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Biomedical subjects

D B Adams

Publications and source records attributed to D B Adams.

At least 73 records · Page 4Linked to original sources
PubMed1989

The entrapped EEA stapler. Backing out with ease.

When the premium CEEA stapler becomes entrapped after performing a low colorectal anastomosis, new instrument design features permit easy removal, avoiding problematic anastomotic injury. After disconnecting the anvil from the cartridge, the anvil center rod can be grasped with a right-angle clamp, allowing the anvil to be angled "sideways" so that it slides by the newly constructed anastomosis and can be withdrawn with ease.

Anastomosis, Surgical↗
PubMed1989

Utility of Doppler color flow imaging for identification of femoral arterial complications of cardiac catheterization.

Doppler color flow and two-dimensional ultrasonographic images of the femoral region were obtained in 25 patients referred for suspected vascular complications of cardiac catheterization. Five patients had normal findings, while 23 abnormalities were noted in 20 patients, including seven femoral arteriovenous fistulae, 12 femoral pseudoaneurysms, and two patients with both femoral arteriovenous fistulas and pseudoaneurysms. Operation confirmed the abnormalities diagnosed by color flow examination in 15 of 20 patients. Three patients refused operation and one was not felt to be a surgical candidate due to high anesthetic risk. One patient died preoperatively and postmortem examination confirmed the color flow diagnosis. Etiologies of the arterial complications included percutaneous aortic valvuloplasty (6), coronary angioplasty (4), and arterial or both arterial and venous catheterization (10). Doppler color flow imaging is a reliable technique for identification of vascular complications following catheterization procedures.

Aged↗
PubMed1989

A preliminary evaluation of factors affecting an experimental system for vaccination-and-challenge with Haemonchus contortus in sheep.

A preliminary evaluation of factors affecting an experimental system for vaccination-and-challenge with Haemonchus contortus in sheep. International Journal for Parasitology 19: 169-175. Studies were made with Haemonchus contortus in sheep to ascertain the influence of a range of factors in the domain of the host, the parasite or the vaccine on the formulation of protocols for vaccination-and-challenge to be used in identifying protective immunogens. The results corroborate earlier findings that protective immunity can follow vaccination with homogenates of parasites and show that initial processing of parasites for a vaccine leaves protective immunogen in a functional state. Sonicates of adult worms produced protective immunity and were identified as raw stock in which to prospect for candidate immunogens. By contrast, sonicates of infective larvae and exsheathing fluid invoked no significant protection and were not accredited for the same purpose. In an experiment unaccompanied by protective immunity, ewes contained lower worm burdens than castrate males indicating that vaccination experiments should be made with hosts of one sex only. Again in an experiment unaccompanied by protective immunity, Freund's complete adjuvant increased susceptibility to infection compared with Freund's incomplete adjuvant or no adjuvant implying a profound and persistent interference from killed mycobacteria on resistance against H. contortus.

Animals↗
PubMed1989

Cross-immunity between Haemonchus contortus and Trichostrongylus colubriformis in sheep.

Cross-protective immunity between the nematode parasites, Haemonchus contortus and Trichostrongylus colubriformis, was examined in sheep vaccinated with irradiated larvae of either species. Secondary immunological responsiveness stimulated in this manner protected only against challenge infection with the species used for vaccination. Significant cross-protective immunity was not observed. Titres of serum antibody to an extract of adult but not infective larval T. colubriformis reflected the specificity for protective immunity. Immediate hypersensitivity skin reactions to nematode extracts did not reflect the antigen-specificity for protective immunity.

Animals↗
PubMed1989

Treatment of external pancreatic fistulas with somatostatin. Second place winner: Conrad Jobst award.

Five patients with external pancreatic fistulas were treated with a synthetic peptide that mimics the action of somatostatin (Sandostatin, Sandoz; East Hanover, NJ). Four of the patients developed fistulas after drainage of pancreatic pseudocysts and one developed a fistula following resection of a pancreatic carcinoid. One day after initiation of therapy, the mean fistula output for the group decreased by 52 per cent. By three days, fistula output decreased by 70 per cent. All fistulas closed in 7 to 44 days. Adverse reactions to the drug included diarrhea in one patient and transient hyperglycemia in another. Sandostatin is effective in decreasing drainage from external pancreatic fistulas and may, therefore, facilitate their closure. No serious adverse reactions to the drug were noted. Further studies will better define the role of Sandostatin in the treatment of pancreatic fistulas.

Adult↗
PubMed1989

Splanchnic venous obstruction. A complication of chronic pancreatitis.

A retrospective review of 20 adult patients with splanchnic venous obstruction secondary to chronic pancreatitis was performed to identify factors important in the preoperative diagnosis and operative management of this disorder. Fifteen patients with isolated splenic vein obstruction, four with portal occlusion and one with isolated inferior mesenteric vein occlusion were studied. Chronic alcoholism was the etiology of the pancreatitis in 18 patients; two patients had a Type IV hyperlipidemia. Four patients with massive hemorrhage from gastric varices were treated with splenectomy. Most patients presented with complaints of chronic pancreatitis, requiring pancreaticojejunostomy to treat the underlying pancreatic disorder. Splenic artery inflow control was obtained preoperatively in six patients and offers a technique that is beneficial in decreasing operative blood loss. The dynamic computerized tomography (CT) scan was a valuable diagnostic tool in identifying splanchnic venous obstruction although selective angiography is required for confirmation of the diagnosis.

Adolescent↗
PubMed1988

Tandem colovaginoscopy in the diagnosis of colovaginal fistula.

The diagnosis of colovaginal fistula with the traditional methods of contrast enema, sigmoidoscopy, and vaginal speculum examination can be problematic. Precise identification of the pathologic anatomy underlying the colovaginal fistula can be obtained by simultaneous flexible fiberoptic vaginoscopy and colonscopy.

Colonic Diseases↗
PubMed1988

Twenty-one-year experience with land mine injuries.

Land mines produce devastating injuries which are usually fatal. In Guantanamo Bay, there have been no survivors from close range, functioning antipersonnel mines of the M-16 series. All 15 antipersonnel mine fatalities suffered extremity amputation. Seven of the 15 patients suffered immediately fatal head, neck, or truncal injuries (Type I injury). The three patients who underwent hospital resuscitation had extremity amputation but were spared major head, neck, or truncal injury. It is in this group of injured that potentially salvageable patients can be identified; for them aggressive rescue and resuscitation must be performed. Those with Type II injuries are the highest priority in any triage plan. In a mass casualty or combat casualty scenario, Type II patients, in particular those with high bilateral above-the-knee amputations, may be reassigned to an expectant treatment category so as to allow the main focus on more salvageable patients. The prehospital management plan emphasizes rapid assessment and triage of patients, use of tourniquets to control extremity hemorrhage, supplemental oxygen or endotracheal intubation if possible, neck immobilization, use of the extremity section of the pneumatic antishock garment if applicable, and rapid transport to a hospital. Hospital management of these patients emphasizes aggressive resuscitation, early endotracheal intubation, and rapid volume replacement with simultaneous balanced salt solution and blood. Operative debridement with broad-spectrum antibiotic coverage and tetanus prophylaxis is performed; wounds are managed in an open fashion and frequently examined at subsequent dates in the operating room.

Amputation, Traumatic↗
PubMed1988

Nonfunctioning pancreatic neuroendocrine tumors presenting as pancreatitis: report of four cases.

The presentation of pancreatic adenocarcinoma as acute or chronic pancreatitis has been well documented; however, there has been only one previous report of either functioning or nonfunctioning pancreatic neuroendocrine tumors associated with pancreatitis. At the Medical University of South Carolina in Charleston, from March 1982 through September 1987, we have managed four patients with nonfunctioning pancreatic islet cell tumors or carcinoids, which presented with attacks of pancreatitis. Three of the patients had recurrent bouts of upper abdominal and lower dorsal back pain with elevation of the serum amylase. One patient presented initially with acute upper abdominal pain and elevation of the serum amylase. Each patient had an endoscopic retrograde cholangeography pancreatography (ERCP) pattern involving the pancreatic duct which was characterized by diffuse dilatation proximal to the site of obstruction. One of the four had a tumor blush on splanchnic angiography. Each patient had CT evidence of a mass in the head of the pancreas; however, one of the four was found to have diffuse involvement of the entire gland at operation. Surgical therapy varied: (a) local excision of the ampullary area with re-anastomosis of the pancreatic duct to the duodenum and choledochoduodenostomy; (b) bypass with cholecystoduodenostomy and caudal pancreaticojejunostomy; (e) total pancreatectomy; or (d) bypass with a Roux-en-Y cholecystojejunostomy and gastrojejunostomy. The choice of the procedure was based on the patient's condition and operative findings.

Acute Disease↗
PubMed1986

Management of the intraluminal duodenal diverticulum: endoscopy or duodenotomy?

The intraluminal duodenal diverticulum is an uncommon congenital anomaly which is associated with obstructive symptoms. Treatment of the symptomatic intraluminal duodenal diverticulum can be undertaken either endoscopically with excision by snare cautery or with duodenotomy and excision of the diverticulum. An understanding of the embryologic and anatomic characteristics of the intraluminal duodenal diverticulum is essential in order to select the best treatment and avoid the pitfall of inadvertent pancreatic or bile duct injury.

Adult↗
PubMed1986

Ventromedial tegmental lesions abolish offense without disturbing predation or defense.

Offense, defense, and predation, three kinds of aggressive behavior, are differentially affected by lesions of the ventromedial tegmentum of the brainstem of the rat. The lesions abolish offense while leaving defense and predation undisturbed. The offense behavior against another strange male, including bite-and-kick attack, offensive sideways posture, and offensive upright posture, was totally abolished, while the rats showed intact motor patterns of defensive upright posture, chasing, and killing bite in the tests for defense and predation. It is argued that these results support a motivational systems analysis of mammalian aggressive behavior. According to such an analysis, offense, defense, and predation are controlled by discrete motivational mechanisms located in different brainstem regions.

Aggression↗
PubMed1984

Locomotor stepping elicited by electrical stimulation of the lateral hypothalamus requires an ipsilateral descending pathway.

The effects of unilateral midbrain lesions on stepping produced by ipsilateral medial forebrain bundle (mfb) stimulation was determined in acute experiments. Rats were anesthetized with nembutal, mounted in a stereotaxic apparatus and suspended over a wheel which rotated when the rat stepped. Stimulation consisted of 10-sec trains of 50 Hz cathodal pulses (0.5 msec) at currents up to 200 microA delivered through monopolar electrodes. The stimulation sites were in the mfb at the level of the subthalamic nucleus. One side of the midbrain was randomly selected to receive a radio-frequency lesion. Certain midbrain lesions (N = 11) abolished or severely reduced stepping elicited from ipsilateral mfb stimulation but produced no effect on contralaterally elicited stepping. Areas of common damage in these lesions included the medial half of the medial lemniscus and the ventral tegmental area (VTA). Lesions that were without effect (N = 18) generally spared the dorsal VTA but damaged extensively either the ventrolateral VTA, medial lemniscus, substantia nigra, red nucleus, or central gray. A supplemental experiment further implicated a critical descending system since neither unilateral nor bilateral mfb lesions blocked stepping elicited by VTA stimulation. Together these results suggest that a descending path through the ipsilateral dorsal VTA mediates stepping elicited by mfb stimulation in the anesthetized rat.

Animals↗