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Biomedical subjects

R R Hanson

Publications and source records attributed to R R Hanson.

8 recordsLinked to original sources

Evaluation of peritoneal fluid following intestinal resection and anastomosis in horses.

Postoperative abdominal fluid changes were compared in 2 groups of horses; those undergoing double small-colon resection and anastomosis (n = 10) and those undergoing exploratory celiotomy alone (n = 5). Peritoneal fluid was collected before surgery and on postoperative days 1, 3, 5, and 7. Total and differential nucleated cell counts, RBC numbers, and total protein and fibrinogen concentrations were evaluated. In both groups, all values were significantly higher than normal on the first postoperative day (after small-colon resection and anastomoses, WBC = 130,350 +/- 23,310 cells/microliters, RBC = 7,389,000 +/- 6,234,000 cells/microliters, total protein = 3.63 +/- 0.16 g/dl; after exploratory celiotomy alone, WBC = 166,620 +/- 34,340 cells/microliters, RBC = 295,000 +/- 86,070 cells/microliters, total protein 4.38 +/- 0.54 g/dl). The number of total peritoneal nucleated cells and RBC significantly decreased after the first postoperative day, whereas total protein and fibrinogen concentrations, percent neutrophils, and percent mononuclear cells remained unchanged. None of the values had returned to normal by postoperative day 7 (after small-colon resection and anastomoses, WBC = 45,600 +/- 8,765 cells/microliters, RBC = 95,390 +/- 53,380 cells/microliters, total protein = 4.39 +/- 0.23 g/dl; after exploratory celiotomy alone, WBC = 43,340 +/- 7,746 cells/microliters, RBC = 12,860 +/- 11,790 cells/microliters, total protein = 3.92 +/- 2.20 g/dl.) The resection and anastomosis group had a significantly lower total protein concentration on the first postoperative day and a significantly higher mean total RBC count over the entire 7-day postoperative evaluation than did horses that underwent celiotomy alone. Other values in the 2 groups of horses did not differ significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical

Headaches in childhood.

Childhood headache is a common problem. The approach to evaluation and therapy is similar to that in adults with the exception that the differential is slightly altered and varies by age. Methods of evaluation have been proposed based on the time course of the illness as well as on pathophysiologic considerations. Although serious intracranial disease needs to be ruled out, in most cases chronic recurrent headache of childhood represents migraine. When doubt exists, close follow-up for 4 to 6 months should clarify the issue. Migraine variants are described that are uncommon or not seen in adults, and their differential diagnosis is discussed. The most difficult differential is between that of migraine and seizures. Variations in history and associated findings are described to help in the diagnosis of seizure versus migraine. Finally, methods of treatment are given based on my experience and review of the current literature. Many patients with migraine will improve over time regardless of what is done, and this should be kept in mind when treating these patients.

Child

Comparison of staple and suture techniques for end-to-end anastomosis of the small colon in horses.

Two techniques for end-to-end anastomosis of the small colon were evaluated in each of 6 horses. A simple interrupted suture pattern that excluded the mucosa and was oversewn with an inverting suture was compared with a triangulated double-row pattern of stainless steel staples. Anastomotic sites were evaluated at 2 weeks, 2 months, and 6 months for extent of abdominal adhesions, lumen diameter at anastomotic sites, bursting pressures, and healing response. Clinical postoperative complications were not associated with either technique. At postmortem examination, there was extensive adhesion formation from the mesocolon to the stapled anastomotic site. The suture technique resulted in greater luminal diameters (P less than or equal to 0.05), with good apposition of the tissue layers. Staples were missing as early as 2 weeks after surgery, and their loss was associated with separation of the muscularis at later evaluation periods. Regardless of technique, all but one anastomotic segment burst away from the anastomotic site along the mesenteric taenial band. For the 12 anastomoses performed in normal horses, the suturing technique was better than the stapling technique because of significantly larger lumen diameters, better anastomotic healing, and minimal intra-abdominal adhesion formation.

Anastomosis, Surgical

Transbronchial biopsy via flexible fiberoptic bronchoscope; results in 164 patients.

The diagnostic accuracy and complication rate of transbronchial forceps lung biopsy combined with bronchial brushing were analyzed in 164 consecutive patients, of whom 95 had nonmalignant disease and 51 had malignant disease. Eighteen patients with abnormal chest radiographs had normal transbronchial forceps lung biopsies and no established diagnosis. Satisfactory specimens were obtained in 153 patients (93 per cent), with diagnositc accuracies of 62, 64, and 67 per cent, respectively, in infectious, interstitial, and malignant lung disease. The over-all diagnostic accuracy was 57 per cent. Seven patients were diagnosed as having metastatic carcinoma to the lung by transbronchial forceps lung biopsy, but brush biopsy was psoitive in only 3. Of the 23 patients with primary lung carcinoma diagnosed by transbronchial forceps lung biopsy, 21 had positive brush biopsies. An additional 3 patients with bronchogenic carcinoma, however, were diagnosed only by brush biopsy. Fluoroscopy was essential for accurate positioning of the biopsy instrument. Increased risk factors were present in 83 patients (51 per cent), among whom the immunosuppressed group presented special problems. Significant bleeding in 15 patients (9 per cent) was controlled by conservative management. Pneumothorax occurred in 7 patients (4 per cent). There were no deaths. Transbronchial forceps lung biopsy in experienced hands is safe and well tolerated. The physician, nevertheless, must be prepared to handle major complications, especially bleeding. The procedure has a resonable diagnostic yield in high-risk patients who have a variety of lung lesions.

Adolescent

Mistaken diagnoses in continuous muscle fiber activity of peripheral nerve origin.

The syndrome of continuous muscle fiber activity of peripheral nerve origin has manifestations that resemble those of many other more common neurologic disorders during childhood and infancy. This similarity often leads to misdiagnosis when an adequate index of suspicion is not entertained and a comprehensive electromyographic examination is not performed. Two affected patients from 1 family are reported to illustrate the type of diagnostic errors that were made before the establishment of the correct diagnosis.

Arthrogryposis

The pneumoconioses.

The pneumoconioses are by and large industrial diseases, although casual contact may be important on occasion, particularly with asbestos. The effect of dust on the lung ranges from only radiographic changes to severe functional impairment. Destruction and fibrosis of lung parenchyma may be the end result in severe disease. Great improvement has been made in recent years in the control of dust in the numerous situations where it may cause disease. We are still faced with evaluating existing standards of particle concentration in air breathed by workers and establishing safe limits and better control of the particles placed into the general environment. Undoubtedly, there are other particulates which potentially can cause lung disease of which we are not aware. Of even more concern is the realization that a latent period of 20 years or so may be necessary for physicians to become aware of the pathologic process. Every physician who sees patients with pulmonary problems must inquire regarding a history of dust exposure and be prepared to interpret that history.

Asbestosis