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Biomedical subjects

M H Metzler

Publications and source records attributed to M H Metzler.

10 recordsLinked to original sources
PubMed1992

Squamous cell carcinoma of the pancreas. Report of an unusual case and review of the literature.

Squamous cell carcinoma is an uncommon form of cancer of the pancreas, comprising 0.5-3.5% of cases. We report an unusual case that occurred in a very young woman and showed cystic characteristics. Interesting radiographic features included extensive pancreatic calcifications and pancreatic duct communication to the mass. A literature review of this rare form of pancreatic cancer is also provided.

Adult↗
PubMed1992

Computed tomographic evaluation to exclude traumatic aortic disruption.

Traumatic aortic disruption from blunt trauma remains a lethal injury. The role of computed tomographic (CT) scanning in the diagnosis of traumatic aortic disruption (TAD) has been debated and varying results have been reported. We reviewed our experience with 133 consecutive cases of blunt trauma with abnormal findings on chest x-ray films of sufficient concern to require further evaluation for TAD. Of the 105 patients who underwent CT scanning as the initial evaluation, 11 (10%) required aortography (Ao) for diagnosis; seven had TAD. Twenty-eight patients with highly suggestive signs of TAD underwent Ao as the initial diagnostic test; five had TAD. Ten of the 12 patients (83%) undergoing surgical repair had good results; one died of exsanguination at surgery and the other suffered a profound neurologic injury. Follow-up by phone or chart review at 6 months to more than 5 years after injury revealed no late mortalities from unrecognized TAD. We conclude that high quality CT evaluation of patients with worrisome chest x-ray films following blunt trauma can be used to exclude TAD in the majority of cases. Aortography is reserved for cases in which there is a high clinical suspicion of TAD and for those patients in whom TAD cannot be confidently excluded by CT scanning.

Aortic Rupture↗
PubMed1991

Endoscopic management of retained cystic duct stones.

The finding of residual common bile duct stones after cholecystectomy is a relatively frequently encountered problem for which effective nonoperative therapy exists. Retained stones in a cystic duct remnant are very rare. We present a case of multiple retained stones in a long variant cystic duct remnant following cholecystectomy and common duct exploration, which was successfully managed with endoscopic sphincterotomy and balloon extraction.

Adult↗
PubMed1988

Trauma associated with three and four-wheeled all-terrain vehicles.

Death or serious injury may occur as the result of accidents involving three- and four-wheeled recreational vehicles. Thirty-two cases of such trauma requiring hospitalization at the University of Missouri Hospital were reviewed, and followup questionnaires sent to each patient. Head and extremity trauma was nine times as frequent as torso injuries. Males were injured in 81% of the cases, and the average age of all patients was 18.6 years. Fifty per cent required intensive-care monitoring and 74% required surgery. Two patients died of head injuries. Of the 25 survivors who responded to the questionnaires, 44% reported either inability to return to work or substantial interference with daily living due to their injuries. Inexperience riding the vehicle, prior use of alcohol, and lack of protective riding apparel were frequently cited as contributing factors in these injuries.

Adolescent↗
PubMed1988

Rewarming from experimental hypothermia: comparison of heated aerosol inhalation, peritoneal lavage, and pleural lavage.

This study compares the thermal transfer and rewarming characteristics of heated aerosol inhalation (HAI) alone and combined with peritoneal lavage (PEL) or pleural lavage (PLL). Closed-system PEL and PLL are equally efficient at rewarming hypothermic dogs and do so at a rate approximating 6 degrees C/h/m2. Cardiovascular responses to PEL and PLL were similar. Serum electrolytes, protein, Hct, and arterial blood gases were comparable and little changed when compared in prehypothermia and postrewarming periods. HAI alone provides little heat for rewarming; more heat is realized from endogenous metabolism. Nevertheless, HAI's ease of use and possible selective cardiac rewarming characteristics argue for its inclusion with other methods of active rewarming. The use of PEL or PLL is governed by clinical circumstances.

Aerosols↗
PubMed1986

Intraabdominal pressures during natural activities in patients treated with continuous ambulatory peritoneal dialysis.

Intraabdominal pressures were measured during natural activities in 6 men, age 24-62 years, treated with continuous ambulatory peritoneal dialysis. The pressures were measured with a pressure transducer secured at the level of the umbilicus in the supine, sitting, and upright positions with 0-3 liters intraperitoneal fluid during talking, coughing, straining, changing position, walking, jogging, exercycling, jumping and weight lifting. Coughing and straining generated the highest intraabdominal pressures in every position. The pressures with weight lifting were proportional to the magnitude of the weight lifted up to 50 lbs, but were lower than those during coughing and straining. The pressures were generally higher with greater intraabdominal fluid volumes, especially with jumping and coughing. Exercycling was associated with lower intraabdominal pressure than was jogging, and the pressures were only minimally influenced by intraperitoneal fluid volumes. The results of this study can be used as a guide in establishing preventive measures in patients with intraperitoneal fluid to decrease complication rates related to raised intraabdominal pressures such as dialysate leaks, hernias and hemorrhoids.

Abdomen↗
PubMed1985

The liver is an organ site for the release of inosine metabolized by non-glycolytic pig red cells.

The metabolic energy source used by the pig red cell, which is unable to metabolize blood-borne glucose, was examined. Potential physiological substrates include adenosine, inosine, ribose, deoxyribose, dihydroxyacetone and glyceraldehyde, of which inosine was previously implicated. A net ATP synthesis by red cells occurs during in situ perfusion through the adult miniature pig liver. HPLC analysis of the perfusate revealed the presence primarily of inosine and hypoxanthine. Inosine production by the liver was 0.015 mumol/g per min. Moreover, red cells maintain ATP when suspended in a balanced salt medium during a 6 h incubation at 38 degrees C, in which inosine is continuously infused to give an external concentration of no more than 3 mumol/l, mimicking its plasma level. Inosine consumption under these infusion conditions was 56 nmol/ml cell per h, which is two orders of magnitude lower than when inosine is present in millimolar concentration. The total red cell inosine consumption of 9.63 mumol/h is much less than the total liver inosine production of 212 mumol/h. These findings suggest that the liver is an organ site elaborating inosine, and that maintenance of a 3 mumol/l inosine in plasma is sufficient to meet the energy requirements of the pig red cells.

Adenosine Triphosphate↗
PubMed1979

Bone formation by revascularized periosteal and bone grafts, compared with traditional bone grafts.

Three groups of dogs were studied to compare the bone formation obtained with traditional bone grafting techniques, and that obtained with revascularized periosteum or revascularized bone grafts--all in unstressed bone. Revascularized periosteum did not produce a significant amount of bone in this unstressed model. At 4 months the revascularized rib grafts had a slightly greater tolerance to stress at the callus site than traditional bone grafts, but the incidence of non-union was the same. We conclude that the use of revascularized bone grafts should be reserved for situations in which traditional bone grafting techniques are unlikely to be successful.

Animals↗