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Biomedical subjects

R F Tranbaugh

Publications and source records attributed to R F Tranbaugh.

23 records · Page 2Linked to original sources
PubMed1981

Colorectal foreign bodies and perforation.

Although most rectal foreign bodies can be removed safely in the emergency room, some require removal in the operating room. Good results can be achieved if basic principles in the management of colorectal injuries in general are applied to colorectal perforations by foreign bodies. Although rectal foreign bodies and colorectal perforations from non-medical rectal instrumentation have been a medical curiosity for many years, especially in metropolitan general hospitals, there can be little doubt that the frequency of such problems is increasing. We expect that community hospitals, will see more of these problems in years to come, if they are not already.

Adolescent↗
PubMed1981

Acute surgical illness in patients with sickle cell anemia.

Acute abdominal pain frequently accompanies sickle cell crisis. The character of this pain may be difficult to discriminate from acute surgical processes such as acute cholecystitis or appendicitis. Seven patients with sickle cell disease presenting with abdominal pain underwent surgery. Review of the medical records demonstrated a characteristic pattern of presentation consistent from crisis to crisis. When patients with known sickle cell disease present with symptoms of abdominal pain, (1) the character of the symptoms, (2) precipitating events, (3) white blood cell count, (4) bilirubin, and (5) fever should be compared with those characteristics in previous crises. Deviation from previous patterns suggests an illness caused by problems other than sickel cell crisis.

Abdomen, Acute↗
PubMed1980

Lung water changes after thermal injury. The effects of crystalloid resuscitation and sepsis.

Respiratory failure after thermal injury is common, but the etiologic roles of high volume crystalloid resuscitation, hypoproteinemia, inhalation injury, or sepsis have not been specifically defined in human studies. We used the thermal-green dye double indicator dilution measurement of extravascular lung water (EVLW) to follow daily lung water changes in seven severly burned adult patients, resuscitated with only crystalloid solutions. An average weight gain of 21.3 kg, a 30% increase (p < 0.001), was present two to three days after admission. Admission EVLW for all patients was 7.9 +/- 1.2 ml/kg, (means +/- SD), and EVLW at the time of maximal weight gain was 5.9 +/- 1.4 ml/kg, a 25% decrease (p < 0.05). Admission pulmonary artery wedge pressure (PAWP) was 8 +/- 3 mmHG, which was not significantly different from PAWP of 13 +/- 4 mmHg at the time of maximal weight gain. In the three patients who died of sepsis, their terminal weight averaged 17.8 kg (27%) above their admitting weight (p < 0.01) and EVLW was 26.4 +/- 4.4 ml/kg, a 200% increase (p < 0.02) from admission. Their terminal PAWP averaged 22 +/- 2 mmHg, a 170% increase (p < 0.005). None of these patients had an increase in EVLW until clinical signs of sepsis occurred and the rise in EVLW preceded the rise in PAWP. Calculated mean plasma colloid osmotic pressure (PCOP) on admission was 20.7 +/- 4.9 mmHg; at the time of maximal weight gain, it was 8.6 +/- 1.7 mmHg (p < 0.001). The PCOP-PAWP gradient fell to -4 +/- 4 mmHg (p < 0.001) at the time of maximal weight gain and remained less than +4 mmHg throughout the study period in all patients. We conclude that massive crystalloid resuscitation while maintaining PAWP below 15 mmHg does not cause an increase in EVLW during the first four days after thermal injury. EVLW actually decreases slightly in all patients despite marked weight gain, hypoproteinemia and a negative PCOP-PAWP gradient. EVLW does not correlate with the PCOP-PAWP gradient in either septic or nonseptic periods. Three patients had severe inhalational injury and normal EVLW for the first four postburn days. It therefore appears that significant interstitial edema does not result from inhalational injury. There is also no evidence that thermal injury causes an early increase in pulmonary capillary permeability. The occurrence of sepsis, however, results in rapid accumulation of lung water, without any change in hydrostatic or osmotic forces. This study supports the primary role of sepsis in altering pulmonary capillary permeability with resulting pulmonary edema.

Adult↗
PubMedDate not supplied

Routine myocardial revascularization with the radial artery: a multicenter experience.

BACKGROUND: Current literature documents use of the radial artery (RA) for myocardial revascularization only as an alternative conduit in cases where the saphenous veins have been previously harvested or are unsuitable for use. Large-scale routine clinical use of the RA as the conduit of choice has not been reported. METHODS: This prospective study evaluated the harvest of the RA from 933 patients and the subsequent use of the conduit as a preferred coronary artery bypass graft second only to the left internal thoracic artery in 930 of these patients. RESULTS: Unilateral RA harvest was performed in 786 patients and 147 patients had bilateral RA harvest. A total of 1080 RAs were harvested; 214 (19.8%) originated from the dominant forearm. There was a mean of 3.30+/-0.93 grafts per patient of which 2.43+/-0.83 were arterial grafts. The mean number of RA grafts was 1.43+/-0.53. Operative mortality was 2.3% with none due to the RA graft(s). There was no ischemia nor motor dysfunction in the operated hands. Thirty-two (3.4%) patients experienced transient thenar dysesthesia that resolved in 1 day to 6 weeks. CONCLUSIONS: Our results demonstrate that routine total or near total arterial myocardial revascularization may be achieved safely and effectively with the use of one or both RAs in conjunction with the internal thoracic artery.

Adolescent↗