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Biomedical subjects

R J Mullins

Publications and source records attributed to R J Mullins.

101 records · Page 6Linked to original sources
PubMed1982

Effects of increased venous pressure on albumin- and IgG-excluded volumes in skin.

The effect of increased venous pressure on the exclusion of plasma albumin and gamma-immunoglobulin G (IgG) in skin interstitium was studied in anesthetized rabbits. In eight rabbits, venous pressure in the left leg was increased from 7 to 26 mmHg, while the right leg served as a control. Samples of plasma and prenodal popliteal lymph were collected for 4 h before taking samples of heel skin. The extracellular and plasma spaces in the tissue samples were measured using 51Cr-labeled ethylenediaminetetraacetic acid (EDTA) and 125I-labeled human serum albumin, respectively. The protein spaces were calculated from measurements of endogenous albumin and IgG concentrations using rocket electroimmunoassay. For control skin, albumin and IgG were both excluded from 50% of the interstitial space. The interstitial space after venous congestion was increased 1.4 times control. There was a washout of interstitial albumin and no change in the albumin-excluded volume fraction. For IgG, there was no change in the extravascular mass and a decrease in the excluded volume fraction. Changes in the interstitial gel matrix of skin were different from those in visceral organs and consistent with a greater amount of collagen.

Animals↗
PubMed1982

Effects of increased venous pressure on albumin- and IgG-excluded volumes in muscle.

The effect of elevated venous pressure on the extravascular distribution space of albumin and gamma-immunoglobulin G (IgG) in muscle was studied in anesthetized rabbits. In nine rabbits, venous pressure in one leg was increased from 8 to 28 mmHg while the other leg served as a control. Samples of plasma and prenodal muscle lymph were collected for 4 h before taking samples of the gastrocnemius muscle. Lymph was collected from a femoral lymphatic after ligating the popliteal efferent lymphatic. The extracellular and plasma spaces in the tissue samples were measured using 51Cr-labeled ethylenediaminetetraacetic acid (EDTA) and 125I-human serum albumin, respectively. The protein spaces were calculated from measurements of endogenous albumin and IgG concentrations using rocket electroimmunoassay. Albumin and IgG were both excluded from 50% of the interstitial space at lymph concentration. After venous congestion, the interstitial volume was twice that of control. Lymph flow increased from 0.82 +/- 0.18 to 4.44 +/- 0.64 microliters/min. The extravascular mass of albumin and IgG increased. There was no change in the excluded volume fraction for albumin but a decrease in that for IgG. Changes in interstitial protein exclusion in skeletal muscle after pressure elevation may not be important in oncotic buffering of the edema.

Animals↗
PubMed1982

Thoracic duct lymph flow after pancreatitis: role in circulatory collapse.

We examined the effects of acute hemorrhagic pancreatitis on thoracic duct lymph flow and its protein concentration. Thoracic duct lymph flow increased and the protein concentration decreased. These changes in the lymph were associated with steady decreases in arterial pressure and cardiac output and increase in systemic vascular resistance. The results suggest that the increased lymph flow and decreased protein concentration were due to either an ultrafiltration causing a dilution of the lymph protein concentration or to the heterogeneous origin of thoracic duct lymph such that redistribution of blood flow to the essential beds (eg, kidneys) after arterial hypotension altered the lymph flow and its protein concentration. The increase in filtration and the absence of a compensatory "autotransfusion" during arterial hypotension may be a mechanism contributing to circulatory shock in acute pancreatitis.

Acute Disease↗
PubMed1980

Primary repair vs ligation for carotid artery injuries.

The morbidity and mortality of carotid arterial injuries in 36 patients were retrospectively reviewed. Primary repair was achieved in 31 patients; nine patients had a stroke postoperatively and five died. Five patients were treated with ligation; three had a stroke postoperatively, but all survived. Postoperative stroke and mortality correlated best with neurological deficit on administration. Patients in shock or with absent arterial flow were also more likely to have postoperative stroke. Twenty-two patients were normal neurologically on admission; all were normal postoperatively and all survived. Five patients were admitted unconscious in severe shock, precluding accurate neurological evaluation; two were normal following repair and three had stroke. Nine patients had a stroke or coma on admission; all nine had postoperative stroke and five died. Autopsy disclosed bilateral cerebral edema in two patients, cerebral edema and ipsilateral ischemic infarction in two patients, and cerebral edema with bilateral necrosis in one patient. No patient had hemorrhagic infarction. On the basis of these findings, carotid artery repair is recommended in all patients who are not comatose, have stable vital signs, and have technically reparable injuries.

Adolescent↗
PubMed1980

The natural history following venous ligation for civilian injuries.

Contrary to prevailing views, documentation of major morbidity after venous ligation for trauma is sparse. Forty-six patients had ligation for injury to the major veins of the lower extremities, namely, vena cava (six), external iliac (five), common iliac (three), common femoral (eight), profunda femoris (six), superficial femoral (thirteen), and popliteal (five). The post-ligation management included: 1) early and extensive fasciotomy when indicated, 2) initial strict bed rest with elevation until edema free, 3) trial ambulation for 2 hours, 4) added elevation if trial ambulation leads to recurrent edema. Forty patients were discharged edema free, and six patients had mild edema. Followup examination in 39 patients revealed no edema in 30 patients, mild edema requiring no treatment in one patient, and moderate edema requiring support hose in eight patients. No severe or massive edema causing ulceration or ischemia occurred. Based on these findings, primary venous interruption is a safe, quick and effective means of managing venous injury whenever the extent of injury or the severity of associated injuries make primary repair hazardous.

Edema↗
PubMedDate not supplied

Outcome of hospitalized injured patients after institution of a trauma system in an urban area.

OBJECTIVE: To determine if risk of death for hospitalized injured patients changes when an urban trauma system is implemented. DESIGN: An analysis of the risk of death in hospitalized injured patients in 1984 and 1985 (pretrauma system), 1986 and 1987 (early trauma system), and 1990 and 1991 (established trauma system) using hospital discharge abstract data. SETTING: A total of 18 acute care hospitals in the four-county area encompassing Portland, Ore. PATIENTS: A cohort of 70,350 hospitalized patients with at least one discharge diagnosis indicating injury. MAIN OUTCOME MEASURE: Death during hospitalization. RESULTS: After the trauma system was established, 77% of patients in the region with an Injury Severity Score (ISS) of 16 or greater were admitted to level I trauma centers. More than 72% of patients with an ISS less than 16 were hospitalized in nontrauma centers. Risk of death for injured patients hospitalized at level I trauma centers declined after the trauma system was established (odds ratio, 0.65; 95% confidence interval, 0.51 to 0.81). Patients who died in trauma centers after institution of the trauma system were younger and had more severe injuries, and the majority died within 1 day of admission, whereas patients who died in nontrauma centers died a median of 5 days after admission. CONCLUSION: Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate.

Adolescent↗
PubMedDate not supplied

Subclinical infection with Mycobacterium leprae--a problem for leprosy control strategies.

Tests for the serodiagnosis of leprosy, including those based on phenolic glycolipid-I (PGL-I), have shown poor specificity for leprosy in studies of endemic communities, despite initially promising results in studies of selected patients. During a 5 years follow-up study of a hyperendemic community in Papua New Guinea, a marked reduction in numbers of seropositive children and an increase in age of those seropositive followed introduction of multi-drug therapy. This was accompanied by a reduced case detection rate and a shift to paucibacillary disease in new cases, consistent with a reduction in transmission. Only a minority of persistently seropositive persons developed leprosy. These observations suggest that subclinical infection with Mycobacterium leprae is common in endemic communities and that PGL-I seropositivity is a marker of subclinical infection, with poor specificity for overt disease. Detection of subclinical infection may confound control strategies which use screening tests to identify asymptomatic highly infectious cases for earlier therapy.

Adolescent↗
PubMedDate not supplied

Oregon trauma system: change in initial admission site and post- admission transfer of injured patients.

OBJECTIVE: Associate statewide trauma system development with a change in the percentage of injured patients initially hospitalized at Levels I and II categorized trauma hospitals and a change in the length of stay (LOS) prior to arrival at a Level I or II hospital (PRE-LOS) and total LOS (T-LOS) for post-admission transfer patients. METHODS: A retrospective analysis was performed using a hospital discharge database of 235,395 discharges with codes for acute injury managed at 74 acute care hospitals in Oregon State from 1983 to 1991. Primary outcome measures were admission site and transfer patient PRE-LOS and T-LOS. Predicator variables included category of initial hospital admission site, injury severity scale (ISS) score, head injury, age, and status of trauma system (pre-system, 1983 to 1987; transitional, 1988 to 1989; and post-system, 1991 to 1992). RESULTS: There was a significant increase in the percentage of initial admissions to hospitals with Level I and II categorization (17.6%, 26.2%, and 27.6% for the three periods of development, respectively; p < 0.00001). The percentage of patients with ISS scores greater than 15 admitted initially to Level I or II hospitals increased from 33.4% to 52.6% and 57.3%; p < 0.00001). Only 1,059 0.57%) of 185,321 patients initially admitted to Level III, Level IV, or noncategorized hospitals were transferred to a Level I or II hospital. Mean PRE-LOS for 1.059 transferred patients showed a significant decrease with system development (2.3, 1.9, and 1.8 days, respectively; p < 0.02). When adjusted for age, ISS score, and head injury effects, mean T-LOS was significantly reduced for the transitional and post-system periods (p < 0.05). CONCLUSIONS: In Oregon, development of a statewide trauma system was associated with increased initial admissions to Level I and II trauma hospitals. For those patients transferred to higher levels of care post- admission, hospital LOSs were decreased with trauma system development.

Adolescent↗