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Biomedical subjects

J M Becker

Publications and source records attributed to J M Becker.

270 records · Page 15Linked to original sources
PubMedDate not supplied

Management of bile leaks following laparoscopic cholecystectomy.

In a series of 650 consecutive laparoscopic cholecystectomies, nine bile leaks were identified (1.4%). Patients with bile leaks presented clinically at a mean of 4.9 days (range: 3-8 days) after surgery complaining of diffuse abdominal pain, ileus, and nausea. Laboratory values for complete blood counts and liver function tests were all mildly elevated. Definitive diagnosis was made on the basis of abnormal hepatobiliary scintigraphy. Management strategies included laparotomy and drain placement (n = 1), laparoscopy and drain placement (n = 3), ERCP and drainage (n = 4), and CT-guided percutaneous drainage (n = 1). When the etiology of the leakage was identified, it was most commonly either dysfunction of the cystic duct clips (n = 3) or leakage from a disrupted duct of Luschka (n = 2). The source of the remaining leaks (n = 4) was never determined. We conclude that bile leaks are an uncommon cause of morbidity following laparoscopic cholecystectomy. Diagnosis can usually be made with nuclear medicine biliary tract scans and a variety of managements alternatives are successful in treating this complication.

Bile↗
PubMedDate not supplied

Previous abdominal colectomy affects functional results after ileal pouch-anal anastomosis.

We assessed the effect of previous abdominal colectomy on functional results after ileal "J" pouch-anal anastomosis (IPAA) in patients with ulcerative colitis. Twenty-five patients with colectomy prior to IPAA were compared with 22 patients who underwent noncolonic abdominal operations prior to IPAA. No differences were observed in pre- or postoperative resting anal sphincter pressure, squeeze pressure, or rectal inhibitory reflex. Previous colectomy was associated with a greater incidence of postoperative small bowel obstruction. Mean +/- SEM daily stool frequency at 1 and 12 months postoperatively, respectively, was 8.9 +/- 0.8 and 5.7 +/- 0.3 for patients who had undergone previous colectomy, and 8.2 +/- 0.7 and 6.0 +/- 0.5 for the no-previous colectomy group (p = not significant). At the same postoperative intervals, nocturnal stool frequency was 1.9 +/- 0.3 and 1.1 +/- 0.2 for the colectomy group and 1.5 +/- 0.3 and 0.6 +/- 0.1 for the no colectomy group (p = 0.05 at 1 year). More patients in the previous colectomy group had greater than or equal to 1 nocturnal stool after 1 year (71% versus 33%, p = 0.03). Although pouch capacity at 1 year was not different in the 2 groups, pouch capacity was directly related to stool frequency in the no colectomy group (r2 = 0.48, p = 0.01), but not in the previous colectomy group (r2 = 0.08, p = not significant). We conclude that previous abdominal colectomy may be associated with a higher overall incidence of small bowel obstruction. Moreover, previous colectomy is a determinant of postoperative nocturnal stool frequency after IPAA, most likely due to altered ileal pouch function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Hydrolysis of oligopeptides by sera used in cell and tissue culture.

Sera commonly used in cell and tissue culture as medium supplements possess high peptidase activity. Pligopeptides incubated with 1% serum are rapidly hydrolyzed to intermediate length peptides and the constituent amino acids. Hydrolysis of lysine peptides is difficult to verify by a quantitative ninhydrin procedure because of reaction of the lysine epsi-lon-amino group and serum components with ninhydrin. Attempts to evaluate oligopeptides as sole sources of indispensable amino acids for cultured mammalian cells are of doubtful value when serum is used as a medium supplement.

Blood↗
PubMedDate not supplied

Quantitation of colonic injury from argon laser, neodymium: YAG laser and monopolar electrocautery applied to flat mucosa and small sessile polyps of the canine colon.

This study determined the optimum laser energy for ablation of colonic mucosal lesions and small sessile polyps in the canine colon. Neodymium (Nd):YAG laser, argon laser, and monopolar electrocautery were applied to exposed canine colonic mucosa for various application times at various power settings. At the minimum energy level necessary to ablate mucosa, the Nd:YAG laser caused greater muscularis injury than the argon laser and monopolar electrocautery. At higher energy levels, monopolar electrocautery and Nd:YAG laser caused greater muscularis injury than argon laser. Small surgically created polyps in the canine colon were ablated endoscopically with the three energy sources. Single-session complete polyp ablation occurred most frequently with Nd:YAG laser and least frequently with argon laser. The depth of tissue injury beneath polyp ablation sites was least with argon laser and greatest with Nd:YAG laser. This study suggests that the argon laser is safer than the Nd:YAG laser or monopolar electrocautery for coagulation of flat colonic mucosal lesions. Although the argon laser is safer for the coagulation of small sessile colonic polyps, it may be less effective than monopolar electrocautery or the Nd:YAG laser for the single-session fulguration of polyps greater than 5 mm in diameter.

Animals↗
PubMedDate not supplied

Role of a hyaluronate-based membrane in the prevention of peritonitis-induced adhesions.

Adhesions remain a significant postoperative complication of abdominal surgery; however, recent evidence suggests that physical barriers may reduce their incidence. Although these adhesion prevention barriers are efficacious when used under aseptic conditions, little is known about their use in the presence of peritonitis, which is associated with an increased incidence of abdominal adhesions. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) has been shown recently to reduce postoperative adhesions in several animal models and in two clinical trials. To investigate the efficacy of HA membrane in the presence of peritonitis, generalized peritonitis was induced in rats by either cecal ligation and puncture (CLP) or cecal ligation (CL) alone. The ceca were resected after 12 hours, and animals were randomly assigned to receive or not receive HA membrane applied to the cecum. At day 7, abdominal adhesions and abscesses were scored. In the presence of peritonitis, HA membrane did not significantly reduce the number or tenacity of adhesions. A trend toward increased abscess formation was associated with HA membrane in the CL group. Although HA membrane has been shown to reduce the incidence and severity of abdominal adhesions under aseptic conditions, this study demonstrates that it is not efficacious in preventing abdominal adhesions in the presence of peritonitis. The association between HA membrane and abscess formation in the presence of experimental peritonitis requires further investigation.

Abscess↗
PubMedDate not supplied

Role of transforming growth factor beta-1 in peritonitis-induced adhesions.

Peritonitis is a major cause of intra-abdominal adhesion formation. The overexpression of transforming growth factor beta-1 (TGF-Beta1), a potent mitogen, chemoattractant, and stimulant for collagen synthesis by fibroblasts, has been linked to tissue fibrosis at various sites throughout the body including peritoneal adhesion formation. Hence we hypothesized that the mechanism(s) involved in peritonitis-induced adhesion formation may be mediated through the upregulation of TGF-Beta1 expression. Peritonitis was induced in rats by cecal ligation and puncture, while a control group underwent sham operation. Adhesions were scored and harvested from both groups at 0, 6 and 12 hours and at 1, 2, 4, 7, and 28 days. Tissue expression of TGF-Beta1 mRNA was determined by quantitative reverse transcription-polymerase chain reaction and TGF-Beta1 protein was localized by immunohistochemical analysis. Serum and peritoneal fluid TGF-Beta1 concentrations were quantified by enzyme-linked immunosorbent assay. Compared with sham operation, peritonitis was associated with a significantly greater incidence of abdominal adhesions and a significant increase in the levels of TGF-Beta1 mRNA expression at days 2, 4, and 7. Immunostaining intensity of TGF-Beta1 in adhesions from the peritonitis group also steadily rose through day 7. In peritoneal fluid, the ratio of active:total TGF-Beta1 was significantly increased in the peritonitis group on days 1, 2, and 4 compared with the sham group. These results suggest that peritonitis is associated with the upregulation of TGF-Beta1, a mechanism that may exacerbate adhesion formation.

Animals↗
PubMedDate not supplied

Effects of hyaluronic acid/carboxymethylcellulose gel on bowel anastomoses in the New Zealand white rabbit.

Intra-abdominal adhesions form in more than 90% of patients undergoing major abdominal surgery and can lead to significant complications. Application of a bioresorbable gel consisting of chemically modified hyaluronic acid (HA) and carboxymethylcellulose (CMC) has shown promise as a means of preventing intra-abdominal adhesions, but there have been concerns that the presence of the gel might interfere with the integrity and healing of bowel anastomoses. We tested the effects of HA/CMC gel on adhesion formation and anastomotic healing in 60 New Zealand white rabbits after transection and complete (100%) or incomplete (90%) anastomosis of the ileum. Half of the animals underwent application of HA/CMC gel and half served as control subjects. Animals were killed at 4, 7, or 14 days after surgery. Anastomotic adhesions were scored in a blinded fashion. Integrity of the anastomosis was tested by measuring bursting pressure at the anastomotic site and in an adjacent section of intact bowel. With complete anastomosis, HA/CMC gel significantly reduced adhesion formation at 7 and 14 days after surgery (P<0.05), but gel application did not inhibit adhesion formation when the anastomosis was incomplete. Anastomosed segments of bowel burst at a lower pressure than intact bowel 4 days after surgery, but bursting pressures were normal at 7 and 14 days. Burst pressures of anastomoses receiving an application of HA/CMC gel were nearly identical to control anastomoses at all three time points. HA/CMC gel did not interfere with the normal healing process of bowel anastomoses. Furthermore, HA/CMC gel decreased adhesion formation after complete anastomoses, yet it did not affect adhesion formation in the presence of anastomotic disruption.

Anastomosis, Surgical↗
PubMedDate not supplied

Ileal pouch salvage following failed ileal pouch- anal anastomosis.

Attempts have been made to salvage failed ileal pouch-anal anastomoses (IPAA) performed for ulcerative colitis or familial polyposis coli. These can be categorized as total reconstruction of the IPAA, partial transabdominal approach, and partial transperineal approach. The aims of our study were to determine the overall success of pouch salvage; to examine the demographics, indications, and outcomes for each approach; and to assess anorectal physiology and patient satisfaction in those with successful salvage operations. We reviewed data, including results of anorectal manometry, from 29 patients undergoing salvage procedures for failed IPAA. Seventeen salvage attempts were successful, 11 attempts failed, and one patient was lost to follow-up. Success rates were 100% in the total reconstruction group, 25% in the partial transabdominal group, and 55% in the transperineal group. In those undergoing total reconstruction of the IPAA (n = 9), functional outcome, as measured by incontinence, improved with 50% reporting incontinence preoperatively compared to 0% postoperatively (P = 0.055). Mean 24-hour stool frequency and nighttime stool frequency declined. All patients reported satisfaction with their outcomes. Sixty percent of patients who underwent ileal pouch salvage following IPAA have been successful in avoiding permanent ileostomy. These results suggest that a continued effort to salvage failed IPAA, including the use of total reconstruction, is a viable alternative to permanent ileostomy.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Response of winter birds to soil remediation along the Columbia River at the Hanford Site.

The Columbia River at the Hanford Site, located in south-central Washington State, U.S.A., is a regionally important refugium for overwintering birds. Some of the river shoreline has been designated by the U.S. Department of Energy for environmental clean-up following past production of materials for nuclear weapons. We evaluated the effects of soil remediation on winter birds at six inactive nuclear reactor areas. Remediation activities consisted of daily excavation and removal of approximately 1035 t of contaminated soil from previously herbicided and denuded areas located between 30 and 400 m and mostly in line-of-sight of the river shoreline. Remediation activities had no apparent effect on numbers of riverine or terrestrial birds using adjacent undisturbed shoreline and riparian habitat.

Animals↗
PubMedDate not supplied

Calculation of metabolic expenditure and substrate utilization from gas exchange measurements.

At least nine different equations have been published for calculating metabolic expenditure by indirect calorimetry. This study examined the differences between equations when they are used for the nutritional assessment in an intensive care unit (ICU). Oxygen consumption and carbon dioxide production were measured in 36 ICU patients and used to calculate metabolic expenditure with the nine equations. The equations produced differences in metabolic expenditure which averaged from 0.8-96 kcal/day. The largest difference produced by any two of the nine equations was 189 kcal/day. Although differences in original stoichiometric data have resulted in numerous different equations for the calculation of metabolic expenditure, these differences are not clinically important. It makes little difference which equation is used for nutritional assessment in an ICU.

Dietary Carbohydrates↗
PubMedDate not supplied

The comet tail artifact.

A description and explanation of an unexpected echographic appearance in a patient who had sustained an abdominal shotgun wound is presented. In the B-scans, a trail of dense continuous echoes, simulating a comet tail, is seen distal to each lead pellet. This comet tail appearance is shown to be a type of reverberation artifact. The effect of object size, shape, composition, and orientation on the appearance of this artifact is demonstrated.

Animals↗
PubMedDate not supplied

Multiplicity and regulation of genes encoding peptide transporters in Saccharomyces cerevisiae.

The model eukaryote Saccharomyces cerevisiae has two distinct peptide transport mechanisms, one for di-/tripeptides (the PTR system) and another for tetra-/pentapeptides (the OPT system). The PTR system consists of three genes, PTR1, PTR2 and PTR3. The transporter (Ptr2p), encoded by the gene PTR2, is a 12 transmembrane domain (TMD) integral membrane protein that translocates di-/tripeptides. Homologues to Ptr2p have been identified in virtually all organisms examined to date and comprise the PTR family of transport proteins. In S. cerevisiae, the expression of PTR2 is highly regulated at the cellular level by complex interactions of many genes, including PTR1, PTR3, CUP9 and SSY1. Oligopeptides, consisting of four to five amino acids, are transported by the 12-14 TMD integral membrane protein Opt1p. Unlike Ptr2p, distribution of this protein appears limited to fungi and plants, and there appears to be three paralogues in S. cerevisiae. This transporter has an affinity for enkephalin, an endogenous mammalian pentapeptide, as well as for glutathione. Although it is known that OPT1 is normally expressed only during sporulation, to date little is known about the genes and proteins involved in the regulation of OPT1 expression.

Amino Acid Sequence↗
PubMedDate not supplied

[Clinical aspects of premature rupture of the membranes].

In this study all deliveries with premature rupture of the membranes (VBS) between 1978 and the midst of 1981 were compared and statistically analysed using a control collective, which consisted of the sum of the respective following delivery. A premature rupture of the membranes was found in 18.1 per cent. We observed a VBS more often in case of increasing age of the mother and significantly more often for primiparae. An infection of the urinary tract seemed to increase the risk of an VBS. The latent period is longer, if the VBS occurred in the early pregnancy. There was no difference between both groups according to the course of birth, the frequency of KPDA, the pressing period and the period of dilatation. Complications with the umbilical cord could not be found more often in the collective of premature rupture of the membranes than in the control group. The umbilical cord prolapse even was rarer in case of premature rupture of the membranes. Difficulties in adaptation and the respiratory distress syndrome could be found significantly more often in the group of VBS, according to the higher rate of premature children in this collective. The possible stimulating effect of the VBS on the induction of the fetal lung maturity was reserved by the higher rate of neonatal infections in case of longer latent periods. We found the amnion infection syndrome in 2.1 per cent if the latent period was less than 24 hours, 10.7 per cent if it was longer than 48 hours and more than 15 per cent if it was 72 hours and more.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗