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Biomedical subjects

J L Cameron

Publications and source records attributed to J L Cameron.

At least 307 records · Page 17Linked to original sources
PubMed1981

The role of systemic antibiotics in operations upon the colon.

A prospective randomized clinical trial was carried out to evaluate the role of parenteral antibiotics in elective operations upon the colon. All patients received a mechanical intestinal preparation, neomycin and erythromycin base orally and topical antibiotic administration intra-abdominally and to the wound at the time of operation. The patients were further randomized into three groups. One group received no parenteral antibiotics; the second group received parenteral cefamandole, and the third group received parenteral penicillin, gentamicin and clindamycin. One hundred and thirteen patients completed the study. The sepsis rate postoperatively was similar for all three groups. When oral and topical antibiotics are used in elective operations upon the colon, parenteral antibiotics provide no additional benefit.

Anti-Bacterial Agents↗
PubMed1980

Acute pancreatitis. Experimental evaluation of steroid, albumin and trasylol therapy.

The efficacy of steroids, albumin and Trasylol administration in the treatment of experimental pancreatitis was evaluated. An isolated, ex vivo, perfused canine pancreas preparation was used and pancreatitis was initiated by free fatty acid infusion. Steroid administration worsened pancreatitis, Trasylol had no effect, and albumin was markedly effective in ameliorating pancreatitis. These results were interpreted as evidence against enzyme extravasation and for capillary injury as the initial step in the pathogenesis of pancreatitis.

Acute Disease↗
PubMed1980

Hepatobiliary complications of ulcerative colitis.

The records of 202 patients with chronic ulcerative colitis seen over a 12 year period were reviewed. Over one half (55 percent) were found to have liver function test abnormalities. These abnormalities correlated with the extent and severity of ulcerative colitis but not with the duration of the disease. Eight patients (4 percent) developed cirrhosis and four required portasystemic decompression for bleeding varices. Four patients (2 percent) developed biliary tract complications. Two patients were diagnosed as having sclerosing cholangitis, and two patients developed carcinoma of the extrahepatic biliary tree. Three of these four patients had whole colon involvement, but all four had mild clinical disease. It is concluded that the hepatobiliary complications of ulcerative colitis are the most frequent and serious extracolonic manifestations of the disease.

Adolescent↗
PubMed1980

Pancreatic islet autotransplantation: results in dogs with chronic duct ligation.

The influence of pancreatic acinar cell atrophy and fibrosis on islet tissue autotransplantation was studied in dogs. Thirty-nine dogs underwent pancreatic duct ligation. After 6 weeks marked acinar cell atrophy and fibrosis developed, similar to that in human chronic pancreatitis. Intravenous glucose tolerance testing revealed only a minor decrease in K value (percent/min decline in plasma glucose) from 2.9 +/- 0.2 to 2.4 +/- 0.1 during the 6 weeks. In a control group of normal dogs, 23 of 26 transplants were successful. In a group of 12 duct-ligated dogs, only 1 of 12 transplants was successful with identical techniques (p less than 0.001). Variations in technique to increase or decrease tissue dispersal did not improve the results in other groups (two successes in 27 dogs). New techniques are required if pancreatic islet transplantation is to be consistently effective in the presence of chronic inflammatory disease of the pancreas.

Animals↗
PubMed1980

Postoperative T-tube cholangiography. Is antibiotic coverage necessary.

One hundred patients undergoing postoperative cholangiography had blood cultures drawn prior to and 15 minutes and six hours after cholangiography. Bile cultures obtained prior to cholangiography grew organisms in 92 of 100 patients with E. coli, Klebsiella pneumoniae and enterococcus being the bacteria most frequently isolated. Anaerobes were isolated from the bile in 21% of the patients. Nine of 83 patients (11%) not receiving antibiotics developed a bacteremia after cholangiography with organisms identical to those in the bile. All nine patients recovered without further complications of cholangiography. Those who developed a bactermia could not be distinguished from the group as a whole on the basis of age, sex, laboratory data, type of surgery or cholangiographic findings. None of the eight patients with negative bile cultures and none of 17 patients on antibiotics at the time of cholangiography experienced a bacteremia. Ninety to 93% of 304 organisms isolated from the bile were sensitive to a combination of a penicillin and an aminoglycoside. Most patients undergoing postoperative tube cholangiography do not develop a bacteremia and do not require antibiotics. Only patients with positive bile cultures who might tolerate a bacteremia poorly, and those who are febrile from cholangitis immediately prior to cholangiography should be covered with a short course of systemic antibiotics.

Adolescent↗
PubMed1980

Disseminated intravascular coagulation and portal hypertension following pancreatic islet autotransplantation.

A patient undergoing subtotal pancreatectomy and intraportal islet tissue autotransplantation for chronic pancreatitis developed severe portal hypertension (49 cm of H(2)O) and acute disseminated intravascular coagulation (DIC). In an attempt to identify the cause of these problems, portal pressure and the activities of the coagulation and fibrinolytic systems were studied in dogs undergoing intraportal autotransplantation of islet tissue. Following intraportal injection of the pancreatic tissue in five control dogs, the portal pressure rose to a maximum of 43.2 cm of H(2)O +/- 2.4 and major coagulation abnormalities occurred. The mean hematocrit value fell to 18% +/- 8.6, the mean platelet count to 218,000 +/- 31,000, the mean plasma fibrinogen to 40 mg/dl +/- 18, and the mean euglobulin clot lysis time (ECLT) to 25 min +/- 4. Partial thromboplastin time (PTT) became prolonged (233 secs +/- 30) and significant quantities of fibrinogen-fibrin degradation products (FDP-fdp) (1:128 +/- 32) appeared. These changes indicate the development of DIC probably secondary to significant amounts of tissue thromboplastin detected in the tissue homogenate infused at time of autotransplantation. In a group of seven dogs in whom heparin and Trasylol (aprotinin) were added to the pancreatic tissue at the time of transplantation, portal pressure rose only to a peak of 28.3 cm of H(2)O +/- 3.6 and no significant abnormalities occurred in mean hematocrit value, plasma fibrinogen, platelet count or ECLT. Minor prolongation of PTT occurred secondary to the activity of heparin. FDP-fdp (1:16) were present transiently during tissue injection. Four patients in whom heparin and Trasylol were added to the pancreatic tissue at the time of autotransplantation developed only minor elevations of portal pressure (mean 15.5 cm of H(2)O) without intravascular coagulopathy.

Animals↗
PubMed1980

Surgical management of Crohn's disease. Influence of disease at margin of resection.

To determine the influence of microscopic disease at an anastomosis following intestinal resection for Crohn's disease, 97 patients undergoing 103 resections were reviewed. Most resections (85/103) involved both small and large bowel and were followed by an ileocolic anastomosis. All resection margins were available and were reviewed. In 52 instances there was no evidence of Crohn's disease at the margins. In 51 instances histologic evidence of Crohn's disease varying from chronic inflammation to tissue destruction was present in one or both margins. The incidence of immediate postoperative anastomotic complications (leak with fistula or abscess, or obstruction) was identical in patients with microscopically normal margins (3/52; 6%) and in patients with microscopic Crohn's disease at the margins (3/51; 6%). The patients were followed for a mean of 5.4 +/- 4.2 years. A clinical recurrence developed during the follow-up period in 50% (26/52) of those patients with normal margins, and in 61% (31/51) of those patients with involved margins. A suture line recurrence developed in 35% (18/52) and required reoperation in 17% (9/52) of those patients with microscopically normal margins. A suture line recurrence developed in 41% of the patients (21/51) and required reoperation in 24% (12/51) of those with microscopically involved margins. None of these differences are statistically significant. The presence or absence of microscopic disease at the anastomosis did not appear to influence immediate anastomotic wound healing or long-term recurrence rates. We therefore recommend conservative resections for Crohn's disease to achieve grossly uninvolved margins rather than the sacrifice of normal bowel to achieve histologically normal margins.

Adolescent↗
PubMed1980

CT of fluid collections associated with pancreatitis.

Fluid collections are an important component of severe pancreatitis because they may produce a detectable mass and may be responsible for prolongation of fever and pain. Among 59 cases of clinically verified pancreatitis, 32 were shown by CT to be complicated by pancreatic and/or extrapancreatic fluid collections. Pancreatic fluid collections, diagnosed in 16 patients, were typically on the anterior or anterolateral surface of the gland and were covered only by a thin layer of fibrous connective tissue. Extrapancreatic fluid collections were detected in the lesser sac (19 cases), anterior pararenal space (15), posterior pararenal space (six), in or around the left lobe of the liver (five), in the spleen (three), and in the mediastinum (one). The potential undesirable consequences of escape of pancreatic juice are necrosis, abscess formation, or prolonged inflammation of the peripancreatic tissues. Relative preservation of pancreatic integrity as observed by CT was regularly found in patients with large extrapancreatic fluid collections, suggesting that escape of pancreatic juice produces a beneficial decompression of the pancreatic duct system.

Acute Disease↗
PubMed1980

Experimental pancreatitis: influence of secretory state of the pancreas.

The influence of the secretory state of the pancreas on the development of pancreatitis in an isolated, ex vivo, perfused canine pancreas model was evaluated. Free fatty acid infusion was used to induce pancreatitis, and secretin, glucagon, and atropine were administered to influence the secretory state. Despite a 40-fold difference in hourly secretory output, the development of pancreatitis as judged by weight gain, hemoconcentration, amylase value, and arterial blood pressure response was similar in the stimulated, basal, and suppressed states. This study casts further doubt on the role of hypersecretion in the pathogenesis of acute pancreatitis.

Acute Disease↗
PubMed1980

Metabolic studies following intrahepatic autotransplantation of pancreatic islet grafts.

A patient with chronic pancreatitis underwent 95% pancreatectomy and islet autotransplantation. The pancreatic tissue was prepared by mincing and collagenase digestion, and then embolized into the liver via the portal vein. The patient has been followed with metabolic studies for 1 year. Fasting normoglycemia returned 3 weeks following operation. Intravenous glucose tolerance tests revealed K values that were similar before operation (1.06), and 3 weeks (0.96) and 4 months (1.09) after operation. Four months after islet transplantation, peripheral, portal, and hepatic vein insulin levels were determined simultaneously following an infusion of glucose (0.25 gm/kg) into the portal vein. During a 10-minute interval, right hepatic vein insulin increased fourfold, left hepatic vein insulin increased twofold, and peripheral vein insulin doubled. During this time portal vein insulin remained constant. In addition, significant levels of pancreatic glucagon were present in both hepatic veins, but were undetectable in the portal vein. At 6 months the patient became hyperglycemic and subsequently has required insulin therapy. Restudy at 10 months following islet transplantation revealed a marked drop in K value (0.34), and no evidence of graft function in the liver. These studies represent convincing evidence of transplanted intrahepatic islet cell function for a 6-month period following operation. The grafts for unknown reasons ceased to function at 6 months.

Blood Glucose↗
PubMed1980

The mesocaval C shunt.

A modification of the mesocaval interposition H shunt utilizes the anterior cephalad portion of the superior mesenteric vein on top of the uncinate process of the pancreas as the site of anastomosis. This site is above the branches of the superior mesenteric vein and ensures a vein of large caliber. When the graft is anastomosed to this portion of the vein, it assumes a C configuration.

Adult↗
PubMed1980

Cimetadine as a preoperative medication to reduce the complications of aspiration of gastric contents.

In an effort to decrease gastric residual and acid content prior to operation and thus to decrease the risk of aspiration, a prospective clinical trial comparing three drugs was carried out. Eighty-four patients undergoing elective craniotomy for a space-occupying lesion were studied. Twenty-eight patients were premedicated with the anticholinergic atropine (0.01 mg/kg); 28 patients were administered the anticholinergic glycopyrrolate (0.005 mg/kg); and 28 patients were given three preoperative doses of cimetadine and no anticholinergic. Gastric acidity was elevated above pH 2.5 in 93% of those receiving cimetadine, in comparison to 54% for glycopyrrolate and 29% with atropine. In addition, the stomach was completely dry in 54% following cimetadine, and in only 25% and 11% following glycopyrrolate and atropine. Cimetadine is more effective as a preanesthetic agent than anticholinergic drugs in decreasing gastric residual and acid content, and essentially eliminates the risk of aspiration.

Adolescent↗
PubMed1980

The incidence of shunt occlusion following portosystemic decompression.

The English literature on portosystemic decompression procedures was reviewed for an 11 year period and is available upon request to the authors. Information on 1,586 end-to-side portacaval shunts, 308 side-to-side portacaval shunts, 550 standard splenorenal shunts, 436 interposition shunts, 319 distal splenorenal shunts and 136 direct mesocaval shunts was obtained. Operative mortality ranged from a low of 6 per cent in patients undergoing a direct mesocaval shunt to a high of 29 per cent among patients undergoing a side-to-side portacaval shunt. The incidence of portosystemic encephalopathy ranged from a low of 2 per cent for direct mesocaval shunts to a high of 36 per cent for side-to-side portacaval shunts. The occlusion rate was 18 per cent for the standard splenorenal shunt, 10 per cent for the distal splenorenal and interposition shunts, 7 per cent for the direct mesocaval and the end-to-side portacaval shunts and 2 per cent for the side-to-side portacaval shunt.

Constriction, Pathologic↗
PubMed1980

Respiratory failure in acute pancreatitis: the role of free fatty acids.

Hypertriglyceridemia has been noted in patients with acute pancreatitis and respiratory failure. Utilizing an isolated, perfused, canine pulmonary lobe, the effect of triglyceride infusion on pulmonary function was evaluated. When heparin was used to anticoagulate the perfusion circuit, the addition of triglyceride to the autologous blood perfusate resulted in massive weight gain (226 gm), intrapulmonary shunting (36%), and a marked drop in pulmonary compliance (congruent to 50%). Heparin activates lipoprotein lipase, and therefore some triglyceride in the perfusate was lipolyzed with a resultant increase in serum free fatty acids (FFAs) to 253 mumole/dl. When anticoagulation of the perfusion circuit was accomplished by defibrinogenation with Arvin, the addition of triglyceride to the autologous blood perfusate caused minimal weight gain (28 gm), no intrapulmonary shunting, and only a slight decrease in pulmonary compliance (22%). Arvin has no effect on lipoprotein lipase, and the FFA level in the perfusate remained normal (less than 70 mumole/dl). Thus it appears that FFA release secondary to the action of pulmonary lipoprotein lipase on blood triglyceride is the important pathogenic step in the induction of respiratory failure in this model.

Acute Disease↗
PubMed1979

Percutaneously placed biliary stents in the management of malignant biliary obstruction.

The management of malignant obstruction of the biliary tree is difficult and often unsuccessful. Advances in the technique of percutaneous transhepatic catheterization have made possible the nonoperative internal drainage of obstructed lesions. We report successful decompression of ten patients with unresectable biliary neoplasms using percutaneously placed internal biliary stents.

Adult↗