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Biomedical subjects

A J Walt

Publications and source records attributed to A J Walt.

At least 37 records · Page 2Linked to original sources
PubMed1984

Serum amylase and its isoenzymes: a clarification of their implications in trauma.

Previous reports on the use of the serum amylase level to assess pancreatic injury in patients with blunt abdominal trauma have been disappointing. The availability of methods to measure the serum isoamylases (P & NP) might be expected to improve the accuracy with which the serum amylase level is used. Sixty-one patients treated for a variety of blunt trauma injuries were studied. All categories of injury were included. Isoamylase levels were determined from admission sera and were compared to injuries found at laparotomy. Three patients had major pancreatic injury but only two of these patients showed a rise in the pancreatic isoamylase. Sixteen additional patients had a rise in the pancreatic isoamylase without evidence of pancreatic injury. Eight of these patients had no component of abdominal injury whatsoever. Two patients with isolated head injury had substantial elevations of pancreatic isoamylase. The regulation of serum amylase is multifactorial and variable. The measurement of serum isoamylase levels does not offer great improvement over the serum amylase in evaluating patients with blunt abdominal trauma.

Adolescent↗
PubMed1983

Mallory-Weiss syndrome. A study of 224 patients.

With the increasing early use of endoscopy, Mallory-Weiss syndrome has been found to be the cause of upper gastrointestinal bleeding in 224 of 2,175 (10.3 percent) patients studied. Since Mallory-Weiss syndrome is a self-limiting disease in more than 90 percent of patients, conservative treatment, including multiple transfusion, electrocoagulation, and compression by a Sengstaken-Blakemore tube in descending order of use, is the treatment of choice, especially in the medically debilitated patient. The cirrhotic patient poses special difficulty and generally has a poor outcome no matter what the treatment. Prolapse of the stomach into the esophagus may be an etiologic factor in a small subgroup of patients.

Adolescent↗
PubMed1983

The world's best-known surgeon.

Henry Norman Bethune was born in Ontario in 1890 and was to become the best-known physician in the world. Bethune, a thoracic surgeon, spent his professional life in Detroit and Montreal, with these periods separated by a year spent as a patient in a tuberculosis sanatorium. This was where his interest in pulmonary disease was stimulated. Pioneer thoracic surgeon, councillor to the American Association for Thoracic Surgery, artist, poet, polemist, conservative-turned-communist, iconoclast, and soldier, Bethune was a highly complex individual. Diverting his energies from surgery to social issues during the depression, Bethune participated in the Spanish Civil War, at which time he designed the world's first mobile blood transfusion unit. Eight months later, Bethune joined Mao Tse-tung's Eight Route Army in China. In 1939 he died of septicemia acquired from a sliver of infected bone while he was operating on a wounded Chinese patient. Bethune's fame today derives principally from the popularization of his accomplishments by Mao, whom he met once and who subsequently decreed that all in China should learn about him. Bethune's posthumous influence played an important role in the reopening of relations between China and the West.

Canada↗
PubMed1983

Endoscopic retrograde cholangiopancreatography after cholecystectomy.

One hundred and eighty-two patients with undiagnosed postcholecystectomy symptoms were studied by ERCP. Successful ampullary cannulation was achieved in 164 patients. ERCP findings revealed an abnormality in 120 patients (73 per cent). Endoscopic sphincterotomy and stone removal were successful in removing calculi in 13 of 17 patients in whom this procedure was attempted. ERCP is often the procedure of choice in the diagnosis and management of patients with postcholecystectomy symptoms. The information gained may permit definitive treatment of the causative conditions, including the extraction of biliary calculi after papillotomy in selected instances.

Abdomen↗
PubMed1982

Aged amylase: a valuable test for detecting and tracking pancreatic pseudocysts.

Amylase-rich fluid that incubates ("ages") within a pancreatic pseudocyst undergoes a change that can be detected by isoenzyme analysis of amylase from the serum. This aging is a result of deamination of the asparagine and glutamine residues on the amylase molecule. Eighteen of 20 patients with surgically proved pseudocysts had greater than 15% aged (deaminated) amylase in their serum. Levels of aged amylase returned to normal following treatment of their pseudocysts. Twenty of 23 patients with acute pancreatitis had levels of aged amylase below 15% (P less than .05). A criterion of 15% aged amylase resulted in 87% specificity, and 91% sensitivity for the diagnosis of pseudocysts. Because this test is noninvasive and easy to perform, it should become the ideal screen for patients at risk of development of pseudocysts, Endoscopic retrograde pancreatography, ultrasonography, and abdominal computed tomographic scanning should be reserved for confirmation of the diagnosis when the result of isoenzyme analysis is positive.

Amylases↗
PubMed1982

A continuing appraisal of pancreatic ascites.

Pancreatic ascites is a distinct clinical entity characterized by elevated amylase and protein levels in the ascitic fluid. This should be distinguished from the ascites of cirrhosis, tuberculosis or metastatic carcinoma. Precise delineation of the ductal anatomy by endoscopic retrograde pancreatography preoperatively will enhance the ability of the surgeon to plan a rational operation and will, thereby, provide the best results. Medical treatment may obviate surgical intervention in a small number of instances but contains intrinsic hazards and should not be prolonged beyond three weeks. In carefully selected patients, limited pancreatic resection, encompassing the site of leakage, produces excellent results.

Adult↗
PubMed1982

A correlation between clinical pancreatitis and isoenzyme patterns of amylase.

Fifty-seven patients admitted with the clinical diagnosis of acute pancreatitis had isoamylase analysis on their sera to determine the source of their hyperamylasemia. Our objective was to correlate the isoamylase pattern with our clinical observations. Thirty-nine of 57 patients (68%) had pancreatic hyperamylasemia as expected, but 18 of 57 patients (32%) had normal levels of pancreatic amylase. The hyperamylasemia in the latter group was due either to nonpancreatic hyperamylasemia (16 of 57) of macroamylasemia (2 of 57). Consequently, hyperamylasemia associated with abdominal pain, nausea, and vomiting led to the incorrect diagnosis of acute pancreatitis in 32% of the patients. The measurement of isoamylase profiles can be done rapidly and inexpensively. Knowledge that hyperamylasemia is nonpancreatic in origin may have an important influence on treatment, hospitalization, and the extent of laboratory and radiologic investigation.

Acute Disease↗
PubMed1980

Hepatic injuries. A 1980 overview.

The present-day management of hepatic injuries is reviewed in the light of experience with over 1 400 cases at Wayne State University. Mortality is now between 10% and 14%, although this is reduced to 5% if only the liver is injured. The disparity between degree of severity of trauma and severity of injury is noted, as is the trend toward a more conservative surgical approach recently. Over 90% of cases can now be managed with comparative ease and with less frequent use of drains and cannulas.

Anti-Bacterial Agents↗
PubMed1980

Symposium on trauma. 3. Major problems in blunt and penetrating abdominal trauma.

Many pitfalls exist in treating patients with blunt and penetrating wounds of the chest and abdomen. The thoracic and abdominal cavities should not be dissociated in the examiner's mind because apparently trivial lesions of one may be associated with serious lesions of the other. Constellations of injuries should be sought, especially in blunt and seat-belt injuries. Life-threatening damage may not be clinically obvious for days or even weeks. Peritoneal lavage, while valuable, should be carefully interpreted. Splenic injury is treated much more conservatively today than in the past with strenuous attempts made to preserve all or part of the organ. When splenectomy is unavoidable, decisions about the need for penicillin and pneumococcal vaccine are important and should include dose and frequency. Liver injuries are also treated more conservatively. Lobectomy is seldom necessary as assiduous local hemostasis and débridement (accompanied in about 3% of cases by ligation of the hepatic artery) are effective when good exposure and preliminary measures to achieve temporary hemostasis are obtained.

Abdominal Injuries↗
PubMed1979

Value of endoscopic retrograde pancreatography in pancreatic ascites.

Endoscopic retrograde pancreatography was easily performed preoperatively in six patients with pancreatic ascites, and no complications resulted from this procedure. The abnormalities observed during the procedure were unpredictable and varied. Endoscopic pancreatograms provided delineation of the pancreatic ductal system, showing one or more sites of ductal leaks into pseudocysts or segmental narrowing of the main pancreatic duct. This preoperative information was invaluable in selecting appropriate surgical procedures.

Adult↗
PubMed1979

Endoscopic retrograde pancreatography in the surgery of pancreatic pseudocysts.

Endoscopic retrograde pancreatography (ERP) was performed on 83 patients with 99 pancreatic pseudocysts (PCP). ERP was successful in 76 patients; in the other seven PCPs were found at operation. Five characteristic ductal patterns are described and illustrated. The PCPs were situated in the head (51 patients), body (21 patients), tail (20 patients). Thirteen PCPs were less than 2 cm, 50 were between 2 and 5 cm, 29 greater than 5 cm. There were multiple PCPs in 13.2% of patients. ERP was a more accurate diagnostic measure than ultrasonography or upper gastrointestinal roentgenograms, revealing the lesion in 89% of patients. Eight patients with pancreatic ascites had the causative PCP demonstrated prior to operation. Three patients had pancreatic pleural effusions; two with effusions on the right had PCPs of the tail. Five patients had spontaneous connections between a PCP and the stomach (four patients) or duodenum (one patient). Rational surgical planning for the management of PCPs is greatly facilitated by preliminary reconnaisance by ERP.

Adult↗