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Biomedical subjects

G Quick

Publications and source records attributed to G Quick.

30 records · Page 2Linked to original sources
PubMed1985

Occult bacteremia in the emergency department: diagnostic criteria for the young febrile child.

We studied a selected series of febrile infants (N = 201) in an attempt to prospectively identify risk factors for bacteremia. Infants with fever less than 39.4 C, vomiting and diarrhea, croup, or viral exanthem or enanthem were not included. Twenty-one infants (9.5%) had positive blood cultures despite the initial judgment of their physician that only viral illness or localized bacterial infection existed. WBC count of more than 15,000 correlated with bacteremia, with a sensitivity of 0.71 and a specificity of 0.73. Extensive multivariate linear regression analysis attempting to increase predictive values was completed. The combination of fever higher than 39.4 C present for more than 12 hours and absolute polymorphonuclear count of more than 9,000 cells/mm3 had a sensitivity of 0.62 and a specificity of 0.78 for bacteremia. Descriptive statistics for groups with and without bacteremia are summarized. We have defined prospectively a population of infants with a high probability of bacteremia and a lower probability of viral illness. Identification of such a group is useful to the emergency physician because early antibiotic therapy may lessen morbidity and mortality. We conclude that an easily obtained data base may be useful in the prospective identification of those at risk for bacteremia.

Blood Cell Count↗
PubMed1984

Hernia en masse.

Described is the case of a patient who developed symptoms compatible with small bowel obstruction approximately 16 hours after a difficult self-performed left inguinal hernia reduction. Exploratory laparotomy was performed, and release of an incarcerated loop of ileum was performed. A large inguinal hernia defect also was found, and this was repaired with a Cooper's ligament repair. The patient recovered uneventfully.

Diagnosis, Differential↗
PubMed1982

Encircling endocardial ventriculotomy for refractory ischemic ventricular tachycardia. I. Electrophysiological effects.

The direct endocardial surgical techniques introduced for the treatment of refractory ischemic ventricular tachyarrhythmias have resulted in decreased surgical mortality rates and increased success rates in comparison to previous indirect techniques. Since the mechanism of action of one of these new techniques, the encircling endocardial ventriculotomy (EEV), is unknown, the present study was designed to clarify the electrophysiological effects of this procedure. Epicardial and intramural electrophysiology was studied in 18 dogs before and after undergoing an EEV. In the absence of induced myocardial ischemia, the procedure caused an epicardial conduction delay of 23 +/- 3 msec (p less than 0.0001) across the boundaries of the incision. When the EEV enriched acutely ischemic myocardium, it was capable in certain instances of isolating spontaneous ventricular electrical activity to the myocardium encompassed by the incision and thereby protecting the remainder of the heart from the arrhythmia. The EEV resulted in total ablation of all (2 Mv/msec) electrical activity at 20 of 48 (42%) subendocardial electrode sites and at 12 of 44 (27%) subepicardial sites monitored within the encompassed myocardium. These data suggest that although the EEV may be capable of isolating ischemic ventricular tachyarrhythmias to the encompassed myocardium, it most commonly ablates the anatomic-electrophysiological substrate necessary for the genesis and perpetuation of these arrhythmias.

Animals↗
PubMed1982

Encircling endocardial ventriculotomy for refractory ischemic ventricular tachycardia. II. Effects on regional myocardial blood flow.

Previous experimental studies of the encircling endocardial ventriculotomy (EEV) have shown a significant alteration of normal local electrical activity within the encompassed region. Although this procedure may result in isolation of ventricular arrhythmias, the data are more suggestive of a less specific effect on regional myocardial blood flow. This study examines the effect of EEV on local myocardial blood flow using the radioactive tracer microsphere technique in 10 dogs. Flows were determined before and after an EEV with the animals on cardiopulmonary bypass at controlled perfusion pressures, temperatures, and heart rates. Blood flow was studied at subepicardial and subendocardial levels inside, outside, and bordering the EEV. Prior to performance of the EEV, subepicardial blood flow in the left ventricular myocardium ranged from 0.81 +/- 0.07 to 0.89 +/- 0.08 ml/gm/min. Subendocardial flows ranged from 0.80 +/- 0.07 to 0.91 +/- 0.09 ml/gm/min. There was no significant difference between any of the flows across each respective layer of myocardium. Following the EEV procedure, blood flow to the subendocardium within the EEV fell to 0.33 +/- 0.07 ml/gm/min, while flow to the subendocardium of the normal regions of the same hearts actually increased to 1.21 +/- 0.23 ml/gm/min. Similar changes occurred at subepicardial levels, with flow at the center of the EEV falling to 0.66 +/- 0.10 ml/gm/min despite a tendency for normal subepicardial flow to increase to 1.78 +/- 0.24 ml/gm/min. Superimposed ischemia to the EEV-encompassed myocardium, created by occlusion of the distal left anterior descending coronary artery (LAD), accentuated this abnormality by demonstrating that the region continues to receive some flow from epicardially based coronary vessels. The data from this study show that the EEV decreased regional blood flow to the encompassed myocardium and suggests that myocardial ischemia may be responsible for ablation of the delicate re-entrant mechanisms that sustain ventricular tachyarrhythmias.

Animals↗
PubMed1982

Encircling endocardial ventriculotomy for refractory ischemic ventricular tachycardia. III. Effects on regional left ventricular function.

In order to assess the effects of the encircling endocardial ventriculotomy (EEV) on regional left ventricular function, we cannulated seven adult mongrel dogs for cardiopulmonary bypass. Two pairs of miniature pulse-transit transducers were placed in mid-myocardium of the left ventricle, one pair in a region that would later be encompassed by an EEV and the other pair in a region of remote normal myocardium. Pressure-dimension data were analyzed during vena caval occlusions (after volume loading) both on and off cardiopulmonary bypass and both before and after performance of an EEV. The EEV results in a significant decrease in diastolic compliance of the encompassed myocardium. No significant compliance changes occurred in the control regions of the same hearts. This change in regional diastolic compliance is partially responsible for a loss of systolic excursion within the EEV-encompassed region and may help to explain the severe left ventricular dysfunction that has been observed in some patients following an EEV.

Animals↗
PubMed1977

An emergency department radiology audit procedure.

An audit was done to ascertain the concordance of radiographic interpretation by the emergency physician and the radiologist. In 8,021 radiographic procedures during the two-month study, concordance of interpretation was found in 97.6%. The primary area of interpretation difficulty was chest radiographs. Specifically, there was limited agreement (10 of 45 films, 22%) regarding the reading of inflammatory processes. Despite this, 40 of the 45 patients (89%) whose chest radiographs were reviewed received proper therapy. The findings in five radiographs were deemed to be significant enough to possibly lead to changes in management.

Emergency Service, Hospital↗
PubMedDate not supplied

A paradigm for multidisciplinary disaster research: the Oklahoma City experience.

The objective of this article is to describe the creation and operation of a multidisciplinary group to examine the Oklahoma City (OKC) bombing. The OKC bombing presented an opportunity to study a major disaster within 2 days of the incident. The Disaster Health Studies Group (DHSG) was created to facilitate this effort. The creation, organization, and operation of the DHSG is outlined. In addition the mission statement, participants, communications, political empowerment, data preservation and collection, data ownership, patient rights, threats to the DHSG, media interactions, funding, the institutional review board process, and results reporting will be detailed. The 22 projects of the DHSG are listed. In conclusion, four main findings are examined: 1) A multidisciplinary disaster study group is feasible and can be rapidly organized; 2) certain organizations and institutions form a core group for facilitation of the research effort; 3) specific issues must be addressed in order for the group to succeed; and 4) the group leader should have disaster expertise and be committed to the multidisciplinary process.

Communication↗
PubMedDate not supplied

Time analysis of consult service emergency department admission process compared with emergency medicine service admission process.

This prospective case-controlled study was performed to compare the time intervals of a consult emergency department (ED) admission process with an emergency medicine (EM) service admission process. During March 1994, the consultant services admitted 307 patients for hospitalization at an urban tertiary academic ED with an EM residency; in April 1994, the EM service admitted 264 patients. The times measured were: 1) triage to examination room; 2) room to first physician contact; and 3) emergency physician contact to admit request. Data analysis was by mode and Wilcoxon tests. We analyzed 537 evaluable admissions. The mode for consultant process was 205 min, and the mode for emergency medicine admissions was 158 min from first physician contact to admit request, for a 47-min difference. All patients arrived stable to an inpatient bed; none was transferred to the Intensive Care Unit or to an operating room in the first 24 h. Concordance of the ED admitting impression and the hospital discharge diagnosis was 99% (259/264). We conclude that in selected tertiary academic EDs, admission of all patients by the EM service is more efficient than a consultant-admission process. Outcomes show the EM admission process may be employed safely and with accurate patient diagnosis.

Consultants↗
PubMedDate not supplied

Effect of nicotinic acid conjugated to DNA-transfecting complexes targeted at the transferrin receptor of HeLa cells.

A conjugate consisting of streptavidin (biotinylated transferrin)-biotinylated polylysine for DNA delivery to cells was modified by partial nicotinylation of the polylysine component of the conjugate and used for transfection studies. A conjugate of biotin10-nicotinyl60-polylysine250 containing 60 weakly basic nicotinyl (pyridine-3-carboxyl) residues was prepared. The design of the modified polylysine was directed to the possible binding of H+ ions in the endosome-lysosomal vesicles (pH 5-6) by the nicotinyl groups, thus circumventing the use of chloroquine. The results obtained, however, while showing a 5- to 6-fold increase in luciferase transfection activity still necessitated an absolute requirement for chloroquine. A further polylysine conjugate containing a larger number of nicotinyl residues, biotin10-nicotinyl120-polylysine250, also was prepared and studied. This macromolecule stimulated luciferase activity to a small extent and was also dependent on chloroquine. Smaller biotinylated polylysine100 conjugates containing nicotinyl groups were also prepared. These were biotin10-nicotinyl30-polylysine100, and biotin10-nicotinyl60-polylysine100, respectively. Both substances, however, gave opaque, hazy aqueous solutions with precipitates on standing and could not be used for further experimental work. The results indicate that the introduction of weakly basic nicotinyl (pyridine-3-carboxyl) groups onto polylysine250 give conjugates that are unable to replace the lysosomotrophic agent chloroquine in the HeLa cell sysem studied. A 5- to 6-fold increase in luciferase activity, however, was found with biotin10-nicotinyl60-polylysine250.

Biotin↗