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Biomedical subjects

J R Utley

Publications and source records attributed to J R Utley.

At least 55 records · Page 3Linked to original sources
PubMed1980

Interstitial hydrostatic pressures in patients undergoing CABG and valve replacement.

Using the Scholander-Hargens wick technique to measure interstitial fluid hydrostatic pressure (IFP) in thigh muscle (MIP) and subcutaneous tissue (SQIP), we have studied 12 patients undergoing cardiopulmonary bypass (CPB). Simultaneous measurements were made of serum total proteins (TP) and colloid osmotic pressure (COP). Bypass was carried out with a nonblood, noncolloid prime. In the postoperative period, colloid and blood were given which raised COP above prebypass levels (see Table II). MIP rises more with hemodilution than does SQIP and is less negative throughout. MIP rises faster when COP drops than does SQIP. These findings suggest that subcutaneous tissue interstitial space is loose and has a high compliance, whereas muscular tissue interstitial space is tight and has a low compliance. The increased pressure represents increase in fluid which is then removed promptly as COP is restored in the postoperative period. Experimental studies in animals show a response similar to MIP in the myocardium.

Aged↗
PubMed1980

Trapping, nontrapping, and release of nine and fifteen micron spheres in dog kidneys.

Variations in the distribution of different size microspheres trapped within an organ depend upon regional variations in delivery or trapping of different size spheres. We have determined the intrarenal distribution of trapped 9 mu and 15 mu spheres, as well as their nontrapping and release in dog kidneys. More 15 mu spheres than 9 mu spheres are normally trapped in the outer cortex, and fewer 15 mu spheres than 9 mu spheres in the medulla. This is true whether the renal blood flow enters the organ through the hilum or through capsular collaterals with chronic renal artery occlusion. The differences in distribution are due to greater trapping of 15 mu spheres than 9 mu spheres in the outer cortex with subsequent greater delivery and trapping of 9 mu spheres than 15 mu spheres in the vasa rectae of the medulla. Axial migration of the larger 15m spheres with greater distribution to terminal branches of a vessel and less distribution to proximal branches does not explain these observations, because it is independent of the transcortical direction of blood flows. Studies with adenosine triphosphate (ATP) vasodilation show that 15 mu spheres are trapped to a greater degree than 9 mu spheres and that previously trapped 9 mu spheres may be released with ATP vasodilation. Nontrapping and release of microspheres are potential sources of error and are greater with 9 mu than 15 mu spheres.

Adenosine Triphosphate↗
PubMed1979

The role of thymectomy in red cell aplasia.

Red cell aplasia is an unusual cause of anemia. Fifty percent of all patients with red cell aplasia will have a thymoma. Twenty-five to 30% of those who undergo thymectomy will be cured. Data are presented that suggest that any patient with red cell aplasia should have thymectomy through a median sternotomy. One of 3 such patients who underwent the operation has had complete remission for two years.

Aged↗
PubMed1979

Control of hemorrhage from a common carotid arterial-cutaneous fistula by temporary implantation of a balloon catheter.

Hemorrhage from an infected carotid arterial-cutaneous fistula was treated by occlusion of the common carotid artery with a 6-French (Swan-Ganz) balloon catheter. After nine months, there was no recurrence of bleeding or neurological sequelae. Temporary balloon occlusion to induce thrombosis of a major artery is an alternative to transcatheter embolization of small particulate material and larger foreign bodies.

Adult↗
PubMed1979

Predicting the need for prolonged ventilatory support in adult cardiac patients.

Forty-nine cardiac surgical patients had ventilatory function tests and measurements of maximum inspiratory (MIP) and maximum expiratory (MEP) pressures preoperatively. The differences between the values of various function tests were compared for patients requiring less than 24 hours of ventilator support and those requiring more than 24 hours. There was a significant difference in the mean values for the two groups in vital capacity (VC) first-second forced expired volume (FEV) midexpiratory flow between 50 and 75 (MMEF 50--75) and 75--85 percent of expired volume (MMEF 75--85), and MEP. The standard deviations of each of the variables were so large that the clinical usefulness was limited. However, when discriminant analysis was used for more than one variable, the combination of MMEF 75--85 and MEP predicted success or failure to wean in 24 hours correctly in 90 percent of instances. On the basis of these simple tests, patients predicted to succeed should be weaned from ventilator support on recovery from anesthesia. Those predicted to fail should be placed on intermittent mandatory ventilation (IMV) and should be weaned following a planned, logical process.

Adult↗
PubMed1978

Acute traumatic hemothorax.

Over the past 5 years, 107 patients have been evaluated for acute traumatic hemothorax at the University of Kentucky Medical Center. Immediate tube thoracostomy was performed on 90 patients for evacuation of blood and air. Only 2 patients died. Thoracotomy was performed as part of the initial therapy in 9 patients. Thoracotomy for continued hemorrhage from a pulmonary parenchymal injury was required in 3 patients from the entire group. Thoracentesis or observation was the initial therapy for limited hemothorax in 8 stable patients. Three of these patients subsequently required tube thoracostomy 2 to 23 days following injury due to expanding effusions, and 1 patient required multiple thoracotomies for sepsis, fibrothorax, and empyema. These observations indicate that early evacuation of blood by means of a tube thoracostomy is essential to minimize morbidity in acute traumatic hemothorax. If continuing hemorrhage after tube thoracostomy occurs, there is a higher association of injury to additional vital structures.

Abdominal Injuries↗
PubMed1978

Results and patterns of perioperative myocardial infarction.

Myocardial injury during a variety of cardiac surgical operations was determined in 57 patients by serial electrocardiograms (ECG's), serial determinations of serum creatine phosphokinase (CPK), and perioperative and postoperative technetium-99m stannous pyrophosphate (PYP) scans. ECG evidence of injury developed in four patients, whereas positive localized injury by PYP scan developed in ten. Twenty-one patients had elevated CPK enzymes postoperatively. The localization of injury by PYP scan correlated with ECG evidence of infarction in only one of four patients. Localized left ventricular injury by PYP scan without new Q waves on the ECG was common (5/12) in patients undergoing aortic valve replacement with perfusion of the coronary arteries. The injury in patients with congenital heart disease occurred at sites of ventricular incision or suggested possible air embolization of the coronary arteries. Perioperative infarction is frequently segmental and nontransmural and occurs in patients with coronary, valvular, and congenital heart disease.

Adult↗
PubMed1977

Intrathoracic splenosis.

Intrathoracic splenosis is a rare complication of combined diaphragmatic and splenic injury. This is the 79th reported case of splenosis and the seventh case of intrathoracic splenosis. That intrathoracic splenosis can mimic carcinoma of the lung on chest roentgenogram is exemplified by the similarity between the patient's chest film and that of his brother who died of lung cancer during the patient's hospital stay.

Diagnosis, Differential↗
PubMed1977

Role of cardiac catheterization in infective endocarditis.

The benefits and hazards of catheterization and angiography were evaluated in 19 patients with acute aortic and/or mitral endocarditis and heart failure. In 14 patients (74%), the bedside diagnosis of valvular insufficiency and heart failure was proved correct. In three patients with both aortic and mitral valve disease, angiography (without hemodynamic measurements) was necessary to clarify the diagnosis. Angiography detected four aortic aneurysmal erosions that were unsuspected clinically, but missed three others. After angiography, heart failure worsened in two patients with severe progressive aortic insufficiency and one died. Thus, catheterization-angiography was of greatest value if more than one left-sided valve lesion was present, if extravalvular diseases mimicked heart failure, or if extravalvular infection was present. Patients with isolated, clear-cut mitral insufficiency usually do not need these diagnostic procedures, and they are probably contraindicated in patients with severe aortic regurgitation with rapidly progressing heart failure.

Adult↗
PubMed1976

Unified approach to carcinoma of the esophagus.

The reversed gastric tube is advocated as a technique to be used in all patients who have carcinomas of the esophagus, whether the lesion is located in the upper, middle or lower esophagus. The tube, constructed out of the greater curvature of the stomach and supplied by the gastroepiploic vessels, invariably has adequate length and sufficient blood supply to heal per primum or to close anastomotic leaks spontaneously when they occur. Since the procedure requires a celiotomy and an incision in the neck, the presence and extent of metastatic disease below the diaphragm and above the clavicle can be evaluated. With prompt resumption of eating, the patients' nutritional status rapidly improves so that they can maintain weight during postoperative irradiation or further surgical procedures, e.g. esophagectomy. It is also effective as a palliative procedure since the patients handle their saliva and other secretions adequately after the procedure.

Aged↗