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Biomedical subjects

T Elkins

Publications and source records attributed to T Elkins.

13 recordsLinked to original sources
PubMed1997

Factors influencing views of patients with gynecologic cancer about end-of-life decisions.

OBJECTIVE: This study was undertaken to assess the life views, practices, values, and aspirations of women with various stages of gynecologic cancer. STUDY DESIGN: A self-administered questionnaire was completed by 108 women with various stages of cancer and 39 women with benign gynecologic disease. The questionnaire included items on demographics in addition to 16 multiple choice and 4 true-false items. The four questions related to criteria of good care, degree of involvement in decision making, psychosocial well-being, religious experience, and aspirations form the basis of this study. The data were analyzed with the Pearson chi 2 test (Systat, version 5.1) with significance set at p < 0.05. RESULTS: The women in this study placed greatest emphasis on receiving "straight talk" (96%) and compassion (64%) from their physicians. The newly diagnosed group put significantly less emphasis on compassion (33%, p = 0.037). Less than half expected their physicians to cure (43%, 56% for newly diagnosed) or contain (49%) the disease. For these women fear was the most dominant psychosocial consequence of having cancer, with difficulty communicating or feeling abandoned, isolated, or embarrassed less common. Those who specified their ears were afraid of pain (63% vs 39% for patients with benign disease, p = 0.019), dying (56%), losing control (48%), or becoming totally dependent (46%). Seventy-six percent indicated that religion had a serious place in their lives, with 49% becoming more religious since their cancer diagnosis, whereas no one became less religious. Ninety-three percent believed that the religious commitment helped sustain their hopes. CONCLUSIONS: These data suggest that (1) physicians should aim to educate their patients sufficiently for them to exercise control over their experience, to allay their fears, and to make personal decisions that further their aspirations, (2) patients in different stages of disease varied in their perceptions of themselves and their aspirations, (3) patients are dealing with fear as a primary problem, and (4) women with gynecologic cancer depend on their religious convictions and experiences as they cope with the disease.

Adult↗
PubMed1996

Urinary fistula.

Recent advances in the repair of nonobstetric fistulas include a tendency toward earlier repair attempts, use of ureteral stenting and endoscopic correction, and even the use of laparoscopy for fistula repair. There has also been an increased use of posthysterectomy cystoscopy for early identification of ureteral or bladder injury to prevent later fistula. The current initial success rate for repair of obstetric fistulas in developing countries ranges from 65 to 95%. Now that most obstetric fistulas can be repaired surgically, management of previously nonrepairable fistulas and fistula-associated complications has become a greater focus of concern. Efforts are underway to increase community based obstetric training to prevent obstetric fistulas, and a new obstetric fistula classification has been proposed to emphasize the complications mentioned above.

Developing Countries↗
PubMed1994

The status of ethics education in obstetrics and gynecology.

To establish the present status of ethics education in obstetrics and gynecology, 256 questionnaires were sent to residency (graduate) and student (undergraduate) education programs. One hundred ninety-eight questionnaires were returned. Fifteen programs offered no ethics education; 167 offered resident level courses; 123 offered undergraduate (student) level courses; and 84 offered postgraduate education. The median number of hours offered was 2 undergraduate, 4 graduate, and 2 postgraduate. The courses offered relied primarily on formal lecture presentation, even though this was not considered most effective by the respondents. Most institutions (85%) used more than one format to present ethics material. General ethics principles were covered in 78% of the reporting institutions. Where ethics case histories were used, they were rated higher in efficacy by the respondents. Only 15% of the reporting institutions had any means of measuring outcomes. The issues cited most frequently as critical in a curriculum were abortion, maternal-fetal conflicts, issues surrounding care decisions at the end of life, and informed consent. The few hours dedicated to ethics were small relative to a long list of issues. Obstetric-gynecologic faculty with any training in medical ethics were uncommon (29%). The form of teaching, except in rare circumstances, seemed to lack structure or design and used few of the available reading materials. Recommendations from this survey include the development of a uniform national curriculum for undergraduate and graduate medical ethics, development of evaluation alternatives for ethics education, and encouragement and support for faculty development in medical ethics.

Bioethical Issues↗
PubMed1991

Stress incontinence and cystoceles.

We studied prospectively 62 women with cystoceles by video-urodynamics before and after operative repair. Of 29 women with grades 1 and 2 cystoceles 8 had residual urine, 14 had urge incontinence and 24 had symptoms of stress urinary incontinence. Of these women 23 had urodynamic evidence of stress incontinence, as did 3 of 5 without stress incontinence symptoms. Of 33 women with large cystoceles 22 had symptoms of stress urinary incontinence but 10 more had urodynamic evidence of stress urinary incontinence. Of these 33 women 18 had significant residual urine and 24 had urge incontinence. Operative repair resolved stress incontinence in 51 of 54 women, urge incontinence in 33 of 38 and residual urine in 24 of 26. Cystoceles recurred in 3 patients, and enteroceles developed in 3 and recurred in 2. These findings indicate that cystoceles may cause voiding dysfunction and lack of symptoms of stress incontinence is unreliable in patients with cystoceles. In addition, cystoceles are associated with other symptoms, most of which actually resolve after operative repair.

Adult↗
PubMed1991

Treatment of incontinence with pelvic prolapse.

There is a surprising lack of prospective data on genital and pelvic prolapse and the relation of these conditions to incontinence. Several abnormalities may be important: uterine prolapse, rectoceles, enteroceles, total vaginal eversion, and cystoceles. The authors describe their experience in 65 cases of various etiologies.

Female↗
PubMed1990

Genetic analysis of a Drosophila neural cell adhesion molecule: interaction of fasciclin I and Abelson tyrosine kinase mutations.

Drosophila fasciclin I is a homophilic cell adhesion molecule expressed in the developing embryo on the surface of a subset of fasciculating CNS axons, all PNS axons, and some nonneuronal cells. We have identified protein-null mutations in the fasciclin I (fas I) gene, and show that these mutants are viable and do not display gross defects in nervous system morphogenesis. The Drosophila Abelson (abl) proto-oncogene homolog encodes a cytoplasmic tyrosine kinase that is expressed during embryogenesis primarily in developing CNS axons; abl mutants show no gross defects in CNS morphogenesis. However, embryos doubly mutant for fas I and abl display major defects in CNS axon pathways, particularly in the commissural tracts where expression of these two proteins normally overlaps. The double mutant shows a clear defect in growth cone guidance; for example, the RP1 growth cone (normally fas I positive) does not follow its normal path across the commissure.

Alleles↗
PubMed1990

Drosophila fasciclin I is a novel homophilic adhesion molecule that along with fasciclin III can mediate cell sorting.

Fasciclin I is a membrane-associated glycoprotein that is regionally expressed on a subset of fasciculating axons during neuronal development in insects; it is expressed on apposing cell surfaces, suggesting a role in specific cell adhesion. In this paper we show that Drosophila fasciclin I is a novel homophilic cell adhesion molecule. When the nonadhesive Drosophila S2 cells are transfected with the fasciclin I cDNA, they form aggregates that are blocked by antisera against fasciclin I. When cells expressing fasciclin I are mixed with cells expressing fasciclin III, another Drosophila homophilic adhesion molecule, the mixture sorts into aggregates homogeneous for either fasciclin I- or fasciclin III-expressing cells. The ability of these two novel adhesion molecules to mediate cell sorting in vitro suggests that they might play a similar role during neuronal development.

Animals↗
PubMed1990

Conduction in the giant nerve fiber pathway in temperature-sensitive paralytic mutants of Drosophila.

To study electrogenic conduction in neurons of the cervical giant nerve fiber (CGF) pathway in Drosophila adults carrying temperature-sensitive paralytic mutations that affect sodium channels, we recorded dorsal longitudinal muscle (DLM) responses evoked by electrical stimulation of the brain. In the mutants tipE, napts and parats, conduction in certain neurons presynaptic to the CGF failed at about the same temperature at which paralysis occurred in each mutant. Conduction in the CGF and neurons postsynaptic to it remained active in all mutants even at very elevated temperatures. In contrast, analysis of sei mutants showed enhanced spontaneous activity at elevated temperatures in at least some neurons of the CGF pathway. The implications of these results with respect to the normal in vivo functions of these genes in neuronal signalling are considered.

Animals↗
PubMed1988

The roles of potassium currents in Drosophila flight muscles.

The roles of different K+ currents in regulating the generation and waveform of action potentials in Drosophila dorsal longitudinal flight muscles (DLMs) were examined in current-clamp experiments. In response to depolarizing current, DLMs displayed an initial transient rectification of the electronic potential lasting for up to hundreds of milliseconds. This delay in excitation was followed by oscillations or graded spikes that finally gave way to sharply rising spikes. Previous voltage-clamp studies of DLMs have revealed an inward Ca2+ current and at least three K+ currents: IA and IK, which are voltage-dependent, and IC, which is Ca2+ dependent. IA and IC are early inactivating currents, while IK is a slow, noninactivating current. In mature adults, selective elimination of IA either with Shaker (Sh) mutations or with 4-aminopyridine (4-AP), had no effect on spike duration or on the delay in excitation. In contrast, when IC was specifically eliminated with the slowpoke (slo) mutation, there was no delay before excitation, the amplitude of the spikes was significantly increased, and the spike duration was increased by 10-fold. Similar results were obtained by reducing IC in normal muscle by intracellular injections of EGTA or by use of low Ca2+ saline. Furthermore, DLM spikes evoked in slo by stimulation of the motorneuron were also broadened, suggesting that IC functions in a similar manner during normal flight as in current-clamped muscles. Elimination of IK along with IA and IC in saline containing tetraethylammonium or Ba2+ resulted in further prolongation of the DLM spike. In Ba2+ saline, there was an additional increase in spike amplitude as well. We conclude that in mature adults, IC, rather than IA, plays the major role in repolarization of DLM spikes and in the delay before excitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1987

Fetal skull fracture and brain injury after a maternal automobile accident. A case report.

A woman in labor and not wearing a seat belt sustained multiple fractures of the pelvis and femur while in an automobile accident. The fetus suffered fractures of the parietal and occipital bones. To minimize maternal pelvic and fetal injury, delivery by cesarean section was performed. The infant had generalized cerebral edema and intraventricular and subarachnoid hemorrhage, diagnosed shortly after birth. Motor abnormalities and residual injury to the periventricular white matter were evident at age 4 months. Use of seat belts may significantly diminish or prevent such injuries.

Accidents, Traffic↗
PubMed1986

A Drosophila mutation that eliminates a calcium-dependent potassium current.

A mutation of Drosophila, slowpoke (slo), specifically abolishes a Ca2+-dependent K+ current, IC, from dorsal longitudinal flight muscles of adult flies. Other K+ currents remain normal, providing evidence that IC is mediated by a molecularly distinguishable set of channels. The pharmacological properties of IC are similar to those of Ca2+-dependent currents in some vertebrate cells. The muscle action potential was significantly lengthened in slo flies, indicating that IC plays the major role in its repolarization.

4-Aminopyridine↗
PubMed1985

Uterine rupture in Nigeria.

Uterine rupture in the developing world remains a significant problem. We treated 45 such cases. The predisposing factors included cephalopelvic disproportion (62%), grand multiparity (33%), previous cesarean section (24%), placental pathology (15%) and abnormal presentation (20%). The factors associated with maternal death included sepsis (71%), macerated stillborn infant (60%), vulvar edema (50%), hand presentation (50%), prolonged labor (42%) and hysterectomy (37.5%). Hemodynamic resuscitation and prompt surgical intervention remain the mainstays of therapy.

Adolescent↗