Biomedical subjects
Keith Wrenn
Publications and source records attributed to Keith Wrenn.
Aneurysmal subarachnoid hemorrhage.
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Calcium-phosphorus product and troponin-T values in renal failure.
PURPOSE: The purpose of this study was to see if there is a significant association between calcium-phosphorus product (CPP) and initial troponin-T values in patients with renal insufficiency. BASIC PROCEDURES: A retrospective study over 4 months from the laboratory database of all patients with serum creatinine values greater than 3 mg/dL who had concomitant troponin T and creatine kinase isoenzymes measured was conducted. The most recent calcium and phosphorus values were also abstracted. RESULTS: There were 87 patients with a mean age of 59 years, a median creatinine value of 51 mg/dL, a mean CPP of 47, and a median initial troponin-T value of 0.18 ng/mL. The troponin level was elevated (>0.05 ng/mL) in 74% of the patients. The CPP was higher than 55 in 28% of the patients. When comparing the troponin values with the CPP, there was no association noted (P = .72). CONCLUSIONS: Although both elevated CPP and troponin values are associated with increased cardiovascular mortality in the intermediate term, we could not demonstrate a useful relationship between the 2 values that would indicate causality or help with the interpretation of the initial troponin level when patients with renal insufficiency present with suspected acute myocardial infarction.
The perils of vinegar and the Heimlich maneuver.
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Images in clinical medicine. Disseminated gonococcal infection.
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Pneumoperitoneum after percutaneous endoscopic gastrostomy: a case report and review.
A complication of percutaneous endoscopic gastrostomy (PEG) is perforation of a hollow viscus. This is typically detected by finding of pneumoperitoneum (PP) on radiographs. However, PP can occasionally be a benign finding. A review of the literature shows many causes for a benign PP, and it has been noted to occur frequently after PEG placement. In the absence of signs or symptoms of peritoneal inflammation, PP usually requires no further investigation or treatment.
Past and present.
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Variability of recommendations for serum alkalinization in tricyclic antidepressant overdose: a survey of U.S. Poison Center medical directors.
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Adenosine dose should be less when administered through a central line.
A patient with a port-a-cath was given 12 mg of adenosine for paroxysmal supraventricular tachycardia (PSVT), resulting in prolonged (13 s) bradycardia and severe side effects. When the same patient presented 2 weeks later for recurrent PSVT, only 3 mg of adenosine was needed to terminate the episode, without the patient experiencing prolonged bradycardia or severe side effects. The literature suggests that for patients with central venous catheters, a lower dose of adenosine should be used to terminate PSVT.
The epidemiology and diagnosis of penetrating eye injuries.
UNLABELLED: It is estimated that there are 3.1 penetrating eye injuries per 100,000 person-years in the United States. OBJECTIVES: To evaluate the epidemiology of penetrating eye injuries and to identify physical examination findings that facilitate the diagnosis and ophthalmologic referral of patients with these injuries. METHODS: This was a retrospective chart review of emergency department patients with penetrating eye injuries seen for evaluation from July 1987 to January 1999. The setting was a tertiary referral, university hospital. Three hundred eighty-four patients with 390 penetrating eye injuries were enrolled; 56% were transferred from outlying hospitals. RESULTS: Penetrating eye injuries were seen almost three times per month. Eighty percent of the injuries occurred in males, and the mean age was 29 years. Twenty-five percent of the patients had used alcohol in the period immediately preceding the injury. Final visual outcome was 28% with enucleation, "no light perception" (NLP) in 10%, light perception to 20/200 in 24%, and light perception of 20/200 or better in 38%. Poor visual outcome was associated with poor initial visual acuity, alcohol use, and delayed presentation (p = 0.036, 0.025, 0.036, respectively). Gun-related injuries caused 33% and motor vehicle crashes (MVCs) caused 21% of the worst outcomes (enucleation or NLP). In MVCs where seat belt use was reported, 71% of injured patients were unrestrained. The most common initial physical findings were hyphema (76%), abnormality of the pupil or uvea (94%), and initial visual acuity worse than 20/200 (77%). All patients had at least one of these findings. Complications occurred in 25% of cases, most commonly traumatic cataract or infection. Complications occurred more commonly in those patients transferred than in those presenting directly (p = 0.002). CONCLUSIONS: Penetrating eye injuries are relatively common, occur predominantly in young males, and often result in poor visual outcome in the affected eye. Motor vehicle crashes, alcohol use, and fire-arm use are associated with more severe injuries.