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Biomedical subjects

D State

Publications and source records attributed to D State.

At least 19 recordsLinked to original sources
PubMed1991

Nipple discharge in women. Is it cause for concern?

Nipple discharge is one of the most common breast complaints in women. Galactorrhea (milky discharge) may occur during pregnancy or breast-feeding or as a result of drug therapy, hypothyroidism, or hyperthyroidism. Nonbloody discharge is most common and is usually benign. Bloody discharge should be considered a sign of cancer until proved otherwise. Persistent galactorrhea and nonbloody discharge can be treated by transecting the mammary ducts. Simple mastectomy may be appropriate in patients with persistent bloody discharge who have a strong family history of breast cancer.

Adult↗
PubMed1989

Hepatic artery versus portal vein and systemic infusion of fluorodeoxyuridine of rabbit VX-2 hepatic implants.

To compare the efficacy of regional and systemic infusions of hepatic tumors, and to correlate this with tumor perfusion, 29 New Zealand white rabbits underwent perfusion of VX-2 hepatic implants. Tritium-labeled fluorodeoxyuridine (H3-FUDR) and technetium-99m-labeled macroaggregated albumin (Tc 99m-MAA) were infused through the hepatic artery, portal vein, and peripheral vein. Hepatic artery infusion resulted in a significantly improved tumor-to-liver ratio of FUDR uptake (p less than 0.001). The increased tumor uptake correlated with a two-fold increase in tumor arterial blood flow as compared with normal liver demonstrated by the MAA infusion. We conclude that infusional therapy is superior to both portal vein and systemic infusions. Portal vein infusion results in no uptake of drug by the tumor. Hepatic artery scintigraphy with MAA may be useful in selecting appropriate patients for this type of therapy.

Animals↗
PubMed1987

Monoclonal antibody staining and impact of surgical technique on the identification and quantitation of steroid receptors in human breast cancer.

In this prospective study of 31 patients, paired receptor levels from biopsy and mastectomy specimens were found to be significantly correlated on biochemical assay. Despite this fact, 6 of 20 tumors that were estrogen receptor-positive on biopsy, had a negative assay from the mastectomy specimen, indicating the need for a fresh tumor specimen. Immunocytochemical staining with monoclonal antibody H222 Spy, an antibody specific for the estrogen receptor, was evaluated in 34 biopsy and mastectomy specimens. With a sensitivity of 85 percent and specificity of 93 percent, this technique compares favorably with the standard biochemical assay.

Adult↗
PubMed1979

Nasogastric suction in alcoholic pancreatitis.

In order to assess the usefulness of nasogastric suction in acute alcoholic pancreatitis, 37 patients with alcoholic pancreatitis were prospectively investigated. The study failed to demonstrate efficacy of nasogastric suction in those patients with mild disease. Application of a system of prognostic signs proved useful in discriminating between mild and severe disease. Routine use of ultrasound examinations detected three pancreatic pseudocysts before they became clinically apparent. In instituting appropriate therapy in mild pancreatitis, factors such as patient comfort should be considered in the absence of proven significant value of nasogastric suction.

Adult↗
PubMed1979

Cardiorespiratory monitoring in postoperative patients: I. Prediction of outcome and severity of illness.

An index for prediction of outcome for use as a measure of the severity of illness was developed by a nonparametric multivariate analysis of cardiorespiratory data from 113 critically ill postoperative general surgical patients. This severity (predictive) index was based on a computerized algorithm that compares a given observed value with the frequency distributions of survivors and nonsurvivors. The difference in the mean values of this index for survivors and nonsurvivors was statistically significant (p less than 0.001) during each stage of shock. Sensitivity of the index in prediction of survival ranged from 70-93% depending upon stage, the specificity of the index ranged from 76-92%, and the predictive accuracy ranged from 87-96%. The severity index is used as a process measure to track the course of critically ill patients and to evaluate the efficacy of alternative therapies.

Cardiovascular System↗
PubMed1978

Resuscitation algorithm for management of acute emergencies.

Assuming that unrecognized or inadequately corrected hypovolemia results in higher mortality and morbidity rates, we developed a systematic approach to resuscitation that would: 1) identify criteria to aid in the recognition of hypovolemia and ensure the expeditious correction of this defect without interfering with diagnostic workup and management; 2) define criteria to prevent fluid overload which may jeopardize the patient's course, and 3) express these criteria in an explicit, systematic, patient care algorithm, ie, protocol, useful to both the resident and the practicing physician. We are now conducting prospective clinical trials with one service using the algorithm and the others acting as the control group. Preliminary results comparing patient outcomes suggest that the algorithm improves patient care by shortening resuscitation time and results in fewer hospital days, intensive care unit days, febrile days, and days on mechanical ventilation as well as reduced mortality. The algorithm provides a systematic plan to organize patient care so that the most urgently needed procedures are not delayed or overlooked.

Algorithms↗
PubMed1978

Comparison of cardiorespiratory effects of crystalline hemoglobin, whole blood, albumin, and Ringer's lactate in the resuscitation of hemorrhagic shock in dogs.

We studied the time course and interactions of hemodynamic, oxygen transport, colloid osmotic pressure (COP), and blood volume responses to 500 ml of crystalline hemoglobin (Hgb), 500 ml of whole blood (WB), 1,000 ml of Ringer's lactate (RL), and 500 ml of plasma protein fraction (PPF) given in random order to 12 mongrel dogs subjected to hemorrhagic shock by the standard Wiggers' technique. In general, hemodynamic and oxygen transport responses were greater and more prolonged after the colloids than after RL. These responses were related to concomitant improvement in blood volume and COP. Of the colloids, Hgb appeared to produce somewhat greater hemodynamic and oxygen transport changes. This was particularly evidenced by comparison of these responses when each fluid was the first agent used after the hemorrhage. By virtue of its capacity to increase COP and plasma volume and to carry oxygen, Hgb improved both the gross circulation and the tissue perfusion, as indicated by cardiovascular hemodynamics and bulk oxygen transport variables.

Animals↗
PubMed1977

Unusual cause of acute abdomen. Sickle cell trait and nonhypoxic splenic infarction.

Splenic infarction under hypoxic conditions is a well-known complication of sickle cell trait (Hgb AS). However, this case illustrates that it may occur without any clinical conditions of circumstances associated with decreased Pao2. In addition, sickle cell trait should be included in the differential diagnoses of splenic infarction even if the patient is not of African ancestry.

Abdomen, Acute↗
PubMed1977

Injuries to the inferior vena cava and their management.

Injuries to the inferior vena cava are being seen with increasing frequency in the civilian population. A review of the experience at UCLA/Harbor General Hospital Medical Center over a ten year period (1966 to 1976) discloses thirty-four patients with major injuries to the inferior vena cava, with an overall mortality of 53%. The factors that appear critical to patient survival are: (1) level of injury (suprarenal versus infrarenal sites); (2) presence or absence of profound shock on admission; and (3) the speed with which diagnosis is made and treatment carried out. Technical considerations regarding identification and handling of inferior vena caval injuries are presented. The mortality rate for major inferior vena caval injuries remains distressingly high and serves as a challenge for future improvement.

Abdominal Injuries↗
PubMed1977

Segmental gastric antral resection in experimental peptic ulceration.

In using the technique of histamine in beeswax peptic ulceration in dogs, these experimental preparations were studied as to their efficacy to protect against ulceration: laparotomy controls; bilateral truncal vagotomy and pyloroplasty; a 50 per cent gastrectomy and vagotomy plus a Billroth II gastrojejeunostomy; a 50 per cent segmental resection of the gastric antrum and corplus plus bilateral truncal vagotomy and pyloroplasty; a 75 per cent gastrectomy and Billroth II gastrojejeunostomy, and a 75 per cent segmental resection of the gastric antrum and corpus and bilateral truncal vagotomy and pyloroplasty. Only a 75 per cent gastrectomy Billroth II and a 75 per cent segmental resection of the antrum and corpus plus vagotomy and pyloroplasty consistently protected against histamine in beeswax induced ulceration.

Animals↗
PubMed1977

Relative hemodynamic effectiveness of whole blood and plasma expanders in burned patients.

In a series of nine fatally burned patients, hemodynamic and oxygen transport measurements were made before, during and after 56 administrations of 500 milliliters of whole blood or colloids and 1,000 milliliters of crystalloids. To enhance comparability, 38 of these studies were conducted at intervals on the same patient, the patient serving as his own control. The data indicate greater hemodynamic responses to colloids than to whole blood and greater responses to whole blood than to crystalloids when the latter was given at twice the volume as well as at four times the volume of the colloid. The data suggest that, in addition to replenishing salt and water, restoration of hemodynamic and oxygen transport variables may be accomplished by expansion of plasma volume with colloids and whole blood. Adequate nutrition is also needed for the increased metabolic needs of the burned patient. Without supplemental nutrition, high grade plasma proteins and tissue proteins may be expended as energy substrates; the lowering of plasma proteins tends to redistribute water from the plasma to the interstitial phase, which increases further the peripheral edema.

Blood Pressure↗
PubMed1976

Septic complications of pancreatitis.

Over an 11-year period 693 patients with acute pancreatitis and 317 with chronic pancreatitis were seen at the Harbor General Hospital. Review of these cases revealed 9 patients with primary pancreatic lesser sac abscess and 11 with secondary abscess. The appropriate management for pancreatic abscess, whether primary or secondary, is early recognition and drainage; multiple drainage procedures may be necessary. Broad spectrum antibodies appear to be helpful and should be used until cultures indicate more appropriate antibiotic therapy. Successful management involves prolonged hospitalization, but contrary to previous reports the success rate is surprisingly high. Eight out of 9 patients with primary abscess and 8 out of 11 patients with secondary abscess survived.

Abscess↗
PubMed1976

Asymptomatic primary hyperparathyroidism.

With the advent of automated equipment for blood chemistry determinations, many patients are presenting with asymptomatic or "biochemical" hyperparathyroidism. In the present series, of 136 patients operated on for hyperparathyroidism, fifty-three were considered asymptomatic. In fifty-one patients, parathyroid pathologic conditions were found; in one patient, it is probable that an adenoma had been missed, and in the other, it is presumed that an error in diagnosis was made. We recommend that surgical exploration be considered as an acceptable alternative to watchful waiting for patients with asymptomatic hyperparathyroidism.

Adenoma↗
PubMed1975

Benign obstructing papilloma of the ampulla of Vater in infancy.

Obstructive jaundice due to benign neoplasms of the extrahepatic bile ducts is rare in all age groups. A case is reported which represents the first obstructing papilloma of the ampulla of Vater found in the pediatric age group and the literature pertaining to benign obstructing neoplasms is reviewed briefly. Differential diagnosis of persistent jaundice past the immediate neonatal period is discussed and the need for operative cholangiogram and open liver biopsy in difficult cases is stressed. Obstructing papillomas and other neoplasms of the extrahepatic bile ducts should be added to the differential diagnosis of jaundice in the pediatric age group.

Ampulla of Vater↗
PubMedDate not supplied

Prediction of outcome and severity of illness by analysis of the frequency distributions of cardiorespiratory variables.

Despite the wide variety of illnesses and operations, we observed a common cardiorespiratory pattern of shock that was differenf for the survivors and nonsurvivors, although no one variable was capable of predicting outcome. Differences between the patterns of survivors and nonsurvivors were defined by range criteria and by cut-points operationally obtained from the frequency distributions of cardiorespiratory variables. The values of each of the 33 variables obtained, at times remote from therapy during each successive stage in the postoperative course, were used to predict survival and death in a series of 113 patients by the range and cut-point methods. An average of 13.5% of all the available variables gave a correct prediction by the range cirteria and 35% by the cut-point method. The mean percentage of Right--Wrong classifications throughout all stages for range and cut-point methods was 80 and 85%, respectively. Using the last available stage, the outcome was correctly predicted by the range criteria in 80% and by the cut point method in 88% of the patients. The high percentage of correct predictions suggests that these methods may provide a measure of the severity of acute illness as well as early warning of impending death.

Blood Gas Analysis↗