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Biomedical subjects

M Bryce

Publications and source records attributed to M Bryce.

5 recordsLinked to original sources

Evolving indications for permanent pacemakers.

New indications for permanent cardiac pacing have been developed in recent years, with numerous studies demonstrating improved clinical outcomes in a variety of disorders. Because hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy, heart failure, neurocardiogenic syncope, and atrial fibrillation are common conditions, every clinician should be aware of evolving alternative therapies for them. Observational studies in patients with refractory, symptomatic hypertrophic obstructive cardiomyopathy and significant left ventricular outflow gradient at rest suggest that cardiac pacing may result in symptomatic and hemodynamic improvement. Clinical trials have not shown conclusive evidence regarding the long-term benefit from pacing in these patients, and it is unclear whether pacing will be a preferred treatment option. Preliminary data suggest that pacing is a viable adjunctive therapeutic approach for improving symptoms in patients with dilated cardiomyopathy and heart failure. Mortality benefit has yet to be established, but it is to be hoped that ongoing randomized clinical trials will provide definitive information on that issue. Patients with refractory neurocardiogenic syncope or those who are intolerant of medical treatment may benefit from pacing therapies, especially those that use rate-drop sensor algorithms. Biatrial pacing has emerged as a technique that resynchronizes atrial electrical activity and has been shown to prevent atrial fibrillation. Multisite atrial pacing for the prevention of atrial fibrillation is considered investigational but seems promising. Newer indications for pacing are expected to result in improved clinical outcomes for hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy and heart failure, neurocardiogenic syncope, and the prevention of atrial fibrillation.

Atrial Fibrillation↗

Adjunctive treatment of compartment syndrome with hyperbaric oxygen.

Trauma-induced compartment syndrome and other acute traumatic peripheral ischemias have been effectively treated with hyperbaric oxygen therapy. We describe a case of compartment syndrome associated with an acute exertional injury. After surgical decompression, hyperbaric oxygen therapy reduced edema and improved tissue viability. The mechanisms of hyperbaric oxygen applicable to the pathophysiology of compartment syndrome are described. We believe that hyperbaric oxygen is a useful intervention in the management of compartment syndrome.

Adult↗

Effect of sibship position on reproductive behavior of couples after the birth of a genetically handicapped child.

We compared the reproductive behavior of 132 white married couples of whom 44 had a child with cystic fibrosis, 44 with either Down Syndrome or neural tube defect, and 44 with cerebral palsy to that of the general USA white married population. The three groups of couples were similar respecting race, religion, maternal age, parental occupation and education, and sex of affected child. Most couples had received some genetic counseling and all were followed for at least 3 years after diagnosis of the affected child. Regardless of the degree of recurrent risk and availability or not of prenatal diagnosis, couples were several fold more likely to reproduce again when the affected child was the 1st rather than later born. From this study and others, we conclude that the three major determinators of reproductive behavior in couples after having a genetically handicapped child are the same as those for the general population. Specifically, these are: parental desire for children, past reproductive experiences (that is, sibship size and perhaps also outcome), and maternal age.

Adolescent↗

Pneumocele of the maxillary sinus. A second case report.

The term pneumocele refers to an expansile bone destructive air containing cyst-like lesion involving the sinus cavity proper, presumably due to obstruction of the major sinus ostium. It differs from pneumoceles described previously that have all been air pockets beyond a paranasal air sinus due to an abnormal fistulous communication, rather than expansion of the sinus cavity itself. In adding this second case to the literature we believe that this rare lesion may be encountered from time to time, and should be considered when an expanded maxillary antrum is found to contain air rather than fluid or soft tissue content.

Adolescent↗