Biomedical subjects
C W Wagner
Publications and source records attributed to C W Wagner.
Reduced synthesis of basement membrane heparan sulfate proteoglycan in streptozotocin-induced diabetic mice.
In diabetes, certain basement membranes become thicker yet more porous than normal. To identify possible changes in the basement membrane, we have grown the Engelbreth-Holm-Swarm tumor, a tissue that produces quantities of basement membrane in normal mice and in streptozotocin-treated, insulin-deficient, diabetic mice. The level of laminin, a basement membrane-specific glycoprotein, and the level of total protein were slightly elevated in the diabetic tissue. In contrast, the level of the basement membrane specific heparan sulfate proteoglycan was only 20% of control. The synthesis of this proteoglycan was also reduced in the diabetic animals, while the synthesis of other proteoglycans by tissues such as cartilage was normal. The synthesis of the heparan sulfate proteoglycan in diabetic animals was inversely related to plasma glucose levels showing an abrupt decrease above the normal range of plasma glucose. Insulin restored synthesis to normal but this required doses of insulin that maintained plasma glucose at normal levels for several hours. Since the heparan sulfate proteoglycan in the basement membrane restricts passage of proteins, its absence could account for the increased porosity of basement membrane in diabetes. A compensatory synthesis of other components could lead to their increased deposition and the accumulation of basement membrane in diabetes.
Congestive heart failure and absent femoral pulses in newborns without coarctation of the aorta.
Two infants with thrombosis of the abdominal aorta are discussed. In each case the presentation was indistinguishable from that in coarctation of the aorta, with heart failure and absent femoral pulses. Surgery in one infant successfully relieved the obstruction. The diagnosis may not be suspected from the history. Aggressive management is indicated.
Barium appendicitis.
We report a case of acute appendicitis with perforation associated with retained appendiceal barium. Abnormally retained barium may lead to appendicitis and this should be kept in mind when a barium-filled appendix is seen in an asymptomatic patient. Routine follow-up films on all patients whose appendix fills with barium are not recommended.
Use of preoperative chemotherapy and radiation therapy in patients with Wilm's tumors.
Four patients underwent preoperative chemotherapy and radiotherapy for Wilm's tumor, and three were without pathological diagnosis. Three of the four are currently free of disease. Patients with massive abdominal tumors and with the clinical and radiological characteristics of Wilm's tumor should receive preoperative chemotherapy and radiation. This treatment plan should provide the best chance of resectability and will, it is hopes, improve the chance of survival in these children.
Gastroschisis.
Twenty-five newborn infants were treated for gastroschisis between 1971 and 1979 at the Eugene Talmadge Memorial Hospital. Primary closure of the defect was accomplished in 17 patients and eight required staged procedures with Silon. The overall mortality rate was 32 per cent. The major causes of death were related to the status of the bowel at the initial procedure as well as weight and body temperature on admission. Respiratory function was not influenced by the type of repair. Since gut dysfunction in the postoperative period is likely to be prolonged, total parenteral nutrition continues to play a major role in survival.
The use of intravenous hydrochloric acid in the treatment of thirty-four patients with metabolic alkalosis.
Since 1972, 34 patients with refractory metabolic alkalosis have been treated with intravenous hydrochloric acid at the teaching hospitals of the Medical College of Georgia. Intravenous hydrochloric acid lacks some of the problems associated with alternative methods of therapy. The acid must always be given through a central vein, and its effects should be monitored closely. The use of intravenous hydrochloric acid is a safe, effective way of preventing the deleterious effcts of severe metabolic alkalosis.
Treatment of metabolic alkalosis with intravenous hydrochloric acid.
Severe alkalosis requires aggressive treatment. Twenty patients at the Talmadge Memorial Hospital have been treated for metabolic alkalosis by infusion of dilute hydrochloric acid through a central venous line. The treatment was effective and there were no major complications. Intravenous hydrochloric acid is preferred to other modes of therapy for refractory alkalosis, especially in the presence of hepatic or renal failure.
Grand rounds at Brooke. Pulmonary embolism: enigma unmasked.
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T-3 resin uptake test using ice-water incubation.
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Congenital familial atrioventricular dissociation. Report of three siblings.
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Unusual renal calcification following acute bilateral renal cortical necrosis. A case report.
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Prenatal diagnosis of complicated abdominal wall defects.
The accurate prenatal diagnosis of anterior abdominal wall defects is important because it affects patient management and prognosis. The pathophysiology of each defect leads to key characteristics that make it possible to differentiate one entity from another. Among these features are the location of the defect in relation to cord insertion, the size and contents of the defect, and the associated anomalies. This article reviews the underlying defects, the characteristic ultrasound findings, the associated anomalies, and the prognosis of simple and complicated abdominal wall defects. The basic features of simple abdominal wall defects (i.e., omphalocele and gastroschisis) were used as the initial points of assessment. A comparison of the different features of these abnormalities and how they differ from one another resulted in the development of criteria that facilitated the understanding of the different ultrasound manifestations of these anomalies.