Biomedical subjects
Publications and source records attributed to J E Rhoads.
The obturator hernia is rare, accounting for only 0.05% of all hernias and 0.2% of all small-bowel obstructions requiring laparotomy at our institution. Typically, there is a delay in diagnosis and surgical intervention, despite the presence of a bowel obstruction. A laparotomy is needed, not a preoperative diagnosis.
The objective of this study was to determine whether the observed vascular collapse and other pathologic features of severe pancreatitis may be related to the induction of nitric oxide synthase (NOS). The rat model of pancreatitis reported by Schmidt et al. was employed. Rats in the experimental groups received pretreatment with known NOS inhibitors, N-Monomethylarginine (NMMA) or Aminoguanidine (AG). Controls included sham-operated rats without pancreatic insult and a diseased control group which received pretreatment with normal saline (NS). Arterial blood pressure was continuously recorded with a femoral arterial catheter connected to a transducer and monitor. Fluid resuscitation for hypotension followed a strict protocol with the administration of 5.0 cc NS for sustained decreases in systolic blood pressure (SBP) below 90 mm Hg at 5-minute intervals. Laboratory parameters and histopathology confirmed the induction of pancreatitis, with 6 to 15-fold increases in serum amylase levels and an average of approximately 20% decrease in serum ionized Ca++ levels. Immunohistochemical studies of the pancreas revealed that pancreatic insult resulted in the induction of NOS. Rats in the saline control group (n = 5) became hypotensive (SBP less than 90 mm Hg) between 3 and 4 hours post pancreatic insult and required an average of 110.0 cc (3-4 x blood volume) of NS fluid resuscitation. Rats which were not resuscitated (n = 5) did not survive.(ABSTRACT TRUNCATED AT 250 WORDS)
We employed 3D reconstruction of CT images for evaluation of hepatic injuries in a series of eight trauma patients. One had additional reconstruction of a renal injury. 3D imaging provided precise anatomical delineation of damaged areas, particularly in relation to major vessels. Moreover, the imaging agreed with operative findings in every case. The 3D reconstruction facilitated decisions regarding intraoperative, reoperative and non-operative management. The improved imaging provided by 3D reconstruction may allow hepatic CT scans to be interpreted with greater ease and accuracy than conventional CT. We believe this is the first report of its use in liver trauma. Current indications may include postoperative confirmation of the extent of hepatic injuries, assessment before reoperation, and contribution to decisions regarding non-operative management. A limitation at present is the time taken for image production, but we suggest that in the future 3D imaging might contribute to evaluation before emergency surgery in patients with abdominal injuries.
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A ten year experience with 2,077 consecutive mammographically guided needle-localization biopsies at a large community hospital is presented. By using this technique, 13.8 per cent of the biopsies were positive, yielding 284 carcinomas. The nonpalpable carcinomas discovered by mammography and the needle-localization technique were compared with those palpable carcinomas diagnosed during the same time period at York Hospital. In the final year of the study, 42.1 per cent of carcinomas treated at the York Hospital were diagnosed by the needle-localization technique. The mammographically detected carcinomas were smaller, more often node-negative and found, on average, at an earlier patient age than palpable carcinomas. The results of this study demonstrate that screening mammography, coupled with an aggressive biopsy policy, will lead to the discovery of many early, node-negative carcinomas of the breast.
Presented is a case report of a multiple trauma patient whose post-traumatic course was complicated by neuroleptic malignant syndrome triggered by therapeutic haloperidol treatments. Once the syndrome was recognized and treated, a dramatic recovery was achieved.
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Adsorption of autologous plasma over nonviable Staphylococcus aureus Cowan I (SAC) followed by reinfusion of the plasma causes regression of (a) chemically induced rat mammary adenocarcinomas (MA), and (b) canine transmissible venereal tumors (TVT) and spontaneously occurring dog tumors. Animal data are more impressive than that from trials in humans. Nine of 41 patients receiving perfusions of adsorbed plasma showed some partial objective response. Eight of these nine patients received multiple perfusions over a period of time. Twenty-one of 41 patients showed subjective responses. Adsorption of autologous plasma over non-protein A--containing S. aureus Wood 46 caused regression of MA. Adsorption of normal rat plasma with SAC, and infusion of this adsorbed plasma into mammary tumor--bearing rats, caused regression of MA. Intravenous infusion of purified protein A alone caused regression of both rat MA and canine TVT. Superimposed on this observation is the finding that, during plasma adsorption, bacterial moieties leach from SAC. It is possible that the immunostimulation observed in plasma-perfused hosts is due to the removal of plasma blocking agents on one hand, and introduction of the bacterial agents on the other.
Ankle-level amputation for diseases involving the foot can be achieved by the Pirogoff amputation instead of the Syme amputation with very good results. This technique provides a strong end-bearing stump and has the advantage that the amputated leg is essentially the same length as the patient's normal leg. With the use of modern prostheses, the results of rehabilitation are very good. We have used the Pirogoff technique for ankle-level amputations in 12 patients during the past 4 years with good results.
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A patient with a metastatic colon carcinoma was treated by immunoadsorption (IA) therapy using heat-killed, formalin-stabilized protein A-containing Staphylococcus aureus Cowan I as the immunoadsorbent. The patient experienced both subjective and objective positive clinical response without undue morbidity. The patient's response correlated well with laboratory findings of decreased concentrations of carcinoembryonic antigen (CEA), immunoglobulin G (IgG), immune complexes (IC) and histopathologic data. The patient underwent surgery following 15 IA treatments; she lived for eighteen months, post-treatment.