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Biomedical subjects

J Ali

Publications and source records attributed to J Ali.

At least 19 recordsLinked to original sources
PubMed1992

The cardiorespiratory effects of increased intra-abdominal pressure in diaphragmatic rupture.

The cardiorespiratory effect of gastric herniation in diaphragmatic rupture with and without increased intra-abdominal pressure (produced by inflation of a pneumatic antishock garment [PASG] to an intraperitoneal pressure of 40 mm Hg) was studied in 16 anesthetized spontaneously breathing (80% oxygen) piglets. Four additional animals had similar measurements after PASG inflation but without diaphragmatic rupture. Arterial blood pressure (BP), cardiac output, arterial blood gases, position of the stomach relative to the diaphragm (as measured on fluoroscopy), and mortality were assessed. Gastric herniation without the PASG (group I: 8 animals) produced slight cardiorespiratory deterioration, with PO2 falling from a baseline measurement of 429 +/- 60 mm Hg to 316 +/- 5 mm Hg at 1 hour. Over this period pH decreased from 7.39 +/- 0.05 to 7.30 +/- 0.02 and PCO2 increased from 39 +/- 5 to 46 +/- 2 mm Hg. With PASG inflation (group II: 8 animals) PO2 decreased to a greater extent, from 410 +/- 30 mm Hg at baseline to 48 +/- 10 mm Hg by 1 hour; pH decreased from 7.38 +/- 0.06 to 6.8 +/- 0.2 and PCO2 increased from 39 +/- 4 to 88 +/- 6 mm Hg. Animals without diaphragmatic rupture (group III: 4 animals) showed a smaller decrease in PO2, from 480 +/- 34 mm Hg at baseline to 320 +/- 50 mm Hg by 1 hour after PASG inflation.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1992

Establishing goals and priorities in a surgery department.

Limitation of resources necessitates prioritization in the planning of goals for a clinical discipline such as surgery. Private practitioners and academic surgeons have their own priorities which reflect their specific, often conflicting, interests. We describe a model (modification of Davies & Morgan, 1983) for establishing goals and priorities with input from both private practitioners and academic full-time surgeons in a large Department of Surgery. The model consists of four phases each of which is divided into input, process and output stages. During the input stage general large group discussion allows identification of disparate views. This is followed by refinement of these ideas in small group discussions (process) which results in the formulation of a report (output). Application of this model resulted in a clear definition of goals and priorities by consensus and placed education first on this list of priorities in spite of a department in which there is a predominance of private practitioners whose major area of activity is in the realm of patient care.

Attitude of Health Personnel↗
PubMed1992

The Advanced Trauma Life Support course for senior medical students.

The authors conducted the Advanced Trauma Life Support (ATLS) Course for 90 students who were in their 4th year of medicine at the University of Manitoba. The impact of the course was evaluated through questionnaires completed by students, instructors and emergency-room physicians. The students' performances were also compared with those of 96 practising physicians who took the ATLS course in Manitoba. The failure rate for students (3.3%) was not statistically different from that for practising physicians (4.2%). Overall, the students' performances in the written test were better (55% of students scored over 90% on the test compared with 15% of practising physicians). The student-to-faculty ratio was 1.5:1 and included 21 physician-instructors. Ninety-five percent of the faculty and students suggested that this course should be mandatory in the 4th year curriculum of medicine and that the course improves trauma care provided by the students and interns by increasing their confidence and improving communication with specialist surgeons. However, 10% of the faculty suggested that more time should be allocated to the surgical-skills practicum. The authors' experience with this program suggests that the ATLS course should be uniformly incorporated in the Canadian undergraduate 4th year medical curriculum and that techniques used in this course should be considered in other areas of the undergraduate medical curriculum.

Canada↗
PubMed1992

Clinical presentations of gastrointestinal inflammatory fibroid polyps.

Two cases of inflammatory fibroid polyps are described. They involved the uncommon sites of the terminal ileum and ileocecal region respectively. Both lesions, although benign, presented as possible malignant tumours. One was associated with anemia and the other with obstructive symptoms. From a review of the literature and the two case reports the authors believe that the diagnosis of such inflammatory fibroid polyps, on clinical and gross appearance, can be difficult, and they emphasize the importance of awaiting histologic assessment before proceeding with extensive definitive surgery.

Aged↗
PubMed1992

Spontaneous gastric decompression of pancreatic pseudocyst.

Spontaneous resolution of pancreatic pseudocysts is being reported with increasing frequency. Although many mechanisms have been proposed one that is not frequently recognized is spontaneous decompression into the gastrointestinal tract. This case report demonstrates the mechanism of spontaneous resolution of a traumatic pancreatic pseudocyst, several weeks after injury, through fistulization between the pseudocyst and the stomach. Spontaneous resolution of a pancreatic pseudocyst after a transient episode of diarrhea should suggest the mechanism of gastrointestinal decompression of the pseudocyst.

Adult↗
PubMed1991

Timing and interpretation of the hemodynamic effects of the pneumatic antishock garment.

STUDY OBJECTIVES: To clarify apparently conflicting reports on the hemodynamic effects of the pneumatic antishock garment (PASG). DESIGN: Ten anesthetized dogs with hemorrhagic hypotension had hemodynamics measured without PASG inflation (group 1) and were compared with ten dogs with PASG inflation (group 2). MEASUREMENTS AND MAIN RESULTS: Baseline and immediate posthemorrhage data were similar in both groups. Group 1 maintained a carotid artery pressure of 85 +/- 9 mm Hg while group 2, by design, maintained baseline CP at 119 +/- 12 mm Hg. After PASG inflation, carotid artery flow increased by 50%, and femoral artery flow decreased tenfold. There was an immediate but transient increase (2.4 +/- 0.1 to 2.7 +/- 0.1 L/min, P less than .05) and a later decrease in cardiac output to 1.9 +/- 0.9 L/min and an increased pulmonary artery wedge pressure and central venous pressure over one hour. Saline (342 +/- 12 mL) reversed the decreased cardiac output without changing pulmonary artery wedge pressure or central venous pressure. CONCLUSION: PASG inflation, therefore, not only increases venous return and cardiac output initially by compressive venous emptying but also decreases venous return and cardiac output later by further venous compression without cardiac decompensation. Thus, apparently conflicting data are explained by the timing and interpretation of the raw hemodynamic measurements.

Animals↗
PubMed1991

The effect of the pneumatic antishock garment (PASG) on hemodynamics, hemorrhage, and survival in penetrating thoracic aortic injury.

To determine if the increased blood pressure associated with application of a pneumatic antishock garment (PASG) affects outcome in thoracic hemorrhage, we assessed hemodynamics, blood loss, and survival in three groups of eight anaesthetized piglets with a 2.5-mm laceration of the descending thoracic aorta. Baseline measurements were made before aortic hemorrhage. During one hour of aortic hemorrhage or until death of the animal, the PASG was not inflated in Group I while the PASG in the other two groups was inflated to maintain carotid artery pressure at 15 torr below baseline (Group II) and at baseline (Group III), respectively. Survival was 100% in Group I, 50% in Group II, and 0% in Group III. Hemorrhage at 22.5 +/- 4.0 mL/min stopped after 18-24 minutes in Group I; the survivors in Group II bled at a rate of 32.5 +/- 3.0 mL/min compared with 43.6 +/- 4.0 mL/min over 26-35 minutes in the Group II nonsurvivors. Group III pigs bled at 107.5 +/- 8.0 mL/min over the 10-18 minutes of survival. The intended blood pressure could not be maintained beyond 30 minutes. Bleeding stopped in Group I when the blood pressure fell to 58.2 +/- 4.5 torr from a baseline of 119.0 +/- 10.0 torr. The blood pressure fell to 48.0 +/- 5.0 torr in the four Group-II survivors. After a transient maintenance of baseline blood pressure in Group III, a precipitous drop in blood pressure with death in 10-18 minutes occurred in all these animals. In this porcine model of thoracic aortic injury, PASG inflation increases hemorrhage and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

The safety and efficacy of clarithromycin in patients with Legionella pneumonia.

Clarithromycin, a new macrolide antibiotic, is at least four times more active in vitro than erythromycin against Legionella pneumophila. In this study the safety and efficacy of orally administered clarithromycin (500 to 1,000 mg bid) in the treatment of Legionella pneumonia were evaluated. Forty-six patients were enrolled in the study, 15 of whom had not responded to previous routine anti-Legionella therapy (erythromycin, ofloxacin, rifampin [rifampicin], or tetracycline). Twelve patients prematurely discontinued the study (nine by the patient's request while feeling well; one because of cancer diagnosis; and two because of adverse events). The response rates after treatment were as follows: clinical cure rate, 98 percent (43/44); clinical success (cure or improved), 100 percent (44/44); radiographic success (cure and improved), 93 percent (28/30); direct antigen fluorescence resolution, 100 percent (40/40); and bacteriologic cure, 100 percent (13/13). Ten patients reported 13 adverse events (seven mild, four moderate, and two severe). Clarithromycin is a safe effective treatment for patients with severe chest infections due to Legionella pneumophila.

Adolescent↗
PubMed1991

Appendicular abscess presenting as neoplastic ileocecal obstruction.

Most complications after appendectomy occur within weeks of the operation. The authors present a case in which an appendicular abscess presented more than 18 years after appendectomy for acute appendicitis. The abscess simulated a neoplastic obstructive process, and a communication was demonstrated between the cecum and the abscess cavity through the appendiceal stump.

Abscess↗
PubMed1991

Pneumatic antishock garment decreases hemorrhage and mortality from splenic injury.

The effect of the pneumatic antishock garment (PASG) in controlling hemorrhage and death from splenic injury was studied in a canine model. Twelve (two groups of 6) anesthetized dogs had their spleens crushed. Carotid blood pressure, carotid blood flow, splenic artery flow and abdominal aortic flow, as well as the death rate and blood loss, were measured. Group 1 dogs did not have PASG inflation, but group 2 dogs had PASG inflation to an intraperitoneal pressure of 60 mm Hg. All group 1 dogs died within 27 to 58 minutes, but all group 2 dogs survived. Blood loss was 9.4 +/- 1.4 mL/min in group 1 and 1.6 +/- 0.9 mL/min in group 2. In group 1 carotid artery blood pressure, carotid artery flow, splenic artery flow and abdominal aortic flow fell from 120 +/- 10 mm Hg, 284 +/- 12 mL/min, 194 +/- 18 mL/min and 285 +/- 10 mL/min respectively to 0 with death of the animals. By 2 hours in group 2 dogs the carotid artery blood pressure had dropped from 116 +/- 12 to 99 +/- 12 mm Hg, and over the same period carotid artery flow, splenic artery flow and abdominal aortic flow fell from 296 +/- 8 mL/min, 190 +/- 26 mL/min and 279 +/- 16 mL/min respectively to 259 +/- 14 mL/min, 39.0 +/- 6 mL/min and 45 +/- 11 mL/min respectively. Thus, inflation of the PASG maintained carotid artery blood pressure wh ile decreasing splenic, abdominal and aortic flow as well as splenic hemorrhage, with a decrease in the death rate, over a 2-hour period.

Abdomen↗
PubMed1990

Retrieval of detached fragment of central venous pressure catheter (CVP) lodged in the right ventricle and pulmonary artery: a case report.

A successful retrieval of a detached segment of a CVP catheter by percutaneous right transfemoral venous route, using a Dotter intravascular retriever basket, is reported. The procedure was monitored under fluoroscopy. Only local anaesthesia, which was infiltrated around the puncture site, was given to the patient. No significant complication was encountered. Successful retrieval of the detached catheter fragment by percutaneous means obviates the need for thoracotomy.

Aged↗
PubMed1989

Acute and chronic Legionnaires' disease and co-existent tuberculosis: a trial of erythromycin.

To assess the prevalence of Legionnaires' disease, 115 patients with 'difficult-to-treat' chest infections were screened for Legionnella pneumophila. The results were positive in 10 (37%) of 27 patients with pulmonary tuberculosis, 15 (22%) of 68 with a recent onset acute respiratory infection, and 7 (35%) of 20 patients with history of a chronic respiratory infection. These 32 patients were enrolled in an open therapeutic trial of erythromycin. Less severe cases (17 of 32) received erythromycin stearate orally (500 mg 4-times daily) for up to 28 days, while severe cases were treated for the first few days with intravenous erythromycin lactobionate (4 g/day). Weekly chest X-ray examinations revealed prompt resolution. Most patients had no signs and symptoms detectable after 7 days, and none persisted up to 28 days. There were no therapeutic failures and microbiological tests on Day 28 were negative for Legionella pneumophila. It is suggested that the possibility of co-existing legionellosis should be considered in all patients with difficult to treat acute and chronic chest infections, particularly in developing countries where tuberculosis is very common, and treatment instituted or supplemented with erythromycin as the drug of choice.

Acute Disease↗
PubMed1989

Effect of temporary external stabilization on ventilator weaning after sternal resection.

The role of mechanical fixation of the chest wall in the treatment of flail chest remains controversial. We report a case of flail chest resulting from major sternal resection. The application of a temporary external stabilization device improved pulmonary mechanics by decreasing the respiratory rate from 36/min to 10/min while increasing tidal volume and vital capacity from 140 +/- 85 ml and 195 +/- 90 ml, respectively, to 450 +/- 110 ml and 905 +/- 310 ml, respectively. The improvement with the temporary device facilitated weaning from mechanical ventilation. We recommend consideration of this technique in selected cases of flail chest resulting from major chest wall resection.

Adult↗
PubMed1989

Legionella pneumophila: laboratory diagnosis in developing countries like Pakistan.

Three hundred random sputum samples were collected for analysis from cases of mild to severe respiratory infections and screened for Legionella pneumophila by both the culture method and also the direct fluorescent antigen test. In one third of the cases, blood specimen was also collected and screened for Legionella serum antibodies. With the direct fluorescent test it was possible to identify Legionella in 9% of the samples while the culture gave positive results in 4.3% of cases. Diagnostic antibody titers (1:256) were obtained in 12% of the samples while another 12% cases showed serum antibody titers of 1:64 to 1:128. In Pakistan where antibiotics are used extensively, the direct fluorescent examination of sputum samples gives more accurate diagnosis of Legionella cases than the culture method.

Colony Count, Microbial↗
PubMed1988

The pulmonary vascular effects of dopamine, dobutamine, and isoproterenol in unilobar pulmonary edema in dogs.

Although catecholamine inotropic drugs are often used to support the circulation of critically ill patients with hypoxemic respiratory failure, their effect on the pulmonary circulation and on gas exchange is incompletely understood. In order to improve our understanding of the effects of these drugs on the pulmonary circulation, we made measurements of total and regional intrapulmonary shunt (Qs/Qt), distribution of pulmonary blood flow, and pulmonary hemodynamics before and after infusions of dopamine (n = 6, 5 micrograms/kg/min), dobutamine (n = 6, 10 micrograms/kg/min), isoproterenol (n = 6, 0.1 micrograms/kg/min), or saline in dogs with unilobar oleic acid-induced pulmonary edema. In addition to permitting determination of the overall hemodynamic and gas exchange effects of these drugs, this preparation allowed measurement of changes in distribution of pulmonary blood flow between normal and edematous lung. In 6 dogs given dobutamine, mean cardiac output (CO) increased by 1 liter/min, while pulmonary arterial pressure (PPA) increased by 2 mm Hg with no change in pulmonary vascular resistance (PVR) or distribution of pulmonary blood flow. There was a 5% increase in mean Qs/Qt which, because of the lack of evidence of pulmonary vasoactivity, was attributed to time or to increased CO. Isoproterenol produced a similar increase in CO, but reduced PPA and PVR indicating pulmonary vasodilator activity. Pulmonary vasodilation was most prominent in edematous lung, resulting in an increase in relative blood flow to the edema lung lobe and a substantial increase in Qs/Qt, exceeding the increase in all other groups. Dopamine, similarly increasing CO, did not change overall PVR but reduced fractional blood flow to the edema lobe by 3.4% of CO. Neither Qs/Qt nor PaO2 changed significantly in this group. The differing effects of these agents on pulmonary hemodynamics, intrapulmonary blood flow distribution, and gas exchange have potentially significant implications affecting the choice of drug used for circulatory support in hypoxemic respiratory failure.

Animals↗
PubMed1988

Effect of tidal volume and PEEP on rate of edema formation in in situ perfused canine lobes.

The effects of raising tidal volume and positive end-expiratory pressure (PEEP) on rate of edema formation were studied in in situ canine left upper lobe preparations. Edema was induced by increasing blood flow to the left upper lobe (4-8 times normal). In the same animal, at equivalent flows and microvascular hydrostatic pressures, rate of edema formation observed with larger tidal volumes was significantly higher than that observed with smaller tidal volumes (0.73 +/- 0.29 vs. 0.58 +/- 0.30, P less than 0.001). Edema was also induced under static conditions (i.e., flow = 0) over a wide range of vascular pressures. Rate of edema formation was plotted against pressure and the best-fit linear regression was obtained. The slopes (g.min-1.mmHg-1.100 g-1) of the regression lines were significantly higher with larger tidal volumes compared with smaller tidal volumes [0.106 +/- 0.010 (SE) vs. 0.081 +/- 0.009, P less than 0.01]. The pressure intercepts were not different (16.1 +/- 1.6 vs. 15.7 +/- 1.8). When mean airway pressures were increased to levels equivalent to those obtained with larger tidal volumes, but by raising end-expiratory pressures, rate of edema formation dropped to levels below base line. We conclude that increasing the amplitude of cyclic changes in lung volume increases edema formation through mechanisms that are independent of changes in operating (i.e., mean) lung volume.

Animals↗
PubMed1987

Effect of bumetanide in capillary permeability pulmonary oedema.

UNLABELLED: To determine if bumetanide, like furosemide, improves shunt through pulmonary vasoactivity, 20 dogs with unilobar oleic acid pulmonary oedema were studied. Fractional perfusion and intrapulmonary shunt of the oedematous lobe were measured at: baseline, 1 1/2 hours after oleic acid infusion, 15 minutes later after either 0.1 mg X kg-1 of bumetanide in ten dogs (Bumetanide Group) or without bumetanide in ten dogs (Control Group), and 2 1/2 hours after the oleic acid, the bumetanide being administered immediately after the 1 1/2 hours post-oleic acid measurements. Lobar shunts for the Bumetanide Group were: 9.3 +/- 4.0, 54.3 +/- 13.6, 54.7 +/- 13.6, 38.6 +/- 12.0 per cent and for CONTROLS: 8.7 +/- 1.6, 45.1 +/- 8.8, 48.3 +/- 7.8, 70.4 +/- 6.2 per cent. Fractional perfusions of the oedematous lobe were: 29.9 +/- 1, 14.7 +/- 1.1, 14.6 +/- 0.7, 19.3 +/- 1.9 per cent in the Bumetanide Group and 28.6 +/- 2.1, 14.2 +/- 1.1, 14.2 +/- 1.5, and 9.9 +/- 1.1 per cent in CONTROLS. Oedema (wet to body weight ratio) was less (p less than 0.05) in the contralateral lobe (2.5 +/- 0.2 vs. 2.9 +/- 0.3) and the oedematous lobe (4.7 +/- 0.4 vs 6.0 +/- 0.5) after bumetanide-induced diuresis. We conclude that bumetanide decreases shunt by decreasing oedema and not through pulmonary vasoactivity.

Animals↗