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Biomedical subjects

C A Burnweit

Publications and source records attributed to C A Burnweit.

10 recordsLinked to original sources
PubMed2000

Preoperative home care for esophageal atresia--a survey.

BACKGROUND/PURPOSE: Long gap esophageal atresia may require months of preoperative management before definitive repair. When 2 recent patients prompted the authors to consider preoperative home care, no published protocol could be identified. This survey is undertaken to determine pediatric surgeons' experience with preoperative home care for long gap atresia. METHODS: A total of 543 surgeons were asked if any patients with long gap atresia had been treated preoperatively at home. For patients sent home, information on nursing care, insurance issues, complications, and timing or type of repair was requested. RESULTS: A total of 380 surveys (70%) were returned. A total of 165 surveys representing 348 patients were included. Forty-one of 165 surgeons (25%) treated 63 of 87 patients (72%) with long gap atresia and an intact upper pouch at home. Home nursing care was provided for 44 patients (70%): 16 (36.4%) night shift, 2 (4.5%) day shift, 3 (6.8%) 24 hour, and 23 (52.3%) intermittent care. No complications referable to preoperative home care were reported. CONCLUSIONS: Significant hesitancy and practice variance exists regarding preoperative home care of patients with long gap esophageal atresia. Many surgeons are satisfied with the safety and cost effectiveness of this technique, although a prospective, multicenter trial is needed to study it in a randomized, controlled fashion.

Esophageal Atresia↗
PubMed1998

Ileal exclusion for Byler's disease: an alternative surgical approach with promising early results for pruritus.

BACKGROUND/PURPOSE: Progressive familial intrahepatic cholestasis (Byler's disease) is often characterized by pruritus-induced self-mutilation with minimal response to medical therapy. The causative cholestasis is likely to progress to cirrhosis necessitating transplantation. Partial external biliary diversion has been used with promising results for the jaundice and debilitating pruritus but all the potential complications and aesthetic concerns of long-term stomas attend this approach. METHODS: The authors describe a terminal ileal exclusion that was first developed for patients who had previously undergone cholecystectomy. Over a 3-year period, we identified for study seven children with liver histology characteristic of Byler's disease accompanying a clinical picture of chronic cholestasis without a defined metabolic or anatomic abnormality. The first two patients underwent a cholecystojejunal cutaneous stoma, until now, the recommended treatment for this condition. The third had previously undergone cholecystectomy so an ileocolonic anastomosis was performed excluding the distal 15% of the small bowel. This child had complete relief of pruritus without evidence of diarrhea. Two more terminal ileal exclusions were performed with similar results before standardizing this approach. The authors approximated small intestinal length using Siebert's graph relating crown-heel length to small intestinal length. The midpoint between the mean and one standard deviation below the mean was determined. Fifteen percent of the estimated small bowel length was measured back from the ileocecal valve and then divided using a linear stapling device. A stapled anastomosis was created between the proximal ileum and the cecum, bypassing the terminal ileum. RESULTS: Four of five children have had relief from their pruritus and self-mutilation with no evidence of diarrhea. Terminal ileal bypass offers a stoma-free, completely reversible "biliary diversion." CONCLUSION: Early results on a few patients are promising, but long-term evaluation of growth, development, and liver function and histology is needed before advocating this as the primary therapy for Byler's disease.

Adolescent↗
PubMed1989

Hypertonic saline-dextran resuscitation of acute canine bile-induced pancreatitis.

In this study, we examined the effects of hypertonic saline-dextran resuscitation (2,400 mOsm of sodium chloride, 6 percent dextran 70) on cardiopulmonary function and extravascular lung water in acute canine pancreatitis. Acute pancreatitis was induced in 21 dogs by injecting 0.5 ml/kg of autologous bile into the pancreatic duct. In 10 dogs, resuscitation was begun with a 4 ml/kg bolus of hypertonic saline-dextran solution; 11 dogs received no bolus. Lactated Ringer's solution was infused in all dogs to maintain mean arterial pressure and cardiac output at baseline values. Pulmonary hypertension accompanied by a significant increase in pulmonary vascular resistance and a decrease in lung blood flow occurred in those dogs resuscitated with lactated Ringer's solution alone. By contrast, dogs in the hypertonic saline-dextran group maintained pulmonary artery pressure and pulmonary vascular resistance at baseline values while nutritive blood flow to the lung decreased progressively. Our data suggest that hypertonic saline-dextran resuscitation effectively restores cardiac function while it significantly reduces fluid requirements, as well as the pulmonary hypertension and pulmonary edema that frequently accompany lactated Ringer's resuscitation of acute pancreatitis.

Acid-Base Equilibrium↗
PubMed1988

Extravascular lung water as an indicator of pulmonary dysfunction in acute hemorrhagic pancreatitis.

This study quantifies lung water in acute hemorrhagic pancreatitis to determine the degree to which pulmonary dysfunction occurs subclinically, before alterations in the arterial blood gases can be measured. Pancreatitis was induced in ten dogs by injecting 0.5 ml/kg of bile into the pancreatic ducts, which had been surgically cannulated. Pulmonary and systemic blood gases and blood pressures, heart rate, extravascular lung water, and lung blood flows were studied over 5 hours while cardiac output and mean arterial pressure were maintained at control values by Ringer's lactate infusion. The percentage of water in lung tissue was determined at the time of sacrifice using gravimetric measurements. Mean arterial pressure, cardiac output, and pulmonary capillary wedge pressure, reflecting intravascular volume status, did not change through at the experiment. By contrast, major disturbances were measured in the pulmonary bed with pulmonary artery pressures rising from 15.6 +/- 1.8/8.1 +/- 1.3 mmHg to 22.0 +/- 1.2/15.6 +/- 1.7 mmHg over 5 hours (p less than 0.01). Peripheral vascular resistance rose from 3.6 +/- 0.6 units to 6.6 +/- 0.4 units (p less than 0.05), whereas bronchial blood flow to the lung fell significantly. These changes in pulmonary hemodynamics were not reflected by changes in the arterial blood gases. Arterial oxygenation was maintained during 5 hours of pancreatitis. The partial pressure of carbon dioxide and the serum pH did not change significantly. There was, however, a progressive rise in extravascular lung water measured by the double-dilution technique from 10.2 +/- 0.8 ml/kg at control to 18.1 +/- 2.8 ml/kg (p less than 0.01) at 5 hours. This was confirmed by direct gravimetric measurements, which revealed an increase in the water content of the lung from 78.1 +/- 0.3% to 86.4 +/- 2.4% over the course of the experiment. Arterial blood gases, therefore, do not necessarily reflect the pulmonary deterioration in acute pancreatitis. These data supported a mechanism of lung dysfunction independent of the circulatory compromise, which often accompanies the disease in the clinical setting.

Acute Disease↗
PubMed1988

Hemodynamic function in acute pancreatitis.

Acute pancreatitis is often associated with impaired cardiovascular function. This study examined the systemic cardiovascular effect of acute pancreatitis induced by injection of autologous bile (0.5 ml/kg) into the canine pancreatic duct. After acute pancreatitis was induced, eight dogs were given no resuscitation (group 1, untreated pancreatitis), and lactated Ringer's solution was infused in 11 dogs (group II, treated pancreatitis) to maintain mean arterial pressure and pulmonary wedge pressure at control values. In the untreated pancreatitis group, mean arterial pressure, cardiac output, stroke volume, and stroke work values decreased (mean arterial pressure from 101 +/- 4 to 74 +/- 12 mm Hg, cardiac output from 118 +/- 7 to 56.2 +/- 1.1 ml/min/kg; stroke volume from 0.93 +/- 0.08 to 0.22 +/- 0.07 ml/beat/kg; p less than 0.05), whereas heart rate and peripheral resistance increased (heart rate from 125 +/- 7 to 185 +/- 10 beats/min, peripheral vascular resistance from 3130 +/- 410 to 4436 +/- 610 dynes/sec/cm5; p less than 0.05). Although coronary blood flow, endocardial-epicardial flow ratio, and myocardial oxygen delivery values decreased progressively in group I after induction of pancreatitis, these changes did not achieve statistical significance. All indices of cardiovascular function and coronary blood flow remained unchanged in group II. Neither dP/dt max, the maximal rate of left ventricular pressure increase, nor dP/dt at a developed pressure of 40 mm Hg (an index of myocardial contractility minimally affected by changes in preload and afterload) were depressed by bile-induced acute canine pancreatitis in either group. Our data indicate that the detrimental effects of acute pancreatitis on cardiovascular function are related solely to hypovolemia and reduced cardiac filling and not to humoral or reflex effects induced by the disease.

Acute Disease↗
PubMed1986

Significance of omental evisceration in abdominal stab wounds.

Over a 4 year period, 115 patients presented to Parkland Memorial Hospital with omental evisceration after a stab wound to the abdomen. All patients underwent exploratory celiotomy. Serious abdominal injuries were found in 86 patients (75 percent), and half of these had two or more organs injured. The injury rate in patients with omental herniation was three times that of patients with simple stab wounds. No preoperative evaluation technique was reliable in identifying patients without injury. There were no deaths and only a 7 percent incidence of minor complications in patients who underwent negative exploration. Our data suggest that omental evisceration in a patient with an abdominal stab wound portends potentially serious injury and supports the policy of expeditious celiotomy.

Abdominal Injuries↗
PubMed1986

Influence of diversion on the development of cholangitis after hepatoportoenterostomy for biliary atresia.

This study was undertaken to determine if the incidence of cholangitis is reduced when external diversion is added to hepatoportoenterostomy for biliary atresia. Nineteen children undergoing hepatoportoenterostomies without diversion between 1975 and 1984 were compared with 12 children who had hepatoportoenterostomies with diverting jejunostomies. Patient data were analyzed for the episodes and severity of cholangitis and other factors known to influence the outcome of biliary atresia. The groups were similar with regard to age of patient at the time of operation, degree of liver damage on biopsy, and the establishment of bile flow after hepatoportoenterostomy. There was no difference in the incidence of cholangitis between the nondiverted (32%) and the diverted (33%) groups. However, the addition of external diversion increased the morbidity and mortality. Four patients with diversion required surgery for bleeding, prolapse, or retraction of the jejunostomy, and two additional patients died as the result of stomal complications. External diversion does not decrease the incidence or severity of cholangitis after hepatoportoenterostomy, but significantly increases the risk of severe and fatal complications.

Bile↗
PubMed1982

Metallothionein mRNA induction in mouse small bowel by oral cadmium and zinc.

Induction of metallothionein mRNA was investigated in organs of mice receiving oral zinc and cadmium. The low molecular weight, heat stability, and 30% cysteine content of metallothionein facilitated its detection in cell-free translation products analyzed by Sephadex G-50 chromatography and by gel electrophoresis. Native and heat-denatured [35S]cysteine-labeled polypeptides directed by poly(A)+ mRNA from organs of mice exposed orally to 3 mg CdCl2 or 15 mg ZnCl2 were compared with those of control mice. Although parenteral administration of CdCl2 (30 micrograms) did not elicit a measurable metallothionein mRNA accumulation in gut, oral administration of this metal induced intestinal metallothionein mRNA to high levels; translatable metallothionein mRNA was not detected in control organs. Five hours after oral CD or Zn, metallothionein constituted 12-17% of [35S]cysteine directed into protein by gut mRNA, and metallothionein mRNA was induced to similar levels in liver, kidney, and spleen of the same mice. After oral Zn, metallothionein mRNA levels in proximal jejunum were twice those in other regions of intestine. Metallothionein mRNA accumulates rapidly in small bowel after oral Zn and Cd; simultaneous induction in other mouse organs indicates a systemic response.

Animals↗