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Biomedical subjects

R D McMillin

Publications and source records attributed to R D McMillin.

6 recordsLinked to original sources
PubMed1984

The influence of sepsis and multisystem and organ failure on mortality in the surgical intensive care unit.

The common causes of death in the surgical intensive care unit (SICU) are infection, hemorrhage, and central nervous system trauma. Due to recent technological advances, many patients now survive the initial metabolic insult only to develop multisystem and organ failure (MSOF). The influence of sepsis on the patients with MSOF leads to a fatal outcome in the majority of cases. A retrospective analysis of 45 patients who died of sepsis and MSOF during 1981 and 1982 was performed. These patients comprised 58 per cent of 77 patients who died of MSOF. Demographic data from these 45 patients and from 32 nonseptic patients who also died of MSOF were compared, and no significant differences were noted. In 78 per cent of the patients who died of sepsis and MSOF, the main source of infection was either the respiratory or gastrointestinal tract. Skin contamination and catheter sepsis were identified in 13 per cent of patients as the main source of infection. Sixty four per cent of patients had positive blood cultures, and at least 50 per cent of those had more than one positive culture site. Predominant organisms isolated were gram-negative bacilli and gram-positive cocci. With the exception of Clostridia in two cases, no positive anaerobic cultures were noted in these patients. When the septic and nonseptic patients were compared, certain factors were identified that may have influenced the development of sepsis in these patients. These factors were poor nutritional status, diabetes mellitus, use of steroids, previous splenectomy, and an average total lymphocyte count below 700.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1984

Vascular injuries associated with pelvic fractures.

Pelvic fractures, which are most often caused by blunt abdominal trauma in our motor vehicle-oriented society, continue to be associated with significant mortality and morbidity. Hemorrhage is the cause of death in nearly 60 per cent of those patients who die of pelvic fractures. With increasing awareness of the problem and improved methods of management, the mortality rate of acute hemorrhage secondary to pelvic fracture should decrease. Four cases of vascular injuries associated with severe pelvic fractures are discussed. One patient presented with bleeding from a false aneurysm of the superior gluteal artery 3 months after his pelvic fracture. This complication was successfully managed by selective arteriographic embolization. The other three patients required early angiography with embolization of hypogastric vessels to control acute hemorrhage after pelvic fracture. Pelvic arteriography with selective embolization of injured vessels is recommended in the management of hemorrhage secondary to severe pelvic fractures. Application of the Military Antishock Trousers (MAST) suit may also be a useful maneuver. These principles of management and a pertinent review of the literature are presented.

Accidents, Traffic↗
PubMed1984

Mucinous cystic neoplasm of the pancreas with latent malignancy.

Mucinous cystic neoplasms of the pancreas are rare. They have traditionally been classified as cystadenoma or cystadenocarcinoma. Over a 5-year period, and three operations, a patient initially diagnosed as having a cystadenoma of the pancreas was subsequently found at the time of definitive total pancreatectomy to have a cystadenocarcinoma. The recent literature suggests that there is not distinction between cystadenoma and cystadenocarcinoma, since these tumors have been shown to contain coexisting areas of malignant and benign epithelium in both types. The authors' experience with this patient demonstrates the necessity for thorough histologic sectioning of these tumors to document the presence of carcinoma, since all of these tumors should be regarded as potentially malignant neoplasms. Surgical therapy for these lesions should be total excision whenever feasible.

Cystadenocarcinoma↗
PubMed1978

Systemic anaphylaxis secondary to the use of 5 per cent plasma protein fractions.

A severe anaphylactic reaction developed in a twenty-six year old female after the administration of only 40 ml of 5 per cent plasma protein fractions (Plasmanate). The reaction was characterized by generalized tingling, chest pain, sudden severe hypotension, and urticaria. The patient responded to intravenous fluid, epinephrine, diphenylhydramine, and steroid administration.

Adult↗
PubMed1978

Acute traumatic hemothorax.

Over the past 5 years, 107 patients have been evaluated for acute traumatic hemothorax at the University of Kentucky Medical Center. Immediate tube thoracostomy was performed on 90 patients for evacuation of blood and air. Only 2 patients died. Thoracotomy was performed as part of the initial therapy in 9 patients. Thoracotomy for continued hemorrhage from a pulmonary parenchymal injury was required in 3 patients from the entire group. Thoracentesis or observation was the initial therapy for limited hemothorax in 8 stable patients. Three of these patients subsequently required tube thoracostomy 2 to 23 days following injury due to expanding effusions, and 1 patient required multiple thoracotomies for sepsis, fibrothorax, and empyema. These observations indicate that early evacuation of blood by means of a tube thoracostomy is essential to minimize morbidity in acute traumatic hemothorax. If continuing hemorrhage after tube thoracostomy occurs, there is a higher association of injury to additional vital structures.

Abdominal Injuries↗