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Biomedical subjects

E F Wolfman

Publications and source records attributed to E F Wolfman.

At least 37 records · Page 2Linked to original sources
PubMed1976

Experimental evaluation of primary repair of colonic injuries.

To evaluate the management of colonic injuries, experimental models simulating acute injuries of the colon were studied utilizing New Zealand white rabbits. Seventy-nine rabbits underwent primary repair of colonic injuries in the presence of massive contamination and none showed any evidence of anastomotic leakage or breakdown. The fact that primary colonic repairs do heal even in the presence of infection suggests that breakdown of colonic anastomosis results from factors other than infection. Despite the absence of anastomotic leaks in this series, morbidity and mortality were high in those animals not given antibiotics. The high morbidity and mortality were due to peritonitis, intra-abdominal abscess, and wound infection, and were directly proportional to the length of time from colonic injury to repair. On the basis of this study, it is concluded that most isolated injuries of the colon can be closed primarily, if antibiotic therapy is begun immediately after injury and continued throughout the operative and postoperative periods.

Abscess↗
PubMed1976

Reversed ileal segment for treatment of ileostomy dysfunction. Clinical application.

Persistent, profuse ileostomy diarrhea developed gradually in a patient over a 12-hour period after proctocolectomy for ulcerative colitis. There was no evidence of ileostomy stenosis or dilation of the ileum proximal to the stoma. He was successfully treated with a reverse ileal segment of 10 cm, and gained 14 to 18 kg. ileostomy output became semisolid and decreased from 1,000 to 2,000 ml/day to 600 ml/day. The transit time changed from 12 minutes to 2 1/2 hours. Antiperistaltic segments of intestine prolong transit time and allow for greater absorption. While most patients with ileostomies are not troubled by severe diarrhea, the small proportion who are may be candidates for a reversed ileal segment.

Adult↗
PubMed1976

Antiperistaltic bowel segment for prevention of ileoproctostomy diarrhea.

Persistent diarrhea accompanied by water, electrolyte, and nutritional depletion and skin excoriation can occur following subtotal colectomy with ileoproctostomy. Attempting to improve the course of these patients, an experimental study using dogs was undertaken to evaluate the use of antiperistaltic ileal segment in the management of ileoproctostomy diarrhea. Subtotal colectomy with ileoproctostomy was performed in dogs. One animal died from weight loss and massive diarrhea with water and electrolyte depletion. The surviving dogs had water and electrolyte imbalance and lost an average of 30.6% of their body weight. A second group of animals was treated identically except that an antiperistaltic ileal segment was placed one foot proximal to ileorectal anastomosis. These dogs maintained their weight and electrolyte and water balance. The stools of these animals became solid, as opposed to the watery diarrhea of the animals with ileoproctostomy only. Ileoproctostomy diarrhea can be successfully controlled by the use of antiperistaltic ileal segment.

Animals↗
PubMed1976

Clinical evaluation of 99mTc-pyridoxylideneglutamate for hepatobiliary scanning.

Clinical evaluation of hepatobiliary scanning using 99mTc-PG was done in twenty normal volunteers and eighty-three patients with liver and biliary tract disease. Satisfactory images of the biliary tract were obtained using small dosages of this agent. In normal humans, the agent reached the liver in 5 minutes, and the common bile duct, gallbladder, and duodenum in 10 to 20 minutes. The gallbladder was not visualized when the cystic duct was obstructed in patients with acute and chronic cholecystitis. In patients with partial common bile duct obstruction, a distended duct was visualized and there was delay in transit of radioactivity into the duodenum. With complete common bile duct obstruction, no radioactivity was seen in the biliary or gastrointestinal tracts up to 24 hours after injection. Hepatocellular disease was characterized by delayed liver clearance and delayed visualization of the biliary and gastrointestinal tracts. There were no toxic or other untoward effects in any patients.

Biliary Tract Diseases↗
PubMed1976

Intestinal necrosis and perforation in patients receiving immunosuppressive drugs.

Immunosuppressive agents are frequently used in transplant recipients for prevention of homograft rejection and in patients with leukemia for treatment of their primary disease. From 1973 to 1975, fifty-nine patients undergoing renal transplantation and forty-one patients with leukemia were treated at the University of California (Davis) Medical Center. Intestinal necrosis and perforation developed in four (7 per cent) of those receiving transplants and in four (10 per cent) of the patients with leukemia. One transplant receipient and all four patients with leukemia had extensive necrosis of both the small and large intestines. Two transplant recipients had isolated sigmoid perforations, and one had splenic flexure colonic perforation. All died from septicemia with septic shock. The etiology of these intestinal complication appears related to immunosuppressive agents, particularly high dosages of steroids. Despite the grave prognosis, early surgical intervention is the only method of dealing with these complications. Early diagnosis as well as properly timed and selected operations are necessary for the successful management of these patients.

Adult↗
PubMed1976

Use of an arteriovenous fistula for treatment of the severely ischemic extremity: experimental evaluation.

Experiments were performed on obligatory bipeds to study the effects of an arteriovenous fistula on a devascularized ischemic limb. Retrograde flow of arterial blood entering the venous system by way of an arteriovenous fistula was demonstrated. Venous valves appeared not to interfere with retrograde arterial flow. The data from these experiments indicate that a "Y" type arteriovenous fistula can lead to functional revascularization in the ischemic limb with arterial obstruction. The dual mechanism of retrograde arterial flow in venous channels and the stimulation of collateral flow adjacent to the fistula seemed to be critical factors. Since a peripheral arteriovenous fistula is a potent stimulus to arterial collateralization in the extremity, its application is worthy of consideration in certain selected patients with advanced and otherwise inoperable arterial occlusive disease.

Animals↗
PubMed1976

Linear abdominal trauma.

Three cases of blunt abdominal trauma are presented to exemplify the mechanism of trauma and the problems of diagnosis associated with any linear blow to the abdomen. The mechanisms of visceral injury are reviewed, and special attention is directed to the abdominal wall injury that can be present in these patients. This injury has special implications in directing the operative approach and repair. An unusual aortic occlusion is described which is peculiar to this type of injury.

Abdominal Injuries↗
PubMed1976

Technetium-99m pyridoxylideneglutamate (P.G.) cholescintigraphy.

Technetium-99m P.G. cholescintigraphy was performed in 27 human volunteers and 81 patients referred for hepatobiliary tract disease. The gallbladder, biliary system, and gastrointestinal tract were well visualized in the normal patients and volunteers. The gallbladder was not visualized in 22 patients with histologically proved cholecystitis with cystic duct obstruction. Nine patients with complet extrahepatic obstruction of the common bile duct were correctly diagnosed. Hepatocellular disease and incomplete obstruction, with and without jaundice, were diagnosed with this technique. Oral cholecystography is superior to this method for the detection of cholelithiasis in nonjaundiced patients.

Biliary Tract Diseases↗
PubMed1976

Effects of antibiotics on prevention of infection in contaminated abdominal operations.

A prospective study was undertaken on 102 patients with massice intraperitoneal contamination from traumatic or spontaneous perforation of intestinal or pancreaticobiliary tract to determine the effects of combined systemic and intraperitoneal antibiotic administration on the prevention of the postoperative sepsis, intra-abdominal abscess formation and wound infection. Large doses of gentamicin and clindamycin were given parenterally before, during, and after the operation for five days. In addition, the peritoneal cavity and the abdominal incision were irrigated intraoperatively with antibiotic solution containing the same antibiotics. The drugs were given so as to provide a potent level of antibiotics during the operation and in the immediate postoperative period. The postoperative wound infection rate was 4 per cent, intra-abdominal abscess 2.9 per cent, sepsis 1 per cent, resulting in a total infectious complication rate of 7.9 per cent. This is a marked reduction in the incidence of infectious complications and compares favorably with the results from either parenteral or intraperitoneal therapy alone. Furthermore, no complications were encountered due to this method of therapy. These results do not indicate that antimicrobial drugs be given prophylactically to all surgical patients, but they strongly suggest the advantages of combined systemic and intraperitoneal antibiotics in the management of patients with massive intraperitoneal contamination.

Abdomen↗
PubMed1975

Radioisotope detection of venous thrombosis. Venous scan vs fibrinogen uptake test.

Experience with the fibrinogen uptake test and the technetium Tc 99m albumin aggregated venous scan in 89 patients showed the latter to be adequate for simultaneous screening for plumonary embolism and venous thrombosis of the lower extremities and pelvis. Because the fibrinogen uptake test differentiated active from inactive venous thrombosis, it is indicated when anticoagulation is considered for patients with a history of thrombophlebitis and equivocal clinical findings of acute activity. It can also be used to monitor high-risk patients and to detect proximal propagation of thrombi. The results of the technetium venous scan were abnormal in 97% of patients with venous thrombosis and the fibrinogen uptake test detected 100% of patients with acute activity. Both tests react to different aspects of the thrombotic disease, thus complementing each other. Because of their reliability, indications for phlebography are now less frequent.

Albumins↗
PubMed1975

Antiperistaltic ileal segment in the prevention of ileostomy diarrhea.

Diarrhea, often profuse, accompanied by skin excoriation and nutritional and electrolyte depletion is a major complication of ileostomy. In an attempt to improve the course of these patients, an experimental study using dogs was undertaken to investigate an antiperistaltic ileal segment for the prevention of ileostomy diarrhea. Ileostomies were created in dogs. All the dogs with ileostomies died within nine days of weight loss and massive electrolyte and water depletion. A second group of animals underwent creation of an ileostomy simultaneously, with an antiperistaltic ileal segment placed 30.5 cm proximal to the ileostomy. These dogs maintained their weight and electrolyte and water balance. The stools in the group with the reversed ileal segment became semisolid to solid, compared to the watery diarrhea of dogs with ileostomies only.

Animals↗
PubMed1975

Inferior vena cava interruption: a new indication?

Propagating illofemoral venous thrombosis that occurs despite adequate anticoagulation can be detected by the serial fibrinogen uptake test. Twenty-three patients who were receiving heparin sodium for confirmed iliofemoral thrombophlebitis underwent the serial fibrinogen uptake test. There was an increasing percentage of isotope uptake at the groin and the upper part of the thigh in eight of these patients, three of whom subsequently developed clinical signs, perfusion, and ventiliation lung scan findings compatible with the occurrence of pulmonary embolism. The remaining 15 patients had decreasing serial fibrinogen uptake during heparin therapy and no sequelas indicative of pulmonary embolism. Progressive thrombosis in adequately heparinized patients indicates failure of anticoagulation therapy and, when this occurs, we believe that interior vena cava interruption should be considered before a first, but potentially lethal, pulmonary embolus develops.

Femoral Vein↗
PubMed1975

Meckel's diverticulum: should it be excised incidentally at operation?

Meckel's diverticulum is the most common congenital abnormality of the small intestine, occurring in about 2 per cent of the population. Complications of a Meckel's diverticulum, including hemorrhage, inflammation, bowel obstruction, and neoplasms, occur in 15 to 33 per cent of cases and invariably demand operative treatment. When signs or symptoms arise from a Meckel's diverticulum, morbidity and mortality are high. Incidental Meckel's diverticulectomy should be performed at any age when the morbidity and mortality of the primary procedure will not be increased substantially.

Adolescent↗
PubMed1975

Traumatic duodenal injuries: an analysis of 32 cases.

Thirty-two patients were treated for duodenal and associated injuries during the past five years. Fifty-nine per cent resulted from penetrating trauma, while 41 per cent were secondary to blunt injury. The incidence of blunt trauma represents a fourfold increase from previously published series. The morbidity rate still remains high at 47 per cent, with fistulas and infections being the most common complications. The mortality rate was 9.3 per cent, with death resulting from major intra-abdominal vascular injuries. Awareness of the potential injury to the duodenum, aggressive resuscitative measures, early operative management and improved postoperative care can lead to further reduction of these figures.

Abdominal Injuries↗