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Biomedical subjects

J Hedley-Whyte

Publications and source records attributed to J Hedley-Whyte.

14 recordsLinked to original sources
PubMed1979

Prediction of outcome of surgery and anesthesia in patients over 80.

We studied the outcome of surgery in 500 patients over 80 years of age. Hospital mortality within one month of surgery was 6.2%. The American Society of Anesthesiologists class 1 to 5 preoperative evaluation scale was useful in predicting death--less than 1% of class 2 patients died, 4% of class 3, and 25% of class 4. Six of seven perioperative deaths were caused by mesenteric infarction. Myocardial infarction was the leading cause of postoperative death. Twenty-four percent of 141 patients who underwent upper abdominal surgery required controlled endotracheal ventilation for more than 24 hours postoperatively; 57% after intrathoracic surgery; and only 2% after surgery that did not enter pleura or peritoneum. Forty-seven patients underwent gallbladder surgery, and 27 peripheral underwent vascular surgery without any hospital fatality. Enflurane appears to be a safe general anesthetic for sick, elderly patients.

Aged↗
PubMed1977

End-respiratory pressure ventilation and sulfobromophthalein sodium excretion in dogs.

Sulfobromophthalein sodium (BSP) 25 mg/kg body wt was given as a single iv injection to 32 fasted dogs. Serum samples at 3, 5, 10, 20, 30, 45, 60, 80, and 120 min postinjection were analyzed for total concentration of BSP and from 30 to 120 min for percent conjugated BSP. Four groups were compared: spontaneous ventilation; intermittent positive-pressure ventilation (IPPV) and continuous positive-pressure ventilation (CPPV) (2 groups). During CPPV, one group of dogs was given a continuous infusion of cholecystokinin octapeptide (CCK-8, 1 ng/kg per min). Central venous pressure averaged 11.3 +/- 0.7 (SE) cmH2O in dogs with CPPV + CCK-8 and 11.8 +/- 0.8 (SE) cmH2O in dogs with CPPV alone. At 3, 5, and 10 min postinjection serum BSP levels were similar in all groups. From 30 to 120 min postinjection serum levels of both free and conjugated BSP were higher in dogs ventilated with CPPV alone than in any other group (P less than 0.01). Dogs given CCK-8 during CPPV had serum BSP levels that were statistically similar to dogs breathing spontaneously or ventilated with IPPV. We conclude that CPPV impairs BSP excretion. This effect is counteracted by CCK-8.

Airway Resistance↗
PubMed1976

Solubility of 92 in blood with different hemoglobin concentrations at low temperatures.

The Brunsen solubility coefficients for O2 in blood obtained from healthy nonsmoking subjects have been determined at 0, 6, and 12 degrees C for bloods of hemoglobin concentrations 5.6, 10.2, 15.7, and 22.5 g/100 ml. Direct gasometric measurements show that blood has a relative solubility (alphabeta/alphah2o) different for each hemoglobin concentration but constant for any given hemoglobin concentration at the temperatures studied (0.6, and 12 degrees C). For hemoglobin concentrations 5.6, 10.2, 15.7, and 22.5 g/100 ml alphabetao degrees C/alphabeta 12 degrees C rations were 1.36, 1.35, 1.35, and 1.35, respectively. The alpha H20(0 degrees C)/alpha H20(12 degrees C) ratio is 1.34. Consequently, it was possible to construct a table for the Brunsen solubility coefficients for O2 in blood from O to 15 degrees C of different hemoglobulin concentrations. Values from 10 to 15 degrees C published in the Biologal Hanbook, Respiration and Circulation, based on extrapolations from previous direct measurements of temperatures from 18 to 37 degrees C differ only 1% from our present results.

Adult↗
PubMed1976

Effect of sodium para-aminosalicylate on oxygen affinity in normal, sickle and fetal human blood.

Sodium para-aminosalicylate (sodium salt of 2-hydroxy-4-aminobenzoic acid, Na-PAS) lowers the oxygen affinity of normal adult human placental, heterozygous and homozygous sickle cell anemic whole blood at 37 degrees C. The reduction of oxygen affinity is related to the type of hemoglobin in the blood. The mean P50 +/- S.E. at pH 7.40 for normal, placental, heterozygoud and homozygous sickle cell anemic blood in 26.2 +/- 0.1, 20.8 +/- 0.3, 26.8 +/- 0.3 and 31.0 +/- 0.5 mm Hg; in the presence of 5.7 mmol of Na-PAS per liter of blood the P50 values are increased to 28.0 +/- 0.3, 22.9 +/- 0.8, 30.5 +/- 0.6 and 33.9 +/- 0.3 mm Hg, respectively. The Bohr effect in normal and placental blood at this Na-PAS concentration is essentially unchanged: in heterozygous and homozygous sickle cell anemic blood, the Bohr factor (deta log P50/deta pH) is reduced from -0.48 +/- 0.02 to -0.41 +/- 0.01 and from -0.53 +/- 0.03 to -0.48 +/- 0.01. The Hill constants (n) of normal and placental blood are not affected by Na-PAS. In homozygous and heterozygous sickle blood, high concentrations of Na-PAS (22.9 mmol/l) decrease the Hill constant from 2.55 to 2.35 and from 2.56 to 2.28, respectively. Na-PAS is more firmly bound to red blood cells than to plasma. The binding of Na-PAS is probably primarily ionic in nature since the drug can be almost completely removed from blood components by dialysis. The changes in oxygen affinity caused by Na-PAS are consistent with conformational changes (R leads to T) which enhance the presence of deoxyhemoglobin.

Adult↗
PubMed1975

Aerosol polymyxin and pneumonia in seriously ill patients.

Pneumonia caused by Pseudomonas aeruginosa occurs frequently in critically ill patients and is associated with a mortality rate of 70 per cent. An aerosol of polymyxin B was administered (2.5 mg per kilogram per day) to the upper airways of 292 patients in a respiratory-surgical intensive-care unit during a seven-month period, in an attempt to prevent Ps. aeruginosa pneumonia. Although only one of the patients studied acquired pneumonia due to Ps. aeruginosa, 10 others acquired pneumonia caused by a polymysinx-resistant organism. Seven pneumonias were caused by organisms not frequently pathogenic to man (flavobacteria, serratia and Streptococcus faecalis). The mortality rate for acquired pneumonia in this study, 64 per cent, is greater than that in previous studies in which either no polymyxin or cyclic polymyxin therapy was used. Continuous use of polymyxin B aerosol appears to be a dangerous form of therapy.

Aerosols↗
PubMed1975

Cellular and regional localization of pentobarbital-2-14C by radioautography of selected areas of mouse brain at loss and return of withdrawal response.

Regional and cellular distribution of pentobarbital-14C in mouse brain was determined by frozen-section radioautographic methods. The mice were studied at the times of loss (WRL) and return (WRR) of withdrawal response following a single intravenous dose of either 40 or 50 mg/kg body weight. At WRL, grey matter areas had higher concentrations of pentobarbital-2-14C than white matter. At WRR grey matter concentrations were not altered, but white matter areas were now similar to the grey. At WRL pentobarbital concentration was 55 per cent higher in large pyramidal cells in the parietal cortex than in surrounding neuropil. At WRL hippocampal pyramidal cell bodies (stratum pyramidalis) and glial cells in corpus callosum had pentobarbital levels similar to that of surrounding neuropil. Levels in the neuropil of these three areas were higher at WRR than at WRL. Lipid-rich compartments had higher pentobarbital concentrations at WRR than at WRL. The results suggest that return of consciousness after pentobarbital anesthesia is associated with intracerebral redistribution of pentobarbital even while there is continuing uptake into brain. (Key words: Brain, pentobarbital uptake; hypnotics, barbiturates, pentobarbital; pharmacokinetics, pentobarbital uptake.).

Absorptiometry, Photon↗
PubMed1975

Cellular distribution and clearance of aerosolized dipalmitoyl lecithin.

Wistar-Lewis rats were anesthetized anc connected to a 3-MHz nebulizer which aerosolized 250 muCi l-alpha-1-palmitoyl-2palmitoyl-[9-10-3H]phosphatidylcholine ([3H]DPL) for 3 min. Appleton frozen-section autoradiographs showed greater than 4 times background radioactivity in approximately 30% of alveoli at 1 min and 2 h after aerosol. As tritium content in the lung decreased, it increased in liver, spleen, kidney, blood, and urine. Percentage of radioactivity from [3H]phosphatidylcholine in the liver declined with time, while [3H]phosphatidylethanolamine doubled between 2 and 12 h. One minute postaerosol 2,500 +/- 500 (SE) type I cells/mm3 lung and 2,500 +/- 750 type II cells/mm3 lung had greater than 20 times background radioactivity; 2 h later only 950 +/- 250 type I cells/-m3 lung still had levels of radioactivity greater than 20 times background while 3,150 +/- 600 type II cells/mm3 lumg now had this level of 3HIDPL. Corresponding numbers of alveolar macrophages were 450 +/- 250 1 min postaerosol and 1,100 +/- 200 after 2 h. Aerosolized DPL as a synthetic surfactant is hampered by significantly faster clearance from the alveolar surface as compared with normal in vivo DPL.

Aerosols↗
PubMed1975

Continuous positive-pressure ventilation and choledochoduodenal flow resistance.

Resistance to flow through the choledochoduodenal junction was measured during constant perfusion (0.8 ml saline/min). In eight dogs, intermittent positive-pressure ventilation (IPPV) and continuous positive-pressure ventilation (CPPV) were compared. Pressure in the common bile duct was always higher during JPPV than IPPV. With the first application of CPPV the rate of intravenous fluid was adjusted to maintain constant Hct. Mean hepatic venous pressure (Phv) increased from 6.6 to 11.5 cmH2O (P less than 0.001). Mean pressure in the common bile duct increased (P less than 0.001) from 11.6 to 14.1 cmH2O. The average increase in resistance was 21%. Changes reversed with return to IPPV. During the second application of CPPV, intravenous fluid was increased to maintain constant arterial pressure. Phv increased to 12.8 cmH2O and pressure in the common bile duct increased to 15.0 cmH2O (30% increase). In four additional dogs, choledochoduodenal resistance during continuous CPPV was reduced by intravenous vasopressin, intravenous norepinephrine and intraducta phenylephrine. CPPV increases resistance to flow through the choledochoduodenal junction, probably by vascular engorgement.

Animals↗
PubMed1975

Prevention of gram-negative bacillary pneumonia using polymyxin aerosol as prophylaxis. II. Effect on the incidence of pneumonia in seriously ill patients.

All 744 patients admitted to a Respiratory-Surgical Intensive Care Unit (RSICU) were included in a prospective study of the effects of a polymyxin (2.5 mg/kg body wt/day in six divided doses) or a placebo aerosol sprayed into the posterior pharynx and tracheal tube (if present), during 11 alternating 2-mo treatment cycles. The incidence of upper airway colonization in the RSICU with Pseudomonas aeruginosa was 1.6% during the polymyxin treatment cycles (total 374 patients) and 9.7% during the placebo cycles (370 patients) (X2 equals 23.2, P less than 0.01). 3 patients in the RSICU acquired Pseudomonas pneumonia, as defined by independent "blinded" assessors, during the polymyxin cycles while 17 acquired a Pseudomonas pneumonia during the placebo cycles (X2 equals 10.2, P less than 0.01). The overall mortality was similar in both placebo and polymyxin-treated groups (12.2 vs. 12.0%). Systemic antibiotic usage was similar in the different cycles; 49% of patients in the placebo and 53% in the polymyxin-treated groups received systemic antibiotics while in the RSICU.

Aerosols↗
PubMed1975

Uptake into brain proteins of 35S-methionine during morphine tolerance.

Effect of morphine sulfate on protein synthesis in rat brain was evaluated in tolerant and nontolerant rats. Male Wistar-Lewis rats were randomly distributed to control, tolerant and nontolerant groups. The rats were made tolerant by giving morphine sulfate (25 mg/kg b.i.d.) for either 42 or 84 days. An aqueous solution of 35S-methionine (0.5 muc/g b.w.t.) was administered i.v. Rats from each group were then sacrificed at 20 minutes, 1 hour and 2 hours after 35S-methionine. The 35S-activity in trichloroacetic acid-precipitated proteins and supernatant fractions from cortex, hypothalamus, putamen, corpus callosum, thalamus, cerebellum, kidney and liver was determined. In addition the amounts of label in lipid, saline-soluble and insoluble proteins of whole brain for tolerant and control rats were determined. The 35S-activity in brain proteins of non-tolerant rats did not differ from those of controls. The six brain areas in tolerant rats 1 and 2 hours after injection of 35S-methionine showed a 15 percent, then 30 percent increase in radioactivity (disintegrations per minute per milligram of protein). Proteins from putamen and corpus callosum had w/w 60 percent of the 35S-activity found in hypothalamus and cortex. There was no difference in 35S-activity in kidney and liver between control and tolerant rats. The radioactivity of the brain lipids was 2 percent of that found in proteins in both tolerant and control groups. Protein synthesis in morphine tolerant rat brain is significantly (P smaller than .01) increased as judged by incorporation of 35S-methionine.

Animals↗