PubMed Health⌕ Search

Biomedical subjects

L Rhyne

Publications and source records attributed to L Rhyne.

11 recordsLinked to original sources
PubMed1982

Sodium citrate premedication in elective caesarean section patients.

The pH and volume of gastric contents from thirty-three patients undergoing elective caesarean section with thiopentone, nitrous oxide, succinylcholine anaesthesia were examined. Twenty patients received Gelusil 30 ml by mouth and thirteen patients received 30 ml of a 0.15 molar solution of sodium citrate. Following tracheal intubation, gastric fluid was sampled through an 18 French Salem sump tube place orally. Mean pH following Gelusil was 4.54 +/- 2.45 (SD) and 2.29 +/- 1.77 following sodium citrate. This difference was statistically different (P less than 0.05). There was no difference in gastric volume between the two groups. Thirty five per cent of patients receiving Gelusil had a pH less than 2.5. This low pH was more likely to occur with prolonged intervals between drug administration and sampling. Significantly more patients receiving sodium citrate had a low pH (85 per cent) and this low pH was not related to the duration of interval between administration and sampling. This study demonstrates that 30 ml of 0.15 molar sodium citrate is not a satisfactory alternative to 30 ml of Gelusil for increasing gastric pH in the paturient when given sixty minutes before operation.

Adult↗
PubMed1982

Antacid anticholinergic regimens in patients undergoing elective caesarean section.

The pH and volume of gastric contents were examined in 60 patients undergoing elective Caesarean Section under thiopentone, nitrous oxide-oxygen, succinylcholine anaesthesia. All patients received Gelusil 30 ml per os preoperatively, while 20 were given atropine 7 microgram X kg-1 and another 20 glycopyrrolate 4 microgram X kg-1 intramuscularly along with Gelusil. Following tracheal intubation, gastric fluid was sampled through an orally placed 18 French Salem Sump tube. After Gelusil alone, the mean gastric fluid pH was 4.54 +/- 2.45 (SD) while it was significantly higher following the combined use of antacid and atropine (6.78 +/- 1.20) or antacid and glycopyrrolate (6.42 +/- 1.72), (P less than 0.01). Differences in gastric fluid volume between the groups were insignificant. All three regimens produced a gastric pH greater than 2.5 when given less than 75 minutes before sampling. When the premedication to sampling interval exceeded 75 minutes the addition of atropine or glycopyrrolate decreased the incidence of gastric pH less than 2.5 from 47 per cent in patients given Gelusil alone to 6 per cent and 14 per cent, respectively. In comparison to Gelusil alone, this difference was significant with atropine (P less than 0.05) but not with glycopyrrolate. Atropine and glycopyrrolate respectively produced 6 per cent and 7 per cent incidences of pH lower than 2.5 combined with gastric volume greater than 25 ml, which were significantly lower than was observed with Gelusil alone (P less than 0.05). This study demonstrates that the addition of atropine or glycopyrrolate to Gelusil premedication provides additional protection against the consequences of aspiration, especially when the premedication to anaesthetic induction period is prolonged.

Adult↗
PubMed1981

A prospective study of histocompatible leukocyte and platelet transfusions during induction chemotherapy of adult acute nonlymphocytic leukemia.

A prospective clinical trial was conducted to test the effectiveness of granulocyte transfusions during induction chemotherapy of patients with adult acute non-lymphocyte leukemia. Thirty-eight patients who received prophylactic granulocyte transfusions from related donors when their phagocyte counts decreased to less than 1000 microliter were compared to twenty-five controls who did not have qualified donors from which to obtain granulocyte transfusions. The frequency of complete remissions (CR) (28/38 versus 7/25) was significantly greater for the granulocyte transfusion group than for controls. Patients older than 45 responded more often in the transfused group (P less than 0.025) when compared to the similar age group in controls. Both duration of complete remission and survival were greater in the granulocyte transfused group. However, these differences were not statistically significant. Survival for all responders (complete plus partial remission) was longer for the granulocyte transfusion group (P = 0.01). No significant difference in frequency or severity of either infection or hemorrhage was noted in the two groups. The advantage noted in this study largely occurred in patients older than 45 and this suggests that this age group is more likely to respond if they have histocompatible donors from which to obtain granulocyte and platelet transfusions. Immune mechanisms may be involved in the beneficial effects observed with HLA compatible granulocyte transfusions.

Adolescent↗
PubMed1981

Necrotizing fasciitis.

Necrotizing fasciitis is a lethal and insidious disease with a high mortality. It often begins in areas exposed to fecal or urinary contamination, and about 70% of cases occur in diabetics. A high index of suspicion should be maintained in diabetic patients with an infection in the perineum, genitalia, thigh, or buttocks. Factors leading to a poor prognosis are increased age and extent of disease at the time of diagnosis, especially myonecrosis. Therapy is primarily radical surgical debridement with adjunctive antibiotic therapy.

Adult↗
PubMed1980

Chloroprocaine vs. bupivacaine for lumbar epidural analgesia for elective cesarean section.

The incidence and degree of hypotension, time to establish surgical analgesia, and several other maternal and fetal variables were studied when 2-chloroprocaine, 3 per cent, and bupivacaine, 0.5 per cent, were used for epidural analgesia in 30 women undergoing elective cesarean section. Surgical analgesia occurred 8 min sooner (P less than 0.001) with chloroprocaine (14 +/- 1 min) than with bupivacaine (22 +/- 2 min). Blood pressure values were significantly lower with chloroprocaine than with bupivacaine during the 18--to-32 min interval after local anesthetic injection, while pulse rates were higher (P less than 0.05) at 18, 20, and 22 min. Hypotension necessitating treatment with ephedrine occurred in 33 per cent of chloroprocaine-treated subjects, compared with 13 per cent of those receiving bupivacaine. Newborn outcome was excellent in both groups, as reflected by umbilical vessel blood-gas values, times to sustained respiration, and 5-min Apgar scores. The authors conclude that chloroprocaine disturbs maternal cardiovascular status more than does bupivacaine when used for cesarean section epidural analgesia. However, chloroprocaine can be employed safely in normal pregnancies if maternal hypotension is corrected rapidly.

Analgesia↗
PubMed1979

Serum alkaline phosphatase determination. Value in the staging of advanced breast cancer.

A retrospective study of 146 patients with metastatic disease was undertaken to verify the clinical impression that radionuclide scanning rarely, if ever, discloses hepatic metastases in breast cancer patients with normal serum alkaline phosphatase (AP) levels. Only two of 39 patients with abnormal liver scans had normal AP levels, and we conclude that liver scans are not necessary as a routine screening method for liver metastases when the AP level is normal. In contrast AP levels were not predictive of bone scan results. All patients with a twofold or greater elevation of the AP level had abnormal bone, liver, or bone and liver scans. Routine AP determinations provide accurate staging information, and their proper use can decrease the cost of initial and follow-up examination of patients with breast cancer.

Alkaline Phosphatase↗
PubMed1979

Chemotherapy versus chemoimmunotherapy in advanced adenocarcinoma of the colon and rectum: a prospective randomized study.

The combination of vincristine, methyl-CCNU, and methotrexate with or without MER-BCG achieved a 2% complete response (CR) and a 11% partial response (PR) with a median duration of 25-29 weeks in 124 evaluable patients with advanced adenocarcinoma of the colon and rectum. Responses were seen in previously untreated patients and in patients refractory to 5-fluorouracil. The median survival of these objective responders (CR + PR) was 57 weeks. The addition of MER-BCG did not appear to influence response rate or duration of survival and was accompanied by significant toxicity. Response was significantly correlated with performance status, sex, and disease free interval and survival with alkaline phosphatase and performance status. Patients with advanced colorectal carcinoma should be stratified according to these variables.

Adenocarcinoma↗
PubMed1978

Adriamycin versus methotrexate in five-drug combination chemotherapy for advanced breast cancer: a randomized trial.

Adriamycin is of noteworthy efficacy in the treatment of metastatic breast cancer. Its role in combination regimens is under investigation. One hundred seventy-five women with advanced breast cancer were entered into a prospectively randomized trial comparing two five-drug regimens. Regimen CMFVP consisted of cyclophosphamide (C), methotrexate (M), 5-fluorouracil (F), vincristine (V), and prednisone (P). Regimen CAFVP was identical but substituted Adriamycin (A) for methotrexate. Twenty-seven patients were disqualified; 148 were evaluable. With CMFVP the complete response rate (CR) was 11%, and the partial response rate (PR) was 46%; with CAFVP, CR was 13% and PR was 45%. Duration of response tended to be slightly longer for patients on the Adriamycin arm. The median survival for CR and PR patients with CMFVP was 20.2 months, which was shorter (p = .07) than the 33 month median survival with CAFVP. Although statistical significance was not reached at the 5% level, the increased survival of responders on the Adriamycin regimen supports the data of other studies which suggest that first line combination chemotherapy in advanced breast cancer should include Adriamycin.

Antineoplastic Agents↗
PubMed1978

Chemoimmunotherapy for disseminated malignant melanoma: a prospective randomized study.

Twenty-eight patients with disseminated malignant melanoma were treated with DTIC (250 mg/m2 iv, Days 1--5) and actinomycin D (0.5 mg/day iv, Days 1--5) at 5-week intervals. Patients were randomly allocated to receive no immunotherapy or immunotherapy consisting of methanol extracted residue of bacillus Calmette-Guérin (0.5 mg intradermally; 100 microgram in five separate sites) every 5 weeks, concomitant with chemotherapy. Of these 28 evaluable patients, 13 received chemoimmunotherapy with one complete response (CR) and 15 received chemotherapy alone with one CR. Both responses occurred in lymph node metastases. No partial responses were seen.

BCG Vaccine↗