The American surgeon
-
The American surgeon · Jun 1996
Comparative StudyRepletion of high energy phosphates in the postischemic neonatal heart.
Milrinone improves function in failing adult hearts, but it has not been examined in the immature myocardium. The purpose of this study was to characterize the effects of milrinone, a phosphodiesterase inhibitor, on immature hearts, and compare these to dobutamine, a commonly used catecholamine inotrope. One hundred isolated working neonatal rabbit hearts were used. ⋯ Cardiac output did not improve when inotropes were begun after 40 minutes. cAMP was higher in milrinone hearts compared to dobutamine, but there was no simple relation between cAMP and ventricular function. Inotropes may increase purine salvage pathway activity. Deriving maximum benefit from inotropes may depend on beginning infusions early, before the appearance of irreversible changes.
-
During pregnancy, intestinal obstruction due to sigmoid volvulus is extremely rare. Only 73 cases have been reported. A 24-year-old black woman, gravida 2, para 1, presented during Week 36 of an otherwise uneventful pregnancy, with intermittent abdominal pain and constipation, and no history of nausea, vomiting, fever, chills, previous medical problems, or prior abdominal surgery. ⋯ She was discharged on postoperative Day 4. Sigmoid volvulus complicating pregnancy is an uncommon and potentially devastating development that should be suspected with worsening abdominal pain and evidence of bowel obstruction. Prompt intervention is necessary to minimize maternal and fetal morbidity.
-
The American surgeon · May 1996
Pneumothoraces secondary to blunt abdominal trauma: aids to plain film radiographic diagnosis and relationship to solid organ injury.
The objective was to identify subtle clues to the diagnosis of small pneumothoraces (PTX) in victims of blunt abdominal trauma (BAT) and to determine the relationship of PTX to solid organ injury. We retrospectively reviewed 1374 abdominal CT scans performed after BAT and assessed each for the presence of PTX and solid organ injury. In patients positive for PTX, the interpretation of the initial portable chest radiograph (PCXR) was noted and the film subsequently reviewed for subtle signs of PTX, presence of subcutaneous emphysema (SQE), and rib fractures. ⋯ Sixty-four of 1290 patients (5%) without CT findings of PTX sustained solid organ injury, whereas 15 of 84 (18%) with PTX had solid organ injury (significant by chi square analysis, P < 0.001). Although a large number of trauma-related pneumothoraces seen on CT will not be seen on admission PCXR, the search for rib fractures and SQE will enhance the sensitivity of detection. This has prognostic value, as the presence of PTX is related to a significantly increased incidence of abdominal solid organ injury.
-
The American surgeon · May 1996
Endoscopic nasoenteral feeding tube placement following cardiothoracic surgery.
Our purpose was to evaluate the safety and efficacy of nasoenteral feeding tube placement in the cardiothoracic surgery patients. This is a retrospective analysis of 15 critically ill cardiothoracic surgery patients who underwent endoscopic placement of an enteral feeding tube beyond the proximal duodenum for maintenance of nutrition. Twenty-five entriflex 10-F nasoenteral tubes were placed endoscopically using a modified technique far into the distal duodenum, and the placement was confirmed radiographically. Mean patient age was 71 years. Seven were males and 8 were females. Eleven had undergone coronary artery bypass surgery, two aortic valve replacement, and two aortic aneurysm repair. The mean duration of tube function was 8.5 days and mean duration of tube feeding was 15.7 days. Of the total 15 patients, 7 required replacement due to various reasons, the most common being self extubation by the patient and malpositioning after initial placement. No cardiac complications or any other complications were noted directly related to the endoscopic procedure. In eight patients, the mean serum albumin level did not change [before: 2.5mg/dL, after: 2.6mg/dL] for the short time (avg. 8.5 days) the tube was functional. ⋯ 1) Endoscopic placement of the nasoenteral tubes is a safe method of providing enteral nutrition in critically ill cardiothoracic surgery patients. 2) Benefits of nasoenteral tubes compared to nasogastric tubes remain unproven, and frequent repositioning of nasoenteral tubes is required. 3) A prospective comparison of nasoenteral and nasogastric tubes is warranted.