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Biomedical subjects

S D Martin

Publications and source records attributed to S D Martin.

34 records · Page 2Linked to original sources
PubMed1993

Atraumatic posterior dislocation of the sternoclavicular joint. A case report and literature review.

Atraumatic spontaneous posterior dislocation of the sternoclavicular joint (SCJ) is an extremely rare event. Only three recorded cases exist in the literature, and they are poorly documented and without roentgenographic confirmation. Spontaneous posterior dislocation of the SCJ occurred in an active 50-year-old woman without any known underlying pathology. Closed reduction attempted five days later was unsuccessful, and the patient was treated conservatively with short-term modification of activity. The patient is asymptomatic and followed carefully one year postdislocation. A review of the literature discloses a 25% complication rate involving the vital structures of the superior mediastinum after posterior dislocation of the SCJ. Because of this high complication rate, a thoracic or vascular surgeon must be available should closed or open reduction become necessary.

Female↗
PubMed1992

A field comparison of the pharyngeotracheal lumen airway and the endotracheal tube.

A prospective, sequential study compared ease of use and bag-valve ventilation delivered by an endotracheal tube (ET) with that of the pharyngeotracheal lumen airway (PtL) for 111 victims of cardiac arrest in the pre-hospital setting. The PtL airway was found to be significantly easier to use as measured by the time required to intubate the patient and the number of attempts to place the device. Arterial blood gas determinations were made on arrival at the hospital and repeated 15 minutes later. No statistical significance could be found between the two airway devices for either the first or second blood gas determination. During PtL ventilation, the first arterial blood gas values were PaCO2, 58 +/- 32 mm Hg; PaO2, 163 +/- 180 mm Hg; pH, 7.15 +/- 0.22. During ET ventilation the first arterial blood gas values were PaCO2, 53 +/- 29 mm Hg; PaO2, 156 +/- 178 mm Hg; pH, 7.16 +/- 0.23. No adverse effects were reported. We conclude that the ability of the PtL to deliver effective ventilation is comparable with that of the ET as measured by arterial PCO2. When the ET method of airway control cannot be achieved, the PtL airway offers an effective alternative.

Adult↗
PubMed1992

Evaluation of hemostatic analytes after use of hypertonic saline solution combined with colloids for resuscitation of dogs with hypovolemia.

The effects of hypertonic saline solution (HTSS) combined with colloids on hemostatic analytes were studied in 15 dogs. The analytes evaluated included platelet counts, one-stage prothrombin time, activated partial thromboplastin time, von Willebrand's factor antigen (vWf:Ag), and buccal mucosa bleeding times. The dogs were anesthetized, and jugular phlebotomy was used to induced hypovolemia (mean arterial blood pressure = 50 mm of Hg). Treatment dogs (n = 12) were resuscitated by infusion (6 ml/kg of body weight) of 1 of 3 solutions: HTSS combined with 6% dextran 70, 6% hetastarch, or 10% pentastarch. The control dogs (n = 3) were autotransfused. Hemostatic analytes were evaluated prior to induction of hypovolemia (baseline) and then after resuscitation (after 30 minutes of sustained hypovolemia) at 0.25, 0.5, 1, 6 and 24 hours. All treatment dogs responded rapidly and dramatically to resuscitation with hypertonic solutions. Clinically apparent hemostatic defects (epistaxis, petechiae, hematoma) were not observed in any dog. All coagulation variables evaluated, with the exception of vWf:Ag, remained within reference ranges over the 24-hour period. The vWf:Ag values were not statistically different than values from control dogs, and actual values were only slightly lower than reference ranges. Significant (P < or = 0.04) differences were detected for one-stage prothrombin time, but did not exceed reference ranges. The results of this study suggested that small volume HTSS/colloid solutions do not cause significant alterations in hemostatic analytes and should be considered for initial treatment of hypovolemic or hemorrhagic shock.

Animals↗
PubMed1989

Clinical ratings and plasma HVA during cocaine abstinence.

Six patients were evaluated over a 21-day period during inpatient recovery from chronic repeated cocaine use. Serial evaluations of Hamilton depression rating, cocaine craving, plasma homovanillic acid (pHVA), and plasma 3-methoxy-4-hydroxyphenylethyleneglycol (pMHPG) concentrations were determined. There was a distinct increase in cocaine craving between 1 and 2 weeks after the last cocaine use. Levels of pHVA also increased at the time of heightened craving. The data provide preliminary evidence to suggest that changes in cocaine craving during abstinence are positively correlated with changes in dopamine turnover.

Adult↗
PubMed1987

The pharyngeo-tracheal lumen airway: an assessment of airway control in the setting of upper airway hemorrhage.

Aspiration of blood from nasal and upper airway injuries is a common problem in trauma patients. The pharyngeo-tracheal lumen (PTL) airway uses a large balloon to occlude the oropharynx. We conducted a postmortem radiographic evaluation of the PTL airway's ability to control simulated upper airway hemorrhage using a barium solution. The PTL airway was inserted in ten patients and the barium solution was instilled in the nose until it was full. Radiographs were taken to determine the extent of containment of the radiopaque liquid. The PTL airway successfully controlled the simulated upper airway hemorrhage in nine of the ten cases studied including one patient with a cleft palate. There was leakage in the tenth case due to a balloon leak. The PTL airway may be the prehospital airway of choice in trauma patients due to its ability to control upper airway hemorrhage, but it requires further clinical testing.

Adult↗
PubMed1984

Comparative study of three methods of resuscitation: closed-chest, open-chest manual, and direct mechanical ventricular assistance.

Presented are the results of a comparison study of three forms of circulatory support during ventricular fibrillation: closed-chest compression (CCC), open-chest manual compression (OCMC), and direct mechanical ventricular assistance (DMVA). DMVA is a method of circulatory support using a bell-shaped device that is affixed to the heart by apical suction and that alternately compresses and expands the ventricles. CCC produced a cardiac index (CI) of 780 mL/min/m2 (19% of control) with a mean arterial pressure (MAP) of 26 mm Hg (23% of control). Both forms of direct cardiac compression produced higher values. OCMC at 60 compressions per minute (CPM) produced a CI of 2,069 mL/min/m2 (52% of control) with an MAP of 50 mm Hg (45% of control). DMVA at the same rate produced a CI of 2,780 mL/min/m2 (70% of control) with an MAP of 72 mm Hg (65% of control). The values for DMVA at 60 CPM were significantly higher than for OCMC at 60 CPM (P less than .005 for CI, and P less than .0005 for MAP). Changing from standard CCC to DMVA at 90 CPM produced the greatest hemodynamic improvements: MAP increased by 250%, and CI increased by 340%. With DMVA at 90 CPM, the systolic pressure, stroke index, and CI were not statistically different from control, prearrest values.

Animals↗
PubMed1984

Accuracy and usefulness of a breath alcohol analyzer.

We evaluated the accuracy of a hand-held breath alcohol analyzer in the rapid determination of blood alcohol levels in the emergency patient with suspected ethanol intoxication. The Alco -Sensor III breath alcohol analyzer was used to measure alcohol levels in orally and nasally obtained end-expiratory breath samples in 55 patients. These levels were compared to directly measured blood alcohol levels. The patients were categorized into cooperative and uncooperative groups. The mean oral breath alcohol level obtained was 0.187 +/- 0.100 g/dL (range, 0.000 to 0.419) while the mean serum level was 0.217 +/- 0.113 g/dL (range, 0.00 to 400). The overall correlation between these two methods of measuring blood alcohol level was strong (r = .879, P less than .001). In cooperative patients the correlation was even stronger (r = .963, P less than .001), while in uncooperative patients the correlation was less but still significant (r = .723, P = .001). Nasally obtained samples correlated well with blood levels in cooperative patients (r = .874, P less than .001), but the correlation was less strong in uncooperative persons (r = .694, P = .003). Our study indicates that the Alco -Sensor III breath alcohol analyzer is sufficiently accurate to be of use in rapidly assessing blood alcohol levels, even when a patient is unable to cooperate fully.

Alcoholic Intoxication↗
PubMed1984

A case report of splenic pregnancy.

A case of splenic pregnancy is reported. The patient was treated surgically with a satisfactory result. The problem of preservation of the spleen in the presence of a spontaneous rupture is highlighted.

Adult↗
PubMedDate not supplied

Coping with chronic illness.

Families suffer in many ways when a member is stricken with chronic illness. Nurses frequently feel a sense of frustration when working with the chronically ill because cure is not possible. The author reviews the goals of care and coping tasks common to the chronically ill. Family coping styles are reviewed with suggestions for effective nurse behaviors with each style.

Adaptation, Psychological↗
PubMedDate not supplied

Proximal tibial osteotomy with compression plate fixation for tibia vara.

A surgical technique for the accurate intraoperative correction of tibia vara deformities with maintainence of postoperative alignment is presented. This was a retrospective study of 13 knees of nine patients with tibia vara deformities treated by proximal tibial and fibular osteotomies using compression-plate fixation. Average age of the patients was 9 + 1 years, with a range of 3 + 1 to 14 + 11 years. The average preoperative deformity was 20 degrees of varus with a range of 15-36 degrees. Average follow-up was 3 + 3 years, with a range of 2 to 4 + 1 years. All patients had intraoperative correction to an average valgus of 5 degrees (range 4-8 degrees valgus), with an overall valgus correction of 25 degrees (range 20-40 degrees). There was one reoperation for unilateral recurrence of deformity in a child who progressed from stage III to stage VI postoperatively. Proximal tibial osteotomy with compression-plate fixation provides an accurate and reliable method for the correction of multiplanar deformities in children and adolescents.

Adolescent↗
PubMedDate not supplied

Outgrowth of chondrocytes from human articular cartilage explants and expression of alpha-smooth muscle actin.

The objectives of this study were to investigate the effect of various enzymatic treatments on the outgrowth of chondrocytes from explants of adult human articular cartilage and the expression of a specific contractile protein isoform, alpha-smooth muscle actin, known to facilitate wound closure in other connective tissues. Explants of articular cartilage were prepared from specimens obtained from patients undergoing total joint arthroplasty. The time to cell outgrowth in vitro was determined and the expression of alpha-smooth muscle actin shown by immunohistochemistry. Treatment of the explants with collagenase for 15 minutes reduced the time to outgrowth from more than 30 days to 3 days. Hyaluronidase, chondroitinase ABC, and trypsin applied for the 15-minute period had no effect on the time to cell outgrowth when compared with untreated controls. Pretreatment with hyaluronidase prior to collagenase reduced the time to outgrowth. A notable finding of this study was that the majority of chondrocytes in the adult human articular cartilage specimens and virtually all of the outgrowing cells contained alpha-smooth muscle actin. We conclude that human articular chondrocytes have the capability to migrate through enzymatically degraded matrix and express a contractile actin isoform. Collagenase treatment reduces the time required for cell outgrowth.

Actins↗
PubMedDate not supplied

Dynamic lateral patellar tilt in the anterior cruciate ligament-deficient knee. A magnetic resonance imaging analysis.

An open-configuration magnetic resonance imaging scanner was used to document patellar tracking abnormalities in 11 anterior cruciate ligament-injured knees. The contralateral normal knees were used as controls. Images were obtained with the quadriceps muscles at rest (knee flexion at 40 degrees, 25 degrees, and 10 degrees) and with the quadriceps muscles contracted (knee flexion at 40 degrees and 25 degrees). When the quadriceps muscles were at rest there were no differences in patellar alignment between the anterior cruciate ligament-injured knees and the contralateral normal knees. When the quadriceps muscles were maximally contracted at 40 degrees of flexion, the patellae of the anterior cruciate ligament-injured knees tilted laterally 3.6 degrees relative to the resting state. When the quadriceps muscles were contracted at 25 degrees of flexion, the patellae of the anterior cruciate ligament-injured knees tilted laterally approximately 4 degrees relative to the resting state. Quadriceps-active lateral patellar tilt at 25 degrees of flexion was greater in the anterior cruciate ligament-injured knees than in the contralateral normal knees, and it correlated with instrumented measurements of anterior tibial translation. Dynamic lateral patellar tilt during open kinetic chain exercises and during other activities that produce anterior tibial translation may contribute to extensor mechanism dysfunction in the anterior cruciate ligament-injured knee.

Adult↗
PubMedDate not supplied

Switching from depot antipsychotics to risperidone: results of a study of chronic schizophrenia. The Schizophrenia Treatment & Assessment Group.

Designed to provide information about patients with schizophrenia who switch from depot neuroleptics to the oral, atypical antipsychotic risperidone, this multicenter observational study enrolled patients who wished to stop the depot, had an unsatisfactory response, or experienced unacceptable side effects. Individuals remained on depot medication for 4 weeks and then received risperidone monotherapy for 3 months. Of the 143 patients who entered the study, 130 received risperidone, 109 completed the initial 16-week study, and 88 entered an optional 12-week follow-up. Symptoms and side effects did not change significantly during the depot phase (mean Positive and Negative Syndrome Scale [PANSS] score 72.2 at baseline, 71.6 at visit 2), but PANSS scores, global assessment of functioning, parkinsonism, and dyskinesia improved significantly during the risperidone phase (mean PANSS score decreased from 71.6 to 55.5 after 3 months). The number of contacts with healthcare professionals fell significantly during the risperidone phase; in addition, symptomatic improvements were maintained during follow-up, and movement disorders continued to decrease significantly. The investigators considered that 81% of patients had switched successfully. Patient acceptance of risperidone was significantly higher than for depot medication (83% vs 23%; P < .001), and 65% considered risperidone better than their previous treatment. Indications for depot medication should be reviewed, and patients may benefit from a switch to risperidone.

Administration, Oral↗