Blood conservation in total joint arthroplasty.
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Biomedical subjects
Publications and source records attributed to J P Meehan.
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James Paget Henry really began his productive research career at the outset of the second world war. His studies of acceleration and the anoxia of high altitude were supported by the development of then new techniques of measuring and recording critical physiologic parameters such as vascular pressures, respiratory functions and haemoglobin saturation. His inquisitive mind made productive use of the instruments that had to be made by skilled instrument makers working in university shops. Much of this instrumentation has now found its way into the clinical arena where it is now the main armamentarium of cardiac diagnostic and respiratory function laboratories. His work in the space program preceeded that of the Russians but did not get recognition until Sputnik awakened the world to the possibilities of space flight. His development of the concept of a cardiovascular basis for fluid volume control and the supportive investigative work undertaken constitute a milestone in the annals of experimental physiology. The chimpanzees used in Project Mercury were found to be hypertensive which was related to the method of capture used by the commercial suppliers. This lead Jim to study the effect of early experience on resting blood pressure, an effort that soon developed into provocative studies of the biological basis of the stress response.
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The history of the acute abdomen describes a shift from emphasis on prognosis to treatment through correlation of clinical and pathological findings. John B. Murphy was an acclaimed leader of American surgery whose name is associated with several diagnostic maneuvers used in the evaluation of the acute abdomen. These include deep-grip palpation used in examination for suspected biliary disease.
Experiments with negative pressure breathing led Gauer and Henry to the discovery of left atrial receptors that affected the release of ADH and the concept of a cardiovascular basis for fluid volume control. Since then, neural mechanisms involving cardiac receptors controlling the release of renin have been described, thus giving strong support for the role of cardiac receptors in fluid volume control. The original experimental work in the dog has been confirmed. The available pool of patients that have undergone heart transplant operations provide the opportunity for more definitive studies on the role of cardiac receptors in the control of cardiovascular function.
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The corpora cavernosa contain a fibrous skeleton composed of tunica albuginea with its fibrous columns, periarterial and perineural fibrous sheaths, and an intraparenchymal fibrous framework attached to all fibrous elements of the corpora cavernosa. This anatomical arrangement probably plays an important part in the firmness of the corpora cavernosa during erection. The fibrous framework, due to its numerous attachments to the deep surface of the tunica albuginea and its columns, when stretched during erection, prevents bending and deformation of the corpora cavernosa.
The nerves of the corpora cavernosa have anatomical characteristics different from other nerves. The intracavernous nerves are located in fibrous tunnels into which numerous fibrous bundles establish attachments. These bundles are part of the fibrous meshwork included in the corpora cavernosa. We suspect that during erection, when the corpora fill with blood and high intracavernous pressure develops, the aforementioned meshwork of fibrous bundles attached to all fibrous elements of the corpora, including the tunica albuginea and the perineural fibrous tunnels, stretches and prevents compression of the intracavernous nerves.
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Corpus cavernosum pressure in man during erection has not been measured previously with a noninvasive technique. Using such a technique it has been shown that during erection in young men intracavernosal pressure has peaks of at least ten times higher than the systemic systolic pressure. These findings indicate that during erection the intracavernosal circulation is contained, at least partially, within a closed system, separated from the general circulation. Also erection cannot be the result of circulatory function only.
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