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Biomedical subjects

D B Skinner

Publications and source records attributed to D B Skinner.

At least 127 records · Page 7Linked to original sources
PubMed1977

Local nerve block anesthesia for peroral endoscopy.

Local glossopharyngeal and superior laryngeal nerve block anesthesia for peroral endoscopy was performed on 500 patients (313 bronchoscopies, 162 esophagoscopies, 25 combined bronchoesophagoscopies). The technique allows easy insertion of rigid and flexible scopes or awake tracheal intubation of conscious patients. Glossopharyngeal nerve block causes temporary abolition of the gag reflex and loss of tactile sensation over the posterior third of the tongue and the lateral and posterior wall of the oropharynx and hypopharynx. Superior laryngeal nerve block results in loss of tactile sensation over the posterior surface of the epiglottis and the mucosa of the larynx and upper trachea. Ten of the 500 patients (2%) had an inadequate glossopharyngeal block, and 4 of the 313 patients who had a bronchoscopic examination had an inadequate superior laryngeal block. In the remaining patients, excellent anesthesia was obtained with good patient acceptance and minimal morbidity.

Anesthesia, Local↗
PubMed1977

Effect of 50% distal small bowel resection on gastric emptying in Rhesus monkeys.

The effect of bowel resection, sufficient to cause gastric secretory changes, on gastric emptying is unknown. Gastric evacuation was characterized in 8 Rhesus monkeys by a modification of George's double sampling test meal. Fifty per cent distal small bowel resection was then performed. Gastric emptying was again studied at 6 weeks and 6 months. The rate constant fell from -0.00289 +/- 0.000467 (+/-1 SEM) to -0.00232 +/- 0.00106 during the early phase, but role to -0.00308 +/- 0.00186 by 6 months, neither value being statistically different from the preoperative values. T1/2 rose from 125.2 +/- 19.2 mins to 367 +/- 173.4 mins by 6 weeks and to 380.9 +/- 161.6 mins by the end of the experiments. Corresponding values for T were: control period 425.8 +/- 63.2 mins, early phase 1223 +/- 589 mins and late phase 1245.9 +/- 529.6 mins. None of these changes were statistically significant. Alterations in emptying time within each animal were consistent at the two postoperative phases. Although the two animals showing acceleration of evacuation were those with least change in secretion, compensation for the observed increase in output of gastric juice did not materially alter the results.

Animals↗
PubMed1977

Effect of antrectomy on gastric hypersecretion induced by distal small bowel resection.

Seven male Rhesus monkeys, with demonstrated gastric hypersecretory response to 50% distal small bowel resection, were studied. This increase in gastric acid output had persisted for more than 6 months. Precise, anatomical antrectomy without vagotomy was performed and intestinal continuity restored by gastroduodenostomy. Complete abolition of basal acid secretion and of the secretory response to histamine occurred. These effects could not be reversed by continuous (5 hour) infusions of pentagastrin at 0.2 microgram/kg hr-1 or 2 microgram/kg hr-1. The dose response curve to gastrin pentapeptide was altered; maximum secretion was greatly reduced and occurred at 10 microgram/kg hr-1. Neither basal serum gastrin or basal serum GIP was significantly reduced by antrectomy. These findings indicate that in this animal model the antrum is essential in the genesis of the hypersecretory state. If these findings are relevant to man precise antrectomy may be the procedure of choice for symptomatic acid hypersecretion after small bowel resection or disease.

Animals↗
PubMed1977

Acute pancreatitis of rare causation.

From a review of 800 patients with acute pancreatitis, eight having rare causation were selected. Definite obstruction of the common pancreatic duct was noted in four patients, and direct injury of the parenchyma, vascular lesions of pancreatic vessels and presumed autoimmune factors were responsible in the remaining four patients. Although the definitive treatment of nonobstructive pancreatitis remains controversial, surgical relief of obstruction of the pancreatic duct provides the most appropriate therapeutic approach for obstructive pancreatitis.

Acute Disease↗
PubMed1977

Mucinous biliary obstruction associated with a cystic adenocarcinoma of the pancreas.

Obstruction of the biliary tree by large amounts of mucinous material is reported in a patient with a mucin-producing cystic adenocarcinoma of the pancreas invading the common bile duct. Although preoperative endoscopic retrograde cholangiography suggested bile duct invasion, mucinous obstruction, as in the previous cases in which it has been reported, was not suspected. Mucinous obstruction, although unusual, should be considered in patients with cystic carcinomas of the pancreas in the presence of jaundice or episodes of cholangitis.

Aged↗
PubMed1976

Survival of dogs subjected to profound hypothermia with circulatory support.

Thirty-one anesthetized dogs were surface cooled at 5 C and rewarmed after a variable period. Respiration was controlled with a volume respirator. When cardiac arrest occurred, circulation was provided with the mechanical ventricular assistance (MVA) device in 23 dogs. Of the animals maintained for four hours below 10 C on the MVA, 83% were successfully resuscitated. None of the dogs maintained for two hours below 10 C without circulation could be resuscitated. Eleven dogs were studied for a long-term survival after chest closure. Only four of them survived longer than three days. Death after rewarming was due to severe pulmonary insufficiency. Results of this study suggest that provision of oxygenation and a pulsatile circulation during hypothermia improve tissue viability of nonhibernators. The model shows potential for in situ preservation of multiple organs in the cadaver.

Alanine Transaminase↗
PubMed1976

Clinical significance of pancreatic ascites.

Recurrence of pancreatic ascites in a patient after two courses of peritoneal lavage suggested pancreatic ductal disruption as the etiolgy, and this was confirmed at operation. Peritoneal lavage in two other patients with pancreatic ascites without ductal disruption or cysts was associated with resolution ascites. The use of peritoneal lavage in patients with acute or chronic pancreatic ascites may guide the selection of those requiring early surgical treatment.

Acute Disease↗
PubMed1976

Immunology and thoracic surgery.

This report reviews the current status of three types of diseases in which knowledge of immunology is changing the practice of thoracic surgery. Evidence is presented for myasthenia gravis being an autoimmune disease. Thymectomy is widely considered to be the therapy of choice for patients with generalized myasthenia regardless of age or sex. Opportunistic pulmonary infections of unusual types are being encountered frequently in patients receiving immunosuppressive drugs for organ transplantation or malignancy. The important role of bronchial brushing and open lung biopsy is stressed. Immunotherapy of several types is currently being investigated experimentally and clinically and promises to change therapy for bronchogenic and esophageal neoplasms.

Adult↗
PubMed1976

Permanent extracorporeal esophagogastric tube for esophageal replacement.

Six patients are presented in whom an extracorporeal esophagogastric tube bypass was employed in lieu of standard methods of esophageal reconstruction. These tubes, obtained from Japan, have functioned well in 4 of the 6 patients. This approach offers an alternative to gastrostomy feedings alone in a patient with advanced esophageal disease in whom no other method of surgical reconstruction can be offered.

Adenocarcinoma↗
PubMed1976

Mechanical circulatory assistance for the treatment of complications of coronary artery disease.

Surgery has become an accepted method of treatment for coronary artery disease and its complications. Revascularization results in significant improvement in symptoms for patients with angina pectoris. Occasionally, patients requiring surgery for angina pectoris will sustain reversible ischemic damage during operation; such patients can be successfully weaned from cardiopulmonary bypass with full recovery when intra-aortic balloon counterpulsation is used. Arrhythmias associated with ischemic damage to the myocardium also can be controlled when IABCP is used for physiologic assistance. Patients in cardiogenicshock of pulmonary edema after acute myocardial infarction have an ominous prognosis. When decompensation occurs, IABCP may be used to stabilize the patient and to allow study and corrective surgery if possible. The prognosis is better for patients with ventricular septal defect, although selected patients without a mechanical defect of the myocardium can be salvaged if the response to IABCP is favorable. Counterpulsation has also been shown to be useful in achieving pulsatile cardiopulmonary bypass and in assisting high-risk patients through operation. External pressure circulatory assist (EPCA) is less effective than IABCP in assisting the failing myocardium; however, the external device is noninvasive and may be a useful adjunct in situations where IABCP is not feasible.

Angina Pectoris↗
PubMed1976

Esophageal malignancies. Experience with 110 cases.

At present radical esophagectomy is the operation of choice whenever resection can be achieved with hope of long-term survival. In patients with extensive node or liver metastases, the palliation achieved by standard resection is superior to that obtained by other methods of treatment such as radiation, bypass, or intubation. Radical resection appears to offer the only current avenue towards improving long-term survival rates in this most difficult of neoplasms. The role of anticipated advances in chemotherapy or immunotherapy on carcinoma of the esophagus remains to be defined, but en bloc resection of the tumor with adequate margins will remain the cornerstone of treatment, hopefully to be improved by new types of adjuvant therapy.

Barium Sulfate↗