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Biomedical subjects

J A Moylan

Publications and source records attributed to J A Moylan.

At least 37 records · Page 2Linked to original sources
PubMed1981

Brachial artery reconstruction using the heparin-bonded Sundt shunt.

Fracture stabilization is often desirable prior to vascular repair in the management of major extremity injuries. This principle is particularly important when long vein grafts are required to minimize the risk of anastomotic disruption during the orthopedic portion of the procedure. However, in situations associated with prolonged periods of preoperative ischemia, early reperfusion of the injured extremity would be optimal. This report illustrates two cases of brachial artery injury in which heparin-bonded shunts were used to establish blood flow to the distal extremity before fracture fixation. The shunts were interposed between disrupted arterial segments and reestablished distal perfusion while associated fractures were internally stabilized. Thus, early revascularization allowed the orthopedic repair to proceed in an unhurried fashion. After adequate stabilization of the fracture, arterial reconstruction was completed using saphenous vein interposition grafts. This technique potentially could improve extremity salvage rates and facilitate the repair of arterial injuries associated with unstable long bone fractures.

Adolescent↗
PubMed1980

Apocrine differentiation in human mammary carcinoma.

Six invasive carcinomas that contained apocrine differentiation as the primary morphologic pattern were selected from a series of 1500 prospectively examined breast carcinomas (0.4%). While apocrine features were seen in many breast tumors, these six cases were identified by uniformly fine granular, pale, eosinophilic cytoplasm with apical cytoplasmic projections similar to that seen in apocrine metaplasia. In each example, ultrastructural analysis revealed the presence of numerous 400-600 nm membrane bound vesicles with dense homogeneous osmophilic cores. These granules clustered toward the apex of the cytoplasm in the majority of the epithelial cells. All six tumors were deficient in high-affinity, low-capacity 8S estrogen and progesterone proteins, while a high-capacity, low-affinity, nonsaturable 4S progesterone-estrogen binding protein was observed. Cortisol did not bind to this protein. These observations characterize the ultrastructure of apocrine carcinoma as a variant of human mammary carcinoma.

Apocrine Glands↗
PubMed1980

Management of penetrating pancreatic injuries: subtotal pancreatectomy using the auto suture stapler.

Penetrating injuries of the pancreas have been accompanied by significant morbidity and mortality. A technique using the TA-55 Auto Suture Stapler (United States Surgical Corp., Stamford, CT) in patients with pancreatic trauma has been developed and employed clinically. The technical aspects of this simplified technique and its role in the prevention of postoperative complications of pancreatectomy are reviewed. This approach supports an aggressive and complete surgical evaluation of pancreatic injuries.

Adult↗
PubMed1980

The importance of gown and drape barriers in the prevention of wound infection.

The gown and drape barrier system has been shown to be an important factor in the prevention of wound infection. Performance differences between disposable and reusable materials as influencing wound infections were demonstrated. A disposable spun-bonded olefin gown and drape system significantly reduced the postoperative wound infection rate. No therapeutic benefit in the preoperative antibiotic group or localwound irrigation group. Factors indicating populations at higher risks for wound infection include age, sex and those requiring long and an emergency type operations. Special attention should be given to the infection prone groups. Unless factors, such as percentage of types of operation, emergency nature, age and sex, are weighed, a comparison of wound infections between hospitals is invalid.

Aged↗
PubMed1979

Hypercalciuresis in trauma patients on high-nitrogen enteral and parenteral diets.

Calcium balances in ten enterally or parenterally hyperalimented trauma victims were compared as protein intake was manipulated from 50.5 +/- 12.8 to 128.0 +/- 17.4 gm/day during an isocaloric metabolic balance study. Calciuresis increased as protein intake increased in all subjects, resulting in an average reduction in daily calcium balance of 195 +/- 65 mg/day (p less than 0.001). There was no difference in fecal calcium in the enterally fed subgroup. Total and "corrected" total serum calcium were lowered, and indirect evidence suggests that ionized calcium was lowered as well. The mechanism of the increase in urinary calcium is not fully elucidated, although it appears to be a direct effect on the kidney rather than an indirect influence of calcium homeostasis. It is suggested that a calorie/nitrogen ratio of about 360 be maintained in enteral and parenteral alimentation of trauma victims. Thus nitrogen balance can be maintained by the increased nonprotein calorie availability, and possible complications of increased calcium mobilization and excretion can be avoided.

Adolescent↗
PubMed1978

The use of a laminar airflow isolation system for the treatment of major burns.

A laminar airflow isolation burn ward was designed which would maintain a sterile environment and also allow unrestricted burn care and rehabilitation to be performed. A very low rate of sepsis and sepsis-related complications have been found in the 115 patients treated in the unit. Patient cross contamination has been completely controlled under laminar airflow conditions. The incidence of burn colonization and infection by virulent gram-negative organisms, namely pseudomonas, serratia, klebsiella, and proteus, in these patients has been extremely low, particularly in comparison with burn patients managed in a non-laminar flow intensive care environment.

Adolescent↗
PubMed1978

Inhalation injury--an increasing problem.

Inhalation injury is a common complication of thermal accidents occurring in one-third of patients burned. The routine use of fiberoptic bronchoscopy on all patients incurring thermal burns provides an accurate and safe means for diagnosis. Although complications for inhalation injury are common, the mortality can be reduced by early diagnosis and attention to careful fluid resuscitation, aggressive pulmonary therapy and the avoidance of prophylatic steroids.

Adolescent↗
PubMed1978

Clinical experience with prophylactic antibiotic bowel suppression in burn patients.

An oral prophylactic antibiotic regimen (neomycin-erythromycin-nystatin) aimed at suppression of the bowel flora was utilized in 20 patients with thermal injury treated in a laminar flow burn unit with strict sterile technique and reverse isolation. The regimen was utilized for an average of 24 days. Surface cultures were obtained twice weekly from multiple areas of the burn wound, and burn wound biopsies were performed one to two times weekly. These patients were compared prospectively with a group of 10 patients treated in otherwise identical fashion, save for the omission of the antibiotic suppressive regimen. Bacterial colonization of the burn wound occurred an average of 19 days after admission in the group receiving antibiotics compared to 4 days after admission in the control group (p less than 0.01). Positive burn biopsies (more than 10(5) bacteria per gm of tissue) were observed twice as often in the group not receiving antibiotics (p less than 0.16) as were infectious complications of several types: bacteremia, burn wound sepsis, urinary tract infections, pneumonitis, cellulitis (0.10 less than p less than 0.20). Staphylococcal or fungal overgrowth were not encountered in the patients receiving prophylactic antibiotics, nor was there an adverse effect on serum creatinine levels with the prolonged use of neomycin.

Adolescent↗