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Biomedical subjects

R F Wilson

Publications and source records attributed to R F Wilson.

At least 289 records · Page 16Linked to original sources
PubMed1977

Nonpenetrating thoracic injuries.

In patients with nonpenetrating thoracic trauma, the rib fractures and other chest wall lesions may distract the physician from dangerous internal injuries in the chest or abdomen which may not be noted unless looked for very carefully. Early vigorous correction of any ventilatory problem is essential, particularly if there is any evidence of impaired tissue perfusion. Shock is frequently due to extrathoracic injuries, particularly intraabdominal bleeding. The flail associated with multiple rib fractures may seem mild initially, but severe underlying pulponary contusion and/or associated extrathoracic injuries make early ventilatory assistance extremely important. Rupture of the thoracic aorta should be suspected in rapid deceleration injuries, but is often not considered unless there is widening of the superior mediastinum on hte chest x-ray. Aortography to confirm the aortic tear should be done if time permits, and early repair of the injury provides the best results.

Adolescent↗
PubMed1977

Variations in adrenocortical responsiveness during severe bacterial infections. Unrecognized adrenocortical insufficiency in severe bacterial infections.

Plasma cortisol levels and their response to .25 mg synthetic A.C.T.H. (Cortrosyn) were studied in 26 septic patients. Four (15.4%) of these patients appeared to have greatly increased adrenocortical activity with plasma cortisol levels averaging 65.4 +/- 14.8 microgram/dl (normal = 8-18 microgram/dl. All four of these patients were agonal and died within five days. Seventeen (65.4%) of these 26 patients appeared to have an appropriate adrenocortical response to severe infection in that their plasma cortisol levels increased (averaging 19.2 +/- 6.0 microngram/dl) following synthetic A.C.T.H. The remaining five patients, who constituted 19.2% of the 26 patients studied, appeared to have some impairment of adrenocortical function. In spite of severe bacterial infections and no history to support Addison's disease, their plasma cortisol levels (averaging 13.8 +/- 3.3 microgram/dl) were not increased above normal and their response to Cortrosyn was much less than would be expected; the increase in plasma cortisol levels in these patients following the synthetic A.C.T.H. averaged 1.1 +/- 3.6 microgram/dl. It is reemphasized that patients with severe sepsis who are not responding adequately to standard therapy should be suspected of having adrenocortical insufficiency and treated accordingly.

Adrenal Cortex↗
PubMed1977

Hypocalcemia and nephrogenous cyclic AMP production in critically ill or injured patients.

Critically ill or injured patients often have impaired cardiovascular function. Since low ionized calcium levels can cause such changes, serum calcium and urine calcium were measured in a prospective study involving 28 criticially ill or injured patients and 16 normal controls. Serum protein levels were also measured to calculate "corrected" total calcium levels. Ionized calcium levels are difficult to measure. Since ionic hypocalcemia is thought to increase the "nephrogenous production" of cyclic AMP, cyclic AMP levels were measured in the blood and urine of these patients and the "nephrogenous" cyclic AMP calculated from the creatinine clearance. The mean total serum calcium in these patients was 7.7 +/- 0.8 mg/dl (S.D.). This was significantly lower (p less than 0.001) than our controls (9.6 +/- 0.6). When corrected for hypoproteinemia, the mean serum calcium (8.7 +/- 0.8) was still significantly lower (p less than 0.005) than control (9.4 +/- 0.5). The mean urine calcium excretion in the patients (56 +/- 66 mg/100 ml G.F.R.) was lower, but not significantly so, than in the controls (84 +/- 44 mg/100 ml G.F.R.). The "apparent nephrogenous" cyclic AMP in the study group was 2,731 +/1 1,451 pm/ml/100 ml G.F.R. The nephrogenous cyclic AMP had a negative correlation (r =-0.45) with "corrected" total calcium levels. Thus "total," "corrected" total, and "ionized" calcium levels appear to be reduced in the majority of critically ill or injured patients studied. The clinical implications of these findings and the potential value of serial cyclic AMP determinations in blood and urine will be discussed.

Blood Proteins↗
PubMed1977

Shock and acute respiratory failure after chest trauma.

Shock or acute respiratory failure developing soon after chest trauma are associated with extremely high mortality and morbidity rates. In a study of 1,136 patients with chest trauma admitted to Detroit General Hospital during a 2-year period (1974-1975), it was found that 218 (19%) had shock or acute respiratory failure when first seen in the Emergency Department. Of these patients, 36% (78/218) died and the survivors had a complication rate of 63% (88/140). Shock was associated with a mortality rate of 7.3% (7/96) but the combination of shock and respiratory failure was particularly lethal, with a mortality rate of 73.1% (57/78)overall. No patient over 45 years of age survived this combination. Efforts to improve results following chest trauma must be directed toward earlier and more aggressive management of both these problems

Adolescent↗
PubMed1977

Cerebrospinal fluid changes in experimental cardiopulmonary bypass using hemodilution with glucose water.

Cardiopulmonary bypass using hemodilution with isotonic glucose water was performed on seven dogs. Intense systemic metabolic acidosis, hyponatremia, hypochloremia, and hyperglycemia were accompanied by only comparatively small changes in the corresponding cerebrospinal fluid values. The data suggested that in the present study, cardiopulmonary bypass was not associated with gross disruptions of the barriers for bicarbonate, sodium, chloride, and glucose between blood and cerebrospinal fluid.

Animals↗
PubMed1977

Variations in plasma levels of adenosine 3',5'-monophosphate during clinical sepsis.

Plasma levels of adenosine 3',5'-monophosphate were measured in 43 patients with bacterial infections of varying degrees of severity. The most severely ill patients, who died within 48 hours of study, had the highest levels of plasma adenosine 3',5'-monophosphate, 38.4+/-29.8 picomoles per milliliter. A significant and progressive decrease in plasma adenosine 3',5'-monophosphate level toward normal was found with lesser degrees of sepsis. However, even those patients who survived exhibited elevations of plasma adenosine 3',5'-monophosphate levels, 12.9+/-5.4 picomoles per milliliter, significantly above normal. Shock and impaired renal function appeared to contribute to the elevated levels found in the most severely ill patients. In those less severely ill, with normal renal function and no shock, the plasma adenosine 3',5'-monophosphate level was still significantly elevated above normal, suggesting that severe bacterial infection itself contributes to the generation of elevated plasma adenosine 3',5'-monophosphate levels. Various hormonal changes or increased cellular permeability, or both, may account for some of the increase of this intracellular nucleotide in the plasma. It is suggested that extremely high levels of plasma adenosine 3',5'-monophosphate are indicative of a poor prognosis.

Adenosine Monophosphate↗
PubMed1977

Fat embolism prophylaxis: a study of four treatment modalities.

Significant coagulation and blood gas changes may occur with uncomplicated extremity fractures. To more accurately define the effect of therapy on these changes, a prospective study of 58 patients with uncomplicated fractures was undertaken. An initial group of 10 selected patients was studied to determine the changes with "standard therapy." The remaining 48 patients were then randomized into five groups: control, increased fluid intake, increased glucose intake, aspirin, and massive steroids. The patients were studied on 5 consecutive days. Treatment of patients in the latter four groups with aspirin or steroids resulted in significant normalization of blood gases, coagulation proteins, and platelet numbers when compared to controls. These measurements in patients treated with fluid loading or increased glucose intake were not significantly different from controls.

Adolescent↗
PubMed1976

Fluid and electrolyte problems in the emergency department.

In management of fluid and electrolyte problems in the emergency department several important principles are: (1) never completely trust the laboratory, (2) abnormalities should be treated at approximately the rate at which they developed, (3) correct only half the calculated deficit at a time and reevaluate the patient, (4) the highest priority in treatment is maintenance of intravascular volume and tissue perfusion. The osmolarity of fluid compartments as related to the fluid and electrolyte responses to stress and resultant fluid requirements for basic needs, current losses and deficits of fluid and electrolytes are discussed in depth. The characteristics of volume, sodium, potassium, chloride, bicarbonate, calcium and magnesium deficits and how to correct them are outlined.

Acidosis↗
PubMed1976

Shock in the emergency department.

Shock continues to be associated with a high mortality rate primarily because of delays in diagnosis and therapy. To diagnose shock early, and thereby increase the chances of reversal before there is extensive deterioration of vital organs, one should look for any decrease in pulse pressure, urine output, urine sodium concentration, alertness or any increase in urine osmolarity, tachypnea or tachycardia. Systolic hypotension, oliguria, metabolic acidosis and a cold clammy skin are late signs of shock. The pathophysiology of early hypovolemic shock includes hyperventilation, vasoconstriction, cardiac stimulation, fluid shifts into the vascular system and platelet aggregation. Late shock is characterized by lysosomal breakdown, subsequent release of kinins (especially bradykinin), impaired cell metabolism and organ function, fluid shifts out of the vascular system because of capillary endothelial damage and intravascular coagulation. The primary cause of shock should not be neglected in favor of treating signs, symptoms, and laboratory data. The resuscitation from the shock process itself involves correction of pathophysiologic changes, based on objective trends and responses rather than isolated measurements. A suggested outline of therapies in order of their use includes: 1) correction of the primary problem; 2) ventilation and oxygen; 3) fluid-loading: 4) inotropic agents; 5) correction of acid-based and electrolyte abnormalities; 6) steroids ("physiologic" or "pharmacologic" doses); 7) vasopressors (especially in elderly, severely hypotensive patients); 8) vasodilators (if excess vasoconstriction); 9) diuretics (if oliguric in spite of the above), and 10) heparin (if DIC). The most common errors are 1) late diagnosis; 2) inadequate control of the primary problems; 3) inadequate fluid loading; 4) delayed ventilator assistance, and 5) excessive reliance on and use if vasopressors and diuretics.

Acid-Base Imbalance↗
PubMed1976

Approach to acid-base problems in the critically ill and injured.

The use of the Henderson-Hasselbalch equation and the relationships between bicarbonate levels and the pCO2 or carbonic acid concentration in evaluating acid-base abnormalities are explained. The etiology, pathophysiology, diagnosis and treatment of respiratory alkalosis and acidosis and metabolic alkalosis and acidosis are discussed. The results of laboratory tests should be examined in relation to the patient's condition and consistency with other laboratory tests. Therapy is directed at correcting the underlying problems and, secondarily, at correcting the numbers. Patients respond primarily to rate of change and not absolute numbers. Therefore, problems should be corrected at approximately the rate they develop. Treatment should be guided by continued patient observation and serial laboratory studies.

Acid-Base Imbalance↗
PubMed1976

Effect of freezing and cold storage on phospholipids in developing soybean cotyledons.

Freezing of plant tissue adversely affects lipid composition. Immature soybean cotyledons (Glycine max L. Merr.) var. "Harosoy 63" were frozen with liquid N(2), dry ice, or stored in a freezer (-20 C) before lipid extraction. The effects of freezing temperature, thawing rate, and cold storage on the lipid composition of frozen tissue revealed significantly higher levels of phosphatidic acid, and diminished levels of phosphatidylcholine, phosphatidylethanolamine, and N-acylphosphatidylethanolamine from the control. Regardless of freezing temperature, phosphatidic acid levels increased from 4.7 mole% to nearly 50 mole% of the total phospholipid when frozen tissues were stored 10 days at -20 C. During the same period, N-acylphosphatidylethanolamine decreased from 54.1 mole% to 6.6 mole% phospholipid. At least 8 mole% of the phosphatidic acid increase occurred during slow thawing of the frozen tissues. In autoclaved samples, phosphatidic acid, phosphatidylcholine, phosphatidylethanolamine, and N-acylphosphatidylethanolamine levels were not different from the control. Labeling of the lipid-glycerol with (3)H, and fatty acids with (14)C, demonstrated the degradation product was primarily phosphatidic acid. Apparently enzymic destruction of the phospholipids occurred during freezing, cold storage, and thawing.

Journal Article↗
PubMed1976

Studies on lipid synthesis and degradation in developing soybean cotyledons.

The metabolic activity of individual lipid classes found in developing soybean cotyledons (Glycine max.) is estimated by determining the degradation rate of the compound under given conditions. Pulse-labeling and dual substrate labeling are used to evaluate this parameter. These studies indicate first order decay kinetics for phosphatidic acid, phosphatidylinositol, phosphatidylcholine, phosphatidylethanolamine, N-acyl-phosphatidylethanolamine, diglyceride, and zero order kinetics for triglyceride in cotyledons var. "Harosoy 63" at 30 days after flowering. Decay coefficients for acyl groups and lipid-glycerol moieties within specific lipid classes from either method are comparable. Half-life (t((1/2))) calculations from the decay coefficients indicate extremely rapid turn-over rates (0.08 to 3.4 hours at 25 C) and suggest similar turnover rates of acyl groups and lipid-glycerol in diglyceride and all phospholipids except N-acylphosphatidylethanolamine where acyl groups are replaced independent of the glycerol moiety. These experiments reveal not only different metabolic activity between lipid components of soybean cotyledons, but also describe a new method for measuring lipid turnover in plants.

Journal Article↗
PubMed1976

Involvement of phospholipids in triglyceride biosynthesis by developing soybean cotyledons.

The incorporation of phospholipids specifically labeled with glycerol-2(3)H and acyl-(14)C by whole cell tissues of developing soybean cotyledons (Glycine max L.) reveals that phosphatidylinositol, phosphatidylcholine, phosphatidylethanolamine, N-acylphosphatidylethanolamine, and phosphatidic acid can be metabolized to diglyceride. The diglyceride formed may be recylced into phospholipid or acylated to triglyceride. Diglyceride from phosphatidic acid and phosphatidylethanolamine is used readily in triglyceride biosynthesis compared to the other phospholipids. Incorporation of N-acylphosphatidylethanolamine having [9-10-(3)H(N)]oleic acid esterified at sn-3 in cotyledons shows rapid acyltransfer of (3)H into triglyceride and therefore N-acylphosphatidylethanolamine appears to participate in triglyceride biosynthesis as an acyl donor. These studies emphasize phospholipid metabolism in developing soybean cotyledons is a dynamic process which plays a key role in triglyceride formation.

Journal Article↗
PubMed1975

Cancer of the lung and its response to non-surgical treatment.

From July 1969 to December 1972 a clinical trial was carried out to determine the effects of radiotherapy and chemotherapy individually or in combination on lung cancer. During the first three years of the study 53 of 234 patients underwent curative resection. III of the remaining patients were inoperable and were suitable for inclusion in the study. The patients were randomly assigned to four groups: 1) observation only, 2) chemotherapy (Hydroxyurea) only, 3) radiotherapy only, or 4) combination chemotherapy and radiotherapy. There were no differences in survival in any of the treated groups.

Chemical Phenomena↗