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Biomedical subjects

W A Sterling

Publications and source records attributed to W A Sterling.

At least 19 recordsLinked to original sources
PubMed1988

Intraabdominal operations in patients with leukemia.

We reviewed results of intraabdominal operations in 23 patients with acute or chronic leukemia to address morbidity, mortality, and factors associated with complications. We found a higher mortality rate among those who had emergency procedures as opposed to elective procedures. Three of four patients who needed reoperation and all four patients with ischemic or perforated viscus died, all from sepsis. Factors such as age, preoperative leukocyte or granulocyte count, or preoperative use of steroids or antineoplastic drugs did not affect the outcome. We therefore recommend early surgical intervention in these patients, even in the face of granulocytopenia, thrombocytopenia, or active medical treatment.

Abdomen↗
PubMed1986

The influence of glucocorticoid dose on protein catabolism after renal transplantation.

Protein catabolic rate (PCR) and protein balance were measured daily by computerized mass balance studies in 20 subjects during hospitalization after renal transplantation. All hospital courses were uncomplicated. Ten subjects received approximately 1 mg/kg/day prednisone, and ten subjects received 3-5 mg/kg/day prednisone on day 1 with a tapering dose to approximately 1 mg/kg/day by discharge. In both groups, PCR rose during the first 3-4 postoperative days then stabilized at an accelerated level. PCR was significantly greater in the higher prednisone group. Despite encouragement most subjects ate less protein than prescribed, and most were in negative protein balance. Mean daily and net protein deficits were more severe in the higher prednisone group. Higher protein intakes improved protein balance. The protein catabolic effects of the two regimens have been defined and a dose dependency demonstrated. In any therapeutic situation the use of the minimum effective dose of steroids seem advised, and high protein intake should be encouraged to improve protein balance. Some steroid morbidity might thus be avoided.

Adolescent↗
PubMed1986

Late stenosis of the subclavian vein after hemodialysis catheter injury.

In the past several years subclavian vein (SCV) access for temporary hemodialysis has achieved widespread popularity. Two cases of SCV stenosis after cannulation with hemodialysis catheters (HCs) are reported. Incapacitating edema of the upper extremity developed only after subsequent establishment of ipsilateral arteriovenous (AV) fistulas. A literature review revealed eight similar cases. Cases are typical in the development of severe upper extremity edema 2 weeks to 25 months after establishment of AV fistulas and in the site of the stenosis that is near the junction of the SCV and internal jugular vein. It is evident from reported studies of asymptomatic patients that SCV stenosis or thrombosis is a common sequel to cannulation of the SCV with HCs. Awareness of potential delayed stenosis is critical in planning vascular access procedures. Recognition of this complication enables intervention that may preserve the fistula. Balloon dilatation was performed on our patients with initial success followed by restenosis in one patient.

Adult↗
PubMed1985

Factitious brittle diabetes mellitus.

Five patients are described in whom factitious disease was the cause of brittle type I diabetes mellitus. The patients were referred from throughout the United States because their physicians had been unable to establish the reason for recurrent hospitalizations for diabetic ketoacidosis or coma. In three of the patients, unexplainable signs, symptoms, and/or laboratory results lead to the diagnosis of factitious disease. In the two remaining patients, long-term follow-up was necessary before a factitious cause was established. These five patients exemplify the extraordinary measures that some patients will utilize to continue as a "patient" rather than return to a normal lifestyle.

Adult↗
PubMed1985

Altered patterns of posttransplant urinary tract infections associated with perioperative antibiotics and curtailed catheterization.

Postoperative urinary tract infections (UTIs) in renal transplant patients were studied before and after introduction of a protocol requiring single-dose perioperative antibiotics and earlier catheter removal. The overall incidence of UTIs was reduced from 55.4% to 26%. The most dramatic reduction was in nondiabetic males, from 56% to 8.2%. There was a small but statistically insignificant reduction in infection rates in females. There was no change in the rate of infection in diabetics. The incidences of noncoliform and mixed infections, in the group as a whole, were dramatically reduced from 42.9% to 12%, but Escherichia coli infections were totally unaffected. This protocol exposed the special susceptibility of women and diabetics to posttransplant UTIs and the different pathogenesis of E coli versus noncoliform infections. These features need more study.

Anti-Bacterial Agents↗
PubMed1985

Decreased plasma volume in post-transplant erythrocytosis.

Five patients, one woman and four men, aged 24 to 54 years, developed abnormally high hematocrits between 4 and 22 months after renal transplantation. In four patients, red cell mass was above normal and plasma volume below normal. In one patient, both red cell mass and plasma volume were below normal. The cause of the deranged plasma volume was not evident. Decreased plasma volume may either contribute to or may, in rare instances, be the only cause of apparent erythrocytosis in renal transplant recipients.

Adult↗
PubMed1985

Hepatic subcapsular hemorrhage associated with pregnancy.

A case of subcapsular hematoma with hemorrhage from the left lobe of the liver in a 37-year-old multiparous patient with toxemia is reported. Approximately 120 cases have been reported in the past, mostly in obstetric and gynecologic journals. The great majority of hematomas were in the right lobe. A triad of toxemia of pregnancy, right upper quadrant pain, and sudden hypotension has been described in these cases. The etiology of subcapsular hemorrhage in patients with toxemia is likely due to fibrin thrombi in hepatic arterioles and sinusoids with periportal hemorrhagic necrosis, since this has been observed in fatal cases. Presumably, subcapsular hemorrhage, once initiated, perpetuates itself to involve an entire lobe. The overall mortality rate in these patients remains at about 75%. Failure to recognize the syndrome and intervene surgically almost always results in death. The only hope for survival is laparotomy with prompt control of hemorrhage. Hepatic artery ligation to control hemorrhage should probably be avoided it is clear that toxemia is a generalized process that adversely affects hepatic reserve and that further compromise may not be tolerated.

Adult↗
PubMed1983

Bovine carotid artery heterografts versus polytetrafluoroethylene grafts. A prospective, randomized study.

A prospective, randomized comparison of BCAH and PTFE vascular access grafts resulted in no statistically significant difference when analyzed for survival rates of complications, types of complications, reasons for failure, and clot salvageability. The results in diabetic patients were similar to those in nondiabetic patients. The majority of retrospective studies and subjective experiences favor PTFE grafts over BCAHs. The explanation may be part that BCAH preceded PTFE grafts into clinical use, and inexperience in the operating room and in the dialysis unit had an effect on BCAH results. A review of impressions of the graft materials indicated a decided preference for PTFE grafts.

Adolescent↗
PubMed1983

Morbidity and mortality after operation in nonbleeding cirrhotic patients.

The purpose of this study has been to provide information on the mortality and morbidity rates for operation on nonbleeding cirrhotic patients and to identify factors that portend a grave prognosis. A review of 102 cirrhotic patients who underwent a variety of major therapeutic operations revealed a mortality rate of 19.6 percent. Mortality rates were significantly increased (p less than 0.05) by emergency operation (45.8 percent), gastrointestinal related operation (27.6 percent), ascites (37.5 percent), a bilirubin concentration greater than 3.5 mg (44.4 percent), a prothrombin time increase greater than 2 seconds (36.1 percent), a partial thromboplastin time increase greater than 2 seconds (50 percent), an alkaline phosphatase concentration greater than 70 units (40.9 percent), an operative blood loss greater than 1,000 ml (33.3 percent), and the presence of one or more postoperative complications (39.6 percent). Mortality rates were not increased after extremity, genitourinary, or gynecologic operations, an albumin concentration less than 3 g, a serum glutamic oxalacetic transaminase concentration greater than 40 units, hepatomegaly, and a history of previous gastrointestinal bleeding. When significant risk factors were added, mortality rates were significantly associated (p less than 0.001): zero to one factors 5.1 percent, two to three factors 19.4 percent, four to five factors 33.3 percent, and more than six factors 66.7 percent. The complication rate was 47.1 percent and included liver failure (42.2 percent), sepsis (18.6 percent), and bleeding (8.8 percent). Thus, in cirrhotic patients a clear need for operation must exist, liver function must be optimized preoperatively, and the most simple and expeditious procedure must be performed to avoid excessive blood loss and postoperative complications.

Adult↗
PubMed1979

A new vascular access procedure for immediate as well as chronic hemodialysis.

A new vascular access procedure consists of attaching an arteriovenous shunt to a subcutaneous arteriovenous fistula. The procedure was designed for patients who need immediate as well as long term hemodialysis and in whom the Brescia-Cimino type of fistula could not be done. Secondary objectives for this new procedure were a prolonged patency interval and a lower complication rate of arteriovenous fistulas. Six patients underwent this procedure and were observed from two to five months. Five shunts remained patent for a minimum of two weeks. Five patients have presently functioning fistulas, and in three of these, both shunts and fistulas remain patent. Two of the presently functioning shunts required declotting. Two shunts were removed when neither declotting nor revision was possible, and one shunt was removed because of infection. One fistula was lost due to a technical error, and two of the five presently functioning fistulas have required declotting. We believe clotting was due chiefly to the fact that patients selected for this procedure were from the group who had multiple previous clotting episodes and vascular access procedures. It remains to be seen whether or not more careful patient selection will accomplish the secondary objectives.

Arm↗
PubMed1978

Echocardiographic assessment of cardiac performance in patients with arteriovenous fistulas.

This noninvasive echocardiographic study of cardiac performance in 27 patients with chronic renal failure and vascular access documented the magnitude of forward cardiac output to be 65 per cent of the observed index. Hemodialysis resulted in acute hemodynamic changes, including an average fall in the cardiac index of 57 per cent, presumably because of a 40 per cent decrease in left ventricular filling volume. In patients in whom the vascular access had functioned longest, a time related cardiac decompensation is suggested by a cardiac index of significantly less than normal, p, 0.0013, with occlusion. Ventricular function was suboptimal three months post-transplant, as reflected by a continued low cardiac index and depressed ejection fraction, although the general reduction in cardiac index and diastolic volume on postoperative day 7 was of the magnitude expected from arteriovenous access occlusion.

Animals↗