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Biomedical subjects

A W Goode

Publications and source records attributed to A W Goode.

81 records · Page 5Linked to original sources
PubMedDate not supplied

Transcellular movement and intracellular concentration of sodium in erythrocytes after surgery and in seriously ill patients.

Erythrocyte intracellular sodium concentration and transmembrane sodium flux were measured in nine healthy patients undergoing uncomplicated elective abdominal surgery. Intracellular sodium concentration was determined by in vitro washing of cells in a solution approximating to intracellular constituents and measuring extracellular sodium contamination with 51Cr EDTA. Sodium flux was determined by radioactive 22Na tracer both as influx and efflux. No change in erythrocyte intracellular sodium concentration or in sodium flux was found postoperatively. In 14 seriously ill surgical patients, all of whom had plasma sodium levels outside the tolerance range of our surgical population, erythrocyte intracellular sodium concentration decreased, but not significantly, compared with patients undergoing uncomplicated surgery (p = 0.16). Furthermore, sodium flux in seriously ill patients was proportional to intracellular sodium concentration. These results are at variance with the hypothesis of 'sick cell syndrome' which is said to be typified by a high intracellular sodium concentration and a reduced sodium efflux. In the surgical patients studied, it is more likely this hyponatremia does not result from a change in sodium flux but is dilutional.

Cell Membrane Permeability↗
PubMedDate not supplied

Somatic change in the estrogen receptor gene associated with altered expression of the progesterone receptor.

Using a fragment of the estrogen receptor (ER) cDNA as a probe, Southern blots of HindIII-digested genomic DNA, from breast tumours and non-cancerous tissue, revealed a 1.6 kb hybridizing fragment (1.6KbHF) in 3 out of 30 tumours, and in 31 out of 80 mastectomy samples (16 sectors from each of 5 patients), which was significantly correlated with the absence of progesterone receptor. In 4 of the patients, sectors which showed the 1.6KbHF co-existed in the same breast with sectors which did not. Neither the use of higher concentrations of the restriction enzyme, not high salt extraction of DNA changed the abundance of the 1.6KbHF relative to other bands. Similar studies on EcoRI digests of the same DNA samples failed to show any variants. As a further control, hybridization of the same Southern blots of HindIII-digested DNA, with a cytochrome P450IIA3 cDNA, also failed to show variants in these samples. It is concluded that the presence of the 1.6KbHF represents a somatic change in the nucleus of these samples which may have functional importance.

Blotting, Southern↗
PubMedDate not supplied

Correlation between albuminuria and positively charged amino acids in gastrointestinal cancer.

This study was designed to examine a possible relationship between plasma free positively charged amino acid concentrations and the degree of microalbuminuria in patients with gastrointestinal cancer. In 42 consecutive patients (22 men and 20 women), comprised of 25 with histologically proven colorectal or gastric cancer, 9 controls and 8 weight-losing patients with benign gastrointestinal disease urinary albumin and plasma amino acid analysis was performed. Microalbuminuria was more prevalent in weight-losing cancer patients (65%) compared with their weight-stable counterparts, benign gastrointestinal patients and controls. This difference reached statistical significance at the 5% level. Additionally, a significant positive correlation (rs = 0.8, p < 0.05) was observed between ornithine and urinary albumin loss in this group of patients. This study suggests that plasma free amino acid alterations in weight-losing gastrointestinal cancer patients may have an effect on renal tubular protein reabsorption.

Aged↗
PubMedDate not supplied

Lipid fuel metabolism after abdominal surgery.

The work investigated fuel interrelationships in surgical patients infused with saline (Group I) or glucose (Group II) (13 patients in each group) on the day of surgery and subsequently maintained solely on saline until the fifth postoperative day. Blood concentrations of non-esterified fatty acids (NEFA) and ketone bodies were markedly increased in response to surgical stress on the day of surgery only in patients who were not administered carbohydrate. Increased concentrations of lactate and glucose were observed on the day of surgery in patients infused with either saline or glucose. As both fatty acid and ketone body concentrations were decreased by glucose infusion, impaired glucose utilization immediately after surgery is not a simple consequence of increased oxidation of lipid fuels. Glucose and lactate concentrations declined after the day of surgery. Despite a progressive fall in plasma non-esterified fatty acid concentrations from the first to fifth post-operative days, blood ketone body concentrations were strikingly elevated in both groups of patients. The findings emphasize the role of the liver in post-operative fatty acid turnover.

Abdomen↗
PubMedDate not supplied

Cardiac output in asymptomatic primary hyperparathyroidism: a stigma of early cardiovascular dysfunction?

The resting cardiac output pre- and postoperatively in 10 patients with asymptomatic primary hyperparathyroidism has been studied. All patients had normal renal function and arterial blood pressure without a previous history of cardiovascular disease. Ten normotensive patients with a non-toxic goitre awaiting thyroidectomy were studied as controls. The mean cardiac output of the hyperparathyroid patients was 7.2 l/minute (range 5.3-8.9) and of the control group 5.8 l/minute (range 5.2-6.3). Following a successful parathyroidectomy with return of the serum calcium to normal, the mean cardiac output was 6.3 l/minute (range 4.9-7.8) (p < 0.04). In 8 of the 10 patients there was a fall in the cardiac output following surgery; in 2 there was an increase. These results suggest that hyperparathyroid patients often have an elevated cardiac output which may fall following a successful parathyroidectomy.

Adenoma↗
PubMedDate not supplied

The use of thallium-201 and technetium-99m subtraction scintigraphy for the localisation of parathyroid adenomas.

Parathyroid adenomas account for approximately 85% of cases of primary hyperparathyroidism. Several preoperative localisation techniques exist to aid the surgeon during neck exploration, with varying degrees of success. We report on the results of a modification of the established technique of thallium and technetium subtraction scintigraphy. The operative findings of 60 patients undergoing neck exploration for parathyroid adenoma were correlated with preoperative thallium and technetium subtraction scintigraphy scans. The radio-isotopes were administered in the reverse order to conventional administration, resulting in enhanced imaging. The adenomatous glands were correctly localised in all cases. The 100% sensitivity of this modified scanning technique supports a strategy of unilateral scan-directed neck exploration.

Adenoma↗
PubMedDate not supplied

Beta-2 microglobulinuria and long-term outcome following curative surgery for primary hyperparathyroidism.

Twentyseven patients admitted for surgery for primary hyperparathyroidism were studied preoperatively. Fifteen were normotensive and 12 were either hypertensive, diastolic blood pressure > 95 mmHg or had a raised serum creatinine measuring 109.7 (55-171) mumol/l. The beta 2 microglobulin (beta 2M) urinary excretion was measured on all patients. The beta 2M levels were raised in all patients preoperatively even in those patients who had normal values for conventional renal function tests. Following curative surgery the values are returned to the normal range. The patients were followed up for a mean of 4.2 (2.8-5.6) years. Six patients who were initially normotensive subsequently developed hypertension and the initial beta 2M ratio was significantly higher 386 (122-680) micrograms/l compared to those who remained normotensive 186 (95-340) micrograms/l (p < 0.05). Even higher preoperative beta 2M excretion was found in the initial hypertensive group 505 (87-1160) micrograms/l compared to those who later developed hypertension 386 (122-680) micrograms/l, p < 0.001. This preliminary study suggests that preoperative beta 2M urinary excretion may be of value in identifying those patients who will subsequently develop hypertension, an identified long term cause of death in patients operated on for primary hyperparathyroidism. Further studies are indicated.

Adult↗
PubMedDate not supplied

Short-term restorative nutrition in malnourished patients: pro's and con's of intravenous and enteral alimentation using compositionally matched nutrients.

In a prospective controlled clinical study 30 patients with moderate degree of malnutrition, normal liver and kidneys, and a functioning gastrointestinal tract were randomized to receive a free amino acid and small peptide enteral diet (15 patients) or an isonitrogenous isocaloric parenteral support for at least 10 days (total energy: 2900 kcal, nitrogen: 14.5 g, carbohydrates: 380 g, fat: 112 g, N/non protein calories: 1/175). The parenteral and enteral diets had the same protein/lipid/carbohydrate composition. The data indicated that both routes led to positive nitrogen balance. Nitrogen equilibrium was achieved by day 3 in the TPN group and by day 5 in the enteral group. There were no significant changes in serum albumin within either group. Serum level of transferrin reached a significant increase in both groups (p = 0.003). Thyroxine-binding prealbumin rose significantly in both groups as well (p = 0.019 and 0.004 respectively). Statistically significant rises in lymphocyte counts (p = 0.003 and 0.001 respectively), in levels of C3 (p = 0.009 and 0.001 respectively), IgA (p = 0.002), IgG (p = 0.004 and 0.003 respectively) and IgM (p = 0.004) occurred in either treatment group. There was a high incidence of negative skin tests at the start of the study in the enteral group (73.3%) and the TPN group (60%). By the end of the study the incidence of negative results for this test was 40.0% and 26.6% respectively. Despite maintenance of similar glucose levels in both groups, TPN led to significantly (p = 0.000) higher serum insulin levels. The serum insulin increased almost linearly over the study period, and eventually prevented fat mobilization and lipolysis, so that free fatty acid levels had fallen significantly (p = 0.000). A significant elevation of the liver enzymes over the study period occurred in the TPN group, but not in the enterally fed patients. The present findings provide no evidence that semi-elemental diets are in any way inferior to isonitrogenous isocaloric regimes parenterally given for a short period of time.

Adult↗