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Biomedical subjects

R F Wilson

Publications and source records attributed to R F Wilson.

At least 181 records · Page 10Linked to original sources
PubMed1989

Predicting and preventing infection after abdominal vascular injuries.

Of 210 patients with major intra-abdominal vascular injuries, 111 (53%) survived more than 48 hours. Of these, 41 (37%) developed serious infections resulting in death or a hospital stay exceeding 14 days (mean, 55 +/- 49) in the 33 who survived. The most frequent serious infections were intraperitoneal and resulted in a 35% mortality rate (8/23). The 111 patients surviving 48+ hours were divided into two groups based on their initial E.D. BP and injuries. The "high-risk" patients (with no obtainable blood pressure on admission, five or more injuries or a colon injury with a systolic BP of 40 to 89 mm Hg) had a serious infection rate of 63% (25/40). This was significantly higher than the serious infection rate of 23% (16/71) in the remaining 71 "low-risk" patients (p less than 0.001). The patients were then evaluated for factors which surgeons might control. In the high-risk group, resuscitation adequate to produce an initial operating room (O.R.) systolic BP greater than 70 mm Hg and early control of bleeding so that less than 10 units of blood were used resulted in a serious infection rate of only 20% (2/10) versus 77% (23/30) in the other high-risk patients (p less than 0.01). In the low-risk patients, having an initial O.R. systolic BP greater than 70 mm Hg and using less than 10 units of blood resulted in a serious infection rate of 13% (6/48) versus 43% (10/23) in the others (p less than 0.05). High-risk patients failing to meet these resuscitation goals must be watched particularly carefully for development of infections.

Abdominal Injuries↗
PubMed1989

A comparison of antibody levels to Bacteroides gingivalis in serum and crevicular fluid from patients with untreated periodontitis.

The levels of IgG antibody to Bacteroides gingivalis were measured in serum and sequential samples of crevicular fluid from healthy and diseased sites in patients with untreated periodontitis using ELISA. All subjects had detectable serum titres but there was a wide variation in titre between subjects. Moderate to strong correlations were found between serum and crevicular fluid levels of IgG. A statistically significant difference was observed between sequential samples of crevicular fluid. There was no difference in the level of specific IgG to B. gingivalis in crevicular fluid between healthy and diseased sites within the same individual.

Antibodies, Bacterial↗
PubMed1989

The occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, Bacteroides intermedius and spirochaetes in the subgingival microflora in relation to the early onset of periodontitis in a group of adolescents.

Subgingival samples were obtained from mesial and distal surfaces of first molars in 100 subjects aged 14 years at baseline. Sites were monitored at 6-monthly intervals for clinical loss of attachment. Six subjects showed greater than 1 mm loss of attachment at one site 18-24 months later. Further samples were obtained from these sites together with a comparison sample from the contralateral site and equivalent sites in a matched control subject. Actinobacillus actinomycetemcomitans was more frequently isolated from sites following loss of attachment, but it was also found in one comparison site and one control subject. Bacteroides gingivalis was found in only one subject at a site which subsequently experienced loss of attachment. A higher median proportion of spirochaetes was observed in sites after diagnosis of loss of attachment. The median proportion of Bacteroides intermedius was higher at both the baseline and 12-month examinations in subjects who subsequently lost attachment. Further work is required to substantiate the differences which preceded diagnosis of loss of attachment.

Actinobacillus↗
PubMed1989

Vascular injury about the knee. Improved outcome.

The records of 41 patients with 43 vascular injuries about the knee (34 popliteal artery, five tibial-peroneal trunk, one proximal anterior tibial artery, and three isolated popliteal veins) were analyzed. The etiology of the injuries were gunshot wounds (22), blunt trauma (11), shotgun wounds (4), and stab wounds (4). Associated injuries included fractures (67%), popliteal vein (54%), and nerves (32%). Arterial repairs consisted of primary repair (19), lateral repair (1), saphenous vein grafts (13), and saphenous vein patching (1). Five patients received polytetrafluoroethylene (PTFE) grafts. Fasciotomy was performed in 27 limbs. The associated venous injuries (21) and isolated venous injuries (3) were managed with ligation (14), primary repair (9), and vein patch (1). The amputation rate was 11 per cent for popliteal artery injuries (4/34). No other amputations were required. All four amputations were associated with massive limb injury (3) or diagnostic delay (1). One patient died during hemodialysis for renal failure resulting from prolonged shock and myoglobinuria. Successful management correlates best with prompt repair of both popliteal arterial and venous injuries and early fasciotomy. Vein repair (vs ligation) is associated with better long-term results.

Adolescent↗
PubMed1989

Hemodynamic benefits of verapamil after aortic reconstruction.

Because of the high incidence of coronary artery disease (CAD) in patients undergoing aortic surgery, and because myocardial oxygen consumption is proportional to blood pressure x heart rate (HR) (pressure-rate product), it is important to prevent increases in these parameters postoperatively. The effect of verapamil, a calcium channel antagonist, on these parameters was evaluated in 30 patients undergoing abdominal aortic reconstruction. Postoperatively HR increased 27% in 19 patients without CAD and 47% in 11 patients with CAD. Pressure-rate product (blood pressure x HR) increased 17% and 31% in these two groups, respectively. Verapamil was able to reduce postoperative HR by 3% in patients without CAD and by 13% in patients with CAD. Verapamil reduced pressure-rate product 8% and 18%, respectively, in the two groups. These reductions were statistically significant in patients with CAD and occurred without reductions in cardiac output or left ventricular ejection fraction. Thus the postoperative increases in myocardial oxygen demand appeared to be primarily related to increased HR after aortic surgery, and these were reduced by verapamil without impairing blood flow or cardiac function.

Aged↗
PubMed1989

Outcome of trauma patients who present to the operating room with hypotension.

The case records of 101 patients with trauma who presented to the operating room (OR) for emergency surgery and had a systolic blood pressure (sBP) less than 90 mm Hg over a period of 3 years were reviewed. The sBP was 70-89 mm Hg in 47 patients, 50-69 mm Hg in 19 patients, and unobtainable in 35 patients. The mortality rates for these three groups were 6 per cent, 79 per cent, and 86 per cent, respectively. The increase in mortality rate with a sBP less than 70 mm Hg was highly significant (p less than 0.001). The duration of initial shock in the OR and emergency department (ED) exceeded 30 minutes in 56 patients, and 35 patients (62%) died. In contrast, of 45 patients who had less than 30 minutes of shock, only 13 patients (29%) died (p less than 0.001). Of the 54 patients who presented to the OR with a sBP less than 70 mm Hg, 42 patients had early cross-clamping of the thoracic aorta. This was performed as a prelaparatomy thoracotomy in 25 patients with abdominal injuries and as part of the thoracotomy in 17 patients with chest trauma. Nineteen (45%) of these 42 patients responded favorably to aortic cross-clamping with a sustained increase in sBP to greater than 90 mm Hg within 5 minutes. Of these 19 patients, 42 per cent survived. The 23 patients who did not respond to aortic cross-clamping died in the OR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Sepsis and antithrombin III, prekallikrein, and fibronectin levels in surgical patients.

Antithrombin (AT), prekallikrein (PK), and fibronectin (FN) were measured in the plasma of 400 patients with a variety of disease states seen at Detroit Receiving Hospital from October 1983 through June 1987. The average lowest AT measured in these 400 patients was 69 +/- 19 per cent (SD) (Normal = 75-120%). The average lowest AT level in 152 septic patients (50 +/- 17%) was significantly lower than in the 248 patients without sepsis (79 +/- 22%) (P less than 0.001). The average lowest PK levels measured in 132 patients was 52 +/- 19 (Normal = 80-120%). The average PK level in 64 septic patients (34 +/- 17%) was significantly lower than in 68 who were not septic (69 +/- 21%) (P less than 0.001). The average lowest FN levels measured in 109 patients was 230 +/- 118 mcg/ml (Normal = 200-350 mcg/ml). The average FN level in 47 septic patients (162 +/- 88 mcg/ml) was significantly lower than in the 62 nonseptic patients (285 +/- 138) mcg/ml. AT or PK levels less than 50 per cent or FN levels less than 150 mcg/ml during the first 24 to 48 hours after severe trauma or burns were associated with a development of later sepsis in 90 per cent, 77 per cent, and 70 per cent, respectively. Thus, low or falling levels of AT, PK, and FN may be of great help in predicting sepsis or providing an early diagnosis in critically ill or injured patients.

Antithrombin III↗
PubMed1989

Coronary artery disease in cardiac transplant patients receiving triple-drug immunosuppressive therapy.

Although triple-drug immunosuppression with cyclosporine, prednisone, and azathioprine has reduced the incidence of acute graft rejection after cardiac transplant, its effect on the development of coronary artery disease is unknown. We have followed up 74 cardiac transplant recipients with yearly coronary angiograms. The probability of acute rejection was 10.8% at 1 year. The incidence of coronary artery disease was 8% at 1 year (six of 74 patients) and 24% at 2 years (11 of 30 patients). In patients who developed posttransplant coronary artery disease, there was a slightly higher, but not statistically significant, incidence of acute graft rejection and pretransplant idiopathic cardiomyopathy. No correlation was found between the incidence of coronary artery disease and recipient age, human leukocyte antigen (HLA) type, hypertension, diabetes, cholesterol level, triglyceride levels, weight gain after transplant, and smoking. These data indicate that triple-drug immunosuppression, despite having produced a significant reduction in the episodes of acute graft rejection, has not decreased the incidence of posttransplant coronary artery disease. Common risk factors for coronary disease and HLA mismatch are probably not important in the pathogenesis of coronary atherosclerosis after cardiac transplantation, whereas the risk for coronary artery disease may be increased by acute graft rejection and pretransplant idiopathic cardiomyopathy.

Azathioprine↗
PubMed1989

Changes in oxygenation and pulse rate during endoscopy.

Continuous monitoring of arterial oxygen saturation and heart rate with a pulse oximeter was performed in 100 consecutive patients undergoing esophagogastroduodenoscopy (78) or colonoscopy (22). Twenty-four patients had decreases in their estimated arterial PO2 level to less than 60 mm Hg during or just after the procedure. In 15 patients the hypoxemia was transient, but in nine others, treatment was required. Twenty patients also developed a tachycardia greater than 120 beats/minute.

Adolescent↗
PubMed1988

Pulmonary artery diastolic and wedge pressure relationships in critically ill and injured patients.

To study pulmonary artery wedge pressure (PAWP) and pulmonary artery diastolic pressure (PADP) relationships, we measured these simultaneously with cardiac outputs 1922 times in 128 patients who were critically ill or in an intensive care unit. In 356 (18.5%) of the readings, the PAWP exceeded the PADP, indicating that the PAWP reading might be erroneous. In 106 (5.5%) of these readings, the PAWP was 6.0 mm Hg or more higher than the PADP, indicating that the PAWP was almost certainly erroneous. In virtually all instances in which this discrepancy was recognized, changing the position of the catheter tip provided a PAWP value equal to or lower than the PADP. On the other extreme, in 49 (30%) of the patients, the PADP was 6.0 mm Hg or more higher than the PAWP. The pulmonary vascular resistance in these patients averaged (+/- SD) 257 +/- 145 dyne/s/cm-5 (normal, 80 to 160 dyne/s/cm-5). The mean pulmonary vascular resistance in the other 74 patients was significantly lower (158 +/- 72 dyne/s/cm-5). The mortality rate with the increased PADP-PAWP gradients was 59% (24/49). This was significantly higher than the mortality rate (34%, or 27/79) seen with lower PAWP-PADP gradients. Thus, the relationship between the PADP and PAWP should be examined closely in critically ill patients. A PAWP higher than the PADP indicates that the PAWP measurement may be erroneous. On the other hand, if the PADP exceeds the PAWP by 6.0 mm Hg or more, the patient has probably developed pulmonary hypertension and has a much poorer prognosis.

Blood Pressure↗
PubMed1988

Collection and biochemical analysis of human dental plaque from the approximal tooth surfaces and comparison with plaque from free smooth surfaces.

The composition of approximal plaque was compared with that normally collected from the free smooth surfaces in investigation of 45 males aged 11-14 years and 75 females aged 13 years. Statistically significant differences in calcium, inorganic and organic phosphorus, magnesium, fluoride and carbohydrate were observed between free smooth-surface and approximal plaque. The concentrations were always lower in the approximal sample, ranging from 55 to 70 per cent of those in free smooth-surface plaque. A subsequent comparison in 12 students indicated that the concentration of total lipids in approximal plaque was about twice that of free smooth-surface plaque, a difference which could explain the quantitative disparity in total composition between the two types of plaque in the studies with children. The differences are consistent with approximal plaque having reduced access to a range of environmental factors due to diffusion limitation in its deeper layers.

Adolescent↗
PubMed1988

Sensitivity and specificity of assessing coronary bypass graft patency with ultrafast computed tomography: results of a multicenter study.

Because a significant number of all patients seen by cardiologists have had coronary bypass surgery, a relatively noninvasive method of assessing coronary bypass graft patency would be very helpful. Ultrafast computed tomography, by virtue of its rapid data acquisition time and reasonable spatial resolution, may be useful in this regard. To determine the sensitivity, specificity and predictive accuracy of this imaging modality as compared with cardiac catheterization, a multicenter study was undertaken. There were two parts to the study. Part I involved the evaluation of 179 grafts in 74 patients studied in the five participating centers between March 1985 and August 1986. Twenty-nine percent of these graft studies were found to be technically inadequate and were excluded before patency determinations began. The remaining group of 127 bypass grafts in 62 patients had studies adequate for interpretation. Fifty-one grafts were to the left anterior descending coronary artery or a diagonal branch, 37 to branches of the left circumflex artery and 28 to the right coronary artery or a posterior descending vessel; in addition, there were 11 internal mammary artery bypass grafts primarily into the left anterior descending or diagonal artery distribution. The sensitivity of detecting angiographically open grafts was 93.4%, the specificity of detecting angiographically closed grafts 88.9% and the predictive accuracy was 92.1%. A subsequent study (Part 2) was performed 9 months later to assess the ability to carry out technically adequate examinations. Of the 138 consecutive graft examinations (50 patients) included in this part of the study, 94.2% of the examinations were found to be technically adequate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Traumatic rupture of ascending aorta and left main bronchus.

A 14-year-old male pedestrian was hit by a truck and admitted with respiratory distress and subcutaneous emphysema. Aortography revealed disruption of the ascending aorta. Bronchoscopy revealed rupture of the left main bronchus at the carina. Both lesions were repaired using a median sternotomy, cardiopulmonary bypass, and a transpericardial approach for the bronchial repair. To our knowledge, this is the first report of successful repair of a combined rupture of a major bronchus and the ascending aorta.

Adult↗
PubMed1988

Videodensitometric analysis of coronary stenoses. In vivo geometric and physiologic validation in humans.

Assessment of the severity of coronary stenoses on arteriograms conventionally is based on subjective estimates of percent luminal diameter narrowing. However, in studies in patients with multivessel coronary artery disease, we have found a poor correlation between percent stenosis and the physiologic significance of an individual coronary obstruction. The purpose of this study was to determine whether computerized videodensitometry would allow estimation of coronary luminal area and therefore prediction of the physiologic significance of individual coronary stenoses in humans. Videodensitometry was used to define the minimal luminal area of 15 left anterior descending, 15 circumflex, and 15 right coronary artery segments in 43 patients. Computer-assisted quantitative coronary arteriography (method of Brown et al) was used to determine the minimal luminal cross-sectional area of these same segments. In each arterial segment, coronary vasodilator reserve was assessed using intraoperative (n = 18 segments) or intracoronary (n = 27 segments) Doppler measurements of coronary vasodilator reserve. Videodensitometric estimates of coronary luminal area correlated well with minimal luminal area defined using the independent geometric technique of quantitative coronary arteriography (r = 0.82, y = 0.97 X + 0.71, SEE = 1.83 mm2, n = 45) and with lesion physiologic significance as defined by studies of the peak-to-resting velocity ratio (r = 0.71, 0.92, and 0.74 for the left anterior descending, circumflex, and right coronary arteries, respectively). Thus, videodensitometry is a promising method that may supplement geometric approaches to quantitative analysis of coronary arteriograms in humans.

Absorptiometry, Photon↗
PubMed1988

Pulmonary inflation reflex: its lack of physiological significance in coronary circulation of humans.

In awake dogs, voluntary deep inspiration results in a marked, reflex-mediated increase in coronary blood flow. To study this reflex in humans, we subselectively measured coronary blood flow velocity (CBFV) with a 3-F coronary Doppler catheter in 12 subjects with angiographically normal coronary arteries. In each subject, intracoronary papaverine increased CBFV to 4.8 +/- 0.2 X resting CBFV and reduced coronary resistance to 0.20 +/- 0.01 X resting coronary resistance, demonstrating normal vasodilator reserve in the vessel under study. Valsalva maneuver reduced CBFV to 0.67 +/- 0.09 X resting CBFV and increased coronary resistance to 1.37 +/- 0.20 X resting coronary resistance (P less than 0.05 vs. control). Maximum voluntary inspiration, however, did not significantly change CBFV (peak response 1.03 +/- 0.05 X resting CBFV) or coronary resistance (0.96 +/- 0.04 X resting). To determine whether augmentation of resting alpha-adrenergic tone would potentiate the reflex, eight patients performed a sustained 33% maximal handgrip for 2 min. Maximal deep inspiration during handgrip failed to result in any significant change in CBFV or coronary resistance. These studies demonstrate that the canine pulmonary inflation reflex has little or no physiological significance in the coronary circulation of conscious humans. Additionally, these data suggest that the magnitude of reflex control of the coronary circulation may vary considerably between dogs and humans.

Adult↗