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Biomedical subjects

L G Britt

Publications and source records attributed to L G Britt.

At least 37 records · Page 2Linked to original sources
PubMed1989

Primary repair of colon wounds. A prospective trial in nonselected patients.

102 patients with penetrating intraperitoneal colon injuries were entered into a prospective study. Colon wound management was undertaken without regard to associated injuries or amount of fecal contamination. Primary repair was performed in 83 patients, segmental resection with anastomosis in 12, and resection with end colostomy in 7. There were no suture line failures in the primary repair group, and one suture line failure in the anastomosis group. The one failure was in a patient who underwent repeated explorations for bleeding before the leak occurred. The septic complication rate was 33% of the entire series and was unrelated to primary repair. Logistic regression analysis to identify risk factors for sepsis included transfusion greater than or equal to 4 units (p less than 0.02), more than two associated injuries (p less than 0.04), significant contamination (p less than 0.05), and increasing colon injury severity scores (p less than 0.02). The method of colon wound management, location and mode of injury, presence of hypotension (BP less than 90), and age did not significantly contribute to sepsis. We conclude that nearly all penetrating colon wounds can be repaired primarily or with resection and anastomosis, regardless of risk factors.

Adolescent↗
PubMed1989

Sigmoid volvulus. A four-decade experience.

During the 40 years from 1945 to 1984, 159 occurrences of sigmoid volvulus in 140 patients were diagnosed and managed. Treatment modalities gradually evolved from primarily operative decompression in the first 20 years to selective, sigmoidoscopic, nonoperative reduction in the most recent 10-year period. Operative reduction was associated with a 10 per cent mortality, while no deaths were associated with nonoperative reduction. A 60 per cent mortality was noted when gangrenous bowel was present. In the most recent 10-year period, 71 per cent of cases were associated with neuropsychiatric diseases, and one third had a previous episode of sigmoid volvulus. The diagnosis was made on the initial plain abdominal radiograph in 60 per cent, and nonoperative sigmoidoscopic reduction attained in 95 per cent. Following nonoperative reduction, elective resection was performed during the same hospitalization with a 5 per cent mortality. Initial management of sigmoid volvulus should consist of nonoperative attempts at reduction with operative reduction reserved for refractory cases or those with ischemic bowel. Elective resection can be safely performed during the same hospitalization.

Adult↗
PubMed1988

Conventional immunosuppressive therapy in modern renal transplantation.

Conventional immunosuppression has been replaced by cyclosporine protocols for renal transplantation in most centers. Some centers have continued using conventional immunosuppression in certain instances. In our series, 104 patients received 105 kidney allografts (58 cadaver, 47 living donor) in 1983 and 1984. No patients was treated with cyclosporine. Patient survival was 95% and 92% at six months and one year, respectively. Eight deaths were caused by sudden cardiorespiratory events (four), liver failure (one), and suicide (one); fatal infection occurred after regrafting in two asplenic patients. Actuarial graft functional survival was 80% at 12 months; living related donor graft survival of 94% at one year was comparatively better than the 66% with cadaveric grafts. Death from excessive pharmacologic immunosuppression did not occur. Graft survival was excellent with living donor and acceptable with cadaveric grafts, especially with good tissue matching. Conventional immunosuppression may remain applicable in renal transplantation under conditions of low risk for graft loss.

Adolescent↗
PubMed1988

Investigation of passive venovenous shunts during the anhepatic period of canine hepatic transplantation.

The anhepatic period of canine orthotopic hepatic transplantation is usually accompanied by cardiovascular instability due to occlusion of both the portal and inferior systemic venous systems. The present study was undertaken in order to determine some of the hemodynamic and renal alterations that occur during a 2 hour anhepatic period in the dog and to investigate the use of a passive endoportal, endocaval venovenous shunt that places both the portal and infrahepatic vena caval limbs of the shunt directly into the divided ends of these vessels. Three groups of experimental animals were studied. One group had hepatectomy without a shunt and was compared with two other groups which had hepatectomy with some form of venovenous shunting. Systemic arterial blood pressure, portal and inferior vena caval pressure, urinary output, and renal histology were all better maintained when a shunt was used.

Animals↗
PubMed1986

Cholestatic jaundice after hepatic transplantation. A nonimmunologically mediated event.

Serial liver biopsy and close clinical monitoring in 55 consecutive hepatic allografts have disclosed a syndrome of cholestatic jaundice that simulates rejection. This syndrome is associated with distinct histologic findings and resolves spontaneously without modification of immunosuppressive management. The cause of the cholestasis is probably related to subcellular organelle damage produced by cold ischemia, and its importance stems from the confusion it creates with regard to rejection diagnosis. Recognition of this syndrome can result in decreased immunosuppression in hepatic allograft recipients, a secondary decrease in infectious complications, and improvement in the survival rate.

Bilirubin↗
PubMed1986

A prospective study of 91 patients undergoing both computed tomography and peritoneal lavage following blunt abdominal trauma.

Recent reports comparing computed tomography of the abdomen (CTA) and diagnostic peritoneal lavage (DPL) following trauma have been contradictory. A 10-month prospective study was conducted at our trauma center comparing both methods. Criteria for entry into the study included suspected blunt abdominal trauma without indication for immediate laparotomy, with either equivocal abdominal examination, diminished sensorium, or neurologic deficit. Ninety-one patients meeting these criteria underwent CTA followed by DPL. CTA was performed using both oral and intravenous contrast; DPL was performed by the open technique with RBC greater than 100,000 mm3 or WBC greater than 500 mm3 as criteria for a positive examination. CTA was interpreted initially by available radiology staff and residents and retrospectively reviewed by an experienced tomographer blind to DPL and surgical results. Twenty patients in whom either test was positive underwent laparotomy; all others were admitted for observation and/or extra-abdominal surgery. Laparotomy revealed 26 organs injured in the 20 patients explored at admission; none of the observed patients required delayed laparotomy. The results of CTA and DPL were compared to the findings at laparotomy or the clinical course of those not explored. The sensitivity, specificity, and accuracy for initial CTA were 60%, 100%, and 91%; for review CTA 85%, 100%, and 97%; for DPL 90%, 100%, and 98%. We conclude that: even with experienced examiners, CTA offers no diagnostic advantage over DPL in blunt trauma; because of relative costs, we do not recommend the routine application of CTA; CTA is a reliable alternative when circumstances prevent the performance of DPL.

Abdominal Injuries↗
PubMed1985

Biopsy-directed immunosuppression following hepatic transplantation in man.

Patients undergoing orthotopic hepatic transplantation were studied with routinely available liver function studies and serial hepatic biopsies. Rejection was diagnosed only if confirmed histologically. Cyclosporine and a rapidly decreasing dose of corticosteroids were used for immunosuppression. Hepatic dysfunction suggesting rejection was seen in 22 instances, but acute rejection was diagnosed histologically in only 6 patients. The liver function studies used in these patients did not accurately distinguish rejection from other causes of hepatic dysfunction. We conclude that liver biopsy as performed in these patients is an accurate and safe means of assessing the adequacy of immunosuppression and minimizing the use of high dose corticosteroids.

Biopsy, Needle↗
PubMed1985

Soft tissue calcium and magnesium content in acute pancreatitis in the dog: calcium accumulation, a mechanism for hypocalcemia in acute pancreatitis.

The mechanism of hypocalcemia in acute pancreatitis remains unknown despite continued investigative work over the past several decades. Because acute pancreatitis is accompanied by multiple systemic manifestations and alterations of plasma membranes, the possibility that an abnormal translocation of calcium from extracellular to intracellular compartments could play a role in hypocalcemia of acute pancreatitis was investigated in dogs. Acute pancreatitis was induced by injecting bile into the pancreatic duct. Plasma calcium, magnesium, and amylase concentrations were determined. Calcium and magnesium contents were also measured in biopsy specimens of pancreas, liver, skeletal muscle, and kidney before and after induction of acute pancreatitis. As expected, hypocalcemia and hyperamylasemia occurred 6 hours after induction of pancreatitis, and persisted throughout the experiment, 13 to 25 hours. Plasma magnesium concentration fell at 6 and 18 hours, and returned to an almost normal level by the end of the study. A significant elevation in calcium content of pancreas (71%), liver (24%), and muscle (112%), and 25% reduction of calcium in kidney were observed in dogs with histologic signs of pancreatitis. However, tissue magnesium concentration fell in pancreas (18%) but remained unchanged in the other tissues investigated. No significant changes in any variables were detected in sham-operated animals. In another group of dogs in which the accessory pancreatic duct was not occluded when bile was injected, the histologic lesions were extremely mild, although the plasma calcium concentration and the pancreatic calcium and magnesium contents were altered just as much as in the severely affected dogs. Data suggest that the hypocalcemia of acute pancreatitis may be the result, at least in part, of accumulation of calcium in soft tissues. The decreased calcium content in kidney could be related to hypocalcemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Amylases↗
PubMed1985

Liver transplantation with cyclosporine and low-dose corticosteroids.

Twenty consecutive patients receiving 21 hepatic transplants were treated with cyclosporine and low-dose corticosteroids. Survival was 80 per cent at 30 days, 75 per cent at 6 months, and 65% in the 6-17 months follow-up period. Compared with earlier series, this improved survival using cyclosporine results from fewer infectious and sound healing complications. Reliance on hepatic biopsy to confirm the diagnosis of rejection may also reduce the corticosteroid exposure and help diminish the complications of excessive immunosuppression.

Biopsy↗
PubMed1985

Autotransfusion in hepatic transplantation.

Hepatic transplantation is often accompanied by a large volume of intraoperative blood loss which may place extraordinary transfusion demands on a community blood bank. In an effort to conserve blood bank resources, intraoperative autotransfusion has recently been used in our adult patients undergoing orthotopic hepatic transplantation. A group of seven patients receiving autotransfusion was studied and compared to another group of five patients who did not receive autotransfusion. In spite of receiving more blood during the transplant procedure, the autotransfusion group required a mean of 7.9 units less banked blood. Post-transplant transfusion requirements and bleeding complications were similar in both groups. Hematocrit and total bilirubin were not adversely affected, while transient elevation of BUN and serum creatinine appeared to be unrelated to the salvage process. This procedure was found to be safe and cost-effective, while conserving blood bank resources.

Adult↗
PubMed1984

Portal vein obstruction in patients requiring hepatic resection or transplantation.

Four patients with chronic portal vein occlusion (or near occlusion) who required major hepatic resection or transplantation are described. In each case, portal vein patency was restored, and objective evidence of long-term patency is presented in three patients. These patients demonstrate the feasibility of restoring and indefinitely maintaining portal venous flow coincident to major hepatic surgery.

Adult↗
PubMed1983

Splenectomy and death in renal transplant patients.

To determine any association of splenectomy and death, 191 recipients of a single renal transplant were reviewed. Pretransplant splenectomy was performed in 90(47%) patients and the spleen was retained ("spleen-retaining") in 101 (53%). Sixty-eight patients (36%) died. Thirty-two fatal infections occurred in asplenic patients compared with ten infection-caused deaths in those retaining the spleen; 12 asplenic and 14 spleen-retaining patients died of noninfectious causes. Age, sex, graft source, HLA mismatch, and period of graft function were similar in asplenic and spleen-retaining patients who died. Prospective, multicenter, and single-center studies support divergent conclusions regarding the risks and benefits of splenectomy in transplantation. Study of specific center experience should precede adopting a policy of pretransplant splenectomy, an irreversible form of immunosuppression significantly related to fatal infection.

Adult↗