Biomedical subjects
Publications and source records attributed to J D Thompson.
Compression of the deep branch of the ulnar nerve distal to the pisohamate hiatus is rare. Two cases of compression of the deep branch at the adductor hiatus are presented. These cases are unique because of pain in the hand without muscle atrophy. One patient has had surgical treatment, and the other patient's symptoms are not severe enough to warrant surgical treatment.
At an average of 18.4 months after fracture, 20 adult patients with nondisplaced radial head or neck fractures were examined regarding manner of treatment and functional outcome: 11 patients were initially immobilized in 90 degrees flexion and nine patients were immobilized in straight extension. Loss of range of motion of the injured elbow averaged 1 degree loss of flexion, 2 degrees loss of extension, 1 degree loss of supination, and 2 degrees loss of pronation. No patient reported any functional impairment, and only five patients (25%) reported any symptoms referable to the injured elbow on follow-up. The manner of initial treatment did not seem to affect ultimate outcome; symptomatic treatment and splinting followed by early range of motion would appear to produce uniformly good results.
The Yale Nursing Intensity Project explored the use of patient classification, done primarily for staffing, as a measurement of nursing resources. Cross-hospital comparisons showed considerable interesting variation, yet to be explained, in minutes of care but there was considerable consistency in the relative nursing intensity of DRGs. Because of differences in staffing and charging practices, intensive care and routine floor care should be separated in any further study of nursing intensity. And because different clinical services show large differences in nursing resource use, costing nursing should be done at least at the service level, if not the actual unit level. A method for establishing a nationwide data set in which nursing could be included is suggested. The virtue of this approach is to provide cross-hospital evidence on which policy decisions about weighting DRGs for nursing in deciding reimbursement levels could be made. In addition, such a system would require hospitals to account for nursing separately from other hospital costs, with attendant benefits for nursing management.
During the 12-month study interval ending March 30, 1986, there were 203 ectopic pregnancies at Grady Memorial Hospital, a ratio of one ectopic gestation per 34 deliveries. Twenty patients with isthmic ectopic pregnancies were selected for treatment by one of three operative modalities. Seven patients with ruptured isthmic ectopic pregnancies underwent segmental tubal resection without reanastomosis. All four patients who underwent segmental tubal resection with primary microsurgical reanastomosis had postoperative hysterosalpingograms demonstrating bilateral tubal patency. One pregnancy has occurred in this group. Nine patients underwent linear salpingostomy. In five of the six patients who had postoperative hysterosalpingography, patency of the involved fallopian tube was demonstrated. Four of these nine patients, including one patient with contralateral tubal occlusion, have conceived. We conclude that linear salpingostomy for isthmic ectopic pregnancies is as effective as segmental tubal resection with primary microsurgical reanastomosis in achieving tubal patency.
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The demise of the National Health Planning and Resources Development Act of 1974 (PL 93-641) raises questions about the degree of public support it had for planning goals. The results of a 1978 nationwide public opinion poll reveal (1) low confidence in and recognition of the Act's institutional arms, the Health Systems Agencies; (2) little support for hospital cost containment strategies and their consequences; and (3) less than average support for these goals and consequences among those groups traditionally under-represented in health planning activities. The results suggest that the Act did not reconcile centralized federal goal formation with democratic local health planning.
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At this stage in the development of diagnosis-related groups (DRG's), there is an imperfect record of the value and amount of nursing resources used by individual patients during a single hospital stay. Previous attempts to isolate the costs of nursing care in relationship to DRG's are reviewed. A research strategy to attain such relative measurements is proposed. Such inquiries are necessary if precise measurements of the relative contribution of nursing to each DRG are to be isolated, if new managerial models are to be isolated, if new managerial models are to be developed, and if objective measurements of severity within DRG's are to be devised.
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In the emergency department at Hennepin County Medical Center, succinylcholine has been used to assist difficult intubations since March 1, 1979. In this report, the first 48 cases are reviewed. In these 48 patients, complete relaxation allowing endotracheal intubation was achieved in 42. Forty of the 42 patients intubated suffered no adverse effects. One patient vomited, delaying intubation, and another developed transient asystole. Six of 48 patients were not successfully intubated after succinylcholine; five of these six subsequently required cricothyrotomy. Inadequate dose, improper technique of administration, foreign material obscuring airway, and idiosyncratic reactions were thought to be reasons for failure. When properly administered, succinylcholine can be used to facilitate difficult intubations in the emergency department with an acceptable incidence of adverse effects or failures.
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A number of metals were examined for inhibition of a canine renal calcium, magnesium-activated adenosinetriphosphatase (Ca2+, Mg2+-ATPase). Of the 27 metals investigated, only compounds of mercury, silver, gold, and uranium demonstrated 50% inhibition of the enzyme at concentrations lower than 10(-4) M. The order of inhibitory potency was Hg greater than Ag greater than U greater than Au. Organic mercury (chlormerodrin, mersalyl, p-chloromercuribenzoate) was less potent than inorganic mercuric chloride, but organic gold sodium thiomalate was equipotent with inorganic gold chloride. The inhibition produced by each metal decreased parallel to the decrease in enzyme activity, seen as the source of enzyme moved from the outer cortex inward to the papilla of the kidney. The regions of highest activity showed the greatest inhibition by each metal, and inhibition decreased as the control activity of the tissue decreased. This variability of inhibition was not related to the protein content of the enzyme preparation. As the ATP concentration increased, the inhibition produced by U was reduced; if the Mg (but not the Ca concentration) was increased while the ATP concentration remained constant, the inhibition increased. Changes in the Ca, Mg, and ATP concentrations did not alter the inhibition produced by Hg, Ag, and Au.
Uterine unification procedures were performed on 17 patients with müllerian anomalies in an attempt to achieve reproductive capability. None of the 17 patients had any living children prior to undergoing these metroplasties. Fifteen patients had a septate uterine anomaly that necessitated use of the modified Jones procedure. The Strassmann procedure was performed in 2 patients, one with a bicornuate uterus and one with a didelphys uterus. After analyzing the follow-up data on 16 of these patients, 12 have conceived at least once (resulting in a total of 15 pregnancies), 3 of those who have not yet conceived have had unprotected intercourse for less than 10 months, and one is utilizing contraception electively. The use of the modified Jones procedure and the Strassman procedure in appropriate circumstances can maximize a patient's chances for fertility with minimal surgical risks.
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To extend our understanding of the mechanism of action of digitalis drugs, we studied electrocardiograms (ECGs), renal function, plasma concentrations of catecholamines, and myocardial and renal Na+ + K+-dependent adenosine triphosphate (Na+ + K+ ATPase) activity in chronically digitalized dogs. Five healthy, male, mongrel dogs received a therapeutic regimen of digoxin (0.1 mg/kg on day 1 in three divided doses followed by 0.025 mg/kg per day) orally for 2-4 months. This resulted in plasma digoxin concentrations of 1.1 to 4.7 ng/ml as determined by radioimmunoassay. Six control dogs received daily gelatin capsules by mouth. ECGs monitored throughout the study showed no changes. Digitalized dogs had elevated plasma norepinephrine concentrations (347 vs. 137 pg/ml in controls) and no change in plasma epinephrine concentrations. Digitalized dogs had elevated glomerular filtration rates (0.74 vs. 0.94 ml/min per g of kidney) without significant changes in renal handling of electrolytes and water. All of the above studies were done without the aid of restraining drugs or infusions. The animals were killed with an overdose of pentobarbital for in vitro studies. In digitalized dogs, microsomal Na+ + K+ ATPase-specific activity was 26 to 33% lower in the renal cortex, medulla, and papilla, and 46% lower in the cardiac left ventricle than in control dogs. Digitalization did not alter the osmolalities of renal tissues. We conclude that chronic reduction Na+ + K+ ATPase activity by one-third dose does not cause abnormalities in renal handling of electrolytes and water, and inhibition of Na+ + K+ ATPase in the left ventricular muscle by one-half is associated with no obvious ECG changes in the dog. Further, elevated plasma norepinephrine concentrations may contribute to both the therapeutic and the toxic effects of digitalis.