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Biomedical subjects

R A Sherman

Publications and source records attributed to R A Sherman.

At least 73 records · Page 4Linked to original sources
PubMed1990

The relationship between situational stress and phantom limb pain: cross-lagged correlational data from six month pain logs.

This study reports the results of the first investigation into the relationship between situational stress and phantom limb pain. Twenty-seven male amputees recorded their pain and overall stress levels daily for 180 days using a 1-10 rating scale. Three possible relationships into the etiology and/or maintenance of phantom limb pain were examined using cross-lagged correlational techniques: an isomorphic relationship (same time increases in pain lead to same time increases in stress and vice versa), a consequence relationship (increases in pain precede increases in stress), and a precursor relationship (increases in stress precede increases in pain). Thirty-seven per cent of subjects demonstrated some significant precursor relationship. Although support was found for all three hypotheses, the most frequently observed relationship was the isomorphic one. Seventy-four per cent of subjects demonstrated some significant stress-pain relationship. The results lend support to the psychological theory underlying the use of psychophysiological interventions such as biofeedback and relaxation therapy in amputees with phantom limb pain.

Adult↗
PubMed1990

Temporal stability of paraspinal electromyographic recordings in low back pain and non-pain subjects.

This paper presents the results of two studies in which bilateral surface EMG recordings of paraspinal muscle tension were measured in 29 lower back pain and 20 normal subjects in 6 different positions (standing, bending from the waist, rising, sitting with back supported, sitting unsupported, prone) on two occasions, and a comparison of the data from both studies. Measures were highly reliable when examined using analysis of variance procedures. Statistically significant reliability coefficients were obtained when the absolute values of the measures were examined, although in some instances less than 20% of the variance was explained. When examined as relative [percent change from baseline (prone) condition] values, differences between the two groups were observed: the normals were statistically more reliable than lower back pain subjects during every condition. Implications for clinical work and both basic and applied research are discussed.

Adult↗
PubMed1990

The effect of oral bases on enteral aluminum absorption.

Physicochemical considerations suggest that citrate may potentiate gastrointestinal aluminum absorption via the formation of an aluminum citrate moiety. We tested this hypothesis and also studied whether sodium bicarbonate would have a similar effect. Eight healthy adults each partook of four oral regimens: aluminum alone, aluminum plus sodium bicarbonate, aluminum plus citrate (as Shohl's solution), and citrate alone. Twenty-four hour urine collections were obtained immediately preceding and during the second day of each medication period for determination of aluminum content. A significant but similar increment in urinary aluminum occurred with both aluminum alone and aluminum plus sodium bicarbonate, while only a small increment was noted with Shohl's solution alone. The rise in urinary aluminum obtained with aluminum plus Shohl's solution, however, was nearly eight times that seen with either aluminum alone or aluminum plus sodium bicarbonate (327 micrograms vs 45 micrograms and 41 micrograms, respectively). Citrate thus appears to augment gastrointestinal aluminum absorption markedly, an effect not shared by an equivalent dose of sodium bicarbonate. Citrate administration to patients with renal failure who are also taking aluminum-containing medication may be harmful.

Administration, Oral↗
PubMed1990

Treatment of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis.

The epidemiology, etiology, pathogenesis, diagnosis, and pharmacotherapy of peritonitis in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis (CAPD) are reviewed. CAPD-associated peritonitis is a localized infection of the peritoneal cavity. Approximately 70% of the cases are caused by a single gram-positive microorganism indigenous to the patient's skin or upper respiratory tract that infects the peritoneal cavity. Gram-negative microorganisms cause 25% of the cases; fungi, anaerobes, and mycobacteria cause approximately 5%. Clinical manifestations include a cloudy, turbid peritoneal dialysate effluent and abdominal pain or tenderness. Diagnosis is confirmed by the detection and isolation of microorganisms in the peritoneal dialysate effluent. Of patients with CAPD-associated peritonitis, 70-80% can be successfully treated on an outpatient basis with intraperitoneal (i.p.) instillation of antimicrobials. Vancomycin, cephalosporins, and aminoglycosides are the agents most commonly used to treat CAPD-associated peritonitis. Most recently, alternative dosing regimens using intermittent i.p. administration of vancomycin have been used. In certain types of CAPD-associated peritonitis (those caused by Pseudomonas aeruginosa or fungi), removal of the peritoneal catheter may be required to achieve a cure. Approximately two thirds of the patients transferring to another form of dialysis from CAPD do so because of peritonitis. Currently available data indicate that the most effective therapy for CAPD-associated peritonitis is i.p. administration of antimicrobial agents with activity against the suspected microorganism.

Bacterial Infections↗
PubMed1989

The mystery of phantom pain: growing evidence for psychophysiological mechanisms.

The direct, and much of the indirect, evidence supporting the existence psychophysiological mechanisms for phantom limb pain is reviewed. Phantom pain is shown to be a symptom class composed of different, but similarly described problems, each having its own underlying mechanisms. At least some descriptive types of phantom pain probably have mainly peripheral, as opposed to only central, origins. Although much of the direct data are preliminary, burning phantom pain is probably related to decreased blood flow in the residual limb, while cramping phantom pain is mainly related to spikelike muscle spasms in the major muscles of the residual limb. Little support is provided for psychological causes for phantom pain, but the expression of phantom pain does appear to be influenced by psychological mechanisms similarly to the ways other chronic pain conditions are influenced. The importance of a careful psychophysiological assessment of patients to treatment success is discussed. Because several different mechanisms are involved, no one treatment is likely to be effective for all of the different types of phantom pain. Appropriate combinations of self-regulation strategies aimed at controlling the underlying physiological problems are likely to be effective in reducing the incidence and severity of burning and cramping types of phantom pain.

Biofeedback, Psychology↗
PubMed1989

Stump and phantom limb pain.

Recent literature suggests that phantom pain and stump pain have closely related physiologic mechanisms and that treatments frequently overlap. Decreased blood flow in the residual limb is related to burning and tingling phantom and stump pain, whereas spasms in major muscles of the residual limb precede cramping phantom and stump pain. There is little support for psychological mechanisms underlying the vast majority of chronic phantom and stump pain problems, but these mechanisms can exacerbate both acute and chronic pain. It is critically important to educate patients about the process of amputation and the physiologic mechanisms of phantom sensation and pain in order to minimize magnification of pain due to stress. Acute stump pain usually responds well to traditional interventions based on identifying and correcting specific problems in the residual limb. Most traditional treatments for phantom pain and chronic stump pain are not effective for more than a few months. Recommended treatments are related to underlying mechanisms. For chronic phantom and stump pain, burning sensations are treated with interventions designed to increase blood flow to the residual limb, whereas cramping sensations are treated with interventions that reduce muscle spasms.

Chronic Disease↗
PubMed1988

Multilumen catheter sepsis and an educational program to combat it.

Catheter-related sepsis is a problem with many variables. A process of elimination may eventually identify the actual cause(s) of this phenomenon. We began our problem-solving approach by observing personnel inserting and caring for central lines, which showed a lack of compliance with existing protocols. A program was designed to provide the correct procedural activities. This study plans to test whether ongoing educational programs and an infection control department that maintains a high degree of visibility are effective in reducing nosocomial line-related infections.

Catheterization, Central Venous↗
PubMed1988

Postprandial blood pressure changes during hemodialysis.

The effect of eating on BP during hemodialysis was examined in nine nondiabetic end-stage renal disease (ESRD) patients. A standard meal was given during 62 of 125 dialysis treatments in a prospectively controlled study. Diastolic (P = 0.01) and mean (P = 0.03) BPs fell significantly faster in the 45-minute postprandial period in the fed treatments compared with equivalent times in the fasting treatments. In this period, symptomatic hypotension occurred 13 times in five patients fed during dialysis compared with two episodes in one patient while fasting (P less than 0.05). Consumption of meals during hemodialysis should be avoided in patients at risk for hypotension during treatment.

Adult↗
PubMed1988

The effect of red cell transfusion on hemodialysis-related hypotension.

Blood pressures of 25 stable end-stage renal disease patients with chronic anemia (mean hemoglobin 5.9 g/dL) who had received 2 units of packed red cells during hemodialysis were studied. Three treatments preceding and three following the transfusion dialysis were compared. Twenty-eight hypotensive episodes preceded and 12 followed transfusion (P = .02). Intravenous sodium chloride used for hypotension declined from a mean of 20.4 to 10.2 mEq per dialysis (P = .01). The rate of decline in mean arterial pressure during dialysis was significantly slower following transfusion (P less than .01). Mean postdialysis weight fell from 62.0 kg before transfusion to 61.5 kg following transfusion (P less than .001). Thus, red cell transfusion raises intradialytic pressure and reduces the frequency of intradialytic hypotension.

Adult↗
PubMed1988

Maggot therapy: a review of the therapeutic applications of fly larvae in human medicine, especially for treating osteomyelitis.

In traditional medical practice, the larvae of some Diptera: Calliphoridae, notably Lucilia illustris (Meigen), L.sericata (Meigen) and Phormia regina (Meigen), have been employed for maggot therapy, i.e. to help clean lesions antiseptically, especially for treatment of chronic osteomyelitis. This mode of treatment remains appropriate for cases where antibiotics are ineffective and surgery impracticable.

Animals↗
PubMed1988

Phantom pain: a lesson in the necessity for careful clinical research on chronic pain problems.

Recent findings suggest that major misunderstandings concerning the prevalence, characteristics, etiology, and treatment effectiveness of phantom pain have led to the widespread mismanagement of amputees throughout the history of modern medicine. For years it has been believed that phantom pain is relatively rare, is of unknown etiology, and probably has a psychological basis. Research results over the last few years, however, suggest that phantom pain is widely prevalent among individuals with amputations and most likely has a physiological basis. Although many different treatments have been introduced recently, few, if any, have yet been documented as effective due to lack of rigorous follow-up studies. Future progress in clinical treatment and increased scientific understanding of phantom pain will require an examination of some of the factors that have led to past confusion regarding scientific research on and clinical treatment of phantom pain.

Amputation, Surgical↗
PubMed1987

Bedside urinary chloride measurement: assessment in the acute setting.

In 100 random urine samples from hospitalized patients, the results of a rapid bedside test for urinary chloride (Quantab chloride titrators) were compared with those of the hospital laboratory. Renal chloride retention (less than or equal to 20 mEq/L) was recognized using the titrator in 25 of 27 samples. There were no falsely low results in samples containing greater than 20 mEq/L by laboratory analysis. The titrator strips should aid in rapid diagnosis of conditions in which the recognition of renal salt retention is important.

Chlorides↗
PubMed1987

Differences between trunk heat patterns shown by complete and incomplete spinal cord injured veterans.

Thermograms showing heat patterns in the trunk of the body were taken of ten intact subjects, seven subjects with incomplete spinal cord injuries (SCI), and fifteen subjects diagnosed as having complete SCIs. Fourteen of the subjects with complete SCIs had a thermal demarcation line across the trunk. This line represented a temperature gradient of one to 2.5 degrees Celsius between a relatively warm upper level where sensations were normal and a relatively cool lower level in which sensations were either absent or different from pre-injury sensations. The transition zone was narrow and sharp for ten of the complete SCI subjects but was wide and gradual for the other five complete SCI subjects. The shape and width of the thermal transition zone corresponded to the location and degree of abruptness with which sensations changed from normal to abnormal. One of the subjects diagnosed as having a complete SCI failed to show a significant transition zone. The temperature difference between the upper and lower portions of his trunk was less than one degree Celsius. None of the intact or incomplete SCI subjects produced the transition zone. Only one incomplete SCI subject showed even a minimal difference in temperature between the normal sensation and abnormal sensation levels. A panel blind to the subjects' conditions was unable to differentiate between intact and incomplete SCI subjects but was able to sort complete from incomplete SCI subjects in all but the case with an indistinct transition zone.

Body Temperature↗
PubMed1987

Digoxin-like immunoreactive substance in chronic hemodialysis patients: effect on digitoxin radioimmunoassay.

Digoxin-like immunoreactive substance(s) (DLIS) in the sera of patients with renal insufficiency may confound attempts to monitor serum digoxin levels. We investigated whether DLIS would affect the radioimmunoassay (RIA) for digitoxin. DLIS was detected by RIA in 9 of 38 chronic hemodialysis patients and in none of 25 healthy controls. Digitoxin levels were not elevated in either the control or dialysis group, and false-positive results for digitoxin by RIA were not obtained in any patient with DLIS. It is concluded that DLIS does not interfere with the digitoxin RIA, nor are digitoxin levels spuriously elevated in chronic hemodialysis patients. Digitoxin may be a preferable preparation for digitalis-dependent dialysis patients with DLIS.

Digitoxin↗
PubMed1987

Treatment of gram-positive peritonitis with two intraperitoneal doses of vancomycin in continuous ambulatory peritoneal dialysis patients.

Eight patients with end-stage renal failure on continuous ambulatory peritoneal dialysis (CAPD), who developed peritonitis, received an intraperitoneal dose of vancomycin (30 mg/kg body weight) with 6 h of peritoneal dwell and then resumed their routine CAPD schedule. Vancomycin concentration in serum, peritoneal dialysate (PD) from an overnight dwell and 1, 2 and 3 h after a new exchange was measured at 48 h (in 5 patients) and 7 days (in 6 patients). Except for an occasional 1-hour peritoneal fluid sample on the 7th day, all samples had satisfactory vancomycin levels. Five of the 8 patients who had gram-positive peritonitis and 1 with 'sterile' peritonitis received another similar intraperitoneal dose of vancomycin at the 7th day. All of these patients had good therapeutic response with a negative PD culture 3 weeks after the cessation of therapy and no relapse of infection in at least 1 month of follow-up. We conclude that 2 intraperitoneal doses of vancomycin (30 mg/kg body weight) given 1 week apart with 6 h of intraperitoneal dwell is an effective and adequate treatment for gram-positive and 'sterile' peritonitis in CAPD patients.

Bacterial Infections↗
PubMed1987

Concurrent variation of burning phantom limb and stump pain with near surface blood flow in the stump.

Thermographic recordings of body temperature were performed on 30 consecutive amputees who reported stump and/or phantom limb pain. Each subject participated in between two and four recording sessions. Whenever possible, subjects came for recording sessions when their pain intensity was different from that of previous sessions. We found that a consistent inverse relationship occurred between intensity of pain and stump temperature relative to that of the intact limb for burning, throbbing, and tingling descriptions of both phantom and stump pain. Heat emanating from the limbs is an accurate reflection of near-surface blood flow. For subjects giving these descriptions of pain, tensing the limb was followed by a decrease in blood flow and an increase in pain. Neither of these relationships held for other descriptions of either phantom or stump pain.

Adolescent↗