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Biomedical subjects

J M Watters

Publications and source records attributed to J M Watters.

29 records · Page 2Linked to original sources
PubMed1989

Hyperglycemia after trauma increases with age.

The metabolic responses to trauma and surgery have been well described and are observed most typically in otherwise healthy young and middle-aged individuals. To investigate the effect of age on blood glucose, insulin, and cortisol responses after mild to moderate trauma, we studied 33 patients (Injury Severity Scores, 5-38, and ages 16 to 81 years) before resuscitation and 24-96 hours postinjury. Age was associated with an increase in serum glucose during both "ebb" and "flow" phases of the injury response, but not with serum insulin. Serum glucose also increased with the degree of injury as reflected in Glasgow Coma Scale on admission and Injury Severity Score subsequently. Serum cortisol responses were increased in older patients and tended to decrease with time following injury. A more detailed knowledge of how age may alter the ability of elderly patients to respond to trauma and critical illness is essential to allow the continued development of rational therapies for such patients.

Adolescent↗
PubMed1988

Inhibition of cyclo-oxygenase attenuates the metabolic response to endotoxin in humans.

Acute infection initiates fever, acute-phase changes, and catabolic responses in the host, resulting in weight loss, hypermetabolism, and accelerated proteolysis. To test the hypothesis that cyclo-oxygenase inhibition might attenuate these responses, we administered Escherichia coli endotoxin intravenously to seven normal volunteers and to seven additional subjects pretreated with a cyclo-oxygenase inhibitor (ibuprofen). Control studies were also performed following administration of saline and ibuprofen alone. Vital signs, metabolic rate, and concentrations of pituitary and stress hormones, as well as those of other substrates, were serially measured. Endotoxin administration produced a response similar to an acute illness, with flulike symptoms, fever, tachycardia, increased metabolic rate, and stimulation of stress hormone release. These changes were markedly attenuated by cyclo-oxygenase inhibition. The leukocytosis, hypoferremia, and elevation of the C-reactive protein level induced by endotoxin were unaffected by cyclo-oxygenase inhibition. These data indicate that activation of the cyclooxygenase pathway is necessary to produce many of the metabolic changes observed during critical illness.

Adult↗
PubMed1988

Retroperitoneal perforation of the rectum during barium enema examination.

Colorectal perforation during barium enema examination is rare. The authors report the case of an 84-year-old woman in whom retroperitoneal perforation of the rectum occurred during barium enema examination. Potential mechanisms of injury include trauma, overinflation of the balloon, recent instrumentation and associated disease of the rectal mucosa. When the colon has been well prepared before examination, and air alone, not barium, has been insufflated into the retroperitoneum, then such injuries may be managed successfully without operation, as in this case.

Aged↗
PubMed1987

Perforated ulcers in critical illness.

Although gastroduodenal ulcers rarely perforate during critical illness, this occurrence causes specific and difficult problems of diagnosis and management. In our review of the records of 19 critically ill patients whose ulcers perforated, we found that classical symptoms were frequently absent. The perforations often were manifested by nonspecific clinical events, such as unexplained ileus or hypotension. Diagnosis was typically delayed and on occasion was first suspected after observing pneumoperitoneum on a routine x-ray. While the ulcers were characteristically very large (greater than 2 cm), minimal inflammation surrounded them. Mortality was 56% in the 16 patients whose perforations were diagnosed before death or discharge. Fifteen patients were treated with simple patching of the ulcer. Perforated ulcers in critically ill patients differ in several important ways from those occurring in otherwise healthy individuals.

Critical Care↗
PubMed1986

Both inflammatory and endocrine mediators stimulate host responses to sepsis.

Host responses to sepsis and trauma are complex and their mediators are not well understood. To examine the roles of "endocrine" and "inflammatory" mediators, we studied healthy volunteers in four experimental groups: continuous 72-hour infusion of normal saline; continuous 72-hour infusion of hydrocortisone, glucagon, and epinephrine; daily intramuscular injection of the inflammatory agent etiocholanolone; and combined etiocholanolone injection--hormone infusion. In this model hypermetabolism, hyperglycemia, hyper-insulinemia, insulin resistance, negative nitrogen balance, and accelerated protein flux were mediated predominantly by infusion of the counterregulatory hormones. Etiocholanolone injection resulted in fever, acute-phase--protein synthesis, and hypoferremia. Leukocyte, temperature, and C-reactive--protein responses reflected major interactions between these stimuli. Both inflammatory and endocrine mediators are necessary for the complete manifestation of host responses to critical illness.

Adult↗
PubMed1986

Role of catabolic hormones in the hypoketonaemia of injury.

Adaptation to fasting results in ketosis, protein conservation, and diminished energy requirements. To determine whether the attenuation of these responses following injury is due to an altered hormonal environment, we infused the catabolic hormones cortisol, glucagon, and adrenaline into seven fasting subjects for 72 h. Saline alone was administered during a comparable control period. Hormone infusion achieved blood levels typical of moderate injury and resulted in hypermetabolism, hyperglycaemia, hyperinsulinaemia, and marked suppression of fasting ketosis. The hypoketonaemia could not be accounted for by decreased precursor availability, accelerated ketone utilization or increased urinary excretion. The altered hormonal environment associated with critical illness attenuates fasting ketosis by limiting hepatic ketogenesis.

Adaptation, Physiological↗
PubMed1985

The induction of interleukin-1 in humans and its metabolic effects.

To investigate the metabolic effects of interleukin-1 and its role as a mediator of host responses to trauma and sepsis, we injected seven healthy male subjects with etiocholanolone, an inflammatory agent that stimulates systemic responses thought to be mediated by interleukin-1. The subjects were fed a constant diet during each 4-day study and received three daily intramuscular injections of etiocholanolone, 0.10 mg/kg. Etiocholanolone injection resulted in inflammation, fever, leukocytosis, increased serum C-reactive protein, hypoferremia, and increased plasma activity of interleukin-1/lymphocyte-activating factor. Plasma concentrations of the counterregulatory hormones were normal. Protein metabolism, as reflected in nitrogen balance, 15N turnover, and forearm flux of alanine and glutamine, was unaltered. Serum glucose and insulin levels and tissue responsiveness to insulin were normal. This dissociation of acute-phase and catabolic responses may reflect the magnitude of the stimulus; higher levels of interleukin-1 may initiate catabolic responses. Alternatively, other mediators such as the counterregulatory hormones may direct the catabolic responses that occur after injury and sepsis.

Adult↗
PubMed1984

Combined hormonal infusion simulates the metabolic response to injury.

To investigate the role of hormones as mediators of the metabolic response to injury, nine normal male volunteers received a continuous 74-hour infusion of the three 'stress' hormones: cortisol, glucagon, and epinephrine. As a control, each subject received a saline infusion during another 4-day period. Diets were constant and matched on both occasions. Hormonal infusion achieved hormone concentrations similar to those seen following mild-moderate injury. With this alteration in the endocrine environment significant hypermetabolism, negative nitrogen and potassium balances, glucose intolerance, hyperinsulinemia, insulin resistance, sodium retention, and peripheral leukocytosis were observed. Additional studies with single hormone infusions indicated that these responses resulted from both additive and synergistic interactions of the hormones. Triple hormone infusion simulated many of the metabolic responses observed following mild-moderate injury and other catabolic illnesses.

Blood Flow Velocity↗
PubMed1982

Pancreatic abscess.

Pancreatic abscess, although an uncommon complication of pancreatitis, is a serious cause of morbidity and death. During the 5-year period beginning in March 1976, 19 patients with pancreatic abscess were seen at the Ottawa Civic Hospital. Abdominal pain, mass, fever and leukocytosis were common; the serum amylase value was usually normal. twelve patients underwent external drainage; in 6 the abscess was drained internally through the posterior wall of the stomach. The overall mortality was 16%. Morbidity was high; 7 (37%) of the 19 patients required reoperation for recurrent sepsis. Differentiation of pancreatic abscess from phlegmonous pancreatitis or pseudocyst can be difficult. Ultrasonography may be useful but computerized axial tomography is the the diagnostic method of choice. Prompt débridement and external drainage are the mainstays of surgical treatment but internal drainage may be appropriate in selected patients.

Abscess↗
PubMed1981

Parenteral nutrition by peripheral vein.

Peripheral parenteral nutrition can provide perioperative nutritional support to patients with inadequate oral intake in whom total parenteral nutrition with hypertonic dextrose administered by a central vein cannot be undertaken because of sepsis, subclavian vein thrombosis, or lack of expertise and familiarity. Peripheral parenteral nutrition may be indicated in patients with marginal nutritional status whose postoperative course and period of starvation are unpredictable and in patients being started on a total enteral nutrition regimen. In patients with increased requirements because of stress or malnutrition who need full nutritional support by a peripheral method, the lipid system is indicated. In certain instances, large enough volumes can be infused to provide sufficient calories and protein for nutritional repletion. Protein-sparing therapy is indicated for nutritional maintenance in patients who do not clearly require full support by total parenteral nutrition but who are taking insufficient calories and protein orally. Peripheral parenteral nutrition avoids the risks of subclavian vein catheterization but requires that adequate peripheral veins are available. The metabolic complications are minimal compared with those of total parenteral nutrition, and the nutritional management of the diabetic patient is greatly simplified. Several techniques of preserving peripheral veins and prolonging their use have been discussed.

Body Weight↗