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Biomedical subjects

J H Bland

Publications and source records attributed to J H Bland.

13 recordsLinked to original sources

Cervical and thoracic pain.

The cervical spine has long been an area in which the assumption is made that no undescribed anatomy and physiology will be forthcoming. Herein described are cervical anatomy and physiology that have not been reported, as well as anatomy that has been extensively described but does not exist. Fresh research needs to be done on the distinctive and poorly understood characteristics of the autonomic nervous system in the cervical spine. Included in research reports are evidence of herniation of intradiscal gas; efficacy of early mobilization of patients with long-standing neck pain; successful surgical treatment relieving severe hemicranial migraine attack; and the use of magnetic resonance imaging in thoracic disk herniation, permitting precise localization and determination of the magnitude of cord compression.

Cervical Vertebrae

Anatomy and physiology of the cervical spine.

Although the lumbar spine was extensively studied from 1934 to the present, the cervical spine has received far less attention. Anatomic, physiological, biochemical, and biomechanical characteristics of the lumbar spine are often presumed to apply to the cervical spine. The differences are far too extensive to warrant such an assumed correlation. Beginning in 1955, the authors have collected 171 whole human spines and studied them anatomically, physiologically, and histologically. Reported in this article are clinically important anatomic characteristics of the nucleus pulposus, the uncinate process, nerve root exit sites, position of the motor (anterior) nerve root, relation of spinal cord volume to size and shape of the spinal canal, anatomy of the anterior and posterior spinal canal, menisci of the zygapophyseal joints, and the anatomy and clinical significance of the autonomic nervous system in the cervical spine.

Autonomic Nervous System

Rheumatic syndromes in endocrine disease.

It is not widely appreciated that endocrine disease may present primarily as rheumatic syndromes, sometimes spectacular in onset, more commonly insidious and subtle, making their true recognition difficult. The underlying hormonal, biochemical, and metabolic events have understandable reflection in the structure and function of bone, joint, and muscle.

Acromegaly

The effect of hemodilution with albumin or Ringer's lactate on water balance and blood use in open-heart surgery.

To determine the effect of intraoperative albumin administration on blood use, water balance, and postoperative clinical course, we studied two groups of adult cardiac surgical patients. Group I (30 patients) received 25 gm of albumin during withdrawal of 2 units of blood prior to cardiopulmonary bypass (CPB) and 50 gm of albumin in the oxygenator prime. Group II (32 patients) received no albumin prior to the end of CPB. No difference in clinical course could be identified, nor was there a significant difference in blood use. Group I patients had lower hematocrit values intraoperatively from the time of blood withdrawal until the conclusion of operation. Coronary artery bypass operations were associated with greater positive water balance than were heat valve operations. Forty-three percent of the patients having coronary artery bypass grafting had a positive water balance greater than 5 liters, whereas 50% of those undergoing valve procedures had a balance less than 3 liters. We conclude that the principal effect of withholding albumin under these circumstances is to increase net positive water balance. The greater positive water balance does not appear to be detrimental.

Adult

The painful shoulder.

The shoulder, a very common site of pain syndromes in medical practice, lends itself well to precise clinical analysis and identification of the pain-sensitive structure or structures. Once identified, rational and effective management can be applied, associated with predictably good prognosis. Early identification of the emerging specific syndrome is important in decreasing the duration of the clinical disorder and in achieving optimum return of shoulder function. Laboratory and X-ray studies are not commonly required in diagnosis and management. There are a confusing variety of names attached to the many shoulder pain syndromes; however, there are two most common categories. One is associated with severe pain but little or no limitation of shoulder movement (at least passive movement), in which the pain-sensitive structure is tendon or tendon sheath; the other is associated with both pain and limitation of active and passive motion, in which the pain-sensitive structures are capsule, bursa, and synovium as well as muscle and multiple tendons.

Arm

Halothane-induced decrease in experimental myocardial ischemia in the non-failing canine heart.

The effect of halothane on net myocardial oxygen balance of ischemic myocardium was studied in the non-failing canine heart. Myocardial ischemia was produced by repeated reversible occlusions of a coronary artery; the severity of ischemia was estimated by summating ST-segment elevations (sigma ST) obtained by epicardial ECG mapping at 15 to 18 sites. Control measurements were obtained before and after administration of halothane (0.75 per cent) to six dogs with chloralose-urethane basal anesthesia. Halothane was associated with significant decreases of systemic arterial pressure (P less than .001), heart rate (P less than .01), and the product of systolic arterial pressure X heart rate (P less than .01), an indirect index of myocardial oxygen consumption, while left atrial pressure remained unchanged at normal levels. sigmaST during occlusion was less (P less .001) during halothane (26.5 +/- 7.4 (SD) mv) than before (36.6 +/- 5.4 mv) or after (34.4 +/- 8.2 mv) its administration. Thus, halothane decreased the severity of experimentally-induced myocardial ischemia in the non-failing canine heart. The data suggest that, in the absence of ventricular failure, halothane influences the relationship between myocardial oxygen supply and demand in a favorable direction when coronary blood flow is limited.

Anesthesia, General