Use of stellate ganglion blocks for chronic chest pain associated with primary pulmonary hypertension.
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Chest Pain↗
Biomedical subjects
W Frist
Publications and source records attributed to W Frist.
Noninvasive detection of human cardiac transplant rejection with indium-111 antimyosin (Fab) imaging.
Diagnosis of rejection after cardiac transplantation is currently made by right ventricular endomyocardial biopsy. To evaluate antimyosin imaging as a noninvasive means of detecting human cardiac rejection, the Fab fragment of murine monoclonal antimyosin antibodies was labeled with indium-111 and given intravenously to 18 patients (age 45 +/- 12 years) in 20 studies 7 days to 9 years after transplantation. Endomyocardial biopsy specimens were obtained at the time of each imaging study. Eight patients had positive scans confirmed by biopsy as rejection, and eight patients had negative scans and no evidence of rejection on biopsy. Discordance was observed in four studies, two with positive scans and no rejection on biopsy and two with negative scans and positive biopsy. The sensitivity, specificity, and overall accuracy of the technique were each 80%. Imaging with radiolabeled antimyosin antibody Fab fragments may be of value in the noninvasive identification of rejection in the cardiac transplant recipient.
Adult↗
Long-term functional results of selective treatment of hand burns.
Four hundred seventy-eight patients with hand burns (786 hands) were treated at the burn service of the Massachusetts General Hospital. Long-term evaluation showed that early incision and immediate autografting of deep second degree, mixed second and third degree, and third degree full-thickness hand burns resulted in 93 percent, 95 percent, and 93 percent, respectively, excellent to good functional results. There was no significant differences in results in patients with superficial second degree burns treated nonsurgically with silver nitrate dressings and early physical therapy compared with results in patients with deep second degree, mixed second and third degree, and third degree hand burns treated with early excision and grafting. No patient with fourth degree burns had excellent to good results. Permanent damage was related to extent of original injury to the extensor tendons and joint capsules. On the basis of this broad experience, it is believed that all burned hands judged unlikely to heal within 3 weeks will benefit from early excision and grafting by experienced surgical personnel.
Adolescent↗
Contribution of activation-inactivation dynamics to the impairment of relaxation in hypoxic cat papillary muscle.
Previous investigation of conventional isometric twitches of normothermic cat papillary muscle has shown that hypoxia prolongs relaxation, and this prolongation is actually accentuated during early reoxygenation. Our aim was to identify how hypoxia and reoxygenation affect the coupled processes of activation and inactivation that govern the time course of internally generated contractile tension (Ti). Activation and inactivation are modeled as first-order processes with rate constants ka and ki, respectively, and the overall isometric muscle as an underdamped second-order lag system driven by Ti. The analytical expression (To) for the externally recorded tension is dominated by two exponential terms incorporating ka and ki. Accurate least-squares fits of digitized twitches to To yielded estimates of ka and ki at 1- to 3-min intervals during control oxygenation, hypoxia, and early and late reoxygenation. Results follow. Compared with control, normothermic hypoxia prolonged activation [at 15 min ka decreased 61% from control, 35.5 +/- 6 (SE) s-1, P less than 0.05] and accelerated inactivation (at 15 min, ki increased 69% from control, 6.0 +/- 0.5 s-1, P less than 0.05). In early reoxygenation (1-3 min) activation remained impaired and inactivation returned to control levels (ki decreased 16% from control, NS). In late reoxygenation (15 min) both processes reverted to control. Thus inactivation kinetics can be dissociated from activation kinetics. Impaired relaxation in normothermic hypoxia is due to prolonged activation, whereas inactivation is actually accelerated. The further impairment of relaxation in early reoxygenation is due to rapid return of inactivation to control at a time when activation is still prolonged.
Animals↗
VD hotline: an evaluation.
A VD hotline started in January 1973 at Monmouth Medical Center, Long Branch, N.J., was evaluated with the following results. Hotline operators handled 260 calls in 1973. The typical caller was a 20-year-old employed male who heard about the hotline from a friend, wanted information about clinic hours and costs, and had questions about symptoms of venereal disease. At Monmouth Medical Center, venereal disease patients who go to the emergency room receive specific diagnosis and therapy, and in the clinic they receive broader medical care. The hotline encourages patients to go to the clinic or to their private physicians. Visits to Monmouth Medical Center for venereal disease increased during the second half of 1972 from 356 to 545 (53%). For the emergency room alone, the rise was 17% and for the clinic, 68%. There was an increase of 20% in the number of patients treated in the emergency room, but the number treated in the clinic leveled. Thus, there was a substantial increase in visits, especially to the clinics where the most care is provided, and a modest increase in treated patients. The causal contribution of the hotline to these increases cannot be stated with certainty. The cost of operating the hotline was $14.70 per call. While high, it might be defended on the basis of avoiding the higher costs of untreated disease. The cost can be reduced by making the hotline serve multiple health purposes. The hotline appeared useful but costly. This retrospective evaluation was hampered by the unavailability of some critical data.
Adolescent↗