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Biomedical subjects

R Goode

Publications and source records attributed to R Goode.

At least 19 recordsLinked to original sources
PubMed1996

Fire fatality study: demographics of fire victims.

Injury or death caused by fire is frequent and largely preventable. This study was undertaken to define the populations, locations, times and behaviours associated with fatal fires. Seven hundred and twenty-seven fatalities occurring within the State of New Jersey, between the years 1985 and 1991, were examined retrospectively. Most deaths were attributed to a combination of smoke inhalation and burn injury. Five hundred and seventy-four fatalities occurred in residential fires. Smoking materials were the most common source of ignition for residential fires. More than half of the fatal residential fires started between the hours of 11 p.m. and 7 a.m. Children and the elderly represented a disproportionate percentage of fire victims. Victims under the age of 11 years or over the age of 70 years constituted 22.1 per cent of the state population but 39.5 per cent of all fire fatalities. Fire-prevention efforts should target home fire safety, and should concentrate on children and the elderly. The development of fire-safe smoking materials should be encouraged.

Adolescent↗
PubMed1994

Neuropathological findings in the brain of Karen Ann Quinlan. The role of the thalamus in the persistent vegetative state.

BACKGROUND: Karen Ann Quinlan had a cardiopulmonary arrest in 1975 and died 10 years later, having never regained consciousness. Her story prompted a national debate about the appropriateness of life-sustaining treatment in patients who are in a persistent vegetative state and led to the development of medicolegal guidelines for the care of such patients. This report describes the neuropathologic features of Quinlan's brain. METHODS: The entire brain and spinal cord were systematically sampled for histologic examination. The brain stem and central cerebrum were embedded en bloc and serially sectioned. Three-dimensional computer reconstructions helped visualize the topographic features of the lesions. RESULTS: Contrary to expectation, the most severe damage was not in the cerebral cortex but in the thalamus, and the brain stem was relatively intact. The neuropathological findings included extensive bilateral thalamic scarring, bilateral cortical scars primarily in the occipital pole and parasagittal parieto-occipital region, and bilateral damage to cerebellar and focal-basal-ganglia regions. The brain stem and basal forebrain and the hypothalamic components of the ascending arousal systems and brainstem regions critical to cardiac and respiratory control were undamaged. The lesions were consistent with hypoxia-ischemia after the cardiopulmonary arrest. CONCLUSIONS: Although the neuropathological findings in the case of Karen Ann Quinlan were complex, the disproportionately severe damage in the thalamus as compared with the cerebral cortex supports the hypothesis that the thalamus is critical for cognition and awareness and may be less essential for arousal.

Adult↗
PubMed1991

Implantable hearing devices.

The use of implantable hearing devices to help persons with hearing loss is still in its infancy. The advantages and disadvantages of various models of implantable hearing devices currently being developed are discussed, and their clinical use is described. Other hearing aid assistive devices are also discussed, particularly the electromagnetic implant hearing aid.

Correction of Hearing Impairment↗
PubMed1989

The effect of metabolic acid-base changes on the ventilatory changes at the end of heavy exercise.

The purpose of this study was to determine the effect of altered metabolic acid-base status on the changes in ventilation in the transition from heavy exercise above anaerobic threshold to rest. Seven subjects ingested, in a randomized and blind manner, either NaHCO3 or CaCO3 (placebo) at a dose of 300 mg.kg-1 body mass and ran on a treadmill for five minutes (90% VO2max and above anaerobic threshold) on ten different occasions. Changes in minute ventilation in the exercise transitions were studied by starting and stopping the treadmill abruptly with a remote switch. The fast increase in ventilation at the start of exercise was not accompanied by a corresponding fast drop in ventilation at the end of exercise (P less than or equal to 0.001) and the effects of chemicals on these changes were not significantly different (P greater than 0.05). A single-component exponential model, without a time delay, was used to determine the time constants of off-transitional decay in ventilation for the two chemicals in each subject. Parametric and non-parametric statistical tests revealed that the time constants were not as significantly different as the venous pH measurements which were significantly higher with NaHCO3 (P less than or equal to 0.001). The results indicate that the absence of fast change in ventilation at the end of heavy exercise is not due to lactic acidosis and the consequent slow ventilatory changes in the off-transition of heavy exercise are at least partly mediated by non-humoral factors such as a central neural reverberatory mechanism.

Acid-Base Equilibrium↗
PubMed1989

Changes in ventilation at the end of heavy exercise of different durations.

The purpose of this study was to examine the effects of duration and the concomitant ventilatory drift of heavy exercise on the changes in ventilation following the cessation of exercise. Seven male subjects ran on a motor-driven treadmill at a constant work-rate of 90% of VO2max for either 5 min or 7 min on 60 occasions. The exercise was terminated abruptly by stopping the treadmill with a remote switch while recording inspired minute ventilation (VI) breath by breath. The fast drop in VI at the end of exercise is significantly less than the corresponding increase at the onset of exercise (P less than 0.05) and this difference is greater with longer duration of exercise. The time constants of the slow ventilatory decline are significantly increased following 7 min of exercise (P less than 0.05). They are also positively related to the drift in VI that occurs with the continuation of heavy exercise beyond 3 min. This relationship is however not statistically significant (P greater than 0.05). These results indicate that the rate of ventilatory decline is slower after the end of a longer duration of exercise and this is caused by mechanism/s that also contribute/s to the ventilatory drift of heavy exercise. As, of the many different possibilities, only the respiratory after-discharge (central neural reverberatory) mechanism is likely to be more activated with a longer duration of exercise and on the basis of our previous observations (Jeyaranjan et al. 1988, 1989), the results suggest that the mechanism of after-discharge is an important mediator of ventilatory response during as well as after the cessation of heavy exercise.

Adult↗
PubMed1989

Role of lactic acidosis in the ventilatory response to heavy exercise.

The purpose of this study was to determine the role of lactic acidosis in the ventilatory response to heavy exercise above anaerobic threshold. Seven subjects ingested either NaHCO3 or CaCO3 at a dose of 300 mg/kg body weight and ran on a motor-driven treadmill at a work load corresponding to 90% of VO2max and above anaerobic threshold for a period of 5 min while minute ventilation and PETCO2 were recorded breath by breath. A total of 10 runs, 5 with CaCO3 and 5 with NaHCO3 in a randomized and blind order, were done in each subject. Statistical analyses of the effects of the chemicals on minute ventilation during the 15 s between min 4.75 and 5 of exercise showed that the differences in ventilation did not reach statistical significance (p greater than 0.05) in 5 of the 7 subjects. Venous pH measurements at the end of exercise revealed a significant increase with NaHCO3 (p much less than 0.05). It is concluded that lactic acidosis is not an essential determinant of ventilatory response to heavy exercise above anaerobic threshold in the majority of the subjects.

Acidosis, Lactic↗
PubMed1988

Changes in respiration in the transition from heavy exercise to rest.

Transitions from rest to exercise and vice versa are reported to be associated with instantaneous changes in minute ventilation and the changes in the off-transitions are thought to be the reverses of those in the on-transitions. Such changes have been observed mainly in mild-moderate exercise and their extrapolation to heavy exercise above anaerobic threshold is unwarranted. Hence, the purpose of this study was to determine the changes in ventilation in the transition from heavy exercise above anaerobic threshold to rest. Five healthy volunteers ran on a motor-driven treadmill at a constant work-load corresponding to 80% VO2max and above anaerobic threshold. Changes in minute ventilation and end-tidal PCO2 in the on- and off-transitions were determined breath by breath by starting and stopping the treadmill abruptly. The results indicate that, contrary to what is reported for mild-moderate exercise, an instantaneous drop in ventilation is absent in the off-transition of heavy exercise above anaerobic threshold. The gradual decline in minute ventilation may be due to a sustained respiratory drive from a central neural reverberatory mechanism, blood-borne respiratory stimuli and/or a peripheral neurogenic drive originating in the so-called metaboloreceptors.

Adult↗
PubMed1987

The contribution of peripheral chemoreceptors to ventilation during heavy exercise.

The purpose of this study was to determine, in man, the contribution of peripheral chemoreceptors to ventilation during constant-load, heavy exercise above anaerobic threshold at sea level, using hyperoxic suppression of peripheral chemoreceptor drive which was obtained by abrupt and surreptitious replacement of inspired air with 100% oxygen for a period of 20-30 sec during the exercise. There was a delay of at least 1 sec from the time of peripheral chemoreceptor blockade to the initial change in ventilation, suggesting the operation of a central neural reverberatory mechanism after the cessation of peripheral chemoreceptor drive. In contrast to Wasserman (1976), whose results indicated a 25% decrease in ventilation within two breaths, in the present study no significant drop was observed until some 4-6 breaths after the air-to-oxygen switch. Furthermore, the drop in ventilation, magnitude of which was of the order of 15%, was transient in 5 out of 8 subjects. In one subject, the ventilation increased following oxygen administration. It is concluded that the peripheral chemoreceptors are not the sole mediators of hyperventilation of heavy exercise above anaerobic threshold in man.

Acidosis↗
PubMed1986

Is ethanol the unknown toxin in smoke inhalation injury?

Of the 12,000 fire-related deaths occurring annually in the United States, it is estimated that 60 to 80 per cent are due to smoke inhalation. Plastic and synthetic materials which have been introduced in home construction and furnishings produce a more toxic smoke when burned. Efforts to identify a "supertoxin" in this smoke have been unsuccessful to date. An alternative approach is to examine why victims are unable to escape, and become exposed to smoke for lethal periods of time. The authors examined the circumstances of death in 39 fire victims (27 adults, 12 children) over a 25-month period. Detailed examination of the fire scene, autopsy studies, and toxicologic analysis were carried out. Position of the victim, and escape efforts were noted. Carbon monoxide was elevated in all victims, with "lethal" levels (= greater than 50%) in 21/39 victims. Cyanide was detected in 24/29 victims, but none had lethal (3 mg/L) levels present. Ethanol was detected in 21/26 adults (80%) and 0/12 children (0%). 18/26 adult victims had ethanol levels above the statutory level of intoxication (10 mg%). Victims found in bed (no escape attempt) had a mean blood ethanol level of 268 mg%, compared with a mean level of 88 mg% in those victims found near an exit (P = .006). Ethanol intoxication significantly impairs the ability to escape from fire and smoke and is a contributory factor in smoke-related mortality.

Adult↗
PubMed1983

125Iodine implants as an adjuvant to surgery and external beam radiotherapy in the management of locally advanced head and neck cancer.

125Iodine seeds either individually placed or inserted into absorbable Vicryl suture carriers were utilized in conjunction with surgery and external beam radiotherapy in an attempt to increase local control rates in patients with (1) advanced oropharyngeal and laryngopharyngeal cancers (T3-T4, N2-N3), (2) massive cervical lymphadenopathy (N3) and an unknown primary site and (3) locally recurrent head and neck cancers. Forty-eight patients were treated with 55 implants. The carotid artery was implanted in 15 patients, while seven patients had seeds inserted into the base of the skull region, and another three patients had implants near cranial nerves. Eighteen of the 48 patients were treated for cure. The actuarial survival at five years in this subgroup was 50%. The overall local control in the head and neck area was 58%. In this group no patients to date have had a local failure in the implanted volume. Seventeen patients with comparable stage of disease treated prior to 1974 with curative intent without 125I implants were analyzed retrospectively for comparison with the implanted patients. The actuarial survival of these patients was 18% and the overall head and neck control was 21%. These differences are statistically significant at a P value of 0.01 and 0.007, respectively. Seventeen patients received implants for local recurrence. The local control in the head and neck area was 50%; however, the 2.5 year actuarial survival was only 17%. The complication rate was 11% (six of 55 implants). The improved survival, the high local control, and the minimal complication rates in this series makes the intraoperative implantation of 125I seeds and effective adjunctive treatment to surgery and external beam irradiation.

Brachytherapy↗