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Biomedical subjects

W Wall

Publications and source records attributed to W Wall.

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

Intensive care course following liver transplantation in children.

We report the postoperative intensive care course of 16 children who underwent 18 orthotopic liver transplantation (OLT) procedures in London, Ontario and compare this experience in our developing transplant center with that reported from the Children's Hospital of Pittsburgh. Assisted ventilation was required in all children, with six requiring ventilation for greater than three days. Six children required positive end expiratory pressure (PEEP) therapy and hypertension was common. Physiologic stability index score was initially high in all patients, but fell on subsequent days. Intensive care survival was 100% with 69% long-term survival, which compared favorably with the information from Pittsburgh. Septic complications, despite immunosuppressive therapy were rare, but hypocalcemia and hypomagnesemia were common.

Adolescent↗
PubMed1987

Orthotopic liver transplantation in children.

Ten children, aged 3 to 16 years, were part of a group of 61 patients who received liver transplants at University Hospital in London, Canada between November 1982 and April 1986. All of the children received cyclosporine in combination with other agents for immunosuppression. Two children died of rejection, one child died from a lymphoma, and one child died from a hypoxic brain injury sustained during a respiratory arrest. Six children are currently alive from 4 months to 2 1/2 years following transplantation. All of the survivors have returned to a normal life style. With current surgical techniques and modern immunosuppression, hepatic transplantation has become the treatment of choice for patients with endstage irreversible liver disease. The extreme shortage of donor organs is now the major factor limiting the application of liver transplantation in children.

Adolescent↗
PubMed1986

Experience of a Canadian multi-organ transplant service.

Organ transplantation has become the treatment of choice for selected patients with end-stage failure of the heart, liver or kidneys. The expanding role for organ transplantation, however, has led to a corresponding increase in the complexity of patient management. In response to these changes, University Hospital, London, Ont., has established an interdisciplinary multi-organ transplant service (MOTS). MOTS coordinates donor organ procurement and patient management. Donor organs have been retrieved from as far south as Dalton, Georgia, as far west as Calgary and as far east as Halifax. As of Dec. 31, 1985, 485 transplants had been performed, including 387 kidney transplants, 51 heart transplants, 3 heart/lung transplants, 43 liver transplants (in adults and children) and 1 pancreas transplant. With current immunosuppressive protocols MOTS projects 1-year patient survival rates of 95% after kidney transplantation, 88% after heart transplantation and 81% after liver transplantation. Patient rehabilitation has been excellent.

Adult↗
PubMed1986

The detection of autoantibodies on HEp-2 cells using an indirect immunoperoxidase kit (Colorzyme).

An indirect immunoenzyme (IIE) kit to detect autoantibodies in the sera of patients with systemic rheumatic diseases has been evaluated and compared to a conventional indirect immunofluorescence (IIF) assay. Both IIF and IIE were performed on a human epithelial cell line (HEp-2) using sera categorized on the basis of their autoantibody specificity. The correlation coefficient between the two assays was greater than 0.77 for all autoantibodies except antimitochondrial antibodies, which had higher end-point titers with the IIE kit. The inter- and intratest variability of IIE and IIF was comparable, differing by no more than one tube dilution. The IIE test had less background staining, allowing for better resolution and easier interpretation of staining patterns. IIE assay in the form of a commercially available kit is a reliable alternative to IIF.

Autoantibodies↗
PubMed1983

Cyclosporine: action, pharmacokinetics, and effect in the BB rat model.

Cyclosporine (Cy) was given to BB rats in an attempt to prevent the onset of diabetes. A dose of 15 to 20 mg/kg/d given orally or subcutaneously was associated with high Cy trough serum levels and caused nephrotoxicity and severe weight loss. Ten mg/kg/d of Cy was tolerated well. Forty rats were treated with Cy starting at 34 days of age. No Cy-treated rats developed diabetes by day 121, compared with 70% of the control rats. Once Cy was discontinued on day 121, 38% of female and 13% of male rats developed diabetes by day 169. Transient, spontaneously remitting hyperglycemia developed in nine rats. This occurred both in control rats and in rats on Cy, but it was more common in females than in males. Thus, Cy prevents diabetes mellitus in the BB rat when trough Cy serum levels greater than 100 ng/mL are achieved. Diabetes occurs in some rats after Cy is discontinued. In all treatment subgroups, diabetes occurred more frequently in females than in males.

Animals↗
PubMed1978

Intraoperative autotransfusion in elective and emergency vascular surgery.

Intraoperative autotransfusion was studied in 62 patients undergoing elective or emergency thoracic or abdominal vascular surgery systemic heparinization. The results in 58 patients who received a mean autotransfusion volume of 1.8 liters were compared with a group of four patients in whom 9 liters of blood was autotransfused. The quality of the autotransfused blood also was studied and was shown to have a normal platelet count (mean, 144,000/cu mm) and normal fibrinogen value (mean, 212 mg%). No significant differences in the hematological or coagulation parameters measured were detected in the groups given moderate or massive autotransfusion. The mean homologous blood requirement during the hospital admission in the "moderate" group was 300 ml and in the "massive" group 1,000 ml. With careful technique excessive hemolysis or pulmonary microaggregate embolism does not occur; 75% of patients required no homologous blood throughout their hospital admission. No complications which would be attributed to autotransfusion were seen in either group. It is concluded that intraoperative autotransfusion is safe and effective and deserves wider application.

Abdomen↗
PubMed1976

Delayed primary closure of the skin and subcutaneous tissue in abdominal surgery.

Infection-prone abdominal incisions in 143 patients were managed by delayed primary closure of the skin and subcutaneous tissue of the abdominal wall. The overall wound infection rate was 1.4% and the rate for 74 open, large bowel operations was 2.7%. These rates compare favourably with a rate of 3.1% for clean inguinal hernia repairs done by the same surgical team over the same period. Delayed primary closure, carried out on the ward 3 days after operation, was simple, easy and did not prolong hospital stay. Its use is recommended in closing all abdominal wounds associated with a special risk of infection.

Abdomen↗
PubMed1976

Intraoperative autotransfusion in major elective vascular operations: a clinical assessment.

Six patients undergoing major elective vascular operations received an average of 1,700 ml. of intraoperative autotransfusion of shed blood. The patients were anticoagulated systemically during operation. The mean platelet count (156,000 per cubic millimeter and fibrinogen value (257 mg. per 100 ml.) were normal in autotransfused blood and the mean hemoglobin level was slightly below normal (11.5 Gm. per 100 ml.). Plasma hemoglobin values were variable. No patient suffered any complication that could be attributed to autotransfusion. Donor blood transfusion was avoided in five of the six patients by salvage and reinfusion of shed blood. No evidence of coagulopathy was found in any patient as measured by platelet count, fibrinogen level, prothrombin time, partial thromboplastin time, euglobulin clot lysis, and fibrin degradation products. The technique of intraoperative autotransfusion is described in detail.

Blood Coagulation↗
PubMed1975

Bloodless open heart surgery with atraumatic extracorporeal circulation.

With careful refinements in the pump oxygenator and a nonblood prime, bloodless open heart surgery may be performed almost routinely. In our series these measures reduced blood trauma, with a remarkable preservation of blood elements, especially platelets, and a corresponding elimination of postoperative bleeding. The mean hematocrit value decreased from 38 to 27% and recovered to 33% in the first 3 hours of postoperative diuresis. Mannitol and furosemide were rarely needed. Of 61 adult patients whp underwent open heart surgery for aortocoronary bypass or valve replacement, the last 43 had a bloodless procedure. Of the 43, 26 (60%) required no bank blood postoperatively (in the operating room or the intensive care unit). In these 26 the operative mortality was 4% (1 patient). Bloodless techniques are invaluable during periods of bank blood shortage. They avoid the dangers of hepatitis and transfusion reaction, and they may minimize the incidence of postperfusion lung syndrome as well as renal complications.

Blood Cell Count↗
PubMed1975

Changes in serum phosphate levels associated with intestinal infarction and necrosis.

Masive intestinal necrosis due to any cause is associated with a chemical complex that may be helpful in the early diagnosis of these conditions. This consists of elevated serum phosphate level, metabolic acidosis with significant base deficit, elevated white blood count, and elevated hemoglobin and hematocrit values. This chemical complex associated with clinical signs and symptoms, may indicate the need for laparotomy. In this way, the time period between vascular occlusion and operation could be shortened and possible lead to more gratifying results than the present day extremely high morbidity and mortality rates which are associated with massive intestinal necrosis.

Acid-Base Imbalance↗