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Biomedical subjects

F L Grover

Publications and source records attributed to F L Grover.

At least 127 records · Page 7Linked to original sources
PubMed1985

Management of blunt and penetrating external esophageal trauma.

The records of 26 patients with external blunt or penetrating esophageal trauma were reviewed to determine clinical features and results of therapy. Twenty-one injuries (four blunt, 17 penetrating) were to the cervical esophagus, and five to the thoracic esophagus. Major physical signs included subcutaneous air, neck hematoma, and blood in the nasogastric tube. Helpful roentgenographic findings were cervical and/or mediastinal air, mediastinal widening, pleural effusion, and pneumothorax (15%). Nine of 12 (75%) contrast studies and five of six (83%) esophagoscopies were positive. Twenty-four patients had associated injuries, the most common of which was tracheal (14 patients) (64%). All patients were managed by prompt surgical exploration, primary closure, and drainage. There were three early deaths. Thirteen patients had postoperative complications, four of which were esophageal leaks. Two of the leaks caused mediastinitis, pleural sepsis, and led to death. They were not treated by early esophageal exclusion or excision. There were no significant strictures or esophageal sequelae in the other patients. It is concluded that early primary closure and drainage results in a relatively high incidence of survival. If a thoracic esophageal leak occurs, aggressive management of prompt esophageal exclusion or excision is necessary to control sepsis and improve survival.

Adolescent↗
PubMed1984

Mechanism of inferior electrocardiographic ST-segment depression during acute anterior myocardial infarction in a baboon model.

Controversy exists concerning the mechanism of electrocardiographic (ECG) ST-segment depression in leads remote from an area of acute myocardial infarction. Thus, 13 baboons were studied during ligation of the distal third of the left anterior descending coronary artery. The morphologic pattern of the ECG limb leads in the supine baboons resembled that of an asthenic human and did not change when the chest was opened. The visually apparent infarct area of the distal anterior wall was confirmed by epicardial ECG mapping 30 minutes after ligation, and by tissue creatine kinase and histologic study at 24 hours. All 13 baboons had ST depression in leads III and aVF of 0.1 to 1.2 mV at 30 minutes, and 11 of 13 had similar changes in lead II. Also, all 13 baboons had ST elevation in lead aVL (n = 10) or aVR (n = 11), suggesting that the ST vector from the infarct area was directed away from the inferior leads. In no baboon did inferoposterior wall ventricular epicardial mapping show evidence of myocardial ischemia, and mean creatine kinase content from the infarct sites was markedly lower than that from posteroinferior sites (12.7 +/- 2.8 vs 20.6 +/- 2.1 IU/mg protein, p less than 0.01). In addition, the inferoposterior myocardium was normal histologically. In conclusion, acute myocardial infarction often results in reciprocal ST depression at sites distant from the area of acute necrosis and need not represent "ischemia at a distance."

Animals↗
PubMed1984

Management of penetrating and blunt diaphragmatic injury.

The past 5 years' experience with diaphragmatic injuries at the University of Texas Health Science Center in San Antonio was reviewed to refine the clinical signs and appropriate treatment. During this period 102 patients were treated. Ninety-three patients incurred penetrating trauma to the diaphragm and nine patients suffered blunt trauma. Chest X-rays were normal in 40 patients, a hemo- and/or pneumothorax was present in 57, herniated abdominal viscera in four, and free air in one. Peritoneal lavage was positive in six of seven patients with blunt diaphragmatic injury, but was falsely negative in two of five patients (20%) with penetrating diaphragmatic injury. Eighty-nine patients (87%) experienced 137 associated injuries (excluding hemo- and/or pneumothorax). Nine patients (8.8%) had an isolated diaphragmatic injury. Four patients (4%) had a diaphragmatic injury associated with only a hemo- and/or pneumothorax. All patients, except for three with injuries recognized late, were operated upon immediately. Two patients had a missed diaphragmatic injury at initial laparotomy. There was one death in the series from a consumption coagulopathy. It was concluded that injuries to the diaphragm should be suspected in all patients with severe blunt torso trauma or with penetrating injuries near the diaphragm. Because of the nonspecificity of X-rays and the 20% false negative rate for peritoneal lavage, we believe that missed injuries and morbidity can be minimized by immediate laparotomy for all patients with abdominal and low thoracic penetrating injuries. Care must be taken not to overlook associated injuries.

Adolescent↗
PubMed1984

Right aortic arch causing left bronchus obstruction.

A case is reported of a right aortic arch vascular ring composed of a right aortic arch with mirror image branches and a retroesophageal left aortic diverticulum with a left ductus arteriosus that appeared as a possible foreign body aspiration in an infant. This vascular ring caused partial occlusion of the left main bronchus with air trapping. A discussion of right aortic arch vascular rings and vascular anomalies that have caused unilateral lung hyperinflation is included in this report.

Journal Article↗
PubMed1983

Effect of venting on myocardial protection by hypothermic cardioplegic arrest.

UNLABELLED: Myocardial rewarming between cardioplegic (CP) infusions is in part attributable to blood circulating through the heart from collateral channels. This experiment was performed to determine if the type of left ventricular (LV) venting affects myocardial temperature (temp) or alters myocardial protection. Twelve dogs underwent cardiopulmonary bypass (CPB) at 37 degrees C and were subjected to 100 min of cardioplegic arrest by intermittent coronary infusion of 300 ml 0-4 degrees C CP solution. Arterial, central venous, left atrial, and LV pressures; cardiac output; systemic, septal (S), right ventricular (RV), and LV temp; myocardial ATP and glycogen were measured; LV pressure/volume curves and LV dp/dt were calculated. Group A (6 dogs) had an LV vent during CPB, and Group B (6 dogs) had the aorta vented via the CP line. CP infusion lowered LV temp to 8 degrees C in Group A vs 13 degrees C in Group B (P less than 0.000002); S temp was lowered to 7 degrees C in Group A vs 11 C in Group B (P less than 0.00007); and RV temp was lowered to 16 degrees C in Groups A and B. Ten minutes after CP, LV and S temp increased to 20-21 degrees C in Groups A and B, and RV temp to 24-25 degrees C in Groups A and B. Twenty minutes after CP all temperatures were the same. Hemodynamics and myocardial metabolic studies were similar in the two groups. CONCLUSIONS: Hearts vented via the LV cooled to a lower temperature vs those vented via the aorta. Venting did not affect myocardial rewarming, myocardial metabolites, or ventricular function.

Animals↗
PubMed1983

Myocardial preservation: effect of venous drainage.

We compared the effect of three methods of venous drainage on myocardial temperature, coronary blood flow as determined with radioactive microspheres, myocardial metabolites (lactate, adenosine triphosphate [ATP], and glycogen), and left ventricular function before, during, and after cardiopulmonary bypass with hypothermic, hyperkalemic cardioplegic arrest. Venous drainage was established in the 6 dogs in Group 1 using a Sarns 51F cavoatrial catheter, in the 7 dogs in Group 2 using two USCI 32F vena caval catheters with tourniquets, and in the 7 dogs in Group 3 using two USCI 32F vena caval catheters without tourniquets. The lowest myocardial temperature was achieved in Group 1 (7.26 degrees +/- 0.45 degrees C compared with 10.45 degrees +/- 0.56 degrees C in Group 2 and 9.78 degrees +/- 0.43 degrees C in Group 3) (p less than 0.001). Myocardial rewarming to 20 degrees C was not significantly different among the groups. Myocardial ATP and lactate levels were similar in all three groups. Myocardial glycogen levels were maintained during ischemia in Group 1 (1,010 +/- 76 mg/dl compared with 686 +/- 39 mg/dl in Group 2) (p less than 0.005). Myocardial blood flow was similar in all groups during the preischemic periods, but during reperfusion a markedly decreased flow was seen in all areas of the myocardium in Group 1 compared with Group 2 (p less than 0.004). Left ventricular function, as measured by the maximum rate of rise of left ventricular pressure, stroke work, and pressure/volume curves, was similar in all groups. We interpret the postischemic blood flow data, glycogen levels, and ventricular compliance differences to suggest that the dogs in Group 1 had less ischemia.

Adenosine Triphosphate↗
PubMed1983

The human tumor clonogenic assay in the treatment of patients with lung cancer.

The human tumor clonogenic assay has allowed the growth of human tumor cells and their testing to chemotherapeutic agents in vitro in a manner much like bacterial antibiotic sensitivities. This report deals with the in vitro test results compared with the in vivo therapeutic sensitivities of human lung cancer. Three hundred twenty-six lung tumor specimens from either primary or metastatic disease were plated using a two-layer technique. Of these, 68% (223) were grown and 41% (133) were applicable to chemosensitivity testing. Only 28 patients were considered for a retrospective analysis of in vitro tumor sensitivity versus in vivo tumor response to chemotherapeutic agents. Among them the percentage of true positives for the assay was 60%, while the percentage of true negatives was 91%. This technique has been encouraging in its initial stages and, with further development, may have an expanding role in the treatment of patients with lung cancer.

Biological Assay↗
PubMed1983

Comparison of flow differences among venous cannulas.

1. Double caval cannulas with snares provide maximum venous decompression, especially of the superior vena cava. Decompression of the right side of the heart is passive and in the heart being perfused requires venting of the right atrium by release of tapes or atrial suction. 2. Double caval cannulas without snares provide good and consistent venous and atrial decompression. The ventricle is decompressed well except when the perfused heart is in the circumflex position. 3. A large single cannula (e.g., USCI 40F) can decompress both the venous system and right side of the heart, although venous and atrial drainage are much less efficient when the heart is in the circumflex position. 4. The Sarns 51F cavoatrial cannula decompressed the venous system as efficiently as the double caval cannulas. In fact, decompression of the atrium and ventricle were consistently much better with the cavoatrial cannula than with any of the other methods. 5. Efficient venous and myocardial decompression using the 51F cavoatrial cannula requires the atrial drainage ports to be positioned in the upper middle section of the atrium. Clinically, the cannula position is correct when both the single and double marking bands on the cannula are outside the atrium.

Animals↗
PubMed1983

Complement localization in ischemic baboon myocardium.

Complement localization was examined by direct immunoperoxidase procedures on frozen sections of baboon myocardium obtained 24 hours after ligation of the left anterior descending coronary artery. There was extensive localization of C3, C4, and C5 in most infarcted myocardial fibers; however, in these infarcted areas of myocardium, complement components were not found in myocytes immediately adjacent to either the endocardium or epicardium. Although C3, C4, and C5 were all present within the same myocardial fibers as assessed in adjacent serial sections, the light microscopic distribution of these components was dissimilar, i.e., C3 and C5 were present in both a granular and a diffuse pattern within myocytes, whereas C4 was always localized in a diffuse pattern. Complement components C3 and C5, but not C4, were also localized in the walls of small muscular arteries in infarcted myocardium. No complement was observed in myocardial fibers or blood vessels in normal baboon myocardium. Electron microscopic evaluation of C3 localization within infarcted myocardium indicated that C3 was associated with contractile elements of myocytes, as well as with membranes of myocyte nuclei, mitochondria, and sarcoplasmic reticulum. Within vascular smooth muscular cells, C3 was associated with myofilaments and mitochondrial membranes. Thus, the results of this study provide new information regarding the cellular and subcellular distribution of complement components in infarcted baboon myocardium. If this localization of C3, C4, and C5 is a result of their in situ activation within the ischemic myocardium, a variety of complement-derived phlogistic products would be expected to have been produced and to have effected, in part, the subsequent inflammatory response.

Animals↗
PubMed1982

Comparison of roller pump versus pressurized bag administration of potassium cardioplegic solution.

We sought to determine the relative efficacy of administering cardioplegia by the pressurized bag versus roller pump technique. Fourteen dogs were placed on cardiopulmonary bypass at 30 degrees C and subjected to 2 hours of cardioplegic arrest. Group 1 (7 dogs) was administered cardioplegic solution from a plastic bag under pressure into the ascending aorta every 20 minutes for the 2-hour period, and Group 2 (7 dogs) was given cardioplegia by means of a roller pump. Myocardial temperature decreased in Group 1 to 13.4 degrees C following administration of the cardioplegic solution, and to 13.1 degrees C in Group 2 (not significant). These temperatures were reached in 3.0 minutes in Group 1 and 1.9 minutes in Group 2 (p less than 0.03). Aortic root pressures during cardioplegic infusion were 31 +/- 2 mm Hg in Group 1 versus 46 +/- 2 mm Hg in Group 2 (p less than 0.01). No significant differences between groups were noted in myocardial distribution of cardioplegia, myocardial blood flow or metabolism, or left ventricular hemodynamics. We conclude that both methods of administering cardioplegia lowered myocardial temperature adequately and protected the myocardium for a period of 2 hours in these normal hearts. The roller pump method facilitated faster cooling and produced significantly higher aortic perfusion pressures, however, which may be important in hearts with coronary stenosis.

Adenosine Triphosphate↗
PubMed1982

Growth of lung cancer in a human tumor clonogenic system.

The human tumor clonogenic assay system has enabled human cancer cells to be grown in vitro and has the potential of providing chemosensitivity results in a manner much like bacterial antibiotic sensitivities. The in vitro growth of human lung cancer cells using this assay has not been previously reported. Over the past 2 years, 3,100 specimens have been plated by means of the two-layer agar technique as developed by Hamburger and Salmon, 302 of which were primary or metastatic lung tumors. Histologic, karyotypic, and nude mice studies confirmed that the colonies were composed of tumor cells. Growth rates (significant growth being greater than or equal to 5 colonies per plate) and plating efficiencies (the number of colonies grown per number of nucleated cells plated) were tabulated for each lung tumor cell type for primary, metastatic, and malignant pleural and pericardial fluids. The average overall growth rate was 199 of 302 (66%)--17 of 19 (90%) large cell carcinomas, 46 of 71 (65%) oat cell carcinomas, 57 of 91 (63%) adenocarcinomas, (* = p less than 0.05 when compared to large cell carcinomas) *40 of 68 (59%) squamous cell carcinomas, *and 39 of 53 (74%) of an undetermined cell type were grown. The average plating efficiency was 0.0236%. In primary tumors, large cell carcinomas had a plating efficiency of 0.0348%, adenocarcinoma 0.0247%, *oat cell 0.0224%, *and squamous cell 0.0113%.* It was concluded that lung tumor cells can be grown in vitro from 66% of lung tumor specimens. The highest growth rates and plating efficiencies were found in large cell carcinomas and the lowest rates in squamous cell carcinomas. This technique may provide a means of testing for the sensitivity of patients' lung tumor cells to various chemotherapeutic agents.

Clone Cells↗
PubMed1981

Does lower systemic temperature enhance cardioplegic myocardial protection?

This study was performed to determine if systemic temperature affects the rate of cooling and rewarming of the myocardium between infusions of cold potassium cardioplegic solution and if it alters the degree of myocardial protection. Twenty-one dogs underwent cardiopulmonary bypass and 3 hours of ischemic arrest produced by infusing 0 degrees to 4 degrees C potassium cardioplegic solution every 20 minutes. The animals were perfused at different systemic temperatures--Group A, 23 degrees C; Group B, 30 degrees, C; and Group C, 37 degrees C. Myocardial temperature decreased to 11 degrees C in Groups A and B as compared with 13 degrees C in Group C immediately after infusion of the potassium cardioplegic solution (p < 0.0007). Myocardial temperature increased to 19 degrees, 21 degrees, and 26 degrees C in Groups A, B, and C (p < 0.000005) 20 minutes after infusion. Myocardial adenosine triphosphate (ATP) concentration significantly decreased, from 6.69 to 3.56 mumoles/gm (p < 0.0003) in Group B and from 4.99 to 2.80 (p < 0.005) in Group C at the end of 3 hours of cardioplegic arrest. Myocardial glycogen levels also significantly decreased, from 1.156 to 446 mg% (p < 0.003) in Group B and from 811 to 439 mg% (p < 0.04) in Group C. Myocardial ATP and glycogen did not decrease significantly in Group A during the period of arrest. Myocardial lactate values increased more in Groups B and C during the arrest period than in Group A. 12.6 versus 6.5 mumoles/gm (p < 0.03). Moderate systemic hypothermia, therefore, appears to enhance the myocardial protection of potassium cardioplegia.

Adenosine Triphosphate↗
PubMed1981

Carcinoma of the esophagus. An aggressive one-stage palliative approach.

We reviewed the records of 44 consecutive patients with advanced esophageal carcinoma treated at either a Veterans Administration or a city-country hospital. The patients, 38 men and six women, ranged in age from 27 to 72 years and had been referred for operative management. The average duration of dysphagia was 5 months. All patients underwent a one-stage esophagogastrectomy with esophagogastrostomy. The last 34 patients also had a modified fundoplication. Lesions at the gastroesophageal junction were approached via a low left thoracotomy and the others via a simultaneous right thoracotomy and laparotomy. All patients had preoperative enteral or parenteral hyperalimentation. Seven patients died within 30 days after operation (operative mortality 16%). Twenty-six patients lived from 3 to 28 months postoperatively (average 11.5 months). Eleven are alive at present (average 10 months). Postoperative complications were as follows: anastomotic leak, three patients (two died); respiratory failure, four (two died); stricture, three; myocardial infarction, two (two died); cholecystitis, one; and pulmonary embolus, one (patient died). Thirty-four patients had modified fundoplication, and an inconsequential anastomotic leak developed in one. In contrast, two of the 10 patients who did not have modified fundoplication died as a result of anastomotic leak. Preoperative hospital stay ranged from 10 to 28 days (average 18); postoperative stay ranged from 10 to 40 days (average 16). Except for the three patients in whom stricture developed, all patients (92%) had continuous relief of dysphagia. We conclude that one-stage esophagogastrectomy with esophagogastrostomy is applicable in most cases and is associated with both satisfactory long-term palliation and a reasonable period of hospitalization. The addition of a modified fundoplication results in a relatively low rate of anastomotic leak.

Adenocarcinoma↗