PubMed Health⌕ Search

Biomedical subjects

H L Laws

Publications and source records attributed to H L Laws.

At least 19 recordsLinked to original sources
PubMed1992

Regulation of glucose kinetics in trauma patients by insulin and glucagon.

The current study was undertaken to evaluate the contribution of insulin and glucagon to regulation of glucose metabolism in man following severe, traumatic injury by manipulating concentrations of insulin and glucagon with infusions of somatostatin. Glucose kinetics were assessed with [U-14C, 6-(3)H]glucose in severely injured patients and compared with data obtained from patients recovering from minor, elective operative procedures. Glucose production was significantly increased in subjects with traumatic injury compared with control subjects (13.0 +/- 0.63 mumol/kg/min v 8.6 +/- 0.27 mumol/kg/min). There was no impairment in glucose oxidation by the injured patients. Modulation of insulin and glucagon with somatostatin indicated that non-insulin-mediated glucose uptake (NIMGU) was significantly elevated in injured patients (12.2 +/- 0.94 mumol/kg/min v 7.4 +/- 0.61 mumol/kg/min). Hepatic glucose output (HGO) in the absence of glucagon was also significantly elevated in injured patients (12.2 +/- 1.20 mumol/kg/min v 5.8 +/- 1.08 mumol/kg/min). Indirect calorimetry showed a 27% increase in resting energy expenditure (REE). Increased protein oxidation accounted for 56% of the increase in REE. Changes in carbohydrate and lipid oxidation accounted for 28% and 15% of the increase in REE. There was no correlation between the injury severity score of the injured patient and the degree of metabolic abnormality. It is concluded from these studies that (1) injured patients have a high rate of glucose turnover in the absence of glucagon and insulin; (2) the reliance on glucose as a source of energy is not diminished in injured subjects; and (3) increases in protein oxidation account for the majority of the increased REE found in injured patients.

Adolescent↗
PubMed1992

Thoracoscopic vagectomy for recurrent peptic ulcer disease.

Duodenal and marginal jejunal ulcers respond promptly to vagus section. When a prior gastric drainage procedure has been done, the approach of choice for these ulcers is vagectomy through the left chest. This report describes four patients who were subjected to thoracoscopic vagectomy and had prompt early benefit. A description of our technique is presented.

Adult↗
PubMed1990

Diagnostic peritoneal lavage in evaluation of acute abdominal disease.

Diagnostic peritoneal lavage (DPL) is an established procedure in evaluation of trauma victims but is less well established for use in patients suspected of having acute intra-abdominal disease. Twenty-six seriously ill patients at our institution who had DPL for acute intra-abdominal disease form the basis of this report. Use of DPL indicated sepsis in ten patients; in seven of the ten, findings were confirmed at celiotomy or autopsy. Only one of the ten survived without laparotomy or confirmatory necropsy indicating the result of DPL had been false-positive. Sepsis was not indicated by DPL in 16 patients. Fourteen patients appeared to have true-negative results confirmed by operation (three patients), autopsy (four patients), or survival longer than two weeks (seven patients). Complications occurred in one patient whose DPL showed sepsis. Two patients with negative results of DPL died within two weeks of examination without confirmatory operation or autopsy and could not be evaluated. We therefore, consider the overall diagnostic accuracy in our patient group to be 95%. We recommend the use of DPL in patients suspected of an acute intra-abdominal disease process who are unable to undergo other evaluation for reasons such as critical illness.

Abdomen, Acute↗
PubMed1979

How and when to use barium for diagnosis of small bowel obstruction.

The diagnosis of intestinal obstruction is readily made when a patient presents with typical history and signs, and when plain films of the abdomen display characteristic findings. Some patients, however, constitute diagnostic problems because abdominal roentgenograms are still equivocal, even after repetition in four hours. In the unclear case, use of a barium meal will safely, promptly, and routinely prove or disprove small bowel obstruction. Intestinal obstruction in which the initial abdominal films tend to be either unrevealing or equivocal include high obstructions, including the superior mesenteric artery syndrome; presence of strangulation; partial small bowel obstruction; and fluid-filled proximal bowel. In intestinal obstruction, characteristic roentgenographic findings with use of barium meal are normal to rather rapid transit time to the point of obstruction; homogenous dilution of barium in dilated proximal loops; and inhomogenous, scattered, and fragmented collections of barium in the distal, collapsed loops.

Administration, Oral↗
PubMed1979

Splenectomy for hematologic disease.

One hundred and thirty splenectomies were performed at the University Hospital in Birmingham for hematologic disorders during a 12 year period. There were seven deaths of which four were related to sepsis in patients with malignant growths which probably impaired immune competence. Splenectomy was found to be uniformly satisfactory for hereditary hemolytic anemia, for hypersplenism complicating rheumatoid arthritis and for the rare instance of primary hypersplenism. Splenectomy was usually salutary in didopathic thrombocytopenic purpura and in antoimmune hemolytic anemia. When done for diagnosis, splenectomy was definitive in about 50 per cent of the instances. Individual patients with thrombotic thrombocyeosinophilia syndrome benefited. Splenectomy for hypoplastic or aplastic anemia in an actual circulation offered only questionable benefit and is rarely necessary for hyperplenism secondary to portal hypertension.

Adult↗
PubMed1978

Training and use of surgeon's assistants.

"Physician extenders" of various types have been produced in the past few years. The University of Alabama in Birmingham has trained surgeon's assistants over the past 9 years, graduating 53 individuals after a 2-year course of didactic, laboratory, and clinical instruction. The graduates have performed satisfactorily, working with surgeons in the community setting and as part of highly specialized teams in large medical centers. One third work in general surgery, one third in cardiovascular thoracic surgery, and one third in other special areas. The authors conclude that these individuals will play an increasing role in allowing surgical therapy to be delivered in an efficient and effective manner.

Alabama↗
PubMed1978

Management of small bowel obstruction.

Preventable deaths from small bowel obstruction result from misdiagnosis, inappropriate delay in operation, inadequate preoperative preparation, and a poorly performed operative procedure. A systematic approach to each of the factors includes repeat physical examination, x-rays and CBC four hours after initial study in questionable cases, a pre-planned therapeutic interventions timetable, adequate intravascular volume and electrolyte levels, and a carefully designed operation which includes as little bowel manipulation and entrance as possible.

Anti-Bacterial Agents↗
PubMed1977

Bilateral catamenial pneumothorax.

Bilateral catamenial pneumothorax occurred in a 32-year-old parous woman. The 41 previously reported cases of catamenial pneumothorax occurred on the right side. This patient was treated with left-sided pleurodesis and, subsequently, with hysterectomy and bilateral salpingo-oophorectomy. The pathologic mechanism of this peculiar syndrome has been attributed to reflux of air via the genitalia and fenestrations in the diaphragm, menstrual shedding of endometrial cells growing in the visceral pleura, or, possibly, aveolar tissue damage secondary to vascular and bronchiolar spasm resulting from dinoprost tromethamine released from menstrual debris. Treatment needs to be tailored to fit the individual patient's specific pelvic and intrathoracic pathology and procreative desires.

Adult↗
PubMed1977

Surgical treatment of the celiac axis compression syndrome.

Six patients with symptomatic celiac axis compression syndrome are reported on. Four were treated surgically with arterial reconstruction. None of these four patients was benefited more than temporarily by the corrective surgery. One patient had an abdominal exploration and highly selective vagotomy unrelated to the celiac axis and is symptom-free ten months after surgery. One patient had no surgery and remains symptomatic. Angiographic evaluation in all patients demonstrated that despite high grade stenosis of the celiac axis, there was no radiographically discernible reduction in constrast flow to the celiac axis because of well developed collaterals from the superior mesenteric artery. These results indicate that compression of the celiac axis may be merely an incidental angiographic finding, so this syndrome needs cautious evaluation.

Adult↗
PubMed1977

Emergency embolization in blunt hepatic trauma.

The right hepatic artery in a patient with traumatic liver tear was embolized with Gelfoam to stop an otherwise uncontrollable hemorrhage. The procedure was probably life saving in this patient. Transient elevated transaminase and bilirubin levels returned to normal 3 weeks after embolization. A repeat hepatic arteriogram 4 months after embolization demonstrated good revascularization of the right hepatic lobe from the left hepatic, left gastric, and gastroduodenal arteries. This case demonstrates the therapeutic value and safety of selective hepatic arterial branch embolization in massive life-threatening hemorrhage.

Adolescent↗
PubMed1977

Intestinal infarction complicating low cardiac output states.

Nonocclusive mesenteric ischemia, leading into intestinal infarction, frequently complicates and causes the fatal outcome in otherwise treatable instances of low cardiac output states. Once intestinal necrosis occurs in these patients, the mortality is almost 100 per cent. A high risk group of patients in whom intestinal infarction occurs because of low cardiac output can be readily identified. A high index of suspicion for the occurrence of intestinal ischemia in these patients should facilitate recognition of the disease during its early stages. The disastrous results experienced by us and others warrant the use of more aggressive methods for the diagnosis and treatment of patients with this condition. A high index of suspicion in a recognizable group of patients observed by selective mesenteric arteriography affords a method for confirmation of the diagnosis of mesenteric vasoconstriction. Once the diagnosis is established, a patient management protocol program should be followed. Sustained infusion of papaverine into the mesenteric artery is useful in reversing mesenteric vasoconstriction. Additionally, the judicious use of celiotomy and intestinal resection, preceded and followed by the sustained infusion of papaverine into the superior mesenteric artery, offers hope for the survival of some of these patients and warrants further use.

Aged↗
PubMed1976

Polyarteritis nodosa causing severe intestinal bleeding.

Rupture of an aneurysm of the mesentergic artery caused severe intestinal hemorrhage in a 50-year-old woman with polyarteritis nodosa. Abdominal angiography not only established diagnosis of polyarteritis nodosa by demonstrating multiple visceral aneurysms but also localized the site of bleeding.

Aneurysm↗
PubMed1976

Small-bowel obstruction: a review of 465 cases.

A retrospective review of experience with small-bowel obstruction at the University Hospital in Birmingham for a ten-year period (January 1963 through December 1972) revealed 465 episodes of obstruction in 415 patients. The mortality was 4% in obstruction due to adhesions, and 28% in obstruction caused by carcinoma; overall mortality was 8%. Intra-abdominal adhesions were the cause of 69% of cases. Malignant obstruction (mostly from metastatic disease) was the second most common cause of obstruction, and external hernia was third. Delay in diagnosis and inappropriately prolonged used of long intestinal tubes added to the mortality and can be avoided. We suggest a plan for prompt, consistent diagnosis and recommend more liberal use of the barium meal in questionable cases.

Adolescent↗
PubMed1975

Factitial mesenteric avulsion.

Colon exteriorization procedures were done in two patients who also were, or became, psychotic. Each patient pulled on the exteriorized loop, causing severe bowel injury. In known or potential psychotics some other form of colonic injury management--other than exteriorization--should be utilized, or extreme caution should be taken to prevent inadvertent self-injury by the patient.

Adult↗