PubMed Health⌕ Search

Biomedical subjects

J W Baer

Publications and source records attributed to J W Baer.

At least 19 recordsLinked to original sources
PubMed1996

Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT.

OBJECTIVE: The purpose of this study was to determine whether CT can be used to diagnose ischemia of the small intestine in patients with small-bowel obstruction due to adhesions or hernia. SUBJECTS AND METHODS: During a 12-month period, 60 patients underwent surgery for complete or high-grade small-bowel obstruction due to adhesions or hernia, and 29 (48%) had evidence of associated intestinal ischemia. All of these patients had been preoperatively diagnosed by CT as having high-grade small-bowel obstruction. At the same time, a prospective determination was made based on the CT as to whether there was any associated intestinal ischemia. All CT scans were performed within 24 hours of the operation. A CT diagnosis of ischemia was based on the presence of two or more of the following signs: bowel-wall thickening, high attenuation of the bowel wall on unenhanced CT scans, mesenteric edema or fluid, asymmetric bowel-wall enhancement on i.v. contrast-enhanced CT scans, pneumatosis, or portal venous gas. Results of the CT examination and surgical findings were then compared. Further evaluation was done with a retrospective multivariate discriminant analysis. RESULTS: Ischemia was prospectively diagnosed on the basis of CT findings in 41 (68%) of the 60 patients. There were no false-negative CT diagnoses (sensitivity, 100%); however, there were 12 CT diagnoses that were false-positive (specificity, 61%). The multivariate analysis corroborated the prospective results by showing high sensitivity (90%) and diminished specificity (50-64%). Bowel-wall thickening and high attenuation of the bowel wall were the most important signs of ischemia on unenhanced CT scans, whereas abnormal bowel-wall enhancement and mesenteric fluid correlated best on enhanced CT examinations. CONCLUSIONS: CT is a sensitive but not completely specific preoperative indicator of intestinal ischemia in patients with small-bowel obstruction due to hernias or adhesions.

Acute Disease↗
PubMed1995

Role of CT in evaluating patients with small-bowel obstruction.

The accurate and rapid diagnosis of acute small-bowel obstruction has troubled surgeons and radiologists for more than a century. With the advent of CT, solving the problem is now a possibility. CT can accurately diagnose obstruction, determine the likely cause and location, and even suggest whether there is associated bowel ischemia or strangulation.

Colonic Neoplasms↗
PubMed1995

Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings.

OBJECTIVE: The expeditious diagnosis of complete and partial mechanical small-bowel obstruction, as opposed to paralytic ileus, during the immediate postoperative period may be difficult on the basis of clinical and plain film radiographic findings. For this reason, we prospectively evaluated the use of CT in this setting and compared it with the clinical and plain film evaluations as well as with various contrast examinations. SUBJECTS AND METHODS: Thirty-six postoperative patients with signs and symptoms of paralytic ileus or mechanical small-bowel obstruction were examined clinically and had plain abdominal radiographs. Based on the findings of these examinations, the surgeon assigned patients to one of the following categories: (1) paralytic ileus, (2) indeterminate, (3) partial mechanical obstruction, or (4) complete mechanical obstruction. CT scans were obtained within 24 hr of the initial diagnostic studies, and patients were then recategorized according to the above classification solely based on CT findings. Initial examination results were then compared with the CT results. In addition, the results of contrast studies, namely, enteroclysis and barium enema, performed after CT small-bowel series, were evaluated. The gold standard for diagnosis was laparotomy in 20 patients, clinical course and follow-up in 13 patients, and clinical course and contrast studies in the other three patients. RESULTS: CT was effective (sensitivity and specificity, 100%) in distinguishing between postoperative ileus and complete mechanical small-bowel obstruction. The combined clinical and plain film findings were often confusing and nondiagnostic (sensitivity, 19%). CT was also valuable in diagnosing and distinguishing partial mechanical small-bowel obstruction from paralytic ileus. Contrast studies (enteroclysis) in four patients with partial mechanical small-bowel obstruction were useful in grading the degree and severity of the obstruction. CONCLUSION: Our results suggest that in the immediate postoperative period, CT is the method of choice for diagnosing mechanical small-bowel obstruction and distinguishing it from paralytic ileus. Contrast studies are useful in further evaluating partial mechanical small-bowel obstruction.

Adolescent↗
PubMed1994

Interleukin-1-induced lung neutrophil accumulation and oxygen metabolite-mediated lung leak in rats.

We found that intratracheal administration of recombinant interleukin-1 alpha (IL-1) into rats rapidly (< 5 h) increased neutrophils in lung lavages and caused an acute edematous lung injury which was reflected by lung albumin accumulation (lung leak) and histological abnormalities (perivascular cuffing). These IL-1-dependent processes were inhibited by prior administration of recombinant IL-1 receptor antagonist and did not occur following administration of heated IL-1. Several lines of evidence suggested that neutrophil-derived oxygen metabolites contributed to lung leak. First, lung leak did not occur in rats rendered neutropenic by vinblastine treatment 4 days before IL-1 administration but did occur in neutrophil-replete rats given vinblastine 1 day before IL-1 administration and control rats given IL-1. Second, treatment with a hydroxyl radical scavenger, dimethyl sulfoxide (DMSO) or a superoxide anion scavenger, manganese superoxide dismutase, decreased lung leak, lung lavage neutrophils, and histological abnormalities in rats given IL-1 intratracheally. Third, intratracheal IL-1 administration increased lung oxidized glutathione (GSSG) levels and expired H2O2 concentrations, and these two indices of oxidative stress were decreased by dimethyl sulfoxide or manganese superoxide dismutase treatment. We conclude that intratracheal administration of IL-1 increases neutrophils in the lung and causes a neutrophil and oxygen metabolite-dependent acute edematous lung injury.

Animals↗
PubMed1994

Liposome-entrapped PGE1 posttreatment decreases IL-1 alpha-induced neutrophil accumulation and lung leak in rats.

We found that treatment with liposome-entrapped prostaglandin E1 (Lip-PGE1), but not with empty liposomes and/or free PGE1, decreased the leak of intravascularly administered 125I-labeled albumin into lungs of rats given interleukin-1 alpha (IL-1 alpha) intratracheally. Lip-PGE1 treatment also decreased lung myeloperoxidase activity, lung lavage neutrophil increases, and lung histological abnormalities found in rats given IL-1 alpha intratracheally. Interestingly, decreased lung leak and lung neutrophil accumulation occurred when Lip-PGE1 was given intravenously 2.5 h after, but not immediately before, intratracheal IL-1 alpha administration. When Lip-PGE1 treatment was given both before and 2.5 h after IL-1 alpha administration, lung leak was decreased to baseline levels. Lip-PGE1 treatment given 2.5 h after IL-1 alpha administration also decreased lung oxidized glutathione levels, which increased in rats given IL-1 alpha intratracheally. We conclude that postinsult treatment with Lip-PGE1 decreases lung leak, neutrophil recruitment, and oxidative responses in lungs of rats given IL-1 alpha intratracheally.

Alprostadil↗
PubMed1994

CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause.

OBJECTIVE: The early diagnosis of small-bowel obstruction is critical in preventing complications, particularly strangulation. Traditionally, the clinical diagnosis of small-bowel obstruction has depended on plain film confirmation. Unfortunately, findings on the plain film may not be confirmatory in 20-52% of cases. The purpose of this study was to determine whether CT is superior to the traditional clinical-radiographic evaluation in prospectively establishing the diagnosis, severity, and cause in cases of suspected obstruction of the small bowel and to see what impact this information might have on treatment, costs, and the need for additional gastrointestinal contrast studies. SUBJECTS AND METHODS: Physicians from three surgical services referred all patients with suspected small-bowel obstruction for plain film and CT evaluation. Eight-five patients were evaluated on 90 occasions during an 11-month period. Obstruction was classified on the basis of clinical and plain film findings as absent, indeterminate, or present (partial or complete). CT scans were obtained in all patients and were interpreted and graded without knowledge of the clinical-radiographic classification. The results of gastrointestinal contrast studies (barium enema, small-bowel series, and enteroclysis) performed in 21 cases were also compared. The gold standard for the diagnosis was surgical findings in 61 cases and clinical course in 29 cases. RESULTS: On the basis of the combined clinical-radiographic findings, the diagnosis was complete obstruction in 21 of 46 cases (sensitivity, 46%; confidence interval (CI), 32-60%). When CT was used, the diagnosis was established in all 46 cases (sensitivity, 100%; CI, 86-100%). In the 25 cases in which the traditional evaluation failed, the early CT diagnosis of complete obstruction prevented a 12-72 hr delay in surgery with its attendant increased morbidity, mortality, and costs. On the basis of the combined clinical-radiographic findings, partial obstruction of the small bowel was diagnosed in six of 20 cases (sensitivity, 30%), whereas all cases were detected with CT. False-positive CT findings for complete obstruction of the small bowel occurred in three cases of paralytic ileus (one each due to small-bowel infarction, lower lobe pneumonia, and peritonitis due to rupture of the urinary bladder). One case of colonic obstruction due to carcinoma in the hepatic flexure was mistakenly diagnosed as partial obstruction of the small bowel. The clinical and plain film evaluation was never precise enough to provide the exact location or cause of small-bowel obstruction. Gastrointestinal contrast studies provided additional useful information regarding colonic abnormalities (four cases), functional grading of partial obstruction of the small bowel (six cases), and exclusion of a false-positive CT diagnosis of complete obstruction in a case of reflex ileus. CONCLUSION: CT is sensitive for diagnosing complete obstruction of the small bowel and for determining the location and cause of obstruction. In comparison, the traditional clinical and plain film evaluation is relatively insensitive. CT should be used when the results of clinical and plain film evaluation are inconclusive. Gastrointestinal contrast studies play an important diagnostic role in partial obstruction of the small bowel and in colonic obstruction with predominant small-bowel dilatation.

Humans↗
PubMed1990

Extraperitoneal mass effect by ascites under tension.

Benign ascites may cause an extraperitoneal mass effect when it becomes loculated by adhesions or when peritoneal recesses are enlarged by ascites under tension. Five symptomatic patients were examined by computed tomography demonstrating ascites as the cause of an apparent mediastinal mass in 1, a retrogastric mass in 1, and a retroperitoneal mass displacing the right kidney anteriorly in 4.

Adult↗
PubMed1987

Munchausen's/AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Challenges in developing an inpatient psychiatric program for patients with AIDS and ARC.

The presence of patients with AIDS and AIDS-related complex (ARC) on a psychiatric unit requires education of and adaptation by staff and other patients as well as changes in the psychiatric milieu. The authors describe their experiences with 36 AIDS and ARC patients admitted to a psychiatric unit over an 18-month period. They address issues related to staff reactions to terminal illness and to increased demands to provide physical care, milieu management that takes into account the limitations of AIDS patients suffering from dementia, diagnostic complications arising from mixed psychopathology in some AIDS patients, and the increased susceptibility of AIDS patients to side effects and toxicity from psychotropic medication. Other issues relating to infection control, ethical concerns, needs of friends and family, and disposition planning are also discussed.

AIDS-Related Complex↗
PubMed1987

Radiology of obesity surgery.

Modern imaging modalities are the key to prompt evaluation of the efficacy and complications of obesity surgery. These are divided into the early and late complications of gastric restrictive surgery and intestinal bypass surgery.

Fluoroscopy↗
PubMed1985

Hemorrhagic pancreatitis: a complication of transcatheter embolization treated successfully by total pancreatectomy.

Since pancreatitis can be produced experimentally in dogs by embolization of microspheres into the pancreatic arterial circulation, there has been speculation that intentional or inadvertent embolization of the pancreas in human subjects could also produce pancreatitis. Although such therapeutic embolization has increased, no pathologically documented case of this complication has been recorded. We have reported the first such case occurring in a patient with a large, highly vascular, nonfunctioning islet cell carcinoma of the tail of the pancreas preoperatively embolized with Gianturco coils and Gelfoam particles suspended in sodium tetradecylsulfate solution to facilitate distal pancreatectomy. The resultant hemorrhagic pancreatitis and duodenal necrosis required a total pancreatectomy. We conclude that, by itself, occlusion of the origin of the splenic and gastroduodenal arteries with coils would have been effective and without complication; however, the addition of Gelfoam particles in a sclerosing solution reduced the microscopic pancreatic circulation to a critical point and resulted in hemorrhagic pancreatitis.

Adenoma, Islet Cell↗
PubMed1984

Computed tomography demonstration of pancreatic microcystic adenoma.

Microcystic adenoma is an uncommon pancreatic neoplasm that is generally thought to be a benign tumor. Herein, we review the literature related to microcystic adenomas and discuss the use of computed tomography in the differential diagnosis of the tumor. The controversy in pathology regarding the presence or absence of a potential for malignant degeneration in microcystic adenomas is presented along with the therapeutic controversy regarding the necessity for total surgical excision. Two new cases of pathologically proven microcystic adenoma of the pancreas are reported. In one case there was evidence of metastasis by computed tomography, sonography, and scintigraphy.

Adenoma↗