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Biomedical subjects

M Stockwell

Publications and source records attributed to M Stockwell.

16 recordsLinked to original sources
PubMed2001

Is couple therapy indicated for borderline personality disorder?

The healing aspects of intimate relationships are being recognized by therapists and supported by empirical findings. Little has been written regarding the indications for couple therapy for individuals with borderline personality disorder. This paper proposes a three-level hierarchy for deciding on the suitability of couple therapy for patients with borderline personality disorder. The hierarchy is based on three separate borderline behavioral clusters--impulsive, identity, and affective--that should be utilized to direct the application of couple therapy to specific patients. The three levels are illustrated by case examples. Delineation of the indications for couple therapy for borderline patients will foster further theoretical and empirical work in the area.

Adult↗
PubMed2000

Respiratory failure due to the combined effects of transdermal fentanyl and epidural bupivacaine/diamorphine following radical nephrectomy.

The transdermal therapeutic system (TTS) fentanyl has been designed for rate-controlled drug delivery. When the system is applied, a fentanyl depot concentrates in the upper skin layers. Plasma concentrations are not measurable until 2 hours after application, and it takes an 8-16 hr latency period until full clinical fentany effects are observed. Following removal, serum fentanyl concentrations decline gradually and fall to about 50% in approximately 16 hours. We report the case of a 77-year-old man with a history of severe arthritis, who was receiving transdermal fentanyl and developed respiratory failure after starting epidural diamorphine/bupivacaine for postoperative pain relief following radical nephrectomy.

Administration, Cutaneous↗
PubMed1995

Superior laryngeal nerve block: an anatomical study.

Superior laryngeal nerve anaesthesia is frequently used to facilitate endotracheal intubation in the awake patient. We have modified the transcutaneous approach to this nerve block to employ a short bevel needle. This improves tactile perception in performing the procedure thus simplifying identification of the correct depth of injection. This study was designed to determine the anatomical basis of superior laryngeal nerve anaesthesia and to estimate the success rate using our modified technique. At autopsy, 20 cadavers had nerve block performed substituting 0.02% methylene blue for local anaesthetic. Dissection was then performed to identify the anatomical structures stained by the simulated local anaesthetic. Additional dissections were performed in formalin-fixed cadavers. We found that the dye was injected into the paraglottic space bounded laterally by the thyrohyoid membrane and thyroid cartilage, medially by the laryngeal submucosa, caudad by the conus elasticus, cephalad by the hyoid bone, and anteriorly and posteriorly by the anterior and posterior thyrohyoid ligaments, respectively. The internal laryngeal nerve, the sensory branch of the superior laryngeal nerve, passed through this compartment and was heavily stained with simulated local anaesthetic. Resistance to the passage of the short bevel needle was provided by the lateral glossoepiglottic fold, not the thyrohyoid membrane as we had expected. Of 40 injections, 39 were deemed successful for a success rate of 97.5%. We conclude that this is a simple and highly successful technique for performing superior laryngeal nerve anaesthesia.

Cadaver↗
PubMed1995

Superior laryngeal nerve blockade and inspiratory resistive load detection in normal subjects.

The site for detection of added inspiratory resistive loads is unknown, but recent evidence suggests that the airways may play an important role. The aim of this study was to discern whether the larynx has an important independent role in conscious detection of added inspiratory resistive loads. A randomized double-blind placebo-controlled study of the effect of superior laryngeal nerve blockade on inspiratory resistive load-detection threshold was carried out in 12 normal subjects (7 women; mean age 27.5 yr; range 18-45 yr). Baseline (preinjection) detection thresholds were similar on the lidocaine [0.58 +/- 0.16 (SE) cmH2O.l-1.s] and saline (0.53 +/- 0.12 cmH2O.l-1.s; P = 0.28) days. There was no significant difference in load-detection thresholds after injection between lidocaine (0.60 +/- 0.15 cmH2O.l-1.s) and saline (0.55 +/- 0.10 cmH2O.l-1.s; P = 0.68). Thus, the larynx does not appear to be an important independent airway site for conscious inspiratory resistive load detection.

Adolescent↗
PubMed1994

An innovative model of system-linked community care: home-based traction as an alternative to institutional treatment.

Home-based traction is an alternative treatment to conventional hospital-based traction for children with orthopedic conditions such as congenital dislocated hip and Legg-Perthes disease. The application of a proposed theoretical model is used to describe the process of the home-based traction innovation. Creativity and innovation occasions a reconceptualization of stresses. The reconceptualization of stress, plus the operational support of coordinated in-home services, can help families and nurses in the community and in the hospital develop, implement, and evaluate this kind of innovative care. In applying the home-based traction professionals empower and legitimize parents as resourceful co-providers of care. The legitimizing of the alternative in-home service affords parents a more optimistic appraisal of their situation as manageable. Parents are free to develop a coordinated response to their overall circumstance, including the treatment of their one child's illness. The evaluation of this home-based traction example found the alternative to be acceptable, safe, effective in accomplishing treatment goals, and less expensive than conventional hospital-based traction.

Adult↗
PubMed1993

Lack of importance of the superior laryngeal nerves in citric acid cough in humans.

The relative importance of laryngeal afferents in the cough reflex in humans is unknown. This study was designed to investigate the importance of superior laryngeal nerve afferents in the cough reflex induced by inhaled nebulized citric acid in awake humans. Nine healthy volunteers had their cough thresholds to inhaled nebulized citric acid measured after superior laryngeal nerve conduction blockade and after a sham nerve block. Of the nine subjects, four showed no change in cough threshold after superior laryngeal nerve anesthesia, three showed increased cough threshold after nerve block compared with no block, and two showed decreased cough threshold after nerve block. The geometric means of the cough thresholds for the nerve block vs. sham block tests were 16 +/- 13 (SD) and 15 +/- 8% citric acid, respectively. There was no statistically significant difference (Wilcoxon signed-rank test) between the cough thresholds with and without superior laryngeal nerve block (P > 0.05). We conclude that, in the awake human, superior laryngeal nerve afferents do not play a necessary role in initiation of citric acid-induced cough.

Administration, Inhalation↗
PubMed1983

Central venous catheters for out-patient management of malignant disorders.

The use of tunnelled central venous catheters in children with malignant disorders is an effective and safe way of giving out-patient chemotherapy and supportive care. The benefits include ready venous access, ease of administration of chemotherapy, decreased time spent in the out-patient clinic, and less anticipatory vomiting and emotional trauma for patients, parents, and staff.

Adolescent↗
PubMed1980

Minor physical anomalies in childhood autism. Part I. Their relationship to pre- and perinatal complications.

In a study of minor physical anomalies and pregnancy complications in autistic children, 45 probands and 52 of their siblings were investigated. While there was a significant association between autism on one hand and minor physical anomalies and pregnancy complications on the other, no such association was found between physical anomalies and pregnancy and birth complications. Further, autistic children with higher anomaly scores had lower IQs, more frequent hospitalizations, and a more normal family history compared to autistic children with lower physical anomaly scores.

Adolescent↗