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Biomedical subjects

R F Smith

Publications and source records attributed to R F Smith.

At least 127 records · Page 7Linked to original sources
PubMed1986

Use of gonozyme on urine sediment for diagnosis of gonorrhea in males.

We compared enzyme immunoassay (Gonozyme; Abbott Laboratories, North Chicago, Ill.) for detection of gonococcal antigen in urine sediments with urethral swab culture for diagnosis of gonorrhea in men attending a venereal disease clinic. The prevalence of infection was 14% by culture (27/196). The sensitivity of enzyme immunoassay was 93% (25/27) compared with the culture method, and the specificity was 99% (167/169). The ability to detect gonococcal antigen in urine sediment may provide the basis for a noninvasive method of screening for gonococcal infection.

Antigens, Bacterial↗
PubMed1986

Incubation time, second blind passage, and cost considerations in the isolation of Trichomonas vaginalis.

In a group of 247 symptomatic and asymptomatic women, 75 (30.3%) were found to harbour Trichomonas vaginalis; 39 (52%) infections were detected by wet mount and 36 (48%) were detected by culture only. Of the latter, 27 produces a positive culture in 3 days or less and 9 were positive, on average, at day 6. The break even cost of culture was $6.75 per patient. Among 70 wet mount-negative, primary culture-negative specimens that received a blind passage, another 3 (4.2%) positive cultures were detected.

Animals↗
PubMed1986

Comparative evaluation of New York City and modified Thayer-Martin media for isolation of Neisseria gonorrhoeae.

Commercially manufactured New York City (NYC) medium and modified Thayer-Martin (MTM) medium were compared for their ability to isolate Neisseria gonorrhoeae from clinical specimens. Twenty-seven public health laboratories throughout California evaluated 4,802 specimens collected from patients attending either sexually transmitted disease or family planning clinics. Total of 726 and 737 N. gonorrhoeae isolates were recovered from NYC and MTM medium, respectively. Although less contamination was noted on NYC medium, MTM medium was equivalent to commercially prepared NYC medium for the isolation of N. gonorrhoeae from clinical specimens.

Cervix Uteri↗
PubMed1986

Contrast media for angiography: effect on renal function.

A total of 125 patients with severe peripheral vascular disease were examined with translumbar aortography. The mean dose of contrast medium injected was 65 ml of Angio Conray (containing 31.2 g of iodine). Forty patients were pretreated with mannitol, and 32 received furosemide. Thirty-eight patients (30%) had diabetes and, presumably, diabetic nephropathy. Eleven of them had significant azotemia (creatinine values greater than or equal to 4 mg/dl). Administration of contrast material did not significantly reduce renal function in any patient group. We conclude that acute renal failure following the injection of contrast material is uncommon, is reversible, and almost always occurs when avoidable complicating factors are present.

Adolescent↗
PubMed1986

Infected femoral artery false aneurysms in drug addicts: evolution of selective vascular reconstruction.

Fifty-four infected femoral artery false aneurysms resulting from chronic drug addiction were managed surgically with an 11% amputation rate and no mortality. Angiography localized the arterial segment involved, which in turn influenced the type of operation performed. Twenty-six aneurysms of anatomically isolated femoral artery segments were ligated and excised without resultant amputation. However, of the 28 aneurysms involving the common femoral bifurcation, 18 required triple ligation and excision that led to six amputations. Six of the 28 aneurysms were reconstructed with autogenous saphenous vein grafts, three by prosthetic grafts, and one by primary anastomosis. No amputations followed vascular reconstruction. However, all synthetic grafts eventually developed septic complications that required graft removal. On the basis of this experience we recommend ligation and excision for single artery segment aneurysms and immediate autogenous reconstruction for selected common femoral bifurcation lesions. This approach has proved safe and has reduced our amputation and graft complication rates. Extensive uncontrollable wound sepsis may contraindicate revascularization. Under these circumstances we estimate a 33% risk of amputation when the common femoral bifurcation is excised.

Adult↗
PubMed1986

High levels of growth hormone and human placental lactogen in pregnancy complicated by diabetes.

The possible involvement of growth hormone (GH) and human placental lactogen (HPL) in the development of diabetic tissue damage during pregnancy was studied in 16 insulin-dependent diabetic patients (IDDM), 8 gestational diabetic patients (GD) and 14 normal pregnant women. GH and HPL were elevated in pregnancies complicated by diabetes but, in contrast to the rise of HPL, GH declined throughout pregnancy in all the groups studied. The concentrations of neither correlated with plasma glucose, insulin requirement or duration of diabetes. HPL was positively correlated with urinary albumin excretion (UAE) in all 3 groups, but with blood pressure only in the IDDM group. There was also a significant and positive correlation in all patients between HPL at the end of pregnancy and placental weight. No evidence of serious tissue damage was found in either diabetic group. The vibration sensory threshold was unaffected by pregnancy and was similar to that of normal women. However, in the IDDM group UAE increased significantly postpartum when compared with second trimester values; they also had higher UAE than the other 2 groups post-delivery. A small but significant rise in diastolic blood pressure (DBP) was found in the 3 groups studied between the second and third trimester and pre-delivery. The same trend in systolic blood pressure (SBP) was seen in the diabetic groups. The IDDM had higher systolic and diastolic blood pressures than the normal women at all stages of gestation.

Adult↗
PubMed1985

Perioperative allogeneic blood transfusions. Survival in patients with resected carcinomas of the colon and rectum.

Blood transfusion (BT) is reported to cause immunosuppression. We postulated that BT might therefore adversely affect the prognosis of carcinomas of the colon and rectum. We analyzed the overall and recurrence-free survival of 366 patients whose colorectal carcinomas were resected. The 199 patients who received perioperative BTs appeared to survive less well than the 167 patients who received no blood products. However, Cox analysis, which adjusts for other prognostic variables, shows that the difference was not statistically significant. Although 43% of transfused patients survived, as compared with 56.5% of nontransfused patients, this difference was due to variables other than transfusion. This study did not support the hypothesis that BT has an adverse effect on survival of patients with colorectal cancer.

Adenocarcinoma↗
PubMed1985

Right ventricular myocardial infarction in patients with chronic lung disease: possible role of right ventricular hypertrophy.

To determine the relation between right ventricular hypertrophy and right ventricular myocardial infarction in patients with chronic lung disease, the records of 28 patients with chronic lung disease, inferior myocardial infarction and significant coronary artery disease (group I) and 20 patients with right ventricular hypertrophy, chronic lung disease without inferior myocardial infarction or significant coronary artery disease (group II) were reviewed. Chronic lung disease was diagnosed by clinical criteria, chest radiographs and pulmonary function tests. All patients had postmortem examinations. Patients in group I were classified into two subgroups: group Ia (without right ventricular hypertrophy) and group Ib (with right ventricular hypertrophy). Right ventricular wall thickness was 3.3 mm +/- 0.5 in group Ia, 6.0 mm +/- 1.1 in group Ib and 8.8 mm +/- 2.4 in group II (group Ia versus Ib, p less than 0.001; group Ia versus II, p less than 0.001; group Ib versus II, p less than 0.001). Eleven patients (78.6%) in group Ib (chronic lung disease with both right ventricular hypertrophy and inferior myocardial infarction) had right ventricular myocardial infarction compared with only 3 patients (21.9%) in group Ia (chronic lung disease without right ventricular hypertrophy and with inferior myocardial infarction) (p less than 0.008). Isolated right ventricular myocardial infarction occurred in four patients (20%) in group II (chronic lung disease with right ventricular hypertrophy, but without evidence of infarction of the left ventricle or significant coronary artery disease). There was no significant difference in the extent of anatomic coronary disease in groups Ia and Ib.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Urine albumin to creatinine ratio-response to exercise in diabetes.

Albuminuria was studied in 40 diabetic children before and after a standardised exercise test, and also in 21 normal children; the results are expressed as geometric mean (95% range) of urine albumin:urine creatinine ratio (mg/mg). There was no significant difference between the mean resting albumin:creatinine ratio in the two groups, or between these ratios before and after exercise in the normal children. In the diabetic children, however, the mean urine albumin:creatinine ratio after exercise was significantly higher than both the value before exercise and the postexercise value of the normal children, with 10 of 40 diabetic children showing a value after exercise greater than the 95% range of the geometric mean of the control group. The diabetic children were also studied by random urine albumin:creatinine ratios and split (erect:supine) 24 hour urine collection; none was abnormal.

Adolescent↗
PubMed1985

The QRS complex during transient myocardial ischemia: studies in patients with variant angina pectoris and in a canine preparation.

We made continuous electrocardiographic recordings on magnetic tape during 15 episodes of ischemia in five patients with variant angina to determine the characteristics of the QRS changes. Orthogonal leads were used and the electrocardiograms were analyzed visually and by digital computer. Changes were quantified by subtracting baseline electrocardiograms from those obtained during ischemia. Large changes in the QRS occurred during ischemia but the waveform quickly returned to baseline when the episode subsided. In all patients there was prolongation of the QRS duration and an increase in QRS voltage during the terminal 40 msec of the waveform in the lead(s) showing the most marked ST displacement. The increase in the terminal QRS could be represented by a vector directed toward the ischemic zone. In a given patient the amplitude of ST displacement varied between episodes, presumably because of variation in the intensity of ischemia, but the QRS changes were directionally similar in each episode. In two patients there was also a smaller change involving the initial 40 msec of the QRS that could be represented by a vector directed away from the ischemic zone. To determine the possible mechanism for the electrocardiographic changes, ischemic episodes of 120 to 150 sec were produced in seven dogs and electrocardiographic recording and analysis techniques similar to those used in patients were employed. Myocardial conduction velocity was measured in three directions in the ischemic zone and was correlated with simultaneous electrocardiographic recordings from the body surface. The electrocardiographic changes in the dog preparation were virtually identical to those in the patients and strongly correlated with a fall in myocardial conduction velocity. We conclude that the QRS changes during variant angina result from the altered excitation pattern produced by conduction delay in the ischemic zone. The probable cause for the increase in terminal QRS voltage is delayed (and uncancelled) activation of the ischemic zone.

Angina Pectoris, Variant↗
PubMed1985

Surgically-related applications of computerized operating room data.

ORMIS data are currently used in a wide range of surgically-related applications--surgical activity reporting, graduate education and residency reporting, clinical research, surgically-related administration and surgical suite administration. Use of the system within Henry Ford Hospital has been increasing as it becomes better known and as its potential usefulness becomes better understood. Willingness to use ORMIS data depends, in large part, upon the perceived accuracy of the stored data and the ease with which these data can be retrieved and reported in a useful form. A high degree of confidence in ORMIS data has been achieved through considerable surgical staff involvement in the ongoing operation of the system. Surgeons participate in the coding of operative procedures, and the provision of surgeon-specific logs has established a feedback loop whereby surgeons can easily verify the accuracy of ORMIS data. Furthermore, special care has been taken to maintain the integrity of ORMIS data by developing extensive error detection and correction facilities. The multifaceted, successful applications reported herein show the increasing importance and usefulness of computerized data in contemporary surgical services.

Computers↗
PubMed1985

Mortal factors in type 2 (NIDDM) diabetes mellitus.

Five years after entry into a study prospective from diagnosis of non-insulin-dependent (Type 2) diabetes, 17 patients were known to be dead and 197 alive. On analysis of 136 patients (12 deaths) in whom there was complete information from clinical, metabolic and hormonal examination both before and 1 yr after start of treatment, an index of liability to death within this first 5 yr was calculated, to separate best the dead from the living. One index value correctly ascribed 83% of the dead and 90% of the living (89% of all predictions correct; Youden's "J" value = 0.73). Estimates from the less complete data on the other 78 patients (5 deaths) did not alter the predictive factors. Prediction is more successful with non-cardiac than with cardiac deaths. Five factors contributed to the predictive index for death. One was a long duration of symptoms as recalled at diagnosis. The other 4 factors all came from the 1-yr review (no death then). These were (a) greater glucose intolerance, as expressed by the KG rate constant for disappearance of i.v. injected glucose from the blood (more useful than fasting glucose concentration); (b) higher systolic blood pressure (more useful than diastolic); (c) less obesity, as expressed by the Body Mass Index, and (d) higher fasting blood glycerol concentration. As expected, hyper-glycaemia (as reflected in the KG value) is important, but adrenergic factors may contribute to (a), (b) and (d). From these results earlier diagnosis of this type of diabetes could well be associated with an improved outlook, and in addition this alone might ameliorate the other factors, but measures to normalise them post-diagnosis also require testing.

Blood Glucose↗
PubMed1984

Differential effects of O-demethyl encainide on induced and spontaneous arrhythmias in the conscious dog.

Encainide is highly effective in suppressing most nonsustained ventricular arrhythmias, but there is evidence that the drug is less effective and may worsen some arrhythmias, particularly in patients with sustained ventricular tachycardia. In most patients it is likely that the major antiarrhythmic effects of encainide are mediated through a potent metabolite, O-demethyl encainide. The effects of infusions of saline solution or O-demethyl encainide on spontaneous ventricular ectopic activity and ventricular fibrillation (VF) threshold were compared in 25 dogs with a mottled myocardial infarct produced by transient coronary occlusion. Plasma levels of the metabolite above 100 ng/ml suppressed (greater than 92%) the spontaneous ventricular ectopic activity that occurred 48 hours after MI, whereas saline solution had no effect. In 15 dogs treated with O-demethyl encainide, the VF threshold decreased an average of 23%, from a baseline level of 23 +/- 8 mA to 18 +/- 9 mA (p less than 0.05). There was a concentration-dependent fall in VF threshold with plasma concentrations of O-demethyl encainide above 150 ng/ml. In 2 dogs with very high plasma concentrations of the metabolite (greater than 1,000 ng/ml), VF was induced by right ventricular pacing alone (S1S1 300 ms). No change in VF threshold was observed in the 8 dogs treated with saline solution, and in each of these dogs VF could be terminated by the countershock protocol. However, in 7 of the 17 dogs treated with O-demethyl encainide, VF could not be terminated by the countershock protocol.(ABSTRACT TRUNCATED AT 250 WORDS)

Anilides↗
PubMed1984

Fasting plasma magnesium concentrations and glucose disposal in diabetes.

Fasting plasma concentrations of magnesium were measured by neutron activation analysis in 30 non-diabetics and 87 diabetics (55 non-insulin-treated, 32 insulin treated). Plasma concentrations of magnesium were lowest in the insulin treated group (mean 0.84 (SEM 0.01) mmol/1; 2.0 (0.02) mg/100 ml), intermediate in the non-diabetics (mean 0.89 (SEM 0.01) mmol/1; 2.2 (0.02) mg/100 ml), and highest in the non-insulin-treated diabetics (mean 0.95 (SEM 0.02) mmol/1; 2.3 (0.05) mg/100 ml). In all diabetics plasma magnesium concentrations were inversely related to plasma glucose values (rs = -0.33; p less than 0.01) and in non-insulin-treated patients to plasma insulin concentrations (rs = -0.28; p less than 0.05), the former confirming previous observations. In 67 of the diabetics the KG constant for disposal rate of glucose during a standard intravenous glucose tolerance test was directly related to fasting plasma magnesium concentrations, and this relation persisted after controlling for age, sex, body mass index, type of treatment, and glucose and insulin values. This direct relation of plasma magnesium concentration with glucose disposal was unexplained by its influence on insulin secretion but was related to insulin sensitivity; hence magnesium may be an important determinant of insulin sensitivity in maturity onset diabetes.

Blood Glucose↗