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Biomedical subjects

H K Wright

Publications and source records attributed to H K Wright.

12 recordsLinked to original sources
PubMed1992

Management of groin hernias in patients with ascites.

The records of 18 cirrhotic patients with ascites and groin hernias (20 inguinal and one femoral) were retrospectively reviewed. Eleven patients underwent repair of their groin hernias (total of 13 repairs). Ten herniorrhaphies were performed electively, two were performed urgently because of recent difficult reduction, and one was performed emergently for incarceration without strangulation. No major and four minor postoperative complications occurred. There were no perioperative deaths or ascites leaks. Of the 13 hernias in 11 patients undergoing repair, 12 (92%) were available for follow-up. In this group, the 12 groin hernia repairs were followed for a mean of 25 months. One recurrence (8%) occurred 11 months after repair. In this same group of patients, five umbilical hernias were repaired, with three recurrences (60%). From this retrospective study, it appears that serious complications from groin hernias in cirrhotics are not common, and elective repair can usually await control of ascites. Additionally, for appropriately selected patients with ascites, elective inguinal hernia repair can be performed safely, with an acceptable rate of recurrence.

Adult↗
PubMed1979

Improving transverse colostomy function.

Loop transverse colostomies as usually constructed without immediate mucocutaneous anastomosis function poorly even a year later, with diarrheal fluid output approaching 1 liter/day on a regular diet. In contrast, primarily matured end transverse colostomies produce an average of 750 cc/day at one month and 560 cc/day at nine to twelve months on a similar diet. A further reduction to 360 cc/day was achieved on an experimental 70 mEq sodium diet. It is suggested that end transverse colostomies with immediate maturation should be performed in all patients requiring a transverse colostomy for more than a very short time to markedly improve colostomy function.

Colon↗
PubMed1976

A possible explanation for postoperative diarrhea after colostomy closure.

The transient diarrhea that sometimes follows the closure of colostomies has been ascribed to rapid transit in the previously defunctionalized distal colon. However, the present study of the temporarily bypassed colon in the rat indicated that a reduced capacity for the absorption of sodium and water develops within two to three weeks after bypass, without significant decreases in transit time or colon volume. After restoration of continuity, the absorptive capacity for water increased to normal under some of the experimental conditions. It is therefore suggested that postoperative diarrhea after colostomy closure in man may be related to a temporary decrease in absorptive capacity in the previously bypassed distal colon.

Animals↗
PubMed1975

Compensatory hypertrophy of the ileum after gastroduodenojejunal exclusion.

One theory of compensatory hypertrophy of the gut suggests that ileal growth after jejunectomy results from exposure of the ileum to villus-enlarging factors emanating from the papilla of Vater. This hypothesis was tested by examination of the ileum after bypass of pancreatobiliary secretions to the colon. Hypertrophy of the ileum occurred after esophagoileostomy and gastroduodenojejunal exclusion, suggesting that adaptive growth of the gut depends on additional factors. There is evidence to support several theories of compensatory hypertrophy. A hypothesis seeking to reconcile the conflicting notions of intraluminal and hormonal stimuli is suggested.

Ampulla of Vater↗
PubMed1975

The functional consequences of colectomy.

The colon plays a decisive role in salt and water conservation in the intact human, normally removing from the terminal intestine approximately one liter of isotonic fluid that escapes small bowel absorption. The primary purpose of this colon function is probably to prevent extracellular fluid volume depletion and only incidentally to produce a normal solid stool. The patient with an ileostomy can partly adapt to replace the absorptive capacity lost after colectomy but is still vulnerable if salt and water intake ceases completely. In contrast, patients with ileorectostomies and some patients with continent ileostomies can almost totally adapt to loss of the colon. These findings suggest that the ileal mucosa can adapt under certain conditions to absorb at rates and concentrations previously thought impossible. This property of ileal mucosa might be utilized in the future to significantly improve the condition of patients who require total colectomy.

Adaptation, Physiological↗
PubMed1975

Jejunal absorption of bile salts after resection of the ileum.

Malabsorption of bile salts plays a major role in the pathogenesis of diarrhea after resection of the ileum, but the diarrhea usually improves with the passage of time. To test the hypothesis that this improvement may occur as a result of increased absorptive capacity for bile salts in the jejunal remnant, everted sacs of jejunal remnants were prepared 3 months after ileectomy. The mean serosal to mucosal concentration ratio of taurocholate found in the experimental jejunal sacs was increased approximately 70 percent over the mean ratios of normal and sham-resected jejunal preparations (p smaller than 0.05). This change may be a manifestation of cellular adaptation in transport function, suggesting that the scope of intestinal adaptation in short gut syndrome goes beyond morphological hypertrophy and hyperplasia.

Animals↗