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A B Peitzman

Publications and source records attributed to A B Peitzman.

82 records · Page 5Linked to original sources
PubMed1982

The effect of intravenous steroids on alveolar-capillary membrane permeability in pulmonary acid injury.

The treatment of pulmonary aspiration of gastric contents remains largely empirical. The purpose of the present study was to evaluate the effect of methylprednisolone administration (30 mg/kg) on alveolar-capillary membrane permeability after pulmonary acid aspiration in dogs. Alveolar-capillary membrane permeability was assessed by several methods. Extravascular lung water volume (EVLW), extravasation of 125I-serum albumin (RISA) into lung parenchyma, and albumin leak into the alveolar spaces were measured. EVLW increased progressively from 5.5 +/- 0.6 to 20.0 +/- 2.3 ml/kg in Group I (Acid) and from 5.4 +/- 1.2 to 22.1 +/- 3.1 ml/kg in Group II (Acid + Steroids) over the 5 hours after acid injury. The ratio of Lung Extravascular RISA to Plasma RISA was 0.56 +/- 0.14 and 0.58 +/- 0.14 in Group I and Group II, respectively (normal = 0.19 +/- 0.06). The tracheal albumin to plasma albumin ratio remained near 1.0 from 2 hours to 5 hours post-aspiration in both groups. This study demonstrated that pulmonary acid injury resulted in a marked increase in alveolar-capillary permeability to albumin, smaller solutes, and water which was not ameliorated by the administration of methylprednisolone.

Adrenal Cortex Hormones↗
PubMed1982

Causes of stroke in carotid endarterectomy.

Carotid endarterectomy performed with the patient conscious under regional anesthesia provides a unique opportunity to determine the time of onset of a neurologic deficit and in deduce a likely cause. If a trial period of carotid occlusion is tolerated without the development of a neurologic deficit (96% of our patients), operation may continue without indwelling shunt. Of the 345 patients who had elective carotid endarterectomies performed without shunt, neurologic deficits lasting longer than 24 hours developed in 6 patients (1.7%), and deficits resolving within 24 hours occurred in 15 patients (4.3%). The neurologic deficit developed during carotid dissection in 3 patients, during carotid occlusion in 1 patient, upon release of carotid occlusion in 2 patients, and in the first 5 postoperative days in 15 patients. Of the 15 postoperative deficits, 9 were transient ischemic attacks similar to preoperative episodes, 4 were strokes, and 2 were visual changes. Twenty of 21 deficits were thromboembolic, reperfusion phenomena or were related to hypotension. Only one (0.3% of 345 cases) could be attributed to cerebral anoxia. We believe comparison of raw stroke rates is not valid in comparing methods of cerebral protection, since most perioperative neurologic deficits are not attributable to hypoperfusion. Furthermore, trial carotid occlusion in the conscious patient is a satisfactory method for determining the need to use a shunt.

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PubMed1981

The effect of increasing end-expiratory pressure on extravascular lung water.

The objective of this study was to define the response of extravascular lung water (EVLW) to different levels of positive end-expiratory pressure (PEEP) following a standardized oleic acid injury to the lung. All animals responded to the injection of intravenous oleic acid by the rapid development of hypoxemia. There was a twofold increase in EVLW during the first 3 hours after oleic acid injection which remained stable during the remainder of the experiment, including periods on PEEP. Intrapulmonary shunt (Qs/Qt) increased significantly (P less than 0.001) during the first hour following oleic acid injection. PEEP therapy resulted in an immediate decrease in Qs/Qt and amelioration of the hypoxemia. Return to zero PEEP resulted in a rapid decrease in PaO2 with concomitant increase in Qs/Qt by the end of the experiment. The oxygen transport in the animals did not improve significantly with the addition of PEEP. This was due to the decrease in cardiac output that more than offset the effects of a diminished Qs/Qt with PEEP. This study indicates that the mechanism by which PEEP improves oxygenation does not appear to be mediated by effect on lung water. The study also emphasizes the importance of determining oxygen transport when managing patients on PEEP.

Animals↗
PubMed1981

Measurement of lung water in inhalation injury.

Pulmonary inhalation injury is a major cause of morbidity and mortality rates in burn victims. But the pathophysiology of parenchymal inhalation injury has not been fully elucidated. In this study, extravascular lung water volume (EVLW) was measured in burn patients with and without inhalation injury. Patients with parenchymal inhalation injury (group II) had elevated admission extravascular lung water volumes (10.12 +/- 3.43 ml/kg), whereas patients without parenchymal injury (group I) had significantly lower lung water values (3.91 +/- 1.49 ml/kg). Both accumulation of EVLW and ventilation-perfusion abnormalities in the group II patients occurred within hours of smoke inhalation. But the severity of inhalation injury did not consistently correlate with the elevation of EVLW. This indicated that both interstitial edema and ventilation-perfusion imbalance contributed, in varying degrees, to the pathophysiology of inhalation injury. In this study, the general clinical criteria for inhalation injury--presence of facial or oropharyngeal burns, carboxyhemoglobin levels, carbonaceous sputum, or closed space injury--did not differentiate patients with airway injury only from those with parenchymal injury. Patients in both groups who died of sepsis had significant (P less than 0.01) increases in EVLW 24 to 48 hours after the clinical onset of sepsis. The normal hydrostatic pressures in these septic patients suggested that the increase in EVLW observed with sepsis was due to an increase in pulmonary capillary membrane permeability.

Adult↗
PubMedDate not supplied

The management of aortoenteric and paraprosthetic fistulae.

Aortoenteric and aortic paraprosthetic fistulae are devastating complications. Most authors recommend total excision of the graft and revascularization of the lower extremities by extra-anatomic bypass. We reviewed the University of Pittsburgh experience with these fistulae in 15 patients between 1977 and 1987. There were 9 aortoenteric fistulae (AEF) and 6 paraprosthetic fistulae (PPF). Seven of the 9 AEF had no abscess surrounding the graft, but communication of the intestine with the aortic anastomosis. One patient died during operation. Six patients underwent a local repair or in situ replacement of the graft. All 6 of those patients survived operation without limb loss. Two of the 9 patients with AEF had evidence of graft infection and underwent total excision of the graft and extra-anatomic reconstruction. Both patients died, one of sepsis and one of aortic stump rupture. All 6 patients with PPF had clinical and operative evidence of overt graft infection and underwent total graft excision and extra-anatomic bypass. Two of these patients died secondary to sepsis. We conclude that AEF, without evidence of graft infection, were safely treated by local repair. Patients with PPF had infected grafts requiring graft removal with significant morbidity and mortality.

Aged↗
PubMedDate not supplied

Oxygen diffusion in chronic venous ulceration.

A diffusion barrier to oxygen caused by fibrin deposition around dilated, proliferating capillaries in patients with venous hypertension may contribute to the development of venous ulceration. This diffusion barrier was studied in 18 patients with venous ulcers using the transcutaneous oxygen (TcPO2) monitor (TCM204 Radiometer, America). TcPO2 sensors were placed adjacent to venous ulcers on lower limbs and on the chest and foot of each patient. Readings were taken after a sensor temperature of 44 degrees C was reached (10-15 minutes). TcPO2 values were markedly decreased in skin adjacent to the ulcers (10 +/- 2 mmHg) compared with those of the chest (64 +/- 2 mmHg) and foot (43 +/- 2 mmHg). Inhalation of 100% oxygen for 10 minutes increased chest TcPO2 in all patients (145 +/- 8 mmHg) and increased TcPO2 in skin around the ulcers in 17 of 18 patients (61 +/- 13 mmHg). This study supports the existence of a local pathologic barrier to oxygen diffusion in patients with venous ulcers.

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