Biomedical subjects
D M Long
Publications and source records attributed to D M Long.
Electrical stimulation of the spinal cord and peripheral nerves for pain control. A 10-year experience.
Patients who underwent implantation of dorsal column stimulators from 1970 to 1973 were reviewed 7-10 years following stimulation. The number who achieved satisfactory pain relief was not significant. The criteria for selecting these patients were reviewed utilizing those now used in 1980. 50% of the patients originally selected would now be rejected for psychological or drug-related reasons. This long-term evaluation indicates no benefit to the patients treated with spinal cord stimulation. However, it appears that psychological factors were the most important reasons for failure. A smaller group of patients studied for 3-5 years following implantation of epidural spinal cord stimulators achieved a 70% pain control rate. Selection factors that explain these differences are discussed.
Perfluoroctylbromide contrast enhancement of malignant neoplasms: preliminary observations.
Fluorocarbons have been used for years as propellants in aerosol sprays. Because of their ability to transport oxygen, perfluorocarbon compounds have been more recently used in artificial fluid respiration. Monobrominated perfluorocarbon compounds are radiopaque and have low enough vapor pressures to be tolerated in biologic systems. Microemulsions of these compounds have been detected in mouse and rat neoplasms and appear to be located within macrophages. In this study of the potential usefulness of these compounds for radiographic contrast enhancement, rabbits with V2 carcinoma thigh implants received either a high-dose (10--12 ml/kg) or a low-dose (2 ml/kg) emulsion of perfluoroctylbromide intravenously. Dense contrast enhancement of some of the V2 carcinomas was demonstrated by both computed tomography and conventional radiography. Four of the five rabbits in the high-dose group died within 9 days but all six rabbits in the low-dose group survived beyond 9 days. Death in the high-dose group was associated with pulmonary consolidation and anesthesia although some animals had extensive V2 metastases. These compounds have some interesting potential applications in imaging, pending further study of their toxicity.
A comprehensive model for the study and therapy of pain: Johns Hopkins Pain Research and Treatment Program.
The Johns Hopkins Pain Research and Treatment Program is based upon individual diagnosis, psychiatric evaluation, and individualized therapy. This is done within the framework of a concurrent program involving neurosurgeons, consulting physicians, psychiatrists, clinical psychologists, social workers and specialized nurses. The basic theme is self-help and self-responsibility. Drug withdrawal is mandatory, and an emphasis is placed upon psychotherapeutic techniques. Pain relieving procedures are available and utilized in a small number of patients.
Strategic planning for hospitals under regulation.
Explore the source record for details and available documents.
Free fat graft in laminectomy.
Explore the source record for details and available documents.
Relief of cancer pain by surgical and nerve blocking procedures.
Explore the source record for details and available documents.
The transcallosal approach to the anterior ventricular system and its application in the therapy of craniopharyngioma.
Explore the source record for details and available documents.
Effects of pressure on cerebrospinal fluid formation: nonsteady-state measurements in dogs.
Effects of pressure on cerebrospinal fluid (CSF) formation were studied in dogs with a recirculatory spinal perfusion tracer clearance technique that does not require steady-state conditions. The data permit statistical analysis of the relationship between the rate of CSF formation and pressure for individual animals. Most animals showed no statistical relationship between CSF formation and intracranial pressure (ICP) and/or cerebral perfusion pressure (CPP). In this study, a disturbance of cerebral blood flow (CBF) autoregulation may have been present in five animals on the basis of CPP reductions, and four of this latter group showed formation to decrease with increasing ICP. It is suggested that CSF formation is normally pressure insensitive. With impaired autoregulation of CBF, formation may follow CBF and CPP passively.
Surgical therapy of chronic pain.
Explore the source record for details and available documents.
Role of dibutyryl cyclic adenosine 3',5'-monophosphate in the genesis of brain edema.
Explore the source record for details and available documents.
Reduction of postoperative pain and narcotic use by transcutaneous electrical nerve stimulation.
Transcutaneous electrical nerve stimulation (TENS) was evaluated as a postoperative analgesic. Patients undergoing lumbar spine operations, hip surgery, and gynecological laparotomies were studied. Sterile electrodes, placed near the incision immediately after operation, were connected to a continuously operating stimulator for 48 hours after operation. Results from 46 experimental patients demonstrated that TENS could reduce the demand for postoperative narcotics in a group of patients who had not used narcotic analgesics before operation. No significant benefit was observed for patients who had used narcotics prior to operation.
Briquet syndrome in a man with chronic intractable pain.
A 51-year-old man was admitted for evaluation and treatment of scrotal pain of 20 years' duration following unilateral orchiectomy for right testicular injury. Past attempts had failed to provide definitive or persistent relief. Physical examination and investigations were unremarkable. Psychiatric assessment revealed an angry, depressed man with a drasmatic, hypermasculine manner and hysterical and obsessive personality traits. Review of systems with a structured interview indicated that the patient had numerous medically unexplained symptoms and that he fulfilled both the Feighner and the Diagnostic and Statistical Manual of Mental Disorders 3rd edition (DSM-III) diagnostic criteria for Briquet syndrome. The case is important because it demonstrates the usefulness of recognizing Briquet syndrome in patients with the single presenting complaint of chronic, intractable pain, and the fact that Briquet syndrome, commonly considered a female disorder, can occur in men regardless of sexual orientation and in the absence of expected compensation. In addition, the case confirms the utility of a structured interview and defined criteria for making the diagnosis of Briquet syndrome.
Strategic planning has market orientation.
A key element in the strategic planning process is active involvement of the hospital's key personnel so that each has a commitment to the ultimate plan.
Dibutyryl cyclic adenosine 3',5'-monophosphate: its role in regulation of cat brain extracellular fluid.
The role of dibutyryl cyclic adenosine 3',5'-monophosphate (db cAMP) in influencing the water content of the cat's gray and white matter was evaluated by intracoritcal injection of 20 micrio L of 2 x 10(-1) to 2 x 10(-6)M solution of db cAMP. Cholera toxin, a stimulator of adenylate cyclase, also was tested. Concentrations of db cAMP less than 10(-3)M failed to produce significant change in brain water content, while concentrations greater than 10(-2)M produced 31.5% +/- 8% and 17.3% +/- 3.6% increases in white matter volume, respectively (P less than .05). Cholera toxin did not increase brain water levels. These results are discussed in relation to the pathophysiology of brain edema.
Comparison of radiopaque perfluorocarbon and Ethiodol in lymphography.
Lymphangiography was performed on 40 adult cats, 39 dogs, 20 rabbits, and 12 rats of mixed sex using Ethiodol or radiopaque perfluorocarbon (BPC). Ethiodol was more radiodense than RPC, but imaging of lymph channels and nodes was satisfactory with the latter. RPC could be infused rapidly, while Ethiodol infusion was time consuming. RPC was biologically inert; Ethiodol produced both local and systemic inflammatory reactions. The lymph node distribution with RPC was more uniform and persisted for longer periods. It was concluded that RPC was an improvement over Ethiodol for lymphangiography.
Surgical postoperative bleeding associated with aspirin ingestion. Report of two cases.
Two patients are reported in whom repeated postoperative hematomas appeared to be secondary to aspirin-induced platelet defect. Routine bleeding and clotting studies will not demonstrate this platelet-induced coagulopathy. A previous history of massive aspirin ingestion makes such a coagulopathy a serious consideration, but the platelet defect may occur with small doses of aspirin. Such aspirin ingestion should be viewed with great concern by the neurosurgeon. The defect is treatable by platelet transfusion.
Familial intradural arachnoid cysts. Report of two cases.
Explore the source record for details and available documents.