Manual ventilation and the Humphrey ADE breathing systems.
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Biomedical subjects
Publications and source records attributed to D Humphrey.
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International discussions concerning rhinomanometry have been held but no numerical comparisons have been reported. In an attempt to make international comparisons between different rhinomanometric results, nasal resistances were measured by active posterior rhinomanometry with a head-out body plethysmograph produced in Canada and by active posterior and anterior methods with a Japanese commercial rhinomanometer, and the results were compared. No significant differences were found between measurements obtained from the two types of equipment. It is believed that this study is the first project of international comparison of rhinomanometry.
This study examined whether the subjective impression of memory function might differentiate healthy elderly subjects from patients with memory complaints, and whether memory complaints differed between patients with and without a dementing illness. Both self-assessment and relatives' responses on a new memory questionnaire differentiated patient groups from control subjects. The relatives' form measuring deterioration in memory function over time identified dementing individuals from those with non-dementing causes for their memory complaints. Factor analysis indicated that patients' memory complaints correlated with depression rather than objective memory performance, while relatives' ratings correlated with objective memory scores, not depression. Stepwise discriminant function analyses showed that objective memory testing greatly improved specificity but not sensitivity of the subjective memory questionnaire alone.
Three hundred and thirty-four measurements of bilateral and unilateral nasal resistance (at delta P 1.0 cm H2O and by time averaging) in 233 adults were carried out by posterior rhinomanometry with a head-out body plethysmograph. Total nasal resistances, calculated by the equation of Ohm's Law for parallel resistors from measured unilateral resistances, were compared with measured total nasal resistances. The time averaged total nasal resistances calculated by use of Ohm's Law for parallel resistors were closer to direct measurements than resistances at delta P 1.0 cm H2O calculated from the same equation. We attempted to fit calculated total nasal resistance with direct measurements by modification of the equation of Ohm's Law for parallel resistors to T = 0.96[R x L/(R + L)]0.92 in the time averaged nasal resistance and T = 1.07[R x L/(R + L)]0.77 in resistance at delta P 1.0 cm H2O (T: total nasal resistance, R: nasal resistance on the right side, L: nasal resistance on the left side). Calculated total nasal resistances from the above equations agreed closely with direct measurements.
Nasal resistances were measured before and after decongestion of the nasal mucosa by posterior rhinomanometry with a head-out body plethysmograph in 95 adults referred to our nasal airflow laboratory. These resistances were calculated by a time averaging method (1), the equation R = delta P/V at delta P 1.0 cm H2O (2) and R = delta P/V at the point of peak flow (3), and the results were compared. Correspondence between resistances from the time averaging method and those from the equation R = delta P/V at delta 1.0 cm H2O, the equation R = delta P/0.83V1.33 was obtained with statistical significance (P less than 0.001) and it is suggested that the value of resistance from the time averaging method represents transitional airflow. At resistances less than 3.5 cm H2O/L/sec, the time averaging method and the equation R = delta P/V at delta 1.0 cm H2O and at peak flow produced almost identical values. At resistances greater than 3.5 cm H2O/L/sec, the time averaging method produced values equivalent to those from the equation R = delta P/V at peak flow but values from the equation R = delta P/V at delta P 1.0 cm H2O different from the former two methods. The results suggest that nasal resistances from the time averaging method and the equation R = delta P/V at the point of peak flow are appropriate expression of nasal patency.
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Ninety patients presented for elective surgery and were randomly divided into three groups and studied on a double-blind basis to assess the efficacy of gastrozepin, a new muscarinic receptor antagonist, compared to cimetidine and placebo. Gastrozepin 10 mg, cimetidine 200 mg and a placebo were given i.v. on average 90 min prior to surgery. Gastric fluid was aspirated immediately after induction of anaesthesia and the volume and pH measured. The mean gastric fluid volume in the placebo group (19.73 ml) was significantly (P less than 0.02) greater than the mean volume of either the gastrozepin group (12.40 ml) or cimetidine group (12.72 ml). Mean gastric pH's were 4.83 (gastrozepin), 6.39 (cimetidine) and 3.21 (placebo) and each of these means differed significantly from the other two (P less than 0.001). However, the number of patients who had a gastric juice volume of more than 25 ml and a pH of less than 2.5 in each of the three groups: gastrozepin, cimetidine and placebo, were 1, 0, and 8, respectively.
The single lever Humphrey A.D.E. anaesthetic system, in both coaxial and parallel (non-coaxial) forms, has recently been introduced. In principle the system offers efficient "universal" function by combining the advantages of Mapleson A, D and E systems. A within-patient comparison of its function in the Mapleson A mode (lever up) in spontaneously-breathing anaesthetized subjects was made to that of the original two lever A.D.E., the Magill (Mapleson A) and the Bain (Mapleson D) systems. The coaxial and parallel single lever A.D.E. systems functioned identically to each other and to the original two lever A.D.E. system, a mean fresh gas flow (FGF) of 51 ml X kg-1 X min-1 causing minimal rebreathing. Under identical conditions, the mean FGF required to just cause rebreathing increased to a mean of 71 ml X kg-1 X min-1 and 150 ml X kg-1 X min-1 with the Magill and the Bain systems respectively. With the single lever system, the switch to its Mapleson E mode for controlled ventilation involves the selection of the only alternative lever position (lever down) without further adjustment. The function and practical advantages in this E mode are presented in Part II.
A clinical trial involving ten anaesthetized adult patients was conducted during controlled ventilation using the Humphrey A.D.E. system in the Mapleson "E" mode (lever down). With each patient acting as his or her own control, the parallel (non-coaxial) and coaxial versions of the single lever Humphrey A.D.E. system were compared, using capnography, to the Bain system (Mapleson D/E). All three systems behaved similarly with predictable patient normocarbia when a fresh gas flow of 70 ml X kg-1 X min-1 was used. The A.D.E. system has the added advantage that the switch from controlled to spontaneous ventilation (or vice versa) is achieved quickly and simply. Spontaneous, assisted or automatic controlled ventilation could be instituted at any time merely by the appropriate lever position.
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A high-pressure liquid chromatographic method has been developed for use as a stability-indicating assay for mecillinam. Seven related compounds and at least one unknown degradation product are well separated and easily determined. The accuracy of the method is in good agreement with the published UV assay and the precision of a series of seven replicate determinations is +/- 1.0% R.S.D.
Moloney lymphomas and Moloney sarcomas share strong tumor antigens. In this report we analyze the cell-surface antigens on a Balb/c Moloney lymphoma, LSTRA, using hyperimmune sarcoma regressor sera (alphaMo) as a primary reagent. We also use heterologous anti-viral p30 and gp70 sera for a direct analysis of virion protein antigens on the LSTRA surface. Using radiolabeled alphaMo-binding assays, we demonstrate that LSTRA tumor antigens detected by these sera are all Moloney viral antigens; approximately 1/3 of these antigenic determinants are expressed on the intact virus, and the other determinants are revealed by detergent lysis of the virus. The major viral antigens expressed on the LSTRA cell surface are viral env gene products, whereas gag gene products are only sparsely represented. We conclude that alphaMo sera detect almost exclusively viral antigens on LSTRA cells, and these antigens are almost exclusively virion env gene products.
Three cases of coincidental infectious mononucleosis (I.M.) and subacute sclerosing panencephalitis (S.S.P.E.) in children are reported. In two of the cases, I.M. preceded the appearance of S.S.P.E. symptoms. The other case of S.S.P.E. was associated with apparent mononucleosis encephalitis. All three patients died within 3 months of S.S.P.E. being diagnosed and had pathological changes characteristic of that disease and raised levels of measles antibody. Two of the patients had apparent T-cell-associated abnormalities which suggested a degree of I.M.-associated immunosuppression. The relation between the two conditions remains obscure.
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