Biomedical subjects
W F Maule
Publications and source records attributed to W F Maule.
Screening for colorectal cancer by nurse endoscopists.
BACKGROUND: Case-control studies have demonstrated that screening by sigmoidoscopy is effective in reducing mortality from colorectal cancer. If nurses performed screening examinations, more patients could be screened and, at current income levels, at a lower cost. METHODS: Two registered nurses and two licensed practical nurses learned to perform examinations with the flexible fiberoptic sigmoidoscope in order to screen patients for colorectal tumors. They performed 1881 independent examinations of outpatients more than 45 years of age. During the same period, 730 examinations were performed by two gastroenterologists in similar patients. RESULTS: The mean depth of insertion of the sigmoidoscope was slightly but significantly greater in the patients examined by the physicians than in those examined by the nurses (48 vs. 46 cm in men, P = 0.003; 41 vs. 38 cm in women, P = 0.002). Adenomas were found in 14 percent of the men and 8 percent of the women examined (P = 0.001). Nine cancers were found in men and four in women. There were no significant differences between the nurses and the physicians in the proportion of examinations that were positive for adenomas or cancer. No complications occurred during the initial examinations or during 894 follow-up sigmoidoscopic procedures. Among the patients whose initial examination results were normal, more of those examined by nurses returned for follow-up sigmoidoscopy after 12 months or more (45 percent, vs. 30 percent of those examined by physicians; P = 0.001). CONCLUSIONS: Nurses can carry out screening by flexible sigmoidoscopy as accurately and safely as experienced gastroenterologists.
Gallstone disease. Pathophysiology, epidemiology, natural history, and treatment options.
In 1991, only symptomatic gallstones should be treated. The treatment of choice for all gallstones continues to be surgical removal. Except for stones in the common bile duct, which are amenable to removal by endoscopic papillotomy, nonsurgical treatment of gallstones should be investigated further before it can have widespread applicability. The major challenge in the future may be medical prevention of gallstone formation in susceptible individuals. Laparoscopic cholecystectomy seems to have moved to the forefront of surgical therapy in patients who are candidates for the procedure.
Cavitating ulcers--pyoderma gangrenosum of the anal canal?
Explore the source record for details and available documents.
Factors associated with postoperative complications in diabetics after biliary tract surgery.
We reviewed all first operations for cholelithiasis at the North Carolina Memorial Hospital from 1973 to 1982 to assess factors associated with postoperative morbidity in diabetics after biliary tract surgery. Diabetics (n = 126) had more frequent postoperative complications (24.6% vs. 12.5%, p less than 0.001) and higher mortality (7.9% vs. 3.0%, p = 0.02) than the nondiabetics (n = 855). Postoperative complications were more frequent in diabetics at both emergency surgery (57.9% vs. 39.1%) and at nonemergency surgery (18.7% vs. 10.2%). Diabetics were older, however, and had more preoperative renal, cardiovascular, and neurologic disease. We used logistic regression analysis to adjust for these differences and to determine independent predictors of postoperative complications. Urgent surgery, operation other than cholecystectomy, cardiovascular disease, and male sex were associated with an increased risk of postoperative morbidity. Diabetes was associated with an increase in risk that was not statistically significant. We conclude that diabetics have increased morbidity primarily because they are older and have other medical problems. The risk conferred by uncomplicated diabetes is modest, and recommendations for prophylactic surgery in asymptomatic diabetics with gallstones should be reexamined in this light.
Primary cardiac amyloidosis: an angiocardiographic clue to early diagnosis.
Restrictive cardiomyopathy produced by primary cardiac amyloidosis may have a clinical syndrome identical to noncalcific constrictive pericarditis. We report two patients with amyloidosis and restrictive physiology who had enlarged papillary muscles shown on left ventricular angiocardiogram. Rapid volume expansion with normal saline failed to produce ventricular filling pressure equilibration as in occult constrictive pericarditis. The absence of diastolic pressure equilibration and enlarged papillary muscles may permit early diagnosis of cardiac amyloidosis.
Management of chemotherapy-induced nausea and emesis.
Explore the source record for details and available documents.
Suppression of the cardiac conditioned response by delta-9-tetrahydrocannabinol: a comparison with other drugs.
Using classical conditioning procedures, the cardiac conditioned response (CCR) was established by pairing one of two tones with the delivery of a peripheral electric shock in Rhesus monkeys. The other tone had no terminal consequence. Such a procedure results in an anticipatory 'anxiety' or 'fear' response to the impending shock signalled by the reinforced tone. The heart rate before the tone in two of the animals was characterized by tachycardia and by bradycardia in the other animal. The effect of intravenous Delta-9-tetrahydrocannabinol (THC) was compared to various doses of diazepam, chlorpromazine, and morphine. The results indicate that THC blocks the CCR in a does-related manner. The effects of THC were similar to diazepam, an anti-anxiety drug. Chlorpromazine and morphine affected the conditioned response in an unreliable manner, and both drugs would attenuate the response in some cases and potentiate it in other instances.
A device for studying the psychophysiologic effects of thermal stimulation of the human esophagus.
Explore the source record for details and available documents.
Biliary tract surgery in the elderly.
Cholecystectomy is the most common surgical procedure in the elderly. Published reports on this operation suffer from small sample sizes, crude analyses, erroneous conclusions, and unsupported recommendations. The authors reviewed all first operations for cholelithiasis at the North Carolina Memorial Hospital from 1973 to 1982 to assess factors associated with postoperative morbidity in patients aged 70 years or older after biliary tract surgery. These elderly patients (n = 142) had more frequent postoperative complications (26.1% vs. 12.0%, p less than 0.0001), and greater mortality (9.2% vs. 2.7%, p less than 0.005) than did 839 younger patients. Patients with preoperative cardiac, renal or neurologic problems had more frequent postoperative complications whether they were old or young. Postoperative complications were more frequent in the elderly for non-emergency surgery (21.2% vs. 9.7%) but not for emergency surgery (44.8% vs. 42.4%). Logistic regression analysis was used to determine independent predictors of postoperative complications. Age greater than or equal to 70 years was associated with an increase in risk that was not statistically significant.