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Biomedical subjects

J M Perry

Publications and source records attributed to J M Perry.

32 records · Page 2Linked to original sources
PubMed1982

'Endometrial' adenocarcinoma of the prostatic urethra arising in a villous polyp. A light microscopic and immunoperoxidase study.

A 77-year-old man had a papillary neoplasm of the prostatic urethra removed by transurethral resection. Light microscopically, much of the tissue consisted of a benign villous polyp lined by prostatic epithelium. An adenocarcinoma with cells that resembled those of uterine endometrial carcinoma was also present within the villous polyp. Using immunoperoxidase techniques, prostatic acid phosphatase and prostatic-specific antigen were localized in the epithelial cells of both the villous polyp and the adenocarcinoma. To our knowledge, this is the first reported case of adenocarcinoma arising in a urethral polyp. The immunohistochemical findings and the close association of the adenocarcinoma with the prostatic epithelium of the villous polyp provided evidence that so-called endometrial carcinoma of the prostatic utricle is of prostatic epithelial origin rather than müllerian derivation.

Acid Phosphatase↗
PubMed1981

Retardant effect of hyperglycemia on the rise in plasma fatty acids following insulin withdrawal in man.

The present study was undertaken to examine the influence of hyperglycemia in retarding the rise in circulating FFA noted after acute insulin withdrawal in man. The arterial FFA response to somatostatin administration was measured in the presence of (a) euglycemia and (b) hyperglycemia. In seven normal men who received somatostatin (0.9 mg/h) with euglycemia maintained by exogenous glucose infusion plasma insulin levels fell to levels 4 uU/ml and plasma FFA concentrations rose from 659 +/- 123 to 2057 +/- 268 uEq/l. When somatostatin was infused with hyperglycemia maintained at approximately 230 mg/dl, plasma insulin levels were again maintained at levels 4 uU/ml. Despite similar insulinopenia plasma FFA concentrations rose from 510 +/- 56 to only 1125 +/- 180 uEq/l, significantly less than in the previous protocol (p less than 0.01). These data indicate that hyperglycemia per se significantly attenuates the rise in circulating FFA caused by acute insulin withdrawal in man.

Adolescent↗
PubMed1979

Hyperglycemia per se (insulin and glucagon withdrawn) can inhibit hepatic glucose production in man.

We examined the effect of hyperglycemia per se on net splanchnic glucose balance. In 2 groups of normal postabsorptive men who had undergone hepatic vein catheterization, somatostatin was administered to block endogenous insulin and glucagon secretion. Exogenous glucose was infused in both groups to maintain euglycemia for 2 h in one group (n = 7) and to induce hyperglycemia of 220-240 mg/dl after 30 minutes of euglycemia in the second group (n = 4). In both groups the induction of insulinopenia and glucagonopenia with euglycemia maintained resulted in an initial 75% fall in net splanchnic glucose production (NSGP). In the group in which euglycemia was maintained NSGP returned to basal rates (157 +/- 31 mg/min) within 2 h. However, in the group in which hyperglycemia was induced, NSGP did not return to basal rates but remained suppressed (28 +/- 4 mg/min) for the duration of the study. These data in normal man indicate that hyperglycemia per se with insulin and glucagon acutely withdrawn can suppress splanchnic glucose production but does not induce net splanchnic glucose storage.

Blood Glucose↗
PubMed1978

Prognostic and therapeutic considerations in ischemic heart disease.

Coronary arteriography and coronary artery bypass surgery have provided a tremendous stimulus to learn more about the natural history of ischemic heart disease. It has become apparent that the most important approach to understanding prognosis involves placing patients into subsets. Clinical presentation is an entry into subsets but is an inadequate way to assess the problem. Anatomical information in the form of coronary arteriographic abnormalities and left ventricular functional abnormalities are powerful prognostic determinants. It remains important to consider matters such as increased blood pressure, cardiomegaly, and perhaps other factors such as cigarette smoking as additive to any anatomical information which can be obtained for any given subset. Premature ventricular contractions, particularly of the complicated type, may be a very powerful and important additive prognostic consideration in all patients with ischemic heart disease but especially those prone to sudden cardiac death. Coronary bypass, surgery now widely practiced in Western Europe and the United States, is an established, integral part of therapy for certain subsets of patients. It clearly cannot resolve the total issue of therapy and must be utilized selectively and critically along with other intensive medical measures to hope to control risk factors and progression of the coronary arteriosclerotic process.

Coronary Angiography↗
PubMed1977

Evidence for an important role of glucagon in the regulation of hepatic glucose production in normal man.

To investigate the role of glucagon in regulating hepatic glucose production in man, selective glucagon deficiency was produced in four normal men by infusing somatostatin (0.9 mg/h) and regular pork insulin (150-muU/kg per min) for 2 h. Exogenous glucose was infused to maintain euglycemia. Arterial plasma glucagon levels fell by greater than 50% whereas plasma insulin levels were maintained in the range of 10-14 muU/ml. In response to these hormonal changes, net splanchnic glucose production (NSGP) fell by 75% and remained suppressed for the duration of the study. In contrast, when somatostatin alone was administered to normal men, resulting in combined insulin and glucagon deficiency (euglycemia again maintained), NSGP fell markedly but only transiently, reaching its nadir at 15 min. Thereafter, NSGP rose progressively, reaching the basal rate at 105 min. These data indicate that the induction of selective glucagon deficiency in man (with basal insulin levels maintained) is associated with a marked and sustained fall in hepatic glucose production. We conclude, therefore, that basal glucagon plays an important role in the maintenance of basal hepatic glucose production in normal man.

Adolescent↗
PubMed1975

Inotropic effects of tolbutamide in man.

The hemodynamic responses of normal subjects to intravenous injections of tolbutamide, 250 mg., and 1,000 mg., were assessed by measurements of serial systolic time intervals. Analysis of results, compared to saline control, revealed evidence of minor inotropic effects during the period five to 10 minutes after infusion. Small but statistically significant (p less than 0.05) decreases in pre-ejection phase and electromechanical systole were noted. The time response of these changes did not correlate with dose of blood level of tolbutamide, and appeared to coincide with peak insulin levels. No inotropic or chronotropic effects were seen during the first four minutes after infusion, suggesting that the myocardial adenyl cyclase-stimulating properties of the drug, previously demonstrated in vitro, are not significant in intact man. The minor late inotropic effects are of doubtful clinical significance, and cannot be invoked to explain the reported increased cardiovascular mortality of patients treated with tolbutamide.

Adult↗
PubMed1975

Coronary arteriography: indications and pitfalls.

Selective coronary arteriography has become an unusually useful technique in evaluating patients with known or suspected ischemic heart disease. The contribution of F. Mason Sones in developing the technique and in emphasizing that properly performed studies in experienced hands can be done at an acceptable risk cannot be overemphasized. Although the study can give information only on the anatomical aspects of the disease, it has remarkably broadened ouo understanding of the whole spectrum of coronary arteriosclerosis and ischemic heart disease. This is related to the fact that the method has provided the opportunity to study an extraordinarily large number of patients representing virtually every clinical subset of the disease. The importance of nonanatomical factors, better prognostic information about the disease, and more complete understanding of the hemodynamic ocrrelates and mechanisms of drug action have resulted from investigative studies using coronary arteriographic methods. Because ischemic heart disease is such a complex and variable entity, it is important to stress that coronary arteriography and left ventricular angiography can provide only anatomical information, and that the method has significant but ordinarily recognizable limitations. Some of these limitations are technical and are not important considerations in experienced hands in well-run laboratories. Other problems are inherent in the anatomical complexity of the disease and the coronary circulation. Hence, appropriate emphasis on the details of the patient's history, including risk factors and age, as well as other selected clinical laboratory studiies, such as exercise electrocardiography, are important in assessing the patient's total problem. Because of these factors, the greatest value of coronary arteriography is realized when it is performed as part of a thoughtful, detailed--and highly individualized--evaluation of the patient.

Adult↗
PubMedDate not supplied

The road to commendation by the Joint Commission.

Undergoing a survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is an arduous and grueling task. In many healthcare settings, there is more emphasis than ever before on achieving commendation status, which is the highest rating possible from JCAHO. This article chronicles one hospital's journey toward receiving accreditation with commendation and is applicable to any hospital preparing for its own survey.

Accreditation↗
PubMedDate not supplied

Multidisciplinary shared leadership.

Shared Governance evolved as a way for hospital nurses to have a role in decision making that affected nursing practice. This article describes how a multidisciplinary shared leadership program can be implemented in a hospital setting in order to empower all staff to participate in decision making and to continue the evolutionary process of continuous quality improvement. Various shared leadership models are described as well as a step-by-step implementation process and one hospital's story of the successful implementation of a council or model.

Decision Making, Organizational↗