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Biomedical subjects

M L Patton

Publications and source records attributed to M L Patton.

31 records · Page 2Linked to original sources
PubMed1983

Vigorous supplementation of a hypocaloric diet prevents cardiac arrhythmias and mineral depletion.

We have previously demonstrated that a hypocaloric, nutritionally deficient, liquid protein diet is associated with potentially life-threatening cardiac arrhythmias, which increased in frequency and complexity over the duration of the study. The present investigation was designed to evaluate the metabolic and cardiac changes associated with a hypocaloric, but otherwise nutritionally complete, diet. Six healthy, obese females from 154 to 182 percent of ideal body weight were evaluated in a metabolic ward for 48 days. The subjects ingested a weight maintenance diet during an eight-day period, which was followed by 40 days of an experimental diet containing 472 kcal of a mixture of protein (60 percent of calories), carbohydrate (25 percent), and fat (15 percent). This diet equaled or exceeded the recommended daily allowances for minerals, trace elements, vitamins, and essential fatty acids. The subjects were monitored for balances of nitrogen and minerals, as well as for the appearance of cardiac arrhythmias by 24-hour electrocardiographic recordings. Nitrogen balance was positive, and the previously demonstrated negative balances for potassium, sodium, calcium, magnesium, and phosphorus were either reversed or markedly decreased. In contrast to our previous study, no arrhythmias were observed in subjects ingesting the present experimental diet, and no significant change in cardiac rhythm was found in 13 obese, but otherwise healthy, outpatients. The data, based on a limited number of subjects, suggest that a hypocaloric diet vigorously supplemented with essential elements, micronutrients, and vitamins appears to be safer than the once popular, incomplete liquid protein preparation.

Adult↗
PubMed1983

Adrenalectomy abolishes and cortisol restores naloxone's beneficial effects on cardiovascular function and survival in canine hemorrhagic shock.

Endogenous opioid substances are activated in and may contribute to the cardiovascular depression of hemorrhagic shock. In order to determine the importance of the adrenal gland in the beneficial effects of the opiate antagonist naloxone in shock we studied 23 adrenalectomized dogs subjected to hemorrhagic shock. Adrenalectomy abolished the salubrious cardiovascular responses to naloxone. Naloxone responses (increased mean arterial pressure, cardiac output, and left ventricular contractility) were restored by giving hydrocortisone 50 mg intravenously before naloxone. Survival was also prolonged in animals receiving naloxone and hydrocortisone compared to naloxone or saline alone; hydrocortisone alone decreased survival. The adrenal glands are necessary for naloxone's beneficial effects, probably via adrenal corticosteroid secretion.

Adrenalectomy↗
PubMed1983

Hyperprolactinemia and delayed puberty: a report of three cases and their response to therapy.

Delayed puberty occurred in three patients (aged 15 to 22 years) with elevated prolactin levels. Despite the varying etiologies, their clinical presentations were marked by absence of galactorrhea, prepubertal genitalia (2/3), and short stature (1/3). Except for hyperprolactinemia, endocrinologic evaluation was normal in two patients. Bromocriptine restored prolactin levels to normal in all three patients, two of whom had prior transsphenoidal surgery, and resulted in initiation of menses in one girl and pubertal development in both boys. The 22-year-old male patient with the empty sella syndrome has progressed through puberty after the addition of oral testosterone.

Adolescent↗
PubMed1983

Body weight and its effect on immunoreactive parathyroid hormone levels.

Immunoreactive parathyroid hormone (iPTH) levels were measured in 12 obese subjects (140-272% ideal body weight) and 10 normal lean volunteers (93-100% ideal body weight). iPTH values were not significantly different in the two groups and tubular maximum phosphate reabsorption (TmP) was comparable in lean subjects and the 4 obese patients tested. 4 obese subjects were evaluated after an average of 6.7% body weight loss, and neither iPTH levels nor TmP were affected. The data indicate that the biological effects of PTH are not enhanced in the massively obese.

Absorption↗
PubMedDate not supplied

Cultured epidermal autograft and the treatment of the massive burn injury.

As a rule, adult and pediatric patients with thermal injuries that involve more than 90% total body surface area (TBSA) burn have poor prognoses. Even for patients who are 5 to 34 years old with a 70% TBSA burn, the mortality rate is 80%. Lack of autologous donor skin, which is essential for permanent wound closure, is the major problem. Recent advances in growth of cultured epidermal autograft (CEA) have allowed closure of full- and partial-thickness burns; in approximately 3 weeks, a 2 cm2 biopsy specimen will produce enough CEA to cover a pediatric patient. Since 1989, we have used this product on nine patients; the average age was 39, and the average TBSA burn was 70% (range, 44% to 93%). We report our approach to use of CEA in six of these patients, including topical applications of 1% silver sulfadiazine and excision of full- and deep partial-thickness wounds within 2 weeks of injury. Temporary closure was achieved with cadaver allograft. "Take" of the allograft forecasted take of CEA. The total operative time of CEA placement was decreased by a two-step technique that obviates repeating debridement: the technique consists of debriding and grafting with allograft, then removing it at the time of CEA placement. CEA take is best on early granulation tissue or freshly excised wounds. Early excision of burn eschar, temporary wound closure with cadaveric allograft and Biobrane (Winthrop Pharmaceuticals, Wound Care Div., Fountain Valley, Calif.), and permanent closure with CEA may improve survival rates among patients with massive burn wounds. CEA is a tremendous asset to the management of massive burn injuries.

Adult↗
PubMedDate not supplied

Trilaminar skin coverage combined with cultured epithelial autografts--a new technique for treating the elderly patient with burn injuries.

Additional morbidity may be associated with standard split-thickness skin graft donor sites in elderly (65 years or older) patients with burn injuries. In an attempt to minimize the area of the donor sites and maximize autografts, we describe a new technique that uses trilaminar harvesting of skin grafts with dermolipectomy closure, and permanent coverage of the autograft layers achieved with cultured epithelial autografts in an elderly burn victim. An 80-year-old man was admitted with a 15% total body surface area burn to the bilateral lower extremities and buttocks. All meshed split-thickness skin grafts (12) applied showed excellent take, and it was reported that the cultured epithelial autograft take was approximately 90%. All dermolipectomy sites healed without infection. Our procedure proved to be a useful technique in the permanent closure of full- and partial-thickness burns in an elderly patient admitted to the burn unit.

Aged↗
PubMedDate not supplied

Endocrine ophthalmomyopathy in adolescence.

A 17-year-old girl presented with euthyroid Graves' disease. Diplopia and extensive limitation of ocular motility bilaterally were the most remarkable features of this case. Even though the patient also had juvenile diabetes mellitus, treatment with systemic steroids was accomplished safely with complete recovery of ocular motility and the disappearance of diplopia in all fields of gaze.

Adolescent↗
PubMedDate not supplied

Toxic epidermal necrolysis after initiation of felbamate therapy.

A 33-year-old woman with a 13-year history of partial complex seizures experienced toxic epidermal necrolysis requiring management in a regional burn treatment center after 16 days of single-agent treatment for epilepsy with felbamate 3600 mg/day. Within 24 hours the target lesions involved 45% of her total body surface area. They coalesced and progressed to exfoliation involving the mucosa and the conjunctiva. The patient was hospitalized for 25 days. Reports in the literature describe life-threatening rashes after treatment with felbamate in combination with other anticonvulsant agents. We believe this to be the first reported case of felbamate-induced toxic epidermal necrolysis induced by single-agent therapy. Although felbamate provides many advantages as an anticonvulsant, its structure can be arranged to a conformation in space similar to that of hydantoins and barbiturates, and thus warrants careful patient monitoring for life-threatening rashes.

Adult↗
PubMedDate not supplied

Intravenous ketorolac for pain management in a ventilator-dependent patient with thermal injury.

A patient with a long-standing history of chronic obstructive pulmonary disease suffered a thermal injury over 20% of his total body surface area. He required opiates for pain management and benzodiazepines for anxiety associated with dressing changes. The narcotics compromised his pulmonary function and level of consciousness, and interfered with several attempts to wean him from ventilator support. Intravenous ketorolac instead of narcotics before dressing changes alleviated the respiratory depression and returned his partial pressure of carbon dioxide-mediated respiratory drive to normal. With these changes, including changes in respiratory rate to tidal volume, he was successfully weaned from ventilatory support. In addition, the patient's level of consciousness improved. These changes increased his participation in his daily physical therapy sessions.

Aged↗
PubMedDate not supplied

Underutilization of breast-conservation surgery with radiation therapy for women with stage Tis, I or II breast cancer.

Despite clinical evidence from the National Institutes of Health consensus panel in 1991 that breast-conservation surgery (BCS) with radiation therapy (RT) is appropriate treatment in early-stage breast cancer, the overall rate of acceptance and actual practice of BCS with RT has remained low. We retrospectively reviewed 228 cases of breast cancer in female patients with stage Tis, I or II breast cancer treated between 1987 and 1995. Thirty-five cases (15.4%) were stage Tis, 70 cases (30.7%) were stage I, and 123 cases (53.9%) were stage II, Overall, 57% of Tis, I or II breast cancers received conservative treatment; 57% of stage Tis, 79% of stage I, and 44% of stage II tumors. These rates of conservative therapy are higher than in other reported series in the literature. BCS with RT produces equivalent rates of morbidity and survival as MRM, and, because it preserves the breast, is preferable for the majority of women who present with stage Tis, I, or II breast cancer.

Adult↗
PubMedDate not supplied

Obturator hernia: laparoscopic diagnosis and repair.

OBJECTIVE: Review of international literature reveals eight reported cases of laparoscopic obturator hernia repair. Non-specific signs and symptoms make the diagnosis of an obturator hernia difficult. Laparoscopic intervention provides a minimally invasive method to simultaneously diagnose and repair these hernias. METHODS AND PROCEDURES: A 35 year old woman presented with lower abdominal pain, vaginal bleeding, and dyspareunia. During gynecological diagnostic laparoscopy, a pelvic floor hernia was suspected, and a general surgical evaluation was sought. At a subsequent laparoscopy, the diagnosis of a left direct inguinal and a right obturator hernia was made. Both were repaired laparoscopically with polypropylene mesh. RESULTS: At follow-up at one and six weeks postoperatively, the patient's complaints of pain had completely resolved. CONCLUSION: The diagnosis of obturator hernia is problematic. The usual presenting signs and symptoms are non-specific. Without conclusive historical or physical findings, laparoscopy is an excellent method for diagnosing obturator hernia. This entity, once diagnosed laparoscopically, can be repaired simultaneously via laparoscopic mesh technique.

Adult↗