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Biomedical subjects

R E Ward

Publications and source records attributed to R E Ward.

At least 91 records · Page 5Linked to original sources
PubMed1986

A simple technique for experimental hepatic vein catheterization in swine.

Hepatic vein catheterization is a valuable technique in studies of hepatic physiology and metabolism. A new technique for hepatic vein catheterization in swine is described which avoids fluoroscopy, incision, or puncture of the hepatic parenchyma. Experience with this new technique in over 40 studies of young pigs has confirmed the reliability of the technique. Management of hepatic vein catheters after insertion and potential sources of error in hepatic venous sampling are discussed.

Animals↗
PubMed1985

Orthotopic liver transplantation in a patient with Amanita poisoning.

Orthotopic liver transplantation in patients with acute toxic hepatitis has not, to our knowledge, been reported. Our recent experience with orthotopic liver transplantation in a 3-year-old girl with acute hepatic failure secondary to Amanita poisoning is described. Aspects of Amanita toxin-induced pathophysiology pertinent to orthotopic liver transplantation are discussed. The results in this case provide important implications for patients with fulminant hepatic failure secondary to other hepatotoxic agents in whom liver transplantation is considered.

Acute Kidney Injury↗
PubMed1985

Hepatic perfusion abnormalities after liver transplantation.

The angiographic and CT findings in a liver transplant patient with perioperative hepatic ischemia are reported. Extensive arterial collaterals and unusual portal-to-hepatic venous shunting in the transplanted liver were observed. Post-transplant clinical, laboratory, and CT findings were compatible with partial right lobe hepatic infarction that was confirmed at autopsy. The possible relationship between the ischemic damage and intrahepatic shunting is discussed. The need for caution during preoperative angiography in potential liver transplant recipients is emphasized.

Adult↗
PubMed1985

Immediate external fixation of unstable pelvic fractures.

Immediate external fixation has been proposed as a means of stabilizing severe pelvic fractures to reduce the chance of organ failure and death. Sixty-six patients were admitted from January 1980 through December 1983 with double fractures of the pelvic ring that involved the posterior elements. Twenty-six patients (39 percent) underwent immediate external fixation for instability, and 40 patients (61 percent) with stable fractures were treated with bed rest. The two groups were similar in age, injury severity score, and degree of shock. The mortality rate of the two groups was the same (12 percent), as was the incidence of organ failure. The mean transfusion requirement in the unstable group was greater, but not significantly. Our results were better than those reported in recent studies in which immediate rigid fixation was not used. We conclude that the patient with multiple trauma without unstable pelvic fracture should undergo immediate external fixation to decrease morbidity and mortality rates and limit soft tissue damage.

Adult↗
PubMed1985

Orthotopic porcine liver transplantation: operative technique.

Considerable interest in experimental liver transplantation has been generated recently due to improvements in the results of clinical liver transplantation efforts. An operative technique for orthotopic porcine liver transplantation is presented which represents modifications of and improvements to previously published techniques. Salient features of the technique include (1) use of a diaphragmatic cuff for the suprahepatic inferior vena cava anastomosis, (2) use of a splenojugular shunt, (3) omission of caval shunts, and (4) use of isoflurane as the primary anesthetic agent. This operative technique has provided excellent survival rates in our transplanted animals.

Animals↗
PubMed1985

Regulation of clones responding to dextran B1355S. III. The thymic-independent and thymic-dependent antibody responses.

The primary antibody response of different mouse strains challenged with two antigenic forms of alpha (1-3) dextran, dextran B1355S and dextran-hemocyanin, was examined. Only BALB/c mice responded with both kappa and lambda antibodies. The kappa to lambda ratio was affected by factors such as the antigenic form of dextran, the time at which the serum was analyzed, and the priming regimen. Surprisingly, priming with hemocyanin in adjuvant increased the kappa portion of the response not only to dextran-hemocyanin but also to dextran B1355S. Other strains of mice responded with only lambda antibodies. These results extend our previous results on the analysis of dextran-specific B cell precursors.

Animals↗
PubMed1985

Technetium-99m NGA functional hepatic imaging: preliminary clinical experience.

Technetium-99m galactosyl-neoglycoalbumin ( [Tc]NGA) is a radiolabeled ligand to hepatic binding protein, a receptor which resides at the plasma membrane of hepatocytes. This receptor-binding radiopharmaceutical and its kinetic model provide a noninvasive method for the assessment of liver function. Eighteen patients were studied: seven with hepatoma, eight with liver metastases, four with cirrhosis (two had concurrent hepatoma and one chronic active hepatitis), and one patient with acute fulminant non-A, non-B hepatitis. Technetium-99m NGA liver imaging provided anatomic information of diagnostic quality comparable to that obtained with other routine imaging modalities, including computed tomography, angiography, ultrasound, and [Tc]sulfur colloid scintigraphy. Kinetic modeling of dynamic [Tc]NGA data produced estimates of standardized hepatic blood flow, Q (hepatic blood flow divided by total blood volume), and hepatic binding protein concentration, [HBP]. Clinical correlation was by classical Child-Turcotte criteria (CTC). Significant rank correlation was obtained between [HBP] estimates and CTC scores (rs = -0.72, p = 0.001). This correlation supports the hypothesis that [HBP] is a measure of functional hepatocyte mass. The combination of decreased Q and markedly reduced [HBP] may have prognostic significance; all three patients with this combination died of hepatic failure within 6 wk of imaging.

Adult↗
PubMed1985

Idiotype regulation: a model for B cell tolerance.

Immunological tolerance represents an individual's nonresponsiveness to self-antigens or foreign antigens. Inasmuch as the mechanism of self-nonself discrimination tolerance is unknown, it remains an area of active investigation because of its implied involvement in certain immune disorders. In this paper we discuss neonatal idiotype suppression and internal idiotope vaccination as models for B cell tolerance. The results demonstrate opposite aspects of idiotope regulation. Neonatal idiotype suppression represents an anti-idiotype-induced establishment of tolerance, whereas an internal antigen vaccine overcomes an established tolerance to self-antigens. New views on the functional importance of idiotype self-tolerance are discussed.

Animals↗
PubMed1984

Monoclonal idiotope vaccine against Streptococcus pneumoniae infection.

A monoclonal anti-idiotope antibody coupled to a carrier protein was used to immunize BALB/c mice against a lethal Streptococcus pneumoniae infection. Vaccinated mice developed a high titer of antibody to phosphorylcholine, which is known to protect against infection with Streptococcus pneumoniae. Measurement of the median lethal dose of the bacteria indicated that anti-idiotope immunization significantly increased the resistance of BALB/c mice to the bacterial challenge. Antibody to an idiotope can thus be used as an antigen substitute for the induction of protective immunity.

Animals↗
PubMed1984

Anthropometry and numerical taxonomy in clinical genetics: an example of applied biological anthropology.

Biological anthropologists can contribute a unique perspective as well as technical expertise to the diagnosis and classification of genetic disorders. Anthropometry has been used with increasing frequency to characterize syndromes and to establish ranges of variation within syndromes. The specific anthropometric-radiologic technique of metacarpophalangeal pattern profile analysis has proven useful in discriminating individuals with the Prader-Labhart-Willi (PLW) syndrome from unaffected persons. Analysis of these data also indicate a negative correlation between age and Z-score transformations of individual hand bone lengths. These findings sound a cautionary note to clinical investigators who would use the Z-score transformation to standardize for age and sex. Problems encountered in the classification of genetic syndromes afford many parallels with those faced by anthropologists in the classification of living and fossil populations. The reliance on "key" traits and the necessity of focusing on pedigree analysis results in a deemphasis of the total range of variation and typological thinking. Application of numerical taxonomic techniques to the classification of the heterogeneous connective tissue disease osteogenesis imperfecta (OI) illustrates the heuristic value of this technique and points out the need to consider phenotypic overlap when defining typologies. Clinical genetics affords just one example of an area in medicine where the unique training and generalist perspective of the biological anthropologist is in demand. The decline in the availability of positions in the traditional academic habitat for biological anthropologists makes it imperative that graduate students be aware of alternatives and that they obtain training in the practical skills which such alternatives will demand.

Anthropology↗
PubMed1984

Blunt cardiac rupture.

Blunt injury to the heart ranges from contusion to disruption. This report comprises 14 patients seen during a 6-year period with cardiac rupture secondary to blunt trauma. Eight patients were injured in automobile accidents, two patients were injured in auto-pedestrian accidents, two were kicked in the chest by ungulates, and two sustained falls. Cardiac tamponade was suspected in ten patients. Five patients presented with prehospital cardiac arrest or arrested shortly after arrival. All underwent emergency department thoracotomy without survival. Two patients expired in the operating room during attempted cardiac repair; both had significant extracardiac injury. Seven patients survived, three had right atrial injuries, three had right ventricular injuries, and one had a left atrial injury. Cardiopulmonary bypass was not required for repair of the surviving patients. There were no significant complications from the cardiac repair. The history of significant force dispersed over a relatively small area of the precordium as in a kicking injury from an animal or steering wheel impact should alert the physician to possible cardiac rupture. Cardiac rupture should be considered in patients who present with signs of cardiac tamponade or persistent thoracic bleeding after blunt trauma.

Adolescent↗
PubMed1983

Emergency thoracotomy in the management of trauma.

The role of emergency room thoracotomy in the management of trauma remains poorly defined despite an increase in its use. Most authors agree that the procedure is effective in the treatment of penetrating thoracic injuries, while its benefit in penetrating injuries below the diaphragm and in blunt trauma has not been established. The best outcome can be expected in patients who have sustained penetrating cardiac and thoracic injuries. Penetrating abdominal wounds that are severe enough to require thoracotomy in the emergency room fare less well; those patients who suffer from blunt thoracoabdominal injuries are least fortunate. The anatomic location and mode of injury greatly influence the outcome of these patients and are useful in determining when to perform this procedure.

Abdominal Injuries↗
PubMed1983

New concepts in the use of axillofemoral bypass grafts.

Over a four-year period, 52 patients underwent axillofemoral bypass operations. Indications for operation were divided into three groups: those that were performed emergently (aortoenteric fistula, graft infection, and leaking aortic aneurysm), those performed electively for aneurysm, and those for ischemia. Operative procedures were categorized as follows: axillofemoral bypass alone, axillofemorofemoral bypass with the proximal femorofemoral anastomosis being graft to graft, or axillofemorofemoral bypass with the femorofemoral anastomosis to either a transected proximal common femoral artery or superficial femoral artery distal to the axillofemoral anastomosis. Thirty-three percent of the unilateral axillofemoral grafts failed, while only 14% of the axillobifemoral grafts failed. There was a further difference between the two methods of femorofemoral grafting with 22% failure in the former group but no failures in the latter.

Adolescent↗
PubMed1983

Hypotension-induced post-traumatic necrosis of the right colon.

Necrosis of the right colon developed after hemorrhagic shock in six young traumatized patients who did not have colon injury. The mean duration of hypotension was 112 minutes, and the mean resuscitation fluid volume required was 22 liters. Signs of right colon necrosis appeared 2 to 7 days after injury (median 2 days). All patients survived right colectomy and ileocolostomy or ileostomy and mucous fistula. The cause of necrosis of the right colon after hemorrhagic shock from major trauma is not clear. Anatomic abnormalities in blood supply to the right colon or a derangement in the physiologic processes of the microcirculation of the right colon must be considered.

Adult↗
PubMed1983

A field evaluation of the Esophageal Obturator Airway.

The Esophageal Obturator Airway (EOA) has been considered an effective ventilatory technique for cardiopulmonary resuscitation; however, few studies of its field effectiveness have been performed. We evaluated the EOA in 158 cases of prehospital cardiac arrest resuscitated by EMT II personnel utilizing the EOA for airway maintenance. The time of insertion from arrival of the unit and the number of unsuccessful attempts were recorded. The EOA took longer than 4 minutes to insert in 47% of cases. It was incapable of being placed in 18.3% of cases, and required two or more attempts at insertion in 30%. There were six survivors in this series (3.7%). Subsequently, we measured arterial blood gas levels during ventilation with the EOA and after endotracheal intubation in 13 patients. Arterial oxygen tension greater than 60 mm Hg was achieved in only four of 13 patients with the EOA. All patients were hypercarbic and acidotic using the EOA. There was marked improvement in all parameters following ET intubation. The EOA presents technical problems which make it inferior to ET tubes in resuscitation of individuals in the field with cardiac arrest. Close monitoring of its use should be undertaken in areas where it is the primary method for airway maintenance.

Adult↗
PubMed1982

Peritoneal lavage and angiography in the management of patients with pelvic fractures.

One hundred consecutive patients with pelvic fractures who had undergone peritoneal lavage and abdominal and pelvic angiography were retrospectively analyzed. Sixty-four patients with negative lavages were treated successfully without laparotomy despite a 20 percent incidence of subcapsular or intraparenchymal hematomas of the liver or spleen. Thirty percent of the patients with positive peritoneal lavages were successfully managed without laparotomy when abdominal angiography failed to identify a source of active bleeding. Abdominal angiography was 92 percent accurate in predicting the presence or absence of hemorrhage in 25 patients who underwent laparotomy. There were no false-positive angiograms. The overall false-negative rate was 2.12 percent. These occurred in two patients with torn mesenteric vessels. Pelvic angiography identified arterial pelvic bleeding in 18 percent of the patients. Eighty-four percent of patients with major pelvic bleeding had successful embolization with prompt cessation of arterial bleeding. We conclude that abdominal and pelvic angiography can be a useful adjunct to peritoneal lavage in detecting intraperitoneal hemorrhage and can be of therapeutic value for arterial pelvic bleeding.

Adolescent↗