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Biomedical subjects

R B Kent

Publications and source records attributed to R B Kent.

At least 19 recordsLinked to original sources
PubMed1995

Spilled gallstones--complications of abdominal-wall abscesses. Case report and review of the literature.

Laparoscopic cholecystectomy has become the preferred method for removal of the diseased gallbladder. While its morbidity and mortality rates are lower than those of the open technique, it does have associated complications which may cause significant morbidity. The morbidity associated with spilled gallstones is not well studied and little can be found in the literature on this subject. We encountered a patient who developed abscesses within the abdominal wall following laparoscopic cholecystectomy. We recommend that spilled gallstones be removed when possible and that surgeons be aware of this possible complication.

Abdominal Abscess↗
PubMed1992

Directed evolution of a protein: selection of potent neutrophil elastase inhibitors displayed on M13 fusion phage.

Inhibitors of human neutrophil elastase were engineered by designing and producing a library of phage-displayed protease inhibitory domains derived from wild-type bovine pancreatic trypsin inhibitor and fractionating the library for binding to the target protease. The affinity of one of the engineered variants for human neutrophil elastase (Kd = 1.0 pM) is 3.6 x 10(6)-fold higher than that of the parental protein and exceeds the highest affinity reported for any reversible human neutrophil elastase inhibitor by 50-fold. Thus the display phage method has allowed us to obtain protein derivatives that exhibit greatly increased affinity for a predetermined target. The technology can be applied to design high-affinity proteins for a wide variety of target molecules.

Amino Acid Sequence↗
PubMed1992

Laparoscopic retrieval of spilled stones.

Spillage of gallstones during laparoscopic cholecystectomy is occasionally a problem. The use of a finger cut off of a size 9 sterile glove as an intraperitoneal sack facilitates the removal of these stones.

Cholelithiasis↗
PubMed1992

One-day hospitalization following modified radical mastectomy.

Postoperative management of patients following modified radical mastectomy has changed dramatically in recent years. Historically, patients usually remained in the hospital with closed suction drainage until the amount of drainage had decreased sufficiently for them to be removed. The feasibility of early discharge on the day following surgery was studied in a prospective manner in 29 consecutive breast cancer patients; 27 underwent unilateral modified radical mastectomy and 2 bilateral mastectomies by a single surgeon. All patients were instructed before surgery about planned early discharge and drain care. Twenty-seven of 29 patients (93.3%) were discharged the day following surgery. However, 2 patients refused discharge and were discharged on postoperative Day Two, and one patient was readmitted for confusion. Drains were removed in the office an average of 5.07 days after surgery. Forty-five per cent of patients developed a seroma that required aspiration at least once. No significant long-term sequela were experienced as a result of early discharge. The average hospital cost was reduced by $2,474.00 or 36 per cent (P less than 0.001) as compared to other surgeons in the same medical center who held to traditional postoperative care. The authors conclude that discharge on the day following surgery for patients undergoing a modified radical mastectomy is safe and cost effective.

Adult↗
PubMed1991

Subcutaneous emphysema and hypercarbia following laparoscopic cholecystectomy.

The recent development of laparoscopic cholecystectomy has introduced the technique of laparoscopy to the general surgical community. As increasing numbers of laparoscopic cholecystectomies are performed, increasing numbers of complications directly related to laparoscopy will result. A case of subcutaneous emphysema and hypercarbia without pneumothorax is reported in a patient undergoing laparoscopic cholecystectomy. Etiology, evaluation, and therapy for subcutaneous emphysema associated with laparoscopy are reviewed.

Carbon Dioxide↗
PubMed1990

Towards less painful local anesthesia.

Local anesthesia, used for numerous procedures in all fields of medicine, has the drawback of providing significant pain upon injection. Twenty-eight volunteers were asked to compare a subcutaneous injection of plain lidocaine with an injection of lidocaine plus bicarbonate. Twenty-four of the twenty-eight volunteers reported less pain with the buffered lidocaine. The dilution of 1 part bicarbonate to 10 parts plain lidocaine produced a solution that was less painful and better tolerated. The local anesthetic lidocaine is used prior to many minor and major surgical procedures. Although it induces adequate anesthesia, the pain of injection is nearly always of considerable discomfort to the patient. There are numerous factors that have been shown to influence the pain of injection. These include speed of injection, size of needle used, area of the body injected, and simply individual patient characteristics. Since lidocaine comes as an acid solution, local tissue irritation is likely the primary source of pain.

Adult↗
PubMed1990

Temporal artery biopsy.

Though surgeons have little input in the selection of patients for temporal-artery biopsy, a knowledge of temporal-artery anatomy and the pathophysiology of temporal arteritis is important. All temporal-artery biopsies done at Carraway Methodist Medical Center between January 1980 and January 1985 were reviewed. Seventy-three biopsies were performed on 70 patients and eight (11.4%) were found to have temporal arteritis histologically. One patient was judged to have temporal arteritis clinically, despite a negative biopsy of short length. Six of eight patients with positive biopsies were female, with an average age of 71.7 years. The most common signs and symptoms of those patients with positive biopsies were temporal headache (8/8), elevated erythrocyte sedimentation rate (7/8), temporal tenderness (5/8), jaw claudication (3/8), and visual changes (3/8). All biopsies were done under local anesthesia and there were no complications. With increasing awareness of the segmental nature of the disease, the length of biopsy specimens (formalin treated) increased from an average of 0.4 cm in 1980 to 2.4 cm in 1984. During this time, the positive rate increased from 0 per cent (0/9) to 17 per cent (4/24). A generous biopsy of approximately 5 cm in length of fresh vessel is recommended to confirm the suspected diagnosis of temporal arteritis.

Aged↗
PubMed1989

Ultrarapid diagnostic peritoneal lavage.

Diagnostic peritoneal lavage is an important adjunct in the evaluation of blunt trauma. The open technique has proven to be safer, though more time consuming, than the closed percutaneous technique. A significant time-consuming aspect of the procedure is the infusion and drainage of the peritoneal lavage fluid. With the use of cystoscopy irrigation tubing, infusion time for one liter of Ringer's lactate averaged 2.9 minutes compared to 14.4 minutes when using IV fluid tubing. Similarly, effusion time was 2.3 times rather than 9.8 minutes. These differences are significant at the 0.0001 level. The average time saved was 19 minutes, allowing more rapid assessment and treatment of these critically injured patients.

Abdominal Injuries↗
PubMed1988

Expression of an ouabain-resistant Na,K-ATPase in CV-1 cells after transfection with a cDNA encoding the rat Na,K-ATPase alpha 1 subunit.

We have used a gene transfer system to investigate the relationship between expression of the rat Na,K-ATPase alpha 1 subunit gene and ouabain-resistant Na,K-ATPase activity. A cDNA clone encoding the entire rat Na,K-ATPase alpha 1 subunit was inserted into the expression vector pSV2neo. This construct (pSV2 alpha 1) conferred resistance to 100 microM ouabain to ouabain-sensitive CV-1 cells. Hybridization analysis of transfected clones revealed the presence of both rat-specific and endogenous Na,K-ATPase alpha 1 subunit DNA and mRNA sequences. A single form of highly ouabain-sensitive 86Rb+ uptake was detected in CV-1 cells, whereas two distinct classes of ouabain-inhibitable uptake were observed in transfectants. One class exhibited the high ouabain sensitivity of the endogenous monkey Na,K-ATPase, while the second class showed the reduced ouabain sensitivity characteristic of the rodent renal Na,K-ATPase. Examination of the ouabain-sensitive, sodium-dependent ATPase activity of the transfectants also revealed a low affinity component of Na,K-ATPase activity characteristic of the rodent kidney enzyme. These results suggest that expression of the rat alpha 1 subunit gene is directly responsible for ouabain-resistant Na,K-ATPase activity in transfected CV-1 cells.

Algorithms↗
PubMed1987

Ouabain resistance conferred by expression of the cDNA for a murine Na+, K+-ATPase alpha subunit.

The molecular basis for the marked difference between primate and rodent cells in sensitivity to the cardiac glycoside ouabain has been established by genetic techniques. A complementary DNA encoding the entire alpha 1 subunit of the mouse Na+- and K+-dependent adenosine triphosphatase (ATPase) was inserted into the expression vector pSV2. This engineered DNA molecule confers resistance against 10(-4) M ouabain to monkey CV-1 cells. Deletion of sequences encoding the carboxyl terminus of the alpha 1 subunit abolish the activity of the complementary DNA. The ability to assay the biological activity of this ATPase in a transfection protocol permits the application of molecular genetic techniques to the analysis of structure-function relationships for the enzyme that establishes the internal Na+/K+ environment of most animal cells. The full-length alpha 1 subunit complementary DNA will also be useful as a dominant selectable marker for somatic cell genetic studies utilizing ouabain-sensitive cells.

Animals↗
PubMed1987

Genes encoding alpha and beta subunits of Na,K-ATPase are located on three different chromosomes in the mouse.

We have made use of a panel of mouse-hamster somatic cell hybrids and restriction fragment length polymorphisms between two mouse species (Mus musculus and Mus spretus) to determine the chromosomal localization of genes encoding the alpha and beta subunits of the Na,K-ATPase (Na+,K+-activated ATP phosphohydrolase, EC 3.6.1.3). DNA probes for three distinct isoforms of the Na,K-ATPase alpha subunit mapped to three different mouse chromosomes: the alpha 1 gene (Atpa-1) cosegregated with the Egf gene on chromosome 3; alpha 2 (Atpa-2) with the cytochrome P-450PB gene family/coumarin hydroxylase locus on chromosome 7; alpha 3 (Atpa-3) with the alpha-spectrin gene on chromosome 1. The Na,K-ATPase beta-subunit gene (Atpb) mapped to the same region of chromosome 1, but it was not tightly linked to the Atpa-3 gene. These results indicate that three isoforms of the Na,K-ATPase alpha subunit are encoded by three distinct genes. The dispersion of Na,K-ATPase genes suggests that their expression is not likely to be controlled by a common cis-acting regulatory element.

Animals↗
PubMed1987

Chromosome-mediated transfer of the murine Na,K-ATPase alpha subunit confers ouabain resistance.

We transferred murine NIH 3T3 metaphase chromosomes into monkey CV-1 cells to investigate the different ouabain sensitivities of rodent and primate cells. In 16 ouabain-resistant transferents, the mouse Na,K-ATPase alpha 1 subunit gene was detected, suggesting that structural differences between the rodent and primate alpha 1 subunits determine the different ouabain sensitivities.

Animals↗
PubMed1986

Breast cancer: presentation and prognosis in the community hospital.

A retrospective analysis of all breast cancer primarily treated at this institution during the ten-year period from 1967 to 1977 revealed 336 cases; in 308 of these cases, complete follow-up of five or more years was available. Clinical staging using the TNM system (tumor, node, metastasis) showed stage I disease in 60 patients, stage II in 94, stage III in 105, and stage IV in 49. Pathologic classification of these 308 cases showed a high incidence of infiltrating ductal carcinoma (88%). Early in the study operative treatment consisted of radical mastectomy, with modified radical mastectomy being more common in the later years. Simple mastectomy was occasionally done palliatively. Adjuvant treatment using cyclophosphamide (Cytoxan), methotrexate, 5-fluorouracil, radiation, and/or hormonal manipulation was then given according to a set protocol. In general, five- and ten-year survival improved with this combined treatment. The mortality among patients with stage I infiltrating ductal carcinoma not given adjuvant therapy suggests the need for proper selection of patients in this group who should receive adjuvant chemotherapy because they are at increased risk.

Adenocarcinoma, Mucinous↗