The Journal of surgical research
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Subcritical iliac artery stenoses become critical stenoses if common femoral artery (CFA) flow rates increase sufficiently. Infrainguinal bypasses done in the presence of subcritical iliac artery stenoses may be in jeopardy on the basis of inadequate inflow if critical iliac stenoses are produced by increased CFA flow resulting from the bypasses. This study was undertaken to define the CFA hemodynamic changes seen with femoropopliteal bypass and to determine the relative effects of subcritical iliac artery stenoses on these pressure and flow changes. ⋯ Despite these increases in CFA flow, CFA pressure indices were unchanged when comparing open with occluded SFAs even in the presence of subcritical iliac artery stenoses. These findings suggest that femoropopliteal bypass does not result in increases in CFA flow rates sufficient enough to cause decreased graft perfusion pressures in the presence of subcritical iliac artery stenoses. Therefore, the patency of an infrainguinal bypass done in the presence of a subcritical iliac artery stenosis should not be adversely affected in the early postoperative period on the basis of inflow.
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The enhanced risk of severe sepsis following splenectomy is now well recognized in both adult and pediatric patients. Prophylactic antibiotics and bacterial vaccines have been utilized with limited success to inhibit the high morbidity and mortality. This study reports the use of glucan, a beta-1,3-polyglucose, as a nonspecific immunostimulant for postsplenectomy pneumococcal sepsis. ⋯ Splenectomy alone did not significantly decrease phagocytic function. An increased leukocytosis in response to pneumococcal infection was observed in splenectomized glucan-treated animals. Nonspecific immunostimulation appears to have significant potential as a treatment strategy against postsplenectomy infection.
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The response of intravascular (PBV) and extravascular (EVLW) pulmonary fluid volumes to varying degrees of positive end-expiratory pressure (PEEP) was examined using double indicator techniques (thermal green dye) in six open-chest anesthetized dogs during the production of oleic acid (0.15 cc/kg)-induced pulmonary injury. Data were obtained at a control state, then 1.5 hr after the oleic acid was injected. Positive-end expiratory pressure (5, 10, 15, and 20 cm H2O) consistently reduced cardiac output prior to and after oleic acid edema was created, with greater reductions occurring with higher levels of PEEP. ⋯ PBV declined from 6.0 +/- 2.4 to 4.0 +/- 1.0 ml/kg with 20 cm H2O of PEEP (P less than .01) in the control state and 4.4 +/- 2.1 to 2.9 +/0 0.9 ml/kg (P less than .01) after oleic acid administration. It is concluded that PEEP significantly reduced intravascular pulmonary fluid volumes along with cardiac output, without changing EVLW. While the effects of altered left ventricular geometry were not examined, the displacement of blood from the central to the peripheral circulation during PEEP must substantially contribute to reductions in systemic flow.