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Biomedical subjects

S Frank

Publications and source records attributed to S Frank.

At least 145 records · Page 8Linked to original sources
PubMed1989

Mortality versus improvement in severe chronic asthma: physiologic and psychologic factors.

Improved outcome (1 to 10 years) of 140 asthmatic children retrospectively correlated with 8 of 49 variables in admission evaluation: (1) age of onset, (2) IgE, (3) night/early AM bronchospasm, (4) aggression, (5) severely disrupted family circumstances, (6) severe psychopathology, (7) psychotic signs, and (8) I.Q. Patients with fatal outcome (6% to 12%) deviated in the last three variables; most were 12.1 to 16.5 years, male, Black/Hispanic, aggressive, depressed and/or anxious. Clinical implications include high-risk identification on the basis of psychologic and physiologic variables, preventative measures, and consideration of residential treatment.

Adaptation, Psychological↗
PubMed1988

Effect of adrenal function on gastrointestinal peptide release in experimental cardiac arrest.

Pancreatic polypeptide (PP), neurotensin, substance P, and vasoactive intestinal polypeptide (VIP) are peptides that modify various autonomic and neural functions. These substances are secreted into the blood in response to physiologic stimuli affecting the gastrointestinal tract. To determine the effect of adrenal hormones on gastrointestinal peptide release we measured blood levels of PP, VIP, substance P, and neurotensin in adrenalectomized and intact dogs undergoing cardiac arrest and cardiopulmonary resuscitation (CPR), a condition associated with maximal adrenal stimulation. One hour after completion of abdominal surgery consisting of bilateral adrenalectomy or exposure of the adrenal glands (sham operation), ventricular fibrillation was induced in 19 dogs by direct ventricular discharge. Despite marked elevations of plasma epinephrine and norepinephrine, CPR was associated with minimal endocrine gastrointestinal involvement, restricted to increased VIP levels in sham-operated dogs. No specific gastrointestinal peptide response to cardiac arrest was seen in adrenalectomized animals, but their plasma PP and VIP levels were higher than those of sham-operated dogs. Therefore, acute maximal adrenal stimulation is associated with selective VIP release. In addition, the higher level of the vagally controlled plasma PP in adrenalectomized animals suggests a tonic inhibitory effect of adrenal secretions on the release of this peptide.

Adrenal Glands↗
PubMed1987

Cerebrospinal fluid changes in experimental cardiac arrest (maximal stress).

Cardiac arrest produces a prompt and maximal increase of plasma catecholamines, with associated elevations of the hormones involved in the endocrine response to stress. To investigate the participation of the central nervous system (CNS) in the generation of the endocrine response, the catecholamines epinephrine and norepinephrine in cerebrospinal fluid (CSF) were measured before, during, and after cardiac arrest accompanied by cardiopulmonary resuscitation (CPR) in adrenalectomized (ADX) and sham-operated (SHAM) dogs. We also determined the activity of acetylcholine esterase (AChE), an intracellular enzyme released into the CSF after hypothalamic or caudate stimulation. During CPR, plasma epinephrine increased significantly in SHAM but not ADX dogs, increasing from (mean +/- SE) 480 +/- 171 to 29,800 +/- 14,200 pg/ml (P less than 0.05). Prearrest CSF norepinephrine was higher in ADX than SHAM dogs and increased in both groups with cardiac arrest, but the increase was significant only in SHAM animals; CSF epinephrine remained unchanged during or after cardiac arrest. CSF AChE activity increased during and after defibrillation; the difference with basal levels became significant when the peak postarrest values were considered (P less than 0.05). These results document biochemical changes occurring in the CNS during maximal stress represented by cardiac arrest. It is suggested that CSF norepinephrine and AChE activity elevations are markers for hypothalamic activation from the stress of cardiac arrest.

Acetylcholinesterase↗
PubMed1987

Plasma catecholamine and serum cortisol responses to experimental cardiac arrest in dogs.

The plasma catecholamine and serum cortisol responses to cardiac arrest (ventricular fibrillation), cardiopulmonary resuscitation (CPR), and ventricular defibrillation were examined in 10 intact (sham-operated controls) and 10 bilaterally adrenalectomized dogs. One hour after surgery, the cardiac ventricles were electrically fibrillated, and 30 s later Standard American Heart Association CPR was begun. After 12 min of CPR, the ventricles were defibrillated. Cardiac arrest per se results in a massive increase in plasma epinephrine and norepinephrine concentrations and indicates that the adrenal medullas are the predominant source of this response. Although the epinephrine response was virtually nonexistent in the adrenalectomized dogs, the norepinephrine response was approximately 30% of that in the sham-operated control animals. Thus there is an adrenomedullary, and perhaps a sympathetic neural, component to the sympathochromaffin response to cardiac arrest. Resuscitation from experimental cardiac arrest tended (P greater than 0.05 less than 0.1) to be lower in the adrenalectomized dogs (1 of 10) than in the animals with intact adrenal glands (6 of 10).

Animals↗
PubMed1986

The electrocardiogram in obesity: statistical analysis of 1,029 patients.

The electrocardiogram in 1,029 obese subjects was correlated with the severity of obesity and with age, sex and blood pressure. The heart rate, PR interval, QRS duration, QTc interval and voltage (R + S or Q wave in leads I, II and III) increased, and the QRS vector shifted to the left with increasing obesity. These changes were independent of age, sex and blood pressure. Bradycardia was present in 19% of the patients, but tachycardia in only 0.5%. ST and T wave abnormalities were present in 11%, correlating better with increasing age and blood pressure than with severity of obesity. Conduction abnormalities were infrequent. Low voltage was present in only 3.9% of the patients and QTc prolongation was present in 28.3%. The heart rate and QRS voltage increase with increasing obesity. Conduction is slowed, and the QRS vector shifts toward the left as percent overweight increases. These changes must be considered when evaluating both baseline electrocardiographic studies in obese patients and the changes seen during weight reduction.

Adolescent↗
PubMed1986

A cadaver workshop to teach medical procedures.

A seminar and workshop were conducted to train students in the indications, techniques and hazards of common diagnostic and therapeutic procedures in general medicine. Cadavers were utilized to teach the techniques of thoracentesis, pleural biopsy, chest-tube insertion, bone marrow biopsy and aspiration, paracentesis, percutaneous liver biopsy and arthrocentesis. The use of cadavers was realistic and provided standardized instruction to each student. The method gave students an opportunity to become familiar with equipment, techniques, indications and hazards of each procedure prior to actual performance. It is readily adapted to a wide variety of additional procedures.

Cadaver↗
PubMed1985

Decision making and job satisfaction among youth workers in community-based agencies.

Sixty-four counselors and 32 alternative school teachers in 13 grass-roots agencies reported on levels of participation, influence, and competence in making clinical and administrative decisions. The data supported predictions that (a) professionals would report greater decision-making opportunities and abilities than nonprofessionals, and (b) that workers in general would report higher levels of participation, influence, and competence in clinical than in administrative domains, and higher levels of competence than influence in both domains. However, regression analyses testing the effects of the decision-making variables on different aspects of job satisfaction did not support predicted interactions among participation, influence, and competence. Rather, decision-making involvements had positive effects and decision-making abilities had negative effects on worker morale. The discussion high-lights the need for further research to identify the underlying processes involved in the observed relationships.

Adult↗
PubMed1985

gamma 3-Melanocyte-stimulating hormone immunoreactivity is a component of the neuroendocrine response to maximal stress (cardiac arrest).

The levels of gamma 3-MSH immunoreactivity (gamma 3MSH-IR), beta-endorphin immunoreactivity (beta-endorphin-IR), ACTH, PRL, and cortisol were determined in 23 patients with cardiac arrest (CA) and in a group of 22 patients consecutively admitted to the Intensive Care Unit (ICU controls). Blood was obtained immediately after CA and at frequent intervals for the next 2 h. In ICU patients, blood was obtained the morning after admission. gamma 3MSH-IR was consistently elevated after CA; it was present in all 23 patients and was detectable in 113 of 114 samples. The mean peak gamma 3MSH-IR level was 162 +/- 20 (+/- SE) pg/ml in CA patients and the mean gamma 3MSH-IR level was 35 +/- 6 pg/ml in ICU controls (P less than 0.01). gamma 3MSH-IR was undetectable (less than 20 pg/ml) in normal subjects. CA also was associated with increases in ACTH, beta-endorphin-IR, cortisol, and PRL. The group of ICU controls had stress hormone levels that were generally within the normal range. Distribution of plasma beta-endorphin-IR by gel chromatography showed two peaks of immunoreactivity corresponding to the beta-endorphin and beta-lipotropin standards in both the CA and ICU control groups. Distribution of gamma 3MSH-IR in CA plasma showed a major peak of immunoreactivity with a mol wt of approximately 6,000 daltons and two minor components of approximately 4,000 and 11,000 dalton. No immunoreactivity coeluted with a gamma 3MSH standard. We conclude that gamma 3MSH-immunoreactive peptides are a consistent component of the massive release of pituitary and adrenal glandular products after CA.

Adrenocorticotropic Hormone↗
PubMed1984

Adrenomedullary response to maximal stress in humans.

The most important neuroendocrine response to stress is an increase in plasma epinephrine concentration. To investigate the clinical significance of this response, plasma catecholamine levels were measured (single-isotope derivative assay) in chronic stress (severe illness; n = 22) and acute maximal stress (cardiac arrest; n = 23). The results were then compared with the values from 60 normal resting subjects: epinephrine (mean +/- SEM) 0.034 +/- 0.002 ng/ml; norepinephrine 0.228 +/- 0.01 ng/ml. Chronic stress (intensive care unit patients) was associated with a fourfold elevation of epinephrine concentration (0.14 +/- 0.06 ng/ml; range 0.01 to 1.37; p less than 0.01 versus normal control subjects). Acute maximal stress (resuscitation following cardiac arrest) resulted in a greater than 300-fold increase in the plasma epinephrine level (10.3 +/- 2.9 ng/ml; range 0.36 to 35.9; n = 15; p less than 0.01). Peak plasma epinephrine levels in successfully resuscitated patients (n = 6) ranged from 0.36 to 273 ng/ml (three patients had received epinephrine therapy). The plasma norepinephrine level was increased twofold in intensive care unit patients (0.52 +/- 0.06 ng/ml; p less than 0.01) and 32-fold after cardiac arrest (7.37 +/- 1.8 ng/ml; p less than 0.01). During resuscitation, the correlation between the simultaneous epinephrine and norepinephrine levels was highly significant: r = 0.76; p less than 0.01. It is concluded that (1) chronic, severe stress produces only moderate elevations of plasma epinephrine levels (up to 1.37 ng/ml), whereas acute stress produces marked increases of plasma epinephrine that may reach the extraordinarily high level of 35.9 ng/ml, (2) the potential toxicity from the adrenomedullary response to acute stress is further exacerbated by the parallel release of norepinephrine, and (3) under close medical monitoring, it is possible to survive with plasma epinephrine concentrations as high as 273 ng/ml.

Adrenal Medulla↗
PubMed1984

[Pharmacokinetic studies following intravenous, intramuscular and rectal administration of methohexital in children].

In pediatric patients methohexitone is used increasingly in different application forms for induction of anesthesia. Plasma concentrations of methohexitone were measured after rectal induction with 25 mg/kg, and after intramuscular injection of 5 mg/kg in 10 children each aged 2-7 years and were compared with 4 children after intravenous administration of 2 mg/kg. The pharmacokinetic parameters of the i.v. administered methohexitone were calculated and compared with the known pharmacokinetics in adults, showing that the open two-compartment-model is also applicable to children with a substantial shorter beta-half-life and a higher clearance. After rectal and i.m. induction with methohexitone the individual plasma concentrations scatter in a relatively wide range. The mean value curves of both application forms are similar with a maximum plasma concentration of 2.76 micrograms/ml between minutes 7-15 (rectal) respectively 2.6 micrograms/ml between minutes 15-30 (i.m.); 2 h later they are 0.57 micrograms/ml (rectal) and 1.03 micrograms/ml (i.m.). In contrast to the 100% available bioactivity of methohexitone after i.m. administration it amounts to only about 17% after rectal induction. As a result one can consider children to be able to eliminate methohexitone sufficiently in the observed plasma concentration range.

Biological Availability↗
PubMed1983

Anti-D antibodies in D- and Du-positive women: a cause of hemolytic disease of the newborn.

Regardless of the decrease in Rh sensitization as a cause of hemolytic disease of the newborn, antenatal antibody screening must be performed in all patients to detect not only anti-D sensitization, but other less common antibodies capable of provoking hemolytic disease of the newborn. The relative incidence of hemolytic disease of the newborn due to sensitization to such irregular antibodies as Kell, Kidd, and Duffy is increasing. We report here five patients who had D- or Du-positive blood with antenatal anti-D sensitization, and whose neonates had hemolytic disease of the newborn of varying severity. Blood that is D- and Du-positive with anti-D has been classified by Tippett; such blood types lack part of the D mosaic and are considered to be "D variants" yet are typed routinely as Rh positive. Anti-D antibody produced by D- and Du-positive blood is indistinguishable from the ordinary variety of anti-D.

Black People↗
PubMed1983

Differential sensitivity of brain iodothyronine 5'-deiodinases to sulfhydryl-blocking reagents.

Propylthiouracil (PTU) and iodoacetate (IAc) partially inhibit the 5'-deiodination of 3,3',5'-triiodothyronine (rT3) in cerebral cortex, but PTU has no effect on the 5'-deiodination of thyroxine (T4). We now report that pretreatment of cerebral cortex microsomes with increasing concentrations of IAc or iodoacetamide inhibits the PTU-sensitive 5'-deiodination of rT3 with half-maximal inhibition at less than 1 microM IAc. PTU-insensitive 5'-deiodination of rT3 and T4 requires 100-1000-fold higher concentrations of IAc to achieve similar inhibition. Trypsinization decreases both 5'-deiodinating activities by greater than 90%. These data suggest that enzyme SH groups do not participate in the 5'-deiodination of T4 or rT3 by the PTU-insensitive pathway.

Animals↗
PubMed1983

Similarity of obesity indices in clinical studies of obese adults: a factor analytic study.

The similarity of measurements obtained with six commonly used obesity indices was assessed with correlational and factor analyses performed on data for 951 obese adults participating in a weight reduction study. Intercorrelations among the indices were found to be very high, with a mean of 0.96. A factor analysis of the six indices resulted in a single factor which accounts for 97% of the aggregate variance in the six indices. A factor analysis of the six indices plus height and weight resulted in two factors. The six indices loaded nearly perfectly on one factor and not at all on the second. Height loaded perfectly on the second factor. The results of these analyses constitute strong empirical evidence that the obesity indices are measuring the same thing and that factor is independent of height. Although anthropological or other special studies may necessitate the use of a particular index, these results suggest that it should make little difference which of the six indices is used in a clinical study of obesity with obese adults.

Analysis of Variance↗