Biomedical subjects

E Cottington

Publications and source records attributed to E Cottington.

15 recordsLinked to original sources

PubMed1994

Hemoconcentration during cardiac arrest and CPR.

The objective of this study was to determine if hemoconcentration occurs during cardiac arrest and cardiopulmonary resuscitation (CPR). The design was an animal model of cardiac arrest and CPR performed at a research institute using six mongrel dogs. After the induction of cardiac arrest, animals were subjected to 4 minutes of ventricular fibrillation followed by 20 minutes of CPR. Resuscitation was then achieved using countershocks, drugs, and intravenous fluids. Hemoglobin concentrations were obtained before arrest and every 5 minutes during CPR. An average peak increase in hemoglobin concentration of 21% was observed during CPR. Hemoconcentration occurs during cardiac arrest and CPR, and this may be a result of a shift in volume from the intravascular to the extravascular space.

Animals↗

PubMed1994

Lymphocyte subsets in relapsing-remitting multiple sclerosis: a longitudinal study of B lymphocytes and T lymphocytes.

Changes in lymphocyte subset populations may provide clues to the dysimmune mechanisms involved in relapsing remitting multiple sclerosis (RRMS). The lymphocyte subgroup CD4+ CD45RA+, thought to be responsible for the induction of suppression is decreased in some patients with MS compared to controls. A possible role for another lymphocyte subset, CD19+CD5+ lymphocytes, has been proposed in autoimmune diseases and multiple sclerosis (MS). To expand this we studied CD4+CD45RA+ (T) lymphocytes and CD19+CD5+ (B) lymphocytes in nine patients with relapsing-remitting MS (RRMS) and nine controls. The patients were examined monthly for an average of ten months and nine relapses were observed in seven patients. One patient underwent monthly gadolinium enhanced magnetic resonance imaging (MRI). Normal percentages CD4+CD45RA+ lymphocytes were found in patients with RRMS. No significant abnormalities in the CD19+CD5+ lymphocyte subpopulation were noted, although a tendency for higher percentages of this subset (approaching statistical significance, P = 0.056) was detected.

Analysis of Variance↗

PubMed1994

Serum estrone concentrations and coronary artery disease in postmenopausal women.

Little is known about the relation between serum sex hormones and either coronary heart disease or the development of atherosclerosis in women. We measured serum estrone concentrations in 87 postmenopausal women (age, 50 to 81 years) who were admitted for diagnostic cardiac catheterization. None of the women were on estrogen replacement therapy. Cases (n = 62) were defined as those women who had > or = 1 coronary artery with > or = 50% occlusion. All control subjects (n = 25) had 0% to 24% occlusion of all coronary arteries. Estrone concentrations, as measured by a combination of extraction, column chromatography, and radioimmunoassay, showed little difference between cases and control subjects. A difference of 6 pg/mL in the estrone level was not associated with a significantly increased risk of coronary artery disease (odds ratio [OR], 1.85; 95% confidence intervals [CI], 0.60, 5.2). Examination of mean estrone levels on the basis of the number of occluded vessels was also not significant. The primary predictors of coronary artery disease in this population were a history of diabetes (OR, 8.8; CI, 1.5, 51.4) and age (5-year increments; OR, 2.1; CI, 1.2, 3.8). There was also some suggestion that women who reported higher lifetime physical activity levels were at a reduced risk for developing coronary artery disease (OR, 0.18; CI, 0.05, 0.65). These preliminary results do not support the hypothesis that serum estrogens are related to coronary artery disease in older women, but these findings need to be replicated in larger populations of older women.

Adult↗

PubMed1993

Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation.

PURPOSE: To analyze the effect on mortality of a protocol for early mobilization with external fixation of patients with pelvic ring injuries. METHODS: From 1981 through 1988, 605 patients with pelvic ring fractures and dislocations were treated. In 1982, a protocol for early external fixation of hemodynamically unstable patients and those with structurally unstable pelvic fracture patterns to achieve early mobilization to an upright chest position was initiated. Mortality rates were compared between 1981 (pre-protocol), 1982 (transitional), and 1983 through 1988, after initiation of a protocol of care that included external fixation of the pelvic injury. No statistical changes occurred from 1983 through 1988. RESULTS: Mortality rates in pelvic ring injury patients fell from 26% in 1981, to 6% in 1983 through 1988 (p < 0.001), whereas during the study period the mean injury Severity Score (ISS), 23, did not change. The mortality rate of a group of consecutive patients with comparable ISSs, but without pelvic ring injuries did not change. The mortality rate in patients with systolic blood pressure < 100 mm Hg at admission fell from 41% in 1981 to 21% 1983 through 1988 (p = 0.0001). Mortality in patients with closed head injuries associated with pelvic ring injuries fell from 43% in 1981 to 7% from 1983 through 1988 (p = 0.0001). The proportion of patients undergoing external fixation rose from 3% in 1981 to 31% in 1983 through 1988 (p = 0.0001). CONCLUSIONS: An organized protocol including external fixation and early patient mobilization to an upright chest position reduced mortality associated with injuries of the pelvic ring. Orthopedic stabilization of major skeletal injuries should be viewed as part of patient resuscitation, not reconstruction.

Clinical Protocols↗

PubMed1992

Head, facial, and clavicular trauma as a predictor of cervical-spine injury.

STUDY HYPOTHESIS: The American College of Surgeons teaches that "trauma occurring above the clavicle should raise a high suspicion for a potential cervical spine injury." In this study, we investigated the association of head, facial, and clavicular trauma with cervical-spine and cord injury. METHODS: The records of 5,021 consecutive trauma patients admitted to a level I regional trauma center during a three and one-half year period were reviewed retrospectively. The incidence rates of head, facial, clavicle, cervical spine, and cervical cord injuries were recorded. Glasgow Coma Scores (GCS) were obtained on all patients. Statistical analysis using multiple logistic regression and chi 2 analysis were performed to determine the relationship between traumatic injury above the clavicle and cervical spine and cord injury. RESULTS: Head-injured patients had no greater incidence of cervical-spine injury than did non-head-injured patients (4.76% vs 4.37%, P = .52) but were found to have significantly fewer spinal cord injuries (1.5% vs 2.3%, P = .048). There was no difference in incidence of cervical-spine injuries between patients with and those without facial injuries (4.2% vs 4.6%, P = .61). However, there were significantly fewer cord injuries among patients with facial injuries (0.75% vs 2.2%, P = .01). The presence or absence of clavicular fracture was not associated with a significant increase in cervical spine (6.9% vs 4.4%, P = 11) or cervical cord injuries (1.6% vs 2.0%, P = .68). A GCS of less than 14 was associated with a higher incidence of cervical-spine injury than was a GCS of 14 or more in both head-injured (6.7% vs 3.9%, P = .007) and non-head-injured patients (12.2% vs 5.9%, P = .002). There was a greater incidence of cervical cord injury among patients with a GCS of less than 14 than in those with a GCS of 14 or more in both the head-injured (2.2% vs 1.2%, P = .09) and non-head-injured (8.8% vs 2.7%, P less than .0001) groups. CONCLUSION: Trauma to the head, face, and clavicle is not associated with a higher incidence of cervical-spine or cord injury. Physiologic parameters such as the GCS appear to be more accurate predictors of cervical spine or cord injury than mere evidence of trauma occurring above the clavicle.

Cervical Vertebrae↗

PubMed1991

Hemodynamic performance and histamine levels after desmopressin acetate administration following cardiopulmonary bypass in adult patients.

Sixteen patients undergoing cardiac surgical procedures were prospectively randomized into two groups to study the hemodynamic and histamine-releasing effects of desmopressin acetate (DDAVP) administration after cardiopulmonary bypass. Ten minutes after administration of protamine for reversal of heparin, DDAVP, 0.3 microgram/kg, was infused intravenously over 5 seconds in group 1, and the same dose of DDAVP was administered over 5 minutes as an infusion in group 2. There were no statistical differences between baseline values in groups 1 and 2. DDAVP decreased mean arterial pressure by 30% and 25% in groups 1 and 2 (69 +/- 5 mm Hg to 52 +/- 8 mm Hg, P less than 0.005, and 79 +/- 20 mm Hg to 55 +/- 8 mm Hg, P less than 0.005), respectively. The hypotension in both groups was related to decreases in systemic vascular resistance (1,616 +/- 262 dyne.s.cm-5 to 1,073 +/- 199 dyne.s.cm-5, P less than 0.005, and 1,850 +/- 541 dyne.s.cm-5 to 1,144 +/- 214 dyne.s.cm-5, P less than 0.005). Phenylephrine infusion successfully treated the DDAVP-induced hypotension in all patients. Arterial histamine levels at 3 and 5 minutes after infusion of DDAVP did not differ significantly from baseline values. It is concluded that DDAVP at 0.3 microgram/kg is a potent vasodilator when administered intravenously and that histamine is not involved in producing its hypotensive effects.

Anesthesia, Intravenous↗

PubMed1991

Risk factors associated with preterm deliveries among racial groups in a national sample of married mothers.

Seven sociodemographic and behavioral factors that may explain the increased risk of preterm deliveries among black women were examined using data from a national sample of 5823 married mothers who responded to the 1980 National Natality Survey (NNS) Questionnaire. There was a twofold increase in the rate of preterm deliveries among black women. Additionally, there was a significant decrease (by 1 week) in the mean gestational age in black mothers (p less than 0.0001) compared with white mothers. The two groups were similar with respect to smoking and age; however, there were significant differences between the two groups with respect to other risk factors. Black women had a higher rate of heavy alcohol use, significantly fewer prenatal visits, prenatal care was started later during pregnancy (p less than 0.0001) and were less educated compared with white women. The odds ratio (OR) for race adjusted for the risk factors was 1.56 (95% confidence interval (CI) equals 1.21, 2.01). All other risk factors except education had adjusted ORs greater than 1. Those risk factors that were more strongly associated with the risk of preterm births included weight gain (OR, 2.10; 95%, 1.79, 2.47), number of prenatal visits (OR, 3.37; 95% CI, 2.87, 3.95) and smoking (OR, 1.34; 95% CI, 1.13, 1.59). We conclude that race is an independent risk factor for preterm deliveries. Additionally, it is shown here that the risk of preterm deliveries is attributable to health behaviors that are amendable to change.

Adult↗

PubMed1989

Trauma and the full moon: a waning theory.

There exists a popular belief in the causal relationship between the moon's phase and the incidence of major trauma. In this retrospective study we reviewed 1,444 trauma victims admitted to the hospital during one calendar year. Full moons were defined as three-day periods in the 29.531-day lunar cycle, with the middle day being described in the world almanac as the full moon. Victims of violence included those patients sustaining blunt assault, gunshot wounds, and stabbings. There was no statistical difference in number of trauma admissions between the full moon, 129 patients per 36 days (mean, 3.58), and nonfull moon days, 1,315 patients per 330 days (mean, 3.98). Mortality rate, 5.4% versus 10.3%; mean Injury Severity Score, 13 versus 15; and mean length of stay, ten versus 12 days, were not significantly different during the full moon and nonfull moon days. Victims of violence were admitted at a similar frequency on full moon, 16 patients per 36 days (mean, 0.444), and nonfull moon days, 183 patients per 330 days (mean, 0.555). We conclude that the belief in the deleterious effects of the full moon on major trauma is statistically unfounded.

Folklore↗

PubMed1989

Acoustic otoscopy in the diagnosis of otitis media.

Acoustic otoscopy detects middle ear pathology by measuring the ability of the tympanic membrane to reflect sound. Fluid or thickening of the tympanic membrane increases sound reflection. We conducted a study to compare acoustic otoscopy with pneumatic otoscopy in identifying middle ear pathology in 80 children (160 ears) presenting to the emergency department with ear or upper respiratory complaints. We then evaluated the use of acoustic otoscopy in 34 adults (68 ears) with and without ear complaints. Using a reflectivity of 5 or more units to signify acute pathology in children, the sensitivity was 82%, and the specificity was 100%. Using a reflectivity of 6 or more units to indicate acute suppurative pathology in adults, the sensitivity was 83%, and the specificity was 95%. We found acoustic otoscopy to be objective, practical, and reproducible. We conclude that acoustic otoscopy is a valuable adjunct in the diagnosis of otitis media in children and adults.

Acoustic Stimulation↗

PubMed1989

Gastrointestinal transit times of a charcoal/sorbitol slurry in overdose patients.

Gut decontamination with a slurry of activated charcoal and sorbitol is one of the methods presently available to decrease total body burden of ingested drug. This one year retrospective audit of patients presenting with a history of recent toxic ingestion was designed to determine the time to stool of a charcoal/sorbitol slurry (CSS) when used for differing ingestants. A total of 69 patients received a CSS. 50.7% took less than 6 hours for their first charcoal stool, while 26.1% had emesis of the CSS within 30 minutes of administration. Ingestion of drugs which may increase gastrointestinal transit time (i.e. opioids, cyclic antidepressants) correlated with prolonged time to stool despite treatment with the CSS. Though a prospective, controlled study needs to be performed, variation in dosage of the CSS may be appropriate in select patient groups to offset the effects of the ingestant on bowel motility.

Adolescent↗

PubMed1988

Effect of alcohol consumption on outcome of pedestrian victims.

The influence of alcohol consumption on the severity of pedestrian injuries has not been studied extensively. In this retrospective study, we reviewed the cases of 143 pedestrian accident victims admitted to our trauma center during 1982 and 1983. Alcohol consumption was present in 30% of patients; 74% of them had blood alcohol levels of more than 100 mg/dL. There was a significant difference in age distribution (P less than .001); the alcohol-related accidents peaked in the 25- to 34-year-old age group, and the nonalcohol-related accidents peaked in the less than 18- and more than 55-year-old groups. Mean Injury Severity Score (25.0 vs 17.8, P less than .01) and mean length of stay (30.9 vs 17.2 days, P less than .005) were significantly greater in the patients who had consumed alcohol. Those patients with ethanol in their blood had significantly more frequent injuries to the spine (25.6% vs 10%, P less than .05) and the chest (32.6% vs 13%, P = .01). Overall mortality (11.6% vs 20%, P = .23) and mortality excluding emergency department deaths (11.6% vs 11.1%, P = .93) were not significantly different between the drinking and nondrinking groups. However, the ED mortality was higher in the nonalcohol group (0% vs 10%, P = .03). We conclude that pedestrian victims are commonly intoxicated and that chest and spine injuries are more common in this population.

Accidents, Traffic↗

PubMed1987

Facilitated intravenous access through local application of nitroglycerin ointment.

Thirty-four patients with diminutive peripheral veins requiring peripheral IV access (PIVA) in the emergency department setting were randomly assigned to one of two treatment groups. One group of patients (Group A) received application of a bland ointment to the dorsum of the hand prior to attempts at cannulation, while the other group (Group B) received application of 2% nitroglycerin ointment to the dorsum of the hand prior to cannulation attempts. Cannulation was achieved in all 34 patients in the study, but required significantly fewer attempts in Group B patients (P = .04). No side effects of the drug were observed in any patient or any staff member applying the ointments. We conclude that application of 2% nitroglycerin ointment to the dorsum of the hand is a safe, effective method of inducing local venodilation that will ensure PIVA with significantly fewer attempts at cannulation.

Adolescent↗

PubMed1986

Transconjunctival oxygen monitoring as a predictor of hypoxemia during helicopter transport.

As the use of helicopters for air transport of critically ill patients increases, the availability of monitoring devices for physiological parameters during flight becomes important. It has long been known that arterial PO2 (PaO2) decreases during unsupplemented, non-pressurized flight. In this study, the authors examined the use of the transconjunctival oxygen (cjO2) monitor for assessing the adequacy of arterial oxygenation during helicopter flight in four healthy volunteers. Arterial PaO2 as measured by conventional blood gas analysis was compared with cjO2 at ground level, 5,000 feet, and 10,000 feet altitude. Mean PaO2 dropped significantly from 93.5 to 81.5 to 58.5 mm Hg, respectively (P less than 0.001, analysis of variance with repeated measures). Mean cjO2 also decreased significantly from 63.8 to 52.0 to 34.8 mm Hg, respectively (P less than 0.001, analysis of variance with repeated measures). Within individual subjects, cjO2 was an accurate predictor of PaO2 (P less than 0.001, multiple regression analysis). The relationship between cjO2 and PaO2 was linear with a regression coefficient of 1.147. The authors conclude that the transconjunctival O2 monitor may be useful for monitoring the adequacy of arterial oxygenation during helicopter flight in hemodynamically stable patients. The results of study also support the use of supplemental oxygen in all patients subjected to helicopter transport.

Adult↗

PubMed1985

Occupational noise exposure, noise-induced hearing loss, and the epidemiology of high blood pressure.

The role of noise exposure in the etiology of high blood pressure is unclear. A cross-sectional study of occupational noise exposure and high blood pressure was conducted in March 1981-August 1982 in a group of blue-collar workers from a noisy (greater than or equal to 89 dBA) and a less noisy plant (less than 81 dBA). There were 197 randomly sampled men from the noisier plant and 169 from the comparison factory. Clinical examinations, audiograms and a psychologic inventory were conducted. Body mass index, alcohol intake, and family history of hypertension were comparable for the two groups. There was no difference in mean systolic or diastolic blood pressure between workers in the two plants. There was, however, a strong relationship between severe noise-induced hearing loss (greater than or equal to 65 dBA loss at 3, 4, or 6 k Hz) and high blood pressure (greater than or equal to 90 mmHg diastolic or taking blood pressure medication) in the 56+ age group in both plants after adjusting for risk factors (p less than 0.02). Multiple regression analysis revealed that in the noisier plant, body mass index, severe noise-induced hearing loss, and noisy hobbies explained a significant amount of the variation in diastolic pressure (p less than 0.05) R2 = 0.19. This suggests that there may be a population at increased risk for hearing loss and high blood pressure.

Adult↗

PubMedDate not supplied

Iron supplementation for acute blood loss anemia after coronary artery bypass surgery: a randomized, placebo-controlled study.

OBJECTIVE: To evaluate the use of oral iron replacement therapy as an effective treatment for acute surgically induced anemia. DESIGN: Double-blind, placebo-controlled, randomized clinical trial. SETTING: Perioperative acute care hospital and a surgery clinic for a single cardiothoracic physician group. PATIENTS: One hundred twenty-eight men and postmenopausal women, 50 years of age or older, admitted for elective coronary artery bypass surgery over a consecutive 8-month period. OUTCOME MEASURES: Before surgery: serum iron, serum ferritin, hemoglobin and hematocrit. Six days after surgery: hemoglobin and hematocrit. Mean of 59 days after surgery: serum iron, serum ferritin, hemoglobin and hematocrit. INTERVENTION: Patients were randomized to one of four groups: control group; placebo group; low-dose group, 50 mg elemental iron + 60 mg ascorbic acid in a multi-vitamin daily; and usual-dose group, 200 mg elemental iron daily. RESULTS: One hundred twenty-one subjects completed the study: 100 men (82.6%) mean age 64.5 years and 21 women (17.4%), mean age 65.7 years. There were no statistically significant age or gender differences among groups. Statistical analysis revealed, except for side effects, no differences between or among groups for any variable measured during the last two time intervals. The mean hemoglobin and hematocrit of the entire sample at 6 days was 9.5 +/- 1.2 gm/dl and 28% +/- 2.3%, respectively. At a mean of 59 days later these values increased equally for all groups to a mean for the cohort of 13.6 +/- 1 gm/dl for hemoglobin and 40.6% +/- 3 for hematocrit. Serum iron and ferritin were within the normal range. The 200 mg group experienced significantly more side effects (p < 0.01). CONCLUSION: Thus the use of oral iron supplements for the treatment of acute blood loss anemia after uncomplicated coronary artery bypass surgery did not assist in restoring red blood cell mass or help maintain total body iron stores.

Acute Disease↗