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Biomedical subjects

W O Griffen

Publications and source records attributed to W O Griffen.

At least 73 records · Page 4Linked to original sources
PubMed1983

The effect of ten and twenty per cent safflower oil emulsion given as thirty to fifty per cent of total calories.

In a prospective study of seven patients undergoing operations, 10 and 20 per cent safflower oil emulsions were found to be safe and effective as a major component of adult parenteral nutrition. Specifically, clinically important adverse effects of the emulsions as monitored by clinical evaluation and screening hematologic and blood chemistry determinations were not identified. Further, an extensive coagulation profile in these patients has failed to identify procoagulant effects of parenteral safflower oil. The optimum dosage of fat for a balanced parenteral diet is not known. Linoleic acid administered as 4 per cent of total calories every other day will treat or prevent essential fatty acid deficiency, and this dosage may be considered a minimum requirement for parenteral fat. The data from this study demonstrate parenteral safflower oil administered as 30 to 50 per cent of total calories is effective in achieving nitrogen balance. The implication is that fat emulsions today allow the use of parenteral diets that match the normal diet consumed orally in terms of the balance of protein, carbohydrate and fat.

Adult↗
PubMed1983

The decline and fall of the jejunoileal bypass.

With the obvious failure of nonoperative means of producing permanent weight reduction in patients with morbid obesity, operative approaches have become popular. In the late 1960's and early 1970's, jejunoileal bypass was shown to produce permanent weight reduction and became the most performed operation. However, as the patients were observed for a long term, many untoward complications became evident. The most serious complication of liver disease and even liver failure with fatalities was observed and has accounted for 91 reported deaths following jejunoileal bypass. Other complications include severe electrolyte imbalance, requiring frequent rehospitalization of the patient; renal calculi which is related to excess oxalate absorption; arthritis which is probably secondary to complement activation of high molecular weight immune complexes formed in response to the absorption of bacterial antigens; cholelithiasis which is related to reduced bile salts; a variety of intestinal difficulties, such as bypass enteritis, and pseudo-obstruction of the colon; osteomalacia and decreased bone mineral content; failure in absorption of some medications and fat-soluble vitamins, and most recently, the possibility of induced carcinoma of the colon. Because of these many complications, it is suggested that the jejunoileal bypass is not an appropriate operation for morbidly obese patients and should be abandoned.

Arthritis↗
PubMed1983

Radiation-induced arterial injuries.

In a 20-year period from 1961 to 1981 at the University of Kentucky Medical Center, there were 20 patients with vascular lesions directly attributable to irradiation. Two distinct patterns of arterial injury attributable to radiotherapy were identified--arterial disruption and occlusion. Arterial disruption occurred in 12 patients--11 carotid blowouts and 1 iliac artery rupture. Two patients underwent prophylactic carotid artery ligation for impending rupture. In the 11 carotid artery ruptures, ligation of the artery in nine patients resulted in stroke or death in five patients. Iliac artery disruption necessitated ligation, which eventually led to severe ischemia requiring hip disarticulation. Unusual arterial stenosis or occlusion occurred in six patients 7 to 24 years after irradiation. Three patients had severe stenosis or occlusion of the common, internal, or external carotid arteries leading to cerebrovascular insufficiency. Three other patients with focal stenosis of the iliofemoral region were successfully treated with bypass grafting.

Adult↗
PubMed1983

Abdominal complications of collagen vascular disease.

A retrospective study of 412 consecutive hospital admissions of patients with collagen vascular disease yielded 63 patients who were admitted for abdominal complaints. Of these 63 patients, 11 died during their admission of primary intra-abdominal pathology or a complication thereof. A significantly higher incidence of abdominal complications occurred in black women (P less than 0.01). Peritoneal signs invariably were lacking in patients who eventually died. Radiographic documentation of small bowel obstruction or gastroduodenal ulceration in these patients was particularly ominous. Rapid radiologic evaluation and early surgical intervention including diagnostic peritoneal lavage should decrease the mortality rate for these difficult patients.

Black People↗
PubMed1982

Primary retroperitoneal cysts: report of an unusual case and a survey of the literature.

A case of a primary retroperitoneal cyst was associated with the chemical abnormalities of Cushing's disease and pheochromocytoma. Review of the literature failed to uncover a similar endocrinologically active retroperitoneal cyst. Primary retroperitoneal cysts, defined as those cysts lying in the retroperitoneal fatty tissue that have no apparent connections with any adult anatomical structure, are rare. These cysts are thought to arise from the mesonephros. They become symptomatic by virtue of their size or position. Diagnosis is suggested by an abnormal intravenous pyelogram and may be confirmed by arteriography. Treatment of choice is excision.

Adult↗
PubMed1982

Patient-controlled analgesia: a new concept of postoperative pain relief.

This report concerns evaluation of patient-controlled analgesia (PCA) in the form of two preliminary investigations. In the first study, the patient-controlled analgesia device, which consists of a pump linked to a timer so that patients can activate intravenous administration of morphine sulfate to themselves during the postoperative period, was used in seven morbidly obese patients. The amount of morphine used during the first 36 hours was found to vary between 32 and 185 mg, with a significant difference in drug usage when related to weight as well as to body surface area. In the second study, morbidly obese patients undergoing gastric bypass operations were prospectively randomized into 12 patients who used the PCA device in the postoperative period and 12 patients who were given standard intramuscular dosages of morphine sulfate. An analgesia and sedation scale was then used to compare the two groups. The patients in the PCA group were able to maintain a state of adequate analgesia without sleep with a significantly greater frequency than were those in the intramuscular injection group. On the basis of answers to a questionnaire given to the patient after 60 hours of morphine analgesia, it was apparent that the PCA group was much more satisfied with that form of postoperative analgesia. It would appear that PCA is an efficacious and safe method of providing for postoperative pain relief.

Analgesia↗
PubMed1982

Vancomycin pharmacokinetics in normal and morbidly obese subjects.

In an uncontrolled study, vancomycin pharmacokinetics were determined in four normal (total body weight [TBW], 65.9 to 89.1 kg) and six morbidly obese (TBW, 111.4 to 226.4 kg) subjects. The morbidly obese subjects were investigated 3 to 4 h after gastric bypass surgery. Mean terminal half-lives, volumes of distribution, and total body clearances for the normal controls and the morbidly obese (TBW, 111.4 to 226.4 kg) subjects. The morbidly obese subjects were investigated 3 to 4 h after gastric bypass surgery. Mean terminal half-lives, volumes of distribution, and total body clearances for the normal controls and the morbidly obese subjects were 4.8 h, 0.39 liter/kg, and 1.085 ml/min per kg versus 3.2 h, 0.26 liter/kg TBW, and 1.112 ml/min per kg TBW. The mean terminal half-life and volume of distribution values were significantly different between the two groups. Strong correlations were found between TBW and both volume of distribution (correlation coefficient, 0.943) and total body clearance (correlation coefficient, 0.981). There results implied that TBW should be used to calculate vancomycin doses for morbidly obese patients. This was supported by the finding that there was no significant difference in the daily dose (in milligrams per kilogram per day) required to produce an average steady-state concentration of 15 micrograms/ml in the two groups (23.4 +/- 1.5 mg/kg per day for normal weight subjects and 24.0 +/- 3.4 mg/kg per day TBW for the postsurgery morbidly obese subjects). Therefore, the morbidly obese required higher total doses (in milligrams per day) than did normal weight subjects to achieve the same mean steady-state concentrations. In addition, normal weight and morbidly obese subjects had similar volumes of the central compartment (7.7 and 6.4 liters, respectively). To avoid high transient peak concentrations which would occur when obese patients are given larger total doses (in milligrams per day), maintenance doses may be given at more frequent intervals. The shorter mean terminal half-lives observed in morbidly obese patients allows more frequent dosing without excessive accumulation.

Adult↗
PubMed1982

Physiopathology and management of hyperosmolar hyperglycemic nonketotic dehydration.

Results of a review of the clinical course of five patients in whom hyperosmotic hyperglycemic nonketotic dehydration developed suggests that a treatment regimen of a high dosage of insulin and free water administration may not be effective. Analysis of the physiopathology of the syndrome points to sodium and water deficits as the principal cause of symptoms. A rapid lowering of the blood glucose level may be detrimental, since this leads to an osmotic gradient between the central nervous system and the intravascular space. Treatment should be directed at the rapid replacement of sodium and water with minimal administration of insulin. This treatment plan allows restoration of membrane potentials by an adequate supply of sodium and maintains osmotic equilibrium by providing diffusable sodium to compensate for the osmotic gradient associated with a gradual lowering of the blood glucose level.

Aged↗
PubMed1982

Massive rectal bleeding of colonic origin: localization of the bleeding site.

Fourteen patients with massive colonic bleeding underwent preoperative evaluation including visceral angiography and/or colonoscopy. Segmental for subtotal colectomy was performed in each case. The freshly excised colonic specimen was opened and washed clean, and the mucosal surface was closely examined by manually compressing the specimen segment by segment in order to detect the minute bleeding site(s), which were then marked with a suture for histologic sectioning. This maneuver was successful in 13 instances. In 11 of these, histologic identification was made; seven were cases of vascular malformations, and four were cases of diverticular bleeding. In 5 of these 11 cases, colonoscopy and/or visceral angiography failed to localize the bleeding sites; four were cases of bleeding of diverticular origin. Of the two patients in whom histologic identification was not made despite suture identification, one underwent a second colonic resection in which bleeding sites were histologically identified; the bleeding was not caused by vascular malformations or diverticula. The method of examining the freshly excised specimen described is useful for accurate histologic identification of the cause of colonic bleeding, particularly for diverticular bleeding. The method is also useful for immediate assessment of adequacy and appropriateness of surgical resection.

Angiography↗
PubMed1981

Pseudolymphoma of the stomach. A diagnostic and therapeutic dilemma.

Pseudolymphoma is an uncommon benign lesion of the stomach that poses a difficult problem in diagnosis and management. The clinical manifestations and endoscopic, radiologic, and biopsy findings are not generally helpful in making this diagnosis preoperatively. Histologic examination of the lesion is the only reliable method that distinguishes pseudolymphoma from true lymphoma. Distinguishing histologic features of pseudolymphomas are (1) formation of true germinal centers, (2) presence of a polymorphous inflammatory infiltrate, and (3) absence of lymph nodal involvement by lymphoma. We report four cases and review the literature to illustrate the features of pseudolymphoma. Subtotal gastric resection is done for diagnostic as well as for therapeutic purposes. Distinction of these benign lesions from malignant lymphomas is important so that unnecessary radical surgery and postoperative radiation therapy or chemotherapy are avoided.

Adult↗
PubMed1981

Bacterial endocarditis in the critically ill surgical patient.

The association of endocarditis with persistent intraperitoneal sepsis and right-sided heat catheterization (Swan-Ganz catheter and central venous catheter) was found in four (27%) of 15 patients with endocarditis identified at the University of Kentucky Medical Center, Lexington, during a 14-year period. These four patients had (1) intra-abdominal abscesses as a persistent source of sepsis, (2) documented septicemia, (3) long-term use of right sided heart catheters, and (4) prolonged hospitalization with a fatal outcome. In each case, endocarditis with persistent septicemia was considered a major factor contributing to a fatal outcome. Identification of a new cardiac murmur associated with septicemia was the most reliable means of diagnosis in these patients. The best form of treatment seems to be prevention by (1) eliminating septic foci, (2) using central catheters for specific indications for as short a period as possible, and (3) promptly discontinuing use of the catheter when septicemia is suspected.

Abscess↗