Biomedical subjects
Publications and source records attributed to J Fisher.
A simple method of grafting around draining abdominal wall fistulas is described. A Silastic sump drain stapled into a doughnut configuration is used. This produces a barrier around the fistula which drains the fluid off as it reaches the perforations of the sump drain.
The reliability of the latissimus dorsi musculocutaneous flap for breast reconstruction following radical mastectomy and an axillary dissection that may have divided the thoracodorsal vessels is enhanced by preservation of the serratus collateral into the flap. Observations during axillary dissections have confirmed the constant presence of the serratus branch. Primate studies document latissimus dorsi flap viability when elevated on this branch. Studies during microvascular transfer document reversal of flow in the serratus branch to supply the latissimus dorsi muscle after division of the thoracodorsal artery. Latissimus dorsi flap elevation as an island may be reliably based on the serratus branch.
Fifty-three married patients with a wide range of severe, persisting psychiatric disorders were randomly allocated to a form of couples therapy (spouse-aided therapy) or to individual therapy. Both were outpatient, goal-oriented therapies, with an overall mean duration of 9.5 hours. Before, during, immediately after, and three months after therapy, patients and spouses completed ratings of target and personal problems, sexual activity and attitudes, psychological symptoms, and marital satisfaction. Ratings were also conducted by independent assessors. Spouse-aided therapy proved superior to individual therapy at a statistically significant level on most outcome measures, with clinically worthwhile improvements in symptoms, problems, and marital satisfaction in both partners. Individual therapy was followed by improvement in some symptoms, but marital dissatisfaction increased and both partners were more depressed at three months follow-up than before treatment.
Twenty four hour recordings of heart rate and respiration were made on 60 infants with lower respiratory tract infection (LRTI) during the acute phase of the illness, on 20 infants with upper respiratory tract infection (URTI) and on 21 control infants. Infants with LRTI and URTI had more apnoeic episodes of longer than 10 seconds compared with controls. The length of apnoeic episodes was greatest in the LRTI group but their frequency decreased with age. In both the LRTI and URTI groups apnoea was associated with bradycardia but the LRTI group also suffered an appreciable number of episodes of bradycardia without apnoea.
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Corticotropin-releasing factor (CRF), recently isolated from sheep hypothalami, has been shown to stimulate secretion of ACTH and beta-endorphin in vitro, and in vivo in rat and man. In previous reports, responses to ovine CRF were studied in heterologous bioassay systems where the ovine sequence was likely to act as a CRF analogue. We administered synthetic ovine CRF to sheep to assess the dynamics of endorphin and cortisol responses. Graded doses of CRF caused a rapid increase in immunoreactive beta-endorphin (iB-E) within 2 min of iv administration, followed by a cortisol response which was maximal 15 min after the iB-E peak. Doses of CRF in excess of 10 micrograms did not increase the magnitude of the peak iB-E response but did prolong the duration of the plasma beta-endorphin rise. Ovine CRF is an extremely potent and rapidly-acting hypothalamic peptide in vivo when assayed in a homologous system.
Two newborn infants had isolated radial nerve lesion documented on electromygraphy. Fibrillation potentials present in one child at age 6 days suggest the possibility of an in utero onset. Skin necrosis present above the triceps muscle and radial nerve favors an entrapment mechanism, possibly from the umbilical cord. Because both patients had complete resolution in 4 months, it is important to differentiate this lesion form the more common but more serious medial brachial plexus lesion.
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We retrospectively reviewed the charts of 308 admissions to a pulmonary disease ward and 100 admissions to the general medical service over one year to find the prevalence, sequelae, and etiology of hypophosphatemia. The overall prevalence of low serum phosphate levels (less than 2.4 mg/dl) occurring at least once during hospitalization in chest patients was 17 percent, but was higher in patients with respiratory infections (28 percent). Moreover, the prevalence of hypophosphatemia on admission (before institution of intravenous fluid or drug therapy) was ten times higher in patients with respiratory infections than in patients with noninfectious respiratory illness or general medical patients (21 vs 2 percent, p less than 0.001). Serum phosphate less than 2.0 mg/dl occurred in 4 percent of patients. Twenty-seven percent of the patients (including two with ventilatory failure) with abnormally low serum phosphate levels had symptoms or signs of uncertain etiology later explicable by the presence of hypophosphatemia. The most common additional laboratory finding associated with hypophosphatemia was elevation of muscle enzymes. Although mortality was no higher in hypophosphatemic patients, hospital stay was twice as long as that of patients with normal levels of serum phosphate. No correlation was found between simultaneous arterial blood gases and serum phosphate levels. Two patients given antacids had severe hypophosphatemia and worsened ventilatory function; phosphate-binding antacids should be used judiciously in patients with severe respiratory disease, since they may lead to the development or worsening of hypophosphatemia and diminished ventilatory function.
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The apo chicken egg white riboflavin binding protein complexes several anthracycline antitumor antibiotics and their metabolites. The Kd value for three important anthracycline glycosides (adriamycin, daunomycin, aclacinomycin A) is approximately identical at 0.5 micro M. The anthracycline occupies the flavin binding site in this complex, having its D-B rings overlaying the region normally occupied by the riboflavin A-C rings, respectively. The glycoside of the anthracycline, attached to C-7 of the A ring, is exposed to the solvent; consequently, the binding protein discriminates poorly between anthracycline A ring geometric isomers. Anthracyclinones, metabolites lacking the C-7 glycoside, are bound about 10-fold more tightly. The basis for the occupancy by anthracyclines of this flavin binding site is a steric homology (both ligands contain planar, linear conjugated rings) permitting the energetically favorable displacement of water from the hydrophobic pocket. The binding protein-anthracycline complex has been used for anaerobic aqueous redox titrations. Dithionite reduction of the anthracycline glycoside provides, in a two-electron process, the 7-deoxyanthracyclinone, via reductive elimination. The bound 7-deoxyanthracyclinone is then further two-electron reduced to the bound hydroquinone. Semiquinone radical intermediates are observed transiently; these are neither stable in solution nor complexed to the binding protein. Oxidation of the hydroquinone is accomplished by several reagents (oxygen, hydrogen peroxide, ferricyanide, cytochrome c). In the case of 7-deoxydaunomycinone hydroquinone, a mixture of two products is produced upon oxidation; these are the chromo-7-deoxydaunomycinone (identical with the first 2-e- reduction intermediate) and its leuco isomer, 8-acetyl-7,8,9,10-tetrahydro-5,8,12-trihydroxy-1-methoxy-6,11-naphthacenedione (iso-7-deoxydaunomycinone). These studies provide useful information concerning the redox properties of the anthracyclines and suggest that these antitumor antibiotics may be capable of functioning as riboflavin antagonists in vivo.
The ventricular fibrillation threshold (VFT) is a measure of myocardial electrical vulnerability to exogenous electrical stimulation. Previous studies have shown that the VFT is inversely related to ischemia. We studied the relation of the VFT to myocardial blood flow (MBF) during ischemia produced by interruption of blood flow to the left anterior descending coronary artery, and severe ischemia produced by retrograde bleeding an ischemic segment of myocardium. The VFT with severe ischemia (8.6 +/- 1.3 mA; MBF 0.024 +/- 0.01 ml/min/gm tissue), although lower than nonischemic control values (14.2 +/- 2.0 mA; 0.76 +/- 0.05; both p less than 0.05), was higher than that obtained with moderate ischemia (4.6 +/- 0.9 mA; 0.15 +/- 0.02 ml/min/gm; both, p less than 0.05). Thus the relationship between the VFT and MBF is nonlinear. Interventions which cause the VFT to rise may do so by worsening rather than improving regional MBF.
The superior approach to the mitral valve through the dome of the left atrium was used for division of a left free wall anomalous pathway. It has been the approach of choice for mitral valve operations at our institution for the past 15 years, facilitating operations particularly when the left atrium is normal in size. Other approaches to the mitral valve are discussed.
Mean inspiratory flow, occlusion pressure and end-tidal PCO2 were measured in six healthy, sitting subjects, during breathing air and rebreathing carbon dioxide, before and after pentazocine 0.5 mg kg-1 i.v. and again after naloxone 20 micrograms kg-1. Pentazocine reduced the occlusion pressure and inspiratory flow responses at a given PCO2 during carbon dioxide rebreathing and these effects were antagonized by naloxone. The relationship of inspiratory flow and end-tidal carbon dioxide during rebreathing was used to measure the PCO2 value at which mean inspiratory flow was 1 litres-1. Occlusion pressure at this PCO2 was reduced in all the subjects by pentazocine, suggesting that the generation of inspiratory flow required less muscle activity. This effect was antagonized by naloxone.
The force required to dilate the uterine cervix to a diameter of 8 mm has been measured in 200 non-pregnant and 40 early pregnant patients. In general, the resistance offered by the cervix was lower in parous than in nulliparous subjects and in pregnant compared with non-pregnant subjects. The phase of the menstrual cycle did not appear to influence cervical resistance but the highest recordings were seen in postmenopausal subjects. Particularly low resistance was encountered in women receiving Depo-Provera for contraceptive purposes.
Subendocardial and early transmural ischemia may have significant clinical consequences while manifesting few ECG changes. Catheters were designed to be introduced transvenously into the right ventricle (RV), and coronary sinus (CS) and transarterially into the left ventricle (LV). The intracavitary electrodes were modified so that the electrodes would not contact the endocardium. In twenty-two dogs ninety-eight graded stenoses of the circumflex and left anterior descending coronary arteries were performed while electrograms (EGM) were recorded simultaneously from the intracardiac (IC) electrodes and surface ECG. Of those stenoses resulting in only nonspecific ECG changes, there were specific ischemic changes on 100% of LV, 60% of RV, and 89% of CS electrograms. Of those stenoses which resulted in no ECG change, there were specific ischemic changes in the 9/31 (29%) of LV, 3/31 (10%) of RV, and 6/31 (19%) of CS electrograms. Recognizable patterns of change occur on the intracardiac electrograms in response to both stenosis and reperfusion, earlier than any change on the ECG. Besides being more sensitive, intracardiac electrodes allowed for the detection of ischemia even in the presence of intraventricular conduction defects, strain patterns, and possibly other situations which might otherwise mask ischemic changes on the ECG.