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Biomedical subjects

E T Peter

Publications and source records attributed to E T Peter.

At least 19 recordsLinked to original sources
PubMed1984

Angiodysplasia of the colon. A review of 17 cases.

From October 1977 through December 1982, 24 patients with lower gastrointestinal tract hemorrhage were diagnosed by visceral angiography as having angiodysplasia of the colon. Seventeen of them underwent surgery for definitive treatment of their hemorrhage. Five patients had lesions on both sides of the colon, and five had coagulation disorders. Three of the 17 patients with lesions isolated to the cecum underwent right hemicolectomy. The rest underwent subtotal colectomy with ileoproctostomy. No patient had recurrent or persistent bleeding. There were three deaths in the subtotal colectomy group (21%); coagulation disorders contributed to two of them. Subtotal colectomy was universally successful in controlling bleeding but had a significant mortality in these elderly patients. Coagulopathy, especially platelet disorders, was a significant risk factor with this diagnosis. A coagulation panel, including platelet function, should be part of the preoperative assessment.

Aged↗
PubMed1982

Trauma of the colon: early drop-back of exteriorized repair.

Exteriorized repair of selected colonic injuries has been reported to be successful. Eighty-two colonic injuries were reviewed to determine the indications for primary repair, exteriorized repair, or colostomy and to assess the feasibility of early drop-back of the exteriorized repaired colon. Injuries were graded into three stages: stage 1, good risk; stage 2, moderate risk; and stage 3, bad risk. Sixty-seven percent of patients with stage 1 injuries underwent primary repair, 61% of patients with stage 2 injuries underwent exteriorized repair, and 61% of patients with stage 3 injuries received a colostomy. Of 38 patients who had exteriorized repair, 29 (76%) had their colon successfully dropped back on an average of five days postoperatively. Nine patients had their exteriorized colon converted to a colostomy on an average of 5.5 days postoperatively. The overall mortality was 2.4%; however, the mortality of the patients with exteriorized repair was 0%. Exteriorized repair with early drop-back is safe and economical for most patients with stage 2 injuries and selected patients with stage 3 injuries.

Adolescent↗
PubMed1982

Severe liver trauma in the face of coagulopathy. A case for temporary packing and early reexploration.

Most liver injuries lend themselves to satisfactory hemostasis and drainage, with or without resectional debridement. A small number of injuries will necessitate massive blood transfusion with clinically significant coagulopathy developing in about half of these patients despite prophylactic infusion of fresh frozen plasma and platelet concentrates. In our experience, after major, discrete arterial and venous vessels are individually ligated, the diffuse ooze from the raw surfaces can be effectively controlled by temporary packing of the liver. Packing provides time for coagulopathy and hypothermia to be corrected and for urgent diagnostic maneuvers to be completed safely. Packs should be removed early (within 24 to 48 hours postoperatively), and surgery performed as indicated by the injury. No intraabdominal abscesses have been encountered among our 12 patients who underwent temporary packing of their liver injuries.

Adolescent↗
PubMed1974

The role of bile in antral mucosal disruption during hemorrhagic shock.

The stress ulcers that occur in shocked dogs are averted by pyloric cross-clamping prior to shock. These experiments studied the role of bile reflux in the pathogenesis of stress ulcers in the shocked dog. Two and one-half hours of hemorrhagic shock in dogs with acute antral pouches isolated from the duodenum did not alter antral mucosal integrity as measured by gastric mucosal volume and ionic flux rates despite a fall in transgastric potential difference (PD) indicating mucosal injury (-33.5 +/- 1.7 m Volts vs -12.8 +/- 2.0, p < 0.01). Similarly 4(1/2) hours of shock did not alter mucosal integrity when the pylorus was cross-clamped during shock (PD -59.8 +/- 1.8 mV vs -42.5 +/- 7.0, p = 0.05). In contrast, 4(1/2) hours of shock in dogs in whom the pylorus was open resulted in increased hydrogen ion back diffusion (-106.3 +/- 21.5 microEq vs -300.5 +/- 63.1, p < 0.01, PD -56.8 +/- 3.6 mV vs -24.3 +/- 3.4, p < 0.01). The concentration of bile acids refluxed into the stomach during unmodified shock (8.45 +/- 3.92 mM) exceeds that necessary to disrupt the gastric mucosal barrier. These data suggest that increased hydrogen ion back diffusion initiated by refluxed bile plays an important role in the pathogenesis of gastric stress ulcers in the shocked dog.

Animals↗