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Biomedical subjects

S Lelcuk

Publications and source records attributed to S Lelcuk.

At least 55 records · Page 3Linked to original sources
PubMed1988

Delayed muscular rigidity and respiratory depression following fentanyl anesthesia.

A delayed effect of fentanyl used for anesthesia may be respiratory distress several hours after surgery. The findings are muscular rigidity, fall in chest wall compliance, hypoventilation, respiratory acidosis, and hypotension. In the past, to our knowledge, this complication was exclusively reported in patients undergoing cardiac surgery, when large fentanyl dosages are employed. This article describes three general surgical patients in whom respiratory distress developed three to five hours following colon surgery when a moderate dose of fentanyl citrate, 55 to 75 micrograms/kg, was used. Initially, all patients had a normal recovery from anesthesia. Later, respiratory distress was successfully treated with a fentanyl antagonist and ventilatory assistance. This delayed toxic phenomenon is thought to be due to the reentry of fentanyl into plasma from deposits in adipose tissue, muscle, and the gastrointestinal tract, leading to a secondary rise in the plasma concentration. It is more likely to be encountered when hypothermia, rewarming, and acidosis are present in the postoperative period. This life-threatening complication is treacherous, since it may occur when the patient has been transferred to the surgical ward and is less closely monitored.

Aged↗
PubMed1988

Prolonged fever as a presenting symptom in adrenal tumors.

Four patients with adrenal tumors in whom prolonged fever was the foremost symptom are presented. Two of the patients had nonfunctional adrenocortical carcinoma, one had a pheochromocytoma without adrenergic hyperactivity, and in the fourth, an aldosteronoma was found. Only in 1 case was the tumor (pheochromocytoma) resectable and this patient became afebrile post surgery. A review of the literature revealed that fever is encountered in 6-10% of cases with adrenal tumors, sometimes as the first manifestation of disease. However, a survey of the large series of fever of unknown origin revealed no mention of adrenal tumors in that group of solid tumors which many cause prolonged fever.

Adrenal Gland Neoplasms↗
PubMed1988

Effects of nitroprusside and ketanserin upon pulmonary edema after acid injury.

Increased hydrostatic pressure and microvascular permeability after acid aspiration as causes of pulmonary and tracheobronchial edema were studied. Eighteen dogs were anesthetized and 3.0 milliliters per kilogram of 0.1 normal hydrochloride instilled into the trachea. After one hour, the platelet count decreased 47,500 per cubic millimeter (p less than 0.05) from base line levels of 221,400 per cubic millimeter and platelet serotonin stores decreased from 2.09 to 1.65 micrograms per 10(9) platelets (p less than 0.05). Mean pulmonary arterial pressure increased progressively from a base line value of 11 to 21 millimeters of mercury four hours after acid instillation (p less than 0.05). Mean arterial pressure fluctuated from a high of 143 millimeters of mercury to the final value, at four hours, of 119 millimeters of mercury. Ketanserin, a serotonin receptor antagonist, infused one hour after acid injury did not prevent release of platelet 5 hydroxytryptamine but led to a 24 per cent decrease in mean pulmonary arterial pressure from 13 to 10 millimeters of mercury (p less than 0.05) and an 11 per cent decrease in mean arterial pressure from 135 to 120 millimeters of mercury (p less than 0.05). Nitroprusside produced a 30 per cent decrease in mean arterial pressure, but only a 20 per cent decline in mean pulmonary arterial pressure (p less than 0.05). Four hours after acid was instilled, untreated dogs produced 129 milliliters of edema fluid from the endotracheal tube. In proportion to the relative decline in mean pulmonary arterial pressure, nitroprusside therapy reduced the volume of edema to 72 milliliters (p less than 0.05) and ketanserin to 52 milliliters (p less than 0.05). These results suggest that 5 hydroxytryptamine contributes to the pulmonary hypertension associated with acid injury and that the volume of edema formed may be directly related to the increase in the hydrostatic pressure.

Animals↗
PubMed1987

Gangrene of the lower limbs in diabetic patients: a malignant complication.

Diabetic foot lesions are a common medical problem with major socioeconomic impact. Gangrene is usually a late and sometimes fatal complication. A series of 118 diabetic patients who underwent amputation of the lower limb at our institution over a 10 year period has been presented. Forty-two patients underwent amputation of the toes or part of the foot, 48 underwent below-knee amputation, and 18 underwent above-knee amputation. In 24 (20.3 percent), the necrotic process advanced postoperatively and necessitated additional amputation. The average hospital stay was 33.6 days. Twenty-eight patients (23.7 percent) died during the postoperative period, and the main cause of death was sepsis. Patients who presented with extensive gangrene had a higher mortality rate. There was no correlation between mortality and the duration of conservative treatment, number of repeated operations, the treatment of diabetes before hospitalization, onset of symptoms, or status of the peripheral pulses. The solution to the problem is early and vigorous preventive treatment. This could be accomplished through highly specialized clinics within the community.

Aged↗
PubMed1987

Training aids for instruction in the initial management of injury casualties and in resuscitation procedures.

Practical experience in the initial treatment of injured patients is not easily available to the medical student. The small number of injured patients available for observation in a short time, the fact that the patients do not necessarily arrive in regular teaching hours, and the large number of students present in teaching groups compound this difficulty. Specialized instruction in these subjects is therefore important. The acquisition and use of teaching aids facilitate precise and efficient presentation of the material. We present teaching aids specifically prepared for instruction in the initial management of the injured and in resuscitation procedures. These aids include a library of video recordings documenting important emergency procedures, a TV camera used for filming these procedures, a collection of slides on the subject of emergency medicine and recent injuries, mannequins for instruction in cardiopulmonary resuscitation (CPR), utilization of the hospital's animal research laboratory for instruction in critical procedures such as venous cutdown, chest drainage, etc., and simulated computer programs.

Animals↗
PubMed1987

Rectoscopic decompression of acute recto-sigmoid obstruction.

Effective non-operative decompression of a low obstruction of the colon can sometimes be accomplished by inserting a tube into the rectum and threading the tip up to a point proximal to the obstruction (1). Failure of this non-surgical decompression would require emergency surgery--either a diverting colostomy or a two-stage resection. A new non-surgical treatment performed on a patient with an obstructive tumor of the recto-sigmoid is described. Decompression of the obstructed bowel was achieved with a rectal tube introduced over a flexible guide wire proximal to the obstruction with the aid of a rectoscope, following which a one-stage procedure--an anterior resection was performed in one patient, while the other was referred for oncological treatment.

Acute Disease↗
PubMed1987

Gastrointestinal anastomotic healing during treatment with perioperative 5-fluorouracil.

This clinical study examines the influence of perioperative administration of 5-fluorouracil (5-FU) on gastrointestinal anastomotic healing. Intravenous 5-FU, 10 mg/kg body weight, was started during surgery and continued for 9 days only when advanced cancer was detected. A total of 32 gastric and enteric anastomoses were performed. All 32 patients with anastomoses recovered without any clinical evidence of leakage. Side effects attributed to 5-FU appeared in five patients, usually in a mild form of diarrhea and vomiting. On the whole, the course of recovery of this group was no different than expected from patients with advanced malignancy undergoing extensive surgery. Based on this, it appears that 5-FU administration during and immediately after surgery has no deleterious effect on the gastrointestinal tract.

Aged↗
PubMed1987

Conventional fractionation radiotherapy combined with 5-fluorouracil for metastatic malignant melanoma.

Clinical and experimental data suggest a synergistic antitumoral effect with the combined treatment of radiotherapy and 5-fluorouracil (5-FU) serving as a radiosensitizer. This combined modality was studied in 30 malignant melanoma patients with advanced locoregional or isolated, bulky, soft-tissue or visceral metastases. All patients were symptomatic, pain being the chief complaint, followed by symptoms related to large tumors. Treatment was given on an ambulatory basis, twice weekly, and consisted of 5-FU, 500 mg/m2 administered in 8-h i.v. drip infusion, followed by radiotherapy 8 h after completion of the 5-FU administration. 60Co teleunit, delivering 400 rad per dose per fraction, was given over 6 1/2 weeks to a total of 5,200 rad. The overall response rate was 70% (21 of 30 patients). Three patients (10%) achieved a complete response lasting from 3 to 11 months, and 18 (60%) achieved a partial response lasting from 3 to 13 months. The response rate was 82% for skin, 75% for lymph node, and 43% for visceral metastases. Symptomatic relief was obtained in 83% (25 of 30) of the patients. This palliative therapy was well-tolerated, and patients were able to maintain their routine lifestyles throughout. Only in one patient was 5-FU abandoned after 3 weeks, due to cardiac ischemia. Similar response rates have only been achieved with radiotherapy alone employing individual fractions of 600 rad or higher. Since the 5-FU we added is known to have a very limited effect on malignant melanoma, this study suggests its potential as a radiosensitizer in malignant melanoma.

Abdominal Neoplasms↗
PubMed1987

Effect of OKY 046, a thromboxane synthase inhibitor, on lung vascular permeability after pulmonary embolism in sheep.

OKY 046, a specific thromboxane synthase inhibitor, was used to investigate whether large pulmonary emboli, like microemboli, cause an increase in thromboxane A2 and an associated increase in vascular permeability in sheep. Nineteen sheep were anaesthetised and had cannulas inserted into the afferent lymphatic of the caudal mediastinal lymph node and pulmonary and carotid arteries. Several days later the animals were pretreated with placebo or OKY 046 0.4 mg/kg one hour before being given clotted blood 0.5 g/kg intravenously. After embolisation in the control animals mean pulmonary artery pressure (MPAP) rose from 12 to 34 mm Hg and pulmonary artery wedge pressure (PAWP) fell from 4.4 to 1.5 mm Hg; the cardiac index did not change but the physiological shunt (QS/QT) rose from 17% to 50%. One hour after embolisation the platelet count fell from 76 to 32 x 10(6)/l whereas at 15 minutes thromboxane B2 rose from 116 to 560 pg/ml in plasma and from 324 to 795 pg/ml in lymph (p less than 0.05). By 2 hours the concentration of thromboxane B2 was higher in lymph than in plasma. Lymph flow rose from 8.7 to a maximum of 27.3 ml/h at 15 minutes but despite the increase in flow the lymph:plasma (L:P) protein ratio did not fall, indicating an increased permeability of the blood vessels to protein. Pretreatment with OKY 046 inhibited the rise in plasma and lymph thromboxane B2, and limited the rise of QS/QT. The changes in MPAP, PAWP, cardiac index, platelet count, lymph flow, and L:P protein ratio, however, were no different from those in untreated sheep. These results indicate that a large pulmonary embolus leads to an increase in plasma and lung lymph thromboxane A2, which moderates the rise in QS/QT in part but not the increase in vascular permeability.

Acrylates↗
PubMed1986

The effects of perioperative fluorouracil administration on convalescence and wound healing.

Administration of chemotherapy is delayed by most clinicians until complete recovery from surgery because it is generally feared that cytotoxic drugs impair wound healing, reduce resistance against infection, and may hinder the recovery process. However, clinical experience is lacking. This clinical study examines the effect of perioperative administration of fluorouracil on the healing of wounds and intestinal anastomoses and the recovery process in general. Forty patients with advanced gastrointestinal tract cancers entered the study. Intravenous bolus administration of 0.5 g of fluorouracil was started during surgery. The patients underwent a variety of abdominal operations for palliation or cure. A total of 22 gastric and enteric anastomoses were performed. One half gram of fluorouracil diluted in 150 mL of 5% glucose solution was given intravenously over one hour daily for ten days postoperatively. The patients were carefully evaluated for any alteration in the postoperative recovery. Thirty-eight of the 40 patients received the full course of fluorouracil. Twenty-one patients had an uneventful postoperative course. Eighteen had mild to moderate respiratory and cardiovascular complications unrelated to fluorouracil administration. One patient died of pulmonary emboli 16 days after abdominoperineal resection. Surgical wounds healed without complications in 37 patients. One case of wound disruption occurred after sigmoidectomy. Two patients developed wound infections that healed secondarily. All 22 patients with anastomoses recovered without any evidence of leakage. Colostomies and gastrostomies functioned as anticipated. Side effects attributed to fluorouracil appeared in seven of the patients; in only two of the patients were complications life-threatening, involving bone marrow depression. All patients recovered after discontinuation of fluorouracil therapy and with supportive treatment. On the whole, the course of recovery of this group was no different than expected from patients with advanced malignant neoplasms who were undergoing extensive surgery. Based on this study, it seems that fluorouracil administration during and immediately after surgery has no deleterious effect on wound healing and recovery.

Abdominal Neoplasms↗
PubMed1986

"Spermatocele" following abdominoperineal resection and radiotherapy.

A 60-year-old man developed repeated spermatic fluid collection in the small pelvis following abdominoperineal resection and radiotherapy for carcinoma of the rectum. The "spermatocele" was due to a fistula originating in the vasoseminal vesicle junction. This complication has not been described previously.

Abdomen↗
PubMed1986

Cyclo-oxygenase products mediate hypoxic pulmonary hypertension.

High-risk infants with a fetal pattern of circulation demonstrate hyperactivity of the pulmonary vascular bed in response to stimuli including mucous plugging, atelectasis, and endotrachial tube suctioning. The resultant increase in pulmonary vascular resistance (PVR) leads to pulmonary hypertension, severe right-to-left shunting, and hypoxemia. Stimuli that trigger pulmonary hypertension cause hypoxia, suggesting the importance of hypoxic pulmonary vasoconstriction (HPV). Although many humoral mediators of HPV have been hypothesized, none have been proven. This study investigates the possible role of the cyclo-oxygenase derivatives thromboxane A2 and prostacyclin as determinants of hypoxic pulmonary hypertension. Open-chested lambs were ventilated with 13% O2 prior to and following treatment with OKY 046, a selective thromboxane inhibitor. In untreated lambs, the partial pressure of arterial oxygen fell from 80 +/- 27 (mean +/- SD) to 35 +/- 13 mm HG (P less than .01). The mean arterial pressure (MAP) remained at 50 +/- 7 mm HG, and the cardiac output (CO) was unchanged at 0.8 +/- 0.2 L/min. The mean pulmonary arterial pressure (MPAP) rose from 11 +/- 4 to 20 +/- 4 mm HG (P less than .01) whereas the PVR increased 70% (P less than .01). TxB2 rose from 147 +/- 85 to 271 +/- 154 pg/mL (P less than .05), and 6-keto-PGF1 alpha rose from 105 +/- 96 to 142 +/- 110 pg/mL. These substances are the hydrolysis products of TxA2 and prostacyclin respectively. In animals treated with OKY 046 prior to ventilation with 13% O2, values for MAP, CO, and PVR were similar to those of the nontreatment period.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Endoscopic decompression of acute colonic obstruction. Avoiding staged surgery.

Colostomy is the traditional treatment for acute obstruction of the sigmoid colon. This entails two or three surgical procedures in a high-risk group of patients. Presented is a nonsurgical approach used in three patients with acute colonic obstruction. Decompression of the bowel was achieved with a tube introduced proximal to the obstruction with the aid of a flexible sigmoidoscope. In a fourth patient, in whom the obstruction was next to the splenic flecture, the procedure failed. In all instances where decompression was successful, a one-stage procedure--primary resection and anastomosis--was performed.

Acute Disease↗
PubMed1986

Femoral vein occlusion following Mc-Vay repair.

Three cases of femoral vein occlusion following a Mc-Vay repair for femoral and inguinal hernias are presented. Phlebography demonstrated constriction of the femoral vein at the site of the repair. This complication is due to compression of the femoral vein by too tight a repair.

Aged↗
PubMed1986

Reduction of polymorphonuclear leukocyte accumulations by inhibition of cyclooxygenase and thromboxane syntase in the rabbit.

Thromboxane (Tx) inhibition prevents pulmonary leukostasis after acid aspiration. This observation prompted study of polymorphonuclear leukocyte (PMN) accumulations and products of cyclooxygenase. Experiments were conducted with a skin abrasion preparation. Five groups of six rabbits were pretreated intravenously with: (1) placebo, (2) ibuprofen, (3) imidazole and two other Tx syntase inhibitors, (4) OKY 1555, or (5) OKY 046. Zymosan-activated serum (ZAS) and leukotriene B4 were used as chemotaxins and balanced salt solution as control. After pretreatment with placebo, PMN accumulation in leukotriene B4 sites was 2130 +/- 874 PMN/mm3 (mean +/- SD). Pretreatment with ibuprofen, imidazole, or OKY 046 decreased (p less than 0.05) accumulations to 205 +/- 139 PMN/mm3, 485 +/- 387 PMN/mm3, and 504 +/- 260 PMN/mm3, respectively. In ZAS sites, placebo pretreatment led to 2006 +/- 866 PMN/mm3, while the ibuprofen, imidazole, and OKY 046 groups had decreased (p less than 0.05) responses of 295 +/- 218 PMN/mm3, 444 +/- 477 PMN/mm3, and 386 +/- 151 PMN/mm3, respectively. Pretreatment with OKY 1555 did not produce significant reductions in response. Six animals in each group received intradermal injections of the two chemotaxins or Hank's balanced salt solution. Reduction in PMN accumulations after cyclooxygenase and Tx inhibition were similar to those observed in the skin abrasion preparation. Pretreatment with either ibuprofen, imidazole, or OKY 046 resulted in a decreased concentration of Tx in abrasion fluid exudate in response to leukotriene B4, 275 +/- 164 pg/ml, 460 +/- 144 pg/ml, and 440 +/- 260 pg/ml, respectively, as compared with 1168 +/- 380 pg/ml in the placebo group. The reduced responses were not the result of a decrease in regional perfusion as measured by 133Xe washout. The in vitro chemotactic response of PMN to leukotriene B4 and ZAS was unchanged after incubation in either ibuprofen, imidazole, OKY 1555, or OKY 046. These data show that cyclooxygenase and Tx syntase are integrally associated with PMN accumulations.

Animals↗
PubMed1986

Nicotine stimulates pulmonary parenchymal thromboxane synthesis.

Smoking increases plasma levels of thromboxane (Tx) B2. Since intravenous nicotine is without effect on platelet TxB2 synthesis, it is likely that lung parenchyma is the site of metabolic importance. This study examines the TxB2 response and functional consequences to the lungs of intratracheal and intravenous instillations of nicotine tartrate. Rat lungs perfused with Krebs-Henseleit (K-H) solution without recirculation were used. After hemodynamic stabilization, the perfusate was either left unaltered or switched to 5 X 10(-4) M nicotine. After 20 minutes of K-H perfusion, effluent levels of TxB2 fell from 41 +/- 6 pg/ml (mean +/- standard error) to 16 +/- 5 pg/ml. A similar decline was noted with nicotine perfusion. K-H perfusion was used throughout the second set of experiments. The lungs were instilled with either saline solution (1 ml/kg body weight) or 5 X 10(-4) M nicotine in saline solution. In the nicotine group, TxB2 levels rose to 86 +/- 5 pg/ml versus 22 +/- 3 pg/ml in saline-instilled controls (p less than 0.05). In addition, pulmonary edema developed in nicotine-instilled lungs. Pretreatment with the Tx synthase inhibitor OKY-046 prevented the rise in TxB2 concentration after nicotine instillation and led to a wet weight/dry weight ratio of 4.0 +/- 0.4 versus 7.5 +/- 1.5 in untreated control lungs (p less than 0.05). Pretreatment with the lipoxygenase inhibitor diethylcarbamazine increased TxB2 levels to 235 +/- 34 pg/ml (p less than 0.05). Diethylcarbamazine also lowered pulmonary artery pressure from 18 +/- 1 mm Hg to 6.1 +/- 0.7 mm Hg in control lungs (p less than 0.05) but did not reduce edema formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗