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Biomedical subjects

J Fernando

Publications and source records attributed to J Fernando.

At least 19 recordsLinked to original sources
PubMed1998

The etiology of narcissistic personality disorder.

This paper presents a view of the etiology of narcissistic personality disorder which, while not new, is at variance with the commonly held position that this disorder is the outcome of the insufficient gratification of the normal narcissistic needs of infancy and childhood. The contrary thesis is presented: that narcissistic personality disorder is the outcome of narcissistic overgratification during childhood. A fixation to this overgratification interferes with the normal maturation and integration of the superego, leading to difficulties in self-esteem regulation and to a tendency to massive externalization. Clinical material is presented to support this view.

Adult↗
PubMed1997

The exceptions. Structural and dynamic aspects.

Selected details are presented from the history of an adult analytic patient who had many of the characteristics Freud describes in his essay on the "exceptions" and are used as a starting point for discussing certain dynamics of this character type. This essay argues that the ego attitude of justified rebellion, which develops in some children because of early maltreatment or physical shortcoming, leads to a distortion in ego-superego interaction and interferes with normal superego maturation. The tendency to massive superego externalization, normal in early latency, is never outgrown and results in many of the characteristic features of the "exceptions."

Adult↗
PubMed1992

Plasma inorganic fluoride with sevoflurane anesthesia: correlation with indices of hepatic and renal function.

The biotransformation and plasma inorganic fluoride ion production of sevoflurane (the new volatile anesthetic) during and after surgical anesthesia was studied in 50 ASA I or II surgical patients. Twenty-five additional patients served as controls by receiving isoflurane. Sevoflurane or isoflurane was administered with a semiclosed (total gas flow, 2 L/min O2) circle absorption system for durations of 1.0 to greater than 7.0 minimal alveolar concentration (MAC) hours for surgical anesthesia (sevoflurane MAC, 2.05%; isoflurane MAC, 1.15%). Preoperative and postoperative blood urea nitrogen and creatinine concentrations were determined. Blood samples were obtained during and after anesthesia in both groups for determining anesthetic blood concentration analysis and plasma fluoride level. Plasma fluoride concentrations did not significantly increase during isoflurane anesthesia. Sevoflurane biotransformation produced a mean peak plasma inorganic fluoride concentration of 29.3 +/- 1.8 mumol/L, 2 h after anesthesia, which decreased to 18 mumol/L concentration by 8 h after anesthesia. The peak plasma inorganic fluoride ion concentration correlated with duration of sevoflurane anesthetic exposure. Five patients given sevoflurane had peak levels transiently exceeding 50 mumol/L, and one of these had a history of ingesting drugs potentially producing hepatic enzyme induction. No increases in postoperative levels of creatinine, blood urea nitrogen, direct bilirubin, or hepatic transaminase and no changes in serum electrolyte level occurred in either anesthetic group. Indirect bilirubin concentration increased significantly after sevoflurane anesthesia, but the increase was not of clinical significance (from 0.30 +/- 0.03 to 0.38 +/- 0.06 mg/dL). Indirect bilirubin concentrations did not increase after isoflurane anesthesia; the concentrations reached 0.31 +/- 0.04 mg/dL and did not differ significantly from those found with sevoflurane.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1992

Sevoflurane is biotransformed by guinea pig liver slices but causes minimal cytotoxicity.

Guinea pig liver slices were used to evaluate the biotransformation and hepatotoxic potential of sevoflurane. Precision-cut liver slices (250-300 microns thick) were incubated in sealed roller vials in buffer at 37 degrees C under 95% O2. Sevoflurane was added to produce 0.9 or 2.1 mM medium concentrations. After incubation (6-24 h), the intracellular K+ content and protein synthesis were determined, along with the defluorination of sevoflurane. Isoflurane was included for comparative purposes. Sevoflurane (2.1 mM) and isoflurane (2.3 mM) had no effect on slice K+ content, but both anesthetics depressed protein synthesis. The biotransformation of sevoflurane was maximal at 95% O2, with threefold more F- produced from sevoflurane than isoflurane. Sevoflurane appears to have a minimal effect on the guinea pig liver slices, which is consistent with in vivo studies in which minimal or no hepatotoxicity has been observed.

1-Propanol↗
PubMed1991

Inhibition of protein synthesis and secretion by volatile anesthetics in guinea pig liver slices.

The decrease in protein synthesis and secretion caused by volatile anesthetics was investigated using Hartley male guinea pig liver slices. Precision-cut liver slices (250-300 mM thick) were incubated in sealed roller vials (3 slices/vial) containing Krebs-Hensleit buffer at 37 degrees C under 95% O2 atmosphere. Volatile anesthetics were injected through a teflon septa cap on a filter paper wick and vaporized to produce constant concentration in the medium. A concentration (1-2.1 mM) and time related (0-24) decrease in protein synthesis (3H-leucine incorporation) and secretion by halothane and d-halothane was observed. d-Halothane was less inhibiting than halothane. Inhibition was not on the uptake of the 3H-leucine but with its incorporation in the nascent peptide. The effects of enflurane (2.2 mM), isoflurane (2.2 mM), and sevoflurane (1.3 mM) on protein synthesis and secretion were also studied. The rank order of decrease in protein synthesis caused by the volatile anesthetics studied was halothane greater than isoflurane greater than enflurane greater than sevofluane greater than d-halothane. Enflurane, isoflurane, and sevoflurane increased the protein secretion while halothane and d-halothane caused a pronounced decrease. Alterations in protein synthesis and secretion appears to be an early and sensitive indicator of cytotoxin injury.

Anesthetics↗
PubMed1991

Minimal biotransformation and toxicity of desflurane in guinea pig liver slices.

Biotransformation and hepatotoxicity of desflurane were evaluated in the guinea pig liver slice culture system. Liver slices (250-300 microns) were prepared from 600-650-g male Hartley guinea pigs. The slices were incubated in sealed vials in a Krebs-Henseleit buffer at 37 degrees C under 95% O2. Desflurane was vaporized to produce media concentrations of 0.7-2.3 mM. After incubation (3-24 h) viability of the slices was determined (K+ content; protein synthesis secretion) along with the biotransformation of desflurane (F-). Isoflurane (2.3 mM) was included in the studies for comparative purposes. Although desflurane caused a mild concentration-related reduction in slice K+ content (1.1-2.2 mM; 20%-40% of control), the effects were less than those produced by 2.3 mM isoflurane (50% of control). High concentrations of desflurane decreased protein synthesis at the first 9 h of incubation, and isoflurane decreased protein synthesis throughout the incubation period. Neither anesthetic affected protein secretion. The biotransformation of desflurane was minimal with threefold less F- produced from desflurane than isoflurane.

Anesthetics↗
PubMed1990

Toxicity of halothane in guinea pig liver slices.

Guinea pigs have proven to be a reliable model of halothane associated hepatotoxicity. An in vitro system with Hartley male guinea pig liver tissue was designed to assess the toxicity of halothane and other volatile anesthetics in the target organ. Precision-cut guinea pig liver slices (250-300 microns) were incubated in sealed roller vials containing Krebs-Henseleit buffer (plus vitamins, amino acids, glutamine, gentamycin) at 37 degrees C, under 95%, 21% and 5% O2/CO2 atmospheres. Halothane (10-15 microliters) was injected through a Teflon septa cap on a filter paper wick and vaporized. Viability of the slices was monitored by measuring intracellular K+ content which was maintained under 95% O2 up to 24 h. A dose- and time-related decrease in intracellular slice K+ by 1.9, 2.1, 2.7 mM halothane in the media was observed. At 2.7 mM halothane a direct physio-chemical effect may be occurring since incubating liver slices from allylisopropyl-acetamide-treated animals did not protect against the drop in intracellular K+. Concentration/time responses of halothane, d-halothane, enflurane, isoflurane and sevoflurane were compared. Sevoflurane had no effect on the liver slice K+ content up to 24 h while the other anesthetics caused the following rank-order decrease in intracellular K+ content: halothane greater than isoflurane and enflurane greater than d-halothane. Precision-cut cultured guinea pig liver slices offer a system where the target tissue for intoxication by anesthetics can be examined for its susceptibility and mechanism of intoxication.

Anesthetics↗
PubMed1984

The use of depot neuroleptic haloperidol decanoate.

Twenty-nine patients were treated with haloperidol decanoate, the dosage ranging from 100 to 300 mg i.m. once a month, with duration of treatment ranging from 3-7 months. It seems that haloperidol decanoate could be useful in schizo-affective disorder/depressed type and also in manic disorder. The investigators were impressed by the relative lack of side effects.

Bipolar Disorder↗
PubMed1983

Training doctors for family practice in primary health care work in Sri Lanka.

Over one-third of the doctors in Sri Lanka are involved in the delivery of PHC. They form one of seven categories of PHC workers--others being the ayurveda physician, the assistant medical practitioner, nurse, midwife, traditional healer and unqualified practitioner. PHC workers function either in the government or private sector. Their functions in the PHC system are not defined and are dependent on state health policies and people's expectations of health care. The secondary and tertiary levels of the health system are managed by the government through a network of hospitals. These hospitals provide Western type health care facilities free to the people. Government PHC workers have access to referral facilities and back up services provided through this hospital system. Doctors functioning within the PHC system had neither undergraduate nor postgraduate training in PHC. Private general practitioners were the first to realise the need for training doctors in PHC. They sought and got government and university approval for postgraduate training in family practice. The family practice training programme is conducted by the Postgraduate Institute of Medicine of the University of Colombo. The course consists of educational and clinical components which could be completed in a minimum of 1 year or maximum of 4 years. Nine private general practitioners and 19 government medical officers registered for the course. Fifteen completed the course in 1 year. Family practice trained doctors will function in a PHC system in which the services provided are not coordinated. Changes in the PHC system are being considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗
PubMed1978

Sex liability to single structural defects.

Forty-two of 52 single, localized defects of morphogenesis showed a nonrandom predeliction to one sex. For some of these malformations, the sex liability may be explained on the basis of normal anatomic or hormonal differences between the sexes. For example, the male excess of "prune belly" or triad syndrome is considered due to the fact that most cases are secondary to obstruction in the penile urethra, and the male excess of pyloric stenosis is hypothesized as being secondary to the muscle hypertrophying effect of testosterone in the male neonate. The sex differences for most of the defects suggest that genes on the X and/or Y chromosome exert a role in morphogenesis that extends well beyond the development of sex-related structures.

Congenital Abnormalities↗