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Biomedical subjects

A M Robinson

Publications and source records attributed to A M Robinson.

At least 19 recordsLinked to original sources
PubMed1991

Adenocarcinoma of the colon and rectum in patients less than 40 years of age.

From 1962 to 1988, 50 of 801 patients with adenocarcinoma of the colon and rectum treated at the National Naval Medical Center were less than 40 years old. Symptoms were present in 47 of the younger patients at presentation. The mean duration of time from the onset of symptoms to diagnosis in this group was 4.9 months. Risk factors for carcinoma of the colon and rectum were identified in 14 of 50 patients less than 40 years old. A significantly greater proportion of patients less than 40 years old had Stage C disease compared with the older group of patients (42 versus 22 per cent, p = 0.014). Stage B disease was more common in patients more than 40 years of age (44.8 versus 26.0 per cent, p = 0.014). The proportion of patients with Stages A and D disease was similar in both age groups. The cumulative survival rate in this group at five and ten years was 43 and 34 per cent, respectively. The five year survival rate in patients less than 40 years old with Stage B disease was 76 per cent and with Stage C disease, 37 per cent. All young patients with Stage D disease were dead at 28 months. Synchronous and metachronous carcinomas of the colon and rectum were uncommon in patients less than 40 years old. Patients less than 40 years of age with carcinoma of the colon and rectum are usually symptomatic and have advanced disease at the time of presentation. Survival time for these patients for each stage of disease is similar to the over-all population of patients with carcinoma of the colon and rectum.

Adenocarcinoma↗
PubMed1990

Occupational therapy in acute inpatient psychiatry: an activities health approach.

This article discusses some of the challenges that occupational therapists working in acute psychiatric inpatient settings commonly face. There is often a lack of sufficient time available for treatment as well as limitations inherent in addressing functional problems in the artificiality of a hospital environment. A theoretical framework is introduced from which the role of occupational therapy and realistic objectives for acute short-term care can be identified. This framework for inpatient occupational therapy practice is based on the concept of activities health, which provides a definition of health in functional rather than medical terms. The importance of emphasizing the patient's competence in roles assumed in community living is emphasized. A step-by-step approach to program development with specific examples is also provided.

Activities of Daily Living↗
PubMed1990

Outpatient hemorrhoidectomy.

Fifty-three patients underwent closed hemorrhoidectomies on an outpatient basis at the Naval Hospital Bethesda, Bethesda, Maryland, and George Washington University Hospital, Washington, DC. Our goal was to show that closed hemorrhoidectomies could be tolerated well in an outpatient setting. We found that patients tolerated this surgery well, and there was no progression of complications due to the out-of-hospital setting. An additional benefit is the cost savings to the patient who does not require an overnight hospitalization. Outpatient hemorrhoidectomy is a technique that can be effectively used in an ambulatory surgical setting with good patient tolerance and acceptance.

Adult↗
PubMed1989

Gastroduodenal polyps in familial polyposis coli.

This endoscopic evaluation of 25 patients with familial polyposis coli (FPC) further establishes gastro-duodenal polyps as a significant extracolonic manifestation of the condition. Ten patients had polyps, distributed as follows: stomach (2), duodenum (4), stomach and duodenum (4). Altogether, there were six gastric and seven duodenal lesions. Half of the gastric tumors were hyperplastic and half were adenomatous. All the duodenal tumors were adenomatous, four being ampullary. The one symptomatic patient had intra-polypoid adenocarcinoma. There were no significant correlations between the endoscopic findings and patient age, sex, presence of colon cancer, or other extracolonic abnormalities. The authors affirm that gastroduodenal polyps are an important component of FPC and recommend that all patients with this condition undergo initial and follow-up gastroduodenoscopy. Multiple small lesions may be carefully monitored, but larger ones, particularly those in the region of the ampulla, must be excised.

Adenomatous Polyposis Coli↗
PubMed1988

Anorectal abscess and fistula-in-ano.

The etiology of anorectal abscess and fistula-in-ano is discussed. The anatomy, which is vital to the understanding and treatment of the above, is reviewed, with two of the more common classifications of fistula-in-ano presented. The different methods of treating each are discussed, and some of the common complications of the procedure are listed. A true understanding of the disease process and anatomy is needed before treatment of fistulous abscesses is begun, but, with it, successful outcomes will occur in most cases.

Abscess↗
PubMed1988

Therapeutic colonoscopy in the treatment of colonic pseudo-obstruction.

Colonic pseudo-obstruction has been recognized since Ogilvie described this disease in 1948. Metabolic, surgical, and medical causes have been implicated at various times. Treatment has included surgical decompression by cecostomy and colectomy. Successful nonoperative decompression by colonoscopy was first reported by Kukora and Dent in 1977. Since that report several authors have reported their results using this technique. Presented here is a series of nine patients with colonic pseudo-obstruction treated initially with colonoscopy. Patients presented with a variety of associated conditions, including post operative patients, orthopedic injuries, metastatic carcinoma, and an unusual case after a normal vaginal delivery. Eight patients responded well to colonoscopic decompression. One patient, the second in the series, was unable to be decompressed with colonoscopy and underwent a cecostomy under local anesthesia. Successive colonoscopy may be required to allow restoration of normal colonic function, as was the case in seven of our patients. One death occurred, due to unrelated causes. The authors have found colonoscopy to be a safe and reliable therapy for colonic pseudo-obstruction.

Adult↗
PubMed1979

Alterations in the rate of lipogenesis in vivo in maternal liver and adipose tissue on premature weaning of lactating rats: a possible regulatory role of prolactin.

Removal of pups for 24 h from rats at peak lactation decreased 3H2O incorporation into lipid in vivo in mammary gland by 95%, whereas it was increased in liver (77%) and adipose tissue (330%). These increases were prevented by administration of prolactin. Plasma insulin increased 3-fold on weaning and this was partially prevented by prolactin.

Adipose Tissue↗
PubMed1978

Utlization of D-3-hydroxy[3-14C]butyrate for lipogenesis in vivo in lactating rat mammary gland.

Incorporation of D-3-hydroxy[3-14C]butyrate into lipid in vivo suggests that lactating mammary gland is a major site of ketone-body utilization. The incorporation decreases in short-term insulin deficiency (2h) and on starvation (24h), but increases again on refeeding (2h). The activity of cytosolic acetoacetyl-CoA synthetase parallels the changes in nutritional state, but is not affected by short-term insulin deficiency.

Acetyl-CoA C-Acetyltransferase↗
PubMed1978

Evidence for a role of insulin in the regulation of lipogenesis in lactating rat mammary gland. Measurements of lipogenesis in vivo and plasma hormone concentrations in response to starvation and refeeding.

Fatty acid synthesis in the mammary gland of lactating rats in vivo was 5-fold higher than in the liver. Starvation decreased fatty acid synthesis in the gland 50-fold, whereas refeeding for 2h completely reversed this change. The plasma insulin concentration decreased 2-fold in starvation and was restored to the fed-rat value on refeeding. Glucagon and prolactin concentrations did not always change in parallel with lipogenesis, suggesting that insulin may be a regulator of this process in the gland.

Animals↗
PubMed1978

Control of glucose metabolism in isolated acini of the lactating mamary gland of the rat. Effects of oleate on glucose utilization and lipogenesis.

Oleate (1mM) had only small inhibitory effects on glucose utilization and lipogenesis in acini isolated from rat mammary gland. Esterification of [1-14C]oleate was unaffected by insulin but were decreased by 60% by acetoacetate (2mM). Glycerol (1mM), but not insulin, relieved this inhibition. These experiments provide further support for the role of acetoacetate in regulating substrate utilization by the gland.

Acetoacetates↗
PubMed1977

Control of glucose metabolism in isolated acini of the lactating mammary gland of the rat. The ability of glycerol to mimic some of the effects of insulin.

Inhibition of glucose uptake by acetoacetate and relief of this inhibition by insulin found previously in slices of rat mammary gland [Williamson, McKeown & Ilic (1975) Biochem. J. 150. 145-152] was confirmed in acini, which represent a more homogeneous population of cells. Glycerol (1mM) behaved like insulin (50 minuits/ml) in its ability to relieve the inhibition of glucose (5 mM) utilization caused by acetoacetate (2 mM) in acini. Both glycerol and insulin reversed the increase in [citrate] and the decrease in [glycerol 3-phosphate] and the [lactate]/[pyruvate] ratio in the presence of acetoacetate. Lipogenesis from 3H2O, [3-14C] acetoacetate, [1-14C]- and [6-14C]-glucose was stimulated, whereas 14CO2 formation from [3-14C]acetoacetate was decreased. Neither insulin nor glycerol relieved the acetoacetate inhibition of glucose uptake when lipogenesis was inhibited by 5-(tetradecyloxy)-2-furoic acid. From measurements of [3-14C]acetoacetate incorporation into lipid in the various situations it is suggested that a cytosolic pathway for acetoacetate utilization may exist in rat mammary gland. In the absence of acetoacetate, glycerol inhibited glucose utilization by 60% and increased both [glycerol 3-phosphate] and the [lactate/[pyruvate] ratio. Possible ways in which glycerol may mimic the effects of insulin are discussed.

Acetoacetates↗
PubMed1977

Effects of acetoacetate administration on glucose metabolism in mammary gland of fed lactating rats.

Administration of acetoactate to fed lactating rats rapidly decreases glucose uptake by the mammary gland, and causes an output of pyruvate, whereas lactate uptake remains unchanged. Similar changes, though not identical, occur in starved lactating rats, which suggests that the increased acetoacetate concentration in this situation may be one of the factors responsible for the alterations in glucose metabolism.

Acetoacetates↗
PubMed1977

Comparison of glucose metabolism in the lactating mammary gland of the rat in vivo and in vitro. Effects of starvation, prolactin or insulin deficiency.

1. Measurements of arteriovenous differences across mammary glands of normal and starved lactating rats, and lactating rats made short-term insulin-deficient with streptozotocin or prolactin-deficient with bromocryptine, showed that only in the starved animals was there a significant decrease in glucose uptake. This decrease was accompanied by release of lactate and pyruvate from the gland, in contrast with the uptake of these metabolites by glands of normal lactating rats. 2. There were no marked differences in metabolite concentrations in freeze-clamped glands in the four conditions studied, apart from a decrease in [lactate] and [pyruvate] and an increase in [glucose] in the glands of the streptozotocin-treated group. 3. Acini isolated from the glands of starved, insulin or prolactin-deficient rats had a higher production of lactate and pyruvate from glucose than did glands from normal rats; this is in agreement with the reported decrease in the proportion of active pyruvate dehydrogenase in these situations [Field & Coore (1976) Biochem. J.156, 333-337; Kankel & Reinauer (1976) Diabetologia12, 149-154]. 4. Addition of insulin did not increase the uptake of glucose by acini from normal glands, but it caused a significant increase in the utilization of glucose by acini from glands of starved rats. Insulin did not decrease the accumulation of lactate and pyruvate in any of the experiments. 5. It is concluded that isolated acini represent a suitable model for the study of mammary-gland carbohydrate metabolism in that they reflect metabolism of the gland in vivo.

Animals↗
PubMed1977

The effect of low-cost maintenance medication on the rehospitalization of schizophrenic outpatients.

In an effort to determine whether expense is a relevant factor when schizophrenic outpatients discontinue maintenance medication, the authors gave low-cost drugs to 44 subjects, while 46 control subjects paid the retail rate. The unexpected result was that the group receiving low-cost drugs had a significantly higher rate of rehospitalization. The authors suggest that monetary investment on the patient's part may be an important factor in successful drug maintenance.

Ambulatory Care↗