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Biomedical subjects

P Douglas

Publications and source records attributed to P Douglas.

13 recordsLinked to original sources
PubMed1991

A developing complex odontome associated with delayed premolar formation.

Delayed development of a bicuspid in the right premolar region of the mandible was observed radiographically in a 16-year-old male patient following surgical removal of a developing odontome. Whilst odontomes are commonly associated with a failure of eruption of permanent teeth, this case was unusual in that there was both failure and marked delay of adjacent permanent tooth germ development, suggesting that the odontome was associated with a regional disturbance of odontogenic tissues in the neonatal period.

Adolescent↗
PubMed1989

[Brief intracavitary radiation (137 cesium) of the prostatic site in localized cancer of the prostate: preliminary results after 9 years].

Incidental detection of an adenocarcinoma's microscopic focus inside a piece of adenoma or TURP-chips is not rare. Generally, these hidden or "latent" carcinomas without any clinical event, are staged T0 (UICC) or stage A (Whitmore). In reviews, we can find justification of two contrasting attitudes: radical prostatectomy or therapeutic abstention. For the last nine years, we have proposed a third method: endocavitary curietherapy by 137 Cs of prostatic lodge, whose first results, in terms of morbidity and mortality, are discussed.

Adenocarcinoma↗
PubMed1988

Antianginal effects of intravenous nitroglycerin over 24 hours.

To determine the constancy of hemodynamic and antianginal effects of the constant infusion of intravenous nitroglycerin (NTG) and their relationship to infusion rate and plasma NTG concentration, we administered maximal tolerated doses of intravenous NTG (range 10 to 120 micrograms/min, mean = 52 +/- 33 micrograms/min) and placebo to 10 patients with chronic stable angina for 25 hr each in a randomized, double-blind fashion. Sublingual NTG (0.4 mg) was given at 24.5 hr of infusion as a positive control. Bicycle exercise time (NIH protocol), blood pressure, heart rate, exercise ST response, and venous plasma NTG were determined before and at 1, 4, 8, 24, and 24.5 hr. Plasma NTG was linearly related to infusion rate, reached a steady state within 15 min and was unchanged over 24 hr (mean = 5.5 +/- 1.2 ng/ml). Mean plasma NTG clearance was 9.3 liters/min. However, during dose titration, patients demonstrated different relationships between plasma NTG and hemodynamic effects, with widely varying slopes and intercepts. Intravenous NTG produced a sustained reduction in blood pressure and a rise in heart rate at rest, and a reduction in blood pressure during submaximal exercise at as late as 24 hr, associated with reduced submaximal ST segment abnormality. In contrast, exercise tolerance to onset of angina showed a marked initial increase on intravenous NTG but fell progressively and did not differ from that with placebo at 24 hr. Increased exercise tolerance was associated with an increase in maximal heart rate and double product (heart rate X blood pressure), suggesting that direct coronary vasodilation and/or reduced left ventricular volume were the principal determinants of increased exercise tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Sublingual↗
PubMed1987

[Immunoscintigraphy using radio-labeled monoclonal antibodies. Development of a method of cancer diagnosis and hopes for a new form of therapy].

Personal results are presented to illustrate the development of immunoscintigraphy for the detection of cancer over the last 12 years, from the early experimental results in nude mice grafted with human colon carcinoma to the most modern form of immunoscintigraphy applied to patients, using I123 labeled Fab fragments from monoclonal anti-CEA antibodies detected by single photon emission computerized tomography (SPECT). The first generation of immunoscintigraphy used I131 labeled, immunoadsorbent purified, polyclonal anti-CEA antibodies and planar scintigraphy, as the detection system. The second generation used I131 labeled monoclonal anti-CEA antibodies and SPECT, while the third generation employed I123 labeled fragments of monoclonal antibodies and SPECT. The improvement in the precision of tumor images with the most recent forms of immunoscintigraphy is obvious. However, we think the usefulness of immunoscintigraphy for routine cancer management has not yet been entirely demonstrated. Further prospective trials are still necessary to determine the precise clinical role of immunoscintigraphy. A case report is presented on a patient with two liver metastases from a sigmoid carcinoma, who received through the hepatic artery a therapeutic dose (100 mCi) of I131 coupled to 40 mg of a mixture of two high affinity anti-CEA monoclonal antibodies. Excellent localisation in the metastases of the I131 labeled antibodies was demonstrated by SPECT and the treatment was well tolerated. The irradiation dose to the tumor, however, was too low at 4300 rads (with 1075 rads to the normal liver and 88 rads to the bone marrow), and no evidence of tumor regression was obtained. Different approaches for increasing the irradiation dose delivered to the tumor by the antibodies are considered.

Animals↗
PubMed1987

Experimental congestive heart failure produced by rapid ventricular pacing in the dog: cardiac effects.

Chronic rapid ventricular pacing in the dog reportedly produces a useful preparation of low-output heart failure. However, little information is available regarding cardiac changes in this preparation. Accordingly, we evaluated the effects of both short-term (3 weeks) and prolonged (2 months) rapid ventricular pacing on cardiac hemodynamics, mass, and chamber size. The effects of short-term pacing on left ventricular wall thickening, blood flow, and metabolism were also examined. Compared with 16 control dogs, dogs paced for either 3 weeks (n = 8) or 2 months (n = 13) exhibited reduced cardiac outputs (control 130 +/- 20 ml/min/kg, 3 week pacing 112 +/- 19 ml/min/kg, 2 month pacing 116 +/- 14 ml/min/kg) and elevated pulmonary wedge pressures (control 10 +/- 3 mm Hg, 3 week pacing 26 +/- 5 mm Hg, 2 month pacing 26 +/- 8 mm Hg) and right atrial pressures (control 4 +/- 1 mm Hg, 3 week pacing 13 +/- 3 mm Hg, 2 month pacing 9 +/- 3 mm Hg) (all p less than .01 vs control). At the postmortem examination, both groups of paced dogs also exhibited increased left ventricular volumes (control 13 +/- 6 ml, 3 week pacing 27 +/- 6 ml, 2 month pacing 26 +/- 8 ml), right ventricular volumes (control 13 +/- 5 ml, 3 week pacing 27 +/- 9, 2 month pacing 24 +/- 7 ml), and right ventricular mass (control 27 +/- 5 g, 3 week pacing 32 +/- 6 g, 2 month pacing 34 +/- 6 g) (all p less than .03 vs control) but had normal left ventricular mass. Three weeks of pacing also decreased percent left ventricular shortening (34 +/- 6% to 17 +/- 7%) associated with a disproportionate deterioration of posterior wall thickening (58 +/- 16% to 17 +/- 18%) (both p less than .01), as assessed by echocardiography. This left ventricular dysfunction was associated with no change in myocardial lactate extraction (prepacing 40 +/- 10%, 3 week pacing 36 +/- 10%), myocardial arteriovenous O2 difference, or myocardial histology, suggesting that it was not due to myocardial ischemia. These data indicate that rapid ventricular pacing in the dog produces a useful experimental preparation of low-output heart failure characterized by biventricular pump dysfunction, biventricular cardiac dilation, and nonischemic impairment of left ventricular contractility.

Animals↗
PubMed1987

Early postoperative changes in left ventricular chamber size, architecture, and function in aortic stenosis and aortic regurgitation and their relation to intraoperative changes in afterload: a prospective two-dimensional echocardiographic study.

We prospectively studied 16 patients with isolated aortic stenosis and eight with isolated aortic regurgitation undergoing aortic valve replacement, using two-dimensional echocardiography preoperatively, intraoperatively, and 41 +/- 7 days postoperatively to calculate the intraoperative change in afterload, quantify the postoperative changes in left ventricular chamber size, architecture, load and function, determine whether the postoperative left ventricular remodeling correlated with the intraoperative change in afterload in aortic stenosis and aortic regurgitation, and assess whether preoperative afterload excess precluded postoperative improvement in left ventricular function. Preoperative left ventricular mass, end-systolic meridional and circumferential wall stresses, ejection fraction, and stress-shortening relations in patients with aortic stenosis and aortic regurgitation were similar. However, our patients with aortic regurgitation had severe systolic dysfunction, with ejection fraction less than 55% in all but one patient, compared with only 10 of 16 patients with aortic stenosis. Left ventricular end-diastolic volume, mass/volume ratio, and chamber shape were significantly different in patients with aortic stenosis and aortic regurgitation (174 +/- 64 vs 294 +/- 140 ml, p less than .01; 1.81 +/- 0.63 vs 1.14 +/- 0.18, p less than .01; and 0.59 +/- 0.09 vs 0.69 +/- 0.09, p less than .05, respectively). Intraoperative end-systolic meridional and circumferential stresses fell significantly in patients with aortic stenosis but remained unchanged in those with aortic regurgitation. The changes in left ventricular volume and ejection fraction during early postoperative remodeling (6 weeks) correlated with the intraoperative change in afterload in patients with aortic stenosis. In contrast, there was no intraoperative change in afterload in patients with aortic regurgitation and no significant changes in left ventricular volume, architecture, or function at 6 weeks or at 6 months. The differences in left ventricular remodeling and changes in function between patients with aortic stenosis and aortic regurgitation in the early postoperative period most probably relates to the major difference in intraoperative reduction in afterload, although a contributory role may have been played by the preoperative left ventricular dysfunction in those with aortic regurgitation that was underestimated by measurement of ejection fraction.

Adult↗
PubMed1985

Effects of reduced left ventricular mass on chamber architecture, load, and function: a study of anorexia nervosa.

We investigated the effects of reduction in left ventricular mass on cavity geometry, afterload, pump function, and exercise performance in 17 patients with anorexia nervosa and in 10 age-and sex-matched normal subjects. Left ventricular mass index determined by two-dimensional echo-cardiography was significantly lower than that in normal subjects (53 +/- 15 vs 79 +/- 18 g/m2; p less than .005). Left ventricular end-diastolic and end-systolic volume indexes were also reduced in patients with anorexia nervosa compared with normal subjects (49 +/- 11 vs 65 +/- 17 ml/m2, p less than .005; 14 +/- 5 vs 19 +/- 4 ml/m2, p less than .025). In spite of the reductions in left ventricular mass and volume indexes, left ventricular chamber architecture described as h/R ratio, mass to volume ratio, and short/long left ventricular axis ratio were normal. Left ventricular afterload assessed as end-systolic meridional and circumferential wall stress was normal (59 +/- 18 vs 79 +/- 19 dyne/cm2 X 10(3) and 170 +/- 26 vs 167 +/- 23 dyne/cm2 X 10(3)). Ejection fraction, percent fractional shortening, and the relationship between end-systolic wall stress and ejection fraction were all within normal limits. In seven patients restudied after a 15% to 20% weight gain, left ventricular mass and volume indexes increased significantly but end-systolic wall stress and ejection fraction did not change. Ten patients with anorexia nervosa and resting heart rates and systolic blood pressures significantly lower than control values underwent treadmill testing. Exercise duration, peak heart rate, peak systolic blood pressure, and peak oxygen consumption in these patients were all significantly lower than normal. The hypotensive effect of fasting resulted in an initial decrease in afterload, which was the stimulus for reduction in left ventricular mass. The left ventricular remodeling associated with the mass reduction occurred in such a way that (1) orthogonal, meridional, and circumferential wall stresses were normalized, (2) normal chamber shape and architecture were maintained, and (3) chamber function and stress-shortening relationships were preserved. Thus down-regulation of left ventricular mass per se, like up-regulation of left ventricular mass, is not associated with abnormal left ventricular function.

Adolescent↗
PubMed1981

[Concentrated radiotherapy of brain metastases].

Presentation of 60 patients with cerebral metastases irradiated with a telecobaltotherapy machine (concentrated high dose treatment) from 1976 to 1979; 47 patients fully completed the treatment: 11 patients had only one part of the concentrated treatment and 36 patients had both parts of the concentrated treatment. Of the 11 patients who received only one part of the concentrated high dose treatment (3 x 650 rads mid-line dose to the whole brain during 3 consecutive days and then, after a rest period of 3 weeks, 12 x 170 rads mid-line dose given in two weeks using classical fractionation, total dose 3990 rads), 9 (81.8%) responded favourably with average survival of 5 months. Of the 36 patients who received both parts of the concentrated high dose treatment, i.e. 3 x 650 rads mid-line dose in 3 consecutive days and then the same treatment repeated 3 weeks later. giving a total dose of 3900 rads, 31 (86.1%) responded favourably with an average survival of 5 months. This type of regimen, using the two-part concentrated high dose treatment ("split course therapy"), not only spectacularly alleviated neurological signs and symptoms but had the added advantage of appreciably reducing the patients' stay in hospital.

Aged↗
PubMed1979

[Considerations on the radiological treatment of inoperable bronchogenic carcinomas or recurrences after surgical intervention].

From 1964 to 1977, 315 carcinomas of the bronchus either inoperable or recurring following surgery were treated by radiotherapy using high energy machines (telecobalt therapy and/or Betatron: X-rays or electrons). 116 patients (36.8%) had well-differentiated squamous cell carcinomas, 70 (22.2%) had undifferentiated or poorly differentiated carcinomas, 97 (30.8%) had small-cell anaplasic carcinomas, and 32 patients (10.2%) had adenocarcinomas or other types of bronchial carcinoma. 199 patients (63.2%) were treated exclusively by radiotherapy and 116 (36.8%) by surgery followed by radiotherapy: 28 had exploratory thoracotomies, 73 curative resections and 15 palliative resections. At the end of irradiation treatment 140 patients (44.5%) showed a subjective and objective (clinical and radiological) improvement, whereas 111 patients, (35.2%) although chest X-rays showed no radiological improvement, had a subjective response; 64 patients (20.3%) showed deterioration. 33.5% of the patients (88/263) lived at least 1 year after completion of radiotherapy: in 25.9% (42/162) the treatment was exclusively radiotherapy and 45.5% (46/101) underwent irradiation after surgery. 12.4% (31/249) of the patients were alive 2 years after completion of irradiation and 5.4% (11/203) after 5 years.

Carcinoma, Bronchogenic↗
PubMed1979

Pesticide residue concentrations in soils of five United States cities, 1971--urban soils monitoring program.

Soil samples from five metropolitan areas including Baltimore, Maryland; Gadsden, Alabama; Hartford, Connecticut; Macon, Georgia; and Newport News, Virginia were analyzed for elemental arsenic, organochlorine pesticides, and polychlorinated biphenyls (PCBs). A representative number of samples were analyzed for organophosphorus pesticides, but none was detected. All areas exhibited heavy soil concentrations of organochlorine pesticides including sigma DDT, aldrin, dieldrin, photodieldrin, chlordane, heptachlor, heptachlor epoxide, endrin, endrin ketone, and endosulfan sulfate. PCBs were detected in three of the five metropolitan areas. Within the metropolitan areas, samples from the urban, or core city, locations generally had higher pesticide concentrations than did samples from suburban locations. Finally, pesticide residue concentrations were generally higher in soils of metropolitan areas than in nearby agricultural soils.

Arsenic↗
PubMed1977

Patterns of the use of benzodiazepines in Australia.

In six suburban areas of Sydney, chosen to provide a socioeconomic cross-section of the city, complete records of dispensing of benzodiazepine were collected over a four-week period. These drugs constituted 3.7% of all dispensing, female patients outnumbered males by 2.3:1, and 98% of patients were over 20 years of age. The predominance of females, and higher age groups was found in all the areas studied, but no socioeconomic correlation was detected in the use of the drugs. Analysis of national dispensing figures confirmed the higher consumption in higher age groups, and revealed no heterogeneity in per capita prescribing rates amongst the States.

Adolescent↗
PubMedDate not supplied

Correlation of cine MR imaging with two-dimensional pulsed Doppler echocardiography in valvular insufficiency.

Eight adults with known valvular insufficiency were studied with cine magnetic resonance (MR) imaging. Our cine MR uses cardiac synchronization of a rapid small flip angle pulse sequence on a 1.5 T MR system. Eleven regurgitant lesions (including aortic, mitral, and tricuspid valves) were imaged with both cine MR and two-dimensional pulsed Doppler echocardiography (2-DPDE). In each case of significant regurgitation the jet of valvular insufficiency was easily seen as a discrete area of low signal with cine MR. Not only was the regurgitant jet identified but also its relative severity agreed well with the 2-DPDE results. In two patients the regurgitant lesions were identified on cine MR prior to 2-DPDE. In addition to the regurgitant jet, chamber enlargement and wall thickening were also well demonstrated. Cine MR is a promising modality for both the detection and semiquantification of valvular insufficiency.

Aortic Valve Insufficiency↗