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Biomedical subjects

L Wise

Publications and source records attributed to L Wise.

At least 217 records · Page 12Linked to original sources
PubMed1980

The effects of Escherichia coli bacteremia on in vitro perfused kidneys.

The renal response to sepsis results in increased renal blood flow, decreased renal vascular resistance, polyuric renal failure and a change in intracortical renal blood distribution. Prior reports used whole animal preparations, where the effects of sepsis on other organs may have led to systemic vasoactive changes altering the experimental model. To elucidate the direct effect of gram negative bacteremia on the kidney, intracortical hemodynamics and urinary flow were investigated using isolated canine kidneys perfused with a nonpulsatile pump oxygenator primed with modified dog plasma. Bacteremia was produced by 2.5 x 10(11) live Escherichia coli organisms infused directly into the perfusate. Intracortical blood flow distribution was measured by radioactive microsphere trapping using 15 microns diameter plastic radioactive microspheres. Urine flow increased 157% (p less than 0.05) following E. coli bacteremia while intracortical blood distribution was unchanged. The polyuric renal failure of sepsis is therefore, a direct result of bacteremia and not secondary to a change in intracortical flow as previously reported. The changes in intracortical blood distribution reported previously in sepsis using intact animal models probably reflect the renal response to release of vasoactive compounds originating in other organs rather than an intrinsic renal reaction to bacteremia.

Animals↗
PubMed1980

Mesenteric hernia.

Acute intestinal obstruction secondary to an idiopathic mesenteric hernia has been reviewed by collecting 139 reports from the literature and studying them from the standpoint of incidence, etiology, pathogenesis, clinical manifestations, diagnosis, treatment and mortality. An acute intestinal obstruction with strangulation in the absence of an external hernia and with no history of previous surgical procedures must suggest the possibility of an internal hernia, especially if the patient has a history of chronic intermittent abdominal distress and a palpable abdominal mass if found on examination.

Adolescent↗
PubMed1979

Telescoping anastomosis of the colon: a comparative study.

The incidence of large-intestinal anastomotic leaks remains unacceptably high. For this reason, we studied the resistance to dehiscence of a telescoping type of anastomosis and compared it with the conventional one-layer, two-layer, and stapled anastomoses in a canine model. These experiments demonstrated that the telescoping anastomosis provided a more resistant suture line during the early postoperative phase and did not cause encroachment of the lumen by the diaphragm, which was consistently produced when an inverting suture line was used. Three days postoperatively the mean bursting pressures of the one-layer, two-layer, and stapled anastomoses were 31 +/- 12, 120 +/- 46, and 52 +/- 21 mm Hg, respectively. The telescoping anastomosis had a mean bursting pressure of 210 +/- 44 mm Hg, which was significantly (P less than 0.01) higher than those of all the other anastomoses tested. However, seven and 14 days after operation, there was no statistically significant difference among the bursting pressures of the various anastomoses. When the different types of anastomoses were examined histologically, it was found that there was considerably more suture-line inflammation, edema, micro-abscess formation, mucosal ulceration and pericolic inflammation of the fat in the one-layer, two-layer, and stapled anastomoses than in the telescoping anastomosis.

Animals↗
PubMed1979

Glucose tolerance in the obese surgical patient.

Intraoperative glucose metabolism was studied in seven grossly obese patients during an intestinal bypass surgical procedure. Preoperative fasting plasma glucose levels were in the low normal range. Results of intravenous glucose tolerance studies during the preoperative period suggested that three patients demonstrated a diabetic utilization of glucose. Fasting awake plasma glucose levels were increased after premedication for anesthesia and surgical treatment. Following induction of anesthesia, laryngoscopy and intubation, there was a further increase in glucose concentrations. In five patients, a 25 gram glucose load was given intravenously during the anesthetic period and prior to operation; glucose utilization was severely impaired in all patients. When the glucose load was not administered to two patients, a slow uptake of glucose was suggested. Surgical trauma did not further decrease glucose utilization after anesthesia. In patients with no glucose load, surgical treatment resulted in a gradual rise in glucose levels. These results suggested that intraoperative glucose utilization is impaired in the obese. Although a marked osmotic diuresis leading to hypovolemia is not apparent in the present study, decreased intraoperative glucose utilization demonstrates that cautious intraoperative administration of glucose should be considered in the obese patient.

Adult↗
PubMed1979

Changes in intrarenal blood flow during sepsis.

The intrarenal hemodynamics of nine dogs were studied using 15 micron diameter plastic radioactive microspheres labeled with either 85Sr or 141Ce injected before and with the alternative isotope injected 30 minutes after the induction of sepsis. Total renal microsphere trapping increased by 30.6 per cent, p less than 0.01, after the induction of sepsis. The glomerular filtration rate was unchanged. Microsphere trapping in the outer and inner cortex increased by 36.9 per cent, p less than 0.005, and by 20.3 per cent, p less than 0.05, respectively, reflecting increased renal blood flow. Fractional renal microsphere distribution in the outer cortex increased from 70.0 to 73.4 per cent, p less than 0.01, following the induction of sepsis. These data confirm that sepsis results in renal vasodilatation. In addition, a shift in intrarenal blood flow to the outer cortex was demonstrated. Since the outer cortex is perfused with blood which first passes through the inner cortex, it can be hypothesized that renal blood flow in septic states may be passing through dilated glomerular vessels unable to trap microspheres in the inner cortex or passing through precapillary open arteriovenous shunts, or both, thereby bypassing inner cortical functioning glomeruli. This may partly explain the decreased renal function associated with increased renal blood flow in septic states.

Animals↗
PubMed1979

Renal vascular effects of stroma and stroma-free hemoglobin.

To assess the renal effects of hemoglobulin infusion, intrarenal hemodynamics were studied in 14 dogs using radioactive microspheres following the infusion of hemoglobin and stroma. Fractional renal microsphere distribution in the outer cortex remained at control levels following the infusion of hemoglobin. When the infusion of stroma followed, there was a 4.3 per cent, p less than 0.01, increase in the outer cortex microsphere distribution at the expense of the inner cortex, p less than 0.05. When the order was reversed, the stroma suspension being infused first, again there was a significant increase in the outer cortex distribution--6.1 per cent; p less than 0.01. When the infusion of hemoglobin followed, the outer cortex microsphere trapping reverted to control levels. These data revealed no effect upon intrarenal blood flow following the infusion of hemoglobin. The previously reported renal toxicity of hemoglobin infusion is, therefore, probably secondary to contamination with stroma. Hemoglobin should be further investigated for use as an ideal resuscitation fluid.

Animals↗
PubMed1978

Cimetidine, carbenoxolone sodium, and antacids for the prevention of experimental stress ulcers.

Cimetidine, an H2-receptor, antagonist, and carbenoxolone sodium, a drug used to stimulate gastric mucus synthesis and increase the life span of gastric epithelial cells, were studied to determine their possible prophylactic effect on the formation of stress ulcers, gastric transmucosal potential difference and gastric pH in rats, using a restraint stress model. The number of ulcers substantially decreased in the rat groups receiving either cimetidine or carbenoxolone pretreatment for two or more days before stress. When the drugs were used in combination, there was an additive effect, since there was a significant decrease in ulcer formation even after half a day of pretreatment. When antacids were used, there was also decreased ulcer formation with half a day of pretreatment. Gastric pH was significantly increased from control levels in all the groups treated with antacid, cimetidine and carbenoxolone. Both cimetidine and carbenoxolone, either alone or in combination, prevented the decrease in potential difference that was produced in the untreated stressed rats. This study suggests that either cimetidine or carbenoxolone, and particularly their combination, may be a useful prophylactic regimen for the prevention of stress ulceration in patients subjected to severe stress.

Animals↗
PubMed1978

Jejunoileal bypass for morbid obesity. A critical appraisal.

One hundred one carefully screened morbidity obese patients underwent jejunoileal bypass and were followed closely over a mean follow-up period of 32 months. Although there were no operative deaths, three per cent of patients died postoperatively of liver failure or its complications. A fourth patient died of a pulmonary embolus after reoperation, and the fifth patient died cachectic with severe diarrhea after excessive weight loss. Nineteen per cent of the patients required restoration of intestinal continuity (reversal), most for either liver failure or late fluid and electrolyte derangements. All but two survived reversal and are doing well despite massive weight gain. Fifty-eight per cent of the patients had major complications which either required major reoperation (reversal, cholecystectomy or incisional hernia repair) or were potentially life-threatening (liver failure, hepatic fibrosis or urinary tract stones). As described in other series, abnormalities in serum electrolytes and vitamins were seen. In addition, hypovitaminosis D occurred in a number of patients and as with other serum parameters measured, was time-dependent in that improvement was seen in most patients over the postoperative interval studied. Because of the high rate of complications and reversals, we believe that jejunoileal bypass should be reserved for patients with morbid obesity whose lives are imminently threatened by obesity or its sequellae.

Adaptation, Physiological↗
PubMed1978

Gangrene of the stomach: a case of acute necrotizing gastritis.

Of the several causes of gastric necrosis, the rarest is acute necrotizing gastritis which appears to be a variant of phlegmonous gastritis. In acute necrotizing gastritis all four major gastric vessels are patent, but gastric gangrene occurs secondary to an over-whelming necrobiotic infection. The case presented herein is of unusual interest because it appears to be only the third reported case of acute necrotizing gastritis with overt gangrene of the stomach. Review of the literature on suppurative gastritis emphasizes the rarity and high morbidity of acute necrotizing gastritis; the patient reported on in this study, however, survived after subtotal gastrectomy and antibiotic therapy. It is our opinion that debridement by gastrectomy must be performed in those patients with transmural, diffusely infected, nonviable gastric tissue.

Female↗
PubMed1978

An anterior transversalis fascia repair for adult inguinal hernias.

During the eight year period from 1967 to 1975, 1,020 patients more than eighteen years old underwent 1,311 inguinal herniorrhaphies. Group I consisted of 723 inguinal herniorrhaphies in which either a Bassini or a Cooper's ligament repair was used. During a four to nine year follow-up period, the total recurrence rate was 11.5 per cent; the recurrence rate for the primary repair group was 7 per cent and for the recurrent group 32 per cent. The follow-up rate was 93.7 per cent. Group II consisted of 591 herniorrhaphies in which the repair was performed by an anterior transversalis fascia technic. During a two to five year follow-up period, the total recurrence rate was 2.7 per cent; 1.8 per cent for primary repairs and 8.0 per cent for recurrent hernias. The follow-up rate was 98 per cent (95 per cent by personal examination). Assuming that the recurrences in group II will occur with the same frequency as in group I, our projected four to nine year recurrence rate is 3.4 per cent. This suggests that the anterior transversalis fascia repair results in a lower recurrence rate than either the Bassini or Cooper's ligament repairs.

Adult↗
PubMed1978

Functional adaptation of the intestinal mucosal enzymes after jejunoileal bypass for morbid obesity.

Functional adaptation of the villus brush border and crypt have been evaluated preceding and following jejunoileal bypass for morbid obesity. Before surgery, 26 of 101 patients who were at least 100% above their ideal weight were randomly included into the study group, and control tissue specimens were collected from the jejunum and ileum. When five patients required revision of the bypass, jejunal and ileal specimens were collected from the functional (included) and nonfunctional (excluded) segments. At 19.2 +/- 5.0 (SD) months following the bypass procedure, there was an increase in alkaline phosphatase, sucrase and thymidine kinase specific activities within the functional remnants; the included ileum demonstrated a greater degree of adaptation than the included jejunum. In the nonfunctional jejunum there was a decrease in alkaline phosphatase and thymidine kinase specific activities, whereas no statistical alteration in mucosal enzyme activities occurred within the nonfunctional ileum. Serum total protein concentrations and serum magnesium levels were also evaluated before bypass and at revision. Mean serum magnesium levels became decreased, whereas serum total protein concentrations were not altered.

Adaptation, Physiological↗