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Biomedical subjects

J Cullen

Publications and source records attributed to J Cullen.

At least 73 records · Page 4Linked to original sources

A comparison of three methods of end-to-end anastomosis in the equine small colon.

Six animals were used to compare simple interrupted, simple continuous, and stapled techniques for end-to-end rotated small colon anastomoses. Three ponies were evaluated three days after surgery for adhesion formation and luminal diameter at each anastomosis site. Two ponies and one horse were evaluated 14 days after surgery for adhesion formation. All anastomosis sites were examined histologically for alignment of tissue planes, and evidence of inflammation. No single technique was superior in all areas examined. While only three of the nine anastomoses had mild fibrinous adhesions at three days after surgery, all anastomoses had varying degrees of well-organized adhesions by 14 days after surgery. Three days after surgery luminal diameter was most comprised by the simple continuous technique. Although the simple interrupted technique was most consistent in its alignment of tissue planes, it was only slightly better than the simple continuous pattern. Stapled anastomoses were inverted or everted at all sites examined. Adhesion formation was less extensive, and histologic evidence of inflammation was less severe, in stapled anastomoses. The average times required to complete the simple interrupted, simple continuous, and stapled anastomoses were 22, 14, and 8 minutes, respectively.

Anastomosis, Surgical↗

Iliocaval compression syndrome.

Iliocaval compression syndrome is a significant disorder in a number of patients who have lower extremity venous complaints. The diagnosis may be suspected by positive findings on exercise strain gauge venous plethysmography and unilaterally increased ambulatory venous pressures. The diagnosis is confirmed by ascending and, in some instances, descending venography which demonstrates the iliocaval compression with or without intraluminal web formation. Transstenosis pressure gradients may be measured to confirm the hemodynamic significance of the lesion. We advocate direct operative repair of the iliocaval junction with rerouting of the iliac artery and excision of the iliocaval webs with cephalic vein patch angioplasty. It provided good results in the present study when coupled with an adjunctive regimen of perioperative subcutaneous heparin and warfarin. Further investigation into the exact prevalence and significance of the iliocaval compression syndrome is needed. Only an aggressive approach to patients with lower extremity venous complaints will help clarify the exact prevalence and natural history of this disorder.

Adult↗

Immune responses in small intestinal transplantation in the rat: correlation of histopathology and monocyte procoagulant activity.

No predictive serologic marker exists for rejection or graft versus host disease (GVHD) reactions in small intestinal transplantation (SIT). SIT was performed in Lewis (Lew) and Lew X Brown Norway Fl hybrid (LBN) rats in the following combinations: group 1, Lew X Lew; group 2 (isolated rejection), LBN X Lew, and group 3 (isolated GVHD), Lew X LBN. Procoagulant activity (PCA), an index of monocyte immune activation, was measured in the peripheral blood mononuclear cells of graft recipients to assess its value as an immunologic monitor. Histologic findings and PCA were evaluated on days 1, 2, and 3 and every 2 to 3 days after SIT. No pathologic findings of graft or host tissue developed in group 1 (n = 14). Histologic rejection (blunted villi and mononuclear cell infiltration) was seen beginning on day 5 in group 2 (n = 19); early GVHD (loss of nodal and splenic architecture) was first noted on days 5 and 6 in group 3 (n = 17). PCA elevation in SIT was seen to precede histologic evidence of rejection or graft versus host disease in this model and may constitute an important marker for these immunologic events.

Animals↗

Characterization of experimentally induced equine leukoencephalomalacia (ELEM) in ponies (Equus caballus): preliminary report.

An isolate of Fusarium moniliforme (M-1225 Cairo #1) was cultured on autoclaved corn and fed daily to 5 ponies at a rate of 2.5 g corn/kg body wt. One pony developed clinical signs of toxicity after 28 days and was sacrificed. The remaining 4 ponies developed no clinical sign of toxicity even after extended exposure. Hematology, serum chemistry, cerebrospinal fluid (CSF), and liver and brain pathology were evaluated as possible diagnostic and prognostic indicators. Hematology was not informative. Aspartate aminotransferase and gamma-glutamyltranspeptidase activities were elevated only in the clinically positive pony. CSF was most informative. Elevated myelin basic protein levels (greater than 14 ng/ml; normal less than 2.0 ng/ml) and cytologic changes consistent with chronic inflammation were observed in the clinically positive pony. Chronic inflammation was also seen in one clinically normal pony. Cytoplasmic vacuolation and clumping were observed in the hepatocytes of all ponies. Brain pathology was consistent with ELEM in the clinically positive pony.

Animals↗

Small intestinal transplantation using cyclosporine. Report of a case.

A case of small intestinal allotransplantation is described. Cyclosporine and Solumedrol were used for immunosuppression. A hemolytic episode occurred, caused by anti-A antibodies derived from graft lymphocytes. Sudden severe encephalopathy developed on the ninth postoperative day, followed by intractable hypotension and death. Hepatic and splenic microinfarcts were identified on postmortem examination. Allograft rejection was identified by serial stomal biopsies and correlated with a rise in monocyte procoagulant activity, a potentially useful serologic marker of rejection. The absence of an anatomic circuit for recycling of cyclosporine did not alter serum radioimmunoassay/high-performance liquid chromatography ratios.

Adult↗

Community outreach: an expanding role for hospitals.

Pressures for paediatric institutions to expand their traditional roles have come from changes in morbidity patterns, training requirements and community needs. Planning for new models of health care delivery has led to the development of the Community Outreach Program (COP), a hospital-based model which utilizes existing community resources to provide early intervention services, training in community paediatrics and integration of hospital and community-based health care. A process evaluation of the COP was performed after 18 months operation. Eighty-eight children were seen in a 7 week period, 20% with complex problems requiring further assessment and community consultation. Staff at the community agencies serviced considered the COP to be a major contributor to health care in their areas. Medical trainees developed new assessment techniques and management strategies for children with problems not previously encountered. It appears that the COP is a useful model for the delivery of health care, in particular to disadvantaged communities.

Australia↗

Clinical and pathologic changes in experimentally induced acute pancreatitis in cats.

Acute pancreatitis was induced in 6 cats by infusion of oleic acid into the pancreatic duct. Clinical changes included fever, tachycardia, and variable degrees of abdominal pain; vomiting occurred rarely, and diarrhea was not noted. Serum lipase activities were significantly increased through the 4th day after the surgical operation, although amylase activities were significantly decreased during most of the acute phase. Serum calcium and phosphate concentrations were decreased significantly on the 4th day after surgical operation. Hematologic alterations included normocytic, normochromic, responsive anemias, but changes in WBC values were not statistically significant. Evidence of exocrine pancreatic insufficiency after induction of acute pancreatitis was not demonstrated in any cats during the study. The results of this study indicate that increases in serum lipase activity are the most consistent and earliest indicators of acute pancreatitis in cats, but that more sensitive methods of laboratory evaluation should be sought.

4-Aminobenzoic Acid↗

Return to theatre--experience at the Mercy Maternity Hospital, Melbourne 1971-1982.

This paper summarizes the problems which necessitated return to theatre at the Mercy Maternity Hospital, 1971-1982. There were 154 of 29,488 patients (0.5%) having obstetrical or gynaecological treatment in theatre who made this journey. They all survived, some after heroic resuscitative measures. Haemorrhage necessitated the patient's return to theatre following 0.2% of Caesarean sections and 0.2% of gynaecological operations. Many obstetric patients who return to theatre are potential maternal deaths. The assistance of an experienced colleague is essential in their management. When massive or continuing haemorrhage occurs at Caesarean section, hysterectomy should be considered, especially if the placenta appears to be morbidly adherent, these being the very patients at risk of a return to theatre if hysterectomy is not performed. With the increasing Caesarean section rate, placenta praevia accreta has become more common, to the extent that ultrasonographic localization of the placenta is recommended in all patients who have had a previous Caesarean section. Curettage is not indicated in the treatment of primary postpartum haemorrhage after Caesarean section; moreover, its performance in the management of secondary postpartum haemorrhage when the patient was delivered by Caesarean section should be regarded as a formidable procedure. When a patient who was delivered vaginally returns to theatre because of continuing haemorrhage after curettage performed for secondary postpartum haemorrhage hysterectomy is likely to be required. Safe methods of suturing the lower uterine segment incision at Caesarean section, and the lateral angles of the vaginal vault after abdominal hysterectomy are described.

Australia↗

Central nervous system lymphosarcoma in the dog.

Central nervous system lymphosarcoma was diagnosed in 8 dogs with seizures and clinical signs compatible with multifocal central nervous system involvement. Cerebrospinal fluid analysis showed high white cell counts with abnormal lymphoid cells in all dogs, and high protein concentration in 5 dogs. Two dogs were given systemic anticancer chemotherapy, and 4 dogs were given a combination of systemic chemotherapy, intrathecal cytosine arabinoside, and craniospinal irradiation, resulting in marked improvement of the clinical signs.

Animals↗

Biofeedback as an adjunct to psychotherapy in the treatment of vaginismus.

This exploratory study examines the use of biofeedback as an adjunct to psychotherapy in the treatment of vaginismus. A set of six Sims-type graded EMG probes was constructed to provide biofeedback from the vaginal sphincter and was tested on a pilot sample of nulliparous women prior to this study. Five sequential cases of vaginismus from a clinic waiting list participated in the program. All five couples completed the program and all reported successful intercourse at its conclusion. The number of sessions devoted to biofeedback probe insertion was almost halved in comparison to previous experience with Sims dilators. Overall treatment duration was not shortened. At follow-up 6 months later, two couples reported pregnancy, one couple was having regular intercourse, and two couples had ceased intercourse. The authors conclude that biofeedback is an effective aid to learning muscle control, is acceptable to patients, and may increase the success rate by minimizing dropouts. The importance of follow-up is stressed.

Adult↗

Morphologic studies of intestinal allograft rejection. Immunosuppression with cyclosporine.

The usefulness of isolated intestinal pouches of an intestinal allograft for monitoring mucosal histology during rejection episodes was studied in a canine model. Total small intestinal autotransplantation was performed in four dogs, and allotransplantation in 18 dogs. Isolated pouches from the proximal and distal ends of the allografts were brought to the skin as stomas. Serial biopsies were obtained from these pouches. Nine allotransplants were treated with a suboptimal dose of cyclosporine. Nine allografted dogs were not immunosuppressed. Biopsies from all animals were normal the first two days postoperatively, and remained so in the autotransplants. Mononuclear cell infiltration in the lamina propria and submucosa was seen up to five days before death from rejection of the allograft in dogs on cyclosporine. At autopsy, all dogs had histologic findings in the transplanted bowel similar to those of simultaneously obtained pouch biopsies. The results show that histologic changes in isolated pouches from intestinal allotransplants reflect changes in the incontinuity segment of the graft and, therefore, such pouches can be used for histologic monitoring of the graft.

Administration, Oral↗

Hepatitis B transmission in school contacts of retarded HBsAg carrier students.

A prospective study was performed to assess the rate of transmission of hepatitis B from mentally retarded carrier students to susceptible mentally retarded peer students or school staff. Eighteen hepatitis B carriers were integrated into a public school program for the developmentally disabled, and serum hepatitis B markers were monitored in staff and students over 14 months. During this time no susceptible staff acquired hepatitis B serologic markers. Of susceptible students, 1.8% demonstrated seroconversion, but the route of infection is likely to have been outside the classroom environment. The results indicate that the risk of hepatitis B transmission is low in this particular school program.

Adolescent↗