Anatomy and imaging of the lesser peritoneal sac.
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Humans↗
Biomedical subjects
W J Dodds
Publications and source records attributed to W J Dodds.
Evaluation and treatment of intraabdominal bilomas.
In a 3-year period, 21 intraabdominal bilomas developed in 18 patients. Fifteen of the patients had a solitary biloma, and the other three patients each had two separate concurrent bilomas. The major cause of biloma formation was postoperative bile leakage from a bile duct after laparotomy done primarily for surgery on the gallbladder or liver. Maximal diameter of the bilomas in the transaxial plane ranged from 2 to 19 cm. Sixteen of the bilomas were in the right upper quadrant, and five were in the left upper quadrant. Two large right-sided collections extended caudally into the lower abdomen. The contours of the bilomas were configured by the diaphragm, mesenteries, liver, and other abdominal organs. On CT and sonography, the bilomas were invariably well demarcated, but most did not have an identifiable capsule. CT did demonstrate a thin rim on four bilomas and a thick rim on one. In 19 bile collections, the CT numbers were less than 20 H. The combination of the clinical history, the location, and the CT appearance of the lesion led to the correct diagnosis in each case. Percutaneous drainage was an effective form of therapy that often eliminated the need for surgical drainage.
Abdomen↗
Colonic perforation in renal transplant patients.
Review of 713 renal transplant patients at the Medical College of Wisconsin yielded 17 (2.3%) with spontaneous colon perforation. The cause seemed to be related to nonocclusive ischemia in the majority of cases (nine). The sigmoid colon was the most common site of perforation (nine cases). The early detection of colon perforation suspected on radiographic examination was associated with improved survival statistics.
Adolescent↗
Sonographic measurement of gallbladder volume.
Sonographic images of the gallbladder enable satisfactory approximation of gallbladder volume using the sum-of-cylinders method. The sum-of-cylinder measurements, however, are moderately cumbersome and time consuming to perform. In this investigation, in vitro and in vivo testing was done to determine that a simple ellipsoid method applied to sonographic gallbladder images yields reasonable volume approximations that are comparable to the volumes calculated by the sum-of-cylinders method. Findings from a water-bath experiment showed that measurement of gallbladder volume by the ellipsoid method closely approximated the true volume with a mean difference of about 1.0 ml. The results of in vivo studies in five volunteers demonstrated that the gallbladder contracted substantially after a fatty meal and that volumes calculated by the ellipsoid and sum-of-cylinders methods were nearly identical. Thus, a simple ellipsoid method, requiring negligible time, may be used to approximate satisfactory gallbladder volume for clinical or investigative studies.
Gallbladder↗
Platelet and fibrinogen kinetics in healthy and African swine fever-affected swine: [75Se]selenomethionine-labeling study.
Platelet and fibrinogen survival times were determined in healthy pigs and in pigs infected with African swine fever (ASF) virus. Cohort labeling with [75Se]selenomethionine was performed. The platelet survival time in healthy pigs was 5.3 +/- 0.7 days, and the fibrinogen survival time was 6.7 +/- 0.8 days. Early deaths and profound thrombocytopenia prevented calculation of accurate platelet and fibrinogen survival times in ASF virus-infected animals. The ASF virus-infected pigs died of extensive hemorrhage and effusions while thrombocytopenic; however, there was normal thrombocytopoiesis during infection, as measured by incorporation of the radionuclide into platelets. There was a slight decrease in plasma fibrinogen concentration when the platelet count decreased. A dysfunctional fibrinogen was present late in the infection.
African Swine Fever↗
Mechanism of thrombocytopenia in African swine fever.
Pigs were inoculated with an African swine fever (ASF) isolate of moderate virulence, and the changes in the number of circulating blood platelets during infection were correlated with the appearance of antiviral antibody and fluctuations in total plasma hemolytic complement concentrations. Thrombocytopenia was detected by postinoculation days (PID) 7 and 8, and antiviral antibody was detected by PID 7, using an indirect immunofluorescence technique. The total hemolytic complement concentration was moderately and transiently decreased from PID 5 to 9, but was consistently low from PID 18 to 26. Pigs inoculated with an ASF virus isolate of greater virulence had a decrease in platelet counts on PID 6 and 7, and the total plasma hemolytic complement levels decreased in all pigs by PID 6 to 7. Antibody to ASF virus was not detected in pigs inoculated with the more virulent isolate. Pigs sensitized to ASF viral antigen with an inactivated-virus vaccine or by previous infection with ASF were challenge exposed. Sensitized pigs became clinically ill and thrombocytopenic by 24 to 72 hours earlier than did inoculated, nonsensitized pigs. Vaccinated pigs inoculated with homologous virus had lower blood virus concentrations than did nonvaccinated pigs. African swine fever virus-sensitized pigs inoculated with heterologous virus had a higher fatality rate than did nonsensitized pigs, and the pigs died peracutely, with only a few gross lesions in evidence. In vitro experiments demonstrated that ASF virus antigen induced platelet aggregation in platelet-rich plasma from recovered, nonviremic pigs. Viral antigen, antibody, or complement was not demonstrable on the surface of platelets from pigs inoculated with ASF virus isolate, by direct immunofluorescence testing.
African Swine Fever↗
Factor IX deficiency (hemophilia B) in a litter of Labrador retrievers.
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Animals↗
Effect of esophageal emptying and saliva on clearance of acid from the esophagus.
We studied clearance of acid from the esophagus and esophageal emptying in normal subjects. A 15-ml bolus of 0.1 N hydrochloric acid (pH 1.2) radiolabeled with [99mTc]sulfur colloid was injected into the esophagus, and the subject swallowed every 30 seconds. Concurrent manometry and radionuclide imaging showed nearly complete emptying of acid from the esophagus by an immediate secondary peristaltic sequence, although esophageal pH did not rise until the first swallow 30 seconds later. Esophageal pH then returned to normal by a series of step increases, each associated with a swallow-induced peristaltic sequence. Saliva stimulation by an oral lozenge shortened the time required for acid clearance, whereas aspiration of saliva from the mouth abolished acid clearance. Saliva stimulation or aspiration did not affect the virtually complete emptying of acid volume by the initial peristaltic sequence. We conclude that esophageal acid clearance normally occurs as a two-step process: (1) Virtually all acid volume is emptied from the esophagus by one or two peristaltic sequences, leaving a minimal residual amount that sustains a low pH, and (2) residual acid is neutralized by swallowed saliva.
Acids↗
Computerized analysis of spike-burst activity of the upper gastrointestinal tract.
Although the electrical recording of spike-burst activity is a well-established technique, the visual-manual analysis of the electrical tracings is laborious and time consuming. Current automated methods for analyzing upper gastrointestinal spike-burst activity involve the use of computer systems capable of storing large quantities of data. We describe herein an automated system for counting myoelectrical spike bursts that provides online detection of spike bursts using a laboratory computer. Because only the parameters that describe each burst are stored, only a minimal amount of computer memory is required. Subsequent analysis of stored information yields tabular or graphical output of data. Results of the computer analysis are comparable with those obtained by visual-manual assessment.
Animals↗
Relationship between swallow rate and salivary flow.
Recent studies indicate that swallow-induced, primary peristalsis is a major determinant of normal esophageal acid clearance. However, factors that regulate the rate of spontaneous swallowing in normal subjects are incompletely understood. We postulated that the rate of salivary flow influences the rate of spontaneous swallows. To test this hypothesis, we did a total of 60 studies measuring salivary flow or the rate of spontaneous swallowing in 10 healthy volunteers, age 10-30 years. Saliva was collected by expectoration. Swallow rate was recorded by a small, transnasal catheter stationed in the pharynx and also, in some circumstances, by cervical electrodes. On separate sessions, we evaluated the effect of five test manipulations on salivary flow and swallowing rate, respectively. The test manipulations consisted of: (1) pharyngeal intubation, (2) sucking of a dummy lozenge, (3) sucking of a peppermint lozenge, (4) bethanechol injection (5 mg subcutaneously), and atropine administration (12 micrograms/kg intravenously). Pharyngeal intubation caused a small, but significant increase in the rate of salivation and spontaneous swallows. Sucking of a peppermint lozenge caused a sixfold increase in salivary flow while nearly doubling the swallowing rate whereas the dummy lozenge caused only a modest increase in salivary flow and swallowing. Cholinergic stimulation by bethanechol elicited a substantial increase in salivary flow and swallowing rate. In contrast, atropine caused a significant decrease in both salivary flow and swallowing. We conclude that in awake, normal subjects the rate of spontaneous swallows is influenced directly by salivary flow. Because oral lozenges substantially increase both swallowing rate and salivary flow, such agents merit investigation as a potentially useful ancillary treatment for the relief of heartburn.
Adolescent↗
A practical technique for preparation of antiserum to canine factor VIII-related antigen.
Identification and measurement of canine factor VIII-related antigen (VIIIR:Ag) has many clinical and research applications, including differential diagnosis of hemophilia A and von Willebrand's disease, use as a marker for specific cell types, and elucidation of the structure of this factor VIII component. We have developed a practical method for producing antibodies to canine VIIIR:Ag that uses 2% agarose filtration for purification and identifies the antigen by correlation with the elution of the peak A280 fraction in the void volume. Antisera for electroimmunoassay (EIA) can be produced in less than four weeks from simple starting materials and with commonly available laboratory equipment. This technique would be useful for either clinical veterinary or comparative research laboratories.
Animals↗
Von Willebrand factor (VIII R:Ag), fibronectin, and insulin-like growth factors I and II in diabetic retinopathy and nephropathy.
We have measured plasma von Willebrand factor (VWF) as the factor VIII-related antigen, plasma fibronectin, and two of the serum somatomedins, insulin-like growth factor I (IGF I) and IGF II, in 51 diabetic patients and 25 nondiabetic control subjects. VWF was significantly higher in the diabetic group than in the controls (173 +/- 9% SEM versus 101 +/- 9%, P less than 0.001), as has been reported by others. However, within the diabetic group there was no significant difference in VWF between those patients without retinopathy, those with background or proliferative retinopathy, or those with macular edema. There was also no difference in VWF between the diabetic subjects with and those without proteinuria. These results rule against a previously advanced hypothesis that the increase in VWF in patients with diabetes is secondary to microangiopathy. No significant difference was observed in fibronectin, IGF I, or IGF II between the diabetic and control groups, between the diabetic group without retinopathy and the retinopathic subgroups, and between the diabetic subjects with and without proteinuria. In the diabetic patients, there was no correlation between diabetic control as assessed by glycosylated hemoglobin and glycosylated serum protein, and the plasma levels of VWF, fibronectin, IGF I, or IGF II. The results of this study strongly suggest that neither plasma VWF, fibronectin, IGF I, nor IGF II plays an important primary role in the pathogenesis of diabetic microvascular disease, although one or more of these factors might play a permissive role.
Adult↗
Influence of transsphincteric fluid flow on spike burst rate of the opossum sphincter of Oddi.
In this study, we evaluated the effect of transsphincteric fluid flow on the rate of spike bursts in the opossum sphincter of Oddi (SO). For chronic studies in awake animals, bipolar electrodes were implanted on the SO, gastric antrum, duodenum, and jejunum. In group 1 animals, surgery was limited to electrode implantation. Subsequently, these animals underwent a cholecystectomy. Group 2 animals had electrode implantation without further surgery. In group 3 animals, bile flow was diverted around the SO, whereas in group 4 animals, pancreatic juice as well as bile was diverted around the SO. Multiple myoelectric recordings were obtained in each animal during fasting and after feeding. In fasted control animals, the rate of SO spike bursts showed cyclic increases synchronous with phase III of the duodenal migratory myoelectric complex. Feeding increased the rate of SO spike bursts. Cholecystectomy had no effect on SO spike bursts in fasted animals. Diversion of bile or bile and pancreatic juice around the SO did not alter the fasting pattern of SO spike bursts. However, flow diversion in the group 3 and group 4 animals did cause a modest decrease of SO spike bursts, from approximately 2/min to about 1/min, during phase I of the duodenal migrating myoelectric complex (p less than 0.05). Sphincter of Oddi spike-burst rate was not affected during the remainder of the migrating myoelectric complex cycle. Neither cholecystectomy nor flow diversion caused any change in the normal SO responses to feeding. Excitatory SO responses caused by motilin or by cholecystokinin-octapeptide were shown to be independent of changes in transsphincteric flow. We conclude that variations in transsphincteric flow cause only minimal alteration of the rate of spike bursts in the opossum SO during fasting. Therefore, factors other than transsphincteric flow, such as hormonal or neural influences, appear to be the major mechanism(s) that regulate the rate of SO contractions in awake opossums.
Action Potentials↗
Von Willebrand's disease in dogs.
Von Willebrand's disease, the most common, mild, inherited bleeding disorder of animals, is an autosomal trait generally causing high morbidity and low mortality and affecting many breeds of dogs. Clinical signs include hematuria, epistaxis, gingival or genital mucosal bleeding, lameness, and prolonged bleeding from cut nails or wounds. Concurrent hypothyroidism exacerbates the disease. Affected dogs and carriers should not be bred or should be tested for von Willebrand's factor before breeding. Treatment involves IV infusion of fresh whole blood or plasma, at 3-5 ml/lb, with topical use of hemostatic compounds, and avoidance of drugs that interfere with hemostasis.
Animals↗
Age-related renal, hematologic, and hemostatic abnormalities in FH/Wjd rats.
This longitudinal study compared the renal morphologic changes and hemostatic defects of FH/Wjd rats at different ages. A second aim was to determine whether the bleeding tendency becomes intensified in older animals by the concomitant renal disease. Results indicated that reduced capacity for platelet 14C-serotonin release (P less than 0.01) was found for each age group studied in comparison with Wistar controls. The nephropathy of old FH/Wjd male rats was more severe than that in either FH/Wjd females or age-matched Wistars of both sexes. The mesangial lesions showed abundant deposits of factor VIII-related antigen, fibronectin, and immunoglobulins, but not C3, along with tightly packed or loose electron-dense material. Polyethylene glycol precipitation and platelet aggregation tests detected small amounts of circulating immune complex-like material. Old FH/Wjd rats did not develop edema, and the glomerular filtration rate remained normal despite the persistent proteinuria, hematuria, and arterial hypertension characteristic of this strain. Our data indicated that the congenital platelet dysfunction does not become more severe in older animals and that the nephropathy seems unrelated, does not appear to be mediated by immune complexes, and, in contrast to the focal segmental glomerulosclerosis of persons, the lesions progress without a parallel impairment of renal function.
Aging↗
Coagulation changes in African swine fever virus infection.
Pigs were infected with highly virulent (Tengani '62), with moderately virulent (DR '79) African swine fever (ASF) virus, or with virulent hog cholera (HC) virus. Changes in platelet counts, selected coagulation assays and concentrations of factor VIII-related antigen (VIIIR:Ag) were monitored. Permeability of aortic endothelium was studied after the injection of Evan's blue dye on various days after infection with DR '79 ASF virus. Virulent ASF virus caused prolongation of the activated partial thromboplastin time (APTT), 1-stage prothrombin time, and thrombin clotting time as early as postinoculation day (PID) 4. These changes became progressively more severe until death. Both virulent HC and DR'79 viruses induced an increase APPT and thrombin clotting time at PID 3 to 4, only occasionally did the prothrombin time increased significantly (P less than 0.01). The APPT began to decrease on PID 7 and 8, but only DR'79-infected pigs lived long enough to regain a normal APTT. Infection by ASF viruses caused acute thrombocytopenia after PID 6 and platelet counts of HC virus-infected pigs decreased progressively from the onset of fever to levels of 1 to 2 X 10(5)/mm3 at PID 6 to 7. All ASF virus-infected pigs had an increase in VIIIR:Ag beginning at PID 3, with maximum increases at PID 6 to 7. Hog cholera virus infection did not cause consistent changes in levels of VIIIR:Ag. Pigs infected with DR'79 virus did not have increased vascular permeability to Evan's blue dye during infection; however, there was markedly decreased staining of the aorta after pigs became thrombocytopenic.
African Swine Fever↗
Endoscopic sphincterotomy: follow-up evaluation of effects on the sphincter of Oddi.
Endoscopic sphincterotomy (ES) alters the structure and motor function of the sphincter of Oddi (SO). The magnitude and duration of these changes, however, have not been critically examined. Before ES, 22 patients with common bile duct stones were evaluated by endoscopic retrograde cholangiography. The pressure gradient between the common bile duct and the duodenum, the SO basal pressure, and the SO peak phasic pressures were obtained. After ES, the electrosurgical incision length was determined using the extended papillotome and an inflated Fogarty balloon as reference. A high correlation existed between the endoscopist's estimate of ES incision size using this technique and the actual length of simulated incisions fashioned in cardboard mounts. These studies were repeated in all 22 patients at 1-yr follow-up and in 8 of these patients at 2-yr follow-up. At 12 mo and 24 mo after ES, the common bile duct (CBD) to duodenal pressure gradient and the sphincter of Oddi basal pressure were virtually eliminated. The amplitude of SO phasic contractions was significantly diminished 12 mo after ES (124 +/- 16 mmHg to 37 +/- 10 mmHg; p less than 0.001), but 24 mo after ES, SO phasic contraction amplitude was not significantly different from the values before ES. Incision length at 1-yr follow-up was reduced in the group of 22 patients from 11.6 +/- 0.8 mm to 8.3 +/- 0.5 mm (p less than 0.001), and in the group of 8 patients from 11.0 +/- 1.5 mm to 7.5 +/- 0.7 mm (p less than 0.025). After an additional 12 mo, however, i.e., 24 mo after ES, the incision length was 6.5 +/- 0.7 mm. There was no significant difference in incision length between the 12-mo and 24-mo examinations. We conclude that after ES, incision length decreases during the first year. There appears to be no further significant reduction in incision length at 2 yr. In addition, the reduction of the CBD to duodenal pressure gradient and the SO basal pressure remain unchanged for at least 2 yr. These manometric findings support the observation that after ES the enlarged opening of the CBD into the duodenum remains open for at least 2 yr.
Ampulla of Vater↗
Role of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of choledochocele.
Choledochocele is a rare abnormality involving the intramural segment of the common bile duct. It may present clinically as recurrent acute pancreatitis, biliary colic, or cholestatic jaundice. A choledochocele may be easily overlooked by the conventional diagnostic methods, such as upper gastrointestinal series, intravenous cholangiogram, abdominal ultrasound, and computed tomography. Endoscopic retrograde cholangiopancreatography is helpful in demonstrating a choledochocele. Additionally, in selected cases, a choledochocele may be effectively managed by endoscopic sphincterotomy. We present the clinical, endoscopic, and radiographic findings in a series of 8 patients with choledochocele. The radiologic technique most useful in demonstrating a choledochocele at the time of endoscopic retrograde cholangiopancreatography is detailed. The pathogenesis, differential diagnosis, and relevant current literature pertaining to choledochocele are discussed.
Aged↗