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Suppression of ventricular fibrillation and positive inotropic action of bethanidine sulfate, a chemical analog of bretylium tosylate that is well absorbed orally.
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Bethanidine sulfate is a closely related chemical analog of bretylium that has virtually identical pharmacologic and antifibrillatory actions on the ventricle. Unlike bretylium, which is very poorly absorbed from the gut, bethanidine is rapidly and effectively absorbed after oral administration. Bethanidine increased ventricular fibrillation threshold in the normal dog heart from an average control value of 28.5 mA to an average peak value of 66.5 mA, an increase of 150 percent. In the infarcted heart, bethanidine increased ventricular fibrillation threshold from an average postinfarction level of 14.4 mA to an average peak value of 55.3 mA, an increase of 327 percent. Like bretylium, the antifibrillatory action of bethanidine was manifested by the appearance of nonsustained ventricular fibrillation when superthreshold shocks induced episodes of ventricular fibrillation lasting from 2 to 120 seconds and converting spontaneously to sinus rhythm. In contrast, the untreated dog heart must always be defibrillated electrically. The onset of antifibrillatory action began as early as 2 minutes after intravenous administration and 15 to 30 minutes after oral administration; peak action occurred in approximately 60 minutes. Bethanidine had prolonged positive inotropic action in the isolated heart as reflected by an increase in cardiac output and blood pressure lasting up to 60 minutes. Bethanidine lowered coronary vascular resistance and increased coronary blood flow. The oral efficacy and rapid onset of action gives bethanidine a potential role in the prevention of out-of-hospital ventricular fibrillation.
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] |
10,000,802
|
Patterns of interectopic activation recorded during pleomorphic ventricular tachycardia after myocardial infarction in the dog.
|
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] |
10,000,803
|
Left and right ventricular morphology in complex congenital heart disease defined by two dimensional echocardiography.
|
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] |
10,000,804
|
The ability of two dimensional echocardiography to define right and left ventricular morphology in congenital heart disease was examined in 19 patients with discordant ventricular connections and abnormal relations, but with two ventricles and two unambiguous atrioventricular (A-V) valves. The two dimensional echocardiographic criteria used to identify a chamber as having right morphology were (1) an irregular endocardial surface, (2) insertion of chordae tendineae into the ventricular septum, (3) presence of an infundibulum, (4) a triangular-shaped ventricular cavity, (5) observation of a moderator band, and (6) recognition of the A-V valve as tricuspid. The two dimensional echocardiographic criteria for a left ventricular morphology were (1) a smooth endocardial surface, (2) presence of two discrete papillary muscle groups, (3) an ellipsoid-shaped ventricular cavity, and (4) recognition of the A-V valve as mitral. Identification of the associated A-V valve as mitral or tricuspid was the most reliable criterion, defining each ventricle in all 19 patients. The nature of chordal attachment and papillary muscle insertion successfully identified all left-sided and posteriorly related ventricles and 9 of the 19 anterior ventricular chambers. Other criteria were less useful although, when observed, they confirmed the ventricular type.
|
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] |
10,000,805
|
Algorithms and the "art' of medicine.
|
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] |
10,000,806
|
Phased trial of a proven algorithm at a new primary care clinic.
|
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10,000,807
|
A previous study showed that a clinical algorithm for respiratory illnesses, consisting of a checklist, a set of instructions (logic), and computer audit/feedback, could reduce costs significantly while maintaining a high quality of care. The results of this study show that the algorithm system, developed and validated at one primary care clinic, can be successfully imported to another primary care clinic. In the present study, the algorithm system significantly improved the completeness of the medical records, reduced the use of medical tests by 20 per cent-75 per cent, and reduced non-provider costs by 36 per cent per patient visit. This study also shows that all three components of the algorithm system appear to be necessary to achieve these improvements and maintain a high quality of medical care. These results suggest that a wider use of the algorithm system for minor acute medical problems is both feasible and useful in providing high-quality cost-effective care that is auditable.
|
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10,000,808
|
Nurse practitioner and physician adherence to standing orders criteria for consultation or referral.
|
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] |
10,000,809
|
The degree to which nurse-practitioners (NPs) and physicians (MDs) follow the mutually agreed-upon rules for their practice and the effects of any deviations are unknown. This study assessed whether NPs adhered to consultation/referral (C/R) criteria in NP standing orders for hypertension, whether MDs adhered to the task-delegation intent expressed in standing orders, and the relationship between adherence and blood-pressure (BP) control. A sample of 161 patients from a practice of five MDs and four NPs in a rural primary care clinic was studied over 16 months. Patient characteristics associated with provider non-adherence were identified by discriminant analysis. NPs failed to obtain consultation or referral for 22 of 66 patients (33 per cent) with conditions requiring C/R. MDs retained 17 of the 43 patients (40 per cent) without C/R conditions. NP non-adherence was associated with care by a single NP, presence of few non-hypertension problems, and need for dietary alteration (p less than .05). MD non-adherence was associated with males and presence of severe non-hypertensive disease (p less than .005). Diastolic BP control (less than or equal to 90 mm Hg) was similar in NP patient groups without C/R conditions, retained by NPs despite C/R conditions and shared with MDs by C/R. Control in the shared group was better than in the MD-treated group with C/R conditions (p less than .025). Although in this setting NPs frequently did not adhere to C/R criteria for hypertension, this did not affect acceptable BP control.
|
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] |
10,000,810
|
Hospitalization for medical-legal and other abortions in the United States 1970-1977.
|
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] |
10,000,811
|
The National Hospital Discharge Survey records for medical-legal, spontaneous, and "other" abortions (ICDA-8 640-641, 643, and 644 respectively) for 1970-1977 were analyzed to investigate the impact of liberalized access to abortion on abortion-related morbidity in the United States. The analysis suggests that in census regions where an increase in medical-legal abortions performed in hospitals occurred over the study period there was an associated decreased likelihood of a "spontaneous" or "other" abortion. The spontaneous and "other" abortion codes appear to have been used synonymously and a small number of each used to classify complications of both illegal and legal abortions performed outside hospitals. There was a significant reduction in length of stay for spontaneous and other abortions between 1970 and 1977. This is suggestive of decreasing severe presenting symptomatology for complicated abortion. The study further suggests that: during 1970-77 illegal abortions were largely replaced by legal procedures; increases in legal abortions beyond those replacing illegal have not resulted in increased rates of hospitalization for complicated abortion; and, the case morbidity rate for legal abortion appears to have declined.
|
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] |
10,000,812
|
Lung cancer mortality and smoking habits: Mexican-American women.
|
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] |
10,000,813
|
Lung cancer mortality was reported to be higher among Mexican-American women as compared with Anglo women from 1950 until 1970; however, smoking habits of Mexican-American women have not been adequately described. This study updates lung cancer mortality data in Texas, describes smoking patterns of 1,255 Mexican-American women from a household survey in the four states bordering Mexico, and compares these findings to a reference group of Anglo women residing in the same area. In 1970, lung cancer mortality rates were similar for Mexican-American and Anglo women in Texas; however, by 1974-1976 Mexican-American women in Texas had a 40 per cent lower rate than Anglo women and by 1979, a 49 per cent lower rate. In our 1979 survey results, Mexican-American women reported lower levels of smoking, both in prevalence and amount smoked, as compared with Anglo women. The lower prevalence was reported for all social and demographic categories examined. The relatively low lung cancer mortality rate is most likely due to relatively low levels of cigarette smoking among Mexican-American women. Based on the trend in lung cancer deaths and our survey findings, we would anticipate a continuing low level of lung cancer mortality among Mexican-American women.
|
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] |
10,000,814
|
Theory and action for health promotion illustrations from the North Karelia Project.
|
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10,000,815
|
The North Karelia Project in Finland illustrates the fundamental goals of health promotion. Specific activities of the project serve as examples of how concepts from the social and behavioral sciences can be applied to achieve estimated reductions in predicted risk of disease. The results in North Karelia are not conclusive, but they are encouraging, and the investigations conducted there is an essential reference for future research in health promotion and disease prevention.
|
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] |
10,000,816
|
The North Karelia Project: what it tells us about the prevention of cardiovascular disease.
|
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] |
10,000,817
|
Some lessons from the North Karelia Project.
|
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] |
10,000,818
|
Physicians and nurse practitioners: do they provide equivalent health care?
|
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] |
10,000,819
|
Data from 40 patients attending a hypertension clinic staffed by physicians were compared to data from 40 patients attending a hypertension clinic staffed by nurses over a period of 15 months. Nurses appeared to have more success in handling obesity and to achieve somewhat better control of hypertension. Attrition rate was 50 per cent, but particularly high in patients not receiving medication in the physician clinic. There were no differences in appointment keeping.
|
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] |
10,000,820
|
Intestinal parasitosis among Southeast Asian immigrants in New Mexico.
|
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0.064717136323452,
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0.04037373140454292
] |
10,000,821
|
Results of an intestinal parasite survey of 776 Southeast Asian immigrants in New Mexico are presented. Parasites were found in 71.8 per cent of the patients; 44.3 per cent were multiply infected. Twenty different parasites were identified, some of which are not common in the United States.
|
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] |
10,000,822
|
Trends in the incidence of breastfeeding for Hispanics of Mexican origin and Anglos on the US-Mexico border.
|
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] |
10,000,823
|
In 1979 the Centers for Disease Control conducted a household probability survey of reproductive aged women living in 51 selected US countries on the US-Mexico border. Information on the incidence of breastfeeding for the period 1971-1979 was analyzed on 345 Anglo women and 689 Hispanic women of Mexican origin. Results indicated that the Anglos are following the national trend of increased breastfeeding, but Hispanics show no indication of an increase in the practice of breastfeeding.
|
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] |
10,000,824
|
Concurrent evaluation of epidemic St. Louis encephalitis: are you on the upward or downward side of the curve?
|
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] |
10,000,825
|
Laboratory confirmation of reported cases of St. Louis encephalitis (SLE) lags 2-4 weeks behind onset of illness. A review of our experience in Mississippi in 1975 and 1976 suggests that plotting the number of reported suspects greater than or equal to 50 years of age by date of onset and adjusting for reporting delays can help determine when the peak of the epidemic has passed. This method circumvents the obligatory delay of serologic tests, minimizes the bias of publicity and intensive surveillance, and may avoid promoting control procedure which are expensive, dangerous, and of uncertain efficacy.
|
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] |
10,000,826
|
The decreasing incidence of endometrial cancer: public health implications.
|
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] |
10,000,827
|
The incidence of endometrial cancer in the San Francisco area between 1969 and 1979 is compared to trends in estrogen sales and prescriptions. Both estrogen use and endometrial cancer incidence increased steadily until 1975 and then decreased significantly. The data support the previously documented association between endometrial cancer and estrogen use, but suggest that short-term usage may carry only slightly increased risk which can be eliminating entirely upon termination of therapy.
|
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] |
10,000,828
|
The recent trend in milk feeding among WIC infants.
|
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] |
10,000,829
|
The type of milk fed infants from birth to six months of age was ascertained by quarterly surveys of a national sample of births. WIC (Women, Infants and Children Program) participants were identified from this sample, and trend data indicate that an increased percentage of WIC mothers ae choosing to breastfeed their infants. Infant formula use has declined in the early months of life, but increased at the expense of cow's milk toward the middle of the first year.
|
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10,000,830
|
Research on nurse practitioners: process behind the outcome?
|
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] |
10,000,831
|
Illness-absences of hospital employees.
|
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] |
10,000,832
|
Life expectancy increases, but the life span is fixed.
|
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] |
10,000,833
|
Advice on administering vaccines.
|
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] |
10,000,834
|
Patellar pain and quadriceps rehabilitation. An EMG study.
|
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] |
10,000,835
|
Eighteen patients (26 knees) giving a history of patellar dislocation and/or subluxation and continued patellar symptoms underwent evaluation to determine the efficacy of their rehabilitation programs. Four-channel cine-electromyography was utilized to assess the relative muscular effort of the vastus medialis, vastus lateralis, vastus medialis obliquus, and rectus femoris in a series of exercises. Ten degrees of flexion of the knee reduced effective muscle effort in the vasti group to an average of 1/4 of the muscle effort demonstrated in full extension of the knee. No consistent pattern was noted by altering the rotation of the hip from neutral to external or internal rotation. The addition of weight (5 lb) to the ankle did not enhance the muscle effort with the knee in full extension. Quadsets and straight leg-raising exercises in full knee extension offer the best quadriceps rehabilitation program in the patient with a patellar malalignment syndrome and persistent symptoms.
|
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] |
10,000,836
|
The heel pad.
|
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] |
10,000,837
|
In an attempt to gain insight into the etiology of heel pain, the heel pad was studied via dissection. The dynamic action of the heel pad as well as varying stimuli interpreted as pain were examined in view of their integral relationship to body functions. It is believed that the major role played by the heel pad has to do with pressure, and the larger number of nerve endings present to respond to pressure suggests that these are also the nerve endings responsible for the sensation of pain.
|
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] |
10,000,838
|
Simplified technique for posterior knee arthroscopy.
|
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] |
10,000,839
|
Diagnostic and surgical knee arthroscopy occasionally requires a posterior knee puncture. Unfortunately, posterior arthroscope insertion can be a difficult and frustrating experience. The technique described attempts to obviate some of these problems. The merits of the technique include speed, safety, and consistency, while at the same time not requiring the purchase of yet another expensive arthroscopic device.
|
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] |
10,000,840
|
Performance of baseball headgear.
|
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] |
10,000,841
|
An experiment was conducted to ascertain the effectiveness of commercially available baseball headgear in a simulated environment where the head of the batter is struck. Using a compressed air cannon, baseballs were fired at an instrumented headform at frontal and temporal locations with and without a helmet. Striking velocities ranged from 50 to 120 mph and rebound velocities were 1/3 to 1/2 of that of the initial speed. Additional impact tests were conducted on equivalent flat helmet sections backed by a rigid steel plate, the results of which seemed to indicate that the materials and configurations currently employed do little to dissipate the energy of the striker. Head accelerations in excess of 1,000 G were measured, but quantitative injury potential could not be assessed since no applicable tolerances currently exist. We concluded that the incorporation of additional external padding on the plastic shell of the helmet and/or modifications of the suspension would significantly improve the energy absorption capabilities of the helmet and further minimize the possibility of head trauma.
|
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] |
10,000,842
|
Surgical management of pancreas divisum.
|
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] |
10,000,843
|
Pancreas divisum is a congenital anatomic variant characterized by nonunion of dorsal and ventral pancreatic ducts in an otherwise fused pancreas. Of 21 patients with divisum documented by endoscopic retrograde cholangiopancreatography, 6 (28 percent) were found to have no reason other than divisum to account for multiple attacks of pancreatitis. Cholelithiasis was present in one patient, who remains free of recurrent pancreatitis after cholecystectomy only. The remaining five patients underwent surgical treatment directed at pancreas divisum in the belief that stenosis of the duct of Santorini at the entrance into the duodenum is responsible for recurrent attacks of pancreatitis. Four of five have done well with follow-up of 12, 13, 18 and 28 months. Successful sphincteroplasty of the duct of Santorini appears to prevent recurrent attacks of pancreatitis due to pancreas divisum. Pancreaticojejunostomy is reserved for those with markedly dilated ducts secondary to chronic pancreatitis.
|
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] |
10,000,844
|
Recurrent compartment syndrome in the posterior thigh. Report of a case.
|
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] |
10,000,845
|
Recurrent compartment syndromes of the lower extremity, which usually occur in conjunction with intense use of muscle groups, can be briefly defined as an uncomfortable circulatory disturbance associated with a pathologic increase in total intramuscular pressure. This syndrome has been reported in each of the four compartments of the leg but not in the thigh. Characteristic features of clinical presentation and physical examination are reviewed in this report. We have found that an intracompartmental pressure test (Whitesides Jr, TE, Haney TC, Morimoto K, et al: Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 113: 43-51, 1975) is an invaluable diagnostic aid. A case involving the medial hamstring groups, with characteristic historical presentation, intracompartmental pressure elevation, and excellent response to fasciotomy, is presented and discussed. The only effective treatment in this case was fasciotomy.
|
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10,000,846
|
Acute pancreatitis of biliary origin: is urgent operation necessary?
|
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] |
10,000,847
|
Stasis before gallstone formation: altered gallbladder compliance or cystic duct resistance?
|
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] |
10,000,848
|
Gallbladder stasis occurs before gallstone formation and provides the link between the hepatic secretion of supersaturated bile and cholesterol cholelithiasis. We recently observed that cystic duct resistance increases while sphincter of Oddi resistance is unchanged in the presence of lithogenic bile without gallstones. Whether alterations in gallbladder function also lead to gallbladder stasis has been unclear. Therefore, we tested the hypothesis that before gallstone formation, stasis results from increased cystic duct resistance and altered gallbladder compliance. Adult, male prairie dogs were fed either a trace cholesterol (control) or a 0.4 percent cholesterol-enriched diet. Cystic duct resistance increased but gallbladder compliance was unchanged before gallstone formation. A significant correlation (p less than 0.001) was found between the lithogenic index and cystic duct resistance in pregallstone animals. We conclude that increased resistance to flow across the cystic duct, and not altered gallbladder compliance, is etiologically related to bile stasis, an important event in gallstone formation.
|
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] |
10,000,849
|
Kinesiology. III. An analysis of peak efforts in sports activities.
|
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] |
10,000,850
|
Fracture of the fused os trigonum.
|
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10,000,851
|
Perceived needs for gastrointestinal endoscopic training in surgical residencies.
|
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10,000,852
|
Questionnaires sent to directors of 126 university surgical residency programs analyzed the availability and quality of fiberoptic gastrointestinal endoscopic training. Seventy percent responded: 59 percent of their programs included some endoscopy training. Only half of the respondents believed their residents were adequately trained in endoscopic techniques. Although 67 percent of institutions had at least one surgeon performing endoscopy, many did not involve surgical residents in their cases. Insufficient caseloads were the rule, with fewer than 30 patients available to each resident for gastroscopy in 63 percent of the programs and for colonoscopy in 89 percent. Only half of all directors were satisfied with their relation with gastroenterology with respect to endoscopy. Gastroenterology service monopolized the performance of endoscopy at 41 percent of the universities. Since endoscopy is helpful in the management of many gastrointestinal disorders treated by surgeons, training surgical residents in such techniques is advisable. To do so properly, program directors must recruit skilled faculty and provide more concentrated endoscopic rotations with adequate caseloads or develop truly sharp educational experiences with their colleagues in gastroenterology.
|
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] |
10,000,853
|
Acute hematogenous pelvic osteomyelitis in athletes.
|
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] |
10,000,854
|
Glucagon, gastric inhibitory polypeptide and the gastrocolic response.
|
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] |
10,000,855
|
Serosal bipolar electrodes and strain gauge force transducers were placed on the right and left colon in subhuman primates to record spike discharges and circular muscular contractions. The effect of glucagon on colonic motor and electrical activity were studied before and after meals. Serum concentration of gastric inhibitory polypeptide was measured simultaneously 15 minutes before and 45 minutes after eating. Serum levels of gastric inhibitory polypeptide increased in response to eating; pre- and postcibal concentrations were not altered by glucagon. The gastrocolic response of the colon to eating was demonstrated. Glucagon inhibited the intrinsic activity of the entire colon before meals and partly inhibited the right colon after meals. Postcibal left colon activity was not inhibited by glucagon. This indicates that a distinct mechanism accounts for the left colonic postcibal increase in contractile and electrical spike activity. A neural or humoral mechanism is implicated but is not specifically identified.
|
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] |
10,000,856
|
Gait analysis. Alterations in support phase forces using supportive devices.
|
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] |
10,000,857
|
This study documents changes in momentary distribution of forces under the foot, comparing barefoot gait to that with heel cups, medial arch supports, and low-dye taping. Cholesterol crystal force plate analysis and a computerized Kistler force platform were used in the study. Low-dye taping or a heel cup significantly diminished the duration of forces under the midfoot, medializing the instant center of forces. A medial arch support shifted the instant center of forces laterally, though it did not diminish the duration of forces under the arch. The relationship between these alterations of force distribution and the treatment of common runner's ailments such as plantar fasciitis, posterior tibial tendinitis, metatarsalgia, and shin splints is much clearer in the light of these results.
|
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] |
10,000,858
|
Total colonic aganglionosis. Analysis of 16 cases.
|
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10,000,859
|
Sixteen of 116 infants (14 percent) with Hirschsprung's disease had total colonic aganglionosis. Treatment was delayed in 6 of 16 patients because the condition was not recognized. Diagnosis was eventually achieved by rectal biopsy and the extent of aganglionosis was documented after multiple intestinal biopsies. All patients were initially managed by diverting enterostomy. Ileoanal pull-through operation was performed in nine patients at 12 to 24 months of age with no operative mortality. The overall mortality rate was 25 percent, including the deaths of two infants with diagnostic delay. Survivors had normal growth and satisfactory bowel function, Hirschsprung's disease should be suspected and rectal biopsy performed in infants with persistent or intermittent abdominal distention and constipation. Instances of total colonic aganglionosis can be documented by appropriate biopsies at the time of laparotomy. The modified Duhamel operation is an acceptable procedure for this condition. A ganglionic antimesenteric patch enteroplasty may prove a useful adjunct in infants with extensive aganglionosis involving the proximal small bowel.
|
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] |
10,000,860
|
Natural history of occult right colon cancer.
|
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] |
10,000,861
|
Alkaline reflux gastritis: a myth or a disease?
|
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] |
10,000,862
|
Angular deformity of the middle fingers in a young athlete. A case report.
|
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] |
10,000,863
|
A case is reported in which a radial deviation deformity of the middle fingers at the proximal interphalangeal joints developed in a young athlete who sustained repeated trauma to the finger tips by a basketball. There were no other factors that suggest a different etiology for this deformity.
|
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10,000,864
|
Natural history of incidental appendectomy in patients with Crohn's disease who required subsequent bowel resection.
|
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] |
10,000,865
|
The records of 20 patients with Crohn's disease who underwent incidental appendectomy and later required bowel resection were reviewed and the following conclusions ascertained. If the patient had had abdominal pain for less than 1 week, appendectomy is followed by minimal problems. If the patient has had abdominal pain for longer than 1 week, incidental appendectomy is followed by an 83 percent incidence of fistula or sinus tract, arising not from the appendiceal stump but from the terminal ileum. The natural history of patients with resection after appendectomy includes more medication and a higher symptom recurrence rate and perhaps operative recurrence rate than their counterparts who have not undergone incidental appendectomy.
|
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] |
10,000,866
|
Development of right inguinal hernia after appendectomy.
|
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] |
10,000,867
|
Effects of total fundoplication on function of the esophagus after myotomy for achalasia.
|
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] |
10,000,868
|
Twelve patients underwent distal esophageal myotomy for achalasia. After denuding the esophageal mucosa over 50 percent of its circumference, a short (2 cm) total fundoplication was performed over a size 56 mercury bougie. Clinical evaluation showed marked symptomatic improvement. Obstructive symptoms are minimal, and no reflux symptoms were noted. Manometric documentation showed a significant decrease in resting esophageal and lower esophageal sphincter pressure. Contraction pressure was also lowered, and peristalsis returned in 36 percent of the waves in the proximal esophagus. Radiologic and scanning documentation revealed slow emptying without evidence of significant reflux. Endoscopic evaluation revealed no esophagitis after 19 months' follow-up.
|
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10,000,869
|
Intrathoracic fundoplication for shortened esophagus. Treacherous solution to a challenging problem.
|
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] |
10,000,870
|
Intrathoracic fundoplication was used in 12 patients with acquired shortening of the esophagus secondary to gastroesophageal reflux. While several patients had excellent results using this approach, five major complications occurred. One patient developed a paraesophageal hernia, while four had ulceration within the wrap itself. One had serious hemorrhage, while another required reoperation to dismantle the intrathoracic wrap. One patient developed a gastrobronchial fistula and eventually died from pulmonary sepsis. The cause of these problems is unknown, but delayed gastric emptying was implicated in two patients. Even though leaving a Nissen fundoplication in the chest seems to be an attractive alternative when the surgeon cannot reduce the wrap below the diaphragm, this alternative is fraught with treacherous complications in a large percentage of patients.
|
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] |
10,000,871
|
Effect of hyperparathyroidism and hypercalcemia on lower esophageal sphincter pressure.
|
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] |
10,000,872
|
Heartburn is a frequent and sometimes initial complaint in hyperparathyroidism, and it is often relieved by successful parathyroid surgery. Four of five patients with primary hyperparathyroidism and heartburn obtained relief of symptoms and had an increase in lower esophageal sphincter pressure after successful operative treatment. Four of five volunteers undergoing calcium infusion exhibited a decrease in lower esophageal sphincter pressure after about 2.5 to 3 hours of infusion. Calcium infusion in a treated patient who had an increase in lower esophageal sphincter pressure postoperatively resulted in a transient return of lower esophageal sphincter pressure to preoperative levels.
|
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] |
10,000,873
|
Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence.
|
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] |
10,000,874
|
This study defines the components of distal esophageal sphincter function which predict gastroesophageal competence and examines the mechanisms by which three antireflux procedures restore competence to the cardia. In a prospective study, the reflux status of 391 patients was determined by 24 hour pH monitoring. Distal esophageal sphincter pressure and length of sphincter exposed to the positive pressure environment of the abdomen was measured by esophageal infusion manometry. Similar pre- and postoperative studies were performed in 45 patients who were randomized to three equal groups for the Hill, Belsey and Nissen antireflux procedures. Two hundred sixty-seven (68 percent) of the 391 patients had a positive 24 hour pH test. Competence of the cardia was related to pressure in the distal esophageal sphincter, to the length of sphincter in the abdomen and to an interaction between both (all p less than 0.05). Thus, competence of the cardia requires an adequate pressure and length of sphincter in the abdomen. In determining competence, the pressure and length effects are not additive, but have an interacting relationship. Sphincter pressure and abdominal length are independently corrected by surgery. Restoration of competence requires increases in both. The gastric fundic wrap best augments distal esophageal sphincter pressure by application of normal functioning smooth muscle to the lower esophagus. Sphincter dynamics are normal after a wrap as the gastric fundus and distal esophageal sphincter share the functions of synchronous contractions and simultaneous relaxation on deglutition.
|
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] |
10,000,875
|
Interaction of chenodeoxycholic acid and dietary cholesterol in the treatment of cholesterol gallstones.
|
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] |
10,000,876
|
Standard doses of chenodeoxycholic acid (15 mg/kg/day) fail to dissolve gallstones in 30 to 50 percent of patients with radiolucent gallstones in a functioning gallbladder. In humans, increasing dietary cholesterol produces increased biliary secretion of cholesterol. Restriction of dietary cholesterol reduces the minimum effective dose of chenodeoxycholic acid and speeds gallstone dissolution. In this study we investigated the interaction of dietary cholesterol and chenodeoxycholic acid in the prevention of gallstones in the prairie dog gallstone model. In animals fed a moderately lithogenic diet, standard doses of chenodeoxycholic acid failed to prevent gallstones. Reduction of the cholesterol stimulus or doubling the dose of chenodeoxycholic acid prevented the formation of gallstones. These findings support the hypothesis that the formation and dissolution of cholesterol gallstones are an expression of the relative strengths of saturating and desaturating stimuli. Therefore, rational therapy for cholesterol gallstone dissolution and prevention requires both reduction of lithogenic stimuli and optimal titration of chenodeoxycholic acid.
|
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10,000,877
|
Cholecystectomy in cirrhotic patients: a formidable operation.
|
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] |
10,000,878
|
Cholecystectomy and common bile duct exploration in cirrhotic patients is associated with an 83 percent mortality if prothrombin time is prolonged 2.5 seconds over control. The causes of death are related to complications of liver disease such as hepatic encephalopathy, ascites, sepsis and hemorrhage. If the prothrombin time is prolonged, major intraoperative blood loss can be anticipated, and blood and plasma transfusion requirements may be massive. Jaundice in the presence of cirrhosis requires careful preoperative evaluation and is most frequently due to hepatocellular disease rather than extrahepatic biliary obstruction. Cholecystectomy and common duct exploration in cirrhotic patients should be performed only for life-threatening complications of biliary tract disease such as empyema, perforation and ascending cholangitis.
|
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] |
10,000,879
|
Neurohumoral observations and the gastrointestinal tract.
|
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10,000,880
|
Vagal interrelationships with the gastric antrum have been studied in depth. A special experimental model, antroneurolysis, demonstrated that the function of the gastric mucosa is maintained after removal of central neural control, that is, vagotomy. A series of experiments are reported which demonstrate the importance of the sympathetic nervous system in the local control of gastrointestinal function. The concept of local neural control of the endocrine and secretory function of the epithelial cells of the intestinal mucosa (internal brain) is proposed.
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] |
10,000,881
|
Bilirubin and alkaline phosphatase values before and after surgery for biliary obstruction.
|
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] |
10,000,882
|
From a study of 178 patients who underwent operation for biliary obstruction, we found that preoperative bilirubin values above 14 mg/dl and alkaline phosphatase values over 5 times normal meant that common duct stones were an unlikely cause of the obstruction. Jaundice for more than 4 weeks before operation, bilirubin values greater than 10 mg/dl and the presence of significant fibrosis in the portal spaces indicated a lower than average chance of postoperative resolution of jaundice. After successful biliary surgery, the rate of decrease in serum alkaline phosphatase was haphazard and of little diagnostic value. The postoperative rate of decrease in the bilirubin values followed first-order kinetics and averaged 8 percent/day. This rate was not significantly influenced by the disease process, the length of preoperative clinical jaundice or the absolute height of the preoperative serum bilirubin level.
|
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] |
10,000,883
|
Morphologic and functional evidence of reinnervation of the gastric parietal cell mass after parietal cell vagotomy.
|
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] |
10,000,884
|
The incidence of recurrent ulceration after parietal cell vagotomy varies greatly and the cause is largely unknown. Whether the vagus nerve can regenerate or reinnervate the gastric parietal cell mass after parietal cell vagotomy was investigated. Careful microscopic dissection of the neurovascular bundle in 130 rats allowed the vagus nerve to be divided to the gastric body with preservation of the antropyloric nerve and gastric vasculature. Gastric secretory tests were performed under basal and stimulated conditions after secretagogue and insulin hypoglycemia stimulation. Rats were killed weekly and the vagal nerve distribution examined by electron microscopy. Stimulated gastric acid output decreased from 164 to 26 mumol/hour immediately after operation (p less than 0.001). One week after parietal cell vagotomy the nerves were swollen with fibroblast infiltration and collagen around axon groups showed degeneration. By the third week after parietal cell vagotomy, the axons were more densely packed with neurofilaments and acid output had increased to 183 mumol/hour. In the fourth and fifth weeks, the enlarged Schwann cell processes had more axons and acid output increased to 262 mumol/hour. By the seventh week, both large and small axons were identified and the acid output was 93 percent higher than the preoperative level (p less than 0.001). The sequential neuropathologic changes of vagus nerve degeneration, regeneration and functional reinnervation of the gastric parietal cell mass after parietal cell vagotomy are shown by this study. If this occurs in man, it may be an important cause of recurrent peptic ulceration after parietal cell vagotomy.
|
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10,000,885
|
Effect of parietal cell vagotomy on gastric emptying in duodenal ulcer disease.
|
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] |
10,000,886
|
Gastric emptying was delayed preoperatively in 9 of 19 patients with duodenal ulcer disease, but all 9 patients with evidence of retention by scan were asymptomatic; gastric emptying was normal in the remaining 10 patients. A significant delay in gastric emptying was documented by scan in 17 of 19 patients immediately after parietal cell vagotomy (despite the absence of symptoms of gastric retention). Delayed emptying was demonstrated in three patients who were restudied more than 1 year after parietal cell vagotomy; again these patients had no symptoms of gastric retention at any time. A sustained reduction in basal and stimulated acid secretion in both the early and late postoperative period was documented in all 19 patients, and serum gastrin levels also remained low. This absence of acid or gastrin stimulation is corroborated by the fact that there was no recurrence of ulcers in these patients during a follow-up period of up to 37 months.
|
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] |
10,000,887
|
Gastric outlet obstruction in peptic ulcer disease: an indication for surgery.
|
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] |
10,000,888
|
Eighty-seven patients with duodenal peptic ulcer disease and gastric outlet obstruction were reviewed retrospectively. All patients were initially treated with standard medical regimens. Gastric outlet obstruction persisted in 49 patients (56 percent) for more than 5 days, necessitating operative intervention. Obstruction relented in the other 38 patients (44 percent), and they were discharged from the hospital. However, late follow-up on the entire cohort revealed that 98 percent of patients with chronic ulcer disease and 64 percent of patients with acute disease ultimately required an operation.
|
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] |
10,000,889
|
Diagnosis and treatment of primary extrahepatic bile duct tumors.
|
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10,000,890
|
Hepatic Injury following halothane, enflurane, and isoflurane anesthesia in rats.
|
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] |
10,000,891
|
Halothane anesthesia administered to enzyme-induced animals in a hypoxic atmosphere consistently produced hepatic necrosis. Rats pretreated with phenobarbital were exposed to hypoxia at varying intervals after administration of halothane, enflurane, or isoflurane anesthesia. Anesthetics were administered at 1 MAC for 2 h. For each agent, hypoxia consisting of 8 per cent oxygen-balance nitrogen for 1 h was imposed at the end of anesthesia. In other groups of rats, we also used a 15-, 30-, 60-, and 120-min interval of 100 per cent oxygen between 2 h of halothane anesthesia and the imposition of hypoxia. Controls included enzyme-induced animals with and without hypoxia, hypoxia alone, and cage controls. Hepatic injury was graded by histologic examination of the livers. Injury was greater when hypoxia followed halothane anesthesia than when it followed enflurane, isoflurane, or enzyme-induction alone. A difference in injury score existed between control animals and those anesthetized with halothane who received a 15-min interval of oxygen before hypoxia. Combined results from the 15- and 30-min delay groups also were different from control. There was no difference between control and halothane groups when the oxygen interval was 60 or 120 min. The injury score of the enflurane and isoflurane groups were comparable to that of controls. We conclude that the potential for hypoxia-induced liver injury during recovery exists after halothane anesthesia. Neither enflurane nor isoflurane anesthesia produced significant hepatic injury in this model.
|
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] |
10,000,892
|
Potencies of inhaled anesthetics and alcohol in mice selectively bred for resistance and susceptibility to nitrous oxide anesthesia.
|
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10,000,893
|
A selective breeding process designed to produce mice resistant (HI mice) and susceptible (LO mice) to nitrous oxide anesthesia was continued through 10 generations. At the tenth, generation, the nitrous oxide requirements of the HI and LO mice (as measured by the partial pressure of nitrous oxide required to abolish the righting reflex) were separated by more than 0.7 atm. The HI mice also had a higher anesthetic requirement for cyclopropane, enflurane, isoflurane, halothane, and methoxyflurane, as measured by response to a tail-clamp stimulus. HI mice given an intraperitoneal injection of ethanol (4 g/kg) had 44 per cent shorter sleep times and 12 per cent higher blood alcohol levels upon awakening than did LO mice. For nitrogen, argon, cyclopropane, isoflurane, enflurane halothane, and methoxyflurane, we determined the doses at which the righting reflex was abolished in HI and LO mice. The separation in righting-reflex ED-50s between these two lines was inversely related to the lipid solubility of the anesthetic. For the most lipid-soluble anesthetic, methoxyflurane, no significant differences in potency, as measured by the righting-reflux ED50, could be detected between the HI and LO mice. In contrast, the separation in anesthetic requirements, as measured by the tail-clamp ED50, was approximately the same for each of the anesthetics tested.
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] |
10,000,894
|
Potencies of convulsant drugs in mice selectively bred for resistance and susceptibility to nitrous oxide anesthesia.
|
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] |
10,000,895
|
To test the possibility that mice selectively bred for resistance (HI mice) and susceptibility (LO mice) to nitrous oxide anesthesia have general differences in central nervous system excitability, we examined the effects of six convulsant agents in these two lines in mice. Using high-pressure helium, flurothyl, pentylenetetrazol, strychnine, (+)-bicuculline, and picrotoxin, we induced convulsions in HI and LO mice. For all of the agents tested, HI mice were significantly more susceptible to convulsions than LO mice. LO mice convulsed at a 13 to 25 per cent higher dose of convulsant agent than did HI mice. In contrast, nitrous oxide requirements (as measured by the partial pressure of nitrous oxide required to abolish the righting reflex), were 49 to 65 per cent higher in HI mice. Therefore, the higher nitrous oxide requirement in HI mice is probably due, at least in part to a generalized increase in central nervous system excitability.
|
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] |
10,000,896
|
Resetting of baroreflex sensitivity after induced hypotension.
|
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] |
10,000,897
|
Effects of hemorrhagic and pharmacologic hypotension on cerebral oxygen utilization and blood flow.
|
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] |
10,000,898
|
Cerebral oxygen utilization and blood flow were measured by the washout of oxygen-15 isotopes injected into the internal carotid artery in baboons during hypotension produced by acute hemorrhage, trimethaphan, and sodium nitroprusside. Acute hemorrhage, trimethaphan, and sodium nitroprusside lowered the mean arterial blood pressure to 52 per cent, 55 per cent, and 47 per cent, respectively, of control values. There were corresponding decreases in cerebral blood flow to 76 per cent (P less than 0.01), 81 per cent (P less than 0.05), and 79 per cent (P less than 0.01) of control values. When the mean arterial blood pressure was decreased 11 per cent with hemorrhage, auto-regulation of the cerebral vasculature was preserved and cerebral oxygen utilization increased 10 per cent (P less than 0.01). When cerebral autoregulation was lost with acute hemorrhage, cerebral oxygen utilization declined 17 per cent (P less than 0.05). When cerebral autoregulation was lost with pharmacologic hypotension, cerebral oxygen utilization was preserved with trimethaphan and increased 17 per cent (P less than 0.05) with sodium nitroprusside. The increase in cerebral oxygen utilization seen with sodium nitroprusside and hemorrhagic (autoregulation preserved) hypotension may be due to stimulation of the sympathetic nervous system with release of circulating catecholamines. However, the mechanism by which circulating catecholamines mediate an increase in cerebral oxygen metabolism during hypotension is not clear.
|
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] |
10,000,899
|
Pharmacokinetics, pharmacodynamics, and dose-response relationships of pancuronium in control and elderly subjects.
|
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] |
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