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Biomedical subjects

R Wolfe

Publications and source records attributed to R Wolfe.

At least 73 records · Page 4Linked to original sources
PubMed1994

Intravenous torsemide as adjunctive therapy in patients with acute pulmonary edema.

The safety and efficacy of intravenous (i.v.) torsemide as adjunctive therapy for acute cardiogenic pulmonary edema was evaluated. Thirteen patients were treated with i.v. torsemide and six patients, with i.v. furosemide, as a positive control. Doses of torsemide, 20 mg or 40 mg, and furosemide, 40 mg or 80 mg, were administered initially. The dose was titrated as necessary over the next 24 hours. In patients who received i.v. torsemide, median fractional sodium excretion significantly increased from 2.88% (0.04-10.1%) at baseline to 6.76% (0.71-11.6%) at peak (P = 0.0342). Hourly urine volume increased from 134 mL (25-400 mL) to 375 mL (145-790 mL) (P = 0.0034). Torsemide administration resulted in a significant improvement in both pulmonary rales and orthopnea. None of the patients experienced serious adverse events or required withdrawal from the study. These results suggest that i.v. torsemide is an effective and well-tolerated diuretic in patients with acute cardiogenic pulmonary edema.

Acute Disease↗
PubMed1993

The effects of differing insulin levels on the hormonal and metabolic response to equivalent hypoglycemia in normal humans.

The aim of this study was to determine if differing concentrations of insulin can modify the counterregulatory response to equivalent hypoglycemia in normal humans. Experiments were conducted in 9 normal, lean men, who had fasted overnight. Insulin was infused in two separate, randomized protocols so that steady-state levels of 486 +/- 33 (low) and 3056 +/- 236 pM (high) were obtained. Glucose was infused during both protocols to ensure that the rate of fall of plasma glucose (0.07 mM/min) and hypoglycemic plateau (2.8 +/- 0.1 mM) were similar. Despite similar plasma glucose levels, EPI (8.7 +/- 0.7 vs. 5.5 +/- 0.7 nM), NE (3.3 +/- 0.3 vs. 2.3 +/- 0.2 nM), and cortisol (811 +/- 36 vs. 611 +/- 72 nM) significantly increased during high compared with low insulin infusion, respectively (P < 0.05). Glucagon, growth hormone, and pancreatic polypeptide levels increased briskly and significantly but were not different during the two insulin infusions. HGP rose significantly from 12.1 +/- 0.3 to 18.1 +/- 1.1 mumol.kg-1 x min-1 in response to the high insulin level (P < 0.05) but remained unchanged (12.1 +/- 0.4 and 11.7 +/- 1.4 mumol.kg-1 x min-1) in the presence of th low insulin level. GRa increased significantly during high insulin levels (3.4 +/- 0.3 to 4.8 +/- 0.7 mumol.kg-1 x min-1, P < 0.05) but remained at a basal rate (3.0 +/- 0.3 to 2.7 +/- 0.6 mumol.kg-1 x min-1) in the presence of low insulin levels. sBP and heart rate increased more during high insulin infusion (18 +/- 5 vs. 6 +/- 5 mmHg and 18 +/- 4 vs. 7 +/- 2 beats/min, respectively, P < 0.05). In summary, the 6-fold higher insulin level resulted in significantly greater increases in catecholamine and cortisol secretion, HGP, lipolysis, heart rate, and sBP despite equivalent hypoglycemia. We conclude that at moderate hypoglycemia, high doses of insulin can augment certain aspects of the counterregulatory response in normal humans.

Adult↗
PubMed1992

Mechanism of regulation of glucose production by lipolysis in humans.

The relationship between the rate of lipolysis and rate of glucose production (Ra) was investigated in 14- and 86-h fasted humans. [6,6-2H]glucose and [2H]5glycerol were infused to measure glucose and glycerol Ra in response to infusions of nicotinic acid in 14- and 86-h fasted subjects (protocol 1). The response of glucose Ra to nicotinic acid alone and nicotinic acid plus unlabeled glycerol was also measured in 86-h fasted subjects (protocol 2). After a 14-h fast, nicotinic acid caused a 30% decrease in plasma insulin levels and a marked (66%) decrease in plasma free fatty acid levels but did not have any significant effect on glucose Ra and concentration. After 86 h of fasting, nicotinic acid decreased glycerol Ra and hence lipolytic rate by approximately 60%. This caused a significant decrease (P less than 0.05) of 16-20% in glucose Ra and uptake. This decrease in glucose Ra was abolished when unlabeled glycerol was also infused with nicotinic acid to maintain glycerol Ra. These findings suggest that, in normal humans, a decrease in the rate of lipolysis regulates glucose Ra via its effect on the availability of glycerol for gluconeogenesis.

Adult↗
PubMed1991

Hemolysis due to branch pulmonary stenosis after the arterial switch procedure.

An infant with d-transposition of the great arteries underwent arterial switch operation using the modified Jatene technique. Severe bilateral branch pulmonary artery stenosis and mechanical hemolysis subsequently developed. The hemolysis resolved after surgical repair of the stenotic arteries. Probable causes are discussed.

Anemia, Hemolytic↗
PubMed1991

Alcohol consumption and the risk of breast cancer: a report from the Tecumseh Community Health Study.

The relationship between prior alcohol consumption and the risk of breast cancer was studied in 1954 women in the Tecumseh Community Health Study (TCHS) who entered the cohort in 1959-1960 and were followed potentially for 28 years. The mean alcohol consumption at baseline was 0.89 (SD 2.2) oz/week for premenopausal women and 0.85 (SD 2.2) oz/week for postmenopausal women. Only 25% of the cohort consumed more than 0.5 oz of ethanol/week or about 1.6 g/day. The adjusted relative risks (RRs) for breast cancer associated with the use of ethanol vs never drinking were 0.93 (95% CI, 0.40-2.18) for ex-drinkers, 1.08 (95% CI, 0.64-1.82) for 0- less than 1 drink/day, 1.23 (95% CI, 0.49-3.10) for 1- less than 2 drinks/day and 1.12 (95% CI, 0.25-5.01) for greater than or equal to 2 drinks/day. There were only 37 subjects in the group at the highest level of consumption (greater than or equal to 2 drinks/day). There was no significant interaction between alcohol and the period of onset of breast cancer (premenopausal or postmenopausal). In the TCHS, alcohol consumption generally at levels not exceeding 2 drinks/day, was not significantly associated with an increased risk of breast cancer. Although we have found little excess risk associated with alcohol consumption, the wide confidence intervals summarized above are not inconsistent with previously published reports that have suggested a modest positive association.

Adult↗
PubMed1991

Pelvic muscle exercise for stress urinary incontinence in elderly women.

PURPOSE: To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community-living elderly women. SUBJECTS: Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. METHODS: Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day. MAIN RESULTS: Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125. CONCLUSIONS: Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.

Aged↗
PubMed1989

Evaluation of the Draeger Anaesthetic Equipment Washing Machine (ANDA 9002).

An evaluation was made of an anaesthetic equipment washing machine. Our results largely substantiated the manufacturers claims. A clean, dry, disinfected load could be produced within 75 min. After minor modifications were made to the machine by the manufacturers, potential users were satisfied with its performance. We recommend consideration of this type of equipment for use in hospitals.

Anesthesiology↗
PubMed1988

Retrospective studies in scleroderma: effect of potassium para-aminobenzoate on survival.

Demographic and survival data are presented for 390 patients with scleroderma. For the entire group an estimated 81.4% survived 5 years from diagnosis and 69.4% survived 10 years. Life-table analyses revealed that adequate treatment with potassium para-aminobenzoate (Potaba KPAB) was associated with improved survival (p less than 0.01); 88.5% 5 year survival rate and 76.6% 10 year survival rate for adequately treated patients. Five and ten year survival rates for patients never treated with KPAB were 69.8 and 56.6%, respectively. Similar findings were obtained by comparing observed to expected mortality for these patients; again, KPAB therapy showed prolongation of survival. The Cox proportional hazards model was also applied to this retrospective study adjusting for baseline clinical involvement, demographics and KPAB treatment. There were some interesting results including a high significance for skin involvement per se as a prognostic indicator: the greater the extent of skin involvement the poorer prognosis. Time from first diagnosis to first University Hospital visit or admission when included as a covariate did not influence survival.

4-Aminobenzoic Acid↗
PubMed1986

Psychosocial and behavioral factors differentiating past drinkers and life-long abstainers.

Studies of the health effects associated with alcohol consumption often use a single non-drinker category as a referent. In this community study (N = 1,672) from Tecumseh, Michigan, past drinkers (N = 191) and life-long abstainers (N = 215) differed substantially for certain behavioral and psychosocial factors. In addition, 65 per cent of the male and 36 per cent of the female non-drinkers were past drinkers. Our findings suggest that a single non-drinking category might lead to ambiguous inferences across studies.

Alcohol Drinking↗
PubMed1985

Use of autogenous split-thickness dermal graft for reconstruction of the lining of the exenterated orbit.

A surgical technique using an exposed dermal graft to line the exenterated orbit has been successful in nine patients. Eight of the nine patients had undergone total maxillectomy at the time of exenteration. A split-thickness (epidermal) skin graft is harvested with a dermatome and hinged at one end. A second split-thickness dermal graft is harvested from the dermal bed of the first graft. The hinged epidermal graft is sutured into its donor site, and the deeper free dermal graft is used to line the orbital cavity. The latter graft tends to be more viable than a split-thickness epidermal graft. Also, because the dermal graft can self-epithelialize or be epithelialized by adjacent tissues, it may be placed adjacent to skin or a mucous membrane.

Aged↗