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Biomedical subjects

J D Cooper

Publications and source records attributed to J D Cooper.

At least 343 records · Page 19Linked to original sources
PubMed1977

Surgical treatment for pulmonary emphysema.

Three in-vivo observations stimulated interest in surgical treatment for emphysema: (a) the destructive changes are rarely generalized, (b) the central portions of the lungs are frequently less seriously affected, and (c) marginal folding produces obstructive change in the more normal lung tissue. If destroyed avascular space-occupying areas can be removed, the compressed lung tissue may be stretched to fill pleural space in a functionally effective fashion. Residual elastic tissue will them maintain patency of terminal bronchioles. Preoperatively the extent of the destructive change can be defined most accurately by pulmonary angiography, and zones of functioning capilary circulation can be identified. Forty-seven patients with multifocal space-occupying emphysematous change have been treated surgically. The postoperative mortality was 21% but worthwhile long-term improvement has been obtained in 45% of patients presenting with disabling dyspnea. In these patients, surgical treatment warrants consideration if significant space occupation accompanies the bullous disease, provided alveolar vascularization can be demonstrated in the compressed adjacent normal lung tissue. Limited resections that preserve all vascularized and potentially functioning lung tissue are preferable. It is essential that obliteration of the hemithorax be obtained promptly in view of the high incidence of postoperative complications requiring secondary operative procedures, if 'leaks' and residual spaces are allowed to persist. Postoperative care in a respiratory intensive care unit is mandatory.

Adult↗
PubMed1977

Intraoperative and postoperative esophageal manometric findings with Collis gastroplasty and Belsey hiatal hernia repair for gastroesophageal reflux.

The combination of a Collis gastroplasty with a Belsey Mark IV fundoplication has proved clinically effective in the management of certain patients with complications of gastroesophageal reflux. The present study measured the effect of gastroplasty and Belsey repair on intraluminal pressure changes in the gastroplasty and lower esophagus. Manometric studies were performed preoperatively, intraoperatively, and postoperatively. In each case the gastroplasty segment of the esophagus was found to function as a high pressure zone (HPZ). The pressure in this zone further increased following the fundoplication. It could be diminished with intravenous administration of Buscopan and augmented with intravenously given pentagastrin. The original lower esophageal sphincter in most instances was included in the upper segment of the gastroplasty tube, but the entire length of the gastroplasty tube functioned as an HPZ, and pressures in the tube were considerably higher than those originally present in the lower esophageal sphincter. These studies provide a physiological rationale for the effectiveness of gastroplasty and fundoplication.

Animals↗
PubMed1976

Systemic infection with Alaria americana (Trematoda).

Alaria americana is a trematode, the adult of which is found in mammalian carnivores. The first case of disseminated human infection by the mesocercarial stage of this worm occurred in a 24-year-old man. The infection possibly was acquired by the eating of inadequately cooked frogs, which are intermediate hosts of the worm. The diagnosis was made during life by lung biopsy and confirmed at autopsy. The mesocercariae were present in the stomach wall, lymph nodes, liver, myocardium, pancreas and surrounding adipose tissue, spleen, kidney, lungs, brain and spinal cord. There was no host reaction to the parasites. Granulomas were present in the stomach wall, lymph nodes and liver, but the worms were not identified in them. Hypersensitivity vasculitis and a bleeding diathesis due to disseminated intravascular coagulation and a circulating anticoagulant caused his death 8 days after the onset of his illness.

Adult↗
PubMed1976

Control, monitor and alarm system for clinical application of a membrane oxygenator.

Membrane oxygenators, now commercially available, are undergoing clinical trials as long-term (days) respiratory support devices for patients in potentially reversible respiratory failure. However, these devices must be used in an integrated system of controls, monitors and alarms if they are to be reliable and easy to operate in the clinical environment. This paper describes such a system. The tubing circuits for blood and for oxygen are described first. Next, details of the blood pump controls are presented. The system features servo control of pump speed to match blood inflow, and deactivation of the pump in the case of excessive output pressure. Gas circuit controls are described which allow the independent adjustment of both oxygen flow through the gas phase of the membrane lung and oxygen pressure developed at the inlet gas port. Audible alarms are provided for low blood inflow to the system, excessive blood outflow pressure, changes in oxygen flow and failure of the electric power supply to the system. In addition to pressure and flow monitors in the blood and gas circuits, blood oxygen saturation is continuously monitored at both input and output of the system. The membrane oxygenator system has proved to be reliable and easy to operate in both animal and human long-term perfusions.

Animals↗
PubMed1976

Emergency open lung biopsy.

Twenty-eight patients underwent open lung biopsy on an emergency basis. The clinical course in each case was deteriorating rapidly, and all were in respiratory failure. The correct diagnosis was established in 96% of the biopsies (27 of the 28 patients). The clinical diagnosis prior to biopsy was in error or incomplete in 15 (55%) of the patients. Specific therapy was lifesaving in 12 of the 28 patients. The value of the procedure outweighed the complications. Thrombocytopenia and positive end-expiratory pressure ventilation were not contraindications to biopsy.

Adult↗
PubMed1976

Combination of membrane oxygenator support and pulmonary lavage for acute respiratory failure.

A 24-year-old woman with chronic granulocytic leukemia and alveolar proteinosis required extracorporeal membrane oxygenator support for respiratory failure refractory to conventional therapy. During perfusion, each lung was lavaged with 10 L. of normal saline. The lavage led to marked clearing of the lungs and improvement in pulmonary function. Extracorporeal support was terminated successfully after 54 hours. The patient died 2 weeks later with bone marrow insufficiency and overwhelming sepsis. Pulmonary lavage is technically feasible during venovenous oxygenator bypass, and may be of value, since such lavage debrides alveoli as well as the bronchial tree. Because pulmonary lavage provides a possible means of improving pulmonary function, it seems worthy of consideration as an adjunct to membrane oxygenator support.

Adult↗
PubMed1976

Cardiorespiratory failure secondary to peripheral pulmonary emboli. Survival following a combination of prolonged extracorporeal membrane oxygenator support and pulmonary embolectomy.

A 19-year-old woman developed cardiorespiratory failure from multiple, peripheral pulmonary emboli apparently developing over the preceding 3 weeks. She was not considered to be an operative candidate. However, when 3 days of intravenous heparin infusion and 30 hours of membrane oxygenator support failed to improve the pulmonary pathology, pulmonary embolectomy was performed. The membrane oxygenator support had to be continued for 34 hours following the operation before it was successfully discontinued. The patient made a complete recovery.

Adult↗
PubMed1975

Measurement of intratracheal oxygen concentrations during face mask administration of oxygen: a modification for improved control.

Direct measurement of the inspired tracheal oxygen concentration was made in patients breathing through standard aerosol face masks. Factors affecting the tracheal FIO2 were analyzed using both mechanical and mathematical models. When oxygen is delivered to the face mask at low flow rates, there is considerable patient variation in the measured tracheal FIO2. Delivery of oxygen at higher flow rates (15 litres per minute or greater), reduces such variation. Furthermore, turbulent air currents within and around the face mask reduce the measured FIO2 and contribute to fluctuations in the FIO2. This effect may be virtually eliminated by placing shields around the mask orifices as described. Using the shielded mask, it is possible to deliver the desired oxygen concentration to the patient more accurately and to maintain humidification of the delivered gases. Changes desired in inspired oxygen concentration are accomplished by changing the concentration of the incoming gas mixture, and not by merely changing the flow rate of oxygen delivered to the system. Using the shielded mask, it is possible to deliver an inspired oxygen concentration of 100 per cent. This is not true with most other commonly used face masks, and, therefore, caution should be used to avoid administration of unnecessary high inspired oxygen concentrations with this type of mask.

Air Movements↗
PubMed1975

Experience with surgical salvage in pulmonary tuberculosis: application to general thoracic surgery.

The diminishing incidence of pulmonary tuberculosis and the increasing effectiveness of drug therapy have resulted in an almost complete disappearance of surgical problems in the management of patients with this disease. However, the lessons learned from the management of such problems should not be forgotten, for they are equally applicable to the management of disabling and life-endangering problems in general thoracic surgical practice. "Salvage" situations develop when therapeutic requirements for control of disease are combined with factors affecting a patient's health so as to increase the surgical risk beyond the range usually considered acceptable. Attempts to salvage patients are indicated when treatment has failed to arrest disease, when life expectancy is threatened, or when return to normal activity is imperiled. Risk may be increased because of age, inadequate cardiopulmonary reserve, or chronic toxemia; in tuberculosis, risk may be increased because of positive sputum culture or resistance of organisms. Experience with 146 tuberculous patients has provided a basis for evaluation of the indications for resection, prophylactic and therapeutic thoracoplasty, and closure of bronchopleural fistulas in general thoracic surgical salvage. Both infection in residual spaces and bronchopleural fistulas are serious complications that can be controlled by thoracoplasty and pedicled muscle grafts. Prophylactic use of osteoplastic thoracoplasty and intercostal muscle grafts warrant more serious consideration. In established complications a "tailored" thoracoplasty can also be combined with an intercostal muscle graft.

Bronchial Fistula↗
PubMed1975

Lung water accumulation with acute hemodilution in dogs.

Extravascular lung water content was determined in vivo, gravimetrically, and histologically in severely hemodiluted (Ringer's lactate), supine, spontaneously breathing, halothane-anesthetized dogs. One group of dogs was studied immediately after undergoing hemodilution to a hematocrit value of less than 10 per cent; a second group was studied after hemodilution and 1 hour of circulatory maintenance with Ringer's lactate; and a third group was evaluated after hemodilution, maintenance for one hour with Ringer's lactate, and reconstitution of oncotic pressure with 75 Gm human salt-poor albumin. Lung water content was increased significantly from a normal of 3.88 Gm water per gram of dry weight to 4.70 Gm per gram of dry weight by hemodilution; it was increased further to 5.71 tgm per gram of dry weight during 1 hour of maintenance with Ringer's lactate. Reconstitution of oncotic pressure decreased the water content significantly to 4.96 and decreased the units demonstrating perivascular-peribronchial cuffing from 81 to 23 per cent. Double indication-dilution measurement of PEVW failed to reliably reflect changes in lung water. Arterial PO2 with the animals breathing 100 per cent oxygen was unchanged in all of the groups. We made the following conclusions: (1) lung water accumulation occurs during severe hemodilution and serum protein depletion; (2) this may be partially reversed by restoration of oncotic pressure; (3) double indicator-dilution PEVW measurements do not reliably reflect changes in extravascular lung water of less than 47 per cent; and (4) interstitial edema of this magnitude does not interfere with blood-gas exchange.

Animals↗
PubMed1975

Cannulation of ascending aorta for long-term membrane oxygenator support.

In this report we shall describe a new route for perfusion during long-term support with the membrane oxygenator. The ascending aorta is cannulated so that blood from the oxygenator mixes with blood in the ascending aorta. Thus oxygenated blood is supplied to both the cerebral and coronary systems.

Adult↗
PubMed1975

Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves.

Resections at the cricoid level pose the problems of damage to the recurrent laryngeal nerve and loss of circumferential cartilaginous support. Strictures within the cricoid ring have usually been managed with keels or stents, whereas neoplasms have been managed by laryngectomy. This paper reports on 6 patients with lesions involving the cricoid who were successfully treated by segmental tracheal resection and removal of all but a thin shell of posterior cricoid plate. The distal trachea was anastomosed at the subglottic level within 1 cm. or less of the vocal cords. Two patients had traumatic transection at the cricotracheal level with disruption of cricoid cartilage and avulsion of both recurrent nerves. Of the other 4 patients with tracheal lesions involving the cricoid, 2 had postintubation strictures, another had chemical burns, and the fourth had adenoid cystic carcinoma. Primary healing and good clinical results were obtained in all 6 patients. In the 4 patients with intact recurrent nerves, nerve function was preserved. This technique provides a method for resection and reconstruction in one stage for selected lesions at the cricoid level.

Adolescent↗