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Biomedical subjects

R Warner

Publications and source records attributed to R Warner.

At least 73 records · Page 4Linked to original sources
PubMed1988

Treatment of urethral diseases with neodymium:YAG laser.

Over a thirty-month period, a wide variety of common urethral problems were treated on an ambulatory basis, with the neodymium:yttrium-aluminum garnet (Nd:YAG) laser. When used discriminately, laser treatment appears to be an effective modality for the management of selected urethral strictures. Thus far, excellent results have been obtained in 30 of 31 cases of short strictures where laser urethrotomy was performed as the first stricture procedure (average follow-up 10 months). Furthermore, in a series of 36 cases of secondary bladder neck contractures, all of the evaluated patients responded well (average follow-up 7 months). Good results were obtained in only 11 of 48 complicated strictures (average follow-up 14 months). However, while most of these extensive strictures were not eradicated, laser therapy generally produced a documented clinical improvement, comparable to urethrotomy or dilatation, in 15 of these cases. A series of 24 condylomata involving the urethra were treated satisfactorily, with no recurrences (average follow-up 13 months). Laser treatment also has been used successfully for the management of several urethral caruncles, urethral polyps, two meatal hemangiomas, one urethral carcinoma, and a distal duplicated urethra. Recently, the Nd:YAG laser has been applied to the prostatic urethra with vaporization of obstructing median bar hyperplasia. Favorable results have been achieved in 5 of 6 cases treated with a newly developed technique that utilizes direct laser contact. Retrograde ejaculation has not been encountered in these patients (average follow-up 6 months). All of these procedures have been accomplished in the office, largely without urethral catheterization. Lidocaine jelly occasionally supplemented with intravenous sedation provided satisfactory anesthesia.

Adult↗
PubMed1988

Nifedipine in chronic cor pulmonale: acute and relatively long-term effects.

After 20 mg sublingual nifedipine in 12 men with clinical stable chronic cor pulmonale the mean arterial pressure and systemic vascular resistance fell, cardiac index rose, and mean pulmonary arterial (Ppa) and wedge (Ppaw) pressures, right atrial pressure, and PaO2 remained unchanged. After 20 mg orally every 6 hours for 24 hours in 11 patients, the mean arterial pressure fell further, systemic vascular resistance remained low, and the cardiac index returned to baseline, whereas the Ppa and Ppaw decreased, but the pulmonary vascular driving pressure (Ppa-Ppaw), right atrial pressure, PaO2, and spirometry and ejection fractions remained unchanged. Of eight patients receiving maintenance therapy four developed untoward side effects in 1 to 3 weeks and one was noncompliant. The remaining three patients evaluated at 6 weeks failed to improve and had unchanged resting hemodynamics. Thus in the absence of a potentially reversible hypoxic pulmonary hypertension, nifedipine may not improve pulmonary arterial pressure and cardiac function in clinically stable patients with cor pulmonale.

Administration, Sublingual↗
PubMed1988

The relationship between schizophrenic patients' perceptions of their parents and the course of their illness.

Sixty-two schizophrenic patients completed the Parental Bonding Instrument (PBI), a measure of perceived parental characteristics, rating their parents on care and protection. PBI ratings were related to a one-year course of illness. Patients who perceived their parents positively tended to experience a milder course of illness if they were in frequent contact with them, and a more severe course if they were not; the reverse was true for patients who perceived their parents negatively. PBI ratings were unrelated to the age at onset of illness. This suggests that patients' perceptions of parental attitudes influence the course of schizophrenia by a current stress effect. The PBI, used alone or in conjunction with other predictors, distinguished good- and poor-outcome cases and appears to be a potentially clinically valuable tool.

Adult↗
PubMed1984

Lack of relationship between plasma insulin and glucagon levels and angiographically-documented coronary atherosclerosis.

In 120 consecutive patients undergoing diagnostic coronary arteriography, fasting blood glucose, plasma insulin, glucagon, serum cholesterol and triglyceride concentrations were measured. The insulin-glucose ratio and insulin-glucagon ratio were calculated. Forty-five patients had normal coronary arteries, 19 had single vessel coronary artery disease and 56 patients had multiple vessel disease. Fasting blood glucose was greater than 120 mg/100 ml in 37 patients (group A) and included 9 of the 10 known diabetics, 3 of whom were being treated with insulin. Seventy-seven patients included in group B had fasting blood glucose concentration less than 120 mg/100 ml. Patients with multiple vessel coronary disease in either group had higher blood glucose and cholesterol concentrations than those with normal coronary arteries or the ones with single vessel disease, but they did not have higher plasma insulin or glucagon levels nor increased insulin-glucose or insulin-glucagon ratios. With comparable extent of coronary artery disease patients in group A had higher plasma insulin levels and insulin-glucagon ratios than those in group B, but no correlation exists between the presence or extent of coronary atherosclerosis and these variables in either group. Thus, neither fasting plasma insulin level nor insulin-glucagon ratio predicts the status of underlying coronary atherosclerosis in either diabetics or nondiabetics.

Blood Glucose↗
PubMed1984

Update: varicocelectomy--a safe outpatient procedure.

One hundred ninety-two males with palpable varicoceles and subfertility who underwent varicocelectomy were studied. Fifty-five patients underwent inpatient varicocelectomy and 137 ambulatory varicocelectomy. We have shown that ambulatory varicocelectomy is safe and effective. Surgical success is not compromised. Most importantly, outpatient varicocelectomy is extremely cost-effective. The average cost of ambulatory varicocelectomy was less than 25 per cent that of an equivalent inpatient procedure, with a mean cost of $372 and $1,536 per person, respectively.

Adult↗
PubMed1983

Systolic hypertension in the elderly. Hemodynamic response to long-term thiazide diuretic therapy and its side effects.

Twenty-three patients older than 50 years, with systolic hypertension, underwent hemodynamic study. Cardiac output and stroke volume varied widely, with several high values. An elevated systemic vascular resistance, when considered as a function of the cardiac output, was the most prevalent hemodynamic abnormality. After administration of hydrochlorothiazide, 50 mg/day, for one month in 20 patients, 18 had a significant fall in BP, systemic vascular resistance, and stroke volume. After one year of continuous therapy, the hemodynamics, studied in 14 patients, did not change further. There were no clinical difficulties with carbohydrate intolerance, azotemia, hyperuricemia, or hypokalemia. No patient had symptoms of orthostatic hypotension or cardiac arrhythmias. Thus, thiazide therapy effectively and safely lowers the BP in most patients with systolic hypertension by reducing systemic vascular resistance.

Aged↗
PubMed1983

Systolic hypertension. Direct and indirect BP measurements.

The BPs of each of 26 patients with systolic hypertension were simultaneously measured indirectly by the cuff-mercury sphygmomanometer (cuff) and directly by intra-arterial recording from a brachial artery. The systolic BPs recorded by the two methods were comparable, indicating that systolic hypertension can be reliably diagnosed by readings from the cuff alone. However, the average diastolic BP was significantly overestimated by the cuff. This error in turn led to an underestimation by the cuff of the pulse pressure and overestimation of the mean arterial pressure. Thus, the low intra-arterial (true) diastolic BP and wide pulse pressure make increased arterial stiffness a plausible contributing factor in the pathophysiology of systolic hypertension.

Adult↗
PubMed1983

Acute effects of captopril on cardiopulmonary hemodynamics and renin-angiotensin-aldosterone and bradykinin profile in hypertension.

Hemodynamic variables were measured and plasma renin activity (PRA), angiotensin II (AII), aldosterone, and bradykinin assays performed in 21 hypertensive men on regular diet and thiazide diuretics before and 60 to 90 minutes after 25 mg oral captopril. Heart rate, right and left ventricular filling pressures, mean cardiac index (CI), and pulmonary vascular resistance (PVR) remained unchanged. The mean intra-arterial pressure (MAP) fell from 140 +/- 5 to 116 +/- 6 mm Hg (p less than 0.001) correlating with reduction of systemic vascular resistance (SVR) (r = 0.87, p less than 0.001), control PRA (r = 0.59, p less than 0.01), and All levels (r = 0.72, p less than 0.005) but not with control bradykinin or its postcaptopril rise (p less than 0.01). The fall in SVR correlated with reduction in plasma All (r = 0.80, p less than 0.001) and aldosterone concentrations (r = 0.53, p less than 0.05). Of four patients (19%) with precipitous fall in MAP after captopril, three needed volume expansion for circulatory support. We conclude: (1) All reduction by captpril and not bradykinin potentiation explains most of the agent's hemodynamic response in hypertensive circulation, (2) endogenous All may have a supportive role for SVR and possibly for CI but not for PVR, and (3) extra precaution is warranted while captopril is being started in patients taking diuretics.

Adult↗
PubMed1983

Recovery from schizophrenia in the Third World.

Approximately two to four billion dollars were spent on the treatment of schizophrenia in the United States in 1971 (Gunderson and Mosher 1975)--about half of one percent of the gross national product. This amount excludes expenditure on social security support for schizophrenics and such indirect costs as loss of productivity. Such a substantial investment should surely have yielded Americans significantly better rates of recovery than in less affluent parts of the world, for psychiatric care is very low on the list of priorities in developing countries. The evidence, however, points overwhelmingly to much better outcome for schizophrenia in the Third World. I will review the evidence in some detail and then analyze the possible reasons for this surprising finding.

Cross-Cultural Comparison↗
PubMed1983

Arterial oxygenation and pulmonary function with Saralasin in chronic lung disease.

During our earlier saralasin infusion study in hypertensive patients, we found a drug-induced rise in arterial oxygen tension (PaO2) associated with unchanged mixed venous PO2 or the PaCO2 and unrelated to cardiopulmonary hemodynamic changes. To test the hypothesis that saralasin improved pulmonary mechanics, blood gases, lung mechanics, lung volumes, diffusing capacity, and distribution of ventilation were analyzed and cardiac output (CO) measured in 12 normotensive men with chronic pulmonary disease before and during a 2 1/2 hour infusion of Saralasin (5 micrograms/kg/min). The PaO2 increased from a mean of 63 +/- 3 (SEM) to 70 +/- 3 mm Hg (p less than 0.001), while the CO decreased from 6.81 +/- 0.52 L/min to 6.18 +/- 0.48 L/min (p less than 0.005). The change in (delta)CO correlated with delta PaO2 (r = -0.67, p less than 0.05). Total systemic vascular resistance rose from 1,201 +/- 134 to 1,353 +/- 147 dynes X sec X cm5 (p less than 0.001). The PaCO2 and other measurements remained unchanged. We conclude that saralasin raised the PaO2 not by changing pulmonary function or mechanics, but by redistributing pulmonary blood flow and improving the ventilation-perfusion relationship.

Adult↗
PubMed1983

Advanced ultrasound evaluation of fetal hydrocephaly.

Advancing technology of ultrasound imaging has unraveled numerous problems in perinatology. The 1980's is the era of high-resolution real time ultrasonography, enabling the diagnosis of fetal hydrocephaly to be made in midtrimester pregnancy even prior to the age of fetal viability. The findings obtained by full evaluation of hydrocephalic fetuses with serial ultrasounds are helpful in appropriate counseling of parents by the birth defects team and in planning the best time and management of delivery in a perinatal center. Arrest of progression of severe hydrocephaly in the second half of pregnancy prior to fetal lung maturity has been accomplished by intrauterine implantation of ventriculoamniotic shunts. The potential risk of maternal soft tissue injury from delivery of an oversized head of a severely compromised fetus can be minimized by partial and slow decompression of fetal head under ultrasound guidance using a #20 spinal needle. The influence of the recent developments on better fetal diagnosis and survival of infants with neural tube defects in 1981 was compared to that obtained during the previous five years.

Female↗