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Biomedical subjects

R Finley

Publications and source records attributed to R Finley.

At least 19 recordsLinked to original sources
PubMed2005

Executive dysfunction in hyperhomocystinemia responds to homocysteine-lowering treatment.

An elevated serum homocysteine level is a risk factor for the development of cognitive impairment. Reported is a late-onset case of hyperhomocystinemia due to a vitamin B12 metabolic deficit (cobalamin C) with cognitive impairment, primarily in frontal/executive function. After homocysteine-lowering therapy, the patient's functional and neuropsychological status improved in conjunction with a decrease in leukoariosis on his MRI scan. These findings suggest that homocysteine-related cognitive impairment may be partially reversible.

Adult↗
PubMed2002

Early patient outcomes after primary and revision total knee arthroplasty. A prospective study.

There has been speculation as to how the outcome of revision total knee arthroplasty (TKA) compares with that of primary TKA. We have collected data prospectively from patients operated on by one surgeon using one prosthesis in each group. One hundred patients underwent primary TKA and 60 revision TKA. They completed SF-12 and WOMAC questionnaires before and at six and 12 months after operation. The improvements in the SF-12 physical scores and WOMAC pain, stiffness and function scores in both primary and revision TKA patients were highly statistically significant at six months. There was no statistically significant difference in the size of the improvement in the SF-12 physical and WOMAC pain, stiffness and function scores between the primary and revision patients at six months after surgery. The SF-12 mental scores of patients in both groups showed no statistically significant difference after surgery at the six- and 12-month assessments. Our findings show that primary and revision TKA lead to a comparable improvement in patient-perceived outcomes of physical variables in both generic and disease-specific health measures at follow-up at one year.

Aged↗
PubMed1999

An epidemic of burkholderia cepacia transmitted between patients with and without cystic fibrosis.

Burkholderia cepacia is an important pathogen in cystic fibrosis (CF) and an infrequent cause of nosocomial infection in non-CF patients. This report describes a large hospital outbreak that appeared to involve both patient groups, a previously unrecognized phenomenon. Ribotype restriction fragment length polymorphism (RFLP) profiles and pulsed-field gel electrophoresis-resolved macrochromosomal RFLPs were analyzed, a ribotype-based phylogenic tree was constructed, and case-control and cohort studies were performed. A single dominant clone was found in both CF and non-CF groups. Phylogenic analysis suggests that it has evolved independently and that such highly transmissible strains can emerge rapidly and randomly. Acquisition risk in the CF patients was linked to hospitalization (odds ratio=5.47, P=.0158, confidence interval=1. 28-26.86) and was associated with significantly increased mortality rates. Infection control policies must now consider this threat of transmission between non-CF and CF patients.

Adolescent↗
PubMed1997

Phase I clinical trial of all-trans-retinoic acid with correlation of its pharmacokinetics and pharmacodynamics.

A phase I trial of all-trans-retinoic acid (ATRA) was conducted to establish the maximum tolerable dose (MTD) of ATRA given once daily to patients with solid tumors. Cancer patients for whom no standard therapy was available were treated with ATRA once daily. Doses were escalated in cohorts of at least three patients. The pharmacokinetics of ATRA were assessed on day 1 for all patients and weekly for 31 patients who received doses of > or = 110 mg/m2 per day. Patients were followed for toxicity and response. Correlations of toxicity frequency and grade with pharmacokinetic parameters were sought. In addition, correlation of changes in ATRA pharmacokinetics with the concentration of ATRA metabolites in plasma were sought. A total of 49 patients received ATRA at doses ranging from 45 to 309 mg/m2 per day. Hypertriglyceridemia was dose-limiting at 269 mg/m2 per day. Other frequent toxicities included mucocutaneous dryness and headache. With chronic dosing, plasma ATRA concentrations fell in 59% of patients. Stable, low, or variable [ATRA] were seen in 16%, 6%, and 16% of patients respectively. Age, gender, smoking, or concurrent medication did not correlate with the pharmacokinetic pattern. Severe toxicities tended to occur with initial peak [ATRA] of > or = 0.5 microgram/ml (1.7 microM), and the toxicity frequency did not change if [ATRA] decreased with continued dosing. No consistent change in 4-oxo-ATRA or retinoid glucuronide concentrations was observed with decreases in plasma [ATRA]. The recommended once-daily ATRA dose is 215 mg/m2, although significant interpatient variability is observed in toxicity and plasma retinoid concentrations. Although not statistically significant, more frequent and severe toxicity tended to occur in patients with higher plasma peak ATRA concentrations. Other factors, such as responses at target tissues, may be at least as important as the plasma ATRA concentration in predicting toxicity and/or response.

Adult↗
PubMed1995

Impacted teeth: prophylactic extractions or not?

Pathologic changes related to impacted teeth are infrequent. However, considerable damage to bone and adjacent teeth may result if they do occur. Four patients are described in whom different circumstances existed with impacted teeth. Extractions are indicated when the anatomic location of the impacted teeth is most favorable and when the patient's systemic and hematologic condition is least compromising, even if the teeth are asymptomatic at that time.

Adolescent↗
PubMed1994

Clinical implications of p53 gene mutation in the progression of Barrett's epithelium to invasive esophageal cancer.

The p53 tumor suppressor gene has been implicated in human esophageal tumorigenesis, and mutations are reported in primary esophageal adenocarcinomas and associated Barrett's epithelium. To evaluate the potential clinical significance of this molecular genetic marker in the progression of Barrett's epithelium to invasive esophageal cancer, we studied 20 patients with Barrett's epithelium, 10 of whom had an associated adenocarcinoma. p53 gene mutations were screened using polymerase chain reaction (PCR)/single-strand conformation polymorphism (SSCP) analysis and p53 oncoprotein distribution by immunohistochemistry. Point mutations were localized to exons 5 and 7 of the p53 gene, previously recognized as "hot spots." p53 gene mutations and immunoreactivity were detected in 7 of 10 patients with primary esophageal adenocarcinomas and in 6 patients with associated Barrett's epithelium, 3 of whom had high-grade dysplasia. Little correlation was observed between p53 positivity and clinicopathologic findings or outcome, although two patients with p53 mutations subsequently developed second primary cancers. Of 10 patients with Barrett's epithelium alone, 6 had p53 mutations, with mild or no dysplasia histologically, suggesting that p53 gene mutation may be an early event in progression to invasive cancer. No patient has developed invasive cancer to date, with a median follow-up of 8 years. These studies further implicate the p53 gene in the Barrett's epithelium-to-carcinoma sequence. Prospective surveillance studies incorporating molecular analysis of the p53 gene are warranted to further evaluate p53 as a predictor of patients at high risk for developing malignancy.

Adenocarcinoma↗
PubMed1993

Taxol: a history of pharmaceutical development and current pharmaceutical concerns.

Taxol, a unique diterpene anticancer compound derived from the bark of the Taxus brevifolia (Pacific yew) tree, induces cytotoxicity by a novel mechanism of action. An antimicrotubule agent, Taxol promotes the formation and stabilization of the tubulin polymer unlike other anticancer agents that induce microtubule disassembly. Because of its poor aqueous solubility, Taxol is formulated as a solution in 50% Cremophor EL and 50% dehydrated alcohol, USP. The Cremophor EL and dehydrated alcohol vehicle used in the formulation of Taxol creates some interesting challenges for its preparation and administration. The pharmaceutical concerns associated with the preparation and administration of Taxol are discussed.

Animals↗
PubMed1991

Functional results of gastric interposition following total esophagectomy.

Functional results of gastric interposition were evaluated in 35 patients at 3 to 84 months following esophagectomy. All patients were satisfied with the results of surgery, although 14 (40%) still experienced some degree of dysphagia. Transit times for radiolabeled solids across the cervical esophagus and anastomosis were not significantly different for the 14 symptomatic patients (mean 77 seconds) versus 21 asymptomatic patients (mean 55 seconds). Spontaneous emptying of the vagotomized intrathoracic stomach appeared complex, with mean percentage radionuclide clearances at 30 minutes (semisolid meal) calculated at 37% for 23 patients with early satiety (versus 42% asymptomatic) and at 38% for nine patients with reflux (versus 39% asymptomatic), all values comparable to emptying of the normal intra-abdominal stomach (35% clearance at 30 minutes). Our data suggest that the interposed stomach appears to retain its gastric identity rather than act as an inert conduit, and that although little correlation exists between postoperative symptoms and objective findings, the stomach remains a satisfactory esophageal substitute.

Adult↗
PubMed1989

Results of a multicenter outpatient burn study on the safety and efficacy of Dimac-SSD, a new delivery system for silver sulfadiazine.

Dimac with silver sulfadiazine (Dimac-SSD), a new silver sulfadiazine delivery system, was evaluated prospectively in a multicenter study for the treatment of outpatient burn injuries. The goal of this study was to evaluate the effect of Dimac-SSD on the microbiology of the burn wounds and to quantitate its clinical safety and efficacy. A total of 197 patients were evaluated. Eight (4%) of these patients did not complete the study. Six patients withdrew because of local discomfort caused by the Dimac-SSD and two patients were terminated because of technical problems. The mean +/- SD duration of treatment with Dimac-SSD was 12 +/- 8.5 days, during which time the mean number of dressing changes was 2.9 per patient. During treatment with Dimac-SSD, the burn wound bacterial flora remained stable and overgrowth with Pseudomonas species or Gram-negative bacilli did not occur. Only four (2%) patients developed clinical infections; thus the Dimac-SSD appeared to have good antimicrobial effectiveness. This dressing was not associated with any organ system or metabolic side-effects and patient discomfort during application and removal was minimal. Thus this new delivery system for silver sulfadiazine was associated with excellent wound healing, a low incidence of wound infections, reduced frequency for dressing changes, and excellent patient compliance.

Acrylates↗
PubMed1987

Pulmonary permeability edema in a large animal model of nonpulmonary sepsis. A morphologic study.

Morphologic studies were undertaken in a sheep model of pulmonary permeability edema (PPE) induced by cecal ligation and perforation. Biopsies taken every 24 hours through 96 hours following induction of sepsis showed, at 24 hours, interstitial edema accompanied by widespread aggregation of polymorphonuclear leukocytes. This was confirmed by electron microscopy, which also demonstrated endothelial cell swelling, platelet aggregation, and fibrin deposition. By 48 hours, a "thromboangiitis" had developed that persisted through 96 hours. In vitro pulmonary angiograms done at 60 and 96 hours showed multiple filling defects; it was possible to demonstrate that these defects corresponded to the "thromboangiitis." These thrombotic lesions, which were not the result of embolization from indwelling lines, closely resembled vascular changes described in the adult respiratory distress syndrome. It is believed that this is the first time that such lesions have been described in a model of PPE resulting from nonpulmonary sepsis.

Animals↗
PubMed1986

The psychosocial adjustment of the Amerasian refugees. Findings from the Personality Inventory for Children.

The purpose of this study was to investigate the psychosocial adjustment of 24 Amerasian youths who had immigrated to the United States in 1983 and 1984. The Personality Inventory for Children (PIC) was translated into Vietnamese and administered to 18 mothers of Amerasian youths in a social service agency in a large southern city. Respondents reported significant mood disturbance and psychological distress in their children. Specifically, the depression, somatization, withdrawal, and psychosis subscales of the PIC were clinically elevated for the entire group. An evaluation of individual profiles revealed marked tendencies toward somatization and withdrawal. These findings are consistent with other studies on the psychosocial adjustment of Southeast Asian refugees.

Adaptation, Psychological↗
PubMed1986

High-energy roller injuries to the upper extremity.

Eleven cases of high-energy industrial roller injuries treated between 1980 and 1984 were retrospectively reviewed. The dominant extremity was affected in nine. Six patients sustained fractures and/or dislocations, and three of these patients required fasciotomies for clinical signs of impending compartment syndromes. All fracture/dislocations, with the exception of a scapula fracture, anterior dislocation of a thumb interphalangeal joint, and a fractured coronoid process of the ulna, required open reduction with internal fixation. Three patients required split-thickness skin grafting for extensive skin degloving. Two patients required immediate amputation. Late sequelae included prolonged edema, nutritional depletion, neuroma formation of the superficial branch of the radial nerve, late carpal tunnel syndrome, and partial brachial plexus palsy. Industrial roller injuries continue to be an occupational hazard associated with more severe crushing trauma than the low-energy wringer washer injuries first described by MacCollum (11). Attention must be paid to the treatment of crushed skin, muscle, and nerves, fracture stabilization, nutritional support, and occupational therapy. Concurrent monitoring for signs of a developing compartment syndrome and complications of rhabdomyolysis is essential.

Accidents, Occupational↗