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Biomedical subjects

R I Wesdorp

Publications and source records attributed to R I Wesdorp.

At least 55 records · Page 3Linked to original sources
PubMed1980

[Results of therapy combining peritoneal lavage and local application of antibiotics in 250 patients with acute perforating appendicitis].

Since 1967, 2480 appendectomies have been performed at the St. Lucas Hospital (Amsterdam) and the St. Annadal Hospital (Maastricht), of which 250 were for perforated appendicitis. A so-called 'combined method' of treatment was used in all these cases: during the operation saline was used to lavage the peritoneal cavity with the patients in the reverse-Trendelenburg position. Antibiotics were left in the peritoneal cavity. No intraperitoneal drainage was performed, but the wound was drained for 5 days. Postoperative treatment consisted of nasogastric suction and parenteral antibiotics for 5 days in combination with anticoagulation. With thus combined approach one death was seen in 250 cases. There were 20 cases of wound infection (8%), 7 pelvic abscesses (2.8%), and 2 retroperitoneal abscesses. No thromboembolic complications were seen because of the use of routine anticoagulation. For 191 patients (77%), total hospitalization was less than 14 days. This method of treatment is compared with recent reports in literature.

Acute Disease↗
PubMed1977

In vitro release of gastrin from isolated perfused antrum.

Gastrin is released from isolated perfused rat antra in a regular fashion by a variety of stimuli, including acetylcholine, glycine, and calcium. Two peaks are seen with the physiologic stimulus, acetylcholine, suggesting perhaps two different antral gastrin populations.

Acetylcholine↗
PubMed1977

Characteristics of release of duodenal gastrin.

Duodenal gastrin release in the dog was studied after mucosal antrectomy with intact duodenal innervation, following which basal gastrin levels fell. Acetylcholine at pH 7 but not at pH 1.5 and insulin hypoglycemia but not 2-deoxyglucose release duodenal gastrin. Glycine (pH7), physiologic saline (pH 7), and balloon distention failed to release duodenal gastrin. These findings suggest differences in release characteristics between canine antral and duodenal gastrin, and point out species differences between man and dog in respect to release of duodenal gastrin.

Acetylcholine↗
PubMed1976

Plasma and parathyroid tumor tissue gastrin and hyperparathyroidism.

Hyperparathyroidism has been associated with an increased incidence of duodenal ulcer, increased acid secretion, and increased plasma gastrin levels. A relationship between these changes, increased serum calcium levels, and the increased incidence of peptic ulceration has been suggested, especially since increased plasma gastrin levels, serum calcium levels, and gastric acid secretion decrease after parathyroidectomy. We have previously suggested that the decrease in plasma gastrin levels after parathyroidectomy may suggest an extragastric source of gastrin, whereas others using immunofluorescent studies have suggested that the parathyroid adenomas themselves might be the source of this gastrin. We prospectively studied in fifteen patients with primary hyperparathyroidism, plasma gastrin and serum calcium levels before and after parathyroidectomy, as well as the gastrin content of parathyroid tumor tissue. The mean basal plasma gastrin level before operation was significantly greater than that of a control group and decreased insignificantly after operation, in contrast to serum calcium levels. No positive correlation could be found between plasma gastrin and serum calcium levels before and after operation. Parathyroid tumor tissue was assayed for gastrin content by radioimmunoassay and no detectable amounts of gastrin could be recovered from any tumor. The results do not support the concept that the extragastric source of gastrin in patients with hyperparathyroidism is the parathyroid adenoma itself.

Adenoma↗
PubMed1976

Basal and meat extract plasma gastrin before and after parietal cell vagotomy and selective gastric vagotomy with drainage in patients with duodenal ulcer.

Basal and meat extract stimulated plasma gastrin (PG) levels and basal and stimulated gastric acid secretion were evaluated pre and postoperatively in duodenal ulcer patients who underwent parietal cell vagotomy without antral drainage (normal duodena) (PC, n=32) or selective vagotomy with drainage (pyloric stenosis) (SV +P, n=11). Before operation, both groups had comparable basal PG values of 52+/-13 pg/ml (PCVP) AND 51+/-18 PG/ML (SV+P), while the peak gastrin level to meat extract stimulation was 173+/-40 pg/ml for the total group of patients. After both operations basal PG levels increased (107+/-18 pg/ml (PCV) and 152+/-45 pg/ml (SV+P) and the gastrin response to meat extract stimulation was augmented after PCV, while the response after SV+P was the same as before operation. Patients with PCV often demonstrated an acid response following meat extract stimulation (3.6+/-0.9 mEq HC1/hr), and pentapeptide stimulation (18.8+/-2.0 mEq/hr) while patients with SV/P showed a minimal response (1.3+/-1.2 mEq HC1/hr meat extract), and 10.7+/-1.8 mEq/hr pentapeptide stimulation. The comparatively intact acid response in the PCV patients may augur a high ultimate recurrence rate.

Adult↗
PubMed1976

L-dopa in hepatic coma.

The use of L-Dopa in hepatic coma has been the subject of numerous reports since 1970. The following represents our experience with a rather heterogenous group of patients treated at the Massachusetts General Hospital over the past 4 years. Thirty-five patients with severe liver disease, a mean age of 53 +/- 3.5 years, including nutritional cirrhosis with acute coma and acute hepatitis were treated. Four patients were judged grade III, 31 patients grade IV. All patients had previously been treated with protein restriction, orally administered non-absorbable antibiotics, fluid and electrolytes, and in some cases, steroids. L-Dopa was given orally in 21 patients, and as a retention enema in 14. Thirteen of the 35 patients did not respond to therapy. Seventeen responded, but did not survive, and 5 patients responded and survived. There was no difference between any of the groups as far as dosage of L-Dopa and clinical features. The one striking finding as the differences between groups was the time of initiation of L-Dopa therapy. In Group I, the survivors, therapy was started within 1.4 +/- 0.8 days after the onset of coma. In Group II, there was an initiation of therapy at 6.7 +/- 1.6 days, and in the non-responders 9.5 +/- 1.6 days. These differences are highly significant. The results suggest that coma may pass from a reversible to an irreversible stage, and that L-Dopa therapy initiated early in the course of hepatic coma, may be of some benefit.

Alcoholism↗
PubMed1976

[Mono- or biphasic release of gastrin. Results after isolated antrum perfusion in vitro].

In an in vivo preparation, isolated rat antra were perfused with different releasing agents in an oxygenated Krebs-Ringer-A solution. Upon perfusion with acetylcholine (+ 0,1 mM eserine), the mean gastrin levels in the effluent increased within 2 min to 4 times the basal level, while there was a smaller second release after 20 min. During perfusion with 50 mM glycine and 30 mM calcium chloride containing Krebs-Ringer-A solution gastrin levels in the effluent increased within 4 min to twice the basal level without a secondary release of gastrin. Perfusion with eserine alone or with Krebs-Ringer-A solution failed to release gastrin. The apparent biphasic release of gastrin with acetylcholine may suggest that antral gastrin may exist in two different populations, one of which is readily accessible, the other less so. Alternatively, the initial peak may consist only of stored gastrin and the second peak of newly synthesized gastrin, stimulated only by the physiologic stimulus of acetylcholine, and not by other releasers.

Acetylcholine↗
PubMed1976

[Behavior of gastrin and gastric juice secretion in acute and chronic kidney failure before and after kidney transplantation].

In 50 patients (10 anephric, 10 with chronic renal failure, and 30 with acute renal failure) the correlation was studied between basal PG levels and basal and stimulated gastric acid secretion. a) The mean PG level in all 3 groups was significantly higher than in the control group, with the highest values in the anephric, which decreased to normal after kidney transplantation. b) In the patients with ARF and after transplantation there was a very positive correlation between PG levels and kidney function. c) Hemodialysis decreased PG levels moderately but significantly. d) Gastric acid studies showed in all groups a very low BAO and basal intragastric pH, with a significant release of gastric acid after pentagastrin stimulation, especially in the anephric.

Acute Kidney Injury↗
PubMed1976

[A new therapeutic principle in hepatic coma: parenteral supply of neutral amino acids].

The effect of two different amino acid solutions given i.v. was investigated in dogs with hepatic encephalopathy after portacaval shunt. The results suggest that (a) isocaloric protein-free nutrition has no impact on the characteristic plasma amino-gram, (b) the infusion of modified concentrations of 6 neutral amino acids may reduce mortality and morbidity in dogs with hepatic coma, and (c) manipulation and normalization of plasma amino acids may be efficacious in providing adequate nutrition while minimizing hepatic encephalopathy.

Amino Acids↗
PubMed1975

[New evaluation of effect of total colectomy and intestinal sterilization following portacaval shunt].

The effect of total colectomy and "intestinal sterilisation" following chronic portocaval shunt was investigated in 96 Sprague-Dawley rats: while both therapeutic procedures are of no significant impact on serum ammonia concentrations there is a significant reduction of brain octopamine, a known false neuro-chemical transmitter, and a clear response on aromatic amino acid levels in brain and plasma. The interference with central and peripheral neurotransmitters is suggested as an alternative mechanism in experimental encephalopathy.

Ammonia↗
PubMed1975

[Mechanism for the liberation of duodenal gastrin in the dog].

The mechanisms of duodenal gastrin release were studied in 13 mongrel dogs after selective mucosal antrectomy: Vagal stimulation with insulin and local perfusion with acetylcholine at pH 7 resulted in a significant increase of the serum gastrin level taken from the pancreatico-duodenal vein. No significant amounts were detected after vagal stimulation with 2-deoxy-d-glucose, local perfusion with acetylcholin at pH 1, 5 nor after duodenal distension with 20, 40 and 120 cm water.

Acetylcholine↗
PubMed1975

The role of plasma amino acids in hepatic encephalopathy.

The dog with an end-to-side portacaval shunt has a plasma amino acid pattern similar to that in man with chronic liver disease and encephalopathy. When dogs with end-to-side portacaval shunts manifested symptoms of hepatic encephalopathy, superior caval catheters were placed and one of three solutions was infused. Whereas almost all animals given a commercially available synthetic amino acid mixture died, a special mixture formulated to normalize plasma amino acids was associated with 100 percent survival and few neurological symptoms. The results suggest that manipulation and normalization of plasma amino acids in animals with hepatic failure may be efficacious in providing adequate nutrition while minimizing hepatic encephalopathy. Moreover, these experiments may shed some light on the mechanism of human hepatic encephalopathy.

Albumins↗