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E F Hirsch

Publications and source records attributed to E F Hirsch.

At least 37 records · Page 2Linked to original sources
PubMed1986

A comparative evaluation of particulate and soluble glucan in an endotoxin model.

Particulate glucan (P) but not soluble glucan (F) has been shown to sensitize rats to endotoxins. This phenomenon is believed to be mediated by the reticuloendothelial system (RES). The effect of glucan-P and -F on the RES, and the response of glucan-treated rats to nonlethal doses of endotoxin were investigated. Rats were injected for 5 days with 10 mg/kg of glucan-P, -F or saline. Three days later rats were either (1) injected with colloidal carbon for clearance studies, (2) sacrificed for organ histology and determination of serum glucose, plasma thromboxane (Tx) B2, and plasma 6-keto-prostaglandin (PG) F1 alpha concentrations, or (3) challenged with a nonlethal dose of endotoxin. The latter were further subdivided into groups for either 30-day survival or for sacrifice at 30 min or 4 h post-endotoxin infusion to obtain blood samples for glucose, TxB2, and 6-keto-PGE1 alpha determinations. Glucan-P induced hepatosplenomegaly and granulomatous changes within the liver and spleen. The carbon clearance halftime was markedly decreased in these animals. In glucan-P-treated rats challenged with endotoxin, elevated concentrations of both plasma prostanoids were observed as well as alterations in serum glucose levels. These changes were less pronounced in glucan-F- or saline- treated rats. Following endotoxin challenge, only 40% of glucan-P-treated rats survived 30 days whereas 100% of both the glucan-F and saline-treated rats survived. We conclude that glucan-P, in contrast to glucan-F, significantly heightens RES function and that this effect likely accounts for the endotoxin sensitivity.

Animals↗
PubMed1986

Residents' experience in the surgery of trauma.

Performance of surgery for trauma is an important part of residency training, yet what constitutes an adequate exposure to trauma surgery is ill defined. A retrospective review of records at a metropolitan receiving hospital was carried out for the academic year 1981-1982. Of the 50,902 patients treated in the Emergency Room more than one third were seen by a surgical resident. During this period 1,651 patients were admitted to General Surgery with traumatic injuries; 193 (12%) required intensive care. Two hundred twenty-seven major operations were performed by the General Surgical Service. For each patient operated on, 56 were seen in the Emergency Room and six required admission for nonoperative care of their injuries. Furthermore, less than 50% of patients admitted to the I.C.U. required surgery. An adequate education in trauma must be based on a large experience in the nonoperative resuscitation, diagnosis, and treatment of trauma victims. Nevertheless, the number of cases performed as operating surgeon provides a useful means of evaluation experience in trauma. Thirty cases are suggested as an appropriate level of exposure to the surgery of trauma, yet only one third of applicants to the American Board of Surgery attained this level.

Boston↗
PubMed1985

Prostanoid production by lipopolysaccharide-stimulated Kupffer cells.

Although some data suggest that macrophages in the reticuloendothelial system (RES) are important sources of thromboxane A2 (TxA2) and prostacyclin (PGI2) during endotoxic shock, we are unaware of data documenting the ability of hepatic macrophages (Kupffer cells) to release either TxA2 or PGI2 when exposed to lipopolysaccharide (endotoxin, LPS). In this study, Kupffer cells were examined for their ability to release prostaglandin E2 (PGE2), TxA2, and PGI2 following stimulation with 0, 1.0, 50.0, and 100.0 micrograms/ml of Escherichia coli LPS. Kupffer cells were obtained from rat livers by enzymatic digestion with 0.05% collagenase followed by enrichment of the macrophage population on the basis of differences in density and adherence among the various cell populations isolated. Based on several criteria (phagocytosis of opsonized sheep erythrocytes, positive staining for esterase and peroxidase, failure to replicate), 95% of adherent cells were Kupffer cells. After 4 days of incubation, cells were stimulated with various doses of LPS for 4 and 8 hr. Prostanoid concentrations in culture supernatants were determined by radioimmunoassay. Increasing doses of LPS significantly (P less than 0.001) increased the concentration of immunoreactive PGE2 (iPGE2) and iTxB2 (the stable metabolite of TxA2). The concentration of i6-keto-PFG1 alpha (stable metabolite of PGI2) increased following stimulation with 1.0 microgram/ml of LPS, but declined as the dose of LPS was increased. The results provide evidence that endotoxin-activated Kupffer cells, like other macrophage populations, release several metabolites of arachidonic acid. Kupffer cell-derived prostanoids, particularly TxA2, may be important mediators of some of the pathophysiologic manifestations of acute endotoxemia.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

The clinical consequences of an industrial aerosol plant explosion.

The factors relating to the clinical outcome of an industrial aerosol plant explosion are reviewed. Eighteen of 24 workers inside the plant required hospitalization and five died. Proximity to the blast was associated with extensive injuries unless workers were shielded by physical barriers or partitions. Burn severity and mortality were increased in those wearing synthetic garments compared to their counterparts wearing fiber clothing. Facial burns occurred in all unprotected workers. Forearm and hand burns in 11 patients required decompressive escharotomies. Topical treatment with silver sulfadiazine was associated with more significant leukopenia and neutropenia than treatment with silver nitrate. We conclude that industrial design should include safeguards which isolate workers from flammable materials, including isolation of explosive materials from working areas, alarm systems to detect leakage of flammable agents, protective barriers and shields, and the regulation and institution of flame and flash-resistant clothing.

Accidents, Occupational↗
PubMed1985

Pericardial complications in hepatic trauma.

During a 5-year period, 35 of 70 patients with liver trauma required entry of the thoracic cavity, with nine deaths. Pericardial complications developed in four of the nine survivors who had both thoracic and abdominal incisions. Two patients resolved their problems (postpericardiotomy syndrome, late pericarditis) with medical therapy. One patient required emergency thoracotomy for pericardial tamponade, and one patient developed constrictive pericarditis that required pericardiectomy. Available data support closure of the pericardium after pericardiotomy. Thoracic extension of abdominal incisions is often necessary. Pericardial complications may occur with hepatic trauma in the early or late postoperative periods and are potentially fatal.

Adolescent↗
PubMed1985

Prognosis and survival as determined by visceral amino acid clearance in severe trauma.

Sepsis, the commonest cause of late death following severe trauma, is related in part to inadequate uptake of amino acids (AA) and synthesis by the liver and other central tissues of proteins essential to immunological defense. Since 'central plasma clearance rate' of amino acids (CPCR-AA) has been found to reflect these functions, serial measurements of CPCR-AA were made in 32 seriously injured patients of whom ten died (31%), nine of sepsis. The mean Index Severity Score on admission for survivors was 31 +/- 1.8 and in deaths 34 +/- 3.9 (N.S.). The blood plasma AA concentrations were not significantly different. However, early in the course before the onset of infection, CPCR-AA in surviving patients was 227 +/- 30 and in those who ultimately died 83 +/- 24 ml/M2/min (p less than 0.001). Later during sepsis the values of CPCR-AA were 176 +/- 28 and 85 +/- 14 ml/M2/min, respectively (p less than 0.01). Thus CPCR-AA appears to be of value as an indicator of amino acid utilization by central tissues and as a predictor of survival or death following severe trauma.

Adult↗
PubMed1983

Rectal trauma. A retrospective analysis and guidelines for therapy.

Twenty patients seen at Boston City Hospital required general or spinal anesthesia for rectal injuries, and 17 required laparotomy. Findings on sigmoidoscopy were falsely negative in 4 of 13 patients examined. Diagnosis was delayed in two patients. Associated injuries occurred in 55 percent, with the lower genitourinary tract being the area most frequently injured. Complications occurred in eight patients (40 percent). Abscess formation and bacteremia were the most common, but iatrogenic complications occurred in four patients. Pulmonary embolism occurred in two patients and was suspected in a third patient. Routine treatment included diverting colostomy with distal irrigation and adequate drainage. Repair of the injury was performed when possible. Two of the 20 patients (10 percent) died, one after a prolonged septic course and one from recurrent pulmonary embolism. Rectal trauma continues to be a challenging injury.

Abscess↗
PubMed1982

Management of vascular injuries to the leg.

Our experience with 69 vascular injuries in 56 patients led us to modify the management of vascular injuries to the leg. We believe that prompt and complete angiography whenever the general condition of the patient allows it, early fasciotomy when indicated before vascular repair, thrombectomy of the injured artery and vein and local instillation of heparinized saline solution, vascular repair before orthopedic stabilization of fractures in selected cases, external fixation of the fracture when there is significant soft tissue injury, and early skin grafting resulted in an improved level of care with a low morbidity and no mortality in our series.

Adolescent↗
PubMed1980

[Not Available].

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History, Early Modern 1451-1600↗
PubMed1979

Gunshot wounds of the left upper abdominal quadrant associated with multiple intraabdominal injuries.

This study reviews low velocity gunshot wounds of the left upper quadrant of the abdomen and presents four cases recently treated at Boston City Hospital. All patients sustained multiple intraabdominal organ injuries and underwent prompt exploration. Hypotension on admission seemed to be the most reliable sign for a prolonged and complicated hospital course. The essential preoperative studies in stable patients should include a chest x-ray and intravenous pyelogram. Intraoperatively, injury to the body or tail or the pancreas is best managed by distal pancreatectomy and sump drainage. Exploration of the retroperitoneum is warranted for bleeding from the kidney. Initial maneuvers should be designed to control hemorrhage from the renal pedicle. If this is unsuccessful or the renal parenchyma is badly fragmented, nephrectomy should be performed. The complications noted in our patients, infection (pneumonia and left subphrenic abscess) and hemorrhage, are comparable to those reported in most large series. Pancreatic complications (fistulas, pseudocysts, and pancreatitis) were not noted.

Abdominal Injuries↗
PubMed1976

The lung: responses to trauma, surgery, and sepsis.

The adult pulmonary distress syndrome is a disease of many etiologies and significantly contributes to the post-traumatic and postsurgical mortality and morbidity. Pulmonary insufficiency associated with shock and hemorrhage is characterized by its relatively short duration, less severe alterations of pulmonary functions, and normal pulmonary vascular resistance. The judicious use of fluids and emphasis in the early use of blood during resuscitation will minimize the magnitude of the pulmonary insult. Severe changes in oxygenation and ventilation, increases in pulmonary vascular resistance, the need for long-term respiratory assistance, and an increase in mortality and morbidity are characteristic of the adult pulmonary distress syndrome that follows severe systemic sepsis. Early aggressive pulmonary support is required in all life-threatening surgical conditions. Endotracheal intubation is preferred to tracheostomy, and the use of a volume respirator will facilitate the control of ventilation and oxygenation. Significant decreases in the functional residual capacity are responsible for refractory hypoxemia and the use of high concentrations of oxygen can be circumvented by the use of positive end expiratory pressure. PEEP is sometimes associated with a decrease in cardiac output and an increase in the pulmonary shunt and occasionally pneumothorax. Continued hemodynamic and pulmonary monitoring of patients is mandatory when using PEEP. Discontinuance of ventilatory assistance is usually possible if the pulmonary shunts are less than 25 per cent, the tidal volumes greater than 5 cc per kg, and the vital capacity at least twice the tidal volume. Recovery from pulmonary insufficiency is predicated on adequate pulmonary management, nutritional support, and the control of the underlying contributory conditions.

Abortion, Septic↗
PubMed1975

Efficacy of intravenous clindamycin and methicillin in gram-positive soft tissue infections.

In a comparative study on a general surgical service, intravenous clindamycin phosphate or methicillin was used to treat a variety of soft tissue infections due to gram-positive organisms, chiefly staphylococci. The infections were rated according to severity, responsible organisms, and site of the infection. Excellent or good clinical and bacteriologic responses were obtained with both clindamycin and methicillin as adjuncts to basic surgical therapy in these soft tissue infections. The adverse effects of each drug were detailed, and were comparable. Clindamycin phosphate is a satisfactory substitute for methicillin in soft tissue infections secondary to gram-positive organisms.

Adult↗