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Biomedical subjects

R Fry

Publications and source records attributed to R Fry.

At least 37 records · Page 2Linked to original sources
PubMed1995

Carcinoma of the anal canal.

From 1975 to 1990 65 patients with carcinoma of the anal canal received radiation therapy alone or in conjunction with other modalities. Follow-up ranged from 12 to 171 months (mean: 59 months; median: 44 months). Actuarial disease-free survival (including salvage surgery) for T1-3 N0 lesions was 88% +/- 7% at 10 years. This was independent of T stage (91% for T1, 88% for T2, and 100% for T3). Disease-free survival was significantly worse for T1-3 N+ lesions (52% +/- 23% disease-free at 10 years, P = .025) and T4 lesions (0/8 disease free by 21 months, P < .001). Of the 57 patients with T1-3 lesions, 46 received low to moderate doses of radiation (< or = 5,000 cGy) in conjunction with infusional 5FU based chemotherapy. These were reviewed for treatment related factors. Among patients treated with low to moderate dose chemoradiotherapy the local control (including salvage surgery) was excellent: 100% for T1 lesions and 88% +/- 6% for T2, 3 lesions. There was a suggestion that increasing the dose of radiation to the tumor may reduce the need for surgery for T2, 3 lesions. For T2, 3 lesions the local control excluding surgery was 63% +/- 12% with 3,000 cGy plus chemotherapy, as opposed to 77% +/- 11% with 4,000-5,000 Gy (mean 4,600 cGy) plus chemotherapy. The most important factor for posttreatment toxicity was the addition of pelvic surgery to chemotherapy and radiotherapy. Eighteen patients who received chemoradiotherapy either had a history of prior pelvic surgery (five cases) or underwent APR following chemotherapy (13 cases). There were a total of nine grade 3 or 4 complications (including all five cases of small bowel obstruction) in this group. There was a significantly lower (P = .04) incidence of complications in the remaining patients: 2/47 (4%). It should be noted that no patient required a colostomy for management of treatment sequelae, the interventions taken were all successful in managing complications, and no complication was fatal. Nonetheless these results suggest that, for some T3 and T2 lesions, measures which reduce the need for salvage surgery might improve overall quality of life by reducing complications, although it may prove difficult to demonstrate an improvement in the excellent disease-free survival. In addition, measures should be taken to reduce the volume of irradiated bowel if a patient has a history of prior pelvic surgery.

Adult↗
PubMed1994

Electroencephalography as an aid in the exclusion of Alzheimer's disease.

OBJECTIVE: To determine the usefulness or otherwise of the awake electroencephalogram (EEG) in the diagnosis of Alzheimer's disease (AD). DESIGN: Prospective collection of one or more awake EEGs in patients diagnosed as having AD or mixed AD and multi-infarct dementia according to current systematic criteria with analysis of those cases confirmed by postmortem examination. Systematized blind interpretation of EEGs. SETTING: Tertiary care practice with both ambulatory and hospitalized patients, ie, neurological department in general hospital and psychogeriatric unit in psychiatric hospital. PATIENTS: A series of 86 subjects with AD and 17 with mixed AD and multi-infarct dementia being those members of a consecutive series on whom postmortem information was available. Awake EEGs in 56 age- and sex-matched control subjects. RESULTS: Seventy-five patients with AD (87.2%) and 13 of the mixed group (76.5%) had abnormal EEGs on first testing, giving a sensitivity of 87.2% for uncomplicated AD. Ultimately, 79 (92%) of 86 patients with AD had abnormal EEGs. Twenty (35%) of 56 EEGs for matching control subjects were abnormal. Moderately abnormal or severely abnormal EEGs were found in 10 (50%) of 20 of the patients with AD of less than 4 year's duration compared with two (4.1%) of 49 of the control subjects, giving a specificity of 95.9% for EEGs with this degree of abnormality. The normal EEG had a negative predictive value of 0.825 with respect to the diagnosis of AD in these populations. CONCLUSIONS: Widespread availability, low cost, and high sensitivity support the use of the awake EEG in the diagnosis of AD.

Aged↗
PubMed1994

The influence of therapeutic self-disclosure on perceived marital intimacy.

This study examines the effect of therapeutic changes in a couple's self-disclosure behavior and its impact on their perception of their marital intimacy. Twenty couples participated in 10 weekly sessions of structured self-disclosure. The Self-Disclosure Coding System was used to rate audiotapes of the second and ninth sessions. Two rates, blind to treatment condition, demonstrated high interrater reliability on measures of changes in: 1) amount of self-disclosure; 2) whether self-references were positive, negative, or neutral; 3) depth of disclosures; and 4) rate of self-reference. Spouses, who were rated as disclosing in greater depth and referring to themselves in a more positive manner, perceived increased intimacy in their marriages as a consequence of therapy. The role of self-disclosure between spouses as a specific technique in marital therapy merits further study.

Female↗
PubMed1993

Temporal lobe atrophy on magnetic resonance imaging in the diagnosis of early Alzheimer's disease.

OBJECTIVE: To evaluate the use of simple ratings and linear measures of atrophy in the temporal lobe structures obtained with magnetic resonance imaging coronal scans in the diagnosis of early Alzheimer's disease. DESIGN: Prospective series. The National Institute for Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease. Blinded assessment. SETTING: Dementia study in a university hospital. SUBJECTS: Patients with Alzheimer's disease (n = 34), scoring 150 or more on the Extended Scale for Dementia, and age-matched healthy community volunteers (n = 39) who had both magnetic resonance imaging coronal scans and a psychometric assessment using the Extended Scale for Dementia within 6 months were included. MEASURES MAIN MEASURES: T1-weighted magnetic resonance imaging coronal scans, a 1.5-T system. The degree of atrophy rated (0 to 4) in both sides of the temporal neocortex, entorhinal cortex, hippocampal formation, temporal horns, third ventricle, lateral ventricles, and frontal and parietal cortex. Linear measures: the area of hippocampus and the maximal transverse width of temporal horns. RESULTS: Differentiation between patients with Alzheimer's disease and controls was limited by considerable variations in sensitivity and specificity. Receiver operating characteristics analysis revealed a clear order of discrimination, the entorhinal cortex and the temporal neocortex being the two best, followed by the temporal horns and hippocampal formation. For a given specificity of 90%, the corresponding sensitivity for the entorhinal cortex, temporal neocortex, temporal horns, and hippocampal formation was 95%, 63%, 56%, and 41%, respectively. Linear measures differed significantly but showed considerable overlap. CONCLUSION: The presence of rated atrophy in selected temporal structures makes the diagnosis of Alzheimer's disease more likely, but the absence does not rule out the possibility of early Alzheimer's disease.

Adult↗
PubMed1993

Adult physical illness and childhood sexual abuse.

Recent interest has centred on the possible long-term physical effects of child sexual abuse. Research is now beginning to be carried out in this area. Some studies are portraying associations that are difficult to substantiate, as the methodological problems are considerable. This article attempts to summarize the literature to date and set some contexts for possible future research directions.

Adaptation, Psychological↗
PubMed1992

Adjunctive radiation therapy for rectal carcinoma.

From 1977 through 1985, 113 patients received radiation therapy in conjunction with definitive surgery for adenocarcinoma of the rectum. Posttreatment consisted of a minimum follow-up of 4 years. Radiation was given as postoperative (eight patients), short-course preoperative (2,000 cGy/5 fx, 21 patients), or as full-course preoperative treatment (4,500-5,000 cGy, 84 patients). Three patients received chemotherapy as part of the adjuvant treatment. The local control for the total group was 90% (local failures, 11 of 113), and the rate of recurrence at any site (distant or local) was 30% (34 of 113). Local failure was not significantly influenced by pretreatment clinical findings, tumor grade, or surgical stage. Because of distant failures, overall recurrence was significantly associated with surgical stage--0% (0 of 15) for Astler-Coller A, 23% (7 of 30) for B1, 25% (7 of 28) for B2, and 50% (20 of 40) for B3 or C lesions (p less than 0.01). Locally advanced pretreatment clinical findings were not independent of surgical stage as predictors of outcome. In particular, 14 of the tumors that received full course preoperative radiation were initially either nearly obstructing, circumferential, or deeply fixed. However, by the time of surgery, they were A or B1 lesions (probably down-staged lesions). Only one of 14 (7%) ultimately failed with a local and distant recurrence. There were four cases (3.5%) of small bowel obstruction requiring surgical management. Overall, there were 12 complications (11%) requiring either surgical or major medical management. The complication rate was not associated with radiotherapeutic factors. A strong association was noted between complications and the surgeon. Of 66 patients who had surgery with two colorectal specialists, four (6%) had serious complications. Of the remaining 47 patients who had general surgeons, eight (17%) experienced serious complications.

Actuarial Analysis↗
PubMed1991

Postgastrostomy tube deformity on upper GI series.

Three cases are presented in which a focal concave deformity occurred along the greater curvature of the stomach on upper gastrointestinal (GI) series. These patients all had recent removal of a surgically placed gastrostomy tube from a similar location. This deformity appears to be related, at least in part, to invaginated gastric mucosa intentionally produced during surgical gastrostomy tube placement. This association and appearance should be noted as it may mimic other lesions.

Adult↗
PubMed1991

Radiographic fallopian tube recanalization: absorbed ovarian radiation dose.

Absorbed radiation dose to the ovaries during radiographic fallopian tube recanalization was estimated in 29 patients with use of thermoluminescent dosimeters placed in the vaginal fornix. With an average fluoroscopic time of 8.5 minutes +/- 5.5 and an average of 14 +/- 5 105-mm spot radiographs obtained, the average absorbed dose to the ovaries was 8.5 mGy +/- 5.6 (0.85 rad +/- 0.56). Technical guidelines for keeping patient radiation exposure to a minimum during this new interventional procedure are suggested.

Adult↗
PubMed1990

A randomized clinical trial of cognitive marital therapy.

Thirty-three couples with severe marital discord referred to a psychiatric outpatient department were randomly assigned to Cognitive Marital Therapy or a control group. Cognitive Marital Therapy is a brief, structured couple therapy, which involves spouses in reciprocal self-disclosure of personal constructs. The control group received the same number of sessions of self-disclosure from a programmed marital enhancement text. Personal distress, marital adjustment, marital quality, and aspects of self-disclosure were measured before and after treatment. Symptoms of depression as well as somatic and compulsive complaints showed significant improvement in both groups. The wives exhibited a trend suggesting that they were making more self-disclosures to their spouses after counseling. No discernable differences in outcome were found between the marital therapy group and the control group. Marital intimacy and marital satisfaction did not improve significantly over the course of 10 therapy sessions. This study suggests that the role of self-disclosure in marital therapy needs further clarification.

Adaptation, Psychological↗
PubMed1990

Helping postacute traumatically brain injured clients return to work: three case studies.

This paper presents three case studies of individuals who had sustained a severe brain injury and who are clients of a return to work programme emphasizing a supported employment approach. The case studies illustrate the types of interventions which are utilized, including job placement; job site and off-site training, advocacy, and compensatory strategies; and ongoing assessment and maintenance of social and productive gains in order to assist with job retention. The results of the case studies may be generalized to the population of brain injury survivors who require intensive and long-term intervention and support in order to return to employment.

Adult↗
PubMed1990

Pelvic congestion in women: evaluation with transvaginal ultrasound and observation of venous pharmacology.

Fourteen women with chronic pelvic pain due to congestion underwent transvaginal ultrasound scanning to observe changes in the diameters of dilated pelvic veins. Spontaneous fluctuations were observed, and intravenous dihydroergotamine resulted in a consistent venoconstrictor response (p = 0.0021) during 20 min observation. Transvaginal ultrasound is useful for imaging dilated pelvic veins and for the study of venous pharmacology.

Dihydroergotamine↗
PubMed1990

Prelingual deafness and psychiatry.

This article provides an introduction to the neglected area of psychiatry and prelingual deafness. 'Deafness' refers to prelingual profound deafness except where indicated, although many of the observations apply to some extent to prelingually partially hearing people.

Communication↗
PubMed1989

Adoption and identity: a case of anorexia nervosa.

Anorexia nervosa, as a retreat from and subsequent avoidance of intolerable maturational turmoil, can provide a vivid insight, especially as body weight is restored to normal within treatment, into the sexual and identity conflicts that have previously characterized the adolescence of the individual. When the adolescent has been adopted into the family then the challenge of developing biological (genetic) identity is especially great to the individual and his adoptive parents. A rare case of anorexia nervosa in a male adoptee is presented against this background. Our patient's dependent and smothering bond with his adoptive mother, which was loving but highly conditional, left him with no room for negotiation when it was threatened by his emerging sexual and other impulsivity and new assertiveness. Understanding and treatment of such cases can also help to shed light on the particular challenges that face many adoptive parents when their adopted children experience the thrust of puberty and enter adolescence.

Adoption↗
PubMed1989

The role of marital intimacy in psychiatric help-seeking.

Epidemiological studies have shown that most people with diagnosable psychiatric illnesses do not seek professional help. Symptoms of non-psychotic emotional illness, interpersonal relationship quality and personality traits have demonstrable associations. The influence of these factors on help-seeking was examined by comparing 57 psychiatric outpatients with a community sample of 90 symptomatic individuals on self-report measures of marital intimacy, life events, and personality, while controlling for symptomatology. Compared to non-patients, outpatients reported less intimacy in their marriages across a variety of relationship dimensions on the Waring Intimacy Questionnaire, and scored higher on the Psychoticism scale of the Eysenck Personality Questionnaire. Marital Intimacy level proved to be the best single predictor of patient and non-patient status, suggesting that help-seeking behaviour may be partly motivated by unsatisfactory marriages. The detection of low marital intimacy in these help-seekers might be an indication for prescribing marital therapy.

Adult↗
PubMed1989

Effect of supported employment on the vocational outcomes of persons with traumatic brain injury.

This paper reports the job placement of 5 males with severe traumatic brain injury. An individual placement model of supported employment was used. All individuals were placed in competitive employment and received staggered intervention over time by trained employment specialists. A multiple baseline design across persons was used to evaluate results. All individuals had been unable to work consistently or at all in competitive work environments. The range of wages was $4.25 to $5.00 per hour with an average of 339 hours of employment specialist intervention time required per case. The major problems experienced by employment specialists were insubordinate and disruptive behaviors as well as other inappropriate social behaviors displayed at the job site.

Adult↗