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Biomedical subjects

B Duarte

Publications and source records attributed to B Duarte.

31 records · Page 2Linked to original sources
PubMed1986

Clinical pharmacy on-call program in the emergency department.

This is a descriptive and evaluative report regarding a clinical pharmacy residency in-house on-call program that facilitates the provision of 24-hour clinical pharmacy consultative services within the emergency department. During the two-year evaluation period, clinical pharmacy residents completed 3.1 consultations per 14-hour call period. Additionally, greater than 90% of the clinical pharmacy recommendations were accepted and completely followed by physician cohorts. These consultations were usually solicited by internal medicine physicians within the emergency department, involved patient-specific drug therapy recommendations, and required about 100 minutes (mean per consultation) of the clinical pharmacist's time. Thus, clinical pharmacy consultative services can be a useful addition to health care within the emergency department in teaching hospitals.

Chicago↗
PubMed1986

The current status of recognition and treatment of severe necrotizing pancreatitis.

The diagnosis and treatment of severe necrotizing pancreatitis poses a major controversy in the realm of surgery of the upper gastrointestinal tract. Certainly all investigators are in agreement that the patient with severe necrotizing pancreatitis who responds promptly and effectively to intensive resuscitative efforts and general support measures should not be operated upon. The role of therapeutic percutaneous peritoneal lavage is not well delineated, but probably does not represent any risk to the patient, and should be attempted in patients in whom the response to nonsurgical measures is questionable or transient or in whom sepsis has not supervened. Operation must be undertaken in patients who do not respond to intensive resuscitative efforts, with or without peritoneal lavage, in the first 24 to 36 hours of management, or in whom the initial response is followed by deterioration of vital organ function, specifically pulmonary, renal, and hepatic function. The presence of gallstones associated with pancreatitis that does not respond to therapy promptly also makes early operation mandatory. Although the results in the alcoholic patient are not satisfactory, the results of early operation in nonalcoholic patients with severe necrotizing pancreatitis has been most gratifying, and has yielded far superior survival rates than the nonsurgical approach.

Acute Disease↗
PubMed1985

Angiotensin II restoration of reflex adrenal medullary secretion to anephric dogs is physiologically dose dependent.

Acute nephrectomy seriously impairs hypovolemic adrenal epinephrine (E) release in the anesthetized dog. That systemically delivered angiotensin II totally restores E release to acutely anephric dogs is equally clear, but the dose-response relationship of this angiotensin II effect is not known. Adrenal secretion rates and arterial plasma E, norepinephrine (NE), and dopamine levels were studied in nine groups of mongrel dogs (n = 5 in each group) under pentobarbital anesthesia: 1) resting animals; 2) hemorrhage (25 ml/kg); 3) hemorrhage after acute nephrectomy; 4-7) hemorrhage, acute nephrectomy, plus iv angiotensin II at a) 0.01 ng/kg X min, b) 0.10 ng/kg X min, c) 1.00 ng/kg X min, or d) 10.00 ng/kg X min; 8) no hemorrhage, acute nephrectomy, angiotensin II (10.00 ng/kg X min); and 9) hemorrhage, kidneys intact, iv angiotensin II (10.00 ng/kg X min). Arterial and adrenal blood were sampled during a baseline prehemorrhage period and 15, 30, 60, and 90 min after hemorrhage. We confirm blunting of reflex E release by acute nephrectomy in the anesthetized dog and show that angiotensin II restores E (P less than 0.01), NE (P less than 0.01), and dopamine (P less than 0.01) release in acutely anephric dogs. Aortic plasma E and NE were also restored to normal by angiotensin II (P less than 0.01 for each). Dogs with intact kidneys show a blunted hemorrhage response of arterial plasma E (P less than 0.01), NE (P less than 0.01), and DM (P less than 0.05) to our largest angiotensin II infusion rate (10 ng/kg X min). The study demonstrates that in acutely anephric conditions, angiotensin II support of reflex catecholamine release is sensitively dose dependent to physiological infusion rates of systemic angiotensin II and suggests further that this angiotensin II effect is restrained by the kidneys.

Adrenal Glands↗
PubMed1985

Parathyroid allotransplantation in the treatment of complicated idiopathic primary hypoparathyroidism.

Parathyroid allotransplantation was performed in a 25-year-old woman with idiopathic hypoparathyroidism that had been diagnosed at age 4 years. Long-term medical management of the primary condition with vitamin D and oral calcium supplementation was complicated by multiorgan calcinosis and renal failure. At the age of 21 years she received a successful cadaver renal allograft. Four years later she developed calcinosis cutis with widespread skin necrosis. Medical control of calcium and phosphate metabolism was unsatisfactory and the skin necrosis became progressive and life threatening. A parathyroid allograft that was performed with tissue from a parathyroid adenoma resulted in normalization of the serum calcium and phosphorus levels with arrest and subsequent healing of the skin necrosis. Later failure of the parathyroid allograft was followed by successful retransplantation of normal parathyroid tissue from a cadaver organ donor.

Adult↗
PubMed1984

Renal modulation of electrically stimulated adrenal medullary secretion.

In acutely anephric dogs, depressed reflex adrenal medullary secretion (AMS) may be related to low plasma angiotensin. Either local (adrenal medulla) or central nervous system mechanisms are responsible. Local influences of acute bilateral nephrectomy on AMS were evaluated after left splanchnic nerve section. Two groups of five healthy, fasted mongrel dogs (16-20 kg) were prepared (Na pentobarbital iv anesthesia, 98% O2/2% CO2, Harvard volume ventilator) at celiotomy with blood pressure and sampling catheters per femoral arteriotomies and left adrenal-femoral venous T-shaped Silastic shunt. Group 2 dogs had acute bilateral nephrectomy. The acutely divided distal left splanchnic nerve was arranged for electrical stimulation (Grass, bipolar nerve stimulator, 1 0 V, 1-msec delay, 10 Hz, 10-msec square wave). Heparin anticoagulation was maintained and arterial pH monitored. Simultaneous adrenal vein, aortic blood sampling, and adrenal blood flow (F) determinations followed 10-min periods of alternating electrical stimulation and nerve rest. AMS for epinephrine (E) and norepinephrine (NE) was calculated [E and NE plasma concentration (single isotope radioenzymatic technique) differences of adrenal vein minus aorta multiplied by F]. Results were grouped, analyzed for variance, and compared (Wilcoxon unpaired rank sum, Student's test, Fischer's tables, ANOVA). Low aortic E, NE concentrations confirmed absent systemic adrenergic stimulation. The AMS ratio of NE:E was low in the anephric group. At the first stimulation interval NE:E was 0.28 +/- 0.14 (1 SD) in renal intact dogs vs 0.11 +/- 0.04 in anephric dogs, P less than 0.05. At rest NE:E was 0.33 +/- 0.12 in group 1 vs 0.17 +/- 0.02 in group 2 dogs, P less than 0.02. Plasma NE was also low in the anephric group (289 mg/liter +/- 126 (1 SD) vs 612 +/- 189, P = 0.033, resting).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Medulla↗
PubMed1984

The role of imaging ultrasound during pancreatic surgery.

Real-time ultrasound imaging was employed at 122 operations for the complications of pancreatitis, adenocarcinoma, and islet cell tumors. Ultrasound was found to be useful in 69% of the operations for pancreatitis and 66% of the operations for tumor. Assistance was provided in diagnosis or definition of pathology. Help in diagnosis consisted in detecting conditions that were not found on preoperative testing or at exploration and excluding conditions that were suspected on the basis of previous diagnostic studies or findings at operation. Better definition of pathology was provided by precise localization of structures, assessment of their size and surrounding anatomy, and distinction of tissue features that helped to recognize their identity. Ultrasound was usually more helpful in defining pathology than in diagnosis. Ultrasound enabled early orientation to important landmarks, reduced the need for contrast x-ray studies, and yielded unique information about the etiology of abnormalities. Although ultrasound has a slow learning curve, we believe that its use during pancreatic operations can significantly aid the surgeon and we recommend its wider application in surgical practice.

Abscess↗
PubMed1983

Comparative accuracy of operative ultrasonography and cholangiography in detecting common duct calculi.

Operative ultrasonography and operative radiographic cholangiography were compared for diagnostic effectiveness with regard to their ability to screen the common bile duct for the presence of calculi. We performed real-time B-mode ultrasonography and cholangiography using two injections of contrast material. In 350 patients, 349 ultrasonic and 285 cholangiographic examinations were performed with technically satisfactory results. The sensitivity, specificity, efficiency, and predictability of a negative test were at a high and comparable level for the two diagnostic procedures. However, the predictability of a positive test for ultrasonography of 91.8% was significantly greater (P less than 0.02) than the predictability of 73.2% for cholangiography. Since predictability of a positive test is based on common duct exploration rather than presumptive evidence of a clinical course, this test may be more valid than the other measures to determine diagnostic effectiveness. The advantages of ultrasonography, which are superior accuracy, favorable image qualities, reduced invasiveness, increased safety, avoidance of contrast material, and lower cost, were contrasted with the problems of ultrasonography, which included a slow learning curve for performance and interpretation of the technique and the limited availability of dedicated ultrasound equipment for surgical operations. We concluded that the advantages outweighed the problems and that operative ultrasonography of the common duct warrants wider application in clinical surgery.

Cholangiography↗
PubMed1981

Primary hyperparathyroidism: four- to eight-year postoperative follow-up demonstrating persistent functional insignificance of microscopic parathyroid hyperplasia and decreased autonomy of parathyroid hormone release.

Thirty-nine patients with primary hyperparathyroidism were studied four to eight years after their initial operation. In six patients, both the pathologist and surgeon agreed on the diagnosis of solitary adenoma; in 16 patients, the surgeon diagnosed solitary adenoma and the pathologist parathyroid hyperplasia (microscopic hyperplasia). In 16 patients, primary chief cell hyperplasia was agreed upon by the pathologist and surgeon. In the 16 patients with microscopic hyperplasia, there have been no long-term recurrences of hypercalcemia, but, in two patients, plasma parathyroid hormone levels are high. Parathyroid hormone--total calcium regression curves demonstrate significant preoperative correlation in solitary adenoma, p less than 0.01, and primary chief cell hyperplasia, p less than 0.05. After operation, significant correlations were not found between parathyroid hormone and total calcium. T-testing slope differences of pre- and postoperative parathyroid hormone--total calcium regression curves demonstrates a significant (p less than 0.01) shift to the right of the microscopic hyperplasia patients after operation, moving them to a broader range of total calcium per picogram parathyroid hormone. We conclude that 1) in primary hyperparathyroidism, positive regulation of total calcium by autonomously released parathyroid hormone exists in patients with solitary adenoma and chief cell hyperplasia; 2) autonomously functioning parathyroid tissue has been removed by operation for solitary adenoma with coexistent microscopic parathyroid hyperplasia. In this four- to eight-year follow-up period, it is clear that microscopic parathyroid hyperplasia is not associated with recurrent hypercalcemia. Two functionally distinct forms of parathyroid suppression are suggested; positively regulated microscopic hyperplasia and negatively regulated pathologically suppressed glands.

Adenoma↗