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Biomedical subjects

W Gill

Publications and source records attributed to W Gill.

At least 19 recordsLinked to original sources
PubMed1978

Steroid hypothermia.

A retrospective study of 17 episodes of septic shock was made. In most patients, intravenous treatment involving a 2 gram bolus of Solu-Medrol produced a precipitous fall in temperature within four hours. Accompanying the temperature change was an improvement in their general physical condition. The hypothermic effect usually lasted approximately 30 hours, after which the temperature would reach a level below the presteroid temperature or would return to the presteroid level. If the sepsis was overwhelming and the patient did not survive, thetemperature response was not as dramatic and lasted approximately eight to ten hours, with no clinical improvement.

Fever↗
PubMed1977

Urinary cyclic AMP and post-traumatic acute renal failure.

Consecutive daily urinary excretion of cyclic AMP has been investigated in 16 patients with severe trauma or illness, five of whom developed acute renal failure (ARF). Fluctuations in the nucleotide excretion exceeded the range found in 20 healthy volunteers (1.26-14.74, mean 7.13+/-1.18 vs. 2.04-10.10, mean 5.07+/-2.21 micronmol/24 h). This resulted in a 41% increase of cAMP excretion in the group with normal renal function (P less than 0.003) with the highest individual increase of 87%. The excretion usually reached its peak by 24 h after trauma and its lowest value by the third day, (first day vs. third day; 7.82+/-4.23 vs. 3.96+/-2.58 micronmol/24 h, P less than 0.05 for a group of 11 patients), while creatinine clearance remained normal. In four patients with severe ARF, the mean urine volume was above control value but the cAMP excretion was reduced to 3.9 to 14.4% and in one patient with a mild ARF to 60.6%. Creatinine excretion of the group was less reduced than that of cAMP (41.2% vs. 19.6%, resp.). cAMP excretion declined proportionally with diminishing creatinine clearance. In the category of 33-65 ml/min it decreased by 33.4% to 3.39 micronmol+/-1.16 micronmol/24 h. cAMP/creatinine ratio proved to be a less sensitive indicator than cAMP/24 h. Daily output of cAMP and creatinine correlated highly with diuresis in ARF patients, controls (always P less than 0.001) and less in patients with normal renal function (P less than 0.02). Urinary cAMP appears to be a very sensitive and early indicator of the onset of ARF and subsequent recovery. This warrants its further study.

Acute Kidney Injury↗
PubMed1977

Trauma.

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Abdominal Injuries↗
PubMed1976

The effect of severe trauma on urinary cyclic AMP in children of different ages.

Under routine clinical conditions the urinary excretion of cyclic AMP was studied in 97 healthy children (3 months to 16 years old) and 65 child victims of various forms of trauma and proved to be age-dependent. The mean admission cAMP urinry levels for children of all ages were increased by 44.8% and were time dependent. In 26 injured children (3 months to 9.5 years old) the excretion increased to 12.10 +/-1.29 mumol cAMP/g creatinine as compared to 8.06 +/- 2.25 mumol cAMP/g crEAtinine (50.0%; P less than 0.01) and in 38 children (9.5-16 years) it rose to 6.43 +/- 4.12 from 4.72 mumol +/- 1.10 (36.2%; P less than 0.001). In 23 victims admitted within the first two hours after trauma the cAMP levels were elevated by 31.25% in contrast to 49.2% elevation in those admitted from 2 to 24 h after trauma. In a five-day follow-up of a group of 15 surviving patients the highest excretion of cAMP was found on the first day. It was followed by a steep decline until the values plateaued on the third day at values slightly elevated above control. Compared with the fifth day, the first day excretion expressed as mumol cAMP/24 h was enhanced by 92.3% (P less than 0.01) and as a ratio to creatinine (muol/g creatine) by 52.24% (P less than 0.05. In comparison with injured adults studied previously under analogical conditions, the cAMP excretory response to trauma in children differs in higher intensity (P less than 0.01) and in the nature of the daily pattern starting with the third day. It is pointed out that the intensity of the cAMP response to pathological stimuli may be age-dependent also in other clinical conditions.

Adolescent↗
PubMed1976

Post-traumatic hepatic dysfunction as a major etiology in post-traumatic jaundice.

Thirty-eight patients who had sustained acute trauma, profound hemorrhagic shock, and massive transfusion were studied prospectively to determine the predominant etiologic factors in the development of post-traumatic jaundice. An analysis of clinical and biochemical factors occurring in association with each bilirubin peak in the postoperative course found the jaundice related to transfusion and surgery in 11 instances, to sepsis and septicemia in 15 instances, and to hepatic dysfunction in 23 instances. Results indicated that admission estimates of SGOT and LDH levels, the height of the bilirubin peak and the postoperative day on which it occurs, and the white cell count and GGT at the time of the peak may be of use in the differential diagnosis. Four case reports were used to emphasize the fluctuating pattern of jaundice and the different etiologic factors that may predominate. Light and electron microscopy from three patients illustrated the structural alterations that accompany the biochemical impairment of liver function and enable a more precise appreciation of this syndrome. Hepatic dysfunction appears to be implicated in a high proportion of patients who develop post-traumatic jaundice, which frequently occurs as part of a spectrum of multiple organ failure.

Adolescent↗
PubMed1976

Marlex mesh in gas gangrene.

Clostridial gas gangrene is a well recognized complication of traumatic and surgical wounds, and is associated with an overall mortality rate of 25% (5, 22). Gas gangrene of a limb results in a mortality rate approximately half that of gas gangrene of the trunk (4, 7, 8, 9, 11, 12, 13, 15, 16, 19, 24). Radical debridement and antibiotic therapy or high amputation of involved limbs are accepted traditional approaches to the problem. The role and value of hyperbaric oxygenation (OHP) remains controversial despite intense study over the past few decades. Patients with gas gangrene involving all layers of the abdominal wall as well as an extremity pose major resuscitative, operative, supportive, and rehabilitative problems. A report is presented of two such patients with comments on the therapeutic modalities employed.

Abdominal Injuries↗
PubMed1976

Fluid therapy in the critically injured patient.

Sufficient clotting factors to ensure coagulation and replacement of lost volume and oxygen-carrying capacity are necessary to obviate many of the complications that may occur when massive transfusions are used in patients with multiple injuries. A regimen that has been successful includes immediate infusion of plasma protein fraction, packed red cells, fresh-frozen plasma, and nonspecific platelets.

Blood Coagulation Disorders↗
PubMed1976

A clinicopathologic study of hepatic dysfunction following shock.

Nineteen patients who had profound hypotensive shock were studied to correlate the light and electron microscopic appearances of the liver with the clinical and biochemical evidence of hepatic dysfunction. Despite the multiple etiologic factors that can result in jaundice in these patients, a fluctuating pattern occurs which enables the correlation of a bilirubin peak with the predominating etiologic factor. Immediately after shock, there was enzymatic and light and electron microscopic evidence of hepatocellular damage, resulting in a jaundice peak on the eighth to tenth day after the shock episode. This was followed by repair and regeneration of the liver as well as an increase in cholestatic enzyme levels. Later, bilirubin peaks occurred when hepatocellular function was further decreased or overloaded against this background of dysfunction related to the episode of shock. Recovery of hepatic function could continue or be delayed by intercurrent disease, particularly systemic infection. Support of hepatic function, similar to that available for pulmonary and renal failure may, in the future, be used to effect the prognosis of these patients.

Bilirubin↗
PubMed1976

Time related response of urinary cyclic adenosine monophosphate to trauma.

Urinary cyclic adenosine monophosphate levels were measured in 150 patients with accidental injury of varying causes. Thirty-eight healthy adults of both sexes serving as controls excreted 2.21 to 6.85 micromoles of cyclic adenosine monomphosphate per gram of creatinine, mean 4.34 +/- 1.25. In 120 patients with trauma on admission, the excretion was increased by 15.7 per cent, p less than 0.05, and the changes showed a time related pattern. In patients admitted within the first 30, 60 and 120 minutes after trauma, the mean excretion was changed by 19, 10 and minus 2.8 per cent, respectively, and in those admitted between two and 24 hours by 30 per cent. Twelve patients with differing types of trauma showed a mean 24 hour excretion reaching its peak on the first day, 44 per cent, and declining to its nadir of 2.25 micromoles per gram of creatinine on the third day, minus 47 per cent, p less than 0.01. A second rise reached its peak on the fifth day, p less than 0.05. Thereafter, the excretion fluctuated widely with peaks significantly above and below the control range, and we were unable to correlate these changes with any specific factors. In post-traumatic acute renal failure, the nucleotide excretion fell within several hours and usually reached low values, that is, below 0.25 micromoles per 1,000 milliliters per 24 hours within one to three days. In general, the excretory pattern for cyclic adenosine monophosphate followed that of creatinine clearance, but in the diuretic phase of the recovering kidney, the cyclic adenosine monophosphate levels remained more depressed than those of creatinine. The high sensitivity of urinary cyclic adenosine monophosphate to abnormalities in renal function suggests its potential as a clinical indicator.

Acute Kidney Injury↗
PubMed1976

Zinc and wound healing.

A review of the literature on zinc and wound healing shows the many gaps of knowledge which still exist. This study of the histologic appearance of wound healing in rats fed various diets demonstrates the serum zinc levels achieved by such diets. No significant improvement was observed in the rate of healing for any one group, but a number of histologic differences were observed.

Animals↗
PubMed1975

Alcohol intoxication and serum osmolality.

The relation between serum osmolality and blood-alcohol was studied prospectively in 565 acute trauma patients. The two measurements were closely correlated. It is therefore possible to estimate the blood-alcohol from serum osmolality to assist in the clinical management of acutely injured patients.

Accidents↗
PubMed1975

Abdominal lavage in blunt trauma.

A technique for abdominal lavage is described and was used to evaluate the abdomen of 671 multiple trauma victims. In 44 per cent (299 cases) there was a bloodstained return and these were regarded as positive. Patients with a positive result underwent exploratory laparotomy which revealed that 89 per cent had significant intra-abdominal trauma requiring a surgical procedure, 8 per cent had trauma which did not require any active surgical correction and 3 per cent had no abdnormal findings. Of all the lavages performed, there were 0-11 per cent false positive and 0-03 per cent false negative results. The value of the test in the context of multiple trauma is emphasized.

Abdominal Injuries↗