Selection of hemodynamic, respiratory and metabolic variables for evaluation of patients in shock.
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Adolescent↗
Biomedical subjects
P Chang
Publications and source records attributed to P Chang.
Prediction of outcome and severity of illness by analysis of the frequency distributions of cardiorespiratory variables.
Despite the wide variety of illnesses and operations, we observed a common cardiorespiratory pattern of shock that was differenf for the survivors and nonsurvivors, although no one variable was capable of predicting outcome. Differences between the patterns of survivors and nonsurvivors were defined by range criteria and by cut-points operationally obtained from the frequency distributions of cardiorespiratory variables. The values of each of the 33 variables obtained, at times remote from therapy during each successive stage in the postoperative course, were used to predict survival and death in a series of 113 patients by the range and cut-point methods. An average of 13.5% of all the available variables gave a correct prediction by the range cirteria and 35% by the cut-point method. The mean percentage of Right--Wrong classifications throughout all stages for range and cut-point methods was 80 and 85%, respectively. Using the last available stage, the outcome was correctly predicted by the range criteria in 80% and by the cut point method in 88% of the patients. The high percentage of correct predictions suggests that these methods may provide a measure of the severity of acute illness as well as early warning of impending death.
Blood Gas Analysis↗
Prospective, randomized study of the efficacy of pressure garment therapy in patients with burns.
A randomized, prospective study was undertaken to determine the efficacy of pressure garment therapy in patients with burns. Patients were randomly assigned to receive either pressure garment therapy or no pressure garment therapy. Patients were observed by use of the Vancouver Burn Scar Assessment Scale to assess the maturity of all involved areas. One hundred and twenty-two consecutive patients were enrolled in the study; 64 were assigned to pressure garment therapy and 58 to no pressure garment therapy. Eight of the patients receiving pressure garment therapy and nine receiving no pressure garment therapy were not involved in the follow-up. No significant differences were found between the two groups when age, body surface area burn, length of hospital stay, or time to wound maturation were compared.
Adult↗
A study of functional viability and metabolic degeneration of human skin stored at 4 degrees C.
We sought to ascertain whether an in vitro assay could be as reliable as an in vivo assay in determining the viability of human skin stored at 4 degrees C. Allografts from six human donors were stored in RPMI 1640 tissue culture medium at 4 degrees C. At fixed intervals during the storage period, all skin specimens were tested concurrently by two different viability assays: (1) transplantation onto surgically created defects on nude mice, and (2) intracellular enzyme activity with use of a 4-hour semiquantitative micromethod system activity (API ZYM; Biomerieux Vitek Inc., Hazelwood, Mo.). Human graft survival on the nude mice was 100% for the first 15 days of storage, and then declined to 50% on storage day 30. The API ZYM assay showed a comparable progressive decrease in enzyme activity over skin storage time. The API ZYM assay is a simple, rapid system that produces reproducible results and is cost-effective when compared to the biologic model.
Animals↗
Pressor action of pyridine-2-aldoxime in malathion poisoning.
1. Intravenous injections of pyridine-2-aldoxime (PAM) produced a marked, prolonged and dose-related rise in blood pressure in anaesthetized cats treated with malathion (MT) and without malathion (NMT). 2. The pressor effect of PAM was significantly reduced by phentolamine and phenoxygenzamine, but unaffected by hexamethonium. 3. Pretreatment with guanethidine and reserpine almost completely abolished the pressor response to PAM. 4. The results indicate that PAM has a potent sympathomimetic action which appears to be mediated through release of catecholamines from storage sites.
Animals↗
A comparison of distribution between simultaneously or sequentially delivered antegrade/retrograde blood cardioplegia.
UNLABELLED: Commercially available cardioplegia delivery systems now allow for antegrade (aortic root, coronary ostia, saphenous vein graft) perfusion to occur either sequentially or simultaneous with retrograde (coronary sinus) perfusion. This study was designed to compare the total flow and local distribution of sequential versus simultaneous antegrade/retrograde cardioplegia delivery. METHODS: Explanted human hearts diagnosed with idiopathic cardiomyopathy underwent a cold cardioplegic arrest and bicaval cardiectomy. Thirty-seven degree centigrade blood cardioplegia containing colored microspheres was then delivered antegrade (red color) at a pressure of 80 mmHg or retrograde (blue color) at a pressure of 40 mmHg. In the sequential group (n = 6), cardioplegia was delivered antegrade and then retrograde for 2 minutes, respectively. For the simultaneous group (n = 6), cardioplegia was delivered both antegrade and retrograde for 2 minutes. The ventricular myocardium was then sampled at 12 representative sites to determine regional cardioplegic flow. RESULTS: Mean total cardioplegia delivery/minute was 0.69 +/- 0.62 mL/g per minute for sequential cardioplegia, and 0.46 +/- 0.19 mL/g per minute for simultaneous cardioplegia (p > 0.05, NS). At the 12 ventricular sites sampled, mean regional cardioplegic flow (mL/g per min) was in general slightly greater for sequential delivery. However, this was not statistically significant (p > 0.05, NS). CONCLUSION: The data suggest that there may be a slight advantage in total cardioplegia delivery and regional cardioplegia delivery when using sequential rather than simultaneous cardioplegia delivery. However, this difference was not statistically significant and is likely not of clinical significance. Therefore, we would recommend using either sequential or simultaneous antegrade/retrograde cardioplegia based upon whichever technique facilitates the conduct of the individual operation.
Aorta↗
Shock in the pediatric emergency service: five years' experience.
We undertook a retrospective study of the risk factors determining outcome of nontraumatic patients with shock in the pediatric emergency service. From October 1992 through September 1997, 22 patients with the diagnosis of shock were identified, including 11 with septic shock (50%), 7 with hypovolemic shock (32%) and 4 with cardiogenic shock (18%). Their age ranged from 2 months to 19 years old. Among the cases, 14 patients (64%) had other underlying diseases. Gram-negative bacterial sepsis (6/11, 55%), dilated cardiomyopathy (2/4, 50%) and acute gastroenteritis (7/7, 100%) were the most frequent causes of septic, cardiogenic and hypovolemic shock, respectively. In total, 12 patients (55%) died. The mortality rate was high in septic shock (9/11, 82%) and cardiogenic shock patients (3/4, 75%), but low in hypovolemic shock patients (0/7, 0%). The risk factors of poor outcome in patients with shock included thrombocytopenia, prolonged prothrombin time and partial thromboplastin time. Patients with leukopenia, a higher level of C-reactive protein, or under 2 years of age tended to have poor outcome.
Adolescent↗
Heart-lung xenotransplantation in primates.
Heart and heart-lung xenografts are a potential solution to the shortage of donors. Concern over the adequacy of conventional immunosuppression in prevention of xenograft rejection, however, has hindered their use. Cyclosporine has not been successful in suppressing the rejection process in cardiac xenotransplantation, and other methods of immunosuppression need to be investigated. Therefore we studied the effect of preoperative total lymphoid irradiation (TLI) in combination with cyclosporine in a primate heart-lung xenograft model using cynomolgus monkey donors and baboon recipients. Heart-lung grafts were harvested from donors and transplanted orthotopically in baboons with use of cardiopulmonary bypass. Recipients were treated in one of three groups: (1) cyclosporine and steroids (controls), (2) cyclosporine and steroids plus TLI 20 Gy, or (3) cyclosporine, steroids, antithymocyte globulin, and TLI 6 Gy. Mean survival time of the baboons treated with cyclosporine and steroids was 8 +/- 0.6 days. The group receiving 20 Gy TLI had prohibitive perioperative mortality; however, one baboon lived an additional 90 days, and at autopsy the heart showed minimal rejection. Treatment with TLI at 6 Gy in combination with cyclosporine, antithymocyte globulin, and steroids comparatively prolonged survival (16 +/- 7.8 vs 8 +/- 0.6 days; p less than 0.001), and all animals in this group died of infection, with only minimal evidence of heart rejection noted in animals surviving 30 days. We conclude that the addition of TLI and antithymocyte globulin to cyclosporine-based standard immunosuppression is a potent immunosuppressant in heart-lung xenotransplantation; nevertheless, infection remains a common complication.
Animals↗
New technique of vascularization of the trachea and bronchus for lung transplantation.
Ischemic necrosis is implicated as a major cause of dehiscence and stenosis of the airway anastomosis in double and single lung transplants. A new surgical technique to maintain systemic arterial blood flow to the transplanted airways by preserving the donor tracheobronchial arterial circulation was investigated. In a primate model, the tracheobronchial arterial circulation to the transplanted airways was maintained by inclusion of an aortic segment with its bronchial arteries and tracheal collaterals in continuity with the lung bloc. The aortic segment, from just proximal to the left subclavian artery to the level of the pulmonary hilum, was vascularized by anastomosis of the subclavian artery to the recipient left subclavian artery or ascending aorta. Double lung transplantation was performed in three baboons; two survived 48 hours, and one was killed at 30 days. One baboon with a left single lung transplant was killed at 30 days, and one baboon with a right single lung transplant survived 22 days. Angiograms obtained 14 days after transplantation showed patent subclavian anastomoses and aortic segments. Postmortem examination revealed patent subclavian anastomoses without thrombi in the aortic segments. There was no airway necrosis, dehiscence, or stenosis. Tracheal and bronchial anastomoses of surviving animals were healed. Histologic examination revealed typical respiratory tissues without ischemia or necrosis. Radiographic examination of aortic segments injected with lead oxide showed patent bronchial arteries extending along the donor trachea and bronchi and to the anastomotic sites. These experimental studies demonstrate that this technique maintains the donor tracheobronchial arterial circulation and may improve tracheal and bronchial anastomotic healing.
Animals↗
Vascular characteristics of intracerebral arteriovenous malformations in patients with clinical steal.
In patients with intracerebral arteriovenous malformations (AVMs), symptoms attributed to steal can lead to progressive debilitating deficits. This study was undertaken to determine which morphologic features of the AVM could be correlated with clinical symptoms of steal. Over a 4-year period, 65 patients with intracranial AVMs were evaluated with angiography supplemented by MR (46 cases) and CT (19 cases). Eleven characteristics of AVM vascular architecture were studied; these included size, lobar location, periventricular/intraventricular location, arterial stenosis, arteriovenous fistulae, angiomatous change (the presence of dilated transcortical collateral circulation), venous drainage pattern (central, cortical, mixed), venous stenosis, venous aneurysm or ectasia, venous variation, and delayed drainage. These characteristics were correlated with a history of clinical steal, which was seen in nine (14%) of 65 patients. Three characteristics were found to correlate highly with steal: angiomatous change (p less than .0001), size (p less than .0001), and peripheral venous drainage (p = .045). The mean size of the AVM nidus was 31.3 cm3 for the entire group of patients, 105.0 cm3 for patients with steal, and 19.5 cm3 for those without steal symptoms. Angiomatous change was seen in six (9%) of 65 patients; all six of these had clinical steal. The association of clinical steal with AVM size, angiomatous change, and peripheral venous drainage may contribute to establishing a prognosis and treatment planning. When a patient's symptoms are caused by steal, treatment with subtotal excision or partial embolization may be beneficial.
Adolescent↗
Management of soft tissue sarcomas: current status.
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Adult↗
The heterotopic right heart assist transplantation.
Heterotopic heart transplantation has been utilized experimentally and clinically to assist the recipient heart in maintaining either the systemic circulation alone or both the systemic and pulmonary circulations. We describe a model in which the heterotopic heart transplantation is utilized to supply the pulmonary circulation while the recipient heart acts as the systemic ventricle. This procedure might be used for selected patients with complex congenital heart disease. The method we have used in five dogs (16.5 to 23.5 kg) consists of preparation of the donor heart by excision after cardioplegic arrest, ligation of the venae cavae, anastomosis of the donor pulmonary artery (PA) to the donor left atrial appendage, and insertion of a left ventricular (LV) apical Dacron graft connected to a valved aortic allograft. Implantation in the recipient consists of anastomosis of the donor left atrium to the recipient right atrium, anastomosis of the LV apical conduit to the recipient main PA, and anastomosis of the donor aorta to the recipient ascending aorta to supply oxygenated blood to the donor coronary circulation. The recipient right ventricle (RV) in the experimental model is inactivated by inducing tricuspid regurgitation and by ligating the proximal PA. Early survival (3 hours) with stable hemodynamic measurements was obtained in all dogs, with the recipient RV excluded from the circulation and with the donor LV pumping the total systemic venous return to the PA. Pulmonary blood flow was maintained even when the ventricular pressure was raised to systemic levels by narrowing the conduit.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Influence of hematocrit on cardiopulmonary function after acute hemorrhage.
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Hematocrit↗
Orthostatic hypotension during combination chemotherapy with vincristine (NSC-67574).
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Adolescent↗
Doxorubicin and dactinomycin therapy for advanced sarcomas.
Doxorubicin and dactinomycin were administered to 25 patients with advanced sarcomas. Twenty-one were evaluable for response. There were six responses (two complete and four partial) (28%) and eight improvements. Responders survived longer than nonresponders, while those with improvements had intermediate survival. Toxic effects included leukopenia in 35% of administered courses, mucositis in 50% of the patients, and congestive heart failure in 21% of the patients. Plasma doxorubicin kinetics did not correlate with excess toxic effects in four patients studied. The response rates and durations of survival obtained with this combination are comparable to those obtained with doxorubicin alone. The marked increase in toxicity makes this combination less desirable than treatment with doxorubicin alone.
Adolescent↗
High-dose cisplatin therapy using mannitol versus furosemide diuresis: comparative pharmacokinetics and toxicity.
The dose-limiting toxic effect of high-dose (100 mg/m2) cisplatin is renal insufficiency. Hydration with furosemide- or mannitol-induced diuresis has been reported to ameliorate this toxicity. Animal studies suggest that mannitol may be superior to furosemide in this regard. Twenty-two patients with advanced neoplasms refractory to conventional therapy were treated with cisplatin at a dose of 100 mg/m2 every 21--28 days. Patients were randomized to receive 37.5 g of mannitol by 6-hour infusion with cisplatin or 40 mg of furosemide prior to cisplatin therapy. Hydration with at least 1 liter of normal saline was given prior to cisplatin. Nephrotoxicity (creatinine greater than 2 mg/100 ml, creatinine clearance greater than 50 ml/minute) occurred in 19% of courses in the furosemide-treated group and in 28% of courses in the mannitol-treated group. Peak plasma platinum concentration, terminal half-life, urinary excretion, and percent protein-bound plasma platinum were similar in both groups. The use of cisplatin at this dose schedule resulted in similar toxicity and pharmacokinetics when using hydration with either furosemide or mannitol.
Adolescent↗
[Neonatal hearing screening].
Auditory deprivation in early life significantly effects speech, language, cognition and learning development. The importance of neonatal hearing screening in order to detect and manage children with hearing impairment during the critical period before three years of age can't be neglected. The neonatal hearing screening program at Veterans General Hospital, Taipei, under a cooperation of audiologists, otologists and pediatricians, identified 1885 neonates for hearing loss from September 1990 to August 1991. There were two study groups, a high risk group of hearing impairment and a non-high risk group. We performed hearing screening and followed-up for the failure at initial test using methods including behavioral observation audiometry, auditory brainstem response, tympanogram, pneumatic otoscopy and questionnaire. Approximately 2.7% of neonates were classified as high risk for hearing loss, the incidence of hearing loss was 8% to 14% in this group. The incidence of hearing loss in non-high risk group was 0.11%. If both groups were contained that the incidence of hearing loss was 0.32% to 0.48%, 0.11% with a sensorineural hearing loss, 0.21% to 0.37% with a conductive hearing loss. Both behavioral audiometry (89% false negative rate) and questionnaire (50% return rate) were not effective for screening purposes in this study. Our results also indicated that the most advantage of using a high risk register lay in the fact that only 2.7% of a total population needed to be screened to identify approximately 67% to 78% of hearing-impaired babies. This saved both time and money.
Audiometry, Evoked Response↗
Lipomyelomeningocele associated with necrotizing enterocolitis in a term neonate.
A six-day-old full-term female infant with lipomyelomeningocele, confirmed by magnetic resonance imaging, suffered from necrotizing enterocolitis (NEC) when he was four-day-old. The clinical presentations were bloody stool and abdominal distension. A plain abdominal film demonstrated pneumatosis intestinalis and air in the portal vein. An emergent laparotomy was performed and revealed diffuse gangrenous change of both small and large bowels. A jejunostomy was done and strong antibiotics were given, but the baby died two days after the operation. In this paper report, the relation between lipomyelomeningocele and NEC is discussed.
Enterocolitis, Pseudomembranous↗