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Biomedical subjects

D B Adams

Publications and source records attributed to D B Adams.

At least 37 records · Page 2Linked to original sources
PubMed1994

Impact of laparoscopic cholecystectomy on the management of cholelithiasis in children with sickle cell disease.

Children with sickle cell disease, well known to have a high incidence of cholelithiasis, are frequently admitted to the hospital for episodes of abdominal pain. Before the advent of laparoscopy, few children with sickle cell and cholelithiasis underwent cholecystectomy unless absolutely necessary, because of the high morbidity of an open cholecystectomy (OC). We reviewed our records of all children with sickle cell disease and cholelithiasis treated from 1985 to 1992 to investigate the impact of laparoscopic cholecystectomy (LC). During that period, 32 children underwent cholecystectomy: 10 OC and 22 LC (all since December 1990). Before December 1990, all children had either classic biliary tract symptoms or abdominal pain of unknown etiology. However, of the 22 LC children, five had asymptomatic cholelithiasis. Only three of the 32 patients had choledocholithiasis, although 30 of 32 had elevated total bilirubins. Two LC children presented with choledocholithiasis and were initially treated with endoscopic sphincterotomy and stent placement. A standard intraoperative cholangiogram (IOC) through the cystic duct was performed in all OC cases. In 19 of 22 LC cases, an IOC through the gallbladder was performed before any dissection; unsuspected choledocholithiasis was not found, but the IOC did allow visualization of the course of the cystic duct, facilitating its subsequent dissection. Total operative length was comparable between the two groups, but the LC patients' postoperative length of stay was half that of the OC patients (2.1 v 4.6 days). Postoperative complications in the OC group included three children who had severe pain, atelectasis, fever, and hypoxemia (30%).

Adolescent↗
PubMed1994

Competitive and territorial fighting: two types of offense in the rat.

Two types of fighting (offense) were compared and contrasted in three experiments on the laboratory rat. In Experiment 1, competitive fighting was obtained in pairs of hungry cagemates by placing one food pellet into their food hopper. In Experiment 2, territorial fighting was obtained by introducing an unfamiliar intruder into the home cage of a male and female pair. Both types of fighting had the same motor patterns. Whereas territorial fighting is strongest against intruders of the same sex, competitive fighting is stronger against the smaller opponent (in this case female) regardless of the sex of the test animal. Whereas territorial fighting is stronger in males, competitive fighting is stronger in females. Whereas gonadectomy reduces territorial fighting in males but not females, it reduces competitive fighting in both sexes. In experiment three, it was shown that food deprivation increases competitive fighting, while it reduces territorial fighting. On the basis of these findings a revised model of the organization of the offense motivational system is proposed.

Aggression↗
PubMed1994

Outcome after lateral pancreaticojejunostomy for chronic pancreatitis.

OBJECTIVE: To assess the outcome of lateral pancreaticojejunostomy in patients with chronic pancreatitis. SUMMARY BACKGROUND DATA: Chronic fibrocalcific pancreatitis associated with pancreatic ductal dilation and chronic pain has been managed successfully with lateral pancreaticojejunostomy. Early results, measured by pain relief and postoperative morbidity and mortality, have been excellent; however, long-term follow-up and overall outcome has been less clearly defined in these patients. METHODS: The outcome of 85 patients who had lateral pancreaticojejunostomy was assessed by reviewing hospital inpatient and outpatient records and conducting patient telephone interviews. RESULTS: Of 62 patients who were alive at follow-up, health status was characterized as good in 24%, fair in 31%, and poor in 45%. Alcohol abuse continued in 42% of patients, whereas narcotic use continued in 35%, insulin use continued in 23%, and pancreatic enzyme supplementation continued in 34%. Rehospitalization for recurrent attacks of pancreatitis and pain was necessary in 40% of patients. Six patients required subsequent operations for complications of chronic pancreatitis. Death occurred in 22 patients (26%) and resulted from continued alcohol abuse, progression of chronic pancreatitis, or late complications of the operation in more than one half the cases. CONCLUSIONS: Although lateral pancreaticojejunostomy provided pain relief, had a low morbidity rate, and no early postoperative deaths, long-term outcome was poor based on the patient's health status, continued alcohol and narcotic use, employment status, subsequent hospitalization to treat recurrent pancreatitis or its complications, subsequent operations required for complications of chronic pancreatitis, and postoperative deaths related to comorbid medical conditions or complications of chronic pancreatitis.

Adult↗
PubMed1994

Transportation of animals and welfare.

All forms of transport are potentially hazardous for animals, regardless of whether travel is between or within countries, or by road, rail, air or sea. However, experience shows that animals can be transported under suitable conditions without harm to their welfare. The provision of suitable conditions and the establishment of a mutually satisfactory framework for regulating the international transport of animals depends on an understanding of welfare needs and of the biological basis for disease, stress and suffering. The author examines the biological aspects of this framework. The capacity of animals to adapt to the different demands of different forms of transport varies with the species and physical state of animals being transported. Key practicalities are the preparation and selection of animals before transport, the provision of suitable environments, feed, water and rest during transport, and arrangements for recuperation after transport. Animals which are compromised by disease or injury must be excluded.

Animal Diseases↗
PubMed1994

Improved cardiac anthropomorphic phantom.

An improved cardiac sonographic phantom is described that simulates the anatomy of the human heart for applications as a low cost quality assurance and training tool in echocardiography. The major new feature in the phantom is the development of a polyurethane sponge left ventricle, which mimics the myocardium during sonographic imaging while undergoing hydraulic pumping. The left ventricle, including prosthetic mechanical mitral and aortic valves, is housed in an optically transparent Lexan chamber or in a tissue mimicking polyurethane rubber torso. Additional new features include a port for transesophageal imaging, and an adjustable calibrated stroke volume on the piston pump, which can serve as a standard for echocardiographic stroke volume measurement. B-scans of the phantom show excellent image quality in all three standard echocardiographic views as well as in transesophageal scanning.

Echocardiography↗
PubMed1994

Colonic complications of pancreatitis.

A retrospective review of 296 patients referred for surgical management of pancreatitis from 1964 to 1992 revealed that 18 (6.1%) had colonic complications. Of seven patients with chronic pancreatitis, six developed pancreatocolonic fistulas. One had stenosis of the transverse colon, which resolved after pancreatic cystjejunostomy, three were managed with local fistula excision and simple colon closure, three had segmental colectomy, and in one the fistula closed spontaneously with expectant management. Three patients had concomitant lateral pancreaticojejunostomy, and two had a cystjejunostomy. There were two postoperative complications, but no mortality. Eleven patients had acute necrotizing pancreatitis. Seven developed segmental colonic infarction that required partial colectomy. Four had colonic fistulas, two managed with partial colectomy and colostomy, and two managed nonoperatively. Eleven patients developed major postoperative complications; four died, two from sepsis and multiorgan failure and two from recurrent hemorrhage from a necrotic pancreatic bed. Our findings indicate that the presentation, management, and outcome of colonic complications differ in chronic and acute pancreatitis. In chronic pancreatitis, pancreatocolonic fistula predominated and could be managed either with local excision or segmental resection of the colon with excellent results. Simultaneous surgical correction of associated pancreatic pathology was possible in five patients. In acute necrotizing pancreatitis, colonic infarction secondary to the necrotizing inflammatory process was frequent and required colon resection. There was substantial morbidity and mortality in spite of treatment with colectomy.

Acute Disease↗
PubMed1993

Arterial hemorrhage complicating pancreatic pseudocysts: role of angiography.

Major arterial hemorrhage associated with pancreatic pseudocysts represents a formidable complication with high mortality rates. This study was undertaken to analyze presentation and outcome and to assess the role of angiography in diagnosis and management of this complication. A retrospective review of 180 patients referred for surgical management of pancreatic pseudocysts from 1964 to 1991 identified 13 patients (7.2%) with arterial hemorrhage. Eight patients presented with intracystic hemorrhage, 4 with upper gastrointestinal bleeding, and 1 with intra-abdominal bleeding. Six patients had gastroduodenal artery bleeding, 4 splenic, and 1 each left gastric, right colic, and left gastroepiploic. The site of bleeding was identified with selective visceral angiography in 9 patients; evidence of pseudocyst bleeding was seen in 5 of 7 patients who had contrast-enhanced computerized tomography (CT) scans. Angiographic embolization for control of hemorrhage was used in 6 patients and operative control in 7. Over the past decade, bleeding has been controlled with angiographic embolization in all patients except 1 with massive bleeding due to splenic artery erosion. Average blood loss was less in patients treated with angiographic embolization (6.8 vs 17.5 units, packed red cells, P < .05, Wilcoxon rank sum test). The sole mortality was a patient with cirrhosis treated in 1969. Clinical presentation of pseudocyst bleeding is variable; the underlying cause is usually related to chronic pancreatitis due to alcohol abuse. The dynamic contrast-enhanced CT scan is valuable in demonstrating evidence of pseudocyst bleeding. Accurate diagnosis with dynamic CT scan and angiography and control of bleeding with angiographic embolization has improved the outcome in patients with this complication.

Adolescent↗
PubMed1993

Systemic responses to challenge infection with Haemonchus contortus in immune Merino sheep.

Some systemic responses to single-dose infection with 10,000 Haemonchus contortus infective larvae were examined in sheep already shown to have protective immunity against the parasite. The major haematological finding was a neutrophil leukocytosis that occurred after the infections became patent but not during the pre-patent period. There was no definitive eosinophilia and no discernible change in the erythrocyte parameters. Systemic hyperthermia was not conclusively evident during the pre-patent period. Enzyme-linked-immunosorbent assays (ELISA) were used to measure the secondary anti-helminth antibody response in serum during the pre-patent period when the establishment of patent infection is resisted. These ELISAs employed preparations from adult worms to represent the parasitic stages of the worm, preparations from infective larvae to represent the pre-parasitic stages of the worm, and exsheathing fluid, which is the soluble material obtained when H. contortus larvae undergo ecdysis and transform from the pre-parasitic to the parasitic phase. Antibody responses to the three preparations differed qualitatively, indicating the presence of three different but perhaps overlapping sets of antigens. The three peaks in antibody against exsheathing fluid may reflect the pulses of antigen delivered to sheep as the parasite undergoes its three moults within the host.

Animals↗
PubMed1993

Offense produced by chemical stimulation of the anterior hypothalamus of the rat.

Offense behavior, including bite-and-kick attack, was obtained by microinjections of picrotoxin into the anterior hypothalamus of the rat. This is the first time that it has been possible to obtain offense by chemical stimulation of the brain, and the localization is more precise than that obtained with electrical stimulation. Mounting behavior and mounting by the opponent were also obtained from the anterior hypothalamus, the former corresponding to results obtained by previous studies using electrical stimulation. Other behaviors obtained from the hypothalamus included locomotion and circling, social and self-grooming, upright posture and boxing, digging, feeding, and leaping.

Aggression↗
PubMed1993

The importance of extrahepatic biliary anatomy in preventing complications at laparoscopic cholecystectomy.

Major biliary complications of laparoscopic cholecystectomy may be prevented by an understanding of extrahepatic biliary ductal and arterial anatomic relationships. The common patterns of anatomic variations important to the surgeon performing laparoscopic cholecystectomy are reviewed with respect to recently reported biliary injury during this procedure. Recommendations for delineating biliary anatomy and avoiding laparoscopic complications are reviewed.

Biliary Tract↗
PubMed1993

Cystic pheochromocytoma: radiologic diagnosis.

Cystic pheochromocytomas are unusual variants of adrenal pheochromocytomas. Computed tomography and pathologic findings in the two cases reported here illustrate three cardinal principles in the diagnosis of cystic pheochromocytomas: (1) A suprarenal cystic tumor discovered on CT may be the result of hemorrhage and necrosis of an adrenal pheochromocytoma. (2) The cystic pheochromocytoma typically exhibits areas of low attenuation, with Hounsfield units in the range of 5 to 15 and rim enhancement on contrast administration. (3) Incidental adrenal lesions with these features discovered on CT scanning are an indication for catecholamine assays to screen for pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1993

Peripheral fat necrosis after penetrating pancreatic trauma: a case report.

Peripheral fat necrosis (PFN), a rare complication of pancreatitis, has been reported previously in association with blunt pancreatic trauma. A patient who developed peripheral fat necrosis after penetrating pancreatic trauma and needed bilateral above-the-knee amputations to treat complications of lower extremity fat necrosis is reported.

Adult↗
PubMed1993

Impact of a major hurricane on surgical services in a university hospital.

Hurricane Hugo struck Charleston, South Carolina, on September 21, 1989. This report analyzes the impact this storm had upon surgical care at a university medical center. Although disaster planning began on September 17, hurricane damage by high winds and an 8.7-foot tidal surge led to loss of emergency power and water. Consequently, system failures occurred in air conditioning, vacuum suction, steam and ethylene oxide sterilization, plumbing, central paging, lighting, and refrigeration. The following surgical support services were affected. In the blood bank, lack of refrigeration meant no platelet packs for 2 days. In radiology, loss of electrical power damaged CT/MRI scanners and flooding ruined patient files, resulting in lost information. In the intensive care unit, loss of electricity meant no monitors and hand ventilation was used for 4 hours. In the operating room, lack of temperature and humidity control (steam, water, and suction supply) halted elective surgery until October 2. Ground and air transportation were limited by unsafe landing sites, impassable roads, and personnel exhaustion. Surgical planning for a major hurricane should include: 1) a fail-safe source of electrical power, 2) evacuation of as many critically ill patients as possible before the storm, 3) cancellation of all elective surgery, and 4) augmented ancillary service staffing with some, although limited, physician support.

Disaster Planning↗
PubMed1992

Aspiration cytologic, ultrastructural, and DNA cytometric findings of solid and papillary tumor of the pancreas.

Solid and papillary epithelial neoplasm of the pancreas (SPENP) is a rare lesion characteristically occurring in young women. By contrast with pancreatic ductal adenocarcinomas, SPENP is a slow-growing tumor that rarely metastasizes or is fatal. The current report describes light and electron microscopic and histochemical findings with DNA flow cytometric analyses of two cases of SPENP. The first patient was a 24-year-old woman; the second, a 72-year-old man. Although SPENP is rare in older men, both patients had characteristic radiographic and light microscopic features of SPENP. Ultrastructural evidence of acinar differentiation was seen in the first patient; the second patient had focal neuroendocrine differentiation. Flow cytometric analysis of the first tumor demonstrated diploid-range DNA content with a 5.8% S-phase fraction (SPF). The DNA cytometric analysis of a biopsy specimen from the second tumor revealed diploid-range DNA content with a 6.1% SPF, although subsequent sampling of the resected tumor showed an aneuploid population with a DNA index of 1.8 and SPF of 2.1%.

Adult↗
PubMed1992

Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst.

The records of 92 patients with symptomatic pancreatic pseudocysts referred for surgical management over a 27-year period were retrospectively reviewed to compare outcome in 42 patients managed with operative internal drainage procedures (group I) with that in 52 patients managed with computed tomography-directed percutaneous catheter drainage (PCD) (group II). The two groups were similar for patient age, sex, pseudocyst location, and cause. The frequency of antecedent pseudocyst-associated complications was less in group I (16.7 versus 38.5%, p less than 0.05). Seven group I patients and four group II patients had major complications (16.7 versus 7.7%, not significant). Group II mean duration of catheter drainage was 42.1 days, and the drain track infection rate was 48.1%. The frequency of antecedent operative cyst drainage was similar (14.2 versus 13.5%), as was the frequency of subsequent operations for complications related to chronic pancreatitis (9.5 versus 19.2%, not significant). Mortality rate was greater in group I (7.1% versus 0%, p less than 0.05). Pseudocysts can be effectively managed either by open operation with internal drainage or by PCD. Drawbacks of PCD include the controlled external pancreatic fistula and the risk of drain track infection. Percutaneous catheter drainage has the following advantages: (1) low mortality rate, (2) does not require a major operation, (3) does not violate the operative field in cases when subsequent retrograde duct drainage procedures are required. Neither PCD nor internal drainage is definitive, and with either technique subsequent correction of underlying pancreatic pathology may be necessary.

Adult↗
PubMed1992

Changing concepts in the surgical management of pancreatic pseudocysts.

A 27-year experience in the surgical management of 160 patients with pancreatic pseudocysts was reviewed. Sixty-eight patients treated from 1964 to 1981 (Group I) were compared to 92 patients managed from 1982 to 1990 (Group II). During the recent period, computed tomography (CT) scanning, endoscopic retrograde cholangiopancreatography (ERCP), selective visceral angiography, and percutaneous catheter drainage (PCD) techniques were available. The mean age of patients was similar in both groups (45 vs 44 years). Most pseudocysts in both periods represented complications of chronic pancreatitis due to alcohol abuse (82% vs 87%). Pancreatitis-associated complications occurring before management (fistula, obstruction, hemorrhage) were more frequent in Group II (19% vs 40%, P less than .05). There was a significant increase in the number of patients managed with external drainage in Group II (10% vs 52%) attributable to the use of PCD as definitive therapy in 46 per cent of patients in the recent period. Use of internal drainage procedures (cystgastrostomy, cystduodenostomy, cystjejunostomy) decreased in Group II (38% vs 16%, P less than .05). The use of lateral pancreaticojejunostomy (LPJ) combined either with caudal resection or cyst drainage has remained constant in both periods (32% vs 24%, NS). Patient morbidity was similar (26% vs 28%, NS) and mortality improved in Group II (9% vs 1%, P less than .05). Internal or external drainage for pseudocyst is often not definitive because of the underlying ductal disease. The authors' current approach is to manage large symptomatic cysts either with internal drainage or PCD; they employ octreotide acetate in the management of persistent pancreatic fistula following external drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Effect of the degree of effort on exercise echocardiography for the detection of restenosis after coronary artery angioplasty.

To determine whether the accuracy of exercise echocardiography is affected by the degree of effort during exercise, we examined 101 patients who had 6 months earlier undergone successful coronary artery angioplasty, with resting and immediate postexercise echocardiography and same-day coronary angiography. A positive exercise echocardiographic response was defined as the development of a new or worsening wall motion abnormality postexercise, compared with resting wall motion. Significant coronary disease (greater than 50% diameter stenosis) was present in 48 patients, 38 of whom had single-vessel disease and 10 of whom had two-vessel disease. Exercise echocardiography correctly identified 32 patients with significant disease (sensitivity 67%) and 44 patients without significant disease (specificity 83%). The effect of the degree of exercise effort on the sensitivity and specificity of the test was evaluated by three criteria; (1) the percentage of maximum predicted heart rate (MHR), (2) the duration of exercise (DUR), and (3) the double product (DP). To determine the influence of the degree of effort upon sensitivity and specificity, the effort criteria were compared between patients with true positive (TP) tests to those with false negative tests (FN), and in patients with true negative (TN) tests compared with those with false positive (FP) tests. No significant differences were detected in MHR, DUR, or DP between TP versus FN patients or between TN versus FP patients. These results indicate that for symptom-limited exercise echocardiography in postangioplasty patients, neither sensitivity nor specificity is significantly affected by the degree of effort during exercise.

Angioplasty, Balloon, Coronary↗