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Biomedical subjects

R D Fisher

Publications and source records attributed to R D Fisher.

At least 19 recordsLinked to original sources
PubMed1993

Perception of male drinkers as a function of their alcoholic beverage preference.

The present study examined perception of a man's likelihood of driving after drinking and his ability to do so as a function of his choice of beverage. Perceptions of his social characteristics were also examined. The sample was composed of 200 volunteer undergraduate psychology students. Equal numbers of male and female subjects read one of four vignettes which varied only in the male protagonist's choice of beverage: beer, wine, shots of distilled spirits, or cola. After reading the story, subjects answered multiple-choice questions about the character, tapping social judgments, situational judgments and drinking and driving judgments. Subject drinking habits were also assessed. The most notable result was the consistently positive perception of the protagonist portrayed as an abstainer. The lack of a consistent alcoholic beverage distinction implies that the beer-spirits double standard is far from a clear-cut discrimination. Possible explanations for results are discussed. This study questions the robustness of the alcoholic beverage type bias and reflects the need for future research.

Adult↗
PubMed1982

Does testicular mass always require orchiectomy?

Surgical exploration of a testicular mass should follow the basic principles of cancer surgery, including an inguinal approach, occlusion of the spermatic vessels, opening of the tunica vaginalis, and careful exploration of the testicle, epididymis, paratesticular structures, and spermatic cord. In a very few patients, when intratesticular lesion is small and moveable and can be seen through the tunica albuginea, and if there is a long history of scrotal mass, then the tunica albuginea should be opened and intratesticular exploration performed. The opening of the tunica albuginea should be opened and intratesticular exploration performed. The opening of the tunica albuginea does not violate the principles of cancer surgery, and for a few selected cases can prevent unnecessary orchiectomy. The incision of the tunica albuginea should no longer represent a surgical taboo to the urologist. Six cases of rare, benign intratesticular tumors are presented along with a rare indication for intratesticular exploration and testicle-preserving surgery.

Adult↗
PubMed1982

Elevation of plasma antidiuretic hormones (ADH) associated with chemotherapy-induced emesis in man.

Eleven randomly hydrated patients with metastatic malignancies received iv bolus chemotherapy. Serial observations of plasma antidiuretic hormone (ADH), serum osmolality, blood pressure, and presence of nausea or emesis were made over the next 3-4 hours. Group 1 (four patients) had no nausea or emesis and no change in ADH, osmolality, or mean blood pressure. Group 2 (seven patients) had nausea and emesis following chemotherapy, with an increase in mean ADH from a baseline level of 5.53 pg/ml to a peak after emesis of 33.83 pg/ml. Group 2 had no significant increase in osmolality or decrease in mean blood pressure before emesis. ADH levels increased 0-40 minutes before emesis and peaked 28-115 minutes (mean, 66) after emesis. Emesis caused by chemotherapy agents is associated with rapid, significant increases in plasma ADH levels, independent of changes in osmolality or blood pressure.

Antineoplastic Agents↗
PubMed1979

Myocardial anaerobic metabolism during isoprenaline infusion in a cyanotic animal model: possible cause of myocardial dysfunction in cyanotic congential heart disease.

Mongrel dogs were made acutely cyanotic by anastomosis of the inferior vena cava to the left atrium and measurements of high fidelity left ventricular pressure, arterial pressure, blood gases, and myocardial lactate arteriovenous differences were determined before pacing, with atrial pacing at a rate of approximately 240 per minute, and during an infusion of isoprenaline to increase myocardial oxygen demands. The animals were divided into two groups on the basis of the arterial PO2 during isoprenaline: acyanotic or control dogs (n = 4, PO2 greater than or equal to 6.7 kPa [50 mmHg], mean = 52) and cyanotic dogs (n = 5, PO2 less than or equal to 4.7 kPa (35 mmHg), mean = 32). Myocardial lactate arterio-venous difference showed no significant changes in the control dogs with pacing or isoprenaline, but myocardial lactate production occurred in all five cyanotic dogs with isoprenaline infusion. These studies demonstrate that myocardial anaerobic metabolism can be produced during times of stress with isoprenaline infusion in a cyanotic animal model at systemic oxygen levels that can occur clinically.

Anaerobiosis↗
PubMed1979

Coarctation of the abdominal aorta: pathophysiologic and therapeutic considerations.

Coarctation of the aorta is the most frequent cause of hypertension in infants and children. Ninety-eight per cent of coarctations occur in the descending aorta near the ligamentum arteriosus. Five patients are presented with the relatively rare problem of coarctation of the abdominal aorta. The anatomic,pathophysiologic and clinical aspects in these patients cover a range of variants. Clinical and laboratory studies of the genesis of hypertension in coarctation are reviewed in chronologic outline. An experimental model of abdominal coarctation with hypertensive and renin-angiotensin II correlations suggests but does not prove a renal mechanism for the hypertension. The same conclusion must be drawn from study of the clinical cases.

Adolescent↗
PubMed1979

Reparative cardiac surgery in infants and small children: Five years experience with profound hypothermia and circulatory arrest.

A five year experience of profound hypothermia and circulatory arrest in the operative management of severe congenital heart disease in 128 infants and children weighing 10 kg or less is reviewed. Hospital mortality was 13% for the entire series--8% in the last two years. Mortality varied with the defect present rather than with the age at operation, and appeared to decline over the five years. There was no morbidity associated particularly with this technique, and no evidence of permanent neurologic nor intellectual impairment. Total arrest time averaged 55 minutes, was related significantly to the defect being repaired, but was not related to hospital mortality. The results support the idea of definitive early cardiac repair for severely symptomatic infants and young children, rather than surgical palliation. The hypothermic arrest technique is attractive since it allows optimal operating conditions, thus permitting an accurate repair and the consequent improvement in surgical results.

Child, Preschool↗
PubMed1979

Rheumatoid pericarditis. Clinical significance and operative management.

The incidence of subclinical pericarditis associated with rheumatoid pericarditis may be as high as 50 percent, but significant impairment of cardiac performance owing to this type of pericarditis rarely occurs. In the past 7 years, we have encountered eight men with congestive heart failure owing to rheumatoid pericarditis. Cardiac catheterization and echocardiography were useful in establishing the diagnosis of pericardial constriction. Pericardiocentesis was unsuccessful in relieving symptoms in the three patients in whom the procedure was performed. Seven patients underwent pericardiectomy; six had constrictive pericarditis and one patient had an acute pericarditis with the sudden onset of cardiac tamponade. The other patient died of cardiac tamponade prior to operation. All patients improved after operation and have remained free of cardiac symptoms 3 months to 4 1/2 years later. The frequent occurrence of adhesive and obliterative pericarditis with loculated effusions suggests the need for pericardiectomy rather than pericardiocentesis in the patient with rheumatoid arthritis and symptomatic pericardial involvement. Immediate and lasting relief of this unusual nonarticular manifestation of rheumatoid arthritis can be expected after pericardiectomy.

Adult↗
PubMed1978

Operative closure of isolated defects of the ventricular septum: planned delay.

Selection of patients and the timing of operation for closure of ventricular septal defect (VSD) can be difficult because the risk of operation must be balanced against the hemodynamic abnormality and the age and size of the infant. In the past 6 years we have individualized our approach to the timing and necessity of operation in the patient with an isolated VSD. During this period, 133 patients with VSD were evaluated, and 71 underwent operative closure of the VSD. Of the 133 patients, 90 were 2 years old or younger, and 40 of them required operation because of congestive failure and growth retardation. Of the 45 infants who did not undergo operation, 17 have small intracardiac shunts with normal pulmonary vascular resistance while the other 28 infants remain compensated and are growing despite moderate left-to-right shunts. A persistent, large intracardiac shunt was the indication for operation in 31 of the 48 older patients; the other 17 older patients remain well. Although 3 severely growth-retarded infants (2 to 4 kg) died soon after operation, all infants weighing 4 kg or more survive. No child has died during preoperative observation, and irreversible pulmonary vascular changes have not occurred. Most infants with VSD and large intracardiac shunts do require early VSD closure, but the risk of operation remains high in the tiny neonate with profound failure. With appropriate hemodynamic and clinical criteria, operation for selected infants can be delayed so that the risk of operation can be minimized.

Age Factors↗
PubMed1978

Hemoptysis and pulmonary aspergilloma: operative versus nonoperative treatment.

The clinical experience with 42 patients with pulmonary aspergilloma evaluated at the Vanderbilt University Affliated Hospitals in a 22-year period was reviewed to determine the necessity and advisability of pulmonary resection. Twenty-nine patients (69%) had sustained one or more episodes of gross hemoptysis. Eleven of the 42 patients were treated operatively with lobectomy, wedge resection, or cavernostomy. Five of them had had hemoptysis preoperatively, but in only 1 patient was massive hemoptysis the primary indication for operation. The single death among these 11 patients occurred in the patient undergoing operation for control of massive hemoptysis. Nonoperative treatment was selected in 31 patients because of advanced chronic lung disease. Twenty-four of these 31 patients experienced 41 episodes of gross hemoptysis during observation periods up to 8 years (average, 32 months). Superimposed bacterial infection usually accompanied the episodes of hemoptysis, and medical therapy with bedrest, antibiotics, and postural drainage was successful in controlling the hemorrhage in 40 of the 41 episodes. One patient died from massive hemoptysis. On the basis of this experience, pulmonary resection for aspergilloma in patients with hemoptysis seems rarely indicated.

Adult↗
PubMed1977

Candida albicans infection of sternum and costal cartilages: combined operative treatment and drug therapy and 5-fluorocytosine.

Two patients with candidal sternal osteomyelitis have been successfully treated by operative debridement and adjuvant drug therapy with 5-fluorocytosine. One patient had developed postoperative candidal wound infection after sternotomy, and the other acquired candidal sternal osteomyelitis following Candida fungemia. The diagnosis, suggested by culture, was confirmed by identification of Candida pseudohyphae in debrided tissue. Histological confirmation of candidal sternal osteomyelitis indicates the need for operative debridement and specific systemic antifungal therapy. The drug 5-fluorocytosine appears to provide effective oral therapy in this situation.

Candidiasis↗
PubMed1977

Contemporary management of myasthenia gravis: the clinical role of thymectomy.

Thirty-six patients with myasthenia gravis have been evaluated and treated over the past five years. Eleven patients had ocular myasthenia gravis and responded well to anticholinesterase medications. Twenty-five patients had generalized myasthenia gravis, and 22 of them were initially treated with anticholinesterase medications; 18(82%) failed to improve or to maintain an initial improvement on medication, and 14 of these 18 patients underwent thymectomy. In addition, 3 patients underwent thymectomy as part of their initial treatment during the later part of this study. All thymectomies were performed through a median sternotomy. All 17 patients manifested sustained improvement as judged by a gain in strength and decrease in medications. Thymectomy is beneficial in the treatment of myasthenia gravis, and it is most efficacious when performed early in the course of the disease.

Adolescent↗
PubMed1977

Salmonella empyema: a review.

A 35-year-old man developed salmonella pleural empyema during a three-month illness. Cultures of the empyema fluid yielded S enteritidis, serotype typhimurium. Cure was achieved by decortication and obliteration of the pleural empyema space, in combination with chloramphenicol therapy given parenterally. Review of the published reports revealed eight similar instances of salmonella empyema. Manifestations and treatment of this group are reviewed.

Adult↗
PubMed1976

Preferential atherosclerosis at the aortic junction of the ligamentum arteriosum: clinical significance and pathological correlation.

Clinical experience with 5 patients who had complications of atherosclerosis within the aorta at the site of the obliterated ductus arteriosus suggested the occurrence of clinically significant preferential atherosclerosis at this location. To examine this hypothesis, the clinical findings in these patients (4 with saccular aneurysm and 1 with systemic emboli from an ulcerated plaque at this location) were correlated with postmortem examination of the aortic isthmus in 40 consecutive cadavers. The point of ductal closure was the area of most severe atheromatous involvement in 32 of the 40 cadavers, and 25 of the 40 specimens demonstrated ulcerated plaques at this location. Microscopical examination consistently demonstrated intimal irregularity or disruption and thinning of the aortic media in this area. These studies indicate that preferential atherosclerosis occurs at the aortic end of the obliterated ducts arteriosus and that these atherosclerotic changes can be a clinically significant development.

Adult↗
PubMed1976

Selective operative treatment for tetraology of Fallot: rationale and results.

Eighty-one patients with tetralogy of Fallot malformations evaluated between July 1, 1971 and November, 1975 are presented. Fifty-one patients underwent primary intracardiac repair; three died. Twenty-seven patients were corrected after a previous palliative shunt; there was one death. Three additional patients have been palliated and are awaiting repair. While the overall mortality in these patients was less than 5%, the infants undergoing total correction before the age of two years appeared to be at greater risk (25%). There were no deaths in the group of patients undergoing palliative procedures. Based on these data it appears that a safely performed palliative shunt in the symptomatic small infant is a reasonable first step, particularly if the outflow tract of the right ventricle is diffusely hypoplastic.

Adolescent↗
PubMed1976

Lung water and urea indicator dilution studies in cardiac surgery patients. Comparisons of measurements in aortocoronary bypass and mitral valve replacement.

We measured transpulmonary indicator dilution curves of 51Cr-erythrocytes, 125I-albumin, 14C-urea, and 3H-water before and six and 24 hours after operation in seven patients undergoing aortocoronary bypass (ACB) and eight patients undergoing mitral valve replacement (MVR). We calculated cardiac output (CO), extravascular lung water (EVLW), the difference between 125I-albumin and 51Cr-erythrocyte distribution volumes (EV albumin), the difference between 14C-urea and 51Cr-erythrocyte distribution volumes (EV urea) and 14C-urea extraction (E) and permeability -surface ares (PS) products. Comparisons between 16 ACB studies and 17 MVR studies showed the MVR group to have a higher EVLW (P less than 0.01). Extravascular lung water decreased after operation. The ratio of EV urea to EV albumin averaged 1.35 in the MVR group and 0.91 in the ACB group (P less than 0.001). 14C-urea E was also higher in the MVR group (P less than 0.05), but PS was similar in the two groups. None of the differences was related to the time that studies were done. We showed that EVLW, calculated using both 125I-albumin and 51Cr-erythrocytes as intravascular indicators and measured blood water content, had a constant relationship to EVLW calculated using only 125-I-albumin as the intravascular indicator and neglecting blood water content, over a broad range of cardiac outputs, hematocrist, and lung water volumes. We conclude that patients with mitral valve disease have an increased distribution volume and E for urea, probably due to hemodynamic changes but possibly due to increased vascular permeability. Extravascular lung water decreases after cardiac surgery regardless of the type of operation. A single intravascular indicator is adequate for estimating extravascular lung water in humans.

Adult↗