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Biomedical subjects

R Phillips

Publications and source records attributed to R Phillips.

At least 55 records · Page 3Linked to original sources
PubMed1987

Hemodynamic evaluation of porcine bioprostheses in the mitral position by Doppler echocardiography.

Twenty-four patients with porcine bioprostheses in the mitral position were studied by Doppler echocardiography followed by cardiac catheterization within 24 hours. Doppler mean diastolic mitral valve gradient was calculated by a 3-point method and mitral valve area was determined by the pressure half-time method. Data from Doppler echocardiography and cardiac catheterization were compared. There was a strong correlation between Doppler echocardiography and catheterization-determined mean diastolic gradient: r = 0.9, standard error of estimate (SEE) = 1.4 mm/Hg (regression equation y = 0.63x + 1.41), p less than 0.001. There was also a strong correlation between Doppler echocardiography and catheterization-determined mitral valve area: r = 0.86, SEE = 0.18 cm2 (regression equation y = 0.64x + 0.52), p less than 0.001. Fourteen patients whose valvular function was considered normal by clinical evaluation had Doppler-calculated mean diastolic gradients of 4.5 to 9.5 mm Hg (mean 6.5 +/- 1.4); the Doppler-determined valve area was 1.15 to 2.0 cm2 (mean 1.54 +/- 0.3). Ten patients had a malfunctioning bioprosthesis, 7 had severe mitral regurgitation and 3 had stenosis. Valvular malfunction in all 10 patients was detected by Doppler echocardiography and confirmed by catheterization and angiocardiography. Nine patients underwent reoperation. Doppler hemodynamic evaluation of porcine bioprostheses in the mitral position provided noninvasive information comparable to that obtained by cardiac catheterization.

Adult↗
PubMed1987

Radiation therapy in primary carcinoma of the vagina.

A retrospective analysis of 32 patients with carcinoma of the vagina treated with curative radiotherapy between 1965 and 1981 is presented. Squamous cell carcinoma was the most common histologic type, found in 78% of the patients. Patients were staged according to the FIGO system. Stage I and II disease was found in 8 and 18 patients, respectively. Six patients had either Stage III or IV disease. The absolute survival rate was 100% for Stage I and 72% for Stage II patients. The pattern of failure was analyzed. All patients who failed had done so within 14 months of completion of treatment. Treatment failure in the pelvis occurred only in 16% of the patients with early disease (Stages I and II) while 81% of the patients with late stage had failed in the pelvis.

Adult↗
PubMed1987

Nutritional support and measured energy expenditure of the child and adolescent with head injury.

Energy expenditure, nitrogen excretion, and serum protein levels were studied from the time of hospital admission until 2 weeks after severe head injury in eight adolescents and four children with peak 24-hour Glasgow Coma Scale scores ranging from 3 to 8. The mean measured energy expenditure (MEE) was 1.3 times Harris and Benedict's predicted value for energy expenditure. Seventy percent of the patients achieved caloric balance (MEE X 1.2) by 4 to 14 days after injury, but balance was not consistently maintained. Five of the 12 patients had intermittent diarrhea, and two had increased gastric residuals. In five patients fluid restrictions were imposed due to either the syndrome of inappropriate secretion of antidiuretic hormone, pulmonary complications, or intracranial pressure complications. For the adolescents (aged 11 to 17 years) the mean calorie intake during the 1st week was 752 kcal/day and for the children (aged 2 to 5 years) it was 340 kcal/day. During the 2nd week the mean calorie intake for the adolescents was 1671 kcal/day and for the children was 691 kcal/day. Mean urinary nitrogen excretion was 307 mg/kg/day for the adolescents and 160 mg/kg/day for the children. The calculated mean nitrogen balance for the eight adolescents and the four younger children was -13.6 and -4.1, respectively. Mean albumin levels decreased from 2.9 gm/dl during the 1st week to 2.4 gm/dl during the 2nd week (normal 3.5 to 5.0 gm/dl). Mean total protein level during the 1st week was 5.4 gm/dl and increased to a mean of 6.0 gm/dl during the 2nd week (normal 6.0 to 7.8 gm/dl). Weight loss ranged from 2 to 26 lb during the 2-week period. From these studies it can be concluded that head injury in the child and adolescent induces a metabolic response that includes increased energy expenditure and decreased serum albumin levels similar to those observed for head-injured adults. Mean nitrogen excretion values are less than those in adults with a severe head injury.

Adolescent↗
PubMed1987

Variation in mortality from ischaemic heart disease between England and Scotland.

A comparison of mortality from ischaemic heart disease under the age of 60 for 1980 to 1981 between the Grampian Health Board and the North Staffordshire Health Authority has been made. A total of 993 deaths was notified by death certificate from the two areas of similar population of which 434 were from Grampian and 559 from North Staffordshire. After examination of general practitioner and hospital case notes, autopsy reports and death certificates, nearly all (532) of the North Staffordshire deaths were accepted as being due to ischaemic heart disease but only three-fifths (263) of the Grampian deaths could be substantiated as there was inadequate information for the remainder. Deaths from ischaemic heart disease seem apparently to be twofold greater in North Staffordshire than Grampian but much of this discrepancy could be attributed to a widely different autopsy rate and to unavailability of case notes. Experience of this survey suggests that the results of other epidemiological investigations may be equally or even more unreliable.

Autopsy↗
PubMed1986

Quantitative analysis of thallium-201 uptake and washout before and after transluminal coronary angioplasty.

Transluminal coronary angioplasty has become an important therapeutic modality in the treatment of coronary artery disease. The effects of coronary angioplasty on regional myocardial perfusion have been reported in only a small series of patients, employing subjective analysis of thallium-201 perfusion scintigrams. Thus, we studied 61 patients with quantitative analysis of thallium-201 uptake and washout before and after undergoing angioplasty. Prior to angioplasty, there were 105 areas in 47 patients with abnormal thallium-201 uptake during exercise, with a mean uptake of 49 +/- 1.3%. The uptake of thallium-201 in these same areas increased to 71.3 +/- 1.9% post angioplasty (P less than 0.0001), and 68 (65%) of the areas showing abnormal uptake returned to normal. Abnormalities in washout of thallium-201 before angioplasty were seen more frequently than in uptake (150 vs 105 areas, P less than 0.05), with 8 patients having abnormal washout in the presence of totally normal uptake. Thallium-201 washout in the abnormal areas improved from 16 +/- 2.8 pre angioplasty to -23 +/- 1.8% post angioplasty (P less than 0.001). Normalization resulted in 6 of the 8 patients with exclusively washout abnormality. Residual abnormalities in uptake and/or washout were seen in 53% of the patients, usually in areas with prior myocardial infarction or supplied by a vessel with significant stenosis which did not undergo angioplasty. Improved thallium-201 uptake and washout corresponded to reductions in percent coronary area stenosis (89 +/- 1.0 to 36 +/- 2.0%, P less than 0.001) and transstenotic pressure gradient (42 +/- 3.0 to 9.0 +/- 2.0 mm Hg, P less than 0.001). Thus, quantitative analysis of thallium-201 uptake and washout provided objective evidence for improved myocardial perfusion after coronary angioplasty. Due to a fairly high prevalence of residual perfusion abnormalities after this procedure, optimal assessment of benefits requires quantitative comparison of thallium uptake and washout before and after coronary angioplasty.

Adult↗
PubMed1986

Long-term performance of polyurethane pacing leads: mechanisms of design-related failures.

Environmental stress cracking has been identified as a crack propagating mechanism in polyurethane-insulated, heart pacemaker leads, which is directly related to specific lead design parameters. Lead designs imposing excessive stress on the polyurethane insulation through an interference fit between the coil and polymer have demonstrated insulation failures. Conversely, low-stress designs have shown virtually no insulation problems. The higher-stress designs have used organic solvents to facilitate coil placement during manufacturing, which may result in lowering the polymer's ability to resist the higher stress. In addition, a specific silver-containing coil wire composition has been found to galvanically corrode upon body fluid intrusion into the lead, ionizing the silver. These ions interact with the polyurethane polymer resulting in the loss of polymer strength. All polyurethane lead failures to date have been specific to high stress and/or chemical interaction. Leads using low-stress designs and nonreactive coil wire compositions continue to demonstrate a positive clinical experience.

Animals↗
PubMed1986

Zopiclone: a new nonbenzodiazepine hypnotic used in general practice.

Ninety-one insomniacs completed a four-week study of the efficacy and safety of zopiclone (Z), 7.5 mg. Patients were randomly allocated to one of two groups, each of which received placebo (P) during one week of the study. Forty-six subjects received medication in the sequence of ZPZZ, and 45 received it in the sequence of ZZPZ. Twice each week, patients filled out presleep and postsleep questionnaires and reported their morning complaints. Compared with placebo, zopiclone produced statistically significant improvements (P less than 0.05) in sleep induction time, duration of sleep, number of awakenings per night, quality and soundness of sleep, morning state of rest, and daytime sleepiness. Headache, dizziness, nausea, and bitter taste were the predominant complaints. Zopiclone can be considered an efficient and safe hypnotic for chronic insomnia.

Adult↗
PubMed1986

Double-blind comparison of ketoprofen and placebo in the treatment of sprains and strains.

Sixty patients (42 men and 18 women between the ages of 18 and 37 years) with grade 2 or grade 3 sprains or elongations participated in a seven-day double-blind study. By random determination, they were treated with either 100 mg of ketoprofen or placebo TID. Pain evaluation, vital signs, concomitant medication, and side effects were determined on days 1,3, and 7. Compared with placebo, ketoprofen produced statistically significant reductions (P less than 0.05) in investigator-rated pain at rest (day 3), on palpation (days 1, 3, and 7), on motion (days 1 and 3), and on the subject-rated analog scale (days 1 and 3). It also achieved a greater relief of pain (days 1 and 3) and greater overall efficacy, as expressed by the statistically significant improvements in the total pain scores on motion and on palpation, on the total pain relief score, on the total pain analog score, and on the sum of pain intensity differences for pain at rest, on palpation, and on motion. Tolerance to the seven-day ketoprofen treatment was excellent. Results from the study indicate that ketoprofen is efficacious in relieving pain following sprains and strains.

Acetaminophen↗
PubMed1985

Exercise after myocardial infarction: long-term rehabilitation effects.

Long-term effects of an exercise programme for patients who had experienced myocardial infarction were investigated. Questionnaires were sent to 305 patients who during a three and a half year period had been invited to participate. Replies from 58 exercised patients, 13 who had dropped out, 75 controls and 69 who declined the invitation were analysed. The amount of exercise now being taken was positively correlated with scores on cardio-vascular and general health, and negatively correlated with symptoms during exercise and taking medication. The exercised group differed from the other groups in that a greater proportion were still taking heavy exercise. The latter scored significantly higher than the rest of the patients on most of the measures used. For effective long-term rehabilitation the problem of encouraging and enabling patients to continue vigorous exercise needs to be resolved.

Exercise Therapy↗
PubMed1985

Defective monocyte function in patients with systemic lupus erythematosus.

Peripheral blood adherent cells from patients with systemic lupus erythematosus (SLE) were shown to have markedly reduced phagocytic activity as compared to normal adherent cells or those from non-SLE patients receiving corticosteroid therapy. Both resting and phagocytosing monocytes showed decreased hexose monophosphate shunt and glycolytic activity. Mononuclear cells from SLE patients showed grossly impaired proliferative activity after NaIO4 activation. Furthermore, addition of SLE adherent cells to normal adherent cell-depleted lymphocytes decreased [3H]thymidine incorporation of the latter cells following NaIO4 treatment. Addition of normal adherent cells to SLE lymphocytes corrected the previous defect, indicating that an adherent abnormality is responsible for the defect in SLE mononuclear cell proliferation to NaIO4 activation.

Blood Bactericidal Activity↗
PubMed1985

Modulation of the sodium periodate (NaIO4) response in systemic lupus erythematosus (SLE): effect of interleukin-1 (IL-1), interleukin-2 (IL-2), phorbol myristate acetate (PMA), and indomethacin.

The proliferative activity of peripheral blood mononuclear cells (PBMN) from patients with systemic lupus erythematosus (SLE) activated by sodium periodate (NaIO4) is greatly diminished. The effect of the cytokines Interleukin-1 (IL-1) and Interleukin-2 (IL-2) on the NaIO4 reaction was investigated. Addition of IL-1 resulted in partial restoration of the reaction of SLE PBMN to NaIO4, and a similar effect was demonstrated in the presence of phorbol myristate acetate (PMA). Addition of IL-2 to NaIO4 activated SLE PBMN, however, caused a marked improvement in their proliferative activity. The presence of indomethacin resulted in only a slight increase in [3H]thymidine incorporation by the NaIO4-treated SLE cells. The results suggest that the defect in the response of SLE PBMN cells to NaIO4 is due to inadequate availability of IL-1 and IL-2. Excessive production of prostaglandin in SLE might also contribute to the defective response to NaIO4 but does not appear to play a major role.

Female↗
PubMed1985

Seventh-Day Adventist vegetarians have a quiescent proliferative activity in colonic mucosa.

The proliferation of epithelial cells in colonic mucosa was studied in humans at varying degrees of risk for colon cancer. Seventh-Day Adventist vegetarians, known to have significantly lower mortality from colon cancer than the general U.S. population, had the most quiescent proliferative activity of mucosal epithelial cells. Increased replication and expansion of the proliferative compartment accompanied increased colon cancer risk. The analytical methods of this study may be useful in assessing the influence of dietary components involved in the initiation, promotion or inhibition of colon cancer, and in developing strategies for nutritional intervention.

Adult↗
PubMed1985

Chromosome banding in salmonid fish: nucleolar organizer regions in Salmo and Salvelinus.

Chromosome banding patterns obtained by silver staining (Ag-NORs) were analyzed in three species of Salmo (rainbow, brown trout, and Atlantic salmon) and three species of Salvelinus (brook trout, lake trout, and arctic char). In rainbow trout and Atlantic salmon the Ag-NORs were found at the secondary constrictions of a single chromosome pair, while in brown trout the Ag-NORs were found on the short arms of one or two of the two longest subtelocentric or acrocentric chromosome pairs. The location of the Ag-NORs was multichromosomal in the three Salvelinus species, occurring on one or both members of four to six different chromosome pairs in different individuals. The Ag-NOR sites were on the short arms of some acrocentric pairs and at the telomeres of other acrocentric pairs and one or two metacentric pairs. Chromomycin A3 positive bands were found at the same sites as the Ag-NORs in all species. In the species with multichromosomal location of Ag-NORs, polymorphisms in the size and location of the NORs were extremely common, so that almost every individual fish had a different pattern of Ag-NOR sites.

Animals↗
PubMed1985

Effects of mineralocorticoids and glucocorticoids on compensatory adrenal growth in rats.

The rapid compensatory growth seen in the remaining adrenal gland of the rat after unilateral adrenalectomy appears to require a functioning neural arc between the adrenal glands and the hypothalamus, but the role of adrenal or pituitary hormones is unclear. We have examined the effect of several steroids on the compensatory adrenal growth (CAG). Female and male rats (average wt 140 g) were unilaterally adrenalectomized and treated with aldosterone (2.1 micrograms/day), corticosterone (B, 28 micrograms/day), dexamethasone (28 micrograms/day), 9 alpha-fluorocortisol (9 alpha FC, 28 micrograms/day), or deoxycorticosterone (DOC, 28 micrograms/day) by continuous infusion for 3 days and then killed. The growth in the remaining adrenal was compared both with sham-operated rats treated with steroid infusions and with noninfused controls. In rats of this size females have larger adrenals than males; untreated male rats have significantly heavier left than right adrenals. In male rats the extent of CAG after no treatment or treatment with aldosterone B, 9 alpha FC, or DOC depended on the size of the adrenal gland removed. In both male and female rats CAG was not significantly affected by aldosterone, in contrast with a recent report, nor by B, 9 alpha FC, or DOC; no significant CAG was seen after dexamethasone. Taken together, these results and previous reports suggest that neurally mediated activation of pituitary and/or local adrenal growth factors may be responsible for CAG.

Adrenal Glands↗
PubMed1985

A new pendant storage oxygen-conserving nasal cannula.

With increasing interest in reducing the cost of oxygen therapy, we recently designed an oxygen-conserving cannula. It reduces the oxygen supply flow necessary to achieve adequate oxygen saturation, but because it requires the use of a reservoir situated under the nose, some patients find it obtrusive. We therefore designed a similar system but displaced the reservoir away from the face and onto the anterior chest wall where it could be hidden from view by the patient's clothing. We evaluated this pendant conserving nasal cannula (PNC) in seven hypoxemic patients with chronic obstructive pulmonary disease. We compared oxygen saturations achieved using the PNC vs the standard steady flow nasal cannula (SNC) at 0.5 through 4 L/min. The mean improvement in oxygen saturation using the PNC vs the SNC was 3.3 percent at 0.5 L/min, 4.3 percent at 1 L/min and 3.1 percent at 2 L/min. These differences were statistically significant (p less than 0.001). The saturation achieved by the PNC at 0.5 L/min was equivalent to that achieved by the SNC at 1.8 L/min. We conclude that the PNC provides effective oxygen delivery to patients at supply flows substantially less than the SNC. The device is aesthetically acceptable to patients and its widespread use in patients requiring chronic oxygen therapy could bring about significant financial savings.

Adult↗
PubMed1985

Low-concentration oxygen therapy via a demand oxygen delivery system.

Recent heightened concern about the costs of medical care has stimulated research and development in devices and schemes for saving costs while retaining quality of care. Consistent with that concern is the fact that standard steady-flow oxygen delivery is so wasteful. Almost its entire benefit occurs at the very beginning of inspiration. We compared the efficacy of nasal oxygen delivery via a new demand oxygen delivery system (DODS) with the standard steady-flow (SF) method. The DODS incorporates a valve and sensor interposed between the oxygen reservoir and the patient, which meters oxygen to the patient only during early inspiration. Twelve COPD subjects with hypoxemia at rest received oxygen at flow settings of 1 to 4 L/min via SF and at various breath interval settings via the DODS method, calculated to match the above spectrum of the SF. We measured oxygen delivery using an ear oximeter. The results indicate that significantly less oxygen was required to provide equivalent saturations using the DODS compared with the SF method (p less than .001). The mean comparative savings in oxygen is better than seven to one favoring the DODS over the SF method. Further study is warranted, since the widespread use of such a device could result in substantial cost saving while increasing the range of portable oxygen delivery.

Aged↗