Search PubMed⌕ Search

Biomedical subjects

L M Flint

Publications and source records attributed to L M Flint.

At least 91 records · Page 5Linked to original sources
PubMed1984

Microcirculatory norepinephrine constrictor response in hemorrhagic shock.

Hemorrhagic shock is characterized by a phase of compensation that preserves central blood flow and intravascular pressure through an integrated vasoconstrictor response mediated by catecholamines, particularly norepinephrine (NE). The skeletal muscle microcirculation is important in this response. Decompensation occurs when arteriolar vasodilation occurs despite continued hypovolemia and high circulatory levels of NE. Using an isolated decerebrate rat cremaster muscle, we measured constrictor response to NE (10(-7)M tissue concentration) in compensated and decompensated shock. Our data indicate that larger arterioles (143 to 152 microns) show persistent constrictor response with lowered sensitivity to NE. Smaller arterioles (11 to 22 microns) and all venules dilate late in shock but retain constrictor responses to NE. Dilator responses contribute to decompensation in small arterioles and venules but not because of altered NE constrictor response.

Animals↗
PubMed1983

Erythrocyte sodium-potassium-stimulated adenosine triphosphatase activity is not related to obesity.

Altered erythrocyte sodium potassium (Na,K)-stimulated adenosine triphosphatase (ATPase) activity has been cited as having pathophysiologic significance in morbidly obese man. Previous studies have failed to consider obese patients after weight loss and, therefore, did not clarify the role of ATPase deficiency as a cause or effect of the obese state. To define more completely the possible alteration of cellular thermogenesis in obesity, a study was made of three groups of people: (1) normal weight controls; (2) morbidly obese; and (3) formerly morbidly obese patients who had lost over 100 pounds after gastric bypass surgery. Erythrocyte ATPase activity was determined by use of an assay that coupled ATPase activity with NADH oxidation in the presence of excess pyruvate kinase, lactic dehydrogenase, and phosphoenolpyruvate. This coupled assay produced a continuous slope so that activity could be calculated from the initial, maximal, linear portion of the decay trace. Results did not demonstrate any statistically significant differences in Na,K-ATPase activity between groups by analysis of variance. A nonsignificant correlation of 0.086 was seen between obesity index and Na,K-ATPase activity. It is concluded that (1) erythrocyte Na,K-ATPase activity is similar in both normal and obese individuals, (2) erythrocyte Na,K-ATPase does not change with weight loss, and (3) therefore, disordered erythrocyte thermogenesis does not have a role in the development or maintenance of obesity.

Adult↗
PubMed1983

Reassessment of Graham-Steele closure in acute perforated peptic ulcer.

We studied 67 patients who had operation for perforated peptic ulcer. Operative treatment included plication with omentum (Graham closure) in 27 patients, vagotomy and pyloroplasty in 32 patients, or vagotomy and antrectomy in eight patients, depending on antecedent ulcer history, degree of contamination, and general patient condition. Mortality was high with simple closure in patients with long-standing perforation or associated disease. Early complications associated with Graham closure included rebleeding, perforation, and obstruction. There were no deaths or major complications related to vagotomy and pyloroplasty. In selected patients, definitive operation is safe and produces excellent long-term results.

Acute Disease↗
PubMed1983

Effects of electrolyte or colloid infusion on the injured lung.

Diffuse lung injury (acid aspiration) and a modest intravascular volume deficit (15% total blood volume) were produced in mongrel dogs. Replacement of lost volume was with shed blood plus an equal volume hydroxy ethyl starch (Group I) or shed blood plus balanced salt solution (3 ml/ml shed blood). Extravascular lung value (EVLW) measurements were used to quantitate edema formation and alveolar arterial oxygen gradient (A-a and O2) was monitored on a reflection of hypoxia. No significant differences were observed in A-a and O2 between groups despite a significantly larger amount of pulmonary edema in Group I (hydroxy ethyl starch).

Animals↗
PubMed1983

Peritoneal lavage: a useful diagnostic adjunct for peritonitis.

Diagnostic peritoneal lavage (DPL) was used to aid in the rapid diagnosis of peritonitis in 138 patients for whom standard diagnostic criteria were not applicable because the patients had altered sensorium, were elderly, or had multiple medical problems. There were abnormal results in 77 patients, and all but one patient had peritonitis. Sixty-five patients had lesions that could be cured only by operative means; 54% of this group of extremely ill patients survived. Of 61 patients with negative results of DPL, only one had intraperitoneal inflammation (acute cholecystitis), which occurred 4 days after DPL. We believe DPL is a useful procedure for the detection of peritonitis in a critically ill subset of patients for whom the standard diagnostic criteria were not available.

Adult↗
PubMed1983

Successful management of injuries to the extraperitoneal rectum.

We reviewed the records of 32 patients having extraperitoneal rectal trauma in the six-year period ending December 31, 1981. There were 23 penetrating injuries and nine blunt injuries. All patients were resuscitated and examined digitally by sigmoidoscope. Complete diverting colostomy and washout evacuation of the defunctionalized rectal segment were performed routinely. Dilatation of the anal sphincter and lavage with two to three liters of dilute povidone-iodine solution permitted cleansing of the rectal segment of all particulate fecal material. Retrorectal suction drains were inserted in 30 patients; the two remaining patients required abdominoperineal resection and gauze packing of the pelvis for control of hemorrhage. The mortality rate due to rectal injury was 3 per cent. Complications occurred in 5 patients (16%).

Accidents, Traffic↗
PubMed1983

Arterial injuries with lower extremity fracture.

Review of the records of 41 patients with lower extremity fractures associated with major arterial injuries disclosed that femoral artery injuries were consistently repaired with excellent results and no amputations. Diagnostic delay contributed to an 18% amputation rate following popliteal artery disruption. When arteries distal to the popliteal trifurcation were completely disrupted, a 25% rate of long-term good results was obtained.

Adult↗
PubMed1983

Efficacy of aerosolized methylprednisolone in an animal model of aspiration pneumonitis.

Methylprednisolone (MPSS, 30 mg/kg) was administered intrabronchially by nebulization 15 min after HCl aspiration in anesthetized dogs. Control animals (SALINE group) received saline nebulization without steroid. Hemodynamic and oxygenation variables were determined before and 1, 2 and 3 hr after aspiration. At autopsy, lungs were removed and desiccated for gravimetric determination of lung water. Three hr postaspiration, intrapulmonary shunting (Qsp/Qt) in the MPSS group was significantly lower (22 vs 41%) and arterial oxygen tension (PaO2) was higher (265 vs 122 torr) than in the SALINE group. Thus, direct application of this glucocorticoid to airway membranes following acid aspiration improved gas exchange without obvious benefit to edema formation or cardiac output.

Aerosols↗
PubMed1982

Use of the rhomboid major muscle flap for esophageal repair.

A 16-year-old boy sustained vehicular blunt trauma with delayed esophageal rupture that resulted in empyema and an esophagopleurocutaneous fistula. Diverting esophagostomy, gastrotomy, and transpyloric jejunostomy were performed, and these procedures permitted satisfactory nutritional support of the patient. Staged direct closure of the esophagus buttressed by a rhomboid muscle flap preserved normal esophageal function. Both clinical application and cadaver dissections have demonstrated that the rhomboid flap has an excellent blood supply and that it can be used to repair lesions on either side in the upper half of the esophagus. Because this flap is extrathoracic, it is not usually distorted by intrathoracic sepsis or previous thoracic incisions. The rhomboid major muscle flap is an excellent alternative to conventional autogenous grafts for esophageal repair.

Accidents, Traffic↗
PubMed1982

Liver failure.

Hepatic failure emerging in a patient after injury is generally manifested as cholestatic jaundice. It differs in several important respects from hepatic failure, as it is understood to present in alcoholic or posthepatitic patients. Sepsis is the etiology of the hepatic failure in the overwhelming majority of patients who die following posttraumatic organ failure. Therefore, aggressive attempts to localize and eradicate infected foci are the foundation of treatment. Exploratory laparotomy will be a necessary diagnostic and therapeutic maneuver in many of these patients and will yield a 50 per cent rate of improvement and survival of patients.

Cholestasis↗
PubMed1982

Resuscitation and transfer of trauma patients: a prospective study.

Improved outcome for trauma patients is closely linked to adequate early resuscitation and timely transfer of selected patients to trauma treatment centers. To document adequacy of early care of patients transferred to a regional trauma center, we analyzed 100 consecutive patients transferred after early care in a licensed emergency department by a medical doctor. Patients were evaluated in four injury categories: 1) neurologic, 2) chest, 3) abdominal, and 4) orthopedic. Standards promulgated by the American College of Surgeons Committee on Trauma and the American College of Emergency Physicians were applied in each injury category, and percentage of noncompliance with these accepted standards was calculated. Dangerous levels of noncompliance with accepted standards of trauma care were documented. On the average, major departures from accepted standards of early care were found in more than 70% of cases, particularly in the potentially lethal areas of airway acquisition and volume replacement. Implications of these data and an evaluation of corrective measures are discussed.

Adolescent↗
PubMed1982

Selective management of flail chest and pulmonary contusion.

Four hundred and twenty-seven patients with severe blunt chest trauma were treated resulting in (1) flail chest, (2) pulmonary contusions, (3) pneumothorax, (4) hemothorax, or (5) multiple rib fracture. The need for endotracheal intubation and mechanical ventilation was determined selectively by standard clinical criteria. Avoidance of fluid overload and vigorous pulmonary toilet was attempted in all patients. Three hundred and twenty-eight patients were treated by nonintubation; 318 patients (96.6%) had a successful outcome, while ten required intubation. Only one patient died. The 99 patients who required intubation and mechanical ventilation had a high mortality because of associated shock and head injury; however, the total mortality for the entire group of patients was 6.5%, with only 1.4% mortality caused by pulmonary injury. The incidence of pneumonia was high (51%), but there was only a 4% incidence of tracheostomy complications. Flail chest and pulmonary contusion without flail chest occurred in 95 and 135 patients, respectively. Half of the flail chest patients were intubated, but 69.5% were intubated less than three days. Twenty per cent of the patients with pulmonary contusion required mechanical ventilation, usually for less than three days. This study demonstrates that patients with severe blunt chest trauma can be managed safely by selective intubation and mechanical, ventilation and that the incidence of complications associated with controlled mechanical ventilation can be greatly reduced.

Adolescent↗
PubMed1982

Open pelvic fractures.

Open pelvic fracture is a devastating injury with a reported 50% mortality rate from massive bleeding and pelvic sepsis. Utilizing a graded approach to management of hemorrhage that included wound packing, anti-shock trousers, angiographic embolization, and hemipelvectomy, we controlled bleeding in all but one of the 35 patients in this series. Patients lost an average of 15 units of blood. The overall survival rate was 94.5% in this series, with one death each from hemorrhage and head injury. Prevention of invasive infection by a diverting colostomy in patients with buttock wounds or perineal wounds was stressed, while anterior soft-tissue wound were managed selectively. Debridement and frequent dressing changes under anesthesia were necessary to prevent and/or treat soft-tissue infection. Associated injuries occur commonly with genitourinary and peripheral nerve trauma and account for the majority of the long-term morbidity.

Adolescent↗
PubMed1982

Cervicomediastinal injuries following blunt trauma.

Blunt injuries to aortic arch branches are encountered with increasing frequency. From 1976 to 1980 20 patients with 26 cervicomediastinal arterial injuries were treated. Physical findings varied depending on the vessel injured: all subclavian artery injuries had positive signs, one carotid artery injury had a bruit as the only finding, and injuries to the innominate artery had no positive physical findings. Angiographic examination was performed in all patients when findings suggested vascular injury or there was a high index of suspicion based on patient history, widened mediastinum, or first rib fracture. Vessels injured included the subclavian (13 instances), carotid (five instances), innominate (five instances) and vertebral (three instances). In injured vertebral arteries were ligated. Innominate artery wounds were reconstructed using Dacron grafts; the remainder were excised in the area of intimal damage with primary anastomosis or interposition of a saphenous vein graft. There were no deaths or major vascular complications. Three patients, each, have major upper extremity neurologic deficits due to brachial plexus stretch injuries.

Adolescent↗