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Biomedical subjects

R D White

Publications and source records attributed to R D White.

At least 253 records · Page 14Linked to original sources
PubMed1977

Anesthesia and postoperative care for cardiac operations.

Almost three decades have passed since the establishment of open-heart surgery, and in such a short life span the specialty has established itself scientifically and reached a certain maturity. New techniques, better understanding of the pathophysiology of cardiac problems, and the effective use of new drugs constantly improve the results of operation. Greater experience in anesthetic management and improved postoperative care will contribute much to the success of this youngest surgical specialty. This review outlines the current principles of anesthesia and postoperative care of patients undergoing cardiac operations. Preanesthetic evaluation provides guidance for anesthetic management, supportive techniques, and postoperative care. During operations, light anesthesia is usually sufficient for patients with cardiac disease and minimizes myocardial depression. Monitoring must provide data on the physiological changes that are taking place from moment to moment during and after operations. Perfusion produces a highly abnormal state, and the severity of complications varies with its duration. Introduction of new drugs has also facilitated hemodynamic management during and after operations. Postoperative care is based on careful observation of the patient and early detection of trends, both of which lead to preventive rather than curative treatment wheneven possible.

Anesthesia, General↗
PubMed1977

Obstruction of the male reproductive tract.

Anatomic obstruction of the male reproductive ducts may be congenital, inflammatory or iatrogenic in origin. Two cases of congenital obstruction and 1 case of iatrogenic obstruction are presented. Accurate identification of the etiology and location of the obstruction is necessary for patient counseling and choice of treatment.

Adult↗
PubMed1976

The uptake of L-glutamate by the retina.

The accumulation of L[14C]glutamate by the isolated rat retina has been studied. When retinae were incubated at 37 degrees C in a medium containing L-[14C]glutamate, tissue/medium ratios of about 40:1 were achieved after 60 min. The labelled L-glutamate was rapidly metabolised and after 10 min about 50% of the radioactivity in the tissue amino acids was present as glutamine, aspartate, and 4-aminobutyrate (GABA). The process responsible for L-glutamate uptake showed many of the properties of an active uptake system: it was temperature sensitive, sodium dependent, inhibited by metabolic inhibitors and showed saturation kinetics. The saturable uptake process could be resolved into two components; a 'high' affinity process (apparent Km = 21 muM, Vmax = 35 nmoles/min/g tissue) and a 'low' affinity process (Km = 630 muM, Vmax = 881 nmoles/min/g tissue). The 'high' affinity and 'low' affinity uptake processes for L-glutamate appeared to have identical properties in the retina. The uptake of L-glutamate was not specific and was inhibited by other acidic amino acids including D-glutamate but not by neutral or basic amino acids. The retinal uptake of L-glutamate is not likely to be due to a homoexchange phenomenon because the retina was capable of achieving a large net uptake of glutamate and the efflux of L-[14C]glutamate from the tissue was not increased by the addition of non-radioactive L-glutamate to the incubation medium. Autoradiographic studies indicated that the sites for glutamate uptake are largely in the neuroglial Muller cells.

4-Chloromercuribenzenesulfonate↗
PubMed1976

Bilateral renal carcinoma in von Hippel-Lindau Disease.

Von Hippel-Lindau disease, one of the phakomatoses, is believed to be a disorder of mesodermal differentiation. Renal lesions, usually cysts or adenocarcinomas with an occasional hemangioblastoma, occur in approximately two thirds of all patients. The renal neoplasms previously reported have been multiple, bilateral, and usually beyond resection. A thirty-eight-year-old white male with a cerebellar hemangioblastoma and bilateral renal adenocarcinoma underwent suboccipital craniotomy, right heminephrectomy, and left radical nephrectomy. No evidence of recurrent disease can be identified ten months postoperatively. An aggressive approach in this systemic disease appears to be warranted.

Adenocarcinoma↗
PubMed1976

Dobutamine for inotropic support during emergence from cardiopulmonary bypass.

Dobutamine, a recently introduced derivative of dopamine, is reported to retain inotropic properties with less pronounced chronotropic and arrhythmogenic effects than isoproterenol. The drug was evaluated in two doses, 5 mug/kg/min and 10 mug/kg/min, in two groups of ten patients each, during emergence from cardiopulmonary bypass. A third group of five patients was studied similarly with isoproterenol, 0.02 mug/kg/min. Cardiac index increased 16 and 28 per cent eith the two doses of dobutamine, respectively, and 9 per cent with isoproterenol. Heart rate, in contrast, increased 6 and 15 per cent with dobutamine (not significant) and 44 per cent with isoproterenol (significant). Dobutamine seemed to associated with fewer arrhythmias than isoproterenol. It is concluded that dobutamine, 5-10 mug/kg/min, is suitable for use during emergence from cardiopulmonary bypass and may possess advantages over isoproterenol.

Adult↗
PubMed1976

Kartagener's syndrome with corrected transposition. Conducting system studies and coronary arterial occlusion complicating valvular replacement.

An 18-year-old man whose sister has classic Kartagener's syndrome was found to have sinusitis, bronchiectasis, and corrected transposition with normal visceral situs. Congenital complete heart block was secondary to absence of conducting-system pathways between a small posterior atrioventricular node and the transposed His bundle and bundle branches. No anterior atrioventricular node was present. Prosthetic valvular replacement of the left-sided (morphologic right) atrioventricular valve was complicated by coronary arterial occlusion by suture, with subsequent myocardial infarction. The case appears to represent an unusual variant of Kartagener's syndrome with the abnormality of laterality being expressed as corrected transposition.

Adolescent↗
PubMed1976

Plasma ionic calcium levels following injection of chloride, gluconate, and gluceptate salts of calcium.

The ionic equivalency of three calcium salts was tested in 15 patients undergoing cardiac surgery with extracorporeal circulation. Of the three salts tested (chloride, gluconate, gluceptate), only calcium chloride showed a reproducible and highly significant relationship between the increase in total calcium and the increase in ionic calcium. It is suggested that extracorporeal circulation may be one clinical situation in which use of a calcium electrode may be of major value. The marked distortion of plasma proteins and pH, the addition of large amounts of citrate, and the differences between various calcium salts indicate that it is probably not possible to predict ionic calcium with assurance and that direct measurement may be necessary for optimal therapy.

Buffers↗