Biomedical subjects
Publications and source records attributed to T Viidik.
Direct inguinal hernias in otherwise well children are very infrequent. Two cases are reported in boys who previously had an indirect inguinal hernia repaired. In neither case had the cord been raised in the initial operation. A back wall repair in each has been satisfactory with no recurrence.
Femoral arteriovenous differences and flux of amino acids across the leg were measured in seven septic patients and compared with those of six nonseptic patients on days 1 and 3 following major surgery. The septic patients were seriously ill and judged clinically to be catabolic. The postoperative patients, although not septic, were expected to have a maximal catabolic response to operation during the first 3 days after operation. Both groups had increased release of phenylalanine from the leg, an index of muscle proteolysis. Septic patients had decreased femoral arteriovenous differences (--20 vs --74 and --60 mumoles/liter) and decreased flux (34 vs 169 and 128 nm/100 gm of calf muscle) of the branched-chain amino acids as compared with the nonseptic postoperative patients on days 1 and 3. The arterial plasmal levels of the branched-chain amino acids and alanine were not different, but phenylalanine was elevated in the septic patients (88 vs 49 and 55 mumoles/liter). The insulin:glucagon molar ratio was lower in the septic patients (2.4 vs 4.4 and 5.5). These findings suggest that in the catabolism of sepsis there is greater oxidation of branched-chain amino acids in muscle than in the catabolism associated with uncomplicated surgery.
In a retrospective analysis of 18 patients with sepsis and adult respiratory distress syndrome, we found that high plasma epinephrine and noradrenalin levels were associated with severe defects in oxygenation that accompany this disease. The result of previous experimental work support the concept that high plasma catecholamine levels augment already existing defects in the ventilation to perfusion ratio and increases the measured intrapulmonary shunt fraction. The results of this study do not, however, delineate whether or not the relationship between high circulating plasma catecholamine levels and severe adult respiratory distress syndrome is causal or simply a measurement of two indexes which reflect the severity of the underlying disease process.
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