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Biomedical subjects

R Lee

Publications and source records attributed to R Lee.

At least 451 records · Page 25Linked to original sources
PubMedDate not supplied

Effect of cardiopulmonary bypass and calcium administration on the splanchnic circulation.

Gastrointestinal complications following cardiopulmonary bypass (CPB) are associated with high mortality rates. The identification of prolonged CPB time and calcium administration as independent predictors of gastrointestinal complications suggests decreased splanchnic perfusion as a possible mechanism. To test this hypothesis, we evaluated splanchnic organ perfusion during CPB and after calcium chloride administration. Mongrel dogs were studied under anesthesia and were cannulated for bypass. CPB was begun at 37 degrees C, and the heart was fibrillated and vented. After 30 min, CPB temperature was reduced to 25 degrees C for 1 h with the heart arrested through cold crystalloid cardioplegia. After rewarming to 37 degrees C for 30 min, the heart was cardioverted, and CPB was weaned off. Calcium chloride (10 mg/kg) or saline was administered. Organ blood flow was determined with radiolabeled microspheres at baseline, during CPB, and after weaning from CPB. Splanchnic organ blood flow did not decrease during any phase of CPB. Calcium chloride administration after CPB had no effect on splanchnic organ blood flow. While gastrointestinal injury may result from CPB, this study suggests that the mechanism of injury is not decreased by splanchnic organ perfusion during bypass. While calcium chloride can cause pancreatic injury, the responsible mechanism is not calcium-induced hypoperfusion.

Animals↗
PubMedDate not supplied

Alpha-fetoprotein-producing gastric cancer.

We measured the sero-positivity rate of serum alpha-fetoprotein (alphaFP) of gastric cancer patients by ELISA assay; forty-two curatively resected patients, 14 palliatively resected patients, 8 who received explo-laparotomy or bypass surgery and 18 patients with systemic metastasis. The sero-positive rate was 9.8% (8/82) and the positivity increased with cancer progression. Sex, age and pathological type were similar between alphaFP-positive and -negative patients. The overall synchronous hepatic metastasis rates in alphaFP-positive and alphaFP-negative groups were 37.5% (3/8) and 12.2% (9/74), respectively (p=0.08). The predictability of synchronous liver metastasis in eight alphaFP-positive patients were as follows: 37. 5% of total patients (3/8), 50.0% (3/6) of unresectable patients, and 60.0% (3/5) of patients with systemic metastasis. In three alphaFP-positive patient with liver metastasis, all the hepatic lesions were intrahepatic and multiple, while in alphaFP-negative patients, 67% (6/9) of the hepatic lesions was single intrahepatic lesion or surface nodule. The predictability of both synchronous and metachronous liver metastasis in alphaFP-positive gastric cancer patients was 75%. These findings suggested that, in advanced stomach cancer patients, especially in stage IV, alphaFP can be used in predicting liver metastasis during follow-up.

Adult↗
PubMedDate not supplied

Overdose with chloral hydrate: a pharmacological and therapeutic review.

The purpose of this review is to highlight the toxicity of chloral hydrate and to review the management of overdoses with chloral hydrate. Three patients are presented in whom life-threatening cardiac arrhythmias dominated the clinical presentation. These arrhythmias were resistant to standard antiarrhythmic therapy. Also, we have reviewed selected features in eight patients who took overdoses of chloral hydrate who were admitted to an intensive care unit between 1981 and 1988. The pharmacology and toxicology of chloral hydrate are discussed with particular reference to the cardiac arrhythmias that are seen with overdosage. A proposed management scheme is detailed, including intravenously-administered propranolol as the preferred first-line antiarrhythmic agent. A case may be made for the discontinuation of the usage of chloral hydrate.

Adult↗
PubMedDate not supplied

The 5-HT2 receptor antagonist sarpogrelate reduces urinary and plasma levels of thromboxane A2 and urinary albumin excretion in non-insulin-dependent diabetes mellitus patients.

1. Therapeutic effects of a 5-HT2 receptor antagonist sarpogrelate on microalbuminuria and thromboxane (TX)A2 biosynthesis were examined in non-insulin-dependent diabetes mellitus (NIDDM) patients. 2. In protocol I, the ankle-brachial pressure index (API; an indicator of peripheral blood flow) and urinary albumin excretion (UalbV; an indicator of renal function) were determined in 42 NIDDM patients who had been treated with 300 mg/day sarpogrelate for 8 weeks. In an analysis of the results, the NIDDM patients were divided into four groups based on the severity of either vasculopathy or nephropathy as follows: group A, API < 0.9, UalbV > or = 100 mg/day; group B, API < 0.9, UalbV < 100 mg/day; group CAPI > or = 0.9, UalbV > or = 100 mg/day; and group D, API > or = 0.9, UalbV < 100 mg/day. 3. In protocol II, 10 NIDDM patients with UalbV values > 100 mg/day were divided into two groups to further confirm the effect of sarpogrelate on albuminuria: group E, the sarpogrelate treatment group (n = 5); and group F, the no treatment group (n = 5). 4. In protocol I, the incidence of a cold sensation in the lower extremities was reduced from 45.2 to 21.4% following sarpogrelate treatment. In patients with UalbV > or = 100 mg/day (groups A and C), UalbV was significantly decreased independent of API, while it did not change in patients with UalbV < 100 mg/day (groups B and D). Plasma TXB2 levels were significantly decreased following sarpogrelate treatment, whereas plasma 6-keto-prostaglandin F1 alpha levels were not. 5. In protocol II, in the sarpogrelate treatment group (group E), albuminuria was significantly improved and both plasma levels TXB2 and urinary TXB2 excretion were significantly decreased. In contrast, in the untreated group (group F), neither plasma levels TXB2 nor urinary TXB2 excretion was changed. 6. In conclusion, microalbuminuria was improved by treatment with the 5-HT2 receptor antagonist sarpogrelate independent of latent vasculopathy. Blockade of 5-HT2 receptors is suggested to be beneficial for the treatment of nephropathy in NIDDM patients. It is possible that the inhibition of TXA2 biosynthesis is involved in the therapeutic effect of 5-HT2 receptor antagonists.

Albuminuria↗
PubMedDate not supplied

Adductor tenotomies in children with quadriplegic cerebral palsy: longer term follow-up.

Adductor tenotomy procedures for prophylaxis against severe hip subluxation in children with quadriplegic cerebral palsy have reported good to excellent success rates; however, the overall follow-up has been short. In a retrospective review designed to obtain longer term follow-up of adductor tenotomies in these children, we found that 58% of our patients had continued subluxation or dislocation with the eventual need for further surgery. These results differ significantly from those of previous studies. There was a trend among the patients who did well to have less preoperative subluxation than those who needed further intervention, but we did not find a statistically significant cut-off value that was predictive of success or failure. Age at the time of surgery also did not influence the outcome in our patient population. An 8-year average follow-up of adductor tenotomies showed a higher loss of hip stability than previous mid range follow-up studies.

Cerebral Palsy↗
PubMedDate not supplied

The energy expenditure index: a method to quantitate and compare walking energy expenditure for children and adolescents.

We used heart rate and walking speed to calculate an energy expenditure index (EEI), the ratio of heart rate per meter walked, for 102 normal subjects, age 6-18 years. Heart rate was measured at self-selected slow, comfortable, and fast walking speeds on the floor and on a motor-driven treadmill. At slow walking speeds (37 +/- 10 m/min) the EEI was elevated (0.71 +/- 0.32 beats/m), indicating poor economy. At comfortable speeds (70 +/- 11 m/min) the EEI values decreased to the maximum economy (0.47 +/- 0.13 beats/m). At fast speeds (101 +/- 13 m/min), the EEI increased (0.61 +/- 0.17 beats/m), indicating poor economy relative to comfortable speeds. A graph of the EEI versus walking speed provides a way to evaluate and compare energy expenditure in a clinical setting.

Adolescent↗
PubMedDate not supplied

An unusual neurologic problem: Werdnig-Hoffmann disease.

Werdnig-Hoffmann Disease, its pathophysiology, and the resulting symptoms are described in this article. A case study is presented with treatment goals outlined, and the appropriate nursing interventions are delineated.

Adult↗
PubMedDate not supplied

Animal experiments as a model for clinical trials of a new dosage form of mitomycin C for peritoneal carcinomatosis.

Rabbits with peritoneal carcinomatosis induced by VX2 carcinoma were used as an experimental model to study a new dosage form of mitomycin C, MMC-CH, comprising activated carbon adsorbing mitomycin C. Rabbits revived an intraperitoneal injection of mitomycin C (1 mg/kg in the form of MMC-CH or 0.185 mg/kg in the form of mitomycin C solution). The two doses were equal in toxicity. MMC-CH extended survival time measured in days to 139% as compared to mitomycin C solution. Autopsy findings showed peritoneal carcinomatosis to be much less developed with MMC-CH than with mitomycin C solution. Hematological and blood biochemical analyses showed no remarkable abnormality.

Animals↗
PubMedDate not supplied

Selective delivery of high levels of mitomycin C to peritoneal carcinomatosis using a new dosage form.

Selective delivery of a high level of Mitomycin C (MMC) in intraperitoneal disseminated lesions was studied using a new dosage form of MMC, called MMC-CH. Intracavitary MMC-CH delivered a much higher level of MMC selectively to intraperitoneal tissues, with a much lower level of MMC in the whole body, in comparison with MMC solution. The index [MMC level in the intraperitoneal organs]: [MMC level in blood] was much higher and increased with time in the MMC-CH group, but not in the MMC solution group.

Animals↗
PubMedDate not supplied

Toxicity and pathological effects of a new dosage form of mitomycin C for carcinomatous peritonitis.

A new dosage form (MMC-CH) of mitomycin C (in a suspension of activated carbon adsorbing mitomycin C in saline), designed for intracavitary use in carcinomatous peritonitis, was studied for its toxicity and pathological effects in rats. The LD50 values determined with the Litchfield-Wilcoxon's method in three types of MMC-CH were 7.6 (100 micrograms/ml MMC and 0.5 mg/ml activated carbon in saline), 16.5 (100 micrograms/ml MMC and 0.75 mg/ml activated carbon in saline), and more than 25 mg/kg (100 micrograms/ml MMC and 1 mg/ml activated carbon in saline), while in mitomycin C solution the value was 3.05 mg/kg. The lethal toxicity decreased with the change of dosage form. Studies on survival, symptoms of intoxication and macroscopic and microscopic examinations of autopsied animals revealed that there was no evidence of any additional side effects produced by the change of dosage form.

Animals↗