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Biomedical subjects

Ronald Smith

Publications and source records attributed to Ronald Smith.

11 recordsLinked to original sources
PubMed2005

Aorta-to-left-atrial shunting through a previously performed heterotopic heart transplant: an unusual complication of orthotopic re-transplantation.

Heterotopic heart transplantation is rarely performed today, except in cases of recipient-donor size mismatch and when addressing complications associated with recipient pulmonary artery hypertension. As in orthotopic cardiac transplantation, occurrence of allograft vasculopathy occasionally calls for re-transplantation. Although orthotopic re-transplantation without removal of the heterotopic allograft has been described previously, we report the case of a patient who presented with an unusual complication.

Aged↗
PubMed2005

Bioavailability enhancement of a COX-2 inhibitor, BMS-347070, from a nanocrystalline dispersion prepared by spray-drying.

Spray drying drug with excipients is usually associated with the preparation of microcrystalline or amorphous drug in order to improve bioavailability. It was found that BMS-347070, when spray-dried with Pluronic F127 from acetone or methylene chloride, was dispersed as nanosized crystalline drug within the water-soluble Pluronic matrix. The reduction in drug particle/crystallite size, coupled with wetting by the Pluronic, resulted in a fast-onset formulation with bioavailability comparable to that of a solubilized and a NanoCrystal formulation. For this system, it is theorized that the polyethylene oxide segments of Pluronic crystallize and that the polypropylene oxide segments remain amorphous, providing a size-restricted domain in which the COX-2 drug crystallizes. This results in improved bioavailability while limiting the potential risk of conversion of an amorphous drug to its crystalline state.

Biological Availability↗
PubMed2005

Itch, pain, and burning sensation are common symptoms in mild to moderate chronic venous insufficiency with an impact on quality of life.

To our knowledge there are no studies evaluating the prevalence and characteristics of itch, pain, and burning sensation among patients with mild to moderate chronic venous insufficiency or assessing the impact of these symptoms on quality of life. In this report 100 patients met the inclusion criteria. Patients who suffered from itch were also assessed with the use of a validated questionnaire and a modified Skindex-16 questionnaire. We found that the prevalence of itch was 66%. Concomitant itch and burning sensation as well as itch and pain were noted in 47% and 44% of the patients, respectively. No correlation was noted between the severity of these symptoms and the degree of venous insufficiency. Itch had a negative impact on quality of life. A limitation of this study is that the participants, who were primarily hospital employees, are more likely to develop these symptoms. Therefore this study does not reflect the true prevalence of these symptoms in the general population. This study found that itch, pain, and burning sensation are common symptoms of mild to moderate chronic venous insufficiency with a significant impact on quality of life.

Adolescent↗
PubMed2005

Left ventricular free wall rupture in acute myocardial infarction: a case report and literature review.

We describe a case of subacute left ventricular free wall rupture during acute myocardial infarction in a 68-year-old man. The diagnosis was confirmed by echocardiography. The patient was supported by an intra-aortic balloon pump until the ruptured wall could be successfully repaired by suturing and gluing a pericardial patch over the defect and bypassing the left anterior descending coronary artery with a vein graft. This case demonstrates that left ventricular free wall rupture is not always fatal and that early diagnosis and institution of intra-aortic balloon pump support in such patients can allow successful bridging to definitive emergency surgical therapy.

Aged↗
PubMed2002

The hypertension-lipid connection: insights into the relation between angiotensin II and cholesterol in atherogenesis.

Clinical data and experimental studies have established the important role of abnormal lipid metabolism in the causation of atherosclerosis and enthroned the hydroxymethylglutaryl coenzyme reductase inhibitors (statins) as a mainstay in management of patients with coronary heart disease. However, emerging experimental data underline the role of vascular renin-angiotensin systems in mediating the early stages of vascular endothelial dysfunction and inflammation as prerequisites for unleashing the cascade of cellular and molecular events that lead to the deposition of foam cells and their eventual progression to the atherosclerotic plaque. We discuss here the biological effects of statins and angiotensin II in the evolution of atherogenesis, underscoring possible links between statins and angiotensin receptor blockers. From the assessment of the commonality of effects resulting from the nonlipidic actions of statins and angiotensin II on the process of atherogenesis, we develop the argument that dyslipidemia may influence the ability to control blood pressure in hypertensive subjects and hypothesize that the combined use of statins and blockers of the renin-angiotensin system may have an additive effect in the management of hypertensive subjects.

Angiotensin II↗
PubMed2002

Fungal keratitis caused by Scedosporium apiospermum: report of two cases and review of treatment.

PURPOSE: We report our experience in treating two cases of Scedosporium apiospermum keratitis and provide a review of basic scientific and clinical data regarding the treatment of this visually devastating disease. METHOD: We present a case report and literature review. RESULTS: A 35-year-old woman and a 73-year-old man both reported pain, redness, and a foreign body sensation in the eye after trauma. They were initially treated with antibacterials. When cultures were positive for S. apiospermum, the first patient was treated with fluconazole and amphotericin with good results. The second was treated with fluconazole and natamycin, but the infection persisted and the eye was eventually enucleated. Review of the literature showed variable responsiveness of S. apiospermum to antifungal treatment. CONCLUSIONS: It is difficult to predict how S. apiospermum keratitis will respond to treatment, but miconazole appears to be useful in conjunction with other antifungals. Voriconazole shows promise as an effective alternative.

Adult↗
PubMed2002

The potential pitfalls of concurrent rhinoplasty and endoscopic sinus surgery.

OBJECTIVE: As the largest portion of the population is becoming middle aged and our society becomes increasingly interested in youth and appearance, so does the number of esthetic surgeries. Rhinoplasty is being performed with increased frequency in recent years. Many surgeons are performing rhinoplasty combined with endoscopic sinus surgery as a means to decrease operating times, healing times, as well as patient cost. Many surgeons may be unaware of several potential life-threatening complications when these two safe procedures are performed concurrently. STUDY DESIGN: A rare but illustrative case depicting a serious complication of concurrent surgery. A retrospective review of our experience and an extensive literature review were performed documenting the type and incidence of minor and serious postoperative complications. RESULTS: A case demonstrating multiple near-fatal complications after rhinoplasty and endoscopic sinus surgery, which are two safe, commonly performed procedures when performed individually. A review of our 268 rhinoplasties performed between 1997 and 2001 demonstrated 11 cases with concurrent surgery. There were no complications noted in this population. CONCLUSION: We conclude and agree with the literature that concurrent surgery is safe and effective.

Adult↗
PubMedDate not supplied

Renin-angiotensin system as a therapeutic target in managing atherosclerosis.

Clinical and experimental evidence suggests that the pathways by which hypertension and dyslipidemia lead to vascular disease may overlap and that angiotensin II (Ang II) is involved in restructuring of the arterial wall in both atherosclerosis and hypertension. Ang II represents a potent proinflammatory agent promoting recruitment of monocytes into the vascular intima. Ang II also indirectly facilitates transformation of macrophages and smooth muscle cells into foam cells by promoting superoxide radical formation (via NADP/NADPH oxidase stimulation). The oxidative stress produced by Ang II leads to enhanced low-density lipoprotein oxidation and degradation of nitric oxide, an important vascular protective molecule capable of retarding atherosclerosis progression. The importance of the renin-angiotensin system (RAS) in atherogenesis is highlighted by studies in animal models as well as human beings indicating that inhibition of angiotensin-converting enzyme or blockade of type 1 Ang II receptors retards the development of atherosclerotic lesions. In light of a causal and central role of Ang II in atherogenesis, blockade of the RAS represents an important therapeutic consideration in the prevention and treatment of atherosclerotic disease.

Angiotensin II↗