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Biomedical subjects

R A Cowley

Publications and source records attributed to R A Cowley.

At least 37 records · Page 2Linked to original sources
PubMed1984

Empyema occurring in the multiply traumatized patient.

During an 11-month period 31 cases of nosocomial empyema were identified in 29 of 741 multiply traumatized patients who remained in our unit for more than 3 days. Nosocomial empyema was defined as purulent culture-positive material drained from the pleural space after five days' hospitalization. All patients had fever and leukocytosis. Possible risk factors included previous aspiration in five patients but none developing pneumonia, prior respiratory tract infection in nine but none with the same pathogen as their empyema, prior antibiotic use in over 50% of the patients, and severe head or chest injury in two thirds of the patients. Thirty-eight pathogens were recovered: S. aureus, 14; beta-streptococci, three; Pseudomonas, six; Klebsiella, two; Enterobacter, two; E. coli, two; other Gram-negative bacilli, six; and anaerobes, three. Fourteen infections were polymicrobic and bacteremia occurred in 42% of the patients. Of these 29 patients, 27 had chest tubes inserted for fluid in the pleural cavity before development of empyema; nine for hemo- or pneumothorax secondary to chest trauma, 11 for pneumothorax while on ventilators, and seven for unexplained sterile pleural effusion. If empyema complicated a prior hemothorax it was usually caused by Staphylococcus aureus and occurred about 10 days after draining blood from the pleural cavity. If empyema was a complication of pneumothorax or serothorax it was usually due to Gram-negative organisms colonizing the upper respiratory tract and occurred within 4 days of draining the fluid. Sixteen per cent of all patients who had chest tubes placed for fluid in their pleural cavity subsequently developed empyema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Superior mesenteric artery and vein injuries from blunt abdominal trauma.

During an 8-year period, from 1974 to 1982, 13 patients were treated for superior mesenteric vascular injury secondary to blunt abdominal trauma. Ten male and three female patients ranged in age from 18 to 68 years (average age, 42.7 years). Six patients presented in profound shock, two presented in cardiopulmonary arrest, and five presented with mild shock. The 13 patients had an average of 3.2 associated intra-abdominal injuries. Six patients had devitalized bowel as a direct consequence of injury to the superior mesenteric vessels. One patient developed intestinal necrosis postoperatively from thrombosis of the superior mesenteric vein which led to extensive small bowel resection. The blood replacement ranged from 2 to 30 units, averaging 11.7 units per patient. Operative procedures included lateral arteriorrhaphy (five patients) and venorrhaphy (11 patients). Four patients required combined vessel repair and one patient required ligation of both vessels and bowel resection. The mortality rate of 57% was primarily due to massive acute hemorrhage, which was larger than could be accounted for by the associated intraabdominal injuries. Free intraperitoneal hemorrhage from the valveless portal system, which can carry up to 60% of cardiac output, causes massive bleeding until abdominal tamponade supervenes.

Abdominal Injuries↗
PubMed1984

Relationship of thyroid hormone patterns to survival in canine hemorrhagic shock.

6 of 13 dogs subjected to 1 h of hemorrhagic shock (BP = 45-50 mm Hg) died during the first convalescent day. Nonsurvivors had lower baseline plasma concentrations of total and free T4 and T3, as well as rT3, and higher T3 uptake values. During shock, dogs that died had significantly lower plasma levels of total and free T4 and T3 and higher T3 uptake. In general, intergroup differences were accentuated during resuscitation. After volume replenishment, indices of thyroid function had stabilized or improved in survivors, but were still deteriorating in dogs that ultimately died. There were no consistent hemodynamic differences between the two groups. Thus, parameters of thyroid metabolism appear to be good prognostic indicators in canine hemorrhagic shock.

Animals↗
PubMed1984

Evaluation of injured intestine with the aid of fluorescein.

In an animal model, a new diagnostic use for fluorescein as an aid in determining intestinal viability after blunt trauma, has been evaluated. Areas of traumatized intestine that do not fluoresce are invariably necrotic; fluorescing tissue is always viable. Fluorescein is a simple and rapid means of evaluating traumatized intestine, and it may prove to be a useful adjunct to the clinical examination.

Animals↗
PubMed1984

The treatment of 179 blunt trauma-induced liver injuries in a statewide trauma center.

The records of 179 patients who were admitted to a statewide trauma center with liver injuries from blunt abdominal trauma are reviewed. The overall mortality for the 119 men and 60 women was 35 per cent. The simpler forms of injury (classes 1, 2, and 3) were easily treated and yielded good results, whereas treatment for major injuries, involving lobar destruction and vena caval injury (classes 4 and 5), yielded poor results. Hepatic artery ligation was successful in only 7 of 17 cases, hepatic lobectomy was successful in 3 of 16 cases, and intracaval shunting was successful in both in which it was attempted. Anatomic variation, severity of injury from blunt abdominal trauma, and perhaps rapidity of evacuation combine to give poor results in these injury categories. While 26 per cent of all mortality occurred in patients with severe head injuries, hemorrhage was the most frequent cause of death (49%). In 19 of these 30 patients, the hemorrhage was from the liver. Infection played a significant role in the deaths of 27 patients. In eight of these 27 patients, the infections were related directly to the liver injury. The number of associated injuries per patient appeared unrelated to the overall outcome of the injury.

Adolescent↗
PubMed1984

EMS response to mass casualties.

Of the three phases of disaster response, the primary phase (immediate postincident to six hours thereafter) represents the core of the EMS-augmented response to save lives. Activities during this phase include triage, victim control and stabilization, communications, and transportation. To cope successfully with the mass casualties of an actual disaster, special emergency forces must be trained (and rehearsed) to act together as a team to treat the critically ill and injured.

Allied Health Personnel↗
PubMed1983

Right ventricular outflow obstruction secondary to right-sided tamponade following myocardial trauma.

A case of isolated tamponade of the right side of the heart, seen as an abrupt change in the cardiac silhouette and as right ventricular outflow obstruction following myocardial trauma, is presented, along with a review of the English-language literature on delayed postoperative tamponade and loculated pericardial effusion. The importance of a low, fixed cardiac output and nonspecific physical findings in suggesting the clinical diagnosis is emphasized. The absence of many of the classic signs and symptoms of pericardial tamponade is noted, as is the possibility of unusual changes in the appearance or function of the heart in the presence of a loculated effusion. Finally, the differential diagnosis and the results of a variety of diagnostic techniques are discussed.

Adult↗
PubMed1983

Response of traumatized splenectomized patients to immediate vaccination with polyvalent pneumococcal vaccine.

In recent years the syndrome of overwhelming post-splenectomy sepsis has been increasingly reported in adults. Since more than 50% of these infections are caused by pneumococcus these post-splenectomy patients are considered a suitable group to receive the pneumococcal vaccine. Previous studies of the response obtained in post-splenectomy patients have been conflicting and we found no study that looked at the response to immediate vaccination in this group of patients. Sixteen consecutive multitraumatized patients received polyvalent pneumococcal vaccine 0.5 ml IM within 72 hours of splenectomy and 10 normal controls were given 0.5 cc polyvalent pneumococcal vaccine. Patients received an average of 19.2 units of blood and blood products; seven were on steroids for concomitant head injury. Antibody was measured by the radioimmune assay. Most of the subjects of both groups responded to at least seven of the 12 measured antigens and no patient in the control group and only one in the splenectomized group responded to all 12 antigens. When rate of response to individual serotypes was compared no difference was found between the two groups. Comparison of geometric mean fold rise and fold rise between the two groups for each of the 12 serotypes revealed essentially no difference. We conclude the response to polyvalent pneumococcal vaccine among polytrauma splenectomized patients is similar to that of normal controls, and that the vaccine can be administered immediately post-splenectomy.

Abdominal Injuries↗
PubMed1983

The pathophysiology of septic shock: responses to different doses of live Escherichia coli injection in rats.

Responses to different doses of Escherichia coli (E coli; 0-18) injection were studied from the pathological standpoint. Various amounts of live E coli were intravenously injected through the tail vein (group A: 2.7-3.3 X 10(9); B: 1.7-2.0 X 10(9); C: 1.2-1.5 X 10(9); D: 0.3-0.5 X 10(9) organisms/100 g of body weight). All rats from group A died within 6 h; 14 out of 15 rats from group D survived. Hypothermia was commonly seen in the lethal groups (groups A, B, and C) prior to death, and hyperthermia was observed only in groups C and D. Leukopenia was seen in all groups and remained in the lethal groups, whereas in group D, leukocytosis following leukopenia was observed at 12 and 24 h. Light microscopic studies were performed in the lethal groups, showing the following differences among the three lethal groups; a dose-related depletion of white pulp of the spleen, cortical hemorrhage of the adrenal glands (only in groups A and B), foci of bacterial colonies in the heart and small intestine with aggregated leucocytes (only in group C); focal liver necrosis was found in group C, but not in group A. Tubular necrosis and cast formation were also predominant in the kidneys of group C animals. The above findings indicate that the milder, lethal group shows more severe morphological changes in all organs except the spleen and adrenal glands, and suggest that sudden death from bacteremia may involve a depleted host defense.

Adrenal Glands↗
PubMed1983

The pathophysiology of septic shock: comparison of systemic hemodynamical responses in the rat following a sonicated, heat-killed, and live E coli injection.

Systemic hemodynamical responses in anesthetized rats subjected to a bolus IV injection of sonicated (50 watts, 3 min), heat-killed (100 degrees C, 15 min), or live E coli suspension (12-15 X 10(8) E coli organisms in 0.5 ml saline per kg body wt) were continuously monitored for 6 h. A transpulmonary thermodilution method was used for measurement of cardiac output. After injection of sonicated E coli suspension, there was a triphasic hemodynamical response: 1) a hypodynamic state immediately following treatment, 2) a recovery phase, and 3) a profound, progressive hypodynamic state in the late phase. In contrast, heat-killed E coli suspension induced a biphasic response: 1) an insignificant hyperdynamic state in the early phase, and 2) a progressive hypodynamic state in the late phase. An injection of live E coli suspension resulted in a biphasic response: 1) a hyperdynamic state in the early phase, and 2) a progressive hypodynamic state in the late phase.

Animals↗
PubMed1983

Orogenital sex as a cause of nonfatal air embolism in pregnancy.

A case of nonfatal air embolism from orogenital sex in the 30th week of pregnancy is described. Because of a delay in the diagnosis, the patient did not receive hyperbaric oxygen therapy until 39 hours after the incident. Severe neurologic dysfunction persisted despite hyperbaric therapy. The world literature on orogenital sex in pregnancy with resultant air embolism is reviewed. The pathophysiology of air embolism and the rationale for hyperbaric oxygen treatment are presented. It is strongly recommended that survivors of this form of air embolism be transferred to hyperbaric facilities as soon as possible to reduce the long-term neurologic sequelae.

Adolescent↗
PubMed1983

Thyroid hormone responses in hemorrhagic shock: study in dogs and preliminary findings in humans.

One hour of hemorrhagic shock in the dog produces alterations in thyroid hormone metabolism far exceeding those seen after elective surgery or thermal injury. The changes in plasma thyroid hormone levels cannot be fully explained by carrier protein loss. Plasma concentrations of total thyroxine (T4) and triiodothyronine (T3) were significantly decreased after only 20 minutes of shock, continued to decrease throughout shock and resuscitation, and remained depressed for several days thereafter. Both hormones reached nadirs during volume replacement of 42% and 17% of baseline, respectively. The total T4 level normalized by the fifth postshock day, but the T3 concentration was still depressed on the ninth day. Plasma albumin, the principal canine thyroid hormone carrier, was significantly reduced 20 minutes after hemorrhage and remained low throughout convalescence. Concentrations of free T4 and T3 decreased during shock, but not as much as the total T4 and T3 concentrations. Reverse T3 levels, corrected for albumin loss, and T3 uptake values were increased during shock and resuscitation. Similar alterations in circulating thyroid hormone concentrations were seen in three patients with major traumatic injury and/or shock. The thyroid hormone changes in shock may represent another example of the "euthyroid sick syndrome."

Adult↗
PubMed1983

Effect of hypothermia on survival time and ECG in rats with acute blood loss.

The effects of hypothermia on survival time and ECGs were investigated in hemorrhagic-shocked rats. Acute blood loss corresponding to LD84 was achieved within 1 min through cannulation of the carotid artery. Immediately following the hemorrhagic episode, extracorporeal cooling was performed by placing the animals, with ice packs attached to their lateral sides, in a cold water bath. Rewarming was achieved by removing the ice packs and resetting the temperature of the water bath to 37 degrees C. With this system, the survival time of the hemorrhagic rats was lengthened from 40 to 60 min without rewarming and to 123 min with rewarming. ECGs showed sinus bradycardia, prolonged PR and QRS intervals, AV block, and finally ventricular fibrillation in both the control and hemorrhagic groups during extracorporeal cooling. During rewarming, the above ECG changes returned to normal in the control group as did body temperature. In contrast, animals in the hemorrhagic group did not survive. Body temperature in this group began to rise toward normal, and above ECG changes showed slight but not complete improvement. It is concluded that extracorporeal cooling can lengthen the survival time of hemorrhagic-shocked rats and that recovery of the disturbed conduction system is a prerequisite for survival from severe hypothermia.

Acute Disease↗