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Biomedical subjects

M M Coleman

Publications and source records attributed to M M Coleman.

15 recordsLinked to original sources
PubMed1999

Back pain and collapse associated with receding subarachnoid blockade.

PURPOSE: Back pain and sudden loss of consciousness during recovery from spinal anesthesia are rare. Severe pain may raise fears of serious neurological damage and result in inappropriate management. Bladder distention may present in this way and clinicians should be alert to this possibility and communicate this to nursing staff. CLINICAL FEATURES: A lumbar spinal anesthetic was performed during a volunteer study, using 15 mg hyperbaric bupivacaine in a healthy 31 yr old man. During recovery, five hours later, as the block regressed to the L1-2 level, he complained of acute, severe back pain and briefly lost consciousness secondary to profound bradycardia. Bladder cathetherization yielded 900 mL urine with immediate and complete relief of symptoms. CONCLUSION: Severe pain secondary to bladder overdistention in the presence of neuroaxial blockade may be referred to the thoracolumbar area, mediated by intact sympathetic afferents. As the saccral parasympathetic supply remains paralyzed, there is no subjective sensation of bladder stretching. If untreated, bladder distention can lead to excessive supraspinal parasympathetic outflow resulting in vasovagal syncope.

Adult↗
PubMed1999

Quantitative comparison of leakage under the tourniquet in forearm versus conventional intravenous regional anesthesia.

UNLABELLED: We compared the quantitative leakage between forearm and conventional IV regional anesthesia (IVRA). Forearm IVRA remains unpopular because of the theoretical risk of local anesthetic leakage through the interosseous vessels. IVRA was simulated on the forearm or arm during two separate, randomized sessions using a double tourniquet in 14 volunteers. A radiolabeled substance, DISIDA (99m Tc-disofenin) with a structure similar to lidocaine, was injected instead of local anesthetic. Volumes of 0.4 mL/kg (maximum 25 mL), were used for forearm IVRA and 0.6 mL/kg (maximum 45 mL) for conventional IVRA. A gamma camera recorded radioactivity levels in the limb distal to the tourniquet every 30 s while the tourniquet was inflated (25 min) and for 20 min postdeflation. The leakage of radiolabeled substance during inflation was similar in both groups, 6%+/-12% (mean +/- SD) from the forearm and 10%+/-20% from the upper arm. After deflation, mean loss of radioactivity was higher in conventional IVRA, 70%+/-7% vs 57%+/-11% and 82%+/-5% vs 69%+/-11% at 3 and 20 min, respectively (P < 0.001). We conclude that forearm IVRA results in tourniquet leakage comparable to conventional IVRA and is potentially safer because the required dose of local anesthetic is smaller. IMPLICATIONS: Using a tourniquet on the forearm for IV regional anesthesia does not increase the risk of drug leakage. This is potentially a safer technique compared with conventional IV regional anesthesia because a much smaller dose of local anesthetic is required.

Adult↗
PubMed1995

Regional comparisons of child abuse and related variables in the United States.

The objective of this article is to familiarize the health care professional with 1990 national data on child abuse and to review some of the trends reported in the literature. The United States was divided into Northeast, Midwest, South, and West. Data were collected, analyzed, and transformed to calculate the incidence and types of abuse reported by region. Variables of interest were income, marital status, perpetrator, age of victim, and drug use by region. To determine significant differences among regions for each type of abuse and related variable, frequency distributions were calculated and chi-squared tests were used. State data summaries were measured for correlation analysis. The West was highest in reported incidence of child abuse (5.9%) and, specifically, physical abuse (36.7%). California reported 55% of the physical abuse in the West. In all regions, neglect and physical maltreatment were reported more than sexual and emotional abuse. The incidence of neglect in the south (52.8%) was greater than in any other region and did not correlate to income in this region. Early detection of child abuse can aid in preventing fatalities. This information should increase awareness of child abuse and result in an increase in reporting if abuse is suspected.

Adolescent↗
PubMed1995

Genetic variation in the COL6A1 region is associated with congenital heart defects in trisomy 21 (Down's syndrome).

Genetic variation in the COL6A1-COL6A2 gene cluster on chromosome 21 was studied in 113 controls and 58 European families (including control and family subgroups of British/Irish origin) having a child with trisomy 21. There were statistically significant differences among subgroups of trisomic children with and without congenital heart defects (CHD) in distributions of definitive, 3-RFLP haplotype classes received from their nondisjoining and disjoining parents. Haplotypes received by trisomic children with CHD from their disjoining parents were not a random sample of controls' haplotypes. Analysis of parental single-RFLP genotypes and linkage disequilibrium patterns confirmed this parent subgroup differed from a random sample of controls. There were no significant differences in parent subgroup genotype distribution at any of nine control loci distributed along chromosome 21q. This sample showed an association between genetic variation in the COL6A1 gene region and congenital heart defects in trisomy 21.

Adolescent↗
PubMed1994

Unusual genotypes in the COL6A1 gene in parents of children with trisomy 21 and major congenital heart defects.

Collagen type VI is a candidate for a role in the pathogenesis of congenital heart defects (CHD) in Down's syndrome. Three restriction fragment length polymorphisms of the COL6A1 gene were used to determine COL6A1 genotypes in 50 families of affected children with trisomy 21 (29 with congenital heart defects and 21 without) and 37 unrelated volunteers. We found seven unusual genotypes in the parents of affected children with Down's syndrome, five being unique to the parents of children with trisomy 21 and CHD. There were no unusual genotypes associated with other chromosome 21 loci. No single COL6A1 genotype was associated with CHD. Thus, the unusual genotypes unique to parents of affected children suggest that genetic variation in the COL6A1 gene region contributes to the pathogenesis of CHD in Down's syndrome.

Child↗
PubMed1993

Meiotic crossing-over in nondisjoined chromosomes of children with trisomy 21 and a congenital heart defect.

We have used DNA polymorphisms to study meiotic crossovers of chromosome 21q in 27 nuclear families. Each family had a child with Down syndrome and a congenital heart defect. Twenty DNA polymorphisms on chromosome 21 were used to determine parental and meiotic origin of nondisjunction and to identify crossovers. Twenty-four cases were of maternal origin, and three were of paternal origin. Twenty-two unequivocal crossover events were identified. Sixteen crossovers were observed in 22 chromosome pairs nondisjoining at the second meiotic division. Fifty percent of crossover events in MI nondisjunction are detectable by molecular genetic means. Thus, the results suggest that, in this sample, each nondisjoined chromosome 21 pair has been involved in at least one crossover event.

Adolescent↗
PubMed1974

Jaw goniometer.

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

Strategic risk management: reducing malpractice claims through more effective patient-doctor communication.

Many malpractice suits are brought not because of malpractice nor even because of complaints about the quality of medical care but as an expression of anger about some aspect of patient-doctor relationships and communications. The theory presented is that under the stress of anxiety and physical illness, some patients regress to childhood needs; physicians are not generally trained to fill such needs. Thus, these patients, angry because of this, express their anger in malpractice suits. This theory has been taught to physicians and medical students as part of a physician continuing medical education (CME) seminar on Loss Prevention/Risk Management through demonstration of active-listening techniques to seminar participants. Physicians who understand and can respond appropriately to the emotional needs of their patients are less likely to be sued. This may also translate into a more fulfilled practice of medicine by those physicians who are most aware of the importance of a positive relationship.

Anger↗