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Biomedical subjects

N B Ackerman

Publications and source records attributed to N B Ackerman.

At least 73 records · Page 4Linked to original sources
PubMed1979

Poor prognosis of patients with intra-abdominal sepsis and hypouricemia.

With uric acid levels of 0.4 to 3.0 milligrams per cent, hypouricemia was noted in 17 patients with intra-abdominal sepsis. This was associated with a fivefold to sixteenfold increase in the urate clearance and uric acid to creatinine clearance ratios. The number of deaths in the 17 patients with hypouricemia is 14 versus 20 for the overall group of 111 patients studied. Two patients had a reversal of the serum uric acid, 24 hour urine uric acid output and uric acid to creatinine clearance ratio, with drainage of the intra-abdominal sepsis. Hypouricemia seems to indicate a poor prognosis in patients with intra-abdominal sepsis.

Abdomen↗
PubMed1979

Protein supplementation in the management of degenerating liver function after jejunoileal bypass.

Five patients who began to have signs of degenerating liver function develop after jejunoileal bypass were treated with protein supplementation, either on an outpatient or inpatient basis, making use of preparations orally and intravenously. Subjective as well as objective evidence of improving liver function was obtained, and all patients have survived. It is important to maintain a high protein intake postoperatively. The most useful tests for assessing the status of liver function in these patients have been serum albumin, serum bilirubin and prothrombin time.

Adult↗
PubMed1978

The significance of serratia as an infectious organism.

The hospital records of 48 patients with infections due to Serratia marcescens were reviewed. Isolates from these patients had been cultured during the period from August 1973 through July 1975, at which time an increase in frequency of infections due to Serratia had been noted. Most of these patients were elderly males with chronic debilitating diseases. All patients had received antimicrobial therapy prior to the time Serratia was first isolated. The majority had had indwelling urinary catheters inserted during some period of their hospitalization. Isolates were obtained predominantly from the urinary tract. In six of the 11 patients who died, Serratia appeared to play a role in the outcome, and all three patients with Serratia septicemia died. Serratia marcescens can be a virulent pathogen with a high degree of resistance to antibacterial agents. Attention must be given to the use of a sterile technique for insertion of urinary catheters, frequent care and cleansing of the catheter-meatal junction and use of a closed drainage system.

Adult↗
PubMed1978

Studies on the capillary permeability of experimental liver metastases.

By using a quantitative Evans blue technique, vascular permeability of Walker carcinosarcomas implanted in the liver was compared with that of the host liver tissue. Rats were sacrificed at intervals from one minute to 96 hours after the intravenous injection of the dye. Permeability activity curves were significantly different for tumors and normal liver. Permeability activity was lower in the tumor at one and five minutes, approximately the same in the tumor and liver from 15 minutes to one hour but, from two hours to 48 hours, the permeability activity was significantly higher in the tumor. The peak tumor-liver permeability activity ratio of 1.87 occurred at six hours, and the highest tumor permeability activity values were seen at 18 hours. Liver permeability activity, in contrast, increased gradually after dye injection, reading peak levels at 24 to 72 hours. At 96 hours, both tumor and liver permeability activity were lower and equal. The differences in permeability activity may be explainable on the basis of structural differences in normal and tumor vessels or may be due to chemical substances released as a result of the presence of the tumor. The differences in permeability activity of tumors and normal tissues may be an important factor in determining the effectiveness of diagnostic and therapeutic techniques.

Animals↗
PubMed1977

Primary arterial ligation in resection of cancer of the colon. Rational and technic.

The dynamics of arterial, venous, and lymphatic flow in the mesentery were studied in dogs, using an electromagnetic flowmeter for the blood and cannulation and gravimetric measurement for the lymph. Ligation of veins caused an increased venous outflow in adjacent veins and a marked increase in lymph flow. When marginal vessels were ligated, eliminating the major collateral flow, venous flow decreased, but elevated lymph flow persisted. Simultaneous ligation of arteries and veins resulted in increases of both arterial and venous flow in adjacent vessels. Lymph flow decreased unless excessive arterial collateral flow persisted. When collateral marginal vessel flow was occluded, adjacent venous and arterial blood flow decreased to control levels. With arterial ligation, collateral arterial blood flow increased slightly, but venous and lymph flow decreased sharply. When collateral marginal vessels were eliminated, adjacent arterial blood flow decreased to control levels and venous flow virtually stopped. As a result of these studies, the technic of early primary arterial ligation followed by marginal vessel ligation appears to be the most satisfactory procedure for decreasing venous and lymphatic outflow and hopefully avoiding dissemination of cancer cells during the operation. This technic is now being used as a modification of the "no touch" technic for cancer of the colon.

Animals↗
PubMed1976

Hyperparathyroidism with coexisting hyperthyroidism.

Diagnosis of parathyroid disease in patients with hyperthyroidism may be difficult on clinical findings alone. Radiologic examination of the bones suggested the possibility of parathyroid disease in this patient. Confirmation of the diagnosis was made when serum calcium levels remained elevated in spite of adequate antithyroid medication. Measurement of serum parathyroid hormone levels may prove to be of greatest value. Of additional interest is the fact that the patient, before her symptoms became apparent, delivered an infant with congenital hypoparathyroidism.

Adult↗
PubMed1976

Problems in differentiating between pancreatic lymphoma and anaplastic carcinoma and their management.

A group of 6 patients with malignancies involving the pancreas is presented, with a range of diagnosis from primary reticulum cell sarcoma to probable anaplastic carcinoma. Even with adequate biopsy and autopsy material, it may be difficult to provide a definitive tissue diagnosis in these patients. Although this entire spectrum of tumors is uncommon, it is important to try to establish a diagnosis whenever possible. Biopsy of the tumor should be performed, even from the pancreas itself, if necessary, particularly when the initial presentation of the disease is unusual or if the pattern of metastasis is different from that usually seen with carcinoma of the pancreas. It is suggested that a therapeutic trial of appropriate radiotherapy and chemotherapy be instituted in patients of this type even if a diagnosis of lymphoma is not firmly established. The possibility exists of survival of some of these patients for periods of one year or more as a result of successive therapy.

Adult↗
PubMed1976

Massive hemorrhage from ileostomy and colostomy stomas due to mucocutaneous varices in patients with coexisting cirrhosis.

Enterostomal varices have been recognized as a cause of serious recurrent hemorrhage in patients with portal hypertension secondary to cirrhosis. Most often the varices at the mucocutaneous junction are the source of the hemorrhage. Three patients--two with hemorrhages from ileostomies and one with hemorrhages from a colostomy--are presented. Local measures have proved successful in controlling hemorrhages. Occasionally direct pressure alone will prove sufficient; more often the bleeding varix will need ligation. Complete revision of the enterostomy under local anesthesia can effect total disruption of the protal-systemic shunt and temporarily can eliminate local hemorrhage. Surgically created portasystemic shunts may be considered in good risk patients in order to eliminate hemorrhage from the stomal varices. Palliative local measures, however, remain the treatment of choice in the high-risk, cirrhotic patient who is unlikely to survive a major operation.

Colostomy↗
PubMed1976

The technique of primary arterial ligation for cancer of the colon as suggested by venous and lymphatic outflow studies.

Because veins and lymphatics constitute the major pathways for metastatic spread of cancer of the colon, the dynamics of venous and lymphatic outflow from the intestine were studied in dogs with use of electromagnetic flowmeter for the veins and cannulation and gravimetric measurement for the lymph. Venour ligation produced sixfold increases in lymph flow. Venous outflow doubled when adjacent veins were occluded but dropped when marginal vessels were ligated. Simultaneous ligation of arteries and veins caused significant decreases in lymph outflow (to 26% of control), but if arterial collaterals remained intact, lymph flow rose more than twofold. Venous outflow doubled after simultaneous occulusion of adjacent arteries and veins, but dropped as marginal vessels were ligated. Arterial ligation alone was most satisfactory, resulting in significant rapid decreases in lymph flow (to 32% of control) and venous flow (to 5% of control. As suggested by these studies, primary arterial ligation, followed by marginal vessel ligation, is being used as a modification of the "no touch" technique for cancer of the colon.

Animals↗
PubMed1976

Diagnosis and management of colovesical fistulas.

Diagnosis and management may present difficult problems in patients with colovesical fistulas. Symptoms in the urinary tract are most common, and cystoscopy, and cystography are the most valuable diagnostic procedures. It may not always be possible to demonstrate the fistula by diagnostic tests, and a high index of suspicion should be maintained in patients with inflammatory or neoplastic disease of the rectosigmoid area or bladder with recurrent cystitis. Definitive treatment should include resection of the fistula and diseased segment of the intestine. Both one stage and multistage procedures have their place in the treatment of this condition. There are specific criteria for success for a one stage procedure.

Adolescent↗
PubMed1975

The differentiation of primary hyperparathyroidism from the hypercalcemia of malignancy.

The presence of hypercalcemia in patients with known cancers may be due to the cancers themselves, or to co-existing primary hyperparathyroidism. The differentiation of primary hyperparathyroidism from the hypercalcemia of malignancy is important since the relief of distressing symptoms and prevention of hypercalcemic crises and renal failure can be accomplished relatively easily by parathyroid surgery in the former condition, and only with difficulty, at times, with fluids and drugs in the latter condition. The histories of three recent patients are presented, which demonstrate the difficulties inherent in the differentiation of these conditions. These patients were ultimately found at operation to have primary hyperparathyroidism in addition to malignancies of the cervix, adrenal gland and kidney. In our experience the following have been helpful in establishing a diagnosis; history of hypercalcemia prior to development of cancer, the type of cancer itself, the effect of cancer therapy on the hypercalcemia, and selective venous sampling with radioimmunoassay for parathyroid hormone.

Adrenal Gland Neoplasms↗
PubMed1975

The influences of changes in temperature on intestinal lymph flow and relationship to operations for carcinoma of the intestine.

The effect of cooling, freezing and warming temperatures on the flow of lymph from the intestines was studied in dogs. When intestinal temperatures were dropped to an average of approximately 40 degrees F., an immediate decrease in lymph flow occurred to a mean value 33 per cent of control levels. With rewarming, lymph flow increased rapidly, rebounding to a level almost twice as great as that in controls. When the intestines were subjected to hypothermia to the point of freezing, lymph flow decreased immediately with flow rates dropping to only 6.6 per cent of control levels. Techniques for achieving freezing in these studies were inefficient, and uniform freezing was not always obtained. Again, with rewarming there was an immediate rise in lymph flow to levels significantly above those in controls. In hyperthermic studies to temperatures of 103 degrees F., a biphasic reaction was noted with an initial increase in lymph flow averaging 71 per cent higher than that in controls followed rapidly by a drop in lymph flow significantly below control levels. These experiments demonstrate that hypothermia, particularly below freezing temperatures, may rapidly decrease and virtually stop lymph flow from an intestinal segment. This suggests that hypothermia might be useful as an adjunctive measure in the operative management of patients with carcinomas of the gastrointestinal tract.

Animals↗
PubMed1975

Symptomatic lipomas of the gastrointestinal tract.

Eleven patients with symptomatic lipomas of the gastrointestinal tract have been observed. The lipomas generally are relatively large, and the signs and symptoms consist mainly of abdominal pain and chronic blood loss. These lesions most commonly are seen in the colon and in the region of the ileocecal valve and less commonly in the small intestine, stomach and esophagus. Distinguishing thest tumors from carcinomas or sarcomas may be difficult, and patients are generally in the same age range as those with cancer. Roentgenologic contrast studies are helphful in localizing the tumors, but accurate tissue diagnosis usually is not made until the lesions are excised. Operative management by either local excision or segmental resection is required, and the prognosis is excellent.

Adult↗
PubMed1975

The importance of candida as an infectious agent.

During the two and a half year period from January 1971 through Jyly 1973, 23 patients had cultures positive for candida from intra-abdominal isolates. Most of these patients had intestinal or biliary fistulas or abscesses and were seriously ill. Major contributing factors to the development of candidal infections included the extensive use of multiple antibiotics, multiple operations, advanced age, and debility. Thirty additional patients had cultures positive for candida from skin and subcutaneous isolates. Candida appeared to contribute to the poor healing of wounds in some of these patients, particularly those with peripheral vascular ischemic lesions and decubitus ulcers. Antibiotics and concurrent diseases, such as diabetes, cancer, renal failure, and cardiovascular disease, were common factors relating to the development and growth of candida in these patients. There is often considerable difficulty in determing whether or not candida is only a contaminant or is an infectious agent contributing to the illness of the patient. This must be determined in each individual instance. In spite of the fact that candida appeared to be a significant infectious agent in many of these patients, specific antifungal therapy was used sparsely. It is suggested that appropriate antifungal drugs be used in patients with significant disease and that there should be greater awareness of the factors leading to the development of these extremely serious candidal infections.

Adult↗