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Biomedical subjects

F B Cerra

Publications and source records attributed to F B Cerra.

At least 199 records · Page 11Linked to original sources
PubMed1979

Selective intra-arterial vasopressin: clinical efficacy and complications.

A retrospective analysis of results obtained over a three year period in 66 patients receiving selective intra-arterial vasopressin (SIAV) for control of 69 episodes of massive gastrointestinal bleeding was presented. SIAV was used when there was a failure of conventional medical therapy and the patient's pathology and/or complicating medical conditions necessitated an attempt at controlling an emergent condition by nonoperative means. Hemmorrhage was completely controlled in 43% of variceal bleeds, 67% of hemorrhage gastritis, 45% of bleeding ulcers, and in 62% of colonic sources. The incidence of rebleeding following initial control was 16%. The surgical mortality for patients who were initial failures of SIAV was 50%. Patients undergoing elective surgery after complete control by SIAV had an 8% mortality. There were five catheter related complications. Minor complications occurred in 41% of patients, but required no treatment. Major complications occurred in 40% of cirrhotic and 21% of noncirrhotic bleeding episodes; and were a contributing factor in five cirrhotic deaths and three noncirrhotic deaths. In critically ill patients in the setting of an Intensive Care Unit, selective intra-arterial vasopressin appears: 1) to be an effective means of controlling certain types of gastrointestinal hemorrhage; 2) to provide an opportunity for an increase in survival rate.

Adult↗
PubMed1979

Proline metabolism in sepsis, cirrhosis and general surgery. The peripheral energy deficit.

Proline metabolism was prospectively evaluated in patients with surgical sepsis, cirrhosis, and elective surgical procedures. Significant correlations were found in the septic patients. Proline levels were an excellent indicator of mortality and correlated positively with lactate levels. Lactate and proline were inversely related to total peripheral resistance and oxygen consumption. In septic patients who expired: the metabolites involved in the hepatic pathways of proline degradation were elevated in proportion to proline; lactate, glutamate and proline were directly related to pyruvate; lactate/pyruvate ratios were constant; proline, glutamate, ammonia, ornithine, lactate and pyruvate levels were inversely proportional to oxygen consumption and total peripheral resistance. The primary defects in sepsis seem to be metabolic; there are very strong correlations in time between physiology and metabolism; the metabolic abnormality seems to be a progressive energy-fuel deficit, possibly from a progressive inhibition of substrate entry into the Krebs cycle.

Citric Acid Cycle↗
PubMed1979

Correlations between metabolic and cardiopulmonary measurements in patients after trauma, general surgery, and sepsis.

Simultaneous longitudinal hormonometabolic-physiologic (cardiopulmonary) profiles were measured in 14 nonseptic trauma/general surgery (T/GS) patients and in ten patients with Gram-negative abdominal surgical sepsis. The physiologic state classification system was used as the frame of reference. There were no response differences between the T and GS groups: they had A State responses. The sepsis (S) patients initially had exaggerated A State responses with significant changes in glucose, fat, amino acid, and glucagon plasma levels relative to T/GS. The S patients who survived (four) demonstrated profiles as in T/GS. The S patients who expired (six) progressively evolved an unbalanced, hyperdynamic B State response with progressive elevations of glucose, lactate, aromatic and branched-chain amino acids and glucagon, and low ketone bodies. There is definite correlation over time between metabolic and physiologic responses; the physiologic responses reflect the metabolic responses; the metabolic responses are consistent with a peripheral energy-fuel deficit.

Adult↗
PubMed1979

A functional parathyroid gland adenoma of transitional oxyphil cells. A light and ultrastructural study.

This report describes light and ultrastructural features of a functional parathyroid gland adenoma, principally composed of transitional oxyphil cells, in a 64-yr-old hypertensive black woman. She was hospitalized for repeated episodes of headaches, lethargy, and dizzy spells. Her serum calcium level was 2.92 mmol/l and immunoassay for parathormone was 390 pg/ml. On neck exploration, the left lower parathyroid gland was found enlarged and therefore removed in toto. The serum calcium and phosphate levels returned to normal following parathyroidectomy. Microscopically, the diagnosis of functional oxyphil adenoma was made. On ultrastructural examination, the tumour was composed principally of transitional cells, occasional typical, and degenerating oxyphil cells. The predominant transitional cells were rich in mitochondria and contained multiple active Golgi complexes, stacked profiles of rough endoplasmic reticulum, and a few secretory granules. On the other hand, typical oxyphil cells were tightly packed with mitochondria at the expense of other organelles. It appeared that neoplastic oxyphil cells were chief cells transformed in response to some unknown oncogenic stimulus.

Adenoma↗
PubMed1979

The physiologic recovery trajectory as the organizing principle for the quantification of hormonometabolic adaptation to surgical stress and severe sepsis.

Preoperative and serial postoperative clinical, cardiovascular, physiologic, and metabolic studies were carried out on 86 patients undergoing coronary artery bypass surgery (CABG); and 48 patients undergoing abdominal general surgical procedures (GSEL). Multivariable statistical analysis of these data showed the patients to be in different physiologic states and to manifest several types of recovery trajectories that could not be discerned on clinical grounds alone. The CABG patients followed one of three types of cardiogenic recovery trajectories. In contrast, GSEL patients show a normal recovery trajectory different from all CABG types. When sepsis develops, and exaggerated stress response (A state) occurs, with increased oxygen consumption and a pattern of amino acids, fat, and glucose breakdown products, which is heightened but similar to the response of nonseptic GSEL patients. With progression of sepsis severity, an unbalanced hyperdynamic recovery trajectory (B state) develops in which a decrease in oxygen consumption is associated with increases in the aromatic amino acids tyrosine, tryptophane, and phenylalanine; and decreases in the branched-chain amino acids, leucine and isoleucine. Triglycerides rise as keto acids fall, but both lactate and pyruvate rise. Glucagon is persistently high, regardless of insulin levels. The quantifiably different physiologic recovery trajectories reflect altered hormone and metabolic states and imply different responses to therapy.

Abdomen↗
PubMed1979

Physiological and metabolic correlations in human sepsis. Invited commentary.

The septic response in man appears to be a disease in which the infecting agent induces a state of disordered metabolic control in the host. The abnormal regulation of metabolic pathways causes a diversion of substrate utilization toward gluconeogenesis and ketone body formation and a reduction in oxidative energy-producing metabolism. This state of metabolic insufficiency is reflected in the pattern of cardiorespiratory, vascular, and physiological compensation. The precise magnitude of the resultant physiological compensation and its rate and direction of change can be quantified by the use of physiological state trajectories which also reflect the magnitude of underlying metabolic derrangements. The prognostic and therapeutic implications of these changes are discussed.

Amino Acids↗
PubMed1978

Surface chemistry characteristics of human umbilical vein used as chronic canine arteriovenous fistulas.

Six bilateral loop arteriovenous fistulas from the femoral artery to the femoral vein were constructed in dogs using Dacron-mesh-coated human umbilical vein. Each graft was punctured twice weekly with a 16 gauge needle for up to 36 weeks, and biopsies were done every four to eight weeks. The long-term patency was 83% at 24 weeks. There was no thrombosis from the needle puncture. Serial histologic examination revealed progressive transmural fibrous cell ingrowth and progressive neointimal cell formation. Scanning electron microscopy demonstrated areas of disrupted basement membrane covered with laminar fibrin meshes, probably representing sites of needle puncture. With multiple attenuated internal reflection spectroscopy of the graft lumens, minimal to moderate lipid deposition was observed to a depth of 1 micrometer at 32-36 weeks. No abnormal amounts of minerals were found within the graft walls with energy-dispersive x-ray analysis. Critical surface tensions remained within the biocompatible range of 20-30 dynes/cm. Human umbilical vein possesses many of the surface chemistry qualities of an ideal vascular prosthesis, has excellent long term patency, and is suitable for use where angioaccess with repeated needle puncture is needed.

Animals↗
PubMed1977

Cruveilhier-Baumgarten disease with associated splenic artery aneurysms.

Cruveilhier-Baumgarten Disease is a rare clinical entity. The distinction between C-B Disease and C-B syndrome rests solely on the liver morphology. In C-B Disease, the liver is morphologically normal. A case of a 27-year-old juvenile diabetic female with C-B Disease is presented. She manifested many of the metabolic and hemodynamic changes of cirrhosis including portal hypertension, encephalopathy, and a hyperdynamic cardiovascular state. There was also associated splenomegaly, hypersplenism, and splenic artery aneurysms. Splenectomy and splenic artery ligation were performed. Liver biopsies had normal morphology. The patient has had no recurrence of her symptoms. The pathogenesis of C-B Disease is unknown.

Adult↗
PubMed1977

Physiologic response patterns to occlusion of clinically significant arteriovenous fistulas.

Seven patients with hemodynamically significant arteriovenous fistulas for dialysis angioaccess were studied by multivarient computer analysis of physiologic data derived from cardiogreen dye dilution curves and A-VO2 before and after acute occlusion of their fistulas and prior to clinical therapy. Three patterns of response were characterized. These patterns seemed to be related to the innate ventricular contractility status, the type of medications, the presence of autonomic neuropathy, and their interplay with alterations in preload and afterload with fistula occlusion. In one patient, the response pattern precluded banding or occlusion of the fistula. In the remainder, the physiolobic responses permitted treatment by banding or occlusion. It seems advisable to adequately evaluate the physiologic response patterns of patients with hemodynamically significant arteriovenous fistulas prior to definitive treatment.

Adolescent↗
PubMed1977

The endothelial damage of pulsatile renal preservation and its relationship to perfusion pressure and colloid osmotic pressure.

To evaluate the effects of pulsatile preservation, 34 heterotopic renal autografts with immediate contralateral nephrectomy were divided into four groups with either the pulsatile preservation or cold storage technique. Group I had pulsatile preservation with plasma-albumin perfusate at a mean pressure of 60 mm. Hg and a colloid osmotic pressure (COP) of 20 to 50 cm. H2O. Group II had pusatile preservation with the same plasma-albumin perfusates as in Group I, but at a mean pressure of 30 mm. Hg. Group III had pulsatile preservation with albumin-phosphate buffer solution at a mean pressure of 30 mm. Hg. Group IV used cold storage technique. Group I demonstrated severe endothelial destruction and denuding of basement membrane. The changes were inversely related to COP. None of these kidneys functioned and, following transplantation, had persistent severe tubular damage and plugging of glomerular capillary loops with platelets, fibrinogen, and white cells. In Groups II and III, there were minimal changes, consisting of widening of the endothelial pores and focal endothelial damage. All of these kidneys functioned following reimplantation with minimal ultrastructural alterations. Group IV had no glomerular changes following preservation or following transplantation. All preservation techniques produced proximal tubular damage. There is a definite mechanical lesion associated with pulsatile preservation, which can be minimized by utilizing low perfusion pressures and solutions of high colloid osmotic pressure and which has the potential of producing a picture resembling hyperacute rejection following transplantation.

Animals↗