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Biomedical subjects

J R Potts

Publications and source records attributed to J R Potts.

51 records · Page 3Linked to original sources
PubMed1985

Approach to the spectrum of Budd-Chiari syndrome: which patients require portal decompression?

Budd-Chiari syndrome (occlusion of the hepatic veins) represents a spectrum disorder. From 1974 to 1984, 20 patients with the syndrome were managed. Eleven required shunt surgery (Group 1) and 5 were managed with nonshunt therapy (Groups 2 and 3). Results have been good. Retrospective review of the liver biopsy specimens showed that Group 1 patients had a greater degree of zone 3 necrosis than Group 2 and 3 patients. We submit that presence of zone 3 necrosis on an initial liver biopsy specimen may define the failing liver of Budd-Chiari syndrome that requires conversion of the portal vein to an outflow tract by shunting.

Adult↗
PubMed1984

Emergency distal splenorenal shunts for variceal hemorrhage refractory to nonoperative control.

Two points are emphasized by this report. First, every attempt should be made to control acute variceal hemorrhage nonoperatively. Such control can be gained in about 80 percent of patients, allowing for a period of stabilization of liver disease, correction of coagulation defects, and nutritional repletion. Operative mortality then becomes equivalent to that in other elective candidates. Second, when necessary, because of ongoing hemorrhage in the face of maximal nonoperative therapy, selective shunting can be accomplished on an emergency basis. In our study, it resulted in a 70 percent survival rate and excellent protection against recurrent variceal hemorrhage with long-term maintenance of portal perfusion in 89 percent of the patients.

Adult↗
PubMed1984

Two stage surgical management of the Budd-Chiari syndrome associated with obstruction of the inferior vena cava.

A new, staged surgical approach to the treatment of Budd-Chiari syndrome complicated by inferior vena caval obstruction has been described. The first stage consists of a mesoatrial shunt. After an interval to allow hepatic decongestion, re-establishment of caval flow and overall improvement in the status of the patient, a portacaval shunt is established and the mesoatrial shunt removed. Such a staged procedure produced an excellent result in the patient reported upon in this study and represents a treatment option in similar patients with Budd-Chiari syndrome complicated by obstruction of the inferior vena cava.

Adult↗
PubMed1984

Restoration of portal venous perfusion and reversal of encephalopathy by balloon occlusion of portal systemic shunt.

Operative ligation of total portasystemic shunts is effective in reversing hepatic encephalopathy but is associated with significant mortality. In the case reported, invasive radiographic techniques were used to occlude a mesorenal shunt and reverse recurrent, disabling encephalopathy in a 72-yr-old woman. Occlusion of the shunt, coupled with coronary vein embolization, improved angiographic portal perfusion from grade IV to grade I, increased nutrient liver blood flow from 577 ml/min to 848 ml/min, and increased the hepatic fraction of cardiac output from 8.8% to 24.9%. Improved hepatocyte function was measured by an increase in galactose elimination capacity from 123 mg/min to 166 mg/min and a decrease in fasting ammonia from 107 micrograms/dl to 33 micrograms/dl. A 10-mo follow-up showed that there has been no recurrence of encephalopathy or variceal hemorrhage. Based on this experience, we conclude that (a) in selected cases total portasystemic shunts can be occluded by invasive radiographic techniques, and (b) restoration of portal perfusion can reverse hepatic encephalopathy and improve liver function.

Aged↗
PubMed1983

Transduodenal sphincteroplasty and transampullary septectomy for postcholecystectomy pain.

Ninety-two patients underwent a transduodenal sphincteroplasty and transampullary septectomy (extended papilloplasty) for chronic, incapacitating upper abdominal pain over an 11-year period. Seventy-nine had a prior cholecystectomy; 42 of 56 patients with reported pathology had documented gallstone disease. Serious morbidity included two moderately severe cases of postoperative pancreatitis and a pulmonary embolus. There were no deaths. Operative findings revealed stenosing papillitis (n = 45), transampullary septitis (n = 40), and papillary dysfunction (n = 7). Histologic examination of septal biopsy specimens revealed inflammation in 34 cases and fibrosis in 19 cases. There were no microscopic abnormalities in 39 biopsy specimens. The results at 1 to 10 years in 83 patients is as follows: good in 36 patients (no pain--43%), fair in 27 patients (occasional pain--33%), and poor in 20 patients (unrelieved by the procedure--24%). Patients with prior sphincteroplasty (12 of 15 with a fair to good result) benefitted the most from the procedure. Those who underwent concomitant cholecystectomy responded poorly. Risk factors for failure include alcoholism, drug addiction, mental illness, and duodenal ulcer disease. The finding of papillary cholesterolosis at operation also was accompanied by a less than optimal result. Transduodenal sphincteroplasty with transampullary septectomy provides long-term benefit to carefully selected patients with chronic abdominal pain after cholecystectomy.

Abdomen↗
PubMed1982

Five year experience with pancreatic pseudocysts.

Twenty-six patients with pancreatic pseudocysts underwent surgical intervention from 1975 through 1979. Chronic alcohol use was associated with pancreatic disease in 84.6 percent of these patients. The clinical findings are not specific, and ultrasonographic examination of the abdomen and computed tomographic scanning have been the most reliable diagnostic tests. External drainage is performed for infected or thin-walled cysts, and carries a complication rate of 72.7 percent in this series. Internal drainage was complicated 31 percent of the time. There were no deaths in this series.

Adolescent↗
PubMed1981

Surgical therapy for chronic pancreatitis: selecting the appropriate approach.

Surgical therapy of 37 patients with chronic pancreatitis is reviewed. Procedures included longitudinal pancreaticojejunostomy (10), DuVal (5), distal resection (4), pancreaticoduodenectomy (2), sphincteroplasty (7), pseudocyst drainage (6) and other miscellaneous procedures. Complication rates were 30 percent for lateral pancreaticojejunostomy, 28.5 percent for sphincteroplasty and 72.7 percent for resection procedures. The overall complication rate was 54.5 percent, and there were two deaths (5.4 percent). Follow-up is presented on 20 patients, of whom 16 are improved, 2 are unchanged and 2 are worse. Eight patients are dead and nine are lost to follow-up. Ductal anatomy is the most important consideration in the selection of a procedure. Lateral pancreaticojejunostomy, when applicable, is the procedure of choice. Resection should be considered when pancreaticojejunostomy has failed or is not indicated with pancreaticoduodenectomy, the procedure of choice in the diffusely diseased gland. Sphincteroplasty should be reserved for use in stenosing papillitis or as an ancillary procedure. Splanchnicectomy can be used for temporary palliation.

Adolescent↗
PubMed1979

Lower extremity amputation: review of 110 cases.

Very significant morbidity and mortality continue to accompany lower extremity amputations. In this study 90 patients underwent 110 amputations over a 4 year period. The overall complication rate was 40 per cent and the overall mortality rate 12.2 per cent. The patients at greatest risk were the above knee amputees greater than 60 years of age with peripheral vascular disease. Amputation of the lower extremity must be recognized as a major, life-threatening procedure. Careful preoperative evaluation of cardiac, pulmonary, and nutritional status along with efforts to prevent sepsis, pneumonia, pulmonary embolism, gastrointestinal ulceration, and renal failure are necessary if the mortality accompanying these procedures is to be reduced.

Adult↗
PubMed1976

Coordinated induction and subsequent activity changes of two groups of metabolically interrelated enzymes. Light-induced synthesis of flavonoid glycosides in cell suspension cultures of Petroselinum hortense.

The enzymes of the flavonoid glycoside pathway were specifically induced upon irradiation of a 10-day-old, dark-grown cell suspension culture of Petroselinum hortense Hoffm. with ultraviolet light. The curves for the activity changes of a first sequence of three enzymes (group I) revealed only small, but significant, differences. Sharp peaks in these enzyme activities were observed at about 17, 22, and 23 h after the onset of the irradiation. The apparent half-lives during the subsequent periods of decline ranged, in the same order, from about 10 to 15 and 17 h. No significant differences were found for the lag periods preceding the increases in the three enzyme activities. The possibility is discussed that the slight differences in the patterns of the light-induced activity changes are mainly due to different rates of degradation of the enzymes, suggesting an otherwise largely interpendent regulation. The patterns of the activity changes of four enzymes of the second sequence (group II) differed greatly from those observed for group I, but were again similar to one another. Thus, the two groups of enzymes appear to be regulated differently, despite their concomitant induction. A sigmoidal curve for the accumulation of the flavonoid glycosides was obtained upon the induction of the enzymes. This curve corresponded closely to that derived by integration of the curve for the activity changes of the first enzyme of group I, phenylalanine ammonia-lyase. It is concluded that this enzyme might be rate-limiting for the entire pathway.

Acyltransferases↗
PubMed1976

The effect of nitrogen limitation on catabolite repression of amidase, histidase and urocanase in Pseudomonas aeruginosa.

In Pseudomonas aeruginosa, the synthesis of histidase, urocanase and amidase is severly repressed when succinate is added to a culture growing in pyruvate + ammonium salts medium. When growth is nitrogen-limited, catabolite repression by succinate of histidase and urocanase synthesis does not occur but succinate repression of amidase synthesis persists. Amidase synthesis is not regulated in the same way as histidase synthesis by the availability of other nitrogen compounds for growth. Growth of P. aeruginosa strain PACI in succinate + histidine media is nitrogen-limited since this strain is defective in a histidine transport system. When methyl-ammonium chloride is added to succinate + histidine media, growth inhibition occurs. Mutants isolated from succinate + histidine + methylammonium chloride plates were found to be resistant to catabolite repression by succinate even in ammonium salts media. It is suggested that the hut genes of P. aeruginosa may be regulated in the same way as in Klebsiella aerogenes, by induction by urocanate and activation by either the cyclic AMP-dependent activator protein or by glutamine synthetase.

Amidohydrolases↗
PubMedDate not supplied

What are the indications for cholecystectomy?

Cholecystectomy is indicated in the presence of gallbladder trauma, gallbladder cancer, acute cholecystitis, and other complications of gallstones. More controversial are the indications for elective cholecystectomy. To properly determine the indications for elective cholecystectomy, the risk of the operation (taking into account the age and comorbid factors of the individual patient) must be weighed against the risk of complications and death without operation (taking into account the symptomatic status of the individual and the functional status of the gallbladder). Cholecystectomy (or some other form of gallstone therapy) is indicated in most patients with symptomatic cholelithiasis--especially those with non-functioning gallbladders. Cholecystectomy is not indicated in most patients with asymptomatic stones.

Cholecystectomy↗