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Biomedical subjects

D E Fry

Publications and source records attributed to D E Fry.

At least 145 records · Page 8Linked to original sources
PubMed1982

Applications of choledochoduodenostomy in biliary tract obstruction.

Forty-three patients each underwent choledochoduodenostomy for distal biliary obstruction. The results were satisfactory for those patients with benign obstructions. Choledochoduodenostomy was complicated by recurrent biliary obstruction in five of 19 patients with obstructing neoplasms, and is generally a poor choice in those circumstances. Choledochoduodenostomy is a useful procedure for patients with benign distal biliary tract obstructions, particularly when dealing with elderly, poor-risk patients.

Adenocarcinoma↗
PubMed1982

Hepatocellular function and nutrient blood flow in experimental peritonitis.

The pathophysiologic basis of organ failure and reduced oxygen consumption in peritoneal infection remains undefined. Plausible explanations include alteration of tissue nutrient blood flow and a primary cellular injury that impairs oxygen metabolism. To define this controversy, we created peritonitis in rats by cecal ligation and puncture. Controls had sham operation. Rats were sacrificed at 6 or 18 hours, liver mitochondria were isolated, and oxidative phosphorylation was studied polarographically. In additional animals indocyanine green (ICG) clearance was studied at low (5 mg/kg) or high (15 mg/kg) doses. The low-dose ICG clearance reflects total hepatic blood flow; a Lineweaver-Burk plot of clearance versus the dose permits extrapolation of clearance to an infinite dose as an indicator of cellular function. Mitochondria studied at 6 hours (n = 10) and 18 hours (n = 10) indicated no differences when compared to paired controls. ICG clearance was unchanged between peritonitis and control rats at 6 hours. However, at 18 hours peritonitis rats had a prolonged half-life of 2.49 +/- 0.31 minutes for the low-dose and 5.29 +/- 0.41 minutes for the high-dose compared to 1.65 +/- 0.07 and 4.34 +/- 0.10 minutes, respectively, for the controls. The Lineweaver-Burk plot of clearance versus dose resulted in peritonitis and control clearance rates intercepting each other at an extrapolated infinite dose. These data indicate that hepatocellular function measured by mitochondrial function and ICG clearance was unaltered. Low-dose ICG clearance indicated reduced total hepatic blood flow. The reduced oxygen consumption in peritonitis appears to have its genesis in altered nutrient blood flow.

Animals↗
PubMed1982

The effects of peritonitis on murine renal mitochondria.

To examine the coupled respiratory functions of murine kidney mitochondria, peritonitis was created in 29 male Sprague-Dawley rats; 29 rats were paired-controls. Peritonitis was created by cecal ligation and perforation. Experimental and control animals were sacrificed at two hours (N = 12), four hours (N = 8), and 6 hours (N = 9), mitochondria were isolated, and state 3, state 4, and Respiratory Control Indices (RCI) were determined. The state 3, state 4, and RCI were unchanged from control values by analysis of variance. From these data, we conclude that the defective oxygen consumptions and organ failure in sepsis is not due to a primary cellular insult to the kidney mitochondria.

Animals↗
PubMed1981

Systemic prophylactic antibiotics: need the 'cost' be so high?

To assess compliance with accepted principles, the use of prophylaxis with systemic antibiotics in selected specialty procedures was examined. The operations reviewed were aortofemoral bypass, pulmonary resections, open-hip procedures, and head-neck cancer procedures that involve the oropharyngeal cavity. Of all patients, 74% received antibiotics preoperatively and 79% received prophylaxis with antibiotics longer than 24 hours postoperatively. Evaluated against the criteria of preoperative initiation and limited postoperative administration (less than 24 hours) only 10% of the patients received appropriate prophylaxis. A 3% incidence of drug-associated complications was identified; each patient with complications had received antibiotics for a prolonged time postoperatively. Reduction in the length of postoperative prophylaxis with systemic antibiotics will reduce (1) the number of drug-associated complications, (2) selection pressures on the hospital microbial population, and (3) needless expense in hospitalized patients.

Anti-Bacterial Agents↗
PubMed1981

Empyema of the gallbladder: a complication in the natural history of acute cholecystitis.

Empyema of the gallbladder was identified in 34 patients. Patients undergoing early operation without attempts at nonoperative treatment had less infectious morbidity and mortality. Delayed operative intervention, extrabiliary abscess, perforation of the gallbladder and common duct exploration are factors that contribute to increased risks in these patients.

Abscess↗
PubMed1981

Surgery in elderly patients.

Operations on patients over 65 years old are increasing steadily in number and complexity. Demographic trends indicate that future increases will be even greater. We reviewed patients having operations of diverse type and magnitude to determine results, with emphasis on the influence of age. Increased risk in older persons was most evident in emergency situations where the frequently associated systemic diseases and the inevitable diminution in organ functional reserves could not be adequately treated or compensated. Appropriate management of elderly patients through surgical procedures requires knowledge of the peculiarities in their responses to disease, medications, and other stimuli.

Aged↗
PubMed1981

Gangrene of the gallbladder: a complication of acute cholecystitis.

Eighteen cases of gangrenous cholecystitis were reviewed to better define causes of morbidity and mortality. All patients in the series presented with signs and symptoms of acute cholecystitis. Cholecystectomy was done as an emergency procedure in 12 patients, while in six patients cholecystectomy followed a failure of nonoperative therapy. Gangrenous cholecystitis in this series was commonly associated with empyema and perforation of the gallbladder. Three of six patients having cholecystectomy after failure of nonoperative treatment died, while only one of 12 patients with immediate cholecystectomy died. This series illustrates that gangrenous cholecystitis usually presents with a clinical picture identical to that of acute cholecystitis. Early operation in the natural history of acute cholecystitis should reduce the frequency as well as the morbidity and mortality of gangrenous cholecystitis.

Acute Disease↗
PubMed1981

Alterations of oxygen metabolism in experimental bacteremia.

To examine the mechanisms underlying organ failure and disordered cellular metabolism in sepsis, systemic oxygenation, hepatic tissue oxygenation, and hepatic mitochondrial metabolism were studied in rats subjected to an LD100 dose of E. coli bacteria administered intravascularly. The animals maintained normal systemic oxygenation and remained normotensive during the six-hour study period. Hepatic tissue pO2 declined nearly 90% in comparison to controls. Isolated hepatic mitochondria demonstrated statistically increased respiratory control indices that are characteristic of cellular hypoxia. Histologic examination of liver tissue showed obliteration of the sinusoids with debris and cellular aggregates. The data suggest that altered cellular oxygen delivery secondary to sinusoidal obliteration may have significance in hepatic failure and subsequent death in septic patients.

Animals↗
PubMed1981

Effects of live Escherichia coli and Bacteroides fragilis on metabolism and hepatic pO2.

Rats were infused intraaterially with 10(9) live E coli, or 10(10) live B fragilis, or 0.9% NaCl solution. Within 6 hr or sooner E coli-treated rats extensive hepatic hypoxia (mean hepatic pO2 less than 5 mm Hg), hypoglycemia, lactacidemia, and microscopic evidence of sinusoidal damage and hepatocyte hypoxia. Mortality was 100% within 24 hr. Rats which received B fragilis showed significantly less hepatic hypoxia (mean hepatic pO2 13.8 mm Hg) and lactacidemia and were euglycemic at 6 hr. Hepatic tissue showed congested sinusoids and depletion of glycogen. Mortality was 0% in 24 hr. NaCl-treated rats were stable over 6 hr of observation; mean hepatic pO2 was 20.6 mm Hg. We suggest that the events associated with acute lethal E coli bacteremia are related in part to strutural interference of the hepatic microcirculation. Although the effects of B fragilis bacteremia were appreciably less pronounced, the ability to establish hypoxic foci may have important implications.

Animals↗
PubMed1981

Once daily dosage versus divided daily doses of carbamazepine therapy in epileptic patients: a pilot study.

The effect of once daily dosage of carbamazepine on fit frequency, electroencephalogram (EEG), behaviour and 24-hour drug levels were compared with those following 2 to 3 divided daily doses treatment. The 14 male epileptics, aged 16 to 18 years, who were studied had already been receiving carbamazepine for an average period of 2.5 years in combination with other anti-epileptic drugs. In this investigation, these patients received their usual daily dose (mean dose 13.9 mg/dg) of carbamazepine in 3-time, twice and once daily regimens. Each treatment period lasted for 4 weeks. Plasma concentrations of carbamazepine and its epoxide metabolite remained within the therapeutic range during the three treatment periods, but the area under the curves were greater during once daily medication. There was also slight decrease in the plasma sodium valproate concentration during the once daily regimen, but the concentrations of other concomitant medication remained unchanged. No significant changes in fit frequency and behaviour were observed athe area under the curves were greater during once daily medication. There was also slight decrease in the plasma sodium valproate concentration during the once daily regimen, but the concentrations of other concomitant medication remained unchanged. No significant changes in fit frequency and behaviour were observed athe area under the curves were greater during once daily medication. There was also slight decrease in the plasma sodium valproate concentration during the once daily regimen, but the concentrations of other concomitant medication remained unchanged. No significant changes in fit frequency and behaviour were observed and none of these patients suffered from any side-effects or toxic effects during once daily medication. EEG revealed a slight increase in abnormality during twice daily medication, but no further deterioration was seen during one daily treatment. In view of this observation, carbamazepine is probably effective as a single daily dose, but further long-term controlled clinical trial in necessary.

Adolescent↗
PubMed1981

Atypical clostridial bacteremia.

Forty-seven patients identified with clostridial bacteremia not characterized by histotoxicity were studied to define better the clinical presentation and results of treatment. Patients were categorized into three groups--one, elderly debilitated patients with multiple associated illnesses and no identifiable focus of infection; two, patients with alcoholism and systemic complications of alcohol abuse and no primary focus of infection, and three, patients with a mechanically treatable primary focus of infection. The over-all mortality was an unacceptable 57 per cent. Antibiotic therapy apparently did not affect the survival rate. Portal bacteremia and ineffective hepatic reticuloendothelial function may be significant factors in those patients without a primary focus of infection.

Aged↗