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Biomedical subjects

J B McCabe

Publications and source records attributed to J B McCabe.

At least 73 records · Page 4Linked to original sources

Intussusception: a supplement to the mnemonic for coma.

Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pain, melena, or mass on initial examination. Either plain radiographs, supplemented by ultrasonography of the abdomen, or a barium enema should be performed in infants with unexplained lethargy.

Coma↗

Comparison of the effectiveness of different cervical immobilization collars.

Immobilization of the cervical spine is a common prehospital and emergency department maneuver. The ability of four different cervical collars to immobilize the cervical spine was studied using radiographic measurement in seven normal volunteers. Restriction of motion during flexion, extension, and lateral bending was studied. Differences between collars exist and require further study to identify the optimum device for immobilization of the cervical spine.

Adult↗

Pacemaker-mediated tachycardia: tracking of atrial fibrillation during DDD pacing.

A 68-year-old man with sick sinus syndrome was treated by implantation of a DDD pacemaker. He subsequently developed a rapid heart rate and was found to have a pacemaker-mediated tachycardia due to tracking of atrial fibrillation by the pacemaker. The tachycardia was abolished by reprogramming the pacemaker, and the patient remained asymptomatic.

Aged↗

An ATP transport system in the intracellular bacterium, Bdellovibrio bacteriovorus 109J.

The intracellularly growing bacterium Bdellovibrio bacteriovorus 109J transports intact ATP by a specific, energy-requiring process. ATP transport does not involve either an ADP-ATP or an AMP-ATP exchange mechanism but, instead, has characteristics of an active transport permease. Kinetically distinct systems for ATP transport are expressed by the two developmental stages of the bdellovibrio life cycle.

Adenosine Triphosphate↗

Microbiologic studies.

Although useful to emergency physicians in determining and following up treatment, the microbiology department can be a source of frustration and erroneous results due to improper or inconsistent methodology, ordering, and interpretation. This article will review the principles of microbiologic specimen collection, handling, and processing as well as noting specific techniques for selected clinical settings.

Bacteriological Techniques↗

Decision making in laboratory test studies.

Evaluation of laboratory tests can be made at multiple levels. Evaluation at the levels of operational and decision making usefulness may be the most important but most neglected areas of analysis. Although quantitative models for such analysis are available, their application is often hindered by lack of precise probability measurements, unavailability of sensitivity and specificity data, and a poor understanding of the decision making process by physicians. A general understanding of such models and their mathematic principles have been presented with the hope that this will improve the diagnostic usefulness and application of the laboratory tests to be discussed in the remainder of this volume.

Clinical Laboratory Techniques↗

Nontraumatic superior dislocation of the patella.

A case of superior patellar dislocation is described. The dislocation was sustained without apparent trauma. Closed reduction was accomplished in the emergency department. No apparent injury to the patellar ligament was sustained.

Humans↗

Physician at the scene of an emergency.

Growth and maturation in the delivery of prehospital emergency medical care has been dramatic in the past 15 years. The increased availability and use of emergency medical services (EMS) has led to more frequent interactions between providers of prehospital care and the medical practitioner. This paper reviews the training and capabilities of emergency medical personnel and introduces the issue of medical control at the scene of an emergency. Also presented are the basics of emergency scene and victim stabilization. Physicians can help improve prehospital care by becoming familiar with local EMS capabilities and personnel.

Ambulances↗

Uptake of intact nucleoside monophosphates by Bdellovibrio bacteriovorus 109J.

The degraded nucleic acids and ribosomes of its prey cell provide Bdellovibrio bacteriovorus 109J with a source of ribonucleoside monophosphates and deoxyribonucleoside monophosphates for biosynthesis and respiration. We demonstrate that bdellovibrios, in contrast to almost all other bacteria, take up these nucleoside monophosphates into the cell in an intact, phosphorylated form. In this way they are able to assimilate more effectively the cellular contents of their prey. Studies with UMP and dTMP demonstrate that they are transported and accumulated against a concentration gradient, achieving internal levels at least 10 times the external levels. Treatment of the bdellovibrios with azide or carbonyl cyanide m-chlorophenylhydrazone eliminates their ability to either transport or maintain accumulated UMP and suggests the presence of a freely reversible exchange mechanism. There are at least two separate classes of transport systems for nucleoside monophosphates, each exhibiting partial specificity for either ribonucleoside monophosphates or deoxyribonucleoside monophosphates. Kinetic analyses of UMP transport in different developmental stages of strain 109J indicate that each stage expresses a single, saturable uptake system with a distinct apparent substrate affinity constant (Kt) of 104 microM in attack phase cells and 35 microM in prematurely released growth phase filaments. The capacity for transport of UMP by the growth phase filaments was 2.4 times that of the attack phase cells. These data, in addition to the apparent lack of environmental control of UMP transport capacity in attack phase cells, suggest that there are two transport systems for UMP in bdellovibrios and that the high-affinity, high-capacity growth phase system is developmentally regulated.

Azides↗

Developmental regulation of globin and nonglobin messenger RNAs in avian erythroid cells.

During embryonic development in the chicken two morphologically distinct erythroid cell populations sequentially appear. Coincidentally with the change in cell populations that begins on the sixth day of embryonic life, the hemoglobins of the early embryo are gradually replaced by a new set of hemoglobins, which are almost identical to those of the adult chicken. We have used recombinant DNAs to investigate the molecular mechanisms underlying these developmental changes. With respect to the eight nonglobin species of messenger RNA that we have studied, seven are present at approximately equal concentrations in erythroid cells from 5-day embryos and from anemic adults. This suggests that the replacement of erythroid cell populations is not accompanied by a general reorganization of gene expression. With respect to globin gene expression, however, we find that all but one of the globin genes studied (alpha D-globin) undergo dramatic developmental regulation. We have also shown that the expression of the gene for the embryo specific alpha-like globin, pi'-globin, is principally regulated at the level of transcription.

Animals↗

Injury to the head and face in patients with cervical spine injury.

The charts of 81 patients with acute cervical spine fracture and/or subluxation were reviewed to determine the incidence of injury to the soft tissue and bone of the head or face in these patients. Motor vehicle accidents accounted for over 69% of these injuries. Only 33 patients had concomitant soft tissue injury to the head or face, and only five had facial and/or skull fractures. Injuries of the skull and face do not usually accompany cervical fractures, and our findings do not support the restriction of post-traumatic cervical spine radiography in the emergency department to patients with obvious head or facial trauma.

Accidents↗

Single-dose antibiotic therapy of urinary tract infection: is it appropriate in the emergency department?

Accurate diagnosis of urinary tract infection (UTI) is possible in the emergency department. Clinical differentiation of upper tract infection (pyelonephritis) from lower tract infection (cystitis) is difficult. The consequences of untreated UTI justify treatment by the emergency physician. Many treatment schemes are available. Single-dose antibiotic therapy is the preferred treatment method for uncomplicated UTI. It reduces compliance problems, effectively cures lower UTI, and provides for early identification of patients with more complex infection. The complications of this therapy are minimal.

Anti-Bacterial Agents↗

Effect of antishock trouser inflation on plasma renin activity during hemorrhagic shock.

The effect of antishock trouser inflation on plasma renin activity during hypovolemic shock was studied in dogs. Following anesthesia, six dogs were bled to a systolic blood pressure of 60 mm Hg. Antishock trousers were inflated to 40 to 100 mm Hg for 20 minutes each. Plasma renin activity was measured before phlebotomy, after phlebotomy, and after each 20-minute period of antishock trouser inflation. Three dogs without antishock trousers served as controls. Experimental animals had a significant rise in blood pressure when the antishock trousers were inflated to 100 mm Hg. Plasma renin activity showed a marked increase following phlebotomy (experimental, 1.55 ng/mL/h to 13.63 ng/mL/h; control, 2.71 ng/mL/h to 19.7 ng/mL/h). Both groups had a continued small, statistically insignificant rise in plasma renin levels throughout the remainder of the experiment. Plasma renin level changes did not explain the observed rise in blood pressure following antishock trouser inflation. Plasma renin levels remained elevated in spite of improvement of blood pressure after application of antishock trousers.

Animals↗

An unusual case of intra-articular dislocation of the patella.

An unusual case of intra-articular patellar dislocation is described in which the patella rotated simultaneously in both the horizontal and vertical axes. The dislocation was sustained without apparent trauma. Reduction could not be accomplished in the emergency department. Closed reduction was accomplished successfully under general anesthesia in the operating room.

Child↗

Direct mechanical ventricular assistance during ventricular fibrillation.

A technique of direct mechanical ventricular assistance (DMVA) has been available since 1966. Ventricular assistance is provided by a glass cup lined with a Silastic diaphragm. It is held on the cardiac ventricles by suction. Alternating positive and negative pressure in the space between the cup and the diaphragm provides a pumping mechanism for blood flow. DMVA was compared to closed chest massage (CCM) and open chest massage (OCM) during ventricular fibrillation in six dogs. Each technique was applied for 10 minutes. Three dogs had CCM followed by OCM and then DMVA. Three dogs had only OCM and DMVA. Blood pressure and cardiac output were measured. All variables were calculated as a percentage of pre-ventricular-fibrillation values. Mean blood pressure was 19.7% with CCM, 39.8% with OCM, and 55.1% with DMVA. Systolic blood pressure was 25.8% with CCM, 51.9% with OCM, and 64.0% with DMVA. Diastolic blood pressure was 17.3% with CCM, 37.3% with OCM, and 48.9% with DMVA. Cardiac output was 13.8% with CCM, 37.1% with OCM, and 58.0% with DMVA. For each variable, OCM produced statistically higher values than did CCM. DMVA produced statistically higher values than did OCM for all variables. These preliminary results suggest that DMVA may be superior to currently available methods of cardiac massage during ventricular fibrillation.

Animals↗

A new library for emergency medicine.

The publication of textbooks that are relevant to emergency medicine has increased rapidly during the past decade. This increase has created confusion in the selection of appropriate texts for both emergency medicine residency and hospital emergency department libraries. A critical review of 703 pre-selected texts was performed. From this review, a recommended list of 165 books for the resident library and 27 books for the emergency department library is suggested. The cost of these libraries is $6,433.05 and $1,230.05, respectively. The libraries are designed to assist emergency physicians and librarians in attaining maximum value in the expensive process of textbook selection.

Bibliographies as Topic↗