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Biomedical subjects

John Kendall

Publications and source records attributed to John Kendall.

4 recordsLinked to original sources
PubMed2006

Cortisol production rate in posttraumatic stress disorder.

CONTEXT: Several authors have reported the unsuspected finding of low cortisol levels (urinary, salivary, and serum) in patients with posttraumatic stress disorder (PTSD). OBJECTIVE: Our objective was to assess concentrations of cortisol and its predominant metabolites, cortisol production rate (CPR), and glucocorticoid receptor (GR) binding characteristics in PTSD compared with normal subjects. DESIGN: Matched PTSD patients and control subjects had CPR determined by a stable isotope dilution technique after infusion of deuterated cortisol. Serum cortisol, urinary cortisol, and its metabolites were measured by gas chromatography/mass spectrometry. GR binding capacity (R(o)) and ligand binding affinity (K(d)) were measured in mononuclear leukocytes. SETTING: All subjects were tested during a 40-h admission in an inpatient clinical research center. PATIENTS AND PARTICIPANTS: Ten patients with PTSD were matched by age and gender with 10 controls. OUTCOME MEASURES: Statistical comparison was conducted for various measures of cortisol in PTSD patients and normal subjects. RESULTS: No statistical difference was found in mean level or circadian pattern of cortisol secretion using serum or salivary immunoassay detection methods. Although in the normal range, urinary cortisol by immunoassay showed statistically lower values over a 24-h period in PTSD patients compared with controls. This finding was not confirmed by gas chromatography/mass spectrometry determination of cortisol or its metabolites. CPR was not statistically different between these groups. GR also showed no alteration in R(o) or K(d) between the groups. CONCLUSION: The data indicate that PTSD in the chronic and unprovoked state is not characterized by an acute biological stress response.

Adult↗
PubMed2004

Blind nasotracheal intubation for patients with penetrating neck trauma.

BACKGROUND: Early airway management is advocated for patients with penetrating neck trauma who have any signs of airway compromise. This study examined the clinical course of patients with penetrating neck trauma who received prehospital blind nasotracheal intubation, including successful intubation rates, and outcomes. METHODS: A retrospective review of patients admitted to the emergency department for penetrating neck trauma was conducted from January 1, 1993 to July 1, 2001 at the Denver Health Medical Center. Patients were identified from the trauma registry, and data were collected using standardized inclusion and exclusion criteria. RESULTS: The study identified 240 patients with penetrating neck trauma. Overall mortality was 8.3%. Among the 240 patients, 89 (37%) required airway management, and 40 (17%) underwent prehospital management with blind nasotracheal intubation. The success rate for prehospital intubation using the blind nasotracheal method was 90%. The mean number of attempts was 1.16 (range, 1-4), and the mortality in this group was 5%. CONCLUSION: The patients managed with blind nasotracheal intubation did not experience complications related to the choice of airway management. Despite prior warnings in the literature, the results of this study suggest that blind nasotracheal intubation may well be a valuable tool for the management of patients with penetrating neck trauma.

Academic Medical Centers↗
PubMed2003

Emergency department ultrasound for hemothorax after blunt traumatic injury.

Diagnosing hemothorax after blunt trauma may be aided by emergency department (ED) ultrasound (US). Various prior studies have evaluated ED US using different gold standards. A prospective study of blunt trauma patients who underwent computed tomography (CT) scan of the chest, abdomen, or both, was performed. Before CT scan, an US examination was performed specifically to identify free fluid in the thorax. The CT scan findings were used as the gold standard for validation of US results. From July 1998 to June 1999, 142 of 155 patients who underwent US and CT scan for evaluation of blunt trauma were included in this study. The CT scan identified 16 cases of hemothorax among these patients. ED US resulted in 2 true-positive, 2 false-positive, 14 false-negative, and 124 true-negative findings. ED US was 12.5% sensitive and 98.4% specific. ED US did not detect small-volume hemothorax identified by CT scan. Future research should focus on further defining the size of hemothorax appreciable with ED US, with increased attention paid to the type of gold standard implemented for its evaluation.

Cohort Studies↗