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Biomedical subjects

M D Peyton

Publications and source records attributed to M D Peyton.

At least 19 recordsLinked to original sources
PubMed1981

Ligation of patent ductus arteriosus in very low birth weight infants.

Twenty-five low birth weight, premature neonates who were refractory to aggressive medical management underwent ligation of symptomatic patent ductus arteriosus. The mean birth weight was 1,007 g and the mean gestational age 29 weeks. Six patients (24 percent) died before discharge, two from continued cardiorespiratory failure. Echocardiography showed significant improvement in left atrial and left ventricular dimensions after ligation. In the premature neonate with respiratory distress and congestive heart failure refractory to aggressive medical management, surgical ligation may be accomplished with an acceptable hospital mortality in very low birth weight infants.

Cardiac Surgical Procedures↗
PubMed1980

Hemophilus influenzae purulent pericarditis in children: diagnostic and therapeutic considerations.

Purulent pericarditis is an unusual complication of infection in infancy and has been associated with an extremely high mortality rate. Early diagnosis followed by combined antibiotic therapy and surgical drainage of the pericardium has markedly improved survival. Between APril, 1975, and February, 1979, nine patients with purulent pericarditis secondary to Hemophilus influenzae type B were treated at the Oklahoma Children's Memorial Hospital. In every case signs and symptoms of congestive heart failure were present, and a pericardial effusion was demonstrated by echocardiography and confirmed by pericardiocentesis. The organism was identified with countercurrent immunoelectrophoresis and antibiotic sensitivity determined by rapid beta lactamase assay. All patients were treated with a combination of parenteral antibiotics and open surgical drainage of the pericardium. There were no deaths and all patients demonstrated marked improvement following operation. Follow-up echocardiography revealed no evidence of pericardial effusion or signs of constriction in any patient.

Anti-Bacterial Agents↗
PubMed1979

Lower extremity amputation: review of 110 cases.

Very significant morbidity and mortality continue to accompany lower extremity amputations. In this study 90 patients underwent 110 amputations over a 4 year period. The overall complication rate was 40 per cent and the overall mortality rate 12.2 per cent. The patients at greatest risk were the above knee amputees greater than 60 years of age with peripheral vascular disease. Amputation of the lower extremity must be recognized as a major, life-threatening procedure. Careful preoperative evaluation of cardiac, pulmonary, and nutritional status along with efforts to prevent sepsis, pneumonia, pulmonary embolism, gastrointestinal ulceration, and renal failure are necessary if the mortality accompanying these procedures is to be reduced.

Adult↗
PubMed1977

Comparison of Nissen fundoplication and Belsey Mark IV in the management of gastroesophageal reflux.

Our experience for the past four years with antireflux surgery has been reviewed. The Nissen fundoplication resulted in symptomatic improvement in 87.5 per cent of cases as compared with 64 per cent who were improved after the Belsey Mark IV procedure. Objective evaluation as measured by the standard acid reflux test (SART) revealed recurrent reflux in 9 per cent of those who underwent fundoplication and in 47 per cent of those treated with the Belsey repair. Mortality rates were similar. These results indicate that Nissen fundoplication is superior to the Belsey Mark IV procedure in the management of gastroesophageal reflux.

Abscess↗
PubMed1977

The asymptomatic bruit.

A review of 144 carotid endarterectomies performed in 108 patients at the Oklahoma Health Science Center over the past six years showed an acceptable operative morbidity and mortality in group of patients with an asymptomatic midcervical bruit who underwent prophylactic carotid endarterectomy prior to anticipated elective surgery. Long-term follow-up showed these patients to be free of neurologic symptoms of fatalities in 100 per cent of long-term survivors and suggests that carefully selected patients with an asymptomatic bruit may undergo carotid endarterectomy to prevent future neurologic complication.

Aged↗
PubMed1976

The effects of coronary vasodilatation on cardiac performance during endotoxin shock.

Results of studies have suggested that endotoxin and lowered coronary arterial perfusion pressures are detrimental to cardiac performance and lead to failure. Prevention of cardiac failure in the isolated canine heart preparation confronted with endotoxin and decreased coronary perfusion pressure was possible by perfusing these hearts with sodium nitroprusside. Prevention of failure was manifested by a lowered left ventricular endiastolic pressure and was associated with increased coronary flow and decreased coronary resistance with increased oxygen delivery and decreased oxygen extraction. Possible explanations for improved performance by dilator perfusion include increased delivery of oxygen and nutrients to myocardial tissue as well as a reduction of ventricular wall tension by dilating the coronary vascular skeleton. Prevention of extravasation of interstitial fluid into myocardial tissue by reducing overperfusion of potentially damaged coronary vessels could serve to maintain myocardial integrity and ventricular compliance. The potential use of such therapy warrants further study, with emphasis on evaluating the hemodynamics of the intact animal.

Animals↗
PubMed1975

Hypoglycemic effects of endotoxin in eviscerated dogs.

Terminal stage, endotoxin shock in the dog is associated with profound hypoglycemia. The response of eviscerated dogs with absent pancreatic and hepatic function is compatible with insulin independent peripheral tissue catabolism of glucose, and an increased lactate-pyruvate ratio suggests anaerobic metabolism. Increased survival in dogs administered exogenous glucose indicates reversible, fuel dependent changes of peripheral tissue metabolism. Since hyperglycemia has been a predominant finding in clinical endotoxin shock, species differences are emphasized, but perhaps closer scrutiny of the terminal stages of clinical endotoxin shock would be more compatible with this experimental model. In any event, an explanation of the metabolic changes in this model may prove valuable in understanding the physiopathology of endotoxin shock.

Animals↗
PubMed1974

Transvenous management of pulmonary embolic disease.

Clinical pulmonary embolic disease was categorized into four classes according to hemodynamic and respiratory effects of the occlusion at the time of diagnosis. A new approach to management of massive embolization (Class III and IV) by transvenous catheter embolectomy was attempted in ten patients with initial success in eight. Three additional deaths occurred postoperatively, two from recurrent embolization prior to vena caval plication. In view of this preventable complication, a wire filter device was developed for insertion at the time of embolectomy. The filter has also been utilized in 15 additional patients with lesser degrees of embolization (Class II). The conal shape of the device permits preservation of flow after embolic capture and followup venacavagrams in nine patients up to 20 months postoperative shows patency in all. Complications occurred in both groups related both to the underlying disorder and to the catheter technics.

Adult↗