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Biomedical subjects

J B Peoples

Publications and source records attributed to J B Peoples.

16 recordsLinked to original sources
PubMed1992

Cholecystectomy during pregnancy without fetal loss.

Cholecystectomy in the pregnant patient has been generally avoided because of the reported high incidence of associated fetal loss that has been linked to spontaneous and elective abortion during the first trimester and premature labor during the third trimester. Recent developments relating to diagnostic and anesthetic management and the use of tocolytic agents have altered the over-all approach to patients. We have, therefore, retrospectively reviewed the medical records of all women discharged from four area hospitals during 1982 to 1987 with a concurrent diagnosis of cholelithiasis and pregnancy. Twenty-two patients met the review criteria. The incidence of biliary stone disease among gravid patients during the time interval was 0.05 per cent. Of 22 patients, none underwent radiation for diagnosis. Nine patients underwent cholecystectomy while pregnant; two were operated upon during the first trimester, four during the second and three during the third. Three required common bile duct exploration and three had intraoperative cholangiograms. Elective abortion was not recommended to the six patients because of radiation exposure. Two of nine had premature contractions develop that were controlled with tocolytic agents. There were no spontaneous abortions. The mean Apgar scores for neonates born subsequent to cholecystectomy was virtually identical to neonates born to patients in whom cholecystectomy was deferred. It is concluded that the diagnosis and surgical treatment of cholelithiasis can be safely undertaken in the pregnant patient without fetal loss. Delaying appropriate surgical therapy no longer seems warranted.

Adult↗
PubMed1991

Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures?

The patency of anastomoses joining the pancreas to either a Roux-Y loop of jejunum or the stomach was evaluated in 26 dogs. At a preliminary operation, the head and uncinate process of the pancreas were resected while carefully preserving the duodenal blood supply. The remaining body and tail of the pancreas were totally obstructed. After obstruction for a mean of 22 (range: 6 to 42) days, one of three anastomoses was performed: (1) inversion pancreatogastrostomy with two layers of sutures; (2) a similar inversion pancreatojejunostomy to the side of a Roux-Y jejunal loop; or (3) pancreatojejunostomy in which the major duct was joined to the jejunal mucosa with interrupted sutures. Six animals were kept for controls. Anastomotic patency was assessed after 8 to 12 weeks by pancreatography, with minimal pressures to achieve anastomotic flow recorded. Weight trends were consistent with anastomotic status. The eight dogs with duct-to-mucosa sutures clearly achieved superior anastomotic patency.

Anastomosis, Surgical↗
PubMed1991

Combined use of topical and systemic antibiotics.

An animal wound model was used to compare the effectiveness of topical and systemic antibiotics and to examine the validity of using a combined regimen of both routes of antibiotic delivery. Gross infection rates and wound bacterial concentrations were determined after contamination with Staphylococcus aureus or Escherichia coli. Both moderate (10(8) colony-forming units [CFU]) and heavy (10(12) CFU) contamination were studied for each organism. Following moderate contamination, topical and systemic antibiotics were equally effective in reducing both wound bacterial content and infection rate, but there was no benefit from the combined use of both modes of antibiotic delivery. An additive effect of the combined regimen was noted only when the level of wound contamination was heavy.

Administration, Topical↗
PubMed1991

Nonfunctioning parathyroid carcinoma.

Parathyroid carcinoma is a rare clinical entity accounting for only 4 per cent of all cases of parathyroid neoplasia. Nonfunctioning parathyroid carcinoma is even rarer. Previously, virtually all patients with these lesions were treated for a nonspecific neck mass. However, in the present case, a preoperative diagnosis of nonfunctioning parathyroid carcinoma was made based on the technetium pertechnetate/thallium 201 subtraction scan. The authors report on the 14th case of nonfunctioning parathyroid carcinoma, a review of the literature, and guidelines for the preoperative and operative evaluation of neck masses suspected to be parathyroid carcinoma.

Adult↗
PubMed1991

Mesenteric venous thrombosis: ten year record review and evaluation of difficulties with the ICD coding system.

A 10-year retrospective review of mesenteric venous thrombosis was accomplished in one metropolitan city. This paper discusses 14 patients with a confirmed diagnosis of mesenteric venous thrombosis. This review also yielded an important realization of an inadequacy of the International Classification of Diseases, 9th edition in coding for mesenteric venous thrombosis. This paper discusses this difficulty in the International Classification of Diseases.

Adult↗
PubMed1990

Operative therapy for sigmoid volvulus. Identification of risk factors affecting outcome.

The medical records of 54 patients treated for sigmoid volvulus from 1983 to 1987 were reviewed. Patient demographics were very similar to previously published results. Four patients (7.4 percent) underwent emergency resection for gangrene with a mortality of 75 percent. Of the 50 patients who presented without ischemia, 23 (46 percent) were managed by nonoperative detorsion while 3 (6 percent) detorsed spontaneously. Fourteen of these 26 patients received no further treatment. Nonoperative mortality was 0 percent. Celiotomy was performed on 36 patients. The type of operative procedure performed had no significant bearing on outcome. Fifteen patients underwent resection and anastomosis; two of these patients died (13 percent). Fifteen patients underwent resection and colostomy with two deaths (13 percent), and six had open detorsion alone with one death (17 percent). The two factors associated with adverse outcome after surgical intervention were patient age and history of previous volvulus. All five deaths occurred in patients older than 70 years presenting with a first episode of volvulus (N = 15, mortality = 33 percent). No deaths occurred among patients younger than 70 years regardless of volvulus history or among those older than 70 years who were being treated for a recurrence (P less than or equal to 0.01). Patients older than 70 years with a first episode of volvulus represent a high risk if subjected to surgical intervention. Nonoperative detorsion alone should be considered for this subgroup of patients.

Age Factors↗
PubMed1990

Reassessment of primary resection of the perforated segment for severe colonic diverticulitis.

Primary resection with colostomy has been widely adopted during the past decade for the treatment of patients with severe complications of diverticulitis. Because of this, a retrospective review was performed of all patients undergoing surgery for colonic diverticular disease during the two time periods 1974 to 1978 (n = 196) and 1982 to 1986 (n = 230). Forty-three patients had abscess or peritonitis from 1974 to 1978, whereas 52 had these complications from 1982 to 1986. Colostomy and drainage alone were used for 31 of 43 patients (72%) from 1974 to 1978, while primary resection with colostomy was used for 39 of 52 patients (75%) from 1982 to 1986 (p less than or equal to 0.5). Despite this shift in treatment method, mortality increased from 14% in 1974 to 1978 to 19% in 1982 to 1986 (p = NS). Patients with peritonitis had identical mortalities (22%) during both intervals. Patients with abscess experienced an increase in mortality from 8% in 1974 to 1978 to 15% in 1982 to 1986 (p = NS). The widespread use of primary resection for patients with severe complications of diverticulitis appears not to have altered mortality for those with diffuse peritonitis and may have worsened the outcome for those with abscess.

Abscess↗
PubMed1990

Assessing the role of routine choledochoscopy during exploration of the bile duct.

Two hundred and five consecutive explorations of the common bile duct were evaluated to assess the value of routine choledoschoscopic examination in preventing retained stones. Conventional exploration was performed in 139 instances (group 1), while routine choledochoscopy was added in 66 procedures (group 2). Preoperative temperature, leukocyte count, total bilirubin, amylase and alkaline phosphatase levels were not significantly different between the groups. Nine retained stones were demonstrated by postoperative cholangiography among the patients in group 1 as compared with three retained stones noted in those in group 2. This difference was not significant. Postoperative mortality and complication rates were unaffected by the performance of an endoscopic study of the biliary tract during ductal exploration. Choledochoscopy added an average of 36 minutes to the duration of the operative procedure (p less than 0.001). Choledochoscopy may prove helpful in selected instances, but the current data do not support its routine use during exploration of the common bile duct.

Cholangiography↗
PubMed1990

A study of the on-duty hours of surgical residents.

A time study was done to ascertain the number of hours spent in the hospital and the types of duties performed by residents enrolled in a multiple-institution, university-sponsored surgical training program. On the average, residents in the Wright State University program spent 90.1 +/- 27.1 hours in the hospital per week. Direct patient care activities required 62.7 +/- 18.8 hours (69.6%) of the average workweek. Purely educational endeavors accounted for 10.0 +/- 6.1 hours (11.1%) of the workweek. Ancillary tasks consumed an average of 8.5 +/- 8.5 hours (9.4%) of the surgical residents' time on duty per week. House officers did obtain a mean of 9.1 +/- 11.0 hours of sleep in those working hours (10.1% of the total time spent in the hospital). Although much variation existed among hospitals in the program, on-duty hours were greater in the private hospitals compared to the federal hospitals; the principal difference was the amount of time spent doing ancillary tasks (10.0 +/- 9.4 hours vs 5.6 +/- 5.6 hours; p less than 0.01). Hours worked by residents on private surgical services were longer than those of residents assigned to staff services (96.4 +/- 22.1 hours vs 86.0 +/- 29.3 hours; p less than 0.04). Again, the major difference was the greater amount of ancillary tasks performed by residents on private services (12.0 +/- 9.5 hours vs 6.2 +/- 7.0 hours; p less than 0.001). This finding could not be attributed to differences in patient census or turnover rates. Longer hours were noted on the general/thoracic surgery services compared to other surgical subspecialties (94.1 +/- 27.3 hours vs 81.5 +/- 24.8 hours; p less than 0.02). More time was spent in direct patient care on general/thoracic surgery (66.3 +/- 19.3 hours vs 54.9 +/- 15.1 hours; p less than 0.002). Despite the shorter workweek, residents on subspecialty rotations spent more time doing ancillary tasks (11.3 +/- 9.7 hours vs 7.3 +/- 7.6 hours; p less than 0.02). More than 60% of the residents' working hours in this program exceeded the arbitrary 80-hour limit, emphasizing the challenge of complying with the imposition of maximum work hours. We recommend that each program closely monitor the activities and hours of its residents to best respond to the pressures for regulation.

General Surgery↗
PubMed1988

Comparison between externally stented and unstented PTFE vascular grafts.

It has been suggested that external stenting of synthetic vascular prosthetic material may improve patency rates in the low flow situation or across joints. This study compared externally stented polytetrafluoroethylene (PTFE) vascular grafts placed across the hip joint in dogs with nonstented PTFE grafts in regard to patency. Twenty animals underwent bilateral common iliac to common femoral artery bypass with proximal ligation of the femoral artery. In each animal one groin was randomly assigned to receive stented PTFE and the other nonstented PTFE. One animal was sacrificed at 2 weeks for graft infection. Nineteen animals received 38 grafts that remained in place 90-120 days. Patency was confirmed with angiography prior to sacrifice. Overall patency was 65 per cent with no significant difference between the two types of graft. Eighteen of 19 dogs (95%) had both the stented and nonstented PTFE grafts either open or closed. It is concluded that intrinsic factors, rather than external graft support, are a more important influence on graft patency in this model.

Animals↗
PubMed1988

The role of pH in altering serum ionized calcium concentration.

Although parathormone primarily determines normal ionized serum calcium concentration [Ca++] over the long term, it has little impact in the acute situation. Nonhormonal changes in [Ca++] have been related to acute changes in serum pH, but these have been believed small. With use of an experimental model of acute pancreatitis, we measured changes in [Ca++] and related them to changes in other serum constituents known to affect it. All 18 animals studied experienced a decrease in total serum calcium concentration [CaT]. Changes in [CaT] correlated only with changes in protein-bound calcium concentration [CaP] (r = 0.98, p less than or equal to 0.0005). They did not correlate independently with changes in albumin, globulin, or total protein concentration. [CaP] varied as a function of albumin, globulin, and phosphate concentration and pH according to the equation: [CaP] = 17.9 +/- 0.89 [albumin] = 0.68 [globulin] - 2.5 pH + 0.12 [phosphate]. Calculated values for [CaP], when this equation was used, correlated strongly with observed values for [CaP] (r = 0.81, p less than or equal to 0.0005). Measured [Ca++] increased in the animals early during pancreatitis and then returned to baseline levels. A few animals experienced ionized hypocalcemia. [Ca++] correlated only with changes in pH (r = 0.87, p less than or equal to 0.02). The calculated response slope was delta [Ca++]/delta pH = -2.9. It is concluded that pH has a greater effect on [Ca++] than previously recognized. The major determinant of [CaT] during periods of rapid physiologic change appears to be [CaP] while that for [Ca++] is pH.

Acute Disease↗
PubMed1987

Efficacy of sucralfate in preventing peptic ulceration induced by nonsteroidal anti-inflammatory drugs.

The nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used analgesics associated with a significant incidence of gastritis and/or peptic ulceration. This study was designed to evaluate the efficacy of sucralfate (SC) in reducing NSAID-induced ulceration in a rat model. Nine groups of 20 rats each were segregated by drug(s) tested. Two NSAIDs, aspirin (ASA) and indomethacin (IND), were tested. Control groups consisted of saline only, ASA only, and IND only. SC was tested against ASA and IND separately, being administered 5 minutes preceding, mixed with, or 5 minutes following each NSAID. Administration of SC before ASA resulted in a reduction of mean ulcers per rat from 10.4 +/- 4.3 to 1.1 +/- 1.3 (P less than or equal to .0001). Administration of SC prior to IND resulted in a reduction of mean ulcer rate from 6.6 +/- 5.4 to 3.0 +/- 3.3 (P less than or equal to .02). When SC was given with IND or following it, no reduction in ulcer rate was observed. When SC was given with ASA or following it, the ulcer rate was reduced to 5.3 +/- 3.0 (P less than or equal to .002). It is concluded that SC is effective in reducing NSAID-induced ulcer production especially when administered before NSAID ingestion.

Animals↗
PubMed1986

Candida and perforated peptic ulcers.

Patients with perforated peptic ulcers who have Candida isolated from peritoneal culture have been noted to have a poor prognosis. Therefore treatment of such patients with systemic antifungal agents has been considered. Because of the toxicity and expense of such therapy, a review of the association was performed. During 1980 to 1985, 48 patients were operated on for benign perforated ulcer. The mean age of the patient group was 66 years. Intraoperative cultures were obtained in 38 patients. Microorganisms were isolated in 28 (74%) patients. Candida was isolated in 16 (57%) of the positive cultures. The overall mortality rate was 16.7%. The mortality rate for patients 65 years of age or older was 25% compared with 0% for those younger than 65 years old. The mortality rate for patients with Candida in their peritoneal fluid was 18.8%. No patient was treated with systemic antifungal agents. No patient developed candidiasis. Of the 16 patients in whom Candida was isolated, it was the only organism in 10 patients and was found in mixed culture with bacteria in six. The mortality rate for patients with Candida alone was 0%. The mortality rate for patients with mixed cultures was 50%. The presence of mixed cultures correlated strongly with both advanced patient age and shock. These factors have previously been correlated with death. It is concluded that the association between peritoneal Candida and excessive death from perforation is linked by an intervening association to advanced age and shock. In this setting, Candida does not appear to be normally pathogenic and does not require systemic antifungal therapy.

Adolescent↗
PubMed1985

Peptic ulcer disease and the nonsteroidal anti-inflammatory drugs.

The medical records of 265 patients with peptic ulcer disease were reviewed for a history of nonsteroidal anti-inflammatory drug (NSAID) use preceding hospital admission. Ninety-five patients (36%) gave a history of regular use of such agents. The admission characteristics of the peptic ulcer patient group not using NSAIDs (age, sex, ulcer location, admission indication, method of diagnosis) were virtually identical to those of the group taking NSAIDs. Although 24.5 per cent of patients not taking NSAIDs were admitted because of hemorrhage from their ulcer compared with 28.4 per cent of NSAID users, only 7.5 per cent of nonusers required surgery for hemorrhage control compared to 29.6 per cent of users. Eighty per cent of patients regularly using more than one NSAID required surgery for an ulcer complication. Hemorrhage mortality was 5 per cent among nonusers compared with 14.8 per cent among users. It is concluded that NSAID use by patients with peptic ulcers adversely affects therapeutic response in general and significantly impairs normal hemostatic mechanisms in patients bleeding from an ulcer.

Adolescent↗
PubMed1975

Mechanisms of hypocalcemia in acute hemorrhagic pancreatitis.

Thyrocalcitonin release mediated by glucagon secreted from the acutely inflamed pancreas has been postulated as a possible mechanism for hypocalcemia in acute pancreatitis. To test this hypothesis, hemorrhagic pancreatitis was induced in a group of thyroidectomized pigs. No source of thyrocalcitonin other than the thyroid has been described in the pig. Their subsequent serum calcium concentrations were compared with those in a group of thyroid intact pigs also given hemorrhagic pancreatitis. The results indicate that the hypocalcemia observed during the first 24 hours following induction of pancreatitis is not related to the presence of an intact thyroid. Differences observed in the degree of hypocalcemia between the two groups 30 to 48 hours after pancreatitis developed may be of significance but could be explained by dilutional differences alone. Thyrocalcitonin apparently has little if any role in the hypocalcemia observed during the course of acute pancreatitis.

Acute Disease↗