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Biomedical subjects

D E Martin

Publications and source records attributed to D E Martin.

At least 19 recordsLinked to original sources
PubMed1991

Thiopental as an adjunct to hypothermia for EEG suppression in infants prior to circulatory arrest.

Fifteen infants were studied to evaluate the effect of profound hypothermia (16 degrees C to 18 degrees C) and hypothermia plus thiopental on the electroencephalogram (EEG) prior to circulatory arrest. Mean patient age and weight were 5.5 +/- 1.2 months and 4.9 +/- 0.3 kg, respectively. After core cooling on cardiopulmonary bypass (CPB), all patients received thiopental, 8 mg/kg, 5 minutes prior to circulatory arrest. Satisfactory EEG recordings were obtained for 9 patients, and serum thiopental concentration was measured in 12 patients. Hypothermia (mean venous return temperature, 17.8 degrees C +/- 1.6 degrees C) alone was associated with persistent cerebral electrical activity in 8 of 9 patients (89%). The addition of thiopental, 8 mg/kg, produced an isoelectric EEG in 6 of these 8 patients (75%). Mean circulatory arrest duration was 44 +/- 4 minutes. EEG activity resumed after reinstitution of CPB in all patients. Serum thiopental concentration at the end of CPB was negligible. It is concluded that hypothermia alone often may not produce EEG isoelectricity, and that the associated cerebral metabolic activity may be suppressed by adjunctive use of thiopental.

Blood Proteins↗
PubMed1991

Hemodynamic effects of muscle relaxant drugs during anesthetic induction in patients with mitral or aortic valvular heart disease.

The hemodynamic effects of three nondepolarizing skeletal muscle relaxant drug regimens were compared during the induction of general anesthesia in 64 patients with valvular heart disease using a double-blind protocol. Patients were first stratified according to primary valvular defect (aortic stenosis, aortic regurgitation, mitral stenosis, or mitral regurgitation). Next, patients were randomly allocated to a drug group, either group A (atracurium), group V (vecuronium), or group MP (metocurine plus pancuronium). Data were collected during three periods: awake, postanesthetic induction, and posttracheal intubation. Four cardiovascular variables were designated a priori as primary variables of interest. These were heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), and systemic vascular resistance index (SVRI). Patients with mitral stenosis showed two significant hemodynamic differences among muscle relaxant drug groups: (1) CI increased in group A but decreased in group MP between the awake and postinduction measurements (P = 0.032); and (2) SVRI decreased in group A but increased in group MP between the awake and postintubation periods (P = 0.034). In contrast, patients with aortic stenosis, aortic regurgitation, or mitral regurgitation demonstrated no statistically significant difference in cardiovascular responses among drug groups. Further analysis was performed using the following data: (1) other hemodynamic variables; (2) incidence of deviations from cardiovascular stability; and (3) the frequency of cardiovascular drug use. This examination showed no important differences among the muscle relaxant drug groups. The small but significant hemodynamic changes observed in mitral stenosis patients in drug groups A and MP were not noted with vecuronium.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed1991

The onset and duration of neuromuscular blockade using combinations of atracurium and vecuronium.

The effect of atracurium-vecuronium combinations on the onset and duration of neuromuscular blockade was investigated in 30 adult patients undergoing general anaesthesia for elective surgery. The patients were randomized to receive either atracurium 0.6 mg.kg-1, vecuronium 0.1 mg.kg-1, or quarter-dose, half-dose, or full-dose combinations of the two drugs. Neuromuscular blockade was assessed by measuring the evoked electromyographic response of the abductor digiti minimi to transcutaneous stimulation of the ulnar nerve. It was found that half-dose combinations of atracurium and vecuronium did not produce a shorter onset time, but did result in a longer duration of neuromuscular blockade than full-doses of either drug alone (P less than 0.01). The quarter-dose combinations did not reduce onset time or increase duration. The full-dose combinations produced both a shorter onset time (P less than 0.01) and a longer duration (P less than 0.001). The results indicate that atracurium-vecuronium combinations are supra-additive in terms of the duration of the neuromuscular blockade produced. However, the inability of atracurium-vecuronium combinations to reduce onset time without increasing duration suggests that there is little advantage in combining the two drugs in clinical practice.

Adult↗
PubMed1991

Brachymetatarsia. A new surgical approach.

Although most practitioners are familiar with brachymetatarsia, it is a relatively uncommon clinical entity presenting for surgical correction. Traditional methods of surgical correction have been successful for the most part; however, a number of potentially devastating complications exist with these procedures. The authors present a review of the deformity, including the historical surgical techniques, and introduce a new surgical approach that minimizes the risk of complication.

Foot Deformities, Congenital↗
PubMed1990

Pulsed dye laser treatment of telangiectases with and without subtherapeutic sclerotherapy. Clinical and histologic examination in the rabbit ear vein model.

The treatment of leg telangiectases with the carbon dioxide or argon laser results in a low success rate and an unacceptable risk of scarring. Sclerotherapy is effective; however, pigmentation and telangiectatic matting induced by extravasation of RBCs and excessive posttreatment inflammation are common. We conducted a clinical and histologic study of therapy with the 585 nm pulsed dye laser alone and in combination with subtherapeutic sclerotherapy in the rabbit ear vein model. The pulsed dye laser alone was effective when 10 joule/cm2 was used. In combination with immediate injection of the sclerosant, effective endosclerosis occurred with all tested laser energies (8 to 10 joule/cm2).

Animals↗
PubMed1990

Electroejaculation in spinal cord injury patients: simplified new equipment and technique.

A new simplified electrostimulation system for rectal probe electroejaculation has been developed and tested 17 times in 13 patients. Seminal emissions were obtained easily from 13 of 17 studies and partial emissions were obtained in 4. Patients with cauda equina and conus lesions with partial intact sensorium also could achieve successful ejaculation by longer stimulation from 2 to 5 minutes with lower currents that could be maintained easily and were tolerated by the patient--a feature unique to our new computerized equipment. The simplicity of operation reduces the number of trained personnel for an electrostimulation procedure, which can be done even in an outpatient setting.

Adult↗
PubMed1990

A comparison of sclerosing agents: clinical and histologic effects of intravascular sodium tetradecyl sulfate and chromated glycerin in the dorsal rabbit ear vein.

The dorsal marginal rabbit ear vein was injected with 0.25 ml of 0.1% or 0.25% sodium tetradecyl sulfate (STS) (Sotradecol Injection) or undiluted or 50% Scleremo (Scl) (chromated glycerin). Only the 50% Scl solution failed to produce clinical or histologic thrombosis at 1 hour. Clinical fading was observed in STS-treated vessels at 10 days postinjection. Histologically, early thrombus formation with focal endothelial necrosis was replaced by fibrosis and microangiopathic recanalization. Although undiluted Scl caused similar, yet milder histologic findings, luminal recanalization after 10 days resulted in a clinically unfaded vessel. The use of 50% Scl produced no endothelial damage with no subsequent change in vessel appearance. Cutaneous necrosis or extravasation of erythrocytes was not observed.

Animals↗
PubMed1990

Cranial nerve paresis following epidural and spinal anesthesia.

Three cases of cranial nerve paresis following epidural and spinal anesthesia are presented. One patient had combined oculomotor and abducens nerve paresis, while the other two patients had solitary abducens nerve pareses. The authors postulate that mechanical traction is the cause of cranial nerve paresis following epidural and spinal anesthesia.

Abducens Nerve↗
PubMed1990

Lesser metatarsalgia evaluation and treatment.

Anatomic and biomechanical aspects of the complex topic of metatarsalgia are reviewed. Cause is classified as structural, functional, and a combination of both. Evaluation of the lesion symptom complex is presented and light is shed on reasons for complications after metatarsal osteotomy. Ways to avoid complications are also discussed. The oblique osteotomy with rigid fixation performed at the distal surgical neck or the proximal metaphysis is recommended.

Diagnosis, Differential↗
PubMed1989

The effect of a standardized premedication on oxygen saturation in the cardiac patient before transfer to the operating room.

The effect of premedication with morphine and scopolamine on arterial hemoglobin oxygen saturation (SaO2) was measured continuously in 26 undisturbed patients in their hospital rooms before coronary artery bypass surgery. Two hours preoperatively each patient received morphine, 0.1 mg/kg, and scopolamine, 0.2 or 0.4 mg. SaO2 was continuously recorded using pulse oximetry from one-half hour before premedication until 1 1/2 hours after premedication. The lowest SaO2 measured both the evening before surgery and one-half hour before premedication was 95% +/- 0.5% (mean +/- SEM). After administration of premedication, the lowest SaO2 for the patient population decreased to 93% +/- 0.4% (P less than 0.001 compared with that before premedication), and occurred 52 +/- 2 minutes after premedication was given. Two patients (8%) had an SaO2 less than 90% (lowest SaO2 for both was 88%). It is concluded that the dose of morphine/scopolamine premedication used was associated with a low risk of clinically important hypoxemia in the patient population studied.

Adult↗
PubMed1989

Cardiovascular evaluation before circulatory arrest for removal of vena caval extension of renal carcinoma.

The use of cardiopulmonary bypass, deep hypothermia and circulatory arrest has decreased the risks of hemorrhage, tumor embolization, incomplete thrombus resection, and warm hepatic and renal ischemia associated with resection of renal cell carcinoma extending into the inferior vena cava above the hepatic veins. Patients about to undergo this operation frequently have significant coronary artery and carotid artery disease, and are at risk for perioperative myocardial infarction and stroke. Preoperative evaluation of the coronary artery and carotid artery circulation by coronary angiography, duplex carotid artery scan and digital subtraction carotid angiography is recommended. Depending upon the severity and location of the cardiovascular disease a sequential or simultaneous operation may be performed. This surgical approach can be used in selected patients to facilitate complete tumor thrombectomy with a low operative risk.

Aged↗
PubMed1989

Mandibular prognathism.

The use of the vertical subcondylar osteotomy for correction of uncomplicated mandibular prognathism is reviewed. Techniques for use in more complicated cases such as when a set back of greater than 10 mm is required are also described.

Humans↗
PubMed1988

Induction of expression of cell-surface homologous restriction factor upon anti-CD3 stimulation of human peripheral lymphocytes.

Homologous restriction factor (HRF) is a 65-kDa membrane protein that inhibits transmembrane channel formation by the membrane-attack complex of complement and by the complement component C9-related cytolytic lymphocyte protein. Stimulation of resting peripheral human lymphocytes with the anti-CD3 monoclonal antibody OKT3 has been shown to induce cytotoxicity in the CD8+ subpopulation. As demonstrated here, OKT3 stimulation also induces expression of cell-surface HRF by CD4+ and CD8+ T lymphocytes. The small proportion of Leu 19+ natural killer lymphocytes present in peripheral blood mononuclear cells was found to express HRF prior to stimulation. Whereas unstimulated peripheral blood mononuclear cells were susceptible to lysis by the membrane-attack complex or by the C9-related protein, OKT3-stimulated peripheral blood mononuclear cells were relatively resistant to both the membrane-attack complex and C9-related protein. This acquired resistance was abrogated by blocking surface HRF with F(ab')2 anti-HRF, suggesting that resistance was due to lymphocyte-membrane HRF. By using solid-phase anti-HRF, a 65-kDa protein was isolated from the activated peripheral blood mononuclear cells and shown to be capable of conferring upon sheep erythrocytes the characteristic activity of human HRF.

Antibodies, Monoclonal↗
PubMed1988

Continuous oxygen saturation monitoring during cardiac catheterization in adults.

Arterial hypoxemia may contribute to morbidity during cardiac catheterization. Therefore, we measured arterial hemoglobin oxygen saturation (SaO2) continuously using pulse oximetry in 29 patients (age range, 21 to 83 years) undergoing cardiac catheterization. Baseline SaO2 was 96 +/- 0.4 percent. All patients had a decrease in SaO2 at some time during the procedure. Eleven patients (38 percent) had episodes of arterial hypoxemia, defined as a decrease in SaO2 below 90 percent. In these 11 patients, the mean number of episodes of hypoxemia was 16 +/- 7, and the mean duration of each episode was 53 +/- 25 seconds. Multiple stepwise regression analysis showed that the minimum SaO2 during catheterization for any patient was significantly associated with the baseline SaO2, duration of the procedure, and end-diastolic volume (EDV) as described by the following regression equation: minimum SaO2 = 46.8 - 0.0580 (duration of procedure in minutes) + 0.5362 (baseline SaO2) - 0.0159 (EDV). Based on our finding of arterial hypoxemia in greater than one third of our patients, we would consider continuous SaO2 monitoring or supplemental oxygen during cardiac catheterization, especially for those patients with poor ventricular function or low resting SaO2 or those expected to have long procedures.

Adult↗
PubMed1988

Fibronectin enhances healing of excised wounds in rats.

Fibronectin (Fn) is a normal plasma and extracellular matrix glycoprotein that is involved in each phase of wound healing. For example, it is incorporated into both fibrin and collagen fibers; it opsonizes circulating tissue debris for removal by the reticuloendothelial system; it is used by macrophages, fibroblasts, and epithelial cells to move into the wound; and fragments of Fn are chemotactic for fibroblasts. In this study, experiments with rats showed that excised lesions treated with Fn healed more rapidly than paired control lesions treated with the carrier alone. Applications of Fn once a day for two days were as effective in speeding healing as twice-daily applications of Fn for 12 days. A single treatment with Fn soon after the initial injury was nearly as effective as more prolonged treatment regimens.

Administration, Topical↗
PubMed1988

Tissue debris at the injury site is coated by plasma fibronectin and subsequently removed by tissue macrophages.

Fibronectin (Fn) is a normal plasma and extracellular matrix glycoprotein that is thought to be important in reticuloendothelial system function as well as in promoting adhesion of various cell types to basement membranes and to each other. Plasma Fn levels are depressed following almost any type of trauma. It opsonizes circulating tissue debris for removal by the fixed cells of the reticuloendothelial system. It has been assumed but not proven that Fn also opsonizes tissue debris at the site of the injury for subsequent phagocytosis by tissue macrophages. In this study, rats were given intracardiac injections of Fn coupled with fluorescence isothiocyanate (Fn-FITC) and human serum albumin-rhodamine isothiocyanate (HSA-RITC). Abdominal Rebuck skin windows were then prepared. Within 24 hours, debris at the sites of injury were observed to be coated with Fn-FITC but not HSA-RITC. This Fn-labeled debris was subsequently ingested by macrophages at the site. No macrophages were found that had taken up HSA-RITC. Thus, Fn is seen to coat tissue debris and effete cells within the wound, and the coated material is subsequently removed by tissue macrophages.

Animals↗