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Biomedical subjects

C E Lucas

Publications and source records attributed to C E Lucas.

At least 19 recordsLinked to original sources
PubMed2006

Upper GI foreign body: an adult urban emergency hospital experience.

BACKGROUND: The efficacy of flexible endoscopy by a single endoscopist in the therapy of foreign body ingestion was assessed at an adult urban emergency hospital. METHODS: Fifty-one adult patients with upper GI foreign body ingestion treated at Detroit Receiving Hospital from 1988 to 2004 were identified. Endoscopic and hospital medical records were reviewed to evaluate etiology, treatment, and outcomes for these patients. RESULTS: The etiology was related to eating in 38(75%) patients, most of whom were eating meat; phytobezoars were seen in four, often after previous upper GI surgery. True foreign bodies were found in 13 patients (25%) and included a screwdriver, a ballpoint pen, spoons, coat hanger pieces, batteries, and latex gloves. Dysphagia was the most common symptom (75%); pain was common in patients with true foreign bodies, and 62% of this group had psychiatric difficulties or problems with drug abuse. Nearly 80% of the food-related group had post-surgical or other upper GI pathology. One patient had an esophageal stricture secondary to previous Sengstaken-Blakemore tube insertion. Flexible endoscopy was successful in extracting the foreign body in almost all (49) patients, with snare extraction the most common therapeutic modality. Both failures were of true foreign bodies that could not be safely removed. In one of these cases, it became necessary to employ the gallstone lithotripter, and the overtube was required in patients with metallic or sharp foreign bodies to protect the upper aerodigestive structures. CONCLUSIONS: Most upper GI foreign bodies are related to food impaction, with meat most often found. Underlying pathology is the rule and should be dealt with immediately. Flexible endoscopy is the treatment of choice for upper GI foreign body removal with near perfect success.

Adult↗
PubMed2001

Endoscopic sphincterotomy for stenosis of the sphincter of Oddi.

BACKGROUND: Sphincter of Oddi dysfunction (SOD) is one of the causes of postcholecytectomy syndrome and biliary pain. Endoscopic sphincterotomy (EST) is recommended in some cases for patients refractory to conservative treatment. By the Milwaukee classification, patients with biliary pain can be divided into three groups. Group I patients show all the objective signs suggestive of a disturbed bile outflow-i.e., elevated liver function tests, dilated common bile duct (CBD), and delayed contrast drainage during endoscopic retrograde cholangio pancreatography (ERCP). Group II patients have biliary-type pain along with one or two of the criteria from group I. Group III patients have only biliary pain, with no other abnormalities. This study confirms the effectiveness of EST for the relief of symptoms in group I patients (papillary stenosis). METHODS: Between 1989 and 1999, we treated eight patients clinically diagnosed as having group I papillary stenosis by EST. Their ages ranged from 52 to 73 years. In addition to biliary pain, all patients were found to have dilated CBD, elevated enzyme levels, and delayed contrast drainage at ERCP. None of the patients had CBD stones or other causes of obstruction. Sphincter of Oddi manometry was not performed. RESULTS: EST was successfully performed in eight patients. Each patient had a very large papilla. A false orifice was found in one patient. In five patients, endoscopic cannulation of the bile duct was very difficult. The use of a long, tapered catheter and guidewire papillotomy was necessary in four patients. A precut papillotomy was performed in one patient. All patients achieved resolution of their symptoms after EST. There were no complications. The average length of the follow-up period was 26 months. CONCLUSIONS: SOD is a real entity that continues to pose a diagnostic dilemma. EST is an effective and safe modality for the treatment of papillary stenosis (group I patients). SOD manometry is not necessary before EST in group I patients.

Abdominal Pain↗
PubMed2001

Mathematical modeling to define optimum operating room staffing needs for trauma centers.

BACKGROUND: Level II trauma centers may be verified (1999, American College of Surgeons Committee on Trauma) with an on-call operating room team if the performance-improvement program shows no adverse outcomes. Using queuing and simulation methodology, this study attempted to add a volume guideline. STUDY DESIGN: Data from 72 previously verified trauma centers identified multiple demographic factors, including specific information about the first trauma-related operation that was done between 11:00 PM and 7:00 AM each month for 12 consecutive months. RESULTS: The annual admissions averaged 1,477 for 37 Level I trauma centers, 802 for 28 Level II trauma centers, 481 for 4 Level III trauma centers, and 731 for 3 pediatric trauma centers. The annual admissions correlated with the number of operations done between 11:00 PM and 7:00 AM (p < 0.001). These 946 operations were performed by general surgery (39%), neurosurgery (8%), orthopaedic surgery (33%), another specialty (9%), or multiple services (10%). Admission to operation time was within 30 minutes for 12.1% of patients (2.6% for blunt and 24.1% for penetrating injuries). The probability of operation within 30 minutes of arrival varied with the number of admissions and with the percentage of penetrating versus blunt injuries. The likely number of operations from 11:00 PM to 7:00 AM would be 19 for 500 annual admissions, 26 for 750 annual admissions, and 34 for 1,000 annual admissions, with 5.83, 7.98, and 10.13 patients, respectively, going to operation within 30 min. The probability that two rooms would be occupied simultaneously was 0.14 and 0.24 for centers admitting 500 and 1,000 patients, respectively. CONCLUSIONS: Trauma centers performing fewer than six operations between 11:00 PM and 7:00 AM per year could conserve resources by using an immediately available on-call team, with responses monitored by the performance-improvement program.

Guidelines as Topic↗
PubMed2001

The effect of trauma program registry on reported mortality rates.

BACKGROUND: This study assesses the relationship that the brand of trauma program registry (TPR) has on mortality rate (MR) in the reports prepared by the American College of Surgeons Committee on Trauma (ACSCOT) trauma center (TC) site surveyors. METHODS: Data from 242 ACSCOT adult TC survey reports (88 Level I, 115 Level II, and 39 Level III) were analyzed for annual trauma volume, injury severity score (ISS), MR, and TPR. Six TPR (A through F) were identified; group F was a composite of several infrequently used TPRs. This report focuses on the ISS range 16-24 because of the likelihood that the mean for each TC would be near 20 and MR is high enough so that a difference, if present, could be statistically documented. RESULTS: For the total group, MR showed no correlation with TC volume or TC level for ISS 16-24. MR was significantly different according to which TPR was used by the TCs. The MR is less (4.8%) for 14 high volume TCs (over 1200 admits) using TPR A compared with 33 low volume TCs (below 800 admits) using TPR A (6.34%). CONCLUSION: The MR for ISS 16-24 in ACSCOT-surveyed TCs differs within subgroups based on type of TPR utilized. This may reflect improper use of the software programs. Enhanced skill in the application of software programs designed to generate ISS scores is essential if meaningful studies on the effects of improved trauma care on MR are to be conducted. Hand scored ISS by trained personnel may circumvent this problem.

Confounding Factors, Epidemiologic↗
PubMed2001

Effect of a composite membrane of chitosan and poloxamer gel on postoperative adhesive interactions.

Excessive postoperative adhesion formation is a major result of surgery. The adhesion reduction effects of a chitosan membrane and poloxamer gel barrier were measured in a rat peritoneal model. Forty-four male Sprague-Dawley rats were divided into four groups (control, poloxamer, chitosan, and poloxamer+chitosan sandwich). Two cm2 of cecal serosa and the adjacent abdominal wall were abraded. The denuded cecum was covered with either a chitosan membrane, a poloxamer gel, chitosan in a sandwich configuration with poloxamer on both sides, or neither (control group) and apposed to the abdominal wall. Fourteen days after surgery adhesions were graded using a whole-number scoring system of zero to five. Adhesion strength was determined using a whole-number system of one to four. Adhesion area was measured on a continuous scale of adhesion severity. Adhesion grades were highest in the control group (5.00 +/- 0.00) and were significantly (P < 0.05) lower in the poloxamer group (3.50 +/- 1.35), the chitosan group (1.64 +/- 1.63), and the poloxamer+chitosan group (1.18 +/- 1.25). The two chitosan-containing groups also had significantly (P < 0.05) reduced adhesion grades in comparison with the poloxamer group. Adhesion area in both chitosan-containing groups was reduced in comparison with control and adhesion strength was reduced significantly (P < 0.05) in all groups compared with control. The poloxamer+chitosan group had significantly (P < 0.05) reduced adhesion strength versus poloxamer only. There was a significant (P < 0.05) linear correlation (r = 0.931, P < 0.001) between adhesion grade and adhesion strength. We conclude that chitosan and the combination of poloxamer+chitosan were shown to effectively reduce adhesion area, grade, and strength.

Adhesiveness↗
PubMed2000

Effects of physiologic albumin and hespan levels on hepatocytes in vitro.

BACKGROUND: Although albumin and hydroxyethyl starch (HES) are routinely used in critically ill, hypoalbuminemic patients, no studies have tested the effect of supplemental albumin and HES on hepatocyte function. METHODS: In this study, the effects of these agents were evaluated by using stable, rat hepatocyte cultures in a collagen sandwich configuration. Hepatocyte synthesis of albumin, urea, and intracellular triglycerides was monitored in Dulbecco's modified Eagle medium (supplemented with fetal bovine serum, hydrocortisone, L-proline, gentamycin, and insulin) without supplemental colloid (control cultures) and with supplemental 2% bovine serum albumin (BSA), 4% BSA, 2% HES, or 4% HES. RESULTS: The albumin secretion in control cultures rose from 31.03 microg/day per 10(6) cells on day 3 to 154.17 microg/day per 10(6) cells by day 12 and remained constant. In contrast, the level of albumin synthesis in the 2% and 4% BSA groups rose from significantly higher initial values (p < 0.05) of 71.25 microg/day per 10(6) cells and 73.27 microg/day per 10(6) cells, respectively, to 127.61 microg/day per 10(6) cells and 107.95 microg/day per 10(6) cells by day 7, then declined rapidly to 58.98 microg/day per 10(6) cells and 41.28 microg/day per 10(6) cells by day 12 when cell disruption was present. HES also reduced albumin synthesis. The urea genesis in the control groups and in the treatment groups was found to be comparable throughout the study. The BSA supplemented groups accumulated large amounts of intracellular lipid droplets during the experiment. The intracellular triglycerides analysis found the 4% BSA group to be significantly (p < 0.05) higher than the 4% HES. CONCLUSION: BSA, added to a collagen sandwich hepatocyte preparation, causes reduced hepatocyte synthesis by day 8, probably a result of intracellular triglyceride accumulation, whereas HES reduces synthesis through unidentified mechanisms.

Albumins↗
PubMed2000

Changing times and the treatment of liver injury.

We hypothesized that the frequency, diagnosis and treatment of liver injury have changed dramatically in the past 30 years. Patients with liver injuries treated in an urban level I trauma center were analyzed for three separate time periods, namely, 1969-1970, 1981-1982, and 1997-1998. The injuries were categorized by etiology; Abbreviated Injury Score severity, and type of treatment, including observation (Ob), laparotomy without treatment of liver injury (OR No Rx), suture repair (Sut), tractotomy with intraperipheral hemostasis (Tr), dearterialization (HAL), and resection (Re) (See Table, below). There were 249 patients in 1969-1970, 70, 79 in 1981-1982, and 116 in 1997-1998. Stab wounds and gunshot wounds decreased from 235 patients in 1969-1970 to 61 patients in 1997-1998. Blunt injuries increased from 14 patients in 1969-1970 to 55 patients in 1997-1998. Major injuries (Abbreviated Injury Score 4-5) fell from 104 to 25 to 20 during the decade. Laparotomy was done in all patients in 1969-1970 and 1981-1982, whereas most blunt injuries were observed in 1997-1998; only 9 of 65 blunt injuries in 1997-1998 required hemostasis. [table in text] We conclude the following: 1) Central urban depopulation reduces experience with liver trauma, 2) abdominal CT increases the diagnosis of liver injury, and 3) observation of stable patients with blunt liver injury is now the standard.

Abdominal Injuries↗
PubMed1999

Lower esophageal sphincter dysfunction often precludes safe gastric feeding in stroke patients.

OBJECTIVES: To determine the relationship between stroke and lower esophageal dysfunction with vomiting and to identify an optimal nutrition protocol based on our findings. PATIENTS AND METHODS: The lower and upper esophageal sphincter functions were assessed in 35 patients who had an acute stroke to determine whether gastric or jejunal enteral feeding was the optimal route. Stroke was due to unilateral ischemia in 20 patients, unilateral intracerebral hemorrhage in 8 patients, and global ischemia in 7 patients. Our study consisted of 18 men and 17 women with an average age of 64 years. RESULTS: Using standard esophageal manometric definitions, the lower esophageal sphincter function was below normal in 24 patients: 3 had global anoxia, 5 had unilateral hemorrhage, and 16 had unilateral ischemia. The upper esophageal sphincter function was low in 30 patients: 6 had global anoxia, 7 had unilateral hemorrhage, and 17 had unilateral ischemia. Based on lower esophageal sphincter pressure, 7 patients underwent tube gastrostomy and 13 patients underwent tube jejunostomy placement. All tolerated enteral alimentation well. Prior to lower esophageal sphincter assessment, 4 patients had percutaneous endoscopy gastrostomy feedings that led to aspiration pneumonitis and consultation for tracheostomy; 2 terminally ill patients were referred to the ethics service, and 2 were converted to feeding via jejunostomy tube at the time of tracheostomy and did well. CONCLUSIONS: Vomiting with aspiration due to lower esophageal sphincter dysfunction is common after acute strokes. Esophageal manometry serves as a guide to find the optimal feeding route.

Adult↗
PubMed1999

Experimental studies of thermal therapy for severe nonvariceal bleeding in dogs.

BACKGROUND: There are several methods of achieving endoscopic hemostasis for nonvariceal hemorrhage, including use of a heater probe, bipolar electrocoagulation, use of a Gold probe, and injection therapy with epinephrine or ethyl alcohol. However, due to clinical variations, clinical studies comparing thermal with injection therapy have yielded conflicting results. Therefore, we used a canine model of acute bleeding from gastric serosal vessels to examine the efficacy of the heater probe and the Gold probe in achieving hemostasis and to compare the injurious effects of these methods with injection therapy. METHODS: Seven mongrel dogs were used in the study. Four were assigned to acute experiments in which transected blood vessels were allowed to bleed profusely. Two dogs of this group were treated with either a large or small Gold probe, while the other two were treated with either a large or small heater probe. In the other three dogs, we tested the chronic effects of the heater probe, the Gold probe, and injection therapy with dilute epinephrine. RESULTS: Complete hemostasis was achieved for all four dogs in the acute experiments. Dogs treated with either a large or small heater probe had coagulation necrosis that extended to the serosa and muscularis but not to the mucosa. The large Gold probe had similar results, but the small Gold probe caused tissue damage to the serosa, muscularis, submucosa, and mucosa at several of the application sites. Both probes caused scarring of the gastric wall. In the chronic experiments, we found that the Gold probe caused larger mucosal ulcers than the heater probe. All ulcers healed in 3 weeks. The epinephrine injection caused localized swelling and discoloration, but after 1 week the tissue returned to normal. CONCLUSIONS: Both the heater probe and the Gold probe are effective in achieving hemostasis in a canine model of nonvariceal hemorrhage, and both methods are superior to injection therapy. For active bleeding ulcers, we currently recommend a combination therapy, using first injection therapy and then a heater or Gold probe. However, clinicians should be aware of the potential for tissue damage.

Animals↗
PubMed1999

Aortic thrombosis associated with cocaine use: report of two cases.

Cocaine use has been associated with many vascular complications which may involve the carotid, coronary, and renal vascular beds. Cocaine may also cause venous thrombosis. This report describes a new entity of cocaine-induced aortic thrombosis. On the basis of clinical findings and response to treatment, a therapeutic algorithm is presented.

Acute Disease↗
PubMed1999

Inhibition of alpha-smooth muscle actin expression in an in vitro wound healing model by certain antibiotics.

OBJECTIVE: This study assesses the effects of antimicrobials on wound healing in an in vitro model of chicken flexor tendons in a collagen gel matrix. Two equidistant tendons were bathed in a culture medium for 28 days as fibroblasts (fb) grew from the tendon ends into the collagen gel and migrated toward each other until gap closure. Five groups of 10 paired tendons each included the control and the study groups, which received oxacillin (Ox), clindamycin (Cl), chloramphenicol (Chl), or tetracycline (Tet) in the culture medium to assess their effects on gap closure rate, fb migration, and myofibroblast alpha-smooth muscle (alpha-SM) actin expression. RESULTS: Gap closure, by day 27, was 98.5% in the controls compared with 97%, 92%, 89.5%, 21.75% in the Tet, Cl, Ox, and Chl groups. Chl retarded gap closure (p < 0.05). Fb migration was similar for all groups. In the control and Ox groups, myofibroblast expressed actin at day 5. By day 7, fb cells were clearly visible in the control, Ox, and Cl groups, whereas, only light actin was present in the Chl and Tet groups. Actin band densities for the Cl, Ox, Tet, and Chl groups were 78.4%, 62.5%, 61.7% and 26.1%, respectively, of the control group. CONCLUSION: These studies suggest that one reason certain antimicrobials impair wound healing, is due to myofibroblast inhibition of alpha-SM actin.

Actins↗
PubMed1999

Surgical decompression of ductal obstruction in patients with chronic pancreatitis.

BACKGROUND: Recurrent acute pancreatitis often leads to chronic obstructive ductal disease requiring operative decompression. METHODS: From 1983 through 1998, 124 patients with ductal obstruction underwent lateral pancreaticojejunostomy (78 patients), distal pancreatectomy with end-to-side pancreaticojejunostomy (27 patients), distal pancreatectomy with placement of a pancreas with a filleted duct within a jejunal limb (15 patients), or pancreaticoduodenectomy (4 patients). Preoperative symptoms included abdominal and back pain (99%), nausea with vomiting (99%), and diarrhea with weight loss (11%). Associated conditions included hypertension (20%) and diabetes mellitus (12%). Endoscopy in 106 patients demonstrated distal stricture (37%), proximal stricture (36%), pseudocyst (30%), chain of lakes (15%), calcification and debris (19%), and bile duct stricture (8%). RESULTS: Two patients died, one of an unrecognized esophageal perforation during intubation and the other of leakage of a 1-layer pancreaticojejunostomy. Thirty-six patients developed 53 complications including intra-abdominal abscess (7 patients) and bleeding requiring reoperation in 1 patient. Pain relief was complete in 61 patients, substantial in 39 patients, moderate in 11 patients, minimal in 8 patients, and nonexistent in 3 patients with multiple stones and narrow duct. Ten patients died, with 6 deaths as a result of pancreatic cancer Two other patients may have died of pancreatic cancer. CONCLUSIONS: Lateral pancreaticojejunostomy is the procedure of choice in most patients. Recurrent pancreatitis usually follows alcoholic binges. Long-term follow-up must assess for pancreatic cancer.

Adult↗
PubMed1998

Simulation program for optimal orthopedic call: a modeling system for orthopedic surgical trauma call.

This report uses a mathematical modeling system to define optimal orthopedic coverage for trauma centers. Data from 2,325 patients treated with emergency orthopedic operations within 24 hours of admission at 78 randomly sampled and at four totally sampled verified centers were used to create a profile of (1) admission by month, day, and hour; (2) operation times; and (3) operation duration. The reason for operation included (1) open fracture or crush (809 patients); (2) irreducible dislocations (164 patients); (3) fracture with vascular injury (seven patients); (4) dislocation with vascular injury (17 patients); (5) compartment syndrome (11 patients); (6) femoral neck fracture in young patients (36 patients); (7) combination of categories 1 to 6 (70 patients); (8) fracture with multiple injuries (171 patients); and (9) urgent not emergent (1,040 patients). The program defined the frequency that an injured patient needing an orthopedic consult would wait beyond 30 minutes because the orthopedic surgeon was doing a trauma related operation at a center with one or two orthopedic surgeons on call. The probability that a patient cannot be seen promptly by one orthopedic surgeon in a center doing 25, 50, 75, 100, 200, and 300 emergency procedures per year is 0.17, 0.74, 1.6, 3.1, 12.5, and 28 patients per year. When two are on call, 1.3 patients, yearly, will wait more than 30 minutes in a center doing 300 emergency procedures. Thus, mandatory orthopedic backup call for a trauma center performing fewer than 100 emergent trauma procedures within 24 hours is unwarranted.

Computer Simulation↗
PubMed1998

Autologous closure of giant abdominal wall defects.

Split-thickness skin graft coverage of exposed and granulating intestines within large abdominal wall defects provides a life-saving permanent biologic dressing. The resultant abdominal wall defect often is closed with mesh, which may infect and fistulize. This report describes bilateral advancement flaps of the external oblique and recti muscles in 11 patients treated over 3 years. The defects, which averaged 16 x 24 cm, were due to necrotizing fasciitis subsequent to trauma with bowel perforation (3 patients), multiple ventral herniorrhaphies (2 patients), perforated diverticulitis (4 patients), and perforated peptic ulcer (2 patients). Eight patients were initially treated elsewhere where closure was achieved by split-thickness skin graft in five patients or mesh in 3 patients; 3 developed enterocutaneous fistulae and were transferred for closure while receiving long-term antibiotic and total parenteral nutrition therapy. All 11 patients had successful primary closure. The 8 patients operated on electively had primary healing; 2 developed seromas. Two of the three patients operated on urgently developed superficial wound infections; both healed by second intent without compromise of the primary closure. The following conclusions can be drawn: (1) the linea alba survives despite necrotizing fasciitis, (2) a tension-free primary closure is feasible; (3) morbidity is minimal, and (4) the long-term result is excellent.

Fasciitis, Necrotizing↗
PubMed1997

Bleeding esophageal ulcers caused by NSAIDs.

This report describes four patients with NSAID-induced esophageal ulcers documented by endoscopy. The cause of injury was ibuprofen alone in two patients, aspirin in one patient, and a combination of aspirin and ibuprofen in one patient. The most common findings were anemia, retrosternal pain, and dysphagia. Three patients had bleeding esophageal ulcers requiring blood transfusions. One patient had massive bleeding which was controlled by endoscopic hemostasis. Three patients were followed up by endoscopy, which showed healing in 3-4 weeks. These NSAID-induced ulcers had characteristic endoscopic features, namely, a large, shallow, discrete ulcer in the midesophagus near the aortic arch with normal surrounding mucosa. These findings suggest that the injury resulted from mucosal contact with NSAIDs. A precise history and immediate endoscopic examination were most important in establishing the diagnosis of esophageal ulcer. Healing occurs if drug-induced injury is recognized early and treatment is appropriately started with antacids and H2 blockade. Offending medication should be discontinued and patients should be counseled to take pills in an upright posture with liberal amounts of fluids well before retiring for the night.

Adolescent↗