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Biomedical subjects

L Wise

Publications and source records attributed to L Wise.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Carcinoma in the retained rectum after colectomy for ulcerative colitis.

A carcinoma arising in an excluded rectal stump 18 years after ileostomy and 14 years after subtotal colectomy has been described. Extent of involvement of the colon, age of the patient at onset of colitis, and duration of symptomatology are factors whcih have been shown to influence the incidence of carcinoma complicating ulcerative colitis. Fifty-eight similar cases of carcinoma developing in a retained rectum were collected from the literature. The incidence of this complication is approximately 3 per cent. Rectum-sparing operations do not appear to decrease the incidence of malignant transformation in ulcerative colitis. A decision to retain the rectum after colonic resection for ulcerative colitis must take into account both the significant incidence of malignant transformation associated with all rectum-sparing procedures and also the significant incidence of recurrent symptoms following this procedure.

Adenocarcinoma↗
PubMedDate not supplied

Oxygenation/ventilation of transported intubated adult patients: a national survey of organizational practices.

INTRODUCTION: Transporting intubated patients is common among ground and air crews, and providing adequate oxygenation/ventilation through transport ventilators (TV) or manual ventilation (MV) is clinically challenging. However, very little data chronicle service or practice patterns of oxygenation/ventilation within the industry. METHODS: During February 1998, a national sample of 250 air transport agencies was surveyed regarding activities and services surrounding this population of transported patients. One-hundred-ninety-three surveys (77%) were returned. RESULTS: Approximately 40% of responding agencies use rotor-wing transportation only. Various combinations of rotor-, fixed-wing, and critical care ground transport were reported among the sample. Crew configuration consisted primarily of RN/EMT-P (75%). For pre-hospital intubated patients, MV alone (37.3%), TV alone (10.9%), or a combination of MV and TV (43.5%) was used, depending on transport circumstances. Programs not involved in pre-hospital transports accounted for 8.3% of returned surveys. Interfacility transports used MV (6.8%), TV (39.4%), and a combination (53.4%). One respondent did not answer the question, accounting for 0.4% of the returned surveys. More than 75% of programs monitored oxygenation/ventilation during transport. Usually some combination of pulse oximetry and CO2 monitoring was used. More than half (59%) of reporting agencies transport more than 80 intubated adults each year. CONCLUSION: Considerable variation exists in practices involving the transport of intubated patients.

Adult↗
PubMedDate not supplied

Surgical feeding gastrostomy: are we overdoing it?

Feeding gastrostomy is a commonly performed procedure in North America. Our aim was to study the outcome of patients undergoing feeding gastrostomy to better define patients who will benefit from the procedure as opposed to those in whom it may be futile. A cohort of the most recent 100 consecutive patients undergoing feeding gastrostomy in a community teaching hospital was retrospectively studied. The main indication for gastrostomy was neurologic disorder interfering with eating/swallowing (group A-54 patients), followed by debilitating systemic disease (group B-26 patients) and obstructive malignancy of the head and neck or esophagus (group C-20 patients). Forty-one patients died within 30 days of the procedure (41%). The overall 30-day survival rates in groups A, B, and C were 70%, 15%, and 85%, respectively. In four patients death was caused by intraperitoneal leak from the gastrostomy site; the remaining patients died of their underlying disease. Five patients required reoperation for gastric leakage around the gastrostomy within 30 days. Only nine patients could be traced who were alive and still using the gastrostomy a year after its placement: two in group A, none in group B, and seven in group C. APACHE II scores at tube insertion also predicted survival; 30-day survival rates in patients with scores of 10 and below, 11 to 15, 16 to 20, and over 20 were 96%, 71%, 48%, and 18%, respectively. No patient with an APACHE score above 15 belonging to group B (debilitating disease) survived more than 30 days. We conclude that to have a beneficial therapeutic effect feeding gastrostomy should be performed selectively. Severe debilitating systemic conditions that interfere with normal eating, when combined with a high APACHE II score, indicate the futility of gastrostomy.

APACHE↗
PubMedDate not supplied

In vivo inactivation of antithrombin III is promoted by heparin during cardiopulmonary bypass.

To study the in vivo effect of heparin on antithrombin III (AT3) when elastase is elevated, the blood of 20 patients undergoing cardiopulmonary bypass (CPB) was assayed for elastase and AT3. The model was chosen because CPB is known to increase plasma elastase and the patients were heparinized. The blood of 20 patients undergoing cardiac surgery was assayed for elastase and AT3 one day preoperatively, every half hour during CPB, and one day postoperatively. Elastase increased significantly and AT3 decreased significantly during CPB. There was a direct correlation between the rise in elastase and decrease in AT3. AT3 decreased even further when elastase was elevated and patients were heparinized (AT3/elastase = 0.04 + 0.07), compared with the drop with elevated elastase alone (AT3/elastase = 0.11 + 0.14) (P less than .0015). These data indicate that (1) CPB is associated with an increase in plasma elastase, (2) elevated plasma elastase is associated with a reduction in AT3, and (3) heparin promotes the inactivation of AT3 when serum elastase is increased. These data confirm the in vitro observation that heparin accelerates the inactivation of AT3 in the presence of elastase.

Analysis of Variance↗
PubMedDate not supplied

Effect of position (semirecumbent versus supine) on postoperative oxygenation in markedly obese subjects.

In 22 markedly obese, otherwise healthy, women studied postoperatively on each of days 1 through 3 after intra-abdominal operation, the effect of position change on arterial oxygenation was assessed. There was a statistically significant decrease in PaO2, an increase in A-aDO2 and a simultaneous modest reduction in PaCO2 with the assumption of the supine position on postoperative days 1 and 2, but not positional difference demonstrable in any studied variable by day 3. This report suggests that during the first 48 hours after abdominal surgery in obese patients, assumption and maintenance of the semirecumbent posture is a valuable therapeutic modality to improve arterial oxygenation.

Abdomen↗
PubMedDate not supplied

Postoperative alveolar-arterial oxygen tension difference: its relation to the operative incision in obese patients.

Forty-eight markedly obese patients for elective jejunoileal bypass were studied during spontaneous ventilation preoperatively and then postoperatively after 2 to 4 hours and on each of days 1 to 5 to determine the effect of the operative incision (midline versus transverse) on the alveolar-arterial oxygen tension difference (A-aDO2). Compared with control (Pre-op.) A-aDO2, there was a significant increase in A-aDO2 in all patients, beginning in the postanesthetic recovery area and continuing through postoperative (P.O.) day 4. Comparing the mean increase in A-aDO2 (P.O.-Pre-op.) between the two incision groups, patients with a midline incision had a significantly greater (p smaller than 0.001) increase in A-aDO2 on control (Pre-op.) value by day 5. The authors conclude that in markedly obese subjects, the midline incision can be expected to result in both more profound and more prolonged reduction in arterial oxygenation postoperatively.

Abdomen↗
PubMedDate not supplied

Hospital costs by clinical parameters for peripheral vascular surgical DRGs.

Health care in America has entered a new era. Administrators and U.S. physicians have begun to examine cost more extensively than before. Our study strived to examine whether clinical parameters existed by which we could predict cost per DRG for peripheral vascular surgery patients. We examined all peripheral vascular surgical admissions (N = 1,169) to our academic medical center from 1/1/85-12/31/86. Patients were separated within DRGs by four clinical variables as follows: emergency room admission, surgical intensive care unit admission (ICU), infusion of plasma product or blood transfusion of a patient. The four clinical variables predicted differences per patient in hospital cost per DRG, a poorer outcome and also potential financial risk to the medical center. Within each DRG, each of these variables (either alone or in combination) predicted higher patient cost. For the ICU identifier, 88.6% of the patients who had a positive identifier had higher costs than patients in the same DRG who were not ICU admissions, for emergency admission, 81.4% of patients, and for both the transfusion (infusion of blood) and the plasma products identifier (infusion of blood products), 100% of patients. We believe that peripheral vascular surgical DRGs may be stratified by cost and outcome by these clinical variables during the patient's hospitalization. Surgeons and administrators may be able to use this methodology to segment those higher cost patients and concentrate efforts of cost containment for these groups.

Blood Transfusion↗