Biomedical subjects

G B Demarest

Publications and source records attributed to G B Demarest.

25 records · Page 2Linked to original sources

PubMed1989

Use of the kinetic treatment table to prevent the pulmonary complications of multiple trauma.

The kinetic treatment table (KTT) has been developed to prevent and treat complications of immobility. Because atelectasis and pneumonia may be related to immobility, we studied the effect of the KTT on the prevention and treatment of pulmonary complications in a prospective randomized study of 30 patients with severe traumatic injuries. All were receiving mechanical ventilation and were randomly assigned to treatment with a KTT or a conventional bed. Both groups received conventional medical-surgical therapy while pulmonary function, chest roentgenograms, and the presence or absence of lung infection were monitored for one week. In the patients who began the study with a clear chest roentgenogram, atelectasis and pneumonia were significantly less frequent in those treated with a KTT (P less than .05). Thus, the KTT can reduce pulmonary complications in selected patients with multiple trauma. The effect of this benefit on overall outcome is uncertain.

Adolescent↗

PubMed1988

Traumatic disruption of the subclavian artery and brachial plexus in a patient with Ehlers-Danlos syndrome.

A 17-year-old girl with Ehlers-Danlos syndrome underwent simple reduction of a dislocated shoulder that was complicated by disruption of the subclavian artery and brachial plexus. The shoulder dislocation was a recurrent condition that had been treated successfully on several previous occasions without complication. During the relocation process, only minor upper extremity manipulation caused injury to the brachial plexus and subclavian artery. Management of an iatrogenic vascular injury was made difficult by the fragile consistency of the anterial wall that would not hold sutures. Amputation of the patient's arm ultimately was required.

Adolescent↗

PubMed1987

Late complications after gastric reservoir reduction with external wrap.

Numerous surgical procedures have been introduced to facilitate weight loss in morbidly obese individuals. Gastric reservoir reduction, wrapping the stomach with an inert fabric, is one such procedure. Nissen fundoplication has been performed in conjunction with this approach to prevent postoperative gastroesophageal reflux. Gastric perforation and functional gastroesophageal obstruction occurring as late as 71 months after this operation represent late complications. Perforation has developed in 14.6% of stomachs wrapped with polypropylene mesh. Nissen fundoplication may contribute to this complication.

Adult↗

PubMed1987

Pericardial tamponade and hemothorax after penetrating injury to the internal mammary artery.

Penetrating wounds to the anterior chest wall are associated with injury to the heart and great vessels. If injury to these structures is suspected, early surgical intervention is indicated. The internal mammary artery also can be involved in penetrating trauma and can present a clinical situation similar to heart injury, as in the case reported.

Adult↗

PubMed1985

Sinoatrial Wenckebach associated with blunt cardiac injury.

A 20-year-old man developed sinoatrial Wenckebach after moderate blunt chest and cardiac trauma from a motor vehicle accident. This unusual dysrhythmia is manifested by grouped beating, a constant PR interval, progressive shortening of the cycle length, and repetitive pauses. Sinoatrial Wenckebach has not previously been described in association with blunt cardiac injury.

Adult↗

PubMed1979

Impaired alveolar macrophage chemotaxis in patients with acute smoke inhalation.

Pulmonary infection is a leading cause of death in patients with smoke inhalation; however, few studies have evaluated the effects of inhaled smoke on the host defense mechanisms of the lung. In this study we investigated the effects of acute smoke inhalation on the random and chemotactic (stimulated unidirectional) migration of human pulmonary alveolar macrophages. Fiberoptic subsegmental pulmonary lavage was performed in 19 normal subjects (12 nonsmokers and 7 smokers) and 7 patients with smoke inhalation. After quantification of lavaged cell populations, random and chemotactic migration was measured using modified Boyden chambers. Zymosan-activated serum was used as a chemotactic stimulant. Mean +/- SE random migration was 6.2 +/- 0.8 cells per 20 microscopic fields in smoking control subjects, 5.7 +/- 0.7 in nonsmoking control subjects, and 5.2 +/- 0.7 in patients with smoke inhalation. These values are not significantly different. In contrast, the mean directed (chemotactic) migration of pulmonary alveolar macrophages was 26.5 +/- 1.9 in smoking control subjects, 22.7 +/- 3.0 in nonsmoking control subjects, and 11.4 +/- 1.4 in patients with smoke inhalation; the latter response was significantly different from that of the smoking (P less than 0.001) and nonsmoking (P less than 0.025) control subjects and the combined average of the 2 control groups (P less than 0.001. In vitro exposure of pulmonary alveolar macrophages to nontoxic doses of smoke produced similar impairment of chemotaxis. These findings may partially explain the enhanced susceptibility of patients with smoke inhalation to pulmonary infection.

Adult↗

PubMedDate not supplied

Obligatory negative nitrogen balance following spinal cord injury.

Obligatory nitrogen losses due to paralysis in the spinal cord-injured (SCI) patient prevent positive nitrogen balance (NB) regardless of the calorie and protein intakes. Ten patients with SCI and 20 controls with nonspinal cord injury (NSCI) matched for time, sex, age, and injury severity score (ISS) were admitted to our Level I trauma center. In both groups, total nutritional support was delivered within 72 hours of admission based on predicted energy expenditures (PEE = Harris-Benedict equation x 1.2 x 1.6) and 2 g of protein/kg of ideal body weight (IBW). Subsequent changes in nutrient delivery were based on NB. No SCI patient established positive NB during the 7-week period following injury despite an average delivery of 2.4 g of protein/kg IBW and 120% of the PEE at the time of peak negative NB (-10.5). In six SCI patients, an average increase of 25% in delivered protein and 12% in delivered calories over a 1-week period effected no change in average NB (-7.4 vs -6.8). Indirect calorimetry in five SCI patients showed that calorie intakes were 110% more than average measured energy expenditures. In contrast, 17 of 20 NCSI patients achieved positive NB within 3 weeks of admission. They required an average delivery of 2.3 g of protein/kg IBW and 110% of PEE to reach positive NB. These data demonstrate the phenomenon of obligatory negative NB acutely following SCI. Aggressive attempts to achieve positive NB in these patients will fail and result in overfeeding.

Adult↗