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Biomedical subjects

L B Pemberton

Publications and source records attributed to L B Pemberton.

At least 19 recordsLinked to original sources
PubMed1992

Insulin-like growth factor-binding protein-3 proteolysis is induced after elective surgery.

The insulin-like growth factors (IGFs) are bound to several binding proteins (IGFBPs) that appear to regulate IGF transport, receptor binding, and action. The concentrations of these peptides are altered by catabolic conditions. To determine if IGF-I and IGFBP levels change after surgery, sera were obtained from 16 patients before and after cholecystectomy. Immunoreactive IGF-I measured in plasma samples from which IGFBPs had been extracted did not change postoperatively. In contrast, IGF-I determined in unextracted samples increased roughly 3-fold postoperatively, presumably due to changes in IGFBPs. Two days postoperatively, IGFBP-3 levels, determined by ligand blot, averaged 36% of preoperative values, whereas levels of IGFBP-2 and a 24,000 mol wt IGFBP did not change significantly. Similarly, by immunoblot, intact IGFBP-3 was decreased 84.2 +/- 20.2%, and a 31,000 mol wt IGFBP-3 fragment increased 57.5 +/- 47.4% postoperatively. Coincubation of postoperative, but not preoperative, sera with control sera resulted in a significant decrease in IGFBP-3 and production of proteolytic fragments. IGFBP-3 proteolytic activity in postoperative sera was markedly inhibited by antipain, Na-p-tosyl-L-lysine chloromethyl ketone, phenylmethylsulfonylfluoride, aprotinin, o-phenanthroline, and EDTA, but not by leupeptin or N-tosyl-L-phenylalanine chloromethyl ketone. This pattern of inhibition is consistent with a metal-dependent trypsin-like serine protease. We speculate that proteolysis of IGFBP-3 may alter tissue uptake of IGF-I and thereby help to counteract the catabolic state caused by surgery.

Blood Physiological Phenomena↗
PubMed1989

The duodenum. Part 1: History, embryogenesis, and histologic and physiologic features.

Long before the Christian era, the duodenum was named and its function in controlling gastric emptying was conjectured. It received almost no further attention until the Eighteenth century when its relation to the bile and pancreatic ducts became know. The embryogenesis of the duodenum and the histological features of the organ are described as well as the gross movements that explain the mature relations of the duodenum to the surrounding structures. The "sphincters" of the duodenum are mentioned and evaluated.

Anatomy↗
PubMed1989

The duodenum. Surgical anatomy.

The second part of this monograph on the duodenum describes the muscular and mucosal changes observed at the gastroduodenal junction. The structure of the duodenal wall and details of the intramural portion of the common bile and pancreatic ducts are described, together with the surgical anatomy of the four parts of the duodenum. The arterial supply, the venous and lymphatic drainage, and the innervations are described from the surgeon's point of view.

Ampulla of Vater↗
PubMed1989

The duodenum. Part 3: Pathology.

Duodenal pathology includes various developmental malformations and acquired lesions. This report provides brief descriptions of various congenital anomalies of the duodenum, including stenosis and atresia, annular pancreas and ectopic duodenal pancreatic tissue, megaduodenum, duodenal diverticula, preduodenal portal vein, and paraduodenal fossae. Acquired lesions, such as duodenal ulcer, tumors, vascular compression, and duodenal trauma are also described.

Duodenal Diseases↗
PubMed1989

The duodenum. Part 4: Surgery.

This is the last part of our efforts to present, if possible, the duodenum in toto as an anatomical and surgical entity. For all practical purposes, Part 4 is a short presentation of the anatomy involved in mobilization and exposure of the duodenum from a surgical standpoint with specific applications. A table with most of the anatomical complications of duodenal surgery is also included.

Duodenum↗
PubMed1987

The role of the nutritional support team in preventing and identifying complications of parenteral and enteral nutrition.

As the technology of parenteral and enteral nutrition advances, a multidisciplinary nutritional support team (NST) can be used to assure quality care. NST functions include developing and using standard protocols and solutions, monitoring patients, and preventing complications. Interventions by NSTs can save money for the hospital as well. Examples from Truman Medical Center (Kansas City, Missouri) illustrate how the NST can perform these functions.

Enteral Nutrition↗
PubMed1986

Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients.

We prospectively studied the infection rates for 59 triple-lumen (TLC) and 68 single-lumen (SLC) subclavian catheters during the administration of total parenteral nutrition (TPN) to surgical or critically ill patients. A standard protocol was used for catheter insertion and maintenance. The infection control committee determined independently whether patients had catheter-related sepsis, an infected insertion site only, or no catheter infection. The TLCs had an increased incidence of catheter sepsis (19%) compared with the SLCs (3%). Low rates (5% for TLCs and 3% for SLCs) of infected catheter sites only indicated that the catheter care was comparable for both groups. The patients in the two groups were similar but not identical; those with TLCs appeared to be sicker and, therefore, at greater risk to develop catheter sepsis than patients with SLC. However, since TLCs were involved in six times more catheter sepsis than were SLCs, limiting the use of a subclavian catheter to giving TPN only and strict adherence to a TPN protocol are necessary to minimize the risk of catheter sepsis.

Candidiasis↗
PubMed1985

Lipolymph nodes of the mesentery.

Although lipolymph nodes have previously involved only pelvic or retroperitoneal lymph nodes, two patients are presented with lipolymph nodes involving the intestinal mesentery. The definitive diagnoses were made by exploratory laparotomy and multiple biopsies of intrabdominal lymph nodes. Both patients with lipolymph nodes are obese, middle-aged, and female, which is the typical clinical presentation. The microscopic picture is distinctive. The lymph nodes are entirely replaced by adipose tissue and have a thin outer rim of nodal tissue. The patient with a diagnosis of lipolymph nodes of the mesentery or the pelvis and retroperitoneum should receive conservative surgical treatment. Since the disease appears to have a benign course, surgical extirpation of abnormal lymph nodes is not needed or warranted.

Adipose Tissue↗
PubMed1977

Shock lung with massive tracheal loss of plasma.

Fulminant pulmonary edema developed in two young, healthy adults within one hour after blood loss, hypolemic shock, and an anaphylactoid reaction to intravenous pyelogram dye. Pulmonary edema developed and they subsequently passed large amounts of edema fluid through the endotracheal tube. Massive loss of plasma-like fluid from the lung required frequent evacuation of the endotracheal tube and intravenous replacement with large amounts of albumin-containing fluids. Both patients were treated with a volume respirator, positive end-expiratory pressure, 100% oxygen, corticosteroids, and tracheostomy. Both patients recovered from massive pulmonary edema with very severe hypoxemia and, three months afterwards, had normal pulmonary function, blood gas levels, and no evidence of pulmonary injury.

Adolescent↗