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Biomedical subjects

D Mercer

Publications and source records attributed to D Mercer.

47 records · Page 3Linked to original sources
PubMed1987

Radioimmunoassay for human pancreatic lipase in acute pancreatitis.

We examined the utility of serum pancreatic lipase by radioimmunoassay as a diagnostic test for acute pancreatitis and its correlation with serum total amylase, pancreatic isoamylase, and lipase activity. Data were analyzed on 11 patients with documented acute pancreatitis, three groups of patients (N = 104) with nongastrointestinal, gastrointestinal, and renal diseases, and 30 healthy controls. Patients with acute pancreatitis had significantly (P less than 0.01) higher mean serum lipase by radioimmunoassay than all other groups. Using a serum lipase of 112 ng/ml as a cutoff point in all patients, the test was 91% sensitive and 96% specific for the diagnosis of acute pancreatitis. The correlation coefficients of serum lipase by radioimmunoassay with respect to total amylase, pancreatic isoamylase, and lipase activity were 0.86, 0.98, and 0.79, respectively.

Acute Disease↗
PubMed1987

Inflation pressure, gastric insufflation and rapid sequence induction.

An investigation was carried out into the relationship between the inflation pressures of normally compliant lungs and the airways pressure necessary to produce the insufflation of gas to the stomach. This relationship was examined during manual ventilation with a mask, using a rapid sequence induction technique. In the absence of cricoid pressure the lungs of all the patients could be ventilated "gently" satisfactorily by hand without gas entering the stomach. In only half of the patients could gas be redirected to the stomach when maximal inflation pressures were generated. It was not possible to cause gas to enter the stomach in any patient with a patent airway when cricoid pressure was applied.

Adolescent↗
PubMed1986

Coagulation factor concentrate usage and the risk of lymphadenopathy: a prospective study.

A prospective evaluation of 115 patients with hemophilia was performed between July 1982 and July 1983. During that period, 24 patients were seen with unexplained, generalized lymph node enlargement. The date lymphadenopathy occurred was recorded. No lymphadenopathy was found in 22 patients who did not receive coagulation factor concentrate. Factor usage was most closely related to the risks of lymphadenopathy (p = 0.004) even after controlling for age. A patient's age affected the risk of lymphadenopathy when the data were analyzed categorically (p = 0.008). A tendency was seen for heavily treated patients to develop lymph node enlargement earlier in the study period. Twenty-one of twenty-four (88%) patients with lymphadenopathy eventually developed HTLV-III/LAV antibodies and had abnormal T4/T8 ratios. These studies emphasize a close relationship between patients with hemophilia using coagulation factor concentrates and those with other risks for immune deficiency and lymphadenopathy. Close follow-up, optimal use of blood products, and further efforts to understand the importance of such changes are indicated in patients with hemophilia.

Adolescent↗
PubMed1985

The preparation of small dermal grafts.

A fast, simple, and accurate method for preparation of dermal grafts by using the Mini Dermatome for removal of the subdermal fat and the epidermis is presented.

Humans↗
PubMed1981

A comparative study of smooth muscle tumors utilizing light and electron microscopy, immunocytochemical staining and enzymatic assay.

A comparative study of eight benign and eight malignant soft tissue spindle cells tumors was done utilizing light and electron microscopy, immunocytochemical staining, and enzymatic assay of tumor homogenates. The tumors were evaluated with two antibodies using both immunofluorescent (IF) and immunoperoxidase (IP) techniques. One antibody, purified rabbit antichicken gizzard myosin antibody (RAMA) delineated only smooth muscle tumors, both benign and malignant. IP was more sensitive than IF using this antibody. Nonmyogenic spindle cell tumors, which served as controls, gave uniformly negative results when stained with this antibody. The second antibody, human antismooth muscle antibody (HASMA), was not as sensitive or specific as RAMA by both IF and IP techniques. Creatine phosphokinase (CPK) isoenzyme assay revealed that both benign and malignant smooth muscle tumors contain a high content of brain and smooth muscle (BB) isoenzyme (skeletal muscle isoenzyme (MM)/BB ratio less than 0.05). In contrast, control nonmyogenic spindle cell tumors exhibited MM/BB ratios of 0.1 or greater. While electron microscopy remains the major diagnostic tool to determine the histogenesis of difficult spindle cell tumors, IP staining methods with RAMA and CPK isoenzyme assay are useful in delineating tumors of smooth muscle origin.

Antigens, Neoplasm↗
PubMed1981

Intra-aortic balloon counterpulsation in septic shock.

Mortality in patients in septic shock remains high (50% to 80%) despite available treatment. In a 76-year-old women with hypodynamic septic shock intra-aortic balloon counterpulsation (IABC) successfully improved the hemodynamic status to the point at which the patient could maintain adequate cardiac output without assistance. The pertinent literature on experimental and clinical shock in which mechanical assistance devices were used, is reviewed. From the few clinical reports available it appears that IABC may be life-saving in those patients with hypodynamic septic shock who deteriorate despite the administration of antibiotics, steroids and vasopressors. Its value in hyperdynamic shock remains doubtful. Since the mortality associated with septic shock has not decreased despite modern management, there is justification in searching for new modalities of treatment, and the use of IABC seems most appropriate and promising.

Aged↗
PubMedDate not supplied

Prehospital identification of acute coronary ischemia using a troponin T rapid assay.

OBJECTIVE: To evaluate the performance of a rapid assay for cardiac troponin T (cTn-T) in patients with chest pain in the prehospital setting. METHODS: A prospective, observational clinical trial in a rural county served by a single emergency medical services system and two emergency departments. Patients fulfilling prehospital criteria to identify acute coronary ischemia (ACI) had a blood sample applied to the cTn-T rapid-assay device. Quantitative analysis of cTn-T was also performed on each sample at a later time. Medical records were reviewed to determine ultimate diagnoses. Non-admitted patients were followed by telephone at one week. Main outcome measures included the sensitivity, specificity, positive predictive value, and negative predictive value of the rapid cTn-T assay for detecting ACI defined as acute myocardial infarction (AMI) or unstable angina (UA) within one week of presentation. RESULTS: Of 87 patients enrolled, 29 were identified with ACI. This included 15 patients diagnosed as having AMI and 14 patients diagnosed as having UA. The cTn-T rapid-assay device was positive for five of 87 patients (5.7%); three were associated with AMI and two with UA. Measurement of a single cTn-T to detect ACI had a sensitivity of 17.2% (0.058, 0.358), specificity of 100% (0.950, 1), positive predictive value of 100% (0.549, 1), and negative predictive value of 70.7% (0.609, 0.806). CONCLUSION: The cTn-T rapid-assay device may be useful in the prehospital setting to identify a small number of patients with ACI. The authors caution, however, that a negative test in the prehospital setting cannot be used to rule out significant disease.

Acute Disease↗
PubMedDate not supplied

Recovery from sevoflurane anesthesia in horses: comparison to isoflurane and effect of postmedication with xylazine.

OBJECTIVE: To compare recovery from sevoflurane or isoflurane anesthesia in horses. STUDY DESIGN: Prospective, randomized cross-over design. ANIMALS: Nine Arabian horses (3 mares, 3 geldings, and 3 stallions) weighing 318 to 409 kg, 4 to 20 years old. METHODS: Horses were anesthetized on three occasions with xylazine (1.1 mg/kg), Diazepam (0.03 mg/kg intravenously [i.v.]), and ketamine (2.2 mg/kg i.v.). After intubation, they were maintained with isoflurane or sevoflurane for 90 minutes. On a third occasion, horses were maintained with sevoflurane and given xylazine (0.1 mg/kg i.v.) when the vaporizer was turned off. Horses were not assisted in recovery and all recoveries were videotaped. Time to extubation, first movement, sternal, and standing were recorded as was the number of attempts required to stand. Recoveries were scored on a 1 to 6 scoring system (1 = best, 6 = worst) by the investigators, and by three evaluators who were blinded to the treatments the horses received. These blinded evaluators assessed the degree of ataxia present at 10 minutes after each horse stood, and recorded the time at which they judged the horse to be ready to leave the recovery stall. RESULTS: Mean times (+/- SD) to extubation, first movement, sternal, and standing were 4.1 (1.7), 6.7 (1.9), 12.6 (4.6), and 17.4 (7.2) minutes with isoflurane; 3.4 (0.8), 6.6 (3.1), 10.3 (3.1), and 13.9 (3.0) minutes with sevoflurane; and 4.0 (1.2), 9.1 (3.3), 13.8 (6.5), and 18.0 (7.1) with sevoflurane followed by xylazine. Horses required a mean number of 4 (2.3), 2 (0.9), and 2 ( 1.6) attempts to stand with isoflurane, sevoflurane, and sevoflurane followed by xylazine respectively. The mean recovery score (SD) for isoflurane was 2.9 (1.2) from investigators and 2.4 (1.1) from blinded evaluators. For sevoflurane, the mean recovery score was 1.7 (0.9) from investigators and 1.9 (1.1) from evaluators, whereas the recoveries from sevoflurane with xylazine treatment were scored as 1.7 (1.2) from investigators and 1.7 (1.0) from blinded evaluators. CONCLUSIONS: Recoveries appeared to vary widely from horse to horse, but were significantly shorter with sevoflurane than isoflurane, although sevoflurane followed by xylazine was no different from isoflurane. Under the conditions of the study, recoveries from sevoflurane and sevoflurane followed by xylazine were of better quality than those from isoflurane. CLINICAL RELEVANCE: Sevoflurane anesthesia in horses may contribute to a shorter, safer recovery from anesthesia.

Adjuvants, Anesthesia↗