Biomedical subjects
C J Wright
Publications and source records attributed to C J Wright.
Anticoagulant activity and operative blood loss after intrapulmonary heparin.
The safety and efficacy of heparin given by the intrapulmonary route are further assessed in this study. A single dose of heparin (2000 units/kg) was given by intratracheal instillation in dogs and measurements of plasma heparin concentration, whole blood clotting time and partial thromboplastin time made at intervals for 48 h. These values rose progressively and in parallel for 7 h and remained elevated for 48 h. A series of operations was performed on dogs within 3 h of a single dose of intrapulmonary heparin (1500 units/kg). Operations involving minimal dissection (small bowel resection) and extensive dissection (resection of muscle) were performed in two separate groups. Within each group the animals were randomly given heparin or saline. In the limited dissection group there were no differences in operative blood loss, wound healing, or sequential haemoglobin and haematocrit measurements. In the group subjected to muscle resection there was increased postoperative wound drainage and a slightly greater fall in haemoglobin and haematocrit in those given heparin. It is concluded that heparin is absorbed from the lung causing significant changes in coagulation parameters. Even with the relatively high dose of 1500 units/kg, operations were performed with minimal hazard. Intrapulmonary heparin may have important clinical applications after further investigation.
Heparin via the lung.
Only recently has it been realized that heparin is absorbed when administered into the lung. Im mice, rats, dogs and humans a large dose of intrapulmonary heparin has been shown to cause a moderate degree of hypocoagulability lasting from 48 hours to 14 days depending on the species. This study is part of an ongoing program investigating the effects of the intrapulmonary administration of heparin. Heparin, 1500 units/kg body weight was instilled into the lung in a group of 12 dogs and an equal volume of saline was given in a control group of 10 dogs. Various hemodynamic and metabolic measurements were made at intervals. As expected there was a prolonged moderate increase in clotting time, but no significant effects from intrapulmonary administration of heparin were demonstrated by any of the other measurements. Much work has yet to be done before intrapulmonary heparin can be used clinically but it has potential importance in the management of thromboembolic disease.
Pipeline hazards--a simple solution.
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Fibreless diet and diverticulosis.
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Prospects of cure in lymphocyte-predominant Hodgkin's disease.
This report concerns a particular benign histologic variant of Hodgkin's disease, the lymphocyte-predominant category of the Rye classification. The group of 24 cases, all involving localized disease, was first reported in 1960, and is now reappraised, incorporating subsequent data. The interpretations of the original findings are confirmed and elaborated. A characteristic feature had been the long relapse-free and symptom-free survival period, which gave a false impression of security but was followed in some instances by disseminated disease, usually after 5-15 years. The proportion of such cases is now shown to be greater, and the possible quiescent period extended. Cure was suspected in some instances, and can now be considered likely in about half of the cases. The present results include a substantial number of patients who have survived for very long periods and who must be regarded as cured, though careful confirmatory autopsies are still unavailable.
Analgesia following oral surgery for day patients: a clincial comparison of two analgesics.
A single-blind, between-patient study was carried out in 167 patients following oral surgery to compare the effectiveness and tolerance of two combination analgesic preparations; pentazocine (15 mg) plus paracetamol (500 mg) and dextropropoxyphene hydrochloride (32.5 mg) plus paracetamol (325 mg). Assessments of pain and pain relief were made over two periods, initially over the 90 minute period following administration of either preparation and secondly, over the subsequent 3 days following discharge. At the hospital, those patients receiving pentazocine plus paracetamol achieved a greater relief of pain than those receiving dextropropoxyphene plus paracetamol, though the differences did not reach statistical significance. At home, pain relief was very similar for both groups of patients, both preparations being effective and well tolerated.
Steroids and severe hemorrhagic shock.
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The effects of severe progressive hemodilution on regional blood flow and oxygen consumption.
Electrolyte solutions are effective in the immediate treatment of hemorrhagic shock, but the acceptable limits of hemodilution are not well defined. In this study oxygen consumption was measured in various tissues at rest and in maximally exercising skeletal muscle during progressive hemodilution. Twenty splenectomized, anesthetized dogs were studied (weight 22.6 +/- 2.0 kilograms). Measurements were made of cardiac output, capillary muscle blood flow in the hind limb, and renal and superior mesenteric arterial blood flow. Arteriovenous oxygen differences in the hind limb, kidney, gut, and in the whole body were calculated from the oxygen content of arterial and appropriate venous samples.
Treatment of carcinoma of the thyroid gland.
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Death from Hodgkin's disease after 18 years' complete remission.
Survival studies on series of patients with Hodgkin's disease have indicated that localized disease and certain histologic types are associated with a favorable prognosis. The permanency of cure in such instances has seldom been proved by long-term followup and autopsy; there is evidence that the disease may remain dormant for considerable periods, with the attendant risk of recurrence. A case is reported wherein a patient was relapse-free for 18 years prior to fatal recurrence, which was confirmed by autopsy.
Regional effects of hypovolemia and resuscitation with whole blood, saline, or plasma.
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Effect of sympathetic inhibition on maximal muscle blood flow in the normal and atherosclerotic human leg.
The control of blood flow in skeletal muscle is incompletely understood, and for this reason the effect of sympathetic inhibition on muscle blood flow in the leg was studied. One group of patients selected for study comprised 20 patients without evidence of vascular disease; a second comprised 20 with peripheral occlusive arterial disease, in whom the site of occlusion varied from the aorta to the lower leg arteries. None had undergone previous vascular surgery or sympathectomy. Variables studied included resting muscle blood flow; maximal muscle blood flow; interval from tourniquet release to onset of peak flow; duration of peak blood flow; muscle blood flow after tourniquet release; and skin temperature in the foot. Muscle blood flow was calculated from xenon-133 clearance. The variables were studied before and after ischemic (thigh tourniquet) and before and after sympathetic inhibition (immersion of hands and wrists in water at 45 degrees C). The significant differences between the two groups related to peak flow after ischemic exercise, the interval from tourniquet release to peak flow and duration of peak flow. Sympathetic inhibition was followed by no significant changes in maximal muscle blood flow, though there was a significant decrease in resting muscle blood flow. The results of the present study, in which noninvasive sympathetic blockade was used, confirm the findings of others that muscle blood flow does not change after operative sympathectomy.
Arteriovenous communications in exercising skeletal muscle with severe acute hemodilution.
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Blunt trauma to the main hepatic artery.
Two patients are presented who sustained common hepatic artery injuries secondary to blunt trauma. One patient had a laceration and thrombosis of the proximal hepatic artery while the second patient developed a false aneurysm with dissection which necessitated ligation of the hepatic artery.