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Biomedical subjects

W W Turner

Publications and source records attributed to W W Turner.

At least 37 records · Page 2Linked to original sources
PubMed1987

Successful use of the Denver peritoneovenous shunt in patients with nephrogenic ascites.

Tense ascites in patients who require hemodialysis for renal failure (nephrogenic ascites) is a rare but ominous complication. Its appearance is often followed by a rapid physical deterioration. Nonsurgical attempts to control the ascites are often unsuccessful. Four patients with refractory ascites were treated with Denver peritoneovenous shunts (DPVS). These patients suffered from ventilatory failure, anorexia with malnutrition, and hypotension during hemodialysis. Patients were followed for as long as 18 months after DPVS, and all experienced clinical resolution of the ascites. Ventilatory failure, malnutrition, and hypotension either improved or resolved after shunting. Shunt-related morbidity occurred in all patients and consisted of mechanical complications in four patients and bacteremia in one patient. These problems were resolved by either revision or removal of the DPVS. No deaths were directly related to shunting. Peritoneovenous shunting successfully treats nephrogenic ascites and reverses the morbid sequelae usually associated with this syndrome.

Adult↗
PubMed1986

Does nasoenteral feeding afford adequate gastroduodenal stress prophylaxis?

Serial pH measurements were performed on 366 gastric aspirates from 20 critically ill patients receiving nasoenteral feeding with Osmolite or Isocal HCN, with no other means of gastric acid buffering. Ten patients (group A) received continuous intraduodenal feeding, and ten patients (group B) received continuous intragastric feeding. Gastric pH was at least 5.0 in 33 (23%) aspirates from group A, compared to 120 (54%) from group B (p less than .001). Only two (20%) group A patients had gastric pH values of 5.0 or greater for at least half of the measurements, compared to six (60%) group B patients. These data indicate that continuous intragastric feeding with Osmolite or Isocal HCN controlled gastric pH better than did intraduodenal feeding. However, neither technique adequately neutralized gastric acidity in these critically ill patients.

Adolescent↗
PubMed1986

Evaluation of energy expenditures in burn patients.

Energy expenditures were estimated using the Curreri equation (CEE), the Harris-Benedict equations (HBEE), and a modification of the Harris-Benedict equations (MHBEE) and then were measured by indirect calorimetry (MEE) in 17 adult patients with burns covering 26% to 79% of their body surface areas. The mean CEE (3,831 kcal/day) was significantly greater, and the mean HBEE (1,813 kcal/day) was significantly less than the mean MEE (2,500 kcal/day). The mean MHBEE (2,720 kcal/day) and the mean MEE were not significantly different.

Adult↗
PubMed1985

Predicting energy expenditures in burned patients.

Daily caloric requirements in patients with major burns are frequently estimated using the Curreri formula (25 X body weight (kg) + 40 X % BSA burned). In nonburned patients modifications of the Harris-Benedict formulas have been used to estimate energy requirements. These equations have not been validated against measured energy expenditures in burned patients. Thirty-five patients with second- and third-degree burns covering from 10 to 75% of the body surface area underwent assessments of energy expenditures by indirect calorimetry and by the Curreri and Harris-Benedict formulas. The mean energy expenditure calculated from the Harris-Benedict formulas (BEE) underestimated the mean measured energy expenditure (MEE) by 23% (p less than 0.001), while the mean energy expenditure calculated from the Curreri formula (CEE) overestimated the mean MEE by 58% (p less than 0.001). There were significant correlations between the MEE, BEE, and CEE. In patients with burns greater than 20% of the body surface area, the correlation between MEE and BEE was higher than that found with the Curreri formula.

Adolescent↗
PubMed1985

Nutritional considerations in the patient with disabling brain disease.

Increased nutritional requirements are now recognized as the typical sequellae of head injury. Whether similar nutritional demands routinely accompany nontraumatic, disabling brain diseases is uncertain. Experience with patients suffering from head injury indicates that clinical criteria for differentiating the severity of neurological impairments categorize rather poorly the levels of nutritional need. Based on available data, "nutritional risk" can only be assigned to broad patient categories. Head-injured patients seem to be at nutritional risk and, by virtue of increased caloric and protein requirements, may benefit, in terms of reduced mortality, from early, intensive nutritional intervention. Because the nutritional risk cannot be established, the indications for aggressive nutritional support in the noninjured patient are even less clear than those for the trauma patient. Parenteral nutrition is often required to meet the goals of nutritional support because inadequacies in gastrointestinal function frequently mitigate successful enteral nutrition. Selective nutritional therapies involving the branched chain amino acids may reduce the attrition of the body cell mass seen in head injury patients. Furthermore, improvements in energy nutrient utilization in other than head-injured patients have been suggested when fat is provided in addition to glucose as a caloric source. When clinically feasible, enteral nutrition offers significant economic and physiological benefits over parenteral nutrition. In this regard, increasing attention has been focused on newer techniques of enteral access. These include percutaneous gastrostomies and nasally inserted small bore feeding tubes. The latter achieve duodenal intubation with a high success rate, and they offer the prospects of improved feeding tolerance and reduced tracheobronchial aspiration by allowing the administration of nutrients distal to the pylorus.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1983

Mortality and renal salvage after renovascular trauma. A review of 94 patients treated in a 20 year period.

Ninety-four patients with 96 renovascular injuries underwent operations over a 20 year period. Forty-nine patients had renal artery injury, 45 had isolated venous injury, and 33 had both vessels injured. Arterial revascularization succeeded in four patients, failed in five, and the results were not documented in three. Revascularization of acute renal artery thromboses was unsuccessful. Isolated renal vein injuries were repaired in 28 patients. The mortality rate was 37 percent for renal artery injuries and 28 percent for isolated renal vein injuries, despite the frequent choice of nephrectomy instead of reconstruction in unstable patients. Renal salvage was accomplished in 10 percent of patients with renal artery injury and in 51 percent of patients with isolated renal vein injury. Renal salvage is not often feasible in patients with renal arterial injuries because of associated renal vein injuries. The success of revascularization of traumatically occluded renal arteries is low and should probably be attempted only in unusual circumstances, such as bilateral injuries. Most isolated renal vein injuries are repairable, and reconstruction should be attempted in stable patients.

Adolescent↗
PubMed1983

Topical corn oil in the management of essential fatty acid deficiency.

Conflicting anecdotal reports about the efficacy of topical linoleate in managing essential fatty acid deficiency prompted this prospective study of 10 critically ill surgical patients receiving continuous total parenteral nutrition (TPN). Ten ml of corn oil (4800 mg of linoleate) were massaged into the skin daily commencing after 7.7 +/- 3.8 (mean +/- SD) days of fat-free intake. Plasma samples were obtained weekly. Total lipids were extracted and methylated, and fatty acids were quantitated by gas-liquid chromatography. The triene:tetraene ratio (20:3 omega 9/20:4 omega 6) increased progressively in patients despite corn oil therapy. In 89% of patients the ratio exceeded 0.2, which is diagnostic of essential fatty acid deficiency (EFAD). Topical application of corn oil does not prevent or treat EFAD in patients on TPN.

Administration, Topical↗
PubMed1983

Chylous ascites: resolution after Denver peritoneovenous shunt.

Chylous ascites complicating a Warren shunt was successfully treated with a Denver peritoneovenous shunt. There was spontaneous closure of the chylous peritoneal fistula seven months after the Denver shunt was inserted. This approach obviates the nutritional and septic complications of repeated paracentesis in the management of patients with chylous ascites.

Chylous Ascites↗
PubMed1983

Recurrent oriental cholangiohepatitis.

The cases of two patients with recurrent oriental cholangiohepatitis are discussed. This syndrome, which has hitherto been rarely encountered in the Western hemisphere, may be seen with increasing frequency because of the influx of immigrants from southeast Asia. Patients typically present with symptoms of recurrent cholangitis. Findings at operation consist of primary bile duct stones associated with intrahepatic and extrahepatic ductal strictures. Surgical therapy is internal biliary bypass to prevent recurrent bile duct obstruction from stones. Even with such treatment, recurrence of cholangitis is common.

Adult↗
PubMed1981

Transhepatic embolization in patients with acute variceal hemorrhage.

Control of acute variceal bleeding by transhepatic embolization was investigated in 14 patients with alcoholic liver disease. In these patients hemorrhage was unresponsive to general supportive measures, intravenous vasopressin and balloon tamponade. Embolization was performed using Gelfoam and a synthetic polymer, bucrylate. Acute hemorrhage was arrested in 86 percent of patients. Rebleeding after transhepatic embolization occurred in 35 percent of patients. There were three deaths from intraabdominal hemorrhage related directly to transhepatic embolization (21 percent). Six patients (43 percent) left the hospital alive. In a group of cirrhotic patients in whom transhepatic embolization was employed after traditional modes of therapy had failed to control variceal hemorrhage, mortality and rebleeding rates were high.

Bucrylate↗
PubMed1981

Essential fatty acid deficiency in critically ill surgical patients.

Plasma fatty acid profiles of 33 critically ill surgical patients receiving fat-free parenteral nutrition were examined at weekly intervals up to 28 days. While plasma total fatty acid concentration remained relatively constant and within the normal range, marked compositional alterations were apparent. Levels of linoleate (18:2 omega 6), the major essential fatty acid in man, fell below normal values (754 +/- 259 micrograms/ml) in 67 percent of patients within 1 week after cessation of oral intake. Decreases in other omega 6 unsaturated fatty acids, derived from linoleate, were also apparent. In contrast, gradual increases were observed in levels of endogenously synthesized fatty acids, palmitate (16:0), palmitoleate (16:1) and oleate (18:1 omega 9). A fatty acid unique to essential fatty acid deficiency, 5,8,11 eicosatrienoate (20:3 omega 9), appeared in 25 percent of the patients during the first week and in all patients by the third week of study. Considering the rapid appearance and progression of these biochemical changes, early initiation of linoleate supplementation appears justified to forestall the development of related clinical sequelae.

Adolescent↗
PubMed1981

Parathyroid map.

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Humans↗