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Biomedical subjects

A G de la Rocha

Publications and source records attributed to A G de la Rocha.

13 recordsLinked to original sources
PubMed1985

Traumatic rupture of the tracheobronchial tree.

Rupture of the trachea and major bronchi usually results from blunt trauma to the chest. To define the characteristics of the condition, the mechanism of injury, presentation and hospital course, the authors reviewed seven cases of tracheobronchial rupture after blunt trauma. Four were injured in a motor vehicle accident, two had a crush injury and one child had a fall from a playground swing. The site of injury was the left main bronchus in three, membranous trachea in two and bilateral bronchi and bronchus intermedius in one patient each. Bronchoplastic repair was performed in four patients with salvage of lung tissue in three. One patient required pulmonary resection. Two patients with a laceration of the membranous trachea did not undergo operation. Two patients died secondary to associated head injuries; one patient underwent repair of the bronchus intermedius and one patient had a lacerated membranous trachea. The possible mechanisms of injury are: rapid deceleration with forward swing of the trachea, widening of the transverse diameter of the chest, exerting traction on the carina, and a rapid rise of airway pressure on impact. Surgical intervention is recommended at an early stage to avoid loss of lung tissue.

Adult↗
PubMed1984

Pain amelioration after thoracotomy: a prospective, randomized study.

Twenty patients undergoing a posterolateral thoracotomy for lung resection or a nonpulmonary procedure were divided into four groups. Group 1 was the control group. Patients in Group 2 had an intercostal nerve block at the time of closure. Those in Group 3 underwent a continuous intercostal nerve block for five days. Electronic pain control was used in Group 4. An additional group of patients underwent operation through an anterolateral thoracotomy (Group 5) and was compared with the control group. Breathing performance was evaluated daily for five days with bedside spirometry, and intergroup comparison was done utilizing the unpaired t test and analysis of variance. Forced expiratory volume in one second, expressed as percent of preoperative values, was significantly better in Group 3 (continuous intercostal nerve block) at 52.4 +/- 9.2% (standard deviation; p less than 0.05) and in Group 5 (anterolateral thoracotomy) at 52.0 +/- 7.5% (p less than 0.05) than in the control group (38.4 +/- 8.8%) five days postoperatively. It is concluded that bedside spirometry is a simple and reliable technique to assess postoperative changes in ventilatory mechanics due to pain. The pain that follows posterolateral thoracotomy can be substantially decreased with a continuous intercostal nerve block. Anterolateral thoracotomy is notably less painful than posterolateral thoracotomy and should be considered the approach of choice for patients with decreased pulmonary reserve who undergo uncomplicated pulmonary resection.

Adult↗
PubMed1984

Sealing the postpneumonectomy space: use of a pectoralis major myodermal flap.

Reconstruction of chest wall defects is performed by a variety of surgical procedures. Use of the pectoralis major myodermal flap following a Clagett procedure appears to be a reliable technique providing satisfactory results. The application of this technique demands a close interaction between the plastic surgeon and the thoracic surgeon.

Aged↗
PubMed1984

Resection of a metastatic sternal carcinoma and reconstruction of the chest wall: a case report.

A large metastatic squamous carcinoma of the anterior chest wall was managed by en-bloc resection of the thoracic wall. The extensive defect resulting from the resection was bridged with Marlex mesh superimposed on an omental flap that served as recipient to partial-thickness skin grafts. This composite reconstruction restored an efficient bellows action to the chest cage, manifested by the lack of anterior flailing and postoperative spirometry values, measured at the bedside, that were 75% of those obtained preoperatively. During the initial postoperative period, however, mechanical ventilatory assistance was required to treat an adult respiratory distress syndrome that together with mild anterior flailing made early extubation impossible.

Carcinoma, Squamous Cell↗
PubMed1982

Diaphragmatic rupture due to blunt abdominal trauma.

Twenty-two instances of diaphragmatic rupture secondary to blunt thoracoabdominal trauma were seen at the Trauma Unit of the Health Sciences Centre, Winnipeg, Manitoba, Canada during a 30 year period. Diaphragmatic laceration occurred in the right leaf in 11, in the left in ten, and in both sides in one instance. In 14, the diagnosis was made and repair effected within 24 hours of presentation. Seven were diagnosed and treated from three days to several years after the injury. Two patients died soon after admission. They were victims of multiple intra-abdominal as well as intrathoracic injuries. Repair was generally effected through a laparotomy during the immediate post-traumatic period. Thoracotomy was used in those diagnosed after the latent interval. The diagnosis of diaphragmatic disruption should be considered in any patient suffering from blunt thoracoabdominal trauma. Usually a roentgenogram of the chest will confirm the suspected injury. In contradistinction to most of the reported series, our experience indicates that right diaphragmatic injuries are more common than what is usually thought.

Abdominal Injuries↗
PubMed1982

Empyema thoracis.

Seventy-five adult and 25 pediatric patients with empyema thoracis are reported upon herein. A high incidence of postpneumonectomy and postlobectomy empyema were found in the adult population, 15.5 and 3.7 per cent, respectively. The causal factors of such a high incidence are unknown. Faulty surgical techniques and poor clinical judgment in the management of patients undergoing thoracic operations will invariably lead to a significant mortality and morbidity. Morbidity was indirectly evaluated by the length of hospitalization, the mean being 56.8 days for the adult population and 22.6 days for the pediatric group. These figures barely expose the degree of frustration and suffering that patients with empyema thoracis go through. To decrease the incidence of iatrogenic empyema with its associated mortality and morbidity, good clinical judgment and impeccable surgical techniques must be used in the management of patients having thoracic operations. An aggressive approach to drain the empyemic space to allow pulmonary expansion of sterilization of the postpneumonectomy space must be taken once faced with this complication. Children require no more than repeat thoracentesis or placement of an intercostal chest tube to obtain sufficient drainage and recovery. Antibiotic therapy must be selected according to the bacteria encountered and the results of the sensitivity test. Close supervision is mandatory to detect overgrowth, frequently encountered with the use of broad spectrum antibiotics. Anaerobic bacteria as well as fungus and acid-fast bacilli must be searched for during the routine bacteriologic workout.

Adult↗
PubMed1981

Acute renal failure as a consequence of sudden renal artery occlusion.

Acute renal failure secondary to renal artery occlusion is rare but can be reversed and is therefore important to cases to draw attention to the diagnosis and management of the condition. In one case, occlusion of the artery to a single functioning kidney was responsible for the clinical presentation; in the other, bilateral renal artery emboli were responsible. The authors present a detailed review of the English literature to determine the prognostic value of the duration of anuria preceding operation in patients with renal artery occlusion to a solitary kidney. This factor showed no correction with viability of renal tissue, functional recovery or patient survival. Surgical management offers the best prospect of success in these patients.

Acute Disease↗
PubMed1980

Oropharyngeal sepsis with endothoracic spread.

Two patients who had oropharyngeal infection with extension into the thoracic cavity through the fascial planes were recently seen at the Health Sciences Centre in Winnipeg. In both instances the infection was odontogenic. A 5-year review of the literature yielded 14 other cases with a similar presentation. In most cases the infection was odontogenic. The overall mortality was 25% (four deaths in 16 patients). Transient deficiency of the swallowing mechanism led to aspiration pneumonia in 44% of the patients. An aggressive surgical approach and appropriate antibiotic therapy are essential in managing these patients. Oral intake should be restricted and nasogastric tube feedings should be considered to diminish the risk of aspiration pneumonia.

Adult↗
PubMed1978

Importance of mixed venous oxygen saturation in the care of critically ill patients.

The relation between mixed venous oxygen saturation and cardiac index was determined in 11 children who underwent surgical treatment for congenital heart disease. The correlation between these two variables was found to be reliable (r = 0.78, P = 0.001). The simple determination of mixed venous oxygen saturation performance, particularly when sophisticated equipment for measuring cardiac output is not available.

Cardiac Output↗
PubMed1977

Thrombosis of Björk-Shiley aortic valve prosthesis: report of three cases.

Thrombotic malfunction of a Björk-Shiley aortic valve prosthesis occurred in three patients 6 to 16 months postoperatively. None of the patients had been taking anticoagulants. Although the presentation was acute, prodromal symptoms could be identified retrospectively in two of the patients. Two patients survived thrombectomy. Postoperative anticoagulant therapy is recommended in patients with these prostheses despite factors that may make such therapy riskier in specific patients. Attention to the character of murmurs and of the closure sound of the prosthetic valve must be part of the routine follow-up. In the emergency situation, when delay must be avoided, catheterization and angiography are unnecessary. The operative approach consists of complete thrombectomy without replacement of the valve or any of its components unless there is obvious periprosthetic leak or prosthetic wear.

Adult↗
PubMed1977

3. Current approaches to popliteal artery repair.

Trauma to the popliteal artery is potentially dangerous, and limb loss may result, especially with delayed diagnosis. Three anatomic factors contribute to the seriousness of the outcome: proximity of the artery to bone, superficial position of the artery and consequent lack of protection, and frequent associated injury to associated collateral blood vessels. Diagnosis of injury to the popliteal artery rests on suspicion and vigilance; the Doppler transcutaneous flow detector and angiography are often useful aids to diagnosis. Methods of treatment that have been used include arterial repair, grafting and fasciotomy, together with management of associated injuries. The bypass principle of vascular reconstruction may improve overall results.

Adult↗
PubMed1972

Assisted circulation following myocardial infarction: a review of 25 patients treated before 1971.

Twenty-five patients with impending death from myocardial infarction were treated with assisted circulation. Of these, 19 had suffered cardiac arrest from which they could not be resuscitated and six were in severe, intractable and expectedly terminal cardiogenic shock.All patients were treated by venoarterial bypass employing a bubble oxygenator. Assistance was continued for an average duration of one hour and 45 minutes at a flow rate between two and four litres per minute. The patients all showed improved cerebral, pulmonary and renal function and acid-base values returned to normal.Five patients survived for at least one month and two were improved; hence 28% of these otherwise terminal patients were helped by this technique of assisted circulation.

Adult↗