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Biomedical subjects

D E Barker

Publications and source records attributed to D E Barker.

At least 37 records · Page 2Linked to original sources
PubMed1995

Temporary closure of open abdominal wounds: the vacuum pack.

Temporary closure of abdominal surgical wounds is occasionally required when conditions of the abdominal wall or peritoneal cavity prevent closure or when early re-exploration is planned. The optimal temporary closure should contain and protect the contents of the peritoneal cavity from external contamination and injury; preserve the integrity of the abdominal wall; be simple to perform and maintain; provide ease of reentry; and have minimal adverse physiologic effects. Based on these criteria, a method of temporary abdominal wound closure (termed the vacuum pack) has been designed and evaluated. The operative technique includes 1) placement of a fenestrated polyethylene sheet between the abdominal viscera and anterior parietal peritoneum; 2) placement of a moist, sterile laparotomy towel over the polyethylene sheet; 3) placement of two closed suction drains over the towel; 4) placement of an adhesive backed drape over the entire wound, including a wide margin of surrounding skin; and 5) suction applied to the drains, creating a vacuum and rigid compression of the layers of closure material. This creates a tight, external seal of the adhesive backed drape and facilitates drainage of the peritoneal cavity. From April 1992-December 1993, this temporary abdominal wound closure was performed 56 times in 28 patients, ages 6-78 years, for periods of 1-11 days. The procedure was used in 17 trauma patients and 11 non-trauma patients. Indications for use included increased intra-abdominal pressure in nine, mandatory re-exploration in 10, and a combination of these indications in nine patients. Pre- and postprocedural airway and systemic blood pressures were unaffected by this closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗
PubMed1994

Percutaneous dilational tracheostomy: report of 141 cases.

Tracheostomy is indicated frequently in the treatment of critically ill patients who require prolonged mechanical ventilation. The purpose of this prospective study was to evaluate our initial experience with 141 cases of percutaneous dilational tracheostomy (PDT) performed over a 2-year period. One hundred twenty PDTs (85%) were placed at the bedside, and 21 (15%) were performed in the operating room in conjunction with other procedures. The procedural complication rate was 11% (16 of 141). Most complications were easily recognized and did not preclude the completion of PDT. One death occurred secondary to severe bronchospasm. The postoperative complication rate was 8% (11 of 141). The most frequent complication was peristomal oozing. The average duration of follow-up after decannulation for patients discharged alive and decannulated was 36 +/- 27 weeks. There were 3 recognized cases of clinically symptomatic tracheal stenosis. We conclude that PDT is comparable with the open method and can be performed rapidly and safely at the patient's bedside.

Adolescent↗
PubMed1994

Laparoscopic cholecystectomy in biliary pancreatitis.

Laparoscopic cholecystectomy has emerged as the treatment of choice for uncomplicated cholelithiasis. Despite early concerns, many surgeons have applied this new technique to more complicated biliary tract disease states, including biliary pancreatitis. To evaluate the safety of laparoscopic cholecystectomy in this setting, we retrospectively reviewed 29 patients with clinical and laboratory evidence of biliary pancreatitis who underwent this procedure between March 1990 and December 1992. The severity of pancreatitis was determined by Ranson's criteria. Two patients had a Ranson's score of 6, one of 5, one of 4, five scored 3, nine scored 2, nine also scored 1, and two patients scored 0. The mean serum amylase level on admission was 1,610 (range 148 to 7680). All patients underwent laparoscopic cholecystectomy during the same hospital admission for biliary pancreatitis, with the mean time of operation being 5.5 days from admission. Operative time averaged 123 minutes (range 60-220 minutes). Intraoperative cholangiography was obtained in 76 per cent of patients. Three patients had choledocholithiasis on intraoperative cholangiography and were treated with choledochoscopy, laparoscopic common bile duct exploration, and saline flushing of the duct. The mean length of hospital stay was 11 days (range 5-32 days). There were seven postoperative complications requiring prolonged hospitalization with all but one treated non-operatively. One patient with a preoperative Ranson score of 6 developed necrotizing pancreatitis and subsequently required operative pancreatic debridement and drainage. There were no deaths in this series and no postoperative wound infections. The average recovery period for return to work was 2 weeks. These statistics compare favorably with literature reports for open cholecystectomy in biliary pancreatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Effect of cardiogenic shock on pharmacokinetics and tissue distribution of ampicillin-sulbactam.

A reversible cardiogenic shock model in pigs investigated shock-induced changes in the pharmacokinetics and tissue distribution of ampicillin-sulbactam and the efficacy of this antibiotic regimen in eliminating enteric bacterial translocation. Sixteen pigs were randomly allocated to 3 groups: group I (shock, ampicillin-sulbactam, n = 6), group II (no shock, ampicillin-sulbactam, n = 6), and group III (shock, no ampicillin-sulbactam, n = 4). Nalidixic acid-resistant E. coli (60 x 10(6) CFU) were instilled into a jejunal loop created in each pig, and bacterial cultures were taken from thoracic duct lymph, periportal, and mesenteric lymph nodes. Ampicillin-sulbactam was administered intravenously at a standard dose of 3 g. Results showed that 1) ampicillin and sulbactam concentrations generally increase during cardiogenic shock; 2) cardiogenic shock does not increase ampicillin concentrations in jejunum and liver; 3) during resuscitation, thoracic duct lymph ampicillin concentrations decrease; and 4) during and immediately after cardiogenic shock, standard doses of ampicillin-sulbactam appear efficacious in eliminating translocated bacteria.

Ampicillin↗
PubMed1994

Needle localization for nonpalpable breast lesions.

Breast cancer will affect approximately one woman in nine, and it is estimated that approximately one-third of the 500,000 new cases of cancer among American women in 1993 will be cancer of the breast. With no current method of prevention available, early detection of breast cancer by regular self and physician performed breast examination in conjunction with screening mammography is emphasized. The rate of breast cancer detection has accelerated due to the ability of mammography to identify nonpalpable breast lesions. From January 1987 to January 1992, 1,323 breast biopsies were performed at Erlanger Medical Center, with 559 of these biopsies performed on 541 patients, utilizing needle localization. Of the 559 biopsies, 92 were positive for malignancy (17%). The mean patient age at detection of malignant lesions was 55.2 years. The most common mammographic abnormality leading to biopsy was an irregular breast tissue matrix (mass or density) with 25/191 (13%) biopsies positive for malignancy. The mammographic abnormality associated with the highest malignancy rate was the presence of calcifications in association with a mass or density 16/56 (29%). The upper outer quadrant (UOQ) was the most common site of biopsy 313/559 (56.0%), and biopsies from this region had the highest incidence of malignancy 67/313 (21%). Eighty-seven of the 92 patients with biopsy-proven malignancy underwent subsequent definitive surgical treatment. Tumor size did not correlate with node negative status, but evidence of microscopic invasion did. Preinvasive (in-situ) lesions were present in 23/92 biopsies (25%). There was no axillary involvement associated with in-situ carcinomas.

Adult↗
PubMed1994

Calciphylaxis: early recognition and management.

Calciphylaxis, a syndrome of disseminated calcification found in chronic renal failure patients with secondary hyperparathyroidism, results in soft tissue calcification and vascular medial calcinosis leading to subsequent ischemic tissue necrosis. It is a rarely occurring condition in which patients present with painful, violaceous, mottled lesions of the extremities and/or trunk that progress to skin and subcutaneous tissue necrosis, non-healing ulcers, and gangrene. We reviewed the clinical course of seven patients (aged 24-69) with calciphylaxis treated at our institution over a 4-year period (October 1988-June 1992). All seven patients underwent parathyroidectomy, with a mean time of 8 weeks (range 3-20 weeks) between the onset of calciphylactic symptoms and parathyroidectomy. Four patients died, three secondary to wound-related sepsis. Of the three survivors, two healed soft tissue lesions primarily. The other required extremity amputation and wound excision before healing. Neither anatomical location of the soft tissue lesions nor post-parathyroidectomy serum calcium and phosphorus levels had any bearing on wound healing or mortality. Lesion severity at the time of parathyroidectomy appeared to best correlate with clinical course. Although treatment with phosphate-binding antacids, total or subtotal parathyroidectomy, and avoidance of challengers such as Vitamin D or local tissue trauma remain the mainstays of therapy, the uniform cure for calciphylaxis remains elusive. Prognosis for patients with calciphylaxis is dismal, even following late surgical intervention. Earlier recognition of the signs and symptoms of calciphylaxis should lead to timely parathyroidectomy in the hopes of ameliorating the symptoms and preventing or retarding its progressive sequelae.

Adult↗
PubMed1993

Use of transesophageal echocardiography in the evaluation of traumatic aortic injury.

Indications for aortography following blunt chest trauma are broad and ill-defined. This study prospectively assessed the role of transesophageal echocardiography (TEE) in the evaluation of suspected aortic injury. We used both TEE and aortography to evaluate 69 patients with suspected thoracic aortic injury. The studies were performed and interpreted by staff radiologists and cardiologists. The mean study time for TEE was 27 minutes, whereas the mean study time for aortography was 76 minutes (p < 0.05). No complications occurred with either procedure. Both TEE and aortography revealed no evidence of aortic injury in 61 patients. There was one false-positive aortogram. TEE identified seven aortic injuries; four were confirmed by aortography. One patient underwent thoracotomy and aortic repair based on TEE findings alone. Aortograms yielded false-negative results for two patients; one injury was confirmed at thoracotomy, the other at autopsy. TEE accurately predicted the presence or absence of aortic injury in each case, for a diagnostic sensitivity and specificity of 100%. TEE can be performed safely and efficiently on the multiple-injury patient. We conclude that TEE is useful in the evaluation of suspected aortic injury.

Adult↗
PubMed1993

Effect of a single Lernaeocera branchialis (Copepoda) on growth of Atlantic cod.

A study was conducted to determine the influence of controlled water temperature on growth rate of Atlantic cod (Gadus morhua) after infection with a single, blood-feeding copepod, Lernaeocera branchialis. Initially, uninfected and infected fish were held in ambient seawater (0-10 C) in a raceway and fed to satiation from October to March. In a second trial simulating the water temperature at which cod live in winter (2-3 C), 2 groups of fish were kept in tanks through which sea water flowed, and they were fed to satiation from February through July. Infected cod held at the ambient temperature consumed more feed, had comparable weight-gain, and showed lower feed conversion efficiency (%) and k-factor than did control fish during autumn to early winter, whereas no difference was apparent during the remaining winter period. Also, no striking difference in feed consumed, weight gained, feed conversion efficiency or k-factor were apparent when the 2 groups of cod were held in heated sea water during winter to early summer. These results suggest that adult cod infected with 1 L. branchialis compensate for the infection in autumn rather than during winter by consuming more fed.

Analysis of Variance↗
PubMed1993

Superior mesenteric artery repair following penetrating trauma.

Superior mesenteric artery injuries remain a challenge to even the most experienced trauma surgeon and continue to carry a significant mortality in spite of aggressive management. If possible, primary arteriorrhaphy should be performed, as mortality has been shown to increase with more complex methods of repair. This probably emphasizes the severity of the vascular injury and hemorrhagic complications rather than the complications of the repair itself.

Adult↗
PubMed1992

Early criteria predictive of prolonged mechanical ventilation.

This study was performed to determine if prolonged mechanical ventilation (MV) could be predicted by objective clinical variables present at 48 hours after MV was instituted. During a 3-month period, 49 (54%) of 91 mechanically ventilated surgical intensive care unit patients required MV for 2 or more days. Twelve (24%) of these patients died. Patients requiring 2-13 days of MV had significantly lower alveolar-arterial oxygen gradients (PAO2 - PAO2), PEEP, and FIO2 on MV day 2 compared with patients with MV greater than or equal to 14 days. PAO2 - PAO2 greater than or equal to 175 mm Hg on day 2 in patients without chronic obstructive pulmonary disease (COPD) was 60% sensitive and 91% specific for MV greater than or equal to 14 days. In survivors, a day-2 PAO2 - PAO2 greater than or equal to 175 mm Hg (without COPD) or a GCS score less than or equal to 9 had a 91% positive predictive value and a 96% negative predictive value for MV greater than or equal to 14 days. We conclude that mechanical ventilation for 14 or more days can be accurately predicted at 48 hours after the institution of ventilatory support by these objective criteria.

Female↗
PubMed1992

The unique sequence of the herpes simplex virus 1 L component contains an additional translated open reading frame designated UL49.5.

We present evidence for the existence of an additional herpes simplex virus 1 gene designated UL49.5. The sequence, located between genes UL49 and UL50, predicts a hydrophobic protein with 91 amino acids. Attempts to delete UL49.5 were not successful. To demonstrate that UL49.5 is expressed, we made two recombinant viruses. First, we inserted in frame an oligonucleotide encoding a 15-amino-acid epitope known to react with a monoclonal antibody. This gene, consisting of the authentic promoter and chimeric coding domain, was inserted into the thymidine kinase gene of wild-type virus and in infected cells expressed a protein which reacted with the monoclonal antibody. The second recombinant virus contained a 5' UL49.5-thymidine kinase fusion gene. The protein expressed by this virus confirmed that the first methionine codon of UL49.5 served as the initiating codon. The predicted amino acid sequence of UL49.5 is consistent with the known properties of NC-7, a small capsid protein whose gene has not been previously mapped. A homolog of UL49.5 is present in the genome of varicella-zoster virus, located between homologs of UL49 and UL50.

Animals↗
PubMed1991

Hip disarticulation: factors affecting outcome.

Hip disarticulation, especially in patients with peripheral vascular disease, has been associated with high morbidity and mortality rates. This report describes patient characteristics that influence the clinical outcome of hip disarticulation. The medical records of all patients undergoing hip disarticulation from 1966 to 1989 were reviewed for surgical indication, perioperative wound complications, and postoperative deaths. Fifty-three patients underwent hip disarticulation for limb ischemia (10), infection (12), infection and ischemia (14), or tumor (17). The overall incidence of wound complications was 60%, and no significant differences were found among the groups. Prior above-knee amputation and urgent/emergent operations were significantly associated with increased wound complications (p less than 0.05). The overall mortality rate was 21%, ranging from 0% (tumor) to 50% (ischemia) and differed significantly among the groups (p less than 0.02). Mortality was significantly associated with urgent/emergent operations (p less than 0.01). Age, diabetes mellitus, and previous inflow procedures did not influence mortality rates. The presence of limb ischemia influenced mortality rates to a greater extent than did infection, and a history of cardiac disease was statistically predictive of death. Wound complications frequently accompanied hip disarticulation, regardless of operative indication, and were significantly increased by urgent/emergent operations and prior above-knee amputation. Hip disarticulation can be performed with low mortality rates in selected patients. Both limb ischemia and infection substantially increase operative mortality rates.

Adult↗