Biomedical subjects
Publications and source records attributed to R C Smith.
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Percutaneous Transhepatic Biliary Drainage (PTBD) is a new but already well-recognised non-surgical method of overcoming extrahepatic biliary obstruction. It can be used as a temporary measure to improve the patient's general condition prior to high-risk operative surgery. It provides time for further investigation and, if the patient has an advanced malignancy, he can be offered a long-term PTBD as the definitive palliative treatment. Thus surgery, with its high rates of mortality and morbidity in such patients, is avoided. In ten cases preoperative PTBD reduced serum bilirubin (P less than 0.01), serum alkaline phosphatase (P less than 0.05), and lactic dehydrogenase (P less than 0.01) levels after 12 +/- 5 days, and resulted in minimal operative morbidity and mortality. Twelve patients with advanced malignancy had long term PTBD and three experienced good palliation for 12-14 months.
Plasma pseudocholinesterase activity was about 100% higher in patients with Alzheimer's type dementia than in similar age controls. Red cell acetylcholinesterase activity tended to be lower in patients than controls. Administration of lecithin substantially increased plasma choline levels but did not alter activity of either of the cholinesterase enzymes.
Certain tip-projecting techniques require insertion of grafts and/or implants into the premaxillary region. These grafts may extend anteriorly into the columella or may have to reach all the way to the tip to exert the projecting forces exactly where the surgeon wishes to have them applied. The most direct technique for insertion of these long grafts is one of the columella-splitting maneuvers, but some patients will not accept the external scarline necessitated. An intraoral approach can be used in these patients or in any others in whom the surgeon wishes to have no external scar. It allows good exposure, easy insertion of the grafts and/or implants, and secure closure for stabilization and fixation of the grafts.
The factors and differences in incisions for face-lifting in women and men are presented and discussed in detail. The recommended approaches hide scars effectively, allow the hair growing in front of the ear to be left in its original location, and prevent future hair growth from being too close to the ear, which would make shaving or washing difficult in men.
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Ten patients diagnosed clinically as having Alzheimer's disease (age range 54 to 73 years) were given 35 g/day of a 53% lecithin mixture for two weeks, in a double-blind crossover design. Patients received memory training during the lecithin condition and "placebo training" during the placebo drug condition. Repeated assessment with Buschke's Selective Reminding Procedure provided no evidence of a therapeutic lecithin effect either during the two week clinical trial or during longer follow-up trials. Noninvasive measurement of regional cerebral blood flow (nr CBF) by the 133Xe-inhalation method, and repeated EEG's also failed to demonstrate a therapeutic effect. These latter indices reflected a decline in cerebral function over the course of the study, a finding which paralleled clinical impressions in four of the patients. Follow-up trials of memory training under placebo and lecithin conditions provided some suggestion that memory training may lead to some immediate improvement in list-learning ability, but the improvement was not well maintained overtime.
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The authors conducted a fixed-dose study of haloperidol blood levels and clinical response in schizophrenic in patients and found that those with steady-state RBC haloperidol levels in the range of 2.4--5.4 ng/ml showed greater improvement than those with lower or higher levels. They found a similar , although nonsignificant, curvilinear relationship between plasma haloperidol levels and clinical response. These findings suggest that the relationship between haloperidol blood levels and clinical response fits a therapeutic window for the treatment of schizophrenia.
Platelet MAO activity in schizophrenics was significantly decreased, by about 15%, after 3 weeks of treatment with haloperidol. Treatment with thioridazine or butaperazine also tended to decrease platelet MAO activity. The neuroleptic-induced decrease began to appear within a few days of treatment and did not show tolerance over 1-2 months of treatment with haloperidol. Platelet MAO activity of schizophrenic patients measured during drug-free base-line was not significantly different from that of normal controls, but MAO activity of schizophrenics was significantly lower than normals after 3 weeks of treatment with neuroleptics. The extent of decrease in platelet MAO activity correlated negatively with base-line prolactin and its increase after 24 hr. With PEA as substrate, the decrease in activity correlated positively with steady state plasma haloperidol.
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This study compares the effects on intimal hyperplasia of different methods of manipulating a vein graft before using it as an arterial substitute. Grafts that were denuded of endothelium showed the most intimal hyperplasia, while those that were washed with saline, dilated with saline or crushed did not differ appreciably from each other with respect to the degree of intimal hyperplasia. The hyperplasia was well developed and stabilized at 3 weeks, which coincided with restoration of the endothelial surface. The similarity between the last three methods of graft manipulation suggests that minor endothelial disruption produced at the time of harvesting the vein is equalized after insertion of the vein into the arterial circulation.
Twenty patients with widespread occlusive vascular disease received sequential bypass grafts for lower-limb salvage. In 16 patients an isolated common femoral or profunda segment was perfused by a proximal graft and run-off was augmented by femoropopliteal bypass. In 4 a femoropopliteal bypass constituted the proximal component perfusing an isolated popliteal segment, run-off being increased by a popliteal-to-tibial graft. Dacron, expanded polytetrafluoroethylene (PTFE) (Gore-Tex), and autogenous vein grafts were used. The mean period of follow-up was 10.6 +/- 7 months and 70% of the limbs were salvaged. Thirteen graft systems remain currently patent, 4 have thrombosed, 2 patients died with patent grafts, and 1 required amputation despite graft patency.