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Biomedical subjects

F Welsh

Publications and source records attributed to F Welsh.

At least 19 recordsLinked to original sources
PubMed2000

Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery.

OBJECTIVE: To determine the influence of abnormal gut barrier function on the risk of septic complications in patients undergoing major resectional surgery for upper gastrointestinal cancer. SUMMARY BACKGROUND DATA: A failure of the gut mucosal barrier to exclude bacteria and endotoxin from the portal and systemic circulation is incriminated in the development of sepsis and multiple organ failure. Although the experimental data is compelling, corroborative evidence from studies in humans is sparse. This study attempted to correlate both preoperative gut barrier dysfunction and the pattern of change after surgery with septic outcome. METHODS: Sixty-eight patients undergoing curative resectional surgery for upper gastrointestinal cancer were monitored for 30-day septic morbidity (intraabdominal abscesses/empyema and pneumonia). Intestinal permeability, serum IgM and IgG anti-endotoxin antibodies (EndoCAb), and serum C-reactive protein were measured before surgery and on postoperative days 1 and 7. RESULTS: Increased intestinal permeability before surgery did not predict septic outcome. Major surgery was associated with increased intestinal permeability and evidence of endotoxin exposure. Comparing sepsis and nonsepsis groups, however, there was no significant difference in intestinal permeability, endotoxin exposure, and the acute phase response after surgery. CONCLUSIONS: This study demonstrates that gut barrier dysfunction occurs after surgery, but the magnitude of change does not differentiate patients in whom sepsis develops and those in whom it does not. Preoperative increased intestinal permeability had no predictive value for sepsis. This study failed to support the thesis that gut barrier dysfunction is directly linked to sepsis.

Acute-Phase Reaction↗
PubMed1998

Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis.

BACKGROUND: In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of systemic inflammatory response syndrome (SIRS) and sepsis. AIMS: To determine whether TEN can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis. METHODS: Glasgow score, Apache II, computed tomography (CT) scan score, C reactive protein (CRP), serum IgM antiendotoxin antibodies (EndoCAb), and total antioxidant capacity (TAC) were determined on admission in 34 patients with acute pancreatitis. Patients were stratified according to disease severity and randomised to receive either TPN or TEN for seven days and then re-evaluated. RESULTS: SIRS, sepsis, organ failure, and ITU stay, were globally improved in the enterally fed patients. The acute phase response and disease severity scores were significantly improved following enteral nutrition (CRP: 156 (117-222) to 84 (50-141), p < 0.005; APACHE II scores 8 (6-10) to 6 (4-8), p < 0.0001) without change in the CT scan scores. In parenterally fed patients these parameters did not change but there was an increase in EndoCAb antibody levels and a fall in TAC. Enterally fed patients showed no change in the level of EndoCAb antibodies and an increase in TAC. CONCLUSION: TEN moderates the acute phase response, and improves disease severity and clinical outcome despite unchanged pancreatic injury on CT scan. Reduced systemic exposure to endotoxin and reduced oxidant stress also occurred in the TEN group. Enteral feeding modulates the inflammatory and sepsis response in acute pancreatitis and is clinically beneficial.

APACHE↗
PubMed1997

Energetic dysfunction in quinolinic acid-lesioned rat striatum.

Impairment of mitochondrial energy metabolism may contribute to the selective neuronal degeneration observed in Huntington's disease and other neurodegenerative disorders. Intrastriatal injection of the excitotoxin, quinolinic acid, produces a pattern of neuronal death similar to that seen in Huntington's disease. However, little is known about the effects of quinolinic acid on striatal energetics. In the present work, time-dependent changes in energy metabolism caused by injection of quinolinic acid into rat striatum were examined. Oxygen consumption by free and synaptic mitochondria was quantified and correlated with the concentrations of nucleotides and amino acids at different times after injection. Compared with saline-treated controls, a decrease in ADP-stimulated (state 3) to basal (state 4) oxygen consumption (respiratory control ratio) by free mitochondria was apparent in quinolinic acid-injected striata as early as 6 h after treatment. No significant changes were seen in nucleotide concentrations at this time. By 12 h after injection, the decline in the respiratory control ratio was more pronounced (45%), and reductions in ATP, NAD, aspartate, and glutamate (30-60%) were also observed. These results show that injection of quinolinic acid in vivo produces progressive mitochondrial dysfunction, which may be a common and critical event in the cell death cascade initiated in Huntington's disease and in animal models of this neurodegenerative disorder. The indicators of mitochondrial function examined in this study, therefore, may be useful in evaluating the efficacy of neuroprotective agents.

Amino Acids↗
PubMed1997

Informatics: a physician's view.

From bedside to boardroom, physicians are coming on-line to use automated information systems. Physicians are increasingly able to scroll through computer screens to scan images and lab summaries. But they will obtain their most critical data by listening to, observing, and examining patients. Practitioners will be driven in two diagnostic realms by informatics: acute care and chronic care. Training of both internists and surgeons will be enhanced. Nurses will be able to take on more of doctors' work. Telemedicine may eventually reduce patient visits to the office and doctors' trips to the emergency department. Health care system management is strengthened and network message traffic smoothed by informatics, but lack of trust will slow acceptance.

Acute Disease↗
PubMed1996

Self-regulation: the true key to success of physician-directed networks.

The purpose of regulation is to promote uniformly high quality health care at a reasonable cost. The purpose of self-regulation is to make regulation more acceptable to the network physicians and create an atmosphere of continual improvement in bedside care. Interviews with medical directors of group practices, independent physician associations, managed care plans, national specialty networks, and physician-hospital organizations were used to learn what methods of self-regulation are popular and effective.

Academic Medical Centers↗
PubMed1995

Cost containment in emergency departments.

Traditionally, cost effectiveness has been overlooked in emergency departments because of a mandate to provide emergency care in every community regardless of expense. However, in the current era of managed care, reduced reimbursement, and cost controls, emergency departments are being examined more carefully to determine whether their costs can be contained or even whether they can become profit centers. Detailed billing, cost accounting, enhanced communication among emergency departments within a community, and linking of suburban and inner-city emergency departments are several means by which emergency departments can control costs and raise revenues.

Cost Control↗
PubMed1995

Accounting for the transition from inpatient to outpatient surgery.

This article reports on some of the factors that have advanced and impeded hospital progress in moving from inpatient to outpatient surgery. Early on, patients, physicians, and hospital administrators all agreed that outpatient surgery had an intuitive appeal. Patients liked it because they didn't have to go in the hospital. Physicians liked it because they could get in and out of the outpatient surgery center more easily than the main hospital operating room. Administrators recognized the inherent appeal of outpatient procedures but were unable or unwilling to switch services from inpatient to outpatient for a variety of reasons. First, empty hospital beds and diminished scope of inpatient operations are a threat to the power of administrators. Moving surgery from inpatient to outpatient settings reduces inhouse operations. Second, reimbursement incentives were definitely in favor of continued inpatient care long after technology was in place for outpatient care. The third and most critical reason was that cost data on outpatient operations were just not available for making decisions on when to move into the outpatient setting. This review of the literature was intended to document the lack of relevant cost-based accounting. Instead, many other factors that more directly slowed progress were encountered. More than anything, this illustrates the erratic course of progress in health care reform.

Ambulatory Surgical Procedures↗
PubMed1990

Blood flow and metabolism in vasogenic oedema.

The relationship between white matter cerebral blood flow (CBF) and glucose metabolism (LCMRgl) was studied in a plasma infusion model of vasogenic oedema in cats. LCBF as determined by iodoantipyrine was found to be significantly decreased in oedematous white matter (17.3 +/- 1.5 ml/100 gm/min) when compared with contralateral control white matter (24.8 +/- 1.8 ml/100 gm/min). If the values for oedematous brain were corrected for dilution, however, the LCBF averaged 25.3 +/- 1.7 ml/100 gm/min, which was the same as control. LCMRgl was found to be significantly increased in plasma-infused white matter (16.3 +/- 2.2 mumol/100 gm/min), compared with control white matter (10.7 +/- 1.3). This difference remained despite correction for dilution and recalculation of LCMRgl values based on altered kinetic constants found in oedematous brain. A similar increase in LCMRgl was noted with saline infusion oedema. It is concluded that increased tissue water does not alter CBF, but does induce an increase in anaerobic metabolism.

Animals↗
PubMed1989

Cerebral blood flow and glucose metabolism in experimental brain edema.

The relationship between cerebral blood flow (CBF) and cerebral metabolic rate of glucose (CMRgl) in the white matter was studied in a plasma infusion model of vasogenic edema in cats. Local CBF, as determined by iodoantipyrine testing, was found to be significantly decreased in edematous white matter (mean +/- standard error of the mean: 17.3 +/- 1.5 ml/100 gm/min) when compared with CBF in the contralateral control white matter (24.8 +/- 1.8 ml/100 gm/min). When the values for edematous brain were corrected for dilution, however, the local CBF averaged 25.3 +/- 1.7 ml/100 gm/min, which was similar to the control value. Local CMRgl was found to be significantly increased in plasma-infused white matter (16.3 +/- 2.2 mumol/100 gm/min) compared with that in control white matter (10.7 +/- 1.3 mumol/100 gm/min). This difference remained, despite correction for dilution and recalculation of local CMRgl values based on altered kinetic constants found in edematous brain. A similar increase in local CMRgl was noted with saline-infusion edema. It is concluded that the increased tissue water level does not alter CBF, but does induce an increase in anaerobic metabolism.

Animals↗
PubMed1980

The effects of cold-induced brain edema and white-matter ischemia on the somatosensory evoked response.

The electrophysiological effects of cold-lesion edema and white-matter ischemia were studied in cats by reference to the short-latency somatosensory evoked response. The primary cortical waves were found to be considerably delayed following a period of white-matter ischemia; hosever, cold-lesion edema appeared to have no significant effect on the evoked response. The authors conclude that vasogenic edema does not interfere with axonal functioning by an ischemic mechanism.

Animals↗
PubMed1980

Bioenergetics of acute vasogenic edema.

The bioenergetic mechanisms of vasogenic edema were studied by measuring concentrations of adenosine triphosphate (ATP), phosphocreatine (CrP), and lactate in rapidly frozen edematous white matter in cats. When edema was produced using a cold lesion, it was found that both ATP and CrP were reduced to one-half of control values, and that lactate was elevated. When a correction was applied for dilution, however, it was found that high-energy phosphates were equal to control values, and that lactate was even more significantly elevated. This pattern contrasted with that seen in white-matter ischemia, in which CrP is depressed out of proportion to ATP. Finally, it was found that the white-matter lactate-concentration in the plasma infusion model of edema was increased. It is concluded that vasogenic edema induces an increase in lactate, but does not deplete high-energy phosphate compounds in affected white matter.

Adenosine Triphosphate↗
PubMed1979

Versatility of lumbar transposition flaps in the closure of meningomyelocele skin defects.

A simple method for repair of skin defects after neurosurgical ablation of meningomyelocele is described. One or two skin flaps adjoining the defect are elevated, the right based superiorly and the left inferiorly. They are then transposed to cover the dural repair, and the donor site is repaired by a split-thickness skin graft. The ability of these flaps to close defects of all sizes is stressed.

Humans↗
PubMed1978

Meningomyelocele skin defects.

Meningomyelocele skin defects in ten newborn infants were closed with bilateral lumbar transposition flaps and split-thickness skin grafts. Eight repairs healed promptly without incident. The superficial layer of the flaps in one patient necrosed and were replaced by skin grafts. One patient died of pneumonia and overwhelming sepsis, though the flaps and grafts were healing without reaction. These flaps were useful, even when small, because their placement could be varied to completely cover the defect.

Humans↗