Biomedical subjects
R Howard
Publications and source records attributed to R Howard.
The founding of the Jardin des Plantes in Paris.
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Concepts of a state "foundation plan". A method of health care delivery.
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Purification and some properties of a non-haem iron protein from the bacteroids of soya-bean (Glycine max Merr) nodules.
A non-haem iron protein was isolated from an extract of soya-bean nodule bacteroids by a procedure including protamine sulphate and heat precipitation followed by chromatography on DEAE-cellulose. The purified protein contains non-haem iron and acid-labile sulphur and exhibits a spectrum with a rather broad absorption shoulder in the region 380-440nm and a more prominent peak at 280nm. From sedimentation-velocity measurements an apparent s(20,w) value of 1.3S was calculated. The protein functions as an electron carrier between the reducing system of illuminated chloroplast fragments and nitrogenase from nodule bacteroids, but it failed to function as a cofactor for the photochemical reduction of NADP in the presence of spinach chloroplasts. Also, it is inactive as a cofactor in the enzymic degradation of pyruvate to acetyl phosphate and CO(2) in the presence of a ferredoxin-free extract of Clostridium pasteurianum. Repeated freezing, storage and thawing of the non-haem iron protein resulted in a marked loss of activity in the photochemical acetylene-reduction assay. A major portion of the activity that was lost was restored as a result of treatment with sodium sulphide, mercaptoethanol and ferrous ammonium sulphate.
The feasibility of an assistant to the physician.
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A mature student's observations on examiner's technique.
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Pneumothorax directly resulting from perforated bronchogenic carcinoma.
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The effect of intravenously administered fat on the coagulation mechanism.
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Attribution of control and teenage pregnancy.
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Association between cerebral structural abnormalities and dermatoglyphic ridge counts in schizophrenia.
Dermatoglyphic ridge counts (1) reflect ontogenic processes during the second trimester of pregnancy and (2) can be influenced by some of the factors that also affect cerebral development. Therefore, the demonstration of an association between dermatoglyphic and cerebral structural measures in patients with schizophrenia would give credence to the view that the structural brain abnormalities associated with this disorder have their origin early in development. Twenty-eight male subjects with schizophrenia and 19 male controls underwent magnetic resonance imaging (MRI) and dermatoglyphic analysis. The pattern of association between the ab-ridge count and nine MRI features was dissimilar in cases and controls for two measures. Associations between dermatoglyphic features, on the one hand, and the frontal CSF (r = .54, P = .004) and fourth ventricular volume (r = .38, P = .05), on the other, were larger in the cases versus the controls (test for interaction, P = .08 and P = .06, respectively). These findings, while in need of replication, support the view that the cerebral structural abnormalities found in patients with schizophrenia are the result of an early pathologic process affecting the development of fetal ectodermal structures.
Excision of herniated nucleus pulposus in children and adolescents.
Eighty-eight patients were treated at the Alfred I. duPont Institute for disc disease from 1940 to 1989. Forty-eight patients, with an average age of 16 years, underwent discectomy. Twenty-three patients were followed for an average of 6 years after initial presentation. Thirteen patients, with an average age of 15 years, and who had radiographic documentation of disc disease, were treated nonoperatively. Eight patients were followed for an average of 6.3 years. The results of discectomy were rated as excellent or good in 91% of the patients, and poor in 9% at follow-up. In the patients treated nonoperatively, the results were rated as excellent or good in 25%, and poor in 75%. Our 6 year follow-up study suggests that discectomy yields excellent to good long-term results in children and adolescents.
Hematologic changes after splenectomy for cytoreduction: implications for predicting infection and effects on chemotherapy.
Postsplenectomy leukocytosis and thrombocytosis are common findings in trauma patients. The intent of this study is to describe postsplenectomy hematologic changes in gynecological oncology surgery and subsequent chemotherapy. We performed a retrospective record review of gynecological oncology patients at our institutions. Postsurgical hematologic changes, infectious morbidity, and pre- and post-chemotherapy hematologic changes were noted. Data were analyzed using repeated measures analysis of variance. We identified 27 patients who underwent cytoreductive surgery with splenectomy. Thirteen patients with splenectomy had postoperative chemotherapy data available, and we matched these patients with 13 control patients who underwent cytoreduction surgery without splenectomy and postoperative chemotherapy. Nine of the 27 splenectomy patients had documented infectious morbidity. There was a significant difference in postoperative platelet counts between the infected and the noninfected splenectomy patients (P= 0.037), and a significant difference between splenectomy and control patients for white blood cell (WBC) counts (P = 0.007). Patients with splenectomy had higher precycle WBC, absolute neutrophil count (ANC), platelet counts, and higher postcycle nadir levels in all cycles compared to control patients. There was a significant overall difference between splenectomy patients and controls with regard to WBC (P = 0.001), ANC (P = 0.005), and platelet counts (P = 0.016) during chemotherapy cycles. Median postchemotherapy nadir WBC was 4.4 (range: 3.4-4.8) for the splenectomy group versus 2.8 (range: 2.5-3.0) for the control group. Median postchemotherapy nadir ANC was 1800 (range: 1320-2450) for the splenectomy group and 1001 (range: 864-1064) for the control group. Median postchemotherapy nadir platelet count was 222 (range: 181-277) for the splenectomy patients and 169 (range 164-215) for the control patients. In conclusion, the patients who undergo splenectomy as part of cytoreductive surgeries have a statistically significant leukocytosis and insignificant thrombocytosis relative to the control patients. Leukocytosis alone is not an accurate indicator of infection. Splenectomy is not associated with an increased risk of chemotherapy-related neutropenia and thrombocytopenia.
Papular urticaria in children.
Papular urticaria is a common pruritic hypersensitivity reaction to the bites of insects of many different types, including fleas, mosquitoes, chiggers, and, more rarely, avian or rodent mites. Which particular insect is the cause varies with geographic location. In San Francisco, children with papular urticaria due to flea bites are part of dermatologic practice year round. With its relatively warm winters and wet, foggy summers, San Francisco is an environment where fleas thrive, and their bites afflict children at day care centers and park playgrounds, as well as in homes with pets. We review the clinical approach to papular urticaria in general, and focus on flea bite prevention and management.
Seeing visual hallucinations with functional magnetic resonance imaging.
We have used blood oxygenation level dependent imaging with functional magnetic resonance imaging (fMRI) to investigate the visual cortex response to photic stimulation during and in the absence of continuous visual hallucinations. A patient with cortical Lewy body dementia who experienced persistent and vivid complex hallucinations underwent fMRI on and off treatment with risperidone. When he was not hallucinating, photic stimulation produced a normal bilateral activation in striate cortex. During hallucinations, very limited activation in striate cortex could be induced. We interpret this result as indicating that at least part of the activity in the brain responsible for the experience of visual hallucinations is located in the primary visual cortex.
The value circle. A profile of J. Richard Gaintner, MD.
This article describes how the arrival of CEO J. Richard Gaintner, MD, at Shands HealthCare signaled a time for refocusing the organization's direction and helping physicians to cope with the changes buffeting the industry. He saw angst and disenfranchisement, sentiments that characterized not only Shands and the University of Florida Health Science Center, but also the entire establishment of American scientific medicine. Gaintner believes--and continually preaches--that practicing medicine in a cost-effective manner will improve, not harm, the quality of care. His willingness to face reality objectively is perhaps his greatest asset in helping physicians deal with managed care. He conveys heartfelt empathy with the day-to-day conflicts they face. But he does not allow himself the temporary luxury of cynicism, and he refuses to accept negativity and pessimism in others. Rather, he asks that physicians and managers understand the system and develop the capacity to work within it and take responsibility for improving it. Beyond exhorting physicians to be accountable for the success of the enterprise, Gaintner creates mechanisms for meaningful physician participation in enterprise management.
Interaction of Rhodium(II) carboxylates with molecules of biologic importance.
Rhodium(II) acetate, propionate, and butyrate showed a considerable variation in their antitumor activity against Ehrlich ascites tumor cells in mice, with the butyrate complex being the most active. The three complexes markedly inhibited DNA synthesis of Ehrlich ascites tumor cells in vivo. Rhodium (II) butyrate was the most potent inhibitor followed by the propionate complex. One hour after administration, rhodium(II) propionate and butyrate induce more uridine-5-3H incorporation into RNA than is seen in the controls. Equilibrium dialysis studied showed that rhodium(II) acetate-1-14C binds to single stranded DNA, poly-A, ribonuclease A, and bovine serum albumin but not to highly polymerized native calf thymus DNA, poly-G, or poly-C. In these cases binding occurred at the two axial positions of rhodium(II) acetate to a nitrogen donor in the ligands. The formation constants of the rhodium(II) acetate and propionate complexes with 5'-adenosine monophosphate were determined. The rhodium(II) propionate complex was more stable. Sedimentation and viscosity measurements of poly-A and poly-A/rhodium(II) acetate complexes indicate a high degree of intramolecular crosslinking in the rhodium(II) acetate/poly-A complex. The rhodium(II) carboxylate complexes were also found to be potent inhibitors of purified DNA polymerase I and RNA polymerase from Escherichia coli.
Learning from experience. Interview by Paul Dinsdale.
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Reasons for readmission to hospital.
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