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Biomedical subjects

C R Spillert

Publications and source records attributed to C R Spillert.

At least 73 records · Page 4Linked to original sources
PubMed1985

Appendicitis versus pelvic inflammatory disease. A diagnostic dilemma.

In order to determine whether any clinical or laboratory findings were helpful in differentiating acute appendicitis (AP) from acute pelvic inflammatory disease (PID), this retrospective study was undertaken. Records of all female patients 12 to 50 years of age, undergoing laparotomy with a preoperative diagnosis of AP over the past 15 years, were reviewed and pertinent data recorded. In comparing AP (n = 106) with PID (n = 39), longer duration of symptoms, relationship of onset of pain to the menstrual cycle, and frequent requests for gynecological consultation distinguished the PID from the AP cases. Although complete reliance cannot be placed on any clinical or laboratory finding in differentiating AP from PID, the final satisfactory outcome justifies laparotomy when the diagnosis cannot be established by other means.

Abdomen↗
PubMed1984

A colocutaneous fistula occurring 50 years after a shotgun injury.

Traumatic fistulae of the gastrointestinal tract are usually acute processes which occur at the time of, or shortly after, the injury. Because of its rarity, we report here a case of a colocutaneous fistula that developed 50 years after a shotgun wound of the abdomen.

Abdominal Injuries↗
PubMed1984

Protective effect of previous burn on murine endotoxemia.

Major body burns suppress the immune system, at least temporarily. However, it has not been demonstrated that following recovery from burn injury, the burned subject can become immunocompetent. This study was designed to test this hypothesis. Swiss-Webster mice (25 +/- 2 gm) anesthetized with intraperitoneal pentobarbital sodium were given full thickness burns on a depilated area of the lower back with a stainless steel tube (2 cm diameter) at 100 C for 10 seconds. Control mice were anesthetized, depilated in the same manner, but sham burned. Six weeks later, (the burn wound was completely healed, and the mice weighed 33 +/- 4 gm) each animal was given 0.3 mg of Escherichia coli endotoxin (055:B5) in saline intraperitoneally. The 24- and 72-hour survivals for the control animals were 31/45 (69%) and 13/45 (29%), respectively; while the 24- and 72-hour survivals for the post burn mice was 26/27 (96%) and 14/27 (52%), respectively (P less than 0.05). All animals surviving 72 hours recovered. These data clearly demonstrate that the survival from endotoxemia is significantly increased in animals that have been previously burned. This observation indicates that the immune system is stimulated 6 weeks postburn.

Animals↗
PubMed1984

The effect of age on severity of murine burns.

There is a higher mortality in elderly subjects with burns. Whether the same amount of heat will cause a greater degree of thermal injury in elderly subjects and thus account, in part at least, for this increased mortality has not been determined and was, therefore, the purpose of this study. Swiss white mice, 1-year-old (elderly) and 3-months-old (young) were anesthetized with pentobarbital sodium and burned uniformly on a depilated area of the back with a steel disc at 100 F for 10 seconds (10% body burn). Burn severity was evaluated in a blinded manner by gross and microscopic criteria at 1, 2, and 4 days postburn. The mean burn severity 1 day postburn was significantly less in the elderly mice compared with the young mice (1.72 versus 3.22, (P less than 0.001). On the 2nd and 4th days postburn, no differences were noted in the degree of burn severity between the two groups. The early apparent diminished burn severity in the elderly mice was unexpected. Possible mechanisms to account for this difference in the old animals may relate to decreased cutaneous microcirculation, alteration in chemical composition of the skin, and the effects of thromboxane A2 and prostaglandin I2. The clinical relevance of these findings concerns the need for more careful clinical management with intentional overassessment of the initial degree of the thermal damage.

Aging↗
PubMed1984

Detrimental effects of ethanol on murine frostbite.

Many references have been made concerning the adverse effects of ethanol in human frostbite. The lack of experimental evidence to support this belief prompted the authors to undertake this investigation. Nineteen Swiss-Webster mice (25 +/- 2 gm) were given intraperitoneal injections of 0.2 cm3 of 50 per cent ethanol (group A) or 0.2 cm3 saline (group B). Thirty minutes later, the animals were anesthetized with pentobarbital (group A 30 mg/kg; group B 50 mg/kg). Lower barbiturate dose was used in group A because of the synergistic central nervous system depressant effect when combined with alcohol. Tail lengths of all animals were measured. The tails were immersed in a 50 per cent ethylene glycol solution (-18 C) for 6 min and then thawed at room temperature (24 C). At 24 hrs, tail circulation was assessed by length of tail perfused with the vital dye alphazurine 2 gm given intraperitoneally. Mortality to 14 days was recorded. All animals survived the initial anesthetic and/or alcohol administration. Group A had a statistically significant (P less than 0.001 Students t test) decrease in length of tail perfused compared with group B at 24 hours (0.98 +/- 0.19 cm versus 2.58 +/- 0.23 cm). Fourteen day survival was 10 per cent in group A compared with 89 per cent in group B (P less than 0.001, chi-square test). We conclude that ethanol has significant adverse effects on tissue perfusion and mortality associated with severe murine frostbite.

Alcohol Drinking↗
PubMed1984

Von Haberer-Finney gastrectomy revisited.

Von Haberer and Finney independently introduced end-to-side gastroduodenostomy for gastrointestinal reconstruction. Clinical appraisal of this procedure with hemigastrectomy is the basis of this report. From 1967 to 1982, 113 duodenal ulcer patients underwent the operation. Indications were intractability in 58 patients, hemorrhage in 36, perforation in two, and obstruction in 17. Truncal vagotomy was performed on all patients except in five with intractability, 19 with hemorrhage, two with perforation, and 17 with obstruction. There were three postoperative deaths (2.7%). Nine patients were lost to follow-up, seven of whom were operated upon 5 or more years previously. Thus far, there has been no clinical evidence of recurrent ulcers or of dumping. Five patients, all chronic alcoholics, were below normal weight. The Von Haberer-Finney gastrectomy has certain distinct advantages: 1) direct inspection of the interior of the descending duodenum is possible during duodenotomy; 2) anatomic continuity of the gastrointestinal tract is established; 3) duodenal stump perforation does not occur because the duodenum can be decompressed via a nasogastric tube passed through the anastomosis; 4) afferent loop syndrome cannot occur; and 5) iron deficiency anemia is less likely because the duodenum is not bypassed.

Adolescent↗
PubMed1983

Effect of age and splenectomy in murine endotoxemia.

The protective role of the spleen in gram-positive infections, particularly in infancy and childhood, is well established. Since it is not known whether the spleen is protective in gram-negative sepsis, particularly in elderly individuals as compared to young subjects, the following study was undertaken. Splenectomized and nonsplenectomized Swiss Webster mice, 3 months old (young), or 12 months old (elderly) were utilized. Splenectomy was performed 4 weeks prior to administration of E coli endotoxin. Mortality in elderly nonsplenectomized mice was significantly greater than that of young nonsplenectomized mice. Prior splenectomy significantly increased the mortality in young mice at 48 h, whereas the mortality of E coli endotoxemia (ECE) in elderly mice was not altered by prior splenectomy. The spleen, therefore, appears to have a protective role for young mice but does not protect elderly mice with ECE. It is postulated that this loss of splenic protection reflects deteriorating splenic function with age.

Aging↗
PubMed1983

Massive hemorrhage from benign solitary ulcer of the rectum.

A case of massive hemorrhage from benign nonspecific ulcer of the rectum necessitating operative intervention is reported. A 42-yr-old woman developed massive hemorrhage from a benign ulcer of the rectum. At laparotomy, a pedunculated fibroid was found to be pressing on the rectum at the site of the ulcer. After hysterectomy and double-barrel colostomy, bleeding ceased and the ulcer healed. The colostomy was closed 3 months later and the patient has remained asymptomatic for 5 yr.

Adult↗
PubMed1983

Comparative study of parenteral piperacillin and cefoxitin in the treatment of surgical infections of the abdomen.

Patients who had contaminated traumatic perforations of the gastrointestinal tract and those with acute peritonitis resulting from acute surgical inflammatory conditions were treated with piperacillin or cefoxitin infused intravenously as single therapy for a minimum of five days. Thirty-four patients were given 4.5 grams of piperacillin every six hours and 26 patients, 2.0 grams of cefoxitin every six hours. In the piperacillin group, 63 organisms (34 aerobes and 29 anaerobes) were isolated from pretreatment cultures, while in the cefoxitin group, 73 organisms (35 aerobes and 38 anaerobes) were isolated. Clinical recovery was achieved in 31 of 34 patients receiving piperacillin therapy and in 24 of 26 patients receiving cefoxitin therapy. Organisms were found to be resistant to the respective drug in two piperacillin-treated patients and in one cefoxitin-treated patient, and the patients were given other antibacterial treatment. One patient from each treatment group died of causes unrelated to septic conditions. No serious adverse effects occurred from either antibiotic.

Abdomen↗
PubMed1983

A critical analysis of clerkship grading procedures.

Rating of clinical performance and examination scores are employed to establish the final grade of students undertaking the surgical clerkship. This retrospective study was undertaken to determine whether there is a correlation between these two grading procedures in evaluating students. Grades for clinical performance and the scores obtained on the written examination-either intramural (IM) or extramural (EM)-by each student for 20 recent consecutive 12-week surgical clerkship rotations were tabulated and the correlation (regression) coefficients of the two grading systems calculated in each rotation. By means of a questionnaire, grading methods employed in 60 randomly selected US medical school surgical departments were requested (55 responded). Correlation coefficients indicate that there is no statistical correlation between the grades of the clinical performance and the written examination in the majority of rotations (80 percent IM and 70 percent EM).GRADING PROCEDURES USED TO DERIVE THE FINAL GRADE AND THE MEANS OF REPORTING IT IN OTHER MEDICAL SCHOOLS ARE AS FOLLOWS: 41 percent (23/55) used the clinical performance and written examination; 38 percent (21/55) used the clinical performance, written examination, and oral examination; and 20 percent (9/55) used the clinical performance only. For the final grade, 91 percent (50/55) subscribed to honors, pass, and fail categories and 9 percent (5/55) preferred a numerical grade.

Clinical Clerkship↗
PubMed1981

Effects of endotoxin in murine burns.

Previous studies in our laboratory have demonstrated the protective effect of the spleen in murine burns. Since the spleen is a reservoir of the reticuloendothelial system (RES) and since small doses of endotoxin stimulate RES activity, the purpose of this investigation was to perform studies to determine whether endotoxin administration will further augment burn protection in splenectomized and nonsplenectomized animals. Swiss white mice were randomly assigned to one of two groups. One group was splenectomized and the other received a sham splenectomy. Twelve weeks later, under pentobarbital anesthesia, all animals were burned uniformly on the lower back. Log doses of Escherichia coli endotoxin or an equal volume of saline were administered intraperitoneally immediately after thermal injury. Severity of burns at 24 hours was assessed from gross and microscopic appearances using a grading scale of 0 (normal) to 4 (severe). Splenectomized controls receiving saline had more severe burns than the sham-splenectomized controls. Endotoxin decreased burn severity in both splenectomized and non-splenectomized mice. However, endotoxin afforded greater burn protection in the splenectomized mice when compared with the non-splenectomized animals.

Animals↗
PubMed1980

Protective effect of a splenic factor in mice with burns.

We have previously described the protective effect of a lipoidal splenic factor (SF) against lethal endotoxemia in mice. Since this protective effect is also accompanied by significant antithrombotic changes, and since burn injury causes thrombosis and consumptive coagulopathy, it was postulated that SF decreased the severity of the burn wound. Swiss white mice were anesthetized with pentobarbital sodium and then burned on a depilated area of the lower back with a 2-cm diameter stainless steel weight at 95 degrees for 10 sec. SF (10 mg/kg) (n = 20) or an equal volume of saline (controls) (n = 13) was administered within 1 hour after thermal injury. Severity of burn injury was assessed by examination of hematoxylin and eosin-stained biopsies obtained 24 hours postburn by a grading scale of 0 (normal) to 4 (severe) depending on the degree of epidermal loss, coagulation necrosis, and inflammatory cell infiltrate. Average degree of burn severity was 1.10 +/- 0.20 for SF recipients and 2.85 +/- 0.27 for the controls (p less than 0.001).

Animals↗
PubMed1980

Protective effect of a splenic extract in mice with endotoxemia.

We have previously described the isolation of a lipoidal splenic extract (LSE) that demonstrated a variety of hematologic effects including inhibition of platelet aggregation both in vivo and in vitro. Since endotoxin causes platelet aggregation and microembolism the protective effect of LSE in endotoxemia was examined in the present study. Both young and elderly Swiss mice given LSE 2--3 hours before endotoxin challenge showed a statistically significant increase in survival compared with saline-treated controls. However, no significant improvement in survival was noted when LSE was administered at the same time as endotoxin. These results add further support to the role of the spleen in the control of infection.

Animals↗
PubMed1980

Salutary effects of a splenic factor in acute hemorrhagic shock.

We have previously described the protective effects of a lipoidal splenic factor (SF) in mice challenged with E coli endotoxin. Whether SF would prove protective in hemorrhagic shock was the subject of the present study. Anesthetized and heparinized Sprague-Dawley rats were bled to a mean arterial pressure of 30 mm Hg. Pressure was maintained at this level for 90 minutes after which all blood was returned to the animals. Control animals received saline (1 ml) IP and the experimental animals SF (10 mg/kg) IP in an equal volume of saline as the controls one hour before bleeding. The 24-hour survival of the controls was 12% (3/25), whereas that of the SF recipients was 67% (4/6) (P less than 0.01). The exact mechanisms by which SF is protective in hemorrhagic shock remain to be determined.

Animals↗