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Biomedical subjects

Robert E Glasgow

Publications and source records attributed to Robert E Glasgow.

8 recordsLinked to original sources
PubMed2005

A conscious mouse model of gastric ileus using clinically relevant endpoints.

BACKGROUND: Gastric ileus is an unsolved clinical problem and current treatment is limited to supportive measures. Models of ileus using anesthetized animals, muscle strips or isolated smooth muscle cells do not adequately reproduce the clinical situation. Thus, previous studies using these techniques have not led to a clear understanding of the pathophysiology of ileus. The feasibility of using food intake and fecal output as simple, clinically relevant endpoints for monitoring ileus in a conscious mouse model was evaluated by assessing the severity and time course of various insults known to cause ileus. METHODS: Delayed food intake and fecal output associated with ileus was monitored after intraperitoneal injection of endotoxin, laparotomy with bowel manipulation, thermal injury or cerulein induced acute pancreatitis. The correlation of decreased food intake after endotoxin injection with gastric ileus was validated by measuring gastric emptying. The effect of endotoxin on general activity level and feeding behavior was also determined. Small bowel transit was measured using a phenol red marker. RESULTS: Each insult resulted in a transient and comparable decrease in food intake and fecal output consistent with the clinical picture of ileus. The endpoints were highly sensitive to small changes in low doses of endotoxin, the extent of bowel manipulation, and cerulein dose. The delay in food intake directly correlated with delayed gastric emptying. Changes in general activity and feeding behavior were insufficient to explain decreased food intake. Intestinal transit remained unchanged at the times measured. CONCLUSION: Food intake and fecal output are sensitive markers of gastric dysfunction in four experimental models of ileus. In the mouse, delayed gastric emptying appears to be the major cause of the anorexic effect associated with ileus. Gastric dysfunction is more important than small bowel dysfunction in this model. Recovery of stomach function appears to be simultaneous to colonic recovery.

Animals↗
PubMed2004

Failed fundoplications.

BACKGROUND: Five percent of patients who undergo fundoplication will require reoperation. The cause of this high failure rate and the best management for these patients remains poorly understood. The aim of this study was to identify patterns and causes of failure of primary antireflux procedures. METHODS: Retrospective review of the medical records of patients who underwent revisional antireflux surgery at 2 tertiary referral centers. RESULTS: Between 1998 and 2003, 39 patients underwent laparoscopic revisional antireflux surgery. The time between primary and revisional surgery was 5.9 +/- 0.4 years. Primary operations included 26 laparoscopic and 13 open fundoplications. All of the 39 revisional operations were attempted laparoscopically, and there was 1 open conversion. Revisional procedures included 31 Nissen and 8 partial fundoplications. The duration of surgery was 138 +/- 10 minutes. Length of hospital stay was 2.1 +/- 0.3 days. At a mean follow-up of 6 months, reflux resolved in 94% of patients. Morbidity occurred in 23% of patients. Four types of failure were identified: type 1 = herniation of the gastroesophageal junction through the hiatus with or without the wrap (n = 21); type 2 = paraesophageal hernia (n = 9); type 3 = malformation of the wrap (n = 2). Six patients had primary wrap failure, and 1 had esophageal dysmotility. CONCLUSIONS: Laparoscopic revisional antireflux surgery is effective treatment for patients with failed primary fundoplications. Successful revisional surgery depends on identification and correction of the reason for primary fundoplication failure.

Adolescent↗
PubMed2004

The benefits of a dedicated minimally invasive surgery program to academic general surgery practice.

In 2001, a dedicated minimally invasive surgery (MIS) program was established at a large university hospital. Changes included improvement and standardization of equipment and instruments, patient care protocols, standardized orders, and staff education. The aim of this study was to evaluate the impact of this program on an academic surgery practice. From January 1999 through October 2003, hospital and departmental databases were reviewed for all records pertaining to general surgery cases. Data trends were analyzed by regression analysis and are expressed as mean +/- SEM. In 1999, 15.0 +/- 0.1% of all general surgery cases were MIS cases compared with 30.2 +/- 0.1% in 2003 (P < 0.0001). During this period, the number of patients requiring conversion from a laparoscopic to an open approach decreased from 14.4% to 4.0% (P = 0.0007). In 1999, 30% of appendectomies were laparoscopic, compared with 92% in 2003 (P < 0.0001). This increase in the rate of laparoscopic appendectomy resulted in a decrease in average length of hospital stay for all patients with acute appendicitis, from 5.5 +/- 1.0 days in 1999 to 2.7 +/- 0.2 days in 2003 (P < 0.0001), and a decrease in total hospital cost per case, from 6569 +/- 400 US dollars in 1999 to 4819 +/- 175 US dollars in 2002 (P < 0.001). Total operating room time per case for cholecystectomy decreased from 131 +/- 3.7 to 108 +/- 3.2 minutes (P < 0.0001), and actual surgery time decreased from 95 +/- 4.1 to 74 +/- 4.0 minutes (P = 0.0006). Implementation of a dedicated MIS program resulted in a significant increase in the number of MIS cases and percentage of general surgery cases performed by MIS. This increase in the utilization of MIS resulted in reduced length of stay and cost and has been accompanied by improvements in operating room efficiency. Changes in practice associated with development of an MIS program have had measurable institutional benefits.

Appendectomy↗
PubMed2004

Pancreatic resection in the elderly.

BACKGROUND: Elderly patients undergoing pancreatic resection present unique challenges in postoperative care. Although mortality rates among elderly patients after pancreatectomy at high-volume centers is known to be low, the anticipated decline in functional status and nutritional parameters has received little attention. Functional decline is an unrecognized but critically important consequence of pancreatic resection in older patients. STUDY DESIGN: This study is a retrospective review, validation cohort, of older and younger patients undergoing major pancreatic resection. The setting is the state of California (database of all hospitals in the state) and The University of California, San Francisco (UCSF; a tertiary care referral center). The study population is a consecutive sample of older (greater than or equal to 75 years) and younger (16 to 74 years) patients from California (January 1990 to December 1996; n = 3,113) and UCSF (January 1993 to November 2000; n = 218), who underwent radical pancreaticoduodenectomy, distal pancreatectomy, or total pancreatectomy for neoplasia. The main outcomes measures were length of stay, complications, mortality, discharge disposition, supplemental nutrition requirement, and readmissions. RESULTS: Elderly patients had higher mortality rates than the young statewide (10% versus 7%, p = 0.006). Although the 3% mortality at UCSF was the same for both groups, older patients were more often admitted to the ICU (47% versus 20%, p = 0.003), treated for major cardiac events (13% versus 0.5%, p < 0.001), discharged with enteral tube feedings (48% versus 16%, p < 0.001), or malnourished on readmission (17% versus 2%, p < 0.005). Older patients were more frequently discharged to skilled nursing facilities (17% versus 1% at UCSF; 24% versus 7% in California; p < 0.001, both groups). CONCLUSIONS: Older patients are more likely than younger patients to require an ICU stay, suffer a cardiac complication, and experience compromised nutritional and functional status after major pancreatic resection.

Adolescent↗
PubMed2004

Trends in research support and productivity in the changing environment of academic surgery.

BACKGROUND: We hypothesized that the changing environment of academic surgery has resulted in a decrease in surgical research funding and basic surgical research productivity of academic departments of surgery. MATERIALS AND METHODS: Trends in National Institutes of Health (NIH) grants to Departments of Medicine and Surgery were analyzed from 1992 to 1999. To assess trends in research productivity, selected basic science journals were screened from 1988 to 1999 for the number of basic research publications where authors cited affiliation with a Department of Medicine or Surgery. RESULTS: NIH funding to Schools of Medicine increased 5.9% per year from 1992 to 1999. Funding to Departments of Medicine increased 21.1% per year, whereas funding to Surgery increased 3.1% per year. As a percentage of total funding to medical schools, NIH funding to Departments of Surgery declined slightly and funding to Departments of Medicine increased 1% per year. The number of grants awarded to Schools of Medicine and Departments of Surgery and Medicine remained constant from 1992 to 1999. The number of publications in basic science journals trended up for both Departments of Surgery and Departments of Medicine. As a percentage of departmental totals, Departments of Surgery publications increased by 9.5% yearly and Departments of Medicine increased 1.5% per year. CONCLUSION: Support for basic surgical research has been static. Despite static grant support, basic research productivity has increased for Departments of Surgery. Basic surgical research remains an integral part of academic surgery department activity.

Academic Medical Centers↗
PubMedDate not supplied

Development of a dedicated hepatopancreaticobiliary program in a university hospital system.

In 2001, a dedicated hepatopancreatobiliary (HPB) cancer program was established at a large, university hospital. Changes included recruitment of specialized HPB faculty, standardization of patient protocols, development of coordinated multidisciplinary research and clinical efforts, collection of prospective surgical outcomes data, and construction of a dedicated cancer hospital. The aim of this study was to evaluate the impact of this program on a university health system including effects on patient volume, surgical volume, outcomes, costs, resident education, and research productivity. Hospital and departmental databases were reviewed for all records pertaining to HPB surgical cases, diagnosis, and financial information over a 6-year period, including 2 years before (1999-2000) and 4 years after (2001-2004) HPB program development. A more than two-fold increase in the number of distinct patients who had HPB diagnosis was seen across all pertinent departments. A five-fold increase in surgical volume was observed. A multidisciplinary approach to care was implemented, leading to a four-fold increase in sharing of patients across departments. Improvements in operative mortality, hospital contribution margin, resident operative experience, and research productivity were observed. The implementation of a dedicated HPB cancer program with coordinated and standardized research, educational, and clinical efforts had measurable institutional benefit.

Clinical Protocols↗
PubMedDate not supplied

Anti-inflammatory effects of PPAR-gamma agonists directly correlate with PPAR-gamma expression during acute pancreatitis.

Peroxisome proliferator-activated receptors (PPARs) are ligand-inducible transcription factors that regulate cellular energy and lipid metabolism. PPAR-gamma agonists also have potent anti-inflammatory properties through down-regulation of early inflammatory response genes. The role of PPAR-gamma in acute pancreatitis has not been adequately examined. In this study, we determined the effect of PPAR-gamma agonists on the severity of pancreatitis and sought to correlate PPAR-gamma expression in pancreatic acinar cells and the severity of acute pancreatitis in vivo. Acute pancreatitis was induced in mice by hyperstimulation with the cholecystokinin analog, cerulein. PPAR-gamma agonists were administered by intraperitoneal injection 15-30 minutes before induction of pancreatitis (pretreatment) or at various times after induction of pancreatitis (treatment). Pancreata and serum were harvested over the course of 24 hours. Serum amylase activity and glucose levels were measured. Pancreata were used for histological evaluation as well as protein and mRNA analysis. Pretreatment of mice with the PPAR-gamma agonists 15-deoxy-Delta12, 14-prostaglandin J(2), or troglitazone significantly reduced the severity of pancreatitis in a dose-dependent manner. This reduction was indicated by reduced serum amylase activity and histological damage (leukocyte infiltration, vacuolization, and necrosis). Although cerulein decreased PPAR-gamma expression in the pancreas, pretreatment with agonists maintained PPAR-gamma expression early in acute pancreatitis. The expression of PPAR-gamma inversely correlated with pancreatitis severity and expression of the proinflammatory cytokines, interleukin-6, and tumor necrosis factor-alpha. Treatment with troglitazone after the induction of pancreatitis reduced serum amylase activity. The results suggest that PPAR-gamma plays a direct role in the inflammatory cascade during the early events of acute pancreatitis. Our data are the first to demonstrate that PPAR-gamma agonists represent a promising therapeutic strategy for acute pancreatitis.

Animals↗