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Biomedical subjects

E E Moore

Publications and source records attributed to E E Moore.

At least 361 records · Page 20Linked to original sources
PubMed1985

Nonresectional management of major hepatic trauma. An evolving concept.

Over a 6 year period, 319 acute liver injuries were identified at laparotomy. Fifty-three patients (17 percent) sustained major hepatic trauma that necessitated complex operative techniques: lobectomy in 21, segmentectomy in 6, selective hepatic artery ligation in 3, and temporary packing in 7. Throughout the study period, there has been a progressive shift to nonresectional therapy. Lobectomy for parenchymal injuries has continued to have a prohibitive mortality rate of 64 percent, whereas alternative procedures, such as hepatotomy, selective hepatic artery ligation, and packing, have had lower mortality rates from hemorrhage without an increase in delayed death from sepsis. Hepatotomy has also proved useful to gain access to retrohepatic vena caval tears. Our present experience supports the national trend of surgical restraint in the operative treatment of complex liver trauma and suggests that hepatic lobectomy is rarely justified.

Adolescent↗
PubMed1985

Local wound exploration of anterior abdominal stab wounds.

At least 25% of stab wounds of the abdomen are superficial. This can be determined in the ED by local wound exploration. If there is no penetration of the posterior fascia as determined by the technique herein described, the patient can be discharged from the emergency department after adequate local wound care is given. Because the patient is not admitted if exploration is negative, this is a safe and cost-effective method of managing superficial stab wounds of the abdomen.

Abdominal Injuries↗
PubMed1985

Emergency cricothyrostomy--technique and anatomical considerations.

Cricothyrostomy is the procedure of choice for emergency airway control when nasotracheal and endotracheal intubation are not possible or contraindicated. A vertical skin incision followed by a horizontal incision in the cricothyroid membrane are used. A number 6 tracheostomy tube should be used due to the anatomic size of the cricothyroid space. Using this technique, complications are rare.

Airway Obstruction↗
PubMed1985

Distal greater saphenous vein cutdown--technique of choice for rapid volume resuscitation.

Rapid fluid administration is essential for the successful resuscitation of hemorrhagic shock. Distal greater saphenous vein cutdown provides quick venous access for rapid volume repletion. The advantages of this simple technique include the physical characteristics of the vessel and its location. In rare instances use of the distal greater saphenous vein may be contraindicated, but in the vast majority of cases it is the cutdown procedure of choice for fluid resuscitation in the critically injured.

Fluid Therapy↗
PubMed1985

Utility of lavage alkaline phosphatase in detection of isolated small intestinal injury.

The ability of lavage alkaline phosphatase (LAP) to detect small intestinal injury was studied in 81 patients who underwent diagnostic peritoneal lavage following blunt and penetrating abdominal trauma. Patients with a grossly positive lavage were excluded. The LAP of five patients with small intestinal injury (79.0 +/- 41.7 IU/L) was significantly greater than in 76 cases without (1.2 +/- 0.4 IU/L; P less than .05). LAP greater than or equal to 3 was seen in six patients. Four had isolated small intestinal pathology, and one had combined small and large bowel injury. In three of these five, other lavage values were normal. One possible false positive occurred. The sensitivity of LAP greater than or equal to 3 (100%) exceeded that of usual lavage parameters in the detection of small intestinal injury. LAP may be a sensitive marker for small intestinal pathology in the immediate postinjury period.

Adolescent↗
PubMed1985

Prehospital advanced trauma life support for critical penetrating wounds to the thorax and abdomen.

The role of advanced trauma life support (ATLS) in the prehospital care of the critically injured is highly controversial. This study analyzes the efficacy of ATLS in the management of critical penetrating wounds of the thorax and abdomen. In the 2 1/2-year period ending July 1984, 203 consecutive patients underwent emergency laparotomy or thoracotomy for gunshot and stab wounds. All patients were treated in the field by advanced paramedics (EMT-P). For gunshot wounds the mean time (+/- S.E.M.) responding to the scene was 4.5 (+/- 0.29) minutes, on the scene 10.1 (+/- 0.41) minutes, and returning to the hospital 6.4 (+/- 0.32) minutes. For stab wounds the mean time responding to the scene was 4.8 (+/- 0.21) minutes, on the scene 9.5 (+/- 0.37) minutes, and returning to the hospital 5.7 (+ 0.30) minutes. The number of intravenous lines started averaged 1.8 per patient. Eighty-one patients had PASG applied and 28 patients underwent endotracheal intubation (21 orally, seven nasally). Thirty-three patients had no obtainable blood pressure, of whom six survived (18%). One hundred sixty (94%) of the remaining 170 patients who had any initial blood pressure survived. One hundred nine (55%) patients had an increase in BP greater than or equal to 10 mm Hg (average, 35.6 mm Hg), 64 (32%) had no significant change, and 25 (13%) had a fall greater than or equal to 10 mm Hg (average, 24.2 mm Hg) from the field to the emergency department. Twenty (80%) of the 25 patients with a fall in blood pressure survived.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1985

Extrahepatic biliary tract injury: operative management plan.

Trauma to the extrahepatic biliary tract is rare but, if overlooked or improperly managed, may be associated with significant morbidity. The following is our most recent 6-year experience with this unusual injury. Among 949 patients undergoing laparotomy for acute trauma, there were 32 (3%) injuries to the gallbladder and five (0.5%) to the common bile duct. All patients with gallbladder injury underwent abdominal exploration because of associated trauma. Cholecystectomy was preferred for 24 (96%) of the 25 with penetrating wounds and three (43%) of the seven with blunt trauma. Nine (28%) patients developed postoperative complications but none were related to the biliary injury. All common bile duct injuries (CBD) were penetrating. Associated intra-abdominal trauma was always present. Partial lacerations were closed primarily over a T-tube. An intrapancreatic CBD lesion was managed by sphincteroplasty and stented with a T-tube. The one patient with complete transection underwent choledochoenterostomy. Postoperative complications were common (50%) but none were related to the biliary injury.

Abdominal Injuries↗
PubMed1985

Limitations of computed tomography in the evaluation of acute abdominal trauma: a prospective comparison with diagnostic peritoneal lavage.

There has been recent enthusiasm for computed tomography (CT) to supplant diagnostic peritoneal lavage (DPL) in the detection of abdominal injuries. We prospectively compared CT to DPL following acute blunt trauma or stab wound to the abdomen. Patients with hemodynamic instability or overt signs of intraperitoneal pathology underwent urgent laparotomy and were excluded from study. Those with indications for DPL had lavage catheter insertion via open technique and attempted aspiration for gross blood. This was followed by contrast CT of the abdomen with a Technicare 2010 scanner. Lavage fluid, when required, was then instilled, recovered, and analyzed. CT interpretations were made in a blind fashion by a single staff radiologist. Decision for laparotomy was based on clinical, DPL, and CT data. In blunt trauma (N = 65), DPL detected 5/5 (100%) injuries discovered at laparotomy and CT 2/5 (40%). Following stab wounds (N = 35), DPL was true positive in 7/7 (100%) and CT in 1/7 (14.3%), with one false positive CT leading to negative laparotomy and one false positive DPL which prompted unnecessary celiotomy. Overall, the sensitivity of DPL was 100% versus 25% for CT and specificity 98.9% for both DPL and CT. In particular, CT missed seven solid visceral (five liver, two spleen), five hollow visceral, one major vascular, and three diaphragmatic lesions requiring operative intervention. In our experience, CT demonstrated an alarming incidence of false-negative studies. Given the widespread variability of CT equipment and personnel we would argue strongly against the use of CT alone in the evaluation of acute abdominal trauma and continue to support DPL as the most accurate and reliable instrument of detection.

Abdominal Injuries↗
PubMed1985

A comparison of PTV and endotracheal ventilation in an acute trauma model.

Percutaneous transtracheal ventilation (PTV) is an active airway management technique that may be an alternative to cricothyroidotomy in critically injured patients. A canine trauma model was devised to compare the ventilatory capacity and hemodynamic effects of PTV to endotracheal intubation. Mongrel dogs (25-37 kg), splenectomized 14 days previously, were anesthetized with pentobarbital and bled to a mean arterial pressure (MAP) of 20 mm Hg. Animals were maintained at this MAP for 1 hour, then resuscitated with simultaneous: a) aortic crossclamping via left thoracotomy, b) Ringer's lactate infusion, and c) active airway support. Control animals (N = 5), intubated with a cuffed endotracheal tube, were ventilated at a rate of 12 per minute, a tidal volume of 500 cc and an FIO2 of 60%. In study animals (N = 5), PTV, for a duration of 1 second, was instituted at the same rate and FIO2. There was no statistically significant difference between the two groups with regard to pO2, pCO2, pH, and hemodynamic parameters. PTV was also performed in the emergency department on four patients unresponsive to resuscitative thoracotomy for postinjury cardiac arrest. PTV rate was 12/minute; duration, 1 second; and FIO2, 100%. Mean values (+/- SEM) for pH, pO2, and pCO2 obtained after 15 minutes of PTV were 7.14 +/- 0.03, 322 +/- 49.5 torr, and 21.5 +/- 4.7 torr, respectively. PTV is comparable to endotracheal intubation with respect to oxygenation, ventilation and hemodynamic response (p greater than 0.05). Our preliminary clinical study corroborates its efficacy in the acute trauma setting and supports further clinical investigation.

Animals↗
PubMed1985

A variant F9 embryonal carcinoma cell line which undergoes incomplete differentiation in retinoic acid.

F9 embryonal carcinoma cells treated with 1 microM retinoic acid undergo irreversible differentiation and simultaneously lose their tumorigenicity. Described here are the isolation and characterization of an F9 variant clone (5C), which undergoes partial differentiation in retinoic acid. The behavior of 5C cells indicates that retinoic acid successfully initiates the differentiation pathway but that complete differentiation is not achieved due to a subsequent block in the pathway. The fact that 5C cells do not undergo complete differentiation, or lose their tumorigenicity in response to retinoic acid, indicates that the lesion affects an element involved in the regulation of both these events. Therefore, further genetic and biochemical characterization of this variant should provide information concerning the relationship between the regulation of differentiation and tumorigenicity. Furthermore, the isolation of this variant establishes the feasibility of genetically dissecting the various steps of the differentiation pathway.

Alkaline Phosphatase↗
PubMed1985

Critical factors in determining mortality from abdominal aortic trauma.

Aortic injuries remain highly lethal. Major factors contributing to death in these patients appear to be free peritoneal hemorrhage and associated abdominal vascular trauma. These conditions often manifest as profound shock upon hospital presentation and portend a grim prognosis. Potential means to improve survival include: 1, vigorous resuscitation and prompt operative intervention in patients with penetrating abdominal trauma presenting in a state of shock; 2, careful search and control of associated vascular injuries prior to definitive aortic repair, and 3, constant vigilance to coagulation function, core temperature and acid-base status.

Abdomen↗
PubMed1985

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. The TPN regimen was 1.0-1.5 gm/kg/day amino acids and 30-45 glucose kcal/kg/day. The BCAA formula used was high in isoleucine and valine, but not leucine. Amino acid plasma levels, blood chemistries, 3-methylhistidine excretion, and nitrogen balance were studied. Control studies showed negative nitrogen balance (-7.1 +/- 2.9 gm) (mean +/- SEM), elevated insulin (61 +/- 21 microunit/ml), and elevated 3-methylhistidine (3MH) excretion (688 +/- 309 micromol); plasma leucine (93 +/- 11 nmol/ml) and isoleucine (37 +/- 23) were low, and valine (155 +/- 20) was elevated. Plasma methionine (40 +/- 9) and tyrosine (70 +/- 12) were high normal. Phenylalanine (85 +/- 5) was elevated. Both groups showed increased nitrogen excretion and positive nitrogen balance during the study (25 per cent, 2.0 +/- 1.4 gm/day; 45 per cent, 1.2 +/- 2.6 gm/day). Three-methylhistidine excretion changed little in either group (557 +/- 149, 414 +/- 91), insulin rose (135 +/- 27, 65 +/- 19), and plasma leucine (82 +/- 4, 71 +/- 9) changed little. Plasma isoleucine (51 +/- 3, 155 +/- 16) and valine (173 +/- 11, 691 +/- 23) both rose, more in the 45 per cent group. Methionine (67 +/- 12, 37 +/- 4) and tyrosine (51 +/- 6, 50 +/- 10) changed little.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Nephrectomy following trauma--impact on patient outcome.

Nephrectomy for trauma is done infrequently due to the success of renal sparing procedures. The purpose of this review was to quantitate the effect of nephrectomy on patient outcome. Over a 5-year period 55 of 783 patients had renal injuries confirmed at trauma laparotomy. Nephrectomy was performed in 14 (25%) of these patients. Thirteen patients had penetrating injuries (12 gunshot wounds, one stab wound) and one patient was the victim of blunt trauma. The average number of associated injuries was 3.6. Three patients exsanguinated intraoperatively. Renal failure (serum creatinine greater than 2.5 mg%) developed in four patients; three required hemodialysis. The average time of onset of renal dysfunction was 3 weeks, and in every case it was preceded by intra-abdominal sepsis. Two patients died, both from multiple organ failure, on postoperative day 25 and 26, respectively. In the seven patients free of renal failure, one patient developed sepsis and subsequently died. Of the eight surviving patients, all had adequate renal function as evidenced by an average blood urea nitrogen of 14 mg%, serum creatinine of 1.3 mg%, and a creatinine clearance of 77 ml/min. Renal failure following nephrectomy for trauma occurs late in the hospital course and is invariably preceded by sepsis. Nephrectomy is a marker of severe intra-abdominal injury, but in itself is not the major determinant of survival.

Abdominal Injuries↗
PubMed1985

Primary repair of the colon: when is it a safe alternative?

Management of civilian colon injuries has clearly departed from the military directive advocating mandatory colostomy. The treatment of 228 colon injuries at the Denver General Hospital was reviewed to elucidate risk factors for colon-related complications and quantify the morbidity of available surgical treatment options. In our population, 68% of patients sustained gunshot wounds with a high percentage of severe colon injuries and associated abdominal organ damage. Primary repair was accomplished in 49% with 17% septic morbidity and 1% septic mortality rates. Colostomy was required in 36% with a cumulative septic morbidity of 48% and 2% septic mortality. The most common complications were abdominal abscess (12%), wound infection (7%), and fecal fistula (4%). Analysis of risk factors for colon-related morbidity showed that the Abdominal Trauma Index (ATI), colon injury severity, preoperative shock, and peritoneal contamination were most important. Synthesis of the treatment outcome and risk factor data yields a proposed management scheme for colon injuries that is based on the patient's hemodynamic status, colon injury severity, and ATI scores. Primary repair by either debridement and simple closure or resection with primary anastomosis is advocated for colon injuries in patients who are hemodynamically stable with an ATI score less than 25.

Abdominal Injuries↗
PubMed1985

Luteinized unruptured follicle syndrome in mild endometriosis. Assessment with biochemical parameters.

Failure to extrude an ovum, with subsequent luteinization of the unruptured follicle (LUF), has been proposed as a cause of infertility in women with mild endometriosis. To assess the incidence of this process we performed laparoscopies in the early luteal phase on 16 women with mild endometriosis and 8 control subjects. Peritoneal fluid was aspirated and a plasma sample obtained concurrently. Estradiol (E2) and progesterone (P) concentrations were determined. A review of the literature suggested that the following hormonal criteria correlated with follicular rupture: fluid E2 greater than or equal to 500 pg/ml, E2 fluid/plasma ratio greater than or equal to 3.1, fluid P greater than or equal to 3,000 ng/dl and P fluid/plasma ratio greater than or equal to 5:1. All control subjects met at least one E2 and one P criterion: 75% met all. In contrast, less than one-third with mild endometriosis met all, and three (19%) met none. Five met only E2 criteria. These findings suggest that LUF occurs occasionally in association with mild endometriosis. Additionally, ovarian steroidogenesis, particularly P secretion, was impaired frequently in the absence of LUF in women with endometriosis.

Ascitic Fluid↗
PubMed1984

Selective management of penetrating neck injuries. A prospective study.

We assessed the feasibility of a selective policy for operative exploration of penetrating neck wounds. Patients with bleeding, hematomas, crepitations, dysphagia, dysphonia, or impaired mental status rendering their conditions nonevaluative had prompt explorations. All other patients were observed in the hospital. Of the 77 patients in this study, 48 (62%) underwent neck exploration based on the preceding criteria; (85%) had major injuries. Of the 29 patients observed according to protocol, none required subsequent exploration for a missed lesion. Ancillary diagnostic procedures in the observed patients consisted of arteriography in four, esophageal contrast studies in five, esophagoscopy in two, and laryngoscopy in one. The average hospital stay for observation was 1.8 days. Our experience confirms the safety and cost-effectiveness of selective exploration for penetrating neck injuries. Moreover, observation does not mandate extensive ancillary testing for level II and III injuries.

Adolescent↗