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Biomedical subjects

J S Huff

Publications and source records attributed to J S Huff.

At least 19 recordsLinked to original sources
PubMed1998

A multicenter study to improve emergency medicine residents' recognition of intracranial emergencies on computed tomography.

STUDY OBJECTIVE: Cranial computed tomography (CT) has assumed a critical role in the practice of emergency medicine for the evaluation of intracranial emergencies. Several recent studies have documented a deficiency in the emergency physician's ability to interpret these studies. The purpose of this study was to quantify the baseline ability of emergency medicine residents to interpret cranial CTs, and to test a novel method of cranial CT interpretation designed for the emergency physician in training. METHODS: A standardized pretest was administered to assess baseline ability to interpret CT scans. A standardized posttest was given 3 months after the course. Each test consisted of 12 CT scans with a short accompanying history. All scans were validated by 3 expert reviewers for difficulty and diagnosis. A 2-hour course based on the mnemonic "Blood Can Be Very Bad" was then administered. "Blood" reminds the examiner to search for blood, "Can" prompts the examiner to identify 4 key cisterns, "Be" denotes the need to examine the brain, "Very" prompts a review of the 4 ventricles, and finally "Bad" reminds the examiner to evaluate the bones of the cranium. RESULTS: Eighty-three residents at 5 institutions were initially examined. The mean percentage correct before the course was 60% (95% confidence interval [CI] 58%-64%) on the standardized pretest. At retesting 3 months after the course, the accuracy rate increased to 78% (n=61, 95% CI 75%-81%, P<.001 paired t test). CONCLUSION: Emergency medicine residents are deficient in their ability to interpret cranial CT scans. A novel educational course was demonstrated to significantly improve this ability.

Adolescent↗
PubMed1998

New-onset sensory loss or alteration.

New-onset sensory loss often poses a problem for emergency physicians because of the vast array of potential causes for this condition and the imprecision patients display in explaining their condition. This article reviews potential causes of particular interest to the emergency physician and illustrates approaches to sensory alteration complaint with case studies.

Acute Disease↗
PubMed1998

The use of the mini-mental status examination in the ED evaluation of the elderly.

This study was done to examine the impact of the mini-mental status examination (MMSE) in the emergency department (ED) evaluation of the elderly patient. The study was a prospective study of the MMSE applied by the investigators with a comparison to the findings of the treating physician, in a university hospital ED with annual volume of 60,000. Participants were a convenience sample of patients older than 65 years of age without apparent mental status abnormality presenting to the ED. Seventy-four patients were entered in the study with 43 exclusions (23 with low educational level, 5 with Glasgow Coma Scale score of <15, and 15 other) leaving 31 cases for analysis. Of the 31 patients, 20 patients had an MMSE score of <24. The MMSE findings agreed with the treating physicians' assessments in 21 (67%) cases. Disagreement occurred in 10 (32%) cases in which the treating physician believed that both the patient's mental status and results of the investigator's MMSE were normal; these 10 cases all involved low MMSE scores as performed by the investigator. When informed of the abnormal MMSE, both the physician's estimate of the patient's mental status and the patient's ED course were altered in all cases. These results show that the MMSE is a valuable screening tool to assess the mental status of the elderly in the ED setting. Unexpected abnormality was noted in a significant minority of patients in this study, altering the patient's course in all instances. The MMSE should be considered in evaluation of all geriatric patients encountered in the ED.

Aged↗
PubMed1998

Comparison of peak expiratory flow rate with speaking time in ED patients presenting with acute exacerbation of asthma.

Thirty-six patients with a history of asthma who presented to an emergency department (ED) with an acute exacerbation were studied prospectively to determine if a correlation existed between peak expiratory flow rate (PEFR) and speaking time. Each patient listened to an instructional audiotape on the proper method of counting and then maximally inhaled and counted until it became necessary to take a second breath. This represented the patient's "speaking time" in seconds. A PEFR was then obtained using a hand-held peak flow meter. The speaking time and PEFR were measured before and after each nebulized albuterol treatment. A total of 169 pairs of pretreatment and posttreatment PEFR and speaking time measurements were obtained. Regression analysis of the PEFR and speaking time demonstrated the PEFR can be predicted by the speaking time with statistical significance (P < .0001). The regression analysis equation was: peak flow (L/min) = 114.8 +/- (17.6 x speaking time).

Adolescent↗
PubMed1998

Selective role of partial XI-VII anastomosis in facial reanimation.

OBJECTIVES: Review techniques available for transposition of an alternative motor neuron if end-to-end anastomosis or interposition nerve grafting cannot be accomplished when there has been a complete facial nerve loss. Describe the selective use of a partial spinal accessory-facial nerve anastomosis and highlight cases when this may be a useful alternative. Describe the modifications of decompression of the facial nerve for tension-free anastomosis and the use of the muscle pedicle for repair of cerebrospinal fluid leakage. STUDY DESIGN: Report of three cases and a review of the literature. METHODS: Charts were reviewed and indications for the procedure were analyzed. The degree of facial movement was recorded as well as the resolution of any cerebrospinal fluid leak. RESULTS: The results varied between Class III and Class IV on the House-Brackmann scale following initial complete paralysis. In the two cases in which spinal fluid leakage had occurred before surgery the leakage was resolved. No donor site morbidity was noted. CONCLUSIONS: The potential of low morbidity associated with the use of the sternocleidomastoid branch, along with the potential for delivering a vascularized muscle pedicle to the temporal bone region, makes selective use of this procedure a valuable addition to the multiple reconstruction options for the paralyzed face.

Accessory Nerve↗
PubMed1995

Hemiballismus as a presenting sign of hyperglycemia.

A 53-year-old man arrived at the emergency department after the onset of progressive hemiballismus. This movement disorder was the only manifestation of his hyperglycemic state. Prompt recognition of the association of unusual movement disorders with nonketotic hyperglycemia will allow for prompt treatment.

Blood Glucose↗
PubMed1995

Case conference: complete heart block in a young man.

A previously healthy 32-year-old man presented to the ED in complete heart block. Ischemic, infectious, and inflammatory conditions were considered in the differential diagnosis. Management options for complete heart block, the etiology of heart block in young adults, and treatment guidelines are reviewed.

Adult↗
PubMed1990

Acute mannitol intoxication in a patient with normal renal function.

A young, previously healthy patient with multiple trauma mistakenly received 400 grams of mannitol over a 3-hour period. The laboratory report of hyponatremia prompted treatment with hypertonic saline before the hyperosmolar state was recognized. The osmolal gap was 118. Mannitol intoxication in a patient without preexisting renal failure is unusual. Identification of an abnormal osmolal gap and recognition of the hyperosmolar state is discussed.

Accidents, Traffic↗
PubMed1986

High-frequency jet ventilation cooling in a canine hyperthermia model.

A study was undertaken to evaluate high-frequency jet ventilation (HFJV) as an adjunct for the treatment of heatstroke. Eleven mongrel dogs were anesthetized, shaved, and externally heated until core temperature reached 43 C (109.4 F). Control animals (n = 6) were cooled passively in room air. Treatment animals (n = 5) were cooled with the addition of HFJV using a flow-interrupter, high-frequency jet ventilator with a rate of 200, a driving pressure of 40 psi, and an inspiratory to expiratory ratio of .5 to deliver room air. Temperatures were measured in brain, pulmonary artery, rectum, and subcutaneous tissue of the chest wall. Serial arterial blood gases, cardiac outputs, and mean arterial pressures were measured at baseline, maximal heating, and at .5, 1, 2, and 12 hours after heating. Animals were sacrificed 12 hours after heatstroke induction. Cooling rates for brain, pulmonary artery, and rectum achieved in the HFJV group were 1.7 times faster than those for the control group (P less than .05), although slower than previously reported cooling rates with gastric and peritoneal lavage. A higher PO2, a lower PCO2, and a more physiologic pH was maintained in the HFJV group than in the control group at 30 and 60 minutes after onset of cooling (P less than .05). Gross and histopathologic examination showed characteristic changes of heatstroke in both groups; no deleterious findings could be attributed to the use of HFJV itself. HFJV warrants clinical investigation as an adjunct for treatment of hyperthermia.

Animals↗
PubMed1984

Giant granular cell tumor of the suprasellar area: immunocytochemical and electron microscopic studies.

We describe a case of a granular cell tumor (GCT) of the suprasellar region with an 11-year history in a 26-year-old woman. The computed tomographic scan showed a midline, contrast-enhancing, noncalcified mass. The biopsy was diagnosed as GCT. The tumor was treated with radiation therapy. At necropsy, a large, homogeneous GCT surrounded by gliosis was found. The tumor cells were filled with granules positive for periodic acid-Schiff, diastase-resistant. The cells did not contain glial fibrillary acidic protein or S-100 protein. Electron microscopy showed tumor cells filled with innumerable lysosomal structures. No intermediate filament was found within the cytoplasm. The tumor cells were not surrounded by a basement membrane. Based on this study and on our review of the literature, the suggestion that GCT has a multicellular origin is upheld.

Adult↗