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Biomedical subjects

E Phillips

Publications and source records attributed to E Phillips.

At least 73 records · Page 4Linked to original sources
PubMed1995

Standard of care.

Did you know that a nurse may be held to the same standard of care as a physician? In a 1989 Indiana case, Planned Parenthood of Northwest Indiana, Inc. v. Vines 543 N.E. 2d 654 (Ind. App. 3 Dist. 1989), a patient and her husband sued a clinic and a nurse for negligence in the insertion of an intrauterine device. The Indiana Court of Appeals upheld a lower court's finding that the nurse-practitioner be held to the standard of care of a physician in performing this procedure.

Humans↗
PubMed1994

Laparoendoscopy (laparoscopy assisted enteroscopy) and partial resection of small bowel.

We investigated laparoendoscopy (laparoscopy-assisted small bowel enteroscopy) as an aid in managing the challenging diagnostic problem of occult small bowel hemorrhage. We performed laparoendoscopy on five nonconditioned dogs and five conditioned dogs. In each case, we laparoscopically inspected the small bowel from the ligament of Treitz to the ileocecal valve. Small bowel was exteriorized, an enterotomy was performed, and an Olympus CL-100L colonoscope was inserted and advanced proximally to the stomach and distally to the ileocecal valve. A segment of small bowel was arbitrarily designated as the site of bleeding, was exteriorized, and was resected. Bowel continuity was restored with a stapled anastomosis. The animals were euthanized and autopsied immediately after the procedure (n = 5) or a week following the procedure (n = 5), at which time the anastomoses were tested for leakage and patency. The entire small bowel was visualized in all animals. There were no anastomotic leaks. Laparoendoscopy may be of value in identifying and treating hemorrhagic origin of small bowel. Clinical trials are warranted.

Anastomosis, Surgical↗
PubMed1994

Residual retroperitoneal mass following chemotherapy for infantile yolk sac tumor.

A child treated with chemotherapy for disseminated yolk sac tumor had a residual retroperitoneal mass after normalization of serum alpha-fetoprotein. The mass was excised and histologically showed only fibrous tissue, necrosis and calcification. To our knowledge this is the first case reported of a prepubertal yolk sac tumor associated with a residual retroperitoneal mass.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

B1 and B2 bradykinin receptors encoded by distinct mRNAs.

Bradykinin receptors have been subdivided into at least two major pharmacological subtypes, B1 and B2. The cDNAs encoding functional B2 receptors have recently been cloned, but no molecular information exists at present on the B1 receptor. In this article, we describe experiments examining the possible relationship between the mRNAs encoding the B1 and B2 types of receptor. We showed previously that the human fibroblast cell line WI38 expresses both B1 and B2 receptors. In this report, we describe oocyte expression experiments showing that the B1 receptor in WI38 human fibroblast cells is encoded by a distinct mRNA approximately 2 kb shorter than that encoding the B2 receptor. We have used an antisense approach in conjunction with the oocyte expression system to demonstrate that the two messages differ in sequence at several locations throughout the length of the B2 sequence. Taken together with the mixed pharmacology exhibited in some expression systems by the cloned mouse receptor, the data indicate that B1-type pharmacology may arise from two independent molecular mechanisms.

Amino Acid Sequence↗
PubMed1994

What are the clinical determinants of early energy expenditure in critically injured adults?

The clinical determinants of energy expenditure in critically injured adults require definition. Among adult blunt trauma victims who required mechanical ventilation, the resting energy expenditure was calculated with the Harris-Benedict equation (HBEE) and the early (< or = 5 days postinjury) energy expenditure was measured by indirect calorimetry (MEE) (n = 115). The MEE was 2052 +/- 531 kcal/day and MEE/HBEE ("stress factor") was 1.24 +/- 0.2. The MEE was correlated with HBEE, age, height, weight, sex, temperature, and paralytic agents (p < 0.01). However, MEE did not correlate with ISS, admission GCS score, admission base deficit, initial systolic blood pressure, or the number of units of packed red blood cells transfused in the first 24 hours after injury (p = NS). Temperature and paralysis correlated with MEE/HBEE (p < 0.01). A regression model of MEE was developed with the clinical variables HBEE, temperature, and the presence or absence of paralytic agents (r2 = 0.62; p < 0.001): MEE (kcal/d) = 1.4(HBEE) + 71.4(temperature) + 274(paralytics; + = 1, - = 2) - 3485. In mechanically ventilated trauma victims, both the early energy expenditure and the stress factor are determined by host factors but are independent of the severity of the anatomic and physiologic insult. The degree of hypermetabolism observed in this population was less than previously reported.

Adult↗
PubMed1993

Role of lymphadenectomy in the treatment of renal cell carcinoma.

We evaluated the role of lymphadenectomy (LND) in the prevention of local recurrence following radical nephrectomy for renal cell carcinoma (RCC) by two retrospective studies. In one, the relative importance of various tumor characteristics to the subsequent development of local recurrence was investigated in 37 patients who underwent radical nephrectomy and later progressed. In 29 evaluable patients, only nodal metastasis was predictive of local recurrence, which developed in 6 of 7 node-positive patients. In our second study the records of 69 consecutive patients with RCC who underwent radical nephrectomy with or without simultaneous LND (N = 42 and 27, respectively) were reviewed. Local control after LND was excellent in node-positive disease; in no node-positive patient with unilateral RCC has a local recurrence developed (N = 5). LND did not extend hospitalization or add to the morbidity of radical nephrectomy.

Carcinoma, Renal Cell↗
PubMed1993

Hinman syndrome: a vicious cycle.

In Hinman syndrome, psychosocial problems are associated with voiding dysfunction, urinary tract infections, and incontinence. The latter can exacerbate the former and a vicious cycle can result in worsening symptoms and renal sequelae. Although interruption of this cycle is difficult, urologic recognition and treatment can have a positive effect. Five cases are presented that demonstrate the cyclical features of Hinman syndrome.

Affective Symptoms↗
PubMed1993

Laparoscopic cholecystectomy in patients aged 65 or older.

Laparoscopic cholecystectomy is replacing open cholecystectomy in the surgical management of gallstone disease in healthy individuals. However, the role of laparoscopic cholecystectomy in patients thought to be at higher risk for surgical morbidity is still being defined. The course of patients aged 65 or greater who underwent attempted and successful laparoscopic cholecystectomies were reviewed. Eleven patients (12%) were converted from laparoscopic to open cholecystectomy. For the 83 patients completing laparoscopic cholecystectomy, the median time of surgery was 115 min and the median length of postoperative stay was 1 day. Two patients required parenteral analgesia longer than 48 h. Seven patients were admitted and monitored postoperatively, although five of these were preoperatively planned. Five patients were readmitted within 30 days. One patient was admitted with a myocardial infarction, one a subphrenic abscess, one an incarcerated hernia, one with pyrexia and leukocytosis (for which no source was identified), and one for an elective urinary tract procedure. Laparoscopic cholecystectomy provides patients aged 65 or older the same benefits of shorter hospital stay and less pain than it provides younger patients. Age alone should not be a contraindication to attempted laparoscopic cholecystectomy.

Age Factors↗
PubMed1993

A two-person, two-handed technique for laparoscopic cholecystectomy.

This manuscript describes a technique of laparoscopic cholecystectomy which permits the surgeon to use both hands. The technique can be modified to accommodate both right- and left-handed surgeons. Advantages we have appreciated in performing over 100 procedures in this manner include a less crowded operating environment, a less costly operating team, and a resident assistant closer to the patient with two hands available so that he or she can better develop the co-ordination necessary to assume increasing responsibility for the procedure.

Cholecystectomy, Laparoscopic↗
PubMed1993

Cloned murine bradykinin receptor exhibits a mixed B1 and B2 pharmacological selectivity.

We have isolated DNA clones encoding functional bradykinin receptors from human, rat, and mouse sources. Genomic bradykinin receptor clones have been isolated from mouse and human cosmid libraries and cDNA clones have been isolated from the human lung fibroblast cell line W138, from the neuroblastoma/glioma hybrid NG108-15, and from rat dorsal root ganglion cells. The receptor protein is encoded by an intronless region of the gene in both mouse and human. There is evidence of a splice acceptor site 8 bases upstream from the initiation codon in all three species. The function of the expressed receptor proteins from mouse, rat, and human was tested by electrophysiological assays after injection of cRNA into Xenopus laevis oocytes and also by binding assays with membranes from COS-7 cells transfected with cloned receptor-encoding DNA. The receptors from human and rat showed the pharmacological properties of B2 receptors in both expression systems when tested with a variety of bradykinin analogues, but receptors from mouse divided into two populations, one population with pharmacological properties of B1-like receptors and another, larger, population with properties of B2 receptors.

Amino Acid Sequence↗
PubMed1993

Income growth among nonresident fathers: evidence from Wisconsin.

This study examines the changes over time in the personal incomes of nonresident fathers--whether divorced or nonmarital--in Wisconsin. Using data from the Wisconsin Court Record data base and the Wisconsin Department of Revenue, the authors examine the incomes of these fathers over the first seven years following a divorce or the initiation of a paternity suit. They also study separately the income patterns of initially poor nonresident fathers and fathers whose nonresident children receive welfare. The most important finding is that the incomes of nonmarital fathers, which typically are low in the beginning, increase dramatically over the years after paternity establishment--often to a level comparable with the incomes of divorced fathers. On the basis of their findings, the authors conclude that failing to establish child support obligations for nonresident fathers simply because their incomes are initially low does not appear justified.

Divorce↗
PubMed1992

Detection of a soluble antigen defined by monoclonal antibody 83D4 in serous effusions associated with breast carcinoma.

Monoclonal antibody (MoAb) 83D4 was generated by immunization with cell suspensions obtained from sections of formol-fixed paraffin embedded human breast cancer. It recognized an antigen expressed in breast carcinomas but not in normal breast tissue. Pleural and ascitic fluids from 66 patients were studied by an 83D4 heterologous sandwich radioimmunoassay (SRIA) using solid-phase immobilized wheat germ agglutinin to detect the 83D4 soluble antigen. Using a cutoff level of 5 units/ml of 83D4 antigen, higher values were found in 22 of 27 breast cancer-associated effusions (mean = 10.72 +/- 6.80 units/ml). The 20 nonmalignant effusion fluids tested showed lower values (mean = 1.16 +/- 1.49 units/ml, P less than 0.001). The antigen was undetectable or present in low levels in effusions from patients with hematologic malignancies. When SRIA results were compared with conventional cytologic diagnosis in breast-cancer effusions, elevated levels of 83D4 soluble antigen were found in all patients (8 of 8) in whom malignant cells had been detected, in 4 of 8 patients with the diagnosis of "suspected malignancy," and in 10 of 11 patients with negative cytologic findings. Using an immunoglucosidase method on cell smears of various origins, MoAb 83D4 stained metastatic cells of breast and ovary carcinomas but did not reactive with mesothelial cells and other normal or malignant cell types. These results suggest that quantitation of the 83D4 soluble antigen may be used to improve the diagnosis of cancer in serous effusions.

Antibodies, Monoclonal↗