Search PubMed⌕ Search

Biomedical subjects

M D Smith

Publications and source records attributed to M D Smith.

At least 433 records · Page 24Linked to original sources
PubMed1988

Pulse steroid therapy in rheumatoid arthritis: can equivalent doses of oral prednisolone give similar clinical results to intravenous methylprednisolone?

Pulse methylprednisolone therapy has dramatic effects on clinical and immunological parameters of disease activity in patients with rheumatoid arthritis. Previous studies of this treatment have all used the intravenous route and methylprednisolone succinate. This study addresses the question of whether oral prednisolone in equivalent doses can substitute for intravenous methylprednisolone in pulse therapy in a double blind parallel study. It is shown that oral prednisolone has clinical and immunological effects equivalent to those of intravenous methylprednisolone, making it possible to administer pulse therapy to patients with rheumatoid arthritis as outpatients without the inconvenience and inherent dangers of intravenous administration.

Administration, Oral↗
PubMed1988

Immunocytologic characterization using monoclonal antibodies of lung lavage cell phenotype in infants who have died from sudden infant death syndrome.

The phenotype of cells obtained from pulmonary lavage in infants who have died from sudden infant death syndrome were examined and compared with cells from control subjects. The only striking difference between the groups was a lack of reactivity of lavage cells with antibody of the CD14A cluster in the sudden infant death syndrome subjects, while antibodies of the CD14B cluster reacted strongly with cells from both the sudden infant death syndrome group and controls. Major histocompatibility complex class II antigens were expressed on approximately 95% of lavage cells, with DQ expressed more frequently than DR or DP. The majority of the lavage cells was macrophages, yet they reacted with CD3 (OKT3) and CD8 (OKT8) antibodies. No interleukin 2 was found in the lavage fluid.

Antibodies, Monoclonal↗
PubMed1988

The effects of hypoxemia on cardiac output. A dose-response curve.

To establish a dose-response curve for the effects of isocapnic hypoxemia on cardiac output (CO), we studied 20 healthy men, aged 20 to 34 years, using a tight-fitting face mask and an isocapnic partial rebreathing system (a modified anesthesia machine). We blended oxygen and hypoxic gas to achieve arterial oxygen saturations (SaO2) of 80, 85, and 90 percent; subjects also breathed 100 percent oxygen and room air (RA). Target SaO2 and end-tidal carbon dioxide were continuously monitored using an ear oximeter and CO2 gas analyzer. Subjects experienced the five SaO2 measurements in random order. CO was measured noninvasively at approximately two-minute intervals, using continuous-wave Doppler echocardiography. Mean cardiac output increased with increasing hypoxemia from 6.84 L/min at FIo2 1.0 to 8.44 L/min at SaO2 80 percent (p less than 0.0005); the increase was entirely due to increased heart rate. We concluded that cardiac output increases significantly in a dose-response manner in response to acute isocapnic hypoxemia in normal persons.

Acute Disease↗
PubMed1988

Pubic ramus fatigue fractures after total knee arthroplasty. A case report.

Fatigue fractures in the rheumatoid population are infrequent but well described clinical and radiographic entities, and rarely occur within the pelvis. These fractures often are difficult to diagnose. Pelvic fatigue fractures are much less commonly detected and reported after total joint arthroplasties. This article reports the sequential appearance of fatigue fractures of the superior portions of both pubic rami after total knee replacement arthroplasties which were not suspected on historical review, physical examination, nor well visualized on initial plain radiographs and technetium bone scanning.

Acetabulum↗
PubMed1988

The clinical and immunological effects of pulse methylprednisolone therapy in rheumatoid arthritis. II. Effects on immune and inflammatory indices in peripheral blood.

Marked effects on C reactive protein, circulating immune complexes, rheumatoid factor and immunoglobulin levels were demonstrated in a group of 40 patients with rheumatoid arthritis, who received pulse methylprednisolone therapy, either as sole treatment or in combination with a disease modifying agent. The only patient groups in which these serological changes were maintained were the groups taking disease modifying agents, with the more significant and sustained changes occurring in the group of patients who started a disease modifying agent at the time pulse therapy was begun. No significant effect of pulse therapy on neutrophil or lymphocyte counts or lymphocyte subsets could be demonstrated. Pulse therapy, per se, did not have a significant effect on the results of intradermal delayed hypersensitivity testing in any patient group.

Antigen-Antibody Complex↗
PubMed1988

The clinical and immunological effects of pulse methylprednisolone therapy in rheumatoid arthritis. III. Effects on immune and inflammatory indices in synovial fluid.

Pulse methylprednisolone therapy has dramatic effects on cellular traffic and immunological variables of disease activity in both the synovial fluid (SF) and peripheral blood compartments. While these effects persisted at 2 weeks in the SF they had reverted to pretreatment levels in the peripheral blood. Pulse therapy resulted in temporary changes in the number of helper and suppressor cells in peripheral blood with an initial fall followed by a rise in the helper to suppressor ratio. In the SF, pulse therapy produced more gradual and sustained effects on the helper and suppressor subpopulations, resulting in a reduction in the helper to suppressor ratio.

Antigen-Antibody Complex↗
PubMed1987

Effect of aortic regurgitation on the assessment of mitral valve orifice area by Doppler pressure half-time in mitral stenosis.

Evaluation of the severity of mitral stenosis by continuous-wave Doppler pressure half-time measurement is now well established. However, few data exist regarding the effect of aortic regurgitation (AR) on the validity of this method. Therefore, 73 patients were studied in whom cardiac catheterization and Doppler echocardiographic examinations were performed. Mitral valve orifice area was determined by the Gorlin equation, 2-dimensional echocardiography and Doppler pressure half-time. Doppler pressure half-time and catheterization estimates of mitral valve area correlated well (r = 0.85) in patients without significant mitral regurgitation. This correlation was maintained in patient subgroups with and without significant (at least 2+) AR (r = 0.86 and 0.83, respectively). Similarly, Doppler and 2-dimensional echocardiographic assessment of mitral valve area showed a strong correlation (r = 0.84). Again, the correlation between the 2 methods was similar in patients with and without significant AR (r = 0.86 and 0.82, respectively). Thus, Doppler pressure half-time estimates of mitral valve orifice area are accurate even in patients with AR.

Adult↗
PubMed1987

Clonidine prevents the short-term down regulation of muscarinic receptors in mouse brain induced by the acetylcholinesterase inhibitor soman.

The influence of clonidine on the down regulation of muscarinic acetylcholine receptors induced by the irreversible acetylcholinesterase inhibitor soman was studied in mouse brain (cortex and brainstem). Muscarinic receptor binding was measured using [N-methyl-3H]scopolamine ([3H]MS) as the probe in a filtration assay. Thirty min after subcutaneous injection of soman at a dose which killed 80-90% of the mice, the concentration of [3H]MS binding sites was reduced by 25-28% in surviving mice. [3H]MS binding affinity (Kd = 0.36-0.42 nM), agonist binding state, and receptor coupling to guanine nucleotide-dependent transducer proteins (G proteins) were not affected by soman. Administration of clonidine (1 mg/kg, s.c.) 5 min prior to soman prevented the decrease in receptor number and decreased the extent of acetylcholinesterase inhibition caused by the soman. It is possible that a reversible inhibition of acetylcholinesterase by clonidine protects the enzyme from irreversible inactivation by soman, thereby decreasing the extent of chronic cholinergic overstimulation with its attendant down regulation of muscarinic receptors.

Acetylcholinesterase↗
PubMed1987

Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital.

Strictly enforced formulary restrictions for aminoglycosides, cephalosporins, and a vancomycin group generated combined savings of $2.61 (p less than 0.0046) per antibiotic day and $34,597 (p less than 0.0003) per month. Even after some cost increases (not significant) in new and other antibiotics, the program saved $1.33 (p less than 0.0175) per antibiotic day and $24,620 (p less than 0.0311) per month for all antibiotics. The pharmacy's 1985 average cost per antibiotic day and its monthly expenditures were $18.45 and $199,003, respectively. In the months following the formulary restrictions, no significant detrimental changes occurred in hospital length of stay or mortality. A retrospective analysis of 322 patients with bacteremia treated before and after the onset of the controls revealed that antibiotics were more appropriately used afterwards.

Aminoglycosides↗
PubMed1987

Treatment of pica in an adult disabled by autism by differential reinforcement of incompatible behavior.

The usefulness of differential reinforcement of incompatible behavior was examined in the treatment of pica in a young man severely disabled by autism in a nonsheltered place of employment. The results indicated that a reduction in pica could be achieved by differential reinforcement of other behavior (DRO). Behaviors which were reinforced included remaining in this assigned location, keeping his hands on his work, working quickly and keeping his mouth clear. Reinforcements included favorite drinks, snacks, activities and praise. Treatment procedures were implemented by direct care paraprofessional staff. Withdrawal of treatment resulted in an increase in pica, with renewed reduction on reinstatement of the reinforcement schedule.

Adult↗
PubMed1987

Herpes simplex virus and facial palsy.

An 8-year-old boy developed acute herpes simplex virus stomatitis followed by transient facial palsy. The possible relationship between this virus and Bell's palsy is discussed.

Child↗
PubMed1987

Quantitative assessment of the hemodynamic consequences of aortic regurgitation by means of continuous wave Doppler recordings.

The purpose of this study was to evaluate the ability of continuous wave Doppler ultrasound recordings to reflect the magnitude and hemodynamic effects of aortic regurgitation. Forty-five patients with angiographically proved aortic regurgitation had Doppler studies performed within 24 hours of cardiac catheterization. High quality spectral recordings of the regurgitant jet were obtained in 31 patients, whereas 14 patients exhibited dropout of high velocity signals precluding measurement of maximal velocities. The slope of the peak to end-diastolic velocity decrease measured by Doppler examination was compared with the decay in the aortic to left ventricular diastolic pressure gradient by catheterization and was found to correlate well (r = 0.86). The Doppler velocity decay slope was generally higher in patients with angiographically severe rather than mild or moderate aortic regurgitation, but considerable overlap was present among groups. However, a diastolic velocity decay slope of greater than 3 m/s2 was seen only in those patients with advanced (3 or 4+) aortic regurgitation. Left ventricular end-diastolic pressure was estimated from the Doppler recordings by subtracting the end-diastolic pressure gradient obtained by the modified Bernoulli equation from the cuff diastolic blood pressure. A correlation was observed (r = 0.84) between Doppler and catheterization left ventricular end-diastolic pressure in the 31 patients with high quality spectral data, although the SEE was substantial (5.5 mm Hg). These data demonstrate that continuous wave Doppler recordings of the regurgitant jet can be useful in assessing the angiographic severity and hemodynamics of aortic regurgitation.

Adolescent↗
PubMed1987

Uses and limitations of exercise Doppler echocardiography in the diagnosis of ischemic heart disease.

This study tested the hypothesis that coronary artery disease might be identified by a decrease in Doppler measurements of flow velocity and acceleration. The response of aortic blood flow velocity and acceleration to exercise was determined in 102 subjects (28 young control subjects and 74 older patients) who underwent continuous wave Doppler echocardiographic examination before, during and immediately after near maximal treadmill exercise. Patients were grouped according to the results of thallium perfusion imaging: Group I = normal, Group II = ischemia with or without prior infarction and Group III = prior infarction only. A significant decrease in the level of velocity and acceleration achieved with exercise was observed both in patients in Group I (normal thallium study) (1.2 +/- 0.3 m/s and 36.8 +/- 14 m/s per s, p less than or equal to 0.005) and in patients in Group II (ischemia) (1.1 +/- 0.3 m/s and 27.7 +/- 11 m/s per s, p less than or equal to 0.0005) compared with values in young control subjects (1.4 +/- 0.2 m/s and 52.7 +/- 16 m/s per s). When groups of patients of similar age who differed in the presence (Group II) or absence (Group I) of ischemia on thallium scintigraphy were compared, no difference was found for maximal velocity (1.1 +/- 0.3 versus 1.2 +/- 0.3 m/s, p = NS), but acceleration was significantly lower in Group II (27.7 +/- 11 versus 36.8 +/- 14 m/s per s, p less than or equal to 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Depressive symptomatology and treatment in patients with end-stage renal disease.

A sample of 60 patients selected at random from an adult population of 419 patients with end-stage renal disease was assessed for major depression. Diagnoses were based on a structured interview using DSM-III criteria. Eighteen patients (30%) met criteria for a major depression on a lifetime basis. In addition, depressive symptoms and treatment for each depressed patient are reported.

Adult↗
PubMed1987

Introduction.

Explore the source record for details and available documents.

Journal Article↗