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Biomedical subjects

J Dobbins

Publications and source records attributed to J Dobbins.

At least 19 recordsLinked to original sources
PubMed1999

Gas in the sternoclavicular joints of patients with blunt chest trauma: significance and frequency of CT findings.

OBJECTIVE: In trauma patients, gas (vacuum phenomenon) in the sternoclavicular joints could represent sequelae of significant distraction forces and thus serve as a potential marker for severe intrathoracic injury. We evaluated the significance and frequency of the finding of gas in the sternoclavicular joints on chest CT of patients with blunt trauma. SUBJECTS AND METHODS: We prospectively studied all chest CT examinations performed at our institution over a 14-week period for the finding of gas in the sternoclavicular joints. Chest CT examinations (n = 267) were performed in 234 patients. We excluded data from follow-up CT examinations (n = 33), limiting our evaluation to the initial CT examination for each patient. Of the study population, 103 patients (83 men and 20 women) who ranged in age from 14 to 79 years (mean, 40 years) had sustained blunt chest trauma. For all trauma patients, we recorded the mechanism of injury and the associated thoracic injuries. RESULTS: CT revealed gas in the sternoclavicular joints in 47 patients (21%). Gas was unilateral in 27 patients and bilateral in 20 patients. Sternoclavicular joint gas was seen in 39 (38%) of the 103 trauma patients but was found in only eight (6%) of the 131 nontrauma patients (p < .0001). In the 39 trauma patients with sternoclavicular joint gas, associated thoracic injuries were seen in 17 patients (44%); either a sternal fracture or a retrosternal hematoma was seen in three patients. Radiographically evident thoracic injury was revealed in 20 (31%) of the 64 trauma patients who had no gas in the sternoclavicular joint; however, 10 of these 20 patients had either a sternal fracture or a mediastinal hematoma. CONCLUSION: Although gas in the sternoclavicular joints is more frequently seen in patients with blunt chest trauma than in patients undergoing chest CT for other indications, this finding does not indicate a greater risk of significant mediastinal or thoracic injury.

Adolescent↗
PubMed1996

Pancreas divisum in a family with hereditary pancreatitis.

Hereditary pancreatitis is characterized by an autosomal-dominant mode of inheritance with incomplete penetrance, onset of symptoms in childhood or early adolescence (mean age of onset approximately 13 years), and an approximately equal sex incidence. Pancreas divisum is a congenital variant of pancreatic ductal anatomy in which the ventral and dorsal pancreatic ductal systems fail to fuse, so that two functional papillae drain the exocrine secretions of the pancreas. In recent years, several reports of pancreatitis associated with pancreas divisum in children have appeared. We now report a family in which the mother, son, and daughter all had presented with recurrent pancreatitis from an early age. Both the mother and son have endoscopic retrograde cholangiopancreatography-documented pancreas divisum, whereas the daughter has a stricture in her distal pancreatic duct. To our knowledge, this is the first such report of "familial" pancreas divisum. The implications of these findings in the setting of hereditary pancreatitis highlight the controversial issues of the clinical significance of pancreas divisum and the appropriateness of surgical therapy.

Child↗
PubMed1995

Metachronous small-bowel adenocarcinoma in celiac sprue.

Celiac sprue, or nontropical sprue, is associated with an increased incidence of digestive tract malignancy. We report a patient with celiac sprue who developed two primary adenocarcinomas of the jejunum > 2 years apart. The second cancer was asymptomatic and detected by surveillance computed tomography. Small-bowel cancers are unusual, and frequency of follow-up has not been established, so that it is important to have a high index of suspicion for these malignancies in celiac patients with vague gastrointestinal symptoms.

Adenocarcinoma↗
PubMed1994

The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas.

BACKGROUND: To evaluate the role of radical resection for low grade cerebral hemisphere gliomas, the authors analyzed the preoperative and postoperative radiographic tumor volumes (computed tomography hypodensity, magnetic resonance imaging-T2 signal hyperintensity) in 53 patients. METHODS: Using a previously described method of computerized image analysis, the authors evaluated whether the percent of resection and volume of residual disease, postoperatively, influenced the incidence of recurrence, time to tumor progression, and histology of the recurrent tumor. Survival was not analyzed in this study. RESULTS: No recurrence was detected, regardless of percent of resection and volume of residual disease, in patients with preoperative tumor volumes less than 10 cm2 (mean follow-up, 41.7 months). Patients with tumors measuring 10-30 cm3 had an incidence of recurrence and time to tumor progression of 13.6% and 58 months, respectively, compared with tumors measuring greater than 30 cm3, which had an incidence of recurrence and time to tumor progression of 41.2% and 30 months, respectively (P = 0.016). All patients (n = 13) who underwent a 100% resection had a recurrence-free follow-up period (mean, 54 months). In the remaining patients (n = 40), as the percent of resection decreased, the incidence of recurrence increased along with a shorter time to tumor progression (P = 0.03). Patients with a volume of residual disease of greater than 10 cm3 had a higher incidence of recurrence (46.2%) and a shorter time to tumor progression (30 months) compared with patients with a tumor volume of residual disease of less than 10 cm3 (incidence of recurrence, 14.8% and time to tumor progression, 50 months) (P = 0.002). Forty-six percent of patients with a tumor volume of residual disease of more than 10 cm3 had a recurrence of higher histologic grade, and this was significantly more frequent than patients with a volume of residual disease less than 10 cm3 (3.7%) (P = 0.0009). Age, radiotherapy, and histologic subtype had no influence on recurrence patterns. CONCLUSION: For tumors greater than 10 cm3, the authors' data suggest that a greater percent of resection and a smaller volume of residual disease conveys a significant advantage, that is, terms of incidence of recurrence and the recurrent tumor phenotype, for patients with low grade cerebral hemisphere gliomas, compared with those who have a less aggressive resection or biopsy. While this may also be the case with tumors less than 10 cm3, further follow-up is necessary to determine the effect of surgery on recurrence patterns for this subset of patients.

Adolescent↗
PubMed1993

Low-grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resection.

Adults and children with low-grade gliomas often present with medically refractory epilepsy. Currently, controversy exists regarding the need for intraoperative electrocorticography (ECoG) to identify and, separately, resect seizure foci versus tumor removal alone to yield maximum seizure control in this patient population. Forty-five patients with low-grade gliomas and intractable epilepsy were retrospectively analyzed with respect to preoperative seizure frequency and duration, number of antiepileptic drugs, intraoperative ECoG data (single versus multiple foci), histology of resected seizure foci, and postoperative control of seizures with or without antiepileptic drugs. Multiple versus single seizure foci were more likely to be associated with a longer preoperative duration of epilepsy. Of the 45 patients studied, 24 were no longer taking antiepileptic drugs and were seizure-free (mean follow-up interval 54 months). Seventeen patients, who all had complete control of their seizures, remained on antiepileptic drugs at lower doses (mean follow-up interval 44 months); seven of these patients were seizure-free postoperatively, yet the referring physician was reluctant to taper the antiepileptic drugs. Four patients continued to have seizures while receiving antiepileptic drugs, although at a reduced frequency and severity. In this series 41% of the adults versus 85% of the children were seizure-free while no longer receiving antiepileptic drugs, with mean postoperative follow-up periods of 50 and 56 months, respectively. This difference was statistically significant (p = 0.016). Therefore, based on this experience and in comparison with numerous retrospective studies involving similar patients, ECoG is advocated, especially in children and in any patient with a long-standing seizure disorder, to maximize seizure control while minimizing or abolishing the need for postoperative antiepileptic drugs.

Adolescent↗
PubMed1991

Factors in pin tract infections.

To determine the factors pertinent to the etiology of pin tract infections, 214 pins in 42 patients were examined prospectively at the time of pin removal. Eighty-nine (41.6%) pin tracts were inflamed, 49 (22.9%) pins had loose anchorages, and 160 (74.8%) pin tips cultured positive for bacteria. The predominant organism cultured was Staphylococcus epidermidis (90.6%), considered nonvirulent, followed by virulent Staphylococcus aureus (37.5%), and Escherichia coli (9.4%). There were 32 loose, inflamed pin tracts. This correlation was statistically significant (P less than .005). There were 40 loose pins whose pin tips had positive cultures. Loose pins correlated for infection with virulent species of bacteria at a highly significant level (P less than .005). Results demonstrate that most pins possess bacterial colonization. Clinically, this means that either inflamed pin tracts or pins with cultures positive for invasive organisms are probably loose and should be removed. Also, mechanical factors are the critical variable in determining the flora of external fixation pins.

Adolescent↗
PubMed1990

Techniques for the determination of left ventricular mass by signal-averaged electrocardiography.

UNLABELLED: The standard ECG correlates poorly with LV mass. The SAECG precisely measures myocardial energy and may allow more exact noninvasive assessment of LV mass. A commercially available system (Corazonix Predictor I) was tested for its ability to reproduce and measure known input energy in square wave and QRS waveforms, using frequency bandwidths different from those used for late potential analysis. A test group of 15 patients was studied to determine optimum filter type and bandwidth for comparison of SAECG energy measurement versus LV mass as determined by echocardiography (Penn conversion) and LV hypertrophy via standard ECG criteria. The best means of energy measurement were maximum and total RMS voltage and the integral of the area under the QRS curve. Optimum correlation with echocardiography was seen with a bidirectional band-pass filter of 5 to 250 Hz applied either to the vector sum of the three orthogonal leads or to the Z lead alone (r values 0.61 to 0.73), which was equal to or superior to standard ECG LV hypertrophy determinants. A second group of 20 patients was studied prospectively to confirm these findings, which yielded similar results. CONCLUSION: (1) the SAECG when appropriately modified serves as a rapid noninvasive assessment of LV mass. (2) These modifications must examine the entire duration and energy spectrum of the surface ECG and not just the region of late potentials. (3) Very low frequencies (below 5 Hz) must be excluded to eliminate the energy present due to DC offset voltage.

Cardiomegaly↗
PubMed1985

Postcholecystectomy syndrome: evaluation using biliary scintigraphy and endoscopic retrograde cholangiopancreatography.

We prospectively studied 30 patients with postcholecystectomy syndrome to determine the efficacy of biliary scintigraphy in the detection of stenosis of the sphincter of Oddi. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP). Biliary scintigraphy disclosed stenosis of the sphincter by agreement with the ERCP or surgical findings in nine (90%) of ten patients and in eight (100%) of eight patients with biliary obstruction from other causes. Retention of activity at 2 hours in visually prominent ducts was the best predictor of abnormal biliary drainage. Biliary scintigraphy is a useful, noninvasive screening test for the detection of postcholecystectomy biliary obstruction.

Adult↗
PubMed1984

Strategy for the use of biliary scintigraphy in non-iatrogenic biliary trauma.

Biliary scintigraphy was used to examine 21 patients who had suspected non-iatrogenic biliary trauma. Seven patients (33%) had scintigraphic evidence of biliary leakage. Ultimately, surgical biliary repair was required for only three of these patients. Visualization of the gallbladder did not occur in eight trauma patients, but only one patient was shown to have cholecystitis. In this series, 16 patients had Tc-99m sulfur colloid scans that offered no significant advantage over cholescintigraphy in the detection of hepatic parenchymal defects. Biliary scintigraphy provides clinically useful information in cases both of blunt and penetrating trauma.

Adult↗
PubMed1980

Liquefactive necrosis of the pancreas: the pancreatic sac.

The authors describe an unusual form of pancreatic necrosis in which the excavated necrotic core is surrounded by a shell of tissue and forms a sac which generally conforms to the axis and contour of the pancreas. This debris-containing sac could be misinterpreted on ultrasound and CT and is best defined by direct injection into the pancreatic duct.

Adult↗
PubMed1980

Effect of D-alanine methionine enkephalin amide on ion transport in rabbit ileum.

The presence of enkephalins in the intestine and the use of opiates to treat diarrheal diseases suggests that enkephalins may affect intestinal ion transport. Using isolated rabbit ileal mucosa, we found that leucine enkephalin, methionine enkephalin, and D Ala2-methionine enkephalin amide (D Ala2-Met E) decreased the short circuit current (Isc) and potential difference although the effect of D Ala2-Met E was more pronounced and prolonged. D Ala2-Met E increased net sodium (+1.27 +/- 0.5 mu eq/cm2h), and chloride absorption (+2.33 +/- 0.4), and increased tissue conductance by 37%. Although the effect of enkaphalin on ion transport is opposite that of cyclic AMP, D-Ala2-Met had no effect on basal or vasoactive intestinal polypeptide-stimulated cyclic AMP levels. The effect of D-Ala2-Met E on Isc was blocked by naloxone, suggesting the involvement of specific opiate receptors. Tetrodotoxin completely blocked the decrease in Isc induced by D-Ala2-Met E but not by epinephrine, inferring that enkephalins are preganglionic neurotransmitters. The effect of D-Ala2-Met E on Isc was not blocked by phentolamine, haloperidol, or pretreatment of animals with 6-hydroxydopamine, suggesting that enkephalin does not affect the Isc by stimulating the release of alpha-adrenergic or dopaminergic agonists. D-Ala2-Met E also decreased the Isc in the presence of carbachol and bethanechol, indicating that enkephalin does not inhibit the release of acetylcholine. Further, up to 10 mu M atropine had no effect on the Isc. These studies demonstrate that enkephalins stimulate intestinal ion transport and may do so by stimulating (or inhibiting) the release of a nonadrenergic, noncholinergic neurotransmitter.

Animals↗
PubMed1979

Diagnosis of annular pancreas with endoscopic retrograde cholangiopancreatography.

Two patients with annular pancreas are described. The diagnosis was established unequivocally with endoscopic retrograde cholangiopancreatography before operation. In both patients there was pancreatitis of the annular pancreas. The first patient also had congenital absence of the ventral pancreas and pancreatic insufficiency. The second patient subsequently developed gastric outlet obstruction. The literature is reviewed.

Adult↗
PubMed1966

Role of plasma lecithin:cholesterol acyltransferase in the metabolism of high density lipoproteins.

The role of the plasma lecithin:cholesterol acyltransferase reaction in the esterification of the cholesterol of human and baboon plasma high density lipoproteins has been studied. Human plasma was incubated in vitro, and the initial rate of cholesterol esterification in lipoprotein fractions obtained by chromatography on hydroxylapatite was determined. The rate of esterification was greater in the high density lipoprotein fraction than in the low density lipoprotein fraction. High density lipoproteins from human and baboon plasma were filtered through columns of Sephadex G 200, and the relative concentrations in the effluent of key lipids involved in the acyltransferase reaction were determined. The ratio of esterified to unesterified cholesterol varied across the lipoprotein peak obtained from either type of plasma. The relative concentration of lecithin compared to sphingomyelin also varied across the peaks obtained with human high density lipoproteins. When human or baboon plasma was incubated with cholesterol-(14)C and the high density lipoproteins were filtered through Sephadex, the specific activity of the esterified cholesterol varied across the lipoprotein peak. Similar results were obtained when plasma esterified cholesterol was labeled in vivo by the injection of labeled mevalonate into baboons. The data suggest that the acyltransferase reaction is the major source of the esterified cholesterol of the high density lipoproteins.

Acyltransferases↗