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Biomedical subjects

R M Stewart

Publications and source records attributed to R M Stewart.

At least 19 recordsLinked to original sources
PubMed1995

Complications of needle catheter jejunostomy in 2,022 consecutive applications.

BACKGROUND: We commonly use needle catheter jejunostomy (NCJ) for early enteral feeding in selected patients. Review of our approach was prompted by the suggestion that enteral feeding represents a "stress test" for the bowel and may be associated with a high complication rate. MATERIALS AND METHODS: We reviewed patients with NCJ inserted over the past 16 years by prospective database, chart review, and conference minutes, with emphasis on complications. RESULTS: During the conduct of 28,121 laparotomies, 2,022 NCJs inserted in 1,938 patients (7.2%) resulted in 34 NCJ-related complications in 29 patients (1.5%) The most common complication was premature loss of the catheter from occlusion or dislodgment (n = 15; 0.74%), and the most serious was bowel necrosis (n = 3; 0.15%). CONCLUSIONS: Needle catheter jejunostomy may be inserted and used with a low complication rate. Most complications were preventable through greater attention to detail and better monitoring of physical examination of patients with marginal gut function.

Catheterization↗
PubMed1992

Chediak-Higashi lymphoblastoid cell lines: granule characteristics and expression of lysosome-associated membrane proteins.

Chediak-Higashi syndrome (CHS) is characterized morphologically by the presence of giant lysosomal granules resulting from the dysregulated fusion of primary lysosomes. Lysosome-associated membrane proteins comprise a family of highly glycosylated proteins which are postulated to facilitate many aspects of normal lysosomal function. In this study, Epstein-Barr virus-transformed lymphoblastoid cell lines derived from a patient with CHS were analyzed for the presence of giant granules and the expression of the lysosome-associated membrane proteins lamp1 and lamp2. Giant myeloperoxidase positive granules typical of CHS, which had a complex structure when examined by electron microscopy, could be demonstrated in the lymphoblastoid cell lines. In situ immunofluorescence with antibodies directed against lamp1 and lamp2 demonstrated abundant expression of each of these proteins in the giant CHS granules. Lack of expression of lysosomal cathepsin G in these granules was also noted. These observations suggest that the lymphoblastoid cell lines provide a convenient model for the study of Chediak-Higashi granules and the lysosome-associated membrane proteins and provide additional evidence that CHS is a "lysosomal" disease. Further study will be necessary to delineate whether the function of these membrane proteins is altered in Chediak-Higashi syndrome.

Antigens, CD↗
PubMed1992

Correlation of abdominal trauma index and injury severity score with abdominal septic complications in penetrating and blunt trauma.

The Abdominal Trauma Index (ATI) was designed to stratify patients with penetrating injuries, and has been used to classify patients with blunt trauma. The Injury Severity Score (ISS) was originally designed to stratify victims of blunt trauma, and it has also been used for victims of penetrating trauma. We attempted to validate the use of ISS and ATI for both penetrating and blunt trauma. A total of 592 penetrating and 334 blunt trauma patients who underwent laparotomy over a 5-year period were evaluated. The overall rate of abdominal sepsis was 7.5% for blunt trauma and 7.6% for penetrating trauma. Mortality (excluding deaths within 48 hours) was 7% for blunt trauma and 1% for penetrating trauma. In the penetrating injury population, an ATI value greater than 15 and an ATI value greater than 25 were significantly associated with abdominal septic complications (ASCs) (p less than 0.001, both comparisons). An ISS greater than or equal to 16 was also associated with ASCs (p less than 0.001). The ASC rate for gunshots was higher than that for stab wounds (11% vs. 2%; p less than 0.001). In the blunt group, an ATI value greater than 15 and an ATI value greater than 25 were associated with ASCs (p less than 0.01 and p less than 0.001, respectively). The association of ASCs and ISS was linear with increasing ISS in patients with blunt abdominal trauma.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1992

Aortoiliac reconstruction following penetrating injury.

In summary, there are several factors essential to successful treatment of major vascular abdominal injuries. Prompt resuscitation and abdominal exploration is paramount. Proximal control can quickly be obtained at the esophageal hiatus and adequate exposure of the retroperitoneum is mandatory. Most aortic injuries can be repaired primarily; however, if an arterial substitute is necessary, then PTFE is the substitute of choice. Reimplantation of the injured iliac artery to the contralateral iliac artery is an option for bifurcation injuries if that will not inordinately constrict the lumen. And finally, four-compartment fasciotomies will decompress the lower extremities and prevent ischemic muscle necrosis following reperfusion injury.

Adolescent↗
PubMed1991

Effect of dietary ethanol on gallbladder absorption and cholesterol gallstone formation in the prairie dog.

Dietary ethanol has been reported to protect against cholesterol gallstone formation. Because enhanced gallbladder absorption of water is important in cholesterol cholelithiasis, we examined the hypothesis that ethanol acts by inhibiting the absorptive function of the gallbladder. Eighteen adult male prairie dogs were fed a lithogenic liquid diet containing 0.4% cholesterol. Half of the animals received 30% of total calories as ethanol, whereas their pair-fed controls received equicaloric amounts of maltose-dextrin. After 3 months, the gallbladders were inspected for gallstones and crystals, and gallbladder and hepatic bile were analyzed. Cholesterol stones and crystals were present in all nine controls. None of the alcohol-fed animals had stones, but four had cholesterol crystals. Gallbladder cholesterol, phospholipids, and total calcium were significantly decreased in alcohol-fed animals. In both gallbladder and hepatic bile, the cholesterol saturation index was significantly lower in alcohol-fed animals, as was the ratio of trihydroxy to dihydroxy bile salts. The ethanol-supplemented diet produced a significant decrease in the absorption of water by the gallbladder as indicated by changes in the gallbladder bile to hepatic bile ratios of the total bile salt concentration (7.29 +/- 1.25 versus 3.84 +/- 0.56; p less than 0.05) and the total calcium (3.37 +/- 0.24 versus 2.43 +/- 0.29; p less than 0.05). These findings indicate that the protective effect of ethanol may be related to its ability both to inhibit gallbladder absorption of water and to alter the composition of biliary lipids.

Absorption↗
PubMed1991

Linkage of loci associated with two pigment mutations on mouse chromosome 13.

Progeny from one intra- and two inter-specific backcrosses between divergent strains of mice were typed to map multiple markers in relation to two pigment mutations on mouse chromosome 13, beige (bg) and pearl (pe). Both recessive mutants on a C57BL/6J background were crossed separately with laboratory strain PAC (M. domesticus) and the partially inbred M. musculus stock PWK. The intra- and inter-specific F1 hybrids were backcrossed to the C57BL/6J parental strain and DNA was prepared from progeny. Restriction fragment length polymorphisms were used to follow the segregation of alleles in the backcross offspring at loci identified with molecular probes. The linkage analysis defines the association between the bg and pe loci and the loci for the T-cell receptor gamma-chain gene (Tcrg), the spermatocyte specific histone gene (Hist1), the prolactin gene (Prl), the Friend murine leukaemia virus integration site 1 (Fim-1), the murine Hanukuh Factor gene (Muhf/Ctla-3) and the dihydrofolate reductase gene (Dhfr). This data confirms results of prior chromosomal mapping studies utilizing bg as an anchor locus, and provides previously unreported information defining the localization of the prolactin gene on mouse chromosome 13. The relationship of multiple loci in relation to pe is similarly defined. These results may help facilitate localization of the genes responsible for two human syndromes homologous with bg and pe, Chediak-Higashi syndrome and Hermansky-Pudlak syndrome.

Animals↗
PubMed1990

Region-specific neural induction of an engrailed protein by anterior notochord in Xenopus.

Anterior-specific neural induction can be assayed by means of an antibody that recognizes the Xenopus homeobox-containing protein En-2. The En-2 antigen is an excellent early marker, since it is present as a discrete band in the anterior neural plate of neurula embryos. Regional induction was assayed by combining dorsal mesoderm with competent ectoderm. Anterior notochord from the early neurula induced En-2 frequently, while posterior notochord induced En-2 less frequently. Presumptive somitic mesoderm and presumptive head mesoderm, though they induced neural tissue, were not strong inducers of En-2. Thus, anterior notochord may be the primary mesodermal tissue responsible for the patterning of the anterior neural plate.

Animals↗
PubMed1990

The anterior extent of dorsal development of the Xenopus embryonic axis depends on the quantity of organizer in the late blastula.

In amphibian gastrulae, the cell population of the organizer region of the marginal zone (MZ) establishes morphogenesis and patterning within itself and within surrounding regions of the MZ, presumptive neurectoderm, and archenteron roof. We have tested the effects on pattern of reducing the amount of organizer region by recombining halves of Xenopus laevis late blastulae cut at different angles from the bilateral plane. When regions within 30 degrees of the dorsal midline are excluded from recombinants, ventralized embryos develop lacking the entire anterior-posterior sequence of dorsal structures, suggesting that the organizer is only 60 degrees wide (centered on the dorsal midline) at the late blastula stage. As more and more dorsal MZ (organizer) is included in the recombinant, progressively more anterior dorsal structures are formed. In all cases, when any dorsal structures are missing they are deleted serially from the anterior end. Thus, we suggest that the amount (lateral width) of the organizer in the MZ determines the anterior extent of dorsal development.

Animals↗
PubMed1990

Attributions for rapid or slow recovery from sports injuries.

Sport participants (n = 276) stated the most likely cause of rapid or slow recovery from injury and rated that causal factor along several dimensions. Examination of the open-ended responses suggested that four general types of attributions were utilized by the athletes: personal factors, injury-related factors, treatment-related factors, and situational factors. Analysis of dimensional ratings indicated: (a) causes of slow recovery were consistently perceived as less stable, controllable, global, and intentional than causes of rapid recovery; (b) causes of slow recovery were sometimes perceived as more internal than causes of rapid recovery; and (c) physical self-esteem interacted with gender to influence dimensional ratings of the attributions. These findings were discussed in relation to the motivational significance of causal interpretations during recovery and in relation to the model of stress and athletic injury presented by Andersen and Williams (1988).

Adult↗
PubMed1988

An outcome study of Gamblers Anonymous.

Retrospective and prospective studies of a total sample of 232 attenders at groups of Gamblers Anonymous suggest that total abstinence from gambling was maintained by 8% of all comers at one year from first attendance and by 7% at two years.

Alcoholics Anonymous↗
PubMed1987

The incidence and risk of early postoperative small bowel obstruction. A cohort study.

Early postoperative small bowel obstruction is a rare (0.69 percent incidence) but serious postoperative complication with a relatively high mortality rate (17.8 percent). Operations performed below the transverse mesocolon impose an increased risk, whereas those limited to the upper abdomen are virtually free of risk. The clinical picture of a patient who initially manifests a return of gut function and advances to a diet, but then has loss of bowel function with distention and pain is most characteristic of early postoperative small bowel obstruction. Any patient in the high-risk group demonstrating this clinical picture should be presumed to have a mechanical small bowel obstruction, and early operation should be considered.

Abdomen↗