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Biomedical subjects

J E Carter

Publications and source records attributed to J E Carter.

At least 55 records · Page 3Linked to original sources
PubMed1994

Acid-base abnormalities associated with cocaine toxicity in emergency department patients.

There is little information on the prevalence and clinical presentation of acid-base abnormalities associated with cocaine toxicity. To address these issues, arterial blood gas results were evaluated in 156 cocaine-associated emergency department patient visits. Arterial blood gas results were obtained as part of the patient's clinical assessment. The majority of patients (52%) had a normal pH (7.35 to 7.45). Thirty-three percent of patients were acidotic, with a pH between 6.4 and 7.35. In 33 patients the acidosis was metabolic, with a HCO3- of 14 +/- 6 mmol/L. The acidosis was primarily respiratory in 18 patients, with evidence of hypoventilation. Hypoventilation was generally secondary to chest trauma or decreased mental status. Alkalosis (pH > 7.45) was observed in 15% of patients, and was usually respiratory, as evidenced by tachypnea and a low PCO2. These results indicate that metabolic and respiratory acid-base abnormalities are common during cocaine toxicity. Acidosis and alkalosis were associated with numerous patient presentations, including chest pain, shortness of breath, decreased mental status, trauma, and seizures. Acid-base abnormalities do not appear to be associated with a specific route of cocaine self-administration. Patients with a history of potential cocaine toxicity should be evaluated for acid-base abnormalities.

Acid-Base Imbalance↗
PubMed1994

A continuing assessment of risk factors for the development of Escherichia coli O157:H7-associated hemolytic uremic syndrome.

Univariate and multivariate analyses were applied to determine risk factors for the progression of Escherichia coli O157:H7 enteritis to hemolytic uremic syndrome (HUS). Both clinical and laboratory variables were assessed for 118 pediatric patients (28 HUS; 90 enteritis only). Verotoxins 1 and 2 were produced by 89% of E. coli strains whereas verotoxin 2 only was produced by 11%. Although a greater frequency of strains producing verotoxin 2 only occurred in HUS isolates (p = 0.11), toxin phenotype was not significantly associated with risk after multivariate analyses. HUS patients with or without neurological manifestations had similar frequencies of the two toxin phenotypes among their isolates. Significant associations for young age (RR = 0.984; 95% CI = 0.971-0.998) and prolonged use of antidiarrheal agents (RR = 44.11; 95% CI = 8.48-229.4) with HUS were apparent. A lesser chance of progression was observed for patients whose strains possessed a 4 kb plasmid (RR = 0.27; 95% CI = 0.08-0.94). Our results are consistent with the hypothesis that progression to HUS is dependent upon both bacterial virulence factors and the clinical characteristics of the individual patient.

Bacterial Toxins↗
PubMed1994

Laparoscopic-assisted vaginal hysterectomy utilising the contact-tip Nd: YAG laser: a review of 67 cases.

The purpose of this study was to determine the efficacy of laparoscopic-assisted vaginal hysterectomy utilising the contact-tip Nd:YAG (Neodymium: Yttrium-Aluminum-Garnet) laser (Surgical Laser Technologies, Oaks, PA). Postoperative activity levels, operative times, blood loss, pain medication use, length of hospital stay, and complications of laparoscopic-assisted vaginal hysterectomy were determined. Sixty-seven women with extensive disease including endometriosis, adenomyosis, adhesions, and multiple fibroids underwent laparoscopic-assisted vaginal hysterectomy (LAVH). The procedures were performed utilising the contact-tip Nd:YAG laser and a laparoscopic linear stapling device. All patients were operated on for a primary diagnosis of pelvic pain and would have required an abdominal approach for surgery due to extensive adhesions, fibroids, or endometriosis. Sixty-eight cases of laparoscopic-assisted vaginal hysterectomy were attempted. In 67 of these cases, the procedure was completed as planned. One case required conversion to abdominal hysterectomy due to extensive adhesions. Average hospital stay after surgery was 2.7 days with a minimum stay of less than one day. The average operating time for the LAVH was 149 minutes with an estimated blood loss of 220 mL and a haemoglobin drop from surgery to day 1 after surgery of 1.9 g. The complication rate was 11.9% with all of the complications occurring in the first 46 cases. By day 14 after surgery, patients reported their activity level at 8.8 on a scale of 1 to 10 with 10 being unlimited activities. By day 21, they reported their activity level at 9.5. The majority of the patients were able to return to work within two weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adnexal Diseases↗
PubMed1993

Asymptomatic and electrically silent myocardial ischemia during upright leg cycle ergometry and treadmill exercise (clandestine myocardial ischemia).

The frequency of "clandestine" (electrically silent and asymptomatic, but scintigraphically evident) myocardial ischemia during treadmill and upright leg cycle ergometric studies was compared in 38 patients with coronary artery disease and reversible ischemia on both thallium-201 scintigraphy and exercise radionuclide angiography. A similar peak double product was attained in both studies. Angina pectoris was significantly more frequent with treadmill exercise than with leg cycling (29 vs 5%, p = 0.0079). An interpretable and positive exercise electrocardiogram occurred in 53% of treadmill tests, but in only 19% of leg cycle tests (p = 0.0025); in a group of 22 patients without scintigraphic ischemia, leg cycle testing had greater specificity (95 vs 64%, p = 0.0248). Ischemia was manifest by symptoms or an abnormal electrocardiogram in 59% of treadmill tests, but in only 18% of leg cycle tests (p = 0.0003). There were no differences between the exercise variables or the degree of scintigraphic abnormalities of the 22 patients with manifest ischemia and the 16 with clandestine ischemia. However, patients with previous coronary artery bypass surgery experienced clandestine ischemia more frequently than did those without bypass surgery (80 vs 33%, p = 0.0103). Thus, clandestine ischemia occurs more frequently during symptom-limited upright leg cycle ergometry (82%) than during treadmill exercise (42%). The symptomatic and electrical manifestations of exercise-induced ischemia have a critical dependence on the type of exercise used.

Adult↗
PubMed1993

Oculocerebral hypopigmentation syndrome associated with Bartter syndrome.

We describe a 20-year-old man with tyrosinase-negative oculocutaneous albinism, mental retardation, epilepsy, sensorineural deafness, ataxia, and Bartter syndrome. When combined, these neurocutaneous and renal findings form a previously unreported combination. The neurological and cutaneous manifestations of this case are distinctly different from those of the syndrome first reported by Cross et al. [1967]. The literature is reviewed and an attempt is made at classifying the oculocerebral hypopigmentation syndromes.

Adult↗
PubMed1993

Anterior ischemic optic neuropathy is not associated with carotid artery atherosclerosis.

BACKGROUND AND PURPOSE: The relation between anterior ischemic optic neuropathy and carotid artery atherosclerotic disease is unclear. We studied patients with anterior ischemic optic neuropathy to determine if they had an increased occurrence of carotid artery stenosis. METHODS: Fifteen consecutive patients with anterior ischemic optic neuropathy were evaluated prospectively for cervical carotid artery stenosis and compared with 30 age- and sex-matched asymptomatic patients and also with 11 age- and sex-matched patients experiencing transient monocular blindness. RESULTS: There was no difference in the mean stenosis of the internal carotid artery between patients with anterior ischemic optic neuropathy (mean carotid stenosis, 19%) and asymptomatic patients (mean carotid stenosis, 9%; p > 0.05), whereas patients with transient monocular blindness had significantly more stenosis (mean, 77%) in the cervical carotid arteries than both control subjects (p < 0.0001) and patients with anterior ischemic optic neuropathy (p < 0.0001). There was also no difference in the percentage of patients with stenosis > or = 30% in anterior ischemic optic neuropathy (two of 15) and asymptomatic patients (five of 30), whereas 10 of 11 patients with transient monocular blindness had stenoses > or = 30%, significantly more than patients with anterior ischemic optic neuropathy (p < 0.0001) and asymptomatic patients (p < 0.0001). CONCLUSIONS: Anterior ischemic optic neuropathy is not a marker for atherosclerotic carotid artery stenosis. The pathogenesis of nonarteritic anterior ischemic optic neuropathy does not involve carotid artery stenosis in most patients.

Aged↗
PubMed1993

Laparoscopic diagnosis and excision of an intact ovarian pregnancy. A case report.

Ovarian pregnancy is an uncommon complication of conception. We report the first case of an intact ovarian pregnancy diagnosed and treated with laparoscopy. With more extensive use of laparoscopy to evaluate abnormal quantitative beta-human chorionic gonadotropin values, intact ovarian pregnancy can be diagnosed and excision accomplished without open exploratory surgery or blood loss.

Adult↗
PubMed1992

Is cardiopulmonary bypass effective for treatment of hypothermic arrest due to drowning or exposure?

Various techniques have been advocated for resuscitation from hypothermic arrest caused by ice-cold freshwater drowning or exposure. We have resuscitated five such patients after emergency hospital admission using cardiopulmonary bypass initiated via median sternotomy. All patients presented to our facility with core temperatures less than 26 degrees C. Three patients had been in full cardiopulmonary arrest for more than 30 minutes prior to arrival. The fourth patient presented in ventricular fibrillation; the fifth was admitted to the hospital in sinus bradycardia that quickly deteriorated to asystole. All had cardiopulmonary bypass emergently initiated via median sternotomy. All were rewarmed on bypass to 37 degrees C and all survived at least 24 hours. Three of the five patients are currently alive and well with normal neurologic function. Cardiopulmonary bypass is an effective technique for resuscitation after hypothermic arrest due to near drowning and/or exposure.

Adult↗
PubMed1992

Torsade de pointes complicating acute myocardial infarction: the importance of autonomic dysfunction as assessed by heart rate variability.

Torsade de pointes is a polymorphic ventricular tachycardia associated with QT-interval prolongation rarely reported to occur in the setting of an acute myocardial infarction. Autonomic dysfunction has been implicated as a major stimulus for the development of this dysrhythmia. We describe the case of an 80-year-old woman who presented with an acute myocardial infarction and progressive QT-interval lengthening. An 89-beat run of torsade de pointes occurred during the time of the peak creatine phosphokinase (CPK) without electrolyte abnormalities or antiarrhythmic therapy. Assessment of autonomic tone using power spectral analysis of two consecutive 24-h Holter recordings was performed indicating that a transient decrease in heart rate variability and increase in sympathetic tone preceded the tachyarrhythmia. This case shows the potential usefulness of heart rate variability analysis as a marker for autonomic dysfunction and arrhythmogenesis, particularly during myocardial ischemia.

Aged↗
PubMed1992

Sequence, ontogeny, and cellular localization of murine surfactant protein B mRNA.

We have isolated and characterized murine surfactant protein (SP-B) cDNAs and determined both the cellular distribution and developmental expression of SP-B mRNA. The nucleotide sequence of the composite SP-B cDNAs and cloned genomic SP-B DNA predicted a primary translation product of 377 amino acids (molecular mass = 41.7 kDa) that contained a single asparagine linked glycosylation site. The 410 base 3' untranslated region contained a novel sequence consisting of a (CCA)21 repeat. Tissue specificity and developmental expression of SP-B mRNA was assessed by Northern blot analysis. A single 1.6-kb mRNA species was detected specifically in lung tissue. In fetal mouse lung SP-B mRNA was detected at low levels on day 15 of gestation and increased markedly between days 16 and 17, reaching adult levels by birth. In situ hybridization analysis of SP-B mRNA demonstrated SP-B expression primarily in bronchiolar and alveolar epithelium, although discrete bronchial cells also contained the SP-B mRNA. The murine SP-B mRNA was expressed in proximal and distal epithelial cells within the respiratory tract and shares a close structural relationship to SP-B from other species.

Animals↗
PubMed1992

Zidovudine and cytomegalovirus retinitis.

A 38-year-old bisexual man with acquired immunodeficiency syndrome (AIDS) who was being treated with oral acyclovir for herpetic stomatitis had a history of blurred vision OS that was diagnosed as cytomegalovirus retinitis. The patient refused ganciclovir administration. Two additional lesions developed OS in the succeeding four months. All clinical evidence of active retinitis cleared after zidovudine was administered, and the patient has remained free of any clinically active retinal lesions for 28 months while continuing to receive acyclovir and zidovudine. Although ganciclovir and foscarnet are the drugs of choice to treat cytomegalovirus retinitis, this observation may be fortuitous for patients whose other AIDS manifestations suggest using zidovudine rather than ganciclovir or for patients whose cytomegalovirus retinitis appears to be resistant to agents currently used to treat this infection.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Risk factors for the central nervous system manifestations of gastroenteritis-associated hemolytic-uremic syndrome.

Hemolytic-uremic syndrome is usually a consequence of enteric verotoxigenic Escherichia coli infection, and a prevailing hypothesis contends that systemically absorbed verotoxins are responsible for the multiple organ involvement. In an attempt to determine whether the central nervous system (CNS) manifestations could occur owing to factors that reflect a toxin insult, the authors studied the association of clinical and laboratory variables with the development of neurological disease. Ninety-one patients with hemolytic-uremic syndrome from 1982 through 1990 were included. Twenty-seven (18 female, 9 male) had a CNS disorder; 17 of these had seizures and there were two deaths. Multivariate analyses led to the following observations: female gender (odds ratio [OR] 8.50; 95% confidence interval [CI] 2.08 to 50.0), prolonged use of an antimotility pharmacological agent (OR 8.50; 95% CI 1.69 to 42.81), and an increased hemoglobin level (OR 1.11; 95% CI 1.05 to 1.17) were associated with an increased risk for developing a neurological manifestation. Prior administration of a blood product was associated with a decreased risk (OR 0.12; 95% CI 0.02 to 0.52). The findings suggest that other mechanisms for CNS disease may exist in addition to direct toxin insult.

Adolescent↗
PubMed1991

Comparison of body composition and somatotype of trained female triathletes.

The body composition and somatotype of 16 trained female triathletes aged 18.8-32.8 years were measured. All of the subjects were engaged in a competitive training programme and participated in the same triathlon. Anthropometric variables included height, mass, selected diameters, girths and skinfolds, and a Heath-Carter anthropometric somatotype. Body composition was determined by hydrostatic weighing procedures and skinfold patterns. Comparisons were made with Olympic swimmers and runners. The triathletes had a mean body mass of 55.2 kg and a mean height of 162.1 cm. When compared to swimmers, the triathletes were somewhat shorter and significantly (P less than 0.005) older. On most other measures, including a balanced mesomorph somatotype of 3.1-4.3-2.6, they were similar to swimmers. This group of triathletes were generally heavier, less lean, more mesomorphic and less ectomorphic than elite runners. Reported body densities from other studies indicated little difference between the triathletes and other groups. Skinfold patterns were similar in shape for all groups, but the runners had smaller values, at all sites, than either swimmers or triathletes. Because of lack of information on cyclists, adequate comparisons were not possible. Regression analysis indicated that training parameters were more important than anthropometric measures in the prediction of performance. It was concluded that this group of triathletes were closer, with respect to both body composition and somatotype, to swimmers than to runners.

Adolescent↗