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Biomedical subjects

L W Martin

Publications and source records attributed to L W Martin.

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

Antipyretic effect of central alpha-MSH summates with that of acetaminophen or ibuprofen.

The neuropeptide alpha-melanocyte stimulating hormone has potent antipyretic properties when given centrally or systemically. Little is known about the mechanism of the antipyretic action and virtually nothing is known about interactions among the antipyretic effects of alpha-MSH and commonly used antipyretic agents. Randomized studies in which alpha-MSH, acetaminophen or ibuprofen, or a combination of alpha-MSH and antipyretic drug, were given IV to rabbits made febrile by endogenous pyrogen, indicate that the antipyretic effect of the peptide is summative with those of the drugs. alpha-MSH has been shown to have a wide safety margin in earlier research and the results suggest that combinations of peptide and antipyretic drugs might be safer and have fewer side effects than larger quantities of the drugs alone.

Acetaminophen↗
PubMed1989

Acute-phase response to endogenous pyrogen in rabbit: effects of age and route of administration.

Aspects of host defense, collectively called the acute phase response (APR), can be induced by central actions of cytokines. To determine whether aging alters this response, aged and young rabbits were given endogenous pyrogen (EP), a crude preparation containing interleukin 1 and other cytokines, via an intracerebroventricular cannula. Arterial blood was sampled before EP administration and 2, 4, and 24 h later. Measurements were made of changes in body temperature, white blood cells, neutrophils, concentration of antipyretic, anti-inflammatory peptide alpha-melanocyte stimulating hormone (alpha-MSH), corticosterone, and C-reactive protein (CRP) concentrations. EP caused greater fever and increases in corticosterone and CRP in young rabbits. EP-induced changes in circulating neutrophils did not show age-related differences. There was no significant change in alpha-MSH in either age group; thus only certain aspects of APR induced by central actions of EP were altered with aging. To determine whether changes in APR caused by peripherally administered cytokines are similar to those after central injection, young female rabbits were given EP by both routes. Although administration caused greater fever, increases in alpha-MSH and corticosterone concentrations and in neutrophil counts were greater after intravenous administration, perhaps the result of a combined influence on peripheral and central receptors. The EP-induced increase in circulating alpha-MSH is a new finding that indicates that this antipyretic and anti-inflammatory peptide is rapidly available to modulate host responses after challenge.

Acute-Phase Reaction↗
PubMed1989

Age- and sex-related differences in febrile response to peripheral pyrogens in the rabbit.

A reduced febrile response with aging has been reported in mice, rats, rabbits, squirrel monkeys and man. Young adult male and female rats and rabbits respond differently to pyrogens, but little is known about relative febrile responses in old male and female animals. To further describe the effects of age and sex on fever, we gave intravenous injections of Salmonella typhosa endotoxin (0.05 micrograms/kg) and of endogenous pyrogen (EP) (40 microliters/kg) to old and young, male and female rabbits. Old females did not exhibit smaller fevers in response to endotoxin compared to young females, but both young and old females had smaller fevers than aged and young males. Old male rabbits did not have a decreased febrile response to endotoxin. Old females, but not old males, showed a reduced febrile response to EP, the presumed endogenous mediator of endotoxin fever, when compared to young rabbits. To determine if the reduced febrile responses were due to reduced capacity to generate heat, D-amphetamine sulfate (2 or 5 mg/kg i.v.) was administered, and the resulting hyperthermias indicated that all groups of rabbits, including the aged and young females, were capable of raising body temperature to high levels. Body weight and reduced capacity to produce and retain heat do not contribute to these differences in fever. We conclude that the febrile response is not uniform over age, and that it is also strongly influenced by sex and type of pyrogen.

Age Factors↗
PubMed1989

Transcatheter coronary artery diagnostic techniques including impedance-catheter and impedance-guidewire measurement of absolute coronary blood flow.

Interventional cardiology requires precise assessment of coronary anatomy and physiology. Unfortunately, however, important interventional decisions are frequently made on the basis of arteriographic data alone. Increasing evidence suggests that visual interpretation of coronary arteriographic studies is irreproducible, inaccurate, and poorly predictive of coronary physiology. Moreover, arteriography is of little value in assessing endothelial ulceration and mural thrombus, which are important pathophysiologic features of unstable angina and acute myocardial infarction. In response to these limitations, several diagnostic transcatheter techniques have been developed that allow more complete assessment of coronary physiology and function. These include fiberoptic angioscopy, reflection spectroscopy (which can combine automated laser therapy with diagnosis), ultrasonic catheterization, and translesional gradient determination. Doppler catheterization permits the assessment of overall coronary flow reserve with the aid of induced hyperemia, whereas subselective digital radiography allows the evaluation of regional coronary flow reserve. The coronary flow reserve, however, may be falsely lowered immediately after balloon dilation, because of endothelial injury, repeated ischemia, or the administration of vasoactive drugs. To circumvent this problem, we have developed impedance-catheter and impedance-guidewire systems that, by applying impedance technology and the principles of indicator dilution, are capable of measuring absolute coronary blood flow. For a flow indicator, we use 0.5 mL of glucose solution (D5W), which has little effect on intrinsic blood flow. The validity of this approach has been demonstrated in experimental and clinical studies. The impedance guidewire is less obstructive than the catheter system, so it probably will become the method with clinical application.

Journal Article↗
PubMed1988

Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations.

Duplications of the alimentary tract are unusual congenital anomalies that frequently present a diagnostic as well as therapeutic challenge to the surgeon. Because these lesions occur so infrequently, they are often not suspected until encountered intraoperatively. Due to the complicated anatomy and common blood supply shared between the duplication and associated native bowel, appropriate management requires a familiarity with the anatomy and clinical characteristics of this entity. To better define the range of patient characteristics, clinical presentation, and preferred therapy, 20 enteric duplications were reviewed in 17 patients treated at the Children's Hospital Medical Center from 1956 to 1986. Ages of patients ranged from 1 day to 11 years; 60% were less than 2 years of age at initial presentation. Seven duplications in six patients involved alimentary tract structures of foregut derivation (esophagus, stomach, and Parts I and II of duodenum), with a predominance of girls (4 of 6). Most of these patients (67%) presented with moderate to severe acute respiratory distress and a mass present on chest radiograph. In 67% of the patients, the correct diagnosis was established before operation. None required emergency operative intervention. By contrast, 13 duplications in 11 patients were of midgut or hindgut derivation (Parts III and IV of the duodenum, jejunum, ileum, and colon). In this group of patients, 62% of the duplications involved the cecum, 23% involved the ileum, and 16%, the jejunum. Seventy-eight per cent of the patients were boys. The most common symptoms were nausea and vomiting, and the most common sign was a palpable abdominal mass. Emergency operative intervention was required of eight of 11 patients with duplications involving the small bowel and colon. Three patients presented with an intussusception, four with signs and symptoms consistent with acute appendicitis, one with a small bowel obstruction, and two with gastrointestinal hemorrhage due to the presence of ectopic gastric mucosa within the duplication. It was found that two important points must be considered in regard to the management of enteric duplications: (1) the common blood supply shared between the duplication and native bowel must be carefully protected to avoid undue sacrifice of normal bowel, and (2) the presence of heterotopic gastric mucosa in 35% of patients negates internal drainage.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormalities, Multiple↗
PubMed1987

Multiple cardiac myxomas with multiple recurrences: unusual presentation of a "benign" tumor.

A 20-year-old woman with a two-week history of palpitations and constitutional symptoms was found to have right atrial and left ventricular myxomas. The myxomas were excised, but the patient had two recurrences of the tumor in the left atrium four and a half years after the initial presentation. The recurrent myxoma was locally aggressive, and removal required excision of the aortic valve. This patient demonstrates the need for careful follow-up for recurrences of myxoma.

Adult↗
PubMed1986

Transtracheal repair of recurrent tracheoesophageal fistula.

A recurrent tracheoesophageal fistula is generally associated with considerable mediastinal induration and inflammation. The conventional operative approach may be formidable with considerable blood loss and a high complication rate. For two infants with recurrent fistulae, we have employed a simplified low cervical transtracheal approach through noninflamed tissues. This brief atraumatic procedure was followed by gratifying results. Details of the approach are presented.

Bronchoscopy↗
PubMed1986

Anal continence following Soave procedure. Analysis of results in 100 patients.

The Soave procedure is an increasingly popular procedure for the definitive therapy of patients with ulcerative colitis. The authors present their experience with 100 patients in whom total proctocolectomy, rectal mucosal stripping, and ileoanal anastomosis (generally using an S-pouch) were carried out. The physiological and anatomical basis of continence is presented, and anastomosis at the top of the columns of Morgagni is recommended. Of the 100 patients in whom this procedure was performed, there was no mortality either in-hospital or later. Of the 12 patients in whom the anastomosis was done 1 cm above the top of the columns (and thus columnar epithelium was retained), six have recurrent anorectal disease, but all are continent both day and night. Three patients in whom the anastomosis was done at the dentate line have had difficulty with continence; two are now continent, but one, after being totally incontinent for 4 years, has required a permanent ileostomy. Of the 69 patients in whom the anastomosis was done at the top of the columns of Morgagni, five are incontinent at night only and two have seepage during both day and night. Thus, if the anastomosis is done at the level recommended, namely, at the top of the columns of Morgagni, retaining no columnar epithelium and anastomosing the ileal pouch to transitional epithelium (which the authors believe not to be subject to the disease of ulcerative colitis), daytime continence will be achieved in 97% and total day and night continence in 90%. The evidence presented suggests that a properly done pull-through procedure with ileoanal anastomosis is the procedure of choice for ulcerative colitis.

Adolescent↗
PubMed1986

Pierre Robin anomaly with an accessory metacarpal of the index fingers. The Catel-Manzke syndrome.

A two-year-old female with the Pierre Robin anomaly and bilateral index finger malformations is described. Hypertelorism, full cheeks, posteriorly rotated ears with prominent antihelix, short neck, simian creases, bilateral fifth finger clinodactyly, and short toes with hypoplastic small nails were also present. Her mother had a subsequent pregnancy that resulted in the delivery at 26 weeks, of a stillborn female fetus with cleft palate, index finger anomalies and congenital heart disease. These two patients are the first females reported with this group of anomalies. The etiology of this combination of malformations, the Catel-Manzke syndrome, is unknown.

Abnormalities, Multiple↗
PubMed1986

Congenital aneurysm of the left sinus of Valsalva. Report of a patient with 19-year survival without surgery.

An unruptured aneurysm of the left sinus of Valsalva was diagnosed by angiography in a 16-year-old male subject 19 years ago. A recent repeated angiographic study documented no change in the aneurysm over the 19-year interval, and the patient has remained asymptomatic. We are aware of no other long-term follow-up reports of patients with this lesion who have not had surgical correction. This case emphasizes the controversy regarding the need for prophylactic surgical correction of an unruptured aneurysm.

Adult↗
PubMed1986

Blunt liver injury in childhood: evolution of therapy and current perspective.

One hundred eighty-eight consecutive children with serious blunt abdominal or multisystem trauma were evaluated between August 1981 and July 1985. Of the 188 patients, 53 (28%) were found to have hepatic parenchymal injuries and are the basis of this report. Four of the 53 (8%) underwent emergency laparotomy for exsanguinating hemorrhage; two patients died, both of hepatic vein lacerations, and two are alive and well after right hepatic lobectomy. Forty-nine (92%) of the children with liver injuries did not require operation for hemorrhage. Four of these 49 patients developed serious complications; hemobilia occurred in one patient and bile peritonitis occurred in three. The one case of hemobilia was resolved without surgery. One child underwent a delayed operative biliary tract reconstruction that was successful. The other two children required a combination of debridement and drainage procedures. Fifty-one of the 53 children (96%) are currently alive without morbidity related to their liver injuries. Both children who died had multiple trauma including central nervous system injuries and had exsanguinating hemorrhage that required emergency laparotomy at initial evaluation. There were no children with "late" hemorrhage and none who developed septic complications. Nonoperative management of most childhood blunt abdominal trauma is possible. Widespread use of abdominal computerized tomography scanning has made this approach practical. This large series of consecutive liver injuries from a large pediatric trauma center illustrates the advantages and the risks of a selective but primarily nonoperative approach to liver trauma in children.

Alanine Transaminase↗
PubMed1985

The critical level for preservation of continence in the ileoanal anastomosis.

Mucosal proctectomy with ileoanal anastomosis was performed for 90 patients with ulcerative colitis or polyposis over the past 18 years. In three, the anastomosis was at the dentate line. All three had varying degrees of soilage necessitating permanent ileostomy in one. For 12 patients with the anastomosis 1.0 cm proximal to the top of the columns, all were totally continent, but six experienced recurrent disease. For 75 in the third group, the anastomosis was at the top of the columns. Five await ileostomy closure. Of the other 70, none experienced recurrent disease and three have mild nighttime soilage, two of which are less than 1 year following operation. We recommend that the transitional epithelium of the anorectal columns be preserved.

Anal Canal↗
PubMed1985

Esophageal atresia.

Esophageal anomalies present a challenge to the pediatric surgeon and demand close attention and care from the nursing staff as well as the surgical staff. We have encountered a survival rate of 96 per cent for all infants undergoing operation for esophageal atresia. An emergency gastrostomy is recommended as an immediate procedure when the diagnosis is established. In many instances, it can be performed with local anesthesia if the infant is particularly small or has developed aspiration pneumonia. The definitive operation is delayed until the infant is in optimum condition to permit a general anesthetic and thoracotomy. Staging is recommended for all infants with a birth weight of less than 2000 gm. Once the infant has recovered from the operative correction of the malformation, significant late complications are rare, and the great majority of individuals lead completely normal lives.

Dilatation↗
PubMed1985

Hirschsprung's disease.

This review of Hirschsprung's disease reflects the authors' experience with it and outlines the current recommendations for management of its various manifestations.

Biopsy↗