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Biomedical subjects

L Wise

Publications and source records attributed to L Wise.

At least 37 records · Page 2Linked to original sources
PubMed1998

Spontaneous perforation of the hepatic duct in adults.

BACKGROUND: Nontraumatic perforations of the extrahepatic biliary ductal system are a rare albeit recognized occurrence in the cystic duct, choledochus and main hepatic duct; the latter appears to be the rarest. METHODS: Recent experience with such a case prompted a thorough review of 26 similar cases previously reported. RESULTS: It appears that obstruction of the biliary tract by gallstones results in raised intraductal pressure leading to dilatation of the biliary tree, subsequent stasis and infection, causing ascending cholangitis and thrombosis of intramural vessels, leading to necrosis and perforation of the duct wall. Most patients present with an acute abdomen and are operated upon. CONCLUSIONS: The goals of operation, which should be tailored to the individual patient, are to stop the bile leak, cure choledocholithiasis and cholangitis and reconstruct the bile duct.

Abdomen, Acute↗
PubMed1997

Reducing nosocomial pressure ulcers.

The authors analyze the processes surrounding an initial failure and eventual success in implementing organizational change. The specific organizational change involves prevention and treatment of pressure ulcers. It provides insight as to how critical factors serve to bring about and sustain change in an organization. It also serves to illustrate deficiencies in traditional and popular change theories.

Academic Medical Centers↗
PubMed1997

Laparoscopic inguinal hernioplasty: a community hospital's experience.

Although controversial, laparoscopic inguinal hernia repair has become increasingly popular among surgeons. The overall advantages of this procedure over conventional hernia repair have not as yet been substantiated. One hundred and three consecutive laparoscopic, transabdominal, preperitoneal inguinal hernia repairs in 91 patients were evaluated retrospectively. Patients' satisfaction was assessed using the Visick grading system. The mean follow-up was 18.3 months. One case was converted to an open procedure. Eighty-eight patients (91%) were discharged on the day of surgery. Eighty-seven patients (96%) were satisfied with the operation (Visick grades I & II). Twenty-nine patients who previously underwent a traditional open herniorraphy stated that they would have preferred the laparoscopic method if they had the choice. Early complications included wound infection (n = 1), urinary retention (n = 1) and intestinal obstruction necessitating a laparotomy (n = 1). All patients were ambulating without significant pain after a mean of 7.6 days, and returned to work after 2.4 weeks on average. There was one case of recurrence. In conclusion, patients are satisfied with the laparoscopic hernioplasty technique, which is associated with a low morbidity and short term recurrence rate. Laparoscopic hernioplasty should be considered a viable and valuable alternative to the open method. It appears especially attractive for recurrent or bilateral hernias.

Adult↗
PubMed1996

Giant hepatic hemangioma studied with intravenous total body arteriography technique. A case report.

Hepatic hemangiomas are the most common benign tumors of the liver. They are usually single, small, and asymptomatic. However, giant hepatic hemangiomas have been reported in the past, usually detected as incidental findings. Radionuclide blood pool imaging studies are used to confirm the presence of a hemangioma. This report describes a case of a giant hepatic hemangioma detected using intravenous total-body arteriography, done as a part of radionuclide blood pool hemangioma study. This simple addition to the regular RBC blood pool hemangioma study helps to determine the size of the liver in the early arterial phase and shows obvious increased blood pool activity in the delayed phase. It is also useful in detecting lesions in other parts of the body when present.

Adult↗
PubMed1995

Cytokines in Crohn's colitis.

BACKGROUND: Increasing evidence points to a pathologic role for cytokines in Crohn's colitis. Levels of cytokines are increased in diseased segments of colon in Crohn's colitis, but no one has studied the concentration of cytokines in clinically and histologically nondiseased segments. METHODS: Mucosal biopsies were obtained from 7 patients with active segmental Crohn's colitis and from 7 controls without inflammatory bowel disease. The concentration of Interleukin (IL)-1 beta, IL-2, IL-6, and IL-8 in patients and controls were determined using enzyme linked immunosorbent assay and compared. Histologic sections were also performed to confirm diseased and nondiseased segments of colon. RESULTS: The concentrations of IL-1 beta, IL-6, and IL-8 were significantly higher in the involved segments of colon (10.3 +/- 4.1, 3.7 +/- 1.0, 34.4 +/- 6.9 picograms [pg] per mg) when compared to controls (1.8 +/- 0.5, 1.1 +/- 0.5, 5.3 +/- 1.0 pg/mg). The concentrations of IL-1 beta, IL-2, and IL-8 (8.5 +/- 2.9, 5.3 +/- 1.2, 26.3 +/- 8.8 pg/mg) in normal appearing segments of colon of patients with Crohn's colitis were also significantly higher than in controls, whose IL-2 level was 2.0 +/- 0.5 pg/mg. IL-1 beta and IL-8 were significantly more concentrated in both the involved and uninvolved colonic segments of patients with Crohn's colitis compared to controls. IL-2 and IL-6 were also more concentrated in Crohn's patients than in controls, but not significantly. The differences in interleukin concentrations between involved and uninvolved segments of colon in patients with segmental Crohn's colitis were not significant. CONCLUSIONS: Although Crohn's colitis is often a segmental disease, concentrations of IL-1 beta and IL-8 are increased throughout the entire colon. These observations reinforce the hypothesis that Crohn's colitis involves the whole colon even when this is not apparent clinically or histologically.

Adult↗
PubMed1995

Preoperative factors of prognostic significance in gastric cancer.

This study was undertaken to investigate the ability of local anatomical and primary histological features of gastric cancers, as well as DNA analysis, to predict prognosis. Using multivariate analysis, results indicate that location of a tumor in the gastric cardia, poor differentiation, involvement of adjacent organs, and aneuploidy are all independent predictors of survival. All of the factors studied can be determined by endoscopic procedures preoperatively on patients with gastric cancers and could be helpful in selecting some patients for perioperative adjunctive therapies.

Adenocarcinoma↗
PubMed1995

Ki-67 reactivity in breast carcinoma analyzed by a computer-assisted image system: preliminary results.

The proliferative index of 63 breast carcinomas was measured on Ki-67 immunostained frozen tissue sections with a computer-assisted image analysis system. The mean proliferative index in estrogen-positive breast carcinomas was lower than in estrogen-negative carcinomas. An inverse relationship between proliferative index and short-term disease-free survival was noted.

Breast Neoplasms↗
PubMed1994

Carcinoma in situ.

Explore the source record for details and available documents.

Breast Neoplasms↗
PubMed1994

Closing the gap between research and practice.

Currently, a 10- to 15-year gap exists between discovery of potential innovations and implementation of these innovations into nursing practice. The Retrieval and Application of Research in Nursing (RARIN) project is helping to reduce this gap in one western hospital. The goal of RARIN is to improve the quality of nursing care by facilitating the transfer of new and clinically relevant nursing information to current practice. This is accomplished by providing nurses with both the tools and training for rapid retrieval of scientific information. Their work areas have been electronically linked with local, national, and international scientific information systems.

California↗
PubMed1994

Exploratory laparoscopy for perforation following colonoscopy.

Colonoscopy is being increasingly used for the diagnosis and therapy of colonic diseases. Bleeding and perforation are two major complications. The management of patients with perforation is undergoing evolution. There is evidence to support conservative management in selected patients with perforation without clinical signs of peritonitis. There is, however, a subset of patients with perforation where a considerable doubt exists about the choice between surgical and conservative management. We report one such patient, a 50-year-old woman with free air under the diaphragm and peritoneal signs following a therapeutic colonoscopy in whom an exploratory laparoscopy was performed. Exploratory laparoscopy is proposed for such patients when there is a question in choosing between surgical and conservative management.

Colonoscopy↗
PubMed1993

The value of flow cytometric analysis in patients with gastric cancer.

Tumors in the gastric cardia and the body/antrum were studied to determine the effect of ploidy and S-phase fractions on patient survival. Forty-two percent of tumors were located in the cardia and 58% in the body/antrum. Nodal metastases occurred more often with cardia tumors than with body/antrum tumors (86% vs 65%). Aneuploidy occurred more frequently in patients with cardia tumors than in patients with body/antrum tumors (39% vs 20%). Metastasis to lymph nodes was more common in patients with aneuploidy than in patients with diploidy (31% vs 7%). S-phase fractions were not different between aneuploid and diploid tumors. More patients with diploid cancer were alive at 5 years than were patients with aneuploid tumors (90% vs 10%). We conclude that primary cellular differences in gastric tumors of the cardia or body/antrum determine patient survival.

Adenocarcinoma↗
PubMed1993

Role of the neutrophil in abdominal aortic aneurysm development.

Elastase release by neutrophils has been implicated in the etiology of abdominal aortic aneurysm (AAA). The present study investigated whether neutrophils in patients with AAA actively synthesize the neutrophil elastase enzyme and the effect of elastin-derived peptides on neutrophil elastase release. Total neutrophil elastase in patients with AAA was significantly higher than in those with aortic occlusive disease and controls. The neutrophil elastase gene was not expressed in any patient group. Elastin-derived peptides induced elastase release, which was significantly higher in patients with AAA than in those with aortic occlusive disease and controls. These data indicate that the peptides of elastin degradation stimulate the release of elastase, but that continuing production of elastase is absent in circulating neutrophils. It is concluded that: (1) neutrophils do not actively synthesize elastase but act as 'mules' or carriers of the enzyme; and (2) elastin breakdown products stimulate the release of elastase at the aortic wall by circulating neutrophils, which in patients with AAA have a predetermined increased amount of elastase.

Aorta, Abdominal↗
PubMed1992

The Henry operation for incarcerated and strangulated femoral hernias.

Selection of a subinguinal, inguinal, or preperitoneal approach permits the surgeon flexibility in managing femoral hernias. A 20-year experience is reviewed, with 44 incarcerated or strangulated femoral hernias corrected using the preperitoneal Henry operation. It is an effective and safe method of repair. Examination of the contralateral side revealed an unsuspected femoral hernia in seven (16%) of the cases.

Aged↗