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Biomedical subjects

R Kane

Publications and source records attributed to R Kane.

At least 55 records · Page 3Linked to original sources
PubMed1988

Ankle tendons: evaluation with CT.

Computed tomographic (CT) analysis of 21 clinically suspected ankle tendon injuries was performed in 18 patients. In six of the 21 ankles surgical exploration was done, and in one ankle evaluation was done while the patient was under anesthesia. In all seven cases the CT findings were confirmed and in three the clinical diagnosis was disproved. CT provided additional information and helped guide treatment in the majority of patients studied. Thus CT is an accurate, noninvasive modality for assessing ankle tendon injuries.

Adolescent↗
PubMed1987

Hepatic cryosurgery with intraoperative ultrasound monitoring for metastatic colon carcinoma.

We utilized cryosurgery with intraoperative ultrasound (IOUS) monitoring in ten patients to treat multiple unresectable hepatic metastases from colorectal carcinoma. The liver was exposed at laparotomy, and tumors were subjected to three cycles of freezing (eight minutes each) and thawing. Freezing was monitored by IOUS, which visualized frozen tumor as a hyperechoic rim with posterior acoustic shadowing. Frozen normal liver appeared hypoechoic after thawing compared with normal unfrozen liver. There were no significant complications. The follow-up ranged from four months to 17 months (median, 7.5 months). Tumor response was documented by pathologic findings (coagulative necrosis), progressive fall of carcinoembryonic antigen levels, and computed tomographic scan evidence of necrosis and shrinkage of tumor. One patient underwent repeated laparotomy five months after cryosurgery and had the frozen lesions resected; there was no residual tumor. This study establishes the technical feasibility and antitumor response of hepatic cryosurgery and the use of IOUS for precise localization and monitoring of cryoablations.

Adult↗
PubMed1987

The influence of domestic position on health status.

Data from the Robert Wood Johnson Foundation 1982 survey of access to health care are used to examine the influence of household composition and members' domestic position--e.g. age, sex, marital status, and presence of children, on health status and use of health services. A hierarchical analysis was undertaken to sort groups of individuals and households having different domestic structures. The results of the analyses of use and access for these groups show that, after controlling for age, domestic position and household arrangements are significant explanatory variables. Ways to refine the approach are discussed.

Adolescent↗
PubMed1987

CT body stereotaxic system for placement of needle arrays.

A new CT body stereotaxic system that is particularly suited to multiple placements of needles precisely in parallel is described. By scanning through a right triangle placed on the patient's skin, the stereotaxic method defines an entry point for the first needle placement. An articulating arm is then used to aim the needle at the entry point and hold the needle at the correct angle. The arm can be angled so that the complex approaches from one scan plane to another can be made to place needle arrays through inaccessible lesions, for instance, beneath the diaphragm. Animal and phantom studies have shown that placement of multiple needle arrays in parallel from CT scan data is possible.

Biopsy, Needle↗
PubMed1986

CT body stereotaxis: an aid for CT-guided biopsies.

A new body stereotaxic system used to facilitate CT-guided biopsies is described. By scanning through a triangle placed on the patient's skin, the method defines an entry point for the biopsy. An articulating arm is then used to aim the needle at the entry point and hold the needle at the correct angle. The arm can be angled so that complex approaches from one scan plane to another can be made in order to take biopsies of lesions beneath the diaphragm. Using the system, 23 of 25 lesions were hit on the first needle manipulation; two manipulations were needed for each of the other two lesions. In comparison with previous experience, procedure time was decreased and the numbers of needle manipulations and localization scans were decreased 75% and 90%, respectively.

Biopsy, Needle↗
PubMed1986

Society of Gastrointestinal Radiologists Roscoe E. Miller Award. Monitoring hepatic cryosurgery with sonography.

The intraoperative sonographic appearance of frozen hepatic tumors and frozen normal liver was correlated with the histologic appearance of pathologic specimens from six patients. Frozen tissue was visualized as a hyperechoic rim with posterior acoustic shadowing. Normal liver that was frozen and then thawed appeared hypoechoic when compared with normal unfrozen liver. These findings allowed visualization of the extent of freezing in relation to tumor margins. Pathologically, frozen tumors showed definite evidence of necrosis. Normal liver tissue was extremely sensitive to cold and was completely necrotic after freezing. The sonographic appearance of frozen and thawed liver correlated precisely with the gross morphologic and histologic changes seen in the cryolesion. It appears that intraoperative sonography allows accurate monitoring of hepatic cryosurgery.

Carcinoma↗
PubMed1984

Systematic biases in functional status assessment of elderly adults: effects of different data sources.

Measuring functional status using specific instruments is an important part of geriatric assessment. These instruments, however, often rely on data sources different from those with which they were originally validated. To study possible biasing effects of different data sources on functional status scores, we examined scores for two widely used instruments (the Lawton Personal Self-Maintenance Scale, PSMS, and Instrumental Activities of Daily Living, IADL, Scale) on a group of hospitalized elderly (n = 61) using three different data sources (the patients themselves, the patients' nurses, and significant others). Analysis showed that PSMS scores derived from patients were significantly higher than scores derived from significant others (p less than .025) and that patient-derived IADL scores were significantly higher than both nurse-derived scores (p less than .001) and significant-other-derived scores (p less than .001). We also compared scores for a group of nursing home patients (n = 68) on the Katz Activities of Daily Living (ADL) Scale, using data obtained from patients and their nurses. Again, the patient-derived scores were significantly higher than those from nurses (p less than .001). We conclude that data sources for determining patient functional ability are not interchangeable and that patients may overstate their functional abilities, whereas significant others may understate them, relative to judgments of skilled nursing personnel.

Activities of Daily Living↗
PubMed1984

Impaired hearing in X-linked hypophosphataemic (vitamin-D-resistant) osteomalacia.

We assessed the hearing of 25 patients with X-linked hypophosphataemic osteomalacia. Twelve patients had subjective hearing loss and 2 had had episodic tinnitus, deafness, and vertigo similar to that in Ménière's disease. On pure-tone audiometry, 19 patients were shown to have sensorineural hearing loss, 3 of whom had evidence of an added conductive element. Tests were done to delineate sensory (cochlear) from neural deafness. Analysis of the stapedius reflex threshold, percentage speech discrimination score, tone decay, and loudness recruitment showed a disturbance of cochlear function. The possible mechanisms responsible for this dysfunction are discussed in the light of pathologic characteristics of familial hypophosphataemia and its extraosseous manifestations. Sensorineural hearing loss, a previously unrecognised complication of familial hypophosphataemic osteomalacia, occurs frequently.

Adolescent↗
PubMed1983

Effect of timing of measles vaccination on compliance with immunizations during the second year of life.

In 1976 the recommended time for routine measles immunization was changed from 12 to greater than or equal to 15 months of age. Because of the known decrease in compliance with immunizations given during the second year of life and the scheduling of an additional visit close to the time of the diphtheria-tetanus-pertussis (DTP) booster immunization, the potential benefit from this change might be offset by a decrease in compliance in securing both measles vaccination and DTP booster immunization. A study of the change in immunization compliance was carried out in a county health facility and in a prepaid medical group practice. Charts of 795 infants (395 born before and 400 born after the change) were reviewed to assess the rates of compliance with measles and with DTP immunizations. Administration of measles vaccine at a scheduled time decreased by 10% (0.05 less than P less than 0.06) at the public health facility after the change in 1976 and by 13% at the prepaid group practice (P less than 0.01). This difference evened out in the public health facility patients by age 2 years, but a 9% decrease was still apparent at the prepaid medical group. A similar pattern was seen in compliance with the DTP booster immunization at each site. Any benefit derived by an increased measles seroconversion rate apparently was offset by an overall decrease in compliance for both measles and DTP booster immunizations.

Community Health Services↗
PubMed1983

UCLA hospice evaluation study. Methodology and instrumentation.

An unbiased evaluation of hospice effectiveness requires a randomized controlled trial (RCT), but the implementation of such a design is difficult. This paper describes the methods of the only RCT to date and reports on the validity and reliability of scales selected or developed to assess attainment of hospice goals. The patients involved are those in a VA hospital in Los Angeles who have cancer and a prognosis of about 6 months and who consent. They and their significant others are interviewed periodically until the patient's death to measure such hospice variables as pain, depression, anxiety, satisfaction with care and the environment, activities of daily living, and bereavement effects. Many of the scales, including McGill Pain, CES-D Depression, and Satisfaction with Care scales, have been validated in other studies with similar samples. The authors' test-retest reliability analyses show that these scales are reliable with advanced cancer patients and their significant others with coefficients ranging from 0.77 to 0.97.

California↗
PubMed1983

The outcome of hospitalization for acute illness in the elderly.

The use of acute-care hospitals by the elderly is rising rapidly, particularly in the age group 75 and older. Any changes that will reduce the length of stay could result in considerable savings in health care costs. It is imperative to look at present policies and explore possible changes that could reduce costs by reducing the total hospital days. A study was conducted in a 290-bed county-founded community hospital in California that serves the majority of disadvantaged and poor elderly residing in an area with a population of approximately 300,000 persons. The objective was to determine what demographic, medical, and sociologic characteristics of elderly patients recorded at admission would be of value in predicting those most likely to change their functional status. It was found that the most important predictors of deterioration of function are (1) older age, especially 85+, and (2) abnormal mental status. Patients admitted from nursing homes had a longer than average length of stay, and those who survived (80 per cent) returned to a nursing home. It was concluded that routine assessment of elderly patients admitted for acute illness or injury could facilitate discharge planning by an early prediction of the level of care that will be required after discharge. This assessment should include preadmission mental and functional status; identification of causes for, and correction of, acute confusional states; and an assessment of the impact of the present illness or injury on future level of function following rehabilitation. This could result in a reduced length of average hospital stay.

Acute Disease↗
PubMed1983

Cultural factors affecting nursing home care for minorities: a study of black American and Japanese-American groups.

In a pilot study of two nursing homes serving primarily different ethnic groups, differences were found in the importance black patients and their relatives attached to the ethnic character of the institution compared with respondents in a Japanese home. The latter placed more emphasis on all aspects of ethnic programming and homogeneity of patients and staff. The blacks placed more emphasis on access to family than on ethnic orientation per se.

Adaptation, Psychological↗