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Biomedical subjects

D State

Publications and source records attributed to D State.

At least 37 records · Page 2Linked to original sources

Injuries to the inferior vena cava and their management.

Injuries to the inferior vena cava are being seen with increasing frequency in the civilian population. A review of the experience at UCLA/Harbor General Hospital Medical Center over a ten year period (1966 to 1976) discloses thirty-four patients with major injuries to the inferior vena cava, with an overall mortality of 53%. The factors that appear critical to patient survival are: (1) level of injury (suprarenal versus infrarenal sites); (2) presence or absence of profound shock on admission; and (3) the speed with which diagnosis is made and treatment carried out. Technical considerations regarding identification and handling of inferior vena caval injuries are presented. The mortality rate for major inferior vena caval injuries remains distressingly high and serves as a challenge for future improvement.

Abdominal Injuries↗

Segmental gastric antral resection in experimental peptic ulceration.

In using the technique of histamine in beeswax peptic ulceration in dogs, these experimental preparations were studied as to their efficacy to protect against ulceration: laparotomy controls; bilateral truncal vagotomy and pyloroplasty; a 50 per cent gastrectomy and vagotomy plus a Billroth II gastrojejeunostomy; a 50 per cent segmental resection of the gastric antrum and corplus plus bilateral truncal vagotomy and pyloroplasty; a 75 per cent gastrectomy and Billroth II gastrojejeunostomy, and a 75 per cent segmental resection of the gastric antrum and corpus and bilateral truncal vagotomy and pyloroplasty. Only a 75 per cent gastrectomy Billroth II and a 75 per cent segmental resection of the antrum and corpus plus vagotomy and pyloroplasty consistently protected against histamine in beeswax induced ulceration.

Animals↗

Relative hemodynamic effectiveness of whole blood and plasma expanders in burned patients.

In a series of nine fatally burned patients, hemodynamic and oxygen transport measurements were made before, during and after 56 administrations of 500 milliliters of whole blood or colloids and 1,000 milliliters of crystalloids. To enhance comparability, 38 of these studies were conducted at intervals on the same patient, the patient serving as his own control. The data indicate greater hemodynamic responses to colloids than to whole blood and greater responses to whole blood than to crystalloids when the latter was given at twice the volume as well as at four times the volume of the colloid. The data suggest that, in addition to replenishing salt and water, restoration of hemodynamic and oxygen transport variables may be accomplished by expansion of plasma volume with colloids and whole blood. Adequate nutrition is also needed for the increased metabolic needs of the burned patient. Without supplemental nutrition, high grade plasma proteins and tissue proteins may be expended as energy substrates; the lowering of plasma proteins tends to redistribute water from the plasma to the interstitial phase, which increases further the peripheral edema.

Blood Pressure↗

Septic complications of pancreatitis.

Over an 11-year period 693 patients with acute pancreatitis and 317 with chronic pancreatitis were seen at the Harbor General Hospital. Review of these cases revealed 9 patients with primary pancreatic lesser sac abscess and 11 with secondary abscess. The appropriate management for pancreatic abscess, whether primary or secondary, is early recognition and drainage; multiple drainage procedures may be necessary. Broad spectrum antibodies appear to be helpful and should be used until cultures indicate more appropriate antibiotic therapy. Successful management involves prolonged hospitalization, but contrary to previous reports the success rate is surprisingly high. Eight out of 9 patients with primary abscess and 8 out of 11 patients with secondary abscess survived.

Abscess↗

Asymptomatic primary hyperparathyroidism.

With the advent of automated equipment for blood chemistry determinations, many patients are presenting with asymptomatic or "biochemical" hyperparathyroidism. In the present series, of 136 patients operated on for hyperparathyroidism, fifty-three were considered asymptomatic. In fifty-one patients, parathyroid pathologic conditions were found; in one patient, it is probable that an adenoma had been missed, and in the other, it is presumed that an error in diagnosis was made. We recommend that surgical exploration be considered as an acceptable alternative to watchful waiting for patients with asymptomatic hyperparathyroidism.

Adenoma↗

Benign obstructing papilloma of the ampulla of Vater in infancy.

Obstructive jaundice due to benign neoplasms of the extrahepatic bile ducts is rare in all age groups. A case is reported which represents the first obstructing papilloma of the ampulla of Vater found in the pediatric age group and the literature pertaining to benign obstructing neoplasms is reviewed briefly. Differential diagnosis of persistent jaundice past the immediate neonatal period is discussed and the need for operative cholangiogram and open liver biopsy in difficult cases is stressed. Obstructing papillomas and other neoplasms of the extrahepatic bile ducts should be added to the differential diagnosis of jaundice in the pediatric age group.

Ampulla of Vater↗