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Biomedical subjects

W Marshall

Publications and source records attributed to W Marshall.

At least 19 recordsLinked to original sources
PubMed1992

Routine pelvic x-ray studies in awake blunt trauma patients: a sensible policy?

To evaluate the usefulness of routine pelvic x-ray films in the resuscitation of blunt trauma victims, 1395 patients were prospectively evaluated over a 13-month period. Of these, 810 (58%) were awake with Glasgow Coma Scale scores greater than or equal to 13 and were enrolled into the study. A history, with directed questions regarding pelvic pain, a clinical examination of the pelvis, and an anterior-posterior pelvic x-ray film (APPX) were obtained for each patient. Thirty-nine patients (5%) had fractures identified on the x-ray films. Of these patients with radiographically identified fractures, 34 (87%) complained of pain and had positive results on clinical examination, two (5%) either complained of pain or had positive results on examination and three (8%) had neither complaint of pain nor positive examination results. Of the 771 patients without fractures 743 (96%) lacked pain complaints or positive examination results. The likelihood of fracture was greatest in patients with complaints of pain and positive examination results (65%) followed by patients with either complaint of pain or positive examination results (16%). Only three (0.4%) of the 743 patients having no complaints of pain and a negative clinical examination had fractures diagnosed roentgenographically. These were minor fractures that did not affect the clinical course. Total charges incurred to diagnose pelvic fractures in this low-yield patient group were $88,028. We conclude that the practice of obtaining a screening APPX is not necessary or cost-effective in the management of awake blunt trauma patients who do not complain of pain and who have normal pelvic physical examination results.

Adolescent↗
PubMed1990

Intestinal permeability in gastrointestinal disorders. Use of oral [99mTc]DTPA.

This study examined intestinal permeability in gastrointestinal disorders by measuring urinary recovery following oral administration of [99mTc]DTPA in 117 subjects. The mean percent of the ingested dose excreted in a 24-hr urine sample was 2.8 +/- 1.6% in 11 healthy controls, 10.8 +/- 10.2% (P less than 0.001) in 21 ulcerative colitis patients, 8.0 +/- 4.7% (P less than 0.001) in 35 Crohn's disease patients, 5.1 +/- 2.9% (P less than 0.01) in 17 patients with heterogeneous digestive disease diagnoses, and 3.2 +/- 4.7% (P greater than 0.05) in 33 patients with hepatobiliary diagnoses. Among ambulatory patients, Crohn's disease subjects, but not ulcerative colitis patients, had greater urinary recovery than the controls (P less than 0.05). The Crohn's disease activity index correlated positively with the radionuclide recovery in Crohn's subjects (r = 0.455, P less than 0.02). In a heterogeneous sample of subjects simultaneous ingestion of [99mTc]DTPA and [51Cr]EDTA produced urinary levels that were correlated positively (r = 0.556, P less than 0.001). Increased absorption of [99mTc]DTPA relative to [51Cr]EDTA, however, was noted in ulcerative colitis patients (P less than 0.05). In conclusion, increased intestinal permeability has been demonstrated by utilizing [99mTc]DTPA in Crohn's disease and ulcerative colitis patients. Although this observation appears to be a nonspecific indicator of injury, the test provides a simple objective means of establishing disease activity, which possibly may be utilized for therapeutic and investigative studies.

Administration, Oral↗
PubMed1990

Cerebrospinal fluid pressure in patients with brain tumors: impact of fentanyl versus alfentanil during nitrous oxide-oxygen anesthesia.

The effects on the cerebrospinal fluid pressure (CSFP) of alfentanil and fentanyl were compared during nitrous oxide-oxygen (N2O-O2) anesthesia in 24 patients who had brain tumors. Monitored variables included CSFP (lumbar subarachnoid catheter), heart rate from electrocardiographic lead II, mean radial arterial blood pressure, and arterial blood gas tensions. General anesthesia was induced with thiopental, 5 mg/kg IV in divided doses, and maintained with 70% N2O in O2; ventilation was held constant (PaCO2 = 37.4 +/- 1.6 mm Hg [mean +/- SEM]). After baseline data were recorded, 16 subjects were randomly assigned to receive either 5 micrograms/kg fentanyl as an intravenous bolus or 50 micrograms/kg alfentanil as an intravenous bolus, followed by an infusion of alfentanil at 1 micrograms.kg-1.min-1. Monitored variables were continuously recorded for 15 min after opioid injection. A third group of 8 patients was studied subsequently; they received only N2O-O2 during a 15-min observation period and served as controls. Blood pressure was held constant with an intravenous infusion of 0.1% phenylephrine, as needed; noxious stimulation was carefully avoided. Cerebrospinal fluid pressure remained unchanged both in patients who received N2O-O2 alone and in those who received fentanyl-N2O-O2. By contrast, those who received alfentanil-N2O-O2 had a gradual increase in CSFP, reaching 30% above baseline values after 10 min and stabilizing thereafter. Although the absolute increase in CSFP during normocarbic alfentanil-N2O anesthesia was relatively small (9.5 +/- 1.3 mm Hg to 13.0 +/- 1.3 mm Hg [mean +/- SE], P less than 0.05), the absence of a similar effect after fentanyl administration suggests that precautionary measures such as hyperventilation are advisable if alfentanil is used for potentiating normocarbic N2O-O2 anesthesia in neurosurgical patients with intracranial mass lesions.

Adult↗
PubMed1989

Circulatory support with a centrifugal pump as a bridge to cardiac transplantation.

Since January 1985, the Heart Transplant Program at Washington University Medical Center, St. Louis, has performed 89 heart transplantations in 86 patients. Twenty patients (23%) have required preoperative mechanical support of circulation or respiration prior to transplantation. The Bio-Medicus centrifugal pump (Bio-Pump) formed the basis of our circulatory support system during the period of this report. Nine patients were placed on the Bio-Pump with the intention of bridging them to transplantation. Six patients required left ventricular assistance; in 2, the device was inserted because they could not be weaned from cardiopulmonary bypass. Two patients required biventricular assistance, 1 because she could not be weaned from cardiopulmonary bypass at the end of a cardiac operation. Extracorporeal membrane oxygenation was necessary in 1 patient for right ventricular decompensation and cardiac arrest four hours after orthotopic cardiac transplantation. One of these 9 patients died on circulatory support, and in another, a complication developed that precluded transplantation. The remaining 7 patients (78%) underwent a successful transplant procedure after an average of 1.6 days of circulatory support (range, 0.5 to three days), and all are long-term survivors of transplantation. There has been 1 late death at 17 months from a cerebrovascular hemorrhage. In summary, the centrifugal pump provides excellent short-term circulatory support for individuals who would otherwise die before cardiac transplantation.

Adolescent↗
PubMed1989

Neuromodulation of synovitis: capsaicin effect on severity of experimental arthritis.

This study addresses the effect of capsaicin on the severity of inflammation in experimental arthritis in the cat. Animals were sensitized with methylated bovine serum albumin (mBSA) and sequential serum antibody levels measured by enzyme-linked immunosorbent assay (ELISA). Synovitis was induced by intra-articular injection of mBSA. Histopathology revealed marked inflammatory cell infiltration and synovial cell hypercellularity, in comparison with the saline-injected control joint which showed no synovitis. In animals given intra-articular capsaicin concurrently with mBSA, there was consistently a diminution in the severity of inflammation compared with contralateral joints receiving mBSA alone. In this experimental system capsaicin appears to moderate the severity of inflammation in feline antigen-induced arthritis.

Animals↗
PubMed1988

Emergency department infraclavicular subclavian vein catheterization in patients with multiple injuries and burns.

We assessed the complications associated with emergency department placement of subclavian vein catheters in trauma and burn patients, reviewing the charts of all of the 441 patients admitted to the burn-trauma unit through the emergency department during 1983. Fifty-two patients (12%) had infraclavicular placement of subclavian catheters while in the emergency department. Sex, age, insertion site, blood pressure at time of insertion, indications for placement, catheters left in place, and complications were recorded. Patients with severe chest trauma or known pneumothorax or hemothorax on the ipsilateral side of line placement were excluded. The eight complications (15%) directly attributable to the procedure itself were one pneumothorax, two hematomas at the site of insertion, one knotted catheter, two misplaced catheters, and two episodes of sepsis, confirming the higher complication rates for emergency subclavian catheter insertion. Two upper extremity, 14 gauge percutaneously placed intravenous catheters are usually sufficient for resuscitation; femoral and cutdown routes offer additional sites for massive resuscitation. Subclavian catheterization is seldom needed in the emergency room. Any intravenous lines inserted in the emergency room should be changed within 24 hours to minimize infection.

Burns↗
PubMed1987

Reduced brain Na+, K+-ATPase activity in rats with galactosamine-induced hepatic failure: relationship to encephalopathy and cerebral oedema.

Previously we have shown that sera from patients with fulminant hepatic failure (FHF) will inhibit partially purified rat brain Na+, K+-ATPase and sodium efflux from human leucocytes in vitro. Similar inhibition may be involved in the pathogenesis of encephalopathy and cerebral oedema in these patients. In the present study we have attempted to establish whether the activity of brain Na+, K+-ATPase is decreased in vivo in rats with D-galactosamine induced hepatic failure using homogenates of snap-frozen brains. Na+, K+-ATPase activity was significantly reduced in the forebrain region at the stage of mild encephalopathy (43 h after injection), while at the deeper stage of coma (43-53 h after injection) enzyme activity was further reduced in the forebrain region and was also significantly reduced in the hindbrain region. Ouabain insensitive ATPase activity was not significantly altered at any time. While a significant increase in the water content (0.5%) of the hindbrain region was found 43 h after galactosamine, there was no clear correlation between the development of cerebral oedema and the reduction of Na+, K+-ATPase activity. The activity of partially purified normal rat brain Na+, K+-ATPase was 15% lower when incubated with sera from rats in the deep stage of coma compared with control sera. These data support other evidence that the reduction in brain Na+, K+-ATPase is likely to be due to toxic substance circulating in serum which have been shown to inhibit this enzyme in vitro and to cause coma when administered to normal animals.

Acute Disease↗
PubMed1985

Sex hormone involvement in the development of experimental virally induced murine salivary gland tumors.

Mice were given a single inoculation of polyoma virus at birth and then orchidectomised or oophorectomised. Unoperated groups received polyoma virus alone whilst further males received testosterone, and females received oestradiol thrice-weekly in addition to polyoma virus inoculation. All groups were then observed over the succeeding 370 days for the development of tumors of the submandibular and parotid salivary glands. Polyoma virus inoculation selectively induced salivary gland tumors in 70% of male animals and 30% of female animals given polyoma virus alone. Testosterone therapy increased the salivary tumor frequency from 69-90% whilst orchidectomy reduced the tumor frequency to 50%. Oophorectomy or oestrogen therapy did not significantly alter the salivary gland tumor frequency in females but oestrogen therapy did result in the development of second primary tumors of breast in 60% of female animals bearing salivary gland tumors. The role of androgens in the development of virally induced salivary gland tumors is discussed as are the possible mechanisms responsible for the development of second primary tumor of breast.

Animals↗
PubMed1984

An implementation of dual energy CT scanning.

We have described a prereconstruction method for dual energy (PREDECT) analysis of CT scans. In theory, this method can (a) eliminate beam hardening and produce an accuracy comparable with monoenergetic scans and (b) provide the effective atomic number and electron density of any voxel scanned. Our implementation proves these statements and eliminates some of the objectionable noise. We constructed a phantom with a cylindrical sleeve-like compartment containing known amounts of high atomic number material simulating a removable skull. Conventional scans, with and without this beam hardener, were done of a water bath containing tubes of high electron and high atomic number material. Dual energy scans were then done for PREDECT. To increase the effective separation of the low and high energy beams by using more appropriate tube filtration, we fabricated a beam filter changer containing erbium, tungsten, aluminum, and steel. We used erbium, tungsten, and steel at high energy and aluminum, steel, and erbium at low energy for data acquisition. The reconstructions were compared visually and numerically for noise levels with the original steel only filtration. We found a decrease in noise down to approximately one-half the prior level when erbium/aluminum or tungsten/aluminum replaced the steel/steel filter. Erbium and tungsten were equally effective. Steel/erbium and steel/aluminum also significantly reduced image noise. The noise in the photoelectric (P) and Compton (C) images is negatively correlated. At any pixel, if the noise is positive in the P image, it is most probably negative in the C. Using this fact, the noise was reduced by postreconstruction processing.

Humans↗
PubMed1984

Study of the ductal epithelial cell component of human labial salivary glands in vitro.

Salivary gland cultures were propagated from primary explant cultures of 55 human labial gland biopsies. Cultures were maintained for at least 7 days in 199 medium plus 20% newborn calf serum and growth measured at this time both by cell counting and planimetry of the area. Ductal cell population identification was undertaken on the basis of an intra-cellular function, the latter being the histochemical detection of the enzyme 11 beta-hydroxysteroid dehydrogenase. Epithelioid cell lines were derived by enzymatic and mechanical means. Non-invasive quantitation of the proportion of ductal epithelial cells present in primary explant cultures, and derived cell lines, was attempted using a radioimmunoassay to detect conversion in the media of cortisol to cortisone. The cell lines were terminated after undergoing 18 passages over 20 weeks. By this time the epithelioid morphology of cells could no longer be equated to a differentiated epithelial cell origin since conversion of cortisol to cortisone in the growth media no longer occurred.

11-beta-Hydroxysteroid Dehydrogenases↗
PubMed1982

A quantitative study on growth and cell population identification in murine salivary gland culture.

Differentiation of neonatal salivary gland cell populations was studied in vitro using primary explant cultures. Growth on glass of the submandibular, sublingual and parotid salivary glands was optimal if the initial explant diameter was less than 0.4 mm and culture was in 199 medium plus 20 per cent newborn-calf serum. Growth was measured by planimetry of the area of cellular outgrowth as a monolayer with continuous cell contacts. Duct epithelial cells identified using ultrastructural, histochemical and immunological criteria, produced evidence of altered morphology by in-vitro conditions. Preservation of enzymic and antigenic markers of ductal epithelial cell origin in vitro irrespective of gross cell morphology allowed quantification of these cells in a mixed cell population.

Animals↗
PubMed1982

Central, as well as peripheral naloxone administration suppresses feeding in food-deprived Sprague-Dawley and genetically obese (Zucker) rats.

Food intake over 90 min post-injection was studied in groups of food deprived (20 hr) female Sprague-Dawley (S.D.) rats, fatty Zucker (fa/fa) rats and their heterozygous lean litter mates (Fa/fa) of various ages, that bar-pressed for food pellets on a FR-1 schedule following a subcutaneous (SC) or an intracerebroventricular (IVT) injection of sterile saline or naloxone HCl. Subcutaneous injections of naloxone HCl (10 mg/kg) reduced feeding in all three groups of rats compared to SC saline; in addition, a greater percentage reduction in food intake over the whole 90 min test period occurred in the fa/fa rats given SC naloxone compared to the Fa/fa group. Intracerebroventricular naloxone (50 micrograms) decreased feeding over the initial 30 min period in the S.D. and Fa/fa rats but a 100 micrograms IVT dose was needed to reduce feeding in the fa/fa group. The results demonstrate that central naloxone administration can suppress feeding in both non-obese and obese strains of rats as it is known to do when given peripherally. These findings add yet further evidence to the premise that endogenous opioid peptides may play an intricate and important physiological role in the regulation of feeding behavior.

Animals↗
PubMed1981

Legionnaires' disease in renal transplant patients.

Legionnaires disease, which is commonly manifested as pneumonia, was only recently recognized to be a bacterial infection. Diagnosis can be difficult because Gram's stain does not readily stain the bacterium in pulmonary secretions, the organism is not readily cultured, and legionellae is not affected by many commonly used antibiotics. In a retrospective review of all of our transplant patients, we identified 14 cases of Legionnaires' disease after 101 renal transplants. The patients characteristically had high fever, polymorphonuclear leukocytosis, dyspnea and an unproductive cough accompanied by radiographic changes of consolidating pneumonia. Legionnaires' disease can be diagnosed by direct immunofluorescent antibody staining, culture on special media or increases in serum titers of legionella antibodies in surviving patients. Since the recognition of Legionnaires' disease in 1977, we have successfully treated seven renal transplant patients using erythromycin with or without rifampin.

Adolescent↗