PubMed Health⌕ Search

Biomedical subjects

C H Shatney

Publications and source records attributed to C H Shatney.

At least 55 records · Page 3Linked to original sources
PubMed1985

Sequential serum complement (C3) and immunoglobulin levels in shock/trauma patients developing acute fulminant systemic sepsis.

The complement system has been implicated in the physiopathology of septic shock. Since infection is a major cause of death in trauma patients, we examined daily serum C3 and immunoglobulin levels in all victims of major trauma during a 3-month interval. Sixteen patients developed acute systemic sepsis 3-15 days after admission. For all variables the lowest values occurred shortly after hospital admission, during or just after fluid resuscitation. Thereafter, the serum C3 and immunoglobulin concentrations gradually returned to the normal ranges, despite the onset of fulminant systemic sepsis. Except for IgM, the occurrence of hypotension during sepsis did not affect the recovery patterns of the measured variables. In the five patients experiencing hypotension, serum IgM dropped transiently but resumed its normalization trend after the restoration of adequate perfusion pressure. In the three nonsurvivors there was no reduction in the serum C3 or immunoglobulin levels prior to death. These data do not support a role for C3 or the immunoglobulins in the pathogenesis of acute fulminant clinical sepsis. On the contrary, the behavior of these substances during severe sepsis is more consistent with protective host defense functions.

Acute Disease↗
PubMed1984

Antibiotic prophylaxis in elective gastro-intestinal tract surgery: a comparison of single-dose pre-operative cefotaxime and multiple-dose cefoxitin.

In a prospective trial conducted at five medical centres, 136 patients aged 18 to 75, undergoing elective gastro-intestinal surgery were randomized to receive a single dose of cefotaxime, 1 g preoperatively, or cefoxitin, 2 g preoperatively followed by 2 g every 6 h for no more than 24 h. Overall infection rates with both regimens were approximately 10%. There were no significant differences in the infection rates between subgroups. Thus, a single preoperative 1 g dose of cefotaxime is as efficacious as, but considerably more cost-effective than, multiple 2 g doses of perioperative cefoxitin in the prevention of infection following elective gastrointestinal tract surgery.

Adolescent↗
PubMed1984

Potential role of nurses in assessing house officer performance in the critical care environment.

A prospective study was conducted to examine the possible contribution of acute care nurses to the evaluation of resident physicians. During a 10-month interval, 98 house officers rotating through a trauma unit were assessed by 2 staff physicians, 1 trauma/critical care fellow, and 3 registered nurses. Residents were evaluated on 33 factors related to 4 categories of activity: personal conduct, professional competence, patient-oriented behavior, and interdisciplinary relations. In all 4 categories, the mean scores of the nurses were significantly (p less than .05) higher than those of the staff physicians, but not significantly different from those of the trauma/critical care fellow. The mean ratings of the latter were generally between the other 2 groups of evaluators. This study revealed that nurses can participate successfully in the resident evaluation process, and that senior physicians on the acute care team are more critical of house officer performance than are nurses or fellows on the team.

Clinical Competence↗
PubMed1984

Relationship of thyroid hormone patterns to survival in canine hemorrhagic shock.

6 of 13 dogs subjected to 1 h of hemorrhagic shock (BP = 45-50 mm Hg) died during the first convalescent day. Nonsurvivors had lower baseline plasma concentrations of total and free T4 and T3, as well as rT3, and higher T3 uptake values. During shock, dogs that died had significantly lower plasma levels of total and free T4 and T3 and higher T3 uptake. In general, intergroup differences were accentuated during resuscitation. After volume replenishment, indices of thyroid function had stabilized or improved in survivors, but were still deteriorating in dogs that ultimately died. There were no consistent hemodynamic differences between the two groups. Thus, parameters of thyroid metabolism appear to be good prognostic indicators in canine hemorrhagic shock.

Animals↗
PubMed1984

Hydroxyethylstarch administration does not depress reticuloendothelial function or increase mortality from sepsis.

Hydroxyethylstarch (HES) is being used increasingly in clinical hemorrhagic shock. Since patients in shock are at high risk of subsequent infection, concern has been voiced about possible adverse effects of HES on the reticuloendothelial system (RES) and host defenses against sepsis. We examined this issue in male albino Holtzman rats given HES or saline (60 ml/kg) i.v. RES function was evaluated 24 and 48 h after HES administration by measuring the intravascular clearance rates (t/2) and organ retention of 131I-triolein lipid emulsion. Neither the intravascular clearance rates nor organ retention of the lipid emulsion was affected at 24 or 48 h after HES. In another group of rats, sepsis was produced by cecal ligation and puncture 2 d after HES or saline infusion. The survival rates were 41% and 43%, respectively, in the saline- and HES-treated animals. These studies reveal no deleterious effects of a clinically relevant volume of HES on either RES function or host resistance to sepsis.

Animals↗
PubMed1983

Efficacy of hetastarch in the resuscitation of patients with multisystem trauma and shock.

A prospective trial of 6% hetastarch (HES) v 5% plasma protein fraction (PPF) as the colloid component of intravenous (IV) fluid resuscitation was conducted in 32 patients with multisystem trauma and/or hemorrhagic shock. Patient age, mechanism and pattern of injury, and IV fluid requirements were similar in both groups. No intergroup differences were noted in indexes of hepatic, pulmonary, or renal function or in the incidence of infection. The frequency of other complications, including bleeding diatheses, and mortality were identical in the two groups. Although this investigation should be viewed as a pilot study, our results suggest that, compared with PPF, HES in large volumes is a safe, effective colloid solution in the resuscitation of patients with multisystem trauma and/or hemorrhagic shock. Further study of HES in a larger number of patients is warranted by these findings.

Adolescent↗
PubMed1983

Septic sequelae after splenectomy for trauma in adults.

Of 619 trauma patients who underwent splenectomy, 503 lived more than 10 days postoperatively. In this group systemic sepsis developed in 114 patients (22.7 percent). The most frequent septic focus was intraabdominal abscess (59 patients). The incidence of postoperative septic complications increased with the severity of trauma. Of the 41 patients who died after the 10th postoperative day, 36 died from sepsis. There were no septic complications or deaths in the 13 patients under age 15 years. Septic morbidity and mortality rates in splenectomized patients were significantly (p less than 0.01) greater than those in 2,368 consecutive trauma patients treated from 1978 to 1979. Long-term follow-up information was obtained in 242 patients. Follow-up encompassed 1,046 patient-years, with a mean patient follow-up interval of 4.4 years. Severe bacterial infections have occurred in six patients (2.5 percent). Thus far there have been no deaths from overwhelming sepsis. Interestingly, 11.5 percent of the patients complained of more severe viral infections after splenectomy. Our data support the concept of preserving the traumatized spleen whenever possible.

Abdomen↗
PubMed1983

Outcomes of trauma patients with no vital signs on hospital admission.

In 5 years, 267 patients with cardiopulmonary arrest after trauma were treated at our institution. The long-term survival rate was 2.6%. Only 1.5% of the 267 patients were functional individuals. Overall, neither the mechanism of injury nor routine emergency thoracotomy influenced the salvage rate. Our results in the management of trauma victims without vital signs indicate that: 1) among blunt trauma patients, those with isolated head injury have the highest survival rate; 2) patients with blunt multisystem injuries involving the chest, abdomen, or truncal orthopedic structures are unsalvageable; 3) cardiopulmonary arrest with penetrating head or neck wounds is a lethal combination; and 4) with the exception of patients sustaining penetrating chest or heart injuries, emergency thoracotomy does not enhance the survival rate of trauma patients who were formerly declared 'dead on arrival.'

Accidents, Traffic↗
PubMed1983

Diagnosis of abdominal abscesses in patients with major trauma: the use of computed tomography.

The usefulness of computed tomography (CT) in diagnosing abdominal abscesses was evaluated prospectively in 69 septic patients who had suffered massive trauma. For the 82 abdominal CT scans obtained, the accuracy rate was 84%, the sensitivity was 92%, and the specificity was 79%. With the use of abdominal CT, 32 patients were spared a "blind" laparotomy in the search for the focus of infection. It is concluded that CT is of significant value in the diagnosis of abdominal abscess in the septic trauma patient.

Abscess↗
PubMed1983

Serum complement levels in canine endotoxin shock: relation to survival and to corticosteroid therapy.

Recent studies suggest prominent roles of the complement system in endotoxin shock and steroid-complement interactions in its treatment. To assess further the potential importance of the complement system in this condition, we measured serum total complement levels in dogs after an IV bolus of 1.5 mg/kg DIFCO E coli endotoxin. Dogs were assigned to control (C), dextran40 (LMD), or LMD + steroid groups. Corticosteroids, given IV 15 min after endotoxin, were 1) methylprednisolone sodium succinate (MPSS), 30 mg/kg; 2) dexamethasone sodium phosphate (DSP), 6 mg/kg; 3) hydrocortisone sodium succinate (HSS), 150 mg/kg; or 4) hydrocortisone sodium phosphate (HSP), 150 mg/kg. LMD was infused to maintain BP greater than 60% of preshock levels during the 4 h of monitoring. Survival rates at 48 h were C--7/24 (29%); LMD--3/12 (25%), MPSS--11/19 (59%) (P less than 0.1); DSP--9/14 (64%) (P less than 0.05); HSS--3/10 (30%) HSP--5/10 (50%). Within 15 min of endotoxin administration, serum complement titers fell at least 48% in all groups. Complement levels returned to the preshock range in only the LMD group. Mean complement levels of all survivors and nonsurvivors were nearly identical throughout the acute experiment. The results indicate that survival in canine endotoxin shock, with or without corticosteroid therapy, is not related to normalization of serum total complement titers during the first few hours after endotoxin injection.

Adrenal Cortex Hormones↗
PubMed1983

[Postsplenectomy infection and immunologic aspects of splenectomy].

Of 619 trauma patients undergoing splenectomy, 503 lived more than 10 days. In this group, 114 patients (22.7%) developed systematic sepsis and 36 patients (7.2%) succumbed from sepsis. Septic morbidity and mortality rates in splenectomized patients were significantly greater than those in 2180 consecutive trauma patients treated in 1978-1979. Septic mortality rate in septic patients was significantly greater than that in 2180 consecutive trauma patients. Septic mortality rate in the patients whose trauma were seen only in the spleen or associated with only one organ injury was also very high. Long-term follow-up information was obtained in 242 splenectomized patients with a mean patient follow-up interval of 4.4 years. Severe bacterial infections have occurred in six patients. Thus far, there have been no deaths from overwhelming sepsis. Of interest, 10% of the patients complained of more severe viral infection following splenectomy. On the other hand, the incidence of postoperative infection in the patients who underwent total gastrectomy with splenectomy was not different from that of the patients who underwent total gastrectomy without splenectomy. However, the incidence of the postoperative infection in the splenectomized patients together with total gastrectomy was greater than that of the the splenectomized patients in trauma.

Adolescent↗
PubMed1983

Thyroid hormone responses in hemorrhagic shock: study in dogs and preliminary findings in humans.

One hour of hemorrhagic shock in the dog produces alterations in thyroid hormone metabolism far exceeding those seen after elective surgery or thermal injury. The changes in plasma thyroid hormone levels cannot be fully explained by carrier protein loss. Plasma concentrations of total thyroxine (T4) and triiodothyronine (T3) were significantly decreased after only 20 minutes of shock, continued to decrease throughout shock and resuscitation, and remained depressed for several days thereafter. Both hormones reached nadirs during volume replacement of 42% and 17% of baseline, respectively. The total T4 level normalized by the fifth postshock day, but the T3 concentration was still depressed on the ninth day. Plasma albumin, the principal canine thyroid hormone carrier, was significantly reduced 20 minutes after hemorrhage and remained low throughout convalescence. Concentrations of free T4 and T3 decreased during shock, but not as much as the total T4 and T3 concentrations. Reverse T3 levels, corrected for albumin loss, and T3 uptake values were increased during shock and resuscitation. Similar alterations in circulating thyroid hormone concentrations were seen in three patients with major traumatic injury and/or shock. The thyroid hormone changes in shock may represent another example of the "euthyroid sick syndrome."

Adult↗
PubMed1982

Hepatic blood flow after canine portasystemic shunting.

Effects of portasystemic shunting on total hepatic blood flow (THBF) were evaluated in mongrel dogs with 35 and 50micro radioactive microspheres. THBF was measured prior to shunting and 1 hour and 3 weeks after surgery. Using systemic and pulmonary artery catheters, pertinent hemodynamic variables were also measured. In sham-operated dogs (n = 5), there were no significant changes in the hemodynamic parameters or the components of THBF during the experiment. After end-to-side shunting (n = 7), animals experienced a significant, permanent fall in hepatopetal portal blood flow (HABF). In contrast, dogs with side-to-side shunts (n = 7) exhibited a transient, significant increase in HABF 1 hour after surgery. Although the shunt eliminated HPBF, the rise in HABF prevented a significant, immediate fall in THBF. Three weeks after surgery, however, HABF had returned to the baseline range, and THBF was significantly lower than the preshunt value. Dogs with H-graft mesocaval shunts (n = 5) also exhibited a transient, significant rise in HABF 1 hour after surgery. Since HPBF did not fall substantially, THBF at this time was significantly higher than the baseline value. Three weeks after surgery, HABF had fallen to the baseline range, but THBF was not significantly different from the preshunt level. In animals with distal splenorenal shunts (n = 11), there was no significant change in HABF after shunting. Both HPBF and THBF were transiently, significantly reduced immediately after surgery, but three weeks later neither parameter was significantly lower than the preshunt values. There were no significant, persistent changes in the systemic perfusion pressures or flows in the shunted groups. These experiments demonstrate that the reported increase in HABF following portasystemic shunting is dependent on the type of shunt and, if it occurs, is a transient phenomenon. Hence, immediate postoperative changes in hemodynamic variables or hepatic blood flows do not necessarily reflect long-term patterns. In the normal dog, total portasystemic shunting produces a permanent, significant decrease in THBF, whereas selective shunting maintains THBF in the near-normal range.

Animals↗
PubMed1982

Post-traumatic pseudoaneurysm of the internal maxillary artery.

Three patients with internal maxillary artery pseudoaneurysms have been reported in the literature. All had antecedent trauma and presented with persistent, painful lateral facial swelling. The diagnosis was established by carotid arteriography. In the patient reported here, a pseudoaneurysm occurred 17 days after gunshot wounds to the back of the neck, and was successfully treated with balloon embolization. Although the lesion can be treated surgically, transvascular embolization appears to be a safer and equally effective mode of therapy.

Adult↗
PubMed1982

Influence of the salt moiety on the effectiveness of corticosteroid therapy in cardiogenic shock.

Using closed chest coronary artery microsphere embolization, myocardial infarction and subsequent shock were produced in healthy adult mongrel dogs. Following infarction animals were distributed among the following groups: (1) control; (2) methylprednisolone sodium succinate (MPSS); (3) methylprednisolone sodium phosphate (MPSP); (4) sodium phosphate (SP); and (5) sodium succinate (SS). Drug doses of equivalent anti-inflammatory activity were administered i.v. 15 min after infarction. Compared to control animals, only dogs treated with MPSS exhibited significant improvements in hemodynamic parameters and permanent survival. Survival in MPSS dogs was significantly (P = 0.02) better than that of either group treated with SP or SS and substantially (P = 0.02) better than that of either group treated with SP or SS and substantially (P = 0.065) better than the survival rate of dogs receiving MPSP. It appears that succinate is permissive, while phosphate is restrictive, with respect to efficacy of methylprednisolone in experimental cardiogenic shock. Possible explanations for these observations are discussed.

Adrenal Cortex Hormones↗
PubMed1982

Effects of naloxone and morphine in hemorrhagic shock.

The effects of naloxone hydrochloride and morphine sulfate on survival were examined in LD40 hemorrhagic shock in rats. Bolus IV injection of naloxone (1.6 mg/kg) following hemorrhage significantly (p less than 0.025) increased the 24 hour survival rate (14/15, 93%), compared to that in saline-treated animals (13/22, 59%). Supraphysiologic doses of IV morphine sulfate did not adversely influence survival (12/15, 80% at 0.5 mg/kg; 8/15, 53% at 0.1, 0.05, and 0.01 mg/kg). Morphine decreased heart rate during shock in a dose-dependent fashion, but did not affect the blood pressure. Compared to responses in the other groups, naloxone had no effect on blood pressure or heart rate in shock animals during the monitoring interval. These results suggest that: 1) endogenous opioid substances, most likely at much lower blood concentrations than those used in the present experiment, may not be important deleterious factors during shock; and 2) enhancement of survival by naloxone in hemorrhagic shock is probably due to effects other than antiopiate activity.

Animals↗
PubMed1982

Recognition of intra-abdominal injury in blunt trauma victims. A prospective study comparing physical examination with peritoneal lavage.

The accuracy of initial physical examination and peritoneal lavage in detecting intra-abdominal injury was assessed in 221 consecutive blunt trauma victims. Of the patients, 121 had negative peritoneal lavages, with one false result, and 100 had positive peritoneal lavages, including six false results and two injuries not requiring surgical correction. Hemoperitoneum occurred in 32 of 71 patients with a depressed sensorium and in 29 of 54 patients with thoracic injury. Twenty-eight of 120 patients with absent bowel tones and 20 of 100 patients with abdominal guarding or rigidity had negative peritoneal lavages. Among the 150 conscious, responsive patients there was a high incidence of false-positive and false-negative abdominal findings on physical examination. Hemoperitoneum was detected in four clinically negative patients. Significant error accompanies the initial abdominal examination and clinical assessment in the blunt trauma victim. In contract, open diagnostic peritoneal lavage is a sensitive and highly accurate test for blunt intraperitoneal injury. We believe peritoneal lavage is the single best test for intra-abdominal injury and should be performed in th majority of patients with such injuries.

Abdominal Injuries↗