Biomedical subjects

M D Saunders

Publications and source records attributed to M D Saunders.

4 recordsLinked to original sources

PubMed1999

Neostigmine for the treatment of acute colonic pseudo-obstruction.

BACKGROUND: Acute colonic pseudo-obstruction -- that is, massive dilation of the colon without mechanical obstruction -- may develop after surgery or severe illness. Although it may resolve with conservative therapy, colonoscopic decompression is sometimes needed to prevent ischemia and perforation of the bowel. Uncontrolled studies have suggested that neostigmine, may be an effective treatment. METHODS: We studied 21 patients with acute colonic pseudo-obstruction. All had abdominal distention and radiographic evidence of colonic dilation, with a cecal diameter of at least 10 cm, and had had no response to at least 24 hours of conservative treatment. We randomly assigned 11 to receive 2.0 mg of neostigmine intravenously and 10 to receive intravenous saline. A physician who was unaware of the patients' treatment assignments recorded clinical response (defined as prompt evacuation of flatus or stool and a reduction in abdominal distention), abdominal circumference, and measurements of the colon on radiographs. Patients who had no response to the initial injection were eligible to receive open-label neostigmine three hours later. RESULTS: Ten of the 11 patients who received neostigmine had prompt colonic decompression, as compared with none of the 10 patients who received placebo (P<0.001). The median time to response was 4 minutes (range, 3 to 30). Seven patients in the placebo group and the one patient in the neostigmine group without an initial response received open-label neostigmine; all had colonic decompression. Two patients who had an initial response to neostigmine required colonoscopic decompression for recurrence of colonic distention; one eventually underwent subtotal colectomy. Side effects of neostigmine included abdominal pain, excess salivation, and vomiting. Symptomatic bradycardia developed in two patients and was treated with atropine. CONCLUSIONS: In patients with acute colonic pseudo-obstruction who have not had a response to conservative therapy, treatment with neostigmine rapidly decompresses the colon.

Abdominal Pain↗

PubMed1989

Beneficial effects of glucose polymer and an H2-receptor blocker in a patient with a proximal ileostomy.

A patient with an ileocolectomy and proximal ileostomy for Crohn's disease had severe diarrhea and steatorrhea. An oral electrolyte solution containing glucose polymer was shown to improve water and electrolyte absorption. Ileal contents were abnormally acidic. Therapy with an H2-receptor blocker raised ileal pH, improved the efficiency of fat absorption, and promoted a gain in body weight.

Adult↗

PubMedDate not supplied

A program evaluation of classroom data collection with bar codes.

A technology incorporating bar code symbols and hand-held optical scanners was evaluated for its utility for routine data collection in a special education classroom. A different bar code symbol was created for each Individualized Educational Plan objective, each type of response occurrence, and each student in the first author's classroom. These symbols were organized by activity and printed as data sheets. The teacher and paraprofessionals scanned relevant codes with scanners when the students emitted targeted behaviors. The codes, dates, and approximate times of the scans were retained in the scanner's electronic memory until they could be transferred by communication software to a computer file. The data from the computer file were organized weekly into a printed report of student performance using a program written with commercially available database software. Advantages, disadvantages, and costs of using the system are discussed.

Child↗

PubMedDate not supplied

Comparison of reinforcement schedules in the reduction of stereotypy with supported routines.

The rates and durations of stereotypic behaviors in four adolescents with severe mental retardation were measured during two daily vocational training sessions and during contiguous periods of leisure in their special education classrooms. Vocational training was conducted in two different tasks, alternating across days. The task requirements for each participant were matched to each participant's learning and performance characteristics. The participants were exposed to a fixed ratio schedule of tokens exchangeable for food items on one task and to a variable interval schedule for the same consequences on the second task. The schedules were chosen as an initial test of a matching-law based prediction by Myerson and Hale (1984): Variable interval reinforcement for adaptive behavior will produce less allocation of responding to maladaptive behavior than will a ratio-based intervention. When work performances stabilized, the schedules of token delivery were reversed across the tasks and performances again stabilized. Results are reported for periods when work performances met stability criteria. Stereotypy occurred more during leisure than during vocational training under either schedule. The major differences in stereotypy between leisure and vocational training were differences in episode length rather than rate of onset. Onset of stereotypy in vocational training, however, occurred at higher rates under the interval schedule than under the ratio schedule in both tasks. The results are discussed in terms of Myerson and Hale's prediction and implications for further research and application.

Adolescent↗