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Biomedical subjects

H D Reines

Publications and source records attributed to H D Reines.

At least 73 records · Page 4Linked to original sources
PubMed1982

Effects of isovolumic hemodilution on massive pulmonary emboli.

Massive pulmonary emboli obstruct the pulmonary outflow tract and release vasoactive amines that further increase vascular resistance in the pulmonary vascular bed. Lowering blood viscosity by isovolumic hemodilution has been suggested as a possible therapeutic modality to increase pulmonary blood flow. This study was performed to determine if hemodilution could affect the aberrancies caused by massive emboli. Ten pairs of mongrel dogs were instrumented and injected with autologous clot until pulmonary artery (PA) pressure rose to 40 mm Hg. One doe was then isovolumically hemodiluted to a hematocrit of two thirds of control with Ringer's lactate. Hemodynamic data, including PA, and arterial and pulmonary capillary wedge pressure (PCW), were obtained immediately following injection of the clot and one hour later. Following this, the dog was sacrificed and all clot was removed and weighed. Three dogs in the control group arrested and could not be resuscitated, while two dogs in the hemodiluted group survived arrest. The hemodynamic data was identical in the two groups. Clots in the control group weighed 9.6 +/- 7 grams while retrieved clot in the hemodiluted dogs was 3.6 +/- 2. Although the hemodynamic data was similar for both groups, the survival rate and decrease in the size of the clot was significantly favorable in the hemodiluted dogs to encourage further study on this technique.

Animals↗
PubMed1981

Pneumonia and bacteremia due to Aeromonas hydrophila.

Aeromonas hydrophila is a gram-negative bacillus which has been rarely identified as a human pathogen except in immunologically compromised hosts. We have recently treated three patients for severe A hydrophila pneumonia and sepsis. Two of these patients were healthy young men who aspirated the organism from contaminated water associated with near drowning. One patient survived severe ARDS and gram-negative sepsis. A third patient with chronic renal failure acquired A hydrophila pneumonia at home and quickly died from the infection. A hydrophila is becoming more commonly recognized as a lethal pathogen and should be sought when gram negative infection is suspected.

Adolescent↗
PubMed1980

Use of military antishock trousers in the hospital.

The military antishock trouser (MAST) suit has demonstrated its versatility in a number of situations. A method of inflation and monitoring for use in hospitalized patients using an oxygen flowmeter is described. This technique is simple to use and gives the physician more flexibility in controlling the inflation pressures of the suit.

Adult↗
PubMed1980

Neurogenic pulmonary edema and missile emboli.

A case of missile emboli to a major intracranial vessel resulting in fulminant pulmonary edema is reported. A discussion of the etiology of neurogenic pulmonary edema (NPE) is presented. The cause is thought to be a marked increase in pulmonary artery pressure, due to a massive catechol release in the CNS, and possibly secondary to post-capillary sphincteric constriction. Missile emboli to the cerebral arteries should be removed in order to avoid distal embolization and infarction. The case reported appears to represent the first documented case of missile emboli causing NPE.

Brain↗
PubMed1979

Increasing incidence of right-sided lesions in colorectal cancer.

One hundred ninety-eight patients with 211 cancers of the colon and rectum underwent elective resection at the University of Vermont College of Medicine during the five year period 1971 through 1975. Analysis of this series demonstrated that 35 per cent of all cancers were located in the cecum and ascending colon, that a similar percentage were classified as Dukes' A cancers, that a synchronous cancer was present in 5.5 per cent of the patients and that diagnosis by rectal examination and sigmoidscopy was possible in only 32 per cent of the patients. Comparison of these results with published data during the past thirty years indicate that there is an increasing incidence of carcinoma of the right colon with an associated decrease in the incidence of carcinoma of the sigmoid colon and rectum. It is recommended that patients be screened by examination of the stool for occult blood rather than by rectal examination and sigmoidoscopy so that these proximal lesions can be diagnosed at an earlier stage. Preoperative evaluation of patients with distal colorectal cancer should include double contrast barium enema examinations and colonscopy to rule out synchronous right-sided lesions.

Aged↗
PubMed1979

The inaccuracy of using 100% oxygen to determine intrapulmonary shunts in spite of PEEP.

The use of 100% oxygen to determine intrapulmonary shunting has been widely advocated. This study was performed to determine the clinical application of this technique in critically ill patients on PEEP. Determinations of intrapulmonary shunting using FIO2 of 0.45 and 1.0 were performed on 18 patients. Machine error was also calculated. Shunt calculations increased by an average of 52% (29% corrected for machine error) with the use of an FIO2 of 1.0 and returned to previous levels when an FIO2 of 0.45 was reinstituted. There was no statistical difference in shunt increase between patients on high (greater than or equal to 15 cm H2O) or low (less than 15 cm H2O) PEEP. The use of 100% oxygen to calculate intrapulmonary shunting in patients on PEEP is misleading in both physiological and methodological terms.

Blood Gas Analysis↗
PubMed1979

Problems encountered with hyperalimentation in critically ill patients.

An analysis of complications arising from hyperalimentation in 17 septic patients in an ICU is presented. All developed hypophyosphatemia. Hyperglycemia necessitated intravenous insulin in 16 patients. Hypoalbuminemia persisted in all patients despite 134 gm of protein a day. Abnormal liver function and azotemia were common. Catheter complications occurred in three of 90 catheter insertions. Mortality in this population was 70%. Guidelines for the use of Dextrostix for monitoring blood glucose levels and a protocol for hyperalimentation in patients with sepsis are suggested.

Acidosis↗
PubMed1978

Effect of surgery on granulocyte/macrophage colony-stimulating factor.

Eighteen surgical patients were studied to determine the effect of anesthesia (general or spinal) and surgery on serum and urinary colony-stimulating factor(s) (CSF). CSF is a leukopoietin that stimulates proliferation of macrophages and granulocytes from bone marrow precursor cells. CSF was assayed by adding aliquots of serum or urine to semisolid agar cultures of bone marrow cells and scoring the number of colonies developing after 7 days of incubation. In all but 1 case, a 3- to 30-fold increase in the 24 hour excretion of urinary CSF was seen on the day of surgery and the first postoperative day. CSF urinary excretion began declining toward normal by the second postoperative day. A parallel increase in granulocyte count, a delayed rise in monocytes, and a decline in absolute lymphocyte counts were also observed. The data suggest that immediately postoperatively there may be a strong stimulus to granulocyte/macrophage proliferation. More rapidly proliferating cells would be anticipated to have increased vulnerability to toxicity from cell cycle-active chemotherapeutic agents.

Adult↗
PubMed1977

Transverse colon volvulus: case reports and review.

Volvulus of the transverse colon is an uncommon event but results in mortality or significant morbidity relatively more often than cecal or sigmoid volvulus. Two cases are presented with emphasis on incidence, predisposing factors, clinical presentation, and radiologic examination. The need for early diagnosis and surgical intervention is stressed.

Adult↗
PubMedDate not supplied

Assessment of 24-hour gastric pH measurements in trauma patients receiving intravenous famotidine by intermittent bolus versus continuous infusion administration.

OBJECTIVE: To compare the effects of intermittent bolus versus continuous infusion intravenous famotidine on gastric pH in critically ill trauma patients. DESIGN: Twenty patients were randomized to receive famotidine by intermittent bolus or continuous infusion for 24 hours. Patients fasted during the study period. Hourly gastric pH measurements were made using an indwelling sensor/sump tube. SETTING: The study was conducted in a university teaching hospital. PARTICIPANTS: Adult patients admitted to the neurosurgical or surgical/trauma intensive care unit within 72 hours of traumatic injury were enrolled in the study if they had two consecutive hourly gastric pH readings of < 4 without receiving antacids, sucralfate, or histamine2-antagonists. MAIN OUTCOME MEASURES: Groups were compared with regard to (1) total dose of famotidine received/24 hours, and (2) number of dosage changes required to maintain a gastric pH value of > or = 4. RESULTS: The median dose of famotidine required to maintain a gastric pH > or = 4 was 50 mg/24 h (25th-75th percentiles = 40-55 mg) in the intermittent bolus group compared with 42 mg/24 h (25th-75th percentiles = 42-52 mg) in the continuous infusion group (p = 0.9577). A dosage increase was required by 5 of 8 patients (62 percent) receiving intermittent bolus therapy, whereas only 2 of 8 patients (25 percent) in the continuous infusion group required a dosage adjustment (p = 0.315, power = 0.318). CONCLUSIONS: Intravenous famotidine (40-50 mg/d) effectively controlled gastric pH in critically ill trauma patients. Patients treated with intermittent bolus therapy required slightly more drug and more frequent dosage adjustments to achieve a gastric pH > or = 4. These differences did not reach statistical significance.

Adult↗