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Biomedical subjects

J Duff

Publications and source records attributed to J Duff.

86 records · Page 5Linked to original sources

Effect of antibiotic and fluid resuscitation upon survival time in experimental intestinal ischemia.

Acute massive intestinal ischemia is an abdominal catastrophe. Prompt diagnosis and restoration of blood flow is essential; otherwise, massive intestinal resection occurs, leading to death or, in the survivors, intestinal cripples. In this study, the time of warm reversible ischemia in the canine intestine was explored. After this time was established, fluids and antibiotics were administered to note change in survival times. Massive intestinal ischemia (superior mesenteric artery was clamped) was tolerated without death for five hours (20 dogs in each group). With six hours of ischemia, a 10 per cent mortality rate occurred; with seven hours of ischemia, a 90 per cent mortality rate occurred. These dogs had a maintenance of 75 milliliters of fluid administered per hour. Using this group of dogs as the control (that is, the group with seven hour clamping time of the superior mesenteric artery with maintenance intravenously administered replacement), fluids were given to dogs in the experimental group to keep the pulmonary artery wedge pressure at a normal value (average of 300 milliliters per hour). This group of dogs had an increased survival rate of 40 per cent (ten dogs). Antibiotics were given to the dogs in the experimental group both before and after clamping, increasing the over-all survival rate to more than 80 per cent (46 dogs). Aggressive fluid replacement and antibiotic coverage may lengthen the so-called golden period in which intestinal ischemia may be reversed by revascularization.

Animals↗

Orthotopic liver transplantation in children.

Ten children, aged 3 to 16 years, were part of a group of 61 patients who received liver transplants at University Hospital in London, Canada between November 1982 and April 1986. All of the children received cyclosporine in combination with other agents for immunosuppression. Two children died of rejection, one child died from a lymphoma, and one child died from a hypoxic brain injury sustained during a respiratory arrest. Six children are currently alive from 4 months to 2 1/2 years following transplantation. All of the survivors have returned to a normal life style. With current surgical techniques and modern immunosuppression, hepatic transplantation has become the treatment of choice for patients with endstage irreversible liver disease. The extreme shortage of donor organs is now the major factor limiting the application of liver transplantation in children.

Adolescent↗

A comparison of cyclosporine A and Nva2-cyclosporine (cyclosporine G) in a rat renal allograft model.

We compared CsG and CsA in the DA-to-Lewis rat renal allograft model. At equivalent oral doses, plasma radioimmunoassay (RIA) CsG levels were higher than CsA (P less than 0.02). Neither drug prevented rejection at doses of 5 mg/kg/day. CsG-treated rats had a higher rejection rate at doses of 7.5 mg/kg/day (P less than 0.05). Both drugs were equally effective in preventing rejection at doses of 10 mg/kg/day. Neither drug was nephrotoxic at the doses used in this study. CsG is a potent immunosuppressant, and thus a potential clinical successor to CsA. Since CsG and CsA provide equivalent immunosuppression at therapeutic doses, CsG's clinical significance will ultimately depend on its nephrotoxicity in man.

Animals↗

Experience of a Canadian multi-organ transplant service.

Organ transplantation has become the treatment of choice for selected patients with end-stage failure of the heart, liver or kidneys. The expanding role for organ transplantation, however, has led to a corresponding increase in the complexity of patient management. In response to these changes, University Hospital, London, Ont., has established an interdisciplinary multi-organ transplant service (MOTS). MOTS coordinates donor organ procurement and patient management. Donor organs have been retrieved from as far south as Dalton, Georgia, as far west as Calgary and as far east as Halifax. As of Dec. 31, 1985, 485 transplants had been performed, including 387 kidney transplants, 51 heart transplants, 3 heart/lung transplants, 43 liver transplants (in adults and children) and 1 pancreas transplant. With current immunosuppressive protocols MOTS projects 1-year patient survival rates of 95% after kidney transplantation, 88% after heart transplantation and 81% after liver transplantation. Patient rehabilitation has been excellent.

Adult↗

Balloon therapy for obesity--when the balloon bursts.

Intragastric balloon placement is a non-invasive treatment for morbid obesity. We report a patient who illustrates incomplete bowel obstruction and pancreatitis following dislodgement of such a balloon. Percutaneous transabdominal puncture of the balloon is an effective method of decompression.

Acute Disease↗

Mountain sickness, retinal haemorrhages, and acclimatisation on Mount Everest in 1975.

During the 1975 British Everest Expedition, which made the first ascent of the south-west face, observations were made in relation to mountain sickness and the appearance of retinal changes. Two Sherpas with cerebral oedema and one Briton with pulmonary oedema were treated. Retinal haemorrhages occurred in four out of six Britons who were newcomers to altitudes over 6000 m (19 685 ft) but in only two out of 14 Britons who had previously visited these altitudes. Intraocular pressures during ascent to 6000 m were within normal limits. The relevance of the ocular findings to acclimatisation in previous years was examined, the results supporting the hypothesis of a "carry-over" effect from previous visits to high altitude.

Acclimatization↗

Laryngeal trauma.

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Accidents↗

The relationship between short-term changes in weight and lower leg length in children and young adults.

As the knemometer is increasingly being used to study changes in lower leg length in conditions associated with weight changes it is important to clearly delineate the relationship between these two variables. Lower leg length and weight were measured in 26 children and nine adults including one pregnant woman. There was a weak but positive relationship between lower leg length and weight fluctuation in children. Daily fluctuations in weight as well as lower leg length were higher in women than men; median lower leg length fluctuation: women, 0.16 mm (P5-0, P95-0.7); men, 0.1 mm (P5-0, P95-0.48) p approximately 0.02, Wilcoxon signed-rank test. Median weight fluctuation: women 0.15 kg (P5-0, P95-0.54); men, 0.1 kg (P5-0, P95-0.5) p = 0.94 (Wilcoxon signed-rank test). Sustained weight gain in pregnancy led to a reduction in lower leg length followed by an increase which was coincident with the appearance of dependent oedema. Lower leg length changes are likely to be positively related to changes in weight when the latter are only modest in magnitude. However, greater sustained increases in weight are likely to have an opposite effect on lower leg length due to direct compression of the lower leg. Due consideration of weight is essential in longitudinal studies of lower leg length changes, especially in conditions which are associated with significant changes in weight.

Adult↗

Obesity in leukemia survivors: the familial contribution.

A high prevalence of obesity in survivors of acute lymphoblastic leukemia (ALL) has been described, but genetic and social influence in obesity has not been analyzed in this group of patients. The authors studied a population of 33 long-term (25 females, 8 males) in first remission who had reached their final height. All patients received cranial irradiation as part of their central nervous system (CNS)-directed therapy and no patient received growth hormone. The body mass index (BMI: weight/height2) of patients and their biological parents was calculated and submitted to statistical analysis. Obesity was defined as BMI greater than the 85th centile. No excessive obesity was found among the males at final height. Fifty-six percent of the females were obese. In this group of 14 obese female survivors 59% had obese mother, but only 14% had obese fathers. The results indicate a significant maternal predisposition to obesity.

Body Height↗