Anxiety, locus of control, and satisfaction in patients undergoing ambulatory surgery.
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Adolescent↗
Biomedical subjects
R A Sherman
Publications and source records attributed to R A Sherman.
Thermographic correlates of chronic pain: analysis of 125 patients incorporating evaluations by a blind panel.
Series of thermograms from 125 sequential participants were analyzed to determine the usefulness of thermography as a tool for evaluating chronic pain. The stability and symmetry of thermographic patterns over time among both healthy subjects and subjects whose pain remained at the same intensity across several recordings were found to be both high and consistent. This was true only if sensitivity was limited to no greater than 0.5C per color band. Greater sensitivity resulted in the creation of inconsistent asymmetrical patterns among healthy and pained subjects. Thermograms were evaluated by the authors' statistical analysis of the heat patterns and by a ten-member panel of scientists. They found thermography an excellent tool for monitoring changes in pain related to variations in near surface blood flow, such as those occurring during a sympathetic block. It was excellent for relating changes in near surface blood flow to changes in phantom limb pain intensity. There was a good relationship between changes in pain intensity and changes in symmetry of heat patterns for most of the disorders examined. Thermography had mixed usefulness in differentiating pain-free from pained subjects reporting knee pain (test efficiency, 98%), leg pain, and back pain (efficiency, 56%). It consistently indicated painful areas among patients with spinal cord injury.
Amputation Stumps↗
The missing gap. A pitfall in the diagnosis of alcohol intoxication by osmometry.
An osmolal gap (a disparity between measured and calculated serum osmolality) may accompany alcohol intoxication. We encountered a patient with methanol toxicity in whom no such gap was present, despite a markedly elevated serum methanol level. Further investigation revealed that serum osmolality had been measured with a vapor pressure osmometer; this technique may not detect volatile solutes such as alcohols. In vitro testing confirmed the insensitivity of vapor pressure osmometry to toxic ranges of both methanol and ethanol. When alcohol toxicity is suspected, an osmolal gap should be sought only if freezing point osmometry is available.
Alcoholic Intoxication↗
The effect of dialysate calcium levels on blood pressure during hemodialysis.
A controlled double-blind prospective study was undertaken of the effect of dialysate calcium levels on BP during hemodialysis. Twenty patients and 240 dialyses were studied using a protocol in which patients underwent alternate hemodialyses with dialysate calcium of 2.5 and 3.5 mEq/L. Dialysate composition was otherwise the same. Mean BPs during dialysis were significantly lower at 1.5, 2.5, and 3.5 hours of dialysis when the lower dialysate calcium was used (P = .007 to .02). However, the difference in BP between the high and low dialysate calcium treatments was clinically minor, with a maximum mean difference (at 1.5 hours) of 4.6 mm Hg. Subgroups of patients with frequent hypotension and low or normal serum calcium did not appear more sensitive to the hypotensive effect of low calcium dialysate. Dialysate calcium levels of 2.5 and 3.5 mEq/L thus differ in their effect on intradialytic BP in a statistically significant, but clinically minor, way. Low calcium dialysate thus may prove useful in the management of patients in whom large amounts of enteric calcium absorption are indicated or unavoidable.
Adult↗
Suppression of aldosterone production by low-dose heparin.
Low-dose heparin has achieved wide use for the prevention of deep vein thrombosis. Full-dose heparin (20,000 U/day or more) has a well-documented suppressive effect on adrenal aldosterone production. To determine whether this effect may also occur with low-dose heparin, 5 healthy male volunteers were given heparin, 5,000 U subcutaneously every 12 h for 10 days, and their renin-aldosterone axis was studied. Plasma aldosterone fell from a mean of 17.2 ng/dl at baseline to 6.6 on day 5 and 4.3 on day 10. The 24-hour urinary aldosterone fell from 11.5 micrograms/day at baseline to 5.3 and 6.8 on days 4-5 and 9-10, respectively. After stimulation with furosemide (60 mg orally) and 4 h ambulation, plasma aldosterone remained suppressed on heparin: 22.4 ng/sl at baseline, 7.0 on day 5 and 6.2 ng/dl on day 10. Plasma renin activity, serum and urinary electrolytes, and body weight were unchanged during the study. Hence, low-dose heparin can inhibit aldosterone production. Patients receiving this treatment should be observed (during and after therapy) for impaired electrolyte homeostasis.
Aldosterone↗
Variability in potassium removal by hemodialysis.
The extent to which plasma potassium determines potassium removal in hemodialysis was examined in 8 end-stage renal disease patients during 51 treatments. Dialyzers, treatment time, blood and dialysate flow were held constant. Dialysate composition was also uniform except that 24 treatments utilized glucose-free dialysate and the remaining 27 a 200 mg/dl glucose bath. At either level of dialysate glucose, approximately 40% of the potassium removal during dialysis could not be accounted for by plasma-dialysate potassium gradient, body weight or serum carbon dioxide content, although glucose-free dialysate tended to increase potassium removal by a mean of 28%. The large, unexplained variability in potassium removal suggests that therapeutic manipulation of potassium flux across cell membranes may improve the management of potassium balance in hemodialyzed patients.
Adult↗
Relationships between near surface blood flow and altered sensations among spinal cord injured veterans.
Ten patients with clinical diagnoses of complete transverse spinal cord tissue destruction were interviewed about any sensations they felt below the level at which normal feelings were evident. All ten reported experiencing various feelings most of the time and nine reported that some of those feelings were usually quite painful. Videothermographs showing differences in skin temperature of 0.1 degrees celsius were taken to evaluate blood flow patterns to a depth of 1.5 cm. Changes in blood flow patterns were found to correlate highly with the level at which sensations changed from normal to abnormal and to correlate virtually exactly with the locations of pain reported from supposedly desenate areas.
Accidents, Traffic↗
Relationships between jaw pain and jaw muscle contraction level: underlying factors and treatment effectiveness.
EMG representations of jaw muscle contraction levels were measured in dental patients with TMJ problems in addition to history and physical evidence of bruxing and clenching, TMJ problems alone, bruxing and clenching, and no pain. Patients with TMJ problems plus bruxing/clenching had EMG levels similar to those with clenching and bruxing problems alone. These levels were far higher than those in the groups with similarly low TMJ problems alone and with no pain. The pain groups were normal for anxiety level and life stress. Although a third of the patients produced a conversion V pattern on the MMPI, no effect was seen on treatment effectiveness. All but a few of the mixed TMJ problem/bruxism/clenching patients and of the bruxism/clenching patients showed considerable reduction in pain through use of treatment oriented toward muscle tension awareness and relaxation. The group with TMJ problems and normal masseter muscle tension made little progress.
Anxiety↗
Amelioration of hemodialysis-associated hypotension by the use of cool dialysate.
The effect of a reduction in dialysate temperature on BP during hemodialysis was studied in seven patients with end-stage renal disease suffering frequently from intradialytic hypotension. Each patient received six dialyses using 34.4 degrees C dialysate. These treatments were preceded (six dialyses) and also followed (six dialyses) by control periods using a 36.7 degrees C bath. Symptomatic hypotension was defined as systolic BP below 100 mm Hg associated with typical symptoms of hypotension requiring treatment with intravenous (IV) fluid. Cool dialysate reduced the frequency of symptomatic hypotension from 0.58 to 0.05 episodes per dialysis (P = less than 0.016). In addition, the rate of fall of mean BP during treatment was substantially slowed with the reduction in dialysate temperature (P = 0.002). Cool dialysate (34.4 degrees C) substantially ameliorates hemodialysis-associated hypotension.
Adult↗
Thrombocytopenia associated with intravenous desferrioxamine.
Desferrioxamine (DFO) was administered intravenously to a 63-year-old chronic hemodialysis patient with osteomalacia believed secondary to aluminum intoxication. Thrombocytopenia was noted after five doses of DFO. Platelet counts normalized after DFO was withheld. Thrombocytopenia recurred upon two rechallenges with this drug. It is suggested that platelet counts be monitored in hemodialysis patients receiving intravenous DFO.
Aluminum↗
Relationships between strength of low back muscle contraction and reported intensity of chronic low back pain.
The electromyographic patterns produced by recording the left and right paraspinal muscles of subjects while in motion (bending and rising) and still (standing upright, sitting supported and unsupported, and prone) were contrasted for people with: 1) no history of back pain; 2) past episodes of low back pain but currently pain free; and 3) chronic low back pain with various diagnosed etiologies. Each of the 83 individuals recorded during episodes of low back pain produced a unique pattern of muscle contraction which was relatively stable between weekly recording sessions. In every case, at least one of the six positions showed elevated contraction levels significantly above that of the 15 subjects with no history of back pain and the 28 with no current back pain. For nine of the eleven subjects who reported changes in pain intensity between recording sessions, a clearly positive correlation occurred between the reported intensity of pain and the level of contraction in the one position most different from the reference group. No diagnostic subgroup of low back pain subjects produced a single unique pattern. Furthermore, no single aspect of the EMG signal, such as bilateral asymmetry, had predictive value for any individual subject. Our recordings did not differ with respect to diagnostic category so further research will have to be done to determine whether the diagnostic categories currently in use do not fit the physiological bases for the problems and/or whether prolonged abnormal levels of muscle contraction eventually produce problems such as disc displacement.
Adolescent↗
Effect of variations in dialysate temperature on blood pressure during hemodialysis.
The effect on BP of alteration in dialysate temperature was studied in 150 hemodialysis treatments in 17 patients using a randomized, double-blind protocol. Each patient was treated using dialysate at 35.6 degrees C, 36.7 degrees C, and 37.8 degrees C. Mean BP during 35.6 degrees C dialysis was significantly higher than during 36.7 degrees C or 37.8 degrees C treatments. Symptomatic hypotensive episodes were more frequent at a dialysate temperature of 37.8 degrees C than during use of cooler dialysates. Modest changes in dialysate temperature thus appear to affect BP during hemodialysis. Dialysate cooler than that routinely employed has a beneficial effect while warmer dialysate has a detrimental one on intradialytic BP. The use of dialysate at least 1 degree C cooler than "isothermic" levels may be appropriate.
Blood Pressure↗
Urinary ligandin in renal tubular cell injury.
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Animals↗
Urinary sodium and chloride during renal salt retention.
One hundred ten episodes of renal salt retention (urinary sodium and/or chloride less than 10 mEq/L) were studied retrospectively to determine the significance of discordance of urinary sodium from chloride. In 16 episodes the urinary sodium exceeded chloride by at least 15 mEq/L. This disparity was associated with the necessity for urinary excretion of substantial quantities of poorly reabsorbed anions (penicillin, ketones, or diatrizoate), a rapidly falling serum bicarbonate level (due to resolving metabolic or developing respiratory alkalosis), or substantial renal insufficiency (serum creatinine greater than 3 mg/dL). In 14 of 110 episodes, urinary chloride exceeded urinary sodium by at least 15 mEq/L. These patients were more often oliguric and had a higher mean serum chloride than patients without this dissociation. In patients with oliguria, hyponatremia, or metabolic alkalosis, measurement of urinary sodium or chloride alone will, in a substantial number of cases, fail to detect renal salt retention. When evidence is sought for renal salt retention, both urinary sodium and chloride should be determined.
Aged↗
Maggot therapy: the surgical metamorphosis.
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Animals↗
Prevalence and characteristics of chronic phantom limb pain among American veterans. Results of a trial survey.
Twelve hundred American amputees who are military veterans were surveyed by questionnaire about their amputations, pain sensitivity, demography, treatment history, stump problems, phantom sensations, and phantom pain. Over sixty percent responded and of these 85 percent reported significant amounts of phantom pain. This is in sharp contrast to both the literature and our clinical experience which indicate that although most amputees seen in a clinical setting report some occasional minor discomfort due to their phantoms, only between one half percent and five percent experience severe phantom pain. There was no relationship between reasons for amputation, use of prosthesis, pain sensitivity, age, years since amputation, or other demographic variables and presence of severity of phantom pain. Those respondents describing phantom pain usually had either momentary episodes of intense, debilitating pain, or virtually continuous discomfort varying in intensity but reaching debilitating levels occasionally. The fairly continuous pains were all similar in description to magnified versions of comfortable phantom sensations reported by other respondents. Few of the reported treatments were of any value.
Chronic Disease↗
Reduction in serum phosphorus due to sucralfate.
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Aluminum↗