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Biomedical subjects

K D Newman

Publications and source records attributed to K D Newman.

65 records · Page 4Linked to original sources
PubMed1989

Current results in repair of esophageal atresia with tracheoesophageal fistula using physiologic status as a guide to therapy.

Since 1966, 118 infants with esophageal atresia associated with tracheoesophageal atresia (Vogt-Gross Type C) have been operated upon with an overall survival rate of 90% at our institution. Since Haight's first survivor in 1941, argument has continued about the relative merits of immediate repair, delayed primary repair, and staged repair, and the criteria for selection of each approach. The Waterston classification served as the foundation for selection of surgical management from 1966 to 1982. Since 1982, physiologic status has been used as the sole basis for surgical management without regard to weight, gestation, or pulmonary condition. Twenty-six patients so chosen for immediate repair have all survived. Fewer have required gastrostomy, and the average hospital stay has shown significant decrease, a reflection of improved overall care of the neonate. Thirteen infants with severe cardiopulmonary compromise had some form of staged repair in this latter period with a 77% survival rate. Our experience using a refinement of Waterston's principles has led to more and earlier primary repairs with maintenance of excellent survival rates in stable infants. A staged approach is still useful for certain severely compromised infants.

Birth Weight↗
PubMed1989

Health promotion at the workplace.

Health promotion encompasses those activities undertaken to improve the quality of one's life, thereby moving the individual forward toward a state of wellness or optimal health. Occupational health nurses are in a prime position to impart knowledge and change attitudes and behaviors and thus are uniquely qualified to plan, develop, implement, and evaluate workplace health promotion programs. Employee health promotion programs are based on the theory that it costs less to educate workers about controllable lifestyle health risks than to pay for the cost of ill health. Comprehensive workplace health promotion programs should be targeted at three levels: awareness, lifestyle/behavior change, and supportive environments, if long-term success is to be achieved. Occupational health nurses may use the Model for Workplace Health Promotion to assist them in planning, developing, implementing, and evaluating programs that provide health and cost benefits for both employees and employers.

Cost-Benefit Analysis↗
PubMed1986

Angina pectoris as the initial manifestation of an aortocaval fistula.

Spontaneous aortocaval fistula is an unusual disorder associated with abdominal aortic aneurysms and with the onset of high-output heart failure. A novel case of spontaneous aortocaval fistula formation that presented with angina is described. Increased myocardial oxygen demand due to elevated myocardial wall tension, inotropic state, and heart rate is the apparent contributing factor. Clinical evidence of ischemic heart disease and heart failure resolved with surgical correction of the shunt. Spontaneous aortocaval fistula formation can be a precipitating cause of new-onset angina.

Angina Pectoris↗
PubMed1986

Evaluation of the role of antinociception in self-injurious behavior following intranigral injection of muscimol.

In rats, bilateral injection of muscimol (30-60 ng/site) into the medial substantia nigra zona reticulata exerted an antinociceptive effect in the hotplate and tail-flick tests. Injections of muscimol into the substantia nigra also induced intense stereotyped behavior and self-injurious behavior (SIB). Tail-flick and hindpaw-lick responses were inhibited between 30 and 120 min after muscimol, but recovered by 240 min. The antinociceptive responses were not due to motor impairment or ataxia induced by muscimol because a variety of highly-coordinated stereotyped behavioral responses, including rearing, sniffing, head bobbing and licking occurred concurrently. Injection of muscimol into the deep mesencephalic nucleus (DpMcN) also inhibited the tail-flick and hindpaw-lick responses and caused stereotyped behavior but did not induce self-injurious behavior. Injections of muscimol into the substantia nigra, angled (45 degrees) to avoid passing through the deep mesencephalic nucleus, still exerted antinociceptive activity and caused self-injurious behavior. Bilateral microinjections of baclofen (300 ng), 4,5,6,7-tetrahydroisoxazols (5,40c)pyridin-3-ol (THIP; 300 ng), sodium valproate + D,L-diaminobutyric acid (1 microgram), substance P (2.5 micrograms) or D-Pro2-D-Trp7.9-substance P (2.5 micrograms), all suppressed hindpaw-lick responses, although only THIP reduced tail-flick responses. None of these treatments evoked self-injurious behavior. Naloxone (10 mg/kg), picrotoxin (5 mg/kg) or atropine (10 mg/kg) injection of muscimol into the substantia nigra (60 ng) or a single pretreatment with p-chlorophenylalanine diethyl ester (PCPA; 500 mg/kg; 48 hr prior to muscimol) failed to suppress the hindpaw-lick response or self-injurious behavior. These results suggest that the injection of muscimol into the substantia nigra evokes a centrally-mediated antinociception which alone is not sufficient to induce self-injurious behavior. Both antinociception and self-injurious behavior after injection of muscimol into the substantia nigra appear unrelated to cholinergic, serotoninergic, or naloxone-sensitive nociceptive systems; however, the role of activation of gamma-aminobutyric acid (GABA) receptors in these actions of muscimol also remains to be clarified.

Analgesics↗
PubMed1983

Pyloric and gastric preservation with pancreatoduodenectomy.

Pyloric and gastric-preserving pancreatic resection was performed in 35 patients with no mortality. Twenty-seven patients were followed for at least 8 months postoperatively and are reported herein in detail. This variation in the Whipple procedure is associated with a satisfactory weight gain after operation for benign disease, does not produce the usual postgastrectomy digestive symptoms, and so far jejunal or anastomotic ulceration has not been a problem. We believe this variation of the Whipple procedure is the operation of choice for benign disease and for certain types of periampullary malignant growth.

Ampulla of Vater↗
PubMed1978

Identification of alpha-adrenergic receptors in human platelets by [3H]dihydroergocryptine binding.

Binding of [(3)H]dihydroergocryptine to platelet lysates appears to have all the characteristics of binding to alpha-adrenergic receptors. At 25 degrees C binding reaches equilibrium within 20 min and is reversible upon addition of excess phentolamine. Binding is saturable with 183+/-22 fmol of [(3)H]dihydroergocryptine bound per mg of protein at saturation, corresponding to 220+/-26 sites per platelet. Kinetic and equilibrium studies indicate the dissociation constant of [(3)H]dihydroergocryptine for the receptors is 1-3 nM. The specificity of the binding sites is typical of an alpha-adrenergic receptor. Catecholamine agonists compete for occupancy of the [(3)H]dihydroergocryptine binding sites with an order of potency (-)epinephrine> (-)norepinephrine>> (-)isoproterenol. Stereospecificity was demonstrated inasmuch as the (+)isomers of epinephrine and norepinephrine were 10-20-fold less potent than the (-)isomers. The potent alpha-adrenergic antagonists phentolamine, phenoxybenzamine, and yohimbine competed potently for the sites, whereas beta-antagonists such as propranolol and dichlorisoproterenol were quite weak. Dopamine and serotonin competed only at high concentrations (0.1 mM). The [(3)H]dihydroergocryptine binding sites could also be demonstrated in intact platelets where they displayed comparable specificity, stereospecificity, and saturability. Saturation binding studies with the intact platelets indicated 220+/-45 receptors per platelet, in good agreement with the value derived from studies with platelet lysates. Ability of alpha-adrenergic agonists to inhibit adenylate cyclase and of alpha-adrenergic antagonists to antagonize this inhibitory effect directly paralleled ability to interact with the [(3)H]dihydroergocryptine binding sites. These data demonstrate the feasibility of directly studying alpha-adrenergic receptor binding sites in human platelets with [(3)H]dihydroergocryptine.

Adenylyl Cyclases↗
PubMedDate not supplied

When appendicitis is suspected in children.

Acute appendicitis is the most common condition requiring emergent abdominal surgery in childhood. The clinical diagnosis of acute appendicitis is often not straightforward because approximately one-third of children with the condition have atypical clinical findings. The delayed diagnosis of this condition has serious consequences, including appendiceal perforation, abscess formation, peritonitis, sepsis, bowel obstruction, and death. Cross-sectional imaging with ultrasonography (US) and computed tomography (CT) have proved useful for the evaluation of suspected acute appendicitis. There has been a great deal of variability in the utilization of these modalities for such diagnosis in the pediatric population. The principal advantages of US are its lower cost, lack of ionizing radiation, and ability to assess vascularity through color Doppler techniques and to provide dynamic information through graded compression. The principal advantages of CT include less operator dependency than US, as reflected by a higher diagnostic accuracy, and enhanced delineation of disease extent in a perforated appendix.

Appendicitis↗