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Biomedical subjects

J Stulc

Publications and source records attributed to J Stulc.

11 recordsLinked to original sources
PubMed1992

Utility of an oral examination in a surgical clerkship.

To evaluate the utility of the oral examination in a surgical clerkship, we designed a prospective and randomized study to relate the subjective impressions of experienced examiners with an objective measure of cognitive knowledge. The examiners were asked to score the student's performance as honors, high satisfactory, satisfactory, or unsatisfactory, according to their subjective impression of the student's ability. Student performance was grouped according to oral examination performance. The cognitive performance in the honors group was significantly better than that of the other groups (Student's t-test, p = 0.05). There was a significant difference in cognitive performance for oral examination groups throughout the rotations (analysis of variance, p = 0.000; Kruskal Wallis, p = 0.05). The oral examination is useful to identify a high level of cognitive achievement but cannot discriminate between groups of median to low competence. It should be used for educational feedback, career counseling, residency recommendations, and professional development.

Achievement↗
PubMed1990

Transport of calcium across the dually perfused placenta of the rat.

1. A rat placenta was dually perfused in situ with modified Krebs fluid. Perfusion was carried out through the femoral artery on the maternal side and through the umbilical artery on the fetal side. 2. Transfer of 45Ca2+ and [3H]L-glucose across the placenta was measured in the maternal-fetal direction. The transcellular component of the maternal-fetal transport of Ca2+, Jmf,tc, was estimated from transfer rates of the two tracers and from Ca2+ concentration in maternal perfusate, [Ca2+]m. 3. At [Ca2+]m of 1.1 mM (physiological concentration of Ca2+ in plasma) Jmf,tc was 92.4 +/- 13.7 nmol min-1 (mean +/- S.D.), which is about 90% of the transport expected in an intact placenta. The permeability-surface area product (PS) of the placenta to [3H]L-glucose was 13.8 +/- 3.9 microliters min-1, about 4 times higher than that expected in intact placenta. 4. Transport of 45Ca2+ changed rapidly when [Ca2+]m was varied. Kinetic constants of the transcellular transport of Ca2+ are the Michaelis constant, Km, = 0.45 mM and the maximum rate of transport, Vmax, = 116 nmol min-1. It follows from this that at physiological levels of Ca2+, transport of Ca2+ to the fetus is relatively independent of changes in [Ca2+]m. 5. Strontium and barium (SrCl2 and BaCl2, 1 mM) decreased Jmf,tc; the response was prompt and reversible. Magnesium (2 mM) had no effect. Maternal-fetal transport of 85Sr2+ and 133Ba2+ was decreased rapidly and reversibly by elevating [Ca2+]m from 0.35 to 2 mM. These observations suggest that Sr2+ and Ba2+ are transported across the placenta by the Ca2+ transport system. This means that the transport is not substrate specific. 6. Cadmium (1 mM-CdCl2) decreased Jmf,tc irreversibly with some latency. The slowness of the response suggests a non-competitive inhibition. Cadmium (0.02 mM-CdCl2) was without effect on Jmf,tc. 7. A Ca2+ channel blocker, nifedipine (10 microM), administered to the maternal side had no effect on Jmf,tc.

Animals↗
PubMed1988

Adenocarcinoma of the appendix.

Sixteen instances of adenocarcinoma of the appendix treated at Roswell Park Memorial Institute between 1964 and 1986 were reviewed. Thirteen of 15 were mucinous and ten were well differentiated. Synchronous metastases were present in 11 patients, with carcinomatosis being the most common pattern of metastases (nine patients). Seven of eight women had ovarian metastases. Nine of the 11 patients with metastatic disease presented with complaints referrable to the metastatic site. The five year survival rate was 50 per cent in the eight patients who underwent right hemicolectomy and 25 per cent in the four patients who underwent appendectomy. The data from this review support right hemicolectomy as the treatment of choice for adenocarcinoma of the appendix. The prolonged survival time of patients with metastatic disease and the symptomatic nature of that disease support the application of palliative oophorectomy in patients with ovarian metastases.

Adenocarcinoma, Mucinous↗
PubMed1987

A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma.

Seventy-four previously untreated patients with metastatic colorectal adenocarcinoma were prospectively randomized into one of three treatment regimens: (1) 5-fluorouracil (5-FU) 450 mg/m2 as an intravenous (IV) bolus daily for five days or toxicity, then 200 mg/m2 IV bolus every other day for six doses; (2) methotrexate (MTX) 50 mg/m2 in normal saline by IV infusion over four hours followed by an IV bolus of 5-FU 600 mg/m2. This was administered weekly for 4 weeks and then every 2 weeks. (3) Leucovorin 500 mg/m2 in a two-hour IV infusion of normal saline with 5-FU 600 mg/m2 as an IV bolus one hour after the Leucovorin began every week for 6 weeks. The combined complete and partial response rates in the three regimens were 11%, 5%, and 48%, respectively (P = .0009). The median duration of response in the 5-FU and Leucovorin regimen was 10 months. There was no statistically significant difference between the treatment regimens with respect to survival time (P = .6). Toxicity in the 5-FU and Leucovorin regimen was predominantly diarrhea (13 of 30 patients, 40%). In this regimen, eight of 13 patients (52%) who developed diarrhea not only required a dose reduction of 5-FU, but also hospitalization for IV hydration. The predominant toxicity in the 5-FU alone regimen and the 5-FU and MTX regimen was leukopenia. One drug-related death occurred in each regimen.

Adenocarcinoma↗
PubMed1979

Lack of effect of ouabain on sodium transport across the rat placenta.

The umbilical vascular bed of the rat placenta was perfused in situ. Ouabain (10(-4)M) in the perfusion fluid had no effect on the unidirectional flux of Na+ from the maternal (electrically negative) to the foetal (electrically positive) side of the placenta, or on the transplacental potential difference. This was taken to indicate that there is no significant active transport of Na+ across the placenta of the rat.

Animals↗
PubMed1978

Effects of isoprenaline and orciprenaline on the vascular bed of the mouse placenta.

High doses of isoprenaline or orciprenaline decreased the rate of transfer of tritium-labelled water from mother to fetus. The effect was blocked by propranolol. Maternal blood spaces of the placental labyrinth in the treated animals were congested with masses of red blood cells. These observations suggest that the placental circulation is impaired by high doses of beta-sympathomimetic drugs.

Animals↗
PubMed1978

Electrical potential difference across the mid-term human placenta.

Electrical potential difference across the mid-term human placenta was recorded during hysterotomy. The average value registered was 2.7 mV (S.E. of mean=0.4 mV, n=7), fetus negative. From this value and the concentrations of Na, K, Ca, Cl and inorganic phosphate in maternal and fetal plasma the possible mechanisms of net transport from mother to fetus are inferred. It is concluded that of the above ions only the transport of Na is compatible with simple diffusion.

Action Potentials↗
PubMed1977

Placental transport of sodium in the guinea-pig.

1. The mechanism of placental transport of Na was studied in guinea-pigs in placentae with intact umbilical blood circulation or in the preparation of the placenta perfused in situ. 2. A constant level of 22Na was maintained in maternal plasma for 60 min, and from the quantity of 22Na recovered from the foetus at the end of this period the influx of Na from mother to foetus was calculated. Ligation of the omphalomesenteric vessels (supplying the everted yolk sac with blood) had no effect on the influx, the corresponding values of influx in the control and treated foetuses being 0-235 +/- 0-020 and 0-247 +/- 0-029 micron-mole/min. g foetal weight (n = 6, the limits are S.E. of mean). The specific activity of Na in amniotic fluid was below that of the maternal or foetal plasma Na by two orders of magnitude. These observations indicate that the extraplacental transport of Na into the foetus is negligibly low. 3. The electrical potential difference (p.d.) and unidirectional fluxes of Na across the placenta perfused in situ were measured by means of 22Na and 24Na administered to the opposite sides of the placental barrier. The fluxes varied with the weight of the foetuses whose placentae were perfused. The flux from the maternal to the foetal side was 0-270 +/- 0-017 micronmole/min.g foetal weight, the flux from the foetal to the maternal side was 0-340 +/- 0-018 micronmole/min.g foetal weight (n = 38). The corresponding p.d. was - 20-7 +/- 1-2 mV (foetal side negative). 4. The active component of Na transport across the placenta was calculated from the unidirectional fluxes and the p.d. The active transport was directed from the foetal to the maternal side, and its rate was 0-211 +/- 0-015 micronmole/min.g foetal weight (n = 38). During perfusion of the placenta with KCN (10(-3) M) the active transport decreased by approximately one third. 5. The flux of Na from the foetal to the maternal side of the perfused placenta was higher than the flux from the maternal to the foetal side. A similar asymmetry of Na fluxes was observed in the non-perfused placenta, the flux from mother to foetus being 0-180 +/- 0-013 micronmole/min.g foetal weight and the flux from foetus to mother 0-235 +/- 0-024 micronmole/min.g foetal weight (n = 12). This indicates that the asymmetry of Na fluxes is caused by the anaesthesia and/or by the trauma of the operation rather than by the perfusion of the placenta. 6. The permeabilities of the perfused placenta to Na and sucrose measured simultaneously from the maternal to the foetal side were 0-0767 +/- 0-0183 and 0-324 +/- 0-0094 cm3/min (n = 7y, respectively. The permeability values bear the same relation to each other as the respective coefficients of free diffusion in water, suggesting that the passive transport of Na across the placenta takes place as simple diffusion through wide aqueous channels. 6...

Animals↗
PubMedDate not supplied

Effect of maternal hypokalaemia on unidirectional maternofetal and net potassium fluxes across the placenta of the anaesthetized rat.

Potassium (K+) fluxes across the placenta of rats, at 21 days gestation, fed a low K+ diet or a control diet were studied. The rats on the low K+ diet had a significantly (P less than 0.001) lower arterial plasma K+ concentration compared to those on the control diet (1.95 +/- 0.12 and 2.93 +/- 0.06 mmol/l respectively; mean +/- s.e., n = 17). Fetal umbilical arterial plasma K+ concentration was unaltered in maternal hypokalaemia and was significantly (P less than 0.001) higher than that of maternal plasma (4.58 +/- 0.15 and 4.66 +/- 0.12 mmol/l in low K+ and control groups respectively). Net K+ flux across the placentas (as measured by fetal accretion between days 20 and 21 of gestation) of hypokalaemic mothers (0.106 +/- 0.02 mumol/min/g placenta, n = 6) was not different to that in controls (0.104 +/- 0.01 mumol/min/g placenta, n = 8). Unidirectional maternofetal flux (Jmf) across the placentas, measured as the accumulation of 42K in the fetuses after injection of the radioisotope into maternal blood, was also not significantly different between the hypokalaemic and control mothers (0.5 +/- 0.08 mumol/min/g placenta, n = 8 versus 0.63 +/- 0.06 mumol/min/g placenta, n = 7, respectively). However, measurement of Jmf by perfusion of the placentas through their fetal circulations yielded a higher value than the accumulation method and in this analysis was significantly (P less than 0.02) lower in the low K+ than in the control group (0.75 +/- 0.10 mumol/min/g placenta, n = 11, and 1.27 +/- 0.14 mumol/min/g placenta, n = 9, respectively). These results show that net placental K+ fluxes are unaltered during maternal hypokalaemia but suggest that unidirectional maternofetal fluxes may be reduced.

Animals↗