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Biomedical subjects

C Ray

Publications and source records attributed to C Ray.

At least 37 records · Page 2Linked to original sources
PubMed1986

Regional isolated limb perfusion of melanoma intransit metastases using mechlorethamine (nitrogen mustard).

Forty-two patients with intransit metastases of melanoma in a limb were treated by isolated regional perfusion chemotherapy using mechlorethamine (nitrogen mustard). Group 1 (n = 12) underwent treatment at low dose, less than 0.35 mg/kg, or low temperature, less than 38 degrees C. Group 2 (n = 30) received higher doses, 0.35 to 0.6 mg/kg, plus heat at 38 degrees C to 41 degrees C. No patient had evidence of disease outside the limb at the time of perfusion. The median follow-up time was 48 months (range, 1 to 9 years). Of the 42 patients, 29 had measurable lesions that responded as follows: group 1, complete response (CR) in two of ten and partial response (PR) in none; group 2, CR in six of 19 and PR in six of 19. The combined CR and PR rate of 12 of 19 in group 2 was significantly higher than that of group 1 (P less than .05). CR lasted only 2 months in the two patients of group 1, but persisted in the six patients of Group 2, four of whom are still alive free of disease at 16, 21, 33, and 40 months. Relapse-free control of disease in the limb was achieved in 36% of the patients in group 2 at 24 months, compared with 0% in group 1 (P less than .05). An overall survival of 74% at 48 months was observed in group 2, significantly higher than that of 64% for group 1 (P less than .05). The status of the regional lymph nodes (RLN) and the number of metastases did not affect tumor response. However, 77% of RLN-negative patients survived 48 months, in contrast to only 38% of RLN-positive patients (P less than .05). One patient died postoperatively of myocardial infarction. No serious systemic toxicity developed. Two patients who underwent repeat salvage perfusions developed a reversible peripheral neuropathy in the limb. Limb function was good after treatment, and dramatically improved in patients who had advanced satellitosis that responded to treatment. These results suggest that heated limb perfusion using mechlorethamine at an adequate dose can offer long-term control of intransit metastases in approximately one third of these patients, with preservation of good limb function and possible prolongation of survival.

Adult↗
PubMed1985

Effect of indomethacin on urine concentration and dilution in the rat.

The precise role of prostaglandins in modulating urine concentration and dilution is unclear. Evidence in vitro has recently cast doubt on the accepted theory that renal prostaglandins inhibit the hydro-osmotic effect of vasopressin. Urine clearance studies were performed on indomethacin treated (prostaglandin deficient) and control anaesthetized water diuretic rats both before and during the addition of vasopressin in maximal (10 m-units) and supramaximal (100 m-units) concentrations. Before the addition of vasopressin, indomethacin treatment inhibited the excretion of a water load by 48.7%. The mean papillary sodium concentration was also greater in this group of rats. Vasopressin (10 m-units) increased the urine osmolality in control and indomethacin treated rats; however, the mean urine osmolality was greater in the indomethacin group (1521 +/- 103 compared with 1120 +/- 98 mosmol/kg; P less than 0.01), as was the papillary sodium concentration. A ten-fold increase in vasopressin depressed the papillary sodium concentration to a level similar to that in the control group and produced a marked natriuresis. Consequently, the mean urine osmolalities and urine flows were similar in control and indomethacin treated rats. These experiments suggest that a major function of renal prostaglandins is to increase the ability of the kidney to excrete a water load. Renal prostaglandins do not interfere with the vasopressin induced increase in distal nephron water permeability.

Animals↗
PubMed1985

Mutations that affect utilization of a promoter in stationary-phase Bacillus subtilis.

Transcription of the ctc gene in Bacillus subtilis is activated only after exponentially growing cells enter stationary phase. The promoter of the ctc gene is utilized in vitro by two minor forms of RNA polymerase, E sigma 37 and E sigma 32, but not by the most abundant form of RNA polymerase, E sigma 55. We have used the ctc promoter to direct transcription of the xylE gene on plasmid pLC4 and observed that xylE was expressed only in stationary-phase B. subtilis. We also have constructed a series of homologous plasmids that differ only by specific base substitutions in the ctc promoter. We observed that the base substitutions that affected utilization of the ctc promoter in vivo (xylE expression) were the same as those that we had previously shown to affect utilization of the promoter in vitro by E sigma 37 and E sigma 32. We conclude that it is likely that the ctc promoter is utilized in vivo by E sigma 37 or E sigma 32.

Acetyltransferases↗
PubMed1984

Nurses' perceptions of early breast cancer and mastectomy, and their psychological implications, and of the role of health professionals in providing support.

The literature on the psychological precursors and outcomes of cancer and the role of the surgeon and nurse in the psychological management of early breast cancer, is briefly reviewed. A questionnaire study tapped nurses' perceptions of the disease and its treatment, patients' problems and the provision of psychological support. Their responses indicated mixed attitudes toward treatment outcomes, but a general enthusiasm for health education. Mastectomy itself was seen as posing serious social problems by half the sample, and serious sexual problems by more than three-quarters, and many felt that the support currently provided for patients is inadequate. While nurses saw themselves as having a key role in giving comfort, they were less likely to see themselves in the role of counsellor. Many of the sample felt that they had not been trained to provide psychological care at this level. Here, the skills of a specialist nurse were looked for, in the case of counselling the patient herself, or the authority of the doctor, when counselling husbands.

Breast Neoplasms↗
PubMed1984

Social, sexual and personal implications of paraplegia.

Paraplegia can lead to social stigmatisation, sexual difficulties, and emotional maladjustment. The specific nature of problems experienced in these areas were investigated in an interview study of 22 male and female paraplegics. These interviews were followed up by a postal questionnaire and both qualitative and quantitative data are presented in this report. Effective counselling can only be offered on the basis of an understanding of problems as they are subjectively experienced, and with an acknowledgement of the wide differences that exist between individuals in the way that they view and react to their situation.

Adaptation, Psychological↗
PubMed1984

II. Coping with spinal cord injury.

Paraplegia creates social, sexual and emotional problems, and the impact of these was investigated in an interview study of 22 male and female paraplegics. Of particular concern was the way in which individuals were coping with the difficulties confronting them. People used a number of strategies for dealing with other people and their attitudes, and for readjusting sexually. In dealing with their own personal feelings about their disability, ways of coping were varied and included suppression, denial and repression, resignation and acceptance, positive thinking and independence and assertiveness. No specific recommendations can be made about ways of coping that will be most adaptive, since these will depend upon the individual and his or her circumstances. What is important for counselling, however, is to recognise the range of coping strategies that are available, and to be able to guide the individual toward those which effect the best match between their needs and the demands of the situation.

Adaptation, Psychological↗
PubMed1984

Pneumatic-to-electrical analog for high-frequency jet ventilation of disrupted airways.

A pneumatic-to-electrical circuit analog is used to describe 2 separate mechanisms by which high-frequency jet ventilators sustain ventilation and oxygenation in the presence of large airway disruptions. The frequency-dependent mechanism is based on variations in the pneumatic equivalent to capacitive reactance. The pressure-dependent mechanism models lung defects on a voltage-controlled resistor. The electrical circuit model is also used to explain the factors leading to gas trapping and inadvertent positive end-expiratory pressure during high-frequency jet ventilation.

Airway Resistance↗
PubMed1984

High-frequency jet ventilation: technical implications.

A variety of technical decisions are required for the proper selection and safe and efficacious application of high-frequency jet ventilation (HFJV). Criteria for analyzing the performance of an HFJV system are presented, along with discussions of some of the more common respiratory measurements and their applicability to HFJV.

Equipment Safety↗
PubMed1984

Experimental evaluation of high-frequency jet ventilation.

The consensus of available studies indicates that high-frequency jet ventilation (HFJV) can adequately ventilate animals in respiratory failure, although a clear superiority to volume-cycled ventilation (VCV) cannot be established. HFJV is probably useful in the presence of airway disruption and in tracheal or pulmonary surgery. Clinical trials and additional bench and animal studies must be performed, to reach a full understanding of the potential benefits of this technique.

Animals↗
PubMed1984

Early prediction of outcome of respiratory failure. Comparison of high-frequency jet ventilation and volume-cycled ventilation.

Data from a prospective randomized investigation comparing volume-cycled ventilation and high-frequency jet ventilation were reexamined to determine whether improvement of respiratory and hemodynamic function, as well as ultimate outcome (death or survival), could be predicted early in the course of the disease. End points were selected for the ratio of the arterial oxygen pressure over the fractional concentration of oxygen in the inspired gas (PaO2/FIO2), the arterial oxygen saturation (SaO2), the arterial carbon dioxide tension (PaCO2), and the cardiac index. Patients were assigned to "success" or "failure" groups, according to the values recorded for those end points 24 hours after institution of mechanical ventilation. Values obtained from initiation of mechanical ventilation to 16 hours later were divided into four time groups. Differences between patients who "succeeded" and "failed" were compared at each time interval. Ultimate outcome was also compared. The PaCO2 and cardiac index were poor predictors of survival. Early values did not foretell the progression of these variables. The PaO2/FIO2 and SaO2 effectively discriminated, at all time intervals, between patients who succeeded and failed on volume-cycled ventilation. On high-frequency jet ventilation, significant differences were evident only after eight hours of support. With both types of ventilator, patients who reached the end point of oxygenation at 24 hours survived in far greater numbers than those who did not. On the basis of this investigation, it appears justified to attempt high-frequency jet ventilation in patients who do not rapidly improve on volume-cycled ventilation. Institution of high-frequency jet ventilation as the initial support method may not be advisable, since failure does not become apparent for many hours.

Cardiac Output↗
PubMed1984

Studies on the cholinergic receptors in sinoauricular node and adjacent auricular tissues of cat.

Cholinergic receptors in pacemaker and contractile tissue of heart were studied in an isolated sinoauricular (s.a.) node preparation of cat containing crista terminalis. Acetylcholine (ACh), 10(-9) - 10(-5), caused concentration dependent negative inotropic and negative chronotropic effects, the former being more prominent than the latter. Atropine (10(-10) - 10(-4)M) prevented these inhibitory effects of ACh in a competitive manner. No cardioexcitatory effect of ACh was seen in these preparations treated with up to 10(-4)M atropine. It is concluded that the pacemaker cells of s.a. node and contractile atrial cells in cat contain inhibitory muscarinic receptors but no ACh sensitive excitatory nicotinic receptors. The contractile cells of atrium are more sensitive than the pacemaker cells of s.a. node of cat to the inhibitory effects of ACh.

Acetylcholine↗
PubMed1983

Tidal volume and airway pressure on high frequency jet ventilation.

The principle of jet injector indicates that large tidal volumes may be delivered on high frequency jet ventilation (HFJV) without increasing airway pressure. Fifteen dogs were ventilated on HFJV in 2 separate experiments. In the first one, tidal volume was maintained constant at 10 ml/kg, while PEEP, respiratory rate, and cannula size were changed in 16 different experimental conditions. In the second experiment, driving pressure was progressively increased from 5 to 45 psig, and PEEP, respiratory rate, and injector size were changed in 32 experimental conditions. Mean airway pressure, tidal volume, driving pressure, thoracic aortic mean pressure, and abdominal aortic mean pressure were the variables measured. Tidal volume linearly increased with driving pressure, while airway pressure only increased when tidal volume exceeded 25 ml/kg. Blood pressure was inversely related to mean airway pressure. Tidal volume was twice as high with the 1.62 mm injector, as compared to the 1.06 mm injector, although resistances are 6 times higher with the smaller injector. The difference is related to the higher entrainment, which is observed when jet flow velocity increases, as is the case when the injector cannula is smaller. The experiments confirmed that HFJV follows the physical principles of jet mixing and entrainment.

Animals↗
PubMed1983

High frequency jet ventilation in experimental airway disruption.

Anecdotal observations suggest that high frequency jet ventilation (HFJV) is beneficial in major airway disruption. Quantitative evaluation is, however, unavailable. In 12 healthy mongrel dogs, a tracheal window of increasing size, from 0.5 x 1 cm to 1.5 x 2 cm, was opened. Dogs were supported on volume-cycled ventilation (VCV) and on HFJV, using injector cannulas of 1.06 and 1.62 mm internal diameter. The tracheal window was then closed and an upper lobectomy performed, followed by total pneumonectomy. Arterial blood gases were obtained after 10 min in each experimental condition. VCV could maintain life-supporting blood gases only with the tracheal window of 0.5 x 1 cm. HFJV, delivered with a 1.06-mm injector cannula, was adequate with a tracheal window of 1 x 1 cm, or after a lobectomy. In all experimental conditions, HFJV delivered with a 1.62-mm injector effectively maintained alveolar ventilation and arterial oxygenation. Gas transport on HFJV is based, in part, on the principles of jet mixing and entrainment; increasingly large tidal volumes can be delivered under conditions of low and constant pressure. Air leaks through pathological openings remain constant even when tidal volume is increased, so that alveolar ventilation can be adequately maintained.

Airway Obstruction↗
PubMed1983

Effect of calcitonin on urine concentration in the rat.

Because mammalian distal nephron segments with both calcitonin- and antidiuretic hormone- (ADH) sensitive adenylate cyclase activity have been described, in vivo and in vitro experiments were performed to study the effect of calcitonin on rat distal nephron water permeability. Calcitonin 1 and 0.1 U/ml, but not 0.01 U/ml, significantly increased the diffusional water permeability in the isolated papillary collecting duct by 15 and 11%, respectively. However, this effect was small when compared with a 68% increase with a supramaximal concentration of ADH (from 4.0 +/- 0.3 to 6.7 +/- 0.9 microns/s; n = 6, P less than 0.01). The normal increase in water permeability with increasing concentration of ADH (0.02 and 0.2 mU/ml) was depressed by the previous addition of calcitonin (1 U/ml) to the bath but was unaltered with the supramaximal ADH concentration (2 mU/ml). Verapamil, a compound that antagonizes cellular calcium entry, did not alter the effect of calcitonin on diffusional water permeability. Calcitonin in concentrations of 0.05, 0.5, and 5 U/ml produced a significant reduction in urine flow and free water clearance. Pretreatment with calcitonin in these concentrations inhibited the antidiuretic action of ADH. These studies suggest that calcitonin acts as a partial agonist to ADH within the distal nephron. It is unclear whether such an action represents a physiological or a pharmacological effect.

Animals↗