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Biomedical subjects

D D Trunkey

Publications and source records attributed to D D Trunkey.

At least 109 records · Page 6Linked to original sources
PubMed1983

Pathophysiology of shock and adult respiratory distress syndrome.

The respiratory failure that develops in surgical patients is usually caused by a surgical problem--shock, trauma, sepsis, pulmonary contusion, aspiration, pulmonary emboli or pain, with its attendant ventilatory compromise. Although the underlying pathophysiology for the respiratory failure in these conditions is not precisely known, the means for prevention are well known. Patients subjected to trauma should be aggressively resuscitated from shock. They should have the chance of being cared for in a facility where an operation can be performed promptly. The respiratory failure of sepsis is best treated by seeking out foci of pus or devitalized tissue and surgically ablating these foci when found. Adherence to these basic surgical principles--aggressive resuscitation of patients in shock and prompt attention to their surgical problems--will alleviate much of the respiratory distress of surgical patients, no matter what the pathophysiology or etiology may be.

Animals↗
PubMed1982

Computed tomography in blunt abdominal trauma.

Emergency abdominal computed tomography (CT) has been performed in more than 200 cases of acute blunt abdominal trauma. Computed tomography was highly sensitive and specific for a wide variety of intraperitoneal and retroperitoneal traumatic lesions. There were no false-positive or false-negative CT interpretations, except for a single case in which residual peritoneal lavage fluid was mistaken for intraperitoneal blood. Computed tomobraphy has major advantages over otherradiologic techniques, including angiography, and may obviate peritoneal lavage and explo4atory laparatomy in some circumstances.

Abdominal Injuries↗
PubMed1982

Endoscopic sclerotherapy versus esophageal transection of Child's class C patients with variceal hemorrhage. Comparison with results of portacaval shunt: preliminary report.

Thirteen Child's class C patients with variceal hemorrhage requiring 6 or more units of blood were randomly assigned to groups receiving either flexible endoscopic sclerotherapy using 5% sodium morrhuate or esophageal transection/reanastomosis employing the EEA Auto Suture stapling instrument. One patient with a previous hiatus hernia repair was assigned to the transection group and had a mesocaval shunt. The randomization groups compared favorably with each other and with a retrospective shunt group (20 patients). Although transection patients required significantly less operative time and fewer blood transfusions, the outcome of the transection group was significantly worse than that of the shunt group. The trend in survival likewise favored the shunt group rather than the sclerotherapy group. Although the reported operative mortality rates of transection and sclerotherapy are less than that of portal decompression, the results of this study--the first controlled trial of these procedures--would warrant distinct caution in using either of these new techniques in high-risk patients. Portal decompression may still be the procedure of choice in class C patients with substantial variceal hemorrhage.

Adult↗
PubMed1981

Factors influencing survival after therapeutic shunts. Results of a discriminant function and linear logistic regressions analysis.

Data on 100 consecutive patients undergoing portasystemic shunt at three hospitals of the University of California, San Francisco, were analyzed retrospectively to look for variables portending poor immediate and long-term outcome. As a determinant of early mortality after portacaval shunt, the Child's classification of the patient remains the single most important factor. If the patient is in Child's class C and has a hematocrit of less than 32 percent, he is even less likely to survive 30 days. The malnourished male patient who resumes drinking postoperatively is least likely to survive 1 year. Though short- and long-term mortality did not correlate with type of shunt, the prosthetic interposition mesocaval shunt was associated with an unacceptably high thrombosis rate of 20 percent in our institutions, and represented a technical failure to achieve the goal of preventing further variceal bleeding. No matter what type of shunt was performed, however, the 30 day mortality of Child's class C patients exceeded 50 percent. In the latter patients methods of treatment other than portasystemic shunts should be evaluated.

Adolescent↗
PubMed1981

Dopamine gangrene. Association with disseminated intravascular coagulation.

Multiple extremity gangrene developed in five patients as a complication of dopamine therapy. The clinical conditions were (1) penetrating chest trauma requiring pneumonectomy with postoperative sepsis, (2) cardiac arrest with aspiration pneumonia, (3) lymphoma with sepsis, (4) Klebsiella pneumonia, and (5) myocardial infarction. The development of acrocyanosis leading to gangrene occurred at dopamine dosages of 5.1 to 10.2 micrograms/kg/min. The alpha-adrenergic vasoconstriction effects of dopamine would not be expected from the doses employed in these patients. Thus, other factors beside pure alpha vasoconstriction are responsible for tissue necrosis after the use of dopamine. We believe that the embolic complications of disseminated intravascular coagulation and hypovolemia are serious risk factors in the development of dopamine gangrene. Peripheral vasoconstriction from dopamine, even at low doses, may set the stage for thrombotic complications of disseminated intravascular coagulation and lead to tissue damage. In laboratory models of disseminated intravascular coagulation, an alpha-adrenergic drug is required to produce peripheral ischemic tissue damage. Treatment of tissue ischemia related to dopamine depends on early recognition of acrocyanosis. Phentolamine, an alpha blocker, has been recommended for treating dopamine ischemia, either through local instillation into ischemic tissues or intravenous infusion. We recommend a high index of suspicion for, and early treatment of, underlying consumptive coagulopathy in all patients requiring dopamine.

Adult↗
PubMed1981

Colorectal foreign bodies and perforation.

Although most rectal foreign bodies can be removed safely in the emergency room, some require removal in the operating room. Good results can be achieved if basic principles in the management of colorectal injuries in general are applied to colorectal perforations by foreign bodies. Although rectal foreign bodies and colorectal perforations from non-medical rectal instrumentation have been a medical curiosity for many years, especially in metropolitan general hospitals, there can be little doubt that the frequency of such problems is increasing. We expect that community hospitals, will see more of these problems in years to come, if they are not already.

Adolescent↗