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Biomedical subjects

K V Arom

Publications and source records attributed to K V Arom.

At least 91 records · Page 5Linked to original sources
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

Prosthesis for correction of single ventricle.

A prosthetic right ventricular conduit that may be applicable in repair of the single ventricle anomaly is reported. The final conduit evolved from a series of animal experiments, which are described.

Animals↗
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

Intrathoracic paraganglioma arising from aorticosympathetic paraganglion.

A slowly growing intrathoracic paraganglion arising from an aorticosympathetic ganglion was removed from a 22-year-old woman. It was adherent to the parietal pleura and azygos vein, but not to the spinal cord. She has been well for the two years since that time. This patient represents the sixth tumor reported in this location. Most of the reported tumors are benign with occasional local invasion as seen in paragangliomas in other locations (carotid and aortic bodies). Complete excision of the tumor is the treatment of choice, but partial excision may provide long-term survival. A new classification and terminology suggested by Glenner and Grimley is emphasized. It groups logically the tumors arising from the paraganglion cells on the basis of anatomic distribution, innervation, and microscopic structure.

Adult↗
PubMed1976

Percutaneous method for arterial and venous monitoring.

A new technic for monitoring blood gases or venous and arterial pressure is described. Catheters are inserted by percutaneous puncture and guided into the femoral and iliac vessels with minimal manipulation. This rapid, simple technic has been used in more than 100 patients without a major complication.

Blood Gas Analysis↗
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

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

Relationship between right ventricular muscle bundles and pulmonary valve. Significance in pulmonary atresia with intact ventricular septum.

The normal pulmonary valvular cusps and related sinuses lie superimposed upon specific muscle bundles of the right ventricular infundibulum. Most prominent of such muscle bundles are those related to the right and left (posterior) pulmonary valvular cusps and sinuses. Least prominent is the muscle bundle related to the anterior pulmonary cusp and sinus. In pulmonary valvular atresia with intact septum the normal relationships are accentuated by right ventricular hypertrophy. A transpulmonary valvotomy done either through the region of the right or left (posterior) cusp tends to extend through subjacent muscle. The opening made through the region of the anterior cusp is more apt to lead directly into the right ventricular cavity.

Cardiomegaly↗
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↗
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

Traumatic pulmonary arteriovenous fistula.

The first case of traumatic pulmonary arteriovenous fistula in the English literature is reported. The case is reported to alert thoracic surgeons to the possibility of this lesion following penetrating chest injuries.

Arteriovenous Fistula↗