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Biomedical subjects

D E Fry

Publications and source records attributed to D E Fry.

At least 109 records · Page 6Linked to original sources
PubMed1985

Candida sepsis. Implications of polymicrobial blood-borne infection.

Eighty-three patients with 117 episodes of candidemia were reviewed to examine the clinically significant variables and the results of treatment for this problem. Mortality was 52%. Patients who had bacteremia either synchronously or metachronously in association with Candida species had poorer survival rates. Staphylococcal and enterococcal species were the most frequently associated bacteria. Patients with Candida parapsilosis had better survival rates than patients with other species. Portals of entry for fungemia were catheters, wounds, the urinary tract, and the peritoneal cavity, but were undefined in 54% of patients. Antifungal chemotherapy could not be identified as affecting the outcome in these patients. It is suggested that candidemia in most patients represents a failure of host defense, and that septicemia of either bacteria or fungi may arise from the gastrointestinal tract in critically ill, immunocompromised patients.

Adolescent↗
PubMed1985

Bacterial synergism between the enterococcus and Escherichia coli.

The pathogenicity of the enterococcus in surgical infections remains unclear. To examine this issue, rats received an intravascular infusion of 10(9) enterococcus. No rats died. Rats that received a sublethal inoculum of Escherichia coli with 5 X 10(8) enterococcus had a 40% mortality (P less than 0.05). Cutaneous infections in rabbits with E. coli, Bacteroides fragilis, and enterococcus were examined singly and in combination. Infections with E. coli measured 21 +/- 1 mm, with enterococcus were 15 +/- 1 mm, and with B. fragilis were 9 +/- 1 mm in diameter. When E. coli and enterococcus were combined together, significantly larger cutaneous infections were noted (P less than 0.05). No apparent synergism existed between the enterococcus and B. fragilis. These data indicate a synergistic relationship between the enterococcus and E. coli.

Animals↗
PubMed1985

Abdominal wall repair with polypropylene mesh in pregnancy.

A woman in her 34th week of gestation required emergency appendectomy for perforation, with postoperative wound dehiscence secondary to fasciitis and tension on the suture line. Polypropylene mesh was used to repair the abdominal wall. Fetal distress necessitated a cesarean section. The mother and child both survived without functional impairment. The indications, the disadvantages, and the unresolved issues concerning the use of polypropylene mesh during pregnancy are presented.

Abdominal Muscles↗
PubMed1985

Bleeding from stress gastritis. Has prophylactic pH control made a difference?

Control of intragastric pH with antacids or H2-receptor antagonists is a standard prophylactic treatment routinely used to prevent or control bleeding from acute erosive gastritis (AEG) in critically ill patients on trauma and surgical services. The incidence of bleeding from AEG was documented on these services retrospectively before and after the institution of standard prophylaxis treatment to determine the relative morbidity, mortality, and risk factors of each era. During the preprophylaxis and postprophylaxis era, the incidence of bleeding was the same, 2.3 per cent (13 of approximately 550 patients in each study period). Prior to prophylaxis, three times as many patients required operation (1 versus 3 patients) although the average transfusion requirement was the same (4.4 units of blood). During both eras the majority of patients were septic and showed other signs of organ failure. Inadequate prophylaxis (failure to prescribe or early discontinuation) was documented in over half of the patients who bled and in the patient requiring operation in spite of a departmental interest in stress gastritis prophylaxis. If antacids and H2-receptor antagonists are used routinely, complications from AEG should be reduced. Even with improved methods of pH control, it appears unlikely that this problem will be eliminated.

Adult↗
PubMed1985

Bacterial inoculum and the activity of antimicrobial agents.

Experimental and clinical infections have concentrations of bacteria that are greater than the concentrations used in the laboratory for the determination of in vitro activity. When realistic concentrations are used, the antibiotic activity is reduced. The optimum selection of antibiotics may require a re-examination of the laboratory procedures for the determination of sensitivity data.

Abdomen↗
PubMed1985

Subpopulations of skeletal muscle mitochondria: response to ischemia.

The respiratory activity of distinct populations of subsarcolemmal (SS) and interfibrillar (IF) skeletal muscle mitochondria was studied in rat hindlimb muscle subjected to 30 min of global ischemia at 37 C. State 3 (ADP-dependent) and state 4 (ADP-independent) rates of respiration were determined polarographically using glutamate as the substrate, in order to calculate the respiratory control index (RCI). The RCI is the ratio of state 3 to state 4 respirations and is a sensitive indicator of mitochondrial coupling. An approximately 20 per cent decline in RCI was noted in the SS mitochondria following 30 min of warm ischemia. This decrease was a direct result of a significant decline in the state 3 respiratory rates. IF RCIs following the ischemic interval were not different from control. These data support the concept of separate populations of mitochondria within the skeletal muscle cell and demonstrate a specific injury pattern in the response to ischemia.

Animals↗
PubMed1984

Early urgent relaparotomy.

We analyzed the indications for and implications of reoperation in 113 patients who required early urgent relaparotomy. Infection with intact organs was the most common indication, causing the most diagnostic difficulties, and presenting the most varied findings. Suture-line leaks and dehiscence were next in frequency. Bleeding caused the earliest relaparotomies and obstruction, the latest. In seven patients a technical error at the primary laparotomy was identified, and in 56 patients an error of some sort was presumed. High-mortality categories were identified, including the elderly, who were particularly susceptible if bleeding or after an emergency primary laparotomy. An aggressive policy of reoperation resulted in 59 survivors and seems to be the only practical approach in the treatment of these usually desperately ill patients.

Aged↗
PubMed1984

Postoperative pneumonia. Determinants of mortality.

Postoperative pneumonia continues to be a major cause of mortality on surgical services. The determinants that affect survival in patients in whom postoperative pneumonia develops are not clearly defined. We completed a retrospective analysis of 136 patients in whom postoperative pneumonia developed after they had major operative procedures between 1974 and 1980. These patients represented 1.3% of all operative cases, yet comprised 10% of the total 614 patients who died during the study period. The average age of the patients in whom pneumonia developed was 66 years. Significant determinants of death by chi 2 analysis included gram-negative pneumonitis, emergent operation, respirator-acquired pneumonia, postoperative peritonitis, and several factors that suggested that host defenses were overwhelmed (remote organ failure, positive blood cultures, or spread of infection to the second lung). We concluded that postoperative pneumonia is a disease of elderly patients and that survival depends on the ability of the surgeon to help the patient localize and resist the challenge presented by virulent gram-negative organisms.

Aged↗
PubMed1984

Surgical suite reconstruction. Infection control.

Careful literature review revealed little information on the safety of using an operating room during major renovation. This study sought to determine if an operating room under renovation increases infectious morbidity in the surgical wound. The observations of this study indicate that it is possible to use a properly ventilated operating room undergoing renovation if the precautions of controlling construction traffic, sealing off the construction area from the OR in use, fastidious housekeeping, environmental culturing, and careful surveillance of wound infections are used.

Air Microbiology↗
PubMed1984

The inhibition by etomidate of the 11 beta-hydroxylation of cortisol.

The effect of a sleep-dose of etomidate on the plasma concentrations of cortisol, 11-deoxycortisol and 17 alpha OH-progesterone was investigated in eight patients; two other patients received thiopentone. Blood samples were collected at 0, 15 and 30 min after etomidate or thiopentone when an injection of tetracosactrin was given and a final sample was collected at 60 min. The plasma cortisol response to tetracosactrin was depressed below normal in patients given etomidate, and the 11-deoxycortisol response was very high, ranging from 36.4 to 184.7 nmol/l. The two patients that received thiopentone had a normal response to all steroids. The identity of the plasma 11-deoxycortisol in two patients was confirmed by high-performance liquid chromatographic separation and quantification by both spectrophotometric and radioimmunoassay measurements. These results suggest that a single dose of etomidate inhibits 11 beta-hydroxylation of cortisol.

17-Hydroxycorticosteroids↗
PubMed1984

The symptomatology of the climacteric in relation to hormonal and cytological factors.

Climacteric symptomatology was investigated in a group of non-selected women aged between 54 and 56 years of age, Vasomotor complaints and dyspareunia, in particular, were noted and related to plasma hormone levels and vaginal cytology. Only 33% of those women who were within 5 years of the menopause had symptoms of a magnitude that might require hormone replacement therapy. Neither the vasomotor complaints nor dyspareunia correlated with the hormone levels or cytology findings to such an extent as to be helpful in planning treatment. Apparently only a minority of women in their middle 50s demonstrate a symptomatic need for hormone replacement therapy and laboratory investigations are of little use in their identification.

Cervix Uteri↗
PubMed1984

Splenectomy in hematologic malignancy.

Fifty patients undergoing splenectomy for complications of hematologic malignancy were reviewed to define indications and results. Primary diseases included lymphoma (n = 14), chronic lymphatic leukemia (n = 13), hairy-cell leukemia (n = 12), myeloid metaplasia (n = 6), and other similar disorders (n = 5). Indications for splenectomy in these patients included cytopenia (n = 37), diagnostic laparotomy (n = 8), "small stomach" syndrome (n = 3), and abdominal pain (n = 2). Splenectomy was performed by the midline approach in 32 patients. In 40 patients, the splenic artery was ligated prior to mobilization of the spleen. The spleens averaged 1650 g; in eight patients accessory spleens were removed. Additional surgical procedures included liver biopsy (n = 30), lymph node biopsy (n = 15), and cholecystectomy (n = 3). Intraoperative blood loss averaged 750 ml. In 14 patients, drainage of the left subphrenic space was used. Splenectomy was effective in 36 of 50 patients. In seven patients, splenectomy was ineffective in correction of cytopenia. Seven mortalities were from bleeding (n = 2), pulmonary embolus (n = 2), postoperative sepsis (n = 2), and progression of primary disease (n = 1). Additional complications included reoperation for bleeding (n = 3), septic complications including pneumonia (n = 14), wound infection (n = 4), and intra-abdominal abscess (n = 2). Splenectomy for the patients with hematologic malignancy is generally effective. Meticulous hemostasis, timely administration of intraoperative platelets, surgical asepsis, and aggressive pulmonary care are essential to reduce morbidity and mortality.

Adult↗
PubMed1984

The impact of demographic trends on hospital surgical care.

The projected increase in numbers and percentages of elderly people has great potential impact on health services generally. Only rarely, however, has the impact of age of patients on a surgical service been quantitated. Two hundred fifty-five consecutive laparotomies performed in men older than 65 years of age were compared with 174 consecutive laparotomies in men younger than 65 years of age, all from a Veterans Administration Medical Center experience. Morbid factors, including mortality, increased with age with the greatest increments over the age of 75 years and especially over the age of 85 years. An intensity-of-care index was devised; the intensity-of-care ratios progressively increased with age. Unless there are significant technical advances, future surgical results will not be as good as they are at present, since the patient composition will be less favorable. Any estimates of the costs of surgical care in the future must include the projected age of patients as a major factor.

Abdomen↗
PubMed1983

Endotoxin, cellular function, and nutrient blood flow.

To study the effects of endotoxemia on hepatic mitochondrial function and nutrient blood flow, rats were given intraperitoneal Escherichia coli endotoxin at a lethal dose for 90% mortality of group. Controls received only diluent. Five hours after the onset of endotoxemia, paired experimental and control animals had indocyanine green (ICG) clearance determined as the half-life (t1/2) at low (5 mg/kg) or high (15 mg/kg) doses. Low-dose ICG clearance represented hepatic nutrient blood flow; a Lineweaver-Burke plot of clearance rate v dose of administration provided extrapolation to an infinite dose and served as a sensitive indicator of hepatocellular function. Additional endotoxic rats were killed at five hours, liver and kidney mitochondria were isolated, and isolates were studied by the polarographic technique; the respiratory control index was determined as a sensitive indicator of efficient cellular oxygen metabolism with glutamate and succinate as substrates. Our data indicated that (1) uncoupling of the mitochondrial function is not identified during the early phase of endotoxemia, (2) reduced nutrient blood flow occurs during this early phase of endotoxemia, and (3) subsequent cellular abnormalities in endotoxemia may be secondary to ischemia and not direct cellular injury.

Animals↗
PubMed1983

Iatrogenic ureteral injury. Options in management.

Twenty-five patients sustained 27 iatrogenic ureteral injuries during various operative procedures. Injuries were managed by ureteroureterostomy in 11 injuries, ureteroneocystostomy in 11, nephrectomy in two, ureteral stent in one, cutaneous ureterostomy in one, and reimplantation into an ileal conduit in one. Four of 25 patients died, three as a result of the failure of ureteral repair and intra-abdominal sepsis. Short-term failure of repair occurred in five patients; long-term failure occurred in three. All patients with injuries missed during the primary operation had poor results of ureteral reconstruction. Immediate recognition of accidental ureteral injury provides optimum results. Injuries within 4 cm of the ureterovesical junction are managed by ureteroneocystostomy; injuries greater than 4 cm, by ureteroureterostomy. Crush injuries require immediate placement of a ureteral stent. Prior pelvic radiotherapy or intra-abdominal infection should preclude any attempt at primary reconstruction.

Adult↗
PubMed1983

Effect of dosage frequency of carbamazepine on drug serum levels in epileptic patients.

The effect of dosage frequency of carbamazepine (CBZ) (brand name Tegretol) on pseudo-steady state drug serum levels were studied in 14 male (16-18 years) epileptics. They had already been receiving CBZ (mean dose 13.7 mg/kg) for an average period of 2.3 years in combination with other antiepileptic drugs. During this investigation, total daily CBZ dose was kept unaltered, but they received medication in thrice, twice and once daily dosage regimes. Each treatment period lasted for 4 weeks. The profiles of 24 h serum drug levels as assessed at the end of each treatment period, were observed to be within the therapeutic range during these 3 regimes. However, as expected, there were higher fluctuations of serum CBZ concentrations during once daily medication than during divided dosage regimes. Other concomitant antiepileptic drugs were continued in 2-3 divided daily doses during these 3 treatment periods, and the serum drug levels were measured at 8 h prior to the morning dosing. The concentrations of other drugs remained unchanged apart from a slight decrease in the serum sodium valproate levels during once daily medication. No clinical or electroencephalographic adverse effects were observed and there was no significant change in the fit frequency. In view of this observation, CBZ (Tegretol tablet) is probably effective as a single daily dose, but further long-term controlled clinical trial is necessary.

Adolescent↗
PubMed1983

Erythrocyte sodium-potassium-stimulated adenosine triphosphatase activity is not related to obesity.

Altered erythrocyte sodium potassium (Na,K)-stimulated adenosine triphosphatase (ATPase) activity has been cited as having pathophysiologic significance in morbidly obese man. Previous studies have failed to consider obese patients after weight loss and, therefore, did not clarify the role of ATPase deficiency as a cause or effect of the obese state. To define more completely the possible alteration of cellular thermogenesis in obesity, a study was made of three groups of people: (1) normal weight controls; (2) morbidly obese; and (3) formerly morbidly obese patients who had lost over 100 pounds after gastric bypass surgery. Erythrocyte ATPase activity was determined by use of an assay that coupled ATPase activity with NADH oxidation in the presence of excess pyruvate kinase, lactic dehydrogenase, and phosphoenolpyruvate. This coupled assay produced a continuous slope so that activity could be calculated from the initial, maximal, linear portion of the decay trace. Results did not demonstrate any statistically significant differences in Na,K-ATPase activity between groups by analysis of variance. A nonsignificant correlation of 0.086 was seen between obesity index and Na,K-ATPase activity. It is concluded that (1) erythrocyte Na,K-ATPase activity is similar in both normal and obese individuals, (2) erythrocyte Na,K-ATPase does not change with weight loss, and (3) therefore, disordered erythrocyte thermogenesis does not have a role in the development or maintenance of obesity.

Adult↗