Biomedical subjects

J E Flemming

Publications and source records attributed to J E Flemming.

5 recordsLinked to original sources

PubMed1993

Spinal epidural abscess. Optimizing patient care.

The medical literature regarding spinal epidural abscess has two common threads: reports of poor prognosis and appeals for rapid treatment. Spinal epidural abscess is a difficult diagnosis to make because of its rarity--many physicians will never see a case during their careers. Among all patients admitted to hospitals, the incidence is approximately one to two cases per 10,000. Only increased awareness and swift management of spinal epidural abscess will improve outcome. Our goal through this report is to enhance the recognition and treatment of spinal epidural abscess. We present 28 new cases of spinal epidural abscess, giving special attention to the peculiarities of the disease; we compile and analyze comprehensive data from cases from literature; and finally, we present the results of 16 retrospective personal interviews of infected patients.

Abscess↗

PubMed1990

Umbilical artery blood velocity waveform analysis in predicting the small-for-dates fetus.

Doppler umbilical artery blood velocity waveforms were recorded longitudinally in 78 randomly selected pregnancies. The waveform maximal (A) to minimal (B) Doppler shift frequency ratios were determined to provide a semi-quantitative measure of impedance to blood flow in the fetoplacental circulation. Fifty-eight of these pregnancies and their outcomes were normal. The A/B ratios from this normal group were used to derive a normal range of this index throughout the second half of pregnancy. A further 45 pregnancies, also randomly selected, were studied once within 2 weeks of delivery. Using those measurements, plus those from the longitudinal groups sampled within 2 weeks of delivery, the predictive values of the A/B ratio in detecting the small for gestational age fetus have been derived. The sensitivity of the umbilical artery A/B ratio in predicting a small for gestational age infant within 2 weeks of delivery was 58% with a specificity of 94%. The positive test predictive value was 69% with a negative test predictive value of 90%. These predictive values are lower than those previously published, probably because high-risk pregnancies were over-represented in earlier studies. Waveform analysis within 2 weeks of delivery did, however, appear to identify fetuses destined to develop a range of perinatal problems. Large prospective studies are needed before the predictive value of Doppler waveform analysis is clarified.

Blood Flow Velocity↗

PubMed1986

Pathologic fracture of the humerus.

Review of patients with pathologic fracture of the humerus disclosed that closed treatment resulted in a high incidence of pain, disability, and failure to heal. The most common cause of pathologic fracture of the humerus is breast cancer. A review of records of 103 patients with persistent disease after initial treatment for breast cancer revealed that 19 had humeral metastases (18.5%); of those with humeral metastases, two patients (10%) had pathologic fractures. Prophylactic internal fixation of humeral metastases is not routinely recommended, but operative treatment for pathologic fracture of the humerus is generally superior to nonoperative methods of fracture management.

Aged↗

PubMed1978

Prostaglandins: renal vascular responses to bradykinin, histamine, and nitroglycerine.

A study was undertaken to evaluate the effects of inhibitors of prostaglandin (PG) synthesis on renal vascular responses to several renal vasodilators in anesthetized dogs. Indomethacin (IND) and meclofenamate (MEC), two dissimilar cyclooxygenase inhibitors were used. An electromagnetic flow probe was placed on the renal artery and a needle was inserted proximal to the probe. Injections of bradykinin, histamine, nitroglycerine, and arachidonic acid (AA) were given before and after administration of IND or MEC, 2.5 mg/kg body wt. In each experiment, inhibition of PG synthesis was estimated by reduction of vasodilator activity following AA injection. Although renal vascular resistance increased slightly after IND or MEC, elevations of renal blood flow in response to injections of bradykinin and nitroglycerine were not affected by PG synthesis inhibitors, whereas percent responses to histamine were enhanced by IND but not MEC. In addition, the action of 5 mg/kg IND on responses to injections and infusions of bradykinin was evaluated. No decrease in vasodilator activity following the kinin was detected in these studies. These results demonstrate that renal vascular responses to bradykinin, histamine, and nitroglycerine were not dependent on endogenously produced products of cyclooxygenase (e.g., prostaglandins) in the kidney of the anesthetized dog.

Animals↗

PubMed1977

Renal vascular effects of endoperoxide analogs, prostaglandins, and arachidonic acid.

Renal vascular responses to analogs of prostaglandin H2(PGH2) were investigated in anesthetized dogs. The analogs were potent renal vasoconstrictors whose actions were not affected either by indomethacin or by alpha-adrenergic or angiotensin antagonists. The constrictor activity of the analogs approximated that of norepinephrine. Responses to PGD2 were also obtained. This prostaglandin, previously thought to be inactive, was found to cause renal vasodilation similar to that caused by PGA2. Responses to the prostaglandin precursor, arachidonic acid, were of two types. In some animals, the response was marked vasodilation, whereas in others transient vasoconstriction preceded the vasodilation. These studies demonstrate that PGH2 analogs are potent renal vasoconstrictors and that PGD2 possesses renal vasodilating properties. In addition, it is suggested that the rapid vasoconstrictor portion of the arachidonate response may represent effects of endogneously produced PGH2.

Animals↗