Biomedical subjects

L F Sillin

Publications and source records attributed to L F Sillin.

10 recordsLinked to original sources

PubMed1992

Pancreatic complications following cardiopulmonary bypass. Factors influencing mortality.

Pancreatic complications following cardiopulmonary bypass are infrequent but are associated with high mortality. All cases of pancreatic complications following cardiopulmonary bypass from 1972 to 1987 at a single institution were retrospectively reviewed. Of 5621 patients who underwent cardiopulmonary bypass, 25 (0.44%) sustained pancreatic complications. There were 15 cases of acute pancreatitis and 10 cases of pancreatic necrosis, with 11 deaths in the group reviewed, a mortality rate of 44%. Factors that were correlated with mortality associated with pancreatic complications in this study include preoperative hypotension, preoperative use of inotropic agents, and renal failure (preoperative and postoperative). Factors that have been previously associated with mortality from pancreatic complications in other studies, such as fluid sequestration, respiratory failure, sepsis, tachycardia, hypocalcemia, age greater than 55 years, and abnormal laboratory findings, were not found to be significantly associated with mortality in this study. Of the five patients for whom complete data were available, not one patient received greater than 800 mg of calcium per square meter of body surface area in the perioperative period. While the exact mechanism of pancreatic injury remains unclear, based on experimental studies and clinical correlation, it is likely that pancreatic ischemia remains a significant contributing factor. We conclude that no factor specifically associated with cardiopulmonary bypass was correlated significantly with mortality.

Acute Disease↗

PubMed1991

Gastric emptying of solids after Roux-en-Y gastrectomy: is extragastric vagal innervation important?

Truncal vagotomy, antrectomy with Roux-en-Y gastrojejunostomy is frequently complicated by poor gastric emptying. The aim of this study was to determine whether the vagal denervation beyond the stomach (extragastric vagal denervation) contributes to this delay in gastric emptying. Three groups of six female mongrel dogs underwent antrectomy, Roux-en-Y gastrojejunostomy, and either truncal vagotomy, gastric vagotomy, or no vagotomy. After operation each dog underwent two separate radioisotope gastric-emptying studies with a small volume solid meal. The dogs were scanned by a gamma-camera continuously for 4 hours, and images of the gastric remnant were summed by computer every 6 minutes. Radioactivity in the gastric remnant region of interest was compared to overall activity and plotted as a function of time. The half-emptying times (X +/- SEM) for each group were truncal vagotomy 164 +/- 24 minutes, gastric vagotomy 79 +/- 23 minutes, and no vagotomy 117 +/- 10 minutes. Animals with a gastric vagotomy had a significantly faster rate of gastric emptying than did those with truncal vagotomy (p = 0.02, Scheffe's test). Therefore the extragastric vagal innervation appears to play a role in determining the rate of emptying of solids after antrectomy and Roux-en-Y gastrojejunostomy.

Anastomosis, Roux-en-Y↗

PubMed1989

Postprandial changes in intestinal slow-wave propagation reflect a decrease in cell coupling.

The purpose of these studies was to determine the effects of feeding on jejunal slow-wave propagation velocity (SWPV). Nine cats were instrumented with six pairs of electrodes implanted 4 cm apart on the jejunum. Electrical activity was recorded at the end of an 18-h fast after which each animal was fed 60 g of canned cat food. Recordings were continued during feeding and for several hours thereafter. This procedure was repeated at least twice for each cat. Average SWPV (cm/s) decreased from a fasting level of 2.28 +/- 0.20 (mean of means +/- SE) to 1.93 +/- 0.16 at 10-20 min, 1.51 +/- 0.11 at 1 h, and 1.37 +/- 0.10 at 3 h postprandially. Corresponding SW frequencies (SWFs) were 19.6 +/- 0.3, 18.7 +/- 0.2, 19.2 +/- 0.2, and 19.0 +/- 0.2 cycles/min, respectively. The differences between the fasting SWPV and that at 1 and 3 h were significant (P less than 0.05). When SWPV was plotted as a function of SWF, the slopes of the corresponding curves were also found to decrease postprandially (P less than 0.05, fasting vs. 1 and 3 h). There was no apparent change in SW amplitude, maximum rate of SW depolarization, or threshold. In the absence of changes in these parameters, the divergence of the slopes at lower SWFs indicates that the decrease in SWPV is because of increased internal resistance, probably the result of uncoupling of intestinal muscle cells. The change is rapid in onset and long in duration, suggesting that an uncoupling factor is released during ingestion of a meal, and that its effect persists for several hours.

Animals↗

PubMed1986

Changes in intercellular electrical coupling of smooth muscle accompanying atrophy and hypertrophy.

Longitudinal tissue impedance was determined for cat circular intestinal muscle that was either hypertrophied due to volume overloading or atrophied due to defunctionalization. These conditions were produced by bypassing 50 cm of jejuno-ileum in six cats and, 2-6 mo later, removing segments from the proximal jejunum of the hypertrophied functional gut and from the atrophied proximal end of the bypassed loop. Impedances were compared with those of jejunal circular muscle from 15 normal cats. Specific tissue impedance was determined by a modification of the method of Tomita (J. Physiol. Lond. 201: 145-159, 1969), which employs Krebs and Krebs-sucrose solutions; a tissue shrinkage of 5%, empirically found to occur in Krebs-sucrose solution, was corrected for. Impedance values were determined at 20 frequencies between 30 Hz and 30 kHz. The value at 30 kHz was taken to represent the specific myoplasmic resistance (Rmyo) of each tissue, while the difference between the value of 30 Hz and 30 kHz was taken to represent the specific junctional resistance (Rj). Values (in omega X cm) for Rmyo were control 134 +/- 2, functional 128 +/- 5, bypassed 151 +/- 6 (mean of means +/- SE). Corresponding values for Rj were control 173 +/- 15, functional 96 +/- 27, bypassed 340 +/- 75. Calculated values (in microF/cm) for junctional capacitance were control 2.66, functional 6.10, bypassed 1.97. Acid uncoupling by saturating the bathing solutions with 100% CO2 revealed a pH-sensitive resistive component of Rj, assumed to be attributable to gap junctions.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1985

Consequences of intraperitoneal bile: bile ascites versus bile peritonitis.

Recent experience with patients with bile ascites and bile peritonitis prompted a review of other case histories in the medical literature of these conditions. The clinical courses of 24 patients with bile ascites and 34 with bile peritonitis were reviewed. Bile ascites occurred most often as a postoperative complication of biliary tract operations and also occasionally after trauma. Clinical signs were minimal except for abdominal distention, and operations were delayed for an average of 30 days. Peritoneal fluid was sterile in the 11 patients studied. In contrast, bile peritonitis occurred most commonly after spontaneous perforation of the gallbladder or hepatic ducts but also after trauma. All patients had severe signs of peritoneal irritation, and operation was performed earlier, at a mean of 4 days after onset of symptoms. Of 11 patients with specimens of their peritoneal fluid cultured, 6 had sterile fluid and 5 had bacteria. Although both bile salt concentration and bacteria have been implicated in the development of bile peritonitis rather than bile ascites, our understanding of the mechanisms involved is still incomplete.

Adolescent↗

PubMed1985

Side-to-side and end-to-side anastomosis in partial gastrectomy and hemicolectomy using the EEA stapler.

We have described a new technique for side-to-side gastrojejunostomy as performed in Billroth II gastrectomy and for end-to-side ileocolostomy after right hemicolectomy utilizing the EEA stapler. By introducing the stapler through the area to be resected, we eliminated the need to close insertion enterostomies. This stapling technique also reduces the hazards and complications associated with multiple pursestring sutures normally required for end-to-end anastomosis with the EEA stapler, since, at most, one such suture is used. With minor modifications, the surgical technique can be applied to other operations in the alimentary tract, thus enhancing the utility of the EEA surgical stapler.

Colectomy↗

PubMed1979

Effective surgical therapy of esophagitis. Experience with Belsey, Hill, and Nissen operations.

During the years 1971 to 1978, 252 patients needed surgical treatment of primary or secondary esophagitis. Major operations performed were 73 Belsey Mark IV repairs, 55 Hill repairs, and 129 Nissen repairs. In the group with primary reflux, barium swallow tests and endoscopy were useful in confirming the diagnosis in patients with typical symptoms; routine biopsy, lower esophageal sphincter, manometry or an acid infusion test did not add to diagnostic certitude. If symptoms were atypical, a biopsy was helpful but manometry and acid infusion were not. Mean symptom scores in this group of patients were improved by each of the "valve-building" operations. Intraoperative dilation after mobilization of the esophagus coupled with a valve-building operation was successful in managing 26 of 29 strictures. Reoperation after an operation failed carried appreciable morbidity and mortality but resulted in good control of symptoms. Addition of a Belsey or Nissen procedure to myotomy for management of primary esophageal motility disorders diminished symptoms and did not cause disabling obstruction.

Collagen Diseases↗

PubMed1979

Electromotor feeding responses of primate ileum and colon.

Serosal bipolar electrodes to record spike discharges and strain gauge force transducers to record circular muscle contractions were placed in pairs on the terminal ileum, cecum, right colon at the ileocecal valve, ascending colon, and proximal transverse colon of sixteen primates. After an overnight fast, electromotor responses to continued fasting or to ingestion of a meal (randomized order) were recorded in awake animals. Feeding led to increased spike discharges and increased frequency of muscle contractions at all sites. The onset of these responses usually was within 6 minutes after feeding; the responses increased progressively during 30 to 45 minutes and then remained more or less at a constant plateau of increased activity. Atropine completely blocked the postcibal responses of ileum and proximal colon for up to 30 minutes. Transit time data of labeled meals excluded direct stimulation by a food bolus as the mechanism of the observed postcibal colonic response. The pattern of response was consistent with humoral mediation.

Animals↗

PubMed1978

A quarter Wheatstone bridge strain gage force transducer for recording gut motility.

Quarter and half Wheatstone bridge extraluminal force transducers for recording of gastrointestinal motility are compared. Modification of the transducer to a quarter bridge is economical, simplifies construction, and improves longevity by eliminating the crossover wire which frequently short circuits. The quarter bridge transducer was found to be as accurate and sensitive as the half bridge transducer.

Animals↗

PubMed1978

Postoperative ileus: a colonic problem?

Postoperative electromechanical activity of the gastric antrum, small bowel, right colon, and sigmoid colon was recorded in stumptail monkeys in response to retroperitoneal dissection and transient clamping of the renal pedicle. Bipolar silver electrodes and extraluminal bonded strain gauge transducers were used to record slow-wave and spike discharges and contractions of intestinal smooth muscle. After operation myoelectric activity was decreased transiently in the antrum and for only a few hours in the small bowel. Right colon contractile activity was decreased significantly for 24 hours and that of the sigmoid colon for 72 hours. Postoperative inhibition of bowel motility appears to be most profound and persistent in the colon.

Abdomen↗