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Biomedical subjects

C L Rice

Publications and source records attributed to C L Rice.

At least 55 records · Page 3Linked to original sources
PubMed1990

Critical care air transportation of the severely injured: does long distance transport adversely affect survival?

Civilian aeromedical transportation systems, both fixed and rotary wing, have proliferated since the middle 1970s. However, outcome data substantiating the benefit of these services have been slow in coming. From February 22, 1982, through March 5, 1984, Airlift Northwest transported 118 trauma patients (aged 15 years and older) an average distance of 340 miles (range, 100 to 800 miles) with fixed-wing aircraft. The in-hospital mortality for this group was 19% compared with 18% for a comparable group of trauma patients who were ground-transported from within the city limits of Seattle, Washington. The two groups did not differ significantly in age, Injury Severity Score, or Glasgow Coma Score. These results suggest that some part of the clinical benefit of a regional trauma center may be extended up to 800 miles with no increase in transport-related mortality.

Adolescent↗
PubMed1990

Inhibition of leukocyte adherence by anti-CD18 monoclonal antibody attenuates reperfusion injury in the rabbit ear.

Tissue injury resulting from ischemia and reperfusion forms the basis of several important disorders including myocardial infarction, stroke, and circulatory shock. To examine the role of neutrophils in this process and to determine the extent to which injury is a consequence of reperfusion, we utilized the monoclonal antibody 60.3, directed to CD18, the human leukocyte adherence glycoprotein, to block intravascular neutrophil aggregation and neutrophil adherence to endothelium in a rabbit model of tissue ischemia and reperfusion. Antibody treatment either before ischemia or after ischemia, but prior to reperfusion, resulted in the same degree of significant protection against endothelial, microvascular, and tissue injury. We conclude that neutrophils and increased neutrophil adhesiveness are important in the development of microvascular and tissue injury after ischemia and reperfusion and that under these circumstances, injury is primarily a consequence of reperfusion.

Animals↗
PubMed1990

A comparison of anthropometry with computed tomography in limbs of young and aged men.

Arm and leg composition determined by anthropometry (AP, girths, and skinfolds) were compared with computed tomography (CT) in 7 young (mean age 31.4y) and 13 old (74.8y) males. Five transverse CT scans, girths, and skinfold measurements were made. In each CT image, total cross-sectional area (CSA), bone CSA, muscle compartment CSA, and "pure" muscle CSA within the compartment were measured. Corresponding volumes were also calculated. Total limb and muscle plus bone CSA and volumes were estimated from AP measures. The two methods were compared, and multiple regression analyses were used to predict component CSA and volumes from AP measures. In both groups, AP component measures in the leg provided more accurate values than in the arm. Skin plus subcutaneous tissue in the old was not well estimated by AP. The greater preponderance of nonmuscle tissue in the muscle compartments of the old, as determined from CT images, was not related to any AP estimates. Prediction equations for various component areas and volumes were derived. Some equations derived for the young could not be obtained for the old due to the reduced ability of AP to accurately assess limb composition of aged men.

Adult↗
PubMed1990

The epidemiology of traumatic rupture of the thoracic aorta in children: a 13-year review.

Traumatic rupture of the thoracic aorta (TRA) is a rare but highly lethal injury in children that occurs as a result of car versus pedestrian accidents and motor vehicle accidents. TRA is often associated with life-threatening injuries to other organ systems. Therefore children with TRA like adults sustaining TRA must be treated urgently but systematically. The rarity of this injury makes it all the more important for physicians treating pediatric trauma victims to be cognizant of the importance of the injury and the clinical and radiographic signs. Even when TRA is promptly recognized in children it is associated with a high in-hospital mortality. The proper use of child restraint systems and adherence to the 55 M.P.H. speed limit may be important factors in reducing the mortality of TRA in children after MVA.

Accidents, Traffic↗
PubMed1990

Inhibition of CD18-dependent neutrophil adherence reduces organ injury after hemorrhagic shock in primates.

Neutrophil adherence or aggregation may be important in the development of organ injury after hemorrhagic shock. Monoclonal antibody (MAb) 60.3 prevents both adherence and aggregation. Therefore we investigated MAb 60.3 treatment in prevention of organ injury after hemorrhagic shock in rhesus monkeys (Macaca mulatta). We performed esophagogastroscopy and placed catheters to measure cardiac output, mean arterial pressure, arterial blood gases, and urine output. Blood was removed to decrease CO to 30% of baseline for 90 minutes. Just before resuscitation, MAb 60.3 (2 mg/kg) or saline solution (control) was administered intravenously. Monitoring and fluid resuscitation continued for 24 hours, with lactated Ringer's solution given as a maintenance infusion (4 ml/kg/hr) plus additional lactated Ringer's solution to maintain CO at preshock levels. Esophagogastroscopy was repeated 24 hours after shock. There were two deaths in the control group at about 72 hours and none in the MAb 60.3 group. MAb 60.3-treated animals required less fluid (9.6 +/- 8.8 ml/kg vs 263.8 +/- 225.7 ml/kg), gained less weight (0.08 +/- 0.11 kg vs 0.70 +/- 0.37 kg), and maintained a higher hematocrit level (35.0% +/- 1.0% vs 26.9% +/- 4.9%). All five control animals had gastritis; MAb 60.3-treated animals had none (p less than 0.05; Fisher's exact test). Inhibition of neutrophil adherence or aggregation with MAb 60.3 at the time of resuscitation reduces fluid requirements and gastric injury in monkeys after hemorrhagic shock.

Animals↗
PubMed1989

Hemodynamic effects of external cardiac massage in trauma shock.

The effectiveness of closed chest cardiopulmonary resuscitation (CCCPR) in maintaining cardiac output has been well studied in cardiac arrest. Trauma surgeons most often encounter shock secondary to hypovolemia or cardiac tamponade, and the effectiveness of CCCPR in that setting has not been established. To determine the hemodynamic effects of external massage in profound shock, hypotension was induced in baboons. Pressures obtained with external massage were compared to spontaneous intra-arterial pressures before compression. Although external massage increased systolic pressures in both tamponade and hypovolemia, diastolic pressures were consistently decreased. We conclude that CCCPR does not augment arterial pressure in the clinical situations associated with decreased LVEDV and is unlikely to provide organ perfusion for trauma victims.

Animals↗
PubMed1989

Arm and leg composition determined by computed tomography in young and elderly men.

Five computed tomography (CT) scans were taken at measured intervals of the legs and arms of young (n = 7) and elderly (n = 13) men. Cross-sectional areas (CSA) of the total limb, muscle plus bone and bone were measured in each scan, and skin plus subcutaneous tissue areas were calculated by subtraction. In addition, in the arm scans the CSA of the extensor and flexor compartments were measured, and in the leg the CSA of the plantar flexor compartment. A value for lean muscle within these compartments was calculated by excluding non-muscle tissue using density measurements based on Hounsfield units. Related volumes for the various components were also calculated using geometric formulae. The results showed that elderly limbs were of a similar overall size as the young, but elderly muscles were smaller (28-36%) with greater amounts of non-muscle tissue located within a muscle, particularly in the plantar flexors (81% more than in the young). Elderly arms had a greater amount of skin plus subcutaneous tissue than the young, but there was no difference in the legs. Muscle volumes were similar to in vitro results reported from cadaver studies and can be predicted from single mid-limb CT scans using regression equations. These results illustrate that, due to the substantially reduced amount of 'pure' muscle tissue in the elderly, comparisons of relative strength with other populations may be misleading unless appropriate measurements of muscle size are considered. Methods to estimate in vivo physiological CSA, which is considered the best means of normalizing strength, have been demonstrated in this study.

Adult↗
PubMed1989

Strength in an elderly population.

Strengths of several upper- and lower-limb muscle groups were measured in an elderly population by using a simple, adaptable dynamometer. The bladder of a sphygmomanometer was modified by folding and surrounding it in a sewn cloth bag. It was then attached to a board for improved stability during the tests. Thirty-seven men and 81 women aged 62 to 102 years were tested. Four muscle groups were statistically determined to best represent strength-two for upper limb and two for lower limb. These strength measures were correlated with anthropometric indices, and a step-wise multiple regression was used to determine the degree of association between the variables. Men were significantly stronger than women in absolute strength, but were not different when strength was expressed relative to body weight. Within each sex, however, age was the most important variable related to loss of strength; body weight was secondary or not significant. These results suggest that age is the most important factor for relating differences in strength in an older elderly population (those aged 75 to 90 or more years). This factor must be accounted for just as body weight or cross-sectional muscle area often are, when comparing strengths in a younger population.

Aged↗
PubMed1989

Role of neutrophils in generalized reperfusion injury associated with resuscitation from shock.

Recent studies suggest that neutrophils are an important factor in the organ injury associated with ischemia and shock. Increased neutrophil-endothelial adhesiveness is essential for neutrophil-mediated vascular injury. To examine the role of neutrophils and neutrophil adhesiveness in the development of injury after hypovolemic shock, and to determine whether this injury is a consequence of reperfusion, we used the monoclonal antibody (MAb) 60.3 (directed to the primary human neutrophil adherence glycoprotein, CD18) to block neutrophil adherence functions at the time of resuscitation in a rabbit model of hemorrhagic shock. None of the unanesthetized control animals subjected to 2 hours of shock (cardiac output, 30% of baseline) followed by resuscitation survived 5 days. All had gross and histologic evidence of injury to lungs, liver, and gastrointestinal mucosa. In contrast, 71% of the animals that received MAb 60.3 immediately before resuscitation survived 5 days (p less than 0.005), and visceral organ injury was absent or markedly attenuated. We conclude that a significant proportion of injury resulting from shock and resuscitation occurs after the ischemic insult and that increased neutrophil adhesiveness plays an important role in the development of multiple organ injury and death following shock and resuscitation (in this model). This injury may be significantly reduced by blocking neutrophil adherence functions with the MAb 60.3--even if administration is delayed until resuscitation.

Acidosis↗
PubMed1988

Emphysematous pyelonephritis in a xanthogranulomatous kidney. An unusual cause of pneumoperitoneum.

Emphysematous pyelonephritis is a rare, life-threatening suppurative infection of the renal parenchyma and perinephric tissues. The disease is encountered primarily in patients with diabetes mellitus or ureteral obstruction associated with perinephric and intrarenal gas. Causative organisms are those normally found in the urinary and gastrointestinal tracts; however, anaerobic bacteria have been demonstrated in only 1% of cases. We describe a case of emphysematous pyelonephritis, which presented as an acute abdomen with pneumoperitoneum in a nondiabetic patient. No visceral injury was found at laparotomy. Multiple gas-producing organisms, including Clostridium ramosum (not previously reported, to our knowledge), were the cause of the free intraperitoneal and perinephric air. Subsequent radical nephrectomy revealed a xanthogranulomatous kidney. An aggressive surgical approach combined with intensive antibiotic therapy, after aerobic and anaerobic culture of excised tissue, is lifesaving.

Adult↗
PubMed1988

Comparison of the histochemical and contractile properties of human triceps surae.

Contractile and histochemical properties of the triceps surae were compared in 16 males and 4 females aged 20 to 49 years. Surface electrical stimulation was used to determine twitch, tetanic and fatigue parameters. From these tests, twitch tension (Pt), time to peak tension (TPT), half relaxation time (1/2 RT), tetanic tensions at 10, 20 and 50 Hz and an index of fatigue (FI) were calculated. A maximal voluntary contraction (MVC) was also performed. Muscle samples from the belly of the lateral gastrocnemius were obtained using the needle biopsy technique. The samples were treated histochemically for myosin ATPase and NADH-tetrazolium reductase in order to classify the fibres as either Type I, slow twitch (ST) or Type II, fast twitch (FT) and to determine fibre areas. Correlations were performed between the grouped male and female contractile and histochemical variables. The results demonstrated significant positive relationships demonstrated significant positive relationships between percentage of ST fibres (%ST) and TPT (r = 0.49), and %ST and the ratio of tetanic forces at 10 Hz to 50 Hz (Po10/Po50) (r = 0.55). No significant relationships were obtained for Pt, 1/2 RT, MVC or FI with any histochemical parameter. The results suggest that fibre type distribution determined using myosin ATPase is related to electrically stimulated isometric contractile speeds and not to voluntary force generation (MVC) or electrically induced fatigue.

Adult↗
PubMed1988

Right ventricular dysfunction in multiple trauma victims.

We studied 17 victims of multiple trauma and found that right ventricular function can be reliably monitored at the bedside using the thermodilution method. In addition, we noted that right ventricular dysfunction occurred early in victims of major trauma without affecting the left ventricular function. If right ventricular function does not improve, the patient is likely to die. Further studies are needed to determine if early intervention aimed at improving right ventricular function can improve survival.

Adolescent↗
PubMed1988

Fluid filtration coefficient of isolated goat lungs was unchanged by endotoxin.

The Starling fluid filtration coefficient (Kf) of blood-perfused excised goat lungs was examined before and after infusion of Escherichia coli endotoxin. Kf was calculated from rate of weight gain as described by Drake et al. [Am. J. Physiol. 234 (Heart Circ. Physiol. 3): H266-H274, 1978]. These calculations were made twice during base line and then at hourly intervals for 5 h after infusion of 5 mg (approximately 250 micrograms/kg) of E. coli endotoxin or after injection of oleic acid (47 microliter/kg). All lungs were perfused at constant arterial and venous pressure under zone 3 conditions. Base-line Kf averaged 27 +/- 10 and 20 +/- 4 (SD) microliter.min-1.cmH2O-1.g dry wt-1 for endotoxin and oleic acid groups, respectively. It was unchanged in the endotoxin group throughout the experiment but approximately doubled in the oleic acid lungs. Pulmonary arterial and venous pressures were not changed significantly during the course of these experiments in either group. Lung wet-to-dry weight ratios of these lungs were 5.6 +/- 0.6 and 6.1 +/- 0.5 ml/g for the endotoxin and oleic acid groups, respectively. This compares with 4.6 +/- 0.5 ml/g for normal, freshly excised but not perfused goat lungs. The small change in lung water and unchanged pulmonary pressures after both endotoxin and oleic acid suggest that lung injury was minimal. We conclude that 1) endotoxin does not cause a direct injury to the endothelium of isolated lungs during the first 5 h of perfusion, and 2) neutrophils are not sufficient to cause increased Kf after endotoxin infusion in this preparation.

Animals↗
PubMed1988

Indomethacin, but not dazoxiben, reduced lung fluid filtration after E. coli infusion.

Goats were divided into three groups and given infusions of live Escherichia coli bacteria. Group I received no treatment, group II was treated with indomethacin (a cyclooxygenase inhibitor), and group III with dazoxiben (a thromboxane synthase inhibitor). Double indicator-dilution extravascular lung water (EVLW) in group I was significantly different from the treated groups. There was an early increase in EVLW in group I and group III but not in group II animals. At 6 h EVLW's in group I, group II, and group III were 100, 45, and 30% above base line, respectively. Lymph flow (QL) and lymph-to-plasma protein ratio (L/P) was not statistically different between groups. Estimated total fluid filtration [QL + d(EVLW)/dt] in group I and III was markedly elevated between 0 and 1.5-2 h after E. coli infusion. Cardiac output (QT) decreased to 40% of base line in group I, and it decreased slightly in group II because of the indomethacin but did not decrease after E. coli. QT decreased in group III but recovered more rapidly than group I. Mean pulmonary arterial pressure increased more rapidly in group I and reached a higher peak than either treated group. At 6 h these groups had similar pulmonary arterial and pulmonary arterial wedge pressures. We conclude that 1) indomethacin but not dazoxiben blocks the early increase in total fluid filtration after bacterial infusion, 2) dazoxiben does not prevent the increased endothelial permeability resulting from infusion of live bacteria, and 3) indomethacin may somewhat ameliorate the endothelial permeability change.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1988

A monoclonal antibody to the adherence-promoting leukocyte glycoprotein, CD18, reduces organ injury and improves survival from hemorrhagic shock and resuscitation in rabbits.

Leukocytes have been shown to play an important role in the development of isolated organ injury after experimental ischemia and reperfusion. To examine the role of leukocytes in generalized ischemia-reperfusion injury we used the MAb 60.3 (directed to the human leukocyte adherence glycoprotein, CD18) to block leukocyte adherence functions in a rabbit model of hemorrhagic shock and resuscitation. In control animals subjected to 1 h of shock (mean blood pressure 45 torr and mean cardiac output 30% of baseline) followed by resuscitation, only 29% survived 5 d. All had gross and histologic evidence of injury to lungs, liver, and gastrointestinal mucosa. In contrast, 100% of the MAb 60.3-treated animals survived 5 d (P less than 0.01) and organ injury was absent or markedly attenuated. The control animals also had a persistent acidosis, lost more weight, and had evidence of continued gastrointestinal bleeding in contrast to MAb 60.3-treated animals. We conclude that increased leukocyte adhesiveness plays an important role in the development of multiple organ injury and death after generalized ischemia-reperfusion and that this injury may be significantly reduced by blocking leukocyte adherence functions with the MAb 60.3.

Animals↗
PubMed1988

Air transport following surgical stabilization: an extension of regionalized trauma care.

A 30-month retrospective review was performed of all trauma patients initially evaluated and operatively stabilized at Level III hospitals, with subsequent specialized air transport within 48 hours of injury to the regional Level I trauma center in Seattle. Nineteen patients were identified, with a mean ISS of 44 (range, 20-66). Mean transport time and distance were 2.4 hours and 456 miles, respectively. The estimated average ground transport time for the same patients was 23.8 hours. No deaths occurred during transport, and the overall survival rate was 58%. Transport charges averaged $4,162, which was 14% of the complete hospitalization cost. We conclude that: 1) patient survival after air transport was no different than that predicted for trauma victims with immediate access to a trauma center; 2) postoperative hemodynamic instability predicted a poor outcome; 3) the higher cost of air relative to ground transport is outweighed by significant time savings in these critically injured patients; and 4) air transport following operative stabilization represents an extension of regionalized trauma care to the isolated areas of Washington and Alaska.

Adolescent↗
PubMed1987

Ageing and isokinetic plantar flexion.

Isokinetic torques (Cybex II) of the plantar flexors in 25 healthy men were compared at 5 angular velocities (30, 60, 90, 120 and 180 degrees X s-1). The purposes were to compare plantar flexion torques in young and old subjects, and to determine whether the expected decrease was significantly associated with age, physical activity, or aerobic fitness. Four groups were studied: young (21.7 +/- 2.0 years) and older (63.3 +/- 2.8 years), active and sedentary. Measurements of height, weight, % body fat, VO2max, and daily leisure energy expenditure (questionnaire) were determined for each subject. Statistical measures of analysis of variance were used to determine significant differences among groups; product moment correlation and stepwise regression analysis were used to describe the degree of association between the dependent variable of plantar flexion torque and the independent variables at each velocity. A decline in torque was observed as the isokinetic velocity of angular motion increased. Age alone was a significant determinant of plantar flexion torque, whereas at the slowest speed, when VO2max was used as an explanatory variable, age was not a significant determinant of torque. At 30 degrees X s-1 47% of the variance in torque was explained by VO2max while at 180 degrees X s-1 49% of the variance was explained by age.

Adult↗