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Dwight Kellicut

Publications and source records attributed to Dwight Kellicut.

5 recordsLinked to original sources
PubMed2006

Thiamine (vitamin B1) improves endothelium-dependent vasodilatation in the presence of hyperglycemia.

Brachial artery vasoactivity (BAVA) is a reliable, noninvasive method of assessing endothelium-dependent vasodilatation (EDV) in vivo. Acute hyperglycemia, impaired glucose tolerance (IGT), and diabetes mellitus impair EDV, a precursor to atherosclerosis. Thiamine is a coenzyme important in intracellular glucose metabolism. The purpose of this study was to evaluate the effect of thiamine on BAVA in the presence of hyperglycemia. Ten healthy subjects (group H, mean age 27 years), 10 patients with impaired glucose tolerance by World Health Organization criteria (group IGT, mean age 65 years), and 10 patients with non-insulin-dependent diabetes mellitus (group NIDDM, mean age 50 years) were studied. Duplex ultrasound was used to measure brachial artery flow changes in response to reactive hyperemia following brachial artery tourniquet occlusion for 5 min. This test was performed after a 10 hr fast and at 30, 60, and 120 min after a 75 g oral glucose challenge along with measurements of blood glucose level (BGL). A week later, BAVA evaluation was repeated after administration of 100 mg of intravenous thiamine. BAVA (% increased blood flow) at peak and trough BGL was compared with and without thiamine. BAVA at peak glucose improved from 69.0 +/- 6.4% to 152.8 +/- 22.9% in group H (p < 0.005), from 57.6 +/- 12.6% to 139.7 +/- 12.4% in group IGT (p < 0.005), and from 57.8 +/- 8.3% to 167.8 +/- 11.6% in group NIDDM (p < 0.005) following administration of thiamine. On the other hand, at trough glucose levels, BAVA remained essentially unchanged in group H (prethiamine 83.8 +/- 6.5% vs. post-thiamine 83.8 +/- 17.0%, p > 0.05) as well as group IGT (prethiamine 96.7 +/- 8.5% vs. post-thiamine 104.0 +/- 17.4%, p > 0.05). BAVA at trough glucose was not measured in group NIDDM secondary to trough BGL > 140 mg/dL. EDV was improved by thiamine in the presence of hyperglycemia in healthy subjects and in patients with IGT and NIDDM. The mechanism by which thiamine improves EDV is not due to a glucose-lowering effect as thiamine had no effect on EDV under normoglycemic conditions. Routine administration of thiamine might improve endothelial function and therefore slow the development and progression of atherosclerosis, especially in patients with IGT and NIDDM who are prone to develop accelerated atherosclerosis.

Adult↗
PubMed2006

Early definitive abdominal closure using serial closure technique on injured soldiers returning from Afghanistan and Iraq.

BACKGROUND: Twenty-nine of 1,284 battle-injured soldiers arriving at Walter Reed Army Medical Center from Operations Enduring Freedom and Iraqi Freedom have abdominal wounds requiring delayed definitive closure with Gore-Tex (WL Gore & Assoc) mesh. METHODS: Serial abdominal closure (SAC) leading to early definitive abdominal closure (EDAC) was achieved using Gore-Tex mesh. Inpatient records of Operations Enduring Freedom and Iraqi Freedom soldiers with open or reopened abdomens were reviewed from March 2003 to August 2005. RESULTS: Twenty-nine soldiers, average age 27 years (range 20 to 42 years) injured by secondary blast effects (n = 19); penetrating (n = 8); motor vehicle crashes (n = 1); and crushing injury (n = 1) were included in the study. Patients arrived at Walter Reed Army Medical Center 8 days (range 3 to 56 days) after injury with Gore-Tex mesh placed 6 days (range 0 to 26 days) from arrival and 14 days (range 4 to 79 days) from injury. SAC was achieved with towel clamp tightening or excision of midline mesh and drawing fascia closer to the midline for an average of 46 days (range 15 to 160 days) before EDAC. One patient is undergoing SAC and another was transferred to another facility. EDAC was achieved in 24 of the remaining of 27 patients (89%). Four patients required early removal of the Gore-Tex mesh, resulting in three patients with planned ventral hernia. One patient underwent EDAC with primary closure and fascial release. EDAC was completed with polypropylene mesh in 17 patients and 6 patients had original Gore-Tex in place. Patients were discharged from the hospital an average of 18 days after closure (range 1 to 89 days) with total hospital days of 62 (range 17 to 197 days). Average followup of patients from placement of Gore-Tex mesh is 264 days (range 31 to 855 days). CONCLUSIONS: SAC with Gore-Tex mesh led to EDAC in 89% of patients and proved to be a safe and effective alternative to planned ventral hernia. SAC allowed protection of abdominal contents, effective fluid management, reclamation of abdominal domain, and early rehabilitation with minimal complications and only one hernia reoccurrence.

Abdominal Injuries↗
PubMed2004

Strategies of arteriovenous dialysis access.

Surgical management of the patient who requires hemodialysis access, while continuing to demand more attention from the vascular surgeon, suffers from discrepancies of approach and strategy. With the increase in incidence of dialysis dependent renal failure among our population, many have attempted to present a uniform, logical strategy with which the vascular surgeon can most effectively treat the hemodialysis patient in the long term. Most notably, the multidisciplinary Dialysis Outcomes Quality Initiative (DOQI) guidelines present the surgeon with a rough outline of hemodialysis access insertion strategy, and it has become nationally recognized as an acceptable summary of treatment strategy and goals. The decision as to the most appropriate surgical access to offer a patient depends on immediate need for hemodialysis, history and physical examination findings, and suitability of available veins in the extremity. While percutaneous, catheter based access affords the luxury of immediate access, these devices suffer from several complicating factors, such as infection, and damage to large, proximal veins. For long-term access, the autogenous access, while perhaps less successful in the immediate short term, is always the preferred access type given its favorable longevity. The surgeons should focus on sites distally on the extremity, reserving proximal sites for potential future access insertions should the primary access fail. In the absence of suitable vein, prosthetic access may be considered. When both the upper and lower aspects of both upper extremities have been exhausted, the surgeon should consider access insertion elsewhere, such as the lower extremity.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

Sentinel lymph node evaluation is technically feasible and may improve staging in colorectal cancer.

PURPOSE: The accurate nodal staging of colorectal cancer (CRC) is important to identify those patients who may benefit from adjuvant chemotherapy. Some have suggested that identification of sentinel lymph nodes (SLN) may improve staging in CRC. We sought to determine: the feasibility of identifying SLN in CRC utilizing isosulfan blue dye; the accuracy of the identified SLN in predicting the status of the remainder of the lymph nodes in CRC; and whether a more thorough evaluation of SLN with serial step sectioning and immunohistochemistry would more accurately stage patients with CRC. METHODS: A pilot trial was initiated at Walter Reed Army Medical Center (WRAMC), and 17 patients with masses on colonoscopy and subsequent tissue diagnosis of CRC were enrolled. Patients underwent standard surgical resection of their CRC with wedge of mesentery containing draining lymph nodes. Isosulfan blue dye was injected around the tumor subserosally/submucosally before dividing the mesenteric portion of the resection (n = 7) or ex vivo (n = 10). Sentinel lymph nodes were defined as all nodes staining blue and were dissected from the mesentery in the operating room. The SLN were sent separately for standard bivalving and hematoxylin and eosin staining (H&E) followed by serial step sectioning and immunohistochemistry (IHC) staining for cytokeratin. RESULTS: Seventeen patients (6 men, 11 women) were enrolled. The average preoperative carcinoembryonic antigen (CEA) was 5.9 (range, 1.2 to 18.9), and the average postoperative CEA was 2.8 (range, 0.7 to 9.1). One patient had a T1 tumor, 6 patients had T2 tumors, and 10 patients had T3 tumors on final pathology. Five cancers were well differentiated, 11 were moderately differentiated, and 1 was poorly differentiated. In all 17 cases, SLN were identified. A mean of 5.5 SLN was found per specimen (range, 2 to 11) with no difference noted between injection techniques (in vivo vs ex vivo). An additional 12 nonsentinel lymph nodes (range, 1 to 29) were identified per specimen. Ten patients had negative SLN and non-SLN. Seven patients were found to have positive SLN (3 by H&E, 2 by serial step sectioning, and 2 by IHC only). CONCLUSIONS: The isosulfan blue technique is technically feasible to allow identification of sentinel lymph nodes. In this study, no false-negative SLN occurred. A total of 7 patients had positive SLN; more importantly, 4 patients were upstaged as a result of serial step sectioning and immunohistochemistry staining. We hypothesize that this method may help pathologists find appropriate lymph nodes for more detailed analysis. As a result, patients may be more accurately staged and counseled for adjuvant chemotherapy, which has been shown to improve survival in node-positive CRC. Further studies should be undertaken to test these preliminary findings.

Journal Article↗