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Biomedical subjects

R P Williams

Publications and source records attributed to R P Williams.

At least 19 recordsLinked to original sources
PubMed1999

An appraisal of research utilization across the United States.

The success of research utilization (RU) is a function of how well it has been incorporated into the cultural norm of the organization. The authors describe current and future nursing research utilization activities in various clinical agencies across the United States and identify barriers and facilitators to those activities. The most frequent RU projects focused on pressure ulcers and pain management. Barriers included lack of resources, organizational culture, change, and nurses' education. Facilitators were leadership commitment, available resources, and a supportive organizational culture.

Clinical Nursing Research↗
PubMed1998

Factors influencing wound healing after surgery for metastatic disease of the spine.

STUDY DESIGN: The study group consisted of 53 patients who underwent 75 operations for spine metastases. Patient and tumor demographic factors, preoperative nutritional status, and perioperative adjunctive therapy were retrospectively reviewed. OBJECTIVE: To determine the risk factors for wound breakdown and infection in patients undergoing surgery for spinal metastases. SUMMARY OF BACKGROUND DATA: Spinal fusion using spine implants may be associated with an infection rate of 5% or more. Surgery for spine metastases is associated with an infection rate of more than 10%. Factors other than the type of surgery performed may account for the greater infection rate. METHODS: Data were obtained by reviewing patient records. Age, sex, and neurologic status of the patient; tumor type and site; and surgical details were noted. Adjunctive treatment with corticosteroids and radiotherapy was recorded. Nutritional status was evaluated by determining serum protein and serum albumin concentrations and by total lymphocyte count. RESULTS: Wound breakdown and infection occurred in 15 of 75 wounds. No patient or tumor demographic factors other than intraoperative blood loss (P < 0.1) were statistically associated with infection. The correlation between preoperative protein deficiency (P < 0.01) or perioperative corticosteroid administration (P < 0.10) and wound infection was significant. There was no statistical correlation between lymphocyte count or perioperative radiotherapy and wound infection. CONCLUSIONS: The results indicate that preoperative protein depletion and perioperative administration of corticosteroids are risk factors for wound infection in patients undergoing surgery for spine metastases. Perioperative correction of nutritional depletion and cessation of steroid therapy may reduce wound complications.

Adrenal Cortex Hormones↗
PubMed1998

Lumbar foot innervation of the medial foot and ankle region.

BACKGROUND: Differences in the dermatomal maps appearing in standard anatomic texts which are in common use may lead to diagnostic confusion in the assessment of patients who suffer from nerve root deficiency. This is particularly evident in the variable depiction of the L4 nerve root dermatome which is carried distally in the saphenous nerve. The purpose of this study is to establish the distal limit of L4 nerve root innervation in the foot by performing cadaveric dissection of the saphenous nerve. METHODS: Dissection of the dorsum of the medial foot and ankle was performed on 20 cadaveric specimens. RESULTS: The saphenous nerve was found to enter the dermis of the medial ankle region (mean = 14.75 mm) distal to the tip of the medial malleolus in the direction of the hallux. In three cases the nerve terminated proximal to the medical malleolus. In all cases the medial forefoot and hallux were supplied by the most medial branch of the superficial peroneal nerve. CONCLUSIONS: These findings suggest that the sensory component of the L4 nerve root terminates in most cases near the medical malleolus, well proximal to the bunion area of the forefoot.

Ankle↗
PubMed1998

Partners in quality.

A university system counters funding cutbacks for nursing education by partnering with a hospital system. The partnership benefits both institutions.

California↗
PubMed1997

Systemic reactions in U.S. Marine Corps personnel who received Japanese encephalitis vaccine.

The overall hypersensitivity reaction rate among 14,249 U.S. Marine Corps personnel who received 36,850 doses of an investigational Japanese encephalitis vaccine was 10.3 per 10,000 doses; reaction rates were 16.1 and 10.3 per 10,000 doses for the first two doses, and 2.0 per 10,000 doses for the third. The reaction rate was 26.7 per 10,000 vaccinees. Of 38 reactors, 26 had urticaria and/or angioedema, and 11 had pruritus. Vaccine reaction intervals clustered within 48 hours for dose 1, but the median reaction interval for dose 2 was 96 hours. A history of urticaria or allergic rhinitis was associated with an increased probability of a vaccine reaction.

Encephalitis Virus, Japanese↗
PubMed1996

Characterisation of the tumour-associated carbohydrate epitope recognised by monoclonal antibody 4D3.

The tumour-associated epitope recognised by monoclonal antibody (MAb) 4D3 is expressed on a high m.w. mucin glycoprotein preparation known as small intestinal mucin antigen (SIMA). This epitope is detected in tissue from a high proportion of patients with colorectal cancer, and elevated levels occur in serum from a significant number of such patients, highlighting the potential clinical utility of MAb 4D3. In the present study, insight into the composition and structure of the carbohydrate epitope recognised by MAb 4D3 was gained following characterisation of 2 glycopeptides that co-purified with SIMA. Sequence analysis of 1 of these glycopeptides revealed that it was identical to the glycoprotein alpha-1-anti-chymotrypsin. This glycoprotein was subsequently deglycosylated to yield 5 forms corresponding to alpha-1-anti-chymotrypsin substituted with 4, 3, 2, 1 or no branched glycans. MAb 4D3 was reactive with each of the glycosylated forms, including the form carrying only 1 branched glycan, but did not react with fully deglycosylated alpha-1-anti-chymotrypsin. MAb 4D3 also reacted to different extents with ovine, bovine or porcine submaxillary mucins, each of which has a different amount of the O-linked sialylated disaccharide known as sialosyl Tn. Of these mucins, MAb 4D3 was most reactive with ovine submaxillary mucin, in which almost all of the carbohydrate chains are sialosyl Tn. Reactivity of MAb 4D3 towards isolated glycans, sialosyl Tn and related structures led to the conclusion that the preferred MAb 4D3 epitope involves the sialylated N-acetyl galactosamine disaccharide as well as an additional monosaccharide present on a neighbouring carbohydrate chain. Although the preferred epitope recognised by MAb 4D3 involves this sialylated disaccharide, the specificity of MAb 4D3 was different from that of other MAbs with a reported specificity for sialosyl Tn.

Amino Acid Sequence↗
PubMed1996

Comparison of the mechanical performance of trochanteric fixation devices.

The transtrochanteric surgical approach to the hip is commonly used, especially for revision hip surgery. Failure of the trochanter to heal can lead to hardware failure, persistent pain, and limp. Rigid internal fixation is needed in this approach to achieve an adequate rate of healing. Newer cable and cable grip systems have been designed to improve trochanteric fixation, but have not been compared to the older Charnley wire fixation techniques. In this study, an in vitro mechanical method previously used to test wire fixation methods was used to compare wire, cable, and cable grip fixation methods. A quasistatic mechanical distraction device was used to compare structural stiffness, load to clinical failure, energy to clinical failure, and maximum load resisted by the fixation devices. The cable grip system was found to be stiffer, to resist a larger load to mechanical failure at 1-cm displacement, and to absorb a greater amount of energy to clinical failure when compared with the other systems. These data suggest that use of the cable grip fixation method should result in improved clinical success compared with the Charnley wire technique.

Adolescent↗
PubMed1996

Myxoid liposarcoma with cartilaginous differentiation.

Common histologic variants of liposarcoma are readily recognized. Histologic classification might be difficult, however, when liposarcoma demonstrates cartilaginous differentiation. Although this phenomenon has previously been noted, it has not, to our knowledge, been reported as a specific pathologic entity. All three patients in the present study were men, ages 37, 42, and 63 years. Each presented with a solitary, enlarging mass of the thigh that was surgically excised. The tumors ranged in size from 8 to 13 cm. Microscopically, each lesion displayed characteristic features of myxoid liposarcoma; in addition, all possessed discrete, rounded foci of mature-appearing hyaline cartilage. One case displayed small foci showing chondrocyte atypia. No other patterns of mesenchymal differentiation were present. All patients received postoperative radiation therapy. No recurrences or metastases have been identified (mean duration, 39 mo). Myxoid liposarcomas with cartilaginous differentiation are of importance because they might be misdiagnosed as malignant mesenchymoma. The latter, if not qualified as to histologic grade, might be presumed to be a biologically more aggressive lesion. In addition, these lesions must be distinguished from two benign processes: chondroid lipoma and extraskeletal chondroma with lipoblast-like cells. Additional studies of this uncommon variant of liposarcoma will be necessary to document further its status as a low-grade sarcoma.

Adult↗
PubMed1995

The versatility of the gastrocnemius muscle flap.

The gastrocnemius muscle rotation flap is a utilitarian procedure for management of soft-tissue defects about the knee. Ten patients underwent medial gastrocnemius muscle rotation flaps at our institution during a 24-month period. Four of the 10 patients underwent primary muscle rotation-plasty for reconstruction following tumor resection; 3 patients had soft-tissue defects following trauma; 2 patients had skin ischemia following total knee arthroplasty; and 1 patient had a soft-tissue defect from scar formation. All procedures were performed by an orthopaedic surgeon. At follow-up of 6 to 24 months, the soft-tissue coverage was maintained in all patients. All of the muscle rotation flaps survived. The gastrocnemius rotation flap provides reliable anterior knee soft-tissue coverage and can be performed by most orthopaedic surgeons.

Adolescent↗
PubMed1993

Monoclonal antibody 4D3 detects small intestinal mucin antigen (SIMA)--glycoprotein in the serum of patients with colorectal cancer.

We have developed a sensitive ELISA using MAb 4D3 for the detection of a novel epitope on Small Intestinal Mucin Antigen (SIMA) and report here that SIMA is present in the serum of patients with colorectal cancer. SIMA has been shown to occur in tissue from a high proportion of patients with colorectal cancer. SIMA derived from serum was similar to tissue-derived SIMA: both eluted in the void volume of a Superose 6 column indicating a molecular weight above 5,000 kDa and they exhibited similar buoyant densities on CsCl gradients. The ELISA was most reliable after pre-treatment of serum with 0.4 M perchloric acid to remove interfering substances. The upper limit for SIMA in normal serum was set as the mean plus 2 standard deviations determined from a group of 97 healthy control subjects. In a sample of 113 patients with colorectal cancer, SIMA serum levels were elevated in 15% of patients with Dukes' Stage A, 38% with Stage B, 32% with Stage C and 75% with Stage D colorectal cancer. SIMA serum levels were compared with those of the widely used tumor marker, carcinoembryonic antigen (CEA). The SIMA assay detected a significant number of sera that were not detected by the test for CEA. We propose that SIMA will prove to be a valuable serological tumor marker, in combination with CEA and other tumor markers, for the detection of colorectal cancer.

Adenocarcinoma↗
PubMed1993

Management of soft-tissue and bone tumors of the foot.

Neoplasms of the foot are relatively rare problems. Because of their rarity, many physicians are not familiar with their diagnosis or treatment. In addition, there is a diversity of opinions about the histogenesis, nomenclature, and treatment of these tumors. A systematic approach to evaluation, diagnosis, and treatment is necessary to ensure prompt, appropriate management of these problems. Topics discussed in this article included the initial evaluation, staging, biopsy, surgical resection, and postoperative care.

Biopsy↗
PubMed1992

External fixation of unstable Malgaigne fractures: the comparative mechanical performance of a new configuration.

An external fixator has been designed that is rigid enough to eliminate the need for skeletal traction in patients with unstable pelvic-ring fractures. This Wichita frame is similar to the Pittsburgh frame but is stiffened by the use of locked crossbars connecting the side triangles. The frame was tested in cadaveric specimens by techniques previously reported. In addition, finite-element modeling of the various frame designs was performed to ensure that the frame configuration was optimal and to supplement in vitro test results. Multiple variables that can influence frame failure loads were examined.

Equipment Design↗
PubMed1992

A histopathologic study of late aseptic loosening of cemented total hip prostheses.

Eighteen patients being treated for revision total hip arthroplasty for aseptic loosening an average of 9.5 years after primary cemented hip arthroplasty were studied. The patients were found to have been symptomatic an average of one year before revision. Review of the roentgenograms at the time of revision revealed that most patients had moderate to severe loosening of the prostheses by Charnley's criteria. These findings were confirmed at surgery. Study of the tissue surrounding the prostheses suggests that the prominent particles were methylmethacrylate "pearls" caused by cement fragmentation. These particles were surrounded by histiocytes that were actively synthesizing and releasing protein. Cement fragmentation and not polyethylene wear may be the major cause of late aseptic loosening of cemented hip prostheses.

Acetabulum↗
PubMed1991

Lipopolysaccharide is the receptor for kappa phage in Serratia marcescens.

Kappa phage active on Serratia marcescens can form plaques on white and red strains with identical efficiencies. To identify the kappa phage receptor, the inactivation of the phage was studied after incubation with several bacterial subcellular fractions. The experiments demonstrated that kappa phage adsorbs to outer membrane fractions of susceptible cells. Proteinase K did not affect the rate of inactivation. Lipopolysaccharide proved to be the primary receptor for kappa phage. Prodigiosin content of the lipopolysaccharide fraction was low.

Adsorption↗
PubMed1991

Cloning and expression in Escherichia coli of a gene encoding proline oxidase of Serratia marcescens.

Proline plays a central role in the biosynthesis of prodigiosin by Serratia marcescens. Proline catabolism takes place by oxidation catalysed by the enzyme proline oxidase encoded by the gene putA. A gene bank of chromosomal DNA from S. marcescens was constructed using the plasmid vector pBR328, and then recombinant DNA was used in transformation experiments with Escherichia coli HB 101 as recipient strain. One of the recombinant plasmids, pSL001, was encoded for proline oxidase. Subcloning experiments led to a second plasmid pSL008 able to maintain proline oxidase activity.

Cloning, Molecular↗
PubMed1991

Noninvasive grading of musculoskeletal tumors using PET.

Twenty-five patients with mass lesions involving the musculoskeletal system were studied with positron emission tomography (PET) in order to determine if a relationship exists between histologic grade and tumor uptake of [fluorine-18]2-deoxy-2-fluoro-D-glucose (FDG). There were 6 benign lesions and 19 malignant lesions of various grades. A high correlation (Rho = 0.83) was found between the normalized uptake of tracer and the NCl grade. The high-grade malignancies had significantly greater (p = 0.0091) uptake of FDG than the combination of benign lesions and low-grade malignancies. All lesions with a normalized uptake value of 1.6 or greater were high-grade, while all lesions less than 1.6 represented either benign tumors or low grade malignancies. This strong relationship between FDG uptake and grade among neoplasms from a wide variety of cell types within a single organ system suggests that the technique may be useful in predicting grade even when the cell type is unknown.

Bone Neoplasms↗