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Biomedical subjects

S H Dougherty

Publications and source records attributed to S H Dougherty.

33 records · Page 2Linked to original sources
PubMed1985

Effects of soil infection potentiating factors on neutrophils in vitro.

Although the ability of soil silicate fractions to potentiate infection is well recognized, the precise mechanisms by which they do so remain unexplained. This study was carried out to investigate the effects of montmorillonite clay, the most potent of these soil infection potentiators, on human neutrophils, erythrocytes, and serum complement in vitro. Using phase microscopy, rapid neutrophil lysis was observed when cells were exposed to untreated clay. After lysis, the cytoplasmic marker enzyme lactate dehydrogenase rapidly adsorbed to the surface of the clay. Both enzyme surface adsorption and cell lysis could be blocked, however, by pretreatment of the clay with human albumin. Likewise, neutrophil chemiluminescence could be stimulated by untreated clay, but not by clay pretreated with 5 percent albumin or 10 percent pooled human serum. Maximal chemiluminescence was stimulated by clay pretreated with 0.1 percent albumin, probably because the partially protective albumin coating delayed cell lysis. Compared with the effect on neutrophils, clay lysis of erythrocytes was incomplete. When zymosan-activated serum samples were exposed to clay, complement activity as measured by neutrophil chemotaxis was suppressed in a dose-dependent fashion. We conclude that montmorillonite clay may potentiate infection by a direct cytotoxic effect on the neutrophil, making it unavailable for bacterial phagocytosis, by local reduction in bacterial opsonization due to depletion of activated complement, and by the release of toxic tissue substances, such as lysosomal enzymes and oxygen free radicals, from leukocytes which may damage host tissue and thus create an environment favorable for bacterial survival.

Adsorption↗
PubMed1984

Early surgery for biliary pancreatitis.

Herein, we documented our successful experience in performing definitive biliary tract surgery on patients with biliary pancreatitis as soon as the diagnosis was made and within 48 hours of admission. Early surgery reduced the length of hospital stay and did not result in associated morbidity, death, or complications of acute pancreatitis. The results of the study support the concept that removing obstruction of the pancreatic duct prevents progression of edematous pancreatitis to hemorrhagic pancreatitis. We conclude that patients with acute pancreatitis should be evaluated urgently for the presence of biliary tract stone disease and should be operated on as soon as the diagnosis of biliary pancreatitis is made, that early definitive surgery can be performed safely on patients with biliary pancreatitis, that cholecystectomy with intraoperative cholangiography and common duct exploration as necessary should be performed in all patients, and that length of stay for patients with biliary pancreatitis is reduced and morbidity and mortality possibly may be reduced by early surgery as compared with delayed surgery.

Acute Disease↗
PubMed1984

Role of enterococcus in intraabdominal sepsis.

Although enterococcus is well recognized as a pathogen in endocarditis, urinary tract infections, and biliary sepsis, its role in other forms of intraabdominal sepsis remains controversial. Antibiotics that lack activity against enterococcus can often be employed successfully in intraabdominal infections, even when enterococci are present as part of the polymicrobial flora. Furthermore, the enterococcus rarely emerges as a blood borne pathogen in such a setting. Breakthrough enterococcal septicemia may occur, however, in the immunodepressed host, particularly in the face of broad-spectrum antibiotic therapy not specific for enterococcus. Like infections with other opportunistic pathogens, enterococcal sepsis under these circumstances carries a high mortality. Specific antienterococcal drug therapy may be indicated as an adjunct to surgical management in selected patients with intraabdominal sepsis.

Abdomen↗
PubMed1983

'Breakthrough' enterococcal septicemia in surgical patients. 19 cases and a review of the literature.

We studied 19 surgical patients with 24 postoperative episodes of enterococcal septicemia not arising from the biliary or urinary tracts or from infected heart valves. Fifteen episodes occurred despite the administration of broad-spectrum antibiotics; in only one patient were these drugs effective against enterococcus. There were 14 episodes of enterococcemia in 11 patients following which the patient survived for at least one week. Thirteen (93%) of those episodes were treated with either ampicillin or drainage, or both. Five of the six long-term survivors received ampicillin therapy. Overall mortality was 68%. The data suggest that the enterococcus may emerge as a blood-borne pathogen in immunodepressed, postoperative patients receiving antibiotics for other infections of enteric origin. Antibiotic therapy specifically directed against this organism (and surgical drainage, if necessary) may be indicated during polymicrobial sepsis of enteric or mixed origin. If the spectrum of antibiotics does not include enterococcus, this organism can cause "breakthrough" sepsis, as can many other opportunistic organisms.

Adolescent↗
PubMed1983

Amebic liver abscess. Differential diagnosis of cholecystitis.

Among patients presenting with pain and tenderness in the right upper quadrant were 75 with cholelithiasis (13 male, 2 under age 50) and 9 with amebic hepatic abscess (6 male, all under age 45). The differential diagnosis of cholelithiasis versus liver abscess was accurately made by prompt sonography and hepatobiliary scintigraphy. Amebic abscess was confirmed by positive serum ameba titers. Presenting symptoms and results of laboratory studies of patients with amebic abscess were indistinguishable from those of patients with cholecystitis. It is concluded that an accurate diagnosis of amebic liver abscess in the differential diagnosis of cholecystitis can be made by sonography and hepatobiliary imaging. Also, in endemic areas of the southwestern United States, amebic abscess should be strongly considered in the differential diagnosis of patients presenting with pain and tenderness in the right upper quadrant and is more common than cholecystitis in young men.

Cholecystitis↗
PubMed1983

The drain-tract sinogram. Guide to the removal of drains and the diagnosis of postoperative abdominal sepsis.

Sinography via previously established abdominal drains or tracts from which drains had been removed may be useful in the diagnosis of postoperative intra-abdominal sepsis. Six cases are presented in which drain tract sinograms with water-soluble contrast facilitated the diagnosis of otherwise cryptic intra-abdominal abscesses, retroperitoneal abscesses, or enteric leaks. In addition, repeated drain tract sinograms can be used to determine the proper timing of intra-abdominal drain removal and may avoid the septic complication of drain removal in cases of residual intra-abdominal sepsis or undiagnosed enterocutaneous fistula.

Adult↗
PubMed1982

Stomach cancer following gastric surgery for benign disease.

The records of 1,079 patients with gastric carcinoma were reviewed. Of these, only 21 (about 2%) had had previous gastric surgery for benign disease, usually peptic ulcer. The average interval between the original gastric surgery and the discovery of stomach cancer was 26.9 years. The symptoms of cancer presentation were not distinguishable from other forms of the postgastrectomy syndrome. Gastric cancer tended to develop in these patients during the sixth decade of life, irrespective of when they had had their original gastric surgery, strongly suggesting an age-related factor. Although it would appear that previous gastric surgery for benign disease is not a major risk factor for the subsequent development of gastric cancer, such a relationship may exist. Patients who have undergone gastrectomy should be followed up carefully for the recurrence of symptoms.

Adenocarcinoma↗
PubMedDate not supplied

Pathobiology of infection in prosthetic devices.

Because of the growing use of implants, infections in prosthetic devices are probably becoming commoner, even though the risk of infection remains low. Multiple factors appear to be involved in the development of these infections, including foreign body-associated tissue damage, impairment of host defenses, bacterial trapping by fibrin, sequestration of bacteria in implant interstices, and the generation of a biofilm on implant surfaces. Although there is a direct association between the tissue reactivity of implants and their ability to potentiate infection, bacterial slime production and adherence to implant surfaces (generation of the biofilm) appear to play a primary role in the pathogenesis of device infections, contemporary prosthetic devices generally being quite nonreactive with respect to host tissues. While virtually any organism can cause these infections, gram-positive bacteria, especially staphylococci, predominate. Infections due to gram-negative organisms and fungi, however, tend to be more serious, often requiring prompt removal of the implant.

Humans↗