Annals of surgery
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Although positive and expiratory pressure (PEEP) is known to depress the cardiac output, the mechanism remains debated. Two series of experiments were designed to explore this mechanism. In the first study, the application of 15 cm H(2)O of PEEP to nine anesthetized, ventilated dogs led to a reduction of cardiac index from (mean +/- one standard error of the mean) 2.71 L/min .m (2) +/- 0.35 to 2.19 L/min m(2) +/- 0.22 (p < .05) and a drop in mean arterial pressure (MAP) from 117 mm Hg +/- 8 to 91 mm Hg +/- 11 (p < .01). ⋯ Comparison of Group I and II showed a significantly greater depression of the cardiac output and MAP in the open-chested animals. At the same time LAP was significantly higher. These data strongly suggest that PEEP and particularly pulmonary hyperinflation induce biventricular failure.
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Irrigation of wounds to remove bacteria and foreign material is an essential of wound management along with debridement. The effectiveness of saline lavage by high pressure (50 psi) pulsatile jet irrigation has been compared with conventional gravity flow and bulb syringe procedures. Experimental paravertebral incisional surface wounds in 234 randomized rats were either clean or traumatized and soiled. ⋯ After three days E. coli was significantly diminished in all wounds, regardless of irrigation or none, owing to host defense mechanisms. Nevertheless, clean contaminated wounds were infected at three days but not at seven days after lavage, while traumatized wounds remained infected at ten days except for those initially irrigated by pulsatile jet. Thus, pulsatile jet irrigation removed bacterial from experimental wounds more efficiently than conventional procedures.
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The records of 238 patients with the diagnosis of small bowel obstruction at the University of Illinois Hospital from 1967 through the spring of 1976 were reviewed. Mortality, intra-operative management, and clinical findings were evaluated. ⋯ Although a variety of individual clinical findings have been advocated as diagnostic aids in patients with small bowel obstruction, this review suggests that attention to a combination of "classic" findings, i.e., leukocytosis, fever, tachycardia and localized tenderness, portends a situation in which conservative observation is safe--namely, the absence of all four findings. The presence of any one or more of these findings mandates early operative intervention.
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Eighty-five recipients and donors of renal allografts were examined for evidence of cytomegalovirus infection before and repeatedly after transplantation. The recipients were also divided into two group on the basis of HLA antigen matching. Better allograft survival was noted in patients well matched for HLA antigens (0-2) mismatched antigens) compared to those poorly matched (three or more antigens mismatched), and in patients free of cytomegalovirus compared to those infected. ⋯ The differing rates of success of transplantation, apparently dependent on blood relationship between donor and recipient, have been assumed largely to be due to inherited factors. This study, however, revealed an important factor to be the disparate incidence of cytomegalovirus infection in sibling, parental, and cadaveric categories of transplantation. The mechanism of this disparity can be explained on the basis of the incidence of latent CMV infection in the recipients and various categories of kidney donors.
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Forty-six episodes of pulmonary infection occurred in 41 patients during a seven year period in which 187 renal transplants were performed in 168 patients. Thirty-seven episodes followed 152 cadaveric transplants (24.39%), and four episodes followed 35 living related donor transplants (11.4%). Five patients had two episodes of pulmonary infection. ⋯ Transtracheal aspiration with Gram stain and direct sensitivity plating routinely provided early and accurate identification of the organism and a guide for therapy in bacterial infections. Pulmonary infection in renal transplant recipients is associated with a high mortality rate. Early diagnosis and specific treatment are essential to successful management.