Diagnostic accuracy of pH monitoring in gastro-oesophageal reflux.
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Biomedical subjects
Publications and source records attributed to R L Henry.
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Behavioural problems in preschool (1-4 years) children are a common cause of referral to health services. Parents of children presenting to the child development unit with behavioural problems (n = 18) were compared with a control group (n = 45). A questionnaire was utilized to examine the parents' expectations of the children's behaviours. As might be expected, the parents of children presenting to the Unit rated their children as having more difficult behaviours. These parents had unrealistic expectations, particularly for the 'negative' behaviours (disobedience, temper tantrums, defiance and whinging). However, they were able to anticipate normal age-related difficulties in some problem areas (dawdling during mealtimes, masturbating, not sharing toys and being jealous of one's siblings). Counselling should address the issue of matching the expectations of parents with the individual rates of development of their children.
A double-blind crossover study was performed on 33 children with asthma to compare the effectiveness of nebulized solutions of preservative-containing and preservative-free ipratropium bromide. Both solutions produced bronchodilation. No significant differences were found between the two solutions at any time after nebulization in minimum and maximum changes from baseline value or in the areas under the lung function time curves. The presently formulated preservative-containing ipratropium bromide solution was not shown to be inferior to a preservative-free compound.
An automated neutralization test for influenza B virus is described in which antibody titers are determined according to the release of neutral red from infected or uninfected cells of the Madin-Darby canine kidney line. Endpoints are determined in a standard enzyme-linked immunosorbent assay reader. The test requires no expensive immunologic reagents and was used to evaluate responses to both vaccination and natural infection against influenza B virus. Overall responses to vaccination were comparable with those obtained by hemagglutination inhibition, using Tween-ether-split influenza B/Ann Arbor/1/86 virus as the antigen (the HI-TE test). The sensitivities of neutralization responses compared with those obtained by the HI-TE test for two vaccines were 88 and 89%; the specificities were lower at 61 and 60%, respectively. Responses to vaccination, measured by hemagglutination inhibition, were significantly higher with split virus compared with whole virus. However, seroconversion by both the HI-TE and neutralization tests was observed in 5 of 10 individuals from whom virus was detected by either culture of nasal or throat washings or the presence of antigen from immunofluorescence in cells from nasal washings.
To study regional blood distribution during extracorporeal membrane oxygenation, we stabilized three groups of five rabbits each (3 to 5 kg) on venoarterial bypass at a flow rate of 30 ml/kg/min. Albumin aggregates (15 to 30 microns) labeled with technetium 99m were injected into the left ventricle during bypass (ventricle), the perfusion cannula during bypass (cannula), and the left ventricle with no bypass (control). Animals were put to death, organs were removed, and the percent distribution was determined with a gamma camera. The Student Newman-Keuls test was used for statistical comparisons. Distribution to both the heart and brain in the cannula group were decreased from control by 55% and 35%, respectively. Distribution to the brain in the ventricle group was also decreased from control by 39%. Intestinal distribution was elevated above control in the ventricle group by 37%, whereas musculoskeletal distribution was elevated 33% above control in the cannula group. No significant changes were noted for the kidneys, stomach, or liver. These data suggest that overall perfusion of some vital organs may be significantly reduced during low-flow extracorporeal membrane oxygenation, specifically in the case of the heart and brain, which may be deprived of oxygenated blood.
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Intracoronary nitroglycerin is frequently administered during invasive procedures such as coronary angioplasty or thrombolysis which may be associated with pain and sympathetic neural stimulation. Whether sympathetic-mediated reflex vasoconstriction interferes with nitroglycerin-induced augmentation of coronary blood flow is unknown. Therefore, coronary and systemic hemodynamics were measured in 19 patients during isometric handgrip exercise (3 min x 25% maximal effort), during intracoronary nitroglycerin, and during handgrip plus intracoronary nitroglycerin. Nine patients had no significant left anterior descending coronary artery stenosis (group 1) and ten patients had greater than 70% left anterior descending coronary artery stenosis (group 2). Handgrip exercise increased heart rate, mean arterial pressure, and coronary sinus and great vein flow 15% while increasing coronary resistance 10%. Intracoronary nitroglycerin (200 micrograms) reduced mean arterial pressure -4 +/- 6% and increased great cardiac vein flow 35-72%. Anterior left ventricular regional coronary flow responses to intracoronary nitroglycerin were unaffected by sympathetic stimulation for group 1. Group 2 had a greater increase in great vein flow with intracoronary nitroglycerin plus handgrip compared to nitroglycerin alone due to increased mean arterial pressure with no change in the great vein resistance. These data indicate that sympathetic stimulation does not alter the nitroglycerin-induced augmentation of coronary sinus and great vein blood flow in patients with and without significant left anterior descending coronary artery stenosis. In patients undergoing invasive interventions who may have increased circulating catecholamines, mild sympathetic (isometric) stimulation does not appear to interfere with the coronary vasodilatory responses to intracoronary nitroglycerin.
Although beta-adrenergic blockade may increase coronary vascular resistance in some patients with severe ischemic heart disease, the effects of beta blockade on the nitroglycerin (NTG)-induced augmentation of coronary blood flow have not been elucidated. Therefore, systemic hemodynamic and anterior left ventricular regional coronary blood-flow (thermodilution) data were measured during administration of NTG into the left coronary artery, before and 10 min after intravenous propranolol (0.1 mg/kg) in 22 patients. Six patients (Group 1) had normal left coronary arteries and nine (Group 2) had severe coronary artery disease with at least greater than 70% narrowing of the left anterior descending artery. In seven additional patients (three without and four with greater than 70% left anterior descending coronary artery disease), measurements were obtained with constant-paced heart rates (Group 3). Before beta blockade, NTG (200 mcg) significantly increased anterior regional great-vein flow [for Group 1, 84 +/- 38% (81 +/- 20 to 140 +/- 60 ml/min); Group 2, 39 +/- 41% (61 +/- 26 to 83 +/- 38 ml/min); and Group 3, 87 +/- 55% (75 +/- 36 to 144 +/- 86 ml/min)]. In Groups 1 and 2, beta-adrenergic blockade reduced heart rate 10% (p less than 0.01) but did not affect mean arterial or pulmonary artery pressures.(ABSTRACT TRUNCATED AT 250 WORDS)
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To evaluate the importance of ventricular ectopic activity on the predischarge treadmill exercise test for predicting mortality in patients after acute myocardial infarction (AMI), 163 patients with uncomplicated AMI were studied using symptom limited low-level treadmill exercise testing and 24-hour ambulatory electrocardiographic monitoring before hospital discharge. All patients were followed for at least 2 years or until recurrent AMI, coronary artery bypass grafting or death. Seventeen patients (10%) died during the follow-up period, 15 patients (9%) had recurrent AMI and 45 patients (28%) underwent bypass surgery. Ventricular ectopic activity was the only single treadmill abnormality that predicted subsequent cardiac death; angina pectoris, electrocardiographic ST-segment depression and a hypotensive blood pressure response did not. The mortality rate in the 20 patients with exercise-induced ventricular ectopic activity was 25%, compared with 8% in those without (p less than 0.004). Furthermore, in this patient population, exercise-induced ventricular ectopic activity was a much better predictor of cardiac death than that detected by ambulatory monitoring. Thus, ventricular ectopic activity on the predischarge treadmill exercise test is an important risk factor for death after AMI.
Although intracoronary nitroglycerin (NTG) is frequently administered to patients having occluded coronary arteries undergoing invasive procedures such as percutaneous transluminal coronary angioplasty or thrombolysis, the extent of NTG-induced augmentation of myocardial blood flow in patients with collaterally filled occluded arteries is incompletely understood. To examine NTG-induced increases in coronary blood flow in patients with occluded left anterior descending coronary arteries (LAD), coronary and systemic hemodynamics were measured during bolus administration of NTG into the left coronary artery in 10 patients with normal LAD (Group 1), 11 patients with greater than 70% and less than 100% narrowing of the LAD (Group 2), and 10 patients who had total occlusion of the LAD with angiographic collateral filling and anterior ventricular wall motion abnormalities (Group 3). NTG increased anterior regional great vein flow (thermodilution) from 72 +/- 19 to 140 +/- 60 ml/min (p less than 0.05), 67 +/- 27 to 108 +/- 66 ml/min (p less than 0.05), and 59 +/- 27 to 74 +/- 36 ml/min (p = NS vs. control, p less than 0.05 vs. peak flow for Group 1) with relative increases from control of 91 +/- 41%, 56 +/- 34%, and 25 +/- 22% for the three groups, respectively. The percent change for Group 3 was significantly lower than both Groups 1 (p less than 0.01) and 2 (p less than 0.05). These data indicate that myocardial hyperemic blood flow responses to intracoronary NTG are markedly attenuated in patients with occluded but collaterally supplied vessels. During invasive procedures in these patients, although significantly attenuated, intracoronary NTG may potentially provide a beneficial effect by augmenting blood flow through collaterals or in adjacent regions.
A blinded study was designed to provide qualitative and quantitative evaluation on the possible therapeutic benefits of the use of Pluronic Polyol F-127 as a substitute skin in standardized third-degree thermal burns. Three separate burns, approximately 1600 mm2, were induced on the shaved backs of young, anesthetized pigs. Each animal served as its own control. One burn site was left untreated while the other two sites were covered with coded preparations of the Pluronic F-127 gel with additives. Polaroid photographs with a fixed focal-length camera were taken of all burn sites for planimetry analysis. Biopsies taken confirmed that third-degree burns were achieved. The pigs were followed for 30 days. The rate of healing of third-degree thermal burns was significantly accelerated over control sites when treated with Pluronic Polyol F-127 plus propylene glycol. When the bacteriostatic agent Garamycin was also added, the rate of healing remained significantly better than untreated controls. With the addition of Piracetam, burn wound healing was actually retarded within 30 days, when applied topically. Thus, wound healing was both accelerated and retarded as a function of the particular Pluronic preparation used to treat specific burn sites. This experimental modulation of wound healing suggests that the non-ionic poloxamer, Pluronic F-127, can significantly enhance the rate of wound healing by some unknown mechanism, possibly by stimulation of epithelial growth factor (EGF).
Gabaculine (3-amino-2,3-dihydrobenzoic acid) was an inhibitor of in vivo chlorophyll biosynthesis in lima bean (Phaseolus lunatus L. cv Henderson). When applied to roots of 9-day-old plants, 10 micromolar gabaculine was sufficient to terminate biosynthesis of new chlorophyll. The trifoliolate leaves which emerged after gabaculine treatment were yellow. Gabaculine-treated plants had slightly lower dry weights; yet, overall plant size showed very little change. Chlorophyll fluorescence induction kinetics and CO(2) exchange measurements were used to monitor both immediate and long-term effects of gabaculine on photosynthesis. A lowered rate of the decline from the maximum level of fluorescence was observed after 10 hours for nitrate-supplemented plants, and all treated plants showed a slightly increased level of original fluorescence after 6 days. No change was observed in the rate of photosynthesis by unifoliolate leaves. The trifoliolate leaves, though not able to photosynthesize, were able to continue respiration. This suggested that heme biosynthesis for mitochondrial cytochromes was not abolished. In untreated lima bean, root nodules were induced by Rhizobium sp. 127E15. Following gabaculine treatment, root nodules formed, but were largely ineffective in nitrogen fixation. Nodule dry weight, nitrogen fixation activity, and leghemoglobin content were decreased by gabaculine.
To determine the relative value of clinical findings, results of low-level treadmill electrocardiographic (ECG) exercise testing and left ventricular (LV) ejection fraction (EF) for predicting cardiac events in the year after an acute myocardial infarction (AMI), 72 patients who had had an uncomplicated AMI were studied with either radionuclide angiography or 2-dimensional echocardiography to assess LVEF and a low-level treadmill exercise test before hospital discharge. All patients were followed for 1 year. Nineteen patients (26%) had at least 1 cardiac event: coronary artery bypass grafting (11 patients), recurrent AMI (6 patients) or cardiac death (6 patients). Multiple logistic regression analysis revealed that total cardiac events were predicted by exercise ECG ST-segment depression or angina, prior AMI, ventricular ectopic activity during exercise and digoxin therapy (cumulative r = 0.58, p less than 0.001). Coronary artery bypass grafting was predicted by exercise ECG ST-segment depression or angina (r = 0.29, p = 0.01). Recurrent AMI was predicted by exercise ECG ST-segment depression or angina, prior AMI and ventricular ectopic activity during exercise (cumulative r = 0.49, p less than 0.001). Cardiac death was predicted by an LVEF of 40% or less (r = 0.38, p = 0.01). The presence of both an LVEF of 40% or less and ECG ST-segment depression on treadmill exercise testing defined a subgroup of patients with a high incidence of early cardiac death (33%).(ABSTRACT TRUNCATED AT 250 WORDS)
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Although intracoronary nitroglycerin (NTG) is frequently required during percutaneous transluminal coronary angioplasty or thrombolysis, the dose-related hemodynamic effects and the extent to which intracoronary NTG--induced coronary hyperemia is limited in patients with coronary artery disease have not been defined. Therefore, we studied 19 patients with coronary artery disease (nine with no or minimal luminal narrowing of the left anterior descending coronary artery [group 1] and 10 with significant left anterior descending coronary stenosis [group 2]; mean arterial pressure and thermodilution coronary sinus and great cardiac vein blood flow were measured during bolus administrations of 50, 200, and 300 micrograms of intracoronary NTG. During the NTG-induced hyperemia, mean arterial pressure decreased 0%, 4% (both p = NS), and 6% (p less than 0.05) after 50, 200, and 300 micrograms doses, respectively. heart rate did not change. Global coronary hyperemia was greatest for 200 micrograms with coronary blood flow increasing (74 +/- 32% in group 1 and 53 +/- 25% for group 2) but was significantly different from 50 micrograms only in group 2 patients. Moreover, the regional coronary blood flow responses were attenuated in group 2 compared to group 1 for 50 micrograms, 18 +/- 13% vs 38 +/- 18%, and for 200 micrograms, 35 +/- 15% vs 72 +/- 34% (both p less than 0.05), with the reduction of regional coronary resistance in group 2 attenuated for all three doses of intracoronary NTG. The 300 micrograms dose did not provide further augmentation of either global or regional coronary blood flow or greater reduction in coronary resistance.(ABSTRACT TRUNCATED AT 250 WORDS)