Biomedical subjects
Publications and source records attributed to D M Thomas.
We present the case of a patient with traumatic ventricular septal defects following blunt chest trauma. The pathophysiology and clinical presentation of the lesion are discussed. Definitive diagnostic procedures should be performed immediately in patients with suggestive findings to establish the diagnosis and to determine the magnitude of the shunt and the presence of pulmonary hypertension.
We retrospectively reviewed 135 presentations (114 patients) of urban hypothermia treated at the discretion of the emergency department staff over a nine-year period from February 1971 to March 1980. Rewarming treatment options included passive external, active external, and heated oxygen aerosol administered by mask or intubation. The rates of rewarming were statistically similar for passive external (0.71 C/hr) and heated aerosol via mask (0.74 C/hr). The rate of rewarming for active external methods was 0.90 C/hr. Heated oxygen aerosol using intubation rewarmed the patient at a significantly greater rate than the passive external method (1.22 C/hr) (P < 0.01). The overall mortality rate for the series was 11.9%, but 47.9% when serious underlying disease was present. Individual mortality rates were 64.3% for active external (9/14), 7.67% for active core with a mask (1/13), 5.2% for passive external (4/68), and 5.0% for active core with a nasotracheal tube (2/40). Active core rewarming using intubation was selected more frequently with moderate and severe hypothermia (P < 0.001). The group of survivors had a higher mean arrival temperature (31.33 C) than did the non-survivors (27.55 C) (P = 0.01). Active core rewarming with heated aerosolized oygen via nasotraheal tube is a safe technique for the rapid rewarming of selected hypothermic patients. The arrival temperature and the presence of serious underlying disease, in addition to the method of rewarming, appear to be major determinants of prognosis.
Three hundred consecutive patients in whom nasotracheal intubation was selected as the method of airway management were prospectively evaluated for success and safety. The intubations were performed in the emergency department by 19 emergency medicine residents and staff. The success rate was 92% when performed "blindly" without Magill forceps. Translaryngeal anesthesia preceded the intubations in 86%. The complication rate for the techniques was 3%. In the 242 survivors, there was no significant or permanent laryngeal damage. The technique, indications, contraindications, advantages, disadvantages, and complications of nasotracheal intubation and translaryngeal anesthesia are reviewed. Nasotracheal intubation is an essential skill allowing a flexible approach to airway management.
During the Decade of the Family, Catholic health care facilities should reexamine their commitment to family-oriented care. Do admission, treatment, and discharge procedures take into account that the patient is one member of a unit? Or do they focus solely on the patient as a physically sick individual?
The Raman spectra of a normal rabbit lens have been recorded over the range of 0 to 4000 cm-1. Spectral results indicate that protein conformation is predominantly beta-pleated sheet. Polarization measurements and assignments for most of the bands have been made; the spectral region for water indicates extensive hydrogen bonding. An N2 laser operating at 337 nm was used to produce cataracts in a rabbit lens; the Raman spectra of the cataractous lens were also recorded. Spectral changes are observable in the water region, and these are correlated with a mechanism of ultraviolet cataractogenesis.
Following the injection of suitable media, the arterial tree of 22 post-mortem human stomachs was studied by angiography, or corrosion and micro-dissection. In stomachs infused exclusively by the right gastroepiploic artery, i.e. following ligation of all other gastric vessels on the stomach wall, both methods produced good fundal filling, while demonstrating consistently poor filling of a strip of stomach wall along the lesser curve. These findings do not support the assertion that in operations involving mobilization and transposition of the stomach the viability of the fundus is critically dependent upon an anastomotic circulation involving the extragastric portion of the left gastric vessels, but rather indicate that these vessels can, if required, be excised with impunity in most patients, provided that there is no extensive atherosclerosis. However, these findings indicate that such a procedure may impair the blood supply of the lesser curve, and they provide an anatomical explanation of the occasional occurrence of necrosis of the lesser curve following proximal gastric vagotomy.
Three patients are described who were admitted to hospital with septicaemic shock due to gallstones, but in none of whom had the presence of gallstones, been diagnosed previously. All 3 had positive blood cultures, Clostridium welchii being isolated in one patient (in another patient this organism was isolated from the bile). Two patients had renal failure requiring dialysis. All 3 patients survived. The management of this serious presentation of gallstones, hitherto poorly described in British literature, is discussed.
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