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Biomedical subjects

W R Smith

Publications and source records attributed to W R Smith.

At least 91 records · Page 5Linked to original sources
PubMed1976

Hyperamylasemia in heroin addicts. Characterization by isoamylase analysis.

Hyperamylasemia was noted in 17 (19%) of a group of 91 hospitalized heroin addicts. Thirteen of the 17 were in acute respiratory distress (12 with so-called "heroin lung" syndrome and one with status asthmaticus). Isoamylase analysis in the hyperamylasemic patients demonstrated S-type isoamylase dominance in 15, P-type isoamylase dominance in one and essentially equivalent P- and S-type isoamylase elevations in one. It would appear from these data that the hyperamylasemia after heroin in most persons addicted to the use of this drug arises from the sources other than the pancreas. Changes in the lungs occurring in association with heroin addiction seem to have an important role among the possible contributory factors.

Adolescent↗
PubMed1975

High incidence of precipitins in sera of heroin addicts.

We analyzed sera of 50 consecutively hospitalized heroin-abuse patients for precipitins against several antigens. Forty-seven addicts had precipitins against extracts from moldy hay, and 34 against extracts from bagasse. Thirty-six showed precipitin bands against extracts from one or more of the following: Aspergillus, Micropolyspora faeni, and Thermoactinomyces vulgaris. These findings were significantly different from those of a control population (P less than .0001 for all antigens tested). The recent culture identification of bacteria and fungi from street heroin suggests that the addicted population may be injecting antigenic material intravenously, with subsequent antibody formation.

Adult↗
PubMed1975

Measures to minimize small intestine injury in the irradiated pelvis.

Small intestine injury causes long-term suffering and high mortality. Five of 187of our patients had developed serious small intestine injury. Four patients had corrective surgery. Three patients died. All were women. Subsequently, all patients who received definitive pelvic irradiation had small intestine roentgenograms to determine itslocation and mobility. Female patients, thin patients, and elderly patients had larger amounts of small intestine in the whole pelvis, a deeper cul de sac, and a greater incidence of relatively immobile small intestine. Patients with relativelyimmobile small intestine in the treatment field may be predisposed to injury. There wasno relationship of the incidence of relatively immobile small intestine to prior pelvicsurgery. We used the findings from the small intestine roentgenograms to modify indiviually the radiotherapy regimen so as to minimize the risk for small intestine injury. Patients were placed in the prone position to displace the small intestineout of the treatment fields used for booster dose irradiation. The treatment field wasmodified to exclude the small intestine. The total tumor dose delivered was determinedby expectations for curve vs. complications. To date, none of the patients in this study group has developed small intestine injury. Cadaver studies showed the feasibility of elective shortening of the pelvic cul de sac. The small intestine can be displacedaway from the bladder, prostate, or cervix.

Age Factors↗
PubMed1975

Acute liver disease after cutaneous thermal injury.

To better define the acute liver disease complicating thermal injury, 81 burn patients were evaluated for hepatic damage. Clinical and laboratory evidence of hepatocellular injury was present as early as 24 hours after burn in 47 patients (58%). Patients with liver disease had a larger mean burn size (p less than 0.01) and greater mortality than patients with normal liver studies. The magnitude of initial enzyme derangements did not distinguish the survivors, but jaundice was associated with a poor prognosis. Seventeen of the 19 jaundiced patients (90%) died. The early occurrence of hepatocellular injury suggested that acute hemodynamic alterations were important etiologically. Intrahepatic cholestasis and jaundice developed later in septic or hypoxic patients and was accentuated by hemolysis and blood transfusions. In these patients, liver histology showed a nonspecific hepatitis. An increased risk of septic complications could not be attributed to the presence of liver disease. Late emergence of conjugated hyperbilirubinemia suggested an underlying septic process.

Acute Disease↗
PubMed1975

The effects of dehydration on the radiologic and pathologic appearance of experimental canine segmental pneumonia.

In an attempt to determine whether dehydration (intravascular fluid depletion) alters the radiologic or histologic picture of segmental Streptococcus pneumoniae pneumonia, we induced pneumonia in 2 groups of dogs, group 1 (normally hydrated) and group 2 (dehydrated). Five hours after the intrabronchial instillation of a brain-heart-Streptococcus pneumoniae mixture, all chest radiographs of dogs in group 1 and 2 were compatible with segmental alveolar pneumonia. Histologic lung sections obtained as early as 2.5 hours after infusion of the brain-heart-Streptococcus pneumoniae mixture revealed intra-alveolar edema with a minimum of leukocytes. By 24 hours after infusion, both groups showed marked intra-alveolar collections of edema fluid, fibrin, and leukocytes. We conclude that in a canine model, moderate dehydration has no effect on the radiologic or histologic features of Streptococcus pneumoniae pneumonia.

Animals↗
PubMed1975

In vitro pleural fluid clottability and fibrinogen content.

Twenty-three specimens of pleural fluid from 23 patients were examined for quantitative fibrinogen, total protein levels, and for clottability in vitro using the recalcification time. Of the 19 specimens of pleural fluid from patients without loculation, 11 (seven exudates) had no detectable fibrinogen; another 8 (six exudates) had a mean fibrinogen level of 55.0 +/- 10.2 mg percent, and a mean recalcification time of 19.4 +/- 2.6 minutes. The pleural fluids from the four patients with loculation had no detectable fibrinogen. The only fluids containing fibrinolytic activity were from the nonloculated non-fibrinogen-containing group. No correlation existed between pleural fluid/plasma total protein ratios and pleural fluid/plasma fibrinogen ratios. In vitro clottability in this study did not reflect the in vivo tendency for coagulation and loculation.

Adult↗
PubMed1975

Pulmonary interstitial fibrosis following near-drowning and exposure to short-term high oxygen concentrations.

Following near-drowning in fresh water, a 19-year-old man experienced severe adult respiratory distress syndrome, necessitating ventilatory support with positive end-expiratory pressure and high oxygen concentrations. Post-extubation, his course was highlighted by persistent hypoxemia and interrupted by a lung abscess which responded promptly to antibiotics. Pulmonary function tests were consistent with severe restrictive disease and chest radiograph revealed persistent bilateral alveolar and interstitial infiltrates. An open lung biopsy on the 26th hospital day showed interstitial fibrosis. Over the ensuing two months, the chest radiograph and pulmonary function tests returned towards normal. We attribute the pulmonary fibrosis to incomplete resolution of the alveolar interstitial pathology secondary to the near-drowning and exposure to high oxygen mixtures.

Adult↗
PubMed1975

Physiologic and biochemical abnormalities in self-induced drug overdosage.

The following abnormalities were observed during the first 24 hours of admission for 162 drug overdosage (OD) episodes in 152 patients: abnormal chest x-ray films; increased A-aO2 gradient; elevated white blood cell (WBC) counts; elevated serum enzyme levels; gross myoglobinuria; skin lesions suggestive of pressure necrosis; and abnormal electrocardiograms. Many sputum cultures were positive for single or multiple potentially pathogenic organisms. These correlations existed: all patients with OD duration of less than 12 hours were hyperthermic; as temperatures increased so did WBC counts; hyperthermic patients had higher creatine phosphokinase (CPK) values than those with hypothermia or normothermia; patients with skin lesions had higher temperatures and CPK values and longer OD duration; serum enzme levels increased with increasing OD duration; patients with CPK levels greater than 10,000 mU/ml had myoglobinuria; and patients with the most abnormal chest x-ray films had higher temperatures and larger A-aO2 gradients. Incidence of pneumonitis is low, even with abnormal chest radiograms, leukocytosis, hyperthermia, and positive sputum cultures. Abnormal temperatures and leukocytosis are probably secondary to stress, hypoxemia, acidosis, and specific drug ingestion rather than infection.

Adolescent↗
PubMed1973

Cecal volvulus.

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Adult↗
PubMed1973

Factors affecting cellulolysis by Ruminococcus albus.

The factors influencing the digestion of pebble-milled cellulose by enzymes were studied by using several strains of Ruminococcus albus including a mutant characterized by a more eccentric location of its colony in the clearing produced by digestion of the cellulose in the thin layer lining the wall of a culture tube. Most of the cellulase is extracellular. As much as 65% of the cellulose could be digested by the cell-free enzymes provided the quantity of cellulose was small. Fresh enzyme was repeatedly administered or the digestion experiment was arranged in a dialysis bag through which digestion products could diffuse. Cellobiose and, to a lesser extent, glucose inhibited digestion. Pebble-milled filter paper, moist crystalline cellulose from cotton, and dry crystalline cellulose (Sigmacel) were digested, but in decreasing rapidity, respectively. Carboxymethylcellulose was digested more rapidly than pebble-milled cellulose but to approximately the same final extent as judged by Cu reduction values. Cell walls from alfalfa were digested. The enzyme preparation was active over the pH range 6.0 to 6.8 and showed most rapid cellulose digestion at 45 C. Part of the cellulolytic activity was irreversibly destroyed by exposure to oxygen. Much of the enzyme was absorbed on cellulose. The absorption and desorption characteristics, as well as the partial inhibition by oxygen, indicate that multiple enzymes are involved.

Adsorption↗