Search PubMed⌕ Search

Biomedical subjects

H C Polk

Publications and source records attributed to H C Polk.

At least 145 records · Page 8Linked to original sources
PubMed1987

Diagnostic pericardial window. A safe alternative to exploratory thoracotomy for suspected heart injuries.

During a five-year period, 104 patients underwent a pericardial window procedure to diagnose possible cardiac injury. Eighty-eight procedures were performed by a subxiphoid approach, and 16 were transdiaphragmatic in combination with an exploratory laparotomy. There were 51 patients with stab wounds, 45 with gunshot wounds, and eight with blunt trauma. All penetrating wounds were near the heart. In seven patients the window disclosed cardiac damage with no clinical signs of tamponade or shock. Fifty-one patients had signs of tamponade; however, only 12 of them had a cardiac injury diagnosed by pericardial window. Nineteen patients had cardiac injuries. One examination had false-negative results and one study had false-positive results. Cardiac wounds repaired included the right ventricle (eight), left ventricle (three), right atrium (five), and cardiac vein or pericardial wounds (three). Complications were negligible and consisted of minor wound infections (two) and postpericardiotomy syndromes (two). The pericardial window provides a rapid and safe means of diagnosing cardiac injuries in patients with equivocal signs of heart injury while sparing the patient without a heart wound a major operation.

Adolescent↗
PubMed1987

Contributions of alimentary tract surgery to modern infection control.

The continuing contributions of alimentary tract operations to a clarification of the clinical utility of devices, procedures, and medications for control of surgical wound infection have been crucial to the advancement of modern surgical practice. Indeed, the foregoing essay has outlined several areas in which additional analysis and clarification should be able to further define valuable methods and combinations thereof. It has been the willingness of the individual surgeon oriented to the alimentary tract to include his operations and his patients in these kinds of rigid trials that have, indeed, allowed a final emergence of these useful adjuncts to the surgical armamentarium, an effect that now pervades all surgical practice.

Anti-Bacterial Agents↗
PubMed1987

Experimental aerobic-anaerobic thoracic empyema in the guinea pig.

The clinical and pathological features of experimental aerobic-anaerobic thoracic empyema in the Duncan-Harley guinea pig are described. Thoracic empyema development and early death (less than 14 days after bacterial inoculation) were noted after various concentrations and species were inoculated into the pleural space with a piece of umbilical tape, which was used as a cofactor. The effect of concomitant hemothorax was also tested. Gram-negative infection was found to have a more virulent course than Gram-positive infection in the thoracic cavity. Moreover, these findings support the thesis that intrathoracic inoculation of anaerobic bacteria, even in combination with other anaerobic species, fails to produce clinical empyemas. However, anaerobic bacteria appear to enhance synergistically the virulence of sublethal and subempyema-forming concentrations of aerobic bacteria such as Staphylococcus aureus and Escherichia coli.

Animals↗
PubMed1987

Screening before surgery for colon neoplasms with a flexible sigmoidoscope by surgical residents.

The value of flexible sigmoidoscopy to screen for colorectal neoplasms was determined in asymptomatic patients. One hundred sixty men (mean age 61 +/- 10), who denied a change in bowel habits or blood in their stools and who had guaiac-negative stools, had flexible sigmoidoscopic examinations performed by surgical residents with little previous endoscopy experience, while a staff surgeon continuously viewed the resident's progress through a teaching scope. Forty-nine benign neoplastic polyps were removed from 21% of the patients. The examination was well tolerated in 93% of these patients who received no medications. Resident endoscopists who had performed more than 15 examinations were more likely to reach 50 cm (79%) than those with less experience. The authors conclude that surgical residents are able to safely and effectively screen for colorectal neoplasms with a flexible sigmoidoscope when supervised.

Adult↗
PubMed1987

Comparison of O antigen-specific urinary immunoglobulins to Escherichia coli in normal women and women prone to Escherichia coli cystitis.

The enzyme-linked immunosorbent assay (ELISA) measured urine and serum levels of O antigen-specific IgA against Escherichia coli in five women prone to recurrent Esch. coli cystitis and in 20 normal women. Serial urine and serum samples were taken from the five women during Esch. coli infections and during uninfected intervals, while a single urine and serum sample was obtained from the 20 normal women. Elevation of any class of serum immunoglobulins for patients with uncomplicated Esch. coli cystitis was absent. A local antigen-specific immunological response, predominantly of the IgA class, was present during Esch. coli cystitis. There was no significant difference (P greater than 0.1) in the urinary or serum levels of any class of immunoglobulins between the recurrent cystitis group when uninfected and the normal women. There was a significant increase (P less than 0.001) in the levels of urinary IgA and secretory IgA during Esch. coli cystitis as compared with the same women when uninfected or with normal women. A deficiency in the local immunological response of women prone to recurrent Esch. coli cystitis is not supported by our data.

Adolescent↗
PubMed1987

Stimulatory effects of muramyl dipeptide upon neutrophils isolated from a local bacterial infection.

This study examined the effects of muramyl dipeptide (MDP) in vivo upon the local inflammatory response to a bacterial challenge. In addition to quantitative bacteriology of the tissues surrounding an infected suture, polymorphonuclear leucocytes (PMN) involved in the local inflammatory response were extracted and estimations made of their number, viability and phagocytic activity. Fewer bacteria were recovered from the muscle around the suture in MDP-treated animals compared to placebo-treated controls (P less than 0.02), although there was no difference in the number of bacteria on the suture itself. Polymorphonuclear leucocytes were present in greater numbers (P less than 0.01), more PMNs were viable (P less than 0.01) and more PMNs had visibly phagocytosed bacteria (P less than 0.01) in the MDP group compared to the placebo group. These data indicate that MDP enhances the local inflammatory response to infection with increased influx, viability and phagocytic activity of PMNs, resulting in improved local control of a test bacterial challenge.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1987

Operative therapy for cholecystitis and cholelithiasis: trends over three decades.

Gallstones constitute a major health problem. In the United States there are approximately 800,000 new cases of cholelithiasis each year. Several developments within the last 20 years are likely to have altered the profile of patients requiring cholecystectomy. All patients undergoing cholecystectomy at three hospitals during 1 year of the last 3 decades were reviewed. The results demonstrate a relative increase in the proportion of elderly patients undergoing cholecystectomy. The incidence of gallstones in blacks appears to be rising. Cholangiography significantly decreased the number of negative common duct explorations throughout this 20-year period. The percentage of patients with choledocholithiasis was stable from 1964 to 1984.

Adult↗
PubMed1986

Enhancement of epidermal regeneration by biosynthetic epidermal growth factor.

Epidermal regeneration depends on mitosis and migration of keratinocytes. Epidermal growth factor is known to stimulate growth of keratinocytes in vitro, thus it might be expected to promote wound healing. The results of this study show that topical application of biosynthetic human epidermal growth factor accelerates epidermal regeneration in split-thickness wounds and partial-thickness burns. The significant enhancement of epidermal regeneration suggests the potential for clinical use of epidermal growth factor for accelerating healing of burns, wounds from trauma, diabetic ulcers, skin graft donor sites, and others.

Animals↗
PubMed1986

Improved understanding of mammary cancer.

Interest in cancer of the breast has begun to yield a concentrated sequence of specific information as to its basic nature, dietary influences, and its hormonal and genetic determinants. Clearly, the advent of improved early diagnosis has allowed the presentation to the clinician of a more favorable aspect of the tumor than has previously been seen, and has altered the overall clinical character of the disease. These advances open the possibilities of greatly expanded and enhanced treatment options, both for the informed physician and the inquiring patient. The rewards of early diagnosis include the possibilities of functional reconstruction, which may alter the potential patient attitude to such an extent that even earlier diagnosis will be achieved in years ahead. The complex issues of multimodality therapy and the honest and valid stratification of patients are the key issues in the further study of this challenging illness.

Breast Neoplasms↗
PubMed1986

Muramyl dipeptide enhances survival from experimental peritonitis.

Muramyl dipeptide is a nonspecific immunostimulant derived from Freund's complete adjuvant. We determined the effect of muramyl dipeptide on two separate animal models for peritonitis. We found that administration of muramyl dipeptide to rats undergoing cecal ligation and puncture significantly reduced mortality. Similarly, mice that underwent cecal ligation alone with muramyl dipeptide administration also had a statistically significant reduction in mortality compared with untreated controls.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1986

Serum kinetics of intraperitoneal moxalactam.

Continuous intraperitoneal administration of antibiotics has been recommended as treatment for peritonitis. The necessity of simultaneous systemic administration of antibiotics remains undefined but usually is performed. Moxalactam kinetics in serum were studied in dogs receiving 15 mg/kg intravenously; 15 mg/kg intraperitoneally; 5 mg/kg hourly with peritoneal lavage; 15 mg/kg intravenously followed by 5 mg/kg hourly intraperitoneally; 15 mg/kg intraperitoneally after 24 hours of peritonitis; and 5 mg/kg hourly by peritoneal lavage after 24 hours of peritonitis. Intraperitoneally administered moxalactam resulted in sustained serum levels compared with intravenously administered drugs. Repeated exchanges in lavage fluid resulted in progressively higher serum levels with each exchange. Peritonitis results in statistically higher levels of serum antibiotic concentration when compared with controls. Continuous intraperitoneal lavage with antibiotics would not appear to require concomitant systemic drug therapy.

Absorption↗
PubMed1986

Colonoscopy after curative resection of colorectal cancer.

Colonoscopy is generally considered to be an important part of the follow-up program for patients who have undergone curative resection of colorectal cancer. However, there are few data available concerning the frequency with which colonoscopy should be performed and for what length of time after operation. Since 1978, our policy has been to examine the colon annually in these patients using colonoscopy alternating with barium enema. We have evaluated the results in 100 patients over a four-year period. Based on size and histology, the significant colonoscopic findings were new colon cancers in three patients and 11 polyps demonstrating increased risk for malignancy in nine patients. This represents an interval yield of 3% per year. From these results and other reports, we recommend that these patients undergo total colonoscopy in the perioperative period to identify and remove synchronous lesions of the colon, and that examination of the remaining colon should be performed annually, preferably with colonoscopy, for at least the first four years after curative resection.

Barium Sulfate↗
PubMed1986

Radionuclide esophageal transit. A screening test for esophageal disorders.

Radionuclide esophageal transit (RET) is a noninvasive method of studying esophageal function. The purpose of this study was to evaluate RET as a screening test for motility disorders in symptomatic patients. Esophageal manometry and RET were performed in 16 volunteers and in 34 patients who were referred for motility evaluation. Each RET study consisted of two swallows of labeled water with the patient in the supine position under a gamma camera. Six patients had achalasia, two had scleroderma, two had diffuse esophageal spasms, and five had a nonspecific motor disorder. In each case the RET time was prolonged (greater than 15 s). Ten patients had reflux esophagitis; two of these had both abnormal manometry results and prolonged RET times. There were nine patients with upper gastrointestinal tract symptoms but normal manometry results and the RET test was positive in two patients. There were no false-negative RET results. The agreement between the RET and manometry results in this series was 96% (48/50). This preliminary experience suggests that RET is as sensitive as manometry for identifying motility disorders.

Adult↗
PubMed1986

A randomized, double-blind trial of single dose piperacillin versus multidose cefoxitin in alimentary tract operations.

For elective alimentary tract operations in which contamination is moderate, single dose prophylaxis with piperacillin is equivalent to triple dose cefoxitin, a well established and effective regimen. Both methods failed to control infection arising in the perineal wound after abdominoperineal resection. Just as is the case with drain site infection, such infection often evolves from postoperative contamination and, indeed, is in theory and in fact unlikely to be controlled by perioperative prophylaxis. This study is among the first of several examining the issue of single dose prophylaxis and will be the harbinger of other studies from other groups examining whether or not the course of therapeutic antibiotics can be safely shortened in patients with peritoneal contamination.

Adult↗