Biomedical subjects
K M Hunter
Publications and source records attributed to K M Hunter.
Patients, physicians, and red parakeets.
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A science of individuals. Medicine and uncertainty.
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Knowledge in medicine. Reading the signs.
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Susceptibility of Staphylococcus aureus.
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An infected dentigerous cyst complicated by periostitis ossificans. Case report.
Periostitis ossificans is a rare condition which has not been previously reported arising from an infected dentigerous cyst. This paper reports such a case in a twelve-year-old boy, and reviews the literature concerning periostitis ossificans.
Toward the cultural interpretation of medicine.
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A comparison of midazolam with and without nalbuphine for intravenous sedation.
The introduction of nalbuphine to intravenous sedation with midazolam added little to the quality of sedation for short operative procedures. There was a greater tendency for patients who received nalbuphine and midazolam to sleep in the afternoon after treatment compared with those who received only midazolam. Significantly more patients had nausea and vomiting in the midazolam/nalbuphine group than did patients in the midazolam-only group.
An N of 1: syndrome letters in the New England Journal of Medicine.
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Bacteraemia and tissue damage resulting from air polishing.
This study investigates the production of bacteraemia in dental prophylaxis by use of a commercially available air polishing device. Prophylaxis by means of the conventional rubber cup and paste method was used as a control. The study showed that air polishing can result in loss of epithelium at the gingival margin. The likelihood of a bacteraemia resulting from air polishing, in the absence of gingivitis, was less than in the group undergoing conventional prophylaxis. Although a higher number of bacteraemias was seen in the control group, the difference between the two groups was not statistically significant. Results indicate that patients who are at risk continue to require antibiotic cover.
Multiple intra-cranial hemorrhages after carotid endarterectomy.
Intra-cerebral hemorrhage is an unusual and often fatal complication of endarterectomy (CEA). Previous cerebral infarction, intra-operative or post operative hypertension, and the use of anti-coagulants are some of the defined major risk factors. Hemorrhage usually occurs early after CEA, and a second hemorrhage has only once been reported. We wish to report a patient who developed three separate hemorrhages following CEA. This patient had a long history of poorly controlled hypertension. We believe that poorly controlled hypertension, in addition to other reported factors, may be an important separate risk factor for post-CEA hemorrhage.
A science of individuals: medicine and casuistry.
Clinical medicine is the application of scientific principles, rules of thumb, and a store of practical wisdom embodied in narratives of individual cases to the care of a person who is ill. Physicians are taught to observe and report the individual case both as a means of fitting nomothetic generalizations to the given circumstances and as a way of refining those generalizations. This narrative construction of illness is a principal way of knowing in medicine. In this view, disease is not so much an entity as an identifiable chronological organization of the events of illness, and medicine, rather than a science, a rational science-using activity in the service of the ill.
Ethics education at Northwestern University Medical School.
The Northwestern University Medical School's Ethics and Human Values Program spans the medical curriculum from first year to fourth and extends into several residency programs. Taught by scholars in the medical humanities and clinicians from almost every specialty, the courses and seminars draw upon philosophy, literature, and law in addressing both immediately pressing social issues and the enduring "everyday ethics" of the physician-patient relationship.
Making a case.
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Midazolam and diazepam compared as sedatives for outpatient surgery under local analgesia.
Patients who had given their informed consent took part in a study to compare the sedative properties of the new benzodiazepine, midazolam, with diazepam. The drugs were administered intravenously and the quality of sedation, profoundness of amnesia, and rate of recovery were examined. Both drugs provided good-quality sedation, with midazolam producing a significantly greater degree of amnesia. Psychomotor tests used to assess recovery showed that patient performance following exposure to either drug had returned to normal 2 hours postsedation. However, patients who had received diazepam were drowsier later in the day and during the night following sedation than those who received midazolam. The implications of these findings are discussed.
A clinical evaluation of benzydamine hydrochloride.
A double-blind clinical trial of the effects of the use of benzydamine hydrochloride for patients undergoing the surgical removal of impacted lower third molar teeth showed no significant effects on swelling and trismus between control and experimental groups, although a significant reduction in the post-operative consumption of analgesics was noted.
Cyanoacrylate tissue adhesive in osseous repair.
Isobutyl 2-cyanoacrylate monomer placed in an osseous defect excited an intense acute inflammatory response in the early stages of repair. Fibrous encapsulation of the adhesive followed, and chronic inflammation supervened for as long as the cyanoacrylate remaine. Damage to established bone, presumable due to toxic breakdown products, occurred even at a distance from the adhesive. Osteoblastic activity was retarded where cyanoacrylate was in close proximity, recovering as fibrous encapsulation and macrophage activity provided protection. Extensive marrow damage was seen, recovery similarly following fibrous protection. Repair progressed as cyanoacrylate was removed. The findings of this investigation, together with other reports of unfavourable bone reaction to isobutyl 2-cyanoacrylate (Kerr & Smyth, 1971; Corn et al., 1972) suggest that it should not be used in bone surgery. An ideal adhesive for use in bone repair should promote rather than retard osteoblastic activity, and should resorb apace with bone regeneration. Thus isobutyl 2-cyanoacrylate does not fulfil the criteria for the ideal adhesive. Hopefully, future development of the cyanoacrylates will circumvent their current disadvantages, resulting in an adhesive acceptable for clinical use in osseous repair.