Biomedical subjects
Publications and source records attributed to R S Gordon.
A 24-year-old woman with a recent diagnosis of infectious mononucleosis presented with fever and left upper quadrant pain. Abdominal computed tomography revealed a splenic abscess that at laparotomy was found to have ruptured. This case illustrates a rare cause of splenic abscess and a rare complication of infectious mononucleosis.
We report the case of a 61-year-old man with a history of a Bilroth II procedure who presented to the emergency department after 12 hours of severe epigastric pain and one episode of coffee-ground emesis. Computed tomography and esophagogastroduodenoscopy revealed intussuscepted jejunum through a gastrojejunostomy that required emergency operative reduction. This case illustrates the rare complication of acute jejunogastric intussusception more than 20 years after a Bilroth II procedure.
A cluster of sternal wound infections (SWI) requiring muscle flap closure occurred in a California hospital in 1988. Review of SWI rates by surgical team revealed that a single team (Team A) was associated with a cluster of SWI requiring muscle flap repair (MFR). Team A's rate of SWI requiring MFR was 2.27% in 441 heart operations. A case/control study was conducted to determine if the higher rate of SWI requiring MFR could be attributed to disproportionately large numbers of patients at high risk treated by Team A. Data on major risk factors for SWI collected for case and control groups included the following: age at operation, weight, body surface area, history of obesity, diabetes mellitus, or cigarette smoking, duration of cardiopulmonary bypass, use of internal mammary artery graft, number of coronary arteries bypassed, use of prostheses, operating room staffing, and emergent nature of operation. No statistically significant differences between Team A cases requiring MFR and control cases were observed for predisposing risk factors. Surgical technique remains a principal suspected risk factor for SWI requiring MFR in this cluster.
A 77-year-old woman with an indwelling gastrostomy tube presented with a clinical picture of pneumonia and small bowel obstruction. During gastrostomy closure and performance of a feeding jejunostomy, inadvertent transmigration of the gastrostomy tube was found to be the etiology of the small intestinal obstruction. This case illustrates a rare complication of enteric feeding tubes.
STUDY OBJECTIVES: This study was designed to establish the frequency, magnitude, and possible etiologies of the dysfunction of activity-sensing internal pacemakers during helicopter aeromedical transport. DESIGN: Two models of Medtronic Activitrax pacemakers were attached externally to healthy adult volunteers. Each volunteer then was loaded into the helicopter and subjected to a flight sequence. Pacemaker firing rates throughout this sequence were recorded. SETTING: On separate days, Aerospatiale Dauphin and Twinstar helicopters completed a total of 23 flights. TYPE OF PARTICIPANTS: Four healthy adult volunteers, two men and two women, participated. INTERVENTIONS: These included intra- and inter-flight threshold re-programming and external magnet application. RESULTS: The average preflight pacemaker rate of 65 beats per minute increased to an average in-flight rate of 105 beats per minute, which resolved to preflight rates on shutdown. This pattern was consistently extinguished with external magnet application. CONCLUSION: The effect of rotor motion and flight vibration on the rate-response of the Activitrax pacemaker is both predictable and easily preventable. Possible guidelines for the safe transport of these patients, using pacemaker reprogramming or external magnet application, are examined.
We discuss the case of a 59-year-old woman who presented to the emergency department with complaints of diplopia for five days. Physical examination disclosed an isolated complete right abducens nerve palsy. Angiography revealed a giant aneurysm from the postcavernous portion of the right internal carotid artery. This case illustrates an unusual etiology of a unilateral abducens nerve palsy.
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The current status of two difficult and controversial issues--confidentiality of preliminary results of clinical studies and compensation for research-related injuries--is outlined. The principle of not publicizing results of clinical research until enough data have been accumulated to give statistically valid support for conclusions is in conflict with the principle of ready availability to the public of results of government-conducted and government-sponsored research. New legislation may be required to resolve the problem. The lack of a mechanism to compensate research subjects for unanticipated injuries that are not the result of negligence is a barrier to obtaining truly informed consent. A plan for overcoming this problem through Department of Health, Education, and Welfare regulations has been proposed and awaits implementation.
Experiments with 14C-labeled urea in human volunteers show that urea is sequestered in the epidermis, where it turns over more slowly than in general body water. Sequestered urea, presumed to be concentrated through insensible evaporation of water, is the source of the excess urea found in sweat. Physiologic and clinical implications of the existence of this urea pool are discussed.
The standard preparation for cleansing the gastrointestinal tract for diagnostic studies such as barium enema usually involves dietary restrictions, purgatives, and cleansing enemas. This preparation is time consuming, often uncomfortable for the patient, and frequently unsuccessful. In this study, we examined the efficacy of saline lavage (without dietary restrictions or cleansing enemas) as a gentle, alternative method for cleansing the bowel, and compared lavage to the standard castor oil method of bowel preparation. Lavage cleansing was preferred by 75% of patients who had previously experienced a castor oil preparation. Although 11% of patients could not consume an adequate (4-liter) lavage volume, there was no significant difference in preparation success rate between the remaining lavage patients and the castor oil patients. Total preparation time for lavage (3 +/- 1 hr) was 60% less than for castor oil. The anticipated dehydration produced by castor oil and the hydration produced by lavage were confirmed. No significant changes were noted, however, in serum electrolytes with either method of preparation. Additional early studies are promising for the lavage method when used in inflammatory bowel disease patients and as a cleansing preparation for colonoscopy.
Five patients with severe acidosis and pulmonary oedema complicating cholera were seen at the Cholera Research Laboratory, Dacca, in a two-year period. All had had inadequate treatment. Their disease resulted in acidosis prior to admission; only the two who subsequently survived received volumes of sodium bicarbonate solutions sufficiently large to repair completely their acidosis. Saline alone worsened pulmonary congestion, while alkali appeared to relieve it despite the accompanying volume expansion. These observations are consistent with the known redistribution of blood to the central circulation in acidosis. Timely and proper treatment of cholera will avert this syndrome, when use of isotonic sodium bicarbonate sufficient to correct acidosis may be very helpful.
A double-blind study was conducted to test the prophylactic effect of a non-absorbable broad-spectrum antimicrobial (oral colistin sulfate) against acute diarrhea in Apache children. Children 1 to 6 months old had over twice the morbidity from diarrhea if assigned to the antimicrobial group as compared to placebo, while the toddler group (7-30 months) taking the antimicrobial had somewhat less diarrhea. Enteropathogenic E. coli were significantly more often isolated from the antimicrobial group (but only in well children). No special effect on the children's growth by the antimicrobial was discerned.
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