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Biomedical subjects

J F Sisley

Publications and source records attributed to J F Sisley.

16 recordsLinked to original sources
PubMed1989

Increased peritoneal fluid lactic acid values and progressive bowel strangulation in dogs.

In the present study, we determined values for peritoneal fluid and blood ammonia, amylase, and lactic acid content in 11 dogs after experimental bowel strangulation. In the nine survivors of this group, we demonstrated a near linear increase in peritoneal fluid lactic acid over a 24-hour period, during which the plasma lactic acid remained relatively constant. A significant increase in peritoneal fluid ammonia was also demonstrated, but this did not occur until more than 16 hours after strangulation. In a second group of two dogs in which simple obstruction was produced, no significant increase in peritoneal fluid lactic acid or ammonia occurred. We did not find significant changes in peritoneal fluid amylase in this study. These data suggest that the determination of peritoneal fluid lactic acid content, especially when compared with concomitant plasma lactic acid, may be useful in the accurate preoperative diagnosis of bowel strangulation.

Ammonia↗
PubMed1988

Use of serum drug concentrations in surgical patients.

Surgical patients frequently require drug treatments that can be assessed with serum drug concentrations. Of the agents for which serum drug concentrations are routinely available, the aminoglycosides theophylline, vancomycin, digoxin, and phenytoin are used most frequently in surgical patients. When using serum drug concentrations, the clinician should have an understanding of the relationships (or lack of) between drug concentrations and therapeutic or toxic effects. When blood is collected for serum concentration determinations, the exact timing of the sample in relation to the dose must be considered. For some drugs, (such as the aminoglycosides, it is necessary to determine peak and trough concentrations, whereas for other agents, like theophylline, the average or mid-dose level may be more important to consider. There are many factors that affect serum drug concentrations. Among these are various disease states, obesity, fluid imbalances, the drug dosage form used, and concurrent drug use. Not all patients require serum drug concentration monitoring; however, with each drug there are high-risk patients who may benefit. When used properly, serum drug concentrations may be helpful in maximizing therapeutic benefits, minimizing or diagnosing drug toxicity, and assessing patient compliance with drug regimens.

Aminoglycosides↗
PubMed1987

Drug interactions in surgical patients.

Drug interactions, defined as when the administration of a single substance (drug, nutrient, or tobacco) modifies the response to a drug, occur relatively frequently in surgical patients and may result in increased morbidity and lengthened hospital stay. Drug interactions also account for some instances of drug ineffectiveness or exaggerated pharmacologic response. There are many types of drug interactions. However, most of them are related to altered drug pharmacokinetic properties, where there are alterations in drug absorption, distribution, metabolism, or elimination; or altered drug pharmacodynamic actions, where two agents may have synergistic, additive, or antagonistic pharmacologic effects. The term, drug interaction, usually refers to pairs of drug substances administered concurrently, but more than two agents may be involved. When patients are taking a large number of different medications, there may be multiple drug interactions with additive or antagonistic effects, the overall effects of which are difficult to predict. There are hundreds of reported drug interactions, and some may be of important clinical consequence. In surgical patients, the majority of drug interactions involve histamine-2 blockers (particularly cimetidine), digoxin, warfarin, or a variety of agents that may be administered during anesthesia. Recognition of the potential for adverse drug interactions is of primary importance in minimizing their effects. Usually, potentially interacting drugs may be administered concurrently as long as appropriate patient or laboratory assessments are performed. For some agents, such as digoxin or theophylline, serum drug concentrations may aid in the avoidance of adverse drug interactions.

Anesthesia↗
PubMed1987

Pancreatic duct disruption and duodenal hematoma associated with endoscopic retrograde cholangiopancreatography.

We have reported a case of intraduodenal duct disruption and duodenal hematoma associated with ERCP. The location of the extravasated contrast material created a confusing picture, which preoperatively was thought to be a pseudocyst, but was found at operation to be a duodenal hematoma. In retrospect, the upper gastrointestinal series done immediately after ERCP was very helpful. We believe that an upper GI series done immediately after ERCP will help determine the location of unusual collections of contrast material seen at ERCP.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1987

Shouldice hernia repair: results at a teaching institution.

Authors with wide experience report that the Shouldice technique for repair of inguinal hernia is very effective. The technique has not gained widespread acceptance or notoriety. For example, the 13th edition of Textbook of Surgery, edited by Sabiston, devotes only one paragraph to this type of herniorrhaphy. Because of the excellent results reported by the Shouldice Clinic, this technique was adopted at the Augusta Veterans Administration Hospital, a teaching hospital of the Medical College of Georgia. Since 1976, a total of 604 Shouldice repairs have been performed by supervised house staff; 468 patients have been followed for up to 8 years and a recurrence rate of 1.3 per cent is reported. Although the follow-up is brief, the Shouldice hernia repair is widely applicable and good results are not dependent on wide experience alone.

Adult↗
PubMed1987

Estradiol and progesterone receptors in a case of fibromatosis of the breast.

A case of fibromatosis of the breast with positive cytosol assays for estradiol and progesterone receptors is described. Estrogen and progesterone receptors in fibromatosis have been only rarely reported in the English literature, and never, to our knowledge, in fibromatosis of the breast. We discuss the implications of these findings and review the literature.

Breast Neoplasms↗
PubMed1987

Computerized axial tomography (CT) as an aid in the diagnosis of hepatic portal venous gas: a case report.

The radiologic finding of hepatic portal venous gas and its surgical implications have been documented previously in the literature. More than 67 cases have been reported. Branching tubular lucencies that extend from the porta hepatis to the edge of the liver are characteristic. In general, air in the biliary tree is central in location, but the distinction may not always be clear. We present a case in which computerized axial tomography was extremely helpful in localizing extraluminal gas to the liver and differentiating between air in the biliary tree and hepatic portal venous gas.

Gases↗
PubMed1986

Highly selective vagotomy with dilatation or duodenoplasty. A surgical alternative for obstructing duodenal ulcer.

Highly selective vagotomy (HSV) is an accepted choice for the treatment of uncomplicated duodenal ulcer. Its use in patients with gastric outlet obstruction, however, remains quite controversial. Since 1980, 69 patients have undergone HSV at the Medical College of Georgia Hospitals. Of these, 20 (29%) underwent either dilatation (14) or duodenoplasty (6) for accompanying outlet obstruction. The obstruction was graded as severe in 17 (85%) and moderate in three (15%). Follow-up evaluation has included Visick grading and endoscopy. There have been two deaths (38 and 54 months following surgery). Both patients were Visick I. Of the 18 patients available for review to date, 12 (67%) are Visick I and four (22%) are Visick II. There have been two failures (11%), discovered only by endoscopic follow-up in asymptomatic patients. No patients have required reoperation. HSV with dilatation or duodenoplasty is a reasonable surgical alternative for the treatment of obstructing duodenal ulcer disease.

Adult↗
PubMed1985

Intraoperative serum and tissue activity of cefazolin and cefoxitin.

We determined the intraoperative serum and wound-muscle concentrations of cefazolin and cefoxitin in 40 patients who were undergoing cholecystectomies. The study employed an open-label design in which all of the patients randomly received cefazolin sodium (20 mg/kg) or cefoxitin sodium (30 mg/kg) intravenously while the patient was in the ward ("on call") or with the induction of anesthesia. Multiple blood and wound-muscle samples were collected intraoperatively and assayed for their cephalosporin concentrations. Considerable differences in intraoperative serum and tissue concentrations between antibiotics were apparent; there were usually higher levels of cefazolin. In all of the patients who received cefazolin sodium, the antimicrobial was detectable in wound tissue at wound closure, while it was detectable in 86% and 38% of patients who received cefoxitin sodium with anesthesia and on call, respectively. Because cefoxitin has a much shorter elimination half-life than cefazolin it seems prudent to administer the agent as close to the start of the operation as possible, and readminister the agent every two to three hours until the wound is closed. For cefazolin, on-call administration appears to be acceptable, with readministration not required for at least four hours.

Abdominal Muscles↗
PubMed1985

Potential drug interactions in surgical patients.

The incidence and frequency of potentially serious drug interactions were evaluated in hospitalized surgical patients. Drug profiles of patients on the general surgical service of a tertiary-care teaching hospital were retrospectively reviewed for two six-month periods to determine how often drugs that are known for major interactions were prescribed concurrently. Interactions were studied that were relatively well documented and potentially harmful to the patients. A total of 1825 patient profiles were reviewed (21,888 patient days). At least one potential drug interaction was found in 17% of the patients. Interactions were found to occur at the rate of 1 for every 59 patient days. Digoxin and cimetidine were the potential interacting drugs in almost 90% of the cases. Hospitalized surgical patients require close monitoring because they frequently receive potentially interacting drugs.

Cimetidine↗
PubMed1982

Barium appendicitis.

We report a case of acute appendicitis with perforation associated with retained appendiceal barium. Abnormally retained barium may lead to appendicitis and this should be kept in mind when a barium-filled appendix is seen in an asymptomatic patient. Routine follow-up films on all patients whose appendix fills with barium are not recommended.

Appendectomy↗
PubMedDate not supplied

Investigation of mezlocillin disposition with a porcine model.

The suitability of the pig as an animal model for mezlocillin disposition was assessed. Serum, urine, and bile were collected after the administration of 50, 100 and 200 mg kg-1 mezlocillin to pigs and drug pharmacokinetics were characterized. Mezlocillin concentrations in biological fluids were determined by HPLC and free mezlocillin was determined by ultrafiltration. The pharmacokinetics of mezlocillin appeared to be independent of dose over the dosage range studied. Total clearance, renal clearance, and biliary clearance were 0.18 (0.05) 1 h-1 kg-1, 0.13 (0.03) 1 h-1 kg-1, and 0.07 (0.02) 1 h-1 kg-1, respectively. The steady-state volume of distribution was 0.29 (0.08) 1 kg-1. The pharmacokinetic parameters determined in the porcine model are similar to those reported for health human volunteers. Therefore, this model appears suitable for the study of mezlocillin disposition, and may be applied to the study of other agents that are appreciably biliary excreted.

Animals↗
PubMedDate not supplied

Intraoperative serum concentrations of cefazolin and cefoxitin administered preoperatively at different times.

The effect of administration time on the serum concentrations of cefazolin and cefoxitin achieved during surgery was studied. Patients about to undergo elective surgery were randomly selected to receive one of four antibiotic prophylaxis regimens. Two of the regimens consisted of cefazolin 20 mg/kg i.v. (as the sodium salt) administered either "on call" to the operating room or with anesthesia in the operating room. The other two regimens were identical except that cefoxitin 30 mg/kg i.v. (as the sodium salt) was substituted for cefazolin. Intraoperative blood samples for analysis of serum concentrations were obtained at the time of surgical incision, one hour after incision, and at wound closure. Forty patients completed the study (10 patients received each treatment). Mean projected cefazolin concentrations at the time of incision and at wound closure for both two-hour and three-hour operations were significantly higher after administration with anesthesia than after "on-call" administration. For cefoxitin, differences in projected concentrations for "on-call" administration versus administration with anesthesia were significant at the time of incision and at wound closure in a two-hour operation. At times corresponding to initial incision, projected free-cefoxitin concentrations were higher than those of cefazolin; however, projected free-cefazolin concentrations were higher than free-cefoxitin concentrations at wound closure for two-hour and three-hour operations. To ensure that antibiotic is present in serum throughout a two- or three-hour surgical procedure, cefoxitin should probably be administered at the induction of anesthesia. Cefazolin administered "on call" appears to be acceptable for maintaining serum concentrations throughout surgery of this duration.

Adolescent↗