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Biomedical subjects

P Phillips

Publications and source records attributed to P Phillips.

At least 217 records · Page 12Linked to original sources
PubMed1987

Screening assessment of penile tumescence and rigidity. Clinical test of Snap-Gauge.

A study was conducted to investigate the clinical usefulness of the Snap-Gauge, a device intended to provide an economical alternative to complete nocturnal penile tumescence (NPT) recording. Twenty-one patients were assessed using the Snap-Gauge either during NPT recording or during the corporeal calibration test (CCT), or both. Patient acceptance of the device was excellent. The results indicate a fair degree of consistency between the Snap-Gauge and CCT measurements. The Snap-Gauge and NPT findings were less consistent. The results suggest that the Snap-Gauge is a reliable and useful screening device for assessing impotent patients. However, it is not an adequate substitute for a more complete NPT monitoring with polysomnographic recording.

Erectile Dysfunction↗
PubMed1987

Human Curvularia infections. Report of five cases and review of the literature.

Curvularia lunata is a saprobic dematiaceous mould that resides primarily in soil (Ellis, 1966). Reports of human disease caused by this organism are rare but include: endocarditis, brain abscess, skin infections, onychomycosis, keratitis, pneumonia, disseminated disease, mycetoma, allergic bronchopulmonary disease, and one case of sinusitis. Since 1983, we have encountered five cases of paranasal sinusitis due to C. lunata. None of the patients suffered from known immunologic disorders or underlying debilitating diseases. These five cases are presented and the literature of human phaeohyphomycosis caused by Curvularia spp. is reviewed.

Adult↗
PubMed1987

Invasive aspergillosis diagnosed by immunohistochemistry with monoclonal and polyclonal reagents.

Therapies differ for invasive infection due to the various filamentous fungi. However, histopathologic identification of Aspergillus, Pseudallescheria, Fusarium, Trichosporon, dematiacious Hyphomycetes, Candida, and Zygomycetes may be confused, and microbiologic isolation is often delayed. To improve diagnosis, we examined the utility of polyclonal and monoclonal antibodies to identify Aspergillus organisms by peroxidase immunohistochemical techniques. Tissues obtained from 68 infected patients were examined. Fungal antigen was detected in all 26 cases of aspergillosis by the monoclonal immunohistochemical test. Hyphae of Aspergillus organisms exhibited strong intracellular and cell wall staining, and extracellular localization was also observed. In contrast, negative tests were observed in tissues from five cases of infection with Pseudallescheria boydii, three with Trichosporon, three with Zygomycetes, six with Candida species, and one with Curvularia, from as well as 20 cases of nonfungal pneumonia. However, cross-reactivity to Coccidioides immitis spherules was noted in three cases. Staining of Candida was observed with the polyclonal antibody but not the monoclonal reagent. This is the first immunohistochemical demonstration of aspergillus antigen with a monoclonal reagent. The study indicates that the monoclonal immunohistochemical technique can distinguish Aspergillus species from other filamentous fungi and may facilitate the clinical diagnosis of invasive aspergillosis.

Adult↗
PubMed1987

Adrenal response to corticotropin during therapy with itraconazole.

Itraconazole is a triazole with a mechanism of action similar to that of ketoconazole. Endocrine side effects of ketoconazole, including impaired cortisol synthesis, have been well documented (A. Pont, J. R. Graybill, P. C. Craven, J. N. Galgiani, W. E. Dismukes, R. E. Reitz, and D. A. Stevens, Arch. Intern. Med. 144:2150-2153, 1984). We examined the adrenal response to corticotropin in 10 patients being treated with itraconazole. No impairment of cortisol synthesis could be demonstrated.

Adrenal Cortex↗
PubMed1987

Deficient production of cyclic AMP: pharmacologic evidence of an important cause of contractile dysfunction in patients with end-stage heart failure.

We studied the effects of different classes of inotropic drugs on human working myocardium in vitro that was isolated from the hearts of patients with end-stage heart failure, and compared the responses to these drugs with those noted in muscles from nonfailing control hearts. Although peak isometric force generated in response to increased extracellular calcium reached control levels in the muscles from patients with heart failure, the time course of contraction and rate of relaxation were greatly prolonged. The inotropic effectiveness of the beta-adrenergic agonist isoproterenol and the phosphodiesterase inhibitors milrinone, caffeine, and isobutylmethylxanthine was markedly reduced in muscles from the patients with heart failure. In contrast, the effectiveness of inotropic stimulation with acetylstrophanthidin and the adenylate cyclase activator forskolin was preserved. After a minimally effective dose of forskolin was given to elevate intracellular cyclic AMP levels, the inotropic responses of muscles from the failing hearts to phosphodiesterase inhibitors were markedly potentiated. These data indicate that an abnormality in cyclic AMP production may be a fundamental defect present in patients with end-stage heart failure that can markedly diminish the effectiveness of agents that depend on generation of this nucleotide for production of a positive inotropic effect.

1-Methyl-3-isobutylxanthine↗
PubMed1987

Recurrent dislocation of the patella. Histochemical and electromyographic evidence of primary muscle pathology.

The role of muscle function in the aetiology of recurrent dislocation of the patella has been examined. Eleven of the 12 patients we studied had joint hypermobility. Muscle biopsies from eight of nine patients treated by surgery had a predominance of abnormal Type 2C fibres, and three of six patients whose quadriceps muscles were studied by electromyography also had abnormal results. Our preliminary findings suggest that there may be a primary muscular defect in many cases of recurrent dislocation of the patella.

Adolescent↗
PubMed1986

Rapid fast to slow fiber transformation in response to chronic stimulation of immobilized muscles of the rabbit.

Limb immobilization causes muscle atrophy particularly of slow oxidative fibers which also suffer the greatest decrement in neural activation. In this study a fast muscle, tibialis anterior, was chronically stimulated using an activity pattern characteristic of nerve fibers to slow muscles to see whether or not this could prevent immobilization induced slow fiber atrophy. Four groups of rabbits were used: unoperated controls, stimulated (10 Hz, 8 h/day), immobilized (neutral position), and a stimulated plus immobilized group. The experimental period was 28 to 30 days or 44 to 50 days. Immobilization caused significant decrease in slow oxidative fiber area which was completely prevented by stimulation. In animals tested for the longer period there was 56% hypertrophy. In addition, the combination of stimulation and immobilization caused a two-fold increase in the number of slow oxidative fibers and greatly increased the proportion of intermediate fibers. Stimulation without immobilization had no effect. Slow fibers in stimulated immobilized muscles had a bimodal area distribution; the number of large fibers (mean area 7059 micron2) was the same as the number of slow oxidative fibers in contralateral muscles, suggesting that they were the preexisting slow fibers, and a small fiber population (mean area 3143 micron2) represented newly converted fast fibers. We conclude that slow muscle units benefit from restoration of activity by chronic stimulation. In addition, the combination of stimulation and immobilization accelerates fast to slow fiber conversion. We suggest that isometric conditions as well as enhanced glucocorticoid effects could account for these findings.

Animals↗
PubMed1986

Compensatory nitrogen retention in growing pigs following a period of N deprivation.

1. Semi-synthetic diets, with dried microbial cells (Pruteen) as the nitrogen source, were used to measure N retention in 50 kg pigs given different combinations of N intake involving periods of deprivation and enhanced supply. 2. Metabolic faecal N losses were 1.92 g/d (1.26 g/kg dry matter eaten) and endogenous urinary losses were 3.96 g/d for pigs given an N intake of 6.9 g/d. 3. Compensatory N retention averaging 4.2 g extra N/d was observed in pigs given enhanced N supply by diets providing 31.0, 60.4 and 93.4 g N/d. In some instances enhanced N retention was maintained for 22 d. 4. Pigs given enhanced N supply by extravagant N intake did not maintain the compensatory response which had been evident initially.

Animals↗
PubMed1986

Grip strength, mental performance and nutritional status as indicators of mortality risk among female geriatric patients.

The study involved 82 consecutive acute admissions of female patients to a geriatric ward. A wide range of medical diagnoses was represented. The patients were assessed in relation to anthropometric measurements (grip strength, mid-arm circumference, triceps skin-fold, and arm muscle circumference), mental test score and serum albumin. The prognostic significance of these variables was considered with regard to mortality. Those who died had significantly lower grip strength (P less than 0.01), arm muscle circumference (P less than 0.05), serum albumin (P less than 0.01) and mental test score (P less than 0.01). A maximum grip strength of greater than or equal to 5 kg was the most sensitive and specific cut-off point to separate survival from death (true positive ratio 0.81, true negative ratio 0.92). Mental test score was positively correlated with grip strength and serum albumin. Grip strength was also measured in 35 healthy female controls of the same age group, and was found to be significantly greater than in the patient group (P less than 0.01). It appears that reduced grip strength, malnutrition and mental impairment are associated with increased risk of mortality in acute illness. Likely mechanisms are discussed.

Acute Disease↗
PubMed1985

Treatment of Pseudomonas and Serratia infections with ceftazidime.

The effectiveness and safety of parenterally administered ceftazidime were assessed in 20 patients with infections caused by Pseudomonas aeruginosa or Serratia marcescens. There were six infections involving the urinary tract, six wound infections, one respiratory tract infection, three septicaemias, one empyema, one mastoiditis and two infections of the epididymis. Sixteen of the isolates were resistant to at least one aminoglycoside antibiotic. Fifteen patients were clinically and bacteriologically cured, two patients improved, but had relapses and three patients showed no response. The lack of clinical response was due to the development of resistance by P. aeruginosa in two patients with osteomyelitis, one of whom also had diabetes mellitus. The third patient who had chronic lymphocytic leukaemia developed post-operative osteomyelitis and septicaemia with serratia. She did not respond to treatment. Side effects consisted of a positive direct Coomb's test without evidence of haemolysis in two patients and a mild maculopapular rash in one patient.

Adult↗
PubMed1985

Infections of central nervous system shunts.

Approximately 1 out of every 10 ventricular shunts for hydrocephalus will become infected. This represents a three- to fivefold increase in infection rate compared with other neurosurgical procedures. Most often, the infection results from colonization of the shunt device by normally nonpathogenic skin flora at the time of surgery. Properties of the foreign body itself may contribute to this increased risk of infection, and most infections are clinically apparent within the first 6 months following surgery. Meticulous surgical technique remains one of the most important variables in reducing shunt infection while the role of prophylactic antibiotics is still unclear. When a shunt infection is suspected, percutaneous needle aspiration of the shunt reservoir is most always diagnostic. Fluid specimens should be sent for Gram smear, culture, and susceptibility testing. Appropriate systemic antibiotics should be started. In most instances, the infected patient should be treated by external ventricular drainage and intraventricular antibiotics until the CSF is sterilized. The drain should then be removed and a new shunt placed. Immediate removal of the infected shunt with simultaneous replacement by a new shunt in a different location also has a high cure rate but carries an increased risk of subsequent infection. With few exceptions, antibiotic therapy alone or partial shunt revision will be unsuccessful, and these therapies carry increased morbidity and mortality rates due to prolonged shunt infection. Despite the frequency of shunt surgery and its high rate of infection, a well-organized investigational approach to this problem has been lacking. Both laboratory and clinical investigation needs to explore new shunting techniques, biomaterials, the role of antibiotics, and microbial factors involving host defenses and the shunt apparatus itself.

Anti-Bacterial Agents↗
PubMed1984

Metalloproteinase inhibitors from bovine cartilage and body fluids.

Inhibitors of the mammalian metalloproteinases, collagenase, proteoglycanase and gelatinase were isolated from bovine cartilage (extracts and culture medium) and bovine amniotic fluid and serum. These inhibitors either bind or do not bind to concanavalin-A--Sepharose, with Mr (gel filtration) of about 30 000 and 20 000, respectively. Cartilage and chondrocyte culture media contained only concanavalin-A-binding inhibitors whereas cartilage extracts contained only a non-binding inhibitor: serum and amniotic fluid contained both forms of inhibitory activities. In moist biochemical respects, particularly in their abilities to inhibit metalloproteinases, all of the inhibitors were found to be similar. It is concluded that the forms of the inhibitors that differ in Mr may be closely related to the tissue inhibitor of metalloproteinases (TIMP) previously purified from rabbit and human sources. These findings help to clarify other studies on collagenase inhibitors and support the concept that TIMP-like inhibitors may be important in the control of connective tissue degradation.

Amniotic Fluid↗