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Biomedical subjects

C E Lucas

Publications and source records attributed to C E Lucas.

At least 127 records · Page 7Linked to original sources
PubMed1982

Primary hemostasis after massive transfusion for injury.

Primary hemostasis, the formation of a platelet plug, was studied in 22 injured patients receiving an average of 21 transfusions during the operation for control of bleeding. The storage age of the blood averaged 15 days; no platelet transfusions were given. Platelet counts (PLT) and bleeding time (BT) were studied intraoperatively; postoperatively at 6 hours, 25 hours, day 2, day 4; and during convalescence (8 days to 3 months). Serial PLT and BT levels were correlated with the number of transfusions and age of blood. During operation, the PLT fell to 109,000/mm3 and the BT was greater than 15 minutes. Thrombocytopenia did not correlate with the number of transfusions or age of blood. The PLT averaged 106,000/mm3 at 6 hours and then fell significantly to 73,000/mm3 at 15 hours and to 76,000/mm3 on day 2. The PLT rose significantly to 110,000/mm3 by day four and increased to supernormal levels by convalescence. The BT remained elevated at 6 hours, 15 hours, day 2, and day 4, and declined to normal by convalescence. Thrombocytopenia and prolonged BT after massive transfusion for injury indicate platelet dysfunction which may protect against disseminated intravascular coagulation. Correction of the thrombocytopenia should be reserved for patients with bleeding.

Bleeding Time↗
PubMed1982

Anergy and altered lymphocyte function in the injured patient.

The failure of the host-defense mechanism following trauma has been recognized, but the site of the deficit is unknown. The immunologic competence of 16 patients, including 15 who had minor injuries and required less than 4 transfusions, was prospectively studied with skin testing, leukocyte counts, and protein electrophoresis. The stimulation ratio (SR) and index of lymphocyte response to phytohemagglutanin (PHA) were measured as the ratio of thymidine uptake in stimulated cells to that of resting cells in both pooled normal serum as well as each patient's serum. Six patients, including the one patient with major injury, had no response to any of the four skin test antigens and were considered anergic (AN). Ten patients with minor trauma responded to at least one of the antigen skin tests and were considered nonanergic (NA). The anergic patients had significantly more shock and more blood transfusions and had significantly lower serum albumin levels. There was no statistical difference between the anergic and nonanergic groups in leukocyte count, absolute lymphocyte count, gamma-globulin fraction, or age. The average PHA Stimulation Ratio of patient lymphocytes in patient serum was significantly higher than the PHA Stimulation Ratio of patient lymphocytes in control serum. This suggests that the lymphocytes of injured patients respond in a greater magnitude when bathed in autologous-serum than when bathed in control pooled serum. Furthermore, the autologous serum did not inhibit the PHA response of control or normal lymphocytes. The presence of an enhancing factor in injured patients' sera or an absence of a supressor substance may be responsible for this phenomenon.

Adult↗
PubMed1982

The value of prophylactic antibiotic therapy during endoscopic retrograde cholangiopancreatography.

Prophylactic antibiotics have been recommended during endoscopic retrograde cholangiopancreatography in the hope of preventing septic complications. However, their effectiveness has not been proved clinically. In this study, the ability of the pancreas to secrete ampicillin, gentamicin and clindamycin after a single intravenous dosage, given prior to endoscopic retrograde cholangiopancreatography in 12 patients, was examined. Simultaneously obtained serum antibiotic levels were within the expected therapeutic range. In contrast, pancreatic ductal levels of ampicillin and gentamicin were too low to be measured in most patients. Most patients had measurable clindamycin levels which ranged from 12.0 to 3.1 micrograms per milliliter in seven patients and was 8.0 micrograms per milliliter in one patient. Parenteral prophylactic antibiotic coverage for endoscopic retrograde cholangiopancreatography is ineffective with gentamicin or ampicillin. Clindamycin may be of value, but it needs further study at higher dosages.

Adult↗
PubMed1981

Altered interstitial fluid space dynamics and postresuscitation hypertension.

Hypertensin occurred 24 to 48 hours after resuscitation in 35 of 86 injured patients, who had combined systolic and diastolic hypertensin (150/100 mmHg) for six or more consecutive hours. Plasma volume (PV), RBC volume, extracellular fluid (ECF) volume by the inulin dilution technique, renal plasma flow, glomerular filtration rate, and peripheral renin levels were measured in hypertensive and nonhypertensive patients an average of 40 hours after injury. The hypertensive patients had an average mean arterial pressure (MAP) of 114 mmHg, compared with 95 mmHg in the nonhypertensive patients. The RBC volume and ECF were comparable for both groups, whereas PV was increased in the hypertensive patients (3.6 L vs 3.3 L). Calculated interstitial fluid space (IFS) volume was greater in the nonhypertensive patients, as was the ratio PV/IFS. The MAP in both groups correlated directly with PV/IFS and serum albumin concentrations, and inversely with peripheral renin concentrations. This suggests that postresuscitative hypertension is not due to fluid overload but rather to the fluid maldistribution related to altered IFS compliance as reflected by the increased PV/IFS.

Blood Pressure↗
PubMed1981

Pulmonary response of massive steroids in seriously injured patients.

The effects of massive steroids on pulmonary function after hypovolemic shock were tested in 114 injured patients who received an average of 13 transfusions, 760 ml plasma, and 11.7 L crystalloid solution; by random selection, 54 patients received methylprednisolone (1 g in operating room plus 3,578 mg average during the next three days). The patients who received steroids had a significant increase in central venous pressure and a decrease in arterial oxygen tension (PaO2) compared with control patients. The inspired oxygen concentration was similar for both groups; the FiO2/PO2, therefore, was significantly deranged (P = less than 0.05) in steroid patients (0.45 +/- 0.05 SE vs 0.37 +/- 0.02 SE). The patients who received steroids has an insignificantly increased pulmonary shunt (25 vs 22%), number of days on a volume ventilator (5.1 vs 3.0 days), and number of deaths (seven vs two), Massive steroids neither prevent nor ameliorate pulmonary failure after shock; indeed, steroids may aggravate pulmonary failure after shock.

Blood Transfusion↗
PubMed1981

The cardiac effect of altered calcium homeostasis after albumin resuscitation.

Supplemental albumin added to a standard non-albumin resuscitation regimen has been shown to significantly impair heartwork in seriously injured patients. The role of calcium dynamics in this myocardial depression was analyzed in 94 injured patients who were in shock for an average of 32 minutes, received an average of 14.5 transfusions, 9.2 L crystalloid, 0.9 L plasma, and 20.9 mEq calcium prior to the end of operation. By random selection, 44 patients received an average of 31 gms of albumin during operation, 207 gms during the early postoperative period (mean = 30 hrs) of extravascular fluid sequestration, and 402 gm during the mobilization period. The albumin resuscitated patients had normal total protein and serum albumin levels and higher total calcium (TC) levels, however, they had a significantly lower Ca++ and Ca++/TC. The accumulative slope for heartwork/filling pressure was significantly depressed in albumin patients as was the mean work unit/filling pressure index. The level of Ca++ and the Ca++/TC ratio correlated directly with the calculated work unit index in both the albumin and non-albumin patients. This suggests that a supplemental albumin binds serum Ca++ causing an increase in TC but a reduction in Ca++ and Ca++/TC. The fall in Ca++ and Ca++/TC seems responsible, in part, for heart failure and pulmonary edema in albumin resuscitated patients.

Albumins↗
PubMed1980

Primary repair vs ligation for carotid artery injuries.

The morbidity and mortality of carotid arterial injuries in 36 patients were retrospectively reviewed. Primary repair was achieved in 31 patients; nine patients had a stroke postoperatively and five died. Five patients were treated with ligation; three had a stroke postoperatively, but all survived. Postoperative stroke and mortality correlated best with neurological deficit on administration. Patients in shock or with absent arterial flow were also more likely to have postoperative stroke. Twenty-two patients were normal neurologically on admission; all were normal postoperatively and all survived. Five patients were admitted unconscious in severe shock, precluding accurate neurological evaluation; two were normal following repair and three had stroke. Nine patients had a stroke or coma on admission; all nine had postoperative stroke and five died. Autopsy disclosed bilateral cerebral edema in two patients, cerebral edema and ipsilateral ischemic infarction in two patients, and cerebral edema with bilateral necrosis in one patient. No patient had hemorrhagic infarction. On the basis of these findings, carotid artery repair is recommended in all patients who are not comatose, have stable vital signs, and have technically reparable injuries.

Adolescent↗
PubMed1980

Postresuscitative hypertension: a reappraisal.

New concepts of cause and therapy for postresuscitative hypertension (PRH) were evaluated in four patients with PRH. Each patient had severe injury and shock, and received an average of 28.3 transfusions, 15.4 L of electrolyte solution, and 1.4 L of plasma by the end of surgery for control of bleeding. Near the end of the sequestration phase, PRH developed. In two patients, PRH (190/100 mm Hg and 180/90 mm Hg) responded to previously recommended therapy; blood pressure fell to about 135/90 mm Hg. Shortly thereafter, bradycardia developed and both patients died. In the latter two patients, PRH (205/115 mm Hg and 150/120 mmHg) was treated less aggressively, maintaining intravenous fluids to keep urine output at a minimum of 50 mL/hr. Postresuscitative hypertension persisted for five and six days as both patients improved, continued to mobilize sequestered fluid, and maintained good organ perfusion. Postresuscitative hypertension may be a cell-mediated protective response to a need for increased capillary hydrostatic pressure to facilitate mitochondrial oxygenation. Fluid replacement should be guided by careful monitoring of cardiac, pulmonary, and renal function.

Adolescent↗
PubMed1980

The natural history following venous ligation for civilian injuries.

Contrary to prevailing views, documentation of major morbidity after venous ligation for trauma is sparse. Forty-six patients had ligation for injury to the major veins of the lower extremities, namely, vena cava (six), external iliac (five), common iliac (three), common femoral (eight), profunda femoris (six), superficial femoral (thirteen), and popliteal (five). The post-ligation management included: 1) early and extensive fasciotomy when indicated, 2) initial strict bed rest with elevation until edema free, 3) trial ambulation for 2 hours, 4) added elevation if trial ambulation leads to recurrent edema. Forty patients were discharged edema free, and six patients had mild edema. Followup examination in 39 patients revealed no edema in 30 patients, mild edema requiring no treatment in one patient, and moderate edema requiring support hose in eight patients. No severe or massive edema causing ulceration or ischemia occurred. Based on these findings, primary venous interruption is a safe, quick and effective means of managing venous injury whenever the extent of injury or the severity of associated injuries make primary repair hazardous.

Edema↗
PubMed1980

Differential serum protein changes following supplemental albumin resuscitation for hypovolemic shock.

The effects of supplemental albumin infusion on serum protein homeostasis were studied in 94 seriously injured patients who received an average of 14.4 transfusion, 9.2 L electrolyte solution, and 829 ml fresh frozen plasma before and during operation. Based on randomization, 46 patients received an average of 31 gm albumin during operation followed by 150 gm/day for 5 days; 48 patients received no albumin. Supplemental albumin caused a significant (p = less than 0.05) increase in total serum protein and albumin concentrations. In contrast, supplemental albumin caused a significant decrease in alpha 1 globulin, alpha 2 globulin, beta globulin, gamma globulin, and fibrinogen levels. The prothrombin time used as index of prothrombin concentration was significantly prolonged in albumin patients. These changes, not previously documented, need further evaluation to determine clinical significance.

Adult↗
PubMed1980

Early sympathetic blockade for frostbite--is it of value?

Sympathectomy has been advocated in the therapy of acute frostbite because ischemia is one determinant of injury severity. Among 66 frostbite victims treated from 1976 through 1978, a group of 15 patients with acute, bilaterally equal injuries judged to be third or fourth degree were treated with immediate intra-arterial reserpine (IAR) in one limb and ipsilateral sympathectomy. Three additional patients who were excellent candidates underwent immediate sympathectomy. The average interval from injury to IAR injection was 3 hours (range 1 to 24 hours). The average interval from injury to sympathectomy was 3 days (range, 12 hours to 10 days). Efficacy of therapy was assessed by comparison of the sympathectomized limb to the contralateral untreated limb. There was no conservation of tissue, resolution of edema, pain reduction, or improved function in sympathectomized limbs compared with those treated with IAR. One patient demarcated more rapidly and one other patient appeared to be protected from recurrent injury. Sympathectomy was not effective therapy for acute frostbite even when achieved early with IAR. Late protection against subsequent cold injury appears to be the only benefit of sympathectomy for frostbite.

Adolescent↗