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Biomedical subjects

D Smith

Publications and source records attributed to D Smith.

At least 739 records · Page 41Linked to original sources
PubMed1992

Percutaneous drainage of tubo-ovarian abscesses.

The authors performed percutaneous drainage of 27 tubo-ovarian abscesses (TOAs) in 16 patients in whom medical therapy with triple antibiotics prior to catheter drainage had not been successful. Percutaneous drainage was successful in 15 of 16 patients (94%). One patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy 3 days after catheter placement because of persistent symptoms and lack of drainage from the catheter; at laparotomy, a large infected phlegmon was found. Two patients had recurrent disease at 3 and 4 months after catheter placement. Bilateral salpingectomy was performed in one patient and total abdominal hysterectomy and bilateral salpingo-oophorectomy in the other. One of these patients had cervical carcinoma, and the other had a long history of recurrent pelvic inflammatory disease and TOAs. The long-term avoidance of surgery was 81.2%. Access routes for catheter drainage were through the anterior abdominal wall for 10 abscesses, through the posterior transgluteal route for 11, and through the transvaginal route for six. Duration of drainage was 1-20 days (mean, 6 days). Complications consisted of transient sciatic pain in two patients and mild bacteremia in one. The results indicate that percutaneous drainage of TOAs is effective in patients in whom medical therapy is not successful.

Abscess↗
PubMed1992

Response of migrating motor complex to variation of fasting intraluminal content.

The characteristics of the phases of the migrating motor complex (MMC) were studied in the antrum, duodenum, and jejunum after alteration of intraluminal gas and acaloric fluid in 17 healthy volunteers. Aspiration of gas and fluid from the upper gastrointestinal tract reduced motor activity. In the antrum and duodenum, phase II contraction amplitude decreased, while in the duodenum and jejunum, the duration of phase II decreased and phase I increased. Phase III contraction frequency decreased in the duodenum only. Intragastric instillation of gas caused an increase of phase II duration and contraction amplitude in all regions. Similar effects were observed after intragastric instillation of fluid. Fasting periodic motor activity is responsive to volume changes of intraluminal gas and acaloric liquid content.

Adult↗
PubMed1992

Systemic infection due to group B beta-hemolytic streptococcus in children. A review of 75 outpatient-evaluated cases during 13 years.

We reviewed 75 outpatient cases of systemic infection due to group B beta-hemolytic streptococcus (GBS) evaluated during a 13-year period. Patient ages ranged from five days to eight months; 75% were younger than two months. Early-onset (less than or equal to seven days of age) GBS disease occurred in 10% of the patients, and late-onset GBS disease in 90%. The racial distribution was 60% black, 35% white, and 5% Hispanic. Symptoms included fever, irritability, lethargy, and altered-feeding pattern which lasted less than 24 hours in 88% of patients. On presentation, 33% were afebrile (eight had GBS meningitis); 32% did not appear ill (six had GBS meningitis). Of the total, 40% had GBS meningitis, of these, a greater proportion had either early-onset GBS disease or neutropenia. Infection other than meningitis was identified in 24% of all patients: pneumonia (six cases), cellulitis/adenitis (six cases), osteomyelitis/septic arthritis (five cases), and otitis media (one case). All patients survived. Systemic GBS infection in an outpatient population can involve infants up to eight months old, is more common in blacks than in whites, can be present without fever or compromised appearance, and usually has low mortality.

Female↗
PubMed1992

Correlating CBC profile and infectious outcome. A study of febrile infants evaluated for sepsis.

The cases of 1,009 febrile infants who were evaluated for sepsis as outpatients during a seven-year period were reviewed to correlate their complete blood count (CBC) profiles with the infectious outcomes. Eighty-one infants had serious bacterial infections (SBIs); the remainder (928) were culture-negative. The infants with SBIs had a significantly greater mean total white blood cell (WBC) count and absolute band count (ABC) than did those who were culture-negative, whereas the difference in mean percent of polymorphonuclear leukocytes was not significant. The sensitivity of the ABC was significantly superior to that of total WBC count in predicting the outcome of SBI. The diagnostic data provided by the ABC can aid physicians in determining the predictive value of CBC profiles for infectious outcome in febrile infants receiving outpatient sepsis evaluation.

Blood Cell Count↗
PubMed1992

Measuring the spiritual needs of hospital patients and their families.

Uses four psychometric instruments in an attempt to measure the spiritual needs of general hospital patients, family members, and persons from the community. Infers that the data suggest that family members tend to be more involved in a search for meaning than are patients and community persons. Discusses implications of the results for pastoral caregivers.

Chaplaincy Service, Hospital↗
PubMed1992

Inhibition of endotoxin-mediated activation of endothelial cells by a perfluorocarbon emulsion.

Endothelial cell (EC) activation plays a key role in the inflammatory response by promoting the margination of leukocytes in inflamed loci. Augmented leukocyte margination to activated EC is mediated by the increased display of leukocyte adhesion molecules on EC surface membranes. The biocompatibility of synthetic oxygen-transport fluids is intimately linked to EC function, since one of the first tissues encountered by such fluids is the vascular endothelium. We investigated the effect of one such agent, a phospholipid-based perfluorocarbon emulsion containing 90% w/v perflurooctyl bromide (perflubron, PFOB) on EC activation. Human umbilical vein EC (HUVEC) were activated by 5 U/ml interleukin-1 (IL-1), 20 U/ml tumor necrosis factor (TNF), or 50 ng/ml E coli endotoxin (LPS) in the presence or absence of up to 20%, w/v perflubron. HUVEC activation was monitored by the extent of up-regulation of expression of intercellular adhesion molecule-1 (ICAM) and endothelial-leukocyte adhesion molecule-1 (ELAM). Exposure of HUVEC to perflubron did not alter the up-regulation of ICAM or ELAM in response to IL-1 or TNF (n = 20). However, at 10% perflubron ICAM up-regulation in response to LPS was inhibited by 95 +/- 6% (n = 9; p less than .05). ELAM expression was similarly affected. The concentration of perflubron required to diminish LPS-induced up-regulation by 50% was 6.0 +/- 0.6% (n = 3). The inhibitory effect of 10% perflubron was overcome by greater than 1 ug/ml LPS (n = 3) and the inhibitory effect was attenuated by adding perflubron to the cultures after LPS.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Substitutes↗
PubMed1992

The treatment of oligodendrogliomas and mixed oligodendroglioma-astrocytomas with PCV chemotherapy.

Malignant oligodendrogliomas have been shown to be responsive to chemotherapy. The authors administered systemic chemotherapy to seven patients with oligodendroglioma or anaplastic oligodendroglioma, and to 14 with mixed oligodendroglioma-astrocytoma. Fourteen patients underwent chemotherapy before and seven after irradiation. The PCV (procarbazine, methyl-1-(2-chloroethyl)-1-nitrosourea (CCNU), and vincristine) chemotherapy was administered every 6 weeks (42-day cycles) for two to five cycles as follows: CCNU, 110 mg/sq m on Day 1; procarbazine, 60 mg/sq m/day on Days 8 to 21; and vincristine, 1.4 mg/sq m/day on Days 8 and 29. Complete or partial (greater than 50% reduction in tumor mass) responses at 20 to 100+ weeks after treatment were noted in 11 (79%) of the 14 patients treated before irradiation, including two with anaplastic oligodendroglioma and nine with mixed tumors. Complete responses were seen in two patients, one with anaplastic oligodendroglioma and one with a mixed tumor. Partial responses were seen in three of seven patients treated after radiotherapy. Stabilization of tumor growth followed PCV chemotherapy in four patients (two treated before and two after radiotherapy). Tumor growth progressed in two patients during therapy despite an initial response and in two patients despite therapy. The authors conclude that mixed oligodendroglial tumors as well as anaplastic oligodendrogliomas are responsive to PCV chemotherapy.

Adult↗
PubMed1992

Rotavirus diarrhoea in children in the highlands of Papua New Guinea.

Children from the highlands of Papua New Guinea, hospitalized for severe diarrhoea, were examined for clinical signs and the presence of rotaviruses. Rotavirus was detected in faecal samples from 68% (23/38) of patients examined. In contrast to other studies, an excess of respiratory symptoms was not observed and the infection rate of disease due to rotavirus was relatively high in children under 6 months of age. In an environment where pigs and humans share close contact a rotavirus strain infecting piglets was also demonstrated.

Animals↗
PubMed1992

A radiographic comparison of erosive osteoarthritis and idiopathic nodal osteoarthritis.

Clinical, radiographic and histologic features suggest that inflammation is central to the pathogenesis of erosive osteoarthritis (OA). Since mediators of inflammation may activate osteoclasts and stimulate release of metalloproteinases in joint cartilage, we hypothesized that patients with erosive OA may have more joint space narrowing and less proliferative bone response (osteophytes, sclerosis) than those with idiopathic nodal OA. Hand radiographs of 33 patients with erosive OA and 33 age and sex matched patients with nodal OA were evaluated for prevalence and severity of joint space narrowing, osteophytes, subchondral sclerosis, subchondral cysts, erosions and subchondral collapse. While the prevalence and severity of OA was greater at each joint in erosive OA than in nodal OA, significant differences (p less than 0.05) were confined largely to the interphalangeal joints. Among patients with erosive OA, radiographic features of OA were more severe in joints with erosive changes than in joints that did not show erosive change (p less than 0.01 in most cases). Notably, when joints with erosive change were excluded, only joint space narrowing was more severe in patients with erosive OA than in the corresponding joints of patients with nodal OA (p less than 0.001). Our analysis did not support the hypothesis that inflammatory mediators modify chondro or osteoneogenesis in erosive OA.

Adult↗
PubMed1992

Sonographic assessment of late proliferative phase endometrium during ovulation induction.

Late proliferative phase endometrium was assessed sonographically in 400 patients undergoing ovulation monitoring or stimulation. Endometrial evaluation was classified in relation to its widest diameter (quantity) and by the presence or absence of a double-layered (outer echogenic/inner hypoechoic) pattern (quality). No patient conceived if the endometrium was totally echogenic and less than 8 mm in diameter. All patients who conceived had an endometrium that was double-layered or greater than 9 mm in diameter. Positive, double-layered patterns correlated with correction of hormonal aberrations such as hypoestrogenism, hyperprolactinemia or hyperandrogenism. Such a positive pattern was also accomplished after discontinuation of clomiphene citrate in certain low-body weight/low-body fat women and administration of human menopausal gonadotropins to those patients. Application of the principles described to ensure the development of an adequate, double-layered (follicular phase) endometrium at midcycle were found to coincide with a higher incidence of pregnancy and viable gestation.

Chorionic Gonadotropin↗
PubMed1992

Purification and characterization of N-acetyl-alpha-D-galactosaminidase from Gallus domesticus.

Exoglycosidases modify carbohydrate epitopes on glycoproteins and glycolipids. The N-acetyl-alpha-D-galactosaminidase from the domestic chicken, Gallus domesticus, is an important exoglycosidase which degrades the human blood group A epitope. This enzyme has never been demonstrably purified or thoroughly characterized. We have developed a technique to purify this enzyme to homogeneity. The isolated enzyme has a molecular weight of 49.1 kDa by SDS PAGE and 145.0 kDa by gel filtration. The enzyme is highly selective for PNP-N-acetyl-alpha-D-galactosaminide and is inactive against other low molecular weight substrates. The enzyme hydrolyzes the terminal N-acetyl-alpha-D-galactosaminide residues from blood group A2 erythrocytes. Protease activity is below detectable limits. The enzyme has a pH optima of 3.7, a pI of 8.15, is relatively unaffected by ionic strength, and is stable at 4 degrees C.

ABO Blood-Group System↗
PubMed1992

Individualized ramp treadmill. Observations on a new protocol.

The many different approaches to exercise testing have hindered the consistent interpretation of hemodynamic, electrocardiographic, and ventilatory gas exchange responses. One of the most influential approaches is the choice of the exercise protocol. Recent data suggest that the protocol can have an important impact on test sensitivity, the reason for test termination, the ST/HR slope calculation, the interpretation of gas exchange responses, and the accuracy with which oxygen uptake is predicted from work rate. Recent recommendations for optimizing the test have focused on the test duration, reducing the increments in work rate, and individualizing the test relative to the purpose of the test and the subject tested. We describe a treadmill test which considers these recommendations for optimizing exercise testing.

Adult↗
PubMed1992

Standardized instructions: do they improve communication of discharge information from the emergency department?

To determine whether standardized instructions enhance communication of discharge information, we provided 197 parents of children in whom otitis media was diagnosed with one of three types of instruction at the time of discharge from a pediatric emergency department: (1) instruction by individual housestaff and medical students after consultation with an attending physician (control group); (2) standardized verbal instructions given by housestaff and students trained in their use (verbal group); or (3) the same instructions given to the verbal group, together with a type-written copy of the information to take home (verbal + written group). Prior to leaving the emergency department and, again, by phone, 1 and 3 days later, parents were questioned concerning the prescribed medication's name, dose, frequency, and duration of administration (medication data), three signs of improvement, and eight signs indicating the need for medical advice (worrisome signs). The mean percentage of correct responses per parent in each group was computed for each information category. Both at exit interview and at follow-up, parents receiving either form of standardized instructions showed significantly greater knowledge of information related to their child's illness than did controls. Information regarding medication data was more likely to be communicated to parents in all groups than were signs of improvement or worrisome signs. The addition of written instructions to standardized verbal instructions did not improve parental recall of discharge information.

Child, Preschool↗
PubMed1992

A weekend orthopaedic initiative list scheme.

The feasibility and safety of running an elective orthopaedic service at the weekend is demonstrated. Weekend timing of such surgery appears to be very popular with patients. The cost of not assessing patients pre-operatively in terms of theatre time lost is shown.

Ambulatory Care↗