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Biomedical subjects

D L Steed

Publications and source records attributed to D L Steed.

17 recordsLinked to original sources
PubMed1992

Changing etiology of iliopsoas abscess.

Over a 5-year period, iliopsoas abscesses were found in 11 patients. Although the most common underlying condition was Crohn's disease (3 of 11 patients), 5 abscesses resulted from hematogenous spread from a distant site. Each of these five patients was elderly, severely malnourished, or had an underlying chronic disease. Fever was a presenting sign in 8 of 11 patients, whereas all 4 patients who presented with back pain had nontuberculous lumbar osteomyelitis or disk space infections. No patient presented with the classic triad of fever, back pain, and anterior thigh or groin pain. Computed tomographic (CT) scans accurately established the clinical diagnosis in 10 of 11 patients. Two of the patients died. One patient was an intravenous drug abuser, whereas the other patient was being treated with steroids for systemic lupus erythematosus. Elderly patients, diabetics, and patients with chronic disease are susceptible to this kind of occult infection and may present with minimal clinical findings. Aggressive diagnosis using CT scanning and treatment with resection of involved bowel, complete drainage of the abscess, and prolonged antibiotics are required to salvage these patients.

Abscess↗
PubMed1992

Randomized prospective double-blind trial in healing chronic diabetic foot ulcers. CT-102 activated platelet supernatant, topical versus placebo.

OBJECTIVE: To assess the efficacy of topically applied CT-102 APST for treating diabetic neurotrophic foot ulcers. RESEARCH DESIGN AND METHODS: Thirteen patients entered a randomized, double-blind trial of topically applied CT-102 APST vs. placebo (normal saline) gauze dressings for the treatment of nonhealing diabetic neurotrophic foot ulcers. CT-102 APST (Curative Technologies, Setauket, NY) was prepared from homologous platelets and contained multiple growth factors including PDGF, PDAF, EGF, PF-4, TGF-beta, aFGF, and bFGF. Inclusion criteria for subjects included diabetes, ulcer of > 8 wk duration, peri-wound transcutaneous oxygen tension > 30 mmHg, platelet count > 100,000/mm3, and no wound infection. Wounds were excised before entry and were > 700 mm3 but < 50,000 mm3 in volume, < 100 cm2 in area, and involved subcutaneous tissue. RESULTS: In the CT-102 group, 5 of 7 ulcers were healed (100% epithelialized) by 15 wk, but only 1 of 6 ulcers was healed by 20 wk with placebo (P < 0.05). Average percent reduction in ulcer area at 20 wk was 94% for CT-102 vs. 73% for placebo. Daily reduction in ulcer volume was 73.8 +/- 42.4 mm3/day (mean +/- SE) for CT-102 vs. 21.8 +/- 8.1 mm3/day for placebo (P < 0.05). Daily reduction in ulcer area was 6.2 +/- 1.8 mm2/day for CT-102 vs. 1.8 +/- 0.4 mm2/day for placebo (P < 0.05). CONCLUSIONS: CT-102 significantly accelerated wound closure in diabetic leg ulcers when administered as part of a comprehensive program for the healing of chronic ulcers.

Chronic Disease↗
PubMed1991

Collagen stability and collagenolytic activity in the normal and aneurysmal human abdominal aorta.

Two issues were addressed in this study. The first was whether a bona fide collagenase exists within the wall of the aorta. The second was whether the activity of this putative collagenase is greater in aneurysmal tissue. No collagenase could be extracted from the wall of the aorta under nondenaturing conditions. However, hydroxyproline was liberated from tissue samples allowed to autolyze at neutral pH under reaction conditions favoring the activity of collagenase. Such an activity was probably enzymic as it occurred in a time- and temperature-dependent fashion and was suppressed by chelators. In normal and stenotic tissue, activity was increased by adding aminophenylmercuric acetate, an activator of latent collagenase. Examination of the blanks revealed that the collagen of aneurysmal aorta was more soluble than normal. Furthermore, its digestion kinetics differed in a way that suggested that aneurysmal aorta possessed a labile component that was absent from normal tissue. Although the activity of the putative aortic collagenase was higher than normal in the aneurysmal tissue, our assays do not distinguish between changes in the amount or activity of the enzyme and alterations in the collagen.

Adult↗
PubMed1991

Inducible synthesis of collagenase and other neutral metalloproteinases by cells of aortic origin.

In view of the possible link between collagenase and the formation of aortic aneurysms we have determined whether cells within the aorta are able to synthesize this enzyme. Explanted cells obtained from fragments of lapine abdominal aorta secreted little or no collagenase. Two related metalloproteinases, gelatinase and stromelysin, were also produced at very low levels. Treatment with purified human monocyte interleukin-1 beta, partially purified lapine, synovial IL-1 or phorbol myristate acetate strongly induced the synthesis of all these enzymes. These activators also increased synthesis of prostaglandin E2. The identity of collagenase was confirmed by detection of the characteristic TCA and TCB breakdown fragments of collagen and by demonstration of collagenase mRNA within activated aortic cells. Unactivated aortic cells contained no detectable collagenase mRNA, suggesting a pretranslational level of regulation. Aortic cells thus possess the ability to express several neutral metalloproteinases and, if a sufficient inflammatory stimulus was present, they might do so in arteries undergoing aneurysmal degeneration.

Animals↗
PubMed1991

Revascularization of an ischemic limb by use of a muscle pedicle flap: a rabbit model.

A rabbit model of hind limb ischemia was designed to demonstrate that new, hemodynamically significant arterial connections will develop between ischemic skeletal muscle and an independently perfused muscle pedicle flap. The right common iliac artery was divided in 15 rabbits. In eight rabbits a muscle flap based on the left deep inferior epigastric artery was transposed to the right thigh (flap group). In seven rabbits a sham operation was performed where the flap was sutured to the abdominal wall (sham group). After 7 days angiography demonstrated arterial connections between the flap and the native limb circulation in all of the flap group animals. The flap increased muscle perfusion in the ischemic limb (2.99 ml/100 gm muscle/minute in the flap group, vs 2.06 ml/100 gm muscle/minute in the sham group, p less than 0.005). Hemodynamically significant vascular connections will develop between a well-perfused muscle flap and an ischemic limb. The augmentation in perfusion provided by these connections can be quantified.

Animals↗
PubMed1979

Iatrogenic myocardial edema with potassium cardioplegia.

Postischemic myocardial edema depresses left ventricular function and coronary perfusion. Pharmacologic cardioplegia is being used increasingly to enhance myocardial protection during cardiac operations. In the present study we varied the colloid osmotic and osmotic pressures and the infusion pressures of four cardioplegic solutions to determine their respective roles in producing or preventing myocardial edema in a nonischemic setting. We found that myocardial edema during potassium cardioplegia (1) is independent of infusion pressures, (2) is caused by isosmotic crystalloid solutions, (3) is worsened by hyposmolar crystalloid solutions, (4) is avoided by the addition of colloid, and (5) is avoided if the solution is made hyperosmotic with the addition of mannitol.

Animals↗
PubMed1978

Osteoma cutis: cutaneous ossification with oral manifestations.

Subcutaneous and mucosal calcifications are rare lesions which present problems in diagnosis. A large bony mass is presented, with dermal and mucosal findings. The literature is reviewed on this non-neoplastic bony lesion and differential diagnosis is discussed.

Adolescent↗
PubMed1978

Effects of pulsatile assistance and nonpulsatile flow on subendocardial perfusion during cardiopulmonary bypass.

We compared the effects of pulsatile and nonpulsatile perfusion in 12 dogs on extracorporeal circulation. In beating empty and fibrillating hearts at 37 degrees and 28 degrees C, coronary blood flow was measured by flowmeter and microspheres at diastolic pressures ranging between 50 and 130 mm Hg. At fixed systemic flow rates (range, 600 to 2,400 ml/min), pulsatile perfusion produced a transient (3 to 4 second) augmentation of diastolic pressure and then resulted in the following: (1) decreased peripheral vascular resistance (p less than 0.05); (2) unchanged peak diastolic pressure (compared with nonpulsatile perfusion); (3) decreased mean aortic pressure (6 to 37%) (p less than 0.05); (4) decreased coronary blood flow (10 to 45%) (p less than 0.05); and (5) decreased subendocardial blood flow (from 512 to 438 ml/100 gm/min) (p less than 0.05). Pulsatile perfusion in beating hearts (37 degrees or 28 degrees C) did not reduce subendocardial vascular resistance, but did improve subendocardial perfusion by 27% and 36% in fibrillating hearts at 37 degrees and 28 degrees C, respectively. We conclude that with the exception of ventricular fibrillation, pulsatile assistance offers no advantage over nonpulsatile perfusion and has the potential disadvantage of requiring higher pump flow rates to achieve any desired level of coronary and subendocardial flow.

Animals↗
PubMed1978

Hyperbaric oxygen in the adjunctive treatment of chronic osteomyelitis of the mandible: report of case.

A case of chronic osteomyelitis has been presented to show the effectiveness of hyperbaric oxygen in treatment of this disease. Surgical intervention is needed, as are adequate cultures, even though the cultures may be difficult to obtain and identify. Because the antibiotic therapy may need to be changed during the course of the disease, the selection of antibiotics should be dictated by positive cultures as well as the clinical course. Antibiotic therapy is needed for four to six weeks after abatement of symptoms.

Child↗