Biomedical subjects
E Phillips
Publications and source records attributed to E Phillips.
Petrillo and its progeny: the Illinois judicial ban on ex parte communications in medical malpractice cases comes under fire.
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Accountability, responsibility, liability.
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The effect of modulation of central serotonin neurotransmission on osmoregulated vasopressin release in rats.
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Role of lymphadenectomy in the treatment of renal cell carcinoma.
We evaluated the role of lymphadenectomy (LND) in the prevention of local recurrence following radical nephrectomy for renal cell carcinoma (RCC) by two retrospective studies. In one, the relative importance of various tumor characteristics to the subsequent development of local recurrence was investigated in 37 patients who underwent radical nephrectomy and later progressed. In 29 evaluable patients, only nodal metastasis was predictive of local recurrence, which developed in 6 of 7 node-positive patients. In our second study the records of 69 consecutive patients with RCC who underwent radical nephrectomy with or without simultaneous LND (N = 42 and 27, respectively) were reviewed. Local control after LND was excellent in node-positive disease; in no node-positive patient with unilateral RCC has a local recurrence developed (N = 5). LND did not extend hospitalization or add to the morbidity of radical nephrectomy.
Hinman syndrome: a vicious cycle.
In Hinman syndrome, psychosocial problems are associated with voiding dysfunction, urinary tract infections, and incontinence. The latter can exacerbate the former and a vicious cycle can result in worsening symptoms and renal sequelae. Although interruption of this cycle is difficult, urologic recognition and treatment can have a positive effect. Five cases are presented that demonstrate the cyclical features of Hinman syndrome.
Laparoscopic cholecystectomy in patients aged 65 or older.
Laparoscopic cholecystectomy is replacing open cholecystectomy in the surgical management of gallstone disease in healthy individuals. However, the role of laparoscopic cholecystectomy in patients thought to be at higher risk for surgical morbidity is still being defined. The course of patients aged 65 or greater who underwent attempted and successful laparoscopic cholecystectomies were reviewed. Eleven patients (12%) were converted from laparoscopic to open cholecystectomy. For the 83 patients completing laparoscopic cholecystectomy, the median time of surgery was 115 min and the median length of postoperative stay was 1 day. Two patients required parenteral analgesia longer than 48 h. Seven patients were admitted and monitored postoperatively, although five of these were preoperatively planned. Five patients were readmitted within 30 days. One patient was admitted with a myocardial infarction, one a subphrenic abscess, one an incarcerated hernia, one with pyrexia and leukocytosis (for which no source was identified), and one for an elective urinary tract procedure. Laparoscopic cholecystectomy provides patients aged 65 or older the same benefits of shorter hospital stay and less pain than it provides younger patients. Age alone should not be a contraindication to attempted laparoscopic cholecystectomy.
A two-person, two-handed technique for laparoscopic cholecystectomy.
This manuscript describes a technique of laparoscopic cholecystectomy which permits the surgeon to use both hands. The technique can be modified to accommodate both right- and left-handed surgeons. Advantages we have appreciated in performing over 100 procedures in this manner include a less crowded operating environment, a less costly operating team, and a resident assistant closer to the patient with two hands available so that he or she can better develop the co-ordination necessary to assume increasing responsibility for the procedure.
Villous adenoma of the duodenal bulb.
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Routine operative cholangiography in patients undergoing laparoscopic cholecystectomy.
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Cloned murine bradykinin receptor exhibits a mixed B1 and B2 pharmacological selectivity.
We have isolated DNA clones encoding functional bradykinin receptors from human, rat, and mouse sources. Genomic bradykinin receptor clones have been isolated from mouse and human cosmid libraries and cDNA clones have been isolated from the human lung fibroblast cell line W138, from the neuroblastoma/glioma hybrid NG108-15, and from rat dorsal root ganglion cells. The receptor protein is encoded by an intronless region of the gene in both mouse and human. There is evidence of a splice acceptor site 8 bases upstream from the initiation codon in all three species. The function of the expressed receptor proteins from mouse, rat, and human was tested by electrophysiological assays after injection of cRNA into Xenopus laevis oocytes and also by binding assays with membranes from COS-7 cells transfected with cloned receptor-encoding DNA. The receptors from human and rat showed the pharmacological properties of B2 receptors in both expression systems when tested with a variety of bradykinin analogues, but receptors from mouse divided into two populations, one population with pharmacological properties of B1-like receptors and another, larger, population with properties of B2 receptors.
Income growth among nonresident fathers: evidence from Wisconsin.
This study examines the changes over time in the personal incomes of nonresident fathers--whether divorced or nonmarital--in Wisconsin. Using data from the Wisconsin Court Record data base and the Wisconsin Department of Revenue, the authors examine the incomes of these fathers over the first seven years following a divorce or the initiation of a paternity suit. They also study separately the income patterns of initially poor nonresident fathers and fathers whose nonresident children receive welfare. The most important finding is that the incomes of nonmarital fathers, which typically are low in the beginning, increase dramatically over the years after paternity establishment--often to a level comparable with the incomes of divorced fathers. On the basis of their findings, the authors conclude that failing to establish child support obligations for nonresident fathers simply because their incomes are initially low does not appear justified.
Detection of a soluble antigen defined by monoclonal antibody 83D4 in serous effusions associated with breast carcinoma.
Monoclonal antibody (MoAb) 83D4 was generated by immunization with cell suspensions obtained from sections of formol-fixed paraffin embedded human breast cancer. It recognized an antigen expressed in breast carcinomas but not in normal breast tissue. Pleural and ascitic fluids from 66 patients were studied by an 83D4 heterologous sandwich radioimmunoassay (SRIA) using solid-phase immobilized wheat germ agglutinin to detect the 83D4 soluble antigen. Using a cutoff level of 5 units/ml of 83D4 antigen, higher values were found in 22 of 27 breast cancer-associated effusions (mean = 10.72 +/- 6.80 units/ml). The 20 nonmalignant effusion fluids tested showed lower values (mean = 1.16 +/- 1.49 units/ml, P less than 0.001). The antigen was undetectable or present in low levels in effusions from patients with hematologic malignancies. When SRIA results were compared with conventional cytologic diagnosis in breast-cancer effusions, elevated levels of 83D4 soluble antigen were found in all patients (8 of 8) in whom malignant cells had been detected, in 4 of 8 patients with the diagnosis of "suspected malignancy," and in 10 of 11 patients with negative cytologic findings. Using an immunoglucosidase method on cell smears of various origins, MoAb 83D4 stained metastatic cells of breast and ovary carcinomas but did not reactive with mesothelial cells and other normal or malignant cell types. These results suggest that quantitation of the 83D4 soluble antigen may be used to improve the diagnosis of cancer in serous effusions.
Expression of functional bradykinin receptors in Xenopus oocytes.
mRNA prepared from various tissues and cultured cells was injected into Xenopus laevis oocytes. Three to five days after injection, the response of the oocytes to the peptide bradykinin was monitored. The oocytes were voltage clamped and the membrane currents generated on application of agonist were recorded. mRNA from NG108-15, rat uterus, and human fibroblast cell line WI38 gave similar responses to bradykinin (1 microM), with an initial inward current (10-20 nA) followed by a prolonged period of membrane current oscillations. The same pattern of response was given by total RNA from rat dorsal root ganglia. No response to bradykinin (10 microM) was recorded from oocytes injected with rat brain mRNA, although these oocytes gave peak inward currents of about 75 nA in response to serotonin (10 microM). mRNA from both NG108-15 cells and rat uterus was fractionated on sucrose gradients. This resulted in an approximately five-fold increase in the size of the response compared to that given by unfractionated mRNA. The largest responses were given by mRNA fractions with a size of approximately 4.5 kb. Data were obtained consistent with the expression of both B1 and B2 receptors by WI38 human fibroblasts and with the expression of only the B2 type of receptor by NG108-15 cells.
The role of cholangiography in laparoscopic cholecystectomy.
Cholangiography is not routinely performed in open surgery, but there are reasons why it should be in laparoscopic cholecystectomy. These include finding common duct stones, identifying the cystic-common duct junction, and noting an inadvertent injury. Thirty-six (7.0%) of 516 laparoscopic cholecystectomies were converted to open surgery; 24 before attempting cholangiography and 12 based on roentgenographic findings. In 73 patients (14.1%), cholangiography showed abnormal findings. Common duct injury was identified in one patient and common duct stones were found in 35. Twenty-one patients were treated laparoscopically and eight underwent open choledocholithotomy. In 22 patients, a short cystic duct was seen that might otherwise have been overlooked, and possible injury was avoided. Cholangiography should be attempted routinely, so that in cases with abnormal findings, open cholecystectomy may be considered.
A randomized trial of sodium fluoride as a treatment for postmenopausal osteoporosis.
The anti-fracture efficacy of sodium fluoride (NaF) was evaluated in 84 postmenopausal white women with spinal osteoporosis. The dose of NaF used was 75 mg/day and all patients in this prospective, randomized, double-blind, placebo-controlled clinical trial received calcium supplements (carbonate salt) 1500 mg/day in addition to participating in a structured physical therapy program. For each of the outcome measures (change in stature, change in cortical bone mass in the forearm and development of new vertebral fractures determined by change in vertebral morphometry and by scintigraphy) there was no significant difference between the fluoride or placebo treated groups. Side effects, predominantly gastrointestinal symptoms and the development of the painful lower extremity syndrome, occurred significantly more frequently in the fluoride group (P less than 0.05). Peripheral fractures were not more frequent in the fluoride group. We conclude that, in the dose and manner used in this study, NaF is no more effective than placebo in retarding the progression of spinal osteoporosis. There is no role for NaF in the treatment of osteoporosis outside the confines of clinical research.
Patient peer orientation groups: an innovative approach.
Both clients and staff can benefit from a patient orientation program conducted at a state psychiatric facility by a psychologist and a registered nurse. The program cited by the authors utilized a group format to decrease the stress experienced by clients when transferred from a closed to an open ward, and to increase the social skills of clients residing on an open unit. Informal observation and verbal feedback from clients and staff indicated positive reactions to the program and noticeable behavior changes. Recommendations include replication of this program on a large scale with control group comparisons, formal assessment, and statistical analysis of the results.
Fatal pneumococcal infection: another plea for the pneumococcal vaccine.
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