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Biomedical subjects

J C Perry

Publications and source records attributed to J C Perry.

81 records · Page 5Linked to original sources
PubMed1980

Clinical features of the borderline personality disorder.

The authors compared 18 patients diagnosed as having borderline personality disorder with 102 patients with orther diagnoses in a psychiatric emergency service. They found that 81 of 129 items obtained from the literature on borderline personality disorder were significantly more characteristic of the patients diagnosed as borderline than patients with other diagnoses. When these items were included in a Borderline Personality Scale they significantly distinguished patients diagnosed as borderline from those with other diagnoses. The patients diagnosed as borderline were not psychotic but were angry, demanding, and difficult to interview; specific histories, interpersonal relationships, defenses, and other judgments of personality functioning were also prominent characteristics of these patients. On the basis of these findings and other studies, the authors maintain that the patients diagnosed as borderline actually had a borderline personality disorder.

Adult↗
PubMed1978

The borderline patient. A comparative analysis of four sets of diagnostic criteria.

In reviewing the evidence for the validity of the diagnosis borderline, four descriptions in the literature seem to offer comprehensive criteria for the diagnosis. When the four are compared, a total of 104 criteria are enumerated encompassing the mental status, history, interpersonal relationships, defense mechansisms, and other judgments of personality functioning of the borderline patient. Half of these criteria are mentioned in only one of the four diagnostic descriptions. This apparent lack of agreement over diagnostic criteria has three possible interpretations: (1) the borderline concept is an illusion; or (2) the concept is adequately defined by those criteria held in common, the others being nonessential; or (3) apart from the concept defined by the common criteria, there are subtypes emphasized by different authors. Although we favor the third interpretation, it is suggested that further speculation await an adequate test of existing diagnostic criteria.

Diagnosis, Differential↗
PubMed1975

Fluroxene toxicity induced by phenobarbital.

Because of reports of fluroxene toxicity in man, the effect of phenobarbital treatment on the toxicity and metabolism of fluroxene was studied in 9 rhesus monkeys. Six monkeys that were exposed to a mean calculated alveolar fluroxene concentration of 5.8% for 4-hr periods up to a total of 16 hr showed no evidence of toxicity. Two animals were sacrificed after a single 4-hr exposure to obtain control measures of fluroxene metabolites in tissues. Four monkeys that had previously survived received exposures to fluroxene and 3 monkeys that had no exposure to fluroxene died during fluroxene anesthesia after treatment with phenobarbital (mean time, 3 hr). Toxicity was manifested by arterial hypotension, pulmonary edema, and arterial hypoxemia. Phenobarbital treatment enhanced production of fluroxene metabolites, including the highly toxic trifluoroethanol. Concentrations of trifluoroethanol in mixed-expired gas, blood, and urine, and of total nonvolatile fluorine in blood, urine, and tissues of animals treated with phenobarbital were 2 to 10 times as in control animals. The results suggest that the rhesus monkey is a valuable model for the study of fluroxene pharmacology and that inclusion of an enzyme-inducing challenge in the evaluation of potential toxicity of other anesthetics seems warranted.

Anesthesia↗
PubMed1975

Cardiorespiratory effects of high positive end-expiratory pressure.

Five healthy rhesus monkeys were ventilated with intermittent mandatory ventilation and 20 torr positive end-expiratory pressure (PEEP) for 8 hours. PEEP was increased to 25 torr and the monkeys were ventilated for 4 more hours. Lactated Ringer's solution and human salt-poor albumin were used to expand plasma and extracellular fluid volume throughout the entire period of study. Homologous blood was administered to maintain hematocrit at control levels and maintenance fluids were infused to maintain transmural pulmonary capillary wedge pressure at 5 to 15 torr. Although cardiac output, mean aortic blood pressure, oxygen consumption, venous admixture, transmural pulmonary capillary wedge pressure, HCO3- and in-vivo base excess were not changed when intermittent mandatory ventilation was employed, cardiac output and blood pressure were significantly depressed by brief periods of controlled mechanical ventilation when alternated with intermittent mandatory ventilation. Sporadic increases in arterial-venous oxygen content difference occurred. Arterial carbon dioxide tension was elevated moderately, with a concomitant depression of arterial pH. No pneumothorax occurred. High PEEP was well tolerated with intermittent manditory ventilation, intravascular volume expansion, and careful cardiovascular monitoring.

Animals↗
PubMedDate not supplied

Should an axis for defense mechanisms be included in DSM-IV?

The purpose of this review is to address empirical evidence bearing on the desirability of including a Defense Mechanisms Axis in DSM-IV. The authors reviewed studies based on standardized clinical or self-report methods for assessing defense mechanisms. Information was sought pertinent to methods for assessment, relevance to clinicians with diverse theoretical perspectives, definitions, suitability for an axial format, complexity, reliability, clinical utility, and relationship to existing axes. Methods for reliably rating defense mechanisms have been developed, and data on the clinical utility of ratings have begun to accumulate. A consensus on definitions is emerging, and evidence supports a hierarchy of defenses based on their adaptiveness. Since training in psychodynamic theory and treatment approaches is required of residencies performed in the United States, all psychiatrists should be able to evaluate patient defenses. However, new methodologies have not been tested under usual clinical conditions with limited, "live" clinical data. A viable option for DSM-IV is the inclusion of a defense mechanisms axis in an appendix of optional axes for use in special clinical and research settings. In addition to providing dynamically meaningful diagnostic data, this axis would facilitate expansion of the empirical data base on a standardized measure of defenses under conditions of routine clinical practice.

Defense Mechanisms↗
PubMedDate not supplied

Permanent cardiac pacemakers: issues relevant to the emergency physician, Part I.

Many people benefit from the implantation of cardiac pacemakers for management of certain cardiac dysrhythmias. These patients are seen regularly in the emergency department with a variety of pacemaker complications and malfunctions. The presence of a pacemaker may also affect management of unrelated medical problems. This two-part series reviews the medical issues related to patients with permanent pacemakers. Part I covers pacing modes and terminology, complications of the implant procedure, and the approach to a patient with a permanent pacemaker. Part II covers the causes, diagnosis and management of pacemaker malfunction; the pacemaker syndrome; the pacemaker Twiddler's syndrome; and other considerations in the paced patient including diagnosis of acute myocardial infarction, ACLS protocols, trauma, and sources of interference. Indications for permanent pacemaker implantation and temporary external pacing will not be covered.

Electrodes, Implanted↗
PubMedDate not supplied

Permanent cardiac pacemakers: issues relevant to the emergency physician, part II.

Many people benefit from the implantation of cardiac pacemakers for management of certain cardiac dysrhythmias. These patients are seen regularly in the Emergency Department with a variety of pacemaker complications and malfunctions. The presence of a pacemaker may also affect management of unrelated medical problems. This, the second of a two-part series, covers the causes, diagnosis, and management of pacemaker malfunction; the pacemaker syndrome; the pacemaker Twiddler's syndrome; and other considerations in the paced patient including diagnosis of acute myocardial infarction, ACLS protocols, trauma, and sources of interference.

Electrocardiography↗
PubMedDate not supplied

Venous air embolism prophylaxis with a surface-active agent.

The protective effect of a nonionic surface-active polyol agent (Pluronic F-68) against bolus injection and constant-rate IV infusion of air was studied in 21 dogs anesthetized with pentobarbital. Aortic, pulmonary artery and right ventricular pressures, cardiac output, end-tidal CO2 concentration, wasted ventilation, and blood surface tensions were measured before and after the IV administration of this surfactant. The magnitudes of change in the cardiorespiratory responses measured after venous air embolism were significant (p less than 0.05) reduced in the treated animals. This agent may be advantageous for surgical patients when an increased risk of venous air embolism exists.

Animals↗