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Biomedical subjects

N M Matolo

Publications and source records attributed to N M Matolo.

At least 37 records · Page 2Linked to original sources
PubMed1978

Catabolism and protein binding of Tc-99m pyridoxylideneglutamate.

Various Tc-99m-labeled compounds have been suggested as replacements for [I-131] rose bengal for imaging of the hepatobiliary system. Among such compounds are Schiff's bases, which are tin-free Tc-chelates easily prepared by 30-min autoclaving of an equimolar mixture of pyridoxal and an amino acid at pH 8.5. We have compared the properties of several Schiff's bases, including Tc-99m pyridoxylideneglutamate (Tc PyG) with [I-131] rose bengal. Under conditions described, Tc-PyG can be prepared free of Tc-pyridoxal and with less than 2% TcO4- radiochemical impurity. Blood clearance and biliary excretion were studied in three animal models, and in normal human volunteers. In all animal models, Tc-PyG initially cleared from the blood more rapidly than rose bengal, but a significant amount of Tc-PyG was excreted in the urine, this in contrast to [I-131] rose bengal which was almost completely excreted through the biliary system. Species differences were observed in the degree of urinary versus biliary clearance of Tc-PyG, with significantly greater urinary excretion in dogs than in monkeys and rabbits. Replacing glutamate with other amino acids did not significantly increase the blood clearance rate or decrease urinary excretion, so that Tc-PyG appears to be at least as good as any of the others studied. Tc-PyG was only 20% bound to plasma proteins, and electrophoretic and chromatographic studies did not reveal any in vivo changes of Tc-PyG before excretion in urine or bile.

Animals↗
PubMed1977

Hepatobiliary scanning using 99mTc-pyridoxylideneglutamate.

Technetium 99m-pyridoxylideneglutamate (99mTc-PG) administered intravenously is excreted by hepatocytes into the bile canaliculi and enters the gallbladder through the cystic duct and consequently, can be used for scanning the hepatobiliary ductal system. A total of 166 patients representing 27 normal subjects, 84 patients referred for investigation for pain in the upper right quadrant of the abdomen and 55 jaundiced patients were evaluated with 99mTc-PG. In normal human volunteers, the agent reached the liver in five minutes, and the common bile duct, gallbladder, and duodenum within 15 minutes. Satisfactory images of the hepatobiliary tract were obtained using small dosages of 99mTc-PG. The gallbladder was not visualized when the cystic duct was occluded. In the presence of acute cholecystitis, cystic duct obstruction, or in chronic cholecystitis where other roentgenographic studies showd a nonfunctioning gallbladder, there was no concentration of 99mTc-PG in the gallbladder. In partial common bile duct obstruction is distended common bile duct was visualized along with delay in transit of radioactivity into the duodenum. Complete common bile duct obstruction was associatedwith no radioactivity in either the biliary or the gastrointestinal tracts up to 24 hours after injection. Hepatocellular disease was characterized by delayed liver clearance and delayed visualization of biliary and gastrointestinal tracts. 99mTc-PG scanning proved capable of differentiating between hepatocellular disease and extrahepatic biliary tract obstruction.

Biliary Tract Diseases↗
PubMed1977

Complications following operation in the previously irradiated abdominopelvic cavity.

Twenty-three patients underwent 32 operations in a previously irradiated abdominopelvic cavity. The overall postoperative morbidity rate was 62% and the mortality rate was 6.2%. The data from this series do not support small bowel bypass as the only acceptable method of management of surgical radiation enteritis. Wide resection with primary anastomosis reduces the long-term morbidity of the "blind-loop syndrome", perforation and fistulization of the isolated loop, and does not have an increased mortality.

Abdomen↗
PubMed1977

Replacement of the peritoneum with amnion following pelvic exenteration.

An analysis was made of 24 patients undergoing pelvic exenteration. By chance, the patients are divided into two groups, 12 having the pelvic floor treated by the traditional means and 12 in whom amniotic membranes have been used. A statistically significant shortening of the hospital stay was experienced by those in the amnion group with a total lack of intestinal complications being related to the raw surface of the pelvis. A large number of recurrent or de novo carcinomas of the vagina following carcinoma of the cervix treated with radiation are identified. Two deaths in this series were related to complications of the small intestine.

Aged↗
PubMed1976

Experimental evaluation of primary repair of colonic injuries.

To evaluate the management of colonic injuries, experimental models simulating acute injuries of the colon were studied utilizing New Zealand white rabbits. Seventy-nine rabbits underwent primary repair of colonic injuries in the presence of massive contamination and none showed any evidence of anastomotic leakage or breakdown. The fact that primary colonic repairs do heal even in the presence of infection suggests that breakdown of colonic anastomosis results from factors other than infection. Despite the absence of anastomotic leaks in this series, morbidity and mortality were high in those animals not given antibiotics. The high morbidity and mortality were due to peritonitis, intra-abdominal abscess, and wound infection, and were directly proportional to the length of time from colonic injury to repair. On the basis of this study, it is concluded that most isolated injuries of the colon can be closed primarily, if antibiotic therapy is begun immediately after injury and continued throughout the operative and postoperative periods.

Abscess↗
PubMed1976

Reversed ileal segment for treatment of ileostomy dysfunction. Clinical application.

Persistent, profuse ileostomy diarrhea developed gradually in a patient over a 12-hour period after proctocolectomy for ulcerative colitis. There was no evidence of ileostomy stenosis or dilation of the ileum proximal to the stoma. He was successfully treated with a reverse ileal segment of 10 cm, and gained 14 to 18 kg. ileostomy output became semisolid and decreased from 1,000 to 2,000 ml/day to 600 ml/day. The transit time changed from 12 minutes to 2 1/2 hours. Antiperistaltic segments of intestine prolong transit time and allow for greater absorption. While most patients with ileostomies are not troubled by severe diarrhea, the small proportion who are may be candidates for a reversed ileal segment.

Adult↗
PubMed1976

Antiperistaltic bowel segment for prevention of ileoproctostomy diarrhea.

Persistent diarrhea accompanied by water, electrolyte, and nutritional depletion and skin excoriation can occur following subtotal colectomy with ileoproctostomy. Attempting to improve the course of these patients, an experimental study using dogs was undertaken to evaluate the use of antiperistaltic ileal segment in the management of ileoproctostomy diarrhea. Subtotal colectomy with ileoproctostomy was performed in dogs. One animal died from weight loss and massive diarrhea with water and electrolyte depletion. The surviving dogs had water and electrolyte imbalance and lost an average of 30.6% of their body weight. A second group of animals was treated identically except that an antiperistaltic ileal segment was placed one foot proximal to ileorectal anastomosis. These dogs maintained their weight and electrolyte and water balance. The stools of these animals became solid, as opposed to the watery diarrhea of the animals with ileoproctostomy only. Ileoproctostomy diarrhea can be successfully controlled by the use of antiperistaltic ileal segment.

Animals↗
PubMed1976

Clinical evaluation of 99mTc-pyridoxylideneglutamate for hepatobiliary scanning.

Clinical evaluation of hepatobiliary scanning using 99mTc-PG was done in twenty normal volunteers and eighty-three patients with liver and biliary tract disease. Satisfactory images of the biliary tract were obtained using small dosages of this agent. In normal humans, the agent reached the liver in 5 minutes, and the common bile duct, gallbladder, and duodenum in 10 to 20 minutes. The gallbladder was not visualized when the cystic duct was obstructed in patients with acute and chronic cholecystitis. In patients with partial common bile duct obstruction, a distended duct was visualized and there was delay in transit of radioactivity into the duodenum. With complete common bile duct obstruction, no radioactivity was seen in the biliary or gastrointestinal tracts up to 24 hours after injection. Hepatocellular disease was characterized by delayed liver clearance and delayed visualization of the biliary and gastrointestinal tracts. There were no toxic or other untoward effects in any patients.

Biliary Tract Diseases↗
PubMed1976

Intestinal necrosis and perforation in patients receiving immunosuppressive drugs.

Immunosuppressive agents are frequently used in transplant recipients for prevention of homograft rejection and in patients with leukemia for treatment of their primary disease. From 1973 to 1975, fifty-nine patients undergoing renal transplantation and forty-one patients with leukemia were treated at the University of California (Davis) Medical Center. Intestinal necrosis and perforation developed in four (7 per cent) of those receiving transplants and in four (10 per cent) of the patients with leukemia. One transplant receipient and all four patients with leukemia had extensive necrosis of both the small and large intestines. Two transplant recipients had isolated sigmoid perforations, and one had splenic flexure colonic perforation. All died from septicemia with septic shock. The etiology of these intestinal complication appears related to immunosuppressive agents, particularly high dosages of steroids. Despite the grave prognosis, early surgical intervention is the only method of dealing with these complications. Early diagnosis as well as properly timed and selected operations are necessary for the successful management of these patients.

Adult↗
PubMed1976

Use of an arteriovenous fistula for treatment of the severely ischemic extremity: experimental evaluation.

Experiments were performed on obligatory bipeds to study the effects of an arteriovenous fistula on a devascularized ischemic limb. Retrograde flow of arterial blood entering the venous system by way of an arteriovenous fistula was demonstrated. Venous valves appeared not to interfere with retrograde arterial flow. The data from these experiments indicate that a "Y" type arteriovenous fistula can lead to functional revascularization in the ischemic limb with arterial obstruction. The dual mechanism of retrograde arterial flow in venous channels and the stimulation of collateral flow adjacent to the fistula seemed to be critical factors. Since a peripheral arteriovenous fistula is a potent stimulus to arterial collateralization in the extremity, its application is worthy of consideration in certain selected patients with advanced and otherwise inoperable arterial occlusive disease.

Animals↗
PubMed1976

Technetium-99m pyridoxylideneglutamate (P.G.) cholescintigraphy.

Technetium-99m P.G. cholescintigraphy was performed in 27 human volunteers and 81 patients referred for hepatobiliary tract disease. The gallbladder, biliary system, and gastrointestinal tract were well visualized in the normal patients and volunteers. The gallbladder was not visualized in 22 patients with histologically proved cholecystitis with cystic duct obstruction. Nine patients with complet extrahepatic obstruction of the common bile duct were correctly diagnosed. Hepatocellular disease and incomplete obstruction, with and without jaundice, were diagnosed with this technique. Oral cholecystography is superior to this method for the detection of cholelithiasis in nonjaundiced patients.

Biliary Tract Diseases↗
PubMed1976

Effects of antibiotics on prevention of infection in contaminated abdominal operations.

A prospective study was undertaken on 102 patients with massice intraperitoneal contamination from traumatic or spontaneous perforation of intestinal or pancreaticobiliary tract to determine the effects of combined systemic and intraperitoneal antibiotic administration on the prevention of the postoperative sepsis, intra-abdominal abscess formation and wound infection. Large doses of gentamicin and clindamycin were given parenterally before, during, and after the operation for five days. In addition, the peritoneal cavity and the abdominal incision were irrigated intraoperatively with antibiotic solution containing the same antibiotics. The drugs were given so as to provide a potent level of antibiotics during the operation and in the immediate postoperative period. The postoperative wound infection rate was 4 per cent, intra-abdominal abscess 2.9 per cent, sepsis 1 per cent, resulting in a total infectious complication rate of 7.9 per cent. This is a marked reduction in the incidence of infectious complications and compares favorably with the results from either parenteral or intraperitoneal therapy alone. Furthermore, no complications were encountered due to this method of therapy. These results do not indicate that antimicrobial drugs be given prophylactically to all surgical patients, but they strongly suggest the advantages of combined systemic and intraperitoneal antibiotics in the management of patients with massive intraperitoneal contamination.

Abdomen↗
PubMed1976

Gastric necrosis from blunt abdominal trauma.

Two patients with ischemic necrosis of a portion of the gastric wall resulting from blunt abdominal trauma are reported. This gastric injury results from avulsion of the mesentery from the injured area or from a shearing force. Careful inspection of the stomach during exploration is emphasized and gastrotomy advocated if injury is suspected. Treatment consists of resection of the ischemic portion of the stomach.

Abdomen↗
PubMed1975

Antiperistaltic ileal segment in the prevention of ileostomy diarrhea.

Diarrhea, often profuse, accompanied by skin excoriation and nutritional and electrolyte depletion is a major complication of ileostomy. In an attempt to improve the course of these patients, an experimental study using dogs was undertaken to investigate an antiperistaltic ileal segment for the prevention of ileostomy diarrhea. Ileostomies were created in dogs. All the dogs with ileostomies died within nine days of weight loss and massive electrolyte and water depletion. A second group of animals underwent creation of an ileostomy simultaneously, with an antiperistaltic ileal segment placed 30.5 cm proximal to the ileostomy. These dogs maintained their weight and electrolyte and water balance. The stools in the group with the reversed ileal segment became semisolid to solid, compared to the watery diarrhea of dogs with ileostomies only.

Animals↗
PubMed1975

Traumatic duodenal injuries: an analysis of 32 cases.

Thirty-two patients were treated for duodenal and associated injuries during the past five years. Fifty-nine per cent resulted from penetrating trauma, while 41 per cent were secondary to blunt injury. The incidence of blunt trauma represents a fourfold increase from previously published series. The morbidity rate still remains high at 47 per cent, with fistulas and infections being the most common complications. The mortality rate was 9.3 per cent, with death resulting from major intra-abdominal vascular injuries. Awareness of the potential injury to the duodenum, aggressive resuscitative measures, early operative management and improved postoperative care can lead to further reduction of these figures.

Abdominal Injuries↗