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Biomedical subjects

J R Starling

Publications and source records attributed to J R Starling.

At least 91 records · Page 5Linked to original sources
PubMed1979

Initial treatment of sigmoid volvulous by colonoscopy.

The initial management of acute, nonstrangulated sigmoid volvulous is to attempt proctosigmoidoscopic, rectal tube, or barium enema reduction and evacuation. If unsuccessful emergency surgery is necessary. The flexible colonoscope offers an additional therapeutic modality to effectuate preoperative reduction of the twisted sigmoid colon if attempts with conventional methods fail. Three cases of acute sigmoid volvulous are presented which illustrate for the first time successful reduction of acute sigmoid volvulous by colonoscopy after failure of the usual methods of treatment. Instead of emergency surgery all of these patients had elective resection with primary colocolostomy. Patients with acute sigmoid volvulous refractile to reduction by conventional modalities should have an attempt at flexible colonoscopic reduction.

Acute Disease↗
PubMed1979

Treatment of hiatal hernia with esophagitis in a patient using esophageal speech after laryngectomy.

Severe reflux esophagitis occurring after total laryngectomy in a patient who has learned to communicate by esophageal speech represents a unique problem in management. It was anticipated that an antireflux operation might interfere with esophageal speech. A Nissen fundoplication resulted in complete resolution of signs and symptoms of reflux esophagitis without compromising esophageal speech. A comparison of pre- and post-operative speech functions suggests that more noticeable changes could result after an antireflux operation in the less proficient speaker and, therefore, only those patients with persistent and unresponsive reflux esophagitis should be operated upon.

Esophagitis, Peptic↗
PubMed1978

Diagnosis of occult familial medullary carcinoma of the thyroid using pentagastrin.

Medullary carcinoma of the thyroid is unique in that it can often be diagnosed solely on the basis of abnormally high basal serum thyrocalcitonin levels. Two brothers described in this report were found to have normal basal serum thyrocalcitonin levels when examined after another family member died from metastatic medullary carcinoma of the thyroid. Pentagastrin, a synthetic analog of gastrin, was subsequently administered to these two high-risk relatives and found to stimulate the release of thyrocalcitonin to abnormally high levels. They were found to have occult medullary carcinoma of the thyroid. Eight other first-degree relatives of the deceased patient with normal basal serum thyrocalcitonin levels were screened with pentagastrin and found to have normal stimulated levels of thyrocalcitonin. This report reinforces the need to recognize that medullary carcinoma of the thyroid can be familial and that physicians are obligated to screen asymptomatic kin who are at high risk. We recommend that all susceptible relatives, even if they have normal basal serum thyrocalcitonin levels, undergo the provocative pentagastrin test with repeat annual testing if necessary. In addition, the provocative pentagastrin test can be used to follow up patients who have undergone thyroidectomy.

Adolescent↗
PubMed1977

Prolongation of survival of rat parathyroid allografts by enhancing serum and tissue culture.

To determine whether survival of allografted rat parathyroid tissue could be enhanced either by the administration of antidonor serum (enhancing serum) or by tissue culture of the graft, parathyroids from Lewis x Brown Norway F1 (LBNF1) rats were transplanted beneath the fascia and between hamstring muscle fibers of hypocalcemic parathyroidectomized Lewis recipients (serum calcium 4.3 +/- 0.13mg%--mean +/- SEM). A drop in serum calcium below 7.5 mg% indicated rejection. Seven group 1 rats that received isogeneic parathyroids recovered from their hypocalcemic state and remained normocalcemic indefinitely. Seven group 2 rats that received LBNF(1) parathyroids experienced a reduced mean maximal response (MMR) of calcium increase of 4.1 +/- 0.2 mg% and the grafts had a median survival time (MST) of 16.0 +/- 1.32 days. Group 3 rats that received 1 ml of enhancing serum by intraperiotoneal injection, cytotoxic titer 1:128, on alternate days for five doses experienced an MMR of 5.0 +/- 0.7 mg% and had an MST of 19.3 +/- 1.07 days. When enhancing serum, cytotoxic titer 1:256, was administered to group 4, the MST of the grafts was increased to 29.7 +/- 1.19 days. When LBNF(1) parathyroid tissue was preserved in tissue culture for 14 to 21 days and then transplanted into Lewis recipients, the MST was 22.5 +/- 1.48 days. The administration of enhancing serum to recipients of cultured parathyroids further extended graft survival, MST 57.5 +/- 2.32 days. In summary, survival of allografted parathyroid tissue can be prolonged by the administration of enchancing serum or tissue culture of the graft. When enhancing serum was administered to recipients of cultured allografted parathyroid tissue, survival was further increased.

Animals↗
PubMed1976

Acute jejunogastric intussusception.

Our patient represents an example of acute retrograde jejunograstric intussusception with the additional finding of a bleeding jejunal ulcer in the intussusception. The ulcer may have been etiological in precipitating the intussusception, or a consequence of mucosal sloughing in the hemorrhagic intussusception. Early diagnosis and immediate surgical therapy resulted in an uneventful recovery.

Acute Disease↗
PubMed1975

Erythrocyte filterability and lysosomal enzymes in patients requiring cardiopulmonary bypass.

Erythrocyte filterability, an index of deformability, and lysosomal enzyme activity were studied in 34 patients requiring cardiopulmonary bypass. In addition fresh human erythrocytes were analyzed after incubation for filterability changes after exogenous lysosomal enzymes were added to the suspension medium. The results showed statistically significant elevations of the filterability index (decrease in filterability of the red cells) after 10 minutes on cardiopulmonary bypass as well as postoperatively. Likewise cathepsin D concentration after 10 minutes of cardiopulmonary bypass of 8.4 plus or minus 0.8 U. was significantly elevated over the preoperative level of 5.3 plus or minus 0.7 U. Furthermore, the pump prime was found to have the highest filterability index as well as concentration of cathepsin D. Supporting our hypothesis that lysosomal enzymes may be a factor affecting erythrocyte integrity was the elevation of the filtration index to 10.5 plus or minus 0.3 U. during incubation with exogenous lysosomal enzymes compared with the control index of 9.0 plus or minus 0.2 U. This stduy implies that the pump prime should be an area of further investigation if alterations of erythrocyte filterability (deformability) and lysosomal enzymes during extracorporeal circulation are shown to have clinical importance.

Animals↗
PubMedDate not supplied

Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia.

During the past 8 years, a total of 36 patients were diagnosed as having either ilioinguinal or genitofemoral neuralgia. A multidisciplinary approach (surgeon, neurologist, anesthesiologist) as well as local blocks of the ilioinguinal nerve or paravertebral blocks of L1,2 were essential to determine which nerve was likely to be entraped. Seventeen of the 19 patients having a diagnosis of ilioinguinal neuralgia after previous inguinal herniorraphy were completely free of pain after resection of the entrapped portion of the nerve. Seventeen patients were diagnosed as having genitofemoral neuralgia after previous inguinal herniorraphy, blunt abdominal trauma, or another operation. Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 12 of 17 of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of operations in the inguinal region. When the diagnosis is made by a multidisciplinary approach, neurectomy is frequently successful in relieving severe pain and paresthesias without serious morbidity.

Adult↗