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Biomedical subjects

J J Skillman

Publications and source records attributed to J J Skillman.

At least 73 records · Page 4Linked to original sources
PubMed1978

Prevention of deep vein thrombosis in neurosurgical patients: a controlled, randomized trial of external pneumatic compression boots.

A prospective, randomized clinical trial in 95 patients undergoing neurosurgical operative procedures was performed to investigate the efficacy of external pneumatic compression (EPC) of the calves as compared with results in a control group that received no specific form of prophylaxis for prevention of deep vein thrombosis (DVT). The diagnosis of DVT was established by the I125 fibrinogen scan and radiographic contrast phlebography. The data indicate that EPC provides significant protection against the development of DVT in comparison with results in the control group (p less than 0.005). There were no known pulmonary emboli in any of the EPC-treated patients. There were no complications of EPC.

Evaluation Studies as Topic↗
PubMed1977

Cardiorespiratory and sympathoadrenal responses during weaning from controlled ventilation.

Weaning from controlled ventilation was attempted in 20 patients who were ventilated with volume constant ventilators for at least 24 hours before study. Measurement of alveolar to arterial oxygen tension differences on 100% oxygen (Aa DO2 1.0) in patients who failed to wean (nonweaners, n = 10), showed a mean AaDO21.0 at 5 minutes after beginning to wean of 388 +/- 56 mm Hg (SEM), and right-to-left shunt (QS/Qt) of 21% values which were significantly different from control (p less than 0.025) and significantly different from ten patients who weaned (p less than 0.005). Since rises in QS/Qt were not accompanied by increased pulmonary capillary wedge pressure, the increased QS/Qt was most likely due to acute atelectasis and not left ventricular failure. These data suggest that patients who fail an initial period of weaning should be placed on positive end-expiratory pressure during subsequent weaning attempts. Significant increases in cardiac output and atrial PCO2 occurred in both groups. Assessment of urinary catecholamine excretion during weaning suggests that sympathoadrenal stimulation often is intense and usually is greater in those patients who weaned successfully. Increased arterial PCO2 may be the mechanism for sympathoadrenal stimulation and rises in cardiac output (r = 0.39, p less than 0.01) during weaning.

Adrenal Medulla↗
PubMed1976

Improved albumin synthesis in postoperative patients by amino acid infusion.

To determine whether intravenous 3.5 per cent amino acid solution enhanced the rate of albumin synthesis in postoperative patients, we measured the albumin synthesis rate by the (14C) carbonate technic in 10 patients on the fourth day after elective gastrointestinal-tract operations. Five patients were randomized to receive a 3.5 per cent solution of essential and non-essential amino acids, and five to receive 5 per cent glucose. A mean (+/-S.E.M.) of 75.0+/-2.0 per day of amino acids or 111.0+/-12.4 glucose was given. In the amino acid group the mean (+/-S.E.M.) albumin synthesis rate was 237+/-24 mg per kilogram per day, in comparison to 157+/-23 in the glucose group (P less than 0.05). The infused amino acids were apparently more effective than plain glucose in promoting albumin synthesis.

Adult↗
PubMed1976

Reversible renal failure following bilateral renal artery occlusive disease. Clinical features, pathology, and the role of surgical revascularization.

Three patients with severe hypertension and rapidly progressive oliguric renal failure who required dialysis were found by aortography to have bilateral renal artery occlusion or stenosis. Each had peripheral arteriosclerosis or an abdominal bruit. Following renal artery reconstructive surgery, all three patients recovered nearly normal renal function in 3 to 12 weeks, though mild hypertension persisted in two patients. The common findings of a normal-sized kidney with collateral blood flow and nearly normal histological features were predictive of recovery of renal function. Prolonged postoperative oliguria in two patients may have been due to increased preglomerular vascular resistance mediated by the renin-angiotensin system.

Acute Kidney Injury↗
PubMed1976

Pulmonary management of the urologic patient.

Morbidity and mortality from pulmonary complications following urinary tract operations can be reduced by preoperative identification of the high risk patient. Pulmonary function tests and arterial blood gases are necessary to identify these patients and to delineate the severity of their pulmonary disease. Respiratory complications can be prevented in many patients with the proper use of pre- and postoperative chest physical therapy and oxygen therapy. Despite the most careful pulmonary management, some patients develop acute respiratory failure following urologic operations. Respiratory failure results from a combination of physiologic abnormalities which impair alveolar ventilation and oxygenation. Utilizing controlled ventilation, supplemental oxygen, and a physiologic approach to treating the underlying cause of respiratory failure, three fourths of urologic patients in respiratory failure may be expected to survive.

Acute Disease↗
PubMed1975

Positive end-expiratory pressure in weaning patients from controlled ventilation. A prospective randomised trial.

Twenty-five patients in acute respiratory failure were randomised to receive either 5 cm of positive end-expiratory pressure (P.E.E.P.) or no-P.E.E.P. while weaning from controlled ventilation. The use of P.E.E.P. resulted in a significant reduction in the increase in alveolar-arterial oxygen tension gradient (AaDO21) which occurred in the group of patients who were converted from controlled ventilation to spontaneous ventilation without P.E.E.P. Patients who weaned without P.E.E.P. had a mean increase in AaDO21 of 102+/-35 mm Hg S.E. while those who weaned with P.E.E.P. had a mean increase of only 10+/-22 mm Hg (P less than 0-03). The use of P.E.E.P. was also associated with a significant improvement in the vital capacity and the maximum inspiratory force. Patients who weaned with P.E.E.P. had an increase in vital capacity of 258+/-108 ml (P less than 0-05) and an increase in inspiratory force of -15+/-5 cm H2O (P less than 0-01), while patients who weaned without P.E.E.P. did not have significant changes in these measurements. The use of P.E.E.P. during weaning may be helpful in patients who fail to wean because of the development of hypoxaemia due to rapid alveolar collapse, since P.E.E.P. appears to minimise the increase in intrapulmonary right-to-left shunt which normally occurs during weaning from controlled ventilation.

Acute Disease↗
PubMed1975

The effect of carbenoxolone on changes in canine and human gastric mucosa caused by taurocholate and ethanol.

The effect of carbenoxolone on taurocholate-induced changes in gastric mucosal permeabiity was assessed in three dogs, each of which was prepared with an antrectomy and a vagally denervated gastric pouch. Perfusion of the canine pouches with sodium taurocholate (40 mM) was associated with an increase in hydrogen ion back diffusion. This effect was not diminished by 10 days of carbenoxolone treatment. The effect of carbenoxolone on ethanol-induced changes in gastric mucosal permeability was assessed in six normal human subjects. A significant increase of gastric mucosal permeability was observed in six normal human subjects after instillation of ethanol (20 percent v/v). After 3 weeks of oral ingestion of carbenoxolone, there was inconsistent protection against ethanol-induced increases in gastric mucosal permeability. Basal secretion of hydrogen ion and postethanol hydrogen ion secretion appear to be diminished by carbenoxolone. These studies suggest that carbenoxolone does not protect against taurocholate- and ethanol-induced increases in gastric mucosal permeability in the dog and in man. It seems unlikely that carbenoxolone exerts its beneficial effect on the healing of gastric ulcers in man by an effect on gastric mucosal permeability.

Administration, Oral↗
PubMed1975

Randomized trial of albumin vs. electrolyte solutions during abdominal aortic operations.

In a prospective randomized trial of 16 patients undergoing abdominal vascular reconstructive procedures, changes in plasma volume, serum oncotic pressure (pis), serum albumin and total protein concentration, alveolar to arterial oxygen tension differences (AaDO2, FIO2 = 1.0), creatinine clearance, body weight, and fluid and sodium intake were examined. By random assignment patients received either an albumin- or a sodium-rich intraoperative fluid regimen. Pulmonary arteriovenous admixture was significantly less in the albumin group (n = 7) than in the electrolyte group (n = 9) on the first postoperative day. The change in AaDO2 correlated positively with the total sodium intake in the electrolyte group. Despite the larger fluid load and significantly greater gain of body weight, patients in the electrolyte group had a postoperative plasma volume significantly lower than the preoperative value. Postoperative values of albumin concentration, circulating albumin mass and pis were significantly greater in the albumin group in comparison to the electrolyte group. Creatinine clearance values were not different between the two groups. The change in pis correlated significantly with sodium intake and circulating albumin mass. Pulmonary shunting and expansion of the extracellular fluid volume may be minimized without adverse effects on renal function by administration of fluids rich in albumin in preference to sodium.

Aged↗