Biomedical subjects
Publications and source records attributed to M Chapman.
Hypercalcemia developed in our teen-aged patient after extended immobilization for a femoral fracture. In all patients immobilized from whatever cause, both blood pressure and serum calcium should be monitored. Since both the hypertension and hypercalcemia respond well to mobilization, every effort should be made to encourage activity as soon as possible.
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A distinction is made between functional and intentional control in parent-child interaction. These concepts are drawn, respectively, from operant and cognitive models of interaction process. Experimental evidence is presented that cognitive factors such as expectations or hypotheses indeed affect the relations between parents and their own children. This necessitates a further distinction between long-term and short-term causal effects: Since changes in parents' expectations for their children may lag behind actual changes in children's behavior, short-term effects inferred from observations of ongoing interactions may not reflect the long-term dynamics of the relationship.
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Until recently, certain Eskimo groups were reported to practice female infanticide in the belief that the time spent suckling a girl would delay the mother's next opportunity to bear a son, males being preferred to females because of their future role as providers in a hunting economy. From sex ratios in census data, rates of female infanticide of up to 66% for some groups have been inferred, leading some ethnographers to conclude that these groups were headed for extinction. Eskimo beliefs regarding the effects of infanticide on fertility, however, are in accord with the results of research on the relation of fertility and lactation: The cessation of lactation following infanticide would significantly shorten the expected interval until the next birth. Given this fact and available field data regarding the parameters of Eskimo population growth, the present computer simulation indicates that Eskimo populations could sustain a rate of 30% female infanticide and still survive. Higher reported rates are explained as the combined result of female infanticide plus the tendency of ethnographers to overestimate the ages of juvenile females relative to juvenile males.
Ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP) were performed in 216 patients with known or suspected pancreatic disease. Both techniques provided accurate information in all groups of patients (normals and those with recurrent acute pancreatitis, chronic pancreatitis, and cancer), and there were no complications. Ultrasound scans gave more information concerning pseudocysts and were more often abnormal than pancreatograms in patients with recurrent acute pancreatitis. It is concluded that the combination of ultrasonography and ERCP constitutes a comprehensive diagnostic approach to patients with upper abdominal problems. The roles of other diagnostic tests for the pancreas, such as computed tomography, isotope scanning, function tests, and angiography, are also discussed briefly.
Gall-bladder stones may be missed on conventional biliary radiology and grey-scale ultrasonography. Patients with unexplained pains and recurrent pancreatitis are increasingly being referred for endoscopic retrograde cholangiography and pancreatography (ERCP). Two cases are presented to illustrate the importance of taking delayed films of the gall-bladder.
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Corrective osteotomy of the long bones may be required in patients with Paget's disease. Experiments on rabbits suggest that the safety of the procedures is of concern while the patient receives Calcitonin. Twenty-four rabbits were divided into 4 groups of 6 animals. Half of each group received maintenance doses of Calcitonin subcutaneously. In all animals the left and right ulnae were osteotomized through middiaphysis. The right ulna was fixed with a "mini" dynamic compression plate. The left ulna was not immobilized. Each group of animals was sacrificed at successive intervals of 3 weeks. Histologically, no difference was found in the healing of the fracture of test or control animals. Radiographically, the fracture line persisted longer in animals receiving Calcitonin (6 weeks vs 3 weeks). All fractures healed by 9 weeks. The fracture line disappeared more rapidly in all the immobilized bones. Based on these observations, administration of Calcitonin is not a contraindication for corrective osteotomy in Paget's disease. Osteotomies should be rigidly fixed to maintain the correction achieved surgically until healing is established.
Twenty-eight unstable four-part intertrochanteric fractures in 27 elderly patients with severely osteoporotic femurs were treated by means of internal fixation (commonly the 130 or 95 A.O. blade plate) in combination with methylmethacrylate. Of the 28, ten patients with eleven fractures were recalled and reexamined; 12 had died; five were lost to followup (1 1/2-8 1/2 years) at the time of this review but sufficient documentation existed for their inclusion. There were no deep wound infections. We did not encounter any hypotension during surgery or as a result of the methylmethacrylate. One patient developed a pulmonary embolus 5 days postoperation and responded well to anticoagulant therapy. There were three failures; one femoral shaft fracture at the plate end, one nonunion, both requiring total hip replacemens, and the third failure was due to malreduction of fracture and was later revised. Where bone fragments were in contact, union occurred rapidly and the presence of cement did not interfere with bone union in any way. The patients were pain free and began full weight bearing the day after surgery.
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Thirty-eight patients who presented with diabetes and a changed state of consciousness satisfied the criteria for lactic acidosis. Sixteen patients were non-ketotic, and 15 of these were receiving phenformin on admission. In all but one of these 15 patients, however, additional renal or cardiovascular abnormalities, or both, could be identified, which supported a multifactorial aetiology for lactic acidosis. Advanced age and cardiovascular and renal disease are absolute contraindications to the use of phenformin in diabetics.
Using an experimental insulated duodenoscope and a diathermy wire, papillotomy has been performed on 10 patients under diazepam sedation. Seven patients had common bile duct stones (6 following cholecystectomy) and 3 had papillary stenosis. Nine of the patients had severe medical or surgical contraindications to further operative treatment. Papillotomy was successful in all patients, with no significant bleeding or other complications. Repeat endoscopy 6-14 days after papillotomy demonstrated a healed biliary orifice of 7-10 mm diameter. Stones had already passed in 3 of the 7 patients; in 2 others, stones were extracted using balloon catheters or Dormia type baskets. Two larger stones could not be removed; in one of these patients the stone and basket became impacted at the papilla and had to be removed surgically 2 days later. Endoscopic papillotomy is an acceptable alternative to surgery in high risk patients, particularly in the treatment of retained common bile duct stones. If long term results prove satisfactory, the technique will have wider application.
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