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Biomedical subjects

D S Wagner

Publications and source records attributed to D S Wagner.

32 records · Page 2Linked to original sources
PubMed1995

Reduction mammaplasty: an outcome analysis.

Reduction mammaplasty is usually performed to relieve painful symptoms and physical signs of macromastia. Justification for reduction mammaplasty should be based on the probability of relieving these clinical signs and symptoms. This retrospective study involved four surgeons who performed a variety of breast reduction procedures and was designed to determine if preoperative symptoms were resolved after reduction mammaplasty. We surveyed 285 women who had reduction mammaplasties from 1988 to 1993. Data from these surveys and the patients' charts were reviewed. A total of 185 patients (65%) returned completed surveys and were included in this study for analysis. Mean age was 40 years with an average follow-up of 3 years. The most common preoperative complaint was shoulder grooving (90%), followed by back pain (82%), shoulder pain (78%), and neck pain (65%). Average amount of breast tissue removed was 855 gm from each breast. Preoperative complaints were substantially reduced after surgery, regardless of the presurgical body mass. Most patients (97%) had improvement of symptoms, and 59% were asymptomatic. Only 3% had no change in their symptoms and none were worse. The complication rate was 45% with fat necrosis/infection being the most common complication (22%). The majority of patients (95%) were either happy or very happy with the surgery, and 98% would recommend surgery to a friend. Our data indicate that reduction mammaplasty relieves preoperative symptoms associated with macromastia.

Adolescent↗
PubMed1994

Conformation of cytochrome c studied by deuterium exchange-electrospray ionization mass spectrometry.

Deuterium exchange of bovine cytochrome c has been monitored by electrospray ionization mass spectrometry. Different charge-state distributions in the mass spectrum appear to represent different protein conformations, but rapid interconversion of the conformations can lead to a coincidence of the deuterium exchange rates. When interconversion is blocked, the conformation corresponding to higher m/z (lower charge) exchanges more slowly, indicating a tightly folded state. Furthermore, the data suggest that at least two conformations can have identical charge-state distributions, but have different exchange rates. Thus, neither charge-state distribution nor deuterium exchange rate alone is a sufficient indicator of protein conformation.

Animals↗
PubMed1994

Deuterium exchange of alpha-helices and beta-sheets as monitored by electrospray ionization mass spectrometry.

Deuterium exchange was monitored by electrospray ionization mass spectrometry (ESI-MS) to study the slowly exchanging (hydrogen bonded) peptide hydrogens of several alpha-helical peptides and beta-sheet proteins. Polypeptides were synthetically engineered to have mainly disordered, alpha-helical, or beta-sheet structure. For 3 isomeric 31-residue alpha-helical peptides, the number of slowly exchanging hydrogens as measured by ESI-MS in 50% CF3CD2OD (pD 9.5) provided estimates of their alpha-helicities (26%, 40%, 94%) that agreed well with the values (17%, 34%, 98%) measured by circular dichroic spectroscopy in the same nondeuterated solvent. For 3 betabellins containing a pair of beta-sheets and a related disordered peptide, their order of structural stability (12D > 12S > 14D > 14S) shown by their deuterium exchange rates in 10% CD3OD/0.5% CD3CO2D (pD 3.8) as measured by ESI-MS was the same as their order of structural stability to unfolding with increasing temperature or guanidinium chloride concentration as measured by circular dichroic spectroscopy in water. Compared to monitoring deuterium exchange by proton NMR spectrometry, monitoring deuterium exchange by ESI-MS requires much less sample (1-50 micrograms), much shorter analysis time (10-90 min), and no chemical quenching of the exchange reaction.

Amino Acid Sequence↗
PubMed1991

Derivatization of peptides to enhance ionization efficiency and control fragmentation during analysis by fast atom bombardment tandem mass spectrometry.

Novel and simple procedures for preparing ethyl-triphenylphosphonium derivatives of peptides are described. These procedures allow an ethyl-triphenylphosphonium moiety to be selectively attached to either the N- or C-terminus. The resulting derivatives contain a positive charge at a fixed position and have significant hydrophobic character. Modification of peptides by these chemical methods significantly enhances the efficiency of fast atom bombardment ionization, especially of hydrophilic peptides. Moreover, upon collisionally activated dissociation, the derivatized peptides generate a predictable series of sequence ions from either the C-terminus or the N-terminus, depending on the location of the ethyl-triphenylphosphonium moiety.

Amino Acid Sequence↗
PubMed1991

Double-pedicle TRAM flap for unilateral breast reconstruction.

Autogenous breast reconstruction with the pedicled TRAM flap has been employed in 500 patients in our series. We have developed and refined indications for use of the single-pedicle TRAM flap and double-pedicle TRAM flap in unilateral breast reconstruction. In our experience with 341 unilateral breast reconstructions, we used a double-pedicle TRAM flap 19 percent of the time; however, in our most recent 50 unilateral modified radical mastectomy reconstructions, the double-pedicle technique has been employed 60 percent of the time. In general, when a TRAM flap is chosen for unilateral reconstruction of a modified radical mastectomy defect, we feel the single-pedicle TRAM flap is the procedure of choice. Carefully selected patients will benefit from the added safety of a double-pedicle TRAM procedure. The indications for the double-pedicle TRAM flap, the technique, and our results are described in detail.

Abdominal Muscles↗
PubMed1990

Placental emboli from a fetus papyraceous.

A syndrome in monozygotic twins that consists of a macerated twin fetus (fetus papyraceous) and a live-born twin with various anatomical defects has been described. The etiology is thought to be placental transfer of emboli or thromboplastic material through vascular shunts. Thromboplastic material precipitates disseminated intravascular coagulation (DIC) in the fetus, with a resultant hypercoagulable state due to relative fetal antithrombin III deficiency. Two cases of this syndrome will be discussed. The case of a live-born twin with intestinal atresia, who developed in utero with a fetus papyraceous, is reported. Emboli were demonstrated in vascular shunts of the diamniotic-monochorionic placenta. The hypothesis of intestinal atresia as a result of a vascular accident is reviewed. Another case involving a live-born twin with congenital skin defects, who developed in utero with a fetus papyraceous, is also reported. The skin defects were a congenital disruption from fetal DIC with resultant hypercoagulable state. Several other manifestations of the placental emboli syndrome will be discussed and the vascular etiology of the disruptions explained.

Adult↗
PubMed1988

Gallstone pancreatitis: a prospective randomized trial of the timing of surgery.

The correct timing of surgery in cases of gallstone pancreatitis is debatable. To delineate more clearly the influence of the timing of surgery in the treatment of the disease, a prospective randomized clinical study of early surgery (less than 48 hours after admission) and delayed surgery (more than 48 hours after admission) was conducted in 165 patients. Ranson's prognostic signs of severity of disease were used to classify the patients into two risk groups: mild pancreatitis (three or fewer positive signs) and severe pancreatitis (more than three positive signs). In patients with three or fewer positive Ranson's signs, the time of surgery appeared to have little effect on the outcome, whereas in patients with more than three positive signs, early surgery resulted in a significant increase in rates of morbidity and mortality. Controlled randomization showed that in patients with gallstone pancreatitis, edematous or hemorrhagic necrotizing pancreatitis can develop, with or without impacted stones, early or late in the progression of the disease, during early or delayed surgery. These findings suggest that (1) although a gallstone initiates a bout of pancreatitis, it does not cause the progression of the disease; (2) the fate of the progression of pancreatitis is decided early by the amount of digestive enzymes being activated; (3) early removal of an impacted stone does not ameliorate the progression of pancreatitis; and (4) surgery should be performed during the initial hospital admission after the pancreatitis has subsided.

Adult↗
PubMed1986

Canine model for the simultaneous measurement of antibiotic levels in tissues and bacterial killing rate.

Antibiotic levels in serum are commonly used to guide antibiotic therapy. The antibiotic levels in interstitial fluid are a more accurate reflection of the efficacy of antibiotic penetration into the tissues. Although there are experimental models for determining interstitial fluid levels, there is no model for measuring the in vivo killing of bacteria, which is the endpoint of antibiotic therapy. We developed an accurate, reliable animal model which allows measurement of the in vivo killing of bacteria along with a determination of antibiotic levels in tissues. Modified Sykes-Moore chambers were applied to the dissected external oblique muscle of 14 dogs. The chambers were inoculated with clinical isolates of Staphylococcus aureus or Escherichia coli. The dogs were treated with cefoxitin or gentamicin. Quantitative cultures were performed, and the antibiotic levels in interstitial fluid were determined.

Animals↗
PubMed1985

Hemorrhagic acalculous cholecystitis causing acute pancreatitis after trauma.

Hemobilia is an uncommonly recognized entity and postoperative acute acalculous cholecystitis is an uncommon clinical entity. Hemorrhagic acalculous cholecystitis causing pancreatitis has apparently not been reported before. We report the case of a multiple trauma victim who, several weeks after his initial injuries, developed acute pancreatitis secondary to hemobilia caused by postoperative hemorrhagic acalculous cholecystitis.

Abdominal Injuries↗
PubMed1981

Autosomal Dominant familial erythrocytosis due to autonomous erythropoietin production.

A family is described in which four members spanning three consecutive generations have erythrocytosis associated with a normal hemoglobin oxygen affinity. When bone marrow from one affected family member was cultured in vitro, erythroid colonies formed only when erythropoietin was added to the culture. Serum erythropoietin, measured by radioimmunoassay, was significantly elevated above normal in each of the affected family members. Bioassayable erythropoietin was detected in the urine of two of the three affected family members. In two of the affected family members, erythropoietin was measured in serum by radioimmunoassay and in urine by bioassay before and for 4 days following an isovolemic phlebotomy, which reduced the red cell mass by 20%. Neither serum nor urinary erythropoietin levels changes following phlebotomy. The erythrocytosis in this family appears to be secondary to inappropriately increased erythropoietin production unassociated with a decrease in the blood oxygen-carrying capacity. This is the first instance in which autonomous erythropoietin production appears to be inherited on an autosomal dominant basis.

Adolescent↗
PubMedDate not supplied

Effect of H1- and H2-receptor blockade on the inhibition of immediate cutaneous reactions.

The effects of cyproheptadine, cimetidine, and their combination on the wheal-and-flare skin-test response was evaluated using an intradermal skin-test technique in a double-blind, placebo-controlled study. Sixteen volunteers with known positive skin-test reactions to at least two antigens were divided into four treatment groups in a four-way crossover design. The patients received baseline intradermal skin tests on the back consisting of dilutions of mixed grasses and weeds, histamine diphosphate and codeine phosphate, and buffered-saline control. Following the baseline testing, the patients received cyproheptadine (4 mg q.i.d.), cimetidine (300 mg q.i.d.), the combination, and placebo in a double-blind trial. Of the 16 patients, 12 completed all treatment courses. Following pretreatment with cyproheptadine, cimetidine, and the combination, areas of wheal-and-flare response for each test substance were significantly suppressed. Although it appeared that the combination augmented wheal-and-flare suppression, the observed difference, compared with the cyproheptadine pretreatment sequence, was not statistically significant. The administration of H1 and H2 antagonists should be discontinued before the diagnostic use of immediate skin tests.

Adult↗