Biomedical subjects

M W Ray

Publications and source records attributed to M W Ray.

7 recordsLinked to original sources

PubMed1995

Treatment of calcinosis with diltiazem.

OBJECTIVE: To test the hypothesis that the calcium antagonist diltiazem is effective in the treatment of calcinosis. METHODS: Diltiazem, 240-480 mg/day, was given to 4 patients with idiopathic or CREST-related (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias) calcinosis for 1-12 years. Serial radiographs of the affected areas, using identical technique, and clinical evaluations were obtained. A fifth patient, who did not tolerate diltiazem, received verapamil, 120 mg/day for 18 months. RESULTS: All patients taking diltiazem had a reduction or disappearance of the calcific lesions, with striking clinical improvement. One patient's case was followed for 12 years. The response to diltiazem during the first 5 years of treatment has been previously reported in detail; however, over 7 years of additional treatment, there was further reduction of the lesions. One patient developed a large calcific lesion while receiving verapamil for hypertension, and after verapamil was replaced with diltiazem, there was a dramatic response. Verapamil was ineffective in the fifth patient, who did not tolerate diltiazem. CONCLUSION: Long-term treatment with diltiazem, but not verapamil, is effective in calcinosis.

Adult↗

PubMed1989

Complications of intracranial pressure monitoring in trauma patients.

A retrospective review of 175 intracranial pressure (ICP) monitors placed in 140 trauma patients over a recent 3-year period showed a 10.3% infection rate. Factors that were related to the development of an ICP monitor-related infection included: 1) duration of monitoring; 2) requirement for serial monitors; and 3) concurrent infection at other sites. These findings are discussed in light of the related literature concerning ICP monitoring and recommendations made to decrease the incidence of infection-related complications.

Adult↗

PubMed1989

Fracture and dislocation of the fourth and fifth cervical vertebral bodies with transection of the spinal cord.

Fracture and double dislocation of C4 and C5 with complete retropulsion of the C5 vertebral body into the spinal canal and complete transection of the spinal cord occurred in a diving accident in an 18-year-old male. The C4 vertebral body was dislocated anteriorly on C5, and the C5 vertebral body was dislocated posteriorly on C6 by extreme flexion and axial loading forces. To the authors' knowledge, fracture-dislocation of the cervical spine with retropulsion of this magnitude and patient survival seems not to have been reported in the literature.

Adolescent↗

PubMed1987

Disposition of phenytoin in critically ill trauma patients.

Estimates of phenytoin pharmacokinetic variables and protein binding were determined in 10 adult critically ill trauma patients. Each study subject received phenytoin sodium as an intravenous loading dose of 15 mg/kg, followed by an initial intravenous maintenance dose of 6 mg/kg/day. Serial blood samples were obtained throughout the seven-day study period and analyzed for total and unbound serum phenytoin concentrations. The concentration data for each patients were fitted to a one-compartment model with elimination defined by the Michaelis-Menten constant Km and the maximum rate of metabolism (Vmax) and to a one-compartment model with first-order elimination. The Michaelis-Menten model used Bayesian parameter estimation while the linear model used weighted non-linear least-squares regression analysis. Unbound phenytoin fraction ranged from 0.073 to 0.25. Free fraction increased 7% to 108% in 9 of 10 patients (median increase 29%) from day 1 to day 7 of therapy. Variable estimates using the Michaelis-Menten model were as follows: volume of distribution, 0.76 +/- 0.15 L/kg (0.58-1.01 L/kg); Vmax, 568 +/- 197 mg/day (350-937 mg/day); and Km, 4.5 +/- 1.8 mg/L (1.8-6.2 mg/L). These estimates fell within the wide range of values obtained in studies using stable patients or healthy volunteers. The Michaelis-Menten model was significantly less biased and more precise than the linear model. Three of four patients who continued to receive their study maintenance dose had substantially lower measured total serum concentrations of phenytoin than predicted using the study variable estimates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

Aphasia for Morse code.

The ability to communicate by Morse code at high speed has, to our knowledge, not been localized within the cerebral cortex, but might be suspected as residing within the left (dominant) hemisphere. We report a case of a 54-year-old male who suffered a left temporal tip intracerebral hematoma and who temporarily lost his ability to communicate in Morse code, but who was minimally aphasic.

Aphasia↗

PubMed1986

Analysis of 76 civilian craniocerebral gunshot wounds.

A retrospective analysis of 76 civilian craniocerebral gunshot wounds treated over a 20-month period is presented. The authors report a 62% mortality rate and conclude that the admission Glasgow Coma Scale (GCS) score is a valuable prognosticator of outcome. Other important findings were: patients with a GCS score of 3 invariably died, with or without surgical intervention; and the presence of intracranial hematomas, ventricular injury, or bihemispheric wounding was associated with a poor outcome. Standardized methods of data reporting should be adopted in order to allow multicenter trials or comparisons that might lead to management practices that could improve results.

Adolescent↗

PubMed1982

Contralateral intracranial aneurysm formation as a late complication of carotid ligation.

Ligation of the carotid artery was the treatment of choice for intracranial aneurysms for many years. While the literature recognizes many complications associated with this procedure, the late occurrence of aneurysms on the side opposite the ligation is only mentioned briefly. Animal studies are reviewed in an attempt to explain a possible cause of this observed phenomenon. The 3 cases presented seem to indicate that this complication may be more common than has been previously realized.

Carotid Arteries↗