PubMed Health⌕ Search

Biomedical subjects

A B Lumsden

Publications and source records attributed to A B Lumsden.

At least 19 recordsLinked to original sources
PubMed1992

The effect of liver denervation on hepatic hemodynamics during hypovolemic shock in swine.

This study tested the hypothesis that the denervated liver is more susceptible to hypovolemic shock than the normal liver. Fourteen swine, seven nondenervated and seven after liver denervation, were studied during hypovolemic shock to 50% of baseline blood pressure. Hepatic artery and portal vein flows were measured using transonic flow probes, and cardiac output and central venous pressure were measured using Swan-Ganz catheters. Hepatic artery flow fell equivalently in the two groups, from 132 +/- 71 to 94 +/- 17 ml/min in the nondenervated group compared with 149 +/- 56 to 91 +/- 55 ml/min in the denervated group. In contrast, portal flow in the denervated group (276 +/- 71 to 119 +/- 53 ml/min) fell significantly (p less than 0.001) more than in the nondenervated group (289 +/- 135 to 194 +/- 70 ml/min). The 58% reduction from baseline in portal flow in the denervated group compared with the 30% reduction in the nondenervated group suggests that the normal compensatory mechanism to maintain portal flow during hypovolemic shock is neurally mediated. It can be hypothesized that sensory afferent fibers might initiate a feedback to splanchnic vasodilatation in response to reduced portal flow. This study supports the hypothesis that the denervated liver is more susceptible to hypovolemic shock.

Animals↗
PubMed1992

Nonoperative management of visceral aneurysms and pseudoaneurysms.

During the period from 1975 to 1991, 41 patients with 60 visceral artery aneurysms were treated at the Affiliated Hospitals of Emory University. The total included 13 patients in whom 16 aneurysms were treated primarily by transarterial embolization. There were seven hepatic artery aneurysms, three splenic artery aneurysms, three gastroduodenal artery aneurysms, two left gastric artery aneurysms, and one right gastroepiploic artery aneurysm. Average age of these patients was 50 years; there were eight males and five females. Seven patients presented with gastrointestinal bleeding, and two patients presented with abdominal pain. In four patients, the aneurysm was an incidental finding. Etiology of the true or false aneurysms consisted of pancreatitis in two patients, trauma in three patients, connective tissue disease in one, and was unknown in the remainder. Embolization was performed in seven cases with Gianturco coils and Gelfoam, with coils alone in four, with Gelfoam alone in four, and with detachable balloons in one instance. Complete occlusion was achieved initially in 13 cases. Recanalization occurred in two patients over a mean follow-up period of 8.6 months, requiring re-embolization in one patient, whereas the other patient was managed expectantly. In three cases, embolization was unsuccessful: two cases required surgical correction, and one case was managed expectantly. Only one complication was related to the embolization procedure, which was a common hepatic arterial dissection that proceeded to the formation of a false aneurysm. Embolization as the primary treatment modality for visceral artery aneurysms should be considered in patients with the following diagnoses: pseudoaneurysms associated with pancreatitis, intrahepatic aneurysms, most splenic artery aneurysms, and gastric, gastroduodenal, and gastroepiploic aneurysms. The procedure has a low risk and may obviate a difficult surgical procedure, but it does not preclude surgical intervention should the need arise.

Adolescent↗
PubMed1992

Acute mesenteric ischemia after cardiopulmonary bypass.

Acute mesenteric ischemia is an uncommon but catastrophic event after cardiopulmonary bypass. From 1980 to 1990, 16,951 cardiac procedures requiring cardiopulmonary bypass were performed at Emory University Hospital in Atlanta, Ga. Eighteen patients (0.1%) had acute mesenteric ischemia that resulted in intestinal infarction. Emergency cardiac surgery had been performed in 16 of the 18 patients, and all 18 patients were vasopressor dependent for hemodynamic support after surgery. Diagnostic difficulties resulted in the diagnosis of intestinal infarction an average of 9 1/2 days after cardiopulmonary bypass. Nonocclusive mesenteric arterial ischemia was the determined cause in all cases. Statistically significant risk factors associated with acute mesenteric ischemia after cardiopulmonary bypass surgery included (1) emergency cardiac surgery (p less than 0.0001), (2) the use of an intraaortic balloon pump (p less than 0.0001), (3) failed angioplasty requiring emergency surgery (p = 0.0074), (4) prolonged pump time (p = 0.0093), and (5) advanced age (p = 0.0016). A high index of suspicion for mesenteric ischemia after cardiopulmonary bypass in patients with identified risk factors may decrease the diagnostic delay and lead to an improvement in the 67% mortality rate seen in this series.

Age Factors↗
PubMed1992

Acute arterial thrombosis in the very young.

The case records of all infants under the age of 6 months who underwent surgery for acute arterial thrombosis between January 1980 and September 1991 were reviewed. Seven infants (nine ischemic limbs) were identified and ranged in age from 5 days to 5 1/2 months (mean 2.4 months); all weighed less than 5 kg (mean 3.9 kg). The cause in each case was iatrogenic. Diagnosis was based on the presence of a cool, mottled extremity associated with the absence of insonated peripheral arterial Doppler signals. Treatment included aortoiliac thrombectomy (n = 2), femoral artery thrombectomy with primary closure (n = 4), femoral artery thrombectomy with autogenous saphenous vein patch (n = 1), and axillary artery thrombectomy with end-to-end anastomosis (n = 1). Palpable pulses were restored in five (56%) of nine limbs and Doppler signals in the remaining limbs. There were no instances of limb loss. Excluding aortoiliac thrombectomy, palpable peripheral pulses were reestablished in only 40% of extremities. Thrombectomy is a safe and simple procedure in even the very youngest of patients with arterial insufficiency, but surgical optimism should be tempered by frequent inability to achieve full and durable success.

Acute Disease↗
PubMed1989

Endotoxemia during percutaneous manipulation of the obstructed biliary tree.

Fourteen patients undergoing percutaneous biliary manipulation were studied on 21 occasions. Using a chromogenic limulus-based assay technique, peripheral endotoxin concentration prior to the procedure was found to be 6.1 +/- 9 pg/ml, increasing to 30.7 +/- 26 pg/ml after the procedure (p less than 0.001). Fourteen of 21 bile cultures and only 1 of 21 blood cultures drawn during the procedure were positive for bacterial growth. There was a clinically modest but statistically significant decrease in blood pressure (p less than 0.05), an increase in temperature (p less than 0.01), and an increase in creatinine concentration (p less than 0.05) before and after biliary manipulation. The presence of infected bile and the preprocedure bilirubin level predicted development of endotoxemia.

Bacteria↗
PubMed1988

Transcranial stab wounds: a report of three cases and suggestions for management.

Transcranial stab wounds are uncommon. Three such cases are presented. The severity of the wounds may vary from innocuous to devastating. Skull films are useful in delineating the depth of penetration. The presence of the knife blade in situ may make the computed tomographic scan impossible to perform or difficult to interpret. Cerebral angiography may be indicated if injury to a major cerebral vessel is suspected or if the patient suffers a delayed subarachnoid or intracerebral hemorrhage. Provided that the patient's clinical status indicates a positive prognosis, transcranial stab wounds should be explored surgically. The weapon should be removed in the operating room immediately before or at the time of operation.

Adult↗
PubMed1988

Carcinosarcoma of the gallbladder: a case report and review of the literature.

A case of pedunculated carcinosarcoma of the gallbladder, presenting with common duct obstruction is reported; radiological, operative and pathological findings are described. The patient was treated with cholecystectomy, common bile duct exploration and postoperative radiotherapy applied through a t-tube. Only 20 cases of carcinosarcoma of the gallbladder have been described. The current state of knowledge regarding the natural history of these tumors are reviewed.

Aged↗
PubMed1987

Primary lymphoma of the breast.

Fifteen patients with primary lymphoma of breast are reported from a 30-year review. Eight of the patients were diagnosed in the last 5 years of this review, suggesting either an increase in the incidence or an increasing awareness of this condition. The age range was from 17 to 77 years. All patients presented with a breast mass and nine had histologically proven axillary node involvement. One patient had Hodgkin's disease and the remainder were non-Hodgkin's lymphoma. Treatment was by a combination of surgery, radiotherapy and chemotherapy. During follow-up which varied from 4 to 20 years (median 8 years) three patients developed metachronous involvement of the opposite breast and three died from their disease. Prognosis was related to tumour histology and stage of disease. The three who died all had high grade centroblastic lymphoma, the three largest tumours and nodal involvement. Five and ten-year survivals were 85 per cent and 73 per cent respectively, better than the survival of patients for either other non-disseminated extranodal lymphomas or breast cancer.

Adolescent↗
PubMed1986

A classical osteogenic sarcoma of the breast: histology, immunohistochemistry and ultrastructure.

A classical osteogenic sarcoma of the breast is described and the results of light microscopy, including immunohistochemistry for epithelial and mesenchymal markers, and of electron microscopy are presented. No epithelial features were detected by any of the methods used, the tumour being considered a true osteogenic sarcoma. The tumour appears to have arisen de novo, and not from a pre-existing fibroadenoma.

Antibodies↗
PubMed1985

Are the lesions of duct ectasia sterile?

A prospective study was established to determine whether, using suitable transport media, bacteria could be isolated from the lesions of mammary duct ectasia. The results indicate that both aerobic and anaerobic organisms are present in a high proportion of patients with nipple discharge associated with this condition and in all patients who develop peri-areolar sepsis (abscess and mammillary fistulae) as part of the syndrome. The lesions of duct ectasia are therefore not sterile and the possibility exists that bacteria have a role in the aetiology and pathogenesis of this condition.

Abscess↗
PubMed1985

Free perforation in Crohn's colitis. A ten-year review.

A review of 198 patients with Crohn's disease of the colon who presented over a ten-year period identified six patients with free perforation of the colon (3 percent). Five were females and all were known to have pre-existing Crohn's disease. Four were taking oral corticosteroids at the time of perforation. The sole male presented with acute toxic dilatation of the colon and had not received previous steroids. Pneumoperitoneum was seen in five of the six patients. Subtotal colectomy with ileostomy appears to be the optimum treatment in patients presenting with this complication of Crohn's disease.

Adult↗
PubMed1985

The relationship of cyst type to risk factors for breast cancer and the subsequent development of breast cancer in patients with breast cystic disease.

The frequency of epithelial hyperplasia and papillary apocrine change in patients with palpable breast cysts lined by either apocrine or flattened epithelium has been compared. Hyperplasia of any degree, severe hyperplasia with or without atypia and papillary apocrine change were all seen significantly more frequently in patients with clinically palpable apocrine cysts. Twelve patients were identified with breast cancer with a history of cyst aspiration, in whom all cysts aspirated could be classified as apocrine or flattened on the basis of cytology or electrolyte composition of cyst fluid. Eleven patients had single or multiple apocrine cysts and one had a single flattened cyst. This represents a significantly increased preponderance of apocrine cysts as compared with that normally seen in patients with cystic disease. The mastectomy specimens of those 11 patients with a history of apocrine cyst aspiration more frequently contained hyperplastic changes and non-invasive carcinoma than age- and menopausal-matched controls who did not have a history of cystic disease. This study suggests that patients who develop cysts lined by apocrine epithelium may be at a greater risk of subsequent breast cancer than those with flattened epithelial cysts.

Breast↗
PubMed1985

Osteogenic sarcoma--a rare primary tumour of the breast.

A case of primary osteogenic sarcoma of the breast is reported and the histological and mammographic features demonstrated. A role for technetium 99 diphosphonate bone scanning in the diagnosis of this condition and measurement of serum alkaline phosphatase activity for monitoring progress of the disease is suggested.

Alkaline Phosphatase↗