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Biomedical subjects

R C Lim

Publications and source records attributed to R C Lim.

At least 73 records · Page 4Linked to original sources
PubMed1976

Prevention of complications after liver trauma.

Treatment of 681 cases of liver trauma during the past ten years at the San Francisco General Hospital was reviewed. The mortality was 14.7 per cent and the morbidity rate 18.9 per cent. The complications relating specifically to liver injury were bleeding subphrenic or subhepatic abscesses, intrahepatic abscess, biliary fistula, and liver failure. These complications and the recommended management of the liver injury are discussed.

Adolescent↗
PubMed1976

Pharyngoesophageal caustic stricture. Treatment by pharyngogastrostomy compared to colon interposition combined with free bowel graft.

Four cases of combined hypopharyngeal and cervical esophageal stricture secondary to caustic ingestion are presented. Although gastropharyngostomy has rarely been used for treatment of patients with caustic stricture of the pharynx and cervical esophagus, we believe that it is a useful procedure and has several advantages over use of the colon. We prefer total esophagectomy and posterior mediastinal transposition of the stomach to the neck followed by gastropharyngostomy in those patients who have minimal stomach involvement.

Adolescent↗
PubMed1976

Specialized blood filters and fresh whole blood.

Platelet counts and platelet functions were determined in fresh whole blood before and after it passed through two types of specialized transfusion filters. Both filters were capable of trapping 20% to 40% of the functional platelets, necessary for hemostasis, especially if heparin was used as the anticoagulant. When fresh whole blood is needed to treat the bleeding patient who has already received massive blood transfusions, these specialized filters should probably not be used.

Blood Platelets↗
PubMed1976

Effect of low molecular dextran on total liver blood flow in hemorrhagic shock.

Hemorrhage amounting to 40% of the calculated blood volume in dogs produced a fall in systemic blood pressure to a level of approximately 50 mm Hg. This was associated with a decline of total liver blood flow of about 60% of normal. Infusion of low molecular dextran (LMD) or saline of a volume, corresponding to 1/7 of the volume of blood taken out, increased the total liver blood flow. This increase was much more pronounced in the LMD group, maybe due to the ability of LMD to simultaneously increase systemic blood pressure, decrease blood viscosity and disaggregate red blood cells in the microcirculation.

Animals↗
PubMed1976

The effect of glucagon on total liver blood flow after occlusion of the hepatic artery. A study in anesthetized, normotensive dogs.

It has earlier been shown that the hormone glucagon has the property of increasing liver blood flow both in normotensive dogs as well as in dogs in hemorrhagic shock. This study was done to evaluate the effect of glucagon given in normotensive dogs after occlusion of the hepatic artery. Glucagon was given in a single dose of 50 mug/kg bodyweight. The study shows that glucagon under these circumstances increased total liver blood flow 67% compared to an increase of 3% in a control group. The increase is statistically significant compared to the effect of placebo injection in a control group. A benefit of the hormone is suggested in man in surgical situation where occlusion of the hepatic artery becomes necessary.

Animals↗
PubMed1976

The spleen.

Explore the source record for details and available documents.

Humans↗
PubMed1975

Advances in management of splenic injuries.

Because there is no such thing as "minor splenic injury", the diagnosis of splenic rupture is a major problem after abdominal trauma. Since it is our policy to explore all penetrating abdominal injuries, the problem of early recognition arises in patients with blunt trauma. When abdominal evaluation is difficult because of associated injuries, we increasingly use peritoneal dialysis. This has been particularly helpful in patients with head injury or drug intoxication and has also contributed to earlier operation in patients with signs of hypovolemia but minimal abdominal findings. Angiography has been useful in doubtful cases. Review of our experience in the last five years with splenectomy (298 cases) has revealed complications, particularly thromboembolic, that have changed our management of these patients. The incidence of clinical pulmonary embolism was 4 per cent in patients having splenectomy for trauma as contrasted with 0.5 per cent in patients having laparotomy for trauma without splenectomy. Postoperative platelet evaluations in patients after splenectomy for trauma revealed thrombocytosis. Detailed follow-up platelet studies showed a peak thrombocytosis at about two weeks, averaging 976,000/mm3. In contrast, similar studies in other patients having laparotomy for trauma showed counts of about 200,000/mm3. Because of the high incidence of thromboembolic complications, a low-dose heparin regimen was initiated. There was a 30 per cent incidence of infection postoperatively.

Abdominal Injuries↗
PubMed1975

Spontaneous delayed splenic rupture--case report of a five-year interval between trauma and diagnosis.

A 27-year-old white man was admitted in shock with a tender distended abdomen 5 years following significant thoraco-abdominal trauma. Immediately following resuscitation he had an emergency exploratory laparotomy because of his critical condition. At operation 3 liters of old and fresh blood were present intraperitoneally and the spleen was ruptured. The spleen was surrounded by and adherent to the omentum and adjacent viscera. Splenectomy was performed and recovery was uneventful. Histologic examination of the spleen confirmed the 5-year interval between injury and rupture. Delayed splenic rupture accounts for 14% of all splenic injuries and has a high mortality. This case represents the longest reported delay between splenic trauma and delayed rupture.

Adult↗
PubMed1975

The use of fresh blood in the treatment of critically injured patients.

Initial transfusion needs aremet by type-specific rather than low titer O-negative blood. When the patient's problem approaches the magnitude of exchange transfusion (5 to 10 units) in less than 4 hours, platelet transfusion to treat dilutional thrombocytopenia is administered. Fresh frozen plasma is administered to provide clotting factors. When five units have been exceeded, platelet, pro-thrombin, and partial thromboplastin are measured. A blood clot is checked for clotting, retraction, and lysis. These tests screen platelet quantity and the intrinsic and extrinsic clotting system. Administered blood is warmed in a water bath or heating coil. Blood gas analysis (pH, pO2, and pCO2) is performed every five units to allow for precise administration of bicarbonate. The electrocardiogram is used to monitor potassium and calcium abnormalities. Hyperkalemia is seldom a problem. Hypocalcemia may be present transiently and is treated with calcium choride. Component therapy is the standard recommended practice. Fresh blood is recommended for the patient who has had an acute exchange transfusion and continues to require large quantities of blood. Fresh blood obviates the need for combining components and allows one transfusion unit to address itself to the multiple needs of the patient.

Acid-Base Equilibrium↗
PubMed1975

Hepatic arterial and portal venous flows during hemorrhage.

Changes of total liver blood flow (TLBF), portal venous and hepatic arterial flows have been investigated using a hemorrhagic model in dogs. The dogs were bled stepwise from normal blood pressure to a pressure of 50-60 mm Hg. TLBF was measured by the xenon clearance method. Hepatic arterial blood flow was measured by electromagnetic flowmeter. Portal venous flow was calculated by subtracting hepatic arterial blood flow from TLBF. Other parameters studied during the experiment were systemic arterial blood pressure and portal venous pressure. Under normotensive conditions TLBF in mean was registered as 127 ml/min X 100 g liver tissue (25 ml/min X kg body weight). The relation between the flow value in portal vein and hepatic artery was on average 2.3:1. The study shows that there was a pronounced decrease of TLBF flow during hemorrhage. Portal venous flow decreased almost parallel to TLBF, while hepatic arterial flow decreased to a lesser extent which means that there was autoregulation in this flow bed. Hepatic arterial flow successively constituted a larger part of TLBF, during hemorrhage sometimes 65% compared to the normal value of about 30%. During the study there was an increase of vascular resistance in the portal venous system and decreased resistance in the hepatic arterial bed.

Animals↗
PubMed1975

Renal trauma and retroperitoneal hematomas-indications for exploration.

One hundred nineteen patients with renal trauma documented at laparotomy or by an abnormal excretory urogram were followed up sufficiently to allow assessment of their postinjury course. One-fourth of these patients had a laparotomy and Gerota's fascia was opened; one-fourth had a laparotomy and Gerota's fascia was not opened; and one-half had no laparotomy. Gerota's fascia was opened only after vascular control of the renal pedicle was obtained. Nonetheless, the loss of renal tissue in this group was high. Twenty-three of 34 patients (68%) required nephrectomy or partial nephrectomy, indicating the severity of their renal injuries. The loss of renal tissue was low in the two groups in which Gerota's fascia was not opened. Six of 85 patients (7%) developed complications eventually requiring nephrectomy or partial nephrectomy; an additional three patients (4%) demonstrated loss of renal tissue on followup urograms, the loss being minimal in all three cases. The relatively low morbidity in these 85 patients indicates that their original renal injuries were, for the most part, less serious than the injuries in the group in which Gerota's fascia was opened. This low morbidity also indicates that retroperitoneal hematomas in the area of the kidney which are nonexpanding, contained, and nonpulsatile need not be routinely explored.

Adolescent↗
PubMed1974

Effect of phototherapy in preterm infants on growth in the neonatal period.

A total of 120 preterm infants were randomly divided at 24 hr of age into three groups: Group I, controls; Group II, continuous phototherapy for 5 days; and Group III, intermittent phototherapy (12 hr on and 12 hr off) for 5 days. At the end of week 1 80% of the control group regained and surpassed their birth weight as opposed to 44 and 57.6% in the continuous and intermittent phototherapy groups, respectively. In weeks 2 and 3 both phototherapy groups had greater weight gain than the control group. Similar but less marked differences were observed in body lenth and head circumference in the three groups. Data suggest decreased growth during phototherapy with subsequent catch-up in growth during weeks 2 and 3. Differences were less marked between infants on intermittent (rather than continuous) phototherapy and controls. Increased metabolic demands and decreased intestinal absorption during phototherapy may be two of the factors responsible for the observed differences in growth in the three groups.

Body Height↗