Biomedical subjects
Publications and source records attributed to E Fletcher.
Laparoscopic pelvic lymphadenectomy is a new procedure to determine the propagation grade of Prostatic adenoma and the treatment to recommend. It is a satisfactory procedure for the diagnosis, with minimal morbidity. It is described our early experience in Panama, 6 patients and 51 lymph nodes removed.
Gastrocystoplasty associated to a Kropp procedure in our experience has been an excellent alternative to improve the quality of life and renal function in patients with severe bladder dysfunction and urinary incontinence. Technically offers easy development of a gastrointestinal segment not requiring ureteral reimplantation or detubularization with the consequent excess of sutures required traditionally in these procedures. Also the postoperative care was smoother and shorter than previously using with the obvious advantage of less mucus production and no metabolic disturbances often present. Further catheterization might be performed through a physiological way obviating abdominal stomas.
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Dilevalol, the R-R optical isomer of labetalol, a nonselective beta-antagonist with vasodilation from selective beta 2 agonism, was administered in sequential multiple bolus intravenous injections of 10 to 100 mg in total doses ranging from 35 to 585 mg (mean dose, 414 mg) to 101 patients with supine diastolic blood pressures above 120 mm Hg. Mean blood pressure was reduced from 200 (+/- 3)/129 (+/- 1) mm Hg to 149 (+/- 2)/101 (+/- 1) mm Hg, a mean reduction of 51/28 mm Hg. The therapeutic goal was established as a reduction in supine diastolic blood pressure to less than 100 mm Hg or a reduction of at least 30 mm Hg. This was achieved in 62 (61%) of 101 patients, with an additional 7 patients having a final supine diastolic blood pressure of 100 mm Hg. Treatment with dilevalol was less successful in black male patients than in the group at large. There was a tendency for older patients to respond better than younger patients. Prior recent treatment of patients with beta-adrenergic antagonists decreased the effectiveness of the drug. Significant orthostatic hypotension was not noted. Sixty-four patients were transferred to oral dilevalol treatment in combination with a diuretic, and blood pressure in this group averaged 160/100 mm Hg after 1 month of therapy. Dilevalol appears to be a safe and effective drug that can be used intravenously successfully in the majority of patients with severe hypertension and provides an alternative to therapy with other agents. It also is a useful agent for oral treatment of these patients after successful intravenous therapy.
A placebo-controlled, double-blind multicenter trial was conducted in 123 patients with severe hypertension to examine the efficacy and safety of intravenously administered nicardipine hydrochloride in controlling blood pressure. Seventy-three patients were initially randomized to receive nicardipine treatment. This group had an initial blood pressure of 213 +/- 3/126 +/- 2 mm Hg. Sixty-seven patients achieved the therapeutic goal (diastolic blood pressure less than or equal to 95 mm Hg; systolic blood pressure less than or equal to 160 mm Hg). Fifty patients were randomized to receive placebo solution. Blood pressure in these patients was 216 +/- 3/125 +/- 2 mm Hg. No patient in this group achieved the therapeutic goal during the "blinded" portion of the study. Forty-four of 49 patients who did not respond to placebo administration responded to subsequent treatment with nicardipine. Patients with end-organ damage were included in the study. These included patients with left ventricular hypertrophy, retinopathy, and renal insufficiency. Patients with and without end-organ damage responded equally well to nicardipine treatment. Serious adverse experiences were infrequent, the most common adverse reaction being headache in 24% of the patients studied.
OBJECTIVE: To compare high fibre diet, basal insulin supplements and a regimen of insulin four times daily in non-insulin dependent (type II) diabetic patients who were poorly controlled with sulphonylureas. DESIGN: Run in period lasting 2-3 months during which self monitoring of glucose concentration was taught, followed by six months on a high fibre diet, followed by six months' treatment with insulin in those patients who did not respond to the high fibre diet. SETTING: Teaching hospital diabetic clinics. PATIENTS: 33 patients who had had diabetes for at least two years and had haemoglobin A1 concentrations over 10% despite receiving nearly maximum doses of oral hypoglycaemic agents. No absolute indications for treatment with insulin. INTERVENTIONS: During the high fibre diet daily fibre intake was increased by a mean of 16 g (95% confidence interval 12 to 20 g.) Twenty five patients were then started on once daily insulin. After three months 14 patients were started on four injections of insulin daily. ENDPOINT: Control of diabetes (haemoglobin A1 concentration less than or equal to 10% and fasting plasma glucose concentration less than or equal to 6 mmol/l) or completion of six months on insulin treatment. MEASUREMENTS AND MAIN RESULTS: No change in weight, diet, or concentrations of fasting glucose or haemoglobin A1 occurred during run in period. During high fibre diet there were no changes in haemoglobin A1 concentrations, but mean fasting glucose concentrations rose by 1.7 mmol/l (95% confidence interval 0.9 to 2.5, p less than 0.01). With once daily insulin mean concentrations of fasting plasma glucose fell from 12.6 to 7.6 mmol/l (p less than 0.001) and haemoglobin A1 from 14.6% to 11.2% (p less than 0.001). With insulin four times daily concentrations of haemoglobin A1 fell from 11.5% to 9.6% (p less than 0.02). Lipid concentrations were unchanged by high fibre diet. In patients receiving insulin the mean cholesterol concentrations fell from 7.1 to 6.4 mmol/l (p less than 0.0001), high density lipoprotein concentrations rose from 1.1 to 1.29 mmol/l (p less than 0.01), and triglyceride concentrations fell from 2.67 to 1.86 mmol/l (p less than 0.05). Patients taking insulin gained weight and those taking it four times daily gained an average of 4.2 kg. CONCLUSIONS: High fibre diets worsen control of diabetes in patients who are poorly controlled with oral hypoglycaemic agents. Maximum improvements in control of diabetes were achieved by taking insulin four times daily.
The osmolalities of 100 plasma samples were measured and compared with the osmolalities calculated from the plasma concentrations (mmol/L) of sodium, potassium, glucose, and urea by several different formulae. The formula recommended by Dorwart and Chalmers (Clin Chem 21: 190, 1975) gave inferior results to those obtained with our "most accurate" formula: osmolality = 1.89 Na + 1.38 K + 1.03 urea + 1.08 glucose + 7.45. We recommend using this formula for calculation of osmolality on equipment linked to a computer. However, for simplicity, and to reduce the possibility of calculation errors, the following formula can be used for manual calculations: osmolality = 1.86 (Na + K) + glucose + urea + 10.
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Mice injected with rat erythrocytes developed anti-erythrocyte autoantibodies which reached a plateau at 4-12 weeks, then gradually declined until at about 24 weeks the majority of mice were negative. In such recovered mice re-challenge with rat erythrocytes produced an accelerated peak of autoantibody and a much more rapid return to a Coombs' negative state. The auto-antibody response was distinguished from the anti-rat response in being more radio-sensitive. Purified autoantibody reacted to higher titre with rat than with syngeneic erythrocytes. Lymphoid cells, from mice given rat erythrocytes (but not sheep, rabbit or guinea-pig erythrocytes) transferred to normal syngeneic recipients given rat erythrocytes suppressed autoantibody production in the recipients. This suppression was much more effective against the autoantibody response than against the response to the inducing cross-reactive antigen; and the degree of suppression was related to the number of cells transferred and to their time of administration relative to the injection of rat erythrocytes. The induction of autoantibody and the generation of suppressor cells in donor animals was unaffected by adult thymectomy. A comparison of the effect of anti-rat erythrocyte antibodies and spleen cells from rat-immunized donors on recipients responses to rat erythrocytes revealed that whereas anti-rat antibodies suppressed both the autoantibody and the anti-rat responses, the spleen cells suppressed only the autoantibody response. Populations of spleen cells, from rat immunized donors, depleted of B cells retained their suppressive activity, whereas the suppressive efficacy of T-cell depleted populations was reduced but not abolished. It is suggested that T cells can specifically interfere with thesponse of autoreactive B cells, although non-T cells (possibly B cells acting by an antibody-feedback mechanism) can also suppress their response.
Inhalation of a few puffs on a cigarette increases the velocity of conduction and shortens the effective refractory period of the A-V node. These effects are attributed to adrenergic stimulation produced by minute amounts of nicotine absorbed. Wenckebach block is abolished whether induced by atrial pacing or occurring spontaneously. Conduction velocity in the His-Purkinje system and in the anomalous pathways in the WPW syndrome were not affected. Smoking increases the ventricular rate in atrial fibrillation, and antagonizes the cholinergic effects of digitalis.
Angular velocity expressed in radians/sec of the rotation movement of the QRS loop at intervals of 2.5 msecs was calculated from a computer program written in Fortran IV. Frontal, horizontal and left sagittal planes were recorded in 125 normal subjects for analysis. The range of angular velocity for 375 QRS loops was from a few radians/sec to a maximum of 95 radians/sec. Average values of maximum angular velocities were: frontal plane, 46.2 radians/sec, horizontal plane, 41 radians/sec, and left sagittal plane, 34.1 radians/sec. Angular velocity expressed as a periodic function of the vector loop is characterized by polyphasic curves. In the frontal plane, curves tend to be more symmetrical with maximum values in the middle. Angular velocity curves are an alternate expression of analysis of planar vector loops employed in clinical practice. Their normal ranges are given in this paper.
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