Biomedical subjects

M D Kerstein

Publications and source records attributed to M D Kerstein.

At least 127 records · Page 7Linked to original sources

PubMed1990

Effects of prostaglandin E1 on oxygen delivery and consumption in patients with the adult respiratory distress syndrome. Results from the prostaglandin E1 multicenter trial. The Prostaglandin E1 Study Group.

We wanted to determine the long-term effects of a continuous infusion of PGE1 on DO2 and VO2 in patients with ARDS. Data were obtained from a randomized double-blind multicenter trial, which evaluated the effects of PGE1 on survival in patients with ARDS. Patients were stratified according to treatment and outcome: placebo-died (n = 8); PGE1-died (n = 12); placebo-survived (n = 9); and PGE1-survived (n = 8). In the placebo-died group, elevations occurred in VO2, which were associated with increases in O2ext and a constant DO2. In contrast, in the PGE1-died group, elevations in VO2 were associated with increases in DO2 and an unchanged O2ext. In the placebo-survived group, VO2 and DO2 decreased, whereas in the PGE1-survived group, VO2 and DO2 increased; however, O2ext decreased in both of these groups. Since impaired O2ext occurs in ARDS, PGE1-induced elevations in DO2, rather than compensatory increases in O2ext, may achieve better tissue oxygenation. We conclude that although the recently completed multicenter trial failed to show an enhancing effect of PGE1 on survival in patients with advanced ARDS, PGE1 may have important effects on oxygen transport and, therefore, may still have a role in the treatment of early manifestations of ARDS, either alone or in combination with other agents.

Alprostadil↗

PubMed1990

Analysis of cardiovascular and pulmonary responses to endothelin-1 and endothelin-3 in the anesthetized cat.

Cardiovascular and pulmonary responses to endothelin (ET)-1, ET-3 and neuropeptide Y (NPY) were investigated in the anesthetized cat. ET-1, 0.1 to 1 nmol/kg i.v., decreased or elicited biphasic changes in arterial pressure (AP), whereas ET-3, in the same doses, decreased AP. Both ETs increased cardiac output (CO) and, at the highest doses, a secondary decrease in CO was observed. NPY, 0.3 to 3 nmol/kg i.v., increased AP and at the highest dose decreased CO. All three peptides had inconsistent effects on right ventricular contractile force and increased central venous pressure. ET-1 at lower doses increased heart rate (HR) and, at 1 nmol/kg, caused a biphasic change. ET-3 increased HR, whereas NPY decreased HR. Systemic vascular resistance (SVR) was increased by NPY and decreased by ET-3, whereas ET-1 elicited biphasic changes. ET-1 and ET-3 increased pulmonary arterial pressure, left atrial pressure and caused biphasic changes in pulmonary vascular resistance (PVR). NPY had no significant effect on PAP or PVR. When pulmonary blood flow was maintained constant, ET-1 and ET-3 had only pulmonary vasoconstrictor activity, whereas NPY and the ET analog had no significant effect. The increase in SVR in response to NPY, the decrease in response to ET-3 or the biphasic change in response to ET-1 were not modified by meclofenamate, hexamethonium or propranolol. Increases in HR in response to ET-1 and ET-3 were reduced by the beta receptor and ganglionic blocking agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Penetrating injuries of the abdominal aorta.

The charts of 56 consecutive patients with penetrating injuries to the abdominal aorta were reviewed in an attempt to identify prognostic factors. Mechanism of injury was gunshot wound (GSW), 82 per cent (.22 cal: 15.2%; greater than .38 cal: 84.8%); shotgun wound (SGW), 5 per cent; and stab wound (SW), 13 per cent. Overall mortality was 73 per cent, with GSW 78 per cent (.22 cal: 0%; greater than .38 cal: 92%), 67 per cent with SGW, and 43 per cent with SW. Average initial systolic blood pressure (ISBP) was 53 (0-130); 87 (0-120) in survivors; and 40 (0-130) in nonsurvivors (NS). Eighteen patients (32%) had no ISBP, with one survivor. Thirty (54%) patients had ISBP less than 70, with three survivors. Six Emergency Department (ED) thoracotomies were performed, with five patients surviving to reach the operating room (OR), and none surviving long-term. Ten patients died in the ED, 18 during surgical intervention, six within 24 hr, and seven greater than 24 hr postop. Average time from injury to OR was 75 minutes, with 122 minutes in survivors, and 53 minutes in nonsurvivors (P less than 0.05); 49 minutes in those dying in the OR; and 58 minutes in those surviving the OR but dying postop (NS). At surgery, six patients had thoracotomy before celiotomy for control of the thoracic aorta, with three surviving the OR and two surviving long-term. Survivors had 2.53 associated injuries; nonsurvivors had 2.89 (NS). No significant difference was noted in number or location of associated injuries between survivors and nonsurvivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗

PubMed1990

Normal angiograms and carotid pathology.

Nonstenotic ulcerated atherosclerotic plaques of the carotid arteries may be associated with symptoms of transient ischemic attacks, amaurosis fugax, and stroke. Preoperative evaluation of patients with these symptoms has traditionally included ultrasound and arch aortography angiograms of the area of the carotid bifurcation. Recent evidence has shown that ultrasound is more accurate in detection and morphologic delineation of these nonstenotic lesions. We analyzed the hospital records of 21 patients with ultrasonographic evidence of disease in whom arteriograms were negative. The patient group comprised 15 men and six women, with an average of 66 years. All patients had symptoms of hemispheric transient ischemic attacks and were evaluated with B-mode ultrasound and arteriography. Ultrasound was positive and arteriogram "negative" in all of the patients (i.e., described by the radiologist as without hemodynamic significant disease or ulceration, or as normal). The ultrasound diagnosis was confirmed at operation with findings of 20 to 50 per cent stenosis and ulcerative plaques. At retrospective review of the arteriograms, three ulcerations were found in the 21 patients. We conclude that B-mode ultrasound better defines nonstenotic ulcerative lesions and decisions to perform carotid endarterectomy may be based on either positive test. An ulcerative plaque by B-mode ultrasound and appropriate symptoms, therefore, may not require angiography before operation.

Aged↗

PubMed1990

Patient compliance with fitted compression hosiery monitored by photoplethysmography.

This study assessed the compliance useage and impact by monitoring of graded compression hosiery in chronic venous disease. Diagnostic methods, such as qualitative photoplethysmography (PPG), have enabled the physician to assess deep-vein valvular incompetence earlier and begin specific treatment measures to slow the progression of symptoms. This study group, comprised of 100 patients, was diagnosed initially with deep-venous thrombophlebitis and evaluated by phleborrheography and PPG at three-month intervals for one year. The patients were instructed to wear fitted, graded compression hosiery after hospital discharge; compliance was 37% at one year. The primary reason for noncompliance was socioeconomic. The price of the ideal graded compression hosiery was not easily within reach of this population and insurance reimbursement was difficult or impossible to obtain. Complaint patients felt better while wearing the compression hosiery. Increasing deterioration of qualitative PPG values of deep-valve assessment was found in both compliant and noncompliant patients at each testing interval. The PPG value deteriorated as time increased with or without the compression hose, although symptoms lessened when the prescribed hosiery was worn. The long-term sequelae of wearing or not wearing the hosiery are yet to be determined, but PPG assessment is normalized with the hosiery in place.

Adult↗

PubMed1990

Postoperative somnolence in patients after carotid endarterectomy.

Eighty-one patients undergoing carotid endarterectomy were divided into two groups based on the degree of stenosis of the carotid artery. Group I, 37 patients, was defined as having severe carotid stenosis (greater than 70%). Group II, 44 patients, was defined as having mild (less than 40%) or moderate (40% to 70%) carotid artery stenosis. Both groups were evaluated for neurologic and psychologic changes in the postoperative period. Prospective analysis demonstrated no significant differences between groups I and II in the areas of cardiac disease, history of preoperative stroke, preoperative and postoperative hypertension, diabetes, or postoperative computed tomography changes. Group II had a significantly higher percentage of carotid artery ulceration (p less than 0.01). Postoperative analysis revealed 34 group I patients had 6 to 8 weeks of lethargy versus two group II patients (p less than 0.01). Eleven group I patients had headaches for the first week postoperatively versus three patients in group II (p less than 0.05). Four group I patients had paranoid ideation, and another four patients had clinical depression, but not one patient in group II (p less than 0.01) had these psychiatric disturbances. These data suggest that significant, reversible neurologic and psychologic changes can occur because of reperfusion after relief of severe stenosis of the carotid artery.

Aged↗

PubMed1989

Nisoldipine inhibits adrenergic responses in the hindquarters vascular bed of the cat.

The effects of the calcium entry blocking agent nisoldipine on adrenergic vasoconstrictor responses were investigated in the hindquarters vascular bed of the cat under conditions of controlled blood flow. Nisoldipine dilated the hindquarters vascular bed and inhibited vasoconstrictor responses to Bay K 8644, a nifedipine analog which promotes calcium entry. During infusion of nisoldipine, vasoconstrictor responses to sympathetic nerve stimulation, norepinephrine, and tyramine were inhibited in a reversible manner. In addition to blocking responses to nerve-released and exogenous norepinephrine, the calcium entry antagonist decreased responses to methoxamine and BHT 933, alpha 1- and alpha 2-adrenoceptor agonists. Responses to methoxamine were reduced by prazosin, an alpha 1-adrenoceptor antagonist, but not by yohimbine, an alpha 2-adrenoceptor blocking agent, whereas responses to BHT 933 were decreased by yohimbine but not by prazosin. The results of these studies suggest that vasoconstrictor responses to neuronally released and exogenous norepinephrine, as well as to selective alpha 1- and alpha 2-adrenoceptor agonists, are dependent in part on an extracellular source of calcium in resistance vessels of the feline hindquarters vascular bed. The inhibitory effect of nisoldipine on vasoconstrictor responses to neuronally released norepinephrine may be important in the antihypertensive actions of calcium entry blocking agents.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗

PubMed1989

Primary repair vs. colostomy for the treatment of penetrating colon injuries.

The charts of 81 consecutive patients with penetrating colonic trauma were reviewed. Sixty-five patients were considered for evaluation. Penetrating abdominal trauma index, associated injuries, length of operative procedure, wounding agent, length of hospital stay, method of treatment, and septic complications were evaluated. Twenty-eight patients were treated with colostomy at the site of injury: five with diverting colostomy proximal to repair, 30 with primary repair (either single or multiple injuries), and two with exteriorization and early drop back. Overall septic morbidity was 15 of 65 (23 percent) patients. No statistically significant difference was found in morbidity between colostomy, 9 of 33 (27 percent), and primary repair, 6 of 30 (20 percent). The two patients with exteriorized repairs had no morbidity. No deaths were reported among the 65 patients studied. Thirty-two of the 33 (97 percent) colostomies were later closed with morbidity in 7 of 32 (22 percent). The mean length of stay for primary repair patients was 10.3 +/- 2.8 days and for colostomy patients, 25.7 +/- 3.8 days, counting days for both initial and colostomy closure admissions (P less than .05). Colostomy was not mandated by anatomic location or number of colonic injuries, circumference of colonic wall involved, presence of fecal contamination, or involvement of mesenteric blood supply. This study indicates that primary repair does not carry an increased risk of septic complications and saves the patient the significant risk and increased hospital stay of colostomy closure. Prospective studies addressing this area are indicated.

Adult↗

PubMed1989

Subclavian-external carotid artery bypass graft. Restoring blood flow to the brain.

This article describes an unusual surgery for a type of carotid artery disease. The perioperative nurse has an important role on the vascular team when performing this procedure. For this reason, a thorough knowledge of the events and possible complications are important in the care of these patients. Careful preoperative nursing assessment and postoperative follow-up will help prevent any complications and promote a successful outcome in these patients.

Carotid Artery Diseases↗

PubMed1989

Transtracheal needle catheter ventilation in complete airway obstruction: an animal model.

Transtracheal needle catheter ventilation (TNCV) may be used as an alternative airway when contraindications to endotracheal intubation exist. A feline model tested the efficacy of low-flow oxygen delivery, and initial data were gathered to define proper catheter calibers to effect adequate oxygenation and ventilation. Cats were anesthetized, trachea intubated, and ventilated for 30 minutes with a pressure-regulated ventilator. Arterial and venous pressures were monitored, and a chest tube was inserted to measure intrathoracic pressures. Arterial blood gas analysis was performed every five minutes during the baseline period. The endotracheal tube was then removed, the trachea cross-clamped, and TNCV instituted. Oxygen flow rates of 1, 3, and 5 L/min were varied with catheter sizes of 14, 16, and 18 g. Data demonstrated that TNCV provided adequate oxygenation and ventilation with flow rates of 3 and 5 L/min with the 14- and 16-g catheters. Satisfactory oxygenation could be obtained with these flow rates with the 18-g catheter, but ventilation was inadequate. Ventilation was unsatisfactory with the 1 L/min flow rate in all catheter sizes. These preliminary data indicate that a minimum catheter:trachea cross-sectional area ratio of 0.03 may be required to obtain oxygenation and ventilation with low-flow oxygen rates of 3 to 5 L/min in cats.

Airway Obstruction↗

PubMed1989

Analysis of inferior venacavography before Greenfield filter placement.

The value of routine preoperative inferior venacavography through a femoral approach was assessed in 64 patients who required a Greenfield inferior vena cava filter. Nearly 11% of the patients had an abnormality, for example, duplication of the inferior vena cava, circumaortic renal vein, interrupted or discontinuous inferior vena cava, and so on, requiring an alternate approach to placement. No deaths or complications occurred upon recognition of the anatomic variant before filter placement. In three of the seven abnormalities encountered, adequate visualization and filter placement could only have been accomplished through femoral catheterization. Preoperative cavograms before Greenfield filter placement should be routinely performed using a femoral approach in the absence of contraindications to this technique.

Filtration↗

PubMed1989

Does open fasciotomy contribute to morbidity and mortality after acute lower extremity ischemia and revascularization?

A retrospective review was undertaken of 127 lower extremity fasciotomies performed for compartment syndrome after acute ischemia and revascularization in 73 patients with vascular trauma and 49 patients with arterial occlusive disease. One hundred twelve (88%) fasciotomies were performed early (at the time revascularization); 15 (12%) were delayed because of late compartment syndrome diagnosis. Ninety-four (77%) patients had more than one accepted indication for fasciotomy. Double-incision fasciotomy was used in 98 (77%) extremities, single-incision fasciotomy was used in 19 (15%), and fasciotomy-fibulectomy was used in 10 (8%). Fasciotomies were closed in 88 (69%) patients an average of 14 days after surgery. Seven patients needed multiple skin grafting procedures or myocutaneous flaps to close the wound; none compromised limb salvage. Five other patients had minor wound infections that resolved. Functional status returned to preoperative levels by the time of discharge from the hospital in 59 (48%) patients. Thirty-one (24%) patients had residual lower extremity disability related to delayed union of the fracture (five), chronic neuropathy (20), leg swelling (one), or ischemic nonhealing fasciotomy wounds (three); two patients had unrelated disabilities. Fourteen (11%) amputations were required for refractory limb ischemia; two (1.6%) were required for wet gangrene of the foot, which infected the fasciotomy site; the others had open noninfected incisions. Eighteen (15%) patients died of cardiopulmonary failure or multisystem failure or both, without fasciotomy-related problems. Open fasciotomy for compartment syndrome after acute lower extremity ischemia and revascularization was associated with an increased risk of minor wound morbidity. However, limb loss and death resulted from persistent ischemia and underlying systemic disease processes or injuries, but not from open fasciotomy wound complications.

Adolescent↗

PubMed1989

Percutaneous transtracheal catheter ventilation (PTCV) in complete airway obstruction--a canine model.

Percutaneous transtracheal catheter ventilation (PTCV) may be used as an alternative airway when contraindications to endotracheal intubation exist. A canine model tested the efficacy of low-flow oxygen delivery, coupled with commonly available intravenous catheters, for PTCV in a large animal model. Previous studies at this institution demonstrated the feasibility of this technique in a small animal model (feline). Eighteen mongrel dogs were anesthetized, intubated, and ventilated for 30 min with a volume ventilator. The endotracheal tube was then removed, the trachea cross-clamped, and PTCV was instituted and continued for 60 minutes. Arterial blood gas analysis was performed every 5-15 min during the experimental period. Oxygen flow rates of 3, 5, and 7 L/min were paired with catheter sizes of 10 and 12 gauge (g) creating six experimental groups (three animals in each group). Data demonstrate that PTCV provided adequate oxygenation (pO2 greater than 450 mm Hg) and ventilation (pCO2 less than 85 mm Hg) with flow rates of 5 and 7 L/min with both catheter sizes. Satisfactory oxygenation (pO2 greater than 250 mm Hg) could be obtained with the 3 L/min flow rate with both catheter sizes, but ventilation was inadequate (PCO2 greater than 200 mm Hg). Using readily available materials and low-flow oxygen rates this PTCV technique was shown to be safe and effective in oxygenating and ventilating this canine model with complete airway obstruction.

Airway Obstruction↗

PubMed1989

High cost of trauma care in the elderly.

Trauma in the elderly is a significant public health problem in terms of morbidity, mortality, and expenditure of health care resources. We compared injury severity score, length of stay, hospital charges, and mortality rate in a group of 60 elderly patients and a group of 60 younger patients admitted to our hospital. The older group had an average hospital stay that was more than four days longer, at an average hospital charge of $15,769.55, and their mortality rate was 15% versus 0% among the younger group. Despite early and aggressive care, the elderly continue to pose an important problem for trauma centers in terms of both length of stay and cost.

Adult↗

PubMed1989

Penetrating injuries to the colon: analysis by anatomic region of injury.

The preferred method for the treatment of penetrating injuries to the colon remains a source of controversy. In our retrospective review of 65 patients with penetrating colon injuries, 33 patients were managed by colostomy formation, 30 were treated by primary repair, and two had exteriorized repair with early return to the abdominal cavity (drop back). The anatomic location of injury was ascending colon in 19 (29%), transverse colon in 20 (31%), descending colon in 22 (34%), and multiple sites in four (6%). The average penetrating abdominal trauma index (PATI) was 24 (ascending colon injuries, 23; transverse colon, 26; descending colon, 24; and multiple colon sites, 28). Overall septic morbidity was 15/65 (23%). Colostomy closure was later done in 32/33 (97%), with a morbidity of 7/32 (22%). The mean length of hospital stay for primary repair was ten days and for colostomy (including both required hospital stays), 26 days (P less than .05). These data suggest that primary repair is as safe as colostomy formation for the management of penetrating colon injuries, regardless of anatomic site of injury.

Adult↗

PubMed1989

Deep vein thrombophlebitis and pulmonary embolism in patients with malignant gliomas.

Patients with malignant gliomas are at increased risk for deep vein thrombophlebitis (DVT) and pulmonary embolism (PE). Difficult anticoagulation in cancer patients undergoing surgery, chemotherapy, or radiotherapy limit the choices of therapy for DVT. Interruption of the inferior vena cava with a Greenfield filter is a safe method of treating patients who have malignant gliomas and DVT with PE. We studied 23 patients treated for malignant gliomas; 16 were men and seven were women, with a mean age of 51 years (range, 26 to 78). Five patients had DVT shown by noninvasive blood flow studies, and four subsequently had PE, as demonstrated by ventilation perfusion lung scan; in one patient PE was diagnosed at autopsy. Of the 23 patients, four with postoperative craniotomy had DVT and all four had PE. Two of the five patients who received preoperative chemotherapy had DVT and three had PE. All patients with PE had a Greenfield filter placed in the inferior vena cava via the internal jugular vein without adverse sequelae.

Adult↗

PubMed1989

Pregnancy and mesenteric venous thrombosis.

A 32-year-old pregnant black woman with multiple gastrointestinal symptoms was operated on because of peritoneal signs. Infarcted bowel caused by venous thrombosis was identified and resected. Laboratory studies, even in retrospect, were not diagnostic. The patient required extensive fluid resuscitation during the perioperative period; the perinatal period was managed by self-administered subcutaneous heparin. A normal birth via the vaginal route ensued.

Adult↗

PubMed1989

Analysis of regional responses to endothelin in hindquarters vascular bed of cats.

Regional responses to endothelin, a peptide derived from endothelial cells in culture, were investigated in the hindquarters vascular bed of cats, when flow varied naturally and when flow was maintained constant with a pump. Intravenous injections of endothelin at doses of 0.03 and 0.1 nmol/kg caused dose-dependent decreases in systemic arterial pressure and increases in distal aortic blood flow. Injection of endothelin at a dose of 0.3 nmol/kg iv caused a biphasic response characterized by an initial decrease in arterial pressure and an increase in blood flow, which was followed by a secondary rise in pressure and a fall in blood flow. When blood flow to hindquarters was maintained constant with a pump, intra-arterial injection of 0.03 nmol endothelin caused a decrease in perfusion pressure, whereas 0.1-1 nmol doses elicited biphasic responses characterized by an initial decrease followed by a secondary increase in perfusion pressure. When compared with other vasoactive peptides, the pressor activity of endothelin was less than angiotensin II by an order of magnitude but was threefold greater than that of neuropeptide Y in the hindquarters vascular bed. The pressor component of the response to endothelin and the response to the calcium agonist BAY K 8644 were decreased in a reversible manner by nisoldipine, a dihydropyridine calcium entry blocking agent. The results of these studies indicate that porcine-human endothelin has both vasodilator and vasoconstrictor activity in the hindquarters vascular bed of cats. The predominant response at a low concentration is vasodilation, whereas at higher concentrations a vasoconstrictor response that was dependent in part on the influx of extracellular calcium could be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗