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Biomedical subjects

J Palmer

Publications and source records attributed to J Palmer.

At least 235 records · Page 13Linked to original sources
PubMed1986

Continuous arteriovenous hemofiltration: improved survival in surgical acute renal failure?

Continuous arteriovenous hemofiltration (CAVH) is an effective method for renal failure management that has the potential to decrease mortality rates. This hypothesis has not been comparatively studied. Fifty six patients with acute oliguric renal failure complicating multiple organ failure had measurements of resting energy expenditure by indirect calorimetry, caloric and protein intake, energy balance, and outcome. Two management protocols included hemodialysis, full calories, and low protein (phase I) or CAVH, full calories, and high protein (phase II). The survival rate in phase I was 12% and 28% in phase II (not a statistically significant difference); CAVH did facilitate parenteral feeding. Patients with positive energy balance had improved survival compared with those with significant energy deficit (37.5% versus 9.4%, p less than 0.025). We conclude that full nutritional support improves survival in acute renal failure. The method of renal replacement therapy is of secondary importance, but CAVH has distinct advantages in the nutritional management of surgical patients.

Acute Kidney Injury↗
PubMed1985

Frozen sections of bone biopsies in metabolic and other bone diseases.

Frozen sections of bone trephine and needle biopsies can be satisfactorily cut in a standard cryostat and, when stained with haematoxylin and eosin, they enable a rapid diagnosis to be made in a wide range of metabolic bone disorders including Paget's disease, osteoporosis, osteomalacia, hyperparathyroidism and renal osteodystrophy. Neoplastic disease of bone may also be diagnosed using the same technique. A tissue diagnosis can be established within an hour of the biopsy being taken, instead of the 1-3 weeks required for resin section diagnosis, with a consequent potential saving in further costly biochemical and radiological investigations, a possible shortening of the patient's stay in hospital and earlier initiation of correct treatment. The method is quick, reliable and highly cost-effective; it is of particular value in laboratories with insufficient workload to justify the expenditure on specialized microtomes and reagents for resin embedding.

Biopsy↗
PubMed1984

Femoral head vitality at reoperation for femoral neck fracture complications.

In seven patients suffering redisplacement, nonunion or segmental collapse after nailing of femoral neck fractures, subsequent changes in the vitality of the femoral head were studied with tetracycline labeling and 99mTc-MDP scintimetry. At reoperation (total hip arthroplasty), the femoral heads were extracted and sawn into slices which were then analyzed. Vitality before nailing was totally lacking (tetracycline labeling) in one case (nonunion), and in the remaining cases moderate reduction was seen, most pronounced in the apical part of the head. In all cases, scintimetry 1-2 weeks after nailing showed reduced femoral head uptake of 99mTc-MDP, but scintimetry some hours before reoperation showed increased femoral head uptake. Isotope analysis of the slices from the extracted femoral heads showed marked reduction of uptake in the apical part of the head, moderate reduction in the distal and anterior parts, and satisfactory uptake in the posterior part of the head and the foveal region, though with individual variations. It was concluded that there is a genuine increase in uptake (revascularization) later in the course in postoperatively avascular heads, and that the apical part of the femoral head sustains the most pronounced vascular damage in femoral neck fracture and is probably the slowest to revascularize.

Aged↗
PubMed1984

Arthritis in cystic fibrosis.

We have confirmed previous observations of a transient, non-disabling recurrent arthritis in patients with cystic fibrosis. This arthritis differs from classic rheumatoid arthritis, is frequently associated with skin arthritis lesions, and its occurrence is unrelated to the severity of lung disease.

Adolescent↗
PubMed1984

Evaluation of a paper-patch test for sweat chloride determination.

This article evaluates a recently developed qualitative sweat patch test (SPT). A battery-powered stimulator with polymer pad electrodes is used to stimulate sweating, followed by the application of a paper patch which collects the sweat and shows color change on sweat chloride levels above 40 to 50 mEq/l. Our data consist of 66 patients with cystic fibrosis, 75 control subjects, and 37 relatives of patients with cystic fibrosis, excluding 22 subjects (11%) with insufficient sweat. There were no false-negative results among 66 patients with cystic fibrosis, and in the control group, 71 of 75 subjects gave negative results and the other four gave positive results. Of the 37 relatives, eight gave positive results; all of the eight subjects are parents of patients with cystic fibrosis. Our results indicate that SPT is useful and reliable when there is sufficient sweat. This portable and simple patch test may serve as an excellent screening test for cystic fibrosis.

Adolescent↗
PubMed1984

Femoral anatomy described in cylindrical coordinates using computed tomography.

A new method, which describes the femoral anatomy in terms of angles and distances is presented. Primary data are obtained from CT and reduced to cylindrical coordinates by a computer program. The approach yields rotational angles for the entire shaft and demonstrates the limitation of conventional measurements of the anteversion angle. The method is proposed as a generalized technique for measurement of rotation in orthopedic radiology.

Biomechanical Phenomena↗
PubMed1984

Clinical comparison of bone scintigraphy with 99Tcm-DPD, 99Tcm-HDP and 99Tcm-MDP.

The bone-imaging agents MDP, DPD and HDP were compared radiochemically (only minor differences were found) in 12 patients with prostatic and 12 patients with breast carcinoma. Each patient received both MDP and either DPD or HDP. The scintigraphic examinations were compared visually and quantitatively. The uptake ratio normal bone/soft tissue was higher for DPD and HDP than for MDP. The ratio pathologic bone/normal bone was highest for MDP, particularly for prostatic carcinoma. The differences in this ratio for breast carcinoma were in general non-significant. The observed differences were minor and of little practical importance.

Aged↗
PubMed1984

Kinetics of 201Tl uptake in adenomas and well-differentiated carcinomas of the thyroid. A double isotope investigation with 99Tcm and 201Tl.

A visually increased uptake of 201Tl chloride corresponding to a 'cold' (131I or 99Tcm ) thyroid nodule is mostly seen in well-differentiated carcinomas but also often in follicular adenomas. Since a visually increased uptake of 201Tl can be due to an increased initial uptake and/or a delayed elimination, an extended dynamic investigation was performed in patients with well-differentiated carcinomas or with follicular adenomas. Data were collected in a dynamic simultaneous double isotope ( 99Tcm + 201Tl) study up to 50 min after intravenous administration. Adenomas could be significantly separated from carcinomas by the elimination (p = 0.0001), but not by the initial uptake.

Adenoma↗
PubMed1983

Allophenic mice produced from embryos aggregated with antibody.

One difficulty in the production of allophenic mice by aggregation of preimplantation embryos is that they frequently roll apart before the bonds between the blastomeres have had time to form. One solution to the problem, described here, is to pretreat one of the embryos with rabbit anti-mouse serum just prior to pushing them together. Blastocyst formation is unhampered by antibody treatment, and numerous allophenic mice have already been produced with this new procedure.

Agglutination↗
PubMed1983

The Nb rat prostatic adenocarcinoma's dose response to methotrexate and adriamycin.

The Noble rat prostatic adenocarcinoma, Nb-Pr-A.I.-II, an androgen-insensitive tumor, is the subject of this experiment. Dose responses were carried out with treatment of these tumors with three doses of adriamycin and two doses of methotrexate. Adriamycin treatment resulted in decreased tumor volume and decreased number of metastases in the higher dosage. Methotrexate also decreased metastasis and tumor volume. No animal treated with either of these agents in this protocol had the tumor undergo complete tumor regression, a criteria used in evaluation of chemotherapies with this animal model.

Adenocarcinoma↗
PubMed1983

Infections in parenteral drug abusers. Further immunologic studies.

In our previous study of soft tissue infections in parenteral drug abusers, two thirds of the infections were polymicrobial. Oral and enteric organisms were frequently recovered. These patients and a group of uninfected addicts showed frequent cutaneous anergy, lymphopenia, and hypergammaglobulinemia. An additional group of uninfected addicts was studied. The mean levels of IgA, IgG, and IgM were higher in the uninfected addicts. In the addict and control groups, elevations in IgA (17 percent of total), IgG (65 percent), and IgM (19 percent) levels were found. Zinc levels were within normal limits. T-cell populations below 70 percent were seen in five of the seven addicts and two of the four control subjects. Reversed helper to suppressor cell ratios were found in three of the seven addicts and control subjects. No consistent pattern of immunologic abnormalities emerged. The interrelationship of the abnormalities in the addict and their relationship to AIDS is unclear.

B-Lymphocytes↗
PubMed1983

Dog bites of the face: a 15 year review.

Over a period of 15 years, 109 patients with 148 dog bites of the face were treated in one Plastic Surgery Unit. In this retrospective review the patterns of injury and treatment are defined with particular reference to specialised anatomical structures involved and the problems of repair. In this study, 87 patients (80%) were under 15 years of age.

Adolescent↗
PubMed1983

Pulmonary resection for complications of cystic fibrosis.

Pulmonary sequelae account for a large proportion of the morbidity and mortality of cystic fibrosis. Bronchiectasis, hemoptysis, and abscess formation are often not responsive to conservative medical therapy. Pulmonary resection in selected cystic fibrosis patients is safe and therapeutically rewarding. Eleven pulmonary resections in ten patients with cystic fibrosis were performed. Patients ranged from 2.5 to 19 years of age. Indications for resection were: (1) abscess and bronchiectasis (nine patients), (2) atelectasis and mass (one patient), and (3) life-threatening hemorrhage (one patient). Surgical resection was employed only for medically refractory lesions which were life-threatening or contaminated otherwise functional lungs. Resection was limited to the most severely diseased areas, sparing functional lung parenchyma when possible. In this series, 9 lobectomies, 1 pneumonectomy, and 1 segmentectomy were performed. Preoperative management included aggressive chest physiotherapy and postural drainage, rigid bronchoscopic lavage, and broad-spectrum parenteral antibiotics. All patients were extubated in the operating room immediately postoperatively. Tracheostomy was not employed. There were no perioperative complications. All patients experienced subjective improvement. Objectively, improvement following surgical resection included: decreased cough and sputum production, and decreased incidence of exacerbations of pulmonary infections. Limited pulmonary resection when combined with intensive preoperative pulmonary toilet is a safe adjunct in the treatment of bronchiectasis and hemoptysis secondary to cystic fibrosis. Pulmonary resection should be limited to only severely destroyed lung parenchyma which is refractory to medical management. In contradistinction to other authors we have not found tracheostomy a necessary adjunct in surgical management.

Adolescent↗
PubMed1983

Comparative efficacy and tolerance study of azlocillin and carbenicillin in patients with cystic fibrosis: a double blind study.

Azlocillin, a new acylureidopenicillin, has been compared to carbenicillin in a controlled, double-blind study for acute exacerbations of pulmonary infections in 29 patients with cystic fibrosis. Twenty-six patients were valid for final analysis of their therapeutic results; 12 treated with azlocillin (group I) at mean dosage of 252 mg/kg/day for a mean duration of 13.2 days of treatment, and 14 treated with carbenicillin (group II) at mean dosage of 505 mg/kg/day for a median duration of 12.6 days. Except for one patient of group I who had Staphylococcus aureus in sputum culture, the remaining patients all had Pseudomonas aeruginosa of mucoid colonial morphology with or without the same organism of rough variety in their sputum culture. Therapeutic efficacy was evaluated according to our scoring system of ten clinical factors, five radiological and five pulmonary function factors with 5 points each and 100 points total if perfect. The percentage of patients who improved by 20% or greater in clinical scores was found in 91.7% of patients in group I and 64.3% of patients in group II, which was statistically significantly different. The percentage of patients who improved by 20% or greater in total scores was found in 80% of group I and 45.5% of group II patients, which was less significant than the evaluation of clinical scores alone. Azlocillin was well tolerated and safe in the dosage employed. Its optimal dosage for patients with cystic fibrosis should be established.

Adolescent↗
PubMed1983

Scintimetric evaluation of nailed femoral neck fractures with special reference to type of osteosynthesis.

With the aid of Tc-MDP-scintimetry 1-2 weeks after nailing of femoral neck fractures, it is possible to distinguish fractures liable to complications. Due to the suspicion that frequent peroperative vascular damage was caused by the four-flanged nail (Rydell), a less traumatizing cylindric nail (Hansson) with an insertion instrument was used. In a prospective investigation in January 1981-February 1982, which included all intracapsular femoral neck fractures, the two above-mentioned methods of osteosynthesis were used randomly. Intravital staining with tetracycline showed the peroperative circulation equivalent in Rydell and Hansson groups. A significant difference in postoperative isotope uptake could be noted between the two groups in 37 patients with undisplaced fractures. In 34 of 45 displaced fractures in the Rydell group evidence of circulatory deficiency appeared in the postoperative scintimetry but in only 23 of 52 of the displaced fractures in the Hansson group, a statistically significant difference. The latter figure corresponds well to the incidence of peroperatively registered severe vascular injury evaluated by tetracycline labelling.

Adult↗