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Biomedical subjects

S Phillips

Publications and source records attributed to S Phillips.

At least 217 records · Page 12Linked to original sources
PubMed1983

Differential transit of liquids and solid residue through the human ileum.

We determined transit of liquids and the solid residue of a mixed meal through the ileocecal region of six healthy men. A multilumen polyvinyl tube was passed from above into a 20-cm segment of terminal ileum, and flow of liquid was assessed by indicator dilution techniques. Three test meals were eaten in random order at 5-hourly intervals. Meal A contained baked beans and polyethylene glycol (PEG 4000). Recovery of PEG 4000 from the ileum served to mark transit of the liquid phase, whereas arrival of solid residue (beans) in the cecum was heralded by a signal of H2 in the breath. PEG 4000 appeared promptly in ileal aspirates, peaking at 1-1.75 h postprandially. Breath H2 excretion was first detected at 1.5-2.5 h after meal A and always peaked later than PEG 4000. When meals shown to be unassociated with generation of breath hydrogen (meals B and C) followed meal A, an augmentation of hydrogen excretion was noted in the early postprandial period. The total volume calculated to pass from ileum to cecum over 24 h was 1,790 +/- 234 ml (range, 1,180-2,515 ml). Ileal flow increased promptly and significantly after each meal (P less than 0.005) and remained high for 3 h or more. These results confirm that, in healthy humans, about 2 liters of chyme pass from ileum to colon each 24 h and ileal flow increases postprandially. They also suggest that the liquid and solid phases of a mixed meal are separate in the ileocecal region.

Adult↗
PubMed1983

Motor responses to food of the ileum, proximal colon, and distal colon of healthy humans.

Intraluminal pressures and motility indexes were recorded from ileum, ascending colon, rectosigmoid colon, and rectum of 6 healthy men. Three different test meals were eaten at 5-hour intervals. During fasting, migrating motor complexes were identified in the ileum. In ascending colon, irregular, isolated peaks of pressure were common; when bursts of continuous activity occurred, their predominant frequency was 6/min. Regular contractile activity occurred in distal colon at a frequency of 2.5-3.5/min. although 3 subjects also demonstrated rates of 7/min. There were both synchronous and independent contractions of the rectosigmoid and rectum, and no temporal relationship was obvious between motor activities of ascending and distal colons. When the preprandial hour contained no migrating motor complex, all meals increased the ileal motility index by 50%. The motility index of ascending and rectosigmoid colons were enhanced by solid meals, but not by meals containing amino acids. We conclude that motor patterns in the colon vary regionally, both fasting and after food. Results obtained at one site of the large intestine should not be extrapolated to others.

Adult↗
PubMed1983

Evaluation of a residency training program in behavioral pediatrics.

The impact of behavioral training upon first-year residents was evaluated by assessing attitudes with regard to 15 clinical "entities," including behavioral disorders, physical disorders, and "mixed" disorders. Each entity was rated at four times: beginning of the year, start of the behavioral rotation, end of the rotation, and end of the year. Multiple-choice questions were also included to assess knowledge regarding behavioral pediatrics. Data were collected from 37 residents, from 1977 to 1980. For behavioral disorders and mixed disorders, residents' self-reported competence increased with regard to diagnosis, management, advising parents, and knowledge of resources. Further, the greatest change occurred during the 2-month rotation. In contrast, change in perceived competence for physical disorders was not specific to the rotation but, rather, increased evenly over the year. Ratings of faculty and housestaff interest remained constant across testing points, and residents' "desire to learn more" and prediction of "future relevance" showed a slight decrease over time, for all disorders. Knowledge regarding behavioral pediatrics increased significantly from the beginning of the year to the start of the rotation, and also during the rotation. These data demonstrate that changes in residents' perceived competence are directly related to their rotation experience, and suggest that behavioral issues can be introduced successfully during the first year of residency training.

Attitude of Health Personnel↗
PubMed1983

Current status of behavioral pediatric training for general pediatric residents: a study of 11 funded programs.

The W. T. Grant Foundation has funded training in behavioral pediatrics for pediatric residents at 11 medical centers. The approaches toward training taken by the 11 funded programs, based on information systematically collected by interviews conducted with departmental chairmen, faculty, and residents during a program visit to each medical center, are described. No single training site emerged as optimal for teaching behavioral pediatrics, although linking such teaching to a "low priority" setting was an educational obstacle. A serious problem in many programs was the lack of ongoing research in behavioral pediatrics. Success in teaching behavioral pediatrics was dependent upon faculty support and a mandatory experience in behavioral pediatrics for all residents.

Adolescent↗
PubMed1982

An asymmetrical model of the airways of the dog lung.

A resin cast of the bronchial tree of a dog was studied down to branches of 0.5-mm diameter. The branches were ordered, and the number of branches, mean diameter, and mean length of branches in each order were determined. The model was developed from these data with the property that delta, the difference in order between the two daughter branches at a bifurcation, is identical for all parent branches of a given order. This property facilitates the use of the model for the calculation of physiological variables such as input impedance (Fredberg and Hoenig, ASME J. Biomech. Eng. 100: 57-66, 1978), and the comparison of such results with those obtained from symmetrical models (Sidell and Fredberg, ASME J. Biomech. Eng. 100: 131-138, 1978).

Animals↗
PubMed1982

Variability of motility of the ileum and jejunum in healthy humans.

Motor patterns of the distal small bowel were defined in healthy humans, using a multilumen polyvinyl tube, passed by mouth in 11 healthy subjects. Five recording sites, spanning 100 cm of tube and featuring a nitrogen hydraulic infusion system, were used to obtain records during 6 h of fasting and 6 or more hours after ingestion of a 600-kcal liquid test meal. The loci of recordings were designated as jejunal, ileal, or terminal ileal, as judged by the length of tube within the intestine and by fluoroscopy. During fasting, the migrating motor complex was present in all subjects and at all levels of the small intestine, but it could not be traced into the colon. Interdigestive cycles were defined primarily by the presence of an "activity front" (phase 3 of the migrating motor complex). Ninety-six migrating motor complexes occurred each 97 min (grand mean for all loci), but intervals between individual activity fronts varied markedly (15-195 min), in contrast to what is reported in other species. The velocity of aboral migration was 4.7 +/- 1.8, 1.3 +/- 0.4, and 0.9 +/- 0.2 cm . min-1 (mean +/- SD) in jejunal, ileal, and terminal ileal, respectively. Rates of continuous, rhythmic contractions during activity fronts declined distally: 12.5 to 10.5 (jejunal), 10.9 to 9.3 (ileal), and 10.0 to 8.6 cycle/min (terminal ileal), respectively. In individual subjects, maximum rates of contraction and velocities of migration always declined distally, but the duration of activity fronts was unrelated to the level of recording. Food interrupted the fasting cycles of motility for periods ranging from 2.75 to greater than 10 h. The transition from the fasting to the fed pattern was prompt and the postprandial motility was that of irregular bursts of contractions interspersed with transient quiescence. These studied demonstrate that the migrating motor complex occurs throughout the human small intestine, and that inter- and intraindividual variations are marked; food disrupts the complex for variable periods. These variations must be considered when abnormalities are being sought in disease states.

Adult↗
PubMed1982

Relationship of motility to flow of contents in the human small intestine.

To measure simultaneously motility and flow of intestinal contents, a multilumen polyvinyl tube was passed by mouth in 10 healthy volunteers. Motility was recorded at five sites, spanning 100 cm of tube, to allow recognition of migrating motor complexes during fasting and during their disruption by food. Loci were designated as jejunal, ileal, and terminal ileal, as judged by length of tube in the intestine and by fluoroscopy. Flow of intestinal contents was measured by indicator (phenolsulfonphthalein) dilution over a 20-cm segment; flow was related to motility at the perfusion site. A liquid test meal of 400 ml and 600 kcal, containing polyethylene glycol 4000, was eaten after 6 h of fasting. During fasting, flow of intestinal contents was intermittent at all levels and varied with the presence of or absence of the activity front ("phase 3" of the migrating motor complex). The activity-front periods contributed 50% of total flow, but occupied less than one-third of the total recording time. Flow corrected for time was significantly greater with the presence of activity front than with phases 1 or 2 of the migrating motor complex (p less than 0.001). In addition, of 45 increments in flow of greater than 0.75 ml . min-1, the majority (82%) were associated with an activity front. The flow rate increased promptly after a meal and fluctuated markedly during the postprandial period in most studies. By the time migrating motor complex had returned, more than 90% of meal marker (polyethylene glycol) was accounted for in intestinal aspirates. In contrast, only 56%-73% of marker was recovered postprandially in those studies in which the migrating motor complex had not returned by the time the study was terminated. Thus, flow of intestinal content is largely intermittent during fasting, peaks of flow being associated with passage of the activity front of the migrating motor complex; on the other hand, half the fasting flow is unassociated with the activity front. Reappearance of the migrating motor complex at any level after a liquid test meal signals clearing of the liquid meal from the more proximal intestine.

Adult↗
PubMed1982

Screening for pharyngeal gonorrhea in the urban teenager.

A retrospective chart review assessed the occurrence of pharyngeal gonorrhea among 546 teenagers who attended a general adolescent clinic and were cultured for gonorrhea; they had been routinely cultured at three sites (cervix/urethra, rectum, and pharynx) regardless of their history of sexual practice. No record of specific sexual practice was available. This population was predominantly urban, black, and female; the age range was 11 to 22 years (mean = 16.5). The overall occurrence of gonorrhea was 14.7% (80/546). Pharyngeal gonorrhea was detected in 2.7% of the study population, representing 12 females and three males. Of the 80 patients with gonorrhea, 15% had only pharyngeal gonorrhea. History was available for 13/15 patients none had pharyngeal symptoms. Approximately half were detected by routine screening at a family planning visit; the remainder had complaints related to sexually transmitted disease. The occurrence of pharyngeal gonorrhea is sufficiently high to merit study of the indications for pharyngeal culture of teenaged patients. Given the potential for disseminated infection and absence of information regarding the reliability of self-report, it currently appears appropriate to culture adolescents routinely for pharyngeal gonorrhea, regardless of stated sexual practice, whenever genital cultures are collected.

Adolescent↗
PubMed1981

Pyelonephritis: the relationship between infection, renal scarring, and antimicrobial therapy.

We studied the relationship between infection, renal scarring, and antimicrobial therapy in pyelonephritis by an experimental model of the disease. Our specific concern was to identify those aspects of the acute phase of infection associated with the induction of the inflammatory response. Our hypothesis was that the degree of the inflammatory response and the extent of the subsequent lesion in the kidney depended on the rate at which a critical number of microorganisms was reached in the kidney. We proposed that the rapid increase in bacterial numbers in the kidney was the stimulus initiating the inflammatory response and not the total number of microorganisms in the kidney. In the experimental investigation, we treated animals with induced renal infection at varying intervals after the establishment of infection, and we determined the effect of antimicrobial therapy on the bacteriologic, gross, and histopathologic features of the disease. The early events relating to the bacterial invasion of the kidney were important determinants but the hypothesis needed extending to account for the fact that antimicrobial agents, administered after bacterial numbers had reached a plateau, still reduced markedly the damage to the kidney. Two factors seem to be involved in the genesis of the pyelonephritic lesion. The first is the rate of acquisition of a bacterial population by a previously sterile organ, but an additional and important component is the total number of microorganisms in the kidney up to 4 days after challenge. Clinically, the results are relevant in that they demonstrate that renal scarring can be prevented or significantly reduced by prompt antimicrobial therapy.

Ampicillin↗
PubMed1981

What's the difference? Pediatric residents and their inaccurate concepts regarding statistics.

Two multiple-choice questions were designed to assess pediatric knowledge of two statistical concepts: (1) correlation and (2) probability values for statistical significance. One question was administered to 684 residents from 24 major pediatric training programs; this response rate represented 84% of all residents in these programs (PL-1, PL-2, and PL-3 years). In 20 of these programs, the second question was administered to 437 residents, representing a 79% response rate. Less than 20% of the residents responded correctly to the first question, and approximately half chose correctly on the second question. Further, no trend toward improvement was apparent with additional years of residency training. This limited knowledge of statistical concepts suggests that pediatricians are not well equipped to evaluate the scientific merit of research reported in pediatric journals.

Humans↗
PubMed1981

Teenagers' preferences regarding the presence of family members, peers, and chaperones during examination of genitalia.

During physical examination that include the genitalia, teenagers are typically separated from their parents and females are provided with a chaperone. To assess teenagers' attitudes regarding this practice, 140 females and 60 males awaiting treatment in a general adolescent clinic were asked their opinion about a physical examination that include the genitalia. Teenagers indicated whether they would want to be accompanied during the examination, and by whom, as a function of the hypothetical clinical situation that varied the sex and familiarity of the physician. Choices reflected teenagers' age and sex, rather than physician characteristics. Young males and females strongly preferred to be accompanied, generally by a family member. With increasing age, males preferred to be alone with the physician whereas females preferred to be accompanied. Regardless of sex and age, virtually none chose the company of peers. Despite strong development differences, however, there also were pronounced individual differences among teenagers of the same age. Our results suggest that service delivery be adapted to the particular preference expressed by individual teenagers. Needs assessment for adolescent programs may best be achieved by conducting similar surveys in local clinical settings.

Adolescent↗
PubMed1980

Improved survival of ventilated neonates with modern intensive care.

The records of 909 infants who required mechanical ventilation over a 42-month period were reviewed; 68.3% of the infants survived. The highest survival rate was in infants with persistent fetal circulation and hyaline membrane disease, and the lowest in infants with congenital anomalies and miscellaneous diseases. The survival rate for each year of the 3 1/2-year study increased from the previous year. There was also a dramatic increase in the survival rate in infants with a birth weight greater than 1,250 gm.

Humans↗