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Biomedical subjects

D Mehigan

Publications and source records attributed to D Mehigan.

14 recordsLinked to original sources
PubMed1999

Inferior mesenteric venous sampling, pulse oximetry, and assessment of colonic perfusion during aortic aneurysm surgery.

Ischemic colitis is a serious complication of aortic surgery. The condition continues to be difficult to diagnose at an early stage. This study monitors the biochemical changes in systemic and selective inferior mesenteric vein (IMV) blood sampling during aortic surgery and compares the reproducibility of this method to intraoperative colonic pulse oximetry in a series of 18 patients undergoing infrarenal aortic aneurysm repair. Base excess, pH, pCO2, and lactate were altered by aortic cross-clamping but returned to normal within 48 hr. IMV inorganic phosphate levels were higher than systemic values, suggesting improved sensitivity with selective sampling. BB isoenzymes of creatine kinase remained normal in all patients. Pulse oximetry signals were inconsistently obtained from the colon. This study establishes the physiological changes in IMV biochemistry during aortic surgery. Unlike intraoperative pulse oximetry, selective IMV sampling provides reproducible measurements of colonic perfusion. This simple and safe technique warrants further assessment of its accuracy at diagnosing ischemic colitis.

Alanine Transaminase↗
PubMed1994

Investigation and management of subclavian steal syndrome.

Patients with subclavian steal syndrome present with symptoms of vertebrobasilar ischaemia. Although angiography has traditionally been used to confirm the diagnosis of subclavian steal and plan reconstructive surgery in symptomatic patients, duplex ultrasonography now offers rapid diagnosis and also permits examination of the other extracranial vessels. The treatment of subclavian steal syndrome is surgical. Extra-anatomic bypass procedures are used to increase inflow to the subclavian artery, abolishing the steal phenomenon. Carotid-subclavian bypass or transposition and subclavian-subclavian or axilloaxillary bypass are the procedures of choice; selection is governed by the presence of coexistent carotid artery disease. Percutaneous transluminal balloon angioplasty of the subclavian artery is an alternative treatment, although the long-term patency rate is inferior to that of extra-anatomic bypass.

Carotid Arteries↗
PubMed1989

Role for prazosin in reducing the development of rabbit intimal hyperplasia after endothelial denudation.

Intimal hyperplasia is the universal response to endothelial denudation and occurs after a variety of vascular procedures. In a proportion of cases the smooth muscle cell proliferation may lead to stenosis of the blood vessels. These vessels exhibit increased sensitivity to noradrenaline that can be reduced by the alpha 1-adrenergic antagonist prazosin. Because the alpha 1-adrenergic receptor and platelet-derived growth factor (which promotes vascular smooth muscle cell proliferation) act through the same metabolic pathway, it was postulated that alpha 1-adrenergic blockade might reduce the development of intimal hyperplasia. Twenty-eight New Zealand White rabbits underwent endothelial denudation of the aorta using a Fogarty balloon catheter. Test rabbits were treated with prazosin from the day of operation until they were killed. All rabbits were killed either 1 or 4 weeks after endothelial denudation. Intimal hyperplasia in cross-sections of the aorta was measured using an X-Y digitizer and was standardized in terms of percentage luminal reduction. Prazosin-treated rabbits had significantly less luminal reduction at 1 week (0.75(1.8) versus 9.7(3.1) per cent, mean (s.d.), P less than 0.001) and at 4 weeks (14.7(4.4) versus 25.3(12.8) per cent, P less than 0.05) than control rabbits. It is concluded that prazosin caused a major reduction in the development of intimal hyperplasia.

Animals↗
PubMed1982

Current role of intravenous cholangiography.

One hundred consecutive intravenous cholangiograms were reviewed. In terms of bile duct and gallbladder visualization, 20 were of excellent quality, 40 were of adequate quality, and 40 were of poor quality or did not visualize. In retrospect, 12 of the studies were originally misinterpreted. Among the 29 patients who were eventually proven to have biliary tract disease, intravenous cholangiography was helpful in making the diagnosis in only 17 (59 percent). In 20 patients the study was performed to establish or rule out a diagnosis of acute cholecystitis; the test was helpful in only 9 (45 percent). It is concluded that intravenous cholangiography frequently results in marginal visualization that is subject to interpretive error. With the current variety of available tests that are able to visualize the biliary tree with a high degree of resolution, intravenous cholangiography has become a diagnostic anachronism.

Adult↗
PubMed1981

The role of systemic antibiotics in operations upon the colon.

A prospective randomized clinical trial was carried out to evaluate the role of parenteral antibiotics in elective operations upon the colon. All patients received a mechanical intestinal preparation, neomycin and erythromycin base orally and topical antibiotic administration intra-abdominally and to the wound at the time of operation. The patients were further randomized into three groups. One group received no parenteral antibiotics; the second group received parenteral cefamandole, and the third group received parenteral penicillin, gentamicin and clindamycin. One hundred and thirteen patients completed the study. The sepsis rate postoperatively was similar for all three groups. When oral and topical antibiotics are used in elective operations upon the colon, parenteral antibiotics provide no additional benefit.

Anti-Bacterial Agents↗
PubMed1980

Hepatobiliary complications of ulcerative colitis.

The records of 202 patients with chronic ulcerative colitis seen over a 12 year period were reviewed. Over one half (55 percent) were found to have liver function test abnormalities. These abnormalities correlated with the extent and severity of ulcerative colitis but not with the duration of the disease. Eight patients (4 percent) developed cirrhosis and four required portasystemic decompression for bleeding varices. Four patients (2 percent) developed biliary tract complications. Two patients were diagnosed as having sclerosing cholangitis, and two patients developed carcinoma of the extrahepatic biliary tree. Three of these four patients had whole colon involvement, but all four had mild clinical disease. It is concluded that the hepatobiliary complications of ulcerative colitis are the most frequent and serious extracolonic manifestations of the disease.

Adolescent↗
PubMed1979

Evaluation of atropine in acute pancreatitis.

A prospective randomized clinical trial was carried out to evaluate the efficacy of atropine in the treatment of acute pancreatitis. Fifty-one patients with elevated amylase levels, and with the clinical signs and symptoms of acute pancreatitis, were included in the study. All were treated with fluids intravenously and analgesics, and a nasogastric tube if needed. In addition, on a random basis, 19 were given atropine intramuscularly and 32 were not. The clinical courses of the two groups of patients did not differ significantly.

Acute Disease↗
PubMedDate not supplied

Inferior mesenteric artery aneurysm.

This case reports a very large inferior mesenteric artery aneurysm and highlights the importance of proper preoperative arteriography in the patients work-up. In addition the case demonstrates an anomalous arterial supply to the gastrointestinal tract from a dilated inferior mesenteric artery which due to occlusion of the superior mesenteric artery and coeliac axis may have been instrumental in the development of this aneurysm.

Aged↗