Biomedical subjects
Publications and source records attributed to T A Johnson.
Ultrasonic endodontic therapy, first introduced in 1957, is rapidly gaining popularity as a means of root canal debridement and enlargement. The most recent literature regarding the clinical and experimental work done with ultrasonic endodontic devices is presented, as well as clinical considerations relative to the use of ultrasonic endodontic treatment.
The movement toward private sector involvement in our correctional services and programs is growing. Before our focus is turned completely to privatization of these services, it would be prudent to analyze the "policy impact of such change. It is evident that the diverse and incompatible policies guiding the government approach to corrections and the absence of any rational planning to answer public interest goals is costly. Moreover, despite the increasing complexity of problems now confronting public authorities, little change has been made in their approach to resolving them. However, is it realistic to assume that the profit/loss barometer of the private sector can be applied in an area of social problems that are so pluralistic and ill defined? What of the many areas of potential legal concern, that is, vicarious litigation, First Amendment right of prisoners, and so forth? These are all areas that need to be researched so that any judgements or decisions made will be sound.
In experimental animals, the calcium channel-blocking agents lessen the arrhythmogenic, ionic, metabolic, and electrical changes that occur during acute myocardial ischemia. To date, these effects have been studied separately, and the effects of these agents on local activation have not been correlated with ionic or metabolic effects. In open-chest, anesthetized swine, we used bipolar and ion-selective plunge electrodes to simultaneously measure ischemia-induced changes in left ventricular local activation, extracellular K+ ([K+]e), and extracellular pH (pHe). The effects of verapamil (0.2 mg/kg) on these variables were studied during a series of 10 min occlusions of the left anterior descending coronary artery. Compared with control occlusions, verapamil (1) slowed the rise in [K+]e at the center of the ischemic zone and at its lateral margin and decreased the peak [K+]e by 0.9 mM at the center (p less than .05) and by 0.1 mM at the margin (p = .10); (2) slowed the development of acidosis and decreased the peak level of acidosis beyond that expected solely as a result of serial occlusions by 0.19 pH units at the center (p less than .05) and by 0.07 pH units at the margin (p = .10); and (3) slowed the development of local activation delay and often prevented the local activation block that was observed during control occlusions. Effects on local activation became less marked at [K+]e levels greater than 9.0 mM, and the effects of verapamil on local activation were not explained solely by its effects on the local rise in [K+]e or fall in pHe. A possible mechanism for this additional effect on local activation is suggested by preliminary results showing a diminution by verapamil of ionic inhomogeneity.
We studied the role of von Willebrand factor in coronary thrombosis in normal, heterozygous, and homozygous von Willebrand's disease pigs by producing coronary stenosis with a Goldblatt clamp positioned around the left anterior descending coronary artery. Flow velocity was assessed by a 20-MHz Doppler velocity probe distal to the Goldblatt clamp. Myocardial extracellular potassium levels were measured by potassium-sensitive electrodes in myocardium supplied by the left anterior descending artery. Whereas stenosis sufficient to block reactive hyperemia to a 20-second occlusion produced an elevation of myocardial extracellular potassium, it produced neither spontaneous cyclic flow reductions nor permanent cessation of coronary blood flow velocity. Injury of the coronary artery at the stenosis site with spring-loaded forceps produced cyclic flow reductions or permanent cessation of flow in eight of nine phenotypically normal pigs. On the other hand, flow variations occurred in none of the 10 von Willebrand's disease pigs, including four given purified von Willebrand factor at a dose that failed to correct the bleeding time (p less than 0.001, chi 2 test). Permanent cessation of flow was caused by an occlusive platelet-fibrin-red-blood-cell thrombus. Scanning electron micrographs from pigs with cyclic flow variations and from von Willebrand's disease pigs showed injured endothelium covered by adherent platelets, red and white blood cells, and fibrin. These data suggest an important role of native von Willebrand factor in sudden occlusive arterial thrombosis following stenosis and intimal injury.
Beta sympathetic stimulation and the beta-adrenergic agonists exert a variety of electrophysiologic effects which contribute to the genesis of ischaemia-related arrhythmias. These are both primary, most likely related to enhancement of the slow calcium current, and secondary, resulting from changes in the metabolism of the ischaemic myocardium as reflected in the accumulation of ions and other end products of metabolism in the extracellular space. In addition, the regional influence of these changes may contribute to the ionic and electrical inhomogeneities. Further studies are needed to define more precisely the factors responsible for the enhanced arrhythmogenicity attributed to beta-adrenergic stimulation.
Ultrasonic measurement of blood flow within the main pulmonary artery (MPA) requires a precise knowledge of the mean blood velocity within this vessel and the cross-sectional area (CSA). Small conformational changes in the elliptical shape of the MPA have substantial effects on the calculation of CSA and, subsequently, flow. We examined the extent of these changes by measuring the pulsatile and mean elliptical dimensions of the MPA in nine anaesthetised, open-chested, mechanically ventilated mongrel dogs using two pairs of 10 MHz ultrasonic, piezoelectric crystals. These custom-made devices were sutured to the PA adventitia along the long and short cross-sectional axes 2 cm distal to the pulmonary valve. Axial dimensions were collected during normal, elevated (via noradrenaline and fluid additions) and reduced (via exsanguination) PA pressures. We confirmed the linear pressure/diameter response in 15/18 axial data sets (r greater than 0.80). Further, the linear axial responses of the long and short diameters were parallel (7/9, p less than 0.05) and have different zero-pressure intercepts (7/9, p less than 0.0001). A mathematical consequence of this parallelism is predictable, although non-constant, eccentricity. Finally, error analysis of multi-axial measurement techniques were shown to improve CSA accuracy by as much as 50% when compared with uni-axial determinations.
This study was performed to determine the reproducibility of the ionic and electrical changes associated with serial ischemic episodes. We used ion-selective and bipolar plunge electrodes to determine the changes in left ventricular extracellular potassium ([K+]e), extracellular pH (pHe), and local activation during sequential 10 min occlusions of the left anterior descending coronary artery separated by 50 min of reperfusion in open-chest anesthetized pigs. We found that uniformly during the initial occlusion, and in approximately 50% of animals during the second occlusion, [K+]e rose more rapidly but to a lower level than in subsequent occlusions. By the third occlusion the changes in [K+]e were reproducible. Extracellular acidosis was greatest in the first occlusion and decreased progressively with each subsequent occlusion. Local activation was characterized by a decrease in spontaneous improvement and increase in block with each successive occlusion. The occurrence of ventricular fibrillation could not be directly attributed to the magnitude of the change in [K+]e or pHe. Moreover, the occurrence of ventricular fibrillation in one occlusion did not necessarily predict its occurrence thereafter. Our results indicate that serial episodes of ischemia are associated with different but predictable changes in ionic and electrical events that may be clinically relevant and that must be appreciated before the results from similar protocols with serial ischemic episodes can be interpreted meaningfully.
To test the sensitivity and accuracy of pulsed Doppler ultrasonography to detect and quantitate left to right aortopulmonary shunt flow, an arterial allograft aortopulmonary anastomosis was constructed in nine adult mongrel dogs. Cardiac output and allograft flow were measured as the diameter of the allograft was varied. Piezoelectric crystals attached to the carotid artery and proximal descending aorta were energized with 20 MHz pulsed Doppler signals. Negative Doppler shift and negative Doppler shift/positive Doppler shift were calculated for seven dogs. All dogs exhibited negative Doppler shift in the carotid artery at zero allograft flow; five of the seven dogs exhibited a similar pattern in the descending aorta. Increasing negative Doppler shift was measured in all dogs from both sites as the allograft flow increased. Excellent linear correlation existed between allograft flow and negative Doppler shift and negative Doppler shift/positive Doppler shift for each dog from both sampling sites. However, marked interanimal variation in the slopes of the linear regression lines existed, making the composite linear correlation very poor. Detection of small left to right aortopulmonary shunting and single measurements to quantitate accurately left to right aortopulmonary shunting introduce errors due to intersubject variation. However, these results suggest that serial ultrasound measurements made over a short time can accurately predict changes in left to right aortopulmonary shunting.
The velocity profile of the main pulmonary artery was determined in nine adult, open-chested, mechanically ventilated mongrel dogs using an intraluminal, needle-mounted, range-gated, pulsed Doppler technique. Mean phasic point velocities were determined at 2 mm intervals across the lumen of the vessel, 2 cm above the pulmonary valve, by recording the Doppler shift of an activated 20 MHz piezoelectric crystal, range-gated 3.5 mm in the direction of the pulmonary valve. Mean Reynolds numbers from the main pulmonary artery ranged from 275 to 1140. Radially normalised intraluminal distance versus mean phasic point velocity plots were constructed which demonstrated a curved profile in all 9 dogs. First order regression analysis demonstrated a poor fit (r: 0.05-0.68). Second order (r:0.61-0.97) and third order (r:0.72-0.99) regression analyses markedly improved the fit, confirming the non-linear nature of the velocity profile. Step-wise third order regression analysis to determine the importance of the entry sequence demonstrated that the most important term for determining the regression coefficient was the X2 term in six dogs. In addition, the velocity profile was noted to be shifted, with the highest velocities recorded between the centre of the vessel and the anterior wall in eight of nine dogs (location of highest velocity: +0.26 radius +/- 0.25 (mean +/- SD).
The velocity profile in the ascending aorta, which has been variously reported as parabolic, skewed or flat, was measured using an intraluminal probe equipped with a miniature piezoelectric crystal activated by a 20 MHz pulsed Doppler with a 1 mm3 sample volume size. Phasic velocities, determined via spectral analyses, were obtained at 2 mm intervals across the aortic lumen of anaesthetised open-chest dogs by sequentially moving the crystal between posterior and anterior walls, maintaining the ultrasound beam parallel to the flow axis. Range-gating allowed data acquisition 3.5 mm proximal to the crystal, thus eliminating probe induced turbulence. Time and spatial distributions of velocities over the cross-section were computed. Expected errors in vessel mean velocity estimates based on point measurements were calculated. Analysis of phasic waveforms showed increased posterior velocities during systole but third order regression analysis of normalised point mean velocities across the lumen showed the best fit was a statistically flat straight line. Centreline referenced analyses indicated the expected difference between point mean velocity and vessel mean velocity was maximal (19.3 +/- 10.1%) 4 mm toward the posterior wall and minimal (4.7 +/- 9.1%) 5 mm toward the anterior wall. Anterior posterior wall referenced analyses indicated the most reliable position for estimating vessel mean velocity from point mean velocity along this axis was 5 mm from the anterior wall.
We have developed and tested an automated system that measures in vitro oxygen consumption by Warburg manometry in as many as 16 units that are under the simultaneous control of a microcomputer which requires attention at the beginning of the study only. The all-glass Submarine Volumometers used are readily adapted to automation using a microcomputer that interacts with an infrared photodetector sensitive to manometric changes in the reaction vessel and a stepper motor that can advance the calibrated micrometer in response to these changes. The microcomputer interacts with the user at the start of the study during data entry and subsequently determines volume changes related to oxygen consumption, calculates respiration rates, and prints or graphs the results without further user interaction. We compared this automated system with manual methods by measuring the oxygen consumption of lung tissue slices and by determining the ability of the system to match known volumes entered manually. We found that the results obtained using the automated system were not significantly different from known manual methods (P less than 0.05).
The antiarrhythmic efficacy and safety of oral flecainide acetate were assessed during a controlled, short-term dosage-maintenance study. Thirteen patients with chronic ventricular ectopy entered a placebo control period, and 11 with persistent, frequent (greater than 600 per 12 hours) premature ventricular complexes (PVCs) advanced to drug therapy. Of 10 patients completing a trial of different doses, nine responded completely, with a mean PVC suppression of 98,3 per cent. Repetitive PVCs were eliminated. The mean effective dose was 189 mg per 12 hours, and the effective plasma concentration before administration of a dose averaged 635 ng per milliliter. One patient responded partially (68 per cent of PVCs suppressed). Flecainide continued to be effective and well tolerated at the end of a two-week outpatient trial in the nine complete responders, maintaining an average PVC suppression of 94.6 per cent. The PR and QRS intervals were mildly prolonged. The echocardiographic ejection fraction was unchanged during treatment. The elimination half-life was long - 18.8 +/- 3.8 hours. Flecainide thus appears to be a highly effective and well-tolerated antiarrhythmic agent with favorable pharmacokinetics.
Male Nicholas turkeys were used in a study designed to determine the effects of high, moderate, and low brooding temperature on the occurrence of leg abnormalities during a subsequent 20 week grow-out period. Performance data were also obtained. There were no significant differences among the poults brooded under any of the three temperature regimens in the incidence of leg weakness or mortality. Body weights and feed/gain ratios measured at 2, 5, 10, 15, and 20 weeks of age were similar regardless of brooding temperature.
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A case of successful treatment of antibiotic-associated pseudomembranous colitis with oral metronidazole is reported. A 67-year-old man developed diarrhea shortly after a 10-day course of oral ampicillin. His diarrhea, consisting of 10 to 12 loose stools a day, had continued for approximately two weeks and was accompanied with abdominal cramping, fever, anorexia, and weight loss. Stool specimen was streaked with blood. Proctoscopic examination revealed a spotty mucous exudate. Rectal biopsy analysis was consistent with pseudomembranous colitis. Metronidazole was initiated at a dose of 500 mg orally three times daily and continued for 10 days. By the third day, the patient was having one bowel movement daily. Proctoscopic examination after 10 days of therapy showed marked improvement with no evidence of pseudomembranous exudate. One month later the patient remained symptom-free.
A case of protamine-associated hypertension in a 76-year-old Caucasian woman with chronic renal failure (CRF) undergoing hemodialysis is reported. Four dialysis runs during March 1977 are described in this report; all involved the i.v. administration of heparin sodium (2500-5000 units) during the five-hour procedures. Protamine sulfate (25-50 mg) was given i.v. at the end of each procedure to neutralize excess heparin. In three of the four dialyses, the patient became short of breath, hypertensive, and tachycardic, usually for less than 10 minutes. In the last of these runs, the patient first became hypotensive and then hypertensive, and was incontinent of urine and feces. Treatment in each case consisted of elevation of the head of the bed and oxygen administration. During the forth dialysis, no adverse reaction occurred. Possible explanations of this phenomenon are discussed, including hypersensitivity to protamine sulfate products and the action of protamine on platelets resulting in serotonin or histamine release. In dialyses where the patient became hypertensive, more protamine on platelets resulting in serotonin or histamine release. In dialyses where the patient became hypertensive, more protamine sulfate was given than was needed to neutralize the heparin. In the run where symptoms were most severe, the patient received only 2500 units of heparin but was given 50 mg protamine sulfate. It is concluded that this reaction occurred as a result of administering excess protamine sulfate, which then acted on platelets. The platelets released either histamine or serotonin, which mediated rapid changes in blood pressure, heart rate, and breathing pattern.
A case of essential fatty acid deficiency (EFAD) associated with fat-free total parenteral nutrition (TPN) therapy in a 53-year-old white male is reported. The patient's tube feedings (Sustacal) were discontinued and a fat-free TPN solution of 25% dextrose injection, 4.25% amino acid injection (Freamine II) and appropriate electrolytes, vitamins and minerals was started when an upper GI study showed complete obstruction of his esophageal-colonic anastomosis. After nearly 1.5 months of fat-free TPN therapy, a diffuse scaly rash appeared on the patient's elbows, groin, arms and legs, and plasma fatty acid analysis showed a gross fatty acid deficiency. One liter of 10% soybean oil emulsion (Intralipid) then was added to 3 liters of TPN daily; linoleic acid accounted for 12% of the total calories of this solution. After 14 days of Intralipid therapy, the patient's skin lesions had cleared and plasma fatty acids had returned to normal. The patient was discharged on tube feedings of Sustacal providing sufficient linoleic acid (8.4% of calories) to prevent recurrence of EFAD. The pathophysiology, diagnosis and treatment of EFAD, and the role of linoleic acid in the disease are reviewed. TPN protocols should include recommendations for administration of linoleic acid to all patients receiving continuous infusion of fat-free TPN.
Drainage of various types of perirectal abscesses can be facilitated by the use of a rectal hook, allowing many of these infections to be easily handled in the outpatient setting. Several types of abscesses, including ischiorectal and pelvirectal abscesses, although usually originating at the crypts of Morgagni, cannot be drained adequately by this technique. Differential diagnosis of anal pain is considered.