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Biomedical subjects

C J Tegtmeyer

Publications and source records attributed to C J Tegtmeyer.

96 records · Page 6Linked to original sources
PubMedDate not supplied

Reducing the discomfort of lidocaine administration through pH buffering.

PURPOSE: A prospective, double-blind study was undertaken to evaluate the effect of using a buffered lidocaine solution on the perception of pain experienced by a patient during its intradermal injection. PATIENTS AND METHODS: One hundred fifty patients undergoing diagnostic angiographic and interventional procedures at the authors' institution were randomly assigned to receive a 1-mL aliquot of one of three lidocaine solutions: plain 1% lidocaine, 1% lidocaine diluted with normal saline in a 10:1 ratio, and 1% lidocaine diluted with 8.4% sodium bicarbonate in a 10:1 ratio. The lidocaine solutions were administered intradermally over 10-15 seconds. A numerical value was placed on the patient's perception of pain, separate from that associated with the 25-gauge needle insertion, with use of a linear visual analog scale. RESULTS: Mean pain scores were as follows: for the 1% lidocaine solution, 2.83 +/- 2.60; for 1% lidocaine plus normal saline solution, 2.89 +/- 2.34; and for 1% lidocaine plus sodium bicarbonate solution, 1.37 +/- 1.73 (P = .0018). CONCLUSION: Buffering lidocaine significantly decreased the discomfort associated with its administration as a local anesthetic.

Adolescent↗
PubMedDate not supplied

Recent development of rigors during infusion of urokinase: is it related to an endotoxin?

PURPOSE: This study was undertaken to determine the prevalence of rigors associated with the use of urokinase (UK) and to assay for the presence of an endotoxin in the UK solution. PATIENTS AND METHODS: Records of 75 patients who underwent 86 UK infusions between January 1988 and July 1992 were reviewed to evaluate for the development of UK-associated rigors. A modified chromogenic limulus amebocyte lysate (LAL) test was performed to determine the presence of endotoxin in four samples of UK from lots associated with rigors, one sample of UK not associated with rigors, sterile water, nonionic contrast medium, and ionic contrast medium. RESULTS: Between January 1, 1988, and July 10, 1990, 43 patients underwent 46 UK treatments (group 1) with no documented rigors (0% prevalence). In 45 of these 46 treatments, a standard, non-pulse-spray bolus of 75,000-500,000 IU of UK (mean dose, 182,222 IU) was used. Between July 11, 1990, and July 6, 1992, 38 patients underwent 40 UK treatments (group 2). In 33 of these 40 treatments, a standard bolus was given. Five patients received a pulse-spray bolus. The mean bolus was 213,768 IU (range, 100,000-500,000 IU). Eleven group 2 patients developed rigors (28% prevalence; P = .0005 vs group 1). The chromogenic LAL tests demonstrated no endotoxin in sterile water, nonionic contrast media, or ionic contrast media. Endotoxin was detected in small concentrations in the four samples of UK associated with rigors and in the UK sample not associated with rigors. CONCLUSION: The increase in the prevalence of rigors associated with the use of UK does not appear to be related to an endotoxin in UK, since the concentration of endotoxin detected is well below the threshold pyrogenic dose in humans.

Contrast Media↗
PubMedDate not supplied

Percutaneous transluminal angioplasty of visceral arterial stenoses: results and long-term clinical follow-up.

PURPOSE: To determine the efficacy and safety of percutaneous transluminal angioplasty (PTA) of the visceral arteries. PATIENTS AND METHODS: We retrospectively evaluated the results of PTA performed in 20 visceral arteries in 19 patients (10 men, nine women; mean age, 63 years). Eleven patients had symptoms characteristic of mesenteric ischemia, four had atypical abdominal pain, and four were undergoing prophylactic dilation before undergoing another procedure involving the abdominal aorta. Clinical follow-up was possible in all patients. RESULTS: PTA was technically successful in 15 of 19 patients (79%); among these 15 patients, 12 (80%) did well clinically. Of the seven PTA procedures that were immediate failures, five failed secondary to an occult malignancy or to extrinsic arterial compression by the median arcuate ligament. Ten (83%) of the 12 patients in whom the procedures were immediate clinical successes are still clinically improved at 4-73 months follow-up (mean, 25 months). PTA was successful in only one of the four patients who had symptoms atypical of mesenteric ischemia, but it was successful in 11 of the 15 patients who had symptoms of mesenteric ischemia or who underwent prophylactic dilation. Major complications occurred in three (16%) of the 19 patients. CONCLUSION: PTA of visceral artery stenoses is effective in patients with symptoms of mesenteric ischemia. It is also effective as prophylaxis in patients undergoing additional procedures in the abdominal aorta.

Abdominal Pain↗
PubMedDate not supplied

Flow characteristics of peripherally inserted central catheters.

PURPOSE: Clinical applications of peripherally inserted central catheters (PICCs) are limited by the relatively small lumina and long lengths of these devices. Quantitative analysis of the flow capabilities of a variety of PICCs was performed to aid in deciding which patients should have a PICC and in selecting the appropriate catheter. MATERIALS AND METHODS: Sixteen different PICCs from six manufacturers were infused at flow rates of 25-270 mL/h. Infusions were performed with distilled water, normal saline, total parenteral nutrition solution, intralipids, and blood. Flow versus pressure curves were generated for each PICC and infusate. Additional catheter data recorded included the working length, outer diameter (OD), and inner diameter (ID) of the PICCs. RESULTS: Because of the thin wall construction of polyurethane catheters, PICCs made from polyurethane showed much better flow rates than silicone PICCs of a comparable OD. The measured ODs of the PICCs were 4-6 F, whereas the IDs ranged from 0.012 to 0.032 inch. Because of the small ID of some PICCs, infusing blood or intralipids is not practical. CONCLUSION: There is significant variability in the flow capabilities of available PICCs. Many of the PICCs require pressures greater than those that can be generated by commercially available infusion pumps. Matching PICC characteristics to the desired application will avoid many of the clinical problems currently encountered with PICCs.

Catheterization, Central Venous↗
PubMedDate not supplied

Clinical experience with saralasin infusion in hypertensive patients.

Renal arteriography gives a reliable anatomic delineation of the renal vasculature. However, the presence of renal arterial disease does not determine the physiologic significance of the lesion. The intravenous infusion of saralasin, a specific angiotensin II antagonist, has been investigated as a method for identifying patients with hypertension dependent upon excessive angiotensin II activity. Correlations between the blood pressure response to saralasin infusion, peripheral and differential renal vein plasma renin levels and renal angiography have been obtained in 35 hypertensive patients. The results suggest that a hypotensive response to saralasin infusion provides an adjunct to renin determinations for recognizing angiotensinogenic renovascular hypertension. However, false negative responses to saralasin occur. The reasons for these negative responses need to be determined before saralasin infusion can be employed as the sole screening test for renovascular hypertension.

Adult↗