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Biomedical subjects

R W Anderson

Publications and source records attributed to R W Anderson.

At least 109 records · Page 6Linked to original sources
PubMed1987

Technicians and the future of pharmacy.

Ways in which pharmacists and pharmacy technicians can grow professionally to fulfill pharmacy's fundamental responsibility for appropriate drug use in patients are described. From the 1985 "Hilton Head Conference" on directions for clinical practice in pharmacy, the idea grew that pharmacists' traditional functions should be melded with a clinical orientation to provide pharmacy's maximum contribution to patient care. When the focus shifts from discrete activities of individual pharmacists to overall responsibilities of the department, each pharmacist and technician can see his or her contribution to the clinical endeavor; technicians assigned with a pharmacist to a specific group of patients are likely to take a more active interest in their jobs. Instead of ratios, patient outcome and job satisfaction should be the determinants of staffing patterns. Delineation of roles as judgmental or nonjudgmental should be replaced by clear job descriptions and procedures and an understanding of the complementary roles of pharmacists and technicians. Important elements in technician training include seminars presented by professional staff members and planned jointly by pharmacists and technicians, departmentwide seminars, policies that encourage technicians to join and participate in professional organizations, and liberal tuition-reimbursement policies. For career advancement, the pharmacy organizational structure might contain three levels: technician trainee, technician, and technician specialist. Pharmacists and technicians can overcome barriers between them by realizing the enormous growth potential and value of the services that both provide.

Job Satisfaction↗
PubMed1986

Influence of amino acids encoded in the 3' open reading frame of the SV40 early region on transformation and antigenicity of large T antigen.

The mutant dlA2414 bears a frame-shift deletion of nucleotides 2936-2927 in the coding sequence for the simian virus 40 (SV40) large T antigen. Based on its nucleotide sequence, this mutant should produce a T antigen containing the first 627 authentic large T antigen amino acids followed by 97 amino acids encoded in the alternate open reading frame at the 3' end of the early region. This protein resembles the hypothetical T* protein that would be translated from an early SV40 mRNA if it were spliced to permit utilization of the open reading frame. We show that stable mouse cell lines can be generated that express the T antigen produced by dlA2414 and that this T antigen has an altered carboxy terminus. In addition, the expected tryptic peptides were missing from the large T antigen and replaced by more hydrophobic peptides. The T*-like protein produced by dlA2414 was apparently less stable than wild-type T antigen and did not stably complex with the cellular phosphoprotein p53. This protein retained the ability to immunize mice against a challenge of syngeneic SV40-tumor cells. The dlA2414 T antigen was expressed at the surface of cells as shown by in vitro lymphocyte-mediated cytotoxicity assay. The results presented here also showed that the expression of a T*-like protein at the cell surface is not likely to be essential for tumorigenesis of cells transformed by SV40.

Amino Acids↗
PubMed1986

Tricuspid valve Candida endocarditis. Successful treatment with valve-sparing debridement and antifungal chemotherapy in a multiorgan transplant recipient.

Tricuspid valve Candida albicans endocarditis developed in a multiple-organ transplant recipient six months after successful treatment of Candida peritonitis. She has had no recurrence or valvular incompetence two years after valve-sparing debridement of the vegetation and prolonged therapy with amphotericin B. This is the second report of long-term success following valve-sparing debridement for tricuspid valve Candida endocarditis. In selected patients without annular involvement or gross valve destruction, excision of the fungal vegetation may allow for long-term cure and a competent valve.

Adult↗
PubMed1986

The effects of pressure-induced right ventricular hypertrophy on left ventricular diastolic properties and dynamic geometry in the conscious dog.

To determine whether chronic pressure overload and hypertrophy of the right ventricle alter the diastolic properties of the left ventricle, six adult dogs underwent banding of the pulmonary artery and were instrumented for studies 8 months later. Fourteen control dogs were also studied. Pressure and dimension data were collected from the dogs while they were awake and unsedated. The anterior-posterior, septal-free wall, and base-apex axis diameters of the left ventricle were measured with ultrasonic dimension transducers. Right and left ventricular pressures were measured with micromanometers. Pulmonary arterial banding resulted in increased right ventricular/body mass ratios (2.70 +/- 0.36 g/kg vs 1.52 +/- 0.15 g/kg control; p less than or equal to .05) and increased left ventricular/body mass ratios (4.84 +/- 0.64 g/kg vs 4.21 +/- 0.49 g/kg control; p less than or equal to .05). Right ventricular peak systolic and end-diastolic pressures were higher among the banded dogs (50 +/- 20/7 +/- 5 mm Hg vs 31 +/- 6/3 +/- 2 mm Hg control; p less than or equal to .05). A rearrangement in the three-dimensional geometry of diastolic filling occurred in the banded dogs. Extension from unstressed diastolic dimension (strain) in the base-apex axis was significantly larger in the banded dogs at left ventricular transmural pressures of 12, 8, and 4 mm Hg; strains in the septal-free wall axis were significantly smaller at transmural pressures of 12 and 8 mm Hg. Normalized diastolic left ventricular pressure-volume data and midwall circumferential stress-strain data were fit to the Kelvin viscoelastic equation. The normalized pressure-volume relationships of the banded dogs lay significantly to the left of those of the controls, indicating a loss of left ventricular chamber compliance. The midwall circumferential stress-strain relationships of the banded dogs were also shifted to the left, indicating a loss of intrinsic myocardial compliance. Thus, during the course of right ventricular hypertrophy caused by right ventricular pressure overload, alterations in the mass, geometry, and material properties of the left ventricle occur. At 8 months the chamber compliance of the left ventricle is compromised by these changes.

Animals↗
PubMed1986

Alterations of myocardial blood flow associated with experimental canine left ventricular hypertrophy secondary to valvular aortic stenosis.

Experimental renovascular hypertension or supravalvular aortic constriction results in left ventricular hypertrophy and impaired minimum coronary vascular resistance. However, these experimental models expose the coronary arteries to increased intra-arterial pressure, so that hypertensive vascular changes might be responsible for the impaired minimum coronary resistance. This study was performed to test the hypothesis that left ventricular hypertrophy in the absence of increased coronary pressure results in abnormalities of myocardial perfusion. Aortic valve stenosis was produced by plication of the noncoronary aortic cusp of 11 dogs at 6-8 weeks of age. Studies were carried out when the animals reached adulthood; mean left ventricular:body weight ratio was 7.1 +/- 0.4 as compared to 4.4 +/- 0.3 g/kg in 11 normal dogs (P less than 0.01). Under quiet resting conditions, myocardial blood flow measured with microspheres was significantly greater than normal in dogs with aortic stenosis. However, during maximum coronary vasodilation with adenosine, mean left ventricular blood flow in dogs with hypertrophy (3.29 +/- 0.39) was substantially less than in normal dogs (6.19 +/- 0.54 ml/min per g; P less than 0.01), whereas minimum coronary resistance was increased from 14.1 +/- 1.7 in normal dogs to 23.7 +/- 5.4 mmHg. min X g/ml (P less than 0.01). To examine the response of myocardial perfusion to cardiac stress, blood flow was measured during pacing at 200 and 250 beats/min. Compared with normal dogs, animals with hypertrophy had a subnormal increase in myocardial blood flow during tachycardia; this perfusion deficit was most marked in the subendocardium. These data demonstrate that left ventricular hypertrophy alone, without increased coronary artery pressure, is associated with impaired minimum coronary vascular resistance and with abnormalities of myocardial blood flow during pacing stress.

Animals↗
PubMed1986

Electrophysiologic properties of the myocardial infarction border zone: effects of transient aortic occlusion.

This study used transmural multipolar electrodes, ventricular pressure monitoring, and cardiac electrical stimulation techniques to examine the effects of transient aortic occlusion on ventricular refractoriness in a canine model of recent myocardial infarction. Six previously instrumented resting awake dogs were atrially paced, followed by timed premature extrastimuli inserted at epicardial pacing sites adjacent to an apical left ventricular (LV) myocardial infarction or in an LV control zone remote from the myocardial infarction. Electrophysiologic and pressure recordings were obtained before and during periods of transient aortic occlusion. Aortic occlusion was applied before the last beat of an eight-beat atrial pacing sequence and resulted in increased peak LV pressure (92.8 +/- 27.7 mm Hg, p = 0.003). Aortic occlusion shortened LV effective refractory period (ERP) recorded from the myocardial infarction border zone in both the subepicardial (-17.0 +/- 11.8 msec, p = 0.019) and subendocardial (-17.7 +/- 10.9 msec, p = 0.011) regions, whereas LVERP of the control zone was unchanged. Conduction latency of premature beats at equivalent coupling intervals and maximum latency observed were unchanged by aortic occlusion. atrioventricular conduction interval shortened in association with aortic occlusion. Thus transient aortic occlusion reduced ventricular refractoriness in the border zone adjacent to the myocardial infarction while control zone refractoriness was minimally or not changed. Heterogeneity of ventricular myocardial refractoriness may result from mechanical dysfunction, potentially increasing susceptibility to arrhythmias.

Animals↗
PubMed1986

Effect of thymopoietin and interleukin 2 on depressed mitogenic responsiveness and colony formation of lymphocytes from patients with preleukemia.

Previously, cloning efficiencies and mitogenic responsiveness of lymphocytes from patients with preleukemic disorders were shown to be significantly depressed. Whole blood T lymphocyte colony formation and 3H-TdR incorporation were used to assess the effects of interleukin-2 (IL-2) and thymopoietin (TP-5) on the proliferation of lymphocytes from patients with preleukemia. There were no statistically significant differences (p greater than 0.05) between any of the test groups stimulated with mitogen alone when compared to groups stimulated with mitogen plus TP-5 and/or IL-2 in either assay system for either patient or control groups. Nevertheless, TP-5 and IL-2 markedly increased the cloning efficiency and mitogenic responsiveness of lymphocytes from many of the patients studied, but in no case restored the proliferation response to the level of mitogen stimulated control lymphocytes. These findings suggest that other soluble mediators/factors may be needed to fully compensate for deficient mitogenic responsiveness and colony formation of lymphocytes from patients with preleukemic disorders which may be multifactoria in origin. Of importance, enhancement of lymphocyte responsiveness to PHA/Con-A with TP-5 and IL-2 suggests the presence of maturational/functional defects in lymphocytes from some of these patients which may be compensated for in part by addition of TP-5 and IL-2.

Adult↗
PubMed1986

Strategic planning for clinical services: the University of Texas M.D. Anderson Hospital and Tumor Institute.

A formal, hospitalwide strategic-planning process provides structure for the pharmacy's plans for implementing clinical services. The state-supported clinical cancer and research center began a formal strategic-planning process in 1981. The institution's planning report, prepared every two years and covering three two-year periods, drives the institution's budget through the state's biennial budget process. The report focuses on each department's responsibilities, areas of service, and relationship to the mission of the institution. Through the long-range planning process, upper-level administrators learned that pharmacy was eager not only to provide high-volume drug distribution services but also to assume direct patient-care and research responsibilities. This prompted an organizational change for pharmacy from a hospital department to a clinical division. The division of pharmacy now consists of three professional departments (patient care, pharmacy research, and pharmacy academic programs) and an administrative support service area. Services offered by each of the three departments are discussed, along with specific initiatives planned for the years 1987-1993. Within the next few years, all managers will come from the ranks of clinical practitioners; nonpharmacists will oversee financial and human resource functions. The division encourages existing pharmacy staff members to enhance their clinical skills through staff development programs. Strategic planning serves the dual purposes of structuring plans for implementing clinical pharmacy services and communicating pharmacy's goals within the institution.

Cancer Care Facilities↗
PubMed1986

Strategic planning for clinical services: panel discussion.

A panel of hospital pharmacy managers representing three institutions discussed issues related to planning for patient-oriented pharmacy services. The panelists discussed organizational benefits of strategic planning, ways to gain momentum for change among pharmacy staff members and from others within the institution, the need for setting realistic goals, and problems in differentiating roles for pharmacy staff. They also discussed the funding of strategic-planning programs. The panelists advocated an integrated approach to providing drug distribution and clinical services. Management must provide whatever support is necessary for integrating patient-oriented services into the daily activities of all pharmacists. That support may be in the form of additional personnel, better use of supportive personnel, staff development programs, or automation. Pharmacists, too, must recognize their combined responsibilities for drug distribution and clinical services. Only by having all pharmacists clinically trained can a department provide clinical services when needed. The experiences of these panelists may be useful to other institutions planning patient-oriented pharmacy services.

Medication Systems, Hospital↗
PubMed1985

The undifferentiated malignant neoplasm. Identification of lymphoma arising in skeletal muscle by immunohistochemical analysis.

The undifferentiated malignant neoplasm presents a significant problem in the intelligent selection of therapy. Because of advances in chemotherapy, there are cancers that are effectively palliated, and sometimes cured if appropriately treated. Characterization of tumors by immunohistochemical stains drastically reduces the incidence of "undifferentiated" diagnoses and will optimize patient management, as illustrated by two cases of large-cell lymphoma arising in skeletal muscle.

Biopsy↗
PubMed1985

Cell cycle oscillators. Temperature compensation of the circadian rhythm of cell division in Euglena.

The effects of different constant temperatures ranging from 16 degrees to 32 degrees C on the free-running, circadian rhythm of cell division were examined in axenic, photoautotrophic batch cultures of the unicellular algal flagellate Euglena gracilis Klebs. A comparative study was undertaken on the wild-type (Z strain) and a diuron-(DCMU)-resistant (ZR) strain. Although the overall growth rate (g) of both strains was rather dependent on temperature, lengthening increasingly at temperatures both higher and lower than the optimum range (about 23 degrees-29 degrees C), the free-running period (tau) of the oscillator hypothesized to underlie the overt rhythmicity in the cell division cycle (CDC) was found to be temperature-compensated over at least a 10 degrees C range. The degree of temperature compensation was most striking in the Z strain (Q10 = 1.05) over the permissive temperature interval of 22 degrees-32 degrees C, where periodic growth could occur. This Z strain had a slightly faster growth rate and displayed a higher degree of synchrony than that observed in the ZR strain, whose circadian clock was not as well compensated (Q10 = 1.23) over the permissive temperature interval of 18 degrees-28 degrees C. These results imply that the CDC is regulated by a circadian oscillator sharing the same features as those generating the many other overt biochemical and physiological circadian periodicities that have been documented for Euglena.

Cell Division↗
PubMed1985

Defining end systole for end-systolic pressure-volume ratio.

The end-systolic pressure-volume (ESPV) ratio (Emax) has recently been accepted as a valid cardiac contractility index. However, in vivo, it is difficult to define end systole (ES) precisely. This study was designed to analyze the effects of eight different ES definitions on Emax. Nine chronically instrumented dogs were studied prior to and during the sequential infusions of phenylephrine (0.2 mg/min), epinephrine (2.0 micrograms/min), and dobutamine (10 micrograms/kg/min). Left ventricular (LV) dimensions and pressure were measured with sonomicrometers and micromanometer. ES was defined at peak LV pressure (PLVP), end-ejection, dp/dt min, 10, 20, 30 msec before dp/dt min, minimum volume before dp/dt min, and left-upper-corner of pressure volume loop (LUC). Although ESPV relationship from each definition was linear (mean r 0.89 +/- 0.3, range 0.76 to 0.99) and sensitive to inotropic changes, the Emax's were not all the same. The r was highest with LUC (mean 0.94 +/- .02, range 0.90 to 0.99) and lowest with PLVP (mean 0.85 +/- 0.03, range 0.76 to 0.92). Emax from PLVP was least sensitive to epinephrine and dobutamine infusions. Thus, in order to compare different values of Emax, the definition of ES must be precise and consistent. Although all the above eight definitions of ES appeared to produce reasonable ESPV relationship, PLVP appeared to be the worst while LUC appeared to be the best ES definition for determining Emax.

Animals↗
PubMed1985

The evolution of the management of penetrating wounds of the heart.

In contrast to neurological surgery, which has its origins in the treppaned skulls of Neolithic man, the realization of cardiac surgery awaited the successful suture of a wound of the heart, an accomplishment of the nineteenth century. While the problem of pneumothorax has been cited as contributing to the delay in the development of surgery of the chest, exposure of the heart can be accomplished extrapleurally: hence, the late development of cardiac suture can be traced more to the ancient premise of the inviolability of the heart, a view which persisted up to the time of the first cardiorrhaphy. The successful demonstration of the heart suture in man quickly led to its widespread adoption. Subsequently, two schools of thought regarding the initial management of penetrating cardiac wounds developed, one advocating conservative treatment with pericardiocentesis, the other prompt cardiorrhaphy. The increasing safety of thoracotomy, along with an appreciation of the unpredictable and frequently catastrophic course following an initial favorable response to pericardiocentesis resulted in the gradual emergence of cardiorrhaphy as the procedure of choice, relegating pericardiocentesis to a diagnostic or temporizing measure.

Cardiac Surgical Procedures↗