Search PubMed⌕ Search

Biomedical subjects

R Alexander

Publications and source records attributed to R Alexander.

At least 91 records · Page 5Linked to original sources
PubMed1994

Duodenogastroesophageal reflux: relationship to pH and importance in Barrett's esophagus.

BACKGROUND/AIMS: Several reports suggest that duodenogastroesophageal reflux may produce esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. The purpose of this study was to understand better the relationship of pH (< 4 and > 7), duodenogastroesophageal reflux, and fasting bile acid concentrations in producing esophageal damage. METHODS: Using a spectrophotometric technique to measure bile reflux, four groups were studied: healthy subjects, reflux patients, patients with Barrett's esophagus, and patients with esophageal symptoms after partial gastrectomy. RESULTS: Simultaneous 24-hour pH and bile monitoring of distal esophagus found close association between total percent of time pH < 4 and duodenogastroesophageal reflux (r = 0.78; P < 0.001) but a poor relationship (r = -0.06) with total percent of time pH > 7, suggesting that the term alkaline reflux is a misnomer. Duodenogastroesophageal reflux increased significantly with the severity of reflux disease, being greatest in patients with Barrett's esophagus and comparable with that in patients with partial gastrectomy. Fasting bile acid concentrations did not distinguish patients with Barrett's esophagus from those with reflux. Rather, increased quantity of acid reflux was the single factor most characterizing patients with Barrett's esophagus. Omeprazole (20 mg twice daily) normalized acid reflux parameters (13.8% +/- 1.6% to 0.8% +/- 0.6%) and significantly (P < 0.001) decreased duodenogastroesophageal reflux (32.8% +/- 6.9% to 4.7% +/- 1.7%). CONCLUSIONS: Acid reflux is the primary factor in the development of Barrett's esophagus. Bile reflux parallels acid reflux and, at best, may have a synergistic role. Aggressive acid suppression with omeprazole markedly decreases both.

Acids↗
PubMed1994

An accurate method for open reduction and internal fixation of high and low condylar process fractures.

OBJECTIVE: This study was undertaken to evaluate a protocol for open reduction of both high and low condylar fractures that consistently produces accurate reductions, uses rigid internal fixation, and allows immediate function. MATERIALS AND METHODS: This protocol was retrospectively evaluated in 22 consecutive patients (23 fractures). RESULTS: All patients functioned immediately. There were no inaccurate reductions, malocclusions, wound infections, neurosensory deficits, or reports of chronic pain. No patients required reoperation. CONCLUSION: The results of this study indicate that this protocol consistently produces accurate reduction of condylar process fractures and allows immediate function with a minimum of morbidity.

Adolescent↗
PubMed1994

A controlled trial of the effects of esmolol on cardiac function.

We have examined the effects of two different bolus doses of esmolol hydrochloride (Brevibloc) on haemodynamic variables in a placebo-controlled, double-blind, randomized trial. Sixty healthy adult patients undergoing minor orthopaedic surgery were given a standardized general anaesthetic using a laryngeal mask airway. Heart rate (HR), mean arterial pressure (MAP), stroke volume (SV) and cardiac output (Q) were measured (the latter two by Doppler ultrasonography) every 1 min for 5 min after injection of either placebo or esmolol 100 mg or 200 mg. HR, MAP, SV and Q decreased significantly (P < 0.05) for both esmolol groups compared with placebo and, except for MAP, esmolol 200 mg had a greater effect than esmolol 100 mg (P < 0.05). Depression was maximal at 2 min after which recovery was observed but was still incomplete at 5 min.

Adolescent↗
PubMed1994

Evaluation of methods of internal fixation of transverse patella fractures: a biomechanical study.

Biomechanical testing was performed to evaluate five techniques of internal fixation of transverse patella fractures. Using cadaveric lower extremities, transverse osteotomies of the patella were performed, and the simulated fractures were fixed with the following techniques: the modified tension band, anterior tension band with a supplemental cerclage wire (the Pyrford technique), tension band with cancellous bone screws, Pyrford technique with cancellous screws, and cancellous screws alone. The fixation techniques were evaluated by measuring the separation of the fracture fragments during loading to produce a physiologic range of motion (90 degrees flexion to full extension). All techniques functioned adequately, with no fracture gap exceeding 1 mm. The tension band with screws technique performed significantly better than did the modified tension band, with an average fracture gap approximately half that of the traditional modified tension band technique. Mechanically, the addition of the screws to the tension band techniques reduces fracture separation by providing compression throughout the range of motion and by resisting the tensile loading during terminal extension.

Aged↗
PubMed1994

A study of oral morphine preference in inbred mouse strains.

C57BL/6J mice, in two-bottle choice paradigms, show increased oral morphine consumption, compared with DBA/2J mice. To determine whether this C57 morphine preference reflects differences in the receptor-mediated, reward-based action of morphine (as opposed to pharmacokinetic or gustatory differences), three experiments were performed. Consistent with previous two-bottle choice experiments, C57 mean (+/- S.D.) morphine consumption was 18 +/- 3 mg/kg/day, while the DBA mice consumed 1.4 +/- 1.2 mg/kg/day. Intraperitoneal naltrexone produced a 50% decrease in C57 morphine consumption (p < 0.01), while DBA mice showed no change. Consumption of fluid from the control bottle was not changed for either strain. Fifteen and 30 min after oral consumption of a morphine solution, plasma levels of morphine and its glucuronide derivative were not different between these two strains. C57 mice maintained a daily morphine intake of approximately 20 mg/kg across morphine concentrations of 0.05-0.4 mg/ml. These experiments suggest that the difference in oral morphine preference between C57 and DBA mice represents a reward-based mechanism which is mediated through opiate receptors.

Animals↗
PubMed1993

A comparison of the laryngeal mask airway and Guedel airway, bag and facemask for manual ventilation following formal training.

Ten volunteers, with no previous experience of resuscitation, were formally trained in the use of the laryngeal mask airway and the oropharyngeal airway (Guedel), bag and facemask for manual ventilation of the lungs in 104 fit, anaesthetised adults. They then used both airways in turn. The order of insertion was randomly allocated, and the times taken for insertion were also recorded. Ventilation for each airway was deemed to be successful if an increase in end-tidal carbon dioxide partial pressure did not occur and arterial oxygen saturation remained greater than 90%. Success rates for the laryngeal mask airway and the Guedel airway, bag and facemask were 87% and 43% respectively (p < 0.001) and the average insertion times were 27.4 s (SEM 1.5) and 15.8 s (SEM 0.50) (no significant difference), respectively. The laryngeal mask airway proved to be easier to use for manual ventilation than the Guedel airway, bag and mask for inexperienced personnel who had received a period of formal training in both techniques.

Education, Nursing↗
PubMed1993

Prospective evaluation of selective venous sampling for parathyroid hormone concentration in patients undergoing reoperations for primary hyperparathyroidism.

BACKGROUND: The utility of standard radiologic imaging studies in guiding reoperative parathyroid surgery for primary hyperparathyroidism is widely known and accepted. The additional information gained by selective venous sampling in that patient population has not been well defined. We report the results of our experience with this method. METHODS: Between 1982 and 1992, 223 consecutive patients underwent reoperations for persistent or recurrent primary hyperparathyroidism after a prospectively determined series of imaging studies. Patients underwent noninvasive testing consisting of ultrasonography, computed tomography, technetium thallium scanning, and magnetic resonance imaging. Patients with negative, equivocal, or discordant results on the noninvasive studies proceeded to angiography. If angiography was negative, selective venous sampling was performed. RESULTS: Eighty-six patients (39%) with negative or equivocal noninvasive test and angiogram results underwent selective venous sampling. Seventy-six patients (88%) had a significant gradient in levels of parathyroid hormone from veins draining the left side of the neck (n = 25), the right side of the neck (n = 33), both sides of the neck (n = 7), and the thymus (n = 11). Correlation of these findings with operative findings revealed a sensitivity of 88% and a specificity of 86%. In the subgroup of patients who underwent venous sampling and had completely negative results of standard radiologic studies (35 of 86; 40%), 28 patients (80%) had venous gradients and seven patients (20%) had no gradient. Of those 28 patients in whom the venous sampling gradients were the only positive localization study, the venous samplings were helpful in 23 patients (true positive gradients), and the operative success rate was 93%. In the seven patients with no positive preoperative localizing studies including venous sampling, there were two operative failures (operative success, 71%). CONCLUSIONS: Our results show that selective venous sampling is a highly sensitive and specific method to regionally localize abnormal parathyroid glands not imaged by standard noninvasive and invasive radiologic techniques. Venous sampling is the study of choice in guiding reoperative procedures for occult abnormal parathyroid glands that are undetected despite the use of all available imaging studies.

Diagnostic Imaging↗