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Biomedical subjects

D Plummer

Publications and source records attributed to D Plummer.

At least 19 recordsLinked to original sources

Pharmacokinetic-pharmacodynamic relations of losartan and EXP3174 in a porcine animal model.

The pharmacokinetics of losartan and EXP3174, an active metabolite of losartan, were evaluated in the anesthetized pig after both a single intravenous dose (3 mg/kg) and during constant intravenous infusion. The pharmacodynamic activities of losartan and EXP3174 were determined during constant intravenous infusion as the degree of inhibition of angiotensin II-induced increase in the diastolic pressure. The systemic plasma clearance of losartan was 22.1 +/- 4.4 ml/min/kg (mean +/- SEM) and had an apparent volume of distribution at steady state of 0.56 +/- 0.16 L/kg after a 3-mg/kg intravenous dose. The elimination half-life of losartan was 40 +/- 6 min. Less than 2% of the intravenous losartan doses was estimated to be present as unconjugated EXP3174. The plasma clearance of EXP3174 was approximately 50% that of losartan, 11.8 +/- 1.5 ml/min/kg, and had a smaller steady-state apparent volume of distribution, 0.18 +/- 0.04 L/kg. The elimination half-life for EXP3174 was slightly longer than that of losartan (52 min). The time course of the pharmacodynamic effects of losartan and EXP3174 closely followed their respective plasma concentrations. The apparent dissociation constant of EXP3174 to the angiotensin II receptor was estimated, based on the total plasma concentrations, to be approximately 5 times lower than that for losartan.

Angiotensin II

Model curriculum for physician training in emergency ultrasonography.

A model curriculum for the implementation and training of physicians in emergency medicine ultrasonography is described. Widespread use of limited bedside ultrasonography by emergency physicians will improve diagnostic accuracy and efficiency, increase the quality of care, and prove to be a cost-effective technique for the practice of emergency medicine.

Curriculum

Emergency department two-dimensional echocardiography in the diagnosis of nontraumatic cardiac rupture.

Myocardial rupture is a catastrophic complication of acute myocardial infarction that usually results in sudden death. If diagnosed quickly, patients with myocardial rupture may be salvaged. This report describes the application of emergency department two-dimensional echocardiography in the diagnosis of six cases of myocardial rupture over two years. Each demonstrated a characteristic hemopericardium on limited single-window examination. These included four patients who met institutional guidelines for thrombolytic therapy. Three patients survived surgical repair, with two long-term survivors.

Aged

Management of sexually transmissible disease. Part 1.

The appearance of AIDS and recent diagnostic and treatment advances has forced the medical profession to become more sophisticated in approaching sexually transmitted diseases. Effective prevention and quality care are fundamental to a sexual health consultation. Obtaining an accurate history on which to base prevention counselling is essential. Treatment of syphilis has not changed in recent years and is not included in this article.

Female

Management of sexually transmissible disease. Part 2--Viral infections.

The management of viral infections, including human immunodeficiency virus (HIV), human papilloma virus (HPV) and herpes simplex virus (HSV), is constantly evolving and should be the domain of all general practitioners. This article reviews current ideas in the treatment of these diseases.

Female

Emergency department echocardiography improves outcome in penetrating cardiac injury.

STUDY OBJECTIVES: To determine the effect of immediate two-dimensional echocardiography on the time to diagnosis, survival rate, and neurologic outcome of patients with penetrating cardiac injury. DESIGN: A ten-year retrospective review. SETTING: Regional trauma center serving a population base of 1.25 million with 85,000 visits yearly. TYPE OF PARTICIPANTS: All patients presenting to the emergency department with penetrating cardiac injury. MEASUREMENTS AND MAIN RESULTS: The records of 49 patients with penetrating cardiac injury were reviewed. Of these, 28 received immediate two-dimensional echocardiography in the ED (echo group) and 21 did not (nonecho group). The probability of survival was derived using TRISS methodology. Differences between groups were determined using either the two sample t-test for parametric data or the Mann-Whitney test for nonparametric data. The overall probability of survival was 33.2%, and the actual survival rate was 81.6%. The probability of survival was 34.2% and 31.8% for the echo group and nonecho group, respectively. The actual survival was 100% in the echo group and 57.1% in the nonecho group. The average time to diagnosis and disposition for surgical intervention was 15.5 +/- 11.4 minutes for the echo group and 42.4 +/- 21.7 minutes for the nonecho group (P less than .001). The Glasgow Outcome Score was 5.0 for the echo group and 4.2 for the nonecho group (P = .007). CONCLUSION: Since the introduction of immediate ED two-dimensional echocardiography, the time to diagnosis of penetrating cardiac injury has decreased and both the survival rate and neurologic outcome of survivors has improved.

Adult

The amino acid sequence of a myotoxic phospholipase from the venom of Bothrops asper.

A myotoxic, basic phospholipase A2 (pI greater than 9.5) with anticoagulant activity has been purified from the venom of Bothrops asper, and its amino acid sequence determined by automated Edman degradation. It is distinct from the B. asper phospholipase A2 known as myotoxin I [Lomonte, B. and Gutierrez, J. M., 1989, Toxicon 27, 725] but cross-reacts with myotoxin I rabbit antisera, suggesting that the proteins are closely related isoforms. To our knowledge, this is the first myotoxic phospholipase to be sequenced that lacks presynaptic neurotoxicity (iv LD50 approximately equal to 8 micrograms/g in mice). The protein appears to exist as a monomer, contains 122 amino acids, and fits with subgroup IIA of other sequenced phospholipase A2 molecules. Its primary sequence shows greatest identity with ammodytoxin B (67%), a phospholipase A2 presynaptic neurotoxin from Vipera ammodytes ammodytes venom. Hydropathy profiles of B. asper phospholipase and the ammodytoxins also show great similarities. In contrast, even though the amino acid sequence identities between B. asper phospholipase and the basic subunit of crotoxin remain high (64%), their hydropathy profiles differ substantially. Domains and residues that may be responsible for neurotoxicity are discussed.

Amino Acid Sequence

Effects of subunit cross-linking on the properties of crotoxin.

Crotoxin was cross-linked using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride. Cross-linked crotoxin had the expected amino-terminal amino acids, amino acid composition, behavior on SDS-PAGE and an 80% reduction of reactable lysine residues. It was also non-toxic, had reduced immunological cross-reactivity toward both poly- and monoclonal antibodies raised to the basic subunit of crotoxin and had lost greater than 95% of its phospholipase activity. Loss of toxicity is due to either subunit cross-linking or the modification of essential residues.

Amino Acids

Fiberoptic intubation in the emergency department.

Fiberoptic-aided endotracheal intubation has been shown to be effective in difficult intubation secondary to anatomic abnormalities and traumatic conditions. A retrospective review of emergency airway management in an emergency department during a 30-month period found 35 patients who underwent fiberoptic-aided endotracheal intubation; 31 were treated for medical conditions, and four were trauma patients. Indications in the medical group included failed nasotracheal intubation (ten), anatomic abnormalities (six), and the initial airway maneuver attempted (15). Indications in the trauma group with suspected cervical-spine injury included failed nasotracheal intubation (one) and initial airway maneuver attempted (three). In the medical subgroup, 25 of 31 patients were intubated successfully fiberoptically. All four trauma patients were intubated successfully, and all attempts were done nasally. The limitations of the technique were varied. Twenty of the 25 successful intubations had times recorded for completion (mean time, 1.8 +/- 1.4 minutes [SD]). Four of the six failed attempts had recorded times of 7.8 +/- 1.4 minutes. The mean time of the four trauma cases was 3 +/- 2.2 minutes. The presence of secretions, blood, or vomitus was the cause in five of the six failed intubations. The sixth patient kept swallowing the distal end of the scope. Fiscal restraints may also limit its use. At our institution, the financial commitment has been approximately +17,000 during the past nine years. Repair or replacement of broken equipment appears to be necessary every two or three years. Immediate airway control is often difficult with fiberoptic-aided endotracheal intubation and should be used only in selected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis

Principles of emergency ultrasound and echocardiography.

Ultrasound is a form of imaging that addresses many needs in emergency medicine. It is fast, accurate, safe, noninvasive, and painless. It rapidly diagnoses immediately life-threatening conditions and reduces the number of invasive or delayed diagnostic methods. However, successful imaging requires an understanding of ultrasonic principles. The physical principles of ultrasound imaging with emphasis on its limitations and the benefits of emergency echocardiography are highlighted.

Cardiac Tamponade

Early fresh frozen plasma prophylaxis of abnormal coagulation parameters in the severely head-injured patient is not effective.

Serious head injury may be complicated by coagulation abnormalities. Fresh frozen plasma (FFP) has been advocated as resuscitation fluid, in patients with head injury, to prevent the development of abnormal coagulation. The efficacy of this practice has never been established. We retrospectively reviewed the records of 149 head-injured patients having a Glasgow Coma Scale of 9 or less. One hundred six received FFP and were without evidence of coagulopathies, while 42 received no FFP or had coagulopathies. Group 1 received FFP within a time from injury (T1) and group 2 received FFP after time (T2) or not at all. Groups were similar in demographics, injuries, presenting Glasgow Coma Scale, and presenting hematologic parameters in serial pretreatment or posttreatment hematologic parameters (P less than .05). There were no differences between patients receiving "early" FFP, as compared with those receiving FFP later or not at all. The time of FFP administration did not appear to be critical for effective prophylaxis against coagulopathy.

Blood Coagulation Disorders

The external rotation method for reduction of acute anterior shoulder dislocation.

Acute anterior shoulder dislocation is a common disorder confronting the emergency physician. Traditional methods of reduction are often technically difficult, time consuming, and painful to the patient. Furthermore, they frequently require more than one physician and occasionally exacerbate the injury. Conversely, the recently described method of reduction by external rotation is a reliable and safe method. A single physician performs the reduction rapidly and patients tolerate it well.

Emergencies

19F NMR imaging of blood oxygenation in the brain.

Perfluorocarbon (PFC) emulsions have been developed as oxygen carrying blood substitutes. High fluorine concentrations allow them to be used in 19F NMR imaging of blood vessels. Furthermore, 19F relaxation times in PFCs are dependent on oxygen tension (pO2) so that NMR imaging may provide a noninvasive method of measuring spatially localized pO2 values in vivo. Using these principles, we have formed 19F images and calculated pO2 maps of the cat brain.

Animals

Evaluation of computer advisor in the interpretation of CT images of the head.

This paper describes the evaluation of a computer advisor system (BRAINS), which was constructed to aid in the interpretation of CT images of the head. It was developed at the National Hospital for Nervous Diseases, Queen Square, London. The system was transferred, without difficulty, to an 'external', that is previously unassociated, site (the Department of Diagnostic Radiology, University of Manchester) for an external evaluation. Response of external users to the system was mixed. Many were unfamiliar with the concept of formal description of images and the evaluation demonstrated the need for a person to person training programme. Users who accessed the HELP facilities most frequently were the most successful in obtaining accurate descriptions and hence satisfactory diagnostic advice. An objective appraisal of user's success in describing images to obtain the correct diagnosis as first choice indicated that, in general, the system performed well.

Brain Diseases

Towards an advisor for MRI.

This paper discusses the role of a computer advisor in MR image acquisition, interpretation and the diagnosis of cerebral disease. The development of an image and statistical database for use in providing advice is described.

Brain Diseases