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Biomedical subjects

R J Carpenter

Publications and source records attributed to R J Carpenter.

At least 109 records · Page 6Linked to original sources
PubMed1982

Preterm labor: cause and management.

Preterm labor has not been eradicated by the introduction of the betamimetic agents. However, with the more effective agents, a marked prolongation of intrauterine existence has allowed further growth and development of small preterm fetuses. This has reduced morbidity and mortality significantly. Further work is necessary. Despite the capability of inhibiting labor with any of several drugs, a major factor in the improved survival of small preterm infants has been instant availability and access to the infant of a neonatologist. In most instances this requires transport to at least a secondary and in most cases to a tertiary care facility. With infants estimated to be under 1500 gm, tocolysis should be employed as an adjunct to transfer of the maternal-fetal unit to a tertiary care facility.

Adrenergic beta-Agonists↗
PubMed1981

Evaluation of three methods for obtaining fetal weight estimates using dynamic image ultrasound.

The effectiveness of three methods (Campbell and Wilkin, Warsof, Warsof et al for estimating fetal weight from measurements of the abdominal circumference (AC) and biparietal diameter (BPD) has been evaluated in 125 patients studied with dynamic image ultrasound. Investigations of the population as a whole indicated that the Campbell-Wilkin and Warsof methods systematically overestimated the weight (mean deviation: 5.3% and 1.6%, respectively), while the method of Warsof et al gave systematic underestimations (mean deviation: - 3.2%). The variability of the two Warsof methods was similar (SD: 8.8% and 8.4%) and significantly lower than that seen with the Campbell-Wilkin method (SD: 13.9%). When separate weight subclasses (500 gm to 4500 gm) were examined, the mean deviations and their variability were significantly lower with the two Warsof methods. The method of Warsof showed the most consistency among the weight subclasses. These results indicate that of these three methods, the best estimates of fetal weight are provided by the Warsof procedure.

Abdomen↗
PubMed1981

Estimating fetal age: effect of head shape on BPD.

Several recent obstetrical sonographic examinations in this department demonstrated that variations in the shape of the fetal skull (e.g., dolichocephaly, brachycephaly) may adversely affect the accuracy of the biparietal diameter (BPD) measurement in estimating fetal age. In each case the cephalic index of the fetal skull (short axis/long axis x 100) was in either the dolichocephalic or brachycephalic range based on established postnatal criteria. Consequently, normal values were determined (mean, 78.3) for the cephalic index in utero based on 316 obstetrical sonographic studies performed at 14--40 weeks. Preliminary experience indicates that a cephalic index greater than 1 SD from the mean (less than 74, greater than 83) may be associated with a significant alteration in the BPD measurement expected for a given gestational age, and that the head circumference can be used effectively as an alternative means of establishing gestational age.

Adult↗
PubMed1980

Nasal septal injury in children. Diagnosis and management.

Although nasal injury is common-place in childhood, nasal septal trauma often is neglected and frequently goes undiagnosed until complications ensue. Only a complete intranasal examination in all cases of nasal trauma will detect intranasal fractures, dislocations, lacerations, hematomas, and abscess formation. Untreated, these septal and associated injuries can lead to considerable functional (nasal respiratory) and cosmetic (external) abnormalities. We report a case to illustrate the destructive sequelae of a "minor" nasal injury. Treatment may require formal surgical exploration with hematoma evacuation, reconstruction of the septal skeletal structures, and repair of lacerations of the intranasal mucosa. We review the management of cartilage resorption secondary to hematoma or abscess formation. A technique for replacing the caudal end of the septum is discussed and illustrated.

Cartilage↗
PubMed1980

Evaluation of insulating materials used during cryosurgery.

During the performance of cryosurgery it is of paramount importance to protect surrounding normal tissue from injury during the freezing process. This study evaluates three different insulating materials that are commonly used: petrolatum gauze, wooden tongue depressors, and styrofoam. To measure the effectiveness of these different insulators, the temperature gradient that developed across these barriers during a freezing cycle was measured. Five separate trials were carried out with each of the insulators, and the grafts demonstrated the results of these experimental trails. The superior insulator was styrofoam. Significant protection was afforded by wood and little protection by the layers of petrolatum gauze. In spite of the similarity in protection offered by the styrofoam and wood insulators, styrofoam is superior because of its flexibility. Our studies indicate that styrofoam is the best and most practical insulator to use during cryosurgical procedures in the head and neck area.

Bandages↗
PubMed1979

Reconstruction after total laryngopharyngectomy.

After resection of a hypopharyngeal cancer, utilization of the remaining pharyngeal mucosa in restoring pharyngoesophageal continuity is the procedure of choice. This is possible in most patients. However, a few patients have cancers that involve the posterior pharyngeal wall and esophageal introitus. Resection in this group involves complete removal of a segment of the laryngopharynx and reconstruction with the use of tissue from the adjacent side of the neck, chest, or alimentary canal. Between 1965 and 1974, 44 patients required reconstruction of a pharyngeal defect with the use of adjacent skin flaps or visceral interposition. Pharyngeal reconstruction with the use of these techniques involved multiple operative procedures, a greater morbidity, and a large time investment by the patient and surgeon. Survival of these patients was shorter than survival of patients who had repair by primary closure of the pharyngeal mucosa because of the extent of the primary lesions.

Adult↗
PubMed1979

The otolaryngologic presentation of myasthenia gravis.

Myasthenia gravis is a neuromuscular disease of insidious onset, characterized by weakness and fatigability of voluntary muscles. Most patients present with symptoms relating to the head and neck and thus may be seen first by the otolaryngologist. Predominant symptoms may be ocular (ptosis or diplopia) or related to fatigue of the oropharyngeal or laryngeal musculature (dysarthria, dysphonia, or dysphagia). Alleviation of muscular weakness and fatigability after administration of anticholinesterase drugs is pathognomonic of myasthenia gravis.

Adolescent↗
PubMed1979

Spastic dysphonia: treatment by selective section of the recurrent laryngeal nerve.

Selective section of the adductor branch of the recurrent laryngeal nerve appears to result in phonatory results similar to complete nerve section without the inherent morbidity. The abductor branch to the posterior cricoid-arytenoid muscle remains intact for glottic opening during inspiration. We emphasize the importance of careful preoperative patient evaluation as described by Dedo. All patients should be seen by a speech therapist and undergo a trial of speech therapy prior to surgical evaluation. A test block of the recurrent nerve with 1% xylocaine is imperative to allow the patient to hear the postoperative speech characteristics and give him a realistic expectation of the surgical result. We find that patients and referring professionals more readily accept the concept of selective nerve section.

Humans↗
PubMed1979

Nasal septal trauma in children.

If the septal component of a nasal injury is adequately managed, usually the entire nasal injury will be well managed. Major or minor nasal trauma can cause cartilage fracture, deviation, dislocation, hematoma, or abscess formation, and the various associated sequelae, some of them life-threatening. A negative x-ray report should never be used as a substitute for a complete intranasal examination in any child with nasal trauma. Any nasal abnormality should be referred for immediate evaluation and treatment.

Child↗
PubMed1978

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): Report of a case with respiratory tract involvement.

The term "sinus histiocytosis with massive lymphadenopathy," introduced in 1969 by Rosai and Dorfman, refers to a newly recognized disease entity characterized by painless cervical lymphadenopathy, fever, leukocytosis, increased erythrocyte sedimentation rate, and hypergammaglobulinemia. The typical course is one of insidious onset, protracted duration of the active disease state, and eventual spontaneous remission, occasionally with subsequent recurrences. Lymph nodes other than those in the cervical area may be involved, and extranodal involvement can occur (such as in the orbit, skin, or respiratory tract). Clinically, this entity may closely simulate malignant lymphoma or nonneoplastic conditions with lymphadenopathy. We present a case in which this disease process extensively involved the respiratory tract and produced obstructive symptoms. The otorhinolaryngologist should be aware of this disease entity and should include it in the differential diagnosis for patients with cervical lymph node enlargement or bronchial obstruction.

Adult↗
PubMed1978

Amniocentesis.

Explore the source record for details and available documents.

Amniocentesis↗
PubMed1977

Cryosurgery of bronchopulmonary structures. An approach to lesions inaccessible to the rigid bronchoscope.

Cryonecrosis of the upper lobe of the lung and bronchi was safely inudced in healthy dogs by application of the cryoprobe to serosal surfaces or, through a bronchotomy, to the mucosal surfaces under direct vision. Seven days after cryosurgery, hyperemia of the bronchus was seen. By 14 days the bronchus at the target site was covered with cuboidal epithelium. Reappearance of normal ciliated epithelium occurred by 180 days after cryosurgery. Cartilage remained intact, and there was no evidence of formation of a stricture or other gross alteration of bronchial architecture. In the lung there was coagulation necrosis; and by 14 days after cryosurgery, there was fibrosis in the target area. There were no complications of the pleural space. Cryosurgery of tissues at the margins of the bronchotomy does not impair healing. Cryosurgery may reduce the necessity for extensive surgery in selected patients with bronchopulmonary tumors, including those inaccessible to the rigid bronchoscope. Clinically, eight patients with recurrent bronchogenic tumors have received palliation by transbronchoscopic cryosurgery.

Animals↗
PubMed1976

Cancer of the hypopharynx. Analysis of treatment and results in 162 patients.

Between 1962 and 1972, 190 patients with squamous cell carcinoma of the hypopharynx were seen; 162 received primary treatment at our clinic. Of the 162 lesions, 117 (72%) originated in the pyriform sinus. The most frequent symptom was pain in the throat (87 patients, 54%). One hundred twenty six patients (78%) had tumors extending beyond the hypopharynx (T3 lesions), and 108 patients (67%) had cervical metastasis (stage III or IV). Treatment modalities included surgical excision in 82 patients, radiation in 39, planned combination of preoperative radiation followed by surgery in 18, radiation plus neck dissection in 15, and surgery plus postoperative radiation in eight. Sixty-nine patients (43%) had recurrent tumor. Recurrences were equally frequent in the primary site and the neck. Comparison of treatment modalities showed no differences in overall recurrence. Surgery alone or in combination with radiation reduced the incidence of local recurrence; however, when recurrences were analyzed in relation to stage of lesion, preoperative or postoperative radiation and surgery offered no advantage over surgery alone in reducing local or neck recurrence or in overall survival rate. Treatment by radiation alone was associated with a poorer survival. For the entire group, three-year survival was 52% and five-year survival was 47%.

Aged↗