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Biomedical subjects

G W Peskin

Publications and source records attributed to G W Peskin.

At least 37 records · Page 2Linked to original sources

Metiamide: more than an H2-receptor antagonist.

The effect of metiamide on acid secretion and calcium uptake by the frog gastric mucosa was tested alone and in combination with histamine, pentagastrin, aminophylline, and dibutyrl cyclic AMP (db cAMP). Metiamide inhibited all stimulants including db cAMP which presumably acts intracellularly beyond the H2 receptor. Metiamide, therefore, actively inhibits at a point within the cell beyond the adenylated cyclase membrane receptor complexes. Metiamide also increases calcium influx into the parietal cell, suggesting yet another possible mechanism of inhibition.

Animals↗

Expanding indications for early parathyroidectomy in the elderly female.

In a study of fifty consecutive patients with hyperparathyroidism we have noted: (1) Automated laboratory studies have increased the incidence of diagnosed hyperparathyroidism, especially in the elderly. (2) Bone abnormalities and mental changes are the most frequent symptoms in this older population. (3) Natural history studies have produced some delay in surgical treatment, accentuating mental aberrations and bone-associated deficits. Especially in the elderly, the benefits in personality change, feeling of well-being, and lessened bone deterioration warrant early operation.

Aged↗

Computerized drug dosing in renal failure: a real problem and a practical solution.

In the presence of impaired renal function a number of pharmacologic agents require dose adjustments to avoid toxicity. Physician dose variations of a wide range of pharmaceuticals, 237 orders for 30 drugs for 107 patients, were compared to doses recommended by a computer program which considers renal function in calculating its dose. Disagreement in dose regimens was evaluated by comparison of physician-dose to computer-dose for three classes of drugs: wide range, narrow range, and 80% renally excreted. With true renal impairment (serum creatinine greater than or equal to 1.2 mg/100 ml and creatinine clearance less than 80 ml/m) significant overdosing occurred for narrow range and 80% renally-excreted agents, 83 and 77% respectively. There is a great potential hazard observed to be avoided. It is recommended that dose adjustments for nephrotoxic or renally-excreted agents be implemented using creatinine clearance (estimated or measured) with, at the very least, manufacturer's recommendations.

Computers↗

Tumor imaging with x-rays using macrophage uptake of radiopaque fluorocarbon emulsions.

Radiopaque fluorocarbon (RFC) emulsions were prepared with small particle size and high concentration of the fluorocarbon. When RFC emulsions were injected intravenously in hamsters, rats, and mice with eight types of malignant tumors, the tumors became radiopaque, except in the mice with spontaneous teratoma of the ovaries. Tumors as small as 3 to 4 mm could be defined radiographically using routine x-ray techniques. The tumors remained radiopaque for days to weeks after injection. Light and electron microscopy revealed characteristic fluorocarbon vacuoles primarily in the tumor macrophages. Thus RFC emulsions may be useful in detection of malignant tumors.

Animals↗

Early appearance of abscess after biliary operation.

Three patients who had an air shadow and fluid levels within seven days after biliary surgery are discussed. In retrospect, this direct evidence of a postoperative abscess was overlooked because of its early appearance and other sources of fever that coexisted.

Aged↗

A study of fundoplication disruption and deformity.

Three distinct forms of postoperative breakdown after Nissen fundoplication have been discussed. Disruption and recurrent reflux is most common, with slipping occurring infrequently. For the first time, three patients developing a proximal gastric pouch deformity causing partial obstruction of the fundus without recurrent herniation are reported on. Two patients required remedial surgery.

Aged↗

Improved retention of stroma-free hemoglobin solution by chemical modification.

The major problems requiring solution before full-scale evaluation of stroma-free hemoglobin solution (SFHS) in a clinical environment are its high oxygen affinity and relatively short intravascular retention time. Through postmanufacture chemical modification of SFHS we have been able to improve both properties as determined in in vitro and in vivo studies. Permatization of SFHS with pyridoxal 5'-phosphate (PLP) does not affect oxygen-carrying capacity and improves the P50 and intravascular retention. This chemically modified hemoglobin is worthy of further evaluation.

Animals↗

Surgical continuing medical education: format and impact.

A survey of 140 continuing medical education (CME) offerings in surgery for 1975-1976 was undertaken. In no instance was there evidence of evaluation of learning or behavior changes after the experience on the part of the sponsors. Estimated cost from the data obrained, 83 courses, was approximated at two million dollars. There is no evidence that this modality achieves the objective of improved patient care. A change from the education-based existing system to a competency-based evaluation system is proposed. The latter, a multicomponent system, has an objective cognitive skills measurement and a measurement of behavior as major elements. Computer simulation-modeling using patient-problems is proposed to define deficits and to be used as an active participatory educational modality. Development of practice profiles, establishment of a data base for determining patient outcome, including morbidity and mortality data, and identification of measures to determine rate of adoption of innovation and loss of obsolescent concepts are required to define behavioral changes. Under the guidance of academic and professional societies working in the community, an effective competency-based educational system dedicated to improved patient care can be specified and implemented.

California↗