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Biomedical subjects

R C Smith

Publications and source records attributed to R C Smith.

At least 253 records · Page 14Linked to original sources
PubMed1985

Fine bore jejunostomy feeding following major abdominal surgery: a controlled randomized clinical trial.

A randomized controlled prospective clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy. Fifty patients undergoing surgery for gastrointestinal malignancy were randomly allocated into treatment and control groups. A low residue liquidized diet (Isocal) was administered to the patients in the treatment group. Control patients received routine intravenous therapy. Nutritional parameters (serum albumin, serum transferrin, serum prealbumin, weight, body fat and fat free mass) were measured pre-operatively and on the tenth postoperative day. Postoperative surgical complications were similar in both groups. There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding. Postoperative stay was significantly longer (P less than 0.01) in the treatment group patients. Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication-free, 'successful treatment', subgroup. It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications, its routine use cannot be recommended.

Aged↗
PubMed1985

Comparative efficacy of red cell and plasma haloperidol as predictors of clinical response in schizophrenia.

The relative utility of steady-state (SS), plasma (Pl), and red blood cell (RBC) haloperidol levels for predicting clinical response was evaluated in a fixed-dose study in schizophrenic inpatients. There were significant curvilinear relationships between the decrease in BPRS Psychosis Factor Scores by day 24 of haloperidol treatment and both Pl (R2 = 0.34) and RBC (R2 = 0.38) haloperidol levels. Although SS RBC haloperidol levels consistently showed a slightly stronger relationship to clinical response than Pl levels in several comparisons, the differences in R2s between Pl and RBC haloperidol were not statistically significant. Ninety percent confidence intervals for the blood level ranges associated with optimal clinical response in our sample of patients were: 6.5-16.5 ng/ml Pl haloperidol and 2.2-6.8 ng/ml RBC haloperidol.

Adult↗
PubMed1985

Lateral ventricular enlargement and clinical response in schizophrenia.

The relationship between enlargement of the lateral ventricles in the brains of schizophrenic patients and clinical response to neuroleptic treatment, as assessed by the ventricle-brain ratio (VBR) and psychopathology scores, was studied in a sample of 39 patients with schizophrenia or schizoaffective psychosis during a drug-free washout and after 3 1/2 weeks of treatment with either haloperidol or thioridazine. There was a weak, but statistically significant positive relationship between VBR and improvement on BPRS Psychosis factor scores after 3 1/2 weeks of treatment, and a negative correlation between VBR and baseline (washout) scores on the BPRS Anergia factor. Patients with enlarged VBRs, as defined by two criteria, also tended to show a better response to neuroleptics than patients below these criterion values.

Brain↗
PubMed1985

Relationship of periodic movements in sleep (nocturnal myoclonus) and the Babinski sign.

To obtain a comprehensive clinical description of periodic movements in sleep, the first 11 videotaped movements of nine patients were studied. These leg movements were characterized by active dorsiflexion of the ankle (91%), dorsiflexion and fanning of the small toes (82%), and dorsiflexion of the great toe (72%). Partial flexion of the knee and hip occurred in 28%. Simultaneous dorsiflexion of the ankle and small toe was almost always the initial change, either preceding or occurring simultaneously with extension of the great toe. Knee and hip flexion almost always followed foot movements. Tonic and/or clonic movements, usually about the ankle, occurred in 75%; plantar flexion of the ankle occurred in 21% at the end of a leg movement. Periodic movements in sleep were thus characterized on detailed videographic analysis by movements similar to the Babinski response. Since both the normally occurring nocturnal Babinski response and periodic movements in sleep are also almost entirely NREM related, the author proposes that periodic movements in sleep are due to the NREM loss of supraspinal inhibitory influences on the pyramidal tract and that the characteristic foot and leg movements are Babinski-type responses secondary to this.

Adult↗
PubMed1985

Operative fine needle aspiration cytology of pancreatic tumours.

Thirty-one patients undergoing laparotomy for tumours in the region of the pancreas had both fine needle aspiration cytology (FNAC) and histological biopsy specimens taken to assess the accuracy of the FNAC technique. There were no false positive results but there were six false negative results following FNAC with only one false negative result of histological biopsy. However, there was sampling bias in favour of histology in each of the five patients with negative FNAC and positive histology; two had metastatic disease and three had histology repeated because the initial frozen section was negative. Two major complications may have resulted from the histological biopsy procedure. It is concluded that fine needle aspiration cytology is the ideal method of biopsying pancreatic lesions because of the inherent risk of complications following histological biopsy.

Biopsy, Needle↗
PubMed1985

Effect of prostaglandins on bradykinin-induced visceral-cardiac reflexes.

We examined the effect of prostaglandins on the reflex cardiovascular response to bradykinin applied to the abdominal organs of anesthetized cats. Bradykinin (10 micrograms/ml) was applied to the serosal surface of the stomach, gallbladder, or jejunum before and after injection of indomethacin (2-10 micrograms/ml iv) and after application of 1 microgram/ml of prostaglandins E1, E2, or F2 alpha (PGE1, PGE2, PGF2 alpha) or prostacyclin (PGI2). In six cats, stimulation of the stomach with bradykinin significantly increased mean arterial pressure (MAP) by 37 +/- 5 (SE) mmHg and maximal dP/dt by 633 +/- 101 mmHg/s. Following indomethacin the bradykinin-induced increases in MAP and dP/dt were significantly reduced to 19 +/- 4 mmHg and 191 +/- 58 mmHg/s, respectively. Treatment with PGE1, PGE2, or PGI2, but not PGF2 alpha, restored the initial bradykinin response. The gallbladder and jejunum responded similarly. Also application of exogenous prostaglandins, PGE2 or PGI2, to the stomach, gallbladder, or jejunum significantly augmented the cardiovascular response to bradykinin. Finally, PGE2 restored a portion of the cardiovascular response to bradykinin following the development of tachyphylaxis. We conclude that prostaglandins are necessary for the full manifestation of the cardiovascular response to bradykinin.

Animals↗
PubMed1985

Columella-labial changes in solution of rhinoplastic problems.

The nose relates intimately to the upper lip. As in all facial cosmetic surgery, anatomic and aesthetic diagnosis of the deformity is essential to providing the best treatment possible in a particular patient. Within a reasonable range, changes may be made easily in the columella-labial area. Often these changes enhance the results of typical rhinoplastic maneuvers and make safer and more predictable the results of the rest of the rhinoplastic surgery. Techniques for altering the columella-labial region are presented. Examples are shown demonstrating diagnostic, aesthetic, and therapeutic aspects.

Cartilage↗
PubMed1985

Erythrocyte ribosyluric acid of dairy cattle normal and deficient for uridine monophosphate synthase.

An inherited deficiency of uridine-5'-monophosphate synthase has recently been discovered in dairy cattle. The possibility was explored that this deficiency might be detected by low amounts of erythrocyte 3-N-ribosyluric acid, since it is synthesized by uridine monophosphate synthase. Ribosyluric acid was lower in six dairy cows with the deficiency compared to six controls, paired on the basis of age, stage of lactation, and diet (.66 vs. 1.38 mumol/ml). However, ribosyluric acid concentration measured in 50 normal cows showed a wide range (.28 to 2.35 mumol/ml), with nine lower than the mean for the deficient animals. This extensive variability may limit the usefulness of ribosyluric acid in diagnosing the inherited deficiency of uridine monophosphate synthase.

Animals↗
PubMed1985

Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized, controlled trial examining renal function.

Thirty patients with obstructive jaundice with plasma bilirubin values greater than 200 mumol/L were randomized at the time of percutaneous transhepatic Cholangiography to undergo immediate or delayed surgery. The patients who had preoperative percutaneous transhepatic biliary drainage (PTBD) for 13.8 +/- 5.8 days had fewer surgical complications than did patients who underwent immediate surgery (p less than 0.02), although when the complications of PTBD were included this advantage was diminished. Immediate surgery caused greater deterioration of renal function as measured by plasma urea, plasma B 2-microglobulin, phosphate clearance, uric acid clearance, and maximal concentrating ability than occurred after PTBD or delayed surgery. The improvement in phosphate clearance that followed PTBD was sustained through delayed surgical treatment, indicating better tubular function in these patients. This article supports the concept that preoperative PTBD will reduce surgical morbidity and will result in less renal impairment than will immediate surgery. However, the morbidity rates of the PTBD procedure will preclude its wide use.

Aged↗
PubMed1985

A clinical approach to the somatizing patient.

Patients with chronic, unexplained physical complaints are evaluated diagnostically in two steps in primary care: (1) brief consideration of three specific, but rare, disorders (somatic delusion, conversion, and malingering); and (2) extensive consideration of the remaining three common but overlapping disorders (somatization disorder, hypochondriasis, and psychogenic pain). Because of frequent confusion in differentiating among the common somatizing disorders and because the treatment is similar for all, the family physician can be content with the general designation of "common somatization syndrome" when unable to distinguish among them. This diagnosis can be easily established by a good history and physical examination. Psychiatric referral is required for the rare somatizing disorders. The primary physician can manage the majority of the common somatizing patients by observing the following principles: develop a good physician-patient relationship, apply techniques of behavior modification, engage the patient at the somatic level but extend it to include associated life stresses, strategically use symptomatic measures, treat depression with full doses of antidepressants, and accept the importance of ongoing contact with the patient irrespective of symptoms. When these therapeutic principles are employed, decreased morbidity, medical utilization, and cost can be expected to follow.

Appointments and Schedules↗
PubMed1985

Prolonged multipurpose venous access in burned patients: three years' experience with Hickman right atrial catheters.

We report the results of 3 years' experience with Hickman right atrial catheters in patients with 30-90% (mean, 52%) body surface burns. The catheters were used as multipurpose lines, including the administration of intravenous nutrition. The strict management protocol that was used is described: 76 catheters were inserted in 66 patients for a total of 9.5 patient years. Four patients had their catheters replaced because of fever but cultures were negative. Three patients had septicemia, from which two died. These results are similar to those reported following the use of rotating peripheral cannulae for fluid replacement only. However, Hickman right atrial catheters provide many nursing and patient advantages and are recommended to provide venous access for intravenous nutrition to patients with major burns.

Adolescent↗
PubMed1984

Injectable collagen for augmentation of facial areas.

We treated 87 patients with injectable collagen during a period of 2 1/2 years. Intradermal augmentations were found to be particularly valuable in frown grooves, the groove between the cheek and the lips and chin, the groove beneath the malar prominence, and the groove just lateral to the labial commissure, and for enhancement of malar pads or prominences. Less successfully treated were fine lines, postrhinoplastic depressions, and punched-out, depressed scars. The augmentations are less permanent, more painful, and more costly than those provided by subdermal injections of silicone, but injectable collagen is available generally for these purposes and injectable silicone is not. Problems of allergy also are drawbacks to the use of injectable collagen. Even with its disadvantages, however, injectable collagen is presently valuable in total care of aging faces and certain scarring.

Aging↗
PubMed1984

Haloperidol. Plasma levels and prolactin response as predictors of clinical improvement in schizophrenia: chemical v radioreceptor plasma level assays.

The relationship between clinical response of schizophrenic patients to haloperidol and (1) blood levels of the medication, determined by both gas-liquid chromatography (GLC) and radioreceptor (RR) assays, or (2) prolactin response to the medication, was examined in an inpatient study using several fixed doses of haloperidol. Regression analysis disclosed a substantial curvilinear relationship between steady-state GLC-determined plasma haloperidol levels and decrease in Brief Psychiatric Rating Scale (BPRS) Psychosis factor scores; however, no substantial relationship was found between clinical response and RR plasma haloperidol levels or serum prolactin response to haloperidol. Our results suggest that steady-state plasma levels of haloperidol determined by the GLC chemical assay are a better predictor of decreases in BPRS Psychosis factor scores than RR assayed plasma haloperidol levels or prolactin response to haloperidol.

Adult↗