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Biomedical subjects

L M Flint

Publications and source records attributed to L M Flint.

At least 127 records · Page 7Linked to original sources
PubMed1979

Definitive control of bleeding from severe pelvic fractures.

Forty patients with severe pelvic fracture and extraperitoneal hemorrhage were reviewed. Eighteen patients seen prior to 1975 (group I) were clinically similar to 22 patients seen subsequently (group II). Major pelvic fracture hemorrhage was defined as bleeding in excess of 2,000 ml over and above initial resuscitation volumes. Ten of 22 group II patients met the criteria for continued extraperitioneal bleeding and were immobilized in an inflatable G-suit after surgically remediable lesions had been excluded. Ventilator support and hemodynamic monitoring were instituted and clinical response recorded. Prompt cessation of bleeding was observed in nine of ten patients. One patient required selective catheterization of a bleeding artery with subsequent embolic occlusion. Significant reductions in overall mortality and the frequency of shock related death were observed in group II patients. Sepsis was the leading cause of late death in survivors. Immobilization of pelvic fracture patients in the G-suit is recommended as a means of controlling continuing retroperitoneal hemorrhage when surgically correctable bleeding points have been dealt with. Failure of patients to respond promptly to the G-suit strongly suggests arterial bleeding amenable to selective catheterization and embolic occlusion.

Adolescent↗
PubMed1979

Selective hepatic artery ligation: limitations and failures.

The hospital records of 540 consecutive patients with hepatic trauma were reviewed. Persistent arterial bleeding from hepatic wounds was encountered in approximately 10% of severe liver injuries. Compression of the porta hepatis will result in cessation of bleeding in such patients and subsequent ligature of the appropriate lobar artery will provide permanent, safe control of bleeding. Failures of selective hepatic artery ligation commonly result from incomplete diagnosis of the extent of injury to portal veins and hepatic veins.

Evaluation Studies as Topic↗
PubMed1979

Hepatic cellular hypoxia in murine peritonitis.

Reduced oxygen consumption and lactic acidosis were observed frequently in patients with peritonitis. This study was designed to evaluate whether reduced oxygen consumption is secondary to deficient oxygen delivery or is a function of primary injury to mitochondria. Peritonitis was produced in rats by cecal ligation and perforation. Animals were killed at 2, 4, and 6 hours and agonally. Oxygen utilization was studied polarographically in isolated hepatic mitochondria with glutamate, pyruvate, and succinate substrates. State 3, state 4, respiratory control index (RCI), and ADP:O ratios were determined. Whole tissue and isolated mitochondrial ultrastructure were examined by electron microscopy. Systemic blood pressure and oxygenation were monitored. Hepatic tissue oxygenation was examined using a surface oxygen electrode. Peritonitis resulted in acceleration of state 3 respiratory rates and increased respiratory control indices at all time intervals. Maximal respiratory control was observed at 4 hours with all substrates. Whole tissue mitochondria demonstrated mild swelling and thinning of membranes and matrix. Experimental and control isolates showed similar orthodox-to-condensed conformational changes. Hepatic tissue oxygenation declined to less than 10% of control by 6 hours, while arterial Po2 was unchanged. The conclusions of this study are that lethal peritonitis results in (1) no primary injury to the hepatic mitochondria, (2) increased efficiency of hepatic mitochondrial oxygen utilization, and (3) reduced hepatic tissue oxygenation. The exact mechanisms of defective oxygen delivery require further study.

Animals↗
PubMed1979

Effects of cooling and intraluminally administered antiseptics on surgically induced ischemia of the intestine in dogs.

The efficacy of surface cooling and intraluminal antiseptic solutions for short term preservation of intestinal segments in preparation for free tissue transfer were investigated. Five segments of the small intestine and five segments of the colon were allocated to each group as follows: group 1, ischemia at 37 degrees C.; group 2, ischemia at 6 to 12 degrees C., and group 3, ischemia at 6 to 12 degrees C. plus povidone-iodine intraluminally. Histologic grading of segments allowed assessment of the efficacy of short term protection against ischemic changes. Surface cooling effectively prevented histologic evidence of ischemia. No additional benefit was observed using povidone-iodine intraluminally. Significant changes in tissue water content and evidence of bacterial invasion were not observed.

Animals↗
PubMed1978

Missile tract infections after transcolonic gunshot wounds.

Severe invasive infections around missiles or missile tracts may occur after transcolonic gunshot wounds. Observations in seven patients disclosed that infections of bone, soft tissue, retroperitoneum, and vascular structures resulted from the contamination of these tissues by missiles that had passed through the lumen of the colon. The infections were frequently obscure and difficult to diagnose unless the missile was considered to be a potential source of contamination. Two of seven patients died as a direct result of infection. Aggressive debridement of missile tracts, removal of accessible missiles, and adjunctive antibiotic therapy were useful.

Adult↗
PubMed1978

Closure of an acute perforated peptic ulcer with the falciform ligament.

When management of a perforated peptic ulcer necessitates simple closure, the omentum may not be of adequate quality to buttress such a closure. In this unusual circunstance, we have found the falciform ligament to serve as an effective alternative to satisfactorily peptic perforations.

Duodenal Ulcer↗
PubMed1978

Emergency operations for Crohn's disease.

Seventeen patients with Crohn's disease requiring emergency operative procedures disclosed important factors leading to successful outcome. In seven of the ten patients not known to have Crohn's disease, the history strongly suggested this diagnosis. Two patients died; three others had major complications, including two anastomotic leaks and two postoperative intraperitoneal abscesses. Wide drainage of abscesses, preservation of intestinal absorptive surface, avoidance of anastomoses in the presence of acute infection, and vigorous supportive nutrition are important features of the management of patients requiring emergency operation for complications of regional enteritis.

Adult↗
PubMed1978

Bleeding vascular malformations of the intestine.

Thirty-nine patients with bleeding vascular malformations were evaluated. The age range was from 3 to 78 years, with a bimodal age distribution. The younger patients had no associated diseases, while those in the older category invariably had an associated cardiac lesion (aortic stenosis in 12 patients and severe atherosclerotic disease in 11 patients). With experience, colonoscopy has become a valuable adjunct to arteriography with the lesion visualized in 12 patients. Arteriography is the most useful study being diagnostic in 35 of 38 cases. Exploration alone was diagnostic in only one of 39 patients. The most common site of bleeding was the cecum (21 patients) followed by the proximal small intestine (eight patients), terminal ileum (seven patients), and ascending colon (five patients). The lesions in the proximal small bowel were much more common in the younger patients and were believed to be congenital. Resection controlled the bleeding in the majority of patients, although four recurrences have been noted. All have been documented angiographically to have been from a new lesion and two were controlled with reoperation. The key elements to control of these patient's bleeding include: (1) systematic work-up with a team approach emphasizing careful visceral angiography, and (2) the avoidance of a premature laparotomy prior to complete evaluation.

Adolescent↗
PubMed1978

Occult splenic abscess: an unrecognized complication of heroin abuse.

Despite increased recognition of surgical problems related to narcotic addiction, splenic abscess has not been commonly recognized as such a complication. Seven male patients with splenic abscess secondary to heroin abuse have been treated. Six had bacterial endocarditis. Symptoms were nonspecific. Splenomegaly in two patients was the only useful physical finding. Five patients had left pleural effusion, of which three were proven to be empyemas. Staphylococcus aureus was the predominant pathogen of of bacterial endocarditis and splenic abscess. The splenic scan was diagnostic. All patients recovered following curative splenectomy.

Abscess↗
PubMed1978

Effect of limiting post-shock pulmonary edema on mortality from bacterial pneumonia.

Dogs were subjected to hemorrhagic shock and then resuscitated according to physiological parameters. Randomly selected dogs received a sublethal dose of intratracheal microorganisms. In comparing the results with those previously reported from our laboratory, in which animals received an 85% greater resuscitation of Ringer's lactate, it appears that pulmonary edema in the post-shock contaminated state can be limited. Furthermore, through minimization of pulmonary edema, pulmonary defenses appear to be improved and mortality from infection reduced.

Animals↗
PubMed1977

Selectivity in the management of hepatic trauma.

Retrospective review of 178 consecutive patients who sustained hepatic injuries confirms that selective application of hepatic artery ligation is an efficient means of definitive hemostasis. Only two of 20 immediate deaths resulted from hepatic parenchymal hemorrhage. Over-all mortality (20%) was not significantly increased where hepatic artery ligation was used. Sepsis was the most frequent complication after severe hepatic trauma.

Abdominal Injuries↗
PubMed1977

Wound management after trauma to the colon.

The records of 62 patients with injury of the colon were reviewed to ascertain the contribution of technics in wound care to morbidity. Primarily closed wounds had a very high frequency of infection (56%). Wounds treated by delayed primary closure or secondary intention developed infection in 19% of patients. Infection in an open wound was associated with intraperitoneal abscess in 73% of cases.

Adolescent↗
PubMed1977

Traumatic hemipelvectomy: a case report.

Traumatic hemipelvectomy is a devasting injury which few patients survive. A survivor of traumatic hemipelvectomy is described. Immediate and long-term management include prompt resuscitation, vascular control, urinary and fecal diversion, wound debridement, wound closure, and physical and psychologic rehabilitation.

Adult↗
PubMed1977

Essential fatty acid deficiency associated with total parenteral nutrition.

Essential fatty acid deficiency is a clinical and biochemical entity encountered in both adults and children. Especially at risk are those patients maintained by fat-free total parenteral nutrition. Linoleic acid is the substance most responsible for the deficien state and essential to its correction. A ratio of trienoic-tetraenoic fatty acids of 0.4 or greater is diagnositc of a chemical deficiency. A severe deficiency affects polyunsatured fatty acids, in both plasma and tissues and, thus, many systems of the body. Mulitple blood transfusions have not proved sufficient to correct chemical deficiency. A recently marketed, commercially available fat supplement, however, may be useful in preventing the problem.

Animals↗