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Biomedical subjects

J M Pierce

Publications and source records attributed to J M Pierce.

At least 19 recordsLinked to original sources
PubMed1995

The successful use of continuous negative extrathoracic pressure in a child with Glenn shunt and respiratory failure.

Following a Glenn shunt, an infant required mechanical ventilation (IPPV) for pneumonia, a phrenic nerve palsy and chylothoraces. In order to improve her deteriorating clinical condition, we used continuous negative extrathoracic pressure (CNEP) to minimise the deleterious effects of IPPV on pulmonary blood flow. She was successfully weaned from IPPV and supported with CNEP.

Blood Gas Analysis↗
PubMed1995

Auditory evoked responses and near infrared spectroscopy during cardiac arrest.

We describe a patient who had a cardiac arrest during anaesthesia, in whom regional cerebral oxygen saturation was being measured by near infrared spectroscopy and the auditory evoked responses (AER) were being recorded. Both of these monitors provided useful information on cerebral oxygenation during cardiac arrest. Changes in the AER as the result of either reduced circulation or hypothermia are similar, and should these two situations occur simultaneously there could be difficulty in the interpretation of the AER.

Anesthesia, General↗
PubMed1995

Pulsatile flow during cardiopulmonary bypass speeds thermal energy transfer: a possible explanation for the reduced afterdrop.

The instantaneous thermal energy balance and rates of thermal energy transfer during hypothermic cardiopulmonary bypass were measured for a group of patients receiving continuous flow and compared with a group receiving pulsatile flow. Cooling was more rapid and the rate of thermal energy delivery during rewarming significantly greater in the pulsatile flow group despite similar rewarming times. The final thermal energy balance at the end of cardiopulmonary bypass was larger and the period of postoperative hypothermia shorter in those receiving pulsatile flow. The greater rate of thermal energy transfer may explain the reduced afterdrop.

Body Temperature Regulation↗
PubMed1991

Malignant peripheral nerve sheath tumor (malignant schwannoma) of urinary bladder in von Recklinghausen neurofibromatosis.

Von Recklinghausen neurofibromatosis occurs in 1 in 3,000 live births; however, urologic manifestations are rare. There have been over 40 reported cases of neurofibroma of the bladder. Malignant degeneration of subcutaneous neurofibroma occurs in about 5 to 10 percent of patients. We believe we present the second reported case of a malignant peripheral nerve sheath tumor involving the bladder in a patient with this disorder.

Adult↗
PubMed1990

Impotence following delayed repair of prostatomembranous urethral disruption.

A group of 26 patients with pelvic fracture and disruption of the prostatomembranous urethra were evaluated for impotence. Impotence was defined as inability to achieve an erection firm enough for vaginal penetration. Of the patients 25 were potent before the injury, whereas 1 was only 7 years old at injury. Seven patients admitted to being potent after the injury but before the final urethral anastomosis. Four patients became potent after urethroplasty. The definitive operation to the urethra was done approximately 6 months after the injury. Only 11 of the 26 patients (46%) reported erections adequate for vaginal penetration. No patient who had adequate erections before urethroplasty became impotent postoperatively. We believe that the impotence was caused by damage to the neurovascular supply to the penis at injury.

Adult↗
PubMed1990

"Bounces": an analysis of short-term return visits to a public hospital emergency department.

From July through September 1987, our emergency department registered 17,214 patients, of whom 569 (3%) returned within two days of initial registration. Cases were reviewed to identify factors associated with return visits. Patient-related factors were responsible for a majority of repeat visits (267 cases, 53%). Illness-related factors, particularly evolution of disease under close outpatient observation, prompted return in 68 cases (13%). An additional 60 patients (12%) returned with new problems unrelated to their initial presentation. Physician-related factors were the primary reason for return in 92 cases (18%). Problems with our public health-care system prompted return in 18 cases (4%). Eighty-seven returning patients (19%) required emergency hospitalization, including 28 discharged due to physician errors. Regular case review of short-term returns to the ED should be included in a comprehensive ED-based program of quality assurance.

Emergency Service, Hospital↗
PubMed1990

Gunshot injuries of the ureter.

We reviewed our more recent results in the management of gunshot wounds of the ureter. Sixteen consecutive patient records were reviewed. Two of the patients died from complications not related to their ureteral injuries. The remaining 14 patients had good results. Proper management consists of: 1) early diagnosis and repair; 2) adequate debridement of devitalized tissue; 3) tensionless spatulated watertight anastomosis with absorbable suture; 4) internal stenting; and 5) drainage of periureteral tissues.

Adolescent↗
PubMed1990

Intracavernous papaverine in the management of psychogenic impotence.

Intracavernous papaverine has found an important place in the management of male erectile failure. The effect of this mode of therapy was studied in 48 patients with psychogenic impotence. The average follow-up for this group of patients ranged from 7 months to 37 months (mean 16.3 months). All the patients in this group were advised sex therapy as an initial mode of therapy. On refusal to undergo sex therapy, they were offered an option of intracavernous papaverine injection. Papaverine appears to break the performance anxiety erectile failure cycle and was noted to have good results. Overall 57.9% patients expressed complete satisfaction with this mode of therapy. One patient (2.1%) developed priapism, which was adequately treated with intracavernous epinephrine. Use of low dosage of papaverine is suggested as an additional mode of therapy in the management of psychogenic impotence.

Adult↗
PubMed1989

Tropospheric lifetimes of halogenated anaesthetics.

Concern has been expressed over the use of the halogenated anaesthetics halothane (CF3CClBrH), enflurane (CF2HOCF2CFClH) and isoflurane (CF2HOCHClCF3) because of their potential for stratospheric ozone destruction. Halogenated species also contribute to global warming. The significance of the anaesthetics in stratospheric ozone loss or in 'greenhouse' heating depends on their atmospheric lifetimes. Because reaction with hydroxyl (OH) radicals is likely to be the main homogeneous sink for these species in the troposphere, we have measured absolute rates of reaction with OH. Comparison with a one-dimensional model indicates that the lifetimes of halothane, enflurane and isoflurane with respect to this reaction are 2, 6 and 5 years, respectively. Thus the small production of the anaesthetics is not offset by anomalously long atmospheric lifetimes to give a large atmospheric burden of the compounds. The anaesthetics will contribute at most a fraction of approximately 5 x 10(-4) to the total atmospheric content of chlorine-containing species.

Air Pollutants↗
PubMed1989

Disruptions of the anterior urethra.

Disruptions of the anterior urethra are caused by blunt trauma such as the straddle injury and also by penetrating trauma such as a gunshot or ice pick. Sometimes, self-inflicted or iatrogenic disruptions can be brought about by intraluminal manipulations. In those cases in which a urethroplasty is later required, one has to tailor the operation to fit the situation. As with reconstructive procedures elsewhere in the body, one has to have a bag full of tricks and use the proper procedure or combination of procedures in solving the problem.

Drainage↗
PubMed1987

Effects of cyclophosphamide alone and scheduled methotrexate-5-fluorouracil combination chemotherapy on transplantable R-3327 prostatic adenocarcinoma in F1 hybrid male rat.

Male F1 hybrid rats bearing the R-3327 transplantable adenocarcinoma demonstrating similar growth patterns within the original sample of animals were carefully separated into control and treatment groups for each growth pattern. This assured treatment of tumors with similar cell kinetics within each group. In one group, cyclophosphamide (100 mg/kg) was injected intraperitoneally once every four weeks for eight weeks (total of two doses). In the second group, methotrexate (7.5 mg/kg) followed in ninety minutes by 5-fluorouracil (50 mg/kg) were injected intraperitoneally once each week for eight weeks (total of eight doses). These drug dosages did not depress the white cell count of the animals, and they tolerated the medicines well. Excellent suppression of tumor growth was obtained in each group with the cyclophosphamide treatment group being significant at the 0.01 level and the methotrexate-5-fluorouracil treatment group being significant at the 0.05 level.

Adenocarcinoma↗
PubMed1986

Myocardial infarction and its influence on male sexual function.

Sexual dysfunction was studied in 50 patients who had had a myocardial infarction (MI) matched with 50 control patients who were comparable in terms of age, hypertension, diabetes, and smoking. The MI group revealed sexual dysfunction in 76%, with erectile dysfunction in 42%. In the control group there was sexual dysfunction in 68% and erectile dysfunction in 48%. There was no statistically significant difference observed between the two groups. However, there was a significant influence of sex counseling on subsequent sexual functioning. Patients who received information as to when it was safe for them to resume sexual activity showed a lesser degree of apprehension in the post-MI period. The need of sexual rehabilitation for these patients and more thorough epidemiological comparative studies are suggested.

Adult↗
PubMed1985

The effects of cyclophosphamide, ketoconazole, aclacinomycin-A, methotrexate, and scheduled methotrexate-5-fluorouracil combination chemotherapy on the transplantable R-3327 prostatic adenocarcinoma in the F1 hybrid male rat.

Male F1 hybrid rats bearing the R-3327 transplantable prostatic adenocarcinoma demonstrating similar growth patterns within the original sample of animals were carefully separated into control and treatment groups. This assured treatment of tumors with similar cell kinetics within each group. In the first study, two separate drug protocols were investigated by intraperitoneal injection, namely cyclophosphamide (100 mg/kg) once every 4 weeks for 8 weeks and scheduled methotrexate (7.5 mg/kg) followed in 90 minutes by 5-fluorouracil (50 mg/kg) once each week for 8 weeks. Excellent suppression of tumor growth was obtained with each treatment protocol. Both were significant at the 0.01 level. In the second study, methotrexate (100 mg/kg) intraperitoneally once each week for 6 weeks, aclacinomycin-A intraperitoneally once each week for 4 weeks, and ketoconazole (60 mg/kg) via gavage 5 times a week for 6 weeks were administered to the animals in each respective group. Aclacinomycin-A and ketoconazole showed significant suppression of tumor growth at the 0.01 and 0.05 levels, respectively. Methotrexate suppressed tumor growth, but did not reach levels of significance over the duration of the study (0.2 less than P less than 0.3).

Aclarubicin↗