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Biomedical subjects

D F Brennan

Publications and source records attributed to D F Brennan.

12 recordsLinked to original sources
PubMed2000

Chronic ectopic pregnancy--two cases of acute rupture despite negative beta hCG.

We present the cases of two women with chronic ectopic pregnancies who presented with acute tubal rupture and hemoperitoneum despite negative beta-human chorionic gonadotropin (beta hCG) pregnancy tests. The appropriate screening use of beta hCG assays to ascertain pregnancy status, the mechanisms by which ectopic pregnancy may be seen with negative beta hCG tests, and the limitations of various assays are discussed. One patient, not initially believed to be pregnant, underwent computed tomography (CT) scan. Experience with use of CT scan in ectopic pregnancy diagnosis is limited; our case illustrates some of the possible CT scan findings. These cases illustrate the potential for ectopic pregnancy to rupture with low, if not undetectable beta hCG hormone levels, and consequently why it is not recommended to rely on quantitative beta hCG levels to guide the decision to proceed with ultrasound imaging.

Abdominal Pain↗
PubMed1997

Bilious vomiting in a 9-month-old infant.

A case of bilious vomiting in a 9-month-old male is reported. The differential diagnosis of infantile bilious vomiting is reviewed, and appropriate diagnostic studies are discussed. The child was found to have intussusception. The common manifestation of this pediatric surgical emergency may vary considerably from classic descriptions. Bilious emesis in infants must be considered a surgical emergency until proven otherwise; intussusception may manifest as bilious vomiting only.

Bile Reflux↗
PubMed1995

Ethanol elimination rates in an ED population.

Knowledge of the rate of ethanol elimination is essential in the assessment of the intoxicated patient. Surprisingly little literature is available regarding ethanol elimination rates in emergency department (ED) patients; prior studies almost exclusively examined populations of alcoholics or normal controls. Consequently, this prospective observational study was undertaken to assess the rate of ethanol elimination in an ED population. Twenty-four consecutive adult ED patients clinically suspected of intoxication who had serum ethanol determinations drawn were enrolled. Patients underwent serial ethanol determinations via breathalyzer (Intoxilyzer 1400, CMI Inc., Owensboro, KY). Linear regression analysis of the plot of decrease in ethanol level over time was performed to determine the rate of ethanol elimination. Initial ethanol levels in the 24 patients ranged from 58 to 447 mg/dL (mean, 249 +/- 109 [SD] mg/dL). Patients were observed for a minimum of 2 and a maximum of 9 observations (mean, 3.9 +/- 1.7), over a period of 0.5 to 12.1 hours (mean, 4.4 +/-3.5 h). Clinical features of intoxication were poorly correlated with ethanol level (r < .5). The rate of ethanol elimination in the ED population was 19.6 mg/dL/h (r = .83; 95% confidence interval [CI], 16.9 to 22.3 mg/dL/h). Subgroup analysis found differences that were statistically significant but small. Multiple regression analysis showed that time was the major variable useful in predicting changes in ethanol level (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Reliability of infrared tympanic thermometry in the detection of rectal fever in children.

STUDY OBJECTIVE: Recently published clinical guidelines for the management of febrile children are based on studies that used rectal temperature data to stratify the risk of bacteremia and septic complications. Appropriate management decisions rely on accurate detection and categorization of fever. Accordingly, this study compared the newer infrared tympanic thermometry (ITT) to rectal thermometry in this regard. DESIGN: Prospective observational study. SETTING: Urban teaching hospital ED with annual census of 60,000. PARTICIPANTS: Consecutive children 6 months to 6 years old who had rectal temperatures measured. INTERVENTIONS: Triage nurses recorded rectal temperatures and bilateral ITT temperatures. Temperatures were correlated by Pearson correlation coefficients and compared using paired t tests with significance set at P < .01. Children were categorized by degree of fever using rectal temperature (afebrile, less than 100.4 degrees F; low fever, 100.4 to 102.9 degrees F; and high fever, more than 102.9 degrees F), and the accuracy of ITT in detecting fever and high fever was determined. RESULTS: Three hundred seventy patients were enrolled in the study. The mean age was 18.4 +/- 11.3 months; boys comprised 56% of patients. The mean temperatures were rectal, 101.0 +/- 2.0 degrees F; right tympanic membrane, 100.4 +/- 1.9 degrees F; and left tympanic membrane, 100.3 +/- 1.9 degrees F. The tympanic membrane temperatures were significantly lower than rectal readings (P << .001 for both right and left versus rectal). Rectal temperatures showed good correlation with both right and left tympanic membrane temperatures (r = .83 and .85, respectively). ITT was 76% sensitive and 92% specific in detecting fever of 100.4 degrees F or more (positive predictive value, 0.92; negative predictive value, 0.76). In the detection of high fever, ITT was only 57% sensitive but 98% specific (positive predictive value, 0.90; negative predictive value, 0.90). Rectal and TM temperatures differed by at least 0.5 degree F in 70% of the patients, 1.0 degree F in 41%, 2.0 degrees F in 12%, and 3.0 degrees F in 3%. CONCLUSION: Despite the statistical correlation between ITT and rectal temperatures, the modalities may yield significantly different temperatures. The poor sensitivity of ITT in detecting fever and high fever may result in clinically important miscategorizations of individual patients. Current clinical management that is based on the presence and height of fever may be adversely affected if ITT is used.

Child↗
PubMed1995

Ectopic pregnancy--Part II: Diagnostic procedures and imaging.

Ectopic pregnancy is an increasingly common and potentially catastrophic condition in which the patient often presents to the ED with abdominal pain or vaginal bleeding. Recent developments in the laboratory (sensitive beta hCG assays, progesterone assays), in ultrasonography (transvaginal probes, Doppler ultrasonography), and in the combination of modalities (discriminatory zone of beta hCG for ultrasonographic evidence of IUP) have allowed the earlier diagnosis of ectopic pregnancy, with the potential for a reduction in maternal mortality and morbidity. Understanding the strengths and limitations of the variety of diagnostic modalities available will allow the clinician to formulate a rational strategy for the early diagnosis of ectopic pregnancy. Numerous algorithms have been developed. All begin with high clinical suspicion for women of reproductive age with abdominal/pelvic pain or vaginal bleeding. Pregnancy testing with a sensitive beta hCG qualitative test is next. For stable patients found to be pregnant, sonography generally follows (often first transabdominally then transvaginally). Unstable patients require immediate resuscitation and gynecology consultation; invasive diagnostic methods may supplant laboratory studies and sonography. Unclear cases may necessitate the use of quantitative beta hCG (discriminatory zone), other pregnancy hormones (progesterone), invasive procedures (laparoscopy, culdocentesis, D&C), or observation (serial beta hCGs). A suggested algorithm incorporating these elements is shown (Fig. 1).

Algorithms↗
PubMed1988

Serum amylase levels in ectopic pregnancy.

Thirty-four women with abdominal complaints and a positive pregnancy test were evaluated for possible ectopic pregnancy (EP). Serum amylase levels were obtained as part of the diagnostic workup to note any correlation of enzyme levels with the presence of EP. Thirteen individuals (30%) were subsequently diagnosed as having an EP, and serum amylase levels in all of these patients were within normal limits, averaging 81 U/L. There was no statistically significant difference in amylase levels between the EP group and the non-EP group (P = .70). Serum amylase levels cannot reliably predict the presence of EP and should not be used as a screening or diagnostic test for this disorder.

Adolescent↗
PubMedDate not supplied

Infrared tympanic thermometry in the evaluation of pediatric acute otitis media.

OBJECTIVE: The reliability of infrared tympanic thermometry (ITT) in children and the effect of acute otitis media (AOM) on ITT are unsettled. This study assessed the effect of AOM on ITT and the utility of ITT in the diagnosis of AOM. METHODS: 520 consecutive children, aged 6 months to 6 years, presenting to the ED of an urban teaching hospital were eligible for this prospective observational study. Nurses recorded oral or rectal reference temperatures (RefTs) and bilateral ITT temperatures upon presentation. Emergency physicians were blinded to the ITT temperatures. AOM was diagnosed according to published clinical criteria. RESULTS: Among 520 patients, 108 had unilateral AOM and 78 had bilateral AOM. In patients with unilateral AOM, the infected ears were warmer (I = 100.4 +/- 1.8 degrees F) than the uninfected ears (U = 100.3 +/- 1.8 degrees F, p = 0.035). However, the disparity in TM temperatures in infected and uninfected ears with unilateral AOM (I - U = 0.2 +/- 0.9 degrees F) was similar to the difference between right and left ears in those without AOM (R - L = 0.1 +/- 0.8 degrees F, p = 0.60). Compared with patients without AOM, patients with AOM demonstrated no significant elevation of ITT temperatures over RefTs (I - RefT = -0.8 +/- 1.2 degrees F in AOM; ITT - RefT = -0.8 +/- 1.2 degrees F in non-AOM; p = 0.94). This study had >99% power to detect a 1.0 degrees F difference for all groups compared. CONCLUSIONS: Infrared tympanic temperature are not helpful in diagnosing AOM in children. AOM has little direct effect on ITT temperatures.

Acute Disease↗
PubMedDate not supplied

Diagnosis of ectopic pregnancy.

Ectopic pregnancy is an increasingly common and potentially catastrophic condition for which patients often present to the ED with abdominal pain or vaginal bleeding. Recent developments in laboratory tests (sensitive beta hCG, progesterone assays), ultrasonography (transvaginal probes, Doppler ultrasound), and combinations of these modalities (hCG Discriminatory Zone for ultrasonographic evidence of intrauterine pregnancy) have allowed the earlier diagnosis of ectopic pregnancy, with an associated reduction in maternal mortality and morbidity. Understanding the strengths and limitations of the variety of diagnostic modalities available will allow the clinician to formulate a rational strategy for the early diagnosis of ectopic pregnancy. Numerous algorithms have been developed. All begin with high clinical suspicion in women of reproductive age with abdominal/pelvic pain or vaginal bleeding. Pregnancy testing with a sensitive beta hCG qualitative test is next. In stable patients found to be pregnant, sonography generally follows, first transabdominally, then transvaginally. Unstable patients require immediate resuscitation and gynecologic consultation; invasive diagnostic methods may supplant laboratory and sonography. Unclear cases may require the use of quantitative beta hCG (discriminatory zone), other pregnancy hormone (progesterone) testing, invasive procedures (laparoscopy, culdocentesis, D & C), or observation (serial beta hCG). A suggested algorithm incorporating these elements is presented (Figure 2).

Abdominal Pain↗