Biomedical subjects

Charles Bakhos

Publications and source records attributed to Charles Bakhos.

5 recordsLinked to original sources

PubMed2006

Role of purinergic cotransmission in the sympathetic control of arterial pressure variability in conscious rats.

Previous studies have shown that the sympathetically mediated oscillations of arterial pressure (AP), the so-called Mayer waves, are shifted from 0.4 to 0.6 Hz after acute alpha-adrenoceptor blockade in conscious rats. This raises the possibility that, under physiological conditions, Mayer waves are mediated by the conjoint action of norepinephrine and other sympathetic cotransmitters. To evaluate the possible role of the cotransmitter ATP in determining the frequency of Mayer waves, AP and renal sympathetic nerve activity (RSNA) were simultaneously recorded in 10 conscious rats with cardiac autonomic blockade before and after acute blockade of P2 receptors with pyridoxal phosphate-6-azophenyl-2',4'-disulfonic acid. P2 receptor blockade did not alter the mean level and overall variability of AP and RSNA but shifted peak coherence between AP and RSNA from 0.43 +/- 0.02 to 0.22 +/- 0.01 Hz. A model of the sympathetic limb of the arterial baroreceptor reflex was designed to simulate Mayer waves at 0.2 and 0.6 Hz, with norepinephrine and ATP, respectively, acting as the sole sympathetic cotransmitter. When both cotransmitters acted in concert, a single oscillation was observed at 0.4 Hz when the gain ratio of the adrenergic to the purinergic components was set at 15. The model thus accounted for an important role for ATP in determining Mayer wave frequency, but not in sustaining the mean level of AP or controlling its overall variability.

Adrenergic Fibers↗

PubMed2006

Effects of delaying appendectomy for acute appendicitis for 12 to 24 hours.

OBJECTIVE: To determine whether delaying appendectomy for 12 hours to avoid disturbing the operating room schedule and to minimize the number of operations during the night negatively affects the outcome of patients with acute appendicitis. DESIGN: Retrospective study. SETTING: Large teaching community hospital. PATIENTS: The medical records of 380 patients who underwent appendectomies between January 1, 2002, and December 31, 2004, were reviewed. Patients proven to have an inflamed appendix on the pathological report were divided into 2 groups. The early group comprised patients who had undergone appendectomies within 12 hours of presentation to the emergency department, including patients with generalized sepsis. The late group comprised patients who had undergone appendectomies more than 12 to 24 hours after presentation. MAIN OUTCOME MEASURES: Length of stay, operative time, and the rate of perforations and complications. INTERVENTIONS: Laparoscopic or open appendectomies. RESULTS: There were 309 patients included in our study. There were no statistically significant differences between the early and late groups in the length of stay, operative time, the percentage of advanced appendicitis, or the rate of complications. CONCLUSIONS: In selected patients, delaying appendectomies for acute appendicitis for 12 to 24 hours after presentation does not significantly increase the rate of perforations, operative time, or length of stay. It decreases the use of the nursing staff, anesthesia team, and surgical house staff during the night shifts, and it decreases the interruption of the regular operating room schedule.

Acute Disease↗

PubMed2006

Vital capacity as a predictor of outcome in elderly patients with rib fractures.

BACKGROUND: This study tests the relationships between early bedside vital capacity (VC) measurement and morbidity, mortality, and resource consumption in geriatric blunt chest trauma patients with rib fractures. METHODS: This was a retrospective study examining all patients > or = 65 years old with rib fractures who had a VC measured within 48 hours of their emergency department evaluation. Outcome variables included pulmonary complications, death from pulmonary complications, hospital length of stay (LOS), intensive care unit length of stay (ICU LOS), and discharge disposition. RESULTS: Thirty-eight patients met the study criteria. The mean age was 80.2 (+/-7.4) years, the mean number of rib fractures was 3.6 (+/-1.6), and the mean ISS was 6.9 (+/-4.7). VC and the percentage of the predicted vital capacity (pVC) were both inversely correlated with LOS (p = 0.0076 and p = 0.0172, respectively). Linear regression analysis suggested that patients with a VC < 1.4 L or < 55% of their pVC had a LOS > 3 days. Mean VC was 36% higher in patients who were discharged home versus those discharged to an extended care facility (ECF; p = 0.025). There was a trend toward significance when comparing VC to ICU LOS (p = 0.079), but none in predicting pulmonary complications (p = 0.3299). No correlations between VC and mortality can be drawn given the single death in the cohort. CONCLUSIONS: Bedside VC is a simple measurement which could predict LOS in elderly patients with rib fractures and may identify those patients requiring ECF upon discharge. Further prospective study may highlight the utility of emergency room VC in determining the disposition of these patients.

Aged↗

PubMed2005

Ruptured giant colonic diverticulum.

Giant colonic diverticulum (GCD) is a rare complication of diverticular disease with less than 150 cases reported in the English literature. The clinical presentation ranges from asymptomatic to that of an acute abdomen. In most cases, giant colonic diverticulum is found in the sigmoid colon. The ideal treatment is elective resection of the sigmoid colon with primary anastomosis. When the diverticulum presents with perforation or obstruction, however, the treatment is a sigmoid colectomy with diverting colostomy (Hartmann procedure).

Aged↗

PubMedDate not supplied

Clinical pulmonary embolus after gastric bypass surgery.

BACKGROUND: Pulmonary embolus (PE) is one of the most common causes of death for patients undergoing gastric bypass surgery. The risk of developing PE has been associated with increased age, greater body mass index (BMI), and chronic venous stasis disease. METHODS: Between 1998 and 2003, 1225 patients underwent open Roux-en-Y gastric bypass (RYGBP) surgery (258 men and 967 women) for the treatment of morbid obesity and its related disorders. The medical records for morbidly obese patients diagnosed with PE after RYGBP were identified. The presenting signs and symptoms were reviewed, and the known risk factors were analyzed. We compared the age and BMI of these patients with those of a randomly selected RYGBP control group. The Mann-Whitney U test was used to analyze the statistical significance of the results. RESULTS: During the study period, 11 patients were diagnosed with PE (0.9%). Six patients were men and five were women, for a gender-specific incidence of PE of 2.3% in men and 0.5% in women. The average BMI was 62.5 kg/m(2) in the men and 59.1 kg/m(2) in the women, much greater than in the control group (men 53 kg/m(2) and women 52 kg/m(2); P <0.005 and P <0.05, respectively). All male patients were super-obese (BMI >50 kg/m(2)). The total number of super-obese patients undergoing RYGBP during the study period was 147, for an incidence of PE in super-obese men of 4%. Nine of the 11 patients developed PE after discharge from the hospital within an average of 10 days. CONCLUSION: The super-obese male patient is at a much greater risk of developing PE than other RYGBP patients (relative risk 4.4). The risk extends to several weeks after discharge. Therefore, extending PE prophylaxis to several weeks after surgery may be warranted.

Adult↗