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Biomedical subjects

L R Smith

Publications and source records attributed to L R Smith.

At least 127 records · Page 7Linked to original sources
PubMed1988

Current prognosis of ischemic mitral regurgitation. Implications for future management.

Ischemic mitral regurgitation is a serious and increasingly common clinical disorder, but at present, little is known of the associated prognostic implications, especially in specific therapeutic subgroups. Over a 6.5-year period beginning January 1, 1981, postinfarction mitral regurgitation was demonstrated ventriculographically in 2,343 (19%) of 11,748 patients having significant coronary artery disease defined at cardiac catheterization. Moderate or severe regurgitation was observed in 381 (3%), and among these patients, four treatment groups were defined: Group I (medical, n = 165), Group II (reperfusion, n = 63), Group III (coronary artery bypass only, n = 94), and Group IV (valve replacement or repair in addition to coronary bypass, n = 59). Multivariable regression analysis of survival data in the overall population and in specific treatment groups was performed with the Cox proportional hazards model. Defined and undefined selection biases precluded formal quantitative survival comparisons among some treatment groups; however, unadjusted and adjusted survival analysis for each group revealed several interesting concepts. First, increasing severity of mitral regurgitation had a progressively negative impact on survival prognosis regardless of treatment. Congestive heart failure, the number of associated disorders, acute presentation requiring cardiac care unit admission, diminished ejection fraction, increasing coronary obstruction, and advanced age all worsened prognosis (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Intraoral pressure and its relationship to velopharyngeal inadequacy.

Intraoral pressure measurements were made during multiple productions of the word "hamper" by each of 267 patients who manifested differing degrees of velopharyngeal inadequacy. The results indicate that intraoral pressure diminishes as the extent of velopharyngeal impairment increases. However, pressure remained above 3 cm H2O in the majority of subjects, even when the impairment was such that intraoral and intranasal pressures were essentially equal. Comparison of these results with model simulations suggests that speakers make adjustments to velopharyngeal impairment that tend to maintain pressures at levels thought to be necessary for obstruent consonant production. Variations in pressure as a function of gender and age parallel those observed in normal children and adults.

Adolescent↗
PubMed1987

Firearms in the home and child safety.

One hundred fifty families who were seen in the pediatric outpatient clinics at The University of Texas Medical Branch, Galveston, were surveyed to learn about firearm possession in the home and its hazards to children. Thirty-eight percent of these families kept at least one gun in their home. Fifty-five percent of this group reported that the gun was loaded at all times, and 10% reported that the gun was kept loaded, unlocked, and within the reach of a child. We identified demographic characteristics of at-risk families and considered national statistics for gun safety. It was concluded that household firearms pose a significant risk to children and that intervention by physicians could help reduce this public health problem.

Accident Prevention↗
PubMed1987

Tamoxifen rechallenge: response to tamoxifen following relapse after adjuvant chemohormonal therapy for breast cancer.

Two-hundred seventy-three node-positive primary breast cancer patients with positive estrogen or progesterone receptors were placed on a short-term chemohormonal adjuvant program that included tamoxifen. At present, 64 have relapsed, 19 of whom have been rechallenged with tamoxifen after disease-free intervals (DFI) ranging from 0.4 to 4.4 years. Most patients had only one site of disease recurrence. Two patients have achieved complete remission (CR) and three partial remission (PR) for a CR and PR rate of 26% (95% confidence interval for CR and PR is 9% to 51%). Duration of response has ranged from 3 to 17+ months. Patients who receive short-term adjuvant therapy with tamoxifen and who relapse may respond to tamoxifen rechallenge. In this series, the response rate to tamoxifen rechallenge was similar to the response rate for patients unselected for estrogen receptor status receiving first-line endocrine therapy for breast cancer relapse.

Adult↗
PubMed1986

Differential sympathetic-parasympathetic interactions in sinus node and AV junction.

This study examined the effects and interactions evoked by various combinations of parasympathetic (P) and sympathetic (S) stimulations on sinus node automaticity and atrioventricular (AV) conduction (both anterograde and retrograde) in 11 two-mo old anesthetized puppies. The respective effects of these autonomic maneuvers were assessed by covariant analysis using a linear regression model of the form Y = alpha 0 + alpha 1 X base line + alpha 2 X sequence + alpha 3 X S + alpha 4 X S2 + alpha 5 X P + alpha 6 X P2 + alpha 7 X (P X S).... The effects of parasympathetic and sympathetic stimulation, of the quadratic term S2, and of the interaction term (P X S) were highly significant (P less than 0.0001) on both sinus node automaticity and AV conduction (anterograde and retrograde). In contrast, the effect of the quadratic term P2 was significant on sinus node automaticity only. Sequence of stimulation whether (SP) or (PS) had no significant effect on either chronotropic or dromotropic properties. Furthermore, whereas augmented antagonism with parasympathetic predominance over sympathetic activity was readily demonstrable in the control of sinus rate, the reverse, i.e., augmented antagonism with sympathetic preponderance over parasympathetic activity, was found to apply to the control of AV conduction (both anterograde and retrograde). Hence, the nature and extent of parasympathetic-sympathetic interactions vary considerably, depending on which cardiac structure and/or function is under scrutiny. It appears that AV conduction is especially sensitive to modulation of sympathoadrenergic activity, whereas sinus node automaticity is particularly responsive to cholinomimetic influences.

Animals↗
PubMed1985

Cardiac output distribution and regional blood flow during hypocarbia in monkeys.

Cardiac output distribution and regional blood flow were studied during hypocarbia independent of changes in ventilatory parameters. Fifteen cynomolgus monkeys were anesthetized with methohexital sodium (8 mg/kg im) and hyperventilated through an endotracheal tube. Hypocarbia at two levels, 28 +/- 1.8 and 17 +/- 0.6 Torr, was achieved by a stepwise decreasing CO2 flow into the semiclosed system. Regional blood flow was determined with labeled microspheres. At each stage of experiments two sets of microspheres (9 and 15 microns diam) were used simultaneously. The use of two microsphere sizes allowed evaluation of the relationship between total (nutritive and nonnutritive) tissue blood flow, determined with 15-microns spheres, and nutritive blood flow, determined with 9-microns spheres. There was no change in cardiac output or arterial pressure during both degrees of studied hypocarbia. Hypocarbia was accompanied by a decrease in myocardial blood flow determined with 15-microns spheres and preservation of the flow determined with 9-microns spheres. Splenic blood flow was decreased, whereas hepatic arterial blood flow was increased during both levels of hypocarbia. Blood flow through the brain, renal cortex, and gut showed a biphasic response to hypocarbia: during hypocarbia at 28 +/- 1.8 Torr, blood flow determined with 15-microns spheres was unchanged (in the gut) or decreased (in the brain and kidneys), whereas blood flow determined with 9-microns spheres was decreased. During hypocarbia at 17 +/- 0.6 Torr, blood flow determined with 9-microns spheres had a tendency to restore to base-line values.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Elevated catecholamines during cardiac surgery: consequences of reperfusion of the postarrested heart.

This study determines whether reperfusion of the heart with elevated blood levels of epinephrine (E) and norepinephrine (NE) during cardiac surgery produces deleterious effects. The study was conducted in 60 patients undergoing coronary artery bypass surgery. Arterial catecholamine values increased significantly (p less than 0.05), from prebypass control levels of 152 +/- 29 and 327 +/- 30 pg/ml of E and NE, respectively, to 415 +/- 78 and 554 +/- 49 pg/ml, at initiation of perfusion of the heart after the aortic cross-clamp was removed. Serial measurement of arterial (A) and coronary sinus (CS) E, NE, potassium, lactate, PO2 and CK-MB revealed that during 10 minutes of reperfusion the heart extracted E (positive A-CS difference, p less than 0.05), but that the NE A-CS difference was 0. The CS effluent contained significantly (p less than 0.05) higher concentrations of potassium, lactate and CK-MB during reperfusion than before aortic occlusion. There was no significant correlation of arterial E and NE, CS E and NE or A-CS differences in E and NE with myocardial release of lactate, potassium or CK-MB. There was a weak association (r = 0.4, p less than 0.01) between coronary sinus CK-MB and aortic occlusion time. Maximal arterial E and NE values did not correlate with 10-hour postoperative (maximal) CK-MB values. These results indicate that reperfusion of the postarrested ischemic heart with high levels of endogenously released catecholamines does not worsen ischemia or contribute significantly to myocardial damage.

Cardiopulmonary Bypass↗
PubMed1984

Renal and splanchnic circulation during infrarenal aortic cross-clamping.

The effect of infrarenal cross-clamping of the aorta on regional splanchnic and renal circulations was studied in seven dogs. Regional blood flow was determined with differentially labeled microspheres (9 and 15 micron in diameter) that were injected simultaneously into the left atrium. Blood flow was measured 30 minutes after surgical preparation was completed (stage I), 20 minutes after infrarenal aortic cross-clamping (stage II), and 20 minutes after supplemented sodium nitroprusside infusion (stage III). Infrarenal aortic cross-clamping was accompanied by a slight increase in the cardiac output (CO) without significant changes in mean arterial pressure (MAP). Blood flow through the gut, hepatic artery, and cortical layer of the kidneys, as determined with 15-micron spheres, was not changed. Nonentrapment of 9-micron spheres in the gut and renal cortex was increased substantially. Blood flow through the juxtamedullary layer of the kidneys was increased. Sodium nitroprusside supplementation decreased MAP by 30%; CO values returned to baseline level. Hepatic artery blood flow, compared with both baseline values and values during aortic cross-clamping, increased significantly. Blood flow, determined with 15-micron spheres, through the gut and renal cortex did not change, and nonentrapment of 9-micron spheres decreased to baseline values. The data suggest a certain shift of blood flow to the juxtamedullary layer of the kidneys during aortic cross-clamping and normalization of intrarenal blood flow distribution during supplemented sodium nitroprusside infusion. Controlled vasoplegia with sodium nitroprusside may help modify peripheral circulatory disturbances in the kidneys and splanchnic system during infrarenal aortic cross-clamping.

Animals↗
PubMed1984

Patient care problems in patients undergoing reoperation for coronary artery grafting surgery.

Over the past six years there has been a 15-fold increase in the number of patients requiring reoperation coronary artery bypass grafting (RCABG) surgery at the University of Alabama in Birmingham. To determine the perioperative risk, a retrospective chart survey of one calendar year's (1981) experience was made comparing the 58 RCABG patients with 59 cohorts undergoing primary operation. All patients were anaesthetized with diazepam, fentanyl and halothane or enflurane anaesthesia. Preoperative evaluation revealed by history that the incidence of unstable angina and digoxin use were greater (p = 0.05) in the RCABG patients. Cardiac catheterization revealed a higher incidence (26 vs 89 percent) of left main coronary disease in controls and similar indices of left ventricular function (wall abnormalities, ejection fraction and LVEDP). Operating and bypass times were longer (p less than 0.01) for RCABG patients and there was a trend for greater (p = 0.08) use of dopamine in the RCABG patients. CK-MB release was significantly (p less than 0.05) greater in RCABG patients. Serious postoperative complications (CK-MB greater than or equal to 15 IU/L, low cardiac output, and death) were significantly (p = 0.02) greater in the RCABG group. It is concluded that RCABG patients represent a greater risk of complications and that new strategies for improving myocardial protection need to be developed to reduce the risk.

Adult↗
PubMed1984

Factors and their influence on regional cerebral blood flow during nonpulsatile cardiopulmonary bypass.

In this study we examined the relationship of regional cerebral blood flow (CBF) to mean arterial pressure, systemic blood flow, partial pressure of arterial carbon dioxide (PaCO2), nasopharyngeal temperature, and hemoglobin during hypothermic nonpulsatile cardiopulmonary bypass (CPB). Regional CBF was determined by clearance of xenon 133 in 67 patients undergoing coronary bypass grafting procedures. There was a significant decrease in regional CBF (55% decrease) during CPB, with nasopharyngeal temperature and PaCO2 being the only two significant factors (p less than 0.05). In a subgroup of 10 patients, variation of pump flow between 1.0 and 2.0 L/min/m2 did not significantly affect regional CBF. We conclude that cerebral autoregulation is retained during hypothermic CPB. Under the usual conditions of CPB, variations in flow and pressure are not associated with important physiological or detrimental clinical affects.

Adult↗
PubMed1984

Morphine-halothane interaction in rats.

The effects of morphine, halothane, and their various combinations on the purposeful movement (PM) response and the heart rate (HR) increase caused by noxious stimulation were studied in 250 rat experiments. Doses that block the PM and HR responses for the single agent and for combinations were determined with a probit procedure and compared with an isobolographic analysis. As was evidenced by the PM response, the combined anesthetic effect of morphine and halothane, with some deviations, may be defined as additive. It also was found that the combined administration of morphine and halothane results in an antagonism for suppression of the HR increase to noxious stimulation. Halothane antagonized morphine to a much greater extent than morphine to halothane.

Animals↗
PubMed1984

Liver circulation and function during isoflurane and halothane anesthesia.

Hepatic arterial blood flow (HABF) and portal blood flow (PBF) were measured in 18 dogs while awake and during isoflurane and halothane anesthesia. Surgical preparation 1 week before the measurements consisted of a left thoracotomy, placement of a left atrial catheter, and insertion of another catheter into the distal aorta via the left femoral artery. Cardiac output and liver blood flow were determined using microspheres at three stages: stage 1-awake state; stage 2-after 45 min of 1 MAC of isoflurane (eight dogs) or halothane (10 dogs) anesthesia; and stage 3-after 45 min of 2 MAC of inhalation anesthesia. Half-life and fractional clearance for indocyanine green (ICG) were determined 1 day before the experiment (awake state), and at the end of stages 2 and 3. Mean arterial pressure (MAP) and cardiac index (CI), as well as PBF, decreased during isoflurane and halothane anesthesia. HABF increased significantly during isoflurane anesthesia, remained unchanged during 1 MAC of halothane anesthesia, and significantly decreased during 2 MAC of halothane anesthesia. Apparently, hepatic oxygen supply was maintained much better during isoflurane than during halothane anesthesia. PBF correlated with CI during halothane (r = 0.97) and, to a certain extent, with MAP during isoflurane (r = 0.66). HABF correlated with CI and MAP during halothane (r = 0.74 and 0.71, respectively) but did not correlate with systemic hemodynamic variables during isoflurane. ICG half-life significantly increased during 1 and 2 MAC of halothane anesthesia. The degree of increase did not correlate with the level of anesthesia or the decrease in total hepatic blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Bacterial endotoxin isolated from a water spray air humidification system as a putative agent of occupation-related lung disease.

Outbreaks of hypersensitivity pneumonitis or humidifier fever were attributed to the inhalation of organic material aerosolized by a chilled-water spray humidification system. The purpose of this study was to isolate and characterize the serologically detectable antigen(s) present in extracts obtained from the humidification system. By using bicarbonate or phenol-water extractions or both, the antigen was isolated and characterized, using colorimetry, gas-liquid chromatography, reverse-phase high-performance liquid chromatography, and X-ray fluorescence. Carbohydrates, hexosamines, phosphorus, and even-numbered saturated and unsaturated fatty acids were constituents of the serologically detectable antigen. When tested in in vivo and in vitro assays, the antigen had demonstrable endotoxin activity. All subjects with biopsy-proven lung disease and a majority of subjects suspected of having lung disease had antibodies directed toward the purified endotoxin. The data strongly suggest that an aerosolized bacterial endotoxin is a putative agent inducing lung disease.

Alveolitis, Extrinsic Allergic↗