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Biomedical subjects

C Ralph

Publications and source records attributed to C Ralph.

15 recordsLinked to original sources
PubMed1977

Hypertonic mannitol in the therapy of the acute respiratory distress syndrome.

Increased pulmonary artery pressure, an increase in pulmonary vascular resistance and an increase in physiologic dead space are consistent findings in patients with post-traumatic respiratory distress. Since mannitol has been shown to decrease renal vascular resistance following trauma, the effect of a bolus injection of 100 ml of 25% solution of this drug on pulmonary hemodynamics and physiologic dead space was investigated in 11 patients who had suffered multiple trauma. Five minutes after the injection, pulmonary vascular resistance fell (p less than .01), cardiac index increased (p less than .001) and physiologic dead space decreased (p less than .05). In contrast, the administration of 40 mg of furosemide produced no significant change in any of these parameters. Mannitol rapidly equilibrates in the extracellular space and exerts an osmotic effect across cell membranes. We postulate that the beneficial response to mannitol on the pulmonary vascular resistance and the improved perfusion of ventilated regions of the lung is due to a reduction in cell swelling and is not explainable by its diuretic effect. Improvement in the distribution of perfusion of pulmonary blood flow by mannitol may be a useful aid in the treatment of the post-traumatic form of the respiratory distress syndrome.

Acute Disease↗
PubMedDate not supplied

Pregnancy in a hemodialysis patient with an ethical/cultural challenge.

Each year, one in 200 women of child-bearing age conceive while on dialysis. Of those pregnancies not electively terminated, 46% result in a surviving infant. Late pregnancy losses are common with 25% ending in second trimester spontaneous abortion, stillbirth or neonatal death (Hou & Firanek, 1998). Despite these alarming statistics, there has been an increase in the number of successful pregnancies reported in the literature (Bagon et al., 1998; Romao et al., 1998). This case study presentation will allow readers to appreciate both clinical challenges and ethical issues associated with a pregnant, hemodialysis-dependent woman. Despite being given information about the risks of pregnancy while on dialysis, Mrs. T. was determined to have a second child (she has a two-year-old son). Her strong religious beliefs led her to believe that Allah would protect her and her child from harm. This created an ethical conflict with many members of the interdisciplinary health care team, who were of the opinion that a pregnancy would be detrimental to Mrs. T's health. Five months after initiation of hemodialysis, Mrs. T. did become pregnant. The unique nature of an Arabic-speaking Muslim woman who was pregnant and on dialysis provided an opportunity for the health care team to become more familiar with cultural and ethical issues that impacted greatly on her care. At 36 weeks, Mrs. T. delivered a healthy 2362 gram (5.1 lb.) baby girl with an apgar score of four and eight.

Adult↗
PubMedDate not supplied

Anti-idiotype cancer vaccines: pre-clinical and clinical studies.

We have previously shown that anti-idiotypic antibodies (Ab2) that functionally mimic the epitope defined by anti-colorectal carcinoma (CRC) monoclonal antibody (Ab1) CO17-1A induce in cancer patients highly specific anti-anti-idiotypic antibodies (Ab3) which are Ab1-like in their binding specificity to tumor cells and antigen. Ab1 GA733, originally produced against gastric carcinoma, binds to the same antigen as Ab1 CO17-1A, but to a different epitope. Ab2 against Ab1 GA733 produced in goats have been previously shown in experimental animals to functionally mimic the epitope defined by the Ab1. For the purposes of studying immune responses, this Ab2 preparation was administered to 12 patients who had previously been diagnosed with CRC but whose tumors were excised prior to Ab2 therapy. Patients were injected subcutaneously with escalating doses (0.5-4 mg) of Ab2 precipitated to alum. Ten of the 12 patients produced antibodies to the administered Ab2. In six patients a fraction of these antibodies bound specifically to the Ab2 and not to normal goat IgG. These anti-anti-idiotypic antibodies (Ab3) shared idiotopes with the Ab1 and bound to antigen-positive, but not antigen-negative, cultured tumor cells. The Ab3 specifically inhibited binding of the Ab1 to tumor cells and therefore may bind to the same epitope as Ab1. Our studies demonstrate that Ab2 are highly specific modulators of cancer patients immune responses to their tumors.

Antibodies, Anti-Idiotypic↗
PubMedDate not supplied

Regulation and the empowerment of nursing.

The International Council of Nurses (ICN) has been a vanguard for the regulation of nursing standards worldwide. In the European region ICN has organized three workshops at which nurses representing 14 countries* critically examined their national legislations and, with their respective nurses' associations, devised concrete plans to change the regulations where necessary in their respective countries. Compared with developing countries, the structures in the European countries are more established and resistant to change, thus making it more difficult for European nurses to break the hard-fast regulatory encasement. An area that has received special attention has been the regulation of nursing specialties, particularly issues relating to their identity and control. An active participant in ICN's European regulation workshops and chief executive of the UK's regulatory body for nursing and midwifery, Colin Ralph takes a stand for empowering the nursing profession through regulation and offers assistance to those who need help in developing nursing regulations, not only in Europe but worldwide.

Europe↗