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Biomedical subjects

D Coln

Publications and source records attributed to D Coln.

26 records · Page 2Linked to original sources
PubMed1980

Successful management of hepatic vein injury from blunt trauma in children.

In children, the majority of deaths from blunt trauma to the liver are caused by large stellate fractures of the posterolateral aspect of the right lobe of the liver with extension into the hepatic veins. Four children with such injuries were successfully treated. Hypotension and abdominal tenderness are not early manifestations of this highly lethal injury in children. When an appropriate mechanism for liver injury exists, paracentesis or peritoneal lavage, followed by prompt laparotomy for hemoperitoneum gives the best chance for early and successful treatment. Large cannulas in arm veins and cross matching for twice the patient's blood volume are used when there is a possibility of a liver injury. The important aspects of operative management are identification of the injury when the abdomen is first opened and prompt control of bleeding. The possibility of hepatic vein injury exists if the surgeon finds the coronary ligament disrupted by a large liver laceration of the posterolateral liver surface. Compressing the liver the diaphragm will usually control the bleeding while blood replacement is accomplished. The hepatic vein entrance into the inferior vena cava is then exposed using a median sternotomy, if necessary. Partial occlusion of the inferior vena cava can usually be safely done with this direct approach if the blood volume has been restored. Frequently valuable time and blood are lost if attemps are made to insert internal shunts.

Child↗
PubMed1978

Blunt trauma to the pancreas in children.

Sixteen children below the age of 12 were operated on for blunt injury to the pancreas during a ten-year period. Unless there was an associated injury, signs and symptoms did not immediately develop. Common to the delayed manifestation of an injury to the pancreas was history of an impaling force to the upper abdomen, abdominal tenderness, and an elevated serum amylase level. The postoperative morbidity for contusion of the pancreas was unpredictable, and a prolonged period without oral alimentation should be anticipated.

Child↗
PubMed1977

Hepatic angiographic changes after trauma.

Selective hepatic arteriography has a limited role in determining the extent and prognosis of injuries to the liver after surgical exploration and treatment. In this small series of thirty asymptomatic patients, there was no difference in the type or extent of injury or in the postinjury convalescence in patients who had abnormal or normal hepatic arteriograms. Angiographic abnormalities of avascular filling defects, pseudoaneurysms, arteriobiliary fistulas, contusions, and occlusions of the hepatic artery were demonstrated in our patients. The demonstration of these hepatic arteriographic abnormalities did not affect the convalescence of our patients if they were asymptomatic. Although hepatic arteriography can be helpful in establishing a diagnosis of hepatic trauma and in defining the extent and location of such injuries, arteriographic abnormalities are not the only criteria for the diagnosis of liver injuries. Arteriography is an ancillary technic to be used in relation to the clinical course of the patient.

Adolescent↗
PubMed1977

Nonoperative management of hemobilia.

Traumatic hemobilia is an uncommon complication of blunt or penetrating liver injury and is characterized by jaundice, biliary colic, gastrointestinal hemorrhage, and a recent history of abdominal trauma. The clinical diagnosis of hemobilia is confirmed by endoscopy and selective arteriography. Selective hepatic artery angiography will locate the site of bleeding, and determine the extent of liver injury. The choice of treatment of hemobilia depends on the severity of the hemorrhage and the extent of injury. The treatment of massive or persistent hemobilia is surgical drainage of hematoma and ligation of bleeding sites. Non-massive hemobilia may be treated conservatively with liver healing documented by serial selective arteriograms. The nonoperative treatment of a case of non-massive hemobilia with a good result is presented.

Adult↗
PubMed1976

The mechanism of action of gastrin on the lower esophageal sphincter.

Gastrin I or pentagastrin caused contraction of the lowe esophageal sphincter in anesthetized oppossums. The contraction was not modified, either qualitatively or quantitatively, by 30 or 1000 mug per kg atropine pretreatment. Moreover, neural block with tetrodotoxin did not influence the effect of gastrin on the sphincter pressure. H2 receptor antagonist, metiamide, did not modify the magnitude of the contractile response of the lower esophageal sphincter to gastrin I. These studies show: a) gastrin does not cause sphincter contraction by stimulating cholinergic neurons: and b) gastrin does not exert an inhibitory effect on the sponcter pressure by stimulating H2 receptors. We suggest that gastrin may contract the lower esophageal sphincter by a direct action on the sphincter muscle.

Animals↗
PubMed1975

A technique for drainage through the bed of the twelfth rib.

Operations in the upper part of the abdomen with anticipated large postoperative collections are best drained through the most direct and dependent route. An effective method through the bed of the twelfth rib, which uses intra-abdominal resection of the rib and a wire suture for locating the drains, has proved satisfactory without compromising dependency or directness. It can be used for the insertion of Penrose drains or a sump catheter with equal effectiveness.

Abdomen↗