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Biomedical subjects

J M Little

Publications and source records attributed to J M Little.

At least 217 records · Page 12Linked to original sources
PubMed1977

Ethanol--its nephrotoxic effect in the rat.

The nephrotoxic effect of ethanol feeding on renal structure and function was evaluated in rats and compared to that in dextrose-fed isocaloric control animals. Alcohol-fed animals had larger kidneys than their controls. Despite this increase in renal mass, the alcohol-fed animals had a 50% reduction in creatinine clearance and a 67% reduction in osmolar clearance compared to their controls. When specific renal constituents were compared, the alcohol-fed animals were found to have twice the renal protein and a 50% increase in renal lipid. Despite these marked structural and functional differences, the light microscopic appearance of the kidneys of the two groups did not appear significantly different. In contrast, the electron microscopic differences were substantial. The renal epithelial cells, particularly of the distal tubules and Henle's loops, were found to show varying degrees of cellular injury and were observed to be sloughing into the lumens. These electron microscopic observations are similar to those obtained in tubular necrosis due to a variety of nephrotoxic agents. We propose, therefore, that chronic alcohol feeding of rats produces significant renal dysfunction and abnormalities of structure such that ethanol should be considered a true nephrotoxin.

Acute Kidney Injury↗
PubMed1977

Pancreatic duct obstruction with an acrylate glue: a new method for producing pancreatic exocrine atrophy.

Ten dogs have been used in a study which demonstrates the feasibility of producing total pancreatic duct obstruction with alkyl-alpha-cyanoacrylate glue. Low pressure injection of glue into the pancreatic duct has led to a reproducible pancreatic atrophy with preservation of the islets. A sharp rise in serum amylase was noted in each dog, but at autopsy examination at monthly intervals after the operation, no evidence of chronic pancreatitis was observed. None of the dogs was rendered diabetic. The success of the experimental technique raises the possibility that such a technique might be useful in the management of human chronic pancreatitis as an alternative to pancreatic resection, and the operation has been performed on three patients so far.

Adult↗
PubMed1976

Amputation of the toes for vascular disease: fate of the affected leg.

53 patients coming to amputation of one or more toes for the late results of degenerative vascular disease were studied prospectively. By a median time of thirteen months, 26 of the 53 had undergone a major amputation of the affected side. Diabetes was associated with the same prognosis as atherosclerosis obliterans uncomplicated by diabetes. A palpable pedal pulse or a functioning arterial reconstruction carried a virtual guarantee of success for the toe amputation. The presence of a popliteal pulse, however, was not associated with any better prognosis than the presence of a femoral pulse alone. Smoking seemed to exert little influence. With the passage of time, the major-amputation rate rose steadily, and by 3 1/2 years almost three-quarters of the patients had come to major amputation.

Aged↗
PubMed1976

Hydatid disease at Royal Prince Alfred Hospital, 1964 to 1974.

A survey of hydatid disease has been carried out at the Royal Prince Alfred Hospital over a ten-year period from 1964 to 1974. It would appear that there has been no change in incidence in hydatid disease in the last 25 years. Fifty per cent of the hydatid cysts dealt with in this series occurred in the liver, and 30% were in the lung. Forty per cent of patients with lung hydatid disease were found to harbour hydatid cysts in the liver as well, while 24% of those with hydatid disease in the liver were found to have co-existent lung cysts. Twenty per cent of patients with pulmonary hydatid cysts presented with urgent complications, while only 7% of those with liver hydatid cysts presented in this way. Twenty-four per cent of the patients in this series were born outside Australia, most of the rest having been born and having lived in New South Wales. In this State, the distribution of hydatid disease remains the same as it was in 1925. Of the serological tests, the Casoni intradermal reaction was positive in 67% of cases, while the complement-fixation reaction was positive in only 52%. Seventy-eight per cent of these patients came to operation; 50% were found to have viable cysts at operation. Morbidity was high from chest infection, prolonged drainage from the site of the cyst and subphrenic abscess. Since few viable cysts were found in patients over the age of 60 years, there is a strong case for conservatism in the treatment of elderly patient with an asymptomatic calcified hydatid cyst. The hydatid-dependent mortality rate in this series was 1-8%. Over a mean follow-up period of five years, in 5% of these patients, there was a proven recurrence of hydatid disease requiring further operation.

Adolescent↗
PubMed1976

Tibial artery bypass.

Experience with 29 tibial bypasses is presented. Twenty-one have remained patent for an average time of 13.2 months. There were two hospital deaths and five additional late ones. Autogenous saphenous vein was used in 27. Electromagnetic flowmeter studies were useful in assessment of patency, but intraoperative arteriography was of limited value only. The use of peroneal artery had equivalent results to anterior and posterior tibial arteries. It is concluded that a reasonable limb prognosis may be offered to the patient with advanced ischemic disease and one or more open tibial vessels. The late mortality in this group is appreciable.

Arteries↗
PubMed1976

Juvenile diabetes mellitus, optic atrophy, sensory nerve deafness, and diabetes insipidus--a syndrome.

Four patients with diabetes mellitus, optic atrophy, and high-frequency neurosensory hearing loss, two of whom also had diabetes insipidus, are described. The frequency of this syndrome among patients with juvenile diabetes appears to be between 1/148 and 1/175. Because of the progressive nature of the disabilities and the autosomal recessive mode of inheritance, careful monitoring of all juvenile diabetic patients for other signs of the syndrome is warranted.

Adolescent↗
PubMed1976

Splenectomy: a review of morbidity.

One hundred and fifty consecutive splenectomies, performed at the Royal Prince Alfred Hospital over a five-year period beginning in 1968, have been reviewed in a retrospective study. Splenectomy incidental to some other resectional procedure in the upper abdomen carried a mortality of 17%, accidental injury to the spleen during upper abdominal surgery carried a mortality of 28%, external trauma to the spleen a 7% mortality, while splenectomy for the diagnosis or therapy of a haematological disorder carried the lowest mortality, namely 4%. Morbidity and mortality were related to the age of the patient, and the mortality among patients 60 years or more was 26%. Pulmonary complications (excluding pulmonary embolus) occurred in 48% of patients. Clinically evident thromboembolism was detected in 10.7% of patients. A definite relationship to platelet counts of more than 500,000/mm3 was noted amongst patients who were not heparinized. Splenectomy is associated with a high morbidity and a significant mortality. Surgeons performing the operation and physicians referring patients for splenectomy need to be aware of the risks involved. Careful patient selection, scrupulous perioperative management, and meticulous surgery may reduce both morbidity and mortality. Elective splenectomy should be managed by a team of surgeons and physicians with a specific interest in the problems involved.

Adult↗
PubMed1976

Bile acid conjugation in fetal hepatic organ cultures.

A new technique has been developed in which mammalian fetal liver can be maintained in organ culture for prolonged periods with intact structure and function. Near-term rat fetal liver explants were incubated in vitro for periods of up to 3 wk with preservation of normal cellular morphology and intercellular (organ) relationships. [14C]cholate was incorporated into tissue and medium conjugates at a constant rate during 21 days in vitro. During a 24-h incubation with radioactively labeled cholic acid, bile acid conjugates accumulated in tissues to a maximum value by 6 h and maintained this value through 24 h. During the same 24-h incubation with [14C]cholate, conjugates were secreted into the medium at a constant rate. Addition of 8 X 10(-4) M taurine to the medium during a 4-day incubation produced a threefold enhancement in the rate of conjugate formation in tissues and medium. Enhanced conjugation in the presence of additional taurine was due almost entirely to increased taurocholate formation and no significant difference was observed in the amount of glycocholate formed. Exposure of explants to 3.6 X 10(-4) M cycloheximide for prolonged periods resulted in inhibition of conjugate formation, but when this concentration of cycloheximide was maintained for only 24 h a significantly (P less than 0.001) increased rate of conjugate formation was observed. The results indicate that metabolic processes in the organ-culture system are in a state of dynamic equilibrium and that morphologic integrity and specific hepatocytic function are maintained after 21 days in vitro. Preferential taurocholate formation was demonstrated in rat fetal liver, and the data suggest that glycine and taurine interact with separate enzymatic systems in bile acid conjugation. The possible mechanisms that mediate the effect of cycloheximide are discussed.

Animals↗
PubMed1975

Effects of radial artery cannulation.

A prospective study has been carried out in 40 patients of the effects of radial artery cannulation for monitoring purposes. A Doppler flow meter was used to secure objective evidence of the incidence of thrombosis in the cannulated radial artery. Twenty-two of the 41 arteries cannulated were shown to have undergone thrombosis, and the haemodynamic defect associated with the arterial block persisted in all but two until the time of the patient's discharge from hospital. Thirteen of the 20 hands in which a persistent block was demonstrated developed features of mild ischaemia. In four instances, these were transient, and disappeared within a few days. In the remaining nine hands, however, the features persisted to the time of the patient's discharge from hospital at an average of three weeks from the date of cannulation. The mean cannulation time was 45 hours. Radial artery cannulation carries a definite morbidity, and should not be used unless there is no other reasonable way of obtaining vital information for the management of a critically ill patient.

Adult↗
PubMed1975

Crustacean intestinal detergent promotes sterol solubilization.

Although crustacean tissue cholesterol content is high, Crustacea, like other arthropods; are incapable of cholesterol synthesis, and presumably are dependent for maintaining tissue cholesterol stores on the intestinal absorption of ingested sterol. A detergent, N-(N-dodecanoylsarcosyl)taurine, representative of a set of detergents synthesized by the crustacean hepatopancreas and secreted into the intestine, is capable of efficient cholesterol solubilization, and thus of promoting sterol absorption.

Animals↗
PubMed1975

Mean flow measurements in aortofemoral arterial reconstructions.

Eighty-seven limbs in 48 patients have been studied with an electromagnetic flow meter at the time of arterial reconstruction designed to restore blood flow from the aorta to the femoral artery system. The mean overall flow was 339 ml per minute. Blood flow in aneurysmal disease was significantly higher than that recorded in obstructive disease. Blood flow in arteries running into a fully patent femoral system was significantly higher than in those that ran only into the profunda. Age, sex, type of surgery and size of graft had no influence on the flow achieved. Reconstructions for rest pain or advanced trophic change produced flows of the same magnitude as reconstructions for intermittent claudication. The patient's weight correlated significantly with the intraoperative flow. The mean flow in the limbs of 28 patients in whom an accurate preoperative weight was known was 2-56 ml/100 gm/minute, taking the hind limb and hemi-pelvis as 25% of the body weight. This is an acceptably "normal" value. A flow of less than 100 ml per minute in an aortoiliac reconstruction was found to be not likely to result in long-term patency.

Aneurysm↗
PubMed1975

A comparison of the supraclavicular and axillary approaches to upper thoracic sympathectomy.

Twenty-nine upper dorsal sympathectomies have been carried out in 18 patients and a comparison made of the supraclavicular with the axillary approach to the upper thoracic sympathetic chain. Thirteen of these operations were carried out for essential hyperhidrosis, 15 for ischaemia in the hand and one for post-traumatic pain syndrome. Fourteen sympathectomies were carried out through the axilla and 15 through the supraclavicular approach. Post-operative pain was felt to be somewhat more severe when the axillary approach was used, but other complications were infrequent and hospital stay was slightly shorter in the axillary group. The axillary approach was felt to offer superior exposure, the capability for wider sympathetic excision, good cosmetic results, avoidance of Horner's syndrome and low morbidity. In the absence of lung disease or the need for a direct exploration of the root of the neck, the axillary approach is to be preferred for upper dorsal sympathectomy.

Adult↗