Biomedical subjects
Publications and source records attributed to B A Rose.
The preservation of neurologic function has become an increasing concern in critical care. Both status epilepticus and increased intracranial pressure may significantly affect cerebral perfusion. This article discusses neurologic emergencies and their pharmacologic management and examines the impact of vasoactive agents on cerebral perfusion.
A retrospective review of patients treated with internal fixation of fractures or dislocations of the hand or wrist over a four-year period was undertaken to determine the complication rates of pin fixation for stabilization of these injuries. One hundred thirty-seven patients who received 422 pins were studied. All pins were unthreaded, measured 0.035-0.069 inches (0.9-1.8 mm) in diameter, were placed with a power drill, and were left protruding through the skin. The mean time that pins were left in place was 6.5 weeks, (range, two days to 24 weeks). Minimum follow-up time was 43 days after pin removal. Thirty-four complications occurred in 24 patients, and the overall complication rate was 18%. Forty-five of the 422 pins were involved (11%). Complications included infections in ten patients (7%), pin loosening without infection in six (4%), loss of reduction in six (4%), symptomatic nonunion in six (4%), impaled flexor tendon in two (2%), asymptomatic pseudarthrosis in one (1%), pin migration in one (1%), median nerve injury in one (1%), and radial artery injury in one (1%). Osteomyelitis developed in two of the patients with infections. Pin tract infection occurred at a mean time of ten weeks and aseptic loosening at a mean time of eight weeks. The frequent complication rates emphasize the need for meticulous pin placement, adequate intraoperative evaluation of pin position, and satisfactory patient compliance. Despite the frequency of these complications, serious permanent sequelae did not occur in most patients.
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This report describes a rare occurrence of a subcutaneous metastatic bronchogenic carcinoma to the distal fingertip. The original clinical presentation suggested an infectious process. Subsequent roentgenograms, sterile cultures, and positive biopsy material revealed that the lesion started as a subcutaneous metastasis that secondarily involved adjacent bone. Amputation of the digit was performed.
Poststimulus rebound contractions and associated action potentials of the circular muscle layer occurred after termination of transmural electrical stimulation. Low concentrations of nicotine (1 x 10(-6) to 5 x 10(-6) g/ml) either abolished or greatly reduced the poststimulus response. The contractile force and time duration of the response were reduced, and the latency of the response was increased by low concentrations of nicotine. The depressant action of low concentrations of nicotine was reversed by an increase in concentration from 5 x 10(-6) to 1 x 10(-4) g/ml. The effects of low concentrations of nicotine were mimicked by 1,1-dimethyl-4-phenylpiperazinium iodide, and they were prevented by hexamethonium, pentolinium, gallamine and large concentrations of atropine. Gallamine increased myogenic electrical and mechanical activity and potentiated the poststimulus rebound response. Pretreatment with guanethidine produced a small reduction in the inhibitory action of nicotine. Propranolol and phentolamine suppressed the poststimulus response, but the specificity of the action was questionable. The effects of nicotine may be mediated by excitation of intrinsic inhibitory neurons.
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