Computerization of anesthesia information management: yet another application.
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Database Management Systems↗
Biomedical subjects
J M Feldman
Publications and source records attributed to J M Feldman.
Bronchial carcinoid tumors: a retrospective analysis of 126 patients.
From 1970 until 1990, 8,958 cases of primary carcinoma of the lung were diagnosed at the Duke University Medical Center. During the same period, 126 patients (mean age, 53 +/- 13 years) were diagnosed with bronchial carcinoid. The overall survival was 78% for 5 years and 71% for 10 years. Surgical treatment in 106 patients included pneumonectomy (15), lobectomy (63 with 9 bronchoplastic procedures), stapled wedge resection (22), and bronchoscopic laser resection (6). The method of diagnosis was chest roentgenography (121), chest computed tomography (77), mediastinal tomography (31), bronchoscopy (81), bronchoscopic brushing and washing (50), bronchoscopic biopsy (40), transthoracic needle biopsy (27), thoracotomy (100), and autopsy (5). Univariate analysis of the medical history, presenting signs and symptoms, diagnostic test results, and pathologic data predicted improved survival (p less than 0.001) for: female sex (n = 58), asymptomatic presentation (n = 47), normal serum serotonin or urinary hydroxyindoleacetic acid levels (n = 76), peripheral location of the primary tumor (n = 50), pathologic stage I or II (n = 91), negative lymph nodes (n = 80), primary tumor 2 cm or less in diameter (n = 67), and typical histology (n = 80). No significance (p greater than 0.1) was observed for age, smoking history, race, family history of carcinoid, environmental exposure, or hemoptysis. The most important factors affecting survival defined by multivariate analysis were (p less than 0.01) pathologic stage, atypical histology, and asymptomatic presentation. Bronchial carcinoid tumors are unique, making up 1% to 2% of primary lung neoplasms and having an excellent prognosis after resection with a 95% 5-year and 93% 10-year survival for pathologic stage I disease.
Analysis of Variance↗
Decentralization in cardiac services.
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Coronary Care Units↗
Asthenopia induced by computer-generated fusional vergence targets.
A questionnaire was used to evaluate asthenopia in 30 normal subjects (Ss). Then, each S experienced 3 min of continuous alternating convergent and divergent fusional vergence or a control condition which was identical to the experimental condition, but without any vergence demand, i.e., version. The stimulus was a computer-generated flat fusion red-blue anaglyph picture of a horse. The order of vergence and version conditions were randomized. Asthenopia measures and maximal fusional vergence ranges measures were repeated immediately after each condition. Results indicated a significantly higher rating of asthenopia after induced vergence than version. There were no differences in maximal fusional vergence ranges or recovery values after the two conditions. Correlations between pretreatment asthenopia scores and asthenopia scores after either induced vergence or version were also not significant. Post hoc analyses of Ss grouped as having either high or low asthenopia, according to baseline ratings, revealed no significant differences in vergence or version conditions. Alternative hypotheses for these results are presented.
Adult↗
Relative strength of central and peripheral fusion as a function of stimulus parameters.
We investigated the role of various stimulus parameters that influence motor fusion responses for peripheral as compared to central fusional stimuli. Results from the initial experiment indicated that a central stimulus equal in size to a peripheral fusion stimulus dominated the response independent of the amount of retinal eccentricity of the peripheral target. A second experiment indicated that the central stimulus dominated even when the peripheral stimulus was larger. However, when the peripheral stimulus was changed in shape so that it became an annulus surrounding the central stimulus, the peripheral stimulus was always stronger. In another phase of the experiment, we found that the extent to which a peripheral stimulus surrounded the central one determined which controlled the response. We concluded that the surrounding perceptual gestalt produced by the peripheral stimulus was the most significant variable determining the relative strengths of central and peripheral fusion stimuli. Clinical implications are discussed.
Adult↗
Iodine 131-labeled metaiodobenzylguanidine scintigraphy and biochemical analyses in suspected pheochromocytoma.
Detection of abnormal catecholamine levels and localization of tumor mass are important factors in the diagnosis and treatment of pheochromocytoma. Iodine 131-labeled metaiodobenzylguanidine scintigraphy was performed in 64 patients with suspected pheochromocytoma if their urinary catecholamine levels were borderline or elevated, or if the clinical suspicion for pheochromocytoma was high in spite of normal urinary catecholamine determinations. The 131I-metaiodobenzylguanidine scans were evaluated for abnormal localization of tracer. Twenty-four-hour urine collections were analyzed for vanillylmandelic acid, homovanillic acid, dopamine, epinephrine, and norepinephrine. Thirty of the 64 patients had pheochromocytomas. The 131I-metaiodobenzylguanidine scan had a sensitivity and a specificity of 88%. The 24-hour urine vanillylmandelic acid and norepinephrine measurements had the best sensitivity (97%), while the vanillylmandelic acid and homovanillic acid measurements had the best specificity (91%). In patients in whom the vanillylmandelic acid measurement and the 131I-metaiodobenzylguanidine scan were normal, no pheochromocytomas were found. In patients in whom the vanillylmandelic acid measurement and 131I-metaiodobenzylguanidine scan were abnormal, a pheochromocytoma was always present. The 131I-metaiodobenzylguanidine scan often documents the presence or absence of a pheochromocytoma and provides localization of the tumor in the preoperative evaluation of these patients.
3-Iodobenzylguanidine↗
Cardiac arrest after succinylcholine administration in a pregnant patient recovered from Guillain-Barré syndrome.
This report describes a parturient who, within 1 month of recovering from a neurologic deficit, suffered cardiac arrest secondary to succinylcholine-induced hyperkalemia. This patient's course may not apply to all patients with GBS because the diagnosis of GBS, although supported on clinical grounds, was not supported by conclusive, objective data. Furthermore, pregnancy, drug abuse, and malnutrition may have had a unique impact on her muscle physiology. Nevertheless, it is important to note that, in any patient who is recovering or has clinically recovered from a neurologic deficit, a normal neurologic examination does not ensure that succinylcholine-induced hyperkalemia will not occur. Although these patients should eventually not be susceptible to succinylcholine-induced hyperkalemia, current data do not support a specific recommendation of when succinylcholine would be safe.
Adult↗
Sequelae of attempted suicide by cyanide ingestion: a case report.
A twenty-eight-year-old man presented emergently after ingesting 800 mg of potassium cyanide in a suicide attempt. He survived only with intensive medical and psychiatric intervention, and went on to develop severe parkinsonian symptoms, including profound micrographia and hypersalivation. Bilateral, symmetrical basal ganglial abnormalities were demonstrated with magnetic resonance imaging. Survival following cyanide poisoning is rare; the clinical, radiologic, and neuropathologic sequelae in other documented cases are reviewed.
Adult↗
Diagnosis and management of pheochromocytoma.
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Adrenal Gland Neoplasms↗
Surgery in patients with unsuspected pheochromocytomas.
In four of the 37 patients operated on for a pheochromocytoma in the last 12 years at Duke Medical Center, the tumor was unsuspected. The first of the four patients had stable blood pressure and pulse during the operative and postoperative period. Although the second patient was thought to have a normal response to surgery, in retrospect her blood pressure showed significant variation. In contrast, the other two patients had wide variations in blood pressure and pulse during the operative and postoperative period. Electron microscopy of the tumor demonstrated numerous dense-core neurosecretory granules suggestive of pheochromocytoma in all four patients. In three of the patients in which measurements could be made, there was a high concentration of norepinephrine (NE) in the tumors that was diagnostic of a pheochromocytoma. Although tissue from the fourth patient was not available for biochemical analysis, his urine and blood tests as well as his ultimate demise from the tumor confirmed that he had a malignant pheochromocytoma. Based on a negative chromaffin reaction--which might be anticipated in a NE-containing pheochromocytoma--one of the patients with the smooth operative course was incorrectly diagnosed as an adrenocortical adenoma. We conclude that although patients with unrecognized pheochromocytomas do not inevitably have wide swings in blood pressure during surgery, this cannot be predicted in a given patient. Thus one should carefully evaluate all patients with suspicious retroperitoneal or intraabdominal masses for possible pheochromocytomas prior to resection of the masses.
Abdominal Neoplasms↗
Carcinoid tumors and the carcinoid syndrome.
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Adolescent↗
Anesthesia during total electrical failure, or what would you do if the lights went out?
This case report describes anesthetic management and monitoring of a patient undergoing abdominal surgery during a 45-minute loss of electrical power. Physical examination, electrical devices with battery backup power, and mechanical devices provided essential monitoring of the patient. Other methods of ensuring the adequacy of ventilation, circulation, and monitoring during total electrical failure are discussed. To decrease the risk during power outages, the authors recommend the following: (1) preparation of an organized plan for such an event that includes ensuring that equipment has reliable backup sources of power; (2) proper maintenance of equipment and batteries; and (3) knowledge of the power requirements of anesthesia equipment and monitoring devices.
Adult↗
Comparison of fusional ranges measured by Risley prisms, vectograms, and computer orthopter.
Maximum base-in (BI) and base-out (BO) fusion vergence ranges were measured in 38 normal subjects using 3 different clinical procedures. These procedures used different instruments, instructions, and vergence stimuli (Risley prisms, vectograms, and video-displayed contour and random dot stereograms) presented at 50.8 cm. Test-retest measures, which were taken on each test for each subject, indicated high positive correlations between test and retest measures for most vergence tests. Paired inter-test correlations among five different tests varied as a function of the pairing as well as type of measure taken (BI, BO, break, recovery). It was concluded that different methods of measuring vergence provide different kinds of information and such tests may not be used interchangeably.
Adolescent↗
Carcinoid tumors: iodine-131 MIBG scintigraphy.
Eighty-two patients with pathologically proved carcinoid tumors were examined with iodine-131 metaio-dobenzylguanidine (MIBG) scintigraphy. Localization scores of I-131 MIBG accumulation in the primary tumor or metastatic site ranged from 0 to 3+ on the basis of comparison with normal liver. I-131 MIBG uptake varied greatly in different patients with carcinoid tumors. The localization scores in known tumor sites were related to the location of the primary tumor in the stomach (1-3+ in two of five patients), pancreas (1-3+ in four of five patients), cecum (3+ in two of two patients), appendix (0 in one of one patient), jejunum (0 in one of one patient), Meckel diverticulum (3+ in one of one patient), terminal ileum (2-3+ in 19 of 28 patients), bronchus (3+ in one of nine patients), thymus (1+ in one of two patients), and unknown (2-3+ in 18 of 28 patients). Tumors of midgut origin concentrated I-131 MIBG more frequently than those of foregut origin. Uptake of I-131 MIBG was more likely if neurohumor levels, particularly serum serotonin, were elevated. There was no relationship of I-131 MIBG uptake to carcinoid syndrome. I-131 MIBG is useful in the determination of the location and extent of some carcinoid tumors, particularly those of midgut origin.
3-Iodobenzylguanidine↗
Detection and treatment of carcinoid tumors.
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Carcinoid Tumor↗
Biochemical and ultrastructural differences between muco-epidermoid and carcinoid tumors of the bronchus.
Bronchial adenomas have been classified into three types: carcinoid tumors, cylindromas (adenoid cystic carcinomas), and mucoepidermoid tumors. Studies from our laboratory have demonstrated that the quantitative measurement of monoamine oxidase (MAO) in homogenates of carcinoid tumors of foregut origin is different than the activity enzymes in other tumors of neural crest origin. In this study we compared the biochemical composition of 12 bronchial carcinoid tumors with the biochemical composition of a rare mucoepidermoid adenoma of the bronchus. Electron microscopy revealed that some cells of the mucoepidermoid adenoma contained mucin and tonofilaments; none of the cells contained neurosecretory granules. The MAO activity of the bronchial carcinoid tumors was much higher than the MAO activity of the mucoepidermoid adenoma. Thus, there are distinctive ultrastructural and biochemical differences in these two types of bronchial adenomas.
Adenoma↗
Effect of the monoamine oxidase inhibitors clorgyline and pargyline on the hyperphagia of obese mice.
Obese-hyperglycemic mice (genotype ob/ob) have higher levels of hypothalamic norepinephrine than their normal-weight litter mates. Brain, as well as some other tissues, contains two types of monoamine oxidase (MAO). In this study we evaluated the effect of administering the Type A MAO inhibitor clorgyline (clorg) and the Type B MAO inhibitor pargyline (parg) on food intake. Acute administration of clorg/parg caused a temporary 50-90% decrease in food intake in normal mice, rats, golden, and Chinese hamsters, but did not alter the food intake of obese mice. To determine if alterations in the concentration of brain monoamines played a role in the effect of clorg/parg on food intake in mice, we determined the concentration of serotonin, dopamine, and norepinephrine in their cerebral cortex and hypothalamus after clorg/parg administration. When compared to normal mice, obese mice had a greater concentration of serotonin in their cerebral cortex and norepinephrine in their hypothalamus. As the obese mice had an equal or even greater increase in hypothalamic serotonin and norepinephrine concentration after clorg/parg administration than the normal mice, it is not likely that increased hypothalamic monoamines are responsible for the decreased food intake produced by clorg/parg administration. Obese and normal mice were treated with weekly injections of clorg/parg from 7 to 19 weeks of age. Clorg/parg produced a persistent 12% decrease in food intake and weight in obese, but not normal mice. Although the medication was discontinued at 19 weeks of age, the decrease in food intake and weight of the obese mice persisted until the time of sacrifice at 31-35 weeks. The combination of clorg/parg had a more profound effect on in vivo and in vitro MAO activity than equivalent amounts of the individual MAO inhibitors. Other anorectic agents such as D-amphetamine and fenfluramine had only a trivial in vitro effect on MAO activity.
Animals↗