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Biomedical subjects

M O Perry

Publications and source records attributed to M O Perry.

At least 37 records · Page 2Linked to original sources
PubMed1988

Compartment syndromes and reperfusion injury.

Compartment syndrome has been defined as increased pressure within a limited space that compromises the blood supply and function of tissues within that space. The pressure rise is usually a result of increased interstitial fluid, although cell swelling may play a part. Most closed compartment syndromes can be detected by repeated clinical examination. Despite the extensive incisions and dissection required for adequate fasciotomy, if the nerves and muscles can be preserved, the limb will often be relatively normal.

Compartment Syndromes↗
PubMed1988

Abdominal aortic aneurysm surgery: the basic evaluation of cardiac risk.

The treatment of coronary artery disease (CAD) prior to abdominal aortic aneurysm (AAA) surgery has reduced the operative mortality, but there is no consensus regarding how best to detect CAD. In this study, 160 patients with AAA were divided into 4 groups according to Goldman's weighted risk factors. All patients were evaluated for CAD by clinical and laboratory methods, including stress electrocardiogram (ECG) and radionuclide studies, and monitored perioperatively with serial ECGs, measurements of serum enzymes, filling pressures, and cardiac output. No one died, but 3.7% had myocardial infarct, 2.5% had heart failure, and 8.1% had arrhythmias. Cardiac complications were rare in patients without clinically evident CAD and in those in Goldman's classes I and II. It appears that patients without clinically detectable CAD can be operated upon with a low risk if they are carefully evaluated and monitored.

Aged↗
PubMed1987

Ischemia: profile of an enemy. Reperfusion injury of skeletal muscle.

Recent experimental studies of temporary skeletal muscle ischemia in dogs showed that progressive deterioration in cell membrane electrical potentials (Em) occurred after partial but not total ischemia. With intracellular adenosine triphosphate concentration within the normal range, cell membrane damage by oxygen-derived free radicals was considered. In rats subjected to 60 minutes of infrarenal aortic occlusion, intra-arterial superoxide dismutase infused during removal of the aortic clamp prevented the continued decrease in Em. These data suggest that oxygen-derived free radicals may be mediators of reperfusion injury of cell membranes.

Adenosine Triphosphate↗
PubMed1987

Carotid body tumor: atypical angiogram of a functional tumor.

Carotid body tumors (CBTs) are rare, usually benign, neoplasms of the extra-adrenal paraganglion system. They are almost always nonfunctional. The diagnosis is generally confirmed by an angiogram that shows a vascular tumor enlarging the space between the internal and external carotid arteries. A 55-year-old man with hypertension and episodes of flushing, palpitations, and dizziness was treated for a firm, nonmobile mass measuring 3 x 2 cm at the left carotid bifurcation. Plasma and urine catecholamines, and the vanilylmandelic acid/creatinine ratios were elevated. Carotid arteriograms showed a vascular mass displacing the vessels, but the space between the arteries was narrowed rather than enlarged, and an atherosclerotic plaque was present. At operation the CBT was removed by resection of the bifurcation and with a temporary shunt a saphenous vein graft was inserted between the common and internal carotid arteries. Pathologic examination revealed a typical paraganglionoma. Although most CBTs produce catecholamines, only 11 patients have been reported to have elevated plasma and urine levels, and most were symptomatic. Since these tumors slowly increase in size, early surgical removal is recommended, even in asymptomatic patients.

Carotid Arteries↗
PubMed1985

Infected aortic aneurysms.

Salmonella organisms have been responsible for half of the reported cases of infected aortic aneurysms, although other bacteria have been incriminated. This is the second reported case in which Campylobacter fetus subspecies fetus apparently infected an inflammatory aortic aneurysm. In this 70-year-old man the organism was isolated and treated prior to resection of the aneurysm and inline grafting. Specific antibiotic therapy was continued for 8 weeks postoperatively. Examination and CT scans obtained after 9 months of follow-up reveal no evidence of recurrent infection.

Aged↗
PubMed1985

Intramural dissection of superior mesenteric artery. A complication of attempted renal artery balloon dilation.

A patient with a right renal artery stenosis and renovascular hypertension was admitted for balloon dilation of the stenotic artery. During the procedure the catheter entered the superior mesenteric artery and caused a mural dissection and occlusion, which was successfully treated by endarterectomy and vein patch angioplasty. Delayed ischemia of the transverse colon required resection and colostomy, but the patient recovered fully after colostomy closure and cholecystectomy were performed.

Aged↗
PubMed1985

Vascular trauma.

Explore the source record for details and available documents.

Angiography↗
PubMed1985

Incomplete recovery of muscle cell function following partial but not complete ischemia.

A simultaneous comparison of the effect of partial and total ischemia on skeletal muscle was made in dogs. The totally ischemic muscle had larger changes in adenosine triphosphate (ATP), creatine phosphate (CP), and cellular transmembrane potential difference (PD) during the 3-hour ischemic period than the partially ischemic muscle. Following recovery, all measured parameters in the totally ischemic muscle returned to normal, but paradoxically the PD in the partially ischemic muscle remained depressed despite the return to normal levels of ATP and CP. Contrary to the results in partially and totally ischemic brain tissue there was no evidence for higher levels of lactic acid in the partially ischemic muscle that could explain the persistent alteration in muscle cell function.

Adenosine Triphosphate↗
PubMed1984

Management of renovascular problems during aortic operations.

Sixty patients who had primary aortic disease (aortic stenosis or aneurysm) and required simultaneous aortic and renal artery operations were divided according to the indications for renal artery repair as follows: group 1, renovascular hypertension (ten patients); group 2, kidney salvage (11 patients); group 3, improvement of renal function (three patients); and group 4, renal artery involvement in the diseased aorta (36 patients). Renal artery reimplantation and aortorenal grafting were usually employed. Two kidneys in the renal salvage group failed, and two main and three accessory arteries were found to be occluded on late follow-up. Three patients died after emergency surgery for aneurysm rupture (two patients) and infected false aneurysm (one patient). The mortality rate for combined operations is higher (5%) than for aortic or renal surgery alone, but simultaneous repair may be needed for technical reasons, or to treat renovascular disease.

Adult↗
PubMed1984

Aortic collagenase activity as affected by laparotomy, cecal resection, aortic mobilization, and aortotomy in rats.

Recent biochemical evidence that aneurysm formation may be related to higher activated collagenase levels within aneurysmal aortic walls in association with reports of asymptomatic aneurysm rupture after laparotomy has led to speculation that operative trauma unrelated to direct aortic injury may increase the chance of aneurysm rupture by inducing collagenase activation within the aortic wall. The purpose of this study was to determine whether aortic collagenase can be activated by distant operative trauma and the kinetics of activation after injury. Ninety-six rats were divided into four groups: group 1--laparotomy alone; group 2--cecal resection; group 3--aortic mobilization; and group 4--aortotomy and repair. Animals within each group were sacrificed 1,3, and 6 hours and 1,2,3,4, and 5 days after surgery. The abdominal aortas were removed and assayed for collagenase activity by incubation with and digestion of tritium-labeled collagen. Collagenase activity was significantly elevated up to 6 hours after direct aortic injury (p less than 0.05) and decreased to normal levels within 2 days. Laparotomy, colon resection, and aortic mobilization had no significant effect on aortic collagenase activity compared to the controls. These data suggest that collagenase activity is a local phenomenon related to wound healing at the site of initial injury. Operative trauma without direct aortic injury had no effect on aortic collagenase activity.

Animals↗
PubMed1984

Cellular changes with graded limb ischemia and reperfusion.

Following distal arterial and venous cannulations in both hind limbs of 10 dogs, left leg arterial pressure was reduced to less than 50 torr (group I) and 50 to 75 torr (group II). Muscle membrane potential difference (PD) measurements, muscle biopsies, and arterial and venous blood samples were taken at baseline, after 3 hours of ischemia, and following 3 hours of reperfusion. Blood gas tensions and blood and muscle metabolites were measured. Muscle creatine phosphate levels fell during the ischemic period, but the adenosine triphosphate concentration remained normal. The PD fell in both groups during ischemia and declined further after reperfusion (p greater than 0.01). The deterioration in cell membrane function occurred in spite of intracellular energy repletion and persisted after reperfusion. The PD appears to be a more sensitive indicator of ischemia-induced cell dysfunction than levels of blood or intracellular metabolites. The cause of the progressive fall in the membrane potential is uncertain, but it may be due to cytotoxicity produced by oxygen free radicals.

Adenosine Triphosphate↗
PubMed1983

Response of extravascular lung water to intraoperative fluids.

The effect of Ringer's Lactate (RL) and a colloid containing salt solution Plasmanate (PL) on extravascular lung water (EVLW) during aortic surgery was evaluated in a prospective study of 18 patients. Measured blood loss was replaced with packed red blood cells. In addition to red blood cell replacement, either RL or PL was infused (1) to maintain the cardiac output (CO) equal to or greater than the preoperative value, (2) to maintain the pulmonary capillary wedge pressure (PCWP) plus or minus 2 mmHg of preoperative values, and (3) to keep the urinary output greater than or equal to 30 cc/hr. Cardiac output, EVLW, PCWP, serum colloid osmotic pressure (COP), and intrapulmonary shunt fraction (Qs/Qt) were measured serially. All baseline values were similar between groups. The groups were well matched for age, associated disease, operating time, blood loss, and blood transfusions. During operation, the RL group required two times the rate of infusion of the PL group. Urine flow rates were similar on the day of surgery, but by postoperative days one and two, the PL group had approximately one-half of the urine flow rate compared to the RL group. Cardiac output and Qs/Qt increased in both groups. EVLW did not change after operation in either group, despite marked decrease in COP in the RL group. These data indicate that crystalloid resuscitation to physiologic endpoints does not increase extravascular lung water. Thus, manipulation of COP by PL was unnecessary in these patients.

Aged↗
PubMed1983

Iatrogenic injuries of arteries in infants.

Iatrogenic injury is the most common cause of vascular insufficiency in infants; cardiac catheterization, arteriography and monitoring procedures are often implicated. Loss of limb is rare, but limb shortening is a frequent complication. The diagnosis is usually obvious; pulses are absent, and the extremity is cold, pale or mottled, and spontaneous motion may be absent. Noninvasive studies and digital intravenous angiography are valuable diagnostic techniques. If the limb is viable, systemic heparinization is useful, since it is often best to defer operation until the infant is older and larger if a complex vascular surgical procedure is contemplated. Simple thrombectomy is likely to succeed if immediate surgical treatment is required to ensure viability. A more femoral reconstruction may be performed when the infant is older, but before limb shortening is permanent. Good results have been obtained in as much as 85 per cent of surgically treated patients.

Angiography↗