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Biomedical subjects

C H Shatney

Publications and source records attributed to C H Shatney.

At least 73 records · Page 4Linked to original sources
PubMed1982

Peritoneal lavage in children and adolescents with blunt abdominal trauma.

The major cause of death in children is trauma. Although prompt recognition of blunt abdominal injury is essential, physical examination is an inexact means of establishing the diagnosis. One hundred thirty-five blunt trauma victims under 16 years of age underwent open diagnostic peritoneal lavage over a three-year period. The overall accuracy rate of peritoneal lavage was 95.5 per cent, which included true-negatives (65.9%), false-positives (4.5%), and true-positives (29.6%). These were no false-negative results. Of 40 patients with intra-abdominal injuries, five (12.5%) did not require surgical correction. Open diagnostic peritoneal lavage is the single best test for detecting serious intra-abdominal injury following blunt trauma in children and adolescents.

Abdominal Injuries↗
PubMed1982

Effects of portasystemic shunting on visceral and portal blood flow in the dog.

Late effects of portasystemic shunting on visceral and portal vein blood flows were evaluated in mongrel dogs with radioactive microspheres. Sham operation (n = 5) produced no significant long-term changes in visceral blood flow. In contrast, there was a significant increase in small bowel perfusion 3 wk after selective and nonselective portasystemic shunting: end-to-side (n = 7), side-to-side (n = 7), H-graft mesocaval (n = 5), and distal splenorenal (n = 11). Variable increases in pancreatic blood flow were noted in all shunt groups. Portal venous blood flow was significantly elevated in all dogs with total shunts and was substantially increased in animals with H-grafts. Compared with baseline levels, perfusion of organs left in continuity with the portal vein after splenorenal shunting was significantly increased. Blood flow from the small bowel was primarily responsible for the magnitude of the change in portal venous flow. The reduction in hepatic perfusion by portal venous blood appears to trigger these compensatory responses. A humoral mediator best explains the phenomena observed.

Animals↗
PubMed1982

The influence of megadose methylprednisolone on experimental myocardial infarct size.

Prior work in our laboratory demonstrated a significant reduction of infarct size following early or late administration of 30 mg/kg of methylprednisolone sodium succinate (MP). This study was designed to determine the influence of larger doses of MP on infarct volume. Healthy anesthetized mongrel dogs with similar cardiac anatomy underwent ligation of the distal third of the LAD coronary artery. Following ligation, animals were randomly placed into control or treatment groups. Treated dogs received an IV bolus of either 50 mg/kg MP at 15 minutes (MP-50) or 30 mg/kg MP at 15 minutes and 1 hour later (2MP-30). Animals were then monitored for 6 hours, sacrificed, and the heart removed. The left ventricle was dissected from the heart, weighed, sectioned, and incubated in nitro-blue tetrazolium solution, an LDH stain. Unstained tissue (infarct) was dissected from the slices and weighed, and infarct volume was calculated. Among 20 untreated animals the infarct size was 14.5% +/- 4.3% of the left ventricle. Treatment with 2MP-30 or MP-50 significantly reduced infarct volume to a similar degree (9.1%-9.6%). There was no difference in the effect on infarct size by "megadose" MP compared to previous results with one injection of 30 mg/kg MP. Therefore, the early use of MP at doses above 30 mg/kg confers no additional protection to the ischemic myocardium.

Animals↗
PubMed1981

The "in vitro skin test": a reliable and repeatable assay of immune competence in the surgical patient.

In vitro blast transformation of human peripheral lymphocytes was tested using standard skin test antigens, the mitogens PHA and Con A, and the mixed lymphocytes reaction. The study group included 15 patients with multiple trauma, 40 with major burns, six following cholecystectomies, six following aortic reconstruction, and 30 normal volunteer controls. Repeated skin testing may sensitive patients to candida and streptokinase-streptodornase (SKSD), and desensitize them to mumps antigen. Blast transformation in response to PPD did not correlate with the clinical status of the patients; similarly, blast transformation in response to stimulation by the mitogens PHA and Con A could not reliably predict the occurrence of septic complications. Reactivity in response to stimulation by the soluble antigens SKSD and mumps and in the one-way mixed lymphocyte reaction accurately predicted the clinical course of patients. This method of "in vitro skin testing" is a reliable and repeatable method of monitoring the immunologic status of patients whose illness or injury requires longitudinal study.

Antigens↗
PubMed1981

Another unacceptable model of primate septic shock.

The lack of a primate model suitably reproducing clinical septic shock prompted an attempt to adapt a successful canine model to the Rhesus monkey. Animals were sedated wih 2 mg/kg Sernylan. Local anethesia for vascular catheter insertion was produced with 1% lidocaine. After baseline hemodynamic and blood measurements, the abdomen was entered and the cystic artery and duct were ligated and divided. A suspension of E. coli (ATCC 25922) was injected into the gallbladder, and the abdomen was closed. Sequential monitoring was performed every 12-24 hours until the animals expired. The first monkey was given 10(8) E. coli/kg, the dose used in the canine model. This animal expired during the first 24 hours with ATCC 25922 E. coli septicemia. The same outcome was seen in the next monkey with 10(6) E. coli/kg. Neither monkey exhibited a hyperdynamic circulatory status. Autopsies revealed no intraabdominal abscess or peritonitis. Three animals were given 10(4) E. coli/kg. One died within 24 hours, one died after 13 days, and one was a permanent survivor. Two had bacteremia but no abscess. None had a hyperdynamic circulatory status. In three other animals the cystic artery and duct were ligated and divided, but no E. coli was given. Survival varied from 11/2 to 21/2 days. None had a hyperdynamic circulatory status. All had bacteremia. Autopsies revealed no abscesses. In summary, the Rhesus monkey is exquisitely sensitive to endogenous and exogenous sources of bacteremia, which produce a hypodynamic circulatory status and death before peritonitis or intraabdominal abscess can develop. Thus, the ischemic, infected gallbladder preparation is an inadequate septic shock model in the Rhesus monkey.

Animals↗
PubMed1981

The timing of surgical treatment of pancreatic pseudocysts.

In an attempt to provide practical guidelines for the management of pancreatic pseudocysts, the results in 114 patients were analyzed from the perspective of the timing of operative intervention. Over-all, the patients undergoing surgical therapy during the first six weeks after pseudocyst formation had higher rates postoperatively of morbidity, mortality and recurrence than did those treated later in the course of the disease. However, further subdivision of the data revealed that the results in patients with uncomplicated pseudocysts were similar, irrespective of the timing of operative treatment. Operative intervention in patients with a pseudocyst who were acutely ill was risky at any time in the course of the disease. Based upon our results and upon information available in the literature, the optimal timing of the operation in patients with uncomplicated pseudocysts appears to be about four weeks after formation of the mass. The utility of ultrasound evaluation in making a surgical decision is also discussed.

Acute Disease↗
PubMed1981

The natural leukocyte response to hemorrhagic shock.

There is a high incidence of bacterial infection in patients after trauma or hemorrhagic shock. Since circulating white blood cells (WBC) are a vital component of host defense mechanisms, we examined leukocyte responses in canine hemorrhagic shock. Twenty adult mongrel dogs were anesthetized with 28.6 mg/kg of IV pentobarbital. Arterial and venous cannulas were inserted, and after baseline hemodynamic and blood determinations the dogs were rapidly bled into a reservoir to a mean arterial pressure of 45 +/- 3 mmHg. The animals were maintained at this pressure for one hour and then resuscitated with twice the volume of shed blood over two hours using Ringer's lactate solution. Serial WBC counts after shock were compared to baseline values using Student's t test. In the first few hours after hemorrhagic shock the total WBC count falls, while the neutrophil population rises significantly. During the first week following shock and resuscitation, the leukocyte count remains elevated due to a persistent increase in the neutrophil population. The lymphocyte count remains depressed. Therefore, changes in the number of WBC after canine hemorrhagic shock do not favor the development of bacterial sepsis, because the neutrophil count remains elevated. Whether or not neutrophil function is adequate remains to be determined.

Animals↗
PubMed1980

Experiences with allopurinal in canine endotoxin shock.

Allopurinol, a xanthine-oxidase inhibitor and potential cell-stabilizing compound, was studied as a possible therapeutic agent in canine endotoxin shock. Circulatory collapse was produced in anesthetized mongrel dogs by IV administration of an LD75 dose of endotoxin. Treatment, with dextran alone, or with dextran and an IV bolus of allopurinol, was initiated 15 minutes after the onset of shock. The administration of 25, 50, or 100 mg/kg of IV allopurinol, accompanied by adequate volume replenishment, produced a significant reduction in the total peripheral vascular resistance and significant increases in cardiac output, blood glucose concentration, and arterial lactate concentration. Survival was not enhanced by allopurinol therapy, and allopurinol administration in normal dogs did not affect the vascular tone or the arterial lactic acid concentration. There was a transient hyperglycemic response and a decrease in the cardiac index in normal animals. The infusion of a postassium-insulin solution, in association with 100 mg/kg of allopurinol, did not significantly improve survival. In summary, although a number of potentially beneficial hemodynamic and metabolic effects were observed following allopurinol administration, survival in canine endotoxin shock was not enhanced.

Allopurinol↗
PubMed1980

Comparative effects of intravenous and intra-arterial methylprednisolone in cardiogenic shock.

This study was undertaken to determine if a portion of intravenously administered methylprednisolone sodium succinate (MPSS) might be metabolized by the lung during cardiogenic shock. With plastic microsphere coronary artery embolization, myocardial infarction and shock were produced in mongrel dogs. Animals were assigned to control, intra-arterial MPSS, and intravenous MPSS groups, with the treated dogs receiving 30 mg/kg of MPSS 15 minutes after infarction. Compared to control animals, the group receiving intra-arterial MPSS had significantly higher mean blood pressure, cardiac index, and blood glucose levels and a lower peripheral resistance during shock. Compared with the intravenous MPSS group, dogs treated with intra-arterial MPSS had significantly lower peripheral resistance and a nearly significantly higher cardiac index. Permanent survival rates were 26% in the control group, 60% in the intravenous MPSS group, and 50% in the intra-arterial MPSS group. Although treatment with intra-arterial MPSS was associated with a better hemodynamic profile than that following intravenous MPSS (suggesting the possibility of corticosteroid metabolism by the lung), survival was not enhanced. It was concluded that functionally insignificant amounts of corticosteroids given intravenously might be inactivated by the lung. Hence, intravenous MPSS injection is a practical and adequate means of administering this valuable agent in cardiogenic shock.

Animals↗
PubMed1979

Surgical treatment of pancreatic pseudocysts. Analysis of 119 cases.

A review was made of the hospital records of 119 patients with pancreatic pseudocysts. Alcoholism, biliary disease and abdominal trauma were the most common antecedent conditions. Abdominal pain was the most frequent symptom, and abdominal tenderness or mass were the most common physical findings. Abdominal echography and contrast study of the upper gastrointestinal tract were diagnostic in 90% of the patients examined. X-rays of the chest, colon, and biliary tract revealed pathology in 30--40% of the patients. Compared to patients with uncomplicated pseudocyst, patients who were acutely ill at the time of external drainage had twice the incidence of postoperative complications. Each subgroup experienced similar, high rates of postoperative death and pseudocyst recurrence. Both groups of patients treated by internal drainage had lower rates of postoperative morbidity, mortality, and pseudocyst recurrence than patients with uncomplicated pseudocysts undergoing external drainage. External drainage should be used in all patients with immature pseudocysts and in critically ill patients with mature pseudocysts not juxtaposed to a portion of the upper gastrointestinal tract. Internal drainage is a safer and more effective procedure in most other patients with mature pseudocysts, irrespective of the clinical status of the patient.

Adolescent↗
PubMed1978

Septic shock associated with operations for colorectal disease.

The hospital records of 24 patients with septic shock associated with the need for surgical treatment of diseases of the colon and rectum were reviewed. In this group of patients shock was caused by gram-negative or anaerobic microorganisms. The sources or infection were the abdomen, chest, and urinary tract. Nineteen (79 per cent) patients survived the acute shock episode, but only four (16 per cent) were permanent survivors. The 15 patients who died following resuscitation from shock succumbed to continuing infection and/or multiple organ failure. Although the timing of treatment did not affect immediate survival, long-term survival occurred only among those patients treated early in the course of shock. Accordingly, the pathophysiology of early septic shock is presented, and the need to recognize and treat the condition at this stage is emphasized. In addition, the author's current treatment protocol, with which they have been able to achieve 85 per cent acute and 60 per cent long-term survival, is discussed.

Adolescent↗
PubMed1978

A new model for the study of septic shock.

Septic shock was produced in 28 healthy mongrel dogs by injecting 10(8) Escherichia coli organisms per kilogram into the gallbladder following division of the cystic artery and duct. Based upon the circulatory responses and the mortality, two distinct groups emerged. In one, the cardiac index decreased significantly, and the total peripheral resistance was elevated. In the other, the cardiac index increased significantly, and the total peripheral resistance was significantly lower. The average survival time in the former group was three days and, in the latter, five days. The physiopathology of this model is remarkably similar to that of human septic shock. Studies are planned to further describe this model to increase its utility in the study of septic shock.

Animals↗
PubMed1976

Effects of allopurinol, propranolol and methylprednisolone on infarct size in experimental myocardial infarction.

With use of a canine model of occlusion of the left anterior descending coronary artery and an intracellular lactic dehydrogenase stain to measure infarct size directly, the effects of allopurinol, methylprednisolone sodium succinate and propranolol were studied. Allopurinol did not influence the extent of myocardial necrosis, whereas both methylprednisolone and propranolol significantly reduced myocardial infarct size. Possible mechanisms of action and clinical applicability of these agents are discussed.

Allopurinol↗
PubMed1976

Total pancreatectomy for ductal carcinoma of the head of the pancreas: current status.

Because of dismal results after pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas, a review was made of patients treated by total pancreatectomy for this condition. Although the early experience with total pancreatic resection was disappointing, the results during the past decade have been encouraging. Among the forty-two patients reported on with sufficient detail for analysis the operative mortality has been 17 per cent, and the morbidity has been 21 per cent. Sixty-five per cent of these patients (20 of 30) have survived at least one year and 53 per cent (16 of 30) have lived at least two years after surgery. The management of the diabetes and pancreatic insufficiency has not been difficult. Total pancreatectomy appears to be preferable to pancreaticoduodenectomy in the treatment of ductal carcinoma of the head of the pancreas.

Aged↗