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Biomedical subjects

L M Jones

Publications and source records attributed to L M Jones.

At least 55 records · Page 3Linked to original sources
PubMed1987

Fluid retention and burn survival.

The relationship between retained fluid and survival has previously been reported from our burn unit. Two hundred thirty cc/kg lean body mass accurately delineated survivors from nonsurvivors. Our previous study did not account for fluid lost through the burn wound. This study was undertaken to evaluate fluid retention per square meter of body surface area which has been corrected for fluid loss from the burn wound using a formula suggested by Mason et al. Data collected from 95 adult patients with burns greater than or equal to 20% body surface area burn (mean age, 42.4 years; mean burn size, 37.7%), who were admitted to our burn unit between January 1978 and September 1985, were evaluated. All patients included in the study were adequately resuscitated and survived the initial 48 hours. A calculation of the total fluid retained during the first 48 hours postburn and estimation of fluid loss from the burn wound were made. A comparison was made between lean body retained fluid and surface area retained fluid. A positive correlation (r = 0.921; p less than 0.001) was demonstrated between these two methods of assessing fluid retention. Fluid retention determined by either method resulted in a higher correlation with survival than any single predictor (age, per cent body surface area burned) of burn survival. Surface area fluid is as accurate as lean body fluid in predicting survival. Additionally, we determined that for the first 48 hours postburn, 4,425 cc fluid retained per meter square body surface area accurately differentiated survivors from nonsurvivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

A correlation of response time and results of abdominal gunshot wounds.

Gunshot wounds to the abdomen are an indication for exploratory laparotomy in all cases except those involving the most superficial abdominal wall injuries. The charts of 123 patients admitted for abdominal gunshot wounds were reviewed for times of arrival on the scene by paramedics, in the emergency room, and in the operating room, as well as for number of admissions. Results of therapy were also graded and correlated with response times. The mean paramedic response time was 4 minutes 30 s. An average of 24 minutes 24 s was spent at the scene and in transport. The average delay from admission to arrival in the operating room was 1 hour 49 minutes. Patients who died spent an average of 54.4 minutes in the emergency room prior to surgical intervention. These results may represent justification for regionalization of trauma and direct transport to the operating room for abdominal gunshot wounds.

Abdominal Injuries↗
PubMed1986

Fluid retention during the first 48 hours as an indicator of burn survival.

The quantity of fluid retained during the first 48 hours of resuscitation has been suggested as an indicator of burn severity and mortality (13). In this study of 82 adult burned patients with more than 20% total body surface burns we found that the net fluid retention during the first 48 hours of resuscitation was a predictor of burn mortality and additionally 230 cc of retained fluid per kilogram of lean body mass in the initial 48 hours postburn was an excellent means for separating survivors from nonsurvivors. Fluid retention as an indicator of burn severity and mortality was compared to other methods of predicting burned patient mortality. Parameters evaluated included the per cent body surface area burned, per cent full thickness burn, presence or absence of inhalation injuries, sex, age, and ultimate outcome. The Abbreviated Burn Severity Index (ABSI) (14) was determined for each patient using these data. A comparison was made between fluid retention data, per cent body surface area burned, and the calculated Abbreviated Burn Severity Index and patient mortality. The power of each variable to predict mortality was evaluated by stepwise regression analysis. From this analysis net fluid retention during the first 48 hours of resuscitation was as accurate as the Abbreviated Burn Severity Index and was a better predictor of mortality than individual components of that Index.

Adolescent↗
PubMed1986

A statistical analysis of drainage versus nondrainage of elective cholecystectomy.

A retrospective review is undertaken to evaluate the effects of drainage versus nondrainage of the gallbladder bed after elective cholecystectomy. Two hundred charts of patients who underwent elective cholecystectomy without choledochotomy were reviewed. Patient selection was based upon several criteria: elective cholecystectomy, lack of explorations of the common duct and lack of associated surgical procedures. Two equal groups were analyzed. Those who had postoperative drainage of the subhepatic space and those who did not have drainage. Postoperative length of stay, maximum postoperative temperature elevation and the number of postoperative analgesics were significantly higher (p less than 0.001) in the drainage group. The rate of progression to regular diet was significantly faster in the nondrainage group (p less than 0.001) and the number of complications was higher in the drainage group (p less than 0.05). No complications were noted due to the lack of drain placement. It was concluded that routine drainage of the subhepatic space after elective cholecystectomy without choledochotomy is unnecessary and contributes to increased postoperative morbidity, length of hospital stay and a higher rate of complications.

Adult↗
PubMed1986

Acute appendicitis during pregnancy.

Forty-one appendectomies were performed on pregnant patients during the period 1973-1983. The preoperative diagnosis of acute appendicitis was correct in 57 per cent of the cases (24 patients). Presenting complaints, physical examinations, and laboratory analysis did not prove helpful in establishing the diagnosis. The incidence of acute appendicitis during pregnancy was 1:4172 (birth/pregnancy). Rapid surgical intervention probably contributed to the low (25%) incidence of perforated appendices. A transverse incision and general anesthesia were preferred. There was no maternal mortality and a 2 per cent rate of fetal loss.

Abortion, Spontaneous↗
PubMed1985

Metabolism of N tau-methylhistidine by mice.

Mice and rats were injected with tracer doses of radioactive N tau-[Me-14C]methylhistidine in order to determine the recovery of the injected radioactivity and the extent of the metabolism of N tau-methylhistidine. In the first 27 h after injection, 96.3, 78.0 and 97.5% of radioactivity was excreted by female mice, male mice and male rats respectively. Recovery after 5 days of collection was 98.4 and 92.8% for female and male mice respectively. However, radioactivity associated with N tau-methylhistidine or its acetylated derivative accounted for 44, 86.5 and 96.0% of the excreted radioactivity for female mice, male mice and rats respectively. In female mice the remaining excreted radioactivity was associated with four major peaks of activity when the metabolites were separated by cation-exchange chromatography. In male mice there were only three of these metabolites present. After chromatographic purification, one metabolite was identified by mass spectroscopy to be 1-methylimidazole-4-acetic acid. Examination of the possible sources of this metabolite indicates that, in mice, N tau-methylhistidine is decarboxylated and enters the chain of reactions common to histamine metabolism. Such extensive metabolism precludes the use of N tau-methylhistidine excretion as an index of myofibrillar protein breakdown in mice.

Animals↗
PubMed1985

Review of gunshot wounds in Dayton, Ohio. Demographics, anatomic areas, results, and costs.

A retrospective review of 210 admissions for gunshot wounds was performed to evaluate the frequency that various anatomic areas were injured, complication rates, results of treatment, and costs. Seventy-two percent of patients had a single anatomic site involved. The complication rate was 13% and the death rate was 10.9%. A good result was obtained in 72%, but 12.4% had long-term disabilities. The average length of stay was 11 days with an average cost of +5,682 per patient. Application of today's prospective payment under diagnosis-related groups suggests this system of payment may adversely affect the delivery of trauma care in this country.

Adolescent↗
PubMed1985

Surgical aspects of the Tenckhoff peritoneal dialysis catheter. A 7 year experience.

The experience with CAPD using the Tenckhoff catheter in 115 patients over a 7 year period has been reviewed. The general indications for CAPD in the patient with chronic renal failure are the mental and physical ability of the patient or his relatives to perform CAPD. In our series, diabetes mellitus has been a relative indication for CAPD, because diabetic patients often have vascular disease severe enough to make long-term hemodialysis difficult. The general contraindications are abdominal problems such as hernias, abdominal wall infections, inflammatory bowel disease, adhesions, and gastrointestinal stomas. Other contraindications are lumbar disk disease and respiratory insufficiency. The surgical principles of catheter insertion have been described. Complications associated with the Tenckhoff catheter were either mechanical (intraabdominal organ injury, incisional hernia, catheter leakage, catheter occlusion, or catheter dislodgement), or infectious (peritonitis or abdominal wall infection). The single most common organism isolated from effluent dialysate in 65 patients with peritonitis was Staphylococcus epidermidis in six patients (9.2 percent), and in 20 patients (30.8 percent), no organism could be isolated. For those patients who had peritonitis, the average frequency was at 8.9 months of CAPD. There were only three deaths (3 percent) directly related to the Tenckhoff catheter and these were due to peritonitis and sepsis. Only 22 (19 percent) of the 115 patients in this series had to discontinue CAPD because of its ineffectiveness or the patient's or relative's inability to perform CAPD.

Abdominal Muscles↗
PubMed1985

Clinical features of mild systemic meningococcal disease with characterization of bacterial isolates.

Neisseria meningitidis is an important cause of fulminant septicemia and meningitis in children. Only limited reports of mild disease associated with this organism exist. In this study, we describe eight children, ages 2.5-19 months, with mild meningococcal disease and characterize the meningococcal isolates from some of these patients. Children with mild meningococcal disease presented with a mean fever of 40.1 degrees C, but without purpura or petechiae. Five were diagnosed as having otitis media and were not thought to be seriously ill when initially observed. Six of the eight children had complete resolution of their clinical symptoms as outpatients. One had apparent meningococcal meningitis that sterilized without antibiotic therapy, and one had persistent low grade bacteremia that cleared within 48 hours after institution of parenteral antibiotics. Characterization of the meningococcal isolates from three of the patients revealed that the organisms were encapsulated, piliated, and contained similar outer membrane proteins. This report confirms that blood stream invasion by N. meningitidis organisms may result in clinically mild disease.

Blood Bactericidal Activity↗
PubMed1984

Interactive effects of insulin and corticosterone on myofibrillar protein turnover in rats as determined by N tau-methylhistidine excretion.

The effects of graded doses of insulin and corticosterone on myofibrillar protein turnover were investigated in growing diabetic rats in order to assess their counteractive roles in the control of protein accretion. N tau-Methylhistidine excretion and carcass protein accretion were measured over 6 days in streptozotocin-diabetic rats receiving either a constant catabolic dose of corticosterone accompanied by graded doses of insulin or a constant dose of insulin accompanied by graded doses of corticosterone. The high corticosterone dose decreased the rate of protein accretion by both increasing the rate of degradation and decreasing the rate of synthesis. Increasing insulin dosage counteracted these effects, but could not restore positive accretion rates. Direct measurement of protein-synthesis rates gave results comparable with those obtained from use of N tau-methylhistidine excretion. At constant insulin dosage, increased corticosterone to 45 mg/kg body wt. per day caused a dose-related linear decrease in protein accretion rates from +4.5 to -3.2% per day. Growth ceased at 28 mg of corticosterone/kg body wt. per day, largely owing to a fall in synthesis rates (-3.5%/day) rather than the increase in degradation rates (+1.0%/day). However, at steroid doses greater than 30 mg/kg body wt. per day the degradation rate increased markedly and accounted for most of the additional fall in accretion. These results show that insulin antagonizes the action of glucocorticoids on both the synthesis and degradative pathways of myofibrillar protein turnover. The changes in fractional degradation rates appear relatively more attenuated by insulin than are those of synthesis.

Animals↗
PubMed1984

Modification of glucocorticoid-induced changes in myofibrillar protein turnover in rats by protein and energy deficiency as assessed by urinary excretion of Ntau-methylhistidine.

The effects of differing degrees of experimental protein-energy malnutrition on the response of myofibrillar protein turnover rates to administration of corticosteroid has been studied in two experiments on rats. The basal control diet, offered ad lib. in each case, contained 40 g protein/kg, and other groups received diets containing 62 X 5, 95 or 220 g protein/kg at 0 X 67, 1 or 1 X 5 times the level of the control energy intake. Daily administration of 25 or 30 mg corticosterone/kg body-weight after 18 d pre-feeding caused an increase in plasma protein, glucose and insulin concentrations, but a decrease in the corticosterone: insulin values. Liver size and protein content increased, as did the fractional excretion of dietary nitrogen as urea-N in all treated groups. However, whereas a fall in food intake and body-weight occurred in one experiment the reverse occurred in the other. Ntau -Methylhistidine excretion was 12% lower for rats receiving 40 v. 220 g protein/kg diet and excretion was increased by only 57 v. 90% respectively, when the two groups of rats were given 30 mg corticosterone/kg per d. Rats which received 25 mg corticosterone/kg per d and up to 95 g protein/kg diet increased excretion of Ntau -methylhistidine by an average 35%. The fractional degradation rate of myofibrillar protein (kd) was reduced by about 10% by the low-protein diet from 3 X 1 to 2 X 8%/d. During corticosterone treatment the increment in kd for rats on this diet was only 60% of that for rats receiving the 220 g protein/kg diet, i.e. an increase of 1 X 8 v. 3 X 0%/d. Energy restriction further reduced kd during low-protein intake but did not affect the response to the corticosterone. Variations in dietary protein from 40 to 95 g/kg had little effect on the increase in kd during steroid treatment. The effect of corticosterone on calculated synthesis rates (ks) differed markedly between experiments. While ks fell by 50-65% in rats which lost weight on treatment, it rose by up to 60% in rats where carcass non-collagen-protein accretion remained unchanged or increased, despite an increase in kd. Protein deficiency decreases the catabolic response to glucocorticoid, but the net metabolic response appears crucially dependent on changes in food intake or the stage of growth of the rat or both. A net anabolic response with increased fractional rates of myofibrillar protein breakdown, synthesis and accretion was observed in growing rats fed on relatively-low-protein diets and given 25 mg corticosterone/kg per d.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1984

Traumatic cholecystectomy.

Injury to the gallbladder following blunt abdominal trauma is an unusual finding at laparotomy, with a reported incidence of less than 2%. Avulsion from the liver and detachment from both the cystic duct and artery is an extremely rare finding. The condition of the patient and the extent of injuries will dictate the procedure performed. In the case presented, total avulsion of the gallbladder was successfully treated with identification and ligation of the cystic duct, and coagulation of small bleeding points, followed by placement of a Penrose drain.

Abdominal Injuries↗
PubMed1984

Immunochemical characterization of rough Brucella lipopolysaccharides.

Lipopolysaccharides (LPS) were extracted from rough strains of Brucella abortus and Brucella melitensis and from strains of the naturally occurring rough species Brucella ovis and Brucella canis. Brucella rough lipopolysaccharides (R-LPS) were readily distinguished from Brucella smooth lipopolysaccharides (S-LPS) and enterobacterial R-LPS, by their chemical, physical, and serological characteristics. B. ovis R-LPS was differentiated from B. abortus, B. melitensis, and B. canis R-LPS by its reaction of partial identity in immunodiffusion. Monospecific mouse sera against B. ovis R-LPS agglutinated only the homologous bacteria but not R cells of other species of Brucella. B. ovis R-LPS contained more 2-keto, 3-deoxyoctonate, and glucosamine as a percentage of dry weight than any other R-LPS tested. B. abortus R-LPS was identified by the absence of an unidentified sugar present in the other R-LPS molecules, and B. melitensis R-LPS could be differentiated from B. canis R-LPS by its higher content of fatty acids. In contrast to S-LPS, all of the R-LPS studied lacked quinovosamine. In electron micrographs, Brucella R-LPS had a granular appearance, in contrast to typical lamellar structures formed by Brucella S-LPS and Escherichia coli R-LPS.

Animals↗
PubMed1984

Bacterial peritonitis. Protecting the high-risk patient.

Cefamandole in combination with tobramycin was evaluated in the treatment of peritonitis as an adjunct to laparotomy and performance of the indicated surgical procedure in 88 patients. The clinical response was judged satisfactory in 91 per cent. Of four deaths, only one could be attributed to infection. Side effects noted were decreased creatinine clearance in 16 patients, increased liver enzymes in ten patients, and eosinophilia in nine patients. Microbiologic studies revealed aerobic peritonitis in 44 cultures and anaerobic in 32. Eighty-five per cent of the gram-negative and 69 per cent of the gram-positive strains were susceptible to cefamandole. Cefamandole alone or in combination with tobramycin appears to be an effective and safe antibiotic when used in appropriate doses for the treatment of bacterial peritonitis.

Adolescent↗
PubMed1982

Molecular events following activation of muscarinic receptors: the role of inositol phospholipids.

Muscarinic cholinergic agonists can provoke a wide variety of physiological responses in target tissues. This can be achieved by mobilisation of calcium from intracellular and extracellular stores. The members of the family of Ca2+-mobilizing receptors to which the muscarinic receptor belongs share the ability to provoke a calcium-independent decrease in the concentration of inositol phospholipids. This response is closely coupled to agonist binding and is thus implicated in the mechanism whereby muscarinic and related receptors bring about elevated levels of Ca2+ in cells. Another widespread response to activation of muscarinic receptors is inhibition of adenylate cyclase possibly through direct interaction with a nucleotide regulatory protein. Circumstantial evidence and analogy with alpha 2-adrenergic receptors suggests that adenylate cyclase inhibition may be mediated by a different form of the muscarinic receptor to that involved in calcium mobilisation.

Animals↗
PubMed1981

The stimulation of inositol lipid metabolism that accompanies calcium mobilization in stimulated cells: defined characteristics and unanswered questions.

It now appears to be generally agreed that the 'phosphatidylinositol response', discovered in 1953 by Hokin & Hokin, occurs universally when cells are stimulated by ligands that cause an elevation of the ionized calcium concentration of the cytosol. The initiating reaction is almost certainly hydrolysis of an inositol lipid by a phosphodiesterase. Phosphatidylinositol, phosphatidylinositol 4-phosphate and phosphatidylinositol 4,5-bisphosphate all break down rapidly under such circumstances. However, we do not yet know which of these individual reactions is most closely coupled to receptor stimulation, nor do we know where in the cell it occurs. With many stimuli, inositol phospholipid breakdown is closely coupled to occupation of receptors and appears not to be a response to changes in cytosol [Ca2+]: this provoked the suggestion that it may be a reaction essential to the coupling between activation of receptors and the mobilization of Ca2+ within the cell. In a few situations, however, it appears probable that inositol lipid breakdown can occur as a result of the rise in cytosol [Ca2+] that follows receptor activation: such observations gave rise to the alternative opinion that inositol lipid breakdown cannot be related to stimulus-response coupling at calcium-mobilizing receptors. It now seems likely that these two views are too rigidly polarized and that some cells probably display both receptor-linked and Ca2+-controlled breakdown of inositol lipids. Both may sometimes occur simultaneously or sequentially in the same cell.

Animals↗