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Biomedical subjects

J K Trinkle

Publications and source records attributed to J K Trinkle.

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

Pulmonary artery aneurysm.

Less than 200 cases of main pulmonary artery aneurysms have been reported and most came from autopsy series. The aneurysms may be associated with congenital cardiovascular lesions, syphilis, degenerative changes in the arterial wall and possibly trauma. Pulmonary artery aneurysm is a true entity which can occur with or without typical clinical findings. Physicians should pay more attention to the so-called "aneurysmal dilatation" or "idiopathic dilatation" of the pulmonary artery and obtain a correct diagnosis by angiography. Since pulmonary artery aneurysm carries a risk of rupturing, the operation should be considered as soon as the lesion is recognized. Few surgical interventions have been reported.

Adult↗
PubMed1977

Management of subclavian and innominate artery injuries.

Subclavian and innominate arterial injuries are life-threatening and require aggressive treatment. Physical findings, chest x-ray examinations, and a high index of suspicion led to expoloration in seventeen of twenty-two patients in this series, but the selective use of arteriography is helpful. Primary repair was accomplished in nineteen of the twenty-two patients. Wide proximal exposure proved to be accompanied by little morbidity with the reward of increasing survival to 95.5 per cent.

Adolescent↗
PubMed1977

Is a left ventricular vent necessary during cardiopulmonary bypass?

This study evaluated the coronary flow and the internal diameter, pressure, and metabolism of the left ventricle using four different cardiopulmonary bypass techniques. Conditioned dogs underwent a 30-minute stabilizing period on cardiopulmonary bypass with a beating, empty heart (normothermia and a flow of 80 ml/kg/min). They were then fibrillated and subjected to four experiments: Group A (7 dogs)--left ventricular vent, caval tapes open; group B (7 dogs)--left ventricular vent, caval tapes closed; group C (7 dogs)--no vent, caval tapes open; group D (4 dogs)--no vent, caval tapes closed. There was no major difference in any of these variables among Groups A and B (both ventricles vented). Group D (no vent, tapes closed) had significantly increased wall tension, decreased coronary flow, decreased subendocardiac flow, and ischemia. In contrast, Group C dogs (no vent, tapes open) had only a slight increase in left ventricular diameter and pressure, with no change from Group A and B dogs in coronary flow, lactate extraction, hydrogen ion production, or potassium difference. Therefore, venting the fibrillating ventricle, either with or without snaring of the caval tapes, is probably the best method to use during the distal anastomosis in a coronary artery bypass operation. However, if a vent is not used, the caval tapes should be left open to allow complete diversion of the venous blood and decompression of the left ventricle.

Animals↗
PubMed1977

Subxiphoid pericardial window in patients with suspected traumatic pericardial tamponade.

The technique, indications, and results of subxiphoid pericardial window in penetrating chest wounds with suspected traumatic pericardial tamponade are reported. The classic signs of pericardial tamponade (elevated central venous pressure, muffled heart sounds, and paradoxical pulse) are unreliable in an emergency situation. Chest roentgenograms and electrocardiograms are of little diagnostic value. Pericardicentesis was either falsely positive or negative in 50% of our patients. Therefore, unexplained high central venous pressure and hypotension were considered to be pericardial tamponade until disproved by the results of a subxiphoid pericardial window. There were 4 negative and 46 positive findings of tamponade in 50 consecutive patients with suspected traumatic pericardial tamponade who underwent creation of a subxiphoid pericardial window. There were no deaths or complications from the procedures. The early use of subxiphoid pericardial window has been a major factor in reducing our mortality rate from penetrating heart wounds to 12% overall, and 8% in the past three years.

Blood Pressure↗
PubMed1977

Subxiphoid anterior mediastinal exploration.

A new surgical technique for anterior mediastinal exploration is described. The technique involves application of a Carlens mediastinoscope by means of a subxiphoid incision. The procedure provides complete exploration of the anterior mediastinal compartment and allows the surgeon to obtain a positive biopsy of the tumor or its lymph node metastases without sternotomy.

Anesthesia, General↗
PubMed1977

Posttraumatic empyema.

This is a report of the experience gained from treating 18 patients with posttraumatic empyema during a 36-month period. The objectives of treatment were twofold: complete reexpansion of the lung, and evacuation of infected foreign material from the pleural space. The techniques of achieving these objectives were tube thoracostomy initially, followed by early thoracotomy if necessary.

Adult↗
PubMed1977

Effects of ventricular fibrillation on coronary blood flow and myocardial metabolism.

Ventricular fibrillation is frequently induced during cardiac surgery to quiet the operative field. The reported effects of fibrillation on the myocardium vary considerably. In an attempt to better define these effects, we subjected 28 dogs to one hour of total normothermic bypass. Myocardial blood flow, lactate, adenosine triphosphate (ATP), oxygen consumption, and left ventricular fibrillation was induced in 5 dogs and continuous electrical fibrillation in 7 dogs. These groups were compared to two respective control groups with beating hearts of 8 animals each. Coronary sinus flow, total coronary blood flow, left ventricular flow, myocardial oxygen consumption, and myocardial tissue lactate increased significantly in the fibrillating hearts. Left ventricular dp/dt decreased with fibrillation, but not significantly. It is concluded that the metabolic demands of ventricular fibrillation exceed the increase in coronary blood flow, when compared to demands of the beating heart, and that decreased left ventricular performance may result.

Adenosine Triphosphate↗
PubMed1977

Prophylactic antibiotics in the treatment of penetrating chest wounds. A prospective double-blind study.

Considerable controversy exists as to whether or not antibiotics should be administered "prophylactically" to patients with penetrating chest trauma. No prospective study of this problem has been reported. Therefore, 75 patients with isolated, penetrating chest injury were randomized prospectively in a double-blind study. Group A patients (38 patients) were given 300 mg. of clindamycin phosphate every 6 hours, beginning with admission and lasting until 1 day following chest tube removal or for 5 days, whichever was shorter. Group B patients (37 patients) were given a placebo on the same schedule. The patients' hospital course, fever, white blood count, culture data, and roentgenograms were recorded serially. Clindamycin-treated patients had a significantly lower incidence of radiographic pneumonia, less fever, and a lower incidence of positive pleural and wound cultures. They acquired empyema less frequently, required fewer operations, and had a shorter period of hospitalization. Antibiotics may be useful, therefore, as adjunctive therapy in the management of penetrating chest trauma.

Adolescent↗
PubMed1977

Effects of methylprednisolone on coronary blood flow and myocardial metabolism during cardiopulmonary bypass.

Corticosteroids frequently are used during cardiopulmonary bypass (CPB) to enhance total body perfusion and myocardial preservation. The mechanisms by which steroids might provide protection to the myocardium have not been clearly defined, however. Therefore this study was performed to measure the effects of methylprednisolone (M-P) on coronary flow and distribution, and on myocardial metabolism and contractility. Twenty-three dogs underwent 1 hour of total CPB, 80 cc/kg/minute at normothermia with beating hearts. Alternate animals received M-P, 30 mg/kg. Myocardial blood flow (microspheres technique), myocardial tissue lactate and adenosine triphosphate, lactate extraction, coronary sinus flow (CSF), and coronary vascular resistance (CVR) were measured before, during, and 60 minutes after bypass. LV dp/dt and cardiac output (CO) were measured before and after bypass. Total coronary flow was significantly higher in the M-P group after 10 and 30 minutes of bypass (93 vs 56 ml/100 gm/minute, p less than 0.05, and 96 vs 71 ml/100 gm/minute, p less than 0.05). Right ventricular flow was higher in the M-P group at 10 and 30 minutes of bypass (98 vs 66 ml/100 gm/minute, p less than 0.05, and 90 vs 78 ml/100 gm/minute). Left ventricular flow was higher in the M-P group at 10 minutes of bypass (79 vs 52 ml/100 gm/minute, p less than 0.08). Septal flow also was higher in the treated group at 10 minutes of bypass (64 vs 49 ml/100 gm/minute) and at 30 minutes of bypass (92 vs 67 ml/100 gm/minute, p less than 0.05). CVR after 10 minutes of bypass was lower in the steroid group (88 mm Hg/ml/100 gm/minute vs 1.39 in the control group, p less than 0.03). It is concluded that M-P increases coronary blood flow and decreases CVR in the empty beating heart during normothermic CPB without altering myocardial metabolism or contractility.20

Adenosine Triphosphate↗
PubMed1976

Transthoracic approach for Pott's disease.

Spinal tuberculosis with paraplegia, although decreasing in incidence, remains a problem in certain sections of the United States and in most underdeveloped nations. Evacuations of the tuberculous abscess, debridement of necrotic bone, and fusion of the anterior spine are maneuvers performed increasingly by thoracic surgeons. Twenty-two patients with Pott's disease and symptoms of back pain, gibbous deformity, and neurological deficit underwent thoracotomy. Nine were paraplegic prior to operation. Postoperatively, spinal fusion occurred in all cases. All paraplegic patients can walk now, and 17 of the 22 treated operatively have been completely rehabilitated and are in school or working. The average hospital stay was 2.4 months. There was 1 operative death. Medical treatment for Pott's disease consisted of bed rest and chemotherapy and resulted in progressive neurological deficit in 2 patients with an average hospital stay of 2.2 years. We believe operative treatment offers two distinct advantages: excellent reversal of even long-standing paraplegia and markedly shortened hospital stay.

Adolescent↗
PubMed1976

Esophagopleural fistula after pneumonectomy.

Rupture of the esophagus into the space left after pneumonectomy is a rare and often fatal complication. Esophagopleural fistulas occurred in three patients following pneumonectomy. After previous methods failed, two patients were successfully treated by using a one-stage procedure which included (1) suture closure of the fistula, (2) buttressing the repair with a viable, pedicled, two-rib intercostal-muscle flap, and (3) performing an extensive thoracoplasty with a continuous drip infusion of neomycin. Such a procedure offers the maximum opportunity for successful treatment of this catastrophic lesion.

Esophageal Fistula↗
PubMed1976

Total anomalous pulmonary venous return with associated patent ductus arteriosus. Two cases with successful correction.

A large patent ductus arteriosus associated with total anomalous pulmonary venous return results in a unique hemodynamic pattern, and long-term survival has been rare. Two patients, aged five and 18 years, underwent successful surgical repair of supracardiac total anomalous pulmonary venous return and an associated large patent ductus arteriosus. The association of the Noonan syndrome in the 18-year-old woman is of additional interest.

Adolescent↗
PubMed1976

Blunt traumatic rupture of the atria.

The case histories of 2 patients with atrial rupture from blunt chest trauma are presented, one of whom is the tenth survivor. Based on a review of these cases and the literature, important factors in the diagnosis and treatment of this easily repairable anatomic lesion are discussed. The importance of rapid recognition and early operation are emphasized.

Adult↗
PubMed1976

Fatal air embolism following gunshot wound of the lung.

Air embolism following penetrating lung trauma has been reported infrequently and its existence is questioned. A death resulting from air embolism following a high-velocity gunshot wound is presented. Appropriate treatment and preventive measures are discussed.

Adult↗