Biomedical subjects
Publications and source records attributed to J T Roberts.
Vascular damage is described in the myometrium adjacent to areas of previous tubal diathermy for sterilisation. Elastosis, different in degree from that seen in the multiparous uterus, is most common, but more striking is medial arteriolar muscle loss with microaneurysm formation and occasional rupture.
Explore the source record for details and available documents.
A series of S-alkanoyl and benzoyl derivatives of 3-mercaptopicolinic acid (3-MPA) was prepared and studied for hypoglycemic activity. Three alkanoyl derivatives (propionyl, pivaloyl, and 1-adamantanecarbonyl, 19-21) were prepared with increasing bulk around the thio ester bond. The benzoyl derivatives contained aromatic substituents chosen from a sigma-pi cluster chart so that the esters prepared had a wide range of electronic and solubility properties. In general, compounds with substituents which increased lipid solubility [p-chlorobenzoyl (4), p-trifluoromethylbenzoyl (6), and pivaloyl (20)] had the greatest potency at a dose of 300 mg/kg. Hydrolysis rates, measured at pH 6 and 8, indicated that in vivo breakdown to 3-MPA probably did not account for the observed hypoglycemic activity of the esters. 4, 6, and 20 were less potent than 3-MPA in comparative dose range studies.
3-Mercapto-4-methylpicolinic acid one of very few compounds derived from 3-mercaptopicolinic acid (3-MPA) to have hypoglycemic activity. In an effort to find compounds with greater potency than 3-MPA, several 4-substituted 3-mercaptopicolinic acids (4-OMe, OC6H5, SMe, SH, Cl, NH2, Et; 1-7) were prepared and tested in 48-h fasted rats. None was hypoglycemic in this test system after oral dosing of 150 mg/kg.
A 31-year-old man, who had undergone splenectomy 18 months previously because of hereditary spherocytosis, suddenly became ill, with fever, vomiting, epigastric pain and shock, and died 10 hours after the onset of his symptoms. Autopsy showed influenzal viremia, pneumococcemia and bilateral adrenal hemorrhage. The rapid course of the patient's illness emphasizes the serious risk of sepsis for individuals who have had a splenectomy. Anti-influenza immunization in such patients should be considered.
Two patients with Sézary syndrome, refractory to conventional treatment, were given cyclophosphamide and antilymphocyte globulin (A.L.G) Both patients showed improvement. One patient subsequently died from widespread varicella and the other relapsed later. It is concluded that A.L.G. may be effective in this condition.
Fifty-six patients with disseminated malignant melanoma were randomly allocated to two treatment groups. The first group C received combination chemotherapy consisting of DTIC and ICRF 159. The second group (C+I) received the same chemotherapy but were also immunized with 2 X 10(7) irradiated allogeneic melanoma cells mixed with 50 mug of percutaneous BCG. The survival rates in both treatment groups C and (C+I) were not significantly different, and only minor enhancement of the chemotherapy was found in the (C+I) group. A similar pattern of tissue response was observed in both groups: lymph node, skin and, to some extent liver metastases, respond better than other sites.
Phenacyl-riphenylphosphorane (1a) and several analogs substituted in the meta position of the phenacyl group lowered blood glucose levels in 48-hr fasted rats. The corresponding phosphonium salts had comparable hypoglycemic activity. Two compounds (1a and 1b) were also hypoglycemic in fed rats, but hypoglycemia could not be elicited in another species.
After oral ingestion of a free amino acid mixture by three cystinuric patients, plasma increments of lysine and arginine were lower and those of many other amino acids were significantly higher than those found in control subjects. Similar results were obtained in control subjects after amino acid imbalance had been artificially induced by the omission of cystine, lysine, and arginine from the amino acid mixture. Especially high increments of alanine and proline provided the best evidence of amino acid imbalance caused by a temporary lysine and, to a lesser extent, arginine and cystine deficit. No such amino acid imbalance was found to occur in the cystinuric patients after ingestion of whole protein, indicating that absorption of oligopeptides produced by protein digestion provided a balanced physiological serum amino acid increment. This is considered to explain the lack of any unequivocal nutritional deficit in cystinuric patients despite poor absorption of the essential free amino acid, lysine.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Coagulation studies were performed on two newborn infants with fatal massive pulmonary haemorrhage. The first showed a reduced level of plasma fibrinogen with defective thrombin-fibrinogen reaction, corrected by protamine, and defective thromboplastin generation. In the second case, a premature infant, the fibrinogen level was normal but there was a severe defect in thromboplastin generation with evidence of an inhibitor. A relationship between the pulmonary haemorrhage and coagulation defects is suggested but not established.
Explore the source record for details and available documents.
A case is described in which Todd's method (1959) for the histological localization of plasminogen activator was applied to neonatal lung tissue obtained at (unsuccessful) open cardiac massage. This was localized around small pulmonary veins, usually at some distance from the hyaline membrane.
STUDY OBJECTIVE: To describe a current method of teaching flexible fiber-optic laryngoscopy. DESIGN: Review of a current technique. SETTING: Inpatient surgery area at a university medical center. PATIENTS: More than 1,000 ASA physical status I and II patients requiring general endotracheal anesthesia for renal lithotripsy were intubated orally using a flexible fiber-optic laryngoscope. INTERVENTIONS: Patients were given a sleep dose of thiopental sodium (4 mg/kg) and paralyzed with a bolus of succinylcholine (1 mg/kg). MEASUREMENTS AND MAIN RESULTS: Peripheral oxygen (O2) saturation, capnography, electrocardiography (EKG), automated blood pressure (BP) measurements, and clinical response of the patients were closely monitored by the attending anesthesiologist. Three obese patients rapidly desaturated, leading to abandonment of the technique for teaching purposes. After ventilation with 100% O2, all 3 patients were rapidly intubated orally by the instructor using the flexible fiber-optic technique. CONCLUSIONS: Oral flexible fiber-optic laryngoscopy and intubation may be taught safely using thiopental sodium and succinylcholine by adhering to the guidelines outlined in this paper.
While malformations of the upper airway are rare, they present challenging management problems and have a potentially devastating impact during anesthesia. This case report describes the management of a patient with a massive supraglottic venous malformation as he underwent transvenous embolization.
STUDY OBJECTIVE: To develop an approach to blind oral intubation. With the aid of a fiberoptic laryngoscope and stylet within an endotracheal tube, a video camera, a monitor, and a recorder to correlate the effects of various manipulations of the airway on access to the trachea, a suitable approach was devised. We then evaluated its efficacy. DESIGN: Randomized, prospective comparison of regimens. SETTING: Inpatient surgery at a university-affiliated teaching hospital. PATIENTS: One hundred adult patients with no known abnormalities of the upper airway by history or on physical examination, scheduled to undergo elective surgery, and without evidence of major cardiac disease or need for a rapid-sequence induction of anesthesia. INTERVENTIONS: Fifty patients in each of two groups were given fentanyl 5 micrograms/kg intravenously (IV), followed 2 minutes later by thiopental sodium 5 mg/kg and succinylcholine 2 mg/kg. Patients in Group 1 (the controls) were orally intubated via direct laryngoscopy using a Macintosh #3 blade. Patients in Group 2 (the experimentals) were intubated orally with the approach developed without the use of a laryngoscope. Intubations were deemed successful if they were performed within 1 minute after the mouth was opened. MEASUREMENTS AND MAIN RESULTS: All the patients in Group 1 were successfully intubated within 1 minute, while 49 of the 50 patients in Group 2 were successfully intubated within 1 minute. CONCLUSIONS: Blind oral tracheal intubation can be successfully performed in a safe and effective manner after appropriate teaching of the technique.