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Biomedical subjects

D E Fry

Publications and source records attributed to D E Fry.

At least 181 records · Page 10Linked to original sources
PubMed1979

Rectal obstruction secondary to carcinoma of the prostate.

The records of 13 patients with symptomatic rectal obstruction secondary to prostatic carcinoma have been critically reviewed to provide criteria for identifying this atypical presentation. The site of obstruction varied from the anal verge to 17 cm by sigmoidoscopy. Significant clinical findings were ureteral obstruction on excretory urography in 12 of the patients, elevated acid phosphatase in eight, intact mucosa over the obstructing mass in seven and osteoblastic bone metastasis in six. Primary diagnosis was generally established by comparing histopathologically the prostate and the obstructing lesion. Colostomy was necessary in nine cases. In three patients colostomy was obviated in partially obstructing lesions by intravenous diethylstilbestrol diphosphate therapy. One patient had an inappropriate low anterior resection. Rectal obstruction is most commonly due to primary adenocarcinoma. Occasionally the obstruction is secondary to prostatic carcinoma masquerading as an intrinsic rectal cancer. Identification of the true nature of the illness is essential for proper treatment.

Adenocarcinoma↗
PubMed1979

Hepatic cellular hypoxia in murine peritonitis.

Reduced oxygen consumption and lactic acidosis were observed frequently in patients with peritonitis. This study was designed to evaluate whether reduced oxygen consumption is secondary to deficient oxygen delivery or is a function of primary injury to mitochondria. Peritonitis was produced in rats by cecal ligation and perforation. Animals were killed at 2, 4, and 6 hours and agonally. Oxygen utilization was studied polarographically in isolated hepatic mitochondria with glutamate, pyruvate, and succinate substrates. State 3, state 4, respiratory control index (RCI), and ADP:O ratios were determined. Whole tissue and isolated mitochondrial ultrastructure were examined by electron microscopy. Systemic blood pressure and oxygenation were monitored. Hepatic tissue oxygenation was examined using a surface oxygen electrode. Peritonitis resulted in acceleration of state 3 respiratory rates and increased respiratory control indices at all time intervals. Maximal respiratory control was observed at 4 hours with all substrates. Whole tissue mitochondria demonstrated mild swelling and thinning of membranes and matrix. Experimental and control isolates showed similar orthodox-to-condensed conformational changes. Hepatic tissue oxygenation declined to less than 10% of control by 6 hours, while arterial Po2 was unchanged. The conclusions of this study are that lethal peritonitis results in (1) no primary injury to the hepatic mitochondria, (2) increased efficiency of hepatic mitochondrial oxygen utilization, and (3) reduced hepatic tissue oxygenation. The exact mechanisms of defective oxygen delivery require further study.

Animals↗
PubMed1979

Clinical implications in bacteroides bacteremia.

The clinical presentation and results of treatment of 98 patients with documented bacteroides bacteremia have been reviewed. Surgically treatable causes were documented in three-quarters of the patients. No one antibiotic or combination thereof significantly influenced survival. Patterns of death from sepsis were through multiple organ failure. Early recognition, or surgical drainage or debridement, or both, and specific aerobe directed antibiotic therapy remain the first line of therapeutic endeavor.

Adolescent↗
PubMed1978

Missile tract infections after transcolonic gunshot wounds.

Severe invasive infections around missiles or missile tracts may occur after transcolonic gunshot wounds. Observations in seven patients disclosed that infections of bone, soft tissue, retroperitoneum, and vascular structures resulted from the contamination of these tissues by missiles that had passed through the lumen of the colon. The infections were frequently obscure and difficult to diagnose unless the missile was considered to be a potential source of contamination. Two of seven patients died as a direct result of infection. Aggressive debridement of missile tracts, removal of accessible missiles, and adjunctive antibiotic therapy were useful.

Adult↗
PubMed1978

Closure of an acute perforated peptic ulcer with the falciform ligament.

When management of a perforated peptic ulcer necessitates simple closure, the omentum may not be of adequate quality to buttress such a closure. In this unusual circunstance, we have found the falciform ligament to serve as an effective alternative to satisfactorily peptic perforations.

Duodenal Ulcer↗
PubMed1978

Unsuccessful postoperative extraction of retained common duct stones: an analysis.

An analysis of unsuccessful extractions of retained biliary calculi using basket catheters reveals more than half the failures are related to the selection, placement, and size of the T tube. A new T tube has been developed which will improve postoperative access to the common duct and facilitate removal of retained calculi.

Adult↗
PubMed1978

Management of aortic bypass graft thrombosis: utility of thrombectomy.

The condition of many patients with early or late thrombosis after an aortic bypass operation can be improved by appropriate secondary operations. Late thromboses generally occur in patients with impaired arterial outflow. Restoration or establishment of good outflow is the most critical part of most secondary operations. Thrombectomy is an expedient procedure and, if properly monitored by arteriography, can in many instances permit retention of the graft limb as a satisfactory conduit, particularly in emergency limb salvage attempts.

Aged↗
PubMed1978

Reassessment of intraoperative decisions: why operations for cancer of the large bowel fail.

A program developed for the intraoperative judgement decisions commonly faced in cancer of the colon and rectum has been published and has been found to correlate frequently with the management carried out in a cancer hospital and on the ward services of university programs in city/county and Veterans Administration hospitals. Those patients whose management varies with the recommendations of the program are subject to statistically significant excess risk of dying in the hospital and excess risk of failure of ultimate control of their malignant process. It is our opinion that this program is not only useful in demonstrating the explicit nature of surgical judgement but is also useful to the operating surgeon as an indication for the need for consultation or reassessment of his obwervations.

Colectomy↗
PubMed1978

Freezing an extremity in preparation for amputation.

Patients requiring a major amputation for ischemia are frequently gravely ill. Physiologic amputation obtained by freezing the leg, usually with a tourniquet, will permit delay and intensive preoperative therapy. In an efficient, safe, and convenient method which we have developed and used in 46 patients, a pump circulates antifreeze solution through a specially constructed boot. The last 32 patients so treated have been analyzed as to indications and results. Advantages obtained control of sepsis, correction of diabetic coma, dialysis for chronic renal failure, improvement in congestive heart failure, and improvement in pulmonary function. Four patients had successful below-knee amputations after control of infection that had previously seemed to dictate above-knee amputation. The control of pain and odor, the resultant appreciation of the family, and the lessened demand on nursing staff offer worthwhile benefits in many of the patients, even in some in whom advanced systemic disease prevented survival.

Adult↗
PubMed1978

Occult splenic abscess: an unrecognized complication of heroin abuse.

Despite increased recognition of surgical problems related to narcotic addiction, splenic abscess has not been commonly recognized as such a complication. Seven male patients with splenic abscess secondary to heroin abuse have been treated. Six had bacterial endocarditis. Symptoms were nonspecific. Splenomegaly in two patients was the only useful physical finding. Five patients had left pleural effusion, of which three were proven to be empyemas. Staphylococcus aureus was the predominant pathogen of of bacterial endocarditis and splenic abscess. The splenic scan was diagnostic. All patients recovered following curative splenectomy.

Abscess↗
PubMed1977

Role of colonic bacteria in the pathophysiology of fecal peritonitis.

This study was designed to clarify the role of colonic bacteria in the reactions accompanying fecal peritonitis. Rats were subjected to septic or nonseptic peritonitis induced by fresh fecal suspensions or suspensions pretreated with heat or antibiotic. Measurements during 8 hr in rats with septic peritonitis recorded bacteremia, hypoglycemia dn progressive hemoconcentration, lactacidemia, and hypocapnea. Mortality was 100% by 24 hr. Nonseptic peritonitis produced significantly lesser degrees of hemoconcentration and hypocapnea. Plasma lactate remained in control ranges while plasma glucose concentrations increased slightly. Mortality was 5% in 24 hr. Parameters in control rats were stable over 8 hr. Hepatic oxygen supply was estimated in each group by multiple platinum wire electrodes. Severe hepatic hypoxia was recorded by 6 hr in rats with septic peritonitis. By contrast, nonseptic peritonitis caused a comparatively mild degree of hypoxia. The pathophysiologic developments in septic rats appear to be largely the result of hypovolemia induced by colonic bacteria. Administration of a colloid solution was effective in preventing its development.

Animals↗