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Biomedical subjects

D G Cunningham

Publications and source records attributed to D G Cunningham.

At least 19 recordsLinked to original sources
PubMed1998

Infantile cortical hyperostosis and facial nerve palsy.

Facial nerve palsy was diagnosed in a 13-month-old child with infantile cortical hyperostosis. Facial palsy preceded the roentgenographic evidence of mandibular hyperostosis but there was concurrent evidence of hyperostosis of multiple other bones. This case exemplifies the importance of maintaining a high index of suspicion for infantile cortical hyperostosis in infants and children presenting with facial swelling and facial nerve palsy.

Facial Paralysis↗
PubMed1994

Preoperative transdermal scopolamine does not reduce the level of nausea and frequency of vomiting after laparoscopic cholecystectomy.

OBJECTIVE: To determine the efficacy of scopolamine administered transdermally before laparoscopic cholecystectomy as a means of reducing postoperative nausea and vomiting. DESIGN: A randomized, double-blind, placebo-controlled study. SETTING: A tertiary-care, university-affiliated hospital. PATIENTS: A volunteer sample of 125 men and women between 20 and 60 years of age scheduled to undergo elective laparoscopic cholecystectomy. Expectant or nursing mothers were excluded, and 35 patients were excluded from the final analysis because of protocol violations. Forty-three patients received scopolamine and 47 patients received a placebo. INTERVENTION: A skin patch (scopolamine or placebo) was applied behind the right ear on the evening before operation and maintained for at least 24 hours postoperatively. MAIN OUTCOME MEASURES: The postoperative level of nausea assessed by the patient on a visual analogue scale, the frequency of vomiting and the frequency of antiemetic use. RESULTS: There was no significant difference in the level of nausea or in the frequency of emesis or use of antiemetics in the first 24 hours postoperatively between the control and study groups. Furthermore, there was no difference in the overall frequency of side effects. However, visual blurring was experienced by six patients in the study group compared with one in the control group (p = 0.082). CONCLUSION: Scopolamine administered transdermally before laparoscopic cholecystectomy does not reduce the frequency or level of nausea and vomiting postoperatively.

Administration, Cutaneous↗
PubMed1989

Large outbreak of food poisoning caused by Salmonella typhimurium definitive type 49 in mayonnaise.

An investigation was conducted to determine the vehicle of infection of an outbreak of food poisoning in a large metropolitan building early in 1988. A questionnaire was distributed to 700 people who had eaten in the building during the week of the outbreak, and attack rates for specific food were calculated. Food and stool samples, environmental samples, and eggs and environmental swabs from the egg suppliers were examined microbiologically. Altogether 474 questionnaires were returned, 120 people reporting gastrointestinal illness. The illness was significantly associated with foods containing mayonnaise. Salmonella typhimurium definitive type 49 was isolated from 76 of the 84 stool samples containing salmonella and from five of the eight samples taken from the chicken house of the main egg supplier. Mayonnaise was probably the vehicle of infection, which was caused by S typhimurium definitive type 49.

Adult↗
PubMed1988

Aeromonas-associated diarrhea in children.

In a 27-month prospective study, Aeromonas spp. were isolated from 7.3% of children with diarrhea and from 2.2% of controls. In 32 patients with diarrhea, ranging in age from 1 to 27 months old, Aeromonas spp. were the only potential bacterial enteropathogens isolated. Principal symptoms of Aeromonas-associated diarrhea were vomiting, fever and bloody stools. Diarrhea was often self-limiting and lasted for 10 days or less in 90% of patients. No secondary spread of diarrhea among close contacts was observed and no clear-cut seasonal patterns of Aeromonas isolation were found. Aeromonas caviae was the most frequently isolated species in fecal samples of patients (24 of 29 isolates) as well as controls (5 of 7 isolates). Cholera toxin cross-reactive cytotoxic enterotoxin was produced by a vast majority of Aeromonas isolates, as compared to a non-cholera toxin cross-reactive cytotonic enterotoxin. In addition no significant correlation was observed between severity of the diarrheal disease and different Aeromonas or the quantity of enterotoxins produced. In our geographic area Aeromonas spp., and A. caviae in particular, seem to be an important and frequent cause of diarrhea in young children.

Aeromonas↗
PubMed1987

HIV testing: changing trends at a clinic for sexually transmitted diseases in London.

Trends in human immunodeficiency virus (HIV) counselling and antibody testing at a London clinic for sexually transmitted diseases showed substantial changes over a 12 month period. From around 100 a month in the summer of 1986 the numbers of people attending rose substantially to 276 in October 1986 and 475 in November at the time of the campaign in the popular press. They rose further still, to 700, at the time of AIDS (acquired immune deficiency syndrome) week in March 1987. In April they fell to the levels seen six months previously. Apart from this increase in overall numbers the proportions of women and heterosexual men who were seen increased.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Right and left ventricular performance in acute hypoxemic respiratory failure.

We examined biventricular performance on two occasions in 28 patients with acute hypoxemic respiratory failure (ARF), using a combination of invasively determined pressures and flows as well as radionuclide scintigraphy to measure the right and left ventricular ejection fractions (RVEF and LVEF, respectively). From the EF and concurrently measured thermodilution stroke volumes, we calculated right and left ventricular end-diastolic and end-systolic volume indices (EDVI and ESVI, respectively). Regression analysis demonstrated that changes (delta) in global right ventricular function (RVEF) were inversely correlated with concurrent changes in the mean pulmonary arterial pressure (MPAP): delta RVEF = 0.015-0.015 delta MPAP (r2 = 0.60; p less than .005), while an increase in right ventricular preload (RVEDVI) was positively correlated with changes in MPAP: delta RVEDVI = 2.68 +/- 6.27 delta MPAP (r2 = 0.46; p less than .005). Global left ventricular function (LVEF) was related to changes in systemic pressures as well as to right-sided events: delta LVEF = -0.01-0.0015(delta RVESVI) + 0.001(delta BP systolic)-0.42(CVP/RVEDVI) (r2 = 0.35; p less than .01). These data confirm the significant influence of right ventricular afterload on RVEF in ARF patients and an apparent interrelationship between altered right ventricular systolic function and global left ventricular performance.

Acute Disease↗
PubMed1985

Thermal dye measurements of extravascular lung water in critically ill patients. Intravascular Starling forces and extravascular lung water in the adult respiratory distress syndrome.

To assess the concurrent influence on extravascular lung water (EVLW) content of the intravascular Starling forces, the pulmonary capillary wedge pressure (PCWP), and the colloid osmotic pressure (COP), we measured EVLW by the thermal green dye technique in 174 patients with and without radiographically defined pulmonary edema; in the former group, patients with cardiac (CPE) and noncardiac (NCPE) causes of pulmonary edema were compared (study A). In 119 patients, EVLW was again measured one to three days later (study B). Patients with CPE demonstrated a significantly lower EVLW (9.3 +/- 3.9 ml/kg) (mean +/- SD) than patients with NCPE (14.5 +/- 4.9 ml/kg; p less than 0.05), despite a higher mean PCWP in the former group (20 +/- 7 mm Hg) than in the latter (12 +/- 6 mm Hg; p less than 0.05). In patients potentially with only a hydrostatic cause of pulmonary edema in study A, regression analysis demonstrated the following: EVLW = 3.2 + 0.30 PCWP (r2 = 0.38; p less than 0.005); and in patients with NCPE, EVLW = 10.9 + 0.304 PCWP (r2 = 0.17; p less than 0.01). In study B the change (delta) in EVLW between the two studies was described as follows: delta EVLW = 0.25 + 0.173 delta PCWP (p less than 0.01) + 0.663 group NCPE (p, not significant) + 0.236 group NCPE X delta PCWP (p less than 0.01). This latter equation indicated that the EVLW content manifested a greater change with concurrent alterations in the PCWP in patients with NCPE than was found in patients with only a hydrostatic influence to EVLW formation. Therefore, NCPE is characterized by a greater measurable thermal green dye EVLW than is observed in CPE at any given PCWP, and the PCWP synergistically influences EVLW accumulation in both CPE and NCPE.

Adult↗
PubMed1985

Assisted ventilation in patients with preexisting cardiopulmonary disease. The effect on systemic oxygen consumption, oxygen transport, and tissue perfusion variables.

We have evaluated systemic oxygen consumption (VO2), systemic oxygen transport, and tissue perfusion variables in 30 patients with preexisting cardiac and underlying pulmonary disease during continuous positive-pressure ventilation and positive end-expiratory pressure [PEEP], during intermittent mandatory ventilation (IMV and PEEP), and during spontaneous ventilation (continuous positive airway pressure [CPAP]), with end-expiratory pressure held constant during all ventilatory modes. Using radionuclide angiography together with invasive determinations of pressure and flow, we also measured left and right ventricular ejection fractions and calculated the end-systolic (ESVI) and end-diastolic (EDVI) volume indices of both ventricles. We found that oxygen transport was significantly greater during CPAP (583 +/- 172 ml/min/M2)(mean +/- SD) than during either IMV and PEEP (543 +/- 151 ml/min/sq; p less than 0.01) or CPPV and PEEP (526 +/- 159 ml/min/M2; p less than 0.01); however, we found no significant change in systemic VO2 with conversion from CPPV and PEEP to CPAP. The increase in oxygen transport was related to a greater cardiac index and, more specifically, to a higher heart rate during CPAP (CPAP, 106 +/- 16 beats per minute; CPPV and PEEP, 97 +/- 14 beats per minute) (p less than 0.01). Enhanced oxygen transport during CPAP was also associated with an increase in mixed venous oxygenation and a decrease in arterial lactate. Although neither the mean left ventricular EDVI nor ESVI changed from CPPV and PEEP to CPAP, the mean pulmonary capillary wedge pressure increased (CPPV and PEEP, 12 +/- 5 mm Hg; CPAP, 14 +/- 7 mm Hg) (p less than 0.01), suggesting the possibility of a decrease in left ventricular compliance with the spontaneous ventilatory mode. This study suggests that in the absence of ventilatory failure, spontaneous ventilation provides for better systemic oxygen transport and overall tissue perfusion than either controlled ventilation or IMV; however, this benefit of enhanced oxygen delivery with spontaneous ventilation may potentially be offset by a decrease in left ventricular compliance.

Aged↗