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Biomedical subjects

M D Pasquale

Publications and source records attributed to M D Pasquale.

At least 37 records · Page 2Linked to original sources
PubMed1997

Outcome of blunt thoracic aortic injury in a level I trauma center: an 8-year review.

BACKGROUND: The purpose of this study was to evaluate our experience with blunt thoracic aortic injury and identify factors predictive of outcome. METHODS: Hospital charts, trauma registry data, and autopsies of 64 patients with blunt thoracic aortic injury from 1988 to 1995 were reviewed. RESULTS: Patients were identified and segregated based on admission physiology. Group 1 patients (n = 19) arrived in arrest. Group 2 patients (n = 10) arrived in shock with systolic BP 90. Group 3 patients (n = 35) arrived with systolic BP>90. All patients in groups 1 and 2 expired. Injury Severity Scores for nonsurvivors in group 3 (n = 12) were significantly higher than survivors. There were no significant differences when comparing time of injury to repair or arrival between groups, or in mortality or paralysis comparing repair techniques or clamp/bypass times. Double lumen endotracheal tubes caused significant operative delays compared to single lumen tubes. CONCLUSIONS: Predictors of survivability were hemodynamic stability on arrival and lower Injury Severity Scores. In thoracic aortic injury patients arriving hemodynamically stable, Injury Severity Score correlated with mortality but not paralysis.

Adolescent↗
PubMed1996

Predicting in-hospital mortality during cardiopulmonary resuscitation.

On the average, 10-15% of patients who undergo cardiopulmonary resuscitation (CPR) following a cardiopulmonary arrest in the hospital environment will survive to be discharged. The purpose of this study was to determine objective factors influencing patient outcome after CPR to determine who should be resuscitated and when to end CPR efforts. The records of 266 patients who underwent in-hospital CPR over a 3-year period were retrospectively analyzed with regard to age, gender, co-morbid conditions, setting of arrest, duration of resuscitation, initial pH and PO2 during resuscitation, and outcome of resuscitative efforts. Twenty-four (9%) patients survived to be discharged from hospital. Eighty-seven (33%) patients arrested in the intensive care unit, 77 (29%) on the ward, 91 (34%) in the emergency room, six (2%) in the cardiac catheterization laboratory and five (2%) in the operating room. There was no significant difference in survival based on location of arrest. Factors associated with a poor prognosis included age greater than 60, co-morbid disease (i.e. pneumonia, sepsis, renal failure, heart disease, etc.), an initial PO2 < 50 mmHg and CPR efforts extending beyond 10 min. Based on this data, guidelines regarding initiation and termination of CPR should be instituted in light of poor outcome in patients over 60 years of age with co-morbid conditions, specifically after 10 min of CPR.

Age Factors↗
PubMed1996

Early inflammatory response correlates with the severity of injury.

OBJECTIVE: To determine if the early inflammatory response correlates with the severity of injury in a blunt trauma model in rats. DESIGN: Prospective, randomized, controlled trial. SETTING: Research laboratory. SUBJECTS: Male Sprague-Dawley rats, weighing 250 to 400 g. INTERVENTIONS: Twenty-two male Sprague-Dawley rats were divided randomly into single hindlimb fracture, bilateral hindlimb fracture, and no fracture groups. At 90 mins, all animals underwent midline laparotomy and aspiration of blood from the inferior vena cava. Venous blood gas, plasma lactate, and plasma concentrations of tumor necrosis factor (TNF), prostaglandin F(6-keto-PGF1 alpha), and interleukin (IL)-6 were sampled. Statistical analysis was done via one-way analysis of variance and Scheffé post hoc analysis. In a second part of this experiment, the effect of hemorrhage on the release of IL-6 was evaluated. Animals in this group were compared with control and bilateral hindlimb fracture animals, using the Student's t-test. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in venous pH or base deficit among the groups. Oxygen saturation was significantly decreased in the bilateral hindlimb fracture group when compared with the control group. In the hemorrhage plus bilateral fracture group, oxygen saturation was significantly decreased when compared with the bilateral fracture group. lactate concentrations in plasma were increased in both fracture groups as well as the hemorrhaged groups. Plasma TNF concentrations were increased in the injured groups but there was no significant difference between single and bilateral hindlimb fracture groups. The 6-keto-PGF1 alpha concentrations were increased in both of the fracture groups when compared with the control group and there was a significant difference between single and bilateral hindlimb fracture groups. Similarly, circulating IL-6 concentrations were significantly higher in the bilateral fracture group than in the single fracture group; both fracture groups were significantly higher than the control group. Hemorrhaged animals had even higher IL-6 concentrations. CONCLUSIONS: Plasma lactate and TNF concentrations were affected by injury, however their concentrations did not correlate with degree of injury. IL-6 concentrations were increased early postinjury and correlated with severity of injury. The 6-keto-PGF1 alpha concentrations in plasma also correlated with the severity of injury and this phenomenon may represent early endothelial activation which may be the source of IL-6 release.

6-Ketoprostaglandin F1 alpha↗
PubMed1996

Defining "dead on arrival": impact on a level I trauma center.

OBJECTIVE: To determine the potential impact of defining criteria for "dead on arrival" (DOA) on a Level I trauma center. METHODS: From 1990 to 1994, trauma patients having cardiopulmonary resuscitation (CPR) performed by certified prehospital personnel were reviewed for time of CPR, outcome, and costs to determine whether any benefit would have been realized had DOA criteria been followed. RESULTS: A total of 106 patients had prehospital CPR; 20 did not meet DOA criteria and underwent resuscitation, three survived (15%). Eighty-six patients met DOA criteria; 16 were pronounced dead without further resuscitative efforts (in-hospital costs of $200/patient), while 70 (81%) had continued resuscitation with no survivors (in-hospital costs of $4150/patient). The positive predictive value for criteria was 100%. Had criteria been implemented, total cost savings over the 5-year period would have been $290,000. CONCLUSIONS: National DOA criteria could dramatically reduce the burden on trauma centers with an estimated minimum annual savings of $14 million.

Adult↗
PubMed1994

Primary lymphoma of the appendix. Case report and review of the literature.

Malignant lymphomas comprise 1-4% of the malignant neoplasms of the gastrointestinal tract, but appendiceal lymphomas are exceedingly rare. Herein is presented a case of a well differentiated lymphocytic lymphoma of the appendix found incidentally at hernia repair. Forty-six cases of appendiceal lymphoma have been reported since 1898 with a mean patient age of 25.7 years. Thirty-one patients presented with right lower quadrant pain, and a mass was an incidental finding in five. Of the 46 cases, follow-up was possible in 28. There were four deaths within 30 days of the operation and five deaths within 1 year. Although extensive follow-up is limited, there have been only two reported deaths secondary to primary appendiceal lymphoma since 1945 and these two cases are discussed in detail. Based on this extensive review, appropriate recommendations are made.

Aged↗
PubMed1994

Blunt injury augments interleukin-6 but not tumor necrosis factor in isolated, perfused rat hindlimbs.

An isolated, perfused hindlimb model in rats was used to examine the immediate inflammatory response after blunt tissue injury. A femur-fracture degloving model was used in isolated rat hindlimbs perfused with a modified Kreb's buffer (pH 7.4) containing albumin, washed human red blood cells (RBCs), amino acids, and glucose at 37 degrees C. Arterial and venous perfusate was sampled at 5, 20, and 80 minutes of perfusion. Initial experiments were conducted in perfusate void of white blood cells (WBCs), group 1 (-inj/-WBC, n = 6) and group 2 (+inj/-WBC). Subsequent experiments were conducted in perfusate containing activated WBCs, group 3 (-inj/+WBC, n = 6) and group 4 (+inj/+WBC, n = 7). Hindlimb muscle was analyzed for adenylate energy charge (EC) and lactate-to-pyruvate ratios (LPR) at the end of each perfusion. This preparation appeared metabolically stable in that oxygen consumption and lactate remained stable during the 80-minute perfusion and muscle EC and LPR indicated aerobic metabolism. Tumor necrosis factor (TNF) and thromboxane B2 (TXB2) were measured in all four groups while prostaglandin F (PGF1 alpha), IL-6, myeloperoxidase, and 8-isoprostane were measured in groups 3 and 4. Initial perfusions in the -WBC hindlimbs indicated no change in TNF release after injury. The TXB2 level increased during perfusion irrespective of injury. The PGF1 alpha was elevated at 80 minutes in both groups 3 and 4, however at 20 minutes PGF1 alpha levels were higher in group 4 compared with group 3. Interestingly, the IL-6 level was significantly elevated at 80 minutes in group 4 but not in group 3.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1994

Elective colostomy closure in an AIDS patient.

This article describes a 27-year-old patient with acquired immunodeficiency syndrome (AIDS) who underwent emergency sigmoid colostomy, Hartmann's pouch, and presacral drainage for rectal perforation. Three months later, he underwent uneventful elective colostomy closure, a procedure previously unreported in an AIDS patient. He remained without gastrointestinal symptoms for 14 months after colostomy closure until he died from central nervous system toxoplasmosis. A diagnosis of AIDS alone should not preclude colostomy closure in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Obstructive uropathy secondary to massive inguinoscrotal bladder herniation.

The bladder is partially involved in 1 to 4% of all inguinal hernias. However, few cases of massive inguinoscrotal herniation of the bladder have been described, all of which have involved unilateral hydronephrosis. We report on a 45-year-old man with incomplete voiding and massively enlarged right scrotum along with elevated creatinine who was found to have massive inguinoscrotal herniation. Preoperative computerized tomography showed bilateral hydronephrosis. Herniorrhaphy was successfully done through an inguinal incision. The left kidney regained normal function with a decrease in creatinine levels. This case is atypical because of the presence of massive inguinoscrotal herniation with bilateral hydronephrosis. Computerized tomography has proved to be a valuable tool in diagnosing such cases. Surgical repair and reduction of hernia can be accomplished through an inguinal incision.

Genital Diseases, Male↗
PubMed1993

Acute appendicitis and the use of intraperitoneal cultures.

We reviewed the charts of 200 patients with a preoperative diagnosis of acute appendicitis (AA) to evaluate the influence and use of intraoperative culture results on patient management and antibiotic selection. Cultures were obtained in 66 percent of patients; 16 percent of the cultures in patients with AA yielded positive results versus 88 percent of cultures in patients with perforated or gangrenous appendicitis (complicated appendicitis [CA]) and in nine patients, positive cultures were used to adjust antibiotic therapy. Patients with CA who had antibiotic changes based on culture results had a complication rate of 25 percent versus a 29 percent rate for this group as a whole. We conclude that intraoperative cultures in patients with AA are rarely positive and do not influence antibiotic therapy or patient management. In CA, antibiotic changes based on culture results do not seem to alter patient outcome. Surgeons tend to rely on the proved efficacy of empiric antibiotic therapy and other basic surgical principles to afford the best outcome for their patients. The routine practice of obtaining peritoneal cultures in patients operated upon for AA and CA should be abandoned.

Acute Disease↗
PubMed1993

Secondary organ dysfunction. From clinical perspectives to molecular mediators.

The systemic inflammatory response and progression to secondary organ dysfunction are manifestations of the host's responses to injury. This article outlines the clinical manifestations of this injury-response cascade. The potential roles of cytokines, eicosanoids, platelet-activating factor, nitric oxide, oxygen-free radicals, and the leukocyte-endothelial interaction are explored in some detail. A goal-directed therapy of source control, resuscitation, and metabolic support is reviewed, and new therapies with monoclonal antibodies and immunomodulated nutrition are described. These new therapies hold great potential for finally improving the outcome of this fatal syndrome.

Antibodies, Monoclonal↗
PubMed1992

Sengstaken-Blakemore tube placement. Use of balloon tamponade to control bleeding varices.

The management of acute variceal bleeding continues to challenge those who care for patients with portal hypertension. Survival depends on rapid institution of an established protocol for resuscitation, diagnosis, and management of the patient. Balloon tamponade plays an important part in the management of this problem along with pharmacologic and endoscopic modalities. It is important in closing, however, to note that guidelines for use cannot compensate for lack of experience and the authors agree with Vlavianos and colleagues in stating that without experience in its use, balloon tamponade is of limited value.

Balloon Occlusion↗
PubMed1992

Groshong versus Hickman catheters.

There has been an increasing need for safe and efficient means of establishing vascular access in the patient with cancer. Recently, the use of percutaneous cannulation of the central veins, using guidewires, venous dilators and tearaway introducer sheaths, has become a popular method of establishing such access. The greatest concerns with the use of such catheters include sepsis, thrombus formation within the vein and catheter malfunction. The current study compared the incidence of these complications with Groshong (Cath Tech CV catheters with Groshong valve) and Hickman (Bard Access Systems vascular access catheters) catheters. Although there was no significant difference in septic complications and thrombus formation between the two groups, there was a significant (p less than 0.05) difference in catheter malfunction. Patients with Hickman catheters experienced significantly less problems with one way intermittent and one way catheters than did patients with Groshong catheters. We conclude that, based on catheter function, the Hickman catheter appears to be a more favorable alternative when compared with the Groshong catheter in the patient with cancer.

Adolescent↗
PubMed1991

Gastric volvulus in the pediatric population.

Acute gastric volvulus in children is uncommon. Since 1899, only 77 cases have been documented in the world literature. In children, mesenteroaxial volvulus is the most common type and associated anatomic defects are the rule. Diagnostic delays result in gastric ischemia, perforation, and death. Nonoperative mortality is 80%. Early recognition, surgical reduction with gastric fixation, and repair of associated defects are the mainstays of therapy for acute gastric volvulus in the pediatric population.

Acute Disease↗
PubMed1989

Selective vs routine use of intraoperative cholangiography. An argument.

We reviewed the course of 314 patients who underwent cholecystectomy at a University Hospital in 1985. Two hundred eighty-five patients underwent cholecystectomy for cholelithiasis. Preoperatively elevated liver function test results, history of jaundice or pancreatitis, or operative findings of palpable common bile duct stone or dilated extrahepatic ducts were criteria for indicated cholangiography. Of 142 patients who had cholangiography with negative results, only 31 were indicated by these criteria. In 93 patients not having cholangiography performed, the criteria were met in only 8 patients. Of 38 patients who underwent common bile duct exploration, only 29 had stones. As operative time, morbidity, and cost were demonstrably increased in patients undergoing cholangiography, a selective approach is advocated. The number of unnecessary common bile duct explorations might be cut by almost half, while the incidence of finding clinically unsuspected yet significant common bile duct stones is negligible.

Cholangiography↗
PubMedDate not supplied

A fever workup guideline.

Fever is a common clinical problem in patients hospitalized with trauma. When an infection is suspected, it is important to identify the source of fever and begin definitive care before more severe morbidity occurs. An undirected approach with "pan cultures" has resulted in a high rate of negative cultures obtained and has increased patient care costs. By developing and using an evidence-based fever workup guideline, this institution was able to evaluate and identify infections and reduce costs.

Algorithms↗