Prevention of suction-induced gastric mucosal damage in dogs.

Gastric suction has traditionally been available in three modes: continuous, sump, and intermittent. An intermittent air injection suction system (IAIS) has been developed in which small (20 to 30 mm) amounts of air are injected two to three times a minute. Very low (20 mm Hg) suction levels are applied.

Cardiac dysrhythmias in the acute setting: recognition and treatment or anyone can treat cardiac dysrhythmias.

The two primary goals in dysrhythmia therapy are: to control the ventricular rate (between 70 and 100 beats per minute) and to maintain sinus rhythm. Maintenance of sinus rhythm is definitely secondary. If a patient is hemodynamically unstable, but has a ventricular rate between 60 and 100 beats per minute, the trouble is almost certainly not due to the cardiac rhythm.

Cardiac dysrhythmias in the acute setting: pathophysiology or anyone can understand cardiac dysrhythmias.

Cardiac dysrhythmias are easy. Unlike the lung (which has formidable neuroendocrine, metabolic, and respiratory responsibilities), the heart is simple. It is an innervated muscular pump.

The protective action of allopurinol in an experimental model of haemorrhagic shock and reperfusion.

Haemorrhagic shock was induced in anaesthetized, open-chest dogs by controlled arterial bleeding, sufficient to reduce and maintain mean arterial blood pressure at 40 mmHg for 30 min. The blood volume was then restored to the pre-shock level by rapid, intravenous reinfusion of the blood shed during the shock period. Haemorrhagic shock produced significant haemodynamic changes, characterized by a marked depression of myocardial function.

Aortocardiac fistula with aortic valve injury from penetrating trauma.

A patient with a delayed aorto-right ventricular fistula and aortic valve injury after penetrating trauma is reported, and 17 similar additional cases from the literature reviewed. By examining the aortic root of adults with normal cardiac anatomy at autopsy, we defined the target area for these injuries as a 2 X 2 cm contact surface between the aorta above the right coronary cusp and the right ventricular outflow tract below the pulmonary valve. Five of the 18 patients required emergency exploration due to hemodynamic instability.

Delayed staple penetration of the heart: transthoracic migration with late tamponade.

Most foreign bodies in the chest do their damage at the time of injury. While needle-like objects may migrate (6), delayed intrathoracic injury is rare. Delayed transthoracic penetration of the heart by a staple is reported, and is felt to be unique because acute hemopericardium resulted 30 days after the time of initial injury.

Comparison of total parenteral nutrition with 25 per cent and 45 per cent branched chain amino acids in stressed patients.

Administration of total parenteral nutrition (TPN) solutions high in branched chain amino acids (BCAA) is thought to improve metabolic support during stress. This prospective, randomized, double blind study compared 45 per cent BCAA with 25 per cent BCAA in 12 patients. Seven patients had multiple trauma; two, gastrointestinal surgery; one, pancreatitis; and two, cirrhosis.

Elevated pulmonary vascular resistance in patients dying from multiple organ failure.

Twenty-one patients with multiple organ failure were studied with hemodynamic monitoring. The five survivors were compared with the 16 nonsurvivors. Significant differences were found in the cardiac index (CI), the left ventricular stroke work index (LVSWI), and the pulmonary vascular resistance index (PVRI).

Amikacin concentrations in serum following intraoperative irrigation of the pleura and peritoneum.

Serum concentrations of amikacin following operative wound irrigation were studied in 17 patients having laporatomy and in eight patients having thoracotomy. Irrigation was done with 500 mg of amikacin in 200 ml of saline. The irrigant was reaspirated after 3 minutes.

Effects of essential fatty acid deficiency and indomethacin on histologic, ultrastructural, and phagocytic responses of hepatic macrophages to glucan.

Glucan administration in the rat induces a hyperplasia and hypertrophy of the reticuloendothelial system (RES) and a concomitant leukocytosis. Increased phagocytic function and lysozymal immunoreactivity of macrophages are also characteristic of the glucan effect. The potential role of arachidonic acid metabolites in mediating this hepatic inflammatory response induced by the RES stimulant glucan was assessed in the present study by two experimental approaches.

Severe thoracic and abdominal injuries associated with lap-harness seatbelts.

We report an unusual constellation of severe thoracic and abdominal injuries in a passenger restrained by a lap-harness seat belt during a high-speed automobile accident. This combination of injuries, which appears to have not previously been described, emphasizes the causative relationship of this protective device.

The effect of intravenous safflower oil emulsion on the clotting mechanism.

A new fat emulsion for intravenous use, derived from safflower oil (Abbott Laboratories), was studied. The clotting mechanism was compared with a battery of tests performed during the infusion of total parenteral nutrition (TPN) using glucose alone and during infusion of TPN using both glucose and fat. Five adult surgical patients underwent TPN with 7.

Trial of low doses of aspirin as prophylaxis in sickle cell disease.

The effects of low doses of aspirin on the frequency and severity of painful vaso-occlusive crises were evaluated in children with sickle hemoglobinopathies. Aspirin was compared with placebo in 49 patients in a double-blind crossover study. Careful monitoring of patients revealed an average of 1.

Factors influencing nutritional assessment in abdominal trauma patients.

Previous work has shown that an abdominal trauma index (ATI) based on anatomic severity of injury reliably predicts complications following abdominal trauma, whereas the Prognostic Nutritional Index (PNI) does not. This study was undertaken to reconcile the disparity between the PNI and ATI as predictors of postoperative morbidity and mortality. Twenty-four patients undergoing immediate laparotomy following acute abdominal trauma were evaluated.

A feasibility study of computer aided diagnosis in appendicitis.

In this study, the hypothesis that computer aided diagnosis could enable a more accurate differentiation between patients with acute appendicitis and those with abdominal pain but normal appendixes was examined. A data base was established by analyzing the records of 476 patients having an emergency measure appendectomy during a five year period. There were 360 or 76 per cent with acute appendicitis, 98 or 20 per cent with normal appendixes and 18 or 4 per cent with other diseases requiring operation.

Clinical evaluation of a low lint surgical sponge.

To evaluate a new low lint, nonwoven surgical sponge material, a prospective, stratified, randomized, single blind study of 232 patients was carried out. Patients studied underwent thoracic, upper abdominal or lower abdominal operations. The new material, in the form of laparotomy pads and sponges, was compared with cotton gauze.

Thermokinetics of cold cardioplegic arrest.

This study was designed to test the hypothesis that the rapidity with which the heart rewarms following cold cardioplegic arrest depends upon the technique of cannulation. In dogs, temperatures were monitored at multiple myocardial sites during rewarming, using four different cannulation techniques: caval cannulation with total bypass, caval cannulation with partial bypass, atrioventricular cannulation, and atrial cannulation. A mathematical model was constructed to facilitate analysis of the data, assuming that the rewarming process can be described by first order kinetics.

Vascular trauma in the groin: contrast between iliac and femoral injuries.

Vascular injuries to the groin are common and often life-threatening. Injuries above the inguinal ligament, to the iliac system, are associated with a 37 percent mortality. Associated intraabdominal injuries are common.

Sex offences against young girls: a long-term record study.

There have been recent attempts to re-define those offenders who are sufficiently dangerous to justify a longer sentence for their current offence than is normally provided in law, but there is little information about the frequency with which serious sexual offenders are reconvicted. Follow-up studies of the re-conviction in the subsequent 24 years and 15 years of those found guilty of rape, incest, and unlawful sexual intercourse with girls under 13 in 1951 and 1961 have therefore been made. The present paper deals with those prosecuted for unlawful sexual intercourse with girls under 13.

Complications of tube thoracostomy for acute trauma.

Closed tube thoracostomy is a common and very useful procedure in therapy of acute thoracic injury. However, it is not without risk. With aggressive use of this procedure in the emergency department, the incidence of technical complications was 1 percent.

Temporary cardiac pacing in traumatic arrest victims.

Temporary ventricular pacing was successfully employed in two patients suffering refractory bradycardia following traumatic cardiac arrest. The hemodynamic response to pacing was dramatic and both patients eventually recovered fully from an apparent moribund state. Cardiac pacing may be an effective adjuvant in the early resuscitation of the massively injured patient.