Biomedical subjects

J Fildes

Publications and source records attributed to J Fildes.

16 recordsLinked to original sources

PubMed2005

CD4-veCD8-ve CD30+ve T cells are detectable in human lung transplant patients and their proportion of the lymphocyte population after in vitro stimulation with donor spleen cells correlates with preservation of lung physiology.

INTRODUCTION: Survival following lung transplantation is less than 50% at 5 years, mainly due to immune-mediated chronic rejection. Recently a novel subset of T cells, CD4-veCD8-ve CD30+ve, so-called double negative (DN) CD30+ve T cells, has been described and shown to be responsible for tolerance in an animal model of skin transplantation. METHODS: We investigated 18 lung transplant recipients for the presence of DN CD30+ve T cells in resting peripheral blood and also following in vitro stimulation of recipient peripheral blood mononuclear cells (PBMCs) with donor spleen cells. RESULTS: Small percentages (0.2% to 6%) of DN T cells are detectable in resting PBMCs of human transplant patients (n = 18), but these did not correlate with allograft function, acute rejection episodes, HLA mismatch, or CMV status. On repeated stimulation of recipient PBMCs (two exposures) in vitro by donor spleen cells (2:1 ratio stimulators to responders) the percentage of DN CD30+ve T cells within the lymphocyte pool correlated with preservation of allograft lung function (both for FEV(1), P = .009, and FEF(25-75), P = .036) and was inversely correlated with grade of chronic rejection. On repeated exposure of recipient PBMCs to donor spleen cells with a 1:1 ratio the percentage of DN CD30+ve T cells correlated with the number of acute rejection episodes of grade 2 or greater. The total number of HLA mismatches correlated with the percentage DN CD30+ve T cells present after primary stimulation of recipient PBMCs with donor spleen cells (1:1 ratio). The number of mismatches at the B locus inversely correlated with the percentage of DN CD30+ve T cells after primary stimulation of recipient PBMCs with donor spleen cells (1:1 ratio; P = .031, n = 18). CONCLUSION: Percentages of DN CD30+ve T cells present following repeated stimulation of recipient PBMCs by donor spleen cells correlated with preservation of graft function following lung transplantation.

Antigens, CD↗

PubMed2001

Computed tomographic scan can be used for surgical decision making in zone II penetrating neck injuries.

BACKGROUND: Controversy surrounds the evaluation of zone II penetrating neck injuries. Current literature supports mandatory exploration or selective management. Computed tomographic (CT) scanning provides high-resolution images that are used for trauma in other body regions. The purpose of this study is to prospectively evaluate the utility of CT scanning in the evaluation of zone II penetrating neck injuries. METHODS: From July 1998 to November 1999, 14 stable patients were studied who sustained zone II penetrating neck injuries. All patients had a physical examination, infusion CT scan of the neck, and an operative exploration. Before surgery, the trauma surgeon evaluated the CT scan and interpreted it as demonstrating either "high" or "low" probability for significant injury. Surgical findings were compared with the surgeon's preoperative interpretation of the CT scan. RESULTS: Three of 14 patients had five significant injuries. All these patients had high probability of injury CT scans, with four of the five injuries specifically diagnosed by CT scan. Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 91%, 75%, and 100% (p < 0.02), respectively. CONCLUSION: This small prospective study demonstrates that zone II penetrating neck injuries can be accurately evaluated by CT scan. In addition, the CT scan can be used for surgical decision making. This will eliminate the need for mandatory exploration and limit the role of angiography, esophagography, and endoscopy in zone II penetrating neck injuries.

Adult↗

PubMed2001

Staged reconstruction after gunshot wounds to the abdomen.

Immediate closure of abdominal incisions after exploration and treatment of gunshot wounds is not always feasible or advisable. Significant bowel edema after massive fluid resuscitation might preclude primary closure, whereas any attempt to close under tension might result in complications ranging from wound dehiscence, infection, and necrosis to the abdominal compartment syndrome with abdominal, cardiopulmonary, and renal complications. For these difficult cases, the open technique has been recommended. The abdomen is left open and is closed when the patient's condition permits. When immediate wound approximation is not possible, temporary coverage can be achieved with a mesh, patch, or a split-thickness skin graft and the definitive reconstruction is deferred for a more optimal time. The purpose of this retrospective study is to report the authors' experience with staged abdominal wall reconstruction after gunshot wounds. From 1989 to 1998, 1933 patients underwent exploratory laparotomy for penetrating wounds to the abdomen. Twenty-nine patients in grave condition and with multiple medical problems were comanaged by the Trauma and Plastic Surgery Services at Cook County Hospital with the following protocol: The abdomen was initially left open and exposed viscera were covered with a variety of methods, including a Gore-Tex patch (W. L. Gore and Associates, Inc., Flagstaff, Ariz.). A split-thickness graft was subsequently placed on the granulation tissue over viscera at an average of 14 days after the last laparotomy. These planned ventral hernias were definitively treated at an average of 7 months after the skin grafting procedure, primarily using the components separation technique. In 24 patients, the fascia was closed primarily without tension, while five patients required the use of synthetic mesh to restore fascial continuity. Nine patients underwent closure of a colostomy or repair of fistulas simultaneously with abdominal wall reconstruction. One patient developed a postoperative hernia, two developed superficial wound dehiscence that healed without further surgery, and one required re-exploration for a failed anastomosis after colostomy closure. All but one patient maintained a stable abdominal wall after the reconstruction. The authors concluded that staged abdominal wall reconstruction should be primarily recommended for patients with complex abdominal wounds and a compromised general condition that precludes primary closure. With this treatment protocol, patients can recover faster from their trauma surgery and the risk of perioperative complications can be reduced. After final reconstruction, the continuity, stability, and strength of the abdominal wall are maintained in the vast majority of cases with the use of autogenous tissue and without the need for alloplastic material. With close cooperation between the trauma team and the plastic surgeon and appropriate timing and planning of each stage, the success rate of the technique is high and the incidence of complications limited.

Abdominal Injuries↗

PubMed1999

A multi-institutional study of factors associated with fetal death in injured pregnant patients.

HYPOTHESIS: Factors associated with fetal death in injured pregnant patients are related to increasing injury severity and abnormal maternal physiologic profile. DESIGN: A multi-institutional retrospective study of 13 level I and level II trauma centers from 1992 to 1996. MAIN OUTCOME MEASURE: Fetal survival. RESULTS: Of 27,715 female admissions, there were 372 injured pregnant patients (1.3%); 84% had blunt injuries and 16% had penetrating injuries. There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). The population suffering fetal death had higher injury severity scores (P<.001), lower Glascow Coma Scale scores (P<.001), and lower admitting maternal pH (P = .002). Most women who lost their fetus arrived in shock (P = .005) or had a fetal heart rate of less than 110 beats/min at some time during their hospitalization (P<.001). An Injury Severity Score greater than 25 was associated with a 50% incidence of fetal death. Placental abruption was the most frequent complication, occurring in 3.5% of patients and associated with 54% mortality. Cardiotrophic monitoring to detect potentially threatening fetal heart rates was performed on only 61% of pregnant women in their third trimester. Of these patients, 7 had abnormalities on cardiotrophic monitoring and underwent successful cesarean delivery. CONCLUSIONS: Fetal death was more likely with greater severity of injury. Cardiotrophic monitoring is underused in injured pregnant patients in their third trimester even after admission to major trauma centers. Increased use of cardiotrophic monitoring may decrease the mortality caused by placental abruption.

Female↗

PubMed1998

Effects of short heat exposure on human red and white blood cells.

BACKGROUND: The infusion of warm intravenous fluid (IVF) is a simple and effective method used to maintain or restore core body temperature. At present, 40 degrees C is believed to be the highest temperature that can be safely administered. There is concern that temperatures greater than 40 degrees C may harm blood cells. The mixing time of IVF infused into a high-flow vein such as the superior vena cava is very short, however, approximately 300 milliseconds. We will determine the maximum temperature and exposure time tolerated by human red and white blood cells without producing injury. METHODS: Whole blood and isolated neutrophils were exposed to temperatures (40-80 degrees C) for short time intervals (150-1,200 milliseconds). Lethal injury to red and white blood cells was measured by the plasma free hemoglobin and percent viability, respectively. Neutrophil viability was measured by trypan blue staining. Sublethal injury to red and white cells was measured by osmotic fragility and oxidative burst, respectively. Neutrophil oxidative burst was measured by chemiluminescence. Control values were compared with postexposure values using analysis of variance with p < 0.05 indicating significance. RESULTS: Lethal injury to red blood cells did not occur until exposure at 70 degrees C for 300 milliseconds (plasma free hemoglobin, 116.3 +/- 34.7 mg%; p < 0.05). Lethal injury to neutrophils did not occur, even at exposure at 80 degrees C for 1,200 milliseconds. Sublethal injury to red blood cells did not occur until exposure at 60 degrees C for 1,200 milliseconds. Sublethal injury to neutrophils did not occur until exposure at 60 degrees C for 600 milliseconds (percent change in oxidative burst = 28.9 +/- 0.96%; p < 0.05). CONCLUSIONS: The exposure of human red blood cells and neutrophils to temperatures up to 60 degrees C for up to 600 milliseconds does not cause lethal or sublethal injury. These findings contribute to the body of evidence supporting the use of centrally infused IVF at temperatures greater than 40 degrees C for active core rewarming.

Erythrocytes↗

PubMed1996

Comparison of percutaneous and surgical tracheostomies.

OBJECTIVE: To compare the safety and efficacy of percutaneous dilational tracheostomy (PDT) with surgical tracheostomy (ST). DESIGN: Prospective randomized trial. SETTING: Public urban teaching hospital. PATIENTS: Twenty-six patients were randomized to undergo PDT and 27 patients to ST. RESULTS: The time from randomization into the study until tracheostomy was performed was 28.5 +/- 27.9 h in the PDT group and 100.4 +/- 95.0 h in the ST group (p < 0.001). PDT was performed in 8.2 +/- 4.9 min vs 33.9 +/- 14.0 min for ST (p < 0.0001). There was no significant difference in intraprocedural complications between the groups. Postprocedural complication rates were 12% for PDT and 41% for ST (p = 0.008). CONCLUSION: PDT is superior to ST logistically. PDT can be performed at the bedside eliminating the risk of patient transport. Because operating room scheduling is not necessary, PDT can be performed earlier once the decision to do a tracheostomy is made, which will improve ICU utilization. PDT is a faster procedure to perform and has fewer postprocedural complications.

Female↗

PubMed1994

Missile embolization revisited: a rationale for selective management.

Embolization of missiles is an unusual presentation of penetrating trauma. Often the management of these injuries may be quite challenging, and selective management continues to be subject to controversy. We report a case of a bullet embolus to the right ventricle from the internal iliac vein in a 15-year-old boy that was managed with observation. An algorithm for diagnosis and management of this phenomenon mandates exploration of emboli to the aorta and peripheral arteries with repair of the vascular entry site and embolectomy. It also recommends operative intervention for symptomatic venous emboli to the heart and pulmonary circulation. Nonoperative management may be considered in patients with asymptomatic emboli to the right heart or the cerebral and pulmonary circulation.

Adolescent↗

PubMed1993

Very hot intravenous fluid in the treatment of hypothermia.

The efficacy and safety of very hot (65 degrees C/149 degrees F) intravenous fluid (IVF) were compared with those of conventional warm (38 degrees C/100.4 degrees F) IVF in the treatment of hypothermia. Eight anesthetized beagles (11-20 kg) were studied. Blood pressure (BP), pulse (P), and core temperature (cT degrees) were recorded at baseline, during hypothermia, and during rewarming. The plasma free hemoglobin (PFHg) was measured to assess hemolysis. Each subject was cooled to 32 degrees C/89.6 degrees F and assigned to receive either 65 degrees C or 38 degrees C IVF via a specially designed multiport balloon-tipped catheter in the superior vena cava (SVC). The IV fluid rate was 80% of the blood volume per hour. Conventional rewarming methods were used in all subjects. After 2 hours the subjects were killed and the SVC was examined for injury. The rate of rewarming was 2.9 degrees C/hour in the 65 degrees C IVF group and 1.25 degrees C/hour in the 38 degrees C IVF group. The cT degrees was significantly different in all subjects after 1 (35.2 degrees +/- 1.03 degrees C vs. 33.2 degrees +/- 0.5 degrees C; p < 0.006) and 2 (37.6 degrees +/- 1.17 degrees C vs. 34.3 degrees +/- 0.9 degrees C; p < 0.004) hours of rewarming. The BP, P, and PFHg were not different. Visual examination of the SVC revealed two lesions in the 65 degrees C IVF group and one in the 38 degrees C group. Mechanical or thermal injury could not be differentiated.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

A comparison of pentastarch and lactated Ringer's solution in the resuscitation of patients with hemorrhagic shock.

Pentastarch is a colloid that is chemically similar to Hetastarch. It has a shorter half-life (12 hr), and produces volume expansion at least 1.5 times the administered volume. We compared Pentastarch to Ringer's lactate in 41 patients (21 Pentastarch, 20 Ringer's lactate) presenting with hemorrhagic shock. The groups were similar in age, sex, race, and type of injury. Significantly less volume of Pentastarch was required initially to resuscitate to a normal blood pressure and urine output than Ringer's lactate (P < 0.005). Coagulation parameters (prothrombin time, partial thromboplastin time, fibrinogen, and factor VIII) were measured for 48 hr post-resuscitation, and no abnormalities were noted in the Pentastarch group. Serum albumin was the same in both groups throughout the study period; however, serum colloid oncotic pressure was elevated at 1 hr post-resuscitation in the Pentastarch group (P < 0.005). There was no difference in ventilatory parameters, blood gases, pulmonary function tests, ventilator days, or hospital days between the two groups. We conclude that Pentastarch is safe and effective for the initial resuscitation from hemorrhagic shock.

Blood Coagulation↗

PubMed1992

Trauma: the leading cause of maternal death.

The records of the Cook County Medical Examiner were reviewed for the period January, 1986, to December, 1989. Ninety-five maternal deaths were identified. The causes of maternal death were categorized as direct maternal, indirect maternal, or nonmaternal. Direct maternal causes of death (18.9%) were the result of complications of pregnancy, labor, delivery, or its management. Indirect maternal causes of death (12.6%) occurred when pre-existing health problems were exacerbated by pregnancy. All other maternal deaths were the result of nonmaternal causes. Nonmaternal causes of maternal death were further classified as traumatic or nontraumatic. Traumatic maternal deaths (46.3%) were attributed to homicide in 57% and suicide in 9%. The mechanism of injury in traumatic maternal deaths included gunshot wounds (22.7%), motor vehicle crashes (20.5%), stab wounds (13.6%), strangulation (13.6%), blunt head injuries (9.1%), burns (6.8%), falls (4.5%), toxic exposure (4.5%), drowning (2.3%), and iatrogenic injury (2.3%). Trauma was therefore the leading cause of maternal death, accounting for 46.3% of deaths in this series.

Adolescent↗

PubMed1991

Soft-tissue infections after trauma.

Soft-tissue infections are best prevented by proper initial management of the wound. When they do occur, they produce certain characteristic physical signs, the appearance of which mandates prompt operative intervention. The extent of debridement is determined by the intraoperative findings. Diagnostic categorization of the infection is performed postoperatively on the basis of the level of soft-tissue involvement and the results of bacterial cultures.

Anti-Bacterial Agents↗

PubMed1988

Pulmonary tumor embolization after peritoneovenous shunting for malignant ascites.

An 85-year-old woman with intractable malignant ascites secondary to ovarian carcinoma underwent peritoneovenous shunting (Denver shunt) in an attempt to alleviate the ascites. Implantation of the shunt resulted in massive embolization of tumor cells to the pulmonary vasculature. Postoperatively, she developed increasing hypoxia with progressive rises in pulmonary artery pressure, and died 48 hours after surgery as a result of occlusion of the pulmonary vascular bed by tumor emboli. This is the sixth reported instance of massive tumor embolization to the pulmonary circulation in patients with peritoneovenous shunting for malignant ascites.

Adenocarcinoma, Papillary↗

PubMed1988

Titration of avirulent Newcastle disease virus by the plaque assay method.

Parameters of a plaque assay for avirulent strains of Newcastle disease virus (NDV) were optimized for reproducibility and optimum titer in LLC-MK2 cells. Plaques were visible after 2 days and maximum virus titers were reached in 3 days. Virus titers were not affected by continued incubation through 6 days, although plaque size increased. An adsorption volume of 0.1 or 0.2 ml per 60 mm Petri dish was optimal, as was an adsorption time of 45 min. Trypsin (2.5 micrograms/ml) and magnesium sulfate (0.03 M) were essential requirements of the overlay medium and the presence of DEAE-dextran (0.02%) resulted in a 30% increase in titer. The use of cell monolayers, 1, 2, or 3 days old facilitated the performance of multiple assays per week and did not affect the virus titer.

Animals↗

PubMed1986

Long-acting beta-adrenergic antagonists as preparation for surgery in thyrotoxicosis.

This report describes our experience with 12 patients with thyrotoxic Graves' disease who were prepared for thyroidectomy using only a long-acting orally administered beta-adrenergic blocking agent (nadolol or atenolol); iodides were not used. This form of preparation proved to be very effective, fast acting, and economical. It permitted rapid preparation of patients for surgery and resulted in excellent control of the manifestations of hyperthyroidism in the perioperative period. The surgery was relatively easy and bloodless, and there were no operative complications. We recommend that these long-acting beta-adrenergic blocking agents be considered as the preferred medication for the preparation of thyrotoxic patients for surgery.

Adrenergic beta-Antagonists↗

PubMed1984

Single radial hemolysis test for quantitation of complement-fixing antibodies to non-hemagglutinating viruses.

A single radial hemolysis test, which overcomes many of the problems of conventional complement fixation tests, was developed for the quantitation of virus complement-fixing antibodies. The test procedure utilized staphylococcal protein A-coated sheep erythrocytes immobilized in agarose into which antigen was incorporated. Undiluted heat-inactivated serum samples were allowed to diffuse radially from wells punched in the agarose. Protein A served to concentrate the subsequent antigen-antibody reaction on the surface of the erythrocytes. Zones of hemolysis were developed by flooding with complement. With adenovirus as a model, basic test parameters were defined, and optimum reagent concentrations and diffusion conditions were determined. A positive linear relationship was found to exist between zone diameter and increasing log concentration of specific antiserum. No correlation was found between zone diameter and total concentration of immunoglobulin G in test sera. Sera rendered anticomplementary by the addition of carrageenan produced hemolytic zones equal to diameter to those observed with untreated sera. Seventy-seven human sera with known complement fixation titers were tested by this method. Good correlation (r = 0.74) between the complement fixation test and single radial hemolysis was observed. This test was highly reproducible and more sensitive than the conventional complement fixation test.

Adenovirus Infections, Human↗

PubMedDate not supplied

Toxicity of Aeromonas salmonicida cells to Atlantic salmon Salmo salar peritoneal macrophages.

Several strains of Aeromonas salmonicida were toxic to cultured peritoneal macrophages of Atlantic salmon, Salmo salar, in minimum doses of 5 x 10(6) CFU, whereas other strains were not. There was no correlation between cytotoxicity and in vivo virulence of the bacteria, the presence or absence of the two major surface components of A. salmonicida (namely, the A-layer and the O-polysaccharide chain of the LPS) nor, finally, with the ability of the strains to produce the following enzymes in vitro: protease, hemolysin, elastase and lecithinase. Toxicity was only observed with metabolically active bacteria and not with formalin- or heat-killed bacteria. The exact nature of the toxic factor remains unknown but is most likely associated with the surface of the bacteria. It is not extracellular since 24 and 48 h culture supernatants of the cytotoxic strains had no apparent effect on macrophages. The cytotoxic effect was found to be severe and rapid, it is likely a major virulence factor of A. salmonicida, but the exact role of such a potent toxin in the pathology of furunculosis has yet to be clarified.

Aeromonas↗