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Biomedical subjects

W Gill

Publications and source records attributed to W Gill.

At least 19 recordsLinked to original sources

Aspects of the pathology and etiology of 'drippy gill' disease of the cultivated mushroom Agaricus bisporus.

Agaricus bisporus sporocarps exhibiting characteristic 'drippy gill' symptoms from a natural outbreak were examined. Discrete bacterial droplets on the hymenial lamellae often coalesced to form ribbons of bacterial ooze. Longitudinal splits on the stipe were lined with a similar bacterial ooze. Bacteria isolated from both the hymenium and stipe were identified as Pseudomonas agarici, and were confirmed to be the causal organism by satisfying Koch's postulates. By light and transmission electron microscopy, the causal bacteria were found to colonize the extrahyphal spaces and degrade the extracellular matrix within affected sporocarps. Degradation of the extracellular matrix was shown to reduce the integrity of the sporocarp, and result in stipe splitting and hymenium disruption. In artificial inoculations of the pileus, bacteria were shown to exist predominantly in sporocarp tissue below the point of inoculation and above affected areas of the hymenium, indicating an approximately vertical passage through the sporocarp via the extracellular spaces. The dissolution of the extracellular matrix, and the observed failure of the bacterium to produce a toxin active against A. bisporus, allow the bacteria to pass through protective membranes unnoticed, and infect the stipe and hymenium prior to veil break. These observations dispel previous assumptions of intrahyphal existence and transmission. In the few instances in which the bacteria were observed to be intrahyphal, the host fungal cell wall was often broken, suggesting intrahyphal existence was opportunistic rather than obligatory. The taxonomic position of a bacterium isolated previously from sporocarps exhibiting symptoms similar to those of drippy gill was determined by examining the biochemical and nutritional profiles of the bacterium, and comparing them with other Pseudomonas agarici isolates.

Agaricus↗

[Extracorporeal membrane oxygenation in neonatology: review of the use of the method].

Extracorporeal life support and extracorporeal membrane oxygenation characterize the use of mechanical devices for temporary support of heart and lung function. The mechanical circuit consists of a blood pump (heart), membrane oxygenator (lung: which accomplishes both carbon dioxide removal and oxygen delivery), heat exchanger and a servo-control module. Venous blood is drained from the right atrium through the right internal jugular vein, and returned oxygenated through either the right common carotid artery (venoarterial bypass), or into a large vein (venovenous bypass). All patients treated must be free of coagulopathies, as all patients are anticoagulated. Neonatal candidates should be older than 34 weeks gestational age and weigh more than 2000 grams. As of March, 1997 twenty six patients have been treated with extracorporeal life support at Tulane Medical Center with an overall survival rate of 62%. Twelve neonates with either meconium aspiration or pneumonia have been treated with a 100% survival. Six children with congenital diaphragmatic hernia have been unsuccessfully treated.

Extracorporeal Membrane Oxygenation↗

Glucagon influence on gluconeogenesis and oxidation of propionic acid and threonine by perfused ovine liver.

An in situ ovine liver perfusion technique was developed and used to study glucagon effects on utilization of simultaneously infused propionic acid and amino acids. Physiological amounts of propionic acid and amino acids (hydrolyzed casein) were infused into livers along with carbon-14 propionic acid or carbon-14 threonine with and without glucagon. Glucagon (5 mg) caused a 75% increase of glucose synthesis and a 19% increase of labeled carbon dioxide production from carbon-14 propionic acid. There also was a decrease of perfusate urea nitrogen when glucagon was present. Glucagon caused a 76% decrease of carbon-14 threonine utilization by ovine livers, and labeled carbon dioxide production from carbon-14 threonine was only 38% of control when glucagon was infused. From these results, glucagon caused an increase of use of propionic acid and a decrease of use of threonine for energetic pathways in sheep liver. Therefore, glucagon directly or indirectly may mediate amino acid sparing by ruminant liver.

Animals↗

[Retrograde brush biopsy of the kidney pelvis and ureters].

Brush biopsies of the kidney and ureter have become established as the most definitive method for the determination of the etiology of lesions arising in or invading into the urinary collecting passages. Retrograde brushing via cystoscopic passage of open-end brushing catheters (5 to 8 French) with subsequent brushing of lesions under TV monitored image intensified fluoroscopic control is the most widely employed brushing technique. Antegrade brush biopsies via percutaneous passage of catheters through the renal pelvis has recently been described by Lang. Recent additions to retrograde brush biopsy include steerable or manipulable tips of brushing catheters to facilitate access to minor calyces. Ureteroscopy with rigid transcystoscopic ureteroscopes has been developed by Lyon to facilitate passage of brushing catheters and in selected instances the direct endoscopic observation of lesion during brushing. Both brushing histology and brushing cytology, with smears of brushes and saline washes post brushing, are integral parts of brush biopsies. Urothelial cytopathology requires special expertise in interpretation of the various effects of drugs, iodine radiographic media and inflammatory lesions on the various cell types of the urothelial layers. The safety and efficacy of retrograde brush biopsy has been published by Gittes (J Urol (1981) 126:146) from his survey of 70 urologists.

Biopsy↗

Steroid hypothermia.

A retrospective study of 17 episodes of septic shock was made. In most patients, intravenous treatment involving a 2 gram bolus of Solu-Medrol produced a precipitous fall in temperature within four hours. Accompanying the temperature change was an improvement in their general physical condition. The hypothermic effect usually lasted approximately 30 hours, after which the temperature would reach a level below the presteroid temperature or would return to the presteroid level. If the sepsis was overwhelming and the patient did not survive, thetemperature response was not as dramatic and lasted approximately eight to ten hours, with no clinical improvement.

Fever↗

Urinary cyclic AMP and post-traumatic acute renal failure.

Consecutive daily urinary excretion of cyclic AMP has been investigated in 16 patients with severe trauma or illness, five of whom developed acute renal failure (ARF). Fluctuations in the nucleotide excretion exceeded the range found in 20 healthy volunteers (1.26-14.74, mean 7.13+/-1.18 vs. 2.04-10.10, mean 5.07+/-2.21 micronmol/24 h). This resulted in a 41% increase of cAMP excretion in the group with normal renal function (P less than 0.003) with the highest individual increase of 87%. The excretion usually reached its peak by 24 h after trauma and its lowest value by the third day, (first day vs. third day; 7.82+/-4.23 vs. 3.96+/-2.58 micronmol/24 h, P less than 0.05 for a group of 11 patients), while creatinine clearance remained normal. In four patients with severe ARF, the mean urine volume was above control value but the cAMP excretion was reduced to 3.9 to 14.4% and in one patient with a mild ARF to 60.6%. Creatinine excretion of the group was less reduced than that of cAMP (41.2% vs. 19.6%, resp.). cAMP excretion declined proportionally with diminishing creatinine clearance. In the category of 33-65 ml/min it decreased by 33.4% to 3.39 micronmol+/-1.16 micronmol/24 h. cAMP/creatinine ratio proved to be a less sensitive indicator than cAMP/24 h. Daily output of cAMP and creatinine correlated highly with diuresis in ARF patients, controls (always P less than 0.001) and less in patients with normal renal function (P less than 0.02). Urinary cAMP appears to be a very sensitive and early indicator of the onset of ARF and subsequent recovery. This warrants its further study.

Acute Kidney Injury↗

Trauma.

Explore the source record for details and available documents.

Abdominal Injuries↗

The effect of severe trauma on urinary cyclic AMP in children of different ages.

Under routine clinical conditions the urinary excretion of cyclic AMP was studied in 97 healthy children (3 months to 16 years old) and 65 child victims of various forms of trauma and proved to be age-dependent. The mean admission cAMP urinry levels for children of all ages were increased by 44.8% and were time dependent. In 26 injured children (3 months to 9.5 years old) the excretion increased to 12.10 +/-1.29 mumol cAMP/g creatinine as compared to 8.06 +/- 2.25 mumol cAMP/g crEAtinine (50.0%; P less than 0.01) and in 38 children (9.5-16 years) it rose to 6.43 +/- 4.12 from 4.72 mumol +/- 1.10 (36.2%; P less than 0.001). In 23 victims admitted within the first two hours after trauma the cAMP levels were elevated by 31.25% in contrast to 49.2% elevation in those admitted from 2 to 24 h after trauma. In a five-day follow-up of a group of 15 surviving patients the highest excretion of cAMP was found on the first day. It was followed by a steep decline until the values plateaued on the third day at values slightly elevated above control. Compared with the fifth day, the first day excretion expressed as mumol cAMP/24 h was enhanced by 92.3% (P less than 0.01) and as a ratio to creatinine (muol/g creatine) by 52.24% (P less than 0.05. In comparison with injured adults studied previously under analogical conditions, the cAMP excretory response to trauma in children differs in higher intensity (P less than 0.01) and in the nature of the daily pattern starting with the third day. It is pointed out that the intensity of the cAMP response to pathological stimuli may be age-dependent also in other clinical conditions.

Adolescent↗

Post-traumatic hepatic dysfunction as a major etiology in post-traumatic jaundice.

Thirty-eight patients who had sustained acute trauma, profound hemorrhagic shock, and massive transfusion were studied prospectively to determine the predominant etiologic factors in the development of post-traumatic jaundice. An analysis of clinical and biochemical factors occurring in association with each bilirubin peak in the postoperative course found the jaundice related to transfusion and surgery in 11 instances, to sepsis and septicemia in 15 instances, and to hepatic dysfunction in 23 instances. Results indicated that admission estimates of SGOT and LDH levels, the height of the bilirubin peak and the postoperative day on which it occurs, and the white cell count and GGT at the time of the peak may be of use in the differential diagnosis. Four case reports were used to emphasize the fluctuating pattern of jaundice and the different etiologic factors that may predominate. Light and electron microscopy from three patients illustrated the structural alterations that accompany the biochemical impairment of liver function and enable a more precise appreciation of this syndrome. Hepatic dysfunction appears to be implicated in a high proportion of patients who develop post-traumatic jaundice, which frequently occurs as part of a spectrum of multiple organ failure.

Adolescent↗

Marlex mesh in gas gangrene.

Clostridial gas gangrene is a well recognized complication of traumatic and surgical wounds, and is associated with an overall mortality rate of 25% (5, 22). Gas gangrene of a limb results in a mortality rate approximately half that of gas gangrene of the trunk (4, 7, 8, 9, 11, 12, 13, 15, 16, 19, 24). Radical debridement and antibiotic therapy or high amputation of involved limbs are accepted traditional approaches to the problem. The role and value of hyperbaric oxygenation (OHP) remains controversial despite intense study over the past few decades. Patients with gas gangrene involving all layers of the abdominal wall as well as an extremity pose major resuscitative, operative, supportive, and rehabilitative problems. A report is presented of two such patients with comments on the therapeutic modalities employed.

Abdominal Injuries↗

Fluid therapy in the critically injured patient.

Sufficient clotting factors to ensure coagulation and replacement of lost volume and oxygen-carrying capacity are necessary to obviate many of the complications that may occur when massive transfusions are used in patients with multiple injuries. A regimen that has been successful includes immediate infusion of plasma protein fraction, packed red cells, fresh-frozen plasma, and nonspecific platelets.

Blood Coagulation Disorders↗