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Biomedical subjects

P Mongan

Publications and source records attributed to P Mongan.

10 recordsLinked to original sources
PubMed2000

Induced hypothermia during emergency department thoracotomy: an animal model.

BACKGROUND: Induced hypothermia is used clinically to prevent ischemic injury during elective procedures. We present an animal model of asanguinous hypothermic (10 degrees C) circulatory arrest, induced through a left anterior lateral thoracotomy after exsanguinating uncontrolled hemorrhage. METHODS: Through a left anterior thoracotomy, 26 swine (45-70 kg) sustained a laceration of the descending thoracic aorta, producing exsanguinating uncontrolled hemorrhage. After 5 minutes of severe hypotension (systolic BP <20 mm Hg), a 22 French Foley catheter was directed cephalad through the enlarged aortic wound. A solution (containing 42.5 mmol/L K+ and precooled to 1 degrees C) was infused to arrest/preserve the heart and brain. A second 24 French Foley catheter was then directed caudally through the same wound. The right atrium was opened to drain the venous system. The animal was cooled with a cardiopulmonary bypass pump (>5L/min) through the Foley catheters. Once 10 degree C was reached, a cannula was placed to the aortic root and the aortic laceration repaired. The animal was maintained at 10 degree C for a total of 90 minutes. Before the rewarming process, the circulation was rinsed with a solution containing normal levels of electrolytes followed by infusion of whole blood. Rewarming was performed by maintaining a 10-degree gradient on the heat exchanger. The first 16 animals were used in nonsurvival experiments to develop the technique and to record dural temperatures and electroencephalogram tracings. The last 10 animals were used to determine long-term survival and neurologic outcome. Group I: seven animals were kept at < 10 degrees C with flows less than 2L/min. Group II: three animals underwent 20, 30, and 40 minutes of no flow once they were cooled to 10 degrees C. After 6 weeks of survival and neurologic examinations, the brains were fixed for histologic evaluations. RESULTS: The average time to cool the head to 18 degrees C and 10 degrees C was 6 minutes and 12 minutes, respectively. The hematocrit fell below 2% by the end of the cooling period. A total of 7 of the 10 animals from the long-term study survived. Group I: five of seven animals survived. Four of the survivors had no appreciable neurologic deficits, were fully functional at 6 weeks, and had no evidence of histologic injury. One of the five survivors in this group had moderate neurologic disability. Of the two animals that died, one died from air embolism from the i.v. line. The second death was in an animal for which maximal cooling to 2.7 degrees C was attempted. Group II: The first two animals that had "no flow" for 20 and 30 minutes were fully functional and had normal neurologic examinations. However, the second animal was found to have brain injury on histologic examination. The last animal in this group died of accidental extubation during recovery. CONCLUSION: Induction of hypothermic arrest through the chest after exsanguination is possible. The further development of this technique may provide an extended state of "suspended animation" to allow for repairs of hemorrhaging injuries in trauma patients who require emergency department thoracotomy.

Animals↗
PubMed1999

Inhaled nitric oxide attenuates increased pulmonary artery pressure following diaspirin crosslinked hemoglobin (DCLHB) administration.

Intravenous administration of diaspirin crosslinked hemoglobin (DCLHb) can result in elevated pulmonary and systemic arterial pressures in some mammalian species. This study was designed to evaluate the ability of inhaled nitric oxide (INO) to attenuate elevations in pulmonary artery pressure in a closed-chested swine model. Yorkshire pigs received escalating doses of INO followed by escalating doses of DCLHb or a single dose of DCLHb followed by escalating doses of INO. Systemic and pulmonary arterial pressures were monitored continuously. Significant elevations occurred in systemic and pulmonary arterial pressure following a cumulative dose of 0.1 gm/kg DCLHb. A single dose of 0.3 gm/kg also resulted in elevations of pulmonary and systemic arterial pressure. Inhaled nitric oxide partially reversed the changes in pulmonary but not systemic pressure. These results indicate that INO might be a therapeutic option for humans who may experience increased pulmonary artery pressure following administration of DCLHb.

Administration, Inhalation↗
PubMed1995

Experience of abuse in primary care patients. Racial and rural differences.

OBJECTIVE: To examine the experience of abuse in rural, urban, black, and white women on the following dimensions: prevalence, symptom experience, health status, medical services utilization, and coping mechanisms. DESIGN: Retrospective study using patient interviews. SETTING: Half the subjects were recruited from a large medical university family medicine center and half from a rural family medicine center, both in the Southeast. PATIENTS: Four hundred seven women were interviewed. Groups were distributed as follows: urban white, 24.9% (n = 99); urban black, 25.6% (n = 102); rural white, 11.1% (n = 44); and rural black, 38.4% (n = 153). MAIN OUTCOME MEASURES: Self-report of abuse (sexual, physical, and emotional) was related to symptom history, current health status, medical services utilization, and coping styles. RESULTS: Sixty-six percent of the total sample reported some kind of abuse. Black, rural women reported the least (52.3%). Presence of greater numbers of symptoms, greater medical services utilization, and lower health status were found in the abused population. Abused women used all types of coping mechanisms to a greater extent than non-abused women. Black women were more likely to use confrontation (F = 8.82 [P = .003]), problem solving (F = 8.24 [P = .004]), and reappraisal (F = 4.13 [P = .04]) than white women. Rural women were more likely to use psychological distancing (F = 5.25 [P = .02]) and escape (F = 5.67 [P = .02]) than urban women, although abused women in general use those coping methods more than nonabused women. CONCLUSIONS: The experience of abuse remains similar across black, white, rural, and urban women; however, coping mechanisms appear to be influenced by group membership.

Adaptation, Psychological↗
PubMed1992

Pressure monitoring can accurately position catheters for air embolism aspiration.

Venous air embolism is a potentially catastrophic surgical complication. While prevention and early diagnosis represent the cornerstones of management, definitive therapy of a massive air embolus relies on aspiration of the air through an appropriately located multiorifice catheter. Currently, the most common method for accurately positioning a multiorifice catheter in the high right atrium is an intravenous electrocardiogram (IVECG). Because that method is not always technically feasible, we evaluated a right ventricular waveform as a marker for accurate and reliable catheter localization. Twenty patients were prospectively evaluated. After successful insertion of an antecubital introducer sheath, a multiorifice catheter was advanced into the central circulation (5 orifices, one at the distal tip and four 1.0 x 1.5 mm side orifices spaced 0.5 cm apart beginning 1.2 cm from the distal tip). Simultaneous IVECG and pressure waveforms were monitored. After the catheter was advanced into the right ventricle, it was withdrawn until an IVECG P-wave characteristic of the superior vena cava-right atrial junction was observed. The time from cannulation of the basilic vein until obtaining a characteristic IVECG of the superior vena cava-right atrial junction was 6.6 +/- 4.2 minutes (mean +/- SD). The distance between loss of the right ventricular waveform to the appearance of the desired IVECG P-wave configuration was 3.6 +/- 0.35 cm (mean +/- SD). Because the origin of the observed IVECG complex (1.7 cm proximal to the distal orifice) and of the right ventricular waveform are located in two different places, the tip of the catheter was not considered to be in an optimal position for air aspiration.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1985

Risk for bladder cancer. Psychological impact of notification.

Informing persons that they have been exposed to a carcinogenic chemical (beta-naphthylamine) may adversely affect these persons and their families. The purpose of this study was to identify and assess the psychological impact of a bladder cancer notification and screening program on persons at risk and their families. Approximately 140 subjects were randomly selected from 850 workers exposed to beta-naphthylamine. The Family APGAR, Impact of Event Scale, and Improved Readability Form of the Minnesota Multiphasic Personality Inventory were administered within four weeks of the initial medical screening and readministered six months later. Results show no evidence of disruption to families or substantive psychopathology among these persons. While the actual acquisition of cancer is undoubtedly a psychological trauma, mere notification of risk may not be traumatic in every situation.

2-Naphthylamine↗
PubMedDate not supplied

A system for assessing clerkship experience using a logbook and microcomputers.

Family Medicine clerkships emphasizing ambulatory care often require multiple teaching sites. Continuous assessment of actual student clinical experiences may not occur because the task of collecting and analyzing the necessary data may be expensive and time-consuming. However, the decreasing price of microcomputers and available software has provided teaching programs with inexpensive and effective tools to perform this task. The Department of Family Medicine at the Medical College of Georgia recently developed and implemented a microcomputer based information management system for use in assessing program and student clinical experiences in a required family medicine clerkship. This system, which uses logbooks as an information source, is able to monitor and provide information which is used to insure that the student's actual clinical experiences are consistent with the goals and objectives of the clerkship.

Ambulatory Care↗