Biomedical subjects

R G Molnar

Publications and source records attributed to R G Molnar.

6 recordsLinked to original sources

PubMed1999

Successful repair of blunt cardiac rupture involving both ventricles.

Blunt cardiac rupture occurs infrequently and is usually lethal. Successful repairs of isolated atrial or ventricular ruptures have been reported when the diagnosis is made early. Our patient sustained blunt cardiac rupture of both ventricles in a motor vehicle accident. The diagnosis was made during emergency exploratory laparotomy when her vital signs deteriorated without obvious cause. A large Satinsky clamp was placed across the apices of the right and left ventricle to control hemorrhage while the repair was done without cardiopulmonary bypass. She survived and was discharged to home with a normal echocardiogram.

Adult↗

PubMed1998

Does neutrophil-mediated oxidative stress play any significant role in producing hepatocellular dysfunction during early sepsis?

BACKGROUND: Although previous studies have indicated that hepatocellular dysfunction during early sepsis can be prevented by prior neutrophil depletion, it remains unknown whether the changes in hepatic oxidative stress induced by activated neutrophils are responsible for the salutary effect of neutropenia on hepatocellular function. MATERIALS AND METHODS: Neutropenia was induced in the rat by intravenous injection of immunoglobulins directly against rat neutrophils (anti-neutrophil Ig) at 16 and 2 h prior to the initiation of cecal ligation and puncture (CLP, i.e., an animal model of polymicrobial sepsis) or sham operation. Neutropenia was confirmed by peripheral blood smears. Neutrophil-competent control animals were given nonimmunized Ig prior to the onset of sepsis. Sham animals received anti-neutrophil Ig or control Ig. The levels of reduced glutathione (GSH) and oxidized glutathione (GSSG) in the liver were determined at 5 h after CLP (i.e., the early, hyperdynamic stage of sepsis) or sham operation by high performance liquid chromatography. RESULTS: Although the levels of hepatic GSH and GSSG decreased significantly at 5 h after CLP, irrespective of neutropenia, the ratio of GSSG/GSH was not significantly altered under such conditions. The decrease in hepatic glutathione concentrations in septic animals may represent the decreased synthesis or increased efflux into the bile or circulation. CONCLUSION: Since neutrophil depletion did not significantly affect hepatic levels of GSH and GSSG as well as the GSSG/GSH ratio but prevented the occurrence of hepatocellular dysfunction, factors other than oxidative stress are likely to be the mechanism responsible for depressing hepatocellular function during the early, hyperdynamic stage of sepsis.

Animals↗

PubMed1998

Vertebral artery surgery.

Vertebral artery revascularization is indicated for symptomatic vertebral artery disease. Safe and effective revascularization can be offered to such patients with good long-term outcomes. Percutaneous transluminal angioplasty, with and without stents, may eventually develop a role. However, prospective trials to compare angioplasty with the safety and long-term efficacy of surgical revascularization are needed before any benefit can be assumed.

Angioplasty, Balloon↗

PubMed1997

The role of neutrophils in producing hepatocellular dysfunction during the hyperdynamic stage of sepsis in rats.

Although studies have shown that hepatocellular function is depressed during the early, hyperdynamic stage of sepsis, the mechanism responsible for this remains unknown. To determine whether neutrophils play any role in producing this depression, hepatocellular function was measured in neutrophil-competent and neutropenic animals subjected to sepsis. Neutropenia was induced by tail vein injection of an immunoglobulin directly against rat neutrophils (anti-neutrophil Ig) at 16 and 2 h prior to the initiation of cecal ligation and puncture (CLP, i.e., a model of polymicrobial sepsis). Neutropenia was confirmed by peripheral blood smears. Neutrophil-competent controls were given nonimmunized Ig before the onset of sepsis. Sham-operated animals received anti-neutrophil Ig or control Ig. Hepatocellular function [i.e., the maximal velocity of indocyanine green clearance (Vmax) and efficiency of the clearance (Km)] was determined by a fiber-optic catheter and in vivo hemoreflectometer at 5 h after CLP (i.e., early, hyperdynamic sepsis) or sham operation. Serum alanine aminotransferase (ALT) levels were also determined. The results indicate that although circulating levels of ALT were not elevated, hepatocellular function was significantly depressed during early sepsis. The depression in Vmax and Km was, however, prevented by neutrophil depletion, suggesting an integral role of the neutrophils in depressing hepatocellular function under such conditions. The results suggest that the prudent modulation of neutrophil function during the early stage of polymicrobial sepsis may be beneficial for preventing or delaying the occurrence of hepatocellular dysfunction.

Alanine Transaminase↗

PubMed1995

Laparoscopic is not better than open appendectomy.

Laparoscopic appendectomy is increasingly being used by general surgeons. The advantages of the procedure over open appendectomy are not as obvious as the advantages of laparoscopic cholecystectomy over open cholecystectomy. This study was a retrospective review of nonrandomized patients of two attending surgeons over the time period 4/11/91 to 2/15/93. Parameters examined included patient age, gender, operating room time, hospital cost, hospital stay, negative appendectomy rate, and wound infection rate. Results showed that there was no difference in the patient age. Gender was significantly different, with the laparoscopic group containing 68% females, whereas the open group contained only 39% (P < 0.01). Operating room time was significantly longer for the laparoscopic group by approximately 18 minutes (P < 0.05). Hospital cost was $1400.00 more expensive for the laparoscopic group (P < 0.05). Hospital stay and wound infection rates were not significantly different. The negative appendectomy rate was 37% for the laparoscopic group and 12% for the open group (P < 0.05). We conclude that laparoscopic is not superior to open appendectomy.

Adult↗

PubMedDate not supplied

Is laparoscopic better than open appendectomy?

Laparoscopic appendectomy is becoming increasingly popular as surgeons strive to manage surgical problems via minimally invasive techniques. We reviewed our early experience in 38 patients with laparoscopic appendectomy and compared it to open appendectomies done during the same time period. We found no difference in hospital costs, stay, or wound infection rate. There was a significant difference in OR time: the laparoscopic approach took longer. We conclude that this new approach is not clearly superior to open appendectomy despite theoretical advantages. Newer instruments and further studies are needed.

Adult↗