Biomedical subjects
Publications and source records attributed to M D Hargrove.
Medicine makes an important distinction by saying it is sometimes proper to allow a patient to die but that one should never actively cause a patient to die. The thin, invisible line which separates these views is being tested and will be debated intensely in the future.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This article is the first of a series on medical ethics which will appear at irregular intervals in the JOURNAL of the Louisiana State Medical Society. The ethical issues which will cover many of the problems encountered in clinical practice that cause a dilemma for physicians and patients. In these cases a choice usually exists and one describes the situation with words such as "should" or "ought." The author will write about current issues in medical ethics. His goal will be to describe a problem and to present the arguments for and against various solutions. He does not intend to tell you how you should react to ethical issues; that is each person's judgment. On the other hand, he will try to give you the arguments and hopes to help you to see the issue from several perspectives.
There is confusion about the meaning of living wills and orders not to resuscitate. Both are very important concepts which allow patients to control some of the decisions at the end of life. Living wills are valid until revoked, have the same meaning throughout Louisiana, and are implemented when a patient becomes incompetent and qualified (certified in writing as having a terminal and irreversible condition). Orders not to resuscitate are policy matters in each hospital, thus they vary throughout the state. They are implemented at the time of cardiac arrest.
Explore the source record for details and available documents.
To determine the incidence and importance of folate deficiency in uremia, we studied 41 patients who had chronic uremia but who were not receiving hemodialysis. Serum folate level was assayed by microbiological, whole serum radioassay, and heat-extracted radioassay techniques. Mean serum folate level, as determined with the Lactobacillus casei method, was 6.9 ng/ml (normal, more than 3.0 ng/ml). The mean heat-extracted radioassay serum folate level was 6.6 ng/ml. Only 10% of our patients had subnormal serum folate values, as determined with these techniques. No cases of megaloblastic anemia were discovered, and the hematologic profiles correlated with L casei and heat-extracted radioassay serum folate values. The mean serum folic acid binding protein (FABP) level was significantly greater for the uremic patients than for control patients (26% vs 9.9%, respectively; P = .0005). Our results show that elevated levels of serum FABP spuriously depress the serum folate level, as determined with the whole serum radioassay technique, but apparently do not retard delivery of folate to the tissue in vivo.
Explore the source record for details and available documents.
We studied the effect of serum folate-binding protein (FBP) on folate radioassays and the relationship of the serum level of unsaturated FBP to the serum folate level in various clinical states. Our modification of a heat-extracted radioassay was compared to a whole serum radioassay. Our results confirmed the existence of elevated serum levels of unsaturated FBP in some normal subjects, in some women taking oral contraceptives, and in most patients with uremia. Elevated levels of unsaturated FBP will produce falsely low results in folate radioassay unless the FBP has been destroyed by heat, as was done in the modified radioassay here presented. In normal and uremic subjects, serum folate and unsaturated FBP levels tended to correlate, whereas in patients taking large doses of folic acid the level of unsaturated FBP fell as the level of serum folate rose.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.