PubMed Health⌕ Search

Biomedical subjects

J H Duke

Publications and source records attributed to J H Duke.

At least 37 records · Page 2Linked to original sources
PubMed1981

Angiography and peritoneal lavage in blunt abdominal trauma.

Records of 123 consecutive patients who underwent abdominal angiography for blunt trauma were reviewed. Twenty-four patients underwent abdominal angiography on the basis of positive physical findings. Seven (29%) required intervention as determined by angiography and the diagnosis was confirmed. Ninety-nine patients had abdominal angiography in association with angiographic evaluation of the chest, pelvis, or extremities. In 14 (14%) the angiogram indicated the need for intervention. In 13 this diagnosis was confirmed at laparotomy. The fourteenth patient was embolized angiographically and did well. Fifty-four patients had peritoneal lavage in addition to their angiograms. Sixteen were positive and 38 were negative. In four patients the lavage was negative and the angiographic findings indicated need for intervention. Three of these four were confirmed at laparotomy and the fourth patient was embolized angiographically. Indications for abdominal angiography in blunt trauma are: 1) incidental to needed thoracic aortography; 2) incidental to angiography when done for pelvic fractures; 3) suspected intra-abdominal injuries when clinical and lavage data are not definitive.

Abdominal Injuries↗
PubMed1980

Eosinophilic infiltration of the stomach.

An unusual case of eosinophilic infiltration of the proximal stomach with direct extension into the left hemidiaphragm, liver, and transverse colon is described. Because the lesion was unresectable, a trial of steroid therapy was begun, with an initially good clinical response. Subsequent extensive tumor necrosis and accompanying diaphragmatic perforation, autolysis of the left lower lung, and a chronic gastropleurocutaneous fistula led to death. This case underscores the aggressive nature which this "histologically benign" neoplasm can pursue.

Aged↗
PubMed1979

Systemic absorption of bacitracin after peritoneal lavage.

Nine patients underwent intraoperative peritoneal lavage with a solution containing 50,000 units of bacitracin in 200 ml of 0.9 per cent sodium chloride. The solution was removed by suction at 2 or 5 minutes, and venous blood samples were obtained at 15 minute intervals for 2 hours after lavage. Concentrations of bacitracin in serum were determined by agar diffusion assay. In the majority of patients, peak concentrations of bacitracin in serum occurred by 15 minutes post lavage. The mean peak serum concentration was 3.8 units/ml, which exceeds peak concentrations after intramuscular injection of 50,000 units. Due to potential nephrotoxicity, bacitracin should be used cautiously in peritoneal lavage solutions and should be abandoned in patients who have renal impairment in whom prolonged elevated serum concentrations could develop.

Absorption↗
PubMed1978

Clinical pharmacology of intravenous and intraperitoneal aminoglycoside antibiotics in the prevention of wound infections.

Seventeen patients had intraoperative peritoneal lavage with a solution containing one gram of kanamycin in 200 ml of 0.9% NaCl. The solution was removed by suction at two or five minutes. Venous blood samples were obtained at 15 minute intervals for two hours following lavage. Despite diligent attempts, an average of only 60% of the solution was recovered by suction. The peak concentration of kanamycin in serum correlated directly with the kanamycin dose (p less than 0.025). In six patients lavaged for five minutes, peak absorption occurred at 15 minutes with serum concentrations of 20.3 +/- 2.0 microgram/ml. In five patients lavaged for two minutes insignificantly (p greater than 0.1) lower peak serum concentrations (15.3 +/- 1.8 microgram/ml) occurred at 15 minutes. Six additional patients had peak kanamycin serum concentrations which occurred at 75 minutes and reached 23.2 and 24.0 microgram/ml in two patients. In three patients who received intravenous gentamicin prior to surgery, nine paired serum and peritoneal fluid samples obtained during three hours preceding lavage showed no significant differences in gentamicin concentrations (p less than 0.5). These pharmacokinetic data demonstrate the penetration of parenterally administered aminoglycosides into intraoperative peritoneal fluid. Kanamycin lavage for wound prophylaxis should be used cautiously and should be abandoned in patients who have renal impairment where prolonged toxic serum concentrations could develop.

Adult↗
PubMed1977

Primary small bowel volvulus: cause and management.

Most reports of patients with primary small bowel volvulus have indicated that the ingestion of a high-bulk vegetable diet in some way contributes to the development of this condition. During a recent 13-month period at Nangarhar University Hospital at Jalalabad, Afghanistan, the frequency of occurrence among 26 patients was found to be related to abrupt changes in dietary intake. The first and last months of the study were Ramadan, the annual period in which Mohammedans abstain from all oral intake during daylight hours and take a single large meal after dark. During these two isolated months, there was a ten fold and nine fold increase, respectively, in the incidence of the condition. Early diagnosis and surgical intervention offer the only possibility for minimizing an otherwise excessive mortality.

Adult↗
PubMed1976

The superior gluteal: an artery at risk in blunt pelvic trauma.

Five patients with pelvic fractures were studied arteriographically and all were found to have injury to one or both superior gluteal arteries, in addition to other injuries. In three of the five patients no adjacent bony damage was seen on plain pelvic roentgenograms. A possible explanation for this finding is given in terms of anatomic relationships within the pelvis. The importance of early arteriography in the diagnosis management of blunt pelvic trauma is emphasized.

Adolescent↗
PubMed1975

Holster accidents: self-inflicted gunshot injuries of the knee and leg.

A man accidentally shot himself in the knee while holstering his own revolver. Although the pain was minimal, the wound "clean", and the joint flexible, angiography revealed a false aneurysm of the popliteal artery, a short segment of minimal tears below it, and a popliteal arteriovenus fistula slightly distal to the false aneurysm. Any penetrating wound of the popliteal fossa whose trajectory points to the vascular structures should be investigated angiographically.

Accidents↗
PubMed1975

Management of surgical nutritional complications in developing countries.

The problem of sufficient nitrogen and caloric supply for surgical patients with pronounced protein catabolism under the working conditions of a surgical department in a developing country is discussed. The authors report good success with Vivonex in the postoperative nutrition of patients with a small bowel perforation with typhoid fever and of patients with diffuse peritonitis following a perforated appendix. Vivonex proved its usefulness also in the alimentation of patients with tropical myositis and extensive burns.

Adolescent↗
PubMed1970

Contribution of protein to caloric expenditure following injury.

1. There is a common clinical impression that because the nitrogen excretion after injury roughly parallels the increased resting metabolic expenditure and weight loss, the primary source of extra fuel is derived from protein. This study has been undertaken to evaluate the caloric contribution of protein to the daily resting metabolic expenditure (RME). 2. Under the most extreme circumstances of nitrogen excretion, massive soft tissue injury, the caloric contribution of protein is only 20 percent of the RME. Body fat stores are the only other major source of fuel from which the semistarved patient can meet the increased demands for energy. 3. Any form of severe injury impairs the mechanisms by which protein breakdown and nitrogen excretion are reduced. 4. Patients undergoing elective operation in this study did not have a significant rise in RME or nitrogen excretion.

Adolescent↗