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Biomedical subjects

D E Fry

Publications and source records attributed to D E Fry.

At least 127 records · Page 7Linked to original sources

Surgical techniques in the management of distal biliary tract obstruction.

Management of obstruction in the distal biliary tree requires the use of different techniques depending upon the cause of obstruction and numerous patient-risk variables. The techniques of choledochoduodenostomy, sphincteroplasty, and choledochojejunostomy are discussed. The common technical component in each of these procedures is the use of monofilament 4-0 polypropylene in a continuous, single-layer technique for all biliary-enteric suture lines. The ease of performance with these methods is emphasized.

Cholestasis↗

The effects of hydrogen-ion concentration on the respiratory efficiency of human liver mitochondria.

To examine the effects of hydrogen ion concentrations on the coupled respirations of isolated human liver mitochondria, eight patients underwent incidental liver biopsies during the conduct of abdominal surgery. Mitochondria were studied by the polarographic technique at pH of 5.5, 6.0, 6.5, 7.0, 7.5, and 8.0. Results indicated severe inhibition of nicotinamide adenine dinucleotide (NAD)-linked substrates but succinate oxidations were minimally affected. Sodium succinate was then studied as a possible substrate in the resuscitation of hemorrhagic shock. Rats were subjected to bleeding to an arterial blood pressure of 50 mm Hg for 3 hours or until 25 per cent of shed blood had to be reinfused to maintain blood pressure. Resuscitation consisted of reinfusion of all shed blood plus a volume of one of four crystalloid regimens: Ringers lactate; isotonic sodium succinate; hypertonic sodium chloride (190 mEq/l): or twice-normal, hypertonic sodium chloride (308 mEq/l). Results indicated that those rats resuscitated with sodium succinate did poorer than animals receiving alternate regimens. The failure of succinate to diffuse across the plasma membrane may explain these data. Additional studies with succinate or a chemical analogue seem warranted.

Animals↗

Associated lung lesions in patients with primary head and neck carcinoma.

From a 9-year Veterans Administration Medical Center experience, 34 patients were identified who had synchronous or metachronous pulmonary lesions in association with primary head-neck carcinoma. Evaluation of the pulmonary lesions included bronchoscopy, mediastinoscopy, and thoracotomy. Lung lesions were felt to be metastatic lesions from head and neck primary in 12 patients, primary lung carcinoma in 20 patients, and metastases from subdiaphragmatic primary neoplasms in two patients. This study demonstrates that head-neck carcinoma may spread to the lung but that associated lung lesions are most commonly second primary neoplasms.

Adult↗

Role of infection in increased mortality associated with age in laparotomy.

Mortality in patients undergoing laparotomy increases with age of the patient. Concomitantly other morbid perioperative factors also are increased, including number and grade of associated system diseases, preoperative infections, severity of disease, emergency operations, post-operative infectious and noninfectious complications, organ failures, and forced secondary operations. All these and other factors may play a role in mortality but two patterns of death are predominant. Some elderly patients present in shock from blood loss or with overwhelming sepsis and die at operation or shortly thereafter. The majority of others who die have intra-abdominal infections preoperatively or they develop infectious complications and these initiate or perpetuate a train of morbid events that prove fatal after days or weeks of intensive supportive therapy. The inability of elderly patients to avoid or to recover from infection appears to be the most common causative factor in increased mortality with age in laparotomy patients.

Age Factors↗

Pulmonary infection complicating intra-abdominal sepsis: clinical and experimental observations.

Pulmonary infection complicating intra-abdominal abscess is a major clinical problem. One hundred and forty-three patients with abdominal abscesses were reviewed; 41 had associated pneumonia by strictly defined criteria. The causative organisms for the pneumonia were Pseudomonas (35), Klebsiella (20), and Enterobacter (16), while abdominal infections were caused by Escherichia coli (22), Klebsiella (21), and Enterococcus (18). The temporal and bacteriologic relationship between the abdominal and pulmonary infection suggested that decreased pulmonary host defenses might be operative in the high incidence of pneumonia observed. An experimental model for intra-abdominal abscess was created using cecal ligation in the rat. Animals with an abdominal abscess had a marked depression of their ability to clear E. coli and Pseudomonas aeruginosa that were injected into the airway. Macrophages from infected animals did not differ in quantity or viability when compared with those in control animals. The ability to ingest bacteria appeared to be normal or enhanced in infected animals, but there was a significant decrease in the ability of the macrophage to kill the ingested organisms. Such macrophage defects may be partially responsible for the infected animals' inability to clear bacteria in a normal manner.

Adult↗

Enterococcal bacteremia: clinical implications and determinants of death.

The pathogenicity of the enterococcus remains controversial despite recognition of this organism in inflammatory exudates. A review of 114 patients with 123 bacteremic events with enterococcus from all hospital services was undertaken. A total of 46% were in the perioperative period. The clinical indications for blood culture varied, but only 19 patients had septic shock at the time. Employing three or more associated diseases as a definition, 71 patients were considered chronically ill. The primary sources of bacteremia were commonly urinary tract (22), soft tissue (17), and intra-abdominal (12). An impressive total of 48 patients had no discernible primary focus of infection. Except for the urinary tract, infections tended to be polymicrobial; 51 patients had associated synchronous or metachronous polymicrobial bacteremias. Antibiotic therapy appropriate for enterococcus did not favorably influence outcome. By chi-square analysis, patients with urinary tract and soft tissue infections had significantly better survival rates than the group as a whole, while patients with intra-abdominal sepsis, polymicrobial bacteremia, or an unknown focus of infection did statistically worse. Enterococcal bacteremia results in a high mortality (54%); its frequent identification with other facultative and anaerobic organisms may indicate that it has a synergistic role; the frequency of unexplained bacteremias stimulates speculation that primary bacteremia from the gastrointestinal tract may be a plausible explanation.

Adult↗

Catheter-associated septic thrombophlebitis.

The clinical presentation and results of management of septic thrombophlebitis in 35 patients over a seven-year period are reviewed. There were 25 men and ten women; 20 patients were over age 50. At diagnosis, fever was present in 33 patients (94%), and 33 (94%) had local signs of inflammation. Pus was expressed from the infusion site in 25 patients (71%). All patients had plastic catheters, with 95% present longer than 48 hours. Klebsiella-Enterobacter was the dominant organism both at the infusion site and in the blood. All patients had surgical excision of the infected vein, followed in 60% by rapid lysis of fever. Other infections were responsible for persistent fever after total excision. Septic thrombophlebitis is best prevented by strict asepsis in catheter placement and rotation of infusion sites every 48 hours. Total excision of the infected vein remains the treatment of choice.

Adolescent↗

A comparison of phenytoin and pheneturide in patients with epilepsy: a double-blind cross-over trial.

A double-blind cross-over trial between pheneturide and phenytoin in ninety-four outpatients with epilepsy is described. There was no significant difference between the frequency of seizures in the two groups. The difficulties in comparing two anticonvulsants of similar efficacy are discussed particularly in relation to ethical problems, the selection of patients and trial design.

Adolescent↗

Bioenergy metabolism of gastric mucosa during stress.

Previous studies have identified a cellular energy deficit in gastric mucosa after ischemia. We studied the processes of energy generation (mitochondrial function) and energy utilization (microsomal adenosine triphosphatase [ATPase] activity) in an experimental model of stress. Rabbits were divided into four groups: I, fed controls (n = 7); II, 24-hour fasted controls (n = 7); III, fasted, anesthetized, and cannulated controls (n = 7); and IV, fasted, anesthetized, cannulated, and bled rabbits. Bleeding consisted of 25 ml blood/kg into a reservoir for 60 minutes; the blood was then reinfused. Animals were killed 30 minutes after reinfusion; antral, corpus, and fundus mucosae were dissected; each region of mucosa was homogenized; and mitochondrial and microsomal fractions were isolated by differential centrifugation. No animals in group I or II had gastric ulcerations. Three of seven animals in group III and all group IV animals had corpus and fundus ulcers. No antral ulcers were seen in any group. The respiratory control index (RCI) of antral mitochondria was increased in groups II, III, and IV but was unchanged in all groups of corpus and fundus mitochondria. Studies of microsomal ATPase activity indicated increased activity of potassium-stimulated ATPase in the corpus mucosa. In the corpus mucosa, total ATPase activity was increased primarily as a consequence of increased potassium-stimulated ATPase. These data indicate that increased RCI is associated with gastric mucosal integrity in the antrum. Accelerated utilization of available adenosine triphosphate by corpus membrane ATPases may further compromise energy homeostasis during stress.

Adenosine Triphosphatases↗

An experimental model of intraabdominal abscess in the rat.

Suitable small animal models of intraabdominal abscess are not available. We have developed a reliable model of intraabdominal abscess in the rat by fasting the animal overnight, devascularizing and ligating the cecum, and injecting 2.5 X 10(8) Escherichia coli and 2.5 X 10(9) Bacteroides fragilis into the ligated cecum. This model results in 39% coli acute mortalities within 48 hours from acute peritonitis, and abscess in 76% of survivals. Subsequent abscesses are 1.0--1.5 ml in volume and contain 4 X 10(8) E coli/ml of pus and 1.4 X 10(9) B fragilis/ml. This model allows chronic evaluation of sepsis in small animals and provides a convenient means to study the abscess microenvironment.

Abdomen↗

Effects of pure or combined inocula of Escherichia coli and Bacteroides fragilis on the liver and related metabolism.

To test for synergy between a facultative and anaerobic bacterium and the role hepatic hypoxia may have in its development, rats were subjected to intravascular infusion of 10(8) Escherichia coli, 10(9) Bacteroides fragilis, or a combination of both. Acute effects were evaluated by selected 6-hour measurements, including hepatic pO2, and longer range effects by liver cultures and histology in rats surviving 7 days. During the acute period, systemic arterial pressure and pO2 in bacteremic groups did not differ from saline-infused controls. However, hepatic oxygen supply was significantly reduced in E. coli rats and those given the combined bacteria (mean hepatic pO2 less than 10 mm. Hg versus 20.8 mm. Hg in controls). Significant increases of plasma lactate and pulse rate were also recorded. By comparison, hepatic pO2 was not reduced significantly in the B. fragilis rats, and pulse rate was similar to controls. Plasma lactate, however, increases more rapidly than in other groups. Survival rates were 100 per cent in the B. fragilis group, 88 per cent in the E. coli group, and 65 per cent in the combined group. The difference between the latter groups was not significant. Hepatic histology was normal in rats of the B. fragilis group at 7 days postchallenge. In survivors of the E. coli and combined inoculum groups, there was evidence of anoxic damage and occasional foci of neutrophilic infiltration. Liver cultures were more often positive in rats of the combined inoculum group (p less than 0.05), most often for E. coli, than in the other groups. In summary, although the acute effects of E. coli were not changed appreciably by combination with B. fragilis, the higher rate of E. coli liver infection in survivors suggests that its viability was enhanced. The role of hepatic hypoxia in this remains unclear. It is feasible that hypoxic foci provided temporary protection for B. fragilis, enabling the organisms to affect favorably the survival of E. coli.

Animals↗

Effects of systemic hyperthermia on the growth patterns of experimental neoplasms.

Hyperthermia has been shown to have a detrimental effect on experimental and human neoplasms. A water bath immersion system is described to evaluate the effects of systemic hyperthermia (SH) on the growth patterns of the Morris hepatoma 7777 in male Buffalo rats. SH and anesthesia were observed to have no long-term detrimental effects on weight trends or chow consumption. Inhibition of growth was demonstrated for this experimental tumor model at extreme SH (41.5 degree to 42.0 degree C), and it was statistically different (P less than 0.01) from the patterns of tumor growth observed in controls and tumor-burdened animals treated with moderate SH (39..5 degree to 40.0 degree C). Cessation of extreme SH resulted in acceleration of tumor growth so that no difference in tumor volume or animal survival was identified SH resulted in retardation of tumor growth patterns, but its effects were not sustained once treatments were stopped.

Animals↗