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Biomedical subjects

L J Auguste

Publications and source records attributed to L J Auguste.

29 records · Page 2Linked to original sources
PubMed1985

Totally implantable indwelling catheter system--alternative techniques of insertion.

Totally implantable indwelling venous catheter systems represent a major advantage for patients requiring frequent or prolonged venous accesses. These catheters are usually inserted via the cephalic vein. When this approach is not feasible, alternative venous sites include the subscapular vein, the external jugular vein, the subclavian vein by direct puncture, the internal jugular vein by direct puncture and the saphenous vein. These techniques are herein reported to help the surgeon faced in the operating room with a difficult venous catheter placement.

Catheters, Indwelling↗
PubMed1985

Effect of operative devascularization on estrogen and progesterone receptor levels in breast cancer specimens.

To compare estrogen and progesterone receptor values between biopsy and mastectomy specimens, we prospectively studied 29 patients with breast cancer treated by incisional biopsy followed by mastectomy. The average tumor size was 5.4 +/- 0.5 cm and the mean age was 57.6 +/- 3.0 years. Nine patients were premenopausal and 20 were postmenopausal. Biopsies were performed without electrocautery, and tissue samples were promptly frozen and subsequently assayed for estrogen and progesterone receptor levels. After mastectomy, samples of residual tumor were excised from the biopsy site, promptly frozen, and assayed for estrogen and progesterone receptor levels. Operating time averaged 87.7 +/- 6.0 minutes. Estrogen receptor levels averaged 100.0 +/- 24.4 femtomole per mg on biopsy specimens and 29.5 +/- 8.2 fmol/mg on mastectomy specimens, representing a 70% decline (p less than 0.02). Of clinical significance is the fact that eight of 29 (27.6%) tumors changed from positive estrogen receptor values in the biopsy specimen to negative (four) and borderline (four) in the mastectomy specimens. Progesterone receptor levels were more variable, but their mean value decreased by 24.4% from 17.6 +/- 6.4 fmol/mg on biopsy samples to 13.3 +/- 4.3 fmol/mg on mastectomy samples (p, not significant). We conclude that the biopsy specimen is usually a more reliable indicator of hormonal receptor status than the mastectomy specimen and recommend that incisional or excisional biopsy specimens be taken for estrogen and progesterone receptor assays before mastectomy.

Adult↗
PubMed1981

Surgical management of perforated diverticulitis.

The surgical management of perforated diverticulitis remains a subject of controversy, with some workers advocating initial drainage with decompressive colostomy and others favoring primary resection of the perforated colon. To evaluate this problem, we reviewed our experience from January 1, 1960 through December 31, 1978. This retrospective study included 25 patients treated by primary resection and 32 patients treated by staged resection. The duration of postoperative fever and ileus and the incidence and type of postoperative complications were similar in the two groups. Hospital stay and the period of disability were significantly shortened when primary resection with primary anastomosis was carried out initially. Overall, the total cumulative hospital stay was long (p < 0.05) for staged resection (48 days) than for primary resection (39 days). The period of disability was also longer (p < 0.001) for staged (134 days) than for primary resection (75 days). Finally, all patients in the primary resection group left the hospital cured, that is, restored to their premorbid condition, while in the staged resection group only 75 percent were cured; 16 percent were finally discharged with colostomies and 9 percent died. These data suggest that whenever technically feasible, primary resection is the treatment of choice for perforated colonic diverticulitis.

Adult↗
PubMed1980

The effects of Escherichia coli bacteremia on in vitro perfused kidneys.

The renal response to sepsis results in increased renal blood flow, decreased renal vascular resistance, polyuric renal failure and a change in intracortical renal blood distribution. Prior reports used whole animal preparations, where the effects of sepsis on other organs may have led to systemic vasoactive changes altering the experimental model. To elucidate the direct effect of gram negative bacteremia on the kidney, intracortical hemodynamics and urinary flow were investigated using isolated canine kidneys perfused with a nonpulsatile pump oxygenator primed with modified dog plasma. Bacteremia was produced by 2.5 x 10(11) live Escherichia coli organisms infused directly into the perfusate. Intracortical blood flow distribution was measured by radioactive microsphere trapping using 15 microns diameter plastic radioactive microspheres. Urine flow increased 157% (p less than 0.05) following E. coli bacteremia while intracortical blood distribution was unchanged. The polyuric renal failure of sepsis is therefore, a direct result of bacteremia and not secondary to a change in intracortical flow as previously reported. The changes in intracortical blood distribution reported previously in sepsis using intact animal models probably reflect the renal response to release of vasoactive compounds originating in other organs rather than an intrinsic renal reaction to bacteremia.

Animals↗
PubMedDate not supplied

Radiation and thyroid carcinoma: radiotherapy, head and neck regions, thyroid carcinoma.

Radiotherapy for benign conditions of the head and neck area was first linked to thyroid carcinoma in 1950. All the salivary glands, the parathyroids, and the facial skin can also develop neoplastic lesions in this setting. Thyroid carcinoma is most commonly papillary or mixed papillary and follicular. It is very often multifocal and can be detected by hand palpation, nuclear scanning, high resolution sonography, and needle aspiration. Each test has its limitations and appropriate protocols for screening and detection should be adapted to different medical centers. The surgical management is controversial and ranges from simple lobectomy to total thyroidectomy with adjuvant 131I treatment and thyroid suppression. We prefer total thyroidectomy if it can be performed safely. With adequate treatment the survival should be good. Prevention by administration of iodine at the time of exposure to radiation seems feasible and deserves further clinical trial.

Adenocarcinoma↗
PubMedDate not supplied

Morbidity of completion thyroidectomy for initially misdiagnosed thyroid carcinoma.

We reviewed 757 cases of thyroid carcinoma treated between 1963 and 1986 to investigate the morbidity associated with completion thyroidectomy when a nodule initially reported to be benign by frozen section is subsequently found to be malignant; 66 patients underwent completion thyroidectomy as a second procedure for initially misdiagnosed thyroid carcinoma. Fifty-one patients had papillary carcinoma, 12 follicular carcinoma, and 3 Hürthle cell carcinoma. Final pathology revealed 28 cases of multicentricity of which 19 were bilateral. Complications included transient hypocalcemia (12.1%), recurrent laryngeal nerve palsy (1.5%), and wound hematomas or infections (9.1%). No cases of permanent hypoparathyroidism or vocal cord paralysis were encountered. Reoperation for initially misdiagnosed thyroid carcinoma appears to be warranted in light of the low morbidity and high incidence of bilateral and multicentric disease reported in this series.

Carcinoma↗
PubMedDate not supplied

Prevention of stress-induced erosive gastritis by parenteral administration of arachidonic acid.

Stress-induced mucosal ulcerations are associated with a decreased synthesis of mucosal prostaglandin (PG) E2. This phenomenon is poorly understood. To investigate whether it is due to a decreased availability of the necessary substrates to the mucosa, four groups of 10 Holtzman rats were studied: group 1 received normal saline by intraperitoneal (ip) injection; group 2 also received ip normal saline, then were submitted to stress, by the cold restraint method; group 3 received a solution of arachidonic acid (AA) ip; and group 4 also received ip AA, then were submitted to stress. After sacrifice, the number of gastric ulcerations were counted and specimens of nonulcerated mucosa were assayed for PGE2 by high-performance liquid chromatography; the mean numbers of ulcers were 0, 5.8, 0.8, and 3 and the mean levels of PGE2 were 55, 41, 125, and 62 pg/mg of wet tissue for groups 1, 2, 3, and 4, respectively. It is concluded that parenteral administration of AA reduces but does not completely eliminate stress-induced gastric ulcerations and that the stressed animals synthesized half as much PGE2 as the nonstressed ones after ip administration of equal amounts of AA, suggesting that stress reduces the availability of AA to the gastric mucosa, possibly by vascular spasm.

Animals↗