Search PubMed⌕ Search

Biomedical subjects

C R Smith

Publications and source records attributed to C R Smith.

At least 325 records · Page 18Linked to original sources
PubMed1980

Double-blind comparison of the nephrotoxicity and auditory toxicity of gentamicin and tobramycin.

Two hundred fifty-eight patients with suspected sepsis were treated with tobramycin or gentamicin in a prospective, randomized, double-blind trial. One hundred forty-six patients received nine or more doses, had serial determinations of serum creatinine, and were evaluated for nephrotoxicity; 91 were able to cooperate with audiometry and were evaluated for auditory toxicity. Auditory toxicity developed in five of 47 (10 per cent) given gentamicin and five of 44 (11 per cent) given tobramycin. Nephrotoxicity developed in 19 of 72 (26 per cent) given gentamicin and nine of 74 (12 per cent) given tobramycin (P less than 0.025). The severity of the nephrotoxicity was not different; the mean increase in creatinine was 1.3 mg per 100 ml (114.9 mumol per liter) in both groups. Both the tobramycin and gentamicin groups had a similar mean age, initial serum creatinine level, total dose, serum aminoglycoside level, and duration of therapy. We conclude that tobramycin causes nephrotoxicity less frequently than does gentamicin.

Acute Kidney Injury↗
PubMed1980

Reorganization of a medical house staff (firm system): its effect on accessibility and continuity of care.

In 1975, the Johns Hopkins Medical house staff was reorganized into four Firms. Each Firm provides inpatient and outpatient care to a group of patients. Two of the goals of the reorganization were to improve accessibility and continuity of care. This study, based on a before and after research design utilizing routinely collected data, sought to determine whether these goals had been attained. Accessibility was assessed by observing changes in waiting time for appointments, broken appointments, and number of patients seen before their scheduled appointments. The results showed that mean waiting time for a Medical Clinic appointment fell from 15 days to 1 day (p < 0.01); broken appointments for new patients fell from 54% to 34% (p < 0.01); no significant changes occurred in broken appointments for old clinic patients (34% vs 32%); and patients seen before their scheduled appointments increased from 30% to 38% (p < 0.001). Continuity was assessed by observing changes in use of emergency and walk-in clinic services, the proportion of Medical Clinic patients lost to follow-up care, the proportion of hospital readmissions returning to the same nursing unit, and the proportion of patients discharged from the hospital who returned to the Medical Clinic. The results showed that use of emergency and walk-in clinic services fell slightly, from 24% of all visits before to 22% of all visits after the Firm System (p < 0.001); no change occurred in the proportion of patients lost to Medical Clinic follow-up (21% before and after the Firm System); the proportion of hospital readmissions returning to the same nursing unit increased from 35% to 73% (p < 0.005); and the proportion of patients discharged from the hospital who returned to the Medical Clinic increased from 21% to 35% (p < 0.001). These data suggest that implementing the Firm System led to improvement in several selected aspects of accessibility and continuity of care but that further improvements could be made.

Ambulatory Care↗
PubMed1980

The meaning of the point of maximum oscillations in cuff pressure in the indirect measurement of blood pressure--part ii.

When measuring blood pressure indirectly, oscillations in the cuff pressure are observed. The cuff pressure for which these oscillations reach a maximum and its relationship to the true mean arterial pressure was investigated using a simple one-dimensional theoretical model of the cuff-arm-artery system. Results from this model indicate that the cuff pressure for maximal oscillation is strongly dependent on compression chanber air volume, pulse pressure, and arterial elasticity. Parallel experimental studies indicate general agreement with the theoretical model. The cuff pressure for maximal oscillations appears to provide a reasonable estimation of the true mean arterial pressure provided compression chamber air volume is kept small.

Animals↗
PubMed1980

The primal scene: a study of prevalence.

Although primal scene experiences have been implicated as causal agents in innumerable psychopathologic states, no study of their actual prevalence exists. The authors conducted five separate studies, in which parents reported that 9%-41% of their children had seen parental intercourse. If the times children see parental intercourse without the parents knowing it and the times children hear parents making noises during intercourse were included, the prevalence would be much higher. In view of the frequent occurrence of primal scene experiences, factors other than the viewing itself must influence psychopathological outcomes when they occur.

Attitude↗
PubMed1980

Custom-molded earplug performance: a retrospective study.

The purpose of this study was to determine the effectiveness of custom-molded earplugs in preventing hearing threshold shifts over a long period of time. A stepwise regression analysis was employed to accomodate job related variables including workplace noise level, demographic elements including age, and factors related to hearing including ear history. These variables would be expected to exert considerable influence on hearing threshold shifts. However, workplace noise level absorbed unexpected small amounts of variation in hearing threshold shifts for the textile worker subjects (N = 1517) even when noise level was entered as the only variable on the first step for each analysis. And, baseline hearing values absorbed unexpected large amounts even when entered on the last step. An argument based on these findings is presented suggesting that custom-fitted hearing protection was effective in preventing substantial changes in hearing threshold level during the period of this investigation.

Adolescent↗
PubMed1980

Creatine kinase isoenzyme patterns in neoplasms of peripheral nerve.

Normal peripheral nerve and neoplastic lesions of peripheral nerve varied in their creatine kinase (CK; EC 2.7.3.2) isoenzyme pattern, as assessed both with electrophoresis and with column chromatography. All three isoenzymes were seen in normal peripheral nerve, but the peripheral nerve tumors, neurofibroma and neurilemmoma, demonstrated predominantly CK-1 isoenzyme activity, with a trace amount of CK-3. No CK-2 activity was demonstrated in these tumors. In contrast, malignant schwannoma tissue contained all three isoenzymes, but in a different proportion than in normal peripheral nerve.

Creatine Kinase↗
PubMed1979

New conjugated hydroxydienoic fatty acids and acetotriacylglycerols from Securidaca longipedunculata seed oil.

Like other members of the plant family Polygalaceae, Securidaca longipedunculata Fres., is a source of fatty acids and triacylglycerols with unusual structures. Its seed oil contains at least seven chromatographically distinct groups of triacylglycerols divided into two series: One series represents monoacetotriacylglycerols, and the other 'normal' triacylglycerols having only long-chain fatty acids. Each series has groups containing zero, one or two conjugated hydroxydienoic acids. In addition, there is a small amount of triacylglycerol incorporating three hydroxy acids. In addition to coriolic (13-hydroxyoctadeca-cis-9,trans-11-dienoic) acid (27%), two of its previously unknown homologs are present: 11-hydroxyhexadeca-cis-7,trans-9-dienoic acid (15%) and 9-hydroxytetradeca-cis-5,trans-7-dienoic acid (2%).

Chromatography, Gas↗
PubMed1979

Relationship between aminoglycoside-induced nephrotoxicity and auditory toxicity.

We have reviewed our data from 391 patients entered into three prospective, double-blind studies of aminoglycosides and evaluated 127 cases to determine whether aminoglycoside-induced auditory toxicity and nephrotoxicity are independent events. The cases selected for evaluation included all patients treated for greater than 3 days (mean, 7.7 days) who had serial creatinine determinations and were able to cooperate with serial bedside audiograms (250 to 8,000 Hz). Patients received either gentamicin, tobramycin, or amikacin. Drug dosage was altered to keep serum levels 1 h after administration between 5 and 10 mug/ml (gentamicin or tobramycin) or 20 and 40 mug/ml (amikacin). The investigators evaluating auditory toxicity and nephrotoxicity were blind to the aminoglycoside being administered. The incidence of auditory toxicity in the nephrotoxic group (18.2%) was not significantly different from that in the nonnephrotoxic group (15.2%) (P = 0.75; Fisher exact test). There was no statistical difference between the nephrotoxic and auditory toxic groups in patient age, total dose of aminoglycoside, initial creatinine level, duration of therapy, or concurrent use of furosemide or cephalothin. We conclude that aminoglycoside-induced auditory toxicity and nephrotoxicity are independent events when the drug is administered for approximately 7 days and when aminoglycoside levels are maintained within a predefined range.

Amikacin↗
PubMed1978

Cephalothin plus an aminoglycoside is more nephrotoxic than methicillin plus an aminoglycoside.

In a prospective, randomised, double-blind trial to determine if cephalothin plus an aminoglycoside is more nephrotoxic than methicillin plus an aminoglycoside, patients were assigned to one of four treatment groups: cephalothin and gentamicin (C.G.), cephalothin and tobramycin (C.T.), methicillin and gentamicin (M.G.), or methicillin and tobramycin (M.T.). The incidence of definite nephrotoxicity was: C.G., 7/23 (30.4%); C.T., 5/24 (20.8%); M.G., 2/20 (10%); and M.T., 1/23 (4.3%). There was no statistically significant difference in nephrotoxicity between the combined gentamicin groups (C.G. and M.G.) and the combined tobramycin groups (C.T. and M.T.). Definite nephrotoxicity developed in 12/47 (25.5%) of the combined cephalothin groups (C.G. and C.T.) and in only 3/43 (7%) of the combined methicilllin groups (M.G. and M.T.). The combination of cephalothin plus an aminoglycoside is therefore more nephrotoxic than the combination of methicillin plus an aminoglycoside.

Acute Kidney Injury↗
PubMed1978

Intrathecal gentamicin for refractory gram-positive meningitis.

The mortality for meningitis due to Staphylococcus aureus or Listeria monocytogenes remains high, ranging from 32% to 77%. We treated a patient with staphylococcal meningitis refractory to methicillin sodium and oxacillin sodium, and a patient with Listeria meningitis refractory to penicillin G potassium and ampicillin sodium; both patients were cured when intrathecal gentamicin sulfate was added to the regimen. The combination of intrathecal gentamicin and a penicillin may be beneficial in refractory staphylococcal or Listeria meningitis.

Adult↗
PubMed1978

Sialadenoma papilliferum of the oral cavity.

Sialadenoma papilliferum is a rare tumor of salivary gland origin. A review of the English-language literature indicates that only four cases have been reported. This article describes the clinical and histologic characteristics of an additional case occurring on the left retromolar pad.

Aged↗