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D L Kaiser

Publications and source records attributed to D L Kaiser.

149 records · Page 9Linked to original sources

Importance of plasma angiotensin concentrations in a comparative study of responses to angiotensin in the maturing newborn lamb.

Plasma angiotensin concentrations were measured in a longitudinal study of the vascular, renal, and adrenal responses to infusions of angiotensin II (AII) in the maturing newborn lamb. Basal plasma concentrations of angiotensin increased with age and correlated with the rising arterial pressure that occurred with maturation. However, age was a stronger determinant of arterial pressure than was plasma angiotensin concentration. For any given dose of AII per kilogram of body weight, the actual plasma angiotensin concentration achieved increased as the lambs matured and gained weight. Therefore, a comparative study of biologic responses to AII in maturing animals must be based on actual plasma angiotensin concentrations achieved rather than on dose of AII infused per kilogram of body weight. When analyzed on the basis of actual plasma angiotensin concentration, the increase in arterial pressure and the suppression of plasma renin activity in response to increasing plasma angiotensin concentrations did not differ significantly as the lambs matured. However, the increment in plasma aldosterone concentrations in response to increasing plasma angiotensin concentrations was diminished in immature lambs (less than 18 days) when compared to the aldosterone responses in the same lambs at older ages.

Aging↗

Outpatient management of diabetes mellitus with patient education to increase dietary carbohydrate and fiber.

The impact of patient education on dietary fiber intake, diabetes control, and serum lipids was examined in patients with non-insulin-dependent diabetes mellitus. Customary outpatient personnel and procedures were used to teach three diet plans: the American Diabetes Association (ADA) diet, the ADA diet modified to increase high-fiber, high-carbohydrate foods (IF), and the IF diet supplemented with oat bran (IFOB). A control group was instructed on foot care to provide teaching visits. Fifty-two patients were recruited from an outpatient clinic and studied over a 6-wk period. Subjects were of low socioeconomic status and had completed a mean of 8.3 yr of education. Patients instructed to increase their intake of high-fiber foods reported a doubling of fiber intake and tolerated the diets well. Increased fiber and carbohydrate intake and decreased fat intake were associated with reductions in fasting plasma glucose levels. Increased fiber intake was also associated with reductions in total serum cholesterol and high-density lipoprotein cholesterol levels. Changes in fiber, carbohydrate, and fat intake were unrelated to changes in weight, serum insulin levels, or hemoglobin A1c levels over the study period.

Adult↗

Thyroid cancer: some basic considerations.

From these data and data from the literature, our recommended treatment for well-differentiated cancer is as follows: For papillary cancer, resection should be adequate to encompass the entire tumor, which in most cases would be complete lobectomy and possibly isthmusectomy. Prophylactic neck dissection is of no value; therapeutic modified neck dissection should be done for stage II disease. Follicular cancer can be treated by lobectomy (for small lesions) or subtotal thyroidectomy. Although total or near-total thyroidectomy may be required in selected patients with large primary cancers or in those with extensive capsular invasion or extrathyroid extension, the number of cases indicating this is small. There were only a few such patients with large primaries requiring total thyroidectomy in this study. Total thyroidectomy is best avoided in most cases, considering the price of hypoparathyroidism and the lack of significant improvement in survival compared with lesser ablative techniques. Postoperative ablation with iodine-131 did not improve survival in staged patients with papillary cancer (the number of patients with follicular cancer was too small for analysis). Postoperative thyroid suppression by exogenous thyroid hormone postoperatively appeared to improve survival. Although the data were not adequate for evaluation in follicular cancer, there seems to be no reason not to use this postoperatively in high-risk patients with either papillary or follicular cancer.

Adenocarcinoma↗

Improving preventive care at a medical clinic: how can the patient help?

We developed a comprehensive individualized preventive care reminder system and then tested the hypothesis that directly involving patients in the reminder process would lead to greater use of preventive services than involving physicians only. There were three experimental groups of 350 patients each: in group 1 physicians and patients received the reminder; in group 2 physicians only received the reminder; in group 3 neither physicians nor patients received the reminder. Nine preventive care services were studied: blood pressure measurement; dental exam; ocular pressure measurement; stool exam for occult blood; influenza, pneumococcal, and tetanus vaccinations; mammography; and Papanicolaou smears. Need for these services was determined by telephone interview and chart review. To determine whether services were obtained, charts were reviewed after four to eight months of follow-up. For overall compliance with preventive recommendations and for several individual services (stool exam for occult blood, tetanus vaccination, mammography), group 1 patients received significantly more preventive care than group 2. Likewise, group 2 patients received more preventive care than group 3. These data show that involving patients in reminder efforts is an effective means of raising the level of preventive services.

Adult↗