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Biomedical subjects

D L Nahrwold

Publications and source records attributed to D L Nahrwold.

At least 19 recordsLinked to original sources
PubMed1992

Computed tomography in the initial evaluation of patients with blunt trauma.

Two hundred sixty-six of 374 consecutive blunt trauma patients underwent emergency computed tomographic (CT) scanning during evaluation at a level I trauma center. The purpose of this study was to develop guidelines for use of CT scanning in the initial evaluation of blunt trauma patients. Of the 131 CT scans of the head obtained, 20 (15%) had positive results. Seven patients whose initial neurologic examinations were normal had abnormal results on head CT scans; none required emergent treatment of their head injury. This suggests that, in the presence of a normal neurologic examination, head CT scans can safely be delayed until other more serious injuries are addressed. Twenty-six CT scans of the chest were performed and ten (38%) were interpreted as abnormal. Chest CT scans provided information about the extent of the injury but did not alter the initial management of any patient and therefore are rarely indicated in the acute evaluation of trauma patients. A total of 110 abdominopelvic CT scans were performed and 20 (19%) were interpreted as positive. Seventy-five percent of those patients with positive CT scans were treated successfully in a nonsurgical fashion.

Chicago↗
PubMed1992

Treatment of peripancreatic fluid collections in patients with complicated acute pancreatitis.

We reviewed an experience with treatment of peripancreatic fluid collections in patients with complicated acute pancreatitis to identify clinical and computed tomography (CT) parameters that are helpful in the selection of patients for treatment and to assess treatment outcome. The extent of CT abnormalities determined a CT severity score (mild = 1, severe = 4). From 1985 to 1990, 650 patients were hospitalized with acute pancreatitis; a peripancreatic fluid collection was found in 36 patients (5.5 percent). Ten of 11 patients with successful outcome after no invasive treatment (group 1) had a low CT severity score of 1 or 2; mean serum albumin was 4.0 gram percent. Of 25 patients who had some form of drainage, 12 had a high CT severity score of 3 or 4 (p < 0.05) and a mean serum albumin of 3.4 grams percent (p < 0.05). Nine patients had only operative drainage (group 2) and 16 had CT-directed percutaneous catheter drainage (group 3). In group 3, percutaneous catheter drainage successfully drained the fluid collection in six patients, while ten patients needed an operation, in addition to percutaneous drainage, to effectively débride and drain the necrotizing pancreatic problem. As a result of the current review, we propose an algorithm for treatment of these patients.

Acute Disease↗
PubMed1992

Acute cholangitis.

Explore the source record for details and available documents.

Acute Disease↗
PubMed1991

Acute diverticulitis. A complicated problem in the immunocompromised patient.

We reviewed the records of 209 patients with acute diverticulitis treated from 1984 through 1989 to determine if immunocompromised patients have a worse prognosis than nonimmunocompromised patients. Forty immunocompromised patients and 169 nonimmunocompromised patients with acute diverticulitis were identified. Free perforation into the peritoneal cavity occurred in 43% (17/40) of immunocompromised patients and 14% (24/169) of nonimmunocompromised patients. Operations were performed in 58% (23/40) of immunocompromised patients and 33% (55/169) of nonimmunocompromised patients. Postoperative morbidity was 65% (15/23) in immunocompromised patients and 24% (13/55) in nonimmunocompromised patients; postoperative mortality was 39% (9/23) and 2% (1/55), respectively. We conclude that acute diverticulitis in the immunocompromised patient is a complicated problem; there is a greater risk of free perforation and need for surgery than in the nonimmunocompromised patient. Furthermore, the prognosis for immunocompromised patients who undergo surgery is worse than that for nonimmunocompromised patients.

Acute Disease↗
PubMed1990

Gastrointestinal lymphoma. A case for primary surgical resection.

The cases of 42 consecutive patients with primary gastrointestinal lymphoma were reviewed to compare the risks and outcomes of different primary treatment modalities. Among patients with localized disease (stages I and II), 12 underwent complete tumor resection and 6 underwent radiation therapy; 5-year survival was 82% and 50%, respectively. Among patients with disseminated disease (stages III and IV), 6 underwent resection of the primary tumor followed by chemotherapy and 18 were treated with radiation and chemotherapy; 5-year survival was 81% and 6%, respectively. Five patients who did not undergo surgical resection before radiation therapy or chemotherapy developed severe life-threatening complications from their primary tumor. Surgical resection before the administration of other therapy should be performed when the patient is considered to be a surgical candidate and resection of the primary tumor is deemed feasible.

Adolescent↗
PubMed1990

The effect of volume and number on fragmentation of gallstones by lithotripsy.

Several factors may affect the fragmentation of gallstones by lithotripsy. We hypothesized that stone volume is an important determinant of degree of fragmentation, while number of stones is less important. The volume of 30 single stones was measured in vitro by water immersion. Thirty sets of multiple stones were matched with single stones of similar volumes. The stones were subjected to 750 shock waves (18 kV) with the Dornier MPL 9000 lithotripter. Degree of fragmentation was assessed by passing fragments through sieves of 1, 2, and 4 mm and recording percentage of stone weight which passed through each sieve. The mean percentage of stone weight passing through sieves of 1, 2, and 4 mm for single stones was 38.2, 49.4, and 59.8. The corresponding values for multiple stones were 46.4, 61.3, and 75.4. These values were not significantly different at P less than or equal to 0.05. Thus, there was no significant difference in fragmentation between single and multiple stones when their volumes were similar. The mean volume of stones with 100% of fragments less than 4 mm (0.80 +/- 0.05 cc) was significantly less than that of stones with fragments greater than 4 mm (1.95 +/- 0.14 cc) (P less than 0.0001). There was a significant inverse linear correlation between stone volume and degree of fragmentation (r = -0.65). We conclude that stone volume is an important determinant of degree of fragmentation and may be the most important criterion in selecting patients for lithotripsy. In this in vitro setting, stone number alone had no effect on degree of stone fragmentation.

Calcinosis↗
PubMed1990

Extracorporeal shock wave lithotripsy for biliary stones.

Extracorporeal shock wave lithotripsy is a noninvasive technique for treatment of patients with gallbladder and bile duct stones. Selected patients with gallbladder stones can be treated on an outpatient basis without general anesthesia and may return to full activity within 1 or 2 days. Stone-free rates of 40% to 60% at 6 months have been achieved in most reported series with minimal morbidity. Bile duct stone lithotripsy has achieved stone clearance in 80% of patients in whom conventional methods were unsuccessful and therefore constitutes a valuable second-line treatment for these patients.

Bile Duct Diseases↗
PubMed1990

Cholecystokinin antagonist prevents hyperamylasemia and improves pancreatic exocrine function in cerulein-induced acute pancreatitis.

Supramaximal cerulein administration induces acute pancreatitis, which markedly impairs pancreatic secretion in conscious rats. We hypothesized that pretreatment with the potent cholecystokinin antagonist, L-364,718, improves the pancreatic secretory impairment associated with cerulein-induced acute pancreatitis. Rats were surgically prepared with gastric, duodenal, bile, and pancreatic fistulas and jugular vein catheters. On postoperative day 4, groups of rats were administered (a) L-364,718 1 mg/kg intraduodenally, (b) cerulein 5 micrograms/kg/h for 6 h intravenously, (c) L-364,718 1 mg/kg intraduodenally followed by cerulein 5 micrograms/kg/h for 6 h intravenously, and (d) safflower oil carrier intraduodenally. On postoperative day 5, we studied cholecystokinin (CCK)-stimulated pancreatic secretion. Plasma amylase was measured at the time of surgery and at the conclusion of experiments on postoperative days 4 and 5. The duodenally administered CCK antagonist had no effect, 24 h later, on CCK-evoked protein secretion and prevented the pancreatic exocrine impairment and hyperamylasemia caused by supramaximal cerulein administration. These observations suggest that cerulein-induced acute pancreatitis is mediated by a CCK-receptor mechanism.

Acute Disease↗
PubMed1990

Acute edematous pancreatitis impairs pancreatic secretion in rats.

There are few observations of in vivo pancreatic secretory changes that accompany acute pancreatitis. We hypothesized that acute pancreatitis impairs pancreatic exocrine function. We developed a conscious-rat experimental preparation with gastric, duodenal, bile, and pancreatic fistulas. We studied cholecystokinin-stimulated pancreatic secretion in conscious rats before and after inducing acute pancreatitis with supramaximal administration of caerulein--5 micrograms/kg/hr intravenously for 6 hours. Marked hyperamylasemia developed in all rats immediately after administration of caerulein. Basal and cholecystokinin-stimulated pancreatic juice flow and protein (enzyme) secretion decreased significantly 24 hours after acute pancreatitis was induced even though plasma amylase returned to basal levels. We conclude that acute pancreatitis markedly impairs pancreatic secretion.

Acute Disease↗
PubMed1990

Rates of morbidity and mortality after closure of loop and end colostomy.

The purported ease and safety of closure of loop colostomy are cited as reasons for avoiding end colostomy, with or without resection. However, data comparing the complications of loop colostomy closure and end colostomy takedown and anastomosis are sparse. We analyzed data from 93 consecutive colostomy closures, of which 62 were loop and 31 were end colostomies. The two groups were comparable with respect to age, the underlying disease and risk factors, such as coronary artery disease, diabetes, hypertension, steroid dependence, hypoalbuminemia and smoking. Closure of end colostomies took longer and was associated with more loss of blood than closure of loop colostomies. However, the mortality rates for closure of loop (4.8 per cent) and end (3.2 per cent) colostomies were not significantly different. The complication rates were identical (16 per cent). Although none of the other risk factors were associated with increased rates of mortality or morbidity, the detrimental effects of steroid dependence and preoperative hypoalbuminemia were striking. All four of the deaths and 60 per cent of the complications occurred in patients with steroid dependence or hypoalbuminemia, or both. The rates of wound infection after primary or secondary closure of the stoma site were not significantly different. We concluded that loop colostomy closure is not associated with fewer complications than closure of end colostomy, even though the latter takes longer and is more difficult. Hypoalbuminemic and steroid-dependent patients should undergo colostomy closure with caution, if at all. Primary closure of the stomal site is safe and reduces the length of hospital stay.

Adrenal Cortex Hormones↗
PubMed1979

Absorption of 2-acetylaminofluorene in the guinea-pig colon.

Absorption of the known chemical carcinogen, 2-acetylaminofluorene has been measured in the colon of guinea pigs. Unidirectional influx across the luminal cell membrane was determined in vitro, and transmural absorption across colonic mucosa was evaluated in vivo. The kinetics of unidirectional influx into colon in vitro do not indicate that absorption proceeds by simple diffusion. The observed saturable uptake is indicative of binding of 2-acetylaminofluorene to a cellular component. With 2-acetylaminofluorene present in the lumen in vivo at an initial concentration of 3.5 microM, the rate of absorption decreases over a 20 min period, which also indicates some form of specific interaction between 2-acetylaminofluorene and the intestinal mucosa. We have evaluated the hypothesis that surfactants and a bile salt act as cocarcinogens by increasing the rate of intestinal absorption of 2-acetylaminofluorene. The results lend no support to this possibility.

2-Acetylaminofluorene↗
PubMed1978

Folic acid transport by mammalian small intestine.

The unidirectional influx of folic acid across the mucosal border of hamster duodenum and rat jejunum was determined. Influx follows saturation kinetics, is sodium-dependent, and is inhibited by methotrexate and is sodium-dependent, and is inhbited by methotrexate and folinic acid in the mucosal bathing solution. In hamster duodenum, the maximal influx is 1.2 nmol/(cm2.h), and the folic acid concentration required to give a half maximal influx (Km) is 7.2 micron.. At mucosal folic acid concentration of 1.5 micron, influx is reduced at least 65% by removal of sodium from the bathing solution. The influx process is significantly inhibited by cyanide and 2,4-dinitrophenol. The possibility was evaluated that the acidic microclimate at the brush border regulates the rate of folic acid transport and that inhibition of transmural transport by sodium-free media, ouabain, and methotrexate is brought about indirectly by an increase in pH of the microclimate. The data favor the alternative concept of a sodium-dependent carrier mechanism for entry of folic acid into the cells. The information presented is consistent with active transport of folic acid by a sodium-gradient mechanism, but additional information will be necessary to substantiate such a model.

Animals↗
PubMed1978

Intestinal ascorbic acid transport following diets of high or low ascorbic acid content.

Active transport of ascorbic acid in ileum is mediated by a carrier mechanism at the brush border membrane. This mechanism may show compensatory changes in activity in response to alterations of dietary ascorbic acid content. The unidirectional influx of ascorbic acid across the brush border into epithelial cells of guinea pig ileum was determined in vitro. Influx was significantly reduced in scorbutic animals and following 14 or 28 days of high doses (5 or 25 times normal) of ascorbic acid. The transport rate was reduced by intramuscular administration of ascorbic acid, suggesting that the transport mechanism may respond to circulating levels of the vitamin.

Animals↗