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Biomedical subjects

F M Perkins

Publications and source records attributed to F M Perkins.

At least 19 recordsLinked to original sources
PubMed2004

Development and validation of a brief, descriptive Danish pain questionnaire (BDDPQ).

BACKGROUND: A new pain questionnaire should be simple, be documented to have discriminative function, and be related to previously used questionnaires. METHODS: Word meaning was validated by using bilingual Danish medical students and asking them to translate words taken from the Danish version of the McGill pain questionnaire into English. Evaluative word value was estimated using a visual analog scale (VAS). Discriminative function was assessed by having patients with one of six painful conditions (postherpetic neuralgia, phantom limb pain, rheumatoid arthritis, ankle fracture, appendicitis, or labor pain) complete the questionnaire. RESULTS: We were not able to find Danish words that were reliably back-translated to the English words 'splitting' or 'gnawing'. A simple three-word set of evaluative terms had good separation when rated on a VAS scale ('let' 17.5+/-6.5 mm; 'moderat' 42.7+/-8.6 mm; and 'staerk' 74.9+/-9.7 mm). The questionnaire was able to discriminate among the six painful conditions with 77% accuracy by just using the descriptive words. The accuracy of the questionnaire increased to 96% with the addition of evaluative terms (for pain at rest and with activity), chronicity (acute vs. chronic), and location of the pain. CONCLUSIONS: A Danish pain questionnaire that subjects and patients can self-administer has been developed and validated relative to the words used in the English McGill Pain questionnaire. The discriminative ability of the questionnaire among some common painful conditions has been tested and documented. The questionnaire may be of use in patient care and research.

Denmark↗
PubMed2001

Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study.

OBJECTIVE: To determine the incidence of groin pain 1 year after inguinal herniorrhaphy and to assess the influence of chronic groin pain on function. SUMMARY BACKGROUND DATA: The reported incidence of chronic pain after inguinal herniorrhaphy varies from 0% to 37%. No cross-sectional cohort studies with high follow-up rates have addressed this problem, and there is a lack of assessment of the functional consequences of chronic groin pain after herniorrhaphy. METHODS: Two sets of self-administered questionnaires were mailed 1 year after surgery. The first established the incidence of chronic groin pain. The second characterized the pain and the effect of the pain on the function of those reporting pain. The study population comprised patients older than age 18 years registered in the Danish Hernia Database who underwent surgery between February 1, 1998, and March 31, 1998. RESULTS: The response rate to the first questionnaire was 80.8%. Pain in the groin area was reported by 28.7%, and 11.0% reported that pain was interfering with work or leisure activity. Older patients had a lower incidence of pain. There were no differences in the incidence of pain with regard to the different types of hernia, the different types of surgical repairs, or the different types of anesthesia. The second questionnaire was returned by 83%. Of these, 46 (4%) reported constant pain. The intensity of pain while at rest was moderate or severe in 40 (3%); with physical activity, pain was moderate or severe in 91 (8%). Impairment of specific daily activities as a result of pain was reported by 194 (16.6%). Pain characteristics were predominantly sensory, with a low use of affective terms. CONCLUSION: One year after inguinal hernia repair, pain is common (28.7%) and is associated with functional impairment in more than half of those with pain. These factors should be addressed when discussing the need for surgical intervention for an inguinal hernia.

Adult↗
PubMed2000

Prospects for the prevention of postherpetic neuralgia in herpes zoster patients.

OBJECTIVE: Herpes zoster is a common and painful disease that is caused by reactivation of the varicella-zoster virus. Herpes zoster pain that persists after healing of the acute infection is termed postherpetic neuralgia (PHN), a chronic pain syndrome that is often refractory to all treatment. The prevalence of PHN is expected to increase substantially in the coming decades, because the incidence of herpes zoster and the risk of PHN will both increase as the population ages. Although the results of recent studies provide a basis for improved treatment of patients with PHN, as many as half of all PHN patients do not obtain relief of their pain. Research on the development of improved treatments is continuing, but it has not been generally recognized that an equally important goal should be the design of interventions to prevent PHN. The prevention of PHN would lead to major reductions in disability, suffering, and the use of health care resources. DESIGN: The results of recent studies that have identified risk factors for the development of PHN and have implicated several peripheral and central mechanisms in its pathophysiology are reviewed. OUTCOME MEASURES: These risk factors and mechanisms of PHN provide a basis for hypothesizing that combining antiviral therapy with analgesic treatment beginning as soon as possible after the onset of herpes zoster would reduce the risk of PHN beyond that achieved by antiviral therapy alone. CONCLUSIONS: This treatment approach would be expected to reduce the risk of PHN in herpes zoster patients by attenuating acute pain and thereby preventing the initiation of central mechanisms of chronic pain.

Herpes Zoster↗
PubMed1999

Thoracic epidural analgesia versus intravenous patient-controlled analgesia for the treatment of rib fracture pain after motor vehicle crash.

BACKGROUND: Pain from rib fracture pain may affect pulmonary function, morbidity, and length of intensive care unit stay. Previous trials have varied epidural technique within the study and have used several outcome variables. METHODS: The charts of patients who sustained rib fractures after a motor vehicle crash between January 1, 1994, and June 30, 1997, were reviewed. Data were collected from 64 patients who had three or more rib fractures and initiation of intravenous patient-controlled analgesia with morphine or thoracic epidural analgesia with bupivacaine and fentanyl within 24 hours of admission. RESULTS: Injury Severity Score and Acute Physiology and Chronic Health Evaluation II scores were not significantly different between groups. Patients in the epidural group had significantly more rib fractures and were significantly older. Patients who received epidural analgesia had significantly lower pain scores at all times. There were no differences in the lengths of intensive care unit or hospital stays, or the incidence of pulmonary complications or organ failure between groups. CONCLUSION: Thoracic epidural analgesia with bupivacaine and fentanyl provided superior analgesia than intravenous patient-controlled analgesia morphine.

APACHE↗
PubMed1997

Penile block timing for postoperative analgesia of hypospadias repair in children.

PURPOSE: It has been well established that a dorsal penile nerve block immediately after surgery decreases postoperative pain in children undergoing hypospadias repair. However, to our knowledge the efficacy of a penile block immediately before versus immediately after surgery for postoperative pain control has not been previously studied in such children. MATERIALS AND METHODS: We evaluated 98 healthy boys 6 months to 12 years old undergoing hypospadias repair. General anesthesia was induced and maintained in a standard fashion. Patients were randomly assigned to receive a penile block with the same total dose of bupivacaine at the completion of surgery, before the incision or before and at the completion of surgery. No other analgesic was administered intraoperatively. Pain was assessed using a modified objective pain-discomfort scale at 15 minutes, and 3, 12 and 24 hours after surgery. The number of doses of acetaminophen required to control postoperative pain was also recorded. RESULTS: Pain scores were defined in a range of 0-no pain to 6-greatest pain. During recovery median pain scores in the 30, 36 and 32 boys who received a penile block after, before, and before and after surgery were 3, 1.5 and 0 at 15 minutes; 2.5, 1 and 0 at 3 hours; 3, 2 and 0 at 12 hours; and 1, 0 and 0 at 24 hours, respectively. There was no difference in acetaminophen doses required 15 minutes and 3 hours postoperatively in the 3 groups. By 12 hours after surgery the number of acetaminophen doses required for pain control was significantly lower in the before and after, and before groups than in the after group. By 24 hours boys in the before and after group required significantly fewer doses of analgesics than those in the after and before groups. There was no statistically significant difference between the after and before groups. CONCLUSIONS: Two penile blocks performed at the beginning and conclusion of hypospadias repair, respectively, provide better postoperative pain control than 1 penile block done before or after surgery (p < 0.05). These patients require less analgesic than those who receive a penile block only before or only after surgery.

Analgesia↗
PubMed1995

Preoperative evaluation of the cervical spine in children with trisomy-21: results of a questionnaire study.

Atlantoaxial subluxation (AAS) is a form of cervical spine instability predominantly found in persons with Trisomy-21. Several case reports describe the occurrence of acute AAS in the perioperative period. Some authors have recommended cervical spine radiographs prior to elective surgery in all children with Trisomy-21. The objective of this study was to determine practice patterns of North American members of the Society of Pediatric Anesthesia with regard to the perioperative evaluation and management of potential cervical spine instability in patients with Trisomy-21. Of 171 respondents, a minority of respondents (18%) obtain preoperative radiographs and/or subspecialty consultation (9%) in asymptomatic children with Trisomy-21. For symptomatic children the majority of respondents would obtain radiographs (64%) and/or preoperative consultation (74%). Approximately half of the respondents would attempt to maintain the head and neck in a neutral position for either asymptomatic (42%) or symptomatic (55%) patients. We conclude that the majority of respondents base their preoperative evaluation of the cervical spine on the signs and symptoms of the patient. This is supported by the literature reviewed, but is contrary to the recommendations made in some case reports.

Anesthesia, General↗
PubMed1994

Deep venous thrombosis following total hip arthroplasty. Effects of prolonged postoperative epidural anesthesia.

The authors studied the use of epidural anesthesia prolonged to 48 hours of epidural analgesia in 120 total hip arthroplasty patients in a case-control fashion. One half of the patients received prolonged epidural anesthesia, while the other matched half received general endotracheal anesthesia. Venograms were obtained after surgery and graded in blind fashion by a single radiologist. The overall incidence of deep venous thrombosis in the epidural versus general anesthetic groups was 23 (14 of 60 patients) versus 40% (24 of 60) (P < .05). There was an identical incidence--8.3% (5 of 60 patients)--of proximal thrombosis in the two groups, and all of the difference in the overall rates of thrombosis occurred in the calf. Fifteen percent (9 of 60 patients) of the epidural patients and 31.6% (19 of 60) of the general anesthetic patients demonstrated this finding (P < .05). Of the 10 proximal clots, 8 (80%) were found in the operative leg, while only 29 (59.2%) of the 49 calf clots were found in the operative leg. Prolonged epidural anesthesia significantly decreases the incidence of deep venous thrombosis after total hip arthroplasty, with its most apparent benefit on calf vein thrombosis secondary to its hyperkinetic effect on lower limb blood flow. The observation that it has no demonstrable effect on the prevention of proximal thrombosis and our finding that the majority of proximal clots are in the operative leg suggest that thrombi in the thigh may be the result of a different primary pathogenic mechanism that is more related to endothelial injury than to changes in viscosity or blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia, Epidural↗
PubMed1993

Parental knowledge and attitudes toward discussing the risk of death from anesthesia.

There is considerable debate as to the extent of disclosure of risks when obtaining informed consent for anesthesia, especially when discussing with parents the rare risk of death of healthy children about to undergo elective, outpatient surgery. In Part I, we attempted to determine parents' knowledge about the risks of anesthesia as well as their thoughts toward either hearing, or not hearing, about the risk of death. In the first part of our study, 115 parents completed questionnaires before speaking with the anesthesiologist. Ninety-six (87%) wanted to know the chances of death as a result of anesthesia, whereas 14 (13%) did not. Seventy-five (68%) parents knew that this risk was "extremely rare," 21 (19%) believed that it occurs "once in a while," and 14 (13%) thought there was "no chance." Eighty-two (74%) parents wanted to know "all possible risks," 26 (24%) wanted to know only "those that are likely to occur," and 3 (2%) wanted to know only about those that would "result in significant injury." Mothers were more likely to want to hear all possible risks, whereas fathers were more likely to want to know only about those that are likely to occur (P = 0.001). Otherwise, responses were not influenced by the sex of the parents, the age of the child, or whether the child or any siblings had had surgery in the past. In Part II, a separate group of 121 parents were surveyed after participating in the preanesthetic discussion with the anesthesiologist.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed1988

Infrared tympanic thermometer: evaluation of a new clinical thermometer.

We have evaluated a new clinical thermometer for accuracy. It determines temperature by measuring infrared radiation given off by a warm object. It was found to be accurate both in vivo and in vitro over the temperature range of 34.0 degrees to 39.5 degrees C. The in vivo assessment was made in patients in the ICU after their return from open heart surgery. The infrared tympanic thermometer tracked the core temperature (as measured by the thermistor tip of the pulmonary artery catheter) closely, with a correlation coefficient of 0.98, and took less than 2 sec to measure. We found this new thermometer to be accurate and, in our opinion, easily usable in the clinical situation.

Body Temperature↗
PubMed1985

Comparison of high-frequency lung ventilation with conventional mechanical lung ventilation. Prospective trial in patients who have undergone cardiac operations.

High-frequency lung ventilation was compared with conventional mechanical lung ventilation following elective cardiac operation. The results indicate that this high-frequency ventilator works as well as conventional mechanical ventilators and that it accomplishes the desired gas exchange at lower peak airway pressures. We conclude that routine use of high-frequency ventilation in the postoperative period is possible and that it may be indicated if lower peak airway pressures are desired.

Blood Gas Analysis↗
PubMed1982

Aldosterone and corticosterone binding and effects on Na+ transport in cultured kidney cells.

A continuous line of cells (A6) derived from toad kidney has been shown to form epithelia in culture that manifest aldosterone-stimulatable transepithelial sodium transport. In this study an efficient filtration assay for nuclear binding of [3H]aldosterone was validated. Specific high-affinity aldosterone and corticosterone binding sites in the particulate (nuclear-enriched) fraction were characterized in intact epithelia. Despite metabolism of both steroids, two high-affinity binding sites for each were demonstrable: aldosterone, K'd1 = 0.85 (+/- 0.19) X 10(-10) and K'd2 = 1.6 (+/- 0.42) X 10(-8) M; corticosterone, K'd1 = 0.5 (+/- 0.31) X 10(-10) and K'd2 = 0.32 (+/- 0.19) X 10(-8) M. Analogue competition-binding studies indicated a qualitative difference in the two sites and co-occupancy of both sites by the two steroids. The sodium transport response to aldosterone and corticosterone approximated a linear function of occupancy of the lower affinity sites. Although the lower affinity sites resemble mammalian glucocorticoid receptors in terms of relative binding affinities for analogues, we conclude that they are the receptors which mediate the aldosterone and corticosterone stimulation of Na+ transport in these epithelia.

Aldosterone↗
PubMed1981

Hormone effects on transport in cultured epithelia with high electrical resistance.

Three continuous lines of amphibian epithelial cells form epithelia with a high transepithelial resistance (greater than 4,000 omega . cm2) in culture. The cell lines are TB-M and TB-6c, derived from the urinary bladder of Bufo marinus, and A6, derived from the kidney of Xenopus laevis. Short-circuit current is equivalent to net mucosa-to-serosa sodium transport in two cell lines and slightly exceeds sodium transport in epithelia formed by TB-6c cells. None of the cell lines has an adenylate cyclase response or a transport or permeability response to vasopressin. Water permeability is low in all three cell lines and is not affected by adenosine 3',5'-cyclic monophosphate (cAMP). In the three lines of cells, cAMP and aldosterone each increases short-circuit current with a time course similar to that seen in naturally occurring epithelia. In contrast to the toad urinary bladder and epithelia of line TB-M in which the aldosterone stimulation of short-circuit current is associated with a fall in transepithelial resistance, there is no change in resistance across epithelia of lines TB-6c and A6. There is also a striking difference in the sensitivity of the three lines to inhibition of short-circuit current by amiloride.

Aldosterone↗
PubMed1981

Transport properties of toad kidney epithelia in culture.

The characteristics of a continuous line of toad kidney epithelial cells (A6) are described. These cells form a monolayer epithelium of high transepithelial electrical resistance (about 5,000 omega . cm2). The cells generate a transepithelial potential difference (apical surface negative) of about 9 mV. The short-circuit current is equivalent to net sodium flux. Net sodium flux is stimulated by aldosterone and by analogues of cAMP. The stimulation is readily reversible. Neither urea permeability nor osmotic water flow is altered by analogues of cAMP. Amiloride eliminates 90% of the short-circuit current. Thus A6 cells form an epithelium with several differentiated properties including hormonal regulation of transport.

8-Bromo Cyclic Adenosine Monophosphate↗