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Biomedical subjects

R Fowler

Publications and source records attributed to R Fowler.

At least 19 recordsLinked to original sources
PubMed1992

Haemodynamic changes and physical performance at comparative levels of haemoglobin after long-term treatment with recombinant erythropoietin.

Physical performance and haemodynamic parameters at rest and with exercise were compared in a prospective, cross-over fashion in 12 anaemic haemodialysis patients (Hb 6.4 +/- 0.5, mean +/- SEM) at two levels of haemoglobin (Hb 9 and 12 g/dl) before and after long-term treatment with recombinant human erythropoietin (rHuEpo). Patients were divided into two groups and measurements made prior to treatment, upon reaching, and after 4 months at the first target Hb (9 g/dl group A, 12 g/dl group B), and after 4 months at the alternative target Hb. Tests included an exercise radionuclide ventriculogram, Doppler echocardiogram, and respiratory function exercise test. Compared to pretreatment, there was a significant reduction in resting pulse rate (P < 0.001), and in pulse rate (P < 0.001) and arterial lactate (P < 0.01) concentrations at specified levels of exercise. Work capacity improved 60% (P < 0.001), and left ventricular mass fell by 26% (P < 0.001). Although cardiac output (CO) during and after exercise was reduced (P < 0.05), resting CO, cardiac index, stroke volume and ejection fraction (rest and exercise) were not significantly altered. There appeared little benefit in having the higher target Hb: no significant difference could be found between target levels for almost any measure. In addition, despite marked improvement from pretreatment levels, performance parameters were still below those of non-uraemic age-matched controls. These results demonstrate the beneficial but incomplete effect of rHuEpo on resting and exercise-related factors, and suggest that most improvement is achieved with modest increments in haemoglobin.

Anemia↗
PubMed1992

Treatment of acute pancreatitis caused by calculous obstruction of the pancreatic duct by ultrasound-guided percutaneous drainage.

In a small percentage of patients with acute pancreatitis, recurrent attacks of pain and hyperamylasaemia occur when feeding is commenced. Recurrences of this type may occur because the pancreas is still swollen and inflamed, and indicate the need for a longer period of "pancreatic rest" before food is introduced. Alternatively, they may reflect the presence of "mechanical" factors leading to the recurrent pancreatitis, such as a gallstone in the common bile duct, a pseudocyst of the pancreas, or pancreatic duct obstruction. Successful resolution of the pancreatitis may require treatment of underlying causative factors. A stone in the pancreatic duct (probably a gallstone) was found to be the cause of recurrent acute pancreatitis in an elderly patient with severe cardiovascular disease, who was unfit for surgery. Pancreatitis settled after percutaneous drainage of the pancreatic duct, the technique described.

Acute Disease↗
PubMed1989

Volume related configurational changes in the aetiology of pelvi-ureteric junction obstruction.

The aetiology of pelivi-ureteric junction (PUJ) obstruction is controversial. We present four patients who had normal or equivocal intravenous pyelograms and non-obstructive Whitaker tests in whom complete pelvi-ureteric obstruction was precipitated by more rapid distension of the renal pelvis. We speculate that in vivo physiological urine flow rates and temporary kinking of PUJ produces a critical increase in pelvic volume and subsequent valvular kinking of the upper ureter, which cannot be usually achieved by maximal urine flow rates alone. Co-existence of vesico-ureteric reflux (VUR) may be a contributory factor to critical pelvic distension and tortuous PUJ. Volume related configurational changes of this type are probably a more frequent cause of PUJ obstruction than is generally recognised.

Child↗
PubMed1988

Physical factors are involved in the destruction of embryos and oocytes during freezing and thawing procedures.

Observations made during the freezing and thawing of mouse and human oocytes and mouse embryos with the cryomicroscope suggest that physical factors as well as physicochemical factors may play a role in the development of lethal damage upon thawing. The point of contact with the approaching ice front may predispose that area to the appearance of future cytoplasmic blebbing. The ice front distorts the oocyte and this distortion remains during its subsequent thermal history and is unrelated to desiccation distortion. Ice initiates the formation of both intra- and extracellular gas bubbles which are apparent upon thawing; with the progression of the thawing process they can be seen to grow in volume. Growth of these bubbles can give rise to expanding vesicles which can totally destroy an embryo. The consequences of these physical factors for the successful cryopreservation of oocytes, embryos, tissues and organs are discussed.

Animals↗
PubMed1987

Uptake of 99mTc pertechnetate in a partial volvulus of the proximal jejunal loop.

High uptake of Technetium-99m Pertechnetate (99mTcO4) in situations unrelated to the presence of acid-secreting gastric cells has attracted recent attention. A 10 year old white girl, investigated for the possible presence of a Meckel's diverticulum, was found to have a partial volvulus of the proximal jejunal loop that exhibited intense localization of Technetium-99m Pertechnetate.

Child↗
PubMed1985

Carcinoma of the lung in patients under 40 years of age.

Bronchogenic carcinoma in the young population (40 years of age or less) is reported to present in an advanced stage and to have a virulent course. Between 1969 and 1979, 101 patients (65 men and 36 women) presented with cancer of the lung. Their mean age was 36.2 +/- 3.9 years (range 18 to 40 years). Eighty-seven percent had a history of cigarette smoking. Fifty percent of the patients had a strong familial history of malignancy of several organs. The interval between onset of symptoms and diagnosis was 4.01 +/- 3.48 months (3.56 +/- 3.34 for the surgically treated group and 4.16 +/- 3.53 for the nonoperated or unresectable group). Diagnosis was made at bronchoscopy in 32 patients, during thoracotomy in 30 patients, during nodal biopsy in 28 patients, and on cytologic examination of the sputum in 9 patients. The most common cell types were adenocarcinoma in 39 patients, squamous carcinoma in 29 patients, and oat cell carcinoma in 18 patients. Eighty-six patients (the majority) presented in stage III, whereas 9 were in stage I and 6 were in stage II. Twenty-seven patients (26.7 percent) underwent resection for cure, whereas 18 patients were inoperable at surgery. Eighteen of the surgical patients had adjuvant radiotherapy, and chemotherapy, immunotherapy, or both. The average length of survival for the nonresected patients was 7.12 +/- 5.9 months (range 1 to 36 months) and the actuarial survival was 1.5 percent at 36 months. The survival for the surgically managed patients was 56.1 +/- 52.6 months (range 3 to 168 months) or 48 percent at 36 months. At 46 to 168 months after treatment, the only survivors were 13 patients who were surgically managed. Stage III patients had longer survival after surgery (24.1 +/- 24.6 months to 7.09 +/- 5.90 months; range 3 to 74 months and 1 to 36 months, respectively). The survival at 5 years for patients with stage I disease was 78.8 percent, stage II disease 66.6 percent, and stage III disease, 3.6 percent. Early diagnosis and aggressive surgical management are necessary to improve the survival of patients with bronchogenic carcinoma under 40 years of age.

Adolescent↗
PubMed1977

Vesicoureteric reflux and ureterovesical obstruction.

The unusual combination of reflux and obstruction as seen in 8 of a series of 40 unduplicated ureters reimplanted for reflux is presented, with particular reference to the mechanical obstructing factors which can be demonstrated. These involve the extravesical rather than the intravesical ureter so that separate pathologic mechanisms for obstruction and reflux must be postulated. This unusual obstruction/reflux combination appears to be more common than is generally recognized, and the need for its early recognition and surgical correction contrasts with the less urgent indications for operative intervention in ureteric reflux alone.

Child↗
PubMed1977

Extravesical reconstruction for ureterovesical obstructions in childhood.

The blind empirical practice of ureteral reimplantation for all types of ureterovesical obstruction is founded on entirely speculative concepts of the nature of the obstruction. A significant proportion of ureterovesical obstructions are caused by a tilt-valve type of abnormality of the distal ureter with a normal juxtavesical segment. These can be corrected rationally by an extravesical ureteroureteroplasty. This procedure was done between 1968 and 1975 to relieve obstruction of 9 ureters in 8 children. The pathological anatomy found in these cases is defined and the technique of operative recognition and reconstruction is described. With adequate operative recognition and appropriate case selection relief of obstruction was achieved and maintained in 7 of the 9 ureters.

Child↗