Thrombocytopenia altering the pulmonary hemodynamic response to intravenous endotoxin.
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Biomedical subjects
Publications and source records attributed to C E Bredenberg.
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A group of 6 patients with malignancies involving the pancreas is presented, with a range of diagnosis from primary reticulum cell sarcoma to probable anaplastic carcinoma. Even with adequate biopsy and autopsy material, it may be difficult to provide a definitive tissue diagnosis in these patients. Although this entire spectrum of tumors is uncommon, it is important to try to establish a diagnosis whenever possible. Biopsy of the tumor should be performed, even from the pancreas itself, if necessary, particularly when the initial presentation of the disease is unusual or if the pattern of metastasis is different from that usually seen with carcinoma of the pancreas. It is suggested that a therapeutic trial of appropriate radiotherapy and chemotherapy be instituted in patients of this type even if a diagnosis of lymphoma is not firmly established. The possibility exists of survival of some of these patients for periods of one year or more as a result of successive therapy.
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The role of positive end expiratory pressure (PEEP) was evaluated in preventing the deleterious mechanical respiratory effects of fatty acid pulmonary embolism. One group of animals had ventilation without PEEP, while the second group had PEEP of 10 cm H2O applied only to the right lung. In the right lung, PEEP slightly reduced the blood flow, increased the vascular resistance, but reduced intersititial edema and reduced the degree of shunting to almost normal. Hypoxemia was prevented in the right pulmonary venous system, but was prominent in the left. The hypoxemia and shunting in the left lung were comparable to the Group I animals without PEEP to either lung. These studies confirm the value of PEEP in the therapy of the pulmonary manifestations of fat embolism which are the lethal factors in the fatty embolism syndrome.
The use of prosthetic tubes for palliation of esophageal carcinoma can be carried out with safety using a combined push-pull method. The advantages of simultaneous endoscopy and laparotomy are illustrated in two cases. For safe durable palliation, emphasis must be placed upon seating the tube under direct vision as well as upon the firm fixation of the tube of the abdominal wall to prevent its subsequent migration.
Acute RDS is a clinical and pathologic phenomenon with many causes. Some of the pulmonary problems are iatrogenic, resulting from the overuse of blood, crystalloids, oxygen, vasopressors, sedation, and immobility. Some are related to the blast effects of injuries at sites distant from the thorax. Other causative factors are metabolic, secondary to diminished peripheral perfusion. The pulmonary capillary bed is a principal target organ in shock--affected by the toxic action of vasoactive substances, gastric aspirates, and fat; by the obstructive action of platelet, fibrin, and leukocyte clots; and by changes in balance between perfusion pressures and oncotic pressures. The rationale of prevention and therapy presented here has resulted (except in those patients with prolonged sepsis) in almost complete disappearance of RDS as a cause of death in our institution.
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