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Biomedical subjects

D C Moore

Publications and source records attributed to D C Moore.

At least 127 records · Page 7Linked to original sources

Intercostal nerve block: a roentgenographic anatomic study of technique and absorption in humans.

Roentgenograms of iothalamate meglumine 60% (Conray) injected bilaterally into the intercostal grooves of the ninth or tenth ribs in 30 surgical patients showed extensive spread of the contrast central and peripherally from the site of injection within 30 seconds, with almost complete absorption within 10 minutes 30 seconds. The spread was visualized in two patients for diagnosis using CT (computed tomography) following injection of iothalamate. It was also confirmed by injecting liquid latex into two corpses prior to autopsy. These findings help to explain why the peak plasma level occurs more rapidly and is higher following intercostal nerve block than from other regional nerve blocks when comparable doses are injected. Also, the study revealed that the optimal site for blocking an intercostal nerve is at the angle of the rib and that the optimal needle is one with a short bevel.

Absorption↗

A sensorineural component in chronic otitis media.

Traditionally, it has been accepted that conductive deafness involves a breakdown in the mechanical conduction of sound, whilst the cochlea remains unaffected. Over a ten year period, it was noticed that a number of patients, mainly children, displayed a mild, high-tone sensorineural component to their conductive loss, whereas others tested under identical conditions with parallel etiologies did not. A sample of 80 children with chronic otitis media and sensorineural involvement was selected from Prince Henry's Hospital and Alfred Hospital, Melbourne, and was compared with 80 children with the same histories, but whose audiograms did not display any sensorineural involvement. The results of this study indicate a need for further research into: 1. The establishment of an internationally acceptable terminology. 2. Early detection of chronic otitis media. 3. Medical/surgical management. 4. The effects on hearing, caused by fluctuating nature of chronic otitis media. 5. Educational and social management.

Adolescent↗

Studies of anabolic steroids. VI. Effect of prolonged administration of oxandrolone on growth in children and adolescents with gonadal dysgenesis.

Twenty-five patients with Turner Syndrome were treated with oxandrolone for six or more months. Mean growth velocity for the first year of treatment was significantly greater than pretreatment control growth velocity. Overall, there was no excessive skeletal maturation. Mean "final" height in nine XO patients (146.4 cm) was significantly greater than mean adult height of an estrogen-treated control group (140.3 cm), while that for five mosaic patients (148.2 cm) was not significantly different from a mean untreated mosaic adult height (145.2 cm).

Age Determination by Skeleton↗

Factors determining dosages of amide-type local anesthetic drugs.

The physical status of the patient (sex, age, weight, height, and underlying disease) has been thought to influence the dosage of local anesthetic drugs that can be injected without causing a systemic toxic reaction, but this belief is not supported by statistically significant data. Furthermore, previous studies of plasma levels of bupivacaine and mepivacaine showed no correlation between dosage and physical status, even when maximum dosages recommended by pharmaceutical companies were exceeded. This study of 9,287 regional blocks, using the statistical tests of multiple regression and chi square, substantiates that the occurrence of systemic toxic reactions in adults does not correlate with dosages and/or physical status of the patient when 400 mg or less of bupivacaine, 450 mg or less of etidocaine, or 500 mg or less of mepivacaine is used. Therefore, the study questions the maximum dosages established for certain local anesthetic drugs, as well as the method by which such dosages were established.

Anesthesia, Epidural↗

Bupivacaine (Marcaine): an evaluation of its tissue and systemic toxicity in humans.

In countries other than the U.S.A., dosages of bupivacaine have been limited to 100 mg without epinephrine and 150 mg with epinephrine. A review of 7,688 regional block procedures employing bupivacaine in concentrations of 0.25, 0.5, and 0.75%, and in dosages as high as 600 mg, indicated that such stringent restrictions: (1) are unwarranted, (2) make comparisons with other local anesthetic agents difficult, and (3) are in need of revision.

Adolescent↗

Arterial and venous plasma levels of bupivacaine following epidural and intercostal nerve blocks.

Arterial and peripheral venous plasma levels of bupivacaine were determined in 30 patients following epidural anesthesia using 150 and 225 mg, as well as following intercostal nerve block with 400 mg. Arterial levels were consistently higher than levels in simultaneously sampled venous blood, and the highest levels occurred with bilateral intercostal nerve block. No evidence of systemic toxicity was observed. The results suggest that bupivacaine may have a wider margin of safety in man than is now stated.

Adult↗

Studies of anabolic steroids: v. effect of prolonged oxandrolone administration on growth in children and adolescents with uncomplicated short stature.

A total of 130 patients with uncomplicated short stature (4 to 17 years of age) were treated with oxandrolone, 0.25 mg/kg/day, for up to four years. Oxandrolone therapy resulted in a two-fold increase in mean growth velocity in the first six months of therapy and was an effective growth stimulant for the full four-year period. There was no overall adverse effect of oxandrolone on post-treatment mean growth velocity or on skeletal maturation relative to height gain. There were 37 patients with greater increase in height age than bone age and 22 patients with greater increase in bone age than height age. Assessment of the contribution of oxandrolone therapy to the latter group is difficult because of inadequate methodology and the wide variation in individual growth patterns. Taken in their entirety, the data suggest that oxandrolone is useful in the prolonged treatment of uncomplicated short stature and is not associated with undesirable acceleration of skeletal maturation.

Adolescent↗

Intercostal nerve block for postoperative somatic pain following surgery of thorax and upper abdomen.

From 1948 to 1973, intercostal nerve block was used 10,941 times or a total of approximately 100,000 individual nerves were blocked. Junior staff (residents) performed 95% of the blocks. The local anaesthetic solution of choice used 0.25 or 0.5% bupivacaine (Marcaine) with adrenaline. Total milligram doses of bupivacaine as high as 400 mg were employed. The duration of the blocks was 9-18 hr. No severe systemic toxic reactions occurred, e.g. disorientation, convulsions, etc. The incidence of pneumothorax was 0.073%.

Abdomen↗