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Biomedical subjects

B L Warren

Publications and source records attributed to B L Warren.

At least 19 recordsLinked to original sources
PubMed1995

Antibiotic monotherapy with meropenem in the surgical management of intra-abdominal infections.

In an open, multicentre, randomised study, the efficacy and safety of meropenem monotherapy as adjuvant antibiotic therapy in the surgical management of intra-abdominal infection was compared with that of the combination of cefotaxime and metronidazole. A total of 160 hospitalised adult patients with intra-abdominal infection requiring surgery were treated intravenously with either meropenem 1 g every 8 h (by bolus injection or infusion; n = 77) or cefotaxime 2 g and metronidazole 500 mg every 8 h (n = 83). Clinical and bacteriological responses to antibiotic therapy were assessed at the end of treatment and at 2-4 weeks' follow-up after treatment. The clinical response rates at the end of treatment and follow-up were 91% and 96%, respectively, for meropenem and 100% and 97%, respectively, for cefotaxime plus metronidazole. The bacteriological response rates were 90% and 93%, respectively, for meropenem and 92% at both time points for cefotaxime plus metronidazole. Both treatments were well tolerated. In this study, meropenem monotherapy was effective and as well tolerated as cefotaxime plus metronidazole. Meropenem monotherapy should, therefore, prove a useful alternative to standard combination therapy for the empirical treatment of intra-abdominal infections.

Abdomen↗
PubMed1995

A survey of South African endoscopic surgical practice.

To coincide with the first annual meeting of the South African Society of Endoscopic Surgeons (SASES), a postal survey of the endoscopic surgical practices of 98 registered specialist surgeons was undertaken. A response rate of 73.5% was achieved, and 94.5% of respondents had personally performed endoscopic surgical procedures. Cholecystectomy (4,557) was the most commonly performed endoscopic surgical procedure and was associated with a postoperative mortality rate of 0.13% and morbidity of 3.5%. Twelve bile duct injuries were reported (0.26%). In descending order of frequency, other procedures reported were diagnostic laparoscopy (1,404), dorsal sympathectomy (412), appendicectomy (396), inguinal hernia repair (146), anti-reflux procedures (83) and diagnostic thoracoscopy (51). No postoperative deaths were recorded and complication rates varied from zero for diagnostic thoracoscopy to 4.8% for inguinal hernia repair and anti-reflux procedures. The selected sample of South African surgeons canvassed appears to have adopted endoscopic surgical techniques with enthusiasm and with complication rates that compare favourably with those reported elsewhere.

Endoscopy↗
PubMed1995

Carcinoma of the gallbladder--a possible regional predisposition in the western Cape and northern Cape.

An analysis of 19 patients with confirmed carcinoma of the gallbladder who were treated over a period of 68 months emphasised known clinical features of the disease, i.e. nonspecific symptomatology, late presentation and poor prognosis. Comparison with 883 patients undergoing surgery for benign calculous biliary tract disease during the same period identified a more advanced mean age (67.0 v. 55.3 years), larger mean maximum stone diameter (20.3 v. 11.9 mm) and a higher proportion of patients resident in the Cape interior and west coast region (57.8% v. 11.8%) as features associated with carcinoma of the gallbladder. Further investigation of the regional predisposition suggested by this study may identify new factors linked to the development of gallbladder cancer.

Adenocarcinoma↗
PubMed1994

Thoracoscopic evaluation of the diaphragm in patients with knife wounds of the left lower chest.

The role of thoracoscopy in assessing the status of the diaphragm in penetrating knife wounds of the left lower chest was studied prospectively in 55 patients. Those with positive thoracoscopic findings (n = 22) proceeded to exploratory laparotomy and those with an uninvolved diaphragm (n = 32) were observed. Thoracoscopy was inconclusive in one patient and two were lost to follow-up. With operative findings or 30-month follow-up data as evaluation endpoints, thoracoscopy in 52 patients was 100 per cent sensitive, 90 per cent specific and 94 per cent accurate. A projected negative laparotomy rate of 63 per cent would have occurred with a policy of mandatory laparotomy; using thoracoscopy the actual rate was 6 per cent. Thoracoscopy is a safe and reliable method of evaluating the diaphragm in patients with left lower thoracic stab wounds.

Adult↗
PubMed1992

Dissection of the uncinate process during pancreatoduodenectomy.

An alternative approach to the dissection of the uncinate process during pancreatoduodenectomy is described. This involves mobilisation of the midgut superiorly and bringing the uncinate process into an antero-inferior position within the operative field. Access to, and visualisation of, the posterior aspect of the superior mesenteric vessels is considerably improved. This approach may avoid many of the potential problems associated with freeing of the uncinate process during pancreatic resection.

Humans↗
PubMed1992

Elective cholecystectomy via a 5 cm subcostal incision.

This report describes a technique whereby elective cholecystectomy is performed through a 5 cm abdominal incision. Initial results in 18 patients compared with 112 historical control patients undergoing conventional cholecystectomy suggest an encouraging reduction in postoperative hospitalisation time, analgesic requirements and period of recuperation. The procedure takes no longer to perform than conventional cholecystectomy and obesity is not a limiting factor, as originally thought. This technique deserves a place alongside laparoscopic and conventional cholecystectomy in future studies seeking the optimal method of managing symptomatic cholelithiasis.

Adult↗
PubMed1992

Small vessel occlusion in acute acalculous cholecystitis.

Ischemia is one mechanism implicated in the pathogenesis of acute acalculous cholecystitis. Gallbladder specimen arteriography was performed to define the comparative status of cystic artery runoff in the macroscopically normal gallbladder (n = 10), in acute gallstone-associated cholecystitis (n = 10), and in acute acalculous cholecystitis (n = 7). Standardized film exposure and quantity of contrast medium administered permitted objective intergroup comparison. Compared to the macroscopically normal gallbladder, specimens of acute gallstone-associated cholecystitis exhibited arterial dilatation and extensive venous filling. In contrast, multiple arterial occlusions, with absent or minimal venous filling, were consistent features of acute acalculous cholecystitis; the degree of arteriographic abnormality for acute acalculous cholecystitis corresponded to the severity of gallbladder pathologic findings. Small vessel occlusion, on the basis of low splanchnic flow or intravascular coagulation, may be a fundamental element in the pathogenesis of acute acalculous cholecystitis.

Acute Disease↗
PubMed1991

Effectiveness of a personalized fitness module on knowledge, attitude, and cardiovascular endurance of fifth-grade students: "heart smart".

The effectiveness of a Personalized Fitness Module was compared to a Traditional Fitness Unit, both of which were designed to develop knowledge, behavioral skills, fitness and positive attitudes. 95 students in Grade 5 and from intact physical education/health classes within two public schools participated in a seven-week cardiovascular fitness program. The experimental group of 48 participated in the personalized and noncompetitive fitness module. The control group of 47 participated in the traditional unit, a teacher-centered fitness module. Students received a total of 14 55-min. lessons over seven weeks. Pre- and posttest measurements included the Superkids-Superfit Knowledge Test, the Children's Attitudes Toward Physical Activity Inventory, and the one-mile run/walk. Data were analyzed using group mean gain scores on eight dependent variables (knowledge, six subscales of attitude, and one-mile run/walk) followed by a multivariate analysis of variance. A significant difference between groups led to a discriminant function analysis as a post hoc test. Findings indicated that the use of the personalized unit can substantially improve one-mile run/walk time. The use of modules of this type in health and physical education programs may promote life-long exercise patterns and fitness.

Cardiovascular Diseases↗
PubMed1990

Plantar fasciitis in runners. Treatment and prevention.

Plantar fasciitis is a common overuse injury found in runners. The plantar fascia, which is responsible for maintaining the integrity of the longitudinal arch, becomes irritated, inflamed or torn by repetitive stresses placed upon it. Commonly cited predisposers of plantar fasciitis are excessive pronation, a flat or cavus foot, tight Achilles tendon, type of training shoes worn, and errors in the training routine. Once the plantar fascia becomes irritated a myriad of conservative measures may be used, including everything from rest, ice and elevation to steroid injections and, if all else fails, surgery. In most cases conservative treatment of one kind or another will alleviate the symptoms of plantar fasciitis. However, it is essential to determine and correct the cause of the problem in order for the runner to resume normal activity levels. Controlling anatomical/biomechanical inefficiencies of the feet, stretching and strengthening exercises for the lower extremity, proper training shoes, and reasonable training routines will alleviate the symptoms of plantar fasciitis in a large percentage of sufferers. To prevent this injury, runners should be aware of the potential overuse injury and take precautionary measures, e.g. seek a biomechanical/anatomical evaluation from a qualified practitioner. The practitioner can then offer suggestions as to the specific steps the runner should follow to prevent the injury condition.

Aspirin↗
PubMed1989

Phaeochromocytoma in pregnancy. A report of 3 cases.

The coincidence of phaeochromocytoma and pregnancy is rare and potentially lethal. Three cases are reported; in 2 the fetus had died before the patient presented. With early diagnosis and appropriate treatment there should be no maternal mortality, and the fetal mortality rate should be reduced to less than 20%.

Adrenal Gland Neoplasms↗
PubMed1988

Determining predictor variables for running-related pain.

The purpose of this study was to determine whether specific predictor variables exist for particular running-related injuries. Data on 134 patients with running-related injuries were evaluated to establish the factors that were associated with specific pain sites. Patient data consisted of a brief running history and measurements of 72 anatomical variables that have been cited in the literature as predisposers to running-related injuries. The descriptive statistics indicated certain associations of variables with each pain group. A factor analysis was used to eliminate multicollinearity and to reduce the 72 variables to 9 factors. The results of a discriminant function analysis using factor scores indicated that patients' membership in one of six pain groups could be predicted correctly in 29.1% of the cases. We concluded that the factors used in this study were not good predictors of pain groups. Physical therapists, however, should publish their data on runners' injuries, treatment, and rehabilitation to supplement the published data that relate anatomical and biomechanical factors to running-related injuries.

Athletic Injuries↗
PubMed1987

Predicting plantar fasciitis in runners.

Ninety-one runners were studied to determine whether specific variables were indicative of runners who had suffered with plantar fasciitis either presently or formerly vs runners who had never suffered with plantar fasciitis. Each runner was asked to complete a running history, was subjected to several anatomical measurements, and was asked to run on a treadmill in both a barefoot and shoe condition at a speed of 3.35 mps (8 min mile pace). Factor coefficients were used in a discriminant function analysis which revealed that, when group membership was predicted, 63% of the runners could be correctly assigned to their group. Considering that 76% of the control group was correctly predicted, it was concluded that the predictor variables were able to correctly predict membership of the control group, but not able to correctly predict the presently or formerly injured sufferers of plantar fasciitis.

Age Factors↗
PubMed1986

Congenital choledochal cyst. A case report.

A congenital choledochal cyst presented as an upper abdominal mass in a non-jaundiced woman; at laparotomy total cystectomy was performed and biliary enteric continuity re-established by a hepaticojejunostomy Roux-en-Y anastomosis.

Adult↗
PubMed1985

Characterization studies of a rat hepatic cytosolic androgen-binding protein.

A rat hepatic cytosolic [3H]methyltrienolone (R1881) binding protein was studied under various conditions. This protein was also compared with the male-specific high capacity--low affinity estrogen-binding protein derived from the same cytosolic fraction. Analysis of the R1881 binding protein in adult (60-85 days old) male rat liver cytosol indicated the presence of a high affinity--low capacity binding site (Kd = 0.3 nM; Bmax = 5.9 fmol/mg) and a lower affinity--higher capacity component (Kd = 10.4 nM; Bmax = 131 fmol/mg). The latter component was eliminated by addition of triamcinolone or cortisol to the assay mixture. Steroid binding to the high affinity R1881 site was specific for testosterone, dihydrotestosterone, androstenedione, and mibolerone, with a moderate specificity to cyproterone acetate, flutamide hydroxide, and estradiol. Saturation studies indicated that these steroids were binding to the same or a similar high affinity component except for flutamide hydroxide which produced nonsaturable displacement. The high affinity site had no specificity for progesterone, diethylstilbestrol, or cortisol. Like the high capacity--low affinity protein, this protein was not present in the immature, adult, or 10-day ovariectomized adult female. However, unlike the high capacity--low affinity protein, it was present in low quantities in the immature male. In addition, castration of the adult for 18 h, 4 days, or 10 days or hypophysectomy for 10-17 days did not have a significant effect on the high affinity component compared with the controls. Testosterone administration to these animals did not alter this protein binding. These studies indicate that a specific, high affinity--low capacity androgen-binding protein exists in rat hepatic cytosol. Furthermore, this protein shows age and sex dependency, but its presence is not affected by altering gonadal or hypophyseal factors in the adult male.

Androgen-Binding Protein↗
PubMed1984

Anatomical factors associated with predicting plantar fasciitis in long-distance runners.

The purpose of this study was to identify anatomical variables associated with plantar-fasciitis sufferers. Selected anatomical variables which were chosen for measurement were leg length, pronation of the subtalar joint, plantar and dorsiflexion ability, and arch height of the foot, as well as the variables height, weight, age, and miles run per week. The means and standard deviations revealed that leg-length inequality, pronation of the subtalar joint, and arch height were not good indicators of plantar-fasciitis sufferers. According to the discriminant-function analysis in which 64% of the subjects were assigned to the appropriate group, plantar flexion, dorsiflexion, and height were good predictors of the recovered and non-recovered sufferers, but could predict no more than 50% of the present sufferers. Therefore, a set of predictor variables was not found for the prediction of plantar-fasciitis sufferers.

Achilles Tendon↗
PubMed1983

Differential effects of diabetes on microsomal metabolism of various substrates. Comparison of streptozotocin and spontaneously diabetic Wistar rats.

We have examined the effect of recent onset diabetes on several aspects of hepatic microsomal metabolism in both streptozotocin (STZ)-induced and spontaneously diabetic BioBreeding (BB) male and female Wistar rats. Differential alterations of the diabetic state on hepatic microsomal enzyme activities were observed. Female diabetic rats exhibited no change in benzo [a]pyrene (BP) hydroxylase activity, a decrease in testosterone delta 4-hydrogenase, and an increase in aniline hydroxylase. On the other hand, male diabetic rats demonstrated a decrease in hepatic BP hydroxylase activity, no change in testosterone delta 4-hydrogenase, and an increase in aniline hydroxylase. Insulin treatment corrected these effects. No change in kidney BP hydroxylase activity was apparent in either female or male diabetics. There were no marked differences between the chemically induced and genetic models of diabetes with respect to the metabolism studies. Serum testosterone levels were significantly lower than control in male BB diabetics, whereas no change was apparent in female diabetics. Light microscopy and serum insulin determinations indicated that the spontaneously diabetic animals we examined were not severely diabetic. From electrophoresis of hepatic microsomal proteins we determined that spontaneous diabetes of short duration does alter the protein distribution in the cytochrome P-450 region. We conclude that the acute effects of STZ-induced and spontaneous diabetes on hepatic microsomal metabolism are quantitatively and qualitatively similar, despite probable differences in etiology of the diabetic state.

Animals↗