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Biomedical subjects

J K Trinkle

Publications and source records attributed to J K Trinkle.

At least 91 records · Page 5Linked to original sources
PubMed1975

Management of flail chest without mechanical ventilation.

The pathophysiology of flail chest is usually described only on the basis of paradoxical respiration, ignoring underlying pulmonary contusion. Two groups of comparable patients were treated either with early tracheal intubation and mechanical ventilation (Group 1), or with fluid restriction, diuretics, methylpredinisolone, albumin, vigorous pulmonary toilet, and intercostal nerve blocks, ignoring the paradox and treating only the underlying lung (Group 2). When tracheostomy and mechanical ventilation were not used the mortality rate went from 21% to O(p = 0.01), the complication rate from 100% to 20% (p = 0.005), and the average hospitalization from 31.3 to 9.3 days (p = 0.005). We conclude that most patients with flail chest do not need internal pneumatic stabilization if the underlying lung is treated appropriately and that tracheostomy and prolonged mechanical ventilation with a volume respirator, as practiced in most respiratory care centers, is usually a triumph of technique over judgment.

Adolescent↗
PubMed1975

First rib fracture: a hallmark of severe trauma.

First rib fractures occurred in 55 patients. This injury is a harbinger of major trauma with 35 patients suffering a major chest injury, and abdominal and cardiac injuries occurring in 18 and eight patients respectively. The mortality associated with this injury was high (36.3%). Neurologic lesions accounted for the majority of deaths, however, unrecognized abdominal injuries and pulmonary complications were significant causes of mortality. Brachial plexus injury (5) and Horner's syndrome (3) occurred in survivors. Three patients had an associated injury of the subclavian artery, and the importance of this association is stressed. One late-developing post-traumatic thoracic outlet syndrome occurred. A fracture of the first rib is a hallmark of severe trauma; its presence should alert the clinician to: 1) generalized massive trauma with abdominal, chest, and cardiac injuries; 2) local injury to the subclavian artery and brachial plexus and; 3) necessity of long-term followup for late-developing sequelae.

Abdominal Injuries↗
PubMed1975

Closed aortic valvotomy and simultaneous correction of associated anomalies in infants.

A small infant with severe congenital aortic stenosis presents a difficult therapeutic problem. Both operative and nonoperative treatment are hazardous--especially when other cardiovascular anomalies are present. This report describes a simple, effective technique for dilating the stenotic aortic valve and simultaneously repairing certain associated defects. The procedure has been used successfully in 3 infants with a postoperative follow-up of 6 months to 4 years. There were no deaths, and the functional results have been excellent. This technique is presented as an alternative to the more hazardous approach to open valvotomy and/or stage correction of associated anomalies.

Abnormalities, Multiple↗
PubMed1975

Pulmonary sling. Case report and collective review.

The eighteenth survivor of correction of an anomalous left pulmonary artery arising from the right pulmonary artery is reported. This is the first case in which postoperative angiography demonstrated patency of the left pulmonary artery. The onset of symptoms in infancy, predominance of expiratory rather than inspiratory stridor, anterior indentation of the esophagus, and lethal progression of symptoms during the first year of life are peculiar to this anomaly. Operation through a left thoracotomy is advocated, with division of the proximal left pulmonary artery and implantation into the main pulmonary artery posterior to the phrenic nerve. Previously reported cases are collectively reviewed.

Angiography↗