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Biomedical subjects

R M Preshaw

Publications and source records attributed to R M Preshaw.

At least 19 recordsLinked to original sources
PubMed1997

Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool.

BACKGROUND: The objective of this study was to combine a physiologic triage score (prehospital index, PHI) with criteria regarding mechanism of injury (MOI) to increase the efficacy of trauma triage. The specific question being asked was: will the combined score improve the sensitivity and specificity over that of the individual scores? METHODS: In this prospective study, 3,147 injury patients (all adults > or = 14 years) were reviewed. Each patient received a PHI score and a MOI score in the field, which were compared with their Injury Severity Score (ISS) at separation. An ISS > or = 16 was defined as major trauma. RESULTS: PHI alone had a sensitivity of 41%, MOI alone had a sensitivity of 73%, whereas the combined PHI/MOI score had a sensitivity of 78%. All three had similar specificities. These findings were statistically significant (p < or = 0.001). CONCLUSION: The combined PHI/MOI score was better at identifying those patients with ISS scores > or = 16 compared with the PHI and MOI scores alone. Although this permitted superior triage (and minimized overtriage), the combined score did not identify all major trauma patients.

Accidents↗
PubMed1996

Cooperative hernia study. Pain in the postrepair patient.

BACKGROUND: The Cooperative Hernia Study assessed postoperative pain in a prospective trial as part of a larger study looking at the recurrence rate and other morbidity of the Bassini, McVay, and Shouldice repairs. METHODS: Patients were randomized to one of three surgical hernia repairs. Patients were seen in follow-up at 6, 12, and 24 months and were assessed for the presence of pain, numbness, paresthesia, and recurrence. RESULTS: Three hundred fifteen patients were seen in follow-up, with 276 seen at the 2-year mark. At 1 year, 62.9% of patients had groin or inguinal pain and 11.9% of patients had moderate to severe pain; 53.6% had pain and 10.6% of patients continued to report moderate to severe pain 2 years postoperatively. The predictors for long-term postoperative pain were as follows: absence of a visible bulge before the operation (p < 0.001); presence of numbness in the surgical area postoperatively (p < 0.05); and patient requirement of more than 4 weeks out of work postoperatively (p < 0.004). Three distinct chronic pains were identified. The most common and most severe pain was somatic, localized to the common ligamentous insertion to the public tubercle. The second was neuropathic and was referable to the ilioinguinal or genitofemoral nerve distribution. This was likely because of injury to the genitofemoral nerves, either at surgery or subsequently by encroachment of scar. The third pain was visceral, ejaculatory pain. Twenty-four percent of patients had postoperative numbness at 2 years, independent of the type of repair. Numbness was most common in the distribution of cutaneous branches of the ilioinguinal and iliohypogastric nerves. CONCLUSION: Pain or numbness are common late sequelae of traditional external surgical hernia repairs. Strategies need to be developed to reduce the risk of these complications.

Adult↗
PubMed1996

Disease-specific quality of life: the Gallstone Impact Checklist.

OBJECTIVE: To develop a disease-specific quality-of-life scale for symptomatic cholelithiasis for use in clinical trials, and to evaluate its reliability, construct validity and responsiveness. DESIGN: Questionnaire. PARTICIPANTS: Health care professionals, patients with symptomatic cholelithiasis and their significant others. INTERVENTIONS: A 114-item questionnaire was developed from open-ended questions completed by the participants. Questions dealt with physical symptoms, activities of daily living, job performance, leisure activities, emotional factors, marital and sexual relations, support networks and financial situation. The questionnaire was administered by an interviewer to 50 subjects booked for elective cholecystectomy: frequency-importance products were calculated for each of the 114 items. A final shortened scale (the Gallstone Impact Checklist [GIC]) contained 41 items and was completed by patients with symptomatic cholelithiasis on two occasions, 4 to 6 weeks apart. RESULTS: The checklist requires 10 to 15 minutes to complete. Reliability of the questionnaire and its four subscales was assessed by Cronbach's alpha (overall questionnaire 0.88, pain 0.60, dyspepsia 0.73, emotional impact 0.78 and food and eating 0.84). Construct validity was established by comparison of questionnaire subscales with global ratings of physical and emotional health. Among subjects who reported a difference in their symptoms attributed to gallstones, there was a significant change in total GIC score and in each of the four subscales. Among patients who had undergone cholecystectomy, the absolute value of the effect size was 1.63. CONCLUSIONS: The GIC has content validity and appears to be a reliable, responsive measure of within-person change for subjects with symptomatic cholelithiasis.

Adult↗
PubMed1994

Tumour implantation at umbilicus after laparoscopic cholecystectomy for unsuspected gallbladder carcinoma.

Seeding of tumour cells at the umbilical port during laparoscopic surgery for staging malignant disease has been reported. In this paper a 69-year-old woman is described who had umbilical metastasis after laparoscopic cholecystectomy for unsuspected gallbladder cancer. The experience of this case and that of other reports suggests that when laparoscopic techniques are used for the resection of tumours, the excised specimen should be enclosed in a nonporous bag for removal through the abdominal wall.

Abdominal Neoplasms↗
PubMed1993

The effect of cyclosporine and liver autotransplantation on bile flow and composition in dogs.

Following liver transplantation bile formation may be influenced by hepatic denervation and cyclosporine therapy. To better establish any effect of liver transplantation on bile secretion, 6 mongrel dogs were studied: 3 underwent liver denervation by a modified autotransplantation procedure and insertion of a Thomas cannula to create a chronic duodenal fistula; 3 others had cholecystectomy and the duodenal cannula placement without manipulating the liver. One month after surgery, two control studies were done, one week apart. Then oral cyclosporine was given in doses of 5, 15, and 50 mg/kg/day for consecutive 1-week periods each. Twice on each cyclosporine regimen, after 4 and 7 days of therapy, the common duct was cannulated and bile collected for 5 h; animals were awake and fasted. The first 3 h of bile collection established basal conditions; flow was then stimulated with consecutive hour-long taurocholate infusions at 1 and 2 mumol/kg/min. In all dogs, bile flow increased as the cyclosporine dose increased, under both basal and bile salt-stimulated conditions. The increased flow primarily resulted from increased bile salt-independent flow. Cyclosporine had no effect on bile salt, bilirubin, or cholesterol secretion. Phospholipid secretion, however, decreased significantly in a dose-related manner with increasing cyclosporine in the dogs with autotransplanted livers, but not in the nontransplanted dogs. This decrease in phospholipid secretion resulted in a significant increase in the calculated cholesterol saturation of bile. Thus, cyclosporine administered orally is not cholestatic but rather increases bile flow independent of any change in bile salt secretion. Cyclosporine reduced phospholipid secretion in autotransplanted dogs, possibly related to denervation of the liver. The resultant change in biliary composition may pose a risk factor for gallstone formation.

Animals↗
PubMed1992

Carcinoid tumors and inflammatory bowel disease.

Three cases are described in which carcinoid tumors arose in previously established inflammatory bowel disease: two were in the ileum in cases of Crohn's disease, and one was in the rectum in a case of ulcerative colitis. Review of this association in the literature suggests that it may be more than fortuitous.

Adult↗
PubMed1992

Conservative management of splenic injury in infectious mononucleosis.

Splenic rupture, in association with mononucleosis, can be lethal. Most reported cases of splenic rupture in patients with mononucleosis have not responded to conservative splenic preserving measures and have resulted in splenectomy. We report a case of traumatic splenic disruption in a patient with mononucleosis in whom conservative management was successful. We recommend consideration of splenic preservation measures in patients with mononucleosis and splenic disruption, if the patient is stable and meets other criteria of conservative management.

Adolescent↗
PubMed1990

The effect of cyclosporine A on bile secretion in dogs.

Cyclosporine A is reported to cause cholestasis, but the evidence is confounded by anesthesia and surgery used in acute experiments. To better investigate the effect of cyclosporine on the liver, bile output was directly measured in three cholecystectomized dogs by cannulating the common duct through a chronic duodenal fistula. Control studies were done 1 month after surgery. Cyclosporine in oral doses of 5, 15, and 50 mg.kg-1.d-1 was then given for consecutive 1-week periods. Twice during each study period, bile output was measured for 5 h in fasted, awake animals: 3 h to establish basal conditions, followed by 2 h of taurocholate infusions at 1 and then 2 mumols.kg-1.min-1. Under basal conditions, bile flow rose with each dose of cyclosporine, increasing 63, 127, and 179% above control with cyclosporine 5, 15, and 50 mg.kg-1,d-1, respectively. Bile flow increased similarly during taurocholic acid stimulation. Cyclosporine had no effect on bile salt or bilirubin secretion. In this chronic dog model isolated from other causes of cholestasis, cyclosporine did not induce cholestasis but rather caused a dose-related choleresis without any change in bile salt secretion.

Animals↗
PubMed1989

Origin of fistulas in Crohn's disease.

In 236 resection specimens of Crohn's disease (127 first excisions and 109 reexcisions) there were 60 specimens with fistulas (excluding anal fistulas): 44 in first excisions and 16 in reexcisions. In primary excisions, 36 fistulas arose in the ileum, three in the colon and five in the ileocecal valve. The majority were located either at the proximal end of a stricture (62%) or within a stricture (31%); four cases (7%) were not associated with strictures. In reexcision specimens, ten fistulas arose at the bowel anastomosis, four arose in the ileum in association with strictures, and two were of doubtful origin. Only four fistulas in primary excisions drained to the skin whereas seven did so in reexcisions.

Colitis↗
PubMed1988

Excessive growth of cultured beta cells from an adult patient with beta cell hyperplasia.

We have studied a 25-year-old female with frequent, severe hypoglycemic episodes. Concurrent with low serum glucose levels, the concentrations of C-peptide and insulin were markedly elevated. Tests for sulfonylurea hypoglycemic agents were negative. Special tests did not disclose any neoplasm. Biopsy of the pancreatic tail revealed islet cell hyperplasia and adenomatosis. About two-thirds of the pancreas was resected, resulting in correction of all metabolic abnormalities. Specific fluorescein-labeled anti-insulin antibodies revealed staining in 60-80% of the cultured cells isolated from the patient's pancreas, while electron microscopy disclosed insulin storage granules in about 80%. By comparison, for each of these findings, the range for cells from normal pancreases was 30-50%. In contrast to these control cells, cells from the patient grew about 2 and 2.6 times more rapidly during the first two cell cycles, and the growth persisted through four cycles. The greater and more enduring growth of the patient's cells in culture must have been at least partly independent of circulating factors. Paracrine/autocrine principles from the beta cells or other islet cells may have been responsible.

Adult↗
PubMed1985

Sex differences in morbidity and mortality from peptic ulcer in Canada, 1950-1981.

Mortality from peptic ulcer disease in Canada declined significantly for males from 1950-1981, but changed little for females. Gastric and duodenal ulcer mortality, and mortality from perforated and bleeding peptic ulcer showed similar trends. Rates of hospitalization for male duodenal ulcer subjects also declined, with lesser effects among males with gastric ulcer, and females with either gastric or duodenal ulcer. Rates of partial gastrectomy and vagotomy and pyloroplasty or gastrojejunostomy declined from 1968-1981, especially for males. These changes in trends in peptic ulcer disease were contrasted with the overall mortality rate in Canada during the same period, which demonstrated a similar decline for both sexes. The trend to lower mortality, hospitalization and surgical procedures for peptic ulcer disease during this period was associated with a change in cigarette smoking habits in males but not females. The trends identified could not be correlated with the introduction of H2 antagonists for specific therapy of peptic ulcer disease.

Adolescent↗
PubMed1984

Seasonal frequency of testicular torsion.

The hypothesis that testicular torsion is more common in winter was examined in a retrospective survey of admissions to three Calgary hospitals. No seasonal peak in incidence of cases of torsion was identified from 1966 to 1982.

Alberta↗
PubMed1982

Necrotizing choledochomalacia after use of monooctanoin to dissolve bile-duct stones.

A 72-year-old man with choledocholithiasis, demonstrated radiologically, was treated by constant perfusion through the gallbladder of monooctanoin (glyceryl-1-monooctanoate) following cholecystostomy for a perforated gallbladder. The monooctanoin was given at a rate of 7.5 ml/h and monitored to ensure that delivery pressure did not rise above 20 cm H2O. Perfusion was carried out for 60 hours, but could not be continued because of abdominal pain, nausea and vomiting. This was followed by progressive jaundice, anorexia and fever. The patient was treated with penicillin G and cefoxitin intravenously and metronidazole orally, but he died 5 weeks after the perfusion. Autopsy showed acute pancreatitis and cholangitis, and a biliary tree filled with pus and a black biliary cast. No calculi were present. The authors consider the possible causes for this patient's death.

Aged↗
PubMed1981

Effects of sulfobromophthalein excretion on biliary lipid secretion in humans and dogs.

The effect of sulfobromophthalein (BSP) on biliary lipid secretion was investigated in 12 cholecystectomized subjects, using a duodenal marker-perfusion technique. A 1-h basal period was followed by intravenous BSP infusion over 3 h, achieving the maximal excretory rate (Tm). The calculated Tm was not different from the measured maximal output. At BSP Tm, bile salt secretion was unchanged, but phospholipid, cholesterol, and bilirubin secretion were markedly reduced. Biliary lipid composition changed accordingly, higher molar percent bile salts but lower phospholipid and cholesterol. In six cholecystectomized dogs with chronic duodenal fistulas, bile was collected directly from the common duct while bile salt secretion was maintained by intravenous taurocholic acid infusion. After a 2-h control period, sufficient BSP was added to create either maximal (Tm) or submaximal conditions. BSP did not alter bile salt secretion but caused a dose-related decrease in phospholipid and cholesterol secretion. Bilirubin excretion was also reduced, whereas bile flow increased. Thus, BSP is hydrocholeretic but decreases phospholipid, cholesterol, and bilirubin secretion in both humans and dogs. The effect on biliary lipid composition is probably through a physical interaction with biliary micelles.

Adult↗