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Biomedical subjects

R E Martin

Publications and source records attributed to R E Martin.

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

The evolution of modern plate osteosynthesis.

Plate osteosynthesis is still recognized as the treatment of choice for most articular fractures, many metaphyseal fractures, and certain diaphyseal fractures such as in the forearm. Since the 1960s, both the techniques and implants used for internal fixation with plates have evolved to provide for improved healing. Most recently, plating methods have focused on the principles of 'biological fixation'. These methods attempt to preserve the blood supply to improve the rate of fracture healing, decrease the need for bone grafting, and decrease the incidence of infection and re-fracture. The purpose of this article is to provide a brief overview of the history of plate osteosynthesis as it relates to the development of the latest minimally invasive surgical techniques.

Bone Plates↗
PubMed1997

Functional properties of neurons in the primate tongue primary motor cortex during swallowing.

Recent studies conducted in our laboratory have suggested that the tongue primary motor cortex (i.e., tongue-MI) plays a critical role in the control of voluntary tongue movements in the primate. However, the possible involvement of tongue-MI in semiautomatic tongue movements, such as those in swallowing, remains unknown. Therefore the present study was undertaken in attempts to address whether tongue-MI plays a role in the semiautomatic tongue movements produced during swallowing. Extracellular single neuron recordings were obtained from tongue-MI, defined by intracortical microstimulation (ICMS), in two awake monkeys as they performed three types of swallowing (swallowing of a juice reward after successful tongue task performance, nontask-related swallowing of a liquid bolus, and nontask-related swallowing of a solid bolus) as well as a trained tongue-protrusion task. Electromyographic activity was recorded simultaneously from various orofacial and laryngeal muscles. In addition, the afferent input to each tongue-MI neuron and ICMS-evoked motor output characteristics at each neuronal recording site were determined. Neurons were considered to show swallow and/or tongue-protrusion task-related activity if a statistically significant difference in firing rate was seen in association with these behaviors compared with that observed during a control pretrial period. Of a total of 80 neurons recorded along 40 microelectrode penetrations in the ICMS-defined tongue-MI, 69% showed significant alterations of activity in relation to the swallowing of a juice reward, whereas 66% exhibited significant modulations of firing in association with performance of the trained tongue-protrusion task. Moreover, 48% showed significant alterations of firing in relation to both swallowing and the tongue-protrusion task. These findings suggest that the region of cortex involved in swallowing includes MI and that tongue-MI may play a role in the regulation of semiautomatic tongue movement, in addition to trained motor behavior. Swallow-related tongue-MI neurons exhibited a variety of swallow-related activity patterns and were distributed throughout the ICMS-defined tongue-MI at sites where ICMS evoked a variety of types of tongue movements. These findings are consistent with the view that multiple efferent zones for the production of tongue movements are activated in swallowing. Many swallow-related tongue-MI neurons had an orofacial mechanoreceptive field, particularly on the tongue dorsum, supporting the view that afferent inputs may be involved in the regulation of the swallowing synergy.

Animals↗
PubMed1997

Managed care guidelines for the economic evaluation of pharmaceuticals.

Foundation Health Corporation, through its National Pharmacy and Therapeutics Committee, requires all pharmaceutical manufacturers and others who wish products to be considered for formulary listing to meet evidentiary and analytical standards in their submission documentation. This article details the evidentiary and analytical standards required from those making submissions and describes the methodological basis of the guidelines. This is the first time, as far as the authors are aware, that a managed care health system in the United States has required formulary submissions not only to meet clinical and economic evaluation standards, but also to take explicit account of the perspective of the managed care group in applying these techniques. Submissions are required to take what is described as a systems impact perspective. This approach is quite different, in both evidentiary and analytical terms, from standards required by health systems in other countries and standards for the economic evaluation of pharmaceuticals proposed by expert groups in the United States.

Cost-Benefit Analysis↗
PubMed1996

Initial assessment and management of common fractures.

The initial assessment and management of all fractures follows a standard protocol. All fractured extremities require a thorough neurovascular examination and evaluation of the skin. Fractures are evaluated and described using standard terminology. These important descriptors include open versus closed fractures, the anatomic location of the fracture, the degree and type of displacement, and the fracture pattern. This forces one to become familiar with the personality of the fracture and ultimately facilitates patient care.

Fractures, Closed↗
PubMed1996

Altered expression and changing distribution of the nerve growth associated protein GAP-43 during ocular HSV-1 infection in the rabbit.

This research examines changes that occur in neurons during corneal herpes simplex virus (HSV-1) infection and focuses on the nerve growth associated protein GAP-43. Cornea and trigeminal ganglion (TG) of New Zealand white rabbits were examined after inoculation of the McKrae and 17 Syn+ strains of HSV-1 to the cornea. Rabbit tissues were taken during acute, latent and induced reactivation stages of infection. Systemic immunosuppression (intravenous injections of cyclophosphamide and dexamethasone) was used to induce reactivation. Western blotting, immunoblotting and autoradiography with the same antibody were used respectively to verify antibody specificity, measure changes in GAP-43 concentration and localize GAP-43 to neurons in the TG. During acute infection, corneal GAP-43 increased significantly while no change was seen in the TG. GAP-43 content was elevated in TG and cornea during viral latency (post-inoculation days 84-154) for both HSV-1 strains. When latent virus was reactivated, the corneal concentration of GAP-43 was more than double that of normal rabbits and the concentration of GAP-43 in TG was reduced compared to the non-reactivated, latently-infected TG. In summary, HSV-1 infected TG neurons expressed more GAP-43 than control neurons and immunosuppressive therapy led not only to viral reactivation and increased GAP-43 concentrations in cornea but also to decreased GAP-43 concentrations in TG. These results suggest that factors which maintain HSV-1 latency and induce reactivation could be linked to elements regulating GAP-43 expression.

Animals↗
PubMed1996

Multiple chemical sensitivities, including iatrogenic allergic contact dermatitis, in a patient with chronic actinic dermatitis: implications for management.

BACKGROUND: Chronic actinic dermatitis represents a spectrum of photosensitive dermatoses. Phototesting and photopatch testing are necessary to elucidate the specific subtype. Such patients may have multiple cutaneous allergies and photoallergies. OBJECTIVE: This is a case report of a patient with chronic actinic dermatitis whose condition was worsened by certain sunscreens and corticosteroids. Our purpose was to identify the specific subtype of chronic actinic dermatitis and cutaneous allergens. METHODS: Phototesting to UVB and UVA was performed. Photopatch testings to standard photoallergens and to Photoplex sunscreen ingredients was performed. Patch testing to standard allergens and proprietary corticosteroids was performed. RESULTS: Positive photoallergies to Photoplex sunscreen and the UVA screen within Photoplex, Parsol 1789 (4-tert-butyl-4'-methoxydibenzoyl-methane), were identified. Positive allergies to Aclovate (alclometasone dipropionate) cream and ointment and Locoid (hydrocortisone butyrate) ointment were identified. The patient showed increased UVB sensitivity. CONCLUSION: This is a case report of a patient with chronic actinic dermatitis. A relevant photoallergy to Parsol 1789 and corticosteroid sensitivities to aclometasone and hydrocortisone butyrate were identified. Multiple cutaneous allergens may be identified in patients with chronic actinic dermatoses, and avoidance of known allergens may result in significant improvement of the chronic dermatitis.

Adrenal Cortex Hormones↗
PubMed1994

Hyperosmolar nonketotic diabetic syndrome following treatment of human immunodeficiency virus infection with didanosine.

OBJECTIVE: To determine whether didanosine (DDI), one of the drugs commonly used to treat infection with human immunodeficiency virus (HIV), contributes to the development of diabetes and hyperosmolar nonketotic diabetic syndrome (HNKDS). CASE SUMMARY: One female patient was treated with DDI for infection with HIV during pregnancy. Soon after starting DDI treatment, she developed diabetes, which progressed to HNKDS. CONCLUSIONS: Although not reported in the literature, hyperglycemia following treatment with DDI has been noted in 82 patients and is usually associated with pancreatitis. DDI should be recognized as one of the drugs known to potentially cause diabetes and HNKDS. With the increasing use of DDI and other drugs that cause hyperglycemia, such as pentamidine and dapsone, blood glucose should be monitored frequently in the HIV-infected patients.

Adult↗
PubMed1994

Retiring some myths about aging and oral health.

Research on the oral health status of elderly populations has been limited in frequency and scope. There is a lack of good descriptive and longitudinal data on salivary gland function, oral mucosal status, and oral sensory performance in health and disease across the adult life span. Thus, confusion for practitioners and patients alike arises from unsubstantiated stereotypes about aging and oral health. There are some commonalities in the origins of the myths discussed in this article. First, many aging generalizations were based on studies that did not account for the health and medication status of the subjects. Second, most aging studies are cross-sectional designs which can result in misleading conclusions due to the age cohort effect. Third, many studies on the histology of aging oral tissues were laboratory animal studies, with results that cannot be generalized to human populations. Fourth, findings on oral health changes are often confounded or influenced by differences in functional status (e.g., the ability to care for oneself), nutritional health, health beliefs and expectations within the study subjects. Fifth, other changes due to aging may have an indirect effect on oral health, for example, an age-related decline in immune function. Sixth, the "older-old" group of elderly commonly labor under misconceptions of normal aging changes. Historically they have not sought dental care as often as the younger elders. This health care seeking behavior is expected to change dramatically when the baby boom generation joins the elderly ranks. The goals of oral health care for the elderly are consistent with those of other health care providers involved in geriatric care, namely maximizing functional performance, fostering independence, and enhancing their quality of life. Dental professionals would be well advised to apply a healthy dose of skepticism to any generalizations about debilitating changes in oral health due to aging alone. Most changes in oral health experienced by the elderly are not the result of age itself, but are the consequences of systemic disease, pharmacotherapy, functional disabilities, and cognitive impairment. When unexplained deleterious changes are seen in the oral health of elderly patients, the knowledgeable and reflective practitioner will account for local, systemic, and environmental factors in formulating a plan of care. In the opening paragraph, questions were posed about the mucosal integrity of a "little old lady." The most beneficial approach for her and all our older patients is to plan treatment utilizing current knowledge about aging and avoiding the traps created by myths and stereotypes. It is time to retire these myths before the baby boomers join the ranks of the retired.

Adult↗
PubMed1994

Preparing for the "silver age of dentistry".

Providing oral health care to older adults will be a challenging and rewarding part of dental practice in the years ahead. It will include understanding normal aging, appreciation of the pathophysiology of chronic diseases experienced by many elderly, and application of key principles of pharmacology in care of patients receiving medications for treatment of these diseases. It will involve an understanding of the interaction of systemic conditions with oral health status, adequate diagnosis of oral disease, and appropriate rational treatment planning with a strong emphasis on preventive dentistry. It will include care provided in nursing homes or during housecalls for the homebound. Dentist-geriatricians will be working with teams of healthcare professionals that include physicians, dentists, podiatrists, ophthalmologists, nurses, social workers, nutritionists, pharmacists, and occupational and physical therapists. Above all, the team will provide skilled compassionate care, which is always good business!

Aged↗
PubMed1994

Management of dry mouth in elderly patients.

Xerostomia is not a natural consequence of the aging process. Although dry mouth is not often found to be a chief complaint of elderly patients, it is a common problem that usually receives inadequate attention. Xerostomia is the feeling of dry mouth due to insufficient secretion of saliva. It is most common among the elderly as a result of adverse effects of drug therapy, head and neck radiation, or autoimmune diseases. Chronic xerostomia has a debilitating effect on the integrity of the hard and soft tissues of the mouth. It often causes difficulty in speaking, tasting, eating, swallowing and denture retention. The goals of treatment are to stimulate salivary flow, or to restore oral moistness and prevent or alleviate the uncomfortable, harmful sequelae of xerostomia. Dentists can significantly enhance the quality of life for xerostomia sufferers by effectively managing the xerostomia sequelae in a compassionate, understanding manner.

Aged↗
PubMed1993

The role of the cerebral cortex in swallowing.

This paper reviews clinical, neuroanatomical, and neurophysiological studies that have implicated the cerebral cortex in the initiation and/or regulation of swallowing as well as related functions such as mastication. Cortical dysfunction has been reported to result in a variety of swallowing impairments. Furthermore, swallowing can be evoked and/or modulated by stimulation applied to restricted regions of the cortex. Neuroanatomical investigations and single neuron recording studies also provide some insights into the cortical structures, pathways, and mechanisms that may mediate deglutition.

Cerebral Cortex↗
PubMed1993

Airway protection during breath-holding.

Little is known about laryngeal function during breath-holding. The completeness of laryngeal closure during breath-holding is clinically relevant during the supraglottic swallow. To investigate this phenomenon, vocal cord position was studied prospectively in 10 adults during breath-holding using nasolaryngoscopy with video recording. The position of the vocal cords was not consistent during breath-holding. Some subjects closed the glottis, while others had variable amounts of glottic opening. Straining and vocalizing at the onset of breath-holding produced both glottic and supraglottic closure, increasing the number of levels of laryngeal closure during breath-holding. Nasolaryngoscopy can be used clinically to document the airway protection, the effects of various protective maneuvers, and any resulting aspiration during breath-holding and during the supraglottic swallow.

Adult↗