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Biomedical subjects

R Humphrey

Publications and source records attributed to R Humphrey.

34 records · Page 2Linked to original sources
PubMed1982

Epibulbar IgA plasmacytoma occurring in multiple myeloma.

The ophthalmic manifestations of a 51-year-old man with multiple myeloma included exudative retinal detachments and multiple epibulbar plasmacytomas. The retinal changes resolved with treatment for systemic effects, and the IgA-producing plasmacytomas rapidly resolved with local irradiation. The young age of onset (37 years), the prolonged course (14 years), and the IgA M protein and epibulbar involvement were, collectively, unusual findings in multiple myeloma. The presence of epibulbar, gastrointestinal tract, and prostate involvement suggested a homing mechanism of IgA-committed cells to mucosal surfaces.

Adult↗
PubMed1982

The left paramedian extraperitoneal approach for aortic reconstructive surgery.

Seventy-five consecutive aortic reconstructive procedures were performed via a left paramedian extraperitoneal approach. These operations included abdominal aortic aneurysmectomies in 28 patients and aortobifemoral grafts in 43. These were combined with aorto-left-renal bypass in four patients and removal of infected aortic prostheses in four other patients. This modified technic obviated the need for excessive retraction by combining the benefits of a paramedian approach with a full-length abdominal incision. Distinct advantage include decrease postoperative abdominal discomfort, minimal paralytic ileus, as well as a shortened convalescence. This extraperitoneal approach is not only suitable for routine aortic reconstructive procedures, but has proven to be especially valuable in cases where increased morbidity is likely with infringement of the peritoneal cavity, such as patients with extensive bowel adhesion, previous colostomy, or infection aortic grafts requiring removal.

Aged↗
PubMed1981

Extrapleural and extraperitoneal staged technique in successful management of complicated thoracic anastomotic aneurysm.

A simplified, staged technique was employed in the management of a descending thoracic aortic pseudoaneurysm occurring in a thoracic aortobifemoral graft that had been placed 10 years earlier. Our initial procedure comprised ligature of the femoral limbs of the functional thoracic aortobifemoral graft together with a right axilloinfrarenal aortobifemoral bypass. This was followed by definitive descending thoracic pseudoaneurysm management 2 weeks later via a thoracoabdominal extrapleural-extraperitoneal approach. This staged approach provided by a preformed shunt, eliminated the disadvantages of heparinization, hemolysis, or trauma of cannulation during the definitive thoracic aneurysmectomy procedure. Ligature and defunctionization of the original thoracic aortofemoral graft simplified the operative dissection, and the extrapleural and extraperitoneal approach minimized postoperative complications.

Aorta, Thoracic↗
PubMed1980

Appraisal of a new rapid enzyme strip.

The accuracy and reliability of new blood glucose measurement strips, BM Test-Glycemie 20-800, were assessed in 99 consecutive patients attending the diabetic clinic and seven subjects at home. The BM Test-Glycemie 20-800 strip technique was compared with the automated hexokinase method and the Reflotest-Glucose test strip technique employing the Boehringer Reflomat. The mean of the blood glucose values was 12.6 +/- 0.6 mmol/L for the hexokinase method and 12.9 +/- 0.6 mmol/L for the 20-800 strip technique, with a mean difference between the hexokinase and the 20-800 strip methods of 1.9 +/- 0.2 mmol/L. In the range 4 mmol/L to 12 mmol/L, the 20-800 strips were found to be extremely accurate, but for blood glucose levels less than 3.5 mmol/L and greater than 12 mmol/L, they were less reliable. Importantly, the strips were often misleading in indicating hypoglycaemia. It is concluded that the BM Test-Glycemie 20-800 strips have a practical and valuable role when used by suitably instructed staff members, or by patients in the management of diabetes, and represent a major advance over urine testing on previously available direct reading enzyme strip methods.

Blood Glucose↗
PubMed1980

Sensorimotor versus cognitive-perceptual training effects on the body concept of preschoolers.

The effects of two training programs on the body concept development of preschoolers as reflected in human figure drawings were investigated in this study. Twenty-four three-, four-, and five-year-old preschool children were divided into two experimental groups and one control group, matched closely by age and sex. All subjects were pre-tested with the Good-enough-Harris Drawing Test and post-tested with the same instrument after a one-month intervention training period. Group A received ten hours of sensorimotor training and Group B received ten hours of verbal body-part identification training. The mean gain scores of the two experimental groups were significantly different, with a greater mean gain by the sensorimotor group. Implications for occupational therapy are discussed.

Art↗
PubMed1976

Hypertension detection and control in a rural white Kentucky community.

This report presents data on the prevalence of elevated blood pressure and the status of hypertension control in a rural Kentucky community. Medical care is provided to the population under study by a long established organization of nurse practitioners. With the exception of young males, detection of hypertension has been relatively successful. However, fewer than 50 per cent of persons with blood pressure greater than 160/100 mmHg are receiving antihypertensive therapy, and greater than 60 per cent of individuals on therapy have blood pressure greater than 160/100 mmHg. Despite detection of hypertension control has not been achieved in this rural white community.

Adolescent↗
PubMed1975

Impaired synthesis of polyclonal (non-paraprotein) immunoglobulins by circulating lymphocytes from patients with multiple myeloma Role of suppressor cells.

Since patients with myeloma have serious abnormalities of humoral immunity, we applied an in vitro assay to determine the capacity of B lymphocytes to mature into immunoglobulin-secreting cells. In peripheral blood lymphocytes from 22 normal persons, geometric mean immunoglobulin synthesis was 4910 ng for IgM, 1270 ng for IgA and 1625 ng for IgG. The synthesis rates of peripheral blood lymphocytes of 22 patients with myeloma were 458 ng for IgM, 321 ng for IgA and 218 ng for IgG. Circulating mononuclear cells from three of six patients tested suppressed polyclonal immunoglobulin synthesis by cocultured normal lymphocytes. Suppressive activity was not mediated by purified T cells alone. Removal of phagocytic mononuclear cells from lymphocyte populations of one patient nullified suppressive activity. Removal of phagocytic mononuclear cells from lymphocyte populations of a second patient led to a nearly 10-fold increase in polyclonal immunoglobulin synthesis. Therefore, host suppressor cells may play a part in the decreased capacity of B lymphocytes to secret immunoglobulin in certain patients with myeloma.

Adolescent↗
PubMedDate not supplied

Exercise physiology in patients with left ventricular assist devices.

LVAD use in the heart failure population is increasing and allows severely impaired patients an opportunity for exercise rehabilitation before cardiac transplantation. Although the LVAD provides nearly all of the cardiac output at rest, the native left ventricle contributes a modest amount during exercise, with the LVAD capable of providing a mechanical cardiac output of 10 L/min or greater. Given the parameters of the LVAD, exercise training responses should yield greater changes in submaximal exercise tolerance rather than changes in peak oxygen consumption. Heart rate and LVAD rate are driven by separate mechanisms but increase similarly during exercise. Blood pressure responses are somewhat variable early post LVAD implantation but normalize. Ratings of perceived exertion appear to be reliable and useful in this population. Evidence to date suggests that early mobilization and progressive exercise training in this population is safe and improves the transplantation experience. Although central contributions to oxygen consumption are limited by the inherent mechanical parameters of the LVAD, adequate cardiac output is provided for routine physical activities and moderate exercise training while the patient awaits transplantation.

Equipment Design↗
PubMedDate not supplied

Altered exercise pulmonary function after left ventricular assist device implantation.

The use of LVADs as a bridge to heart transplantation is increasing steadily as more surgical centers add this effective strategy for end-stage heart failure patients. Fundamental exercise physiology in the presence of LVADs has been described previously, and data is available that supports the safety and efficacy of exercise in this population. Variants to the expected exercise response that may be secondary to LVAD implantation, such as the pulmonary restrictive pattern that developed in the patient described in this case study, may occur. Clinicians should consider assessment and monitoring of pulmonary function in this patient population, especially in patients with exercise-induced dyspnea and perhaps patients with pre-existing pulmonary limitation.

Exercise↗
PubMedDate not supplied

Safety and efficacy of exercise training in a patient awaiting heart transplantation while on positive intravenous inotropic support.

The safety and efficacy of exercise training in patients with congestive heart failure (CHF) is well established; however, the impact that exercise has on the subgroup of CHF patients awaiting heart transplant while on intravenous positive inotropic support remains largely unreported. This case study describes the safety and efficacy of exercise training in a patient awaiting heart transplant while on intravenous milrinone. Over a 1.2-year period, 246 exercise sessions were conducted with a total of 180.15 hours of aerobic exercise. During that time, the patient experienced only one hypotensive episode during exercise and had no other adverse events. The patient demonstrated a 38% increase in aerobic exercise time and a 34% increase in sustainable exercise workload. Research is needed to demonstrate the positive impact of exercise training on this subgroup of CHF patients.

Aged↗
PubMedDate not supplied

Relationship between ventilatory expired gas and cardiac parameters during symptom-limited exercise testing in patients with heart failure.

PURPOSE: This study investigates the relationship between ventilatory expired gas and cardiac parameters measured during exercise testing in patients with heart failure. METHODS: Twenty-five subjects (12 male, 13 female) diagnosed with compensated heart failure underwent symptom-limited exercise testing with ventilatory expired gas analysis. Metabolic and cardiac measures of interest were collected during testing. RESULTS: Mean peak oxygen consumption (VO2), minute ventilation/carbon dioxide production (VE/VCO2) slope, percentage of age predicted maximal heart rate achieved during exercise testing (%APMHR), and peak respiratory exchange ratio were 14.7 +/- 4.7 mL O2/kg/min-1, 33.8 +/- 9.8, 76% +/- 15%, and 1.1 +/- 0.11, respectively. The VE/VCO2 slope was significantly correlated with the following: %APMHR (r = -0.81, P < 0.001), peak VO2 (r = -0.83, P < 0.001), VO2 at ventilatory threshold (r = -0.70, P < 0.001), and the dead space to tidal volume ratio (VD/Vt) (r = 0.65, P < 0.001). The ability of peak VO2 and %APMHR to predict the VE/VCO2 slope was significant (r = 0.86, r2 = 0.72, P < 0.0001). CONCLUSION: This study demonstrates the importance of analyzing multiple exercise test parameters, including metabolic measures, in patients with heart failure.

Adult↗