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Biomedical subjects

E G Ford

Publications and source records attributed to E G Ford.

At least 37 records · Page 2Linked to original sources
PubMed1991

Sepsis after coronary bypass grafting: evidence for loss of the gut mucosal barrier.

Postoperative infections may originate from a patient's gastrointestinal tract. We studied infections after coronary artery revascularization. Three hundred twenty-nine patients underwent coronary artery revascularization from January 1987 to March 1990. Eight of the 329 (2.4%) died; none of the deaths were infection related. Fifty-five culture-proven infections were identified in 22 of 321 survivors (6.8%); 9 infections (16%) were gram-positive, 5 (9%) were fungal, and 41 (75%) were gram-negative. Site of infections were respiratory tract, 58%; urinary tract, 18%; blood, 13%; and mediastinum, 11%. Ninety-six percent of respiratory tract and all urinary tract infections were gram-negative or fungal. There was no significant difference between infected and noninfected groups in sex, age, smoking history, preoperative hematocrit or leukocyte count, serum albumin level, or time on extracorporeal bypass. The infected group required intubation and nasogastric suction for a significantly longer time than the noninfected group (p less than 0.001). Time to enteral alimentation was significantly longer in the infected group (p less than 0.02). We were unable to correlate the number of infections with the lengths of intubation, nasogastric suction, or time to enteral alimentation. This study supports the concept of postoperative infections arising from bacterial translocation across the patient's gastrointestinal tract. The most significant risk factor is the length of the gastrointestinal tract disuse.

Adult↗
PubMed1991

The impact of extracorporeal membrane support in the treatment of congenital diaphragmatic hernia.

Neonates with congenital diaphragmatic hernia (CDH) treated by immediate surgical intervention and conventional ventilatory support have an overall poor survival. The potential of extracorporeal membrane oxygenation (ECMO) therapy to improve survival of infants with CDH remains controversial. Comparison was made in a single institution's pre-ECMO and post-ECMO survival statistics to establish efficacy of extracorporeal support for persistent pulmonary hypertension (PPH). This study was accomplished by stratifying patients by an oxygen index (OI). Sixty-eight patients were treated for CDH from 1977 to 1986 without ECMO. Fifty-eight patients underwent repair of CDH within the first 24 hours of life. Data could be retrieved for calculation of the OI in 46 patients. Nineteen patients developed an OI of 40 or greater; one survived (5%). Three of 27 patients with an OI less than 40 died (OIs = 34, 38, and 38). Thirty-one patients were treated from 1987 to 1989 and none were excluded from ECMO based on a minimum PO2. Fifteen had an OI less than 40 (range, 1 to 38), were treated conventionally, and 13 survived (87%). Sixteen patients had an OI greater than 40 and 13 qualified for ECMO. Nine of 13 survived (69%). Comparing pre-ECMO and post-ECMO survival for infants with an OI of 40 or greater (5% v 69%), there is a significant improvement in survival when ECMO is used (P less than .001). ECMO support offers a strong adjunct in management of neonates with CDH who develop PPH.

Extracorporeal Membrane Oxygenation↗
PubMed1991

Fecal fat, cyclosporine, and alpha 1-antitrypsin for assessment of small bowel function following transplantation.

Many factors affect the integrity of transplanted small bowel. These include ischemic preservation and immunologic injury as well as the division of intestinal lymphatics during transplantation. This study was undertaken to evaluate the recovery of fat absorption in transplanted small bowel in syngeneic rats. Orthotopic transplantation of the total small bowel with resection of the native intestine was performed. The experimental (n = 11) and a pair-fed, sham-operated control (n = 8) groups were fed a 50% kcal corn oil semipurified diet. Studies of cyclosporine (CSA) absorption, maltose absorption, dietary fat, and fecal alpha 1-antitrypsin (FA1AT) excretion in transplanted animals were performed preoperatively and at 15, 30, and 50 days postoperatively. There was no significant difference in the weight change or fat and maltose absorption in experimental animals compared with control animals at any time point. Peak serum CSA levels were lower at day 15 in transplanted animals than in controls (P = 0.006) and improved but remained lower than those in controls at days 30 and 50 (P = 0.017). FA1AT excretion was increased on postoperative day 15 (accompanied by a decrease in body weight) and returned to control levels at days 30 and 50. Transplanted isogeneic rats had weight recovery and fat and carbohydrate absorption similar to those of controls. Transplanted animals had a protein-losing enteropathy measured by FA1AT at day 15 that resolved by 30 and 50 days, respectively. CSA absorption showed a much more gradual return to control levels and remained abnormal at 50 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Vascular access in the neonate following extracorporeal membrane oxygenation.

An infant maintained on extracorporeal membrane oxygenation (ECMO) has unlimited vascular access. When the infant is returned to conventional ventilator therapy, the need for vascular access persists for days to weeks. Providing alternative central venous access may be problematic, particularly while the infant is still heparinized during the first 12 hours after decannulation. In this study, secondary central venous catheters (CVC) were placed, at the time of decannulation, into the internal jugular vein from which the venous bypass cannula is removed. Fifty-four of 90 infants supported with ECMO had secondary CVCs placed (60%) and vascular access maintained for 2 to 122 days (mean, 17.5 days). Four catheters were removed for culture-proved line sepsis (7.4%). Neck wounds were reexplored for bleeding, while on bypass, in 2 of 4 patients in the sepsis group. There were no deaths related to catheter sepsis. Catheter-related septic infants had been on bypass for 50 to 88 hours (mean, 72.7 hours) as compared with 11 to 312 hours (mean, 104 hours) for the entire ECMO group, P = NS. This experience (942 catheter-days) suggests that secondary CVC placement into the vein used for bypass is safe with infectious complications comparable to catheters placed through primary wounds. Infants requiring neck explorations for bleeding while on bypass are not candidates for secondary CVC placement.

Catheterization, Central Venous↗
PubMed1990

Stimulation of wound bursting strength during protein malnutrition.

Nutrition is one of the most important factors affecting wound healing. Patients who have significant protein malnutrition and require emergency surgery are frequently encountered. Conventional nutritional preparation for surgery, with intravenous hyperalimentation, requires 10 to 14 days to demonstrate advantageous reversal of catabolism. Growth hormone is known to have an anabolic effect in malnourished animals. The purpose of this investigation was to study the ability of growth hormone, administered from the time of celiotomy, to improve wound strength in protein-malnourished animals and compare its efficacy with preoperative nutritional repletion. Rats were divided into four groups: Group I--normal control rats, group II--malnourished rats, group III--malnourished rats treated with growth hormone for 5 postoperative days, and group IV--malnourished rats refed normal chow for 3 days before operation. Controlled laparotomy wounds were closed with monofilament nylon which was removed at the time wound bursting strength was tested. Bursting strengths at the sixth day postoperative were as follows (means +/- SD): (table; see text) Wound strength of malnourished animals was significantly less than that of controls, (P less than 0.001). Wound bursting strength of groups III and IV was significantly improved over that of malnourished animals (group II), P less than 0.001. The bursting strength of group IV was significantly higher than that of group III. Growth hormone administration following celiotomy is nearly as effective in improving wound healing as preoperative nutritional repletion. These results suggest that growth hormone may be clinically applicable in preventing wound complications in malnourished patients requiring urgent or emergency laparotomy.

Abdomen↗
PubMed1990

The effect of perioperative exogenous growth hormone on wound bursting strength in normal and malnourished rats.

Patients with significant malnutrition secondary to underlying disease may require major surgical intervention on an urgent basis. Nutritional restoration using enteral or intravenous alimentation requires a delay of 10 to 14 days and is frequently not practical. With the availability of human growth hormone (GH) produced by recombinant DNA technology, this study was undertaken to evaluate the effect of exogenous GH on wound tensile strength in a rat model. Fifty-four animals were divided into three groups: group I, normal nourished control; group II, malnourished; group III, malnourished, rat GH treated (1 mg GH administered 3 days preoperative and 5 days postoperative celiotomy). Wound tensile strength was measured at 6 days postoperatively. Wound strengths in malnourished rats were significantly less than in normal controls (P less than .001). With the administration of growth hormone in group III, wound strength was significantly improved when slightly improved over normally nourished controls (P less than .05). A dose response curve demonstrated progressive improvement in wound tensile strength from 0.01 mg/d to 1.0 mg/d. Thus growth hormone administration to malnourished animals significantly enhances wound strength. With the availability of recombinant produced human GH these observations may be clinically applicable.

Abdominal Injuries↗
PubMed1990

Wound collagenase activity correlates directly with collagen glycosylation in diabetic rats.

Extracellular glycosylation of proteins in diabetics may contribute to observed impairments in wound healing. We investigated the interactions of blood glucose concentration and wound collagen glycosylation, collagen content, and proteolytic activity during wound healing in diabetic animals. Rats were made differentially hyperglycemic with intraperitoneal injection of streptozotocin (0-65 mg/kg body weight). Animals with blood glucose concentrations greater than 240 mg glucose/dL were classified as diabetic, those with blood glucose concentrations less than 160 were grouped as nondiabetic. Polytetrafluoroethelene (PTFE) wound cylinders were surgically implanted in 32 rats and removed on postoperative day 5. Harvested cylinders were analyzed for hydroxyproline content, collagen glycosylation, and collagenase and protease activity. Collagenase activity was 14% higher in diabetics than nondiabetics (P less than .001). Glycosylation of wound collagen averaged 48.0% higher in diabetics (P less than .001). Wound hydroxyproline content was 39% lower in diabetics (P less than .05). Studies show a high degree of correlation (Pearson) of wound collagen nonenzymatic extracellular glycosylation (NEG) with mean blood glucose concentration (r = .98, P less than .001). Wound collagen glycosylation correlates strongly with both protease activity (r = .86, P less than .001) and collagenase activity (r = .83, P less than .001). This study demonstrates a significant blood glucose concentration dependent increase of glycosylation in newly synthesized collagen in hyperglycemic animals that is associated with increased collagenase activity and decreased wound collagen content.

Animals↗
PubMed1990

It may be more significant than you think: BB air rifle injury to a child's head.

BB guns of 20 years ago were constructed of coils and springs which generated relatively little force, so that a projectile posed little threat of serious injury. Today, the coil and spring construction has been replaced by pump action pneumatic chambers which allow generation of muzzle velocities near 350 ft/sec. Speeds of 150 ft/sec and 200 ft/sec are required for skin penetration and bone penetration, respectively. We present a seven-year-old boy who suffered intracranial parenchymal injury from an air-powered BB gun projectile while playing with friends. We discuss literature which suggests these once-innocent toys are now harbingers of severe, if not fatal, injury.

Child↗
PubMed1990

Value of the O-nitrophenyl-beta-D-galactopyranoside test to differentiate among the aerobic actinomycetes.

A comparative study to determine beta-D-galactosidase activity among 171 strains of aerobic actinomycetes (including mycobacteria and rhodococci) was performed by using two growth media and four O-nitrophenyl-beta-D-galactopyranoside (ONPG) substrates. The ONPG test was found to be a valuable screening test to differentiate between the ONPG-positive Nocardia spp. and the rapidly growing ONPG-negative mycobacteria and rhodococci. However, ONPG results varied significantly depending on the growth medium and test substrate used.

Actinomycetales↗
PubMed1990

Emergency center laboratory evaluation of pediatric trauma victims.

Emergency center (ER) trauma evaluations often include leukocyte count (LC), serum amylase (SA), electrolytes (EL), and urine analysis. We reviewed records of 100 pediatric ER patients to determine utility of these tests in management of blunt injury. SA was evaluated in 65 patients and ranged from 30-146 U/L (mean 50.6 U/L); 14 patients with normal CT scans had SA from 30-68 U/L (mean 49.1 U/L). Six patients with intraabdominal or retroperitoneal injuries had SA from 30-130 U/L (mean 64.0 U/L), P = NS. LC was determined in 76 patients and ranged 2.3-28.3 k/ml (mean 13.8 k/ml). Patients with normal abdominal CT (12) had mean LC 14.8 k/ml (range 7.2-19.6 k/ml). Eight patients with injuries on CT had mean LC 14.4 k/ml (range 3.5-27.1 k/ml). ER, SA, and LC did not alter patient management. Thirty-four patients had serum sodium, 36 potassium, and 33 chloride and bicarbonate determinations. Sodium, potassium, and chloride levels were uniformly normal; bicarbonate and leukocyte counts were uniformly abnormal in initial evaluations. These changes are expected in response to severe injury and their determinations did not alter patient care. Combined laboratory urinarlysis (LA) and urine dipstick (DA) analysis for hematuria had sensitivity 75.0 per cent (specificity 81.6%). LA predicted injury with sensitivity 75.0 per cent (specificity 81.6%). DA predicted injury with sensitivity 60.0 per cent (specificity 79.2%). DA accurately represented LA results (sensitivity 100%, specificity of 94.5%). DA is a rapid and effective replacement of LA in evaluation of trauma patients in the emergency center.

Amylases↗
PubMed1990

Partial splenic embolization. An effective alternative to splenectomy for hypersplenism.

Splenectomy for massive splenomegaly and hypersplenism carries a significant morbidity and mortality. We have used partial splenic embolization (PSE) as an effective alternative to splenectomy. Ten PSE procedures were performed on nine patients without mortality and with minimal morbidity. The age of the patients ranged from 8 months to 32 years (mean 14 years). The causes of splenomegaly and hypersplenism included cystic fibrosis with cirrhosis (2), tyrosinemia and cirrhosis (1); thalassemia (1), hemophilia with Human Immune Deficiency Virus infection (2), chronic hepatitis with portal hypertension (1), malignant histiocytosis (1), and Wiskott-Aldrich Syndrome (1). All procedures were performed under local anesthesia with sedation. A percutaneous femoral artery approach to the splenic artery was used to deliver Ivalon sponge particles (280-800 microns) into the spleen. Splenic infarction was assessed by postembolization angiograms. All of the patients except one demonstrated improvement of hematologic parameters. In one patient, however, cytopenia improved only after a second embolization. In the total series, there was an early mean rise of 8,600/mm3 in the leukocyte count (range 2,900-14,900) and 212,000/mm3 in the platelet count (range 30,000-718,000). Follow-up ranged from 4 months to 7 years. Improvement of the blood picture has been persistent in seven of the eight patients who showed initial improvement. Transient procedural complications included fever (5), pleural effusion (2), pneumonia (1), and splenic abscess (1). One patient had paralytic ileus lasting for 10 days and one patient developed a streptococcal peritonitis 3 weeks after embolization. No patient developed pancreatitis or vascular compromise of other abdominal viscera.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Pseudocysts of the pancreas in children.

Sixteen children with pancreatic pseudocysts were treated from 1965-1988. Blunt trauma was the etiology of pseudocyst formation in 69 per cent of children with 50 per cent resulting from the abdomen impacting bicycle handlebars. Chronic pancreatitis is an uncommon cause of pseudocyst formation in children. Medical therapy is directed towards reduction of pancreatic stimulation and nutritional support, which are maintained through pseudocyst resolution or maturation. Pseudocysts spontaneously resolved in 25 per cent of patients. Complications occurred in 25 per cent during nonoperative management. Children may safely undergo internal drainage earlier than adults (3-4 weeks vs 6 weeks). Internal drainage by cystoenterostomy was curative in eight patients. Persistent fistula drainage developed for five weeks in one patient who had surgical external pseudocyst drainage. One patient required distal pancreatectomy for a transected pancreatic duct. Spontaneous resolution of psseudocysts while on medical therapy is more frequent in children than in adults, and major complications (abscess formation, hemorrhage, and fistula formation) are usually not encountered. Pseudocyst rupture is the major complication of conservative management. We had no pseudocyst recurrences and 11 of 12 children treated surgically were discharged home within ten days of operation.

Abdominal Injuries↗
PubMed1989

Protein glycosylation and collagen metabolism in normal and diabetic rats.

The high concentration of glycosylated extracellular proteins found in diabetics may contribute adversely to wound healing. The degree of collagen glycosylation was correlated with collagenase activity and 5-hydroxyproline (5-OHP) levels in surgical wounds of normal and diabetic animals. Expanded polytetrafluoroethylene (PTFE) wound cylinders were implanted subcutaneously in 10 normal and 10 streptozotocin-induced diabetic rats. Nonenzymatic glycosylation (NEG) of protein was inhibited in half the subjects in each group by daily enteral acetylsalicylic acid (ASA). Wound cylinders were removed on the fifth day and assayed for collagenase activity and 5-OHP levels, and the degree of collagen glycosylation was measured with an assay for 5-hydroxymethylfurfural (5-HMF). Results were compared using Student's two-tailed t test. When compared with controls, diabetic animals had less wound 5-OHP (1.87 +/- 0.01 vs 3.11 +/- 0.03 micrograms/cm PTFE) (P less than 0.0001), higher levels of glycosylated collagen (215 +/- 11 vs 150 +/- 9 micrograms 5-HMF/mg protein) (P less than 0.001), and increased collagenase activity (13.5 +/- 0.6 vs 11.7 +/- 0.5 microgram collagen/mg protein/hr) (P less than 0.001). When ASA was added to the diet of diabetic animals, results in each case were statistically indistinguishable from controls. The collagenase activity of nondiabetic animals receiving ASA was decreased from nondiabetic controls (7.6 +/- 0.5 vs 11.7 +/- 0.5 microgram collagen/mg protein/hr) (P less than 0.001). These data show that ASA inhibits NEG of wound collagen in vivo, and ASA may normalize some abnormalities of wound healing found in diabetic animals.

Animals↗
PubMed1989

Gamma-globulin enhances survival in pneumococcal-challenged asplenic infant rats.

Early augmentation of a patient's immune system can be a valuable adjunct to standard supportive and antibiotic treatment of overwhelming postsplenectomy sepsis (OPSS). Normal humoral immune factors against pneumococcal sepsis are replenished by the parenteral administration of human gamma-globulin (HGG). Monthly prophylactic administration of HGG to asplenic individuals to prevent OPSS has been suggested. The cost of such measures is prohibitive, and the risk of serum-transmitted disease is significant. We administered HGG to splenectomized infant rats with pneumococcal sepsis to determine if mortality rates could be reduced and survival time prolonged. Fifty-six three-day-old rats underwent splenectomy and another 56, laparotomy without splenectomy. Twenty-eight animals from each operative group were administered HGG and the other 28, human serum albumin (HSA), 12 and 24 hours after inoculation with varying dosages of log-phase Streptococcus pneumoniae. The LD50 for asplenic animals was less than 50 colony forming units (cfu) per animal, while for the group with spleens, the LD50 was 250 to 500 cfu. There were no significant intragroup variations in LD50 between HGG and HSA subgroups. Survival times were compared using the BMDP1L-Life Tables and Survival Functions, and the generalized Wilcoxon t-test. These data show that host immunity to pneumococcal challenge in asplenic infant animals might be fully restored by the administration of HGG, even after the onset of symptoms. Survival of an asplenic child with evidence of OPSS might be enhanced by immediate administration of HGG.

Animals↗
PubMed1989

Mycobacterium avium and Mycobacterium intracellulare infections in patients with and without AIDS.

A genetic probe (Gen-Probe) was used to evaluate potential epidemiologic and susceptibility differences of Mycobacterium avium complex (MAC) strains isolated from 154 patients with and without the acquired immunodeficiency syndrome (AIDS). Genetic analysis revealed that 98% of the 45 patients with AIDS harbored only M. avium regardless of the anatomic or geographic source of the isolate; in contrast, approximately 40% of MAC isolates recovered from 109 patients without AIDS were M. intracellulare. Most M. intracellulare of respiratory origin recovered from patients without AIDS were involved in infectious processes. When 95 MAC isolates (M. avium, n = 53; M. intracellulare, n = 42) were evaluated for in vitro susceptibility to primary or secondary antimycobacterial drugs, significant differences were noted. M. intracellulare was more susceptible to streptomycin, rifampin, and ethambutol than M. avium; the converse was true for ethionamide. The results of this study suggest potentially important differences in disease spectrum and in vitro susceptibility profile for M. avium and M. intracellulare.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Quality control of individual components used in Middlebrook 7H10 medium for mycobacterial susceptibility testing.

The acceptability of different lots of commercial components which constitute our basal medium for susceptibility testing of mycobacteria was evaluated. The basal medium consisted of Middlebrook 7H10 agar supplemented with 10% oleic acid-albumin-dextrose-catalase and 0.5% glycerol. Studies were performed by using three separate microbiologic assays, and results were compared with parallel tests on previously standardized and acceptable lots of media. Components were rejected if comparison with standardized medium showed a major change in growth support or susceptibility status of any reference strain to any antimicrobial agent tested. Of the components tested in such a manner, 7 of 23 (30%) lots of 10% oleic acid-albumin-dextrose-catalase, 2 of 13 (15%) lots of Middlebrook 7H10 agar, and 0 of 5 lots of glycerol were found to be unacceptable. This study demonstrates that individual lots of components of this basal medium may vary significantly in their suitability for susceptibility testing, and failure to detect such variation may dramatically affect susceptibility profiles.

Anti-Bacterial Agents↗
PubMed1987

Serum albumin (oncotic pressure) correlates with enteral feeding tolerance in the pediatric surgical patient.

The influence of serum oncotic pressure (Serum Albumin [SA]) on gastrointestinal (GI) tolerance of enteral feedings was prospectively studied in two phases. Phase I consisted of 46 patients, aged 3 months to 12 years, (mean 47 months) selected for enteral tube feeding via the stomach or small bowel. Twenty-eight patients had an SA greater than 3.0 g/dL and received 82% of predicted caloric and protein needs. Administration of the enteral diet was stopped for two or more days in four of the 28 patients because of GI intolerance. Eighteen patients had an SA less than 3.0 g/dL and received 51% of predicted protein needs. Ten of the 18 patients had diet intolerance for two or more days, (P less than .001). Student's t-test was used for data analysis. In phase II, 20 patients, aged 4 months to 14 years (mean 49 months), with an SA less than 3.0 g/dL underwent repletion with salt poor albumin as calculated by the following formula: Albumin Replacement = [3.5 g/dL--Serum Albumin (g/dL)] X [weight (kg) X 3] Mean prereplacement SA was 2.31 g/dL; immediately after replacement it was 3.43 g/dL, and 1 week later it was 3.41 g/dL. These patients received 87% of predicted calories and nitrogen and only two of 20 had diet intolerance for two or more days. These data suggest that correction of SA levels allows for better tolerance of enteral diets and that SA will remain normal after intravenous replacement if adequate nutrients are provided while correcting the SA.

Adolescent↗