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Biomedical subjects

E McAllister

Publications and source records attributed to E McAllister.

16 recordsLinked to original sources
PubMed1995

Prolonged evaluation of epinephrine and normal saline solution injections in an acute ulcer model with a single bleeding artery.

BACKGROUND: Animal studies of epinephrine or normal saline solution injection for bleeding ulcers do not consistently demonstrate local tamponade effect. METHODS: We studied the change of bleeding rates of 28 acute gastric ulcers with a single bleeding artery in 10 dogs. Four injections of 1 mL epinephrine 1:10000 at 1 mm from the spurting artery (n = 7) were compared to four injections of normal saline solution 1 to 5 mL (n = 12) and to four dry needle sticks (n = 9). Bleeding rates were measured at initial arterial incision and at minutes 1, 5, 10, 15, 20, 25, and 30 after treatment. RESULT: Reductions in early blood loss to 24.3% +/- .05 of baseline occurred with saline solution, to 17.7% +/- .03 with epinephrine, and to 66.0% +/- 1.8 in controls (p < .05 for epinephrine and saline solution vs control). A tendency for saline solution injected ulcers to resume bleeding was identified, with late blood loss increasing to 26.9% +/- .05 of baseline, (saline solution vs control) compared to 7.7% +/- .02 in epinephrine injected ulcers (p < .05 vs control). CONCLUSIONS: The early acute hemostatic effect of injection therapy depends on local tamponade. The prolonged hemostatic effect is a combination of tamponade and vasoconstriction, with advantage of epinephrine over saline solution.

Animals↗
PubMed1995

Partial portal decompression alleviates thrombocytopenia of portal hypertension.

Thrombocytopenia due to splenic sequestration of platelets occurs commonly in patients with portal hypertension. Partial portal decompression for bleeding esophagogastric varices, via the small diameter H-graft portacaval shunt (HGPS), is intended to partially decompress the portal system below bleeding threshold but also to maintain a degree of portal hypertension sufficient to maintain prograde portal perfusion. This study was undertaken to determine whether the reduction of portal pressures seen in patients undergoing HGPS is sufficient to relieve the thrombocytopenia seen in patients with portal hypertension. A total of 74 patients underwent small diameter HGPS for bleeding esophagogastric varices not amenable to medical management. Thirty-four (46%) patients had thrombocytopenia (platelet count < 80,000/mL) before shunting. Platelet counts were obtained preshunt, at discharge, and from 1 to 3 years after shunting. Portal pressures decreased significantly from 30mm Hg +/- 5.6 (SD) pre shunt to 19mm Hg +/- 5.8 (SD) after shunting (P < 0.001). Platelet counts increased from a pre-shunt value of 61,000/mL +/- 2,700 (SEM) to a platelet count of 139,000/mL +/- 21,800 (SEM) at discharge (P < 0.006) and to 102,000/mL +/- 17,500 (SEM) 1 to 3 years after shunting (P < 0.001). Patients undergoing portasystemic shunting for bleeding esophagogastric varices are frequently thrombocytopenic. Partial portal decompression using the 8 mm HGPS is sufficient to alleviate thrombocytopenia associated with portal hypertension immediately following HGPS and for years to follow. The presence of thrombocytopenia does not preclude the use of partial portal decompression in patients with bleeding varices requiring operative intervention.

Adult↗
PubMed1994

Perineal reconstruction after surgical extirpation of pelvic malignancies using the transpelvic transverse rectus abdominal myocutaneous flap.

BACKGROUND: The nonhealing perineal wound is often a catastrophic complication after aggressive surgical extirpation of pelvic malignancies. METHODS: Eleven patients underwent perineal reconstruction using an inferiorly based transpelvic transverse rectus abdominal myocutaneous (TRAM) flap for large nonhealing postsurgical perineal wounds. After debridement of the perineum, the rectus muscles and their skin islands were mobilized, preserving their inferior epigastric blood supply. The flap was then taken through the midline abdominal incision transpelvically into the perineal defect. The study population was composed of three men and eight women ranging in age from 43 to 76 years (mean 59). The primary diagnosis was recurrent carcinoma of the rectum or anus (n = 5), recurrent squamous cell carcinoma of the vulva or cervix (n = 4), and recurrent sacral chordoma (n = 2). All patients had received adjuvant radiation therapy and all patients had undergone one to four previous attempts at perineal closure. The perineal defect ranged in size from 72 cm2 to 1,250 cm2 (mean 337). RESULTS: There were no perioperative deaths. Ten of the 11 patients (91%) had primary wound healing of the TRAM flap, perineal wound, and donor site. One patient with recurrent chordoma developed recurrent tumor at the suture line 4 months postoperatively. CONCLUSIONS: The inferiorly based transpelvic TRAM flap is a safe and effective reconstructive technique for recalcitrant nonhealing perineal wounds after extirpation of pelvic malignancies.

Adult↗
PubMed1994

Is triple contrast computed tomographic scanning useful in the selective management of stab wounds to the back?

We devised a protocol to prospectively manage stab wounds to the back with the hypothesis that the triple contrast computed tomographic (CT) scan is an effective means of detecting occult injury in these patients. All wounds to the back in hemodynamically stable adults were locally explored. All patients with muscular fascial penetration underwent triple contrast CT scanning utilizing oral, rectal, and IV contrast. Patients did not undergo surgical exploration if their CT scan was interpreted as negative or if the CT scan demonstrated injuries not requiring surgical intervention. Fifty-three patients were entered into the protocol. The time to complete the triple contrast CT scan ranged from 3 to 6 hours at a cost of $1050 for each scan. In 51 patients (96%), the CT scan either had negative findings (n = 31) or showed injuries not requiring exploration (n = 20). These patients did well with nonsurgical management. Two CT scans documented significant injury and led to surgical exploration and therapeutic celiotomies. Although triple contrast CT scanning was able to detect occult injury in patients with stab wounds to the back it did so at considerable cost and the results rarely altered clinical care. Therefore, its routine use in these patients is not recommended.

Back↗
PubMed1993

Sarcoptic mange.

Explore the source record for details and available documents.

Animals↗
PubMed1993

The gastroileoileal pouch: an alternative continent urinary reservoir for patients with short bowel, acidosis and/or extensive pelvic radiation.

We report on 6 patients who underwent a new type of continent urinary diversion: the gastroileoileal reservoir. These are a select group of patients who presented with the short bowel syndrome, acidosis, borderline diarrhea and/or severe pelvic radiation, which precluded the use of terminal ileum and the ileocecal segment. Considering these factors, and based on the different functional properties of the stomach as well as the need for a large reservoir, a segment of stomach and proximal ileum was used to construct the reservoir. Four patients have been followed for at least 6 months, with the longest followup being 12 months. Temporary dysphagia requiring hydrogen blockers developed in 1 patient. Results indicate excellent function of the continent urinary system, lack of metabolic complications, absent diarrhea and excellent patient tolerance. This procedure could be a useful alternative in some difficult clinical situations when continent urinary diversion is desirable.

Acidosis↗
PubMed1993

An easy approach to laparoscopic cholangiography.

Laparoscopic cholecystectomy has become the procedure of choice for surgical removal of the gallbladder. Intraoperative cholangiography is often needed to define ductal anatomy and to detect choledocholithiasis, a procedure which often proves more difficult than its open counterpart. Several newer cholangiocatheters have been introduced which have made laparoscopic cholangiography easier, however, the standard approach through an existing operating port will usually place the catheter at an odd angle, making catheterization of the cystic duct all but impossible in some cases. To avoid this acute angle between the catheter and the cystic duct, the authors have begun using a standard central line introducer as the port through which the catheter is inserted. When placed in the proper position through the lateral abdominal wall, this approach allows the catheter to be inserted parallel and in line with the cystic duct for much easier and faster cannulation.

Catheterization↗
PubMed1992

Laparoscopy through an inguinal hernia for diagnosis of intraperitoneal pathology.

During the repair of an incarcerated inguinal hernia, a 68-year-old gentleman was found to have unsuspected ascites. Upon palpation of the peritoneal cavity through the hernial sac, superficial nodules could be appreciated, suggesting abnormal pathology. A laparoscope was placed through the hernia sac after establishing a pneumoperitoneum through the same approach. This allowed visualization of the entire peritoneal cavity and appropriate exploration of the abdominal viscera. Biopsies confirmed unsuspected metastatic renal cell carcinoma. The authors describe this technique and suggest possible indications for its use.

Aged↗
PubMed1988

The acute surgical abdomen after cardiac surgery involving extracorporeal circulation.

From 1972 through 1984, 7140 cardiac operations were performed at one university teaching hospital; they were reviewed to elucidate common factors in patients developing an acute surgical abdomen after cardiac surgery and extracorporeal circulation. Twenty-one patients (0.29%) developed an acute surgical abdomen in the period following cardiac surgery. The abdominal surgical complications were, in general, due to complications of peptic ulcer disease, decreased intestinal blood flow, and cholecystitis. There was no correlation between preoperative history, physical examination, cardiac function, laboratory data, and the subsequent development of an acute abdomen. Mortality rate, 24% after abdominal surgery, was increased with emergency cardiac operations, combined cardiac procedures, complications of cardiac surgery, unnecessary delay of abdominal surgery, and abdominal wound complications. Major abdominal wound complications were seen in 38%. Patients undergoing cardiac surgery may develop a variety of common abdominal surgical disorders. Patients so inclined cannot be identified prior to cardiac surgery. Ulcer prophylaxis, wound management, prompt resuscitation, and timely surgery are critical.

Abdomen, Acute↗
PubMed1983

The incidence of Down's syndrome over a 19-year period with special reference to maternal age.

The incidence of Down's syndrome in the Liverpool and Bootle areas from 1961 to 1979 was investigated. A total of 319 liveborn cases was ascertained over this period. Using 3-year moving averages, the incidence of the condition fell gradually from 1.62 per 1000 livebirths for 1961 to 1963 to 1.09 per 1000 livebirths for 1977 to 1979. This trend is significant at the 0.1% level. Over the same period the mean maternal age of Down's syndrome births fell gradually from 36.7 years in 1961 to 29.0 years in 1979. This trend is significant at the 1% level. There was a contemporaneous decrease in the proportion of total births to women over 35 years in the study area. Cytogenetic analysis was performed on 175 out of the 319 index cases (54.9%). Of these, there were 161 trisomies (92%), 11 translocations (6.3%), and three mosaics (1.7%). Between 1969 and 1979 four terminations of pregnancy for Down's syndrome were performed, all for trisomy. Quinquennial age specific incidences for Down's syndrome were calculated for the years 1960 to 1964, 1965 to 1969, 1970 to 1974, and 1975 to 1979. There have been no statistically significant changes over this time. It is suggested that the fall in incidence of Down's syndrome can be explained by the fall in mean maternal age.

Adult↗
PubMed1981

Cytochalasin inhibition of isolated rat gastric parietal cell function.

Submicrogram concentrations (0.04-0.29 microM) of the microfilament disrupting agents cytochalasins D, E, and B (CD, CE, CB) were shown to inhibit secretagogue-stimulated 14C-aminopyrine accumulation (AP) in isolated rat gastric mucosal parietal cells. The microtubule disrupting agent colchicine had little influence on AP accumulation. Histamine- and dibutyryl cyclic AMP (DbcAMP)-stimulated AP accumulation was inhibited with an order of potency CD greater than CE approximately equal to CB. CB inhibition of these secretagogue actions was, however, only approximately 65-70% of the maximal stimulated response, whereas CD and CE caused 100% inhibition. On the other hand, carbamylcholine-stimulated AP accumulation was inhibited 100% by all cytochalasins tested with an order of potency CD approximately equal to CE greater than CB. These data are discussed in relation to acid secretagogue-induced morphological changes involving actin filament organization in parietal cells.

Actins↗