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Biomedical subjects

R B Smith

Publications and source records attributed to R B Smith.

At least 379 records · Page 21Linked to original sources
PubMed1976

Selective and total shunts in the treatment of bleeding varices. A randomized controlled trial.

Two types of surgical therapy of bleeding esophageal varices were evaluated in 48 patients by a randomized controlled trial: 24 were randomized for a total shunt and 24 for the selective shunt. In two of the latter, a total shunt had to be performed for technical reasons. The fatality rates (six in the 24 total, and six in 22 selective [performed], and seven in 24 selective [randomized]), the frequency of shunt occlusion (two in each group), and of recurrent gastronintestinal bleeding (three in each group) were similar. Encephalopathy developed more often after a total shunt -- 10 of 24, or one per 58 patient-months -- than after selective (performed) -- one of 22, or one per 593 patient-months (P less than 0.005). Total shunts consistently diverted the hepatopetal mesenteric-portal flow from the liver. Deterioration of hepatic function (maximum rate of urea synthesis) was greater after total than selective shunt (P less than 0.05).

Adult↗
PubMed1976

Cardiovascular effects of insulin.

Insulin increased the heart rates of seven diabetics with normal cardiovascular reflexes. This effect, which was not due to hypoglycaemia, was greater in the upright than in the supine position and was produced by as little as one unit given intravenously. This increase in heart rate may be a compensatory response to maintain cardiac output.

Blood Glucose↗
PubMed1976

Spectrofluorometric determination of hydroflumethiazide in plasma and urine.

A rapid, accurate, sensitive, and reproducible assay for hydroflumethiazide in plasma and urine was developed after studies of its UV and fluorescence spectral properties and partitioning behavior. The assay is based on initial extraction from acidified plasma or urine into ether, back-extraction into basic solution followed by acidification to about pH 1, and measurement of the fluorescence derived from the unionized molecule. Analysis of variance indicated no significant differences in assays performed on the same day. The mean recovery was 98.8 +/- 7.4% for plasma over a concentration range of 0.2-2.0 mug/ml. The method is convenient for routine clinical use and has sufficient sensitivity to quantify hydroflumethiazide levels after administration of therapeutic doses.

Animals↗
PubMed1976

Iatrogenic microphallus secondary to circumcision.

Three cases of apparent microphallus secondary to overzealous circumcision are presented. Proper diagnosis avoids unnecessary diagnostic studies. Moreover, a good functional and cosmetic result is virtually assured with appropriate resurfacing and thick split thickness skin grafting of the penile shaft. The best treatment would appear to be prevention of the complication by adequate instruction to personnel doing routine circumcisions.

Child↗
PubMed1976

Benign fibrous paratesticular tumors.

Utilizing the criteria of Goodwin, a case each of chronic proliferative periorchitis and multiple fibromas of the tunica vaginalis testis causing paratesticular tumors is presented and discussed. Both of these rate processes appear to be distinct and separate clinical entities, although they appear to be similar histologically. With increased awareness by those treating intrascrotal masses, these processes may be correctly recognized and more testes may be salvaged.

Adult↗
PubMed1976

Detection of renovascular hypertension: saralasin test versus renin determinations.

Angiotensin blockade was established in hypertensive patients with the competitive inhibitor saralasin and the blood pressure response was compared to prior renin determinations. Two patients with subsequently confirmed renovascular hypertension had normal peripheral renin and non-lateralizing renal vein renin ratios, yet both showed a clear-cut lowering of blood pressure after administration of the blocking agent, indicating the presence of renin-mediated hypertension. Thus, direct in vivo testing with saralasin appears to offer certain advantages over renin determinations.

Angiotensin II↗
PubMed1976

Preoperative vascular embolization as an adjunct to successful resection of large retroperitoneal hemangiopericytoma.

A large retroperitoneal hemangiopericytoma was resected successfully with the aid of preoperative control of the blood supply of the lesion with percutaneous intra-arterial gelfoam and ferromagnetic silicone embolization. We believe that this resection would not have been possible without this adjuvant technique. Future application of this combined technique will enable more aggressive surgical intervention in unresectable vascular tumors and arteriovenous malformations.

Adult↗
PubMed1976

External sphincter spasticity syndrome in female patients.

The external sphincter spasticity syndrome is described with regard to diagnosis, etiology, pathophysiology and treatment. Use of urodynamic techniques (especially urethral pressure profile and diagnostic pudendal blocks) and adrenolytic agents and diazepam in the treatment of the dysfunction is discussed. We consider this clinical entity to be much more common than perviously reported.

Adult↗
PubMed1976

Diagnosis and management of arterial stenosis causing hypertension after successful renal transplantation.

Renal artery stenosis causing hypertension has been noted in 11 patients after successful renal transplantations. We believe that all patients with moderate to severe post-transplant hypertension should be evaluated with angiography and selective renin determinations. However, because of definite risk to the graft we believe that operative intervention should be undertaken only if hypertension is uncontrolled or if declining renal function is present and attributable to the stenosis.

Adolescent↗
PubMed1976

Percutaneous transtracheal ventilation.

The technique of percutaneous transtracheal ventilation (intermittent jets of oxygen under high pressure, 50 pounds per square inch [psi]) has been used for resuscitation during anesthesia and prior to tracheostomy, and has been established as an important adjunct to life-support techniques. The technical aspects are described together with experimental evidence that intermittent jet ventilation is necessary to eliminate carbon dioxide. The complications occurring with a series of 80 patients are reported along with experimental work in ventilation of dogs with compressed air sources, including truck tires. Emergency physicians should be familiar with this technique and equipment for its use should be readily available in the emergency department. The potential role of transtracheal ventilation in the mobile intensive care unit at accident sites has been explored and appears promising. Conventional airway support techniques should be applied prior to resorting to transtracheal ventilation.

Adolescent↗
PubMed1976

Jet ventilation for fiberoptic bronchoscopy under general anesthesia.

An oxygen jet method ventilating patients during laryngoscopy has been applied to fiberoptic bronchoscopy. A 3.5 mm plastic tube 24.5 cm long was inserted into the trachea through the mouth. An intermittent jet of oxygen at 3.5 atm (50 psi) was applied to this tube using a 1.5 mm ID plastic catheter to ventilate the patient. Anesthesia was accomplished with intravenous thiamylal and Innovar. The patients were paralyzed with continuous succinylcholine. The technique has subsequently been used without complications in more than 1,000 patients. A fluidic ventilator was developed for delivering and controlling the oxygen jet. The airway pressure can be monitored continuously and, by the use of fluidic devices, the jet can be set to cut off automatically if the airway pressure is too high. The above techique for laryngoscopy with the fluidic ventilator was used in 28 patients undergoing fiberoptic bronchoscopy (Olympus 5.7 mm diameter). The airway pressure was continuously monitored with a line attached to the suction port of the bronchoscope. Arterial PCO2 ranged from 23 to 42 mmHg and PO2 from 105 to 325 mmHg. The high PO2 levels were maintained even during suctioning. General anesthesia for fiberoptic bronchoscopy can be performed using an endotracheal tube not smaller than 8 mm internal diameter (ID). The advantages of the oxygen jet technique are that it can be used in smaller patients and that the upper airway can be examined.

Anesthesia, General↗
PubMed1976

Survey of aflatoxicosis in farm animals.

Over a 22-month period, 278 submissions of farm animals were made to the North Carolina Diagnostic Laboratory for suspected aflatoxicosis, and 94 cases were confirmed on the basis of finding aflatoxin in the feed and the occurrence of bile ductule proliferation. There was an annual variation in the incidence of aflatoxicosis, as well as a seasonal variation: the peak incidence occurred in the winter, and the minimum incidence occurred during the summer. The annual increase coincided with the corn harvest. All confirmed cases occurred on farms that raised and stored their own corn, and 88% were in swine. The cases were geographically localized in the eastern section of North Carolina (94% of the total cases) where 82% of the swine and 79% of the corn are produced. Mean concentration of aflatoxin in feed samples from the confirmed cases was 3,890 mug/kg, and the mean value for corn used in making the feed was 5,180 mug/kg. Only aflatoxin B1 was found in the samples. These data were interpreted to mean that the incidence and severity of aflatoxicosis is greater than previously suspected, that poor on-farm storage of corn is a primary contributing factor, that aflatoxin formation continues during and after the milling process, and that mycotoxicoses other than aflatoxicosis may cause equal or greater problems.

Aflatoxins↗
PubMed1976

A study of addicts' career experiences with methadone.

Recent public concern over illicit methadone use has generated considerable interest among both treatment authorities and researchers. Unfortunately, many professional studies on the topic have done little to clear up certain misconceptions surrounding methadone use. In building upon earlier empirical work, the authors sought to explore the role of methadone within the context of addict career experiences as a whole. Interviews revealed considerable differentiation in types of experiences and purposes for use with respect to a variety of demographic and drug career attributes. The findings suggest the need for some rethinking about prevailing conceptions of "the problem" of illicit methadone use.

Adult↗