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Biomedical subjects

J I Fishburne

Publications and source records attributed to J I Fishburne.

At least 37 records · Page 2Linked to original sources
PubMed1982

Bacterial endocarditis in pregnancy.

Bacterial endocarditis in pregnancy is uncommon but serious. A case is presented of subacute bacterial endocarditis with severe aortic and mitral valvular insufficiency and with associated multiple systemic and cerebral emboli. Therapy consisted of cesarean section at 33 weeks' gestation followed by aortic and mitral valve replacement; there was no maternal or fetal mortality. The English literature on infective endocarditis complicating pregnancy is reviewed.

Adult↗
PubMed1980

Vascular and uterine responses to dobutamine and dopamine in the gravid ewe.

Dopamine, a naturally occurring catecholamine precursor of norepinephrine, has been used in the treatment of cardiogenic shock. Following intravenous administation it increases cardiac output, blood pressure, and renal blood flow. Dobutamine is a directly acting inotropic agent which increases myocardial contractility without significantly changing blood pressure. This study was devised to compare the effects of these two drugs on uterine blood flow (UBF), uterine tonus (UT), mean arterial blood pressure (MAP), and heart rate (HR). Chronically instrumented pregnant ewes near term were infused with differet concentrations of dopamine and dobutamine while HR, MAP, UT and UBF were recorded continuously. Dopamine produced a decrease in UBF and an increase in MAP and UT while the HR response was variable. Dobutamine administration resulted in a marked increase in HR and a decrease in UBF, while MAP and UT remained essentially unchanged. Uterine vascular resistance increased with both drugs during high-dosage administration, but the rise was more pronounced following dopamine infusion. Since dobutamine exhibits less alpha-adrenergic activity than dopamine this drug would seem to be preferred when an inotropic agent is required for treatment of the pregnant patient.

Animals↗
PubMed1980

Effects of nitroglycerin and nitroprusside on the uterine vasculature of gravid ewes.

The effects of nitroglycerin (TNG) and sodium nitroprusside (SNP) on mean aortic pressure (MAP), uterine blood flow (UBF), uterine vascular conductance (UVC), and pulse rate (PR) were compared when the two agents were infused to prevent and treat hypertension induced by norepinephrine (NE) in gravid ewes. When infused alone, TNG, 19 microgram/kg/min, decreased MAP 19 per cent and increased PR 33 per cent from control values (P less than 0.05), but did not significantly change UBF or UVC. In comparison, SNP, 3 microgram/kg/min, decreased MAP 20 per cent and increased PR 43 per cent (P less than 0.05), and did not significantly change UBF or UVC. When given alone, four successive 2-min infusions of NE produced dose-related increase in MAP and decreases in UBF, UVC, and PR; values were significantly different from control with the two higher doses of NE. Although MAP, UBF, and UVC were still significantly changed from control levels when NE was given in the presence of the above infusions of TNG or SNP, MAP was lower and UBF and UVC were higher compared with when NE was given alone (P less than 0.05). When given to control hypertension induced by a continuous infusion of NE, TNG or SNP produced uterine vasodilatation and significantly increased UBF. Nitroglycerin and SNP were equally effective in counteracting the maternal hypertension and antagonizing the uterine vascular effect of NE. It is concluded that TNG and SNP counteract uterine vasoconstriction resulting from alpha-adrenergic stimulation and do not produce a shunt of blood flow away from the uterine vasculature when used to control hypertension in gravid ewes.

Animals↗
PubMed1979

Responses of the gravid uterine vasculature to arterial levels of local anesthetic agents.

Responses of the uterine vasculature and myometrium to uterine arterial infusions of local anesthetic agents were evaluated in chronically prepared conscious ewes between 86 and 141 days of gestation. Decreases in uterine blood flow (UBF) with increasing levels of anesthetic drugs were similar to those previously observed in nonpregnant ewes. A 25% decrease in UBF occurred at 7 micrograms of bupivacaine, 11.5 micrograms of 2-chloroprocaine, and 19.5 micrograms of lidocaine per milliliter of control UBF. Myometrial tonus did not change significantly except with bupivacaine where an increase occurred (P less than 0.001). These data indicate that local anesthetic agents may lower gravid UBF by a direct vascular effect and by stimulation of myometrial contractility. The possible clinical implications of these observations are discussed.

Anesthetics, Local↗
PubMed1979

Physiology and disease of the respiratory system in pregnancy. A review.

This review has attempted to describe the changes in respiratory physiology which occur during pregnancy and to use this knowledge to aid in the understanding of respiratory disease. Three forms of respiratory failure have been described and representative examples of each discussed.

Anesthesia, Obstetrical↗
PubMed1977

Regional training program of laparoscopy: impact on regional care.

In response to large numbers of requests for laparoscopic sterilization, the University of North Carolina began a training program to provide this service on a regional basis throughout the state. This report reviews the final distribution of centers providing these services: one within 50 miles of every person in the state. The clinical experience of 30 private physicians (excluding experience of residency training programs) was reviewed and found to parallel the national experience in provision of services, in complications, and in pregnancies. The brief but intense training program (2 days at the University of North Carolina and one morning at the physician's hospital) was found to result in rates of complications and failures similar to national levels of performance. Should the demand for laparoscopic sterilization increase in the coming years, the region has sufficient numbers of safely trained physicians to respond.

Female↗
PubMed1977

Ultrasonographic description of succenturiate placenta.

Postpartum hemorrhage may occur in cases of a retained succenturiate lobe. More catastrophic is rupture of the fetal vessels connecting the lobe to the placenta. A case is presented demonstrating the sonographic description of a large succenturiate lobe.

Adult↗
PubMed1976

Spring clip sterilization: one-year follow-up of 1,079 cases.

This is a report of 1,079 patients who underwent laparoscopic clip sterlization as of March, 1974. A one-year follow-up was obtained on 977 patients, or 90.5 per cent. Complications due to the clip technique appear limited to postoperative cramps for 24 to 48 hours in 26 per cent of patients. No ectopic pregnancies were detected. Pregnancies, when corrected for unsuspected existing pregnancies and surgical and manufacturing errors, occurred in 2 to 6 cases, for a method failure rate of 2 to 6/1,000. This report documents that experienced laparoscopists can perform this practice with local anesthesia, in combination with first-trimester abortion, and in hospital facilities other than an operating room.

Anxiety↗
PubMed1976

Ventilatory and blood gas changes during laparoscopy with local anesthesia.

A study was performed on a series of healthy patients undergoing laparoscopy for tubal ligation with local anesthesia in a non-operating room setting. Ventilatory parameters, blood gas, pH, blood pressure, and pulse were monitored. The results revealed that no adverse effect on hemoglobin saturation or carbon dioxide exchange were found when fentanyl alone was used as a supplementary analgesic. An occasional vagal reflex was observed, and it is recommended that an intravenous line be established in the event that pharmacologic intervention should become necessary. Nitrous oxide produced les with this minimal analgesia.

Adult↗
PubMed1975

Spring clip tubal occlusion: a report of the first 400 cases.

Between September 1972 and March 1974, laparoscopic tubal sterilization was performed on 394 patients with the use of a spring-loaded plastic clip under local analgesia and on an outpatient basis. Intravenous fentanyl and infra-umbilical infiltration and tubal spray with 1% lidocaine were found to be very acceptable and effective forms of analgesia. The average time spent by a patient in the hospital was 4 hours, 26 minutes. There was no major immediate complications apart from vasovagal reactions in 34 patients. Up to June 30, 1974, six patients in the series had become pregnant, not as a failure of the clip per se, but as a result of improper application of the clips. This seems to be a safe, simple, and effective method of female sterilization with great potentials of reversibility.

Adult↗
PubMed1975

Outpatient laparoscopic sterilization with therapeutic abortion versus abortion alone.

Records of 108 patients undergoing combined vacuum aspiration and laparoscopic sterilization in an outpatient surgical program were reviewed and compared with those of 195 patients who underwent abortion only in the same outpatient program. Mean operating time for the combined procedure was 30 minutes; total mean hospitalization time was 5 hours and 7 minutes. Complication rates for the combined procedure and for abortion alone were 9.2 and 7.2 per cent, respectively. Subsequent hospitalization was necessary for 4.7 per cent of patients undergoing the combined procedure and 3.1 per cent of those having abortion only. Laparoscopic sterilization has been found to add no significant morbidity but has markedly reduced cost and hospitalization for the patient desiring permanent contraception following first trimester abortion.

Abortion, Therapeutic↗