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W Maxwell

Publications and source records attributed to W Maxwell.

13 recordsLinked to original sources
PubMed2006

[The undetected brain lesion in sports. Minor traumatic brain injury and its sequelae].

The minor traumatic brain injury (mTBI) in sports is often looked at as a bagatelle. The treating physician underestimates the severity of the injury suspecting that a mTBI is a nonstructural lesion with an overall excellent prognosis in the majority of the cases. This paper shows that the minor traumatic brain injury may be a structural brain lesion with potentially life-threatening dangers. The therapy should follow exactly defined guidelines, e.g., stepwise protocol of the Concussion in Sports (CIS-) Group. Return to sports activities should happen only when all physical but also cognitive symptoms have subsided. All mTBIs that have been sustained prior to the actual injury have to be recorded properly because repeated mTBIs may cause chronic degenerative brain damage. Neuropsychological testing will aid in the correct diagnosis of a mTBI and is a useful parameter in the course of the injury. In the future biochemical markers may serve as indicators of the severity of the brain injury and may also aid in predicting the outcome after TBI. Today biochemical markers do not serve as a substitute for neuroimaging.

Adolescent↗
PubMed2001

Nurse practitioner patient centered telephone calls in a VA primary care geriatric clinic.

PURPOSE: To present original research of a retrospective study of telephone calls by nurse practitioners (NP) to geriatric primary care patients over the period of one year in a Veteran's Administration primary care clinic in the southeast. DATA SOURCES: A convenience sample of the electronic patient progress notes labeled "telephone call" of three full time NPs was collected from May 1, 1998 through April 31, 1999. A total of 1,541 unique telephone calls made by NPs to patients were examined. CONCLUSIONS: Patient telephone calls consume work time, which is often hidden and uncounted when examining time spent with patients. Most calls (62%) were generated by others; the remainder (38%) were initiated by the NPs. The greatest number (42%) of requests related to medication refills. IMPLICATIONS FOR PRACTICE: Many patients requested to talk to the NP for non-clinical issues; many of the requests could have been handled by other staff. It is as if the patient no longer has the traditional call bell to call the nurse but now has the telephone to call the NP. The personal aspect of the phone call may be what is needed by some of the patients looking for a form of human contact.

Aged↗
PubMed1994

Focal brain injury: histological evidence of delayed inflammatory response in a new rodent model of focal cortical injury.

Cortical contusions are one of the most common characteristics in head injury and are regarded by many as the hallmark of significant injury. No experimental study has clarified the roles of mechanical forces, haemorrhage and ischaemia in the process of progressive acute brain damage and later neurobehavioural dysfunction. We have devised a new, simple reproducible rodent model of focal cortical injury which employs a 'pure' mechanical/physical force applied through the intact dura. Using this model we have investigated the time course and pattern of changes in neurons, glia and microvasculature. With the exception of haemorrhage, this model closely reproduces the light- and electron microscopy features of human contusion. In the absence of perivascular haemorrhage we have demonstrated delayed perivascular protein leakage and polymorphonuclear-leukocyte infiltration of the damaged cortex. We postulate that a component of the delayed blood brain barrier breakdown demonstrated in human focal head injury (which may contribute to swelling and brain damage) is due to an acute inflammatory response, the magnitude of which is dependent on the amount of tissue injury.

Acute-Phase Reaction↗
PubMed1993

Changes in immunological parameters during interleukin 2 and interferon 2 alpha treatment of recurrent renal cell carcinoma and malignant melanoma.

Immunological parameters were studied in patients with either advanced renal cell cancer (n = 7) or advanced malignant melanoma (n = 6) during treatment with a low-dose continuous intravenous treatment with human recombinant interleukin-2 (hr IL-2) and recombinant interferon alpha-2a. Before treatment, natural killer (NK) cell activity was found to be significantly lower in these patients than in 10 normal controls. However, the numbers of NK cells in circulation were equivalent; following incubation of the patients' peripheral blood mononuclear cells (PBMC) with IL-2 for three days normal lymphokine activated killer (LAK) cell activities were induced. Thus, in-vitro incubation with IL-2 appeared to overcome a defect in NK activity. We next examined the effect of IL-2/IFN alpha therapy on in-vitro LAK induction. Treatment significantly increased in-vitro LAK activity in eight of nine patients tested, although in-vivo LAK cell activity was not altered during treatment. The numbers of NK cells (CD16+ CD56+) in peripheral blood showed a significant increase in seven of ten patients as a result of treatment. The three patients who showed the best clinical response also showed the highest increase in expression of these phenotypic markers. T cells were found to be activated in 8/10 patients as indicated by increased co-expression of CD3 with CD25 after completion of 4-day continuous intravenous infusion of IL2. Four days before the start of treatment, cancer patient PBMC stimulated with concanavalin A (con A) produced significantly greater amounts of TNF compared to normal controls. In-vitro inducible TNF was found to decrease following treatment. Since IL-2 production and lymphocyte proliferation in response to Con A were normal in the patient group and were not altered by treatment, the reduction in TNF levels seemed not to be a general inhibitory effect. Further study of these and other changes in the immune system during IL-2/IFN alpha treatment may help to understand how these immunoregulators cause tumour destruction and to predict their usefulness in individual patients.

Adult↗
PubMed1992

Early post-traumatic cerebral blood flow mapping: correlation with structural damage after focal injury.

Focal post traumatic mass lesions such as contusions and intracerebral haematomas are common, and often difficult for neurosurgeons to manage, because little is known of their pathophysiology. We have mapped cerebral blood flow, and studied small vessel ultrastructure at different time points within the first three weeks of head injury, in patients with these lesions. A zone of ischaemic brain is always present around these lesions, and persists for weeks or months. This accords with astrocyte swelling and microvascular compression seen on electron microscopy. Focal zones of hyperaemia were also present in 42% of patients, within the first two weeks of injury, and this appeared only within apparently normal tissue as judged by late MRI or CT.

Astrocytes↗
PubMed1992

A phase 2 trial of recombinant interleukin-2 and 5-fluorouracil in patients with metastatic colorectal carcinoma.

The toxicity and efficacy of sequential 5-fluorouracil (5-FU) and recombinant interleukin-2 (IL-2) were evaluated in 12 patients with metastatic colorectal carcinoma. This combination of 5-FU and IL-2 produced a 10% partial response rate with 40% of patients remaining in stable disease while on therapy. No clear improvement in survival was demonstrable. In contrast to the disappointing response rates the overall level of toxicity was very low with no treatment related deaths. It is concluded that modifications in treatment schedules are required before further similar studies are commenced.

Adult↗
PubMed1991

Thyroid dysfunction can predict response to immunotherapy with interleukin-2 and interferon-2 alpha.

Thyroid dysfunction is a well-recognised side-effect of treatment with interleukin-2 (IL2). We assessed the correlation between the development of abnormal thyroid function and tumour response in 13 patients receiving IL2 and interferon-2 alpha (IFN2 alpha) for advanced malignancy. Seven patients had normal thyroid function during treatment, and all of these patients have since died of progressive disease. Of six patients who did develop thyroid dysfunction during treatment, one patient has died of progressive disease. However, statistically we were unable to confirm a definite correlation between the development of thyroid dysfunction and survival in this small group of patients.

Adult↗