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Biomedical subjects

W J Marshall

Publications and source records attributed to W J Marshall.

At least 19 recordsLinked to original sources
PubMed1995

Rupture of the deep femoral artery from blunt trauma.

Massive hemorrhage from the deep femoral artery is an uncommon entity in the setting of blunt extremity trauma without femur fracture. A case of deep femoral artery injury causing massive hemorrhage treated by angiographic embolization is reported. In this patient, persistent unexplained hypotension warranted angiographic analysis of a pelvic fracture. Because of a swollen right thigh, the negative pelvic angiogram was extended to include the lower extremity, confirming the diagnosis of a ruptured branch of the deep femoral artery. Bleeding was controlled with embolization that promptly resolved the patient's hemodynamic instability. The salient feature in common with previous reported cases of deep femoral artery injury was hemodynamic instability beyond accountable blood loss. We recommend angiographic analysis with radiological and surgical intervention in the setting of thigh swelling without femur fracture and unexplained hypotension. This management strategy was well tolerated, and the patient received minimal transfusions.

Acetabulum↗
PubMed1992

Neuromuscular blockade in aeromedical airway management.

STUDY OBJECTIVE: Induction of paralysis before intubation is controversial in the aeromedical setting. We reviewed our experience using neuromuscular blockade with nurse/paramedic aeromedical teams to determine effectiveness and outcome. MATERIALS AND METHODS: In 670 flights during a 16-month period, 119 patients required endotracheal intubation aided by muscle relaxant administration. Age ranged from two months to 83 years, with a mean of 33 years. All patients were hyperventilated with 100% oxygen before intubation. Sedation was given if presenting systolic blood pressure was greater than 100 mm Hg. A short-acting depolarizing agent was then given in a 1-mg/kg dose. Once the airway was secure, a longer-acting, nondepolarizing agent and/or sedation was given. RESULTS: Of the 119 patients, 115 (96.6%) were orally intubated. Four (3.4%) required surgical airway intervention because of injuries and conditions prohibiting oral intubation. Of 115 oral intubations, 99 (86%) were achieved on the first attempt. Eight patients (7%) were intubated on a second attempt, and another eight were intubated on a third attempt. There was no change in operator. Sixty-eight percent of patients requiring airway management were multiple trauma victims with associated head injuries. There were no laryngeal injuries, detected cardiac rhythm changes, bleeding episodes, or neurologic complications despite incomplete cervical-spine evaluation. CONCLUSION: Neuromuscular blockade can be used safely and effectively in the field by experienced nurse/paramedic teams. Although problematic intubation was not eliminated, the difficulties encountered were manageable and the overall risk/benefit ratio was acceptable.

Adolescent↗
PubMed1991

Plasma uric acid in patients receiving anticonvulsant monotherapy.

In newly diagnosed adult patients with epilepsy followed prospectively on monotherapy, carbamazepine and phenytoin were associated with a fall in plasma uric acid, but sodium valproate and phenobarbitone were associated with a rise in plasma uric acid. The mechanisms and significance of these findings are discussed.

Adolescent↗
PubMed1990

In the end....

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Altruism↗
PubMed1989

Laser reflections from relatively flat specular surfaces.

A major element in laser range control procedures has been the control of stray reflections from glass reflectors which may be near the laser target. These hazardous reflections have been thought to extend as far as the direct beam for near grazing angles of incidence. Modern military laser rangefinders and designators can be hazardous to the unaided eye to distances of 10 km or even greater. For this reason, many square kilometers of laser range area have been necessary to conduct laser tests when flat specular reflectors may be present on targets. Fortunately, sophisticated pointing systems have been developed with these laser systems to ensure that the direct beam is confined to the immediate target area. In most cases, flat specular reflectors also have been eliminated from the immediate target area. In some instances, however, specular reflectors still exist near or on laser targets. For these special cases, a more definitive mathematical treatment of hazardous laser reflections is desired. The divergence of a laser beam which has been reflected from a flat specular surface is dependent on the size of the reflector, the divergence of the laser creating the reflection, and the curvature of the reflecting surface. It can be shown mathematically that the curvature of even an optical flat, a reference surface used to compare the flatness of other surfaces, will produce a significant additional beam spread, thereby reducing the hazards of reflected beams. The natural curvature of plate glass or window glass is much greater, reducing the hazards even further. The extent of the hazards for reflections of various types of lasers and reflecting surfaces is discussed.

Eye Injuries↗
PubMed1989

Synchronized independent lung ventilation in the management of pediatric unilateral pulmonary contusion: case report.

Utilizing a double-lumen endobronchial tube, synchronized independent lung ventilation (SILV) was successfully employed to manage severe unilateral pulmonary contusion in a 6-year old trauma patient. This appears to represent the youngest reported patient in whom this technique has been utilized. Early institution of this treatment modality may substantially increase survival.

Accidents, Traffic↗
PubMed1989

"Genericgate".

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Crime↗
PubMed1988

Frequency of pancreatitis in fulminant hepatic failure using isoenzyme markers.

Evidence of acute pancreatitis was sought in 35 patients with fulminant hepatic failure. Total amylase was raised in 22 patients and isoenzyme separation showed a distinct P3 isoenzyme (indicative of pancreatitis) in 14. In four patients with marked hyperamylasaemia (greater than 1000 U/l) the predominant isoenzyme was the salivary fraction. Pancreatic lipase was abnormally raised (greater than 200 U/l) in 34 patients but exceeded 1000 U/l in 12 of the 14 with a distinct P3 isoenzyme. Thus on the basis of a distinct P3 isoenzyme of amylase and an increased pancreatic lipase activity evidence of pancreatitis was found in 34% of patients in this series.

Acute Disease↗
PubMed1987

Osteopenia in systemic mastocytosis: natural history and responses to treatment with inhibitors of bone resorption.

Studies of a 63-year-old woman with osteopenia due to systemic mastocytosis are reported. Delay in making the diagnosis and the occurrence of coincident medical problems meant that radiographs during a 12-year period were available for study. Skeletal symptoms began 20 years after the skin lesions of mastocytosis first appeared, but once established bone loss was rapid, particularly from cortical bone (estimated at 3.75% pa). Biochemical and histological measurements indicated a "high turnover" bone disease and treatment with inhibitors of bone resorption was assessed. Oral, but not intravenous, clodronate was effective in reducing bone turnover as judged by falls in hydroxyproline excretion (p less than 0.01) and serum alkaline phosphatase (p less than 0.01). Mithramycin and chlorambucil were ineffective. Clodronate may be beneficial in arresting bone loss in this disorder.

Biopsy↗