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Biomedical subjects

M J Cunningham

Publications and source records attributed to M J Cunningham.

At least 73 records · Page 4Linked to original sources
PubMed1994

Markers of hemostatic activation in affected coronary arteries during angioplasty.

To characterize the extent of early activation of the hemostatic system following angioplasty, we obtained blood samples from the involved coronary artery of 11 stable angina patients during the procedure and measured sensitive markers of thrombin formation (fibrinopeptide A, prothrombin fragment 1.2, and soluble fibrin) and of platelet activation (beta-thromboglobulin). Levels of hemostatic markers in venous blood obtained from 14 young individuals with low pretest probability for coronary artery disease were not significantly different from levels in venous blood or intracoronary samples obtained prior to angioplasty. Also, there was no translesional (proximal and distal to the lesion) gradient in any of the hemostatic markers before or after angioplasty in samples obtained between 18 and 21 min from the onset of the first balloon inflation. Furthermore, no significant difference was noted between angioplasty and postangioplasty intracoronary concentrations. We conclude that intracoronary hemostatic activation does not occur in the majority of patients during and immediately following coronary angioplasty when high doses of heparin and aspirin are administered.

Adult↗
PubMed1993

Progressive sensorineural hearing loss in association with distal renal tubular acidosis.

The autosomal recessive inherited syndrome of distal renal tubular acidosis and sensorineural hearing loss may present in one of two distinct fashions. The rare adolescent form is characterized by mild renal tubular acidosis, mild to moderate sensorineural hearing loss, and otherwise normal growth and development. The more common infantile type typically presents in the first year of life with failure to thrive, acidosis, and a more severe sensorineural hearing loss. In this report, progression of sensorineural hearing loss is documented for the first time in two siblings with the infantile variant. This association suggests that all children with distal renal tubular acidosis should undergo sequential audiologic evaluations with the institution of appropriate amplification and educational intervention as needed.

Acidosis, Renal Tubular↗
PubMed1993

The cause of aural polyps in children.

This 20-year retrospective review identifies 35 pediatric patients with aural polyps in an attempt to assess for clinical predictors of significant otopathologic conditions. Chronic otitis media (43%), cholesteatoma (29%), and retained tympanostomy tubes (23%) were the common causes. Unusual causes included mycobacterial infection and Langerhans' cell histiocytosis. Multivariate analysis revealed the co-occurrence of conductive hearing loss at presentation to be a significant clinical predictor (P = .03) of cholesteatoma; the histopathologic finding of keratin-induced giant cell reaction was nonspecific in this respect. Cholesteatoma was also prevalent in recurrent polyp cases, suggesting the need for prolonged follow-up in those children whose initial clinicopathologic evaluation does not yield a definitive diagnosis.

Adolescent↗
PubMed1993

Percutaneous balloon valvuloplasty for severe mitral stenosis during pregnancy: a review of therapeutic options.

A woman presented at 29 weeks' gestation with previously undiagnosed severe mitral stenosis. She did not respond to medical therapy, and underwent successful percutaneous balloon mitral valvuloplasty with complete resolution of her symptoms. The remainder of her pregnancy was uncomplicated, and she delivered a healthy infant at 40 weeks' gestation. Percutaneous balloon valvuloplasty offers an innovative alternative to standard surgical therapy if medical management is unsuccessful.

Adult↗
PubMed1993

Tympanostomy tubes: experience with removal.

Whereas the clinical indications for tympanostomy tube placement are well-established, the indications for operative tympanostomy tube removal remain unspecified. A 1-year retrospective review done at the Massachusetts Eye and Ear Infirmary revealed 131 tympanostomy tubes to have been removed under general anesthesia. Chronic otorrhea, granuloma formation, tube nonfunction due to blockage, and migration of the tube into the middle ear constituted the surgical indications in 75 cases. The remaining 56 tubes were removed on the physicians' judgment that artificial ventilation was no longer required. Selected cases are presented. While the vast majority of tubes spontaneously extrude uneventfully, a comparatively small number of patients do require operative tube removal. Practice guidelines for surgical tube removal are suggested.

Acute Disease↗
PubMed1992

Apnea and the elongated uvula.

Four cases of respiratory distress and apnea associated with an elongated uvula are presented. In all cases, the uvula was found to intermittently fall onto the epiglottis and vocal cords. In all four patients, resection of the uvula led to resolution of all airway symptoms. It is hypothesized that the uvula, touching the vocal cords, caused intermittent laryngospasm and subsequent symptoms of cough, airway obstruction, and cyanosis. The anatomic reasons for such phenomenon are discussed.

Airway Obstruction↗
PubMed1992

Meningitis and midline facial deformity.

A baby with unilateral cleft lip, midline cleft palate and hypertelorism developed meningitis in the first 48 h of life. Examination of the nasopharynx showed a soft tissue mass, which was confirmed as a basal encephalocele by computed tomography. There was also congenital hydrocephalus and the corpus callosum was absent. Surgical treatment included repair of the anterior basal skull defect, repair of the lip and palate, and ventriculo-peritoneal shunt. There is currently evidence of developmental delay and right-sided visual impairment due to Morning Glory syndrome. This case demonstrates that basal encephalocele should be considered in any baby with midline facial deformity who develops meningitis.

Cleft Lip↗
PubMed1992

Orbital complications of acute sinusitis: comparison of computed tomography scan and surgical findings.

The accuracy of computed tomography (CT) in distinguishing an abscess from cellulitis in children who present with orbital manifestations of paranasal sinus infection remains in question. In this 10-year retrospective study, CT results are compared with surgical findings in 19 patients with orbital complications who underwent surgical exploration within 24 hours of their CT scans. Fifteen of the 19 CT scan interpretations indicated abscesses that were verified intraoperatively. Two patients had negative surgical explorations despite CT interpretations predicting abscesses. An abscess was also surgically documented in 1 of 2 patients whose preoperative scans indicated cellulitis alone. We conclude that the correlation between radiologic and operative findings in 16 of these 19 cases, although not absolute, does substantiate the use of CT scanning as a therapeutic guide in children presenting with orbital disease secondary to paranasal sinusitis.

Abscess↗
PubMed1992

The old and new of acute laryngotracheal infections.

Laryngotracheal infections in childhood frequently result in airway obstruction, the major symptom of which is stridor. The primary aims of management are to establish a diagnosis rapidly and to maintain or secure the child's airway. Medical treatment and airway stabilization measures vary for the three most prevalent laryngotracheal infections--supraglottitis, laryngotracheitis, and bacterial tracheitis--as well as for older and newer infectious airway entities.

Acute Disease↗
PubMed1991

Extended-field radiation therapy in early-stage cervical carcinoma: survival and complications.

Four hundred fifteen patients with early-stage cervical carcinoma were explored via a transperitoneal approach for radical hysterectomy at the Hospital of the University of Pennsylvania between January 1, 1960, and December 31, 1985. Twenty-four of these patients were found to have histologic documentation of para-aortic lymph node metastases. Twenty-one patients (88%) were treated primarily with extended-field radiotherapy. Forty-eight percent of these patients have survived greater than 5 years from diagnosis. Six patients have been followed more than 10 years after initial treatment. All six are alive although one patient has recurrent disease that was diagnosed at 164 months. Patients with adenocarcinoma or adenosquamous carcinoma had a survival significantly lower than that of those with squamous cell cancers (p = 0.022). Complications included one treatment-related death from multiple fistulas and sepsis, one vesicovaginal fistula, two enteric fistulas, and two small bowel obstructions. The major morbidity rate was 19%. Extended-field radiation is effective therapy for para-aortic nodal metastasis associated with early-stage squamous cell carcinomas of the cervix but carries a considerable morbidity rate. Other modalities such as combined chemotherapy and radiation may be necessary for adenocarcinoma.

Adenocarcinoma↗
PubMed1991

Preventing perioperative obstruction of tympanostomy tubes: a prospective trial of a simple method.

The intraluminal obstruction of tympanostomy tubes by hemorrhage incurred in the perioperative period is not a rare problem. The exact frequency, however, is unknown and methods of prevention have not been studied. We prospectively investigated a method of unilaterally coating one grommet with antibiotic ointment in 128 children undergoing bilateral tympanostomy tube placement; the contralateral tube was not treated. We established the incidence of intraluminal obstruction by blood in untreated grommets to be 4.7%. The incidence of hemorrhagic obstruction of the coated tubes was less (2.3%) but did not achieve statistical significance (P less than 0.20). The technique of antibiotic ointment application to the tympanostomy tube at the time of surgery was not sufficiently efficacious to justify routine use.

Acute Disease↗
PubMed1990

Diastolic function in left ventricular hypertrophy: clinical and experimental relationships.

The evaluation of patients with left ventricular hypertrophy and the clinical syndrome of congestive heart failure requires the ability to distinguish between the etiologies of abnormal systolic contractile function and abnormalities of diastolic relaxation and filling. In patients with left ventricular hypertrophy and congestive heart failure, predominant diastolic dysfunction should be suspected when elevation of left ventricular diastolic pressure is detected in the presence of normal diastolic chamber volume or dimensions and preserved systolic shortening. The mechanisms which account for diastolic dysfunction in the presence of cardiac hypertrophy are controversial and are likely to be multiple. These mechanisms may include changes in left ventricular geometry, per se, changes in the composition of the left ventricular wall (fibrosis or alteration in collagen), and dynamic factors which modulate diastolic force inactivation (loading conditions, cytosolic calcium handling, cyclic AMP availability). In addition, recent studies suggest that hypertrophied cardiac muscle may be particularly susceptible to develop diastolic dysfunction in response to the stress of hypoxia or ischaemia.

Cardiac Volume↗