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E A Talman

Publications and source records attributed to E A Talman.

5 recordsLinked to original sources

Medial collagen organization in human arteries of the heart and brain by polarized light microscopy.

The mechanical properties of collagen as a biopolymer ensures that collagen has a significant influence on the mechanical behavior of the host tissue. Structural organization is a key to that influence. We have assessed this relationship quantitatively in the tunica media of arteries from the heart and brain, using the polarizing light microscope and Universal stage. Arteries from 22 autopsies were isolated, cannulated and fixed with 10% buffered formalin, at a distending pressure spanning normal values in vivo. We prepared the tissue for light microscopy, with paraffin embedding, sectioning at 7 microns, and staining with picrosirius red to enhance the natural birefringence of medial collagen. Individual measurements, 30 to 50 per arterial section, referenced against the central axis of the vessel segment, revealed a coherent organization, with an average orientation which was within 1 to 2 degrees of being perfectly concentric for all artery segments. Analysis was done with Lambert projections and circular statistics. We calculated the circular standard deviation, which was 5.2 degrees for 27 brain arteries (S.D. 1.9 degrees) and 5.6 degrees (S.D. 2.1 degrees), for 5 coronary arteries sectioned at less than 15 degrees. Our interpretation is that medial collagen can be strained even though highly aligned, revealing a mechanical property which contrasts that of type I collagen.

Azo Compounds

A 25-year experience with total portosystemic shunts and reappraisal of colon exclusion.

The results of 43 total shunt procedures for bleeding esophageal varices performed consecutively at two community hospitals from 1956 to 1981 are reviewed. Of 15 patients with immediate preoperative bilirubins greater than 2.0 mg/dl, 11 died following shunt surgery. Of 28 other shunted patients with immediate preoperative bilirubins of less than 2.0 mg/dl, there was only one in-hospital death, thus substantiating the contention that the last preoperative serum bilirubin value is the best predictor of operative mortality. Of ten patients with appreciable ascites verified at the time of operation, there were only two survivors, and both of these had preoperative bilirubins of less than 2.0 mg/dl. Twenty-nine of the 31 patients who left the hospital were still living at least one year after operation. All 23 patients operated on prior to 1977 were available for 5-year follow-up, and there were 14 survivors (60%). Thirteen of the 31 patients (42%) manifested some degree of hepatic encephalopathy, as interpreted by necessity for protein restriction and either Neomycin or Lactulose. Incapacitating post-shunt hepatic encephalopathy developed in one patient who required recurrent hospitalizations for episodic coma. This patient underwent a total abdominal colectomy and ileorectal anastomosis, with elimination of all episodes of encephalopathy for the subsequent 4 1/2 years. The previous 16 cases in the literature of surgical treatment of post-shunt encephalopathy are reviewed, and the efficacy of such colon exclusion is reassessed.

Adult

Role of arteriography in rectal hemorrhage due to arteriovenous malformations and diverticulosis.

Nine patients with arteriographic right colon arteriovenous malformations (AVM's) are reviewed. Even though five of the eight surviving patients had diverticulosis in remaining colon, right colectomy with removal of the AVM effectively controlled bleeding in seven of the eight patients in follow-up intervals of 14-66 months. Such results suggest that right colon AVM, rather than diverticulosis, may be the more common cause of chronic recurrent lower intestinal hemorrhage in the elderly. Rebleeding occurred in one patient and has heretofore been reported in seven cases. However, since AVM bleeding is rarely life-threatening, right colectomy for chronic recurrent rectal bleeding is justifiable as the initial operative procedure for an AVM, even in the presence of left colon or sigmoid diverticulosis. In the same five year period, 1973-1977, four additional patients with massive hemorrhage, characteristic of diverticulosis, had emergency arteriography with demonstration of a localized site of diverticular bleeding that was controllable by partial colon resection. Consequently, segmental resection of the colon, utilizing selective arteriography, has thus far eliminated bleeding in eight of nine patients with diverticulosis. The judicious use of arteriography in patients with diverticulosis and rectal bleeding substantially reduces the requirement for subtotal colectomy and ileoproctostomy.

Adult