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Biomedical subjects

J W York

Publications and source records attributed to J W York.

9 recordsLinked to original sources
PubMed2001

Comparison of open transabdominal AAA repair with endovascular AAA repair in reduction of postoperative stress response.

Operative intervention causes a necessary biologic response known as the hypermetabolic stress response. Less invasive operative procedures may cause fewer metabolic and endocrine derangements. To evaluate the metabolic and endocrine differences between endovascular and transperitoneal abdominal aortic aneurysm (AAA) repair, 10 patients underwent standard open repair (open group) and 10 patients underwent endovascular repair of AAA (endovascular group) with a modular bifurcated endograft. Blood samples were obtained prior to general anesthesia (baseline) and every 6 hr for a 24-hr period. Assays for hormones related to the postoperative stress response as well as retinol-binding protein were performed. Peak hormonal values are presented in relation to the baseline. Demographic analysis of the two groups showed that there were no significant differences in age or ASA classification. The open group had a 9.6-fold increase in epinephrine release, which was significantly higher than the 1.6-fold increase in the endovascular group (p < 0.05). Elevations in cortisol were also significantly higher in the open group. Early postoperative nutritional derangements, as reflected by the levels of retinol-binding protein, were far less in the endovascular group than in the open group. Endovascular AAA repair appears to be associated with a marked reduction in the hypermetabolic stress response and nutritional deterioration, compared to traditional open repair. This reduction in physiologic stress may have salutary effects on the incidence of postoperative medical morbidity.

Abdominal Muscles↗
PubMed2001

Development of oral heparin therapy for prophylaxis and treatment of deep venous thrombosis.

OBJECTIVE: To review the current research and published literature regarding the development of oral heparin therapy for the prophylaxis and treatment of deep venous thrombosis. BACKGROUND: Currently, the accepted practice of prophylaxis and/or treatment of acute deep venous thrombosis (DVT) is intravenous or subcutaneous (SQ) heparin followed by oral warfarin or SC low molecular weight heparin (LMWH) therapy followed by warfarin. Both of which are less than ideal. More recently, advances have been made towards an effective oral heparin preparation that would resolve many of the drawbacks to the current therapies. METHODS: A review of the current and relevant English literature identified via a search of the Medline database from January 1990 to present. RESULTS: Initial oral heparin therapy for DVT was unsuccessful due to presumed inadequate intestinal absorption as a result of heparin's molecular and structural characteristics. The development of oral heparin therapy, based on combining heparin with the carrier molecule Sodium N-(8[2-hydroxybenzoyl]amino) caprylate (SNAC) to enhance its intestinal absorption and bioavailability for the prophylaxis and treatment of DVT has been demonstrated to be effective in animal models. More recent efforts have been aimed at human trials. CONCLUSION: Recent advances in prophylaxis and treatment of DVT have stimulated great interest among researchers to develop an effective, convenient, and well tolerated oral therapy. An effective oral heparin therapy may represent an ideal method of prophylaxis and treatment of DVT.

Administration, Oral↗
PubMed2001

Prevention and management of ureteral injuries during aortic surgery.

Ureteral injury during aortic surgery may lead to life-threatening consequences. Unlike gynecologic or abdominal surgical procedures in which ureteral injuries more commonly occur, this type of iatrogenic injury may be particularly hazardous because of the presence of prosthetic graft material. Ureteral obstruction by extrinsic compression, from an anteriorly placed graft limb or retroperitoneal fibrosis, is the most commonly reported type of ureteral complication. In most vascular surgical series, direct ureteral injury occurs in less than 1% of cases, and ureteral obstruction occurs from 2% to 14% of aortoiliac reconstructions. Prevention of ureteral injury begins with an intimate knowledge of the anatomy of the ureter along its entire course from the abdomen to the pelvis, and a realization of possible anomalies. Recognition of an injury is the next key to a successful outcome. Intraoperative recognition of an injury may allow immediate repair with a high rate of success. There are many options for the management of ureteral injuries depending on the nature of the injury, the time of diagnosis, and the level of the ureter at which the injury has occurred. The authors review the anatomy and most common causes of ureteral injury during aortic surgery and provide a guide to appropriate surgical management of these injuries.

Aortic Aneurysm, Abdominal↗
PubMed1999

Increased efficiency and cost-effectiveness in the evaluation of the blunt abdominal trauma patient with the use of ultrasound.

The efficacy and effectiveness of ultrasound (US) in evaluating patients suspected of having blunt abdominal trauma are near that of computed tomography (CT) and diagnostic peritoneal lavage (DPL). Because no cost-effectiveness study has been reported, the purpose of this study was to demonstrate that US is more efficient and cost-effective than CT/DPL in evaluating blunt abdominal trauma. Over a 9-month period, 331 patients suspected of sustaining blunt abdominal trauma were evaluated at a Level I trauma center by US, CT, and/or DPL. Cost data and time to disposition were determined for analysis. The sensitivity, specificity, and accuracy of US were similar to those reported in previous studies. There was a significant difference in time to disposition with the US group being significantly lower (P = 0.001). The total procedural cost was 2.8 times greater for the CT/DPL group than for the US group. US is not only effective in diagnosing blunt abdominal trauma, but it is also more efficient and cost-effective than is CT/DPL.

Abdominal Injuries↗
PubMed1976

Lactate dehydrogenase changes following several cardiac hypertrophic stresses.

The effects of four different cardiac hypertrophic stresses on cardiac lactate dehydrogenase (LDH) isozyme composition and activity were examined. Altitude-induced right ventricular hypertrophy was accompanied by an increase of 10% in the M subunit of LDH in right ventricle, left ventricle, and atria. Left ventricular hypertrophy induced by aortic stenosis also produced isozyme changes in the ventricles, but of only half the magnitude. Biventricular hypertrophy, induced by running or swimming, was accompanied by 4-5% increases in M LDH in the ventricles only. We conclude that changes in LDH activity are directly related to changes in the M subunit in all three portions of the heart. No changes in H subunit were noted under any of the stresses. It appears that the magnitude of changes in cardiac LDH isozyme composition are only marginally related to extent of hypertrophy.

Altitude↗
PubMed1975

Effects of physical training on several glycolytic enzymes in rat heart.

In response to a program of daily swimming for 16 weeks, the activities of pyruvate kinase and lactate dehydrogenase increased significantly in the hearts of young male rats. The isozyme composition in M of cardial lactate dehydrogenase increased from 28.5 to 32.7% in the trained animals. Phosphofructokinase activity and glycogen content were unchanged. The hearts of the exercising animals were 28% heavier than those of sedentary paired weight controls.

Animals↗