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Biomedical subjects

M G Ochsner

Publications and source records attributed to M G Ochsner.

At least 19 recordsLinked to original sources
PubMed1992

Development and organization for casualty management on a 1,000-bed hospital ship in the Persian Gulf.

A 1,000-bed hospital ship designed for trauma patients was deployed to the Middle East with the objectives of preparing for large numbers of casualties resulting from Operation Desert Storm from conventional, chemical, and biological weapons. Plans for receipt and decontamination of casualties, triage, and optimal utilization of the 1,000-bed facility were developed. Mass casualty drills were conducted, involving all aspects of patient care from the flight deck to the wards. Trauma and critical care registries were developed to collect casualty data that could then be analyzed for specific military purposes and compared with current civilian registries. Attempts were made to identify the advances in shock resuscitation, systems management, and operative treatment from the civilian community that could be applied to care of combat casualties. Difficulties with accomplishing these objectives included limited trauma experience and supplies and poorly defined medical regulating and evacuation policies. The development of these programs, as well as the unique difficulties encountered, are discussed.

Disaster Planning↗
PubMed1992

Associated aortic rupture-pelvic fracture: an alert for orthopedic and general surgeons.

Blunt trauma patients with pelvic fractures have been shown to have a two-fold to five-fold increased risk of aortic rupture compared with the overall blunt trauma population. A retrospective review was performed to determine whether the relationship between aortic rupture and pelvic fracture could be further delineated using a pelvic fracture classification based on mechanism of injury. Of 4,157 consecutive blunt trauma patients, 371 (8.9%) had pelvic fractures, 34 (0.8%) had ruptured thoracic aortas and 12 had both injuries. When pelvic fractures were classified according to vector of force, 10 of 12 (83%) aortic ruptures occurred in patients with an anterior-posterior compression fracture pattern, an incidence of aortic rupture eight times greater than that of the overall blunt trauma population. There was no increased incidence of aortic rupture among patients with any other pelvic fracture pattern. We conclude that the previously reported association between aortic rupture and pelvic fracture can be further specified to include, predominantly, those patients with an anterior-posterior compression fracture pattern.

Adolescent↗
PubMed1991

A modified Seldinger technique for peritoneal lavage in trauma patients who are obese.

We have devised a technique of peritoneal lavage that combines the semi-open and the Seldinger techniques for use in trauma patients who are morbidly obese that is fast, safe and obviates the extensive incision that is required to adequately visualize the peritoneum when using the open method. We have successfully used this technique in six patients whose weight exceeded the weight limit of 135 kilograms of our CT scanner.

Abdominal Injuries↗
PubMed1990

Fibrin glue as a hemostatic agent in hepatic and splenic trauma.

Fibrin glue is a biologic hemostatic agent that coagulates and seals upon application. It is made by combining human fibrinogen concentrate with standard thrombin solutions containing calcium. Similar to epoxy glue, the two components are applied simultaneously in equal volumes resulting in an almost instantaneous formation of a coagulum. Fibrinogen concentrate is prepared in the blood bank from single donor plasma. Fibrin glue can be applied topically or injected into the parenchyma of solid organs. Twenty-six patients sustained hepatic or splenic trauma from May through August 1989--17 liver and nine splenic injuries. The glue was effective after one application in 21 patients and after a second in five. Hemostasis was achieved despite coagulopathy and thrombocytopenia in eight patients. There were no re-explorations for bleeding, and nine complications occurred in six patients. Our experience suggests fibrin glue is an effective, underutilized adjunctive hemostatic agent in trauma.

Fibrin Tissue Adhesive↗
PubMed1989

Diagnostic pneumoperitoneum in the pediatric patient with a unilateral inguinal hernia.

Controversy continues among surgeons over the management of pediatric patients with unilateral groin hernias. Currently, advocated treatment modalities include repair of only the clinically apparent side, exploration of the contralateral side when the ipsilateral hernia is repaired, or performance of contrast herniography before surgery. Another technique for consideration--diagnostic intraoperative pneumoperitoneum--is a simple, quick, safe, and highly accurate means of detecting a clinically inapparent contralateral inguinal hernia during the initial surgery. This technique, the results of its use, and a review of the literature are included.

Adolescent↗
PubMed1989

Pelvic fracture as an indicator of increased risk of thoracic aortic rupture.

Thoracic aortic rupture is a lethal injury associated with severe blunt trauma. Survival is directly related to early diagnosis and operative treatment. Establishing the diagnosis requires a high index of suspicion, recognition of radiologic evidence of mediastinal bleeding, and identification of injuries frequently associated with aortic rupture. A retrospective review of blunt trauma patients at the Washington Hospital Center Trauma Unit and data from the Major Trauma Outcome Study identified a two- to fivefold increase in the incidence of aortic injury among patients with pelvic fracture. Twenty to forty-five per cent of patients with aortic rupture had associated pelvic fracture. Our study documents that pelvic fracture is as reliable an indicator of associated aortic rupture as many currently accepted injuries. Its presence should raise suspicion for aortic injury.

Aorta, Thoracic↗
PubMed1987

Peritoneal lavage in pediatric patients sustaining blunt abdominal trauma: a reappraisal.

One hundred twenty-eight patients from 0 to 18 years of age underwent diagnostic peritoneal lavage following blunt abdominal trauma. Seventy-eight had negative lavages and 50 were positive. Forty-one patients underwent exploratory celiotomy after positive lavage results. A review of the operative findings and need for surgical intervention led to the conclusion that 12 of these operations were not necessary. Due to the oversensitivity of peritoneal lavage a strongly positive result mandates further diagnostic evaluation unless the patient's clinical status requires exploratory celiotomy.

Abdominal Injuries↗
PubMed1983

Renal cell carcinoma: the Ochsner Medical Institution experience (1945-1978).

We reviewed 161 patients operated upon for renal cell carcinoma between 1945 and 1978. Life table and survival analyses were computed to compare the effects of stage, tumor differentiation, cell type, surgical technique, renal vein involvement and sex on the years of survival. Patients with stage I and well differentiated tumors had the best prognosis. All patients surviving 10 years or more had well differentiated tumors. The type of nephrectomy did not affect survival and lymphadenectomy was only of value in staging the disease. The stage and differentiation of the tumor were more important to outcome than choice of therapy.

Adenocarcinoma↗
PubMed1982

Acute urinary retention: causes and treatment.

Acute urinary retention often is secondary to obstruction of the bladder or distal genitourinary system, which may be induced by any of a number of medical or surgical conditions. Treatment varies according to the cause.

Carcinoma↗
PubMed1981

Contrasting effects of vasodilators on oxygen tension and membrane potential of canine gastric surface epithelium.

Our purpose was to study the effects of three related vasoactive drugs on gastric epithelial oxygenation and metabolism. By means of an ultramicroelectrode technique, oxygen tension and transmembrane potential difference of surface epithelium were determined in an in vivo canine gastric chamber model. Intra-arterial papaverine (30 micrograms kg-1 min-1) caused a significant depression of epithelial PO2 and potential difference (PD), a transient inhibition of total gastric oxygen consumption, and a 70% increase in total gastric blood flow. Following cessation of the papaverine infusion, epithelial PO2 and PD continued to decline, whereas gastric blood flow and oxygen consumption return to baseline. Isoproterenol (0.0125 microgram kg-1 min-1), on the other hand, had no significant effect on epithelial PO2 and PD although it increased total gastric blood flow 33%. Dopamine (0.1 microgram kg-1 min-1) had no significant hemodynamic effects. To test the importance of papaverine-induced epithelial hypoxia, hydrochloric acid (160 mM) and sodium taurocholate (3 mM) were added to the epithelial bathing solution during intra-arterial infusion of either papaverine or isoproterenol. Necrosis and ulceration of the gastric mucosa were seen with the infusion of papaverine but not with the infusion of isoproterenol. Our results indicate that papaverine increases total gastric blood flow at the expense of nutrient blood flow to surface epithelium. We conclude that nutrient blood flow to surface epithelium is critical to the ability of the gastric mucosa to resist injury by luminal acid and bile. Furthermore, papaverine should not be used clinically to enhanced gastric blood flow because it is potentially injurious to the mucosa.

Animals↗
PubMed1978

Partial cystectomy in the treatment of transitional cell carcinoma of the bladder.

Between 1950 and 1974, 35 men and 10 women underwent partial cystectomy for transitional cell carcinoma of the bladder. Indications, contraindications and the principles of technique for partial cystectomy as therapy for transitional cell tumors of the bladder are discussed. All patients were evaluated postoperatively, with cystoscopic examination every 3 months for 1 year, every 6 months for 3 years and then at yearly intervals if no tumors had been detected. None of the patients received preoperative irradiation. Eight ureters were re-implanted and 6 prostate glands were enucleated at the time of partial cystectomy. There was 1 death in the immediate postoperative period. Complications developed in 13 patients, 3 of which were considered major. When recurrences were noted appropriate therapy was performed as indicated. Irradiation was the most commonly used method to treat distant metastases. The over-all 5-year survival rate is 57.7% (26 patients). Thirty-four patients were followed for 10 years. The survival rate for this group of patients was 32.4% (11 patients). The results of this study correlate well with other published reports.

Adult↗
PubMed1978

Adenocarcinoma of the bladder as seen at Ochsner Medical Institutions.

Adenocarcinoma of the bladder is an uncommon malignancy comprising less than 2% of all bladder tumors. Eleven cases of adenocarcinoma of the bladder were seen from 1947 to 1977 at the Ochsner Medical Institutions. Six of the tumors were urachal in origin, and five involved the base and lateral walls of the bladder. Six patients were treated with total cystectomy, four with segmental cystectomy, and one with radiation therapy only. The average survival time for the patients with urachal adenocarcinoma was 2.8 years and for those with vesical adenocarcinoma, 2.4 years. Although segmental cystectomy is recommended by some, the authors recommend radical cystectomy for all patients with adenocarcinoma of the bladder.

Adenocarcinoma↗
PubMed1977

Congenital giant hydronephrosis in adults.

Giant hydronephrosis is the term designating the presence of more than 1,000 ml. of fluid in the collecting system. Of 4 cases of congenital hydronephrosis found over a three-year period at the Ochsner Medical Institutions, 2 were associated with unsuspected carcinomas. Hydronephrosis may first be detected as a mass palpable in the abdomen and displacing the intestines on gastrointestinal films. Excretory urography, retrograde pyelography, and angiography confirm the diagnosis. The treatment of choice is nephrectomy.

Adenocarcinoma↗