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Biomedical subjects

J Bordley

Publications and source records attributed to J Bordley.

18 recordsLinked to original sources
PubMed1990

Pancreaticoduodenectomy for bleeding periampullary tumors.

Periampullary neoplasms with necrosis or ulceration may have potentially troublesome and occasionally life-threatening bleeding. Four patients required pancreaticoduodenectomy for control of bleeding; three had adenocarcinoma of the duodenum and head of the pancreas, and one had an ulcerated carcinoid tumor of the duodenum. In two of these patients, incomplete resection was performed, and in one there was evidence of metastatic disease to the liver. Surgical results were excellent, postoperative courses were benign, and satisfactory palliation was provided. Improving morbidity and mortality with radical resection and aggressive radiotherapy and chemotherapy after surgery with the potential for bleeding from tumor necrosis make resection a reasonable alternative for palliation when localized but advanced disease exists.

Adenocarcinoma↗
PubMed1988

Gentamicin dosing requirements in patients with acute pancreatitis.

Increased endothelial permeability is postulated in patients with pancreatic inflammatory disease. As a result, a deficit in total circulating blood volume may occur as fluid is sequestered within the extravascular space. To counteract this fluid sequestration, exogenous fluid is administered, which results in expansion of total body water. The object of this study was to determine whether the fluid sequestration and potential total body water increase observed in patients with the diagnosis of pancreatitis affects the pharmacokinetics--and thus dosing requirements--of the water-soluble aminoglycoside gentamicin. Data collected from a clinical pharmacokinetic monitoring service were analyzed in 17 patients with primary diagnoses of acute pancreatitis and 17 closely matched controls. Volume of distribution corrected for total body weight (p = 0.029), volume of distribution corrected for ideal body weight (p = 0.031), and total body gentamicin clearance (p = 0.05) were determined to differ statistically in pancreatitis patients from those values calculated in control patients. Patients with pancreatic inflammatory disease, on the basis of these pharmacokinetic parameter estimates, were found to require approximately a 25% greater dose than controls in order to achieve therapeutic peak serum gentamicin concentrations.

Acute Disease↗
PubMed1986

Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon.

The seventh case of probable cefazolin-induced pseudomembranous colitis is reported. Perforation of the colon necessitated sigmoid resection. The postoperative course was protracted, and illustrates the difficulty of managing advanced pseudomembranous colitis when the oral route of antibiotic administration is not available. Although rare, pseudomembranous colitis related to cefazolin administration is a potentially fatal complication. The routine use of prophylactic antibiotics must be weighed against this possibility.

Aged↗
PubMed1986

Carnitine metabolism during fasting in dogs.

During starvation, a series of changes in whole body fuel use occur that result in conservation of fuel, particularly protein. Use of fat stores for ketone production and direct oxidation of fat as a primary fuel are characteristic of starvation. However, the mechanism by which this change develops is unclear. Carnitine is an important compound in the control of fat metabolism, since long-chain free fatty acids must be coupled with it to cross the mitochondrial membrane. This study attempts to define, in the fasting dog model, the interaction between plasma and muscle carnitine, its acyl esters, and the energy substrates available. Eight adult beagle dogs were studied during an 8-day period of starvation. Muscle and plasma were analyzed for free carnitine (FC), acid-soluble fraction, and long-chain esters (LCE), as well as substrate hormone profiles. Total carnitine (TC) and short-chain esters (SCE) were calculated. Muscle was analyzed for carnitine palmityl transferase activity (CPT). These measurements were performed on days 3, 5, and 8. There was a significant (p less than 0.05) loss in weight on days 3, 5, and 8. TC and FC increased significantly (p less 0.05) only on day 8; this occurred simultaneously with a significant (p less than 0.05) decrease in CPT. It was preceded by a significant (p less than 0.05) and persistent increase in plasma TC, FC, and LCE that developed on day 3. During starvation there was an increase in plasma carnitine levels before changes in muscle. The increase in muscle carnitine occurred between days 5 and 8 of starvation and seemed to be associated with a fall in CPT. This may be responsible either for or secondary to the decrease in metabolic rate that occurs during prolonged starvation.

3-Hydroxybutyric Acid↗
PubMed1985

Management of bleeding angiodysplasia of the upper small intestine.

Five patients thought to have bleeding angiodysplasia in the distal duodenum and proximal jejunum were treated surgically after conservative measures failed to control hemorrhage. Aspiration through a long oral tube preoperatively and intraoperative endoscopy were most helpful in locating the site of bleeding.

Aged↗
PubMed1982

Chronic pancreatitis with cyst formation after prednisone and thiazide treatment.

Acute pancreatitis has been associated with multiple drugs. Some animal and autopsy studies have shown chronic focal changes. Most clinical reports have shown acute pancreatitis at autopsy or an acute clinical course. Herein we present a patient with chronic pancreatitis with cyst formation that was detected several months after steroid administration had been stopped. The histological findings in the resected pancreas showed ectatic ducts, acute and chronic inflammation, and laminated protein concretions in dilated pancreatic ducts. The findings in this patient suggest that drug therapy might be etiological in causing selected cases of chronic pancreatitis.

Benzothiadiazines↗
PubMed1979

The use of glucagon in operative cholangiography.

We have found intravenously administered glucagon to be useful in relaxing the sphincter of Oddi during operative cholangiography. It is readily available, has few potential side-effects, is easily administered intraoperatively and has been promptly and reliably effective.

Adult↗
PubMed1979

Causes for 340 reoperations on the extrahepatic bile ducts.

Three hundred forty of 5,086 patients undergoing operations on the extrahepatic biliary trees at the Swedish and University of Washington Hospitals in Seattle between 1956 and 1970 required reoperation on this system. This figure for reoperations did not include procedures for subhepatic or subphrenic abscess and/or wound complications. The most common cause for reoperation was an attempt to retrieve a residual or recurrent common duct stone (26.8% of the cases). The second most common cause for re-exploration was a tumor obstructing the common bile duct (18.9%). Less frequent causes for secondary surgery were stenosis of the ampulla of Vater (10.3%), bile duct injury (12.1%), pancreatitis (10.3%), inflammatory stricture (1.5%), cystic duct remnant (5%), and many other less important problems. Thus 4.7% or almost one in 20 of all our biliary operations were secondary. We feel that operative cholangiograms supplemented by manometry are the useful adjunct towards finding otherwise undetectable biliary pathology, whether on the basis of stones, tumors, or structures. We also feel that placement of T-tubes with a large arm going to the surface will allow the removal of most stones left behind after common bile duct explorations with the assistance of directable stone baskets.

Adolescent↗
PubMed1978

One per cent incidence of recurrent gallstones six to eight years after manometric cholangiography.

The national incidence of retained and recurrent common duct stones is between 2 and 7%. A prospective comparison of operative common duct pressure flow rates as opposed to operative cholangiography was commenced in 1968 to assay another diagnostic technique to assist in the reduction of this rather high incidence of recurrence. We are now reporting the 6-8 year follow-up data on the first 200 patients, 190 (95%) of whom were reevaluated in 1977. In our inital reports we were surprised to find that our accuracy with flow and pressure studies was 93%, not significantly different from that found with operative cholangiography (92%). The measurements of flow, resting pressure, and opening pressure in the patients with stones or strictures at the lower end of the bile duct were each significantly different from those found in normal ducts (p < 0.001). We considered normal flow to be 10 ml/min saline at 30 cm of pressure and normal intrabiliary pressure to be less than 16 cm of saline was measured through the cystic duct. To date only one individual has had to undergo reoperation for stones and another for recurrent biliary obstruction. A third individual is suspected of, but not proven, to have a retained stone. No patient who had a normal operative cholangiogram, flow and pressure studies, has had a late recurrence of stones. We have presented the specifications of a new catheter for performing flow and pressure x-ray studies, which we feel may be used to primarily evaluate the distal duct with greater accuracy and clarity. We think that this inexpensive but reliable method has an important place in biliary surgery, particularly where operative cholangiography may not be available, or, for one reason or, another, is not reliable.

Catheterization↗
PubMed1966

Hemoglobins in sheep: multiple differences in amino acid sequences of three beta-chains and possible origins.

Among the three adult sheep hemoglobins (A, B, and C), two (A and B) are reportedly products of alleles. The beta-chains of A and B differ by at least seven scattered amino acid residues whereas the beta-sequence of C differs from A by at least 16 residues and from B by at least 21 residues. These changes suggest that the origin of C-beta antedated the divergence of A and B. Five shared differences between A-beta and C-beta with respect to B-beta can be interpreted as the result of selective advantage in favor of B. A complex of additional mechanisms has possibly been involved in maintaining the A-B- C porymorphism.

Amino Acid Sequence↗