Biomedical subjects
D A Gilbert
Publications and source records attributed to D A Gilbert.
Microsurgical hypospadias repair.
Successful primary hypospadias repair depends on careful execution of surgical principles, particularly during the urethroplasty portion of the procedure. These principles include careful tissue handling, development of well-vascularized flaps, and avoidance of placing sutures in the uroepithelial surface. Despite meticulous repair, the complication rate requiring secondary surgery is 15 to 30 percent. For the past year, the authors have utilized an operating room microscope, microsurgical instruments, a specially designed microsuture, and a Biooclusive dressing to decrease the postoperative morbidity and subsequent complications requiring secondary surgery (6.5 percent). A comparison of 50 hypospadias patients on whom no microsurgical repair had been used was made with 62 patients on whom microsurgical techniques were employed. The nonmicrosurgical group had 17 complications, 12 of which required reoperation (24 percent). The microsurgical group had 8 complications, 4 of which required reoperation (6.5 percent).
The ethics of mandatory elder abuse reporting statutes.
The ethics of mandatory elder abuse reporting statutes are analyzed in terms of beneficence, autonomy, and nonmaleficence. The statutes, based on the ethical principle of beneficence, are now the law in 37 states. However, evidence to support that the statutes actually fulfill rules derived from beneficence is weak. As a result, the strength of rules derived from autonomy and nonmaleficence, already strong within nursing, is increased, and potential conflicts between the rules to remove harm but to obtain consent, to prevent harm but to maintain confidentiality, and to provide benefits but to inflict no harm are created.
Acid phosphatase and phosphoamino acid phosphatases in murine erythroleukaemic cells.
The activities of acid and alkaline phosphatases and phosphotyrosine, phosphoserine and phosphothreonine phosphatases were measured in Friend murine erythroleukaemic (MEL) cells. The effects of treating the cells with dimethyl sulphoxide (DMSO), an inducer of differentiation, were examined. In untreated cells alkaline phosphatase activity was undetectable, though there were significant amounts of acid phosphatase (76 +/- 15 mU/mg protein) and phosphotyrosine phosphatase (16 +/- 0.9mU/mg protein); phosphoserine and phosphothreonine phosphatase activities (9 +/- 0.4 and 7 +/- 0.6mU/mg protein, respectively) were lower than for phosphotyrosine phosphatase. Addition of 1 or 2% DMSO to the culture medium resulted in the expected cell death within 2 weeks. With 0.5% DMSO, cells remained viable for at least 8 weeks, but while some appeared to have smaller nuclei and retained their rounded appearance, others became fibroblastic within several days and adhered to the culture vessel. The treated cells which had kept their morphology showed no difference in acid phosphatase activities as compared with untreated controls; phosphotyrosine phosphatase was lower (9 +/- 0.8mU/mg protein) and phosphoserine and phosphothreonine phophatases higher (11 +/- 0.5 and 10 +/- 0.4mU/mg protein, respectively) than in the controls. The Km values for p-nitrophenyl phosphate were similar in untreated and treated cells (0.069 and 0.068mM, respectively); for phosphotyrosine the Km value was lower in the treated cells (0.97mM) than in the controls (1.9mM).
Penile curvatures.
Penile curvatures are common. They are caused by tethering inelastic tissues that can be from the skin externally, from the congenital fibrous tissue of hypospadias and epispadias, and from inelastic tunica albuginea as in fractures, trauma, or Peyronie's disease. At the present time, with sexual organs exposed in photographs, human sexuality talked about with more freedom, and sexual experiences more open, a great deal of mental stress and anxiety can be produced by penile curvatures. Adjunct to this are impotency and other sexual problems. Surgical treatment is generally curative with grafts, flaps, excision of tunica albuginea, or repositioning and coaptation of the corporal bodies. Also, the use of a sex therapist can offer additional aid to the physician and realistic acceptance by the patient. More attention should be given to the patient with this problem. It is not well recognized by most physicians, and therefore, patients may suffer needlessly in silence without adequate help.
The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity.
The severely mangled extremity presents a challenge in appropriate surgical management. Very few objective data were found about this problem. To clarify the situation, criteria for a "mangled extremity' were defined, a multidisciplined approach employed, and a retrospective graduated grading system developed. Sixty consecutive trauma patients with severely injured extremities during the past 3 years were reviewed. Seventeen patients fit the category of Mangled Extremity Syndrome (M.E.S.). Injuries were retrospectively classified using a graduated grading system directed at four major tissue systems of the extremity involved (integument, nerve, artery, and bone). Additional scoring items were included to define the significance of trauma sustained outside the extremities. Patients who ultimately came to amputation could have been identified preoperatively at initial emergency evaluation utilizing this graduated grading system. Retrospective data suggest that a Mangled Extremity Syndrome Index (M.E.S.I.) of 20 is the dividing line below which functional limb salvage can be expected and above which limb salvage is improbable. Prospective application of this system, as well as an organized multidisciplined approach, could be useful in the identification of functionally retrievable versus probably irretrievable extremities, thus identifying and helping define the indications for amputation. The grading system criteria and results in these 17 patients form the basis of this report.
Prevention of acute aspirin-induced gastric mucosal injury by 15-R-15 methyl prostaglandin E2: an endoscopic study.
The deleterious effects of aspirin on gastric mucosa have been well documented in experimental and clinical studies. Prostaglandins offer a potential method by which this injury may be prevented. In these studies, we developed a single-dose endoscopic assay system of aspirin-induced gastric mucosal injury in normal volunteers. With this system, 27 of 30 volunteers (90%) demonstrated severe mucosal injury after ingestion of aspirin. Subsequently, we evaluated whether pretreatment with 15-R-15 methyl prostaglandin E2 prevented severe injury after ingestion of aspirin. Following an initial dose-response study, a double-blind crossover trial was performed using pretreatment with placebo or with 10-micrograms doses of 15-R-15 methyl prostaglandin E2 for 24 h before treatment with aspirin. The results of this trial indicate that prostaglandin pretreatment significantly prevented the occurrence of endoscopically visible severe gastric mucosal injury after single-dose aspirin administration.
Tricyclic antidepressant therapy for peptic ulcer disease.
The role of tricyclic antidepressants (TCAs) as agents for treatment of peptic ulcer disease is of growing interest. In both placebo-controlled clinical trials and comparative studies with cimetidine, TCAs have proved effective and safe as ulcer-healing agents. The mechanism of action by which TCAs produce healing has not been fully elucidated. In vivo studies in man have generally shown that TCAs decrease gastric acid secretion. In addition to their well-known anticholinergic properties, in vitro studies have indicated potent H1- and H2-receptor blocking activities for these agents. Separate from these effects on acid output, the antipain/depression effect of TCAs may be of benefit in certain patients with ulcers. Other advantages of these agents include their long half-lives, low cost, and readily available serum monitoring. Further clinical studies with detailed physiologic and psychologic observations and serum monitoring using TCAs in patients with peptic ulcer disease are needed.
Procedure manuals in office surgery.
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Cell cycle variability: the oscillator model of the cell cycle yields transition probability alpha and beta type curves.
The limit cycle concept of cell replication attributes cell cycle variability to continuous random modulation of the rates of reactions forming the intracellular control system believed to be responsible for replication processes. It is shown that this model can yield frequency histograms and both alpha and beta type accumulative distribution curves (with respect to generation times and also to cycle phases) which are of the various forms seen experimentally. The results thus provide additional support for this concept.
An oscillator cell cycle model needs no first or second chance event.
Theoretical data is presented to support the view that a limit cycle oscillator model of the cell cycle (as originally described) which accounts for random triggering of replication, can also accommodate the experimental results which have caused the supporters of the Transition Probability model to introduce the occurrence of yet a second chance event. In particular, it explains why the addition of a suboptimal amount of mitogen in a split dose alters the probability of triggering at each treatment but, generally, has little effect on the delay before the initiation of S-phase. It is also confirmed that, other than in some exceptional circumstances, lowering the probability of triggering in the oscillator model may have little effect on the minimum "intermitotic" time (as required by the evidence of the Transition Probability proponents) and, moreover, the oscillator concept provides reason why this should be so.
Upper gastrointestinal tract bleeding. Predisposing factors, diagnosis, and therapy.
The mortality from upper gastrointestinal (GI) tract bleeding has remained constant at 10% during the past 40 years. Many drugs may precipitate upper GI tract bleeding by disrupting the gastric mucosal barrier. Aspirin-induced injury to the gastric mucosa and GI tract bleeding have been documented in many studies; some of the mechanisms involved are known, but others are still being investigated. An approach to the bleeding patient is suggested; initial resuscitation, history taking, physical examination, determination of bleeding levels, and diagnostic procedures to determine the cause of bleeding are reviewed. Also described are available therapies for GI tract bleeding-gastric lavage, drug therapy, endoscopic control, electrocautery, thermal probe, tissue adhesive, and laser photocoagulation. The merits of the argon laser and the neodymium-yttrium aluminum garnet laser (both still in experimental stages) are described and compared. No pharmacologic or endoscopic therapies for upper GI tract bleeding have been proved effective.
Iced saline lavage does not slow bleeding from experimental canine gastric ulcers.
The efficacy and safety of iced saline lavage for upper gastrointestinal bleeding is unproven. In this study, canine stomachs were lavaged in vivo to determine whether iced saline staunched bleeding from mechanically induced acute gastric ulcers. Each animal served as its own control. Bleeding rates were measured during an initial period of saline lavage at 37 degrees C. Saline at 4 degrees C, with or without added norepinephrine, was no more effective than saline at 37 degrees C in decreasing the rate of gastric hemorrhage. These data do not support the clinical practice of lavaging with iced saline or norepinephrine-containing solutions in human gastric hemorrhage.
Endoscopic hemostasis using laser photocoagulation and electrocoagulation.
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National ASGE survey on upper gastrointestinal bleeding: complications of endoscopy.
Data about the risks of upper endoscopy in patients with upper gastrointestinal bleeding was gathered as part of a prospective national survey of the ASGE membership. Endoscopic complications occurred in 21 of 2320 endoscopies (0.9%). These included 12 major (perforation, aspiration, bleeding) and 9 minor (mucosal tear, medication reaction, transient cardiac or pulmonary episode) complications. There were 3 deaths attributable to major complications of the procedure. These fatalities all occurred in patients with severe major underlying illnesses. Although these results indicate a higher complication rate than earlier retrospective ASGE surveys on endoscopy, they are comparable to other available data about the risks of endoscopy in the specific group of patients with upper gastrointestinal bleeding.
The national ASGE survey on upper gastrointestinal bleeding. I. Study design and baseline data.
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The national ASGE survey on upper gastrointestinal bleeding. II. Clinical prognostic factors.
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The national ASGE survey on upper gastrointestinal bleeding. III. Endoscopy in upper gastrointestinal bleeding.
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