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Biomedical subjects

R A Sherman

Publications and source records attributed to R A Sherman.

At least 37 records · Page 2Linked to original sources
PubMed1997

Validation of a revised slow-stop flow recirculation method.

Slow flow/stop flow methods have replaced the three needle technique as methods of choice for measuring recirculation. However, the time delay after reducing blood flow may affect the BUN in the systemic (slow flow/stop flow arterial line) sample and therefore limit the accuracy of this methodology. It has been observed that recirculation does not occur in a properly cannulated access unless the access blood flow rate is less than the dialyzer blood flow rate (BFR). This suggests that the systemic sample could be obtained at a higher than usual blood pump rate. We studied 50 patients and compared a revised slow-stop flow (S/SF) recirculation technique in which the systemic sample was drawn after the blood pump rate was reduced to 120 ml/min for 10 seconds and then stopped, to a non-urea based method that utilized indicator velocity dilution (IVDM). Seven patients were found to have recirculation by IVDM; all had recirculation by S/SF of more than 10% (minimum 16.7%) and an access BFR that was less than the dialyzer BFR. In the 43 patients without recirculation by IVDM, the mean recirculation by S/SF was 1.9 +/- 3.2% (mean +/- SD). Five patients without recirculation by IVDM had more than 5% recirculation by S/SF (range, 5.9 to 8.3%). Although there was a small systematic tendency to overestimate recirculation, this modified urea based method was still able to detect recirculation with good reliability. Single values above 10% are highly likely to indicate the presence of true recirculation. Repeated values over 5%, are also likely to be significant, indicating the presence of true recirculation and its clinical correlate, marginal access blood flow.

Blood Circulation↗
PubMed1997

A new dressing design for use with maggot therapy.

Maggot therapy has been used since the 1930s for treating soft-tissue wounds. Despite decades of experience with this therapy, selecting appropriate dressing materials continues to be a problem. Before initiating our maggot therapy service, we needed to develop a dressing that would (1) prevent the maggots from escaping, (2) permit oxygen to reach the maggots, (3) facilitate drainage, (4) allow inspection of the wound, (5) require minimal maintenance, and (6) be of low cost. The optimal dressing design proved to be a two-layered cagelike dressing, the bottom layer of which comprised a hydrocolloid pad, applied to the surrounding healthy skin and covered by a fine chiffon or nylon mesh. Liquefied necrotic tissue drained through the mesh and was absorbed in a top layer of gauze, which was replaced periodically. Thus it was possible to contain the maggots within the wound by means of readily available materials.

Aged↗
PubMed1997

A brief history of vascular access for hemodialysis: an unfinished story.

Progress in the development of permanent vascular access for hemodialysis has been much slower than progress in other areas of end-stage renal disease (ESRD) patient care. This article provides a brief historical overview of the major means used for vascular access since the start of chronic hemodialysis. These access modalities include external shunts, arteriovenous fistulae, prosthetic arteriovenous grafts, needle-less access devices, and tunneled central venous catheters. Despite the evolution of access methodology, vascular access complications remain a major impediment to the full rehabilitation of the chronic hemodialysis patient.

Arteriovenous Shunt, Surgical↗
PubMed1997

Behavioral treatment of exercise-induced urinary incontinence among female soldiers.

One-third of 450 female soldiers surveyed indicated that they experienced problematic urinary incontinence during exercise and field training activities. The other crucial finding of this survey was probably that 13.3% of the respondents restricted fluids significantly while participating in field exercises. Although only 5.3% of respondents felt that their urine leakage had a significant impact on their regular duties, it is obvious that many more are sufficiently worried about leakage to put themselves at significant risk for dehydration-related injuries. This study tested whether behavioral interventions effective among older people could help younger soldiers. Thirty-nine female soldiers reporting exercise-induced urinary incontinence underwent urodynamic assessments of bladder capacity, urethral closure pressure, and detrusor contraction pressures as well as a symptom questionnaire before and after therapy. They were stratified by diagnosis of physical stress incontinence or mixed urge/stress incontinence and randomized into two groups. Twenty-three participants performed pelvic muscle exercises with urethral biofeedback for 8 weeks, and 16 participants performed pelvic muscle exercises alone. Patient reports as well as the post-treatment examinations indicated that all subjects improved significantly. Only five subjects in the biofeedback/exercise and three in the exercise-only group desired further treatment. All subjects initially diagnosed with detrusor dysfunction had normal readings at the end of the study. Thus, behavioral treatments can be effective against exercise-induced urinary incontinence among most female soldiers.

Adult↗
PubMed1996

Low-cost, low-maintenance rearing of maggots in hospitals, clinics, and schools.

With the recent resurgence in the interest and use of maggot therapy, blow fly rearing can be expected to increase. The rearing of these necrophagous flies is technically simple, but can be expensive, malodorous, and wasteful of space. Although there are numerous references to maggot rearing in the older literature, they do not adequately address these specific problems. Therefore, we describe several of the simple, low-cost, and unobtrusive strategies for rearing blow flies that have proven useful in our hospital-based insectary.

Animals↗
PubMed1996

Prevention of lower limb pain in soldiers using shock-absorbing orthotic inserts.

The utility of shock-absorbing boot and sneaker inserts for reducing the occurrence of lower limb pain among male US Army basic trainees was evaluated. Every other training unit was given inserts. The inserts were issued prior to the start of training when combat boots and sneakers were fitted. According to post-training questionnaires and the participants' medical records, the inserts did not have any preventive effect on occurrence of lower limb problems during training. Five hundred seventeen trainees were issued inserts, 397 were followed but not issued inserts, and 218 were not issued but purchased them on their own. Thirty-eight percent of those issued inserts had lower limb pain problems compared with 29% of those not issued inserts and 38% of those who bought their own. There was no statistical difference between these rates of occurrence. Prior to training, there were minor differences between the groups' scores on physical fitness test scores and run times. These differences disappeared during training so that there were no differences among the groups on either training or clinical variables during or after basic training.

Adult↗
PubMed1996

Comparative effectiveness of videothermography, contact thermography, and infrared beam thermography for scanning relative skin temperature.

Videothermography (Video TRM), infrared beam thermography (IRTHRM), and contact thermography (Contact TRM) are utilized to detect asymmetries in temperatures between paired limbs. This information is controversially used in many diagnostic procedures in rehabilitation medicine. In this study, the effectiveness of the above techniques for scanning skin heat patterns and detecting asymmetries is compared. The skin over both lower limbs was imaged with each technique sequentially on 139 male and 15 female patients reporting lower limb pain. Images were also made of an electronic heat producer in order to determine relative accuracy. Contact TRM was unable to accurately image many areas with curved surfaces and was unable to produce accurate recordings when several sensors with differing temperature ranges had to be used on the same subject. It was also relatively inaccurate when imaging the heat producer. Video TRM was easy to use and produced excellent recordings but was difficult to transport. IRTHRM used in conjunction with a grid map of the body was the simplest and least expensive system to use for scanning and was as accurate as Video TRM.

Adolescent↗
PubMed1995

Interdialytic weight gain and nutritional parameters in chronic hemodialysis patients.

The extent of interdialytic weight gain (IDWG) in chronic hemodialysis patients is usually attributed to the level of compliance with fluid restriction. However, in view of the substantial water content of food (and caloric content of beverages), IDWG also may be a function of calorie and protein intake and may reflect the nutritional state of patients. To investigate this theory, the relationship between 2-day IDWG and body weight, normalized protein catabolic rate (nPCR), serum albumin, and delivered Kt/V urea was assessed in a prospective, randomized study of 860 chronic hemodialysis patients in 56 dialysis units. Compared with patients having < 2 kg IDWG (n = 378), patients with > 3 kg IDWG (n = 138) weighed more (dry weight, 76.8 v 61.7 kg), had higher nPCR (1.15 v 0.96 g/kg/d), and had higher serum albumin levels (3.96 vs 3.79 g/dL) (all P < 0.001) but did not have different levels of Kt/V (1.04 v 1.06). When IDWG was assessed as a function of dry weight, patients with IDWG > 4.5% of dry weight (n = 151) had higher nPCR (1.17 v 0.94 g/kg/d) but weighed less (60.1 v 70.0 kg) and had a higher Kt/V (1.14 v 1.01) than patients with IDWG < 3% of dry weight (n = 355) (all P < 0.001). Artifactual association between IDWG and nPCR attributable to an accentuated two-pool effect from differing ultrafiltration requirements was unlikely as assessed by the relationship between modeled Kt/V and prescribed Kt/V determined using an anthropometric urea volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary Proteins↗
PubMed1995

Maggot therapy for treating pressure ulcers in spinal cord injury patients.

For centuries, maggot therapy (MT) has been recognized as an aid to wound healing. By including live blowfly larvae in wound dressings, earlier physicians noted thorough debridement which hastened wound healing. We initiated a prospective controlled study to evaluate the utility of maggot therapy for treating pressure ulcers in spinal cord injury patients in the modern era. Eight of our patients received MT after a baseline assessment of healing under conventional therapy (defined as any therapy prescribed by the patient's primary care team). Surface area, tissue quality and healing rates were monitored weekly. MT debrided most of the necrotic wounds within one week, which was more rapid than all other non-surgical methods. Wound healing was more rapid during MT than during antecedent conventional therapy (p = 0.01). No complications were seen. We have demonstrated that MT can be beneficial in the treatment of pressure ulcers in persons with spinal cord injuries. MT was significantly more effective and efficient than the current, conventional treatment alternatives being used. MT was also safe, simple and inexpensive. MT can be a valuable modality in the treatment of pressure ulcers.

Adult↗
PubMed1995

Effects of seven antibiotics on the growth and development of Phaenicia sericata (Diptera: Calliphoridae) larvae.

Maggot therapy is used for patients with severe tissue destruction, who often receive antibiotics concurrently. Therefore, we studied the effects on maggots of ampicillin, cefazolin, ceftizoxime, clindamycin, gentamicin, mezlocillin, and vancomycin in concentrations of 1, 10, 100, and 1,000 times the average minimum bactericidal or bacteriostatic concentration against highly susceptible organisms. There was a reduction in larval survival in media with gentamicin at concentrations of 1,000 times the average pharmacologic level, or 4,000 micrograms/ml (2.7% survival), versus lower concentrations (80-88% survival). Maturation of the surviving pupae to adults also was decreased at this concentration. Media with cefazolin concentrations of 100 times the average bacteristatic level, or 800 micrograms/ml, also led to a significant decrease in larval survival (70% versus 80-88%). There were no differences in larval survival, rate of maturation, or pupal weights for organisms reared on media containing ampicillin, ceftizoxime, clindamycin, mezlocillin, or vancomycin. P. sericata matured normally--and thus can be used therapeutically--when exposed to standard pharmacologic levels of the 7 antibiotics tested. Furthermore, the methods employed herein may be helpful to forensic entomologists attempting to develop models for drug ingestion by maggots.

Animals↗
PubMed1995

A simple, sterile food source for rearing the larvae of Lucilia sericata (Diptera: Calliphoridae).

Larvae of the sheep blowfly Lucilia sericata (Meigen) were reared on various mixtures of puréed liver, agar, brewer's yeast and trypsin, in order to develop a simple, sterile, tissue-based diet. Growth and survival rates of larvae reared on a sterile 1:1 mixture of puréed liver with 3% Bacto agar equalled or exceeded those of larvae reared on raw liver. The addition of yeast and/or trypsin to the medium was of no additional benefit. This sterile, homogenous, tissue-based substrate offers a simple, convenient, inexpensive growth medium for rearing larvae for maggot therapy, and for testing the effects of various chemicals and dietary constituents on necrophagous insect larvae. It may be useful, therefore, in studies of myiasis, forensic entomology, and toxicology. This rearing medium also has the advantage that it can be stored for many months at room temperature without progressive decomposition or offensive odour.

Animal Feed↗
PubMed1995

Maggot debridement therapy. An alternative treatment for nonhealing ulcers.

The authors illustrated a chronic bilateral plantar foot ulcer of several years' duration that was resistant to all forms of conventional therapy, yet was resolved after 13 1/2 weeks of maggot therapy. The contralateral foot ulcer showed no improvement during the same period, despite continual inpatient conventional dressing changes. At a time when medical cost containment is a critical issue, maggot therapy may resurge as a viable alternative in treating nonhealing wounds.

Aged↗
PubMed1995

Prediction and portrayal of repetitive stress-induced lower limb pain disorders among soldiers in basic training using videothermography.

OBJECTIVE: Thermography has been widely espoused for both detecting and portraying pain problems. Development of repetitive stress-induced lower limb pain during army basic training is a relatively common occurrence. This study was designed to assess the usefulness of thermography for differentiating soldiers who developed lower limb pain during training from those who did not. This information was intended to be used to determine the usefulness of pretraining thermograms taken just as people came into the army in predicting which trainees would develop these conditions during training. DESIGN: Videothermographic pictures were taken of the lower limbs of 639 newly enlisted soldiers who had just arrived at a large U.S. Army base but had not yet begun basic training. The amount of symmetry was correlated with the development of lower limb pain. Each soldier reporting lower limb pain and "controls" with nonpain problems (usually minor colds) received a thermographic evaluation identical to the original evaluation when they came for their medical examination. RESULTS: Among prebasic trainees, 37% showed 1.0 degrees C of asymmetry somewhere in their lower limbs, 14% were asymmetrical by between 1.1 degrees and 2.0 degrees C, 5% by 3.0 degrees C and 4% by 4.0 degrees C or more. Thus, only 40% of the prebasic trainees were within accepted "normal" limits before participating in training. Thirty-nine percent of those with asymmetrical thermograms developed lower limb pain compared with 28% of those with symmetrical thermograms (significant at p < 0.05). It was impossible to predict from any thermographic measurement on the lower limbs which soldiers were most likely to develop lower limb pain. This held true even for those pretrainees with the greatest asymmetries. Eighty-four percent of trainees reporting lower limb pain produced abnormal thermograms regardless of whether or not they produced abnormal thermograms prior to training. CONCLUSION: Thermograms were of little value for either predicting or portraying repetitive stress-induced lower limb pain in this population.

Cumulative Trauma Disorders↗
PubMed1995

What physicians should know about Africanized honeybees.

The Africanized honeybee, popularly known as the "killer bee," is already well established in Texas and has recently entered California and Arizona. As the Africanized honeybee spreads in North America, the medical community must become aware of the problems associated with this insect and ensure that sting emergencies can be handled quickly and appropriately. The major differences between Africanized and European honeybees are that the former are more irritable, they swarm more readily and frequently, they defend their hives more vehemently, and they sting more collectively. It is not the composition nor the volume of an individual bee's venom, but rather the cumulative dose of multiple stings that accounts for the morbidity and mortality associated with Africanized honeybee-sting incidents. Even nonallergic persons are susceptible to the toxic effects of these large combined venom loads. Africanized honeybee-sting victims are treated the same as victims of European honeybee stings. Authorities will prepare for the bees' arrival by expanding public awareness, teaching risk-avoidance behavior, providing for the removal of troublesome hives, and developing sting treatment protocols that can be initiated rapidly in the field or emergency departments. Health care professionals should participate in the educational efforts and in the development of needed emergency response protocols so that the effects of the Africanized honeybee will be merely a nuisance rather than a plague.

Animals↗