Biomedical subjects
Publications and source records attributed to J W Kern.
This case illustrates a developmental variant of the acromion resulting in apparent widening of the acromioclavicular joint space rather than discontinuity of the inferior cortices of the acromioclavicular joint. Had an axillary view not been obtained, an erroneous radiographic diagnosis of grade I acromioclavicular separation might have been suggested.
This paper demonstrates clinically that the interactional features of a transference neurosis are the waking equivalents of a manifest dream. Through analytic investigation of the emerging repetitive extraverbal elements of apparent transference resistance behavior, it is discovered that the systematic analysis of the details of such behavior yields a picture of synthetic construction fundamentally the same as that seen in dreams. By using Freud's technique of systematic dream interpretation, the tightly organized, coded, and camouflaged presence of many key compromise formations determining a neurosis are found to be represented in compact, highly condensed clinical interactions, providing an overall picture of dreamwork in action. The four components of dreamwork are found to be the principal means by which the unconscious genetic and dynamic material is represented in the analytic field.
Two methods of calculating heparin infusion rates for patients with venous thrombotic disease were compared; one method was based on a one-compartment pharmacokinetic model, the other on patient weight. Sixty-eight patients with presumed thromboembolic disease were started on continuous i.v. heparin sodium (porcine) using an infusion pump. Patients were divided into two groups--the infusion rate of Group I was based on patient weight (77 units/kg/4 hrs) and the infusion rate of Group 2 was determined by a pharmacokinetic equation based on a one-compartment heparin model. Heparin effect was measured by an activated partial thromboplastin time (APTT). The initial heparin infusion rate for Group 1 (4,784 +/- 672 units/4 hrs) was significantly greater (p less than 0.039, two-sample t-test) than that for Group 2 (4,413 +/- 779 units/4 hrs), but the variances of the rates were not significantly different (p = 0.40, ratio of variance F-test). Both methods for estimating initial heparin infusion rates gave mean APTT values in the center of the therapeutic range, but the variance in the APTTs of Group 2 patients was significantly smaller (p = 0.004) than that of Group 1. The pharmacokinetic model was more precise and reliable. This model should be valuable for insuring heparin's therapeutic effect without exposing patients to the potential risk of hemorrhage.
Gentamicin pharmacokinetics were studied in eight patients with ascites. Gentamicin serum levels were measured by radioimmunoassay immediately before, 15 minutes after, and at one and two estimated half-lives after intermittent i.v. infusions of gentamicin. Volumes of distributions (Vd) calculated for the eight patients were significantly larger than mean values reported for the drug in normal patients (p less than 0.025). Vd ranged from 20.2 to 53 liters and correlated poorly with lean and total body weights. In patients with ascites or abnormal extracellular fluid volumes, gentamicin dosage should be based on frequent measurements of serum gentamicin levels and on clinical response.
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The relative in vivo availability of gentamicin when administered by two different intravenous methods was evaluated in patients treated in a surgical intensive care unit in a randomized, prospective, crossover study. Each patient received gentamicin therapy via intravenous piggyback (IVPB) and in-line burette (ILB) methods. In the IVPB method, the drug was mixed in 5% dextrose in water (D5W) and infused intermittently. In the ILB method, the drug was mixed using the patient's total nutrient admixture (TNA) solution as the diluent in an ILB, which was inserted between the TNA bottle and its administration set and infused intermittently. A serial sampling of four sets of serum concentrations of the gentamicin was obtained. Pharmacokinetic parameters (Kel, Vd, and a maximum serum concentration) were calculated from the four sets of concentrations collected per patient. The IVPB method yielded mean values of Kel, Vd, and C1.5mg/kg of 0.13 hr-1, 0.39 liter/kg, and 5.1 micrograms/ml, respectively. The ILB method yielded mean values of Kel, Vd, and C1.5mg/kg of 0.14 hr-1, 0.34 liter/kg, and 5.6 micrograms/ml, respectively. A t-test for paired samples was applied to these mean values. Significant difference was not found (p greater than 0.05). The intermittent infusion of gentamicin, using TNA as the diluent and an ILB, produced equivalent serum concentrations when compared with D5W as the diluent.