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Biomedical subjects

J Payne

Publications and source records attributed to J Payne.

At least 91 records · Page 5Linked to original sources
PubMed1989

Financial crisis in a family practice residency: a successful strategy.

A family practice residency program in a California public teaching hospital was faced with a financial crisis that threatened its elimination. Hospital officials and medical leaders developed a strategy that resulted in (1) personnel reductions focused principally on hospital overhead departments, (2) reductions in faculty teaching fees, (3) increased resident and faculty productivity, (4) increased patient access to ambulatory areas, (5) decreased utilization of laboratory, radiology, respiratory, physical therapy, pharmacy, and cardiology services, and (6) more favorable contracts with providers for patient care services. The hospital met its financial objectives primarily as a result of collaborative efforts of the hospital management team and a committed faculty vested in the success of the institution.

California↗
PubMed1988

Two monoclonal rat antibodies with specificity for the beta-chain variable region V beta 6 of the murine T-cell receptor.

Two rat monoclonal antibodies (mAbs), 44-22-1 and 46-6B5, which recognize an alloreactive cytotoxic clone, 3F9, have been further tested on a panel of T hybridomas and cytotoxic T-cell clones for binding and functional activities. The mAbs recognized only those cells sharing the expression of the T-cell receptor beta-chain variable region gene V beta 6 with 3F9. All V beta 6+ cells were activated by these mAbs under cross-linking conditions and their antigen-specific activation was blocked by soluble mAb. Furthermore, depletion of 46-6B5+ normal lymph node T cells eliminated all cells expressing the epitope recognized by 44-22-1 and V beta 6 mRNA.

Animals↗
PubMed1988

Selective use of heparin in aortic surgery.

The incidence of distal ischaemia following aortic reconstruction may be as high as 25%, despite the use of systemic heparin. As anticoagulation may be associated with excessive operative blood loss, a retrospective study was performed to assess the prevalence of these problems, in a consecutive series, during a 30-month period. Evaluation of reconstruction was possible in 161 patients with aneurysm and 38 patients with occlusive disease. The incidence of vessel occlusion was 21% in the occlusive and 4% in the aneurysm group (P less than 0.05). Four of seven patients who had major vessel occlusion had serious complications, and there were two resultant deaths. These problems occurred despite the administration of heparin. Blood loss and operating time were quantitated in the patients who had resection for aortic aneurysm. Both were significantly longer in patients who received heparin (P less than 0.05) and the differences were maintained when patients were stratified according to increments in dose or operating time, and according to whether woven tube or bifurcation grafts were performed. It was concluded that aneurysm surgery, in the absence of distal occlusive disease, could be safely performed without the use of systemic heparin, but surgery for occlusive disease still requires heparinization.

Aged↗
PubMed1988

B lymphocytes from X-linked agammaglobulinemia. Delayed expression of light chain and demonstration of Lyonization in carriers.

We report an unusual phenotype of B cells in a patient with X-linked agammaglobulinemia (XLA), and cellular evidence for Lyonization of B cells from his mother and sister. The patient has a failure of B cell maturation at the stage of early B lymphocytes, associated with production of D(mu delta) H chain. The phenotype of his B cells includes: (a) limitation to expression of the mu and delta H chain isotypes, (b) production of mu and delta H chains of reduced size and (c) delayed expression of L chain. Peripheral blood and B cell lines from the patient's mother and sister include 50% cells that express H chain without L chain. B cell lines from the mother and sister produce full-length mu and gamma H chains and truncated mu and delta chains corresponding to the H chains produced by the patient's B cells. Clones with normal and XLA phenotype have been isolated from B cell lines derived from the patient's mother. We conclude that the dimorphism of mother's and sister's B cells results from Lyonization, implying that the gene defect in XLA is intrinsic to B lymphocytes.

Agammaglobulinemia↗
PubMed1987

Preoperative risk assessment in cardiac surgery: comparison of predicted and observed results.

In the present climate of quality-assurance policies, rigorous requirements for informed consent, and a constantly changing patient population, a system of preoperative risk assignment and postoperative correlation was developed to monitor and evaluate surgical performance. Patients were categorized by operation, priority (emergent, urgent, elective), New York Heart Association Functional Class, and risk. Risk was assigned before operation using data from the Coronary Artery Surgery Study (CASS) and the recent literature. Data were collected by a full-time data manager and were stored and analyzed by computer. From January 1, 1984, to July 1, 1985, 1,303 patients underwent operation for acquired disease. This group included 913 patients undergoing isolated primary coronary artery bypass grafting (CABG). The comparison of predicted and observed results showed: (Table: see text). For patients undergoing isolated primary CABG, the elective group had an operative mortality of 0.6% (2/329); the urgent group, 1.1% (5/450); and the emergent group, 5.2% (7/134). Preoperative risk assignment is an effective method of quality assurance. Female sex and age older than 60 years, which predicted an operative mortality of 2 to 5% in the CASS study and other recent series, did not predict a similar risk in our series.

Adult↗
PubMed1986

Dumbbell neuroblastoma presenting without spinal cord findings.

Patients with dumbbell neuroblastoma present with a wide variety of spinal cord problems. We recently treated an infant with a large dumbbell neuroblastoma who was neurologically intact. Because a CAT scan showed a retroperitoneal mass to be abutting the right vertebral body at T12-L1, a precautionary myelogram was performed, which revealed extensive intraspinal extension. We report this case to emphasize the need to have a high index of suspicion of spinal cord involvement in light of a normal neurologic examination since, any attempt at removing the extraspinal part, first, could cause serious neurologic sequelae. We also wish to emphasize avoiding radiation therapy when the tumor has been removed grossly to lessen the development of kyphoscoliatic deformity. The infant will be routinely followed with serial VMAs and ultrasound.

Humans↗
PubMed1985

The distribution of orally administered 14C-aniline HCl in tissues of dairy cattle, swine and laying pullets.

Single or chronic daily (30 d) doses of 14C-aniline (an aromatic amine) were administered to dairy cattle, swine and laying pullets to determine the amount of an ingested synfuel-related chemical that would remain in consumable animal products. The 14C-residues were found in muscle, liver, other edible organs and fat, as well as in milk and eggs. The predominant site of deposition in acute- and chronic-exposed pullets was kidney, followed by internal yolk (immature ovum of ovary) and then liver. Egg yolk was the major site of 14C-radioactivity in whole eggs. Liver, then kidney, were the major sites of deposition in acutely exposed swine; when chronically exposed, only liver showed preferential deposition with other tissues surveyed yielding similar concentration values. Dairy cattle yielded tissue distribution patterns similar to chronic swine. Within 8 h after an acute exposure, 14C-residue was detected in milk which reached its maximum at 24 to 32 h. Our data demonstrate that derived concentration values of 14C-residue in tissues was dependent upon the species studied as well as on the mode of exposure, acute versus chronic. Although the concentration values were variable, sufficient amounts of 14C-aniline and (or) its metabolites were found in consumable products.

Aniline Compounds↗
PubMed1985

Experimental evaluation of complete electrically powered ventricular assist system.

The LVAS utilizing an intrathoracic blood pump and a parathoracic, electrohydraulic energy converter has a number of promising features. These include: transcutaneous energy transmission and an implanted variable volume device which eliminate the need for percutaneous access; utilization of an intrathoracic blood pump and variable volume device which allow the diaphragm and abdominal cavity to remain intact; parathoracic or subcutaneous location of the transformer secondary, energy converter, internal battery and interconnecting elements allowing replacement with a minor surgical procedure; employment of the "biolized" continuous blood contacting surface which has the potential of long-term use without anticoagulants and utilization of an electrohydraulic energy converter which provides synchronization without requiring transducers and associated electronics and which provides lubrication of mechanical components. The development effort, which began separately in 1977 and has been conducted jointly by Nimbus and the Cleveland Clinic since 1980, has demonstrated that the above features can be incorporated in a reliable LVAS. In particular, the system in vivo test series have demonstrated the soundness of the basic concepts and led to refinements which were demonstrated in the 6-1/2 mo test. All elements of the system have been utilized during the in vivo test program. Component tests of significance include: LVAS and total heart blood pump in vivo experiments of up to 7 mos duration which demonstrate the blood compatibility of the biolized surface without the use of long-term anticoagulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Observed differences in postoperative lymphocyte transformation are explained by patient and population variations.

In the present study, the kinetics of the lymphocyte response to phytohemagglutinin were examined by harvesting lymphocytes at 24 hour intervals in four nonoperated control subjects, preoperatively and postoperatively in six men who underwent herniorrhaphy, and in four people who had colectomy for adenocarcinoma. Nonorthogonal analysis after logarithmic transformation and adjustment for individual and population variations showed no differences in preoperative and postoperative transformation. No age effects were seen. The previous evidence that surgery inhibits transformation to phytohemagglutinin was explained by wide kinetic variations in both patient and control populations.

Adenocarcinoma↗
PubMed1984

Fate of Bacillus sphaericus 1593 and 2362 spores used as larvicides in the aquatic environment.

Dry powders produced from insecticidal Bacillus sphaericus strains 1593 and 2362 were applied against Culex tarsalis and Anopheles franciscanus mosquito larvae in small-plot field trials. Good control of C. tarsalis, but not of A. franciscanus, was produced at 0.1 and 0.2 lb/acre [ca. 0.122 and 0.244 kg/ha]. B. sphaericus spores settled rapidly from upper water layers and accumulated in bottom muds. Control of third/fourth-instar C. tarsalis larvae was maintained through day 4 after testing and was related to the presence of at least 100 spores per ml in the upper water layer 2 days earlier. B. sphaericus was shown to recycle in dead larvae both in the laboratory and in the field, producing an increase of 100- to 1,000-fold in spore numbers. There was no evidence of recycling in treated water nor of significant spore persistence upon reflooding of ponds after a very hot, dry period.

Animals↗
PubMed1984

Laryngeal carcinoma--or is it laryngeal blastomycosis.

A patient is described who was evaluated for persistent hoarseness. Although an initial diagnosis of squamous cell carcinoma of the larynx was made, review of the pathology slides revealed pseudoepitheliomatous hyperplasia, acanthosis, and what appeared to be a fungal infection. After a detailed work-up was initiated the patient was treated successfully with ketoconazole for a blastomycosis infection of the larynx. The literature relative to blastomycosis infections of the respiratory larynx is reviewed. The authors emphasize that patients who show evidence of acanthosis and pseudoepitheliomatous hyperplasia along with the diagnosis of squamous cell carcinoma should be suspected as having a potential fungal infection.

Aged↗
PubMed1983

Osteotomy of intermaxillary suture for closure of median diastema.

A technique for performing an osteotomy of the intermaxillary suture has been described. By removing the cortical bone and soft tissue that lines the intermaxillary suture between the anterior surface of the maxilla and the incisive foramen, stability of orthodontic closure of the median maxillary diastema has been achieved.

Cranial Sutures↗