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Biomedical subjects

A Sandler

Publications and source records attributed to A Sandler.

71 records · Page 4Linked to original sources
PubMed1994

Is hypoxic pulmonary vasoconstriction important during single lung ventilation in the lateral decubitus position?

Hypoxic pulmonary vasoconstriction (HPV) has not been demonstrated in human single lung anaesthesia in the lateral decubitus position (LDP). The purpose of this study was to determine whether (1) HPV occurs in the non-dependent, non-ventilated lung, and (2) if the infusion of sodium nitroprusside (SNP) inhibits HPV. During intravenous anaesthesia the tracheas of seven patients were intubated with double lumen endotracheal tubes. Standard monitors plus radial and pulmonary arterial catheters were placed. Patients were positioned in the LDP and haemodynamic and gas exchange data were recorded for each of three stages; I: two-lung ventilation, II: single, dependent lung ventilation (1 LV) and III: 1LV with infusion of SNP. In stage II the PaO2 decreased from 531 +/- 42 mmHg to 285 +/- 42 mmHg (P < 0.05) and Qs/Qt increased from 12.3 +/- 2.7 to 29.0 +/- 6.3% (P < 0.05). With SNP infusion there was a 30% increase in cardiac index (CI) (P < 0.05). The SNP infusion was not associated with changes in Qs/Qt or PaO2. This model demonstrates changes in Qs/Qt and PaO2 associated with single-lung ventilation in ASA I and II patients in the LDP but we were unable to demonstrate inhibition of HPV by SNP.

Anesthesia, Intravenous↗
PubMed1994

Pancreatic enzyme elevations after blunt trauma.

BACKGROUND: Elevations in levels of the pancreatic enzymes amylase and lipase occur frequently after trauma. The purpose of this prospective study was to examine the incidence of these enzyme elevations in patients suffering blunt trauma, their natural history, and their relationship to posttraumatic pancreatitis. METHODS: One hundred consecutive trauma patients were studied on admission to the surgical intensive care unit with daily serum amylase and lipase measurements, which were blinded to the clinical service. If the enzyme levels were elevated after 3 days, the patient was enrolled in the study and observed and examined daily, and enzyme levels were measured every other day. These patients were fed enterally by the clinical service if no symptoms of clinical pancreatitis were present. RESULTS: In 17% of patients persistent pancreatic enzyme elevations developed. These patients more frequently had had hypotension, higher Injury Severity Scores, and were more likely to have had severe head injuries than those whose enzyme levels remained normal. Five percent of those studied displayed evidence of clinical pancreatitis, and none of these patients had only isolated head injuries. Lumbar spine injuries and retroperitoneal hematomas were present more frequently in the group in whom symptomatic pancreatitis developed. CONCLUSIONS: After blunt trauma 17% of patients displayed persistent pancreatic enzyme elevations, but the majority remained asymptomatic despite enteral feeding. Retroperitoneal injury may identify patients at risk for pancreatitis. Patients with isolated head injuries should be fed enterally.

Adolescent↗
PubMed1994

Synergism of taxol and gallium nitrate in human breast carcinoma cells: schedule dependency.

Since Taxol (paclitaxel, NSC-125973) arrests cells in mitosis and gallium nitrate (NSC-15200) inhibits cell replication in the S phase, and the two drugs have different biochemical targets, we tested the hypothesis that the combination of these drugs may be synergistic in human breast carcinoma cells. MDA-MB-435 human breast carcinoma cells were grown in monolayer in culture. Taxol and gallium inhibited cell proliferation with IC50 = 13 nM and 180 microM, respectively. In clonogenic assays, Taxol and gallium yielded IC50 = 2 nM and 25 microM, respectively. Synergism was observed in both cell proliferation and colony formation assays depending on the treatment schedule. Gallium (300 microM) 24 h prior to Taxol (10 nM) synergistically decreased cell proliferation to 6.5% of untreated cells, which was 50% of the predicted value. In clonogenic assay, gallium (40 microM) given 16 h prior to Taxol (2 nM) yielded 8.7% colony formation of the untreated cells, which was 44% of the predicted value. Combination chemotherapy with Taxol and gallium with this protocol schedule may be useful in the treatment of human breast carcinoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Acute thrombocytopenic purpura in relation to the use of drugs.

The relation of acute thrombocytopenic purpura (TP) to the use of drugs was investigated in a case-control study conducted in eastern Massachusetts, Rhode Island, and the Philadelphia region; 62 cases over the age of 16 years with acute onset and with a rapid recovery were compared with 2,625 hospital controls. After control for confounding by multiple logistic regression, use of the following drugs in the week before the onset of symptoms was significantly associated: trimethoprim/sulfamethoxazole (relative risk [RR] estimate, 124), quinidine/quinine (101), dipyridamole (14), sulfonylureas (4.8), and salicylates (2.6). The overall annual incidence of acute TP was estimated to be 18 cases per million population. The excess risks for the associated drugs were estimated to be 38 cases per million users of trimethoprim/sulfamethoxazole per week, 26 per million for quinidine/quinine, 3.9 per million for dipyridamole, 1.2 per million for sulfonylureas, and 0.4 per million for salicylates. Associations with sulfonamides, quinidine/quinine, sulfonylureas, and salicylates have been previously reported, but the present study has provided the first quantitative measures of the risk. The association with dipyridamole was unexpected. In general, despite large RRs, the incidence rates attributable to the drugs at issue (excess risks) were low, suggesting that TP is not an important consideration in the use of the various drugs.

Acute Disease↗
PubMed1992

Transdermal fentanyl: acute analgesic clinical studies.

The transdermal therapeutic system (TTS) is a novel technique of drug administration that can mimic long-term continuous intravenous infusions in maintaining stable drug plasma concentrations. Fentanyl, a potent lipid-soluble synthetic opioid, has been incorporated into such a system and has undergone preliminary clinical trials in postoperative patient populations to assess analgesic efficacy and incidence of undesirable side effects (pruritus, nausea and vomiting, urinary retention, respiratory depression). In general, when applied 2 hr preoperatively, a TTS (fentanyl) patch (in different doses) provides moderate-to-good analgesia for a variety of surgical procedures for periods of up to 3 days. Most patients will require small amounts of systemically administered opioids for supplementary analgesia, especially in the first 24 postoperative hr. The incidence of side effects such as nausea and vomiting varies between studies but can be as high as 70%. Clinically significant respiratory depression is rare but was reported in several of the studies. TTS (fentanyl) is a simple and useful technique for the control of postoperative pain.

Administration, Cutaneous↗
PubMed1991

[Contribution of early electromyography in the prognostic assessment of facial paralysis].

26 patients suffering from total facial palsy of different etiologies underwent an electromyography of the facial muscles between the 5th and 15th day, and were followed up for one year. The muscular activity in forced mimetics, the blink reflex, and the electric response latency were studied after stimulation of the stylomastoid foramen. Early EMG with detection of one or several motor units is a decisive factor in the final prognosis. The methodology and advantages of EMG are compared to those of electroneuronography.

Adolescent↗
PubMed1988

The effect of truncal vagotomy on the response of the canine lower esophageal sphincter to varying doses of pancreatic polypeptide.

Lower esophageal sphincter pressure (LESP) and plasma pancreatic polypeptide (PP) levels increase after ingestion of a protein meal. This study was done to determine whether an increase in LESP would occur during intravenous administration of exogenous PP at physiologic and pharmacologic doses and whether the integrity of vagal innervation would alter the response. Manometric observations were made, in each of five dogs, of the LESP before and during intravenous infusion of bovine PP at doses ranging from 0.05 to 10 micrograms/kg/hour. Blood samples were obtained simultaneously with LESP measurements for radioimmunoassay determinations of PP. The lowest dose of PP (0.05 microgram/kg/hour) did not produce an increase in either LES pressure or circulating levels of immunoreactive PP. At all other doses, a significant increase occurred in the LESPs and in plasma PP levels. Infusion of PP at 1.0 microgram/kg/hour produced levels of PP similar to those seen postprandially (300 to 400 pg/ml). After vagotomy, studies were repeated at doses ranging from 1.0 to 5.0 micrograms/kg/hour. Infusion of PP at 1.0 microgram/kg/hour produced PP levels similar to those seen in the prevagotomy period; however, there was no change in LES pressures from the fasting postvagotomy values. Administration of PP at 1.5, 2.0, and 5.0 micrograms/kg/hour did produce slight increases in LESP values, which were significantly less than those observed prevagotomy. These higher doses of PP postvagotomy also produced pharmacologic levels of plasma PP. These results demonstrate that an increase in LESP occurs when exogenous PP is administered at doses that produce physiologic levels of PP in dogs with intact vagi; vagotomy results in a marked attenuation of this response.

Animals↗
PubMed1987

Provisional assignment of the gene for uridine monophosphatase-2 (Umph-2) to mouse chromosome 11.

The segregation of the mouse gene for uridine monophosphatase-2 (Umph-2) was examined in 14 independent mouse-Syrian hamster hybrids and 10 hybrid subclones. Umph-2 cosegregated with the mouse galactokinase (Glk) gene in 23 of the 24 hybrids and showed at least four discordances with all other mouse marker isozymes examined. The observed synteny of Umph-2 and Glk, which has also been observed in humans, indicates that the mouse Umph-2 gene is on chromosome 11.

Animals↗