Biomedical subjects
Publications and source records attributed to M E Cunningham.
A case of segmental dilatation of the ileum with an associated Meckel's diverticulum is reported in an 8-year-old child with anaemia. The pre-operative demonstration of this association has not previously been described in the literature.
A direct assay for measuring sperm-associated immunoglobulin G (IgG) and an indirect assay for measuring IgG plasma antisperm antibodies were devised utilizing fluorescein-labeled antihuman IgG and a fluorescein-activated flow cytometer. The method singularly analyzed Ig attached to the surface of sperm because sperm and nonsperm cells were separately assessed. The direct assay technique results correlated with results from a previously reported direct radiolabeled antiglobulin assay. As few as 100,000 sperm are required in the indirect method; the sensitivity of the indirect technique corresponded with that of a previously reported indirect radiolabeled antiglobulin assay.
Previously frozen and fresh sperm from infertile and fertile men were assayed for sperm-associated immunoglobulin G (IgG) to determine the effect of a simple freezing technique on the assay results. A direct radiolabeled antiglobulin assay (DRAA) and a direct fluorescein-labeled antiglobulin assay (DFAA) utilizing a fluorescein-activated flow cytometer were employed. The amount of IgG detected by the DRAA and the percentage of sperm that fluoresced in the DFAA generally declined when frozen sperm were used, but only the DFAA showed a statistically significant decrease. However, the degree of decline was predictable (r = 0.91 in both assays), and whether the test remained positive or negative when frozen sperm were used was not significantly affected.
A series of 86 pediatric lumbar spine abnormalities was evaluated to determine the diagnostic benefit of radiography in oblique projection as compared to frontal-lateral projections alone. In only four patients was an abnormality apparent on the oblique view which had not already been demonstrated by the frontal-lateral series; each of these represented an isolated spondylolysis. Because the diagnostic yield was low at a patient cost of more than double the gonadal radiation dose, it is recommended that oblique views be eliminated in the routine radiography of the pediatric lumbar spine.
A patient is presented who had a hydatidiform mole with a coexisten fetus and bilateral theca lutein cysts. The complete diagnosis was made by grey-scale ultrasonography.
Progressive multifocal leukoencephalopathy is a rapidly progressive patchy, demyelinating process seen in patients with a long standing reticuloendothelial disorder. The first instance of abnormal angiographic features of this entity simulating a neoplasm is presented.
Three cases of anencephaly diagnosed in utero by ultrasound are presented and the ultrasound diagnostic criteria for anencephaly are illustrated. The literature regarding anencephaly is reviewed and the malformation discussed. Diagnostic ultrasound should be used to screen high-risk patients for this fetal anomaly. In addition, all patients clinically suspected of possible fetal malformation or polyhydramnios should be examined by ultrasound.
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Endothelin is a peptide with 21 amino acids that is produced by ischemic or injured endothelial cells. As indicated by in vitro and animal studies, endothelin is also a potent constrictor for renal mesangial and coronary vessels, a bronchoconstrictor, and an endocrine regulator. Our laboratory has shown that endothelin is an agonist for monocyte production of interleukins-1, -6, and -8, prostaglandin E2, and substances that trigger superoxide production. Systemic endothelin levels increase in patients with hypoperfusion and sepsis, indicating that endothelin may be yet another important cytokine in critical illness. Though endothelin has been shown to be a potent vasoconstrictor in healthy dogs, systemic vascular resistance does not increase in critically ill patients with high endothelin levels. (We hypothesize that this might be due to prostaglandin E2-mediated vasodilation predominating over endothelin-mediated vasoconstriction.) We questioned whether any changes occur in systemic endothelin levels in patients with major burns (> 20%). Ten hemodynamically stable patients resuscitated by a modified Parkland formula to a urine output greater than 30 ml/hr had endothelin levels drawn on admission and at 1, 6, 12, 24, and 48 hours after admission. Endothelin levels were measured by radioimmunoassay. Mean endothelin levels were elevated at 205 +/- 28 fmol/ml at all time points in contrast to levels of 39 +/- 9 fmol/ml in the healthy control group. In summary, systemic endothelin levels increase significantly in patients with major burns. Endothelin may be yet another cytokine playing a significant role in the immune, inflammatory, and multiorgan dysfunction observed with major burns.
Endothelin is produced by injured or ischemic endothelium and causes monocyte production of interleukins-6 and 8 in vitro. Endothelin levels increase in patients with burn injuries, and we asked whether interleukin-6 and 8 levels increased in patients with burn injuries concurrently with endothelin. Fourteen patients with more than 20% body surface area burns were resuscitated to maintain urine output of 0.5 to 1.0 ml/kg/hr. Blood was drawn on admission and at 12, 24, and 48 hours. Endothelin was measured by radioimmunoassay, interleukins-6 and 8 were measured by enzyme-linked immunosorbent assay. Endothelin levels increased to 6.1 +/- 2.3 fmol on admission, 5.7 +/- 2.1 at 12 hours, 6.9 +/- 2.7 at 24 hours, and 6.4 +/- 2.7 at 48 hours (vs 0.5 in healthy controls). Interleukin-6 increased to 243 +/- 220 pg/ml on admission, 276 +/- 198 at 12 hours, 400 +/- 282 at 24 hours, and 379 +/- 274 at 48 hours (vs less than 50 in healthy controls). Interleukin-8 increased to 504 +/- 309 pg/ml on admission, 483 +/- 263 at 12 hours, 575 +/- 306 at 24 hours, and 698 +/- 667 at 48 hours (vs less than 50 in controls). Endothelin-1 and interleukin-6 and 8 levels increase in patients with burn injuries. Endothelin-mediated activation of monocytes that cause cytokine production may have clinical relevance in patients with burn injuries.
Magnetic resonance imaging was utilized to evaluate three women, one of whom was pregnant, with a clinical diagnosis of anterior spinal artery syndrome. In each case, development of spinal cord infarctions was spontaneous. Sagittal and axial MR images of the spine were obtained prior to and following administration of Gd-diethylenetriamine pentaacetic acid. Magnetic resonance showed no cord enlargement or signal abnormality on T1-weighted images prior to contrast medium administration. On T2-weighted images there was abnormal increase in signal intensity in the cord at levels corresponding to the neurologic deficits in all three patients. Variable contrast enhancement was demonstrated in these areas. Magnetic resonance imaging was positive, whereas CT-myelography, carried out in the two nonpregnant women, failed to demonstrate any abnormalities.
"Joint pain" may be a chief complaint reported by patients who are suffering from bursitis or tendinitis. Both disorders can develop in various joints throughout the body, but this article emphasizes the heel area since it is a common site for both disorders. Also addressed are the essential diagnostic features, general medical management, and nursing issues relevant to these disorders.
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Although the term "fibromyalgia" has appeared in the literature for 90 years, the disease may go unrecognized by clinicians. It is a devastating disease, more common than rheumatoid arthritis, yet its cause remains a mystery. There is no cure for fibromyalgia; however, nurses may be able to help improve the quality of life for the patients who live with this disease. This article explores theories of causation, treatment modalities, and the potential role of nurses in their work with these patients.
The promotion of healthy self-concept in clients is an important outcome in nursing practice. The nurse's own self-concept is also an important factor affecting one's ability to meet the needs of others. Several scholars who speak from an Afrocentric cultural base echo a warning about the potential deleterious effects on self-concept that can occur as a result of internalization of the perspectives of other cultures to the exclusion of perspectives from one's own culture. Proponent and opponent arguments have been articulated concerning the question, "Are there African American perspectives on biomedical ethics?" In this paper, the proponent view is supported, and the potential influence of Afrocentrism on self-concept is explored.