to compare diagnostic practices between two clinical sites. Diagnoses generated by researchers using the patient version of the SCID and by psychiatric interviews were compared for 100 patients. The participants had been randomly assigned to one of two acute treatment sites within the same institution, as part of a larger study of an alternative to inpatient hospitalization. Overall reliability between the SCID and the clinicians, as determined by weighted Kappa, was poor. There was considerable variability among the major diagnostic categories, with higher agreement for schizophrenia and bipolar disorder than for others. The agreement for schizoaffective disorder was extremely low. There were also significant differences in the patterns of diagnosis between the two sites. The patient version of the SCID appears to produce results that are very different from clinical practice, which, in turn, may be influenced strongly by location.

Adult↗
PubMed1995

The damage control laparotomy.

The damage control laparotomy is an advancement in the management of massively injured trauma victims. Mortality for this group of patients remains high but some can be saved using staged abdominal reconstruction for trauma. Massive liver injuries, pelvic trauma, and retroperitoneal injury are some of the indications for this approach. Careful replacement of blood and blood products along with correction of hypothermia and optimization of oxygen transport represents a critical phase in this management approach. It must be emphasized that abdominal packing must not be used without repairing major vascular injuries. Premature packing and inadequate packing also should be avoided. This staged approach to abdominal trauma is not a panacea; however, improved trauma care is possible if this technique is used carefully.

Abdominal Injuries↗
PubMed1994

Health and well-being of childbearing women in rural and urban contexts.

As part of the national focus on women's health issues, it is important to identify those health-related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health-related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty-five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self-actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women.

Adolescent↗
PubMed1994

The operative and nonoperative management of blunt liver injury.

The surgical approach to liver injury depends on a clear and concise characterization of the wound. Blunt trauma can produce devastating wounds that disrupt hepatic venous drainage. Atrial caval shunting remains a useful technique for Grade V liver wounds. Liver packing may be necessary if diffuse lobar injury, acidosis, hypothermia, and coagulapathy are present. The general surgeon must have a wide array of surgical options that can be used for various combinations of injury. This article proposes that operatively identified retrohepatic hematomas, which remain unchanged after a period of observation, should be left undisturbed. Data supporting this approach, from a series of cases managed nonoperatively, are presented.

Humans↗
PubMed1993

Diagnosis and treatment of the slit ventricle syndrome.

Slit ventricles are a complication of a functioning shunt. This article examines the diagnosis and treatment of slit ventricles and slit ventricle syndrome, the pathophysiology involved, a rationale for treatment, and the direction of therapy in the near future. The authors conclude that determining which type of SVS is present is the first step in treatment and that the best treatment is a strategy aimed at the specific type of SVS that is responsible for the symptoms.

Brain Diseases↗
PubMed1992

The history of ventriculoscopy: where do we go from here?

With the availability of better endoscopes, improved lighting and increased instrumentation, the use of ventriculoscopy and ventriculostomy in the management of hydrocephalus is becoming increasingly more common. Neurosurgeons recognized the potential for endoscopic surgery early in this century, but were frustrated in many of their attempts at treatment due to the poor quality of the instruments available. Nevertheless, much progress has been made, and the stage was set for better results with modern instrument design. This paper reviews the history of endoscopes in neurosurgery and ponders the direction these instruments will take us in the near future.

Cerebral Ventricles↗
PubMed1992

On healing.

Explore the source record for details and available documents.

Culture↗
PubMed1992

The operative approach to pancreatic injury.

Major pancreatic trauma is uncommon and often challenging even for the most experienced trauma surgeon. An organized, well-rehearsed operative approach to these injuries represents the surgeon's best defense. This article highlights operative decision-making. Operative assessment is reliable. The integrity of the main pancreatic duct is the major discriminating variable in the management of pancreatic injury. Pancreaticoduodenectomy can be done safely for devitalizing injuries to the head of the pancreas associated with major duodenal and common bile duct injury. For selected cases, distal pancreatectomy with splenic preservation is realistic. The surgeon must have a wide array of procedures from which to select for major complicated pancreatic trauma.

Abdominal Injuries↗
PubMed1991

Trauma-adult respiratory distress syndrome.

Sixteen trauma victims with adult respiratory distress syndrome were retrospectively examined. High injury severity score (mean: 44), massive transfusion requirements, and prolonged ventilator days characterize this group. Persistent intra-abdominal infection accounted for two of three deaths in this series. Most of these patients were managed without paralysis using intermittent mandatory ventilation and positive-end expiratory pressure (PEEP). High frequency jet ventilation was necessary in one subject. Two patients exhibited early ARDS reversal, ie, clinical improvement, better chest x-ray and decreased shunt (within 72 hours) when an intra-abdominal septic focus was eradicated. Principles of critical care for these patients remain: an FiO2 less than .40, limiting barotrauma, using PEEP for alveolar recruitment and close monitoring of O2 transport.

Adolescent↗
PubMed1990

Chronic encephalitis, epilepsy, and cerebrovascular immune complex deposits.

Refractory epilepsy, electroencephalographic abnormalities, progressive hemiplegia, and contralateral hemicerebral atrophy developed in a previously healthy 3-year, 9-month-old girl. Extensive laboratory testing showed elevated serum antinuclear antibody titers, cerebrospinal fluid oligoclonal bands, and elevated immunoglobulin G (IgG): albumin ratio, IgG index, and IgG synthesis rate. Pathological study of a subtotal hemispherectomy specimen revealed widespread cerebral vasculitis with immunofluorescence staining for IgG, IgM, IgA, C3, and Clq, and ultrastructural evidence of vascular injury in addition to severe cortical atrophy with marked neuronal loss. Cerebrospinal fluid abnormalities in other reported patients suggest that immunological abnormalities may not be unique to this girl. These data suggest possible immunopathogenetic mechanisms in these patients.

Antibodies, Antinuclear↗
PubMed1990

Intrauterine growing skull fracture.

Growing skull fractures with development of leptomeningeal cysts are rare complications of head injuries and have not been described in the perinatal period. The case history of a newborn with bilateral parietal fractures and the formation of a leptomeningeal cyst on one side detected at birth is presented. The importance of radiographic evaluation, including skull films, computered tomography, and magnetic resonance imaging, as well as the associated subarachnoid cyst and the age of presentation are discussed.

Arachnoid Cysts↗
PubMed1990

Relationship between performance of selected scapular muscles and scapular abduction in standing subjects.

The purpose of this study was to examine the relationship between muscular forces generated by the middle trapezius and pectoralis minor muscles and the position of the scapula in relaxed standing. The muscular forces of 60 subjects were measured in standard manual muscle testing positions with a hand-held dynamometer. Scapular abduction in standing was measured with a tape measure. Each measurement was taken twice, and the measurements were shown to be reliable. The correlation between scapular abduction and middle trapezius muscle force was .20. The correlation between scapular abduction and pectoralis minor muscle force was .14. The correlation between scapular abduction and a ratio of middle trapezius muscle force to pectoralis minor muscle force was .01. The results indicate that no relationship exists between the position of the scapula in standing subjects and the muscular force produced by the middle trapezius and pectoralis minor muscles. Clinical practices based on an assumed relationship between these variables (eg, the practice of using middle trapezius muscle strengthening exercises to correct a forward shoulder position) should be reexamined in light of these findings.

Adult↗