The clinical nurse specialist as a consultant.
Explore the source record for details and available documents.
Consultants↗
Biomedical subjects
M L Walker
Publications and source records attributed to M L Walker.
Surgical treatment of sagittal synostosis.
A technique for the correction of scaphocephaly is described. It is safe, is technically straightforward, and rapidly corrects the deformity. The results of a standardized operative procedure in 50 patients are reviewed.
Cranial Sutures↗
How nursing service administrators view clinical nurse specialists.
Explore the source record for details and available documents.
Administrative Personnel↗
Management of pancreatic trauma: concepts and controversy.
Four cases of pancreatic trauma are critiqued, and an algorithm to guide management is outlined. The key to operative assessment of pancreatic injury is the presence or absence of major ductal disruption. The surgeon's assessment is usually accurate, but when doubt exists, intraoperative pancreatography is advocated. In patients with significant pancreatic head injury with ductal disruption and associated duodenal injury, pancreaticoduodenectomy is recommended. In spite of reports to the contrary, duodenal diverticulization should be reserved for the patient with a repairable duodenal injury in association with a pancreatic head wound without ductal disruption.
Accidents, Traffic↗
Pediatric head injury: the critical role of the emergency physician.
Neurologic injury is a significant source of morbidity and mortality in pediatric patients. In order to clarify the factors influencing outcome in pediatric patients with severe head injury, we studied 200 consecutive patients with Glasgow Coma Scale (GCS) scores of 8 or less. The following data were collected: age, GCS score, presence of mass lesions, oculovestibular reflexes (OVR), pupillary size and reactivity, intracranial pressure (ICP), apnea, presence of hypotension, hypoxia (PO2 less than 60 torr), or hypercarbia (PCO2 greater than or equal to 35 torr), presence of multiple trauma, and Modified Injury Severity Scale (MISS) score. Outcome was assessed by the Glasgow Outcome Scale at a minimum of six months following recovery. Of the 200 patients in the study, 86 (43%) had isolated head injury (IHI) and 114 (57%) had head injury plus multiple trauma (HI + MT). Overall, 26% of patients had mass lesions; 28% had altered OVR; 33% had fixed, dilated pupils; 79% had increased intracranial pressure; and 29% had hypotension, hypoxia, or hypercarbia. Overall mortality was 21.5%. Severity of injury (as judged by presence of mass lesions, GCS, OVR, fixed pupils) was more pronounced in patients with IHI, although increased ICP was more common in patients with HI + MT; however, death was almost three times more common in patients with HI + MT (30% versus 10.5%). In the IHI group, two of nine patients who died (22%) had hypotension, hypoxia, or hypercarbia; all but four patients (88%) in the HI + MT group had hypotension, hypoxia, or hypercarbia.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Gonadal status influences developmental patterns of serum prolactin in female rhesus monkeys housed outdoors.
Although estradiol (E2) is thought to facilitate PRL secretion under certain conditions in female primates, the role of E2 or other ovarian products in the control of PRL secretion during puberty is unknown. The present study examined the influence of gonadal status on serum PRL levels in prepubertal monkeys housed in an outdoor environment. Basal levels of PRL were examined in three groups of spring-born females that were studied from 12 to 28 months of age (May 1982 to September 1983): gonadally intact (INT; n = 8), ovariectomized (OVX; n = 5), and ovariectomized and treated chronically with E2 (E2OVX; n = 5). All groups exhibited a significant annual rhythm in PRL levels with peaks (10-20 ng/ml) at 14 and 26 months (June to July) and a nadir (less than 2 ng/ml) at 19 months (November to December). Basal PRL levels were significantly higher from 12 to 15 months (May to August) in E2OVX subjects, with OVX having significantly greater concentrations than INT females. Group differences were not evident during the period of minimal secretion from 16 to 20 months (September to January). Finally, levels were again significantly higher in both E2OVX and OVX subjects during the subsequent period from 21 to 27 months (February to August). Although serum levels of E2 were lower in INT (30.9 +/- 2.3 pg/ml) than E2OVX females (51.4 +/- 4.0 pg/ml), group differences in PRL could not be attributed to E2 since OVX females, with no measurable levels of E2 (less than 15 pg/ml), had intermediate levels of PRL. These data suggest that during primate maturation serum PRL levels are dampened by some product of the ovary. Furthermore, whether age specific or environmentally mediated, this rhythm indicates an annual alteration in PRL release, with absolute levels enhanced by E2 replacement after ovariectomy, for prepubertal monkeys housed outdoors. In addition, a significant maturational increase in PRL levels was observed only in INT females when serum levels of PRL were compared for the ages 12-16 months to 24-28 months corresponding to the period between May and September for 2 successive years. These changes in PRL were not related to age-dependent changes in serum E2. Acute treatment of both E2OVX and OVX females with a single injection of E2-benzoate at three different ages did not induce any changes in serum PRL.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
Estimation of body fat in female rhesus monkeys.
Measurement of height (crown-rump length), body weight, and abdominal subcutaneous fat depth, based on skinfold thickness taken from 13 female rhesus monkeys comprising two age groups were correlated with body fat values derived from tritiated water determinations of total body water. The manner with which each measure was related to percent body fat differed as a function of age of the animal. In the young, nulliparous females, crown-rump length was the single best predictor of body fat, whereas in the older, multiparous females, skinfold thickness correlated most highly with body fat. When all measurements, including the Quetelet index [(wt/ht)2 x 1,000], were combined statistically and regressed against percent body fat, a significant increase in predictive ability was obtained. When each age group was considered separately, the resulting equations again reflected the age-group biases. In addition, as an internal check on the validity of the regression equations, an additional regression analysis was performed using morphometric data from selected animals in each age group. These equations yielded accurate estimates of body fat when compared to determinations made from total body water. These analyses indicate that the predictive accuracy of morphometric data is greatly enhanced by using these measurements in concert. Furthermore, the utility of such predictions is influenced by the specific physical characteristics of the subject population.
Adipose Tissue↗
Severity of illness and injury in pediatric air transport.
To assess severity of illness or injury in pediatric patients undergoing air transport, we prospectively evaluated 636 patients during 29 months of service. All patients were classified by age, diagnosis, and method and distance of transport. Therapeutic intervention scoring system (TISS) scores were calculated in all patients, Glasgow coma scale (GCS) scores were used in patients with altered level of consciousness, and Modified Injury Severity Scale (MISS) scores were used in patients with multiple trauma. A total of 57.5% of patients were transported by helicopter, 37.5% by fixed-wing aircraft, and 5% by ground transport. Mean distance of transport was 207 miles. Age ranged from 3 weeks to 16 years, with 45% of children under 1 year of age. Trauma (24.6%), neurologic disease (24.2%), and respiratory failure (20%) were the most common diagnoses. Eighty-one percent of patients were taken to surgery or admitted to the intensive care unit immediately on arrival at the regional children's hospital. Mean TISS score was 36.7, with 51% of patients having TISS scores greater than 30. The mean MISS score was 34.5, and 75% of patients had MISS scores greater than 25. Nineteen percent of patients had GCS scores less than or equal to 8. Overall mortality was 7%, with 9% mortality in patients with trauma versus 6.3% in nontraumatic diseases. TISS scores greater than 30, MISS scores greater than 25, and GCS scores less than or equal to 8 were associated with increased mortality (P less than .01).
Adolescent↗
Further experience with the modified abbreviated injury severity scale.
In a 3-year period of prospective study, 250 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a modification of the Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except for neurologic injuries. Neurologic injuries are scored by using a combination of the Glasgow Coma Scale (GCS) and other neurologic findings (presence of surgical mass lesion, pupillary light response, and oculocephalic reflexes). The MISS is calculated as the sum of the squares of the three most severely injured body areas. The mean MISS score was 27.8, with 38% of MISS scores greater than or equal to 25 and 62% less than 25. Among those with MISS scores greater than or equal to 25 there was a 40% mortality and 30% disability, while there were no mortalities and 1% disability for those with MISS scores less than 25 (p less than 0.001). Overall mortality was 15%, with 10% disability. Mean MISS scores for death and disability were 33.4 and 30.2, respectively. Neurologic injuries were present in 173 patients (69%); 128 patients had severe head injuries (coma greater than 6 hours duration); 80% of all deaths were due to neurologic injury and all but two deaths had some degree of head injury; the remaining 20% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 73% mortality, while those with grades 4 and 3 injury had 8% and 2% mortality, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Abdominal Injuries↗
Bactericidal activities of five antibiotics during short-term exposure to coagulase-negative staphylococci.
After a 1-h exposure to concentrations used for topical prophylaxis in neurosurgical procedures, bacitracin, vancomycin, and oxacillin were bactericidal against more than 90% of 48 body fluid isolates of coagulase-negative staphylococci. More than 10% of isolates survived despite exposure for 4 h to concentrations of gentamicin and streptomycin greater than those employed for topical prophylaxis.
Anti-Bacterial Agents↗
Factors affecting outcome in the pediatric patient with multiple trauma. Further experience with the modified injury severity scale.
In a 5-year period of prospective study, 369 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a Modification of Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except that the classification of neurological injuries are scored by the Glasgow Coma Scale (GCS) and other neurological findings (presence of a surgical mass lesion, pupillary light response, and oculocephalic reflexes). The MISS is calculated as the sum of the squares of the three most severely injured body areas. The mean MISS score was 23.8 with 33% of MISS scores greater than 25 and 67% less than 25. Among those with MISS scores greater than 25 there was a 44% mortality and 31% disability. In the group with MISS scores less than 25, there were no mortalities, and a 1% disability (p less than 0.001). Overall mortality was 14% with 9% disability. Mean MISS scores for death and disability were 35.1 and 29.6, respectively. Neurologic injuries were present in 274 patients (74%). 163 patients had severe head injury (coma greater than 6 h duration). 86% of all deaths were due to head injury and all but 2 deaths had some degree of head injury. The remaining 14% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 74% mortality, while those with grades 4 and 3 injury had 8 and 1.5% mortality. In a comparison with pediatric patients with head injury only (coma greater than 6 h, no multiple trauma) there was found to be a 12% mortality in the head injury only group versus a 33% mortality in the multiple trauma plus head injury group. The MISS serves as an accurate predictor of morbidity and mortality in pediatric trauma. The best predictors of outcome were a MISS less than 25 and the degree of neurological injury.
Adolescent↗
Endocrine control of the seasonal occurrence of ovulation in rhesus monkeys housed outdoors.
In female rhesus monkeys (n = 12) housed in a seminatural environment, serum gonadotropin and steroid levels fluctuated annually in a pattern indicative of a seasonally restricted period of ovulatory cycles in the fall and winter and anovulatory cycles in the spring and summer. This seasonal endocrine rhythm occurred independent of pregnancy and lactation, although the presence of a suckling infant delayed the onset of ovulation in the fall by 81 +/- 3.7 days (Dec. 4 vs. Sept 14). Except for serum PRL, levels of gonadotropin and ovarian hormones were similar in lactating and nonlactating females during the spring and summer anovulatory months. Serum levels of LH (less than 10 ng/ml), FSH (less than 4 micrograms/ml), and 17 beta-estradiol (E2; less than 30 pg/ml) were low throughout the summer anovulatory period, exhibiting a significant rise approximately 20 days before first ovulation. Serum progesterone levels were low throughout the 100 days before ovulation (less than 0.5 ng/ml) and did not rise until ovulation occurred. PRL levels remained elevated (greater than 20 ng/ml) in lactating females until 50 days before the first ovulation of the breeding season, but were low throughout the ovulatory, anovulatory, and ensuing ovulatory periods (less than 10 ng/ml). During the breeding period, females exhibited from two to six ovulations. Although the first ovulation of the breeding season occurred within a 40-day period for all females, a subset (n = 6) ceased ovulations significantly earlier than the remaining six females (Jan. 26 vs. March 3). The early cessation of ovulation for these females was associated with significantly lower body weight. After the last ovulation, FSH and E2 fell and remained low, at levels indistinguishable from those of the ensuing spring-summer anovulatory period. In contrast, in females who ceased ovulations later in the breeding season, the period following the luteal phase of the last ovulation was characterized by E2 and gonadotropin levels that were intermediate between those of the anovulatory months and normal follicular phase values. Serum progesterone levels were slightly but significantly elevated following the last ovulation for both groups of females. These data indicate that low basal levels of gonadotropin secretion during the seasonal anovulatory period may result from diminished GnRH secretion or from an alteration in pituitary sensitivity to GnRH stimulation. These data further suggest that the timing of ovulations and associated changes in the neuroendocrine system controlling gonadotropin secretion may be mediated by an environmental variable.
Animals↗
Oestradiol and somatomedin-C influence body weight patterns in premenarchial rhesus monkeys housed outdoors.
The influence of gonadal status on the pattern of changes in body weight was examined in three groups of outdoor-housed premenarchial rhesus monkeys (Macaca mulatta) from 1 to 2 years of age. Gonadally intact (n = 8) and ovariectomized oestradiol-treated females (n = 5) gained significantly more weight than ovariectomized untreated females (n = 5). The overall larger weight gains for the intact and ovariectomized oestradiol-treated groups were associated with significantly higher fasting levels of serum insulin. All subjects exhibited two periods of significant weight gain from 12 to 16 months of age between May and September and from 21 to 24 months of age between February and May. Serum GH and somatomedin-C levels were also raised during these periods of accelerated growth. Although the pattern of serum GH was similar among groups, serum somatomedin-C levels were significantly higher in both intact and ovariectomized oestradiol-treated subjects from 21 to 24 months of age, suggesting physiological levels of oestradiol may facilitate somatomedin-C production during periods of increased GH secretion. Thus, absolute changes in body weight in outdoor-housed premenarchial rhesus monkeys are influenced by gonadal status, possibly mediated through increases in serum insulin. Furthermore, dynamic changes in body weight occur during prepubertal development, with the largest increments associated with increased somatomedin-C levels at specific ages synchronized with natural changes in the environment.
Animals↗
In vitro comparison of primary incisor enamel surfaces etched with an acid solution or acid gel.
Explore the source record for details and available documents.
Acid Etching, Dental↗
Consequences of first pregnancy in rhesus monkeys.
Explore the source record for details and available documents.
Aging↗
Using lasers in neurosurgery.
Surgical lasers have definite limitations. They are best at removing small tumors in delicate brain locations. They are useful for extrinsic lesions and have been found to be helpful in pediatric neurosurgery. They are not useful for many intrinsic hemisphere tumors, especially glioblastoma. The laser does not make a surgeon better; it may, however, allow the surgeon to dissect the tumors in a more delicate and precise way.
Animals↗
Menstrual cycle characteristics of seasonally breeding rhesus monkeys.
Rhesus monkeys in seminatural environments exhibit a distinct seasonal mating cycle with conceptions restricted to the fall and winter months. In the present study, the characteristics of menstrual cycles were examined during a 1-year period in twelve rhesus monkeys in whom pregnancy was prevented. Menses occurred throughout the year, but ovulations were observed only in the fall and winter months. Menses in the spring and summer months occurred irregularly and were associated exclusively with anovulatory cycles. The total number of ovulations exhibited by these females during the breeding season ranged from two to six and was positively related to body weight, mean luteal phase progesterone (P) levels of normal cycles and social dominance rank. Ovulations with a short luteal phase were exhibited by four females (seven cycles), with the likelihood of occurrence increasing as the breeding season progressed. The incidence of abnormal cycles was predicted from the linear combination of parity, body weight and luteal phase P of normal ovulatory cycles. These results suggest that during the seasonally delimited period of ovulation, females exhibit a range in the quality and quantity of ovulations which may be predicted by certain idiosyncratic physical and behavioral traits.
Animals↗