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Biomedical subjects

S Rubin

Publications and source records attributed to S Rubin.

At least 127 records · Page 7Linked to original sources
PubMed1988

The expanded role nurse. Part II. Role implementation strategies.

This is the second article of a two-part series describing implementation of Expanded Role Nurse positions at University Hospital, London, Ontario. In Part II, the author discusses sources of role stress and strain and presents strategies to prevent or minimize role problems. Role stress results when the role incumbent is unable to meet the expectations of the social structure. Goal attainment is impaired and role relationships are disrupted. Strategies to prevent role problems should be identified and implemented during role development.

Communication↗
PubMed1987

Antireflux surgery in infants with bronchopulmonary dysplasia.

We reviewed the medical records of nine infants with severe bronchopulmonary dysplasia and gastroesophageal reflux who underwent fundoplication-gastrostomy surgery. All the infants were born prematurely, required preoperative mechanical ventilation, and were failing to thrive. The operative procedure was well tolerated by all the infants. Seven patients were extubated by day 11, and two patients required long-term ventilation. There were two postoperative deaths, both attributed to acute respiratory deterioration followed by cardiorespiratory failure. The postsurgical respiratory response was observed to be a rapid decrease in oxygen requirements and an absence of further aspiration episodes. A mean decrease of 0.14 in fractional inspired oxygen concentration was noted by 30 days postoperatively, and by 180 days the decrease in fractional inspired oxygen concentration was 0.22. All infants were fed by gastrostomy by postoperative day 4, with no evidence of clinical reflux. The nutritional response was noted to be an increase in growth velocity with increasing age (ie, catch-up growth) and ease of feeding. At both 30 and 180 days postoperatively, the mean growth velocity was more than double the preoperative growth velocity. In addition, ease of postoperative feeding reduced the nursing care requirements and allowed earlier discharge from hospital. Fundoplication and gastrostomy is effective in facilitating growth and feeding in addition to decreasing oxygen requirements in infants with severe bronchopulmonary dysplasia and gastroesophageal reflux.

Bronchopulmonary Dysplasia↗
PubMed1987

Familial polyposis coli in childhood.

Familial polyposis coli has generally been considered a disorder of adulthood that is rarely identified in children. We report 3 affected kindreds in which the disorder was diagnosed in 6 of 11 potentially affected children between 8 and 16 years of age. Experience with these kindreds demonstrates that polyps frequently develop during childhood in affected individuals. Colonoscopy was found to be preferable to the air-contrast barium enema, in that it was as sensitive a technique for detection of adenomas, and in that it also permitted collection of biopsies for histologic confirmation. We recommend that colonoscopy be performed late in the first decade of life before symptoms develop. Total colectomy, rectal mucosectomy, and ileo-anal anastomosis eliminated the risk of malignancy, preserved anal sphincter function by both clinical and manometric assessment, and was readily adapted to by these children.

Adenocarcinoma↗
PubMed1985

[Which is the best drug combination for the short-term therapy of tuberculosis? A prospective randomized study with 190 patients].

190 patients with positive cultures for M. tuberculosis were treated in the initial phase as inpatients for 2-3 months at random with either pyrazinamide (Z) or ethambutol (E) in combination with isoniazid (H) and rifampicin (R). In the continuation phase as out-patients they were treated by their family doctor for a further seven months with a new randomization using either R or E combined with H. Regular controls of drug intake using urine test strips were 97% positive. The patients treated with Z showed a tendency to more rapid conversion to negative cultures despite the significantly shorter duration of initial-phase treatment. During the average observation period of 33 months after commencing therapy there were five relapses (without development of drug resistance). The distribution over the four patient groups did not allow statistical conclusions to be drawn. All of the relapses occurred during the first year after the treatment ended. All relapsing patients showed an unusually long delay (108 days) before the tuberculosis cultures proved negative, in comparison with only 48 days in all patients. The relapse rate of 3.6% equals comparable controlled studies in the literature of the last four years, in which patients were initially hospitalized for two months or received medication under direct supervision as out-patients. The family doctors treated their patients on average for ten months instead of the nine months recommended in the treatment scheme ("doctor's compliance"). This seems to be a direct consequence of the earlier recommendations in favour of a longer duration of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Extended field irradiation in the treatment of patients with cervical carcinoma involving biopsy proven para-aortic nodes.

Between November 1974 and November 1979, 15 patients with cervical carcinoma were treated with extended field irradiation for biopsy proven para-aortic lymph node (PALN) metastases. Treatment consisted of pelvic and para-aortic irradiation at a daily dose of 180 to 200 rad per day, delivering 4000 to 6000 rad to the pelvis and 4000 to 5000 rad to the para-aortic nodes. One or two intracavitary insertions each delivered an additional 2000 to 3500 rad to point A. The three year actual disease free survival for the 12 patients with Stage I and II disease was 50%. All six survivors remain alive without evidence of disease for 41 to 93 months, with a mean and median follow-up of 65 months. All patients dying of disease did so within 26 months, all but one dying within one year. All patients with Stage III and IV are dead of disease. Pelvic disease was controlled in 11 of 12 patients with Stage I or II disease, and in one of the three patients with Stage III and IV disease. There was no clinical indication of failure in the PALN in any patient. Nine patients failed with disseminated disease. Three of 15 patients (20%) suffered serious treatment-related complications. Two of these were attributed to the pelvic irradiation, with one patient requiring a colostomy. Thus, complications resulting from the extended field irradiation were seen in only one patient (6.7%). There was no treatment related mortality. Extended field irradiation can lead to a 50% survival in patients with Stage I and II cervical carcinoma and PALN metastases, a survival comparable to that reported in patients with involved pelvic nodes.

Adenocarcinoma↗
PubMed1983

Phase separation in rat lenses cultured in low glucose media.

Experimental evidence that indicates the nuclear opacity that develops in the hypoglycemic cataract in rat lenses is the result of a phase separation of the lens cytoplasm is presented. Phase diagrams of the cytoplasm of organ-cultured lenses were constructed for a series of incubation times in normal and hypoglycemic media. In normal media, the maximum phase separation temperature, Tmax, of the lens cytoplasm decreases with time. In hypoglycemic media, Tmax increases with time and exceeds 37 C after 24 hrs. The increase in Tmax can be stopped and reversed if the lens is returned to normal media within 8 hrs; in good agreement with an earlier biochemical analysis of the kinetics of hypoglycemic cataract formation.

Animals↗
PubMed1982

Role of vasodilators in the changing phases of acute myocardial infarction.

Application of vasodilators in evolving myocardial infarction has not yet received wide acceptance. Heretofore, clinical trials of a variety of vasodilator agents have been conducted without regard to the phase of the disease with its changing pathologic features and altering cardiac function. A classification of these phases based on the underlying myocardial disease--ischemia, necrosis, compensation, and healing--may allow a more rational interpretation of the available information. At present, vasodilators are not recommended during the ischemic phase, although some evidence suggests that preload modification by use of nitroglycerin may be beneficial in certain instances. Vasodilator drugs productive of arterial impedance reduction are probably of the greatest value late in the necrotic phase and in the compensation and healing phases. It is in these circumstances that heart failure becomes clinically manifest and maximal short-term efficacy of this intervention can be achieved. Impedance reduction, using agents such as sodium nitroprusside, will cause a prompt improvement manifested by a reduction in left ventricular filling pressure and in pulmonary congesting pressure and an increase in cardiac output. A significant improvement in short-term survival, at least, should be expected by judicious use of vasodilators.

Angina Pectoris↗
PubMed1982

Effect of aging on respiratory responses to CO2 and inspiratory resistive loads.

We studied 10 elderly individuals over 60 years of age and 18 individuals less than 30 years to determine whether aging affects the response of the respiratory control system to chemical stimuli or to altered mechanical conditions. Both groups consisted of males and females who were nonsmokers. Ventilation and the isometric force developed by the inspiratory muscles (occlusion pressure) was assessed during hypercapnia while the subjects breathed under control conditions or through a load at the mouth that increased inspiratory resistance. Ventilation responses to progressively increasing CO2 were lower but not significantly so in the older group. There were significant differences in ventilatory pattern in the two groups. However, occlusion pressure responses to hypercapnia and to resistive loads were the same. The results suggest that aging has little or no adverse effect on respiratory control.

Adult↗
PubMed1982

Congenital lobar emphysema: a case with bronchial atresia and abnormal bronchial cartilages.

An infant with congenital left upper lobe emphysema presenting with respiratory distress and failure to thrive, which necessitated lobectomy, is described. Careful pathological examination revealed two defects in association with the emphysema: bronchial atresia and defective bronchial cartilage in the affected lobe. Whilst congenital lobar emphysema is the term usually employed to describe this clinical presentation of respiratory distress in infancy, 'panlobular emphysema of infancy' would be a more accurate description. Congenital defects in the airways may account for the development of emphysema, but there may be a more fundamental congenital tissue abnormality at alveolar level.

Bronchi↗
PubMed1978

Serum fucose as a monitor for recurrent malignancy.

Serum fucose determinations were performed on 19 patients with "stable" or "inactive" malignancies, 33 patients with "active" malignancies, and 14 "normals." A significant difference in the values between "normal" and "stable" patients and those with "active" cancer is shown. A role for this relatively simple serological test for diagnosing and following metastatic cancer is suggested.

Adult↗
PubMed1978

Long-term outpatient vasodilator therapy of congestive heart failure. Consideration of agents at rest and during exercise.

Increased left ventricular filling pressure and reduced cardiac output are two major hemodynamic deficits in pump failure. In patients with chronic heart failure, consequences of these hemodynamic deficits and diminished cardiac reserve are manifested initially during stress and eventually at rest. The purpose of therapeutic interventions include reduction of ventricular filling pressure increase in cardiac output and improvement in cardiac reserve. To achieve these goals, the hemodynamic effects of predominantly venodilators (nitrates), predominantly arteriolar dilators (hydralazine) and the combination of nitrates and hydralazine were evaluated in patients with chronic heart failure at rest: left ventricular filling pressure (mm Hg) control 28, nitrates 17, hydralazine 25, nitrates plus hydralazine 18; cardiac output (liters/min/m2) control 2.1, nitrates 2.1, hydralazine 3.2, nitrates plus hydralazine 3.3; mean blood pressure (mm Hg) control 87, nitrates 85, hydralazine 83, nitrates plus hydralazine 85. These data suggest improved left ventricular performance with a combination of nitrates and hydralazine. Exercise hemodynamics improved in some patients, suggesting that such vasodilator therapy may be beneficial in chronic heart failure.

Chronic Disease↗