Biomedical subjects
Publications and source records attributed to J H Meredith.
Although replantation of completely amputated wrists and forearms is now commonplace, in 1965 the replantation of this "wrist level" amputation was the first reported in the western world. The details of the technique used are contrasted with current standard of care.
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Techniques for managing traumatic diastasis of the pubic symphysis include bed rest, hip spica casting, pelvic slings, external fixation, and internal fixation. We report herein our experience with 14 consecutively managed patients in whom we successfully stabilized traumatic pubic diastasis with a single two-hole plate fixation. The average age of the 13 men and one woman was 30 years; followup averaged 17 months. Most of the patients had associated injuries (Injury Severity Score average, 19). Nine patients had concomitant disruption of the sacroiliac joint requiring either delayed open reduction and internal fixation or prolonged skeletal traction; among the five remaining patients, time to mobilization (bed to chair) averaged 1 day. There were no complications attributable to the procedure; i.e., no infections, and no failures of fixation. In this small series of patients early two-hole plate fixation of the traumatic diastasis of the pubis satisfactorily restored the disrupted anterior pelvic ring, contributed to early mobilization of the patients, and made reduction of a concomitantly disrupted sacroiliac joint easier, whether accomplished by skeletal traction or open reduction and internal fixation during a second procedure.
Total injury in ischemic skeletal muscle is a function of ischemic damage and reperfusion injury. In an attempt to decrease reperfusion injury, we gave the oxygen-derived free radical scavengers allopurinol, superoxide dismutase, or mannitol during reperfusion of canine gracilis muscle made ischemic for 4 hours. We measured muscle O2 consumption (MVO2), and tissue calcium, water, and adenosine triphosphatase (ATP) before ischemia, after ischemia, and at 5 minutes and 60 minutes of reperfusion. The results at 60 minutes showed no improvement in MVO2 or ATP. In fact, ATP was significantly depressed with allopurinol and superoxide dismutase treatment, and tissue edema did not decrease in any of the groups. We conclude that the simple addition of oxygen-derived free radical scavengers during the initial reperfusion of totally ischemic skeletal muscle does not attenuate reperfusion injury.
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Sclerosing peritonitis has recently emerged as a complication of peritoneal dialysis associated with a high morbidity and mortality. These patients experience the characteristic syndrome of nausea, vomiting, abdominal pain, partial small bowel obstruction, and impaired ultrafiltration. A pathologic finding is the replacement of mesothelial cells with a thick layer of nondistensible fibroconnective tissue. We report here a 58-year-old white woman who developed peritoneal sclerosis after 4 years of peritoneal dialysis, including 3 years of continuous ambulatory peritoneal dialysis. Risk factors included peritoneal exposure to low concentrations of formaldehyde and a 1-week exposure to long-dwell acetate dialysate. Laparotomy for partial small bowel obstruction with resection of the involved segment was complicated by enterocutaneous fistulae, which improved only on cessation of oral intake and treatment with home parenteral nutrition. We have reviewed the literature to find 20 cases of sclerosing peritonitis in patients on peritoneal dialysis. A 78% mortality rate is reported in cases that had surgical intervention. We conclude that the use of long-term parenteral nutrition with cessation of oral intake may be necessary in the management of sclerosing encapsulating peritonitis.
In an attempt to establish a specific drug regimen that would retard neointimal fibrous thickening (NFT) and promote patency of small arterial grafts, we studied acute platelet accumulation and 3-month patency of 4 mm polytetrafluoroethylene (PTFE) grafts in dogs treated with oral aspirin (2 mg/kg/day) in combination with dipyridamole (5 mg/kg/day) (ASA/D) or ticlopidine (25 mg/kg/day) (T). After 3 days of treatment, 15 dogs were given indium 111-labeled autologous platelets and then had bilateral femoral artery grafts placed (control, 10 grafts; each drug group, 10 grafts). The calculated graft radioactivity expressed as average counts per 10 minutes +/- standard error of the mean (SEM) was as follows: control = 542,003 +/- 63,991; ASA/D = 135,163 +/- 14,443 (p less than 0.001, Student's t test); T = 104,650 +/- 14,004 (p less than 0.001). Bilateral femoral artery and carotid artery grafts were placed in 15 other dogs (control, 20 grafts; each drug group, 20 grafts). Three months later the 60 grafts were excised and their patency recorded: control = 20% (4 of 20 grafts); ASA/D = 70% (12 of 17 grafts) (p less than 0.01, chi-square analysis); T = 30% (6 of 20 grafts) (p greater than 0.05). Mean anastomotic NFT +/- SEM of each graft was measured with an ocular micrometer: control = 1.6 +/- 0.2 mm; ASA/D = 0.7 +/- 0.2 mm (p less than 0.001, Student's t test); T = 1.3 +/- 0.2 mm (p greater than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)
This retrospective study analyzes the results of 198 consecutive greater curvature gastroplasties performed in 23 male and 175 female patients with morbid obesity. The gastroplasty consisted of the creation of a 30-50 cm3 proximal gastric pouch by a double application of the TA-90 stapler, modified by removing three staples near the pin and trimming the cartridge to prevent crushing of the stomach at the outlet. The outlet was calibrated to a diameter of 1 cm and reinforced with a polypropylene seromuscular suture. No deaths occurred; postoperative complications included 32 superficial wound infections (16.2%), 24 incisional hernias (12.0%), 15 staple-line disruptions (7.6%), seven gastric outlet obstructions (3.5%), five subphrenic abscesses (2.5%), three perforations (1.5%), one splenic infarction, and one enterocutaneous fistula. One hundred sixty-one (81%) patients have been followed for a mean of 34 months (range 24 to 56 months); their mean weight loss is 36.4 per cent +/- 32.9 per cent of excess body weight. Only 45.5 per cent of these patients can be considered to have had satisfactory weight loss. Because this is not as effective as other forms of surgical therapy, the authors do not recommend greater curvature gastroplasty for the treatment of morbid obesity.
Polytetrafluoroethylene (PTFE) grafts, 1 mm in internal diameter, were interpositioned in the infrarenal aortas of 20 adult Sprague-Dawley rats with either continuous or interrupted sutures. The interrupted-suture (I-S) technique was used in ten rats, the continuous-suture (C-S) technique in the other ten. After followup of 90 days, the overall patency rate for the 20 rats was 95% (19/20); all grafts in the C-S group were patent; one graft in the I-S group had occluded on the day of operation. Since excellent patency rates were obtainable with these minute PTFE grafts placed in the rat aorta by either technique, the speed with which the C-S technique can be accomplished appears to make it preferable.
The effects of ibuprofen (Motrin), dipyridamole (Persantine), and prostacyclin on the deposition of platelets on polytetrafluoroethylene grafts (5.5 cm long, 4 mm internal diameter implanted into both femoral arteries of 21 dogs) were studied by harvesting autologous platelets, labeling them with 51Cr, and reinjecting them 15 minutes before cross-clamping. Arterial flow was adjusted to 65 ml/min and monitored continuously. Ibuprofen (12.5 mg/kg) and dipyridamole (2.5 mg/kg) were each administered as a single intravenous injection in four dogs (eight grafts) and five dogs (10 grafts), respectively. Prostacyclin (50 ng/kg/min) was administered by continuous intravenous infusion in five dogs (10 grafts). Seven dogs (14 grafts) served as controls. Grafts were removed 2 hours after implantation, and radioactivity (counts per 10 minutes) was determined in four segments of each graft (including both anastomoses) with a gamma-counter. Counts were averaged for each group of dogs. Significance was calculated by the Student t test. Platelet deposition in control dogs averaged 10,033.9 +/- 1134.2 SE; that in prostacyclin-treated dogs averaged 2513.7 +/- 276 SE (p less than 0.001); that in ibuprofen-treated dogs averaged 5453.4 +/- 1336.3 SE (p = 0.02); that in dipyridamole-treated dogs averaged 11,213.7 +/- 1632.5 SE (p = 0.55). These data demonstrate the effectiveness of prostacyclin and ibuprofen in reducing platelet deposition on polytetrafluorethylene grafts in dogs.
A rare case of duodenoureteral fistula, manifested by pneumaturia, dysuria, and hematuria, followed a shotgun injury to the right upper abdominal quadrant five years previously. The kidney and affected ureter were removed and the duodenal opening closed successfully.
The effectiveness of ticarcillin (one 6 g dose at the start of the operation) and cephalothin (three 2 g doses given at 4 hour intervals from the start of the operation) as prophylactic antibiotics in operations on the colon, stomach, small bowel or obstructed biliary tract was determined in a prospective, randomized, blind study of 190 patients. Data from the 152 patients forming the definitive study revealed a significant reduction in the rate of wound and peritoneal infections with the use of ticarcillin (3.4 percent) and cephalothin (5.3 percent) over that with the use of a placebo (27.8 percent). Cultures showed no evidence of antibiotic resistance in the contaminant organisms of patients who later developed infections. Both antibiotic regimens offered excellent protection against infection after gastrointestinal operations; neither produced untoward side effects. The very short duration of treatment, particularly with ticarcillin, conferred the additional benefits of low cost, simplicity of drug administration, and negligible risk of the emergence of resistant bacterial strains.
A canine model in which joined carotid arteries were anastomosed to 6-mm grafts (average length, 45 cm) of polytetrafluoroethylene (PTFE) or Dacron double velour and the grafts were anastomosed to the ligated distal abdominal aorta was used to study long-term graft patency. The 16 dogs with PTFE grafts and the 15 dogs with Dacron grafts were sacrificed at three-, six-, and 12-month intervals, or whenever a graft occluded. At three months, eight of 11 PTFE and 11 of 11 Dacron grafts were patent; at six months, two of three PTFE and three of three Dacron grafts were patent; at 12 months, one of two PTFE grafts and the one remaining Dacron graft were patent. All grafts were examined grossly and microscopically. The PTFE grafts showed increasing degrees of calcification and intimal fibrin deposition; the Dacron grafts had no calcification and less intimal fibrin deposition. The model was satisfactory for studying long, small-diameter vascular grafts, but PTFE was not found to be superior to Dacron in this study.
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Expanded microporous polytetrafluoroethylene (PTFE) has been used experimentally and clinically for small-vessel bypass or replacement grafting; the results vary widely. This study assessed short (4--cm) femoral and carotid artery replacement PTFE grafts and longer (12--cm) femoral artery bypass PTFE grafts that crossed a flexion crease. Pore size at the blood-graft interface ranged from 10 to 30 mu. At the end of three months, overall patency rate was 22%. No long bypass grafts remained patent. The pore size and type of anastomosis did not affect patency. The occlusion was always thrombotic, associated with fibrin at the suture line. Nine of the 20 short carotid grafts (45%) and five of 22 short femoral grafts (22%) remained patent. These poor results indicate that further experimental studies are needed before PTFE is used clinically when an alternative exists.
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