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Biomedical subjects

R M Peters

Publications and source records attributed to R M Peters.

At least 19 recordsLinked to original sources
PubMed1990

Sampling of lung interstitial fluid in intact dog.

This paper reports a method of sampling fluid from the peribronchial-perivascular space (PBVS) of the lungs in intact closed chest dogs. The PBVS was sampled by introducing a wick catheter into the PBVS through a mediastinoscope. The right lymph duct was cannulated by the method of Vriem and Ohkuda [J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 54: 199, 1983] for collection of lymph to compare to peribronchial fluid. The colloid osmotic pressure (COP) of PVBS and right lymph duct fluid (RLDF) were compared in a series of dogs infused with lactated Ringer's solution (LR) and lactated Ringer's combined with three other conditions: left atrial balloon inflation (LRB), oleic acid infusion (LRO), and oleic acid infusion and left atrial balloon inflation (LROB). Prior to LR infusion, the volume of samples of fluid from the PBVS wicks was inadequate for measuring COP (less than 4 microliters). This difference was significantly only in the later samples at 3, 4, and 5 hr in the LR and LRB groups. In the LRO and LROB groups, protein content and amount of fluid sampled were greater than in the LR and LRB groups, but the mean COPs of the wick PBVS and RLDF were not significantly different. This method of directly sampling interstitial fluid from the lungs of dogs without thoracotomy confirms the high COP of fluid from the lung interstitium. This method of PBVS fluid sampling is potentially feasible in a human patient undergoing mediastinoscopy.

Animals↗
PubMed1989

Interactive microcomputer for acquisition of patient information.

Written records and first-generation hospital information systems do not meet their primary purpose to assist physicians in solving patients' problems. Simply automating the present chart formats is not the answer. An example of the concept needed for charting is the intensive care unit chart. Anesthesiology charts provide little useful information for the continued care of the patient postoperatively. They serve principally as legal archival documents. Automation of the anesthesia record should free the anesthesiologist of the need to search for preoperative information and to manually record most information intraoperatively. Decisions about how much data to archive and how to extract the data pertinent to continuing care are the challenges for physicians. The technologic tools are available for the design and implementation of a software system that focuses on effective communication of the patient's problems throughout the perioperative period as the patient moves from ward to operating room, through the recovery room and intensive care unit, and to the ward and home.

Anesthesiology↗
PubMed1989

Metabolism of D lactate in patients receiving hypertonic sodium lactate solution.

The use of hypertonic saline solutions for resuscitation of patients with a decreased extracellular fluid volume is generating more clinical interest. One of the solutions, hypertonic lactated Ringer's solution (HLS), contains lactate in both the D(-) and L(+) forms. Because humans lack D lactate dehydrogenase, the metabolism of D lactate in patients receiving large amounts of lactate in a clinical setting was examined. Three patients undergoing extensive aortic surgical procedures and receiving HLS for replacement of perioperative fluid loss were studied. These patients were given an average of 27 grams of D lactate in a 24 hour period and excreted 8 per cent of the total dose in the urine. The average maximum elevation of D lactate in the serum of 3.53 millimoles per liter. Pharmacokinetic analysis revealed a half-life of D lactate in the serum of 36.4 minutes. The volume of distribution was 20 per cent of the body weight. These results demonstrate that D lactate is metabolized rapidly even when given in large amounts to humans during the perioperative period. Whether or not this metabolism occurs during hypoperfusion is not known.

Aorta↗
PubMed1988

An automated method of separating patient from ventilator work on the lungs.

This paper describes a method of determining the amount of work on the lungs done by the patient and the ventilator using various modes of ventilation. The method uses a pneumotachograph to measure air flow, and measures pressure from an esophageal balloon and at the airway. The patient's work is separated from the ventilator work by analysis of the esophageal pressure. When esophageal pressure is below end-expiratory esophageal pressure during inspiration, work is being done by the patient. When esophageal pressure is above end-expiratory level, the ventilator is doing the work. The calculations are done using an IBM PC computer. The studies of normal subjects show that in the assist mode with increased airway resistance, significant work by the subject is required to trigger the ventilator. Two patients are presented when the assist mode resulted in excessive amounts of work and fatal outcomes. Measurement of the mechanical work required of the patient can provide useful information for the control of ventilator therapy.

Adult↗
PubMed1987

Misrepresentation and responsibility in medical research.

Early in 1985, after being questioned about duplicate data in two of his papers, Robert A. Slutsky, M.D., resigned his appointments as a radiology resident (trainee) and nonsalaried associate clinical professor in the Department of Radiology at the University of California, San Diego. During the following year, faculty committees investigated Slutsky's entire bibliography of 137 articles published in seven years; 77 (including reviews) were classified as valid, 48 were judged questionable, and 12 were deemed fraudulent. The majority of these papers were published while Slutsky was a research or clinical trainee in cardiology, nuclear medicine, and then radiology. Our analysis of this case leads us to conclude that research fraud, although probably rare, in view of the size of the research establishment, may evade detection, and that there are scientists prepared to run the appreciable risk of submitting inaccurate statements for publication. Sophisticated dishonesty can escape detection by peer review and replication. The emphasis on competition and the pressure to produce, while intended to advance the discovery of truth, may foster a conflict between personal career goals and the intellectual motivation of scientists to seek the truth. The scientific community needs to address the issues raised by recent reports of fraud. Each institution and granting agency must have procedures for investigating suspected fraud or unethical practices, procedures that protect both the person who reports such practices and the accused person from premature disclosure. As we heighten awareness, we must avoid a "witch hunt." Deterrence of research fraud is clearly needed, but institution of practices that might stifle originality or discourage cooperative research would be counterproductive.

Authorship↗
PubMed1987

Serum osmolar and electrolyte changes associated with large infusions of hypertonic sodium lactate for intravascular volume expansion of patients undergoing aortic reconstruction.

To better define the serum osmolar and compositional changes associated with the infusion of a large volume of hypertonic saline solution (sodium of 250 milliequivalents per liter), we compared resuscitation using a hypertonic crystalloid (HSL) to Ringer's lactate (RL) in 52 patients undergoing aortic reconstruction. There were no differences between the groups in any of the preoperative measurements, the duration of operation, operative blood loss or transfusion requirement. The RL group required 9.5 liters of fluid intraoperatively as compared with 6.3 liters required by the HSL group (p less than 0.01). There was no significant difference between the groups in the amount of sodium infused to achieve resuscitation or in the sodium balance at the end of the study period. Hypernatremia (average maximum serum sodium: 157 milliequivalents per liter) and hyperosmolarity (average maximum serum osmolarity: 320 milliosmoles per liter) resolved in the HSL group within 48 hours. Correction of the hyperosmolar state was thought to be due to the judicious administration of free water and a decrease in renal free water clearance. The HSL group required significantly greater potassium administration during the early postoperative period due to increased kaluresis. HSL is safe and effective for use in the resuscitation of moderate blood volume deficit. Changes in serum sodium values and in osmolarity resolve rapidly. The serum potassium level should be monitored closely and replaced aggressively.

Aorta↗