Biomedical subjects
J Templeton
Publications and source records attributed to J Templeton.
Major blunt abdominal trauma due to child abuse.
We reviewed 15 years' experience with childhood trauma at two hospitals in different cities, one a city hospital, the other a children's hospital, to learn the extent, circumstances, presentations, and consequences of major blunt abdominal trauma due to child abuse. Some 10,000 children admitted to these hospitals for treatment of injuries from 1972 through 1986 provided the basis for the study; the incidence and severity of pediatric trauma at the two hospitals was similar, in that 13% of the visits to both hospitals' emergency rooms were for trauma, of which 5% resulted in admission. Major blunt abdominal trauma due to child abuse accounted for 22 of these cases, six at the former, 16 at the latter, and represented less than 0.50% of all abused children seen at both institutions. The average age was 24 mo; 14 were boys and eight were girls. In only two instances was the family unit intact; in both, the child was abused by the babysitter. Otherwise, the father, or the mother's "boyfriend," was responsible. Overall mortality was 45%, and was related both to type of injury and presenting signs. Of one who presented with an epigastric mass due to a pancreatic hematoma, none died; the pseudocyst which subsequently developed resolved on bowel rest and TPN. Of three who presented with bilious vomiting due to duodenal hematoma, none died; one required operative evacuation. Of five who presented with peritonitis due to duodenojejunal rupture, one died; this child presented greater than 24 hr following injury in profound septic shock. Of three who presented with hypovolemia due to moderate hemorrhage, none died; the former two were managed conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Prenatal ultrasound diagnosis of thoracopagus conjoined twins.
Explore the source record for details and available documents.
Fluid resuscitation following liver laceration: a comparison of fluid delivery above and below the diaphragm in a pediatric animal model.
Liver laceration is the most common cause of mortality following blunt abdominal trauma in children. To determine the optimal route for volume expansion in the clinical setting of blunt abdominal injury, we compared the response to fluid resuscitation delivered above (Group 1) or below (Group 2) the diaphragm in a canine model of liver laceration. After induction of hemorrhagic shock by resection of 45% to 55% of the right median hepatic lobe followed by immediate closure of the laparotomy incision, we monitored pulse, arterial and venous pressures, urine output, pH, and lactate levels for three hours or until death. Physiologic and biochemical parameters did not differ significantly between the two groups; three of six (50%) of those receiving fluids through the external jugular vein and four of seven (57%) resuscitated through the femoral vein survived for three hours. Comparing survivors and nonsurvivors in both groups, those animals that lived for three hours maintained a higher pH, a greater urine output, and a lower serum lactate level. We conclude that the route of IV fluid administration does not affect the response to volume expansion; lactate levels, urine output, and pH provide valuable guides to the adequacy of resuscitation; and in appropriately resuscitated patients, even with serious liver lacerations, operative repair may be unnecessary except in the face of clinical or biochemical deterioration despite optimal fluid and blood replacement.
An animal model for the study of hemorrhagic shock from abdominal trauma in children.
Trauma is the most frequent cause of death in children over one year of age, and liver laceration secondary to blunt abdominal injury is frequently the major cause of hemorrhagic shock. In the current study, we have developed an animal model for the study of hemorrhagic liver lacerations in childhood. Using puppies six to 12 weeks of age, and three to nine kilograms in weight, we have been able to reliably produce shock (89%) without an excessive initial mortality rate (11%). The animals experienced a decrease in mean arterial pressure to 50% of the baseline level within 1.3 to eight minutes after the injury. This model will permit the study of various methods of resuscitation from blunt abdominal trauma in future experiments.
Joint report of the Third International Workshop of Canine Immunogenetics. II. Analysis of the serological typing of cells.
Using a standardized microlymphocytotoxicity assay, seven international laboratories evaluated 144 anti-dog lymphocyte antigen (DLA) sera in 319 mixed breed and 152 Beagle dogs. The workshop confirmed the serological definitions for DLA-A2, A3, A9; DLA-B4, B5, B6, B13; DLA-C11(Cwl); and C12(Cw2). Two new specificities were assigned to the DLA-A locus (Aw14 and Aw15) in only the mixed breed dogs. A third specificity (Cw3), was assigned to the DLA-C locus. The antigen and gene frequencies of these alleles differed between the two groups of dogs, but the frequencies of the "blank" were similar in both groups. Future international collaborations will be necessary to definite more completely the polymorphisms of the major histocompatibility complex (MHC) of the dog. Those efforts will benefit from the standard serological test established in this workshop.
Vascular injury associated with low-velocity dislocations of the knee.
Complete dislocation of the knee is a relatively rare condition. When it occurs as a result of high-velocity injury, such as in a road traffic accident, associated vascular injury is generally suspected. In low-velocity injuries, however, distal pulses are often maintained throughout, and the possibility of vascular injury may erroneously be discounted. We report four cases of low-velocity dislocation of the knee, only one of which had an overt vascular disruption, but three of which had arterial damage. On the basis of our experiences, we recommend arteriography in all cases of complete dislocation of the knee.
External fixation in contemporary fracture management.
Important advances have been made within the last two decades in the field of fracture management. The development of the AO internal fixation system and the advances in cast bracing techniques are but two of the improvements worthy of mention. It is, however, in the field of external fixation of fractures that the greatest advances have been made. This paper traces the history of external fixation up to the present day and discusses, with examples, the application of external fixation in the management of complex limb fractures.
Endogenous digitalis: current status and progesterone derivatives as candidates.
Explore the source record for details and available documents.
Joint report of the Third International Workshop on Lymphocyte Alloantigens of the Horse, Kennett Square, Pennsylvania, 25-27 April 1984.
The Third International Workshop on Lymphocyte Alloantigens of the Horse was held on 25-27 April 1984 in Kennett Square, Pennsylvania. Twelve laboratories from five countries participated. The principal purpose of this Workshop was to determine the phenotypic and gene frequencies of the 10 equine lymphocyte antigens (ELA) and a non-ELA lymphocyte antigen, ELY-2.1, in several breeds of horse. A total of 86 alloantisera characterized in previous workshops were tested against lymphocytes from 1179 horses. In addition, several experimental antisera were also tested against the same panel of lymphocytes. As a result of analysis of these data, the Workshop recognized two new equine lymphocyte alloantigens: W11 of the ELA system, and ELY-1.1, an antigen not linked to the ELA system.
Ultrasound evaluation of neck masses in children.
Neck masses in children are a frequent occurrence and in some instances create a diagnostic dilemma for the clinician. The authors' two-year experience using ultrasonography in the evaluation of 34 children with neck masses is reviewed. Twenty-two patients had lesions arising outside the thyroid gland; 12 lesions arose from the thyroid gland. Ultrasonography proved to be an accurate imaging modality for localizing the mass and demonstrating its relationship to the thyroid gland, trachea, and major neck vessels. The borders and extent of the lesions were well outlined, as well as their internal consistency. Based on this review, the authors recommend that ultrasonography be the first screening procedure in pediatric patients who present with perplexing neck masses.
Intraoperative ultrasound guidance for needle biopsy of a contralateral intrarenal "tumorlet" in a child with Wilms' Tumor.
Explore the source record for details and available documents.
Progesterone derivatives that bind to the digitalis receptor: effects on Na+,K+-ATPase and isolated tissues.
The steroid nature of the cardiac glycosides (CG) suggests that an endogenous steroid (or steroids) may be the natural ligand for the specific receptor site, i.e., Na+,K+-ATPase. Derivatives of progesterone (PROG) that compete in a [3H]ouabain radioreceptor binding assay (RRA) are characterized by 17 alpha-acetylation and modifications in the B ring. Chlormadinone acetate (CMA) is the most potent analog identified thus far, having about one-twentieth the RRA potency of ouabain. CMA interacts at the ouabain site on Na+,K+-ATPase, inhibits the enzyme in the same rank order of species sensitivity as do the CG, and inhibits the sodium pump in vitro in guinea pig atrium and perfused heart, cardiac myocytes, rat diaphragm, and red blood cells. CMA does not cross-react with digoxin antiserum, which indicates that CG antibodies are not necessarily directed at molecular determinants of biological activity. By crystallographic analysis, the 20-carbonyl moiety in CMA is seen spatially oriented so as to be equivalent to the lactone 23-oxygen atom in the CG. CMA exerts primarily cardiodepressant effects, in accordance with the often-reported similar action of PROG. Negative inotropy may be mediated other than by Na+,K+-ATPase because PROG itself has no significant CG-like actions. Positive inotropy by CG, cardiodepression by CMA and PROG or low concentrations of CG, occasional transient enhancement of contractility by CMA, and pump stimulation by low concentrations of CMA or CG may reflect different affinities of the compounds for sites that mediate Na+,K+-ATPase/pump inhibition, positive inotropy, and negative inotropy. Thus, PROG derivatives related to CMA appear to be likely candidates for endogenous digitalis-like hormones. Body tissues possess the enzymes for conversion of PROG to derivatives related even more closely than the semisynthetic CMA to the CG configuration.
Mobilization of canine hemopoietic stem cells by pyran copolymer (NSC 46015).
Pyran copolymer (NSC 46015), a divinyl ether maleic anhydride of broad spectrum molecular weight, was infused into six normal mongrel dogs. The effect on canine blood and bone marrow colony forming units in culture (CFU-C) was followed over an 11-day period. Significant elevation of circulating CFU-c was noted 2 days after pyran infusion; normalization occurred by day 7 postinfusion. Bone marrow CFU-C were decreased 2 days and 5 days after pyran administration. A further increase in circulating CFU-C was noted when pyran was administered twice, 5 days apart. The mobilizing effect of pyran copolymer appears promising enough to warrant further exploration of blood as a source of hemopoietic stem cells for transplantation purposes.
The impact of a private group practice of converting to an automated medical information system.
As hardware and software developments make medical information systems increasingly available to physicians office practices and outpatients facilities, there is a need to focus on systems installation and conversion issues. In addition to the detailed step-by-step implementation plan, the overall impact of the new system should be anticipated. The purchasers should consider such issues as new information flow and user communication patterns between patient care and ancillary and support departments; restructuring of fundamental approaches to work allocation for either batch or real-time systems; and new emphasis on any departments vital to problem-spotting and solving. At California Primary Physicians (CPP), an awareness of these changes did not develop until well after the official "live" data had passed and the staff had been successfully using the system for several months. This paper explains how the above issues have emerged and the impact they have had on CPP, and provides a framework for anticipating such matters in any system installation.
Perthes' disease--a long term follow-up.
Explore the source record for details and available documents.
Clostridium difficile in toxic megacolon.
Explore the source record for details and available documents.
Postoperative monitoring of myocardial oxygen tension: experience in 51 coronary artery bypass patients.
Following a preliminary feasibility report, polarographic monitoring of myocardial tissue O2 tension (Pmo2) in 51 coronary bypass patients has been accomplished. In this context, the influence of rapid atrial pacing (RAP), O2 inhalation, and intra-aortic balloon assistance (IAB) was statistically analyzed using Wilcoxon sign-rank and Student's t-tests. Electrodes were implanted in revascularized and nonrevascularized areas for comparison (24.0 +/- 1.1; and 26.3 +/- 1.8 mmHg Pmo2, p, not significant). Increasing myocardial O2 demand with RAP caused a 6% PmO2 drop (p less than 0.01). A 70% O2 inhalation increased Pmo2 by 30% (p less than 0.01). In 5 cases the benefit of IAB was confirmed by a 41% increase in Pmo2 (p = 0.02). These data support the clinical usefulness of polarographic Pmo2 as a measure of regional myocardial oxygenation. In addition to early recognition of intraoperative or postoperative graft failure previously reported, the efficacy of various therapeutic interventions can be more precisely determined.