PubMed Health⌕ Search

Biomedical subjects

L Flancbaum

Publications and source records attributed to L Flancbaum.

At least 73 records · Page 4Linked to original sources
PubMed1989

Improved survival from compound 48/80-induced lethal stress and inhibition of myocardial histamine and carnosine mobilization by lodoxamide.

The precise roles of carnosine and histamine in the physiologic response of the cardiovascular system to stress are unknown. We have previously shown in skeletal and cardiac muscle that carnosine serves as a histidine reservoir available for subsequent histamine synthesis following trauma and sepsis. This study was designed to quantify the effect of histamine-releasing and blocking agents on the myocardial carnosine-histamine pathway as well as on survival during severe stress. Four groups of mature (9-month-old) Sprague-Dawley rats were treated with either (1) saline, (2) lodoxamide (L, mast cell degranulation inhibitor), (3) compound 48/80 (a mast cell degranulator which causes stress), or (4) L followed by 48/80, and observed until agonal or the end of 30 min. When either endpoint was reached the animals were sacrificed and their hearts were removed for tissue analyses of histidine, histamine, 3-methylhistamine, and carnosine via high-pressure liquid chromatography. All five L-pretreated animals survived challenge with 48/80 while all five animals given 48/80 alone died (P less than .005). This mortality correlated well with the increase in the myocardial levels of histidine (P less than or equal to .0005), histamine (P less than or equal to .0077), and 3-methylhistamine (P less than or equal to .0004) and the decrease in carnosine (P less than or equal to .009) experienced by the animals treated with 48/80 alone in comparison to the control, L-only- and L + 48/80-treated groups. A protective effect of L was shown against the deleterious effects of 48/80 which is associated with prevention of myocardial carnosine mobilization to histidine and histamine. These data support the role of carnosine as a nontoxic myocardial histidine reservoir which is mobilized in response to stress-induced increases in histamine requirements.

Amino Acids↗
PubMed1989

Use of cholescintigraphy with morphine in critically ill patients with suspected cholecystitis.

Diagnosis of acute cholecystitis in critically ill patients is often difficult; clinical signs are subtle, and radiologic tests are nonspecific and have a high incidence of false-positive results. This study reviews our experience with intravenous morphine sulfate as an adjunct to promote gallbladder filling in 18 critically ill patients who demonstrated nonvisualization of the gallbladder during cholescintigraphy performed as part of a diagnostic workup for occult sepsis. Findings suggestive of a biliary source included fever, leukocytosis, abdominal tenderness, abnormal liver function test results, fasting, and total parenteral nutrition. Morphine was administered to all 18 patients after nonvisualization of the gallbladder; in 17 cases prompt visualization was noted, thus excluding cystic duct obstruction. The remaining patient underwent operation for acalculous cholecystitis. None of the 17 patients whose gallbladders were visualized had a subsequent clinical course consistent with untreated biliary sepsis. Radionuclide cholescintigraphy with morphine appears to be useful in the evaluation of critically ill patients with suspected biliary sepsis. It is particularly helpful in confirming or excluding the diagnosis of acute acalculous cholecystitis in patients who are fasting or receiving total parenteral nutrition and initially demonstrate nonvisualization of the gallbladder and in patients who have previously documented gallstones.

Biliary Tract Diseases↗
PubMed1989

Abdominal candidiasis in surgical patients.

Although abdominal candidiasis in critically ill surgical patients is becoming increasingly common, optimal management has not been defined. We treated 16 patients with abdominal candidiasis over a 36 month period. Violation of the gastrointestinal tract mucosa was the most common precipitating event (13 patients). Predisposing factors included: CVP catheters, broad spectrum antibiotics, and parenteral hyperalimentation in all patients, H2-blockers/antacids in 14 patients, as well as malnutrition (7 patients), DM (3 patients), alcoholism (3 patients), and steroids/chemotherapy (3 patients). Candida was isolated from an abscess in seven patients, peritoneal fluid in six patients and both in three patients. In four patients abdominal candidiasis was preceded by positive cultures from blood or two peripheral sites which had not been treated. All patients were treated with amphotericin B (146-4000 mg) without any major adverse effects. Fungal infection was eradicated in ten patients; three patients succumbed to candidiasis. Patients treated within seven days required less Amphotericin B and appeared to have a better outcome than those having delayed treatment. The authors conclude that abdominal candidiasis is a potentially lethal infection in critically ill surgical patients that should be aggressively treated. Amphotericin B can be safely administered and concurrent antibiotics need not be stopped.

Abdomen↗
PubMed1988

Vascular and neural invasion in colorectal carcinoma. Incidence and prognostic significance.

The incidence and significance of histologic vascular and/or neural invasion in 77 patients with colorectal carcinoma treated over a 6-year period were analyzed retrospectively. Vascular invasion was found in 37.6% of patients and neural invasion in 14.3%. The following three types of vascular invasion were identified: tumor lining epithelium, tumor thrombi, and destruction of the vessel wall. The incidence of metastases in patients with vascular invasion was 60% as opposed to 17% in those without vascular invasions (P less than 0.0001). Survival in these patients was 29.7% and 62.2%, respectively (P less than 0.003). Metastases were found in 72.7% of patients with neural invasion, as opposed to 27% of those without neural invasion (P less than 0.01). Survival was 29.6% as opposed to 57.7% in those without neural invasion (P less than 0.003). Even among patients in the same Dukes' stage, prognosis, as determined by incidence of recurrence, metastases, and survival, was worse significantly among those patients demonstrating vascular invasion (P less than 0.03). Examination of patients with colorectal carcinoma for the presence of vascular and neural invasion may provide useful information for determining future treatment and prognosis.

Colonic Neoplasms↗
PubMed1988

Blunt bladder trauma: manifestation of severe injury.

Twenty-nine patients with bladder injuries requiring operative treatment as a result of blunt trauma are presented. Motor vehicle accidents accounted for 86 per cent of the injuries. Hypotension and gross hematuria were the most prevalent clinical features, 68 per cent and 97 per cent, respectively. All patients had multiple associated injuries requiring operative treatment, average 2.9 per patient. Pelvic fractures occurred in 93 per cent and intra-abdominal injuries in 48 per cent of patients. The majority of ruptures (72%) were intraperitoneal. Mortality, related to associated injuries, was high (34%), attesting to the magnitude of injury sustained by the victim.

Abdominal Injuries↗
PubMed1988

The suicidal jailhouse hanging.

Jailhouse suicide is commonly attempted by hanging. Two prisoners recently have been treated in our trauma service after unsuccessful attempts at suicidal hanging. Both of our patients demonstrated problems related to hypoxic encephalopathy, fluid and electrolyte disturbances, and mental status change, all as a result of this injury. These patients' hospital course illustrates some of the salient features in the management of this unusual patient population.

Adult↗
PubMed1988

Blunt trauma to the liver. Analysis of management and mortality in 323 consecutive patients.

This study represents a 6 year 4 month experience with blunt trauma to the liver of patients from the Maryland Institute for Emergency Medical Services Systems, a major regional trauma center. The significance of this study is that it describes a large, relatively homogeneous population and analyzes what the state of the art for liver trauma has been in a center dedicated solely to trauma that has a full-time staff of trained traumatologists. Three hundred twenty-three consecutive patients with blunt liver trauma are presented, representing 3.5% of 9271 patients admitted to the institute over the period of this study. Ninety per cent had associated traumatic injuries requiring operative intervention. A mortality rate of 31% (101 patients) was noted; 41.5% of the deaths, due primarily to liver injury, occurred intraoperatively during the initial operation following admission. The use of simple suture techniques and resectional debridement to control hemorrhage are advocated. Anatomic lobectomy, intracaval shunting, and hepatic artery ligation were uniformly unsuccessful. The use of drains was associated with a significantly increased incidence of infectious complications (p less than 0.00002).

Adult↗
PubMed1988

Gastrointestinal complications after cardiac surgery.

Gastrointestinal (GI) complications after cardiac surgical procedures are infrequent but severe. Thirty-three GI complications were identified in 25 patients who underwent cardiac surgery during a 7-year period (2.0% incidence). The mortality rate for patients having these GI complications was 44%. Acute acalculous cholecystitis was the most lethal complication (86%). Acute pancreatitis was the most common complication (eight patients). Most patients responded well to conservative measures. Five patients had upper GI hemorrhage and three had lower GI bleeding that required more than 2 U of packed red blood cells. All patient conditions were diagnosed endoscopically and none necessitated operation. Of the remaining patients, one was operated on because of perforated duodenal ulcer, one because of perforated diverticulitis, and one because of pseudo-obstruction of the colon, and one patient underwent diagnostic laparotomy and showed negative results for presumed acalculous cholecystitis. Liver failure was fatal in all three patients in whom it occurred. GI complications correlated significantly with advanced age, prolonged bypass times, valve surgery, and the female sex. We conclude that septic GI complications--particularly acute acalculous cholecystitis and perforated viscus--after cardiac surgery are uncommon but lethal. Clinical features are often subtle, and a high index of suspicion is necessary for an early diagnosis and the institution of appropriate treatment.

Acute Disease↗
PubMed1988

Early diagnosis and treatment of blunt diaphragmatic injury.

Diaphragmatic rupture following blunt torso trauma is an infrequent injury often posing a considerable diagnostic challenge. Between June 1984 and July 1986, nine patients sustaining rupture of the diaphragm due to blunt trauma were treated. All were injured in high-speed motor-vehicle accidents. Six patients arrived in shock (SBP less than or equal to 95 mm Hg). All patients had multiple associated injuries; mean ISS = 41.5. Eight patients (89%) had associated intra-abdominal injuries, the spleen being injured most frequently (63%). Associated thoracic injuries occurred in six patients (67%). The admission CXR was abnormal in eight patients (89%) but diagnostic of diaphragmatic rupture in only four. DPL was positive in four of five patients (80%) and falsely negative in one. Seven ruptures were left-sided, one right-sided and one involved the central tendon. All injuries were diagnosed shortly after admission and successfully repaired via a transabdominal approach. One patient died as a result of a massive subdural hematoma. Blunt diaphragmatic rupture is an indication of a high-energy insult and is usually associated with other major organ system injuries. An aggressive approach to the management of the multiply injured patient can result in early recognition and successful treatment of this injury.

Adolescent↗
PubMed1987

Dobutamine in elderly septic shock patients refractory to dopamine.

The hemodynamic effects of dobutamine (2.5-20 micrograms/kg per min) were studied in six elderly patients with septic shock which was refractory to dopamine (15 micrograms/kg per min). Dobutamine infusion resulted in significant increases in cardiac index (CI), stroke index (SI) and left ventricular stroke work index (LVSWI) and similar declines in heart rate (HR), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance (SVR) and total pulmonary resistance (TPR). Dose response curves demonstrated a linear rise in CI with increasing doses of dobutamine and parallel decreases in HR and PCWP. MAP was unchanged. These data indicate that dobutamine may be a useful adjunct to dopamine therapy in the management of elderly patients with septic shock.

Aged↗
PubMed1987

The intra-aortic balloon pump as an adjunctive therapy for severe myocardial contusion.

The management of patients with post-traumatic myocardial contusion requires close electrocardiographic and hemodynamic monitoring. When complications such as cardiogenic shock occur, aggressive treatment using Swan-Ganz catheterization for monitoring of intravascular volume and cardiac inotropic support are necessary. Failure to restore hemodynamic stability using these measures is an indication for the use of intra-aortic balloon pump counterpulsation. A case of successful management of a patient with post-traumatic myocardial contusion complicated by refractory cardiogenic shock using intra-aortic balloon pump counterpulsation is presented. Use of the intra-aortic balloon pump improved cardiac output, eventually resulting in hemodynamic stabilization.

Adult↗
PubMed1987

The significance of stable patients with sternal fractures.

A retrospective review of patients admitted with sternal fractures without massive trauma to the chest or hypotension was undertaken. Chest pain was present in 59 of 60 patients while external signs of bruising were noted in one-third. The standard anteroposterior (AP) roentgenogram of the chest was diagnostic in all patients. Thirty-four (56.7 per cent) patients had 51 significant noncardiac injuries, an average of 1.5 injuries per patient. Most commonly, these were orthopedic injuries, fractures of the rib and closed head injuries. Sixty-two per cent of the patients with sternal fractures had abnormal electrocardiograms (ECG) at some time, of which 34 per cent had ECG changes consistent with ischemia. The admission ECG was normal in 20 (48 per cent) patients. Three of these patients subsequently had significant ECG changes. Fractures that were comminuted or involved the sternal angle were more likely to be associated with ECG abnormalities than were simple fractures of the sternal body. Only three patients had elevated creatine phosphokinase-myocardial bond fractions. Two dimensional echocardiography and biventricular radionuclide angiocardiography were normal in 11 patients, including five patients with ECG abnormalities. There were no deaths related to the sternal fractures per se or to associated injuries. Sternal fractures result from high energy trauma and should be suspected in patients with chest pain after blunt thoracic trauma. The lateral roentgenogram of the chest is the most useful diagnostic test. There is a high incidence of associated cardiac and noncardiac injuries in these patients mandating close observation with ECG monitoring in the intensive care unit.

Adolescent↗
PubMed1986

Orotracheal intubation in suspected laryngeal injuries.

Airway control in patients with suspected laryngotracheal injury following blunt trauma is a challenging problem. Tracheostomy remains the treatment of choice in most instances. This report describes a patient with a laryngotracheal injury in whom initial airway control was achieved using orotracheal intubation. The indications for this method are discussed, and an approach to initial airway management in these injuries is outlined.

Adult↗
PubMed1986

Blunt injury to the diaphragm: an analysis of 44 patients.

Forty-four patients sustaining blunt trauma with resultant diaphragmatic rupture during a 5 1/2-year period are presented. In 41 (93%), the diagnosis was established within 6 hours of admission. The correct diagnosis was made preoperatively in 19 patients operated on acutely (42%), in 22 (53%), ruptured diaphragm was an incidental finding at celiotomy or thoracotomy. The admission chest roentgenography, diagnostic peritoneal lavage, UGI contrast studies, and computed tomography were the most useful diagnostic aids. The transabdominal operative approach was utilized in 39 patients (89%). All patients had associated extra-abdominal injuries and 26 patients (59%) had associated intra-abdominal injuries. The mortality rate was 20.4%; early deaths were attributable to hemorrhage and severe head injury, late deaths to sepsis and progressive multiorgan failure.

Accidents, Traffic↗
PubMed1986

Emergency surgery in patients with post-traumatic myocardial contusion.

Little information concerning the prognostic and functional significance of post-traumatic myocardial contusion appears to exist. During a 10-month period, 19 patients with major blunt thoracic trauma were diagnosed as having myocardial contusion using clinical findings, serial ECG and CPK-MB isoenzyme determinations, and biventricular radionuclide angiocardiography (RA). All patients had associated thoracic and extrathoracic injuries. ECG and RA were useful and complementary tests, detecting abnormalities in 90% and 47% of patients, respectively. Only one patient had an abnormally elevated CPK-MB. All patients required operative treatment for associated injuries, 15 (79%) on the day of admission. Eleven patients required perioperative cardiac inotropic support and one needed IABP. No late complications were attributable to the cardiac contusions per se; no patients died. Emergency surgery for associated injuries in patients with myocardial contusion can be safely performed using hemodynamic monitoring to guide cardiac inotropic support measures. Myocardial contusion does not constitute an absolute contraindication to necessary operations in polytraumatized patients.

Adolescent↗
PubMed1986

Acute trans-rectus traumatic hernia.

Abdominal wall herniae following blunt trauma are rare. Two cases of acute traumatic rectus abdominis muscle and anterior rectus sheath hernia, an apparently unreported entity, are described. Early recognition of the injury by physical examination and sometimes ultrasonography or CT is important. Repair should be early except in selected cases.

Abdominal Muscles↗