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Biomedical subjects

J J White

Publications and source records attributed to J J White.

At least 37 records · Page 2Linked to original sources
PubMed1992

A critical analysis of blood transfusion requirements in children with blunt abdominal trauma.

Over the past 2 years, 178 children with blunt abdominal trauma were admitted for observation. Fifty-five patients (31.5%) had intra-abdominal injury confirmed by computerized tomography (CT) scan, laparotomy, or postmortem examination. Forty-four children (80%) were managed with observation only; nine had other operations. Eleven patients (20%) required an operation for their intra-abdominal injuries. Thirteen patients died, ten from head or spinal injuries and three from intra-abdominal injuries (5.5%). Of 35 children with intra-abdominal injuries observed without any type of operation, 27 (77%) were not transfused (mean Pediatric Trauma Score [PTS] 8, Injury Severity Score [ISS] 19.3, average low hemoglobin [ALH] 10.1). The other eight were transfused an average of 49 cc/kg (mean PTS 4.5, ISS 26.5 ALH 6.1). Twenty children had operations. Eleven 11 (20%) of these were laparotomies; nine were transfused an average of 200.6 cc/kg (mean PTS 6, ISS 33, ALH 9). Nine had neurosurgical/orthopedic procedures (mean PTS 6.2, ISS 27.7), with six transfusions averaging 84.9 cc/kg (ALH 8.9). There were no significant complications. Blood transfusion was necessary only for 33 per cent of the observed cases, usually with multiple injuries. Blood should be transfused only to maintain hemodynamic stability (normal vital signs and tissue perfusion). Hemoglobin levels as low as 7 gm% do not mandate transfusion in children who are hemodynamically stable.

Abdominal Injuries↗
PubMed1991

Decortication for childhood empyema. The primary provider's peccadillo.

Of the 31 children treated for empyema thoracis secondary to pneumonitis at the Loma Linda University Medical Center, Loma Linda, Calif, from 1980 to 1990, 23 responded to prompt directed antibiotic therapy coupled with drainage, usually tube thoracostomy. All patients were cured clinically; some demonstrated residual pleural reaction with chest roentgenography or computed tomography that resolved over time. Decortication was necessary in eight severely ill children; three required concurrent lung resection for abscess. Distinct from the nonoperated group, there was a pattern of initial antibiotic trials in these patients averaging 6.5 different drugs plus delayed drainage of effusions. Delay in the initiation of antibiotic therapy was six times longer for the operated vs the nonoperated group. Delay to tube thoracostomy was 18 days for the decorticated children compared with 5.4 days for the nondecorticated children. All eight children responded completely and rapidly to their decortications. Roentgenographic changes lagged considerably behind the clinical course of the child, and computed tomographic scans provided better identification of chest tube placement but little information predictive of the need for decortication. Decortication for empyema seldom is necessary when a child is treated promptly with appropriate antibiotics directed by thoracentesis findings, and drainage, usually tube thoracostomy. The criterion for decortication is persistent sepsis, not the roentgenographic appearance of the chest.

Adolescent↗
PubMed1991

Assignment of the human prohibitin gene (PHB) to chromosome 17 and identification of a DNA polymorphism.

Prohibition is a recently identified antiproliferative protein whose exact role in the cell is under investigation. To determine the human chromosomal location of the prohibition gene (PHB) and whether this site corresponds to that of any suspected tumor suppressor gene, we have analyzed DNA from three sources by hybridization analysis: mouse--human hybrid cell lines, hybrid cell lines containing portions of human chromosomes, and human metaphase chromosomes in situ. All three techniques confirm a location in the region 17q21-q22, a region genetically linked to early-onset human breast cancer. Further analysis will be required to establish the significance of this relationship; Southern hybridizations show a polymorphic EcoRI site that may be useful for this purpose.

Blotting, Southern↗
PubMed1990

DNA alterations in prostatic adenocarcinoma and benign prostatic hyperplasia: detection by DNA fingerprint analyses.

DNA fingerprinting can be utilized to examine a large number of autosomal loci throughout the human genome. Alterations in banding patterns observed on DNA fingerprint analyses reflect DNA alterations ranging from single base changes to complex chromosomal rearrangements. In this report, we describe the application of this technique to prostatic adenocarcinoma (CAP) and benign prostatic hyperplasia (BPH). The majority of CAP cases (12 of 14) displayed alterations in at least 1 of the approximately 30 resolvable bands obtained by fingerprint analyses when compared with DNA obtained from peripheral white blood cells. Unexpectedly, 5 of the 12 cases of BPH examined revealed at least 1 identifiable band alteration in the prostatic tissue. These findings demonstrate the usefulness of fingerprint analyses in the examination of cancer-associated genetic alterations. They also suggest the presence of observable genetic alterations in BPH.

Adenocarcinoma↗
PubMed1989

Eicosanoid regulation of acute intestinal vascular permeability induced by intravenous peptidoglycan-polysaccharide polymers.

A model of rapidly developing, self-limited acute vascular permeability changes localized to the gut-associated lymphoid tissue (GALT) of the rat was used to study the role of prostaglandins (PGs), thromboxanes (Txs), and leukotrienes (LTs) in the in vivo regulation of early intestinal inflammatory events. Sprague-Dawley rats were pretreated with metabolites, enzyme inhibitors, or receptor antagonists of the arachidonic acid pathway before intravenous injection of sonicated peptidoglycan-polysaccharide polymers derived from group A streptococci (PG-APS, 5 micrograms rhamnose/g body weight). Rats were killed five minutes after PG-APS injection and were evaluated grossly for petechiae of the intestinal parenchyma and lymphoid aggregates. Indomethacin or dexamethasone increased intestinal injury by PG-APS by inducing mid-small bowel and cecal parenchymal hemorrhage. Indomethacin significantly diminished colonic lymphoid aggregate hemorrhage. PGE1, PGE2, and prostacyclin dramatically inhibited GALT hemorrhage; prostacyclin was the most potent with an effective dose of 0.1 microgram/kg. Dazmegrel, a specific Tx synthetase antagonist, significantly inhibited PG-APS-induced vascular permeability. Dazmegrel continued to diminish colonic lymphoid aggregated hemorrhage during concurrent treatment with indomethacin, which removed potential endogenous prostaglandin protection. Diethylcarbamazine, a lipoxygenase inhibitor, and FPL-55712, a LT receptor antagonist, inhibited the PG-APS-induced lesions, with FPL-55712 being more potent. LT blockade had a predominant effect on the intestinal parenchymal hemorrhage. We postulate that the normal homeostatic suppression of inflammation induced by phlogistic bacterial cell wall polymers is PG mediated, and that pathological responses are Tx and LT dependent.

Animals↗
PubMed1988

Ectopic gastric-like duplication of the pancreas.

A 4-month-old girl presented with intermittent left upper quadrant abdominal pain and was found to have an ectopic cystic gastric-like duplication attached to the tail of the pancreas. The literature, pathology, clinical features, diagnosis, and treatment are discussed.

Choristoma↗
PubMed1987

Effects of morphine on rat kidney glomerular podocytes: a scanning electron microscopic study.

Degenerative kidney changes are associated with heroin use in human addicts, but it is not known whether these changes result from exposure to the opioid or from contaminants in street heroin. In the present study, 4-6-month-old rats each received 1 subcutaneous pellet containing 75 mg of morphine or placebo, followed 3 days later by implantation of 2 additional morphine or placebo pellets. Seven days after implantation of the first pellet, the rats were killed by aldehyde perfusion. The right kidney was excised, and coronal slices were prepared for scanning electron microscopy. Micrographs were taken at 5000X and were scored on the presence of short or long microprojections (a score of '1' indicating few and a score of '4' indicating many). Morphine significantly altered the frequencies of scores for long microprojections, suggesting that morphine treatment increased the number of microprojections on glomerular podocytes. No changes in filtration slits, pedicels, or blebbing (foval enlargements) were noted. The data support the view that kidney degeneration associated with opioid abuse reflects effects of opioids per se, and they are consistent with microprojection changes as a function of altered intracellular cyclic AMP levels.

Animals↗
PubMed1986

Early recognition and successful management of pelvic cellulitis following hemorrhoidal banding.

Reports have focused attention on a rare but potentially serious complication following rubber band ligation of internal hemorrhoids: pelvic cellulitis with progression to shock and death. This report documents the successful treatment of pelvic cellulitis. The timely use of broad-spectrum antibiotics at an early stage is critical. Emphasis is placed on early recognition and treatment of this potentially fatal complication.

Adult↗
PubMed1985

Who is my patient after my patient dies? Issues in organ procurement.

Organ donation, procurement, and transplantation have become commonplace events. When a person is dying, the attending physician's "patients" include not only the grieving family but also the many unknown persons awaiting an organ for transplantation. A regional transplant program can be immensely helpful to the attending physician, the hospital staff, and the family of the dying patient.

Adolescent↗
PubMed1981

Correction of hypersplenism without splenectomy.

Permanent interruption of splenic artery blood flow to the spleen was accomplished in a 4.5-yr-old girl with significant hypersplenism secondary to biliary cirrhosis. The splenic artery was successfully occluded by transfemoral catheterization and selective instillation of bucrylate tissue adhesive.

Child, Preschool↗
PubMed1980

A simple objective system for early recognition of overwhelming neonatal respiratory distress.

The early recognition of severe respiratory distress in the newborn allows for optimal care. The prompt identification of overwhelming respiratory failure may assist in the selection of candidates for new therapeutic techniques. We have evaluated, both retrospectively and prospectively, a simple scoring system for neonatal respiratory insufficiency. During the first 24 hr of life, serial inspired oxygen values (FiO2) are plotted with serial pH measurements against time on a graph. With pulmonary insufficiency, the lines cross. The severity of the insufficiency is quantified by integrating the area between the crossed lines. The 25 infants in our Regional Intensive Care Unit Nursery who died with respiratory distress syndrome (RDS) during 1976 were compared with surviving infants matched for gestational age, birth weight, and admission date; all patients received similar conventional management. The difference in the mean 24-hr cumulative scores between the two groups was significant (p < 0.01). Only 1 infant with a score over 40 U ultimately survived (96% specificity). From January 1978 through June 1979, data were graphed at the bedside on 100 neonates who required respiratory support, and analyzed without knowledge of the eventual outcome. Overall, the scoring system predicted the final outcome in 95% of the cases. False positive determinations were minimal, the system accurately selecting 86/87 ultimate survivors (98.8% specificity). These data suggest that this simple scoring system may prove useful in identifying infants with overwhelming respiratory distress. Such infants may be considered for specialized care or innovative yet unproven treatment modalities.

Humans↗
PubMed1980

The natural history of bronchial atresia. Serial observations of a case from birth to operative correction.

A 10-year-old child presented with a history of intermittent respiratory symptoms since birth. Progressive shift of the mediastinum away from a hyperexpanded left upper lobe to the right side was evident on serial chest films, since birth. Bronchograms demonstrated atresia of the bronchus to the hyperexpanded segment. Xenon washout demonstrated prolonged half-time in the left upper lobe resulting from collateral ventilatory channels. Resection of the apical posterior segment of the left upper lobe was performed without complication. Bronchial atresia with collateral ventilation caused "lobar emphysema" in this patient.

Bronchi↗
PubMed1978

N-type anorectal malformations.

Three cases of N-type anorectal malformations have been encountered. Two girls with anorectal-vestibular fistulas (one with a normal anus and the other with mild stenosis) were typical of 15 other such cases in the literature. A boy with an anorectal-urethral fistula and covered anus had a lesser variant than most of the other 8 males in the literature. The frequently accompanying esophageal, renal, and skeletal anomalies were not present, nor did he have anterior urethral hypoplasia. The constellation of other major associated anomalies in the boys, but not in the girls, follows the pattern of other types of anorectal malformations and suggests an earlier and/or more severe teratogenic insult in the boys. Anterior perineal resection of the fistula is appropriate for girls with N-type fistulas and for those boys with normal anterior urethras. An additional urethroplasty is necessary for boys with anterior urethral hypoplasia. Our experience and that from the literature suggest that N-type anorectal malformations constitute a rare but real entity, akin to N-type tracheoesophageal fistulas. A plea is made that they be included in classifications of anorectal anomalies.

Anal Canal↗