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Biomedical subjects

R C Smith

Publications and source records attributed to R C Smith.

497 records · Page 28Linked to original sources
PubMedDate not supplied

Nasofrontal angle changes in rhinoplasty.

In emphasizing changes in the nasal tip, the rhinoplastic surgeon often neglects modifications that should be made in other aspects of the profile. Techniques that advance, retrodisplace, and inferiorly or superiorly displace the nasofrontal angle are discussed, calling attention to this part of the profile. Nasofrontal angle modifications can (1) eliminate certain hazards of tip changing along, (2) make possible effects that cannot be achieved with tip positioning alone, and (3) make rhinoplasty more predictable in certain cases.

Cephalometry↗
PubMedDate not supplied

Fine-bore peripheral catheters versus central venous catheters for delivery of intravenous nutrition.

We present a descriptive study of 229 consecutive inpatients requiring intravenous nutrition. These patients received either complete peripheral intravenous nutrition via a fine-bore silicone catheter (n = 80) or short Teflon catheter (n = 15) or received conventional central intravenous nutrition (n = 134). Nutrient delivery was similar for both systems, providing 0.2-0.4 g N.kg-1 x day-1 and 0.13-0.15 mJ.kg-1 x day-1 from preparations containing 4.3 MJ/L total energy (65-75% lipid: 25-35% glucose for peripheral support and 100% glucose for central delivery) with 6 g N/L. We compared the incidence of catheter complication and the probability of catheter function over time for the peripheral and conventional central systems. Venous access complications were seen only with central venous catheterization (10.4%). Chemical phlebitis occurred in 17% of fine-bore catheters and 91.4% of Teflon catheters. The infective phlebitis rate of fine-bore silicone catheters was 1.02% and daily risk of phlebitis 0.016%, with no instance of device-related bacteremia or sepsis. Central-line microbial contamination (21.7%) and catheter-related sepsis (3%) were significantly greater (p < 0.0005, chi 2 goodness-of-fit test) than with fine-bore silicone and Teflon catheters. The probability of complication-free function against time was similar (0.75 < p < 0.90, log-rank test) in fine-bore silicone catheters and central venous catheters. We conclude that fine-bore silicone catheters provide long-term phlebitis-free delivery of complete peripheral intravenous nutrition.

Adult↗
PubMedDate not supplied

Adenoid cystic carcinoma metastatic to the lung. Report of a case diagnosed by fine needle aspiration biopsy cytology.

Cytologic examination of a fine needle aspiration (FNA) biopsy specimen served to diagnose a lung metastasis in a patient with an adenoid cystic carcinoma primary in a minor salivary gland of the hard palate. The aspiration cytologic features of the metastatic adenoid cystic carcinoma were similar to those of primary adenoid cystic carcinoma, including uniform tumor cells with scant cytoplasm surrounding transparent, mucoid spherical bodies. FNA biopsy cytologic diagnosis of metastatic adenoid cystic carcinoma is accurate, particularly if mucoid spherical bodies are present.

Biopsy, Needle↗
PubMedDate not supplied

A topographical model of clinical decision making and interviewing.

A model linking clinical decision making, interviewing skills, and countertransference is presented. It derives from the psychoanalytical topographic model which is hierarchically organized into unconscious, preconscious, and conscious aspects of thought, feeling, and action. This model provides a format for understanding and teaching about physicians' unconscious, unrecognized responses to patients (countertransference), an important determinant of physician learning about clinical decision making and the clinical interview.

Countertransference↗
PubMedDate not supplied

Simultaneous human forearm and calf metabolic exchange.

Simultaneous forearm and leg metabolic exchange studies were performed to compare metabolic exchange and change in metabolic activity over time across the forearm and calf skeletal muscle beds in response to nutritional treatment. Seven postoperative upper-gastrointestinal resection patients received intravenous nutrition (IVN) for 10 days. Immediately before IVN was begun, simultaneous ipsilateral forearm and calf blood flow with arterial and venous sampling for plasma glucose and free fatty acids (FFAs), and whole-blood glycerol, lactate, pyruvate, and nitrogen were measured. After 10 days of IVN, these parameters were repeated in carefully standardized steady-state conditions. Although there were no differences between the arm and the leg with mean flux measurements, correlation of arm and leg flux values were only significant for FFA (p < 0.01) and blood nitrogen (p < 0.05). Forearm and leg metabolic exchange results were not in sufficient agreement to permit reliable use of these results interchangeably for individuals. Errors in blood flow measurement appear to be a major determinant of the poor relationship between forearm and leg flux measurements (limits of agreement 3.32-4.72 ml.dl-1 tissue.min-1). In conclusion, both forearm and leg metabolic exchange studies can be used to show the metabolic effects of treatment when groups of subjects are studied, but variability of the methods used result in poor agreement for the measurements of an individual.

Aged↗
PubMedDate not supplied

Metabolic evaluation of a 75% lipid/25% glucose high nitrogen solution for intravenous nutrition.

OBJECTIVE: To compare the metabolic response to a 75% lipid/25% glucose regimen of intravenous feeding with that of a regimen of isocaloric isonitrogenous glucose alone. DESIGN: Randomised crossover study. SETTING: University department of surgery. SUBJECTS: 14 Patients (of 18 consecutive) who did not develop infections after major upper gastrointestinal operations. INTERVENTIONS: Patients received five days of each of two regimens, both of which provided 0.38 g nitrogen and 0.155 MJ (37 kcal)/kg/day. MAIN OUTCOME MEASURES: Nitrogen balance, prealbumin and transferrin concentrations, and basal efflux of amino acids from the lower limb before and after a five day course of each regimen. RESULTS: Mean (SD) nitrogen balance increased from -11.4 (2.6) g/day to 1.7 (4.1) and 1.6 (5.5) g/day after lipid/glucose and glucose alone, respectively (p < 0.0001). Basal prealbumin and transferrin concentrations increased after both regimens, but significantly so only after lipid/glucose (p < 0.01 and < 0.02, respectively). Mean (SD) net basal efflux of total amino acids from the lower limb was significantly reduced after both regimens, (p < 0.0001 in each case). Net basal alanine efflux was significantly reduced only by glucose alone, and basal glutamine efflux only by lipid/glucose (p < 0.05 in each case). Plasma free fatty acids were increased only by glucose alone (p < 0.001), and glucose alone augmented tissue uptake of glucose significantly more than lipid/glucose (p < 0.01 and < 0.05, respectively). CONCLUSIONS: The solution high in lipids and nitrogen was well tolerated. There was no difference in improvements in nitrogen balance or amino acid flux across the lower limb, but lipid/glucose was associated with higher increases in visceral protein concentrations.

Amino Acids↗
PubMedDate not supplied

Metabolic response to a high-lipid, high-nitrogen peripheral intravenous nutrition solution after major upper-gastrointestinal surgery.

We compared the metabolic response to peripheral intravenous nutrition (peripheral IVN) with the response to central IVN when given after major gastrointestinal surgery. Eighteen consecutive patients who had undergone upper-gastrointestinal surgery were randomly assigned to receive either peripheral IVN (75% nonprotein calories supplied as lipid, n = 9) or central IVN (n = 9). Each group received 0.50 +/- 0.03 g N.kg-1 fat-free mass.day-1 (mean +/- SD with 100:1 kcal:g N (0.42 MJ:1 g N). Metabolic studies were undertaken before IVN (2nd postoperative day) and after 10 days of IVN. Negative nitrogen balance was reversed with both treatments (p < 0.001). The significant net efflux of individual amino acids from peripheral tissue before IVN was reduced toward balance, and there were no significant differences between the groups. The postoperative response of the plasma proteins (fibronectin, prealbumin, and transferrin) was similar in both groups. Peripheral IVN decreased postoperative peripheral net uptake of glucose to a net balance. Central IVN resulted in decreased free fatty acid, glycerol, and beta-hydroxybutyrate concentration with increases in plasma insulin concentration and the net uptake of glucose and pyruvate in peripheral tissue. The effect of intravenous nutrition on the metabolic response to major surgery was similar when nonprotein calories were supplied wholly as glucose requiring a central delivery system or when 75% of nonprotein calories were given as lipid when a peripheral delivery system was used. This study supports the development of peripheral IVN feeding systems.

3-Hydroxybutyric Acid↗