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Biomedical subjects

D A Browdie

Publications and source records attributed to D A Browdie.

17 recordsLinked to original sources
PubMed1991

Diagnosis of poststernotomy infection: comparison of three means of assessment.

Of 737 adults undergoing cardiac operations through a median sternotomy over a 2-year period (January 1988 to January 1990), sternal-substernal space infection requiring mediastinal exploration developed in 8. Six of these patients as well as 18 additional patients were evaluated for possible poststernotomy wound infection by computed tomography (4 true positive, 4 false positive, 10 true negative, 2 false negative), indium-111 leukocyte scanning (5 true positive, 0 false positive, 18 true negative, 1 false negative), and epicardial pacer wire cultures (6 true positive, 1 false positive, 12 true negative, 0 false negative). On the basis of this experience it is suggested that in addition to computed tomography, indium-111 leukocyte scanning and epicardial pacer wire cultures may be useful in the diagnosis of poststernotomy deep wound infection.

Humans↗
PubMed1990

Temporary banding of the gastroesophageal juncture in a very small neonate with esophageal atresia and tracheoesophageal fistula.

A 700 gm, small-for-gestational-age infant with severe respiratory distress, esophageal atresia, and Type C tracheoesophageal fistula was treated with initial banding of the gastroesophageal juncture followed by a gastrostomy. Primary repair was completed later, when the infant had stabilized and grown. Continuous air pressure had distended the fistula, thus dilating the distal esophagus and facilitating repair. In very small, high-risk infants with Type C esophageal atresia and tracheoesophageal fistula, banding of the distal esophagus enables enteral feeding and time for growth while protecting the lungs from repetitive aspiration and pneumonia and facilitates subsequent repair. The patient described here is one of the smallest infants reported to survive this problem. It is also the first time the enlargement of the distal pouch and removal of the band from above have been described.

Abnormalities, Multiple↗
PubMed1984

Surgical management in interrupted aortic arch and atrioventricular canal.

This report concerns the management of two infants born with a combination of interrupted aortic arch with atrioventricular canal and possible left ventricular hypoplasia. Staged management including initial reconstruction of the aortic arch followed by partial intracardiac correction and, finally, closure of intentionally created atrial septal defects was successful.

Aorta, Thoracic↗
PubMed1979

The use of prostaglandin E1 and Blalock-Taussig shunts in neonates with cyanotic congenital heart disease.

Six unselected neonates with cyanotic congenital heart disease and life-threatening degrees of arterial oxygen desaturation have been managed by a protocol that includes administration of prostaglandin E1 (PGE1) and early Blalock-Taussig shunting. In 5 patients (seven paired observations) partial pressure of arterial oxygen (PaO2) rose from 19 mm Hg to a mean of 32.9 mm Hg within 20 minutes of initiation of PGE1 (0.1 to 0.2 microgram/kg/hr), infused intravenously or through an aortic catheter placed at ductal level or with both methods. The nonresponsive patient was older than the patients showing a positive response (1 month versus 24 to 96 hours). Following catheterization, immediate palliative operation including a Blalock-Taussig shunt was carried out. Although all had a satisfactory PaO2 (mean, 49 mm Hg) postoperatively, the PGE1-nonresponsive patient experienced serious intraoperative bradycardia, hypotension, and acidosis in contrast to the PGE1-responsive group. In this study, the use of PGE1 was not associated with any apparent serious side effects.

Drug Evaluation↗
PubMed1977

Adult respiratory distress syndrome (ARDS), sepsis, and extracorporeal membrane oxygenation (ECMO).

This report presents data obtained in the care of 830 patients requiring assisted ventilation. When these patients were divided into groups by the severity of their respiratory failure as defined by the duration of ventilatory assistance (greater than 48 hours, less than 48 hours) and level of positive end expiratory pressure (PEEP) required (greater than 5 cm HoH, less than 5 cm HoH), it was found that evidence of concurrent bacterial infection was present in the majority of patients with severe respiratory failure. This finding could not be explained by infection acquired after the onset of respiratory failure. In addition, this analysis demonstrated the important association of active pulmonary infection with the occurrence of barotrauma in these patients. Case analysis of patients subjected to extracorporeal membrane oxygenation has led to the suggestion that underlying sepsis in patients failing to respond to conventional ventilatory assistance similarly limits the usefulness of membrane oxygenator support.

Adolescent↗
PubMed1977

Effect of Corynebacterium parvum on colony-stimulating factor and granulocyte-macrophage colony formation.

Because Corynebacterium parvum has tumor-inhibitory properties and stimulates granulocyte-macrophage production, it may have clinical value in combination with chemotherapy. The leukopoietic effect of killed suspensions of C. parvum was studied in mice using the technique of in vitro clonal culture of hematopoietic cells. After C. parvum injection, there was a prompt, sustained elevation of serum colony-stimulating factor followed by an increase in granulocyte-macrophage precursor cells in the spleen and increases in blood mononuclear and granulocyte cells. Colony-stimulating factor production is suggested as a major mechanism of stimulation of granulocyte-macrophage proliferation by C. parvum. Since rapidly proliferating hematopoietic cells may have increased sensititity to cytotoxic agents, the details of hematopoietic stimulation by C. parvum may be critical in the sequential timing of combined C. parvum and chemotherapy treatment to obtain maximal tumor inhibition and minimal hematopoietic toxicity.

Animals↗
PubMed1975

Ineffectiveness of methylprednisolone in the treatment of pulmonary dysfunction after cardiopulmonary bypass.

Fifty consecutive adults undergoing elective cardiac surgery with cardiopulmonary bypass received a single dose of methylprednisolone (30 mg/kg) at the time of anesthesia. The results were compared with those in the immediately preceding fifty adult patients who underwent elective cardiac surgery and who did not receive corticosteroids. The age, sex, and weight of the patient, mortality, nature of the lesions treated surgically, bypass time, smoking history, physiologic evidence of preexisting lung disease, preoperative New York Heart Association class, preoperative left ventricular end diastolic pressure, incidence and duration of the postoperative low cardiac output syndrome, postoperative arrhythmias, operative and postoperative blood loss and postoperative hours of respiratory support, dynamic lung-thorax compliance, alveolar arterial oxygen gradient, fraction of wasted ventilation, and incidence of tracheostomy were tabulated and statistically contrasted. The two groups were comparable relative to all preoperative factors, except for a slightly higher end diastolic pressure in the patients who received steroids. Methylprednisolone given at the time of anesthesia was associated with a higher intraoperative blood loss, a higher incidence of low cardiac output syndrome, and an increased requirement for postoperative mechanical ventilation. As bypass time approached three hours, the proportion of patients requiring prolonged support in both groups became similar. It was concluded that pretreatment with methylprednisolone in massive doses had an overall adverse cardiopulmonary effect.

Adult↗
PubMed1975

Clostridium sordelli infection.

A case of human Clostridium sordelli soft tissue infection is presented. Analysis of this patient's course led to the use of a mouse experimental model for examination of this organism's potential for toxin production. Data thus obtained correlated with that seen in this instance of human infection, indicates that the lethal effects of this organism may be related to the ability to Clostridium sordelli to produce a widespread "toxin-mediated" edema with subsequent marked "third-space" sequestration of fluid.

Adult↗