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Biomedical subjects

R A Clark

Publications and source records attributed to R A Clark.

At least 397 records · Page 22Linked to original sources

Percutaneous catheter biliary decompression.

Percutaneous catheter biliary decompression was performed in 42 patients with obstructive jaundice. Internal drainage was accomplished in 27 patients (64.3%), and external drainage in 15 patients (35.7%). Serum bilirubin levels decreased at a mean rate of 1.4 mg/dl/day. Tissue diagnosis was obtained by percutaneous aspiration biopsy in nine patients (21.4%). Complications occurred in 10 patients (23.8%): septic shock, two; bilious pleural effusion, one; hepatic subcapsular hematoma, one; sepsis, six. There was one death related to the procedure. The catheter management problems encountered included pain, catheter dislodgement or migration, lumen occlusion, and external bile leakage.

Aged↗

Self-mutilation accompanying religious delusions: a case report and review.

A case is described of a man who castrated himself while depressed over deviated sexual urges, with eventual favorable response to psychiatric hospitalization and psychotherapy. The literature on self-mutilation is then reviewed, comparing 26 cases of enucleation of eyes, cutting off a hand, mutilating genitals (by males) and cutting out the tongue. Recommendations for treatment and study are attention to previous history or evidence of self-injury, preoccupation with Biblical passages regarding self-injury, preceding drug abuse and early loss of the father in males. Rapid tranquilization and intensive psychotherapy are advised following hospitalization.

Adult↗

The effect of beta-adrenoceptor agonists and antagonists on gastric emptying in man.

1. The effect of beta-adrenoceptor agonists and antagonists on gastric emptying of a solid meal labelled with Indium113m was measured by a gamma camera in healthy volunteers or patients with hypertension. Each subject acted as his own control. 2 In ten subjects given isoprenaline (10 or 20 mg) sublingually 30 min before the meal, gastric emptying half-times were significantly prolonged (P less than 0.05). No effect was observed when isoprenaline was given immediately before the meal. 3 Salbutamol, 4 mg four times daily for 1 week also significantly prolonged gastric emptying in four subjects (P less than 0.05). 4 The effect of isoprenaline on gastric emptying was blocked by propranolol 40 mg four times daily for 1 week. 5 In ten subjects propranolol 40 mg four times daily alone for 1 week was found to significantly speed up gastric emptying (P less than 0.005), suggesting that emptying of the normal stomach is subject to some degree of adrenergic inhibition.

Adrenergic beta-Agonists↗

The effect on paracetamol absorption of stimulation and blockade of beta-adrenoceptors.

1 The effect of drugs acting on beta-adrenoceptors on the absorption and excretion of paracetamol was studied in 26 volunteers and nine patients with mild hypertension, each subject acting as his/her own control. 2 Isoprenaline given 30 min before paracetamol significantly slowed absorption, the effect being dose related, and blocked by prior administration of propranolol. 3 When isoprenaline was given immediately before the paracetamol, absorption was not altered, although a cardiovascular response was seen. 4 Oral salbutamol also delayed paracetamol absorption. 5 Propranolol given alone increased the rate of paracetamol absorption. 6 These results with the changes in the rate of gastric emptying produced by these agents.

Acetaminophen↗

Superior mesenteric angiography and blood flow measurement following intra-arterial injection of prostaglandin E1.

The hemodynamic effects of intra-material prostaglandin E1 (PE1) administered via the angiographic catheter were evaluated in 14 patients. Blood flow in the superior mesenteric artery (SMA) after PGE1 infusion was compared with control SMA blood flow as measured by the "spillover" angiographic reflux method, using a specially designed injector/film-changer system. In all patients, SMA blood flow increased by more than 50% and visualization of the SMA and portal vein was enhanced.

Adult↗

Pulmonary lymphatics visualized during pedal lymphangiography.

Two cases of pulmonary lymphatic opacification during lymphangiography in the presence of a normal thoracic duct are reported. The most likely route of filling of the pulmonary lymphatics in the lower lobes is by reversed flow from the thoracic duct through the inferior pulmonary ligament lymphatics. Retrograde flow from the bronchomediastinal trunk is unlikely.

Aged↗

Damage to Candida albicans hyphae and pseudohyphae by the myeloperoxidase system and oxidative products of neutrophil metabolism in vitro.

In previous studies, we noted that Candida hyphae and pseudohyphae could be damaged and probably killed by neutrophils, primarily by oxygen-dependent nonphagocytic mechanisms. In extending these studies, amount of damage to hyphae again was measured by inhibition of [(14)C]cytosine uptake. Neutrophils from only one of four patients with chronic granulomatous disease damaged hyphae at all, and neutrophils from this single patient damaged hyphae far less efficiently than simultaneously tested neutrophils from normal control subjects. Neutrophils from neither of two subjects with hereditary myeloperoxidase deficiency damaged the hyphae. This confirmed the importance of oxidative mechanisms in general and myeloperoxidase-mediated systems in particular in damaging Candida hyphae. Several potentially fungicidal oxidative intermediates are produced by metabolic pathways of normal neutrophils, but their relative toxicity for Candida hyphae was previously unknown. To help determine this, cell-free in vitro systems were used to generate these potentially microbicidal products. Myeloperoxidase with hydrogen peroxide, iodide, and chloride resulted in 91.2% damage to hyphal inocula in 11 experiments. There was less damage when either chloride or iodide was omitted, and no damage when myeloperoxidase was omitted or inactivated by heating. Azide, cyanide, and catalase (but not heated catalase) inhibited the damage. Systems for generation of hydrogen peroxide could replace reagent hydrogen peroxide in the myeloperoxidase system. These included glucose oxidase, in the presence of glucose, and xanthine oxidase, in the presence of either hypoxanthine or acetaldehyde. In the presence of myeloperoxidase and a halide, the toxicity of the xanthine oxidase system was not inhibited by superoxide dismutase and, under some conditions, was marginally increased by this enzyme. This suggested that superoxide radical did not damage hyphae directly but served primarily as an intermediate in the production of hydrogen peroxide. The possible damage to hyphae by singlet oxygen was examined using photoactivation of rose bengal. This dye damaged hyphae in the presence of light and oxygen. The effect was almost completely inhibited by putative quenchers of singlet oxygen: histidine, tryptophan, and 1,4-diazobicyclo[2.2.2]octane. These agents also inhibited damage to hyphae by myeloperoxidase, halide, and either hydrogen peroxide or a peroxide source (xanthine oxidase plus acetaldehyde). Myeloperoxidase-mediated damage to hyphae was also inhibited by dimethyl sulfoxide, an antioxidant and scavenger of the hydroxyl radical. These data support the involvement of oxidative mechanisms and the myeloperoxidase-H(2)O(2)-halide system, in particular in damaging hyphae in vitro and perhaps in vivo as well.

Candida albicans↗

Religious delusions among Jews.

Though most previous publications described religious delusions only among Christians, a review of cases at Friends Hospital revealed that they are equally common among Jews. Five cases are given, four illustrating psychotic reactions to stress, one demonstrating that a religious experience does not necessarily result in psychosis. Content may come from either the Old or New Testaments. The Messiah delusion is discussed in more detail, with a historical example from the 17th century. Since persecution and other social stress leads to fantasies of a savior, Jewish people are now particularly vulnerable to Messianic delusions.

Adolescent↗

Mesenteric varices: a source of mesosystemic shunts and gastrointestinal hemorrhage.

The presence of mesenteric varices was demonstrated angiographically in 7 patients with portal hypertension. In 4 of these cases the mesenteric varices were the source of lower gastrointestinal bleeding which was successfully controlled by intra-arterial infusion of vasopressin. The radiological diagnosis and management of mesenteric varices is discussed and the pertinent literature is briefly reviewed.

Adult↗