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Biomedical subjects

C W Van Way

Publications and source records attributed to C W Van Way.

At least 37 records · Page 2Linked to original sources
PubMed1985

Amikacin concentrations in serum following intraoperative irrigation of the pleura and peritoneum.

Serum concentrations of amikacin following operative wound irrigation were studied in 17 patients having laporatomy and in eight patients having thoracotomy. Irrigation was done with 500 mg of amikacin in 200 ml of saline. The irrigant was reaspirated after 3 minutes. Measurement of amikacin in the irrigant allowed calculation of the retained dose. Serum levels were measured before surgery, and at 30 minutes, 60 minutes, 6 hours, and 12 hours following irrigation. Amikacin was assayed by a microbiological technique. The retained dose after peritoneal irrigation was 350 +/- 128 mg, and after pleural irrigation was 100 +/- 79 mg. The average maximum serum level in the peritoneal irrigation group was 9.4 +/- 6.7 gm/ml; in the thoracotomy group it was 3.5 +/- 1.7. Fourteen of the 17 laparotomy patients but only one of the eight thoracotomy patients had measurable plasma levels at 6 hours. Plasma half-life in the laparotomy group was 2.81 +/- 1.34 hours, and in the thoracotomy group 1.53 +/- 0.83 hours. Interoperative amikacin irrigation, even with immediate aspiration, results in significant absorption in both thoracotomy and laporatomy patients. There was less absorption and a shorter serum half-life in the thoracotomy patients.

Absorption↗
PubMed1985

Comparison of total parenteral nutrition with 25 per cent and 45 per cent branched chain amino acids in stressed patients.

Administration of total parenteral nutrition (TPN) solutions high in branched chain amino acids (BCAA) is thought to improve metabolic support during stress. This prospective, randomized, double blind study compared 45 per cent BCAA with 25 per cent BCAA in 12 patients. Seven patients had multiple trauma; two, gastrointestinal surgery; one, pancreatitis; and two, cirrhosis. The TPN regimen was 1.0-1.5 gm/kg/day amino acids and 30-45 glucose kcal/kg/day. The BCAA formula used was high in isoleucine and valine, but not leucine. Amino acid plasma levels, blood chemistries, 3-methylhistidine excretion, and nitrogen balance were studied. Control studies showed negative nitrogen balance (-7.1 +/- 2.9 gm) (mean +/- SEM), elevated insulin (61 +/- 21 microunit/ml), and elevated 3-methylhistidine (3MH) excretion (688 +/- 309 micromol); plasma leucine (93 +/- 11 nmol/ml) and isoleucine (37 +/- 23) were low, and valine (155 +/- 20) was elevated. Plasma methionine (40 +/- 9) and tyrosine (70 +/- 12) were high normal. Phenylalanine (85 +/- 5) was elevated. Both groups showed increased nitrogen excretion and positive nitrogen balance during the study (25 per cent, 2.0 +/- 1.4 gm/day; 45 per cent, 1.2 +/- 2.6 gm/day). Three-methylhistidine excretion changed little in either group (557 +/- 149, 414 +/- 91), insulin rose (135 +/- 27, 65 +/- 19), and plasma leucine (82 +/- 4, 71 +/- 9) changed little. Plasma isoleucine (51 +/- 3, 155 +/- 16) and valine (173 +/- 11, 691 +/- 23) both rose, more in the 45 per cent group. Methionine (67 +/- 12, 37 +/- 4) and tyrosine (51 +/- 6, 50 +/- 10) changed little.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Elevated pulmonary vascular resistance in patients dying from multiple organ failure.

Twenty-one patients with multiple organ failure were studied with hemodynamic monitoring. The five survivors were compared with the 16 nonsurvivors. Significant differences were found in the cardiac index (CI), the left ventricular stroke work index (LVSWI), and the pulmonary vascular resistance index (PVRI). The CI was higher in survivors (4.38 +/- 1.71) than in nonsurvivors (3.43 +/- 1.49). The LVSWI was also higher (43.0 +/- 16.8, 28.7 +/- 12.8) than in nonsurvivors (47.4 +/- 2.91). The PVRI was lower in survivors (168 +/- 122) than in nonsurvivors (474 +/- 291). It is postulated that the elevated PVRI in MOF is related to the adult respiratory distress syndrome.

Adult↗
PubMed1984

Severe thoracic and abdominal injuries associated with lap-harness seatbelts.

We report an unusual constellation of severe thoracic and abdominal injuries in a passenger restrained by a lap-harness seat belt during a high-speed automobile accident. This combination of injuries, which appears to have not previously been described, emphasizes the causative relationship of this protective device.

Abdominal Injuries↗
PubMed1983

The effect of intravenous safflower oil emulsion on the clotting mechanism.

A new fat emulsion for intravenous use, derived from safflower oil (Abbott Laboratories), was studied. The clotting mechanism was compared with a battery of tests performed during the infusion of total parenteral nutrition (TPN) using glucose alone and during infusion of TPN using both glucose and fat. Five adult surgical patients underwent TPN with 7.0 per cent amino acid solution for ten days, receiving glucose as their only nonprotein calorie source on days one, two, nine, and ten (40 kcal/kg/day). On days three through eight, 10 per cent fat emulsion (600-900 ml/day) was given each day to provide one-third of the nonprotein calories. Simplate bleeding time, prothrombin time, activated partial thromboplastin time, fibrinogen (Biuret method), platelet count, platelet aggregation, serum functional antithrombin, and viscoelastic curves were measured on days one, three, six, and ten. Some of these studies were abnormal at baseline and during the study. No significant changes were seen with fat emulsion infusion. The patients did not exhibit any evidence of clinical bleeding. This new intravenous fat emulsion did not appear to be associated with alterations in the clotting mechanism. However, two of five patients showed increases in serum triglycerides and one patient died during the study.

Adult↗
PubMed1982

A feasibility study of computer aided diagnosis in appendicitis.

In this study, the hypothesis that computer aided diagnosis could enable a more accurate differentiation between patients with acute appendicitis and those with abdominal pain but normal appendixes was examined. A data base was established by analyzing the records of 476 patients having an emergency measure appendectomy during a five year period. There were 360 or 76 per cent with acute appendicitis, 98 or 20 per cent with normal appendixes and 18 or 4 per cent with other diseases requiring operation. The records were analyzed with regard to history, physical examination and laboratory findings. The data base was then divided randomly into two parts. Part 1 was subjected to univariate discriminant analysis, using the chi-square test. The only quantities which were significantly different between appendicitis and a normal appendix were sex, duration of symptoms, anorexia and vomiting. Multivariate discriminant analysis was used to derive an abdominal pain index which discriminated between appendicitis and a normal appendix with a sensitivity of 0.82 and a specificity of 0.39. Using the abdominal pain index to evaluate the patients in part 2 of the data base, 23 or 40 per cent of the 58 patients with a normal appendix would have avoided operation. However, 31 or 18 per cent of the 169 patients with appendicitis would have not been operated upon; three of those 31 had perforated appendixes. Computer aided diagnosis was no more effective than unaided clinical diagnosis in appendicitis.

Abdomen↗
PubMed1982

Clinical evaluation of a low lint surgical sponge.

To evaluate a new low lint, nonwoven surgical sponge material, a prospective, stratified, randomized, single blind study of 232 patients was carried out. Patients studied underwent thoracic, upper abdominal or lower abdominal operations. The new material, in the form of laparotomy pads and sponges, was compared with cotton gauze. Safety of the material was evaluated by a battery of biochemical and hematologic tests. No clinically significant differences were seen. Effectiveness was evaluated by measuring fluid absorption. The new material was significantly more effective than cotton gauze in both configurations studied. Since this article was completed, the sponge material has been refabricated into laparotomy pads which are appreciably softer and more comformable than the study pads. The newest revision has been cleared by the Food and Drug Administration for clinical use.

Abdomen↗
PubMed1981

Vascular trauma in the groin: contrast between iliac and femoral injuries.

Vascular injuries to the groin are common and often life-threatening. Injuries above the inguinal ligament, to the iliac system, are associated with a 37 percent mortality. Associated intraabdominal injuries are common. These patients must be identified promptly, given broad-spectrum antibiotics and taken immediately to the operating room for exploration through a midline incision. Injuries below the inguinal ligament are usually to the femoral vessels and are rarely fatal. These patients may be evaluated more extensively before leg exploration. Associated intraabdominal injuries are unusual, but disability from femoral fractures and nerve injuries are common.

Abdominal Injuries↗
PubMed1980

Complications of tube thoracostomy for acute trauma.

Closed tube thoracostomy is a common and very useful procedure in therapy of acute thoracic injury. However, it is not without risk. With aggressive use of this procedure in the emergency department, the incidence of technical complications was 1 percent. Our review suggests that complications can be further diminished by the routine use of large thoracostomy tubes that are placed well up on the chest after confirmation of an open pleural space, by avoiding the use of a trocar for tube placement, and by the use of a high volume, low pressure suction system. Empyema was the most common complication associated with tube thoracostomy after trauma. It occurred in 2.4 percent of the patients. Its exact causes is not known, and the role of prophylactic antibiotics needs to be established.

Adolescent↗
PubMed1980

Temporary cardiac pacing in traumatic arrest victims.

Temporary ventricular pacing was successfully employed in two patients suffering refractory bradycardia following traumatic cardiac arrest. The hemodynamic response to pacing was dramatic and both patients eventually recovered fully from an apparent moribund state. Cardiac pacing may be an effective adjuvant in the early resuscitation of the massively injured patient.

Adult↗
PubMed1976

Studies of plasma renin activity in coarctation of the aorta.

Experimental and clinical studies were performed to assess the role of the renin-angiotensin system in producing hypertension in coarctation of the aorta. Basal and stimulated peripheral plasma renin activity were determined in the canine model and in four patients with coarctation. The animal studies showed no significant elevation of peripheral plasma renin activity (PPRA), and no increase in the response of PPRA to stimuli. The human studies showed a significant elevation in the response to PPRA to postural change and to exercise in three of four patients with coarctation, as compared to the same patients after correction of the coarctation. It is concluded that hyperactivity of the renin-angiotensin system is not the primary cause in coarctation hypertension in dog or man. It is nonetheless probable that the renin-angiotensin system has a role in coarctation hypertension, and further studies will be necessary to determine its place.

Adolescent↗
PubMed1976

Hemorrhagic necrosis of pheochromocytoma associated with phentolamine administration.

A case of ruptured pheochromocytoma is presented, the pathophysiology discussed, and the literature reviewed. Evidence is presented that the use of alpha-adrenergic blockade in general, and phentolamine in particular, may predispose to this complication. Twelve cases of massive hemorrhagic necrosis with or without rupture were found in the literature, including the present case. Six had no operation; one survived. Six had immediate operation; 4 survived. An additional case of hemorrhage into a small pheochromocytoma following phentolamine is presented. This tumor was neither ruptured nor massively necrotic, but the case supports the hypothesis that alpha-adrenergic blockade may cause hemorrhage within the pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1975

Nitrogen balance in postoperative patients receiving parenteral nutrition.

Fifteen patients were given parenteral nutrition with hyperosmolar glucose during the postoperative period (days 1 to 5): nine received an average of 10.5 gm of nitrogen and 2,340 kilocalories/day, six were given an average of 5.9 gm of nitrogen and 1,600 kilocalories/day. Eight patients (controls) received no nitrogen and 520 kilocalories/day. The results of this study confirm our early findings that total parenteral nutrition is capable of reversing the negative nitrogen balance of the immediate postoperative period; this reversal depends on administration of adequate nitrogen and calories. In patients with moderate surgical procedures, at least 8 gm of nitrogen and 1,800 kilocalories/day are required to correct the negative nitrogen balance. When total parenteral nutrition is instituted, adequate nitrogen and calories should be given even if insulin is required to control hyperglycemia.

Dietary Carbohydrates↗