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Biomedical subjects

T Phillips

Publications and source records attributed to T Phillips.

At least 73 records · Page 4Linked to original sources
PubMed1986

In vivo modulation of glutathione by buthionine sulfoximine: effect on marrow response to melphalan.

The effect of giving buthionine sulfoximine (BSO), 0.0265 g/mouse (6 mM), at 12 and 6 hr before treatment with melphalan--0.0 mg, 3 mg, 6 mg, and 9 mg/kg, was studied in C3H mice, and was compared with control groups that received normal saline 12 and 6 hr before identical melphalan treatment. BSO treatment resulted in depletion of GSH levels in bone marrow, liver, and muscle to 65, 13, and 41% of control levels, respectively. Hematological toxicity was assessed by measurement of CFU-S survival and peripheral white cell counts. CFU-S survival decreased with increasing doses of melphalan, but no difference was observed with BSO pre-treatment. Likewise, WBC counts following melphalan 9 mg/kg, were similar irrespective of BSO pre-treatment. These data suggest that the marrow toxicity seen with melphalan is not worsened by pre-treatment with BSO and that if tumors can be pre-sensitized with BSO, there may be a clinical role for melphalan/BSO drug combination.

Animals↗
PubMed1986

Early open reduction and internal fixation of the disrupted pelvic ring.

Early open reduction and internal fixation (ORIF) of extremity fractures in patients with multiple injuries has been demonstrated to be safe, improve survival, and decrease the incidence of respiratory failure. Complications leading to abandonment of planned operative fixation and death in several patients with pelvic fractures led us to initiate a policy of early ORIF of the disrupted pelvic ring. Early ORIF of the pelvis was performed in 15 multiply injured patients between May 1984 and August 1985. Patients ranged in age from 13 to 79 years, their Hospital Trauma Index-ISS scores ranged from 14 to 68, and number of preoperative transfusions ranged from 0 to 42. Types of fractures were A-P compression, two, lateral compression, one, vertical shear, seven, complex, two, and acetabulum with ring disruption, three. All patients were resuscitated, transported in pneumatic antishock garments, and evaluated by abdominal and pelvic CT scan (in two patients following celiotomy). Preoperative angiograms to assess retroperitoneal hemorrhage in eight patients resulted in identification and control of significant bleeding in five. The mean time from injury to pelvic stabilization was 38 hours. Seven patients underwent ORIF within the first 24 hours. In most cases simultaneous anterior and posterior internal fixation was performed with the patient in the lateral decubitus position. Excluding associated procedures, operative time averaged 5.1 hours. Intra-operative transfusions averaged 4 units (range, 0-11). Rigid fixation was achieved in all patients. Most patients were out of bed by the third postoperative day. No patient developed respiratory failure. Two patients developed wound infections. Modification of our technique has avoided this complication in the latter part of this series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Use of the contrast-enhanced CT enema in the management of penetrating trauma to the flank and back.

There have been few innovations in the management of penetrating trauma of the flank and back since that reported by Peck and Berne in 1981. During 1984-1985 our Trauma Service treated 119 patients with injuries in these areas. In 56 patients management was based on the results of the contrast-enhanced CT enema (CECTE), a computerized tomographic technique designed to delineate all of the retroperitoneal viscera by simultaneously opacifying the small bowel, duodenum, colon, GU tract, and major vessels. Specific radiographic findings were present on 44 scans. Twelve scans were negative. Six scans were considered indications for angiography because of the proximity of the identified missile wounds or their hematomas to major vascular structures. One of these arteriograms revealed a renal artery pseudoaneurysm which would otherwise have remained undiagnosed. In 30 cases the penetrating wounds were well delineated by CECTE, and their nature and location were considered appropriate for nonoperative management. None required subsequent exploration. In eight cases CECTE demonstrated that the wounds were located so as to place specific viscera at risk for significant injury, but no definite injury was identified. Five of these patients were successfully managed by further evaluation and close observation, two were explored, and one signed out of the hospital. No scan demonstrated extravasation from a hollow viscus. Overall, 52 of our 56 patients (92%) were successfully managed nonoperatively on the basis of the interpretation of their CECTE findings. CECTE can be useful in the management of stable patients with penetrating trauma to the back and flank by identifying the nature and location of the resulting retroperitoneal injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1986

An analysis of 161 falls from a height: the 'jumper syndrome'.

Vertical deceleration injuries represent a distinct form of urban blunt trauma. We reviewed 161 adult patients, admitted over 36 months, who jumped or fell from a height of one to seven stories and survived emergency department resuscitation. Charts and radiographs were analyzed to identify common injuries, complications, and causes of death. Those who fell five or more stories had a mean ISS of 41, for a predicted survival of 50% but actual survival of 83%. Virtually all these patients had multiple fractures. Sixty per cent of them presented in shock, yet more than two thirds had angiographically demonstrated retroperitoneal hemorrhage as their major source of bleeding. Thirteen patients had significant intra-abdominal injuries, with only one associated with major hemorrhage. Utilizing early diagnostic peritoneal lavage, ten of 13 patients explored had a therapeutic laparotomy. Hollow viscus perforations accounted for about one half of the abdominal injuries, including three duodenal injuries. Conclusions. 1) Patients who present in shock after falls from height are much more likely to be bleeding from retroperitoneal than intraperitoneal sources. 2) Early tap and lavage followed by emergency angiography and transcatheter embolization is the treatment of choice in this group of patients. 3) Although these patients often have multiple complex injuries, the prognosis for long-term survival is good. Therefore, we advocate early aggressive operation stabilization of fractures to permit patient mobilization, facilitate pulmonary toilet and nursing care, and to decrease long-term disability.

Abdominal Injuries↗
PubMed1986

Acute spinal cord ischemia: prevention of paraplegia with verapamil.

Although irreversible damage to the central nervous system has been considered inevitable after 6 min of circulatory deprivation, there has been evidence for almost 20 years that this may be the consequence of postischemic events. Recent investigations have implicated calcium-mediated phenomena as responsible for damage to neuronal cells in the reperfusion period. We studied the effect of verapamil on the neurologic sequelae of spinal cord ischemia using somatosensory evoked potential monitoring in a canine preparation of spinal cord ischemia. Ten mongrel dogs weighing between 20 and 30 kg each were divided into two groups. The experimental group was pretreated with 0.4 mg/kg verapamil and the control group received no treatment. The thoracic aorta was then occluded. Flow was restored 17 min after there was complete loss of somatosensory evoked potentials. Experimental dogs received additional doses of verapamil upon reperfusion and at 1, 2, 3, 4, 5, 6, and 10 hr after reperfusion. Four of five verapamil-treated dogs were able to walk postoperatively, whereas all of the control dogs suffered dense paraplegias (p = .02). We conclude that verapamil can ameliorate the sequelae of spinal cord ischemia and that this preparation is suitable for the study of the mechanisms of ischemic neuronal damage in an area outside the brain.

Animals↗
PubMed1986

Effects of intraventricular methotrexate on cerebrospinal fluid monoamine metabolites in rhesus monkeys.

Previous work suggested that methotrexate (MTX) may cause encephalopathy by inhibiting biosynthetic pathways for dopamine and serotonin in the brain. We examined this issue by measuring the neurotransmitter metabolites homovanillic acid and 5-hydroxyindoleacetic acid in the lumbar CSF of rhesus monkeys receiving continuous intracerebroventricular infusions of MTX or dichloromethotrexate. Infusion of the lowest dose (0.05 mg/day) produced a large (300%) rise in homovanillic acid levels and a modest elevation in 5-hydroxy-indoleacetic acid. During higher dose infusion, which was associated with clinical encephalopathy, the biogenic amine metabolites fell from their previous elevated levels. In one encephalopathic monkey, an injection of 1 mg of leucovorin produced a marked elevation in CSF monoamine metabolites within 1 hour and rapid clinical recovery. In contrast, leucovorin produced no change in monoamine metabolites in control animals. The data suggest that MTX may block egress of monoamine metabolites from CSF at the lower doses and suppress neurotransmitter turnover at toxic doses which cause encephalopathy. Serial measurements of CSF monoamine metabolites deserve further investigation as biochemical markers for toxic effects of MTX on neuronal metabolism in the CNS.

Animals↗
PubMed1986

African swine fever. I. Morphological changes and virus replication in blood platelets of pigs infected with virulent haemadsorbing and non-haemadsorbing isolates.

Replicating and mature viral particles were detected with the transmission electron microscope in blood platelets of pigs infected with virulent haemadsorbing and non-haemadsorbing African swine fever virus isolates. Although platelet numbers decreased terminally in infected pigs, the most noticeable morphological damage to these cells apparent in the last 2 days of the disease included cytoplasmic swelling, vacuolation, fragmentation and loss of dense granules.

African Swine Fever↗
PubMed1985

Hemipelvectomy, a lifesaving operation in severe open pelvic injury in childhood.

Near-complete traumatic hemipelvectomy probably carries an extremely high mortality rate. The usual techniques which have been used to control major hemorrhage associated with pelvic fractures such as transperitoneal vascular ligation, intra-arterial embolization, and packing are not applicable (14). Successful management requires prompt recognition of the nature of this injury so that surgical efforts may be directed at resuscitation and expeditious operative completion of the traumatic amputation. When this decision is made appropriately, the dual goals of control of hemorrhage and prevention of sepsis can be achieved. We report the management of a 7-year-old boy who sustained this injury after being struck by a tractor-trailer. In spite of massive resuscitation, hemorrhage could not be controlled and the child remained in shock. When it was recognized that he had sustained an incomplete traumatic left hemipelvectomy, it was surgically completed, permitting prompt control of the hemorrhage and restoration of hemodynamic stability. Intestinal and urinary diversion allowed an uneventful postoperative recovery without significant infection. Although hemipelvectomy appears to be a radical procedure in children with major pelvic injuries, it may be lifesaving and should therefore be considered in those with severe unilateral pelvic injury and uncontrollable hemorrhage. The potential for physical rehabilitation in the group of young, mostly male patients who have survived this injury appears to be unexpectedly good.

Accidents, Traffic↗
PubMed1985

The diagnostic superiority of computerized tomography.

One hundred three patients with blunt abdominal trauma were studied using computerized tomography (CT). By protocol CT was performed in hemodynamically stable adults either: before tap and lavage (T&L)--32 patients; after 'negative' (less than 20,000 RBC/mm3) or 'borderline' (20,000-50,000 RBC/mm3) lavage--28 patients; or to evaluate hematuria--43 patients. CT was performed after administration of oral and intravenous contrast. A comparison of T&L and CT was made in 60 patients. 16 of 42 patients with negative lavage had 22 injuries identified by CT. One of these patients with bilateral renal artery transection, mesenteric and pararenal hematomas died of a closed head injury. Six of 14 patients with borderline lavage results had nine injuries found on CT, including two with actively bleeding spleens confirmed at operation or angiography. One patient with a large retroperitoneal hematoma underwent successful control of hemorrhage by embolization. Only one injury, a paranephric hematoma found at operation was not identified preoperatively by CT. Seventeen of 85 patients with hematuria had GU abnormalities identified by CT. Findings included seven intrarenal hematomas or contusions, three fractures, three major renovascular injuries, four para- and six perinephric hematomas, and three collection system injuries with extravasation. The majority of these injuries were found in patients with more than 50 RBC/HPF; however, six of 47 patients with less than 20 RBC/HPF had abnormalities including a retroperitoneal bladder perforation and a renal mass (hypernephroma). Two bladder perforations and one urethral injury were identified by CT cystogram. Abdominal CT is more sensitive and specific than T&L or IVP.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1984

A comparison of lenient and strict operant conditioning programmes in refeeding patients with anorexia nervosa.

The present paper compares a lenient and a strict operant conditioning programme in refeeding patients with anorexia nervosa. Sixty-five consecutive in-patients participated in the study. We found no significant difference in the rate of weight-gain between the two treatments. There were, however, a number of practical advantages in using the more lenient programme: it was more economical of nursing time, and patients were more accessible to psychotherapy. The programme was also more acceptable to the patients.

Adolescent↗
PubMed1983

The influence of glucose on serum galactose levels in man.

To investigate the effect of simultaneous glucose and galactose administration on serum galactose levels in man, volunteers were given a standard galactose meal of 0.5 g galactose/kg BW alone and with various body weight related glucose loads and with fructose; lactose was also given to a group of volunteers. Two groups of subjects received the standard galactose meal alone and with a simultaneous intravenous infusion of glucose or insulin. There was a marked individual variation in the serum galactose response to the standard galactose meal, the maximum galactosemia ranged from 0.23 to 4.56 mmole/L. Peroral glucose suppressed the serum galactose response to galactose producing significant reductions in the mean area under the serum galactose response curves. At a glucose intake of 0.15 g/kg by-32 +/- 14.3%, 0.50 g/kg BW -69 +/- 5.93% and at 0.75 g/kg BW -75 +/- 4.93%. Ingestion of glucose with galactose did not increase galactose loss in the urine. Lactose produced similar serum galactose, glucose and insulin responses to those seen after administration of equal quantities of galactose and glucose as monosaccharides. Fructose did not affect serum galactose levels when given with the standard galactose meal. Intravenous glucose produced a significant reduction of 56 +/- 14.1% in the mean area under the galactose response curve [p less than 0.01], whereas intravenous insulin did not affect the serum galactose response to peroral galactose.

Adolescent↗
PubMed1983

Antimelanoma hybridoma antibodies against partially purified melanoma antigen.

We have immunised BALB/c mice with a melanoma antigen obtained after papain solubilisation of the membranes of a metastatic melanoma tumour and fused the immune spleen cells to the mouse myeloma line P3-NS1/1-Ag4.1. The produced hybridoma antibodies (Mel-PV antibodies) recognised the initial melanoma antigen in haemagglutination, but did not react with any of the HLA phenotypes tested by cytotoxicity on a panel of B lymphocytes with known HLA-A and B phenotypes. We rosetted red blood cells coated with protein A with dispersed cells from fresh melanoma tumours, and a high degree of specificity for human malignant melanocytes was observed. Purified Mel-PV antibodies were also tested by indirect immunofluorescence and found to be oriented towards cytoplasmic components of malignant melanoma cells. These results indicate that the use of melanoma antigens for preparing monoclonal antibodies maintained a satisfactory degree of specificity and may be an adequate starting point for defining common and specific antigenic determinants on human melanoma.

Animals↗
PubMed1983

Plasma vasopressin and blood pressure. Studies in normal subjects and in benign essential hypertension at rest and after postural challenge.

Plasma vasopressin levels were compared in three groups comprising normotensive, mildly hypertensive, and more severely hypertensive patients, both under basal conditions and following an 85 degrees head-up tilt, a stimulus known to provoke vasopressin release in man. Vasopressin levels increased two- to fivefold in all subjects after tilt; however, neither the basal levels nor the maximal levels attained at 45 to 60 minutes after tilt differed in the three groups. These data do not support the postulated role for vasopressin in the causation or perpetuation of non-accelerated essential hypertension in man.

Adult↗
PubMed1983

Extracorporeal immunomodulation (EIM) by plasmaleukapheresis (PLP) in the treatment of steroid resistant renal rejection.

We report the use of plasmaleukapheresis (PLP) to treat renal allograft rejection which had failed to respond to conventional pulse corticosteroid therapy. Twenty-three patients who failed to respond to at least 3 boluses of IV methylprednisolone received PLP. Sixteen of these patients had either complete (12) or partial (4) response to PLP. In the responding group, the mean serum creatinine was 1.5 +/- 0.3 mg/dl. In the partially responding group, the mean serum creatinine was 3.9 +/- 0.3 mg/dl. Plasmaleukapheresis resulted in the reduction in levels of circulating immune complexes (CIC), and T and B cells. Circulating null cell levels increased. All 5 patients with low (less than 10%) pretransplant cytotoxic antibody levels had complete response to plasmaleukapheresis. We conclude that PLP, perhaps by removal of CIC, antibody and/or population of circulating T or B cells, may be capable of reversing steroid resistant rejection, especially in patients with low levels of pretransplant cytotoxic antibodies.

Adult↗
PubMed1983

Traumatic hemipelvectomy: report of two survivors and review.

Two surviving patients with traumatic hemipelvectomy are presented. Rapid transport, aggressive initial resuscitation, and attention to detail in the rehabilitation phase are necessary for the successful management of these patients. The viability of the psoas muscle should be assessed, because of the high possibility of avulsion. Associated nerve injury and complicating meningitis can be serious problems in the management of such patients. There is need to include this entity in the existing classifications of pelvic fractures. Hemipelvectomy is proposed as an alternative in the management of the severe unilateral open pelvic fracture with uncontrollable bleeding.

Accidents, Traffic↗
PubMed1982

Effect of brain growth stages on T-maze acquisition in mice.

Recently, it has been shown that brain growth is characterized by periods of especially large increases in growth, with "plateaus" in growth between these "spurt" periods. In humans, these spurts in brain growth are correlated with spurts in mind growth, collectively termed phrenoblysis. Brain growth spurts in rodents occur at 0-6, 8-12, and 17-23 days of age with plateaus in-between. We examined two questions. First, are there differences in learning ability associated with spurts and plateaus in brain growth? Second, can learning during these stages be altered through genetic and environmental manipulations? We employed the high and low lines of the Fuller brain weight selection mice, which are known to have different developmental patterns, and early handling procedures, known to alter growth rates. The results showed that animals tested during a proposed brain growth spurt were superior to animals tested during a brain growth plateau in learning a shock-escape T-maze.

Age Factors↗