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Biomedical subjects

E Fisher

Publications and source records attributed to E Fisher.

At least 109 records · Page 6Linked to original sources
PubMed1986

Behavioral weight reduction program for mentally retarded adult females.

Behavioral treatment approaches to obesity in 17 mild-to-moderate retarded female adults were assigned to one of two experimental conditions, (a) behavioral self-control along with a physical activity component and (b) behavioral self-control. No significant differences were noted between groups on the indices of body weight and tricep skinfold thickness. A one-way analysis of variance with a repeated measure yielded a significant main effect of time for change in weight for both groups at the end of the 8-week treatment. Questions were raised about the possible role of nonspecific motivational factors versus cognitive factors in behavioral-weight reduction programs.

Adult↗
PubMed1986

Remote skin injury: a protean complication of open heart surgery.

In the 12-month period ending August, 1984, 14 adult patients (2.9%) developed within 24 hr following open heart surgery skin defects of varying magnitude remote from the incision site. Electrical injury secondary to a grounding defect was documented in two patients and suspected in one. Four patients' injuries were caused by the roller device when transfering from operating room table to intensive care unit bed. The remaining eight patients all had skin loss at sites of pressure on either the head, back, buttocks, or arm. Retrospective analysis showed no correlation with mean pressure during cardiopulmonary bypass (CPB), depth of cooling, length of time to rewarm, or the use vasoactive drugs. Subsequently, core temperature plus ten surface temperatures were monitored during and following CPB in ten patients. The data showed that during active cooling and rewarming, skin temperature actually lagged behind the core temperature (4 C). Thus, the skin appears to develop a relative oxygen debt during CPB which may decrease the threshold for skin injury particularly in older patients who may have other predisposing factors, such as obesity, generalized atherosclerosis, diabetes, or friable skin. Pressure points during positioning and subsequent skin trauma must be meticulously avoided in any patient undergoing CPB.

Adult↗
PubMed1985

Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer.

In 1976 we began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of Stage I and II breast tumors less than or equal to 4 cm in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental mastectomy alone, or segmental mastectomy followed by breast irradiation. All patients had axillary dissections, and patients with positive nodes received chemotherapy. Life-table estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant-disease-free, and overall survival at five years that was no worse than that after total breast removal. In fact, disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy (P = 0.04), and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy (P = 0.07, and 0.06, respectively). A total of 92.3 per cent of women treated with radiation remained free of breast tumor at five years, as compared with 72.1 per cent of those receiving no radiation (P less than 0.001). Among patients with positive nodes 97.9 per cent of women treated with radiation and 63.8 per cent of those receiving no radiation remained tumor-free (P less than 0.001), although both groups received chemotherapy. We conclude that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for Stage I and II breast tumors less than or equal to 4 cm, provided that margins of resected specimens are free of tumor.

Breast Neoplasms↗
PubMed1985

In vivo alteration of a mutant human protein using the free thiol cysteamine.

Inborn errors of metabolism in which there is a mutant protein due to a cysteine for arginine substitution may be amenable to treatment with the free thiol cysteamine. Evidence for this derives from patients with type III hyperlipoproteinemia, who are homozygous for apolipoprotein E2, which differs in charge and in vitro function based on a single such amino acid substitution. The plasma of a type III hyperlipoproteinemic patient, when made at least 50 microM with respect to cysteamine in vitro, demonstrated a charge shift of the apolipoprotein E isoelectric focusing pattern from the E2 to the normal E3 and E4 positions. Two children treated for cystinosis with cysteamine each exhibited some charge alteration of their apoE3 to a form migrating in the apoE4 position. The use of thiol reagents such as cysteamine to specifically alter selected mutant human proteins, such as antithrombin III Toyama, may be added to our therapeutic armamentarium in the treatment of life-threatening metabolic disorders.

Apolipoprotein E2↗
PubMed1985

Cardiorespiratory disease associated with Hallermann-Streiff syndrome: analysis of craniofacial morphology by cephalometric roentgenograms.

This paper analyzes the craniofacial morphology in a patient with typical Hallermann-Streiff syndrome (HSS) who developed symptomatic cardiorespiratory deficiency at the age of 48 years. The patient had obstructive sleep apnea (OSA), hypoxia, hypercarbia, pulmonary hypertension, tricuspid insufficiency, and right ventricular failure. Analysis of cephalometric roentgenograms, done 15 years earlier, revealed severe mandibular hypoplasia with marked underdevelopment of the ramus and body. The gonial angle was abnormally obtuse. The condylar and coronoid processes were reduced in size. The anteroposterior dimension of the upper airway was markedly narrowed. Cephalometric roentgenograms of six other HSS patients from our clinic were compared to those of the reference patient. Considerable variation in the features of the syndrome were noted. None of the other patients showed definitive airway obstruction. Comparison was also made with cephalometric roentgenograms of a patient with Treacher Collins syndrome and of a patient with progeria. The former showed airway obstruction associated with a deformed hypoplastic mandible; the latter had an unobstructed airway despite a small mandible because of associated hypoplasia of the maxilla and tongue. The HSS reference patient improved after oxygen therapy, diuretics, antibiotics, and relief of OSA. Patients with HSS, as well as those with Treacher Collins syndrome, appear to be at risk for the development of cardiopulmonary disease if they have obstructed airways. OSA has been shown to have developed in two patients with HSS. The resultant cardiopulmonary insufficiency of such patients may be preventable if airway obstruction can be relieved relatively early in life.

Adolescent↗
PubMed1984

Assessing physical containment in recombinant DNA facilities.

This paper has presented a computer model that has been developed to explore the effectiveness of various physical containment strategies. The specific applications that are considered here concern recombinant DNA operations, a technology where technical constraints inhibit the direct monitoring of physical containment effectiveness. Simulations have been used to assess several aspects of recombinant DNA containment, including the effects of using different protocols and host organisms, establishing tradeoffs between physical and biological containment levels, and recognizing the variability introduced by human error and equipment failures. In considering these questions, we have focused on the operator's exposure, although the model that has been developed can also be used to estimate the total release of viable recombinant organisms to the environment. Comparing benchtop protocol simulation results with scale-up protocol results indicates that operator exposure in the former situation may be two or three orders of magnitude lower. A similar difference is apparent between the operator's exposure during a standard scale-up protocol and a protocol that replaces manual sampling with automated sampling. Because the specific activities in a facility influence organism release dramatically, physical containment effectiveness cannot be represented with a single estimate of organisms released per facility per time for each containment level. Results from simulations using E. coli chi 1776 and simulations using hardier organisms indicate that, in a well ventilated facility, the operator's inhalation of viable organisms is essentially unaffected by using the disabled host organism. It should be noted, however, that these simulation results only reflect the differences in the survival of the aerosolized organisms; the relative survival and establishment of organisms after inhalation is not considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Computers↗
PubMed1983

Efficacy of pulmonary artery banding in infants with complete atrioventricular canal.

Total correction in infants less than 1 year old with complete atrioventricular (AV) canal carries a significant operative mortality. However, past reports suggest that the alternative palliative procedure, pulmonary artery banding (PAB), may be contraindicated in the presence of severe mitral insufficiency and/or a large left ventricular to right atrial shunt. Contrary to these previous reports, we report the results in 21 consecutive patients with congestive heart failure who underwent PAB at a mean age of 3.9 +/- 2.8 months and at a weight of 3.6 +/- 0.9 kg. (17/21 less than 6 months). Regardless of mitral valve competency, PAB was performed in conjunction with ligation of a patent ductus arteriosus (11 patients) and coarctation repair (two patients) with one death secondary to gastrointestinal bleeding (4.7% in-hospital mortality); one patient required early band readjustment because of hypoxemia. Repeat cardiac catheterization in 10 patients performed 4 to 41 months after PAB showed significant reduction in pulmonary hypertension and flow with no change in pulmonary vascular resistance. All infants were symptomatically improved after PAB and four have undergone successful total correction. Previous reports since 1977 indicate a significantly higher risk for total repair of complete A V canal before 1 year of age (36/147, 24%) than the risk for PAB in this series (p less than .05). Therefore, we believe that PAB is a rational alternative to total repair as the initial surgical treatment for symptomatic infants with complete A V canal, particularly when anatomic variants known to increase operative risk are recognized before cardiotomy.

Cardiac Catheterization↗
PubMed1982

Aortic thrombosis after umbilical artery catheterization.

Neonatal arterial thrombosis has become more common with the use of umbilical artery catheters; however, catheter-induced aortic thrombosis is rare. A review of the literature disclosed a 100% mortality from medically managed neonatal aortic thrombosis. Two cases of umbilical artery catheterinduced acute neonatal thrombosis were managed successfully by surgical thrombectomy. Severe lower extremity ischemia and hypertension with aortic occlusion developed in two neonates, and intractable congestive heart failure developed in one of the neonates. This seems to be the first documented report of successful surgical treatment of umbilical artery catheter-induced aortic thrombosis. Acute neonatal aortic occlusion should be considered a surgical emergency.

Acute Disease↗