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Biomedical subjects

S A Dulchavsky

Publications and source records attributed to S A Dulchavsky.

16 recordsLinked to original sources
PubMed1992

Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow.

The effects of increased intra-abdominal pressure (IAP) on intestinal blood flow were studied in eight anesthetized pigs. Mesenteric artery blood flow (MABF), intestinal mucosal blood flow (IMBP), tonometric intramucosal pH (pHi), mean BP (MAP), cardiac output (CO), and pulmonary artery wedge pressure (PAWP) were measured as IAP was raised to 10, 20, 30, and 40 mm Hg by infusing lactated Ringer's solution (LR) into the peritoneal cavity. The MAP was kept constant with IV LR. Cardiac output fell slightly from 5.4 +/- 1.1 at baseline to 4.0 +/- 1.2 L/min at an IAP of 40 mm Hg (p less than 0.05). An IAP of 20 mm Hg caused significant decreases in MABF (73% +/- 22% of baseline) (p less than 0.05) and IMBF (61% + 12% of baseline) (p less than 0.05). These changes became progressively greater as the IAP was increased to 40 mm Hg. The pHi fell to 6.98 +/- 0.14 at 40 mm Hg IAP (p less than 0.01), indicating severe mucosal ischemia. Thus increased IAP can cause severe intestinal ischemia, which may be more important than the cardiac, pulmonary, and renal changes usually described.

Animals↗
PubMed1992

Antibiotic-primed fibrin gel improves outcome in contaminated splenic injury.

Fibrin gel (FG) has recently been shown to be bactericidal in the management of contaminated hepatic injury; antibiotic loading of fibrin gel (AFG) may augment this effect. We evaluated the antimicrobial properties of FG and AFG in a rat model of contaminated splenic injury. Fibrin gel was made from centrifuged plasma of separate donor rats and bovine thrombin. Antibiotic fibrin gel was similarly produced following intravenous injection of 70 mg/kg ticarcillin. Male Holtzman rats (250-300 g) were anesthetized and a laparotomy done. The abdomen was contaminated with 1 x 10(7) Bacteroides fragilis and the spleen transected in the midportion. Treatment consisted of splenorrhaphy (S) (n = 7), FG application (n = 7), or AFG (n = 7). The animals were autopsied at 1 week to evaluate abscess formation and abdominal adhesions (grade I = none, grade II = mild, grade III = severe). Antibiotic/fibrin gel significantly decreased abscess formation following splenic injury when compared with S (2 of 7 vs. 7 of 7; p less than 0.05 by ANOVA) without an increase in adhesions. Fibrin gel also decreased abscess formation but not significantly (4 of 7 vs. 7 of 7). Histologic analysis confirmed the beneficial effect of FG and AFG on wound healing. The bactericidal effect of FG is improved by antibiotic loading in contaminated intraabdominal injury.

Animals↗
PubMed1992

Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow.

The effects of increased intra-abdominal pressure (IAP) on hepatic perfusion were studied in five anesthetized pigs. Doppler flow probes were used to measure hepatic artery blood flow (HABF) and portal venous blood flow (PVBF), and laser Doppler flowmetry was used to assess changes in hepatic microvascular blood flow (HMVBF). Hepatic blood flow responses to 10, 20, 30 and 40 mm Hg increases in IAP were assessed while the mean arterial BP (MAP) was maintained at baseline levels with IV crystalloid infusions. Although cardiac output and MAP were normal, HABF and HMVBF fell significantly with 10 mm IAP, and at 20 mm Hg IAP, HABF was 45% of the control value, PVBF was 65% of the control value, and HMVBF was 71% of the control value (p less than 0.05). At 30 and 40 mm Hg, hepatic blood flow was reduced even more. Thus, modest increases in IAP can cause significant impairment of hepatic perfusion despite a normal BP and cardiac output.

Abdomen↗
PubMed1992

Peripheral vascular cutdown.

Critically ill patients who are not candidates for percutaneously placed arterial and venous lines require surgical cutdown. Although significant complications may arise from inadvertent injury to the vessel or associated structures during arterial and venous cutdown, these complications can be minimized by meticulous technique. With attention to site selection and catheter care, the useful life of these complex catheters approaches that of percutaneously placed devices. Finally, although the sequelae of placement by these techniques--including wound and catheter infection, distal ischemia, and vessel ligation--are increased, the need for appropriate intravascular access in these patients far outweighs the potential risks.

Critical Care↗
PubMed1992

Electrolyte and acid-base changes with massive blood transfusions.

The case records of 471 patients with massive transfusions of ten or more units of bank blood within 24 hours were reviewed to analyze the electrolyte and acid-base changes. The patients who lived had a less severe acidosis (7.23 +/- 0.15 vs 7.11 +/- 0.17) and the HCO3 was higher (19.8 +/- 15.2 vs 13.4 +/- 6.8) (P less than 0.001). The mean anion gap, despite the low HCO3, was 11.8 +/- 7.8 mEq/L. A combined metabolic and respiratory acidosis, often following bicarbonate therapy, was fetal in 83 per cent (39/47). Serum potassium values (K) were high in 22 per cent and low in 18 per cent of patients. If potassium levels were "corrected" by subtracting 0.5 mEq/L for each 0.1 pH of metabolic acidosis, only 5 per cent of patients were hyperkalemic. Patients dying within 48 hours of the massive transfusions had higher potassium levels (4.9 +/- 1.1 vs 4.4 +/- 0.9; P less than 0.001). Ionized calcium levels (Ca++) were less than normal (1.13-1.32 mmol/L) in 94 per cent of patients and were very low (less than 0.70 mmol/L) in 46 per cent (108/234). The mortality rate with severe ionic hypocalcemia was 71 per cent (vs 40% in patients with more normal values); P less than 0.0001. pH, PCO2, K, and Ca++ must be followed closely with massive transfusions. Rapid correction of volume and pH, without overcorrection, is essential.

Blood Gas Analysis↗
PubMed1992

Fibrin gel limits intra-abdominal adhesion formation.

Autologous fibrin gel (FG) has recently been reported efficacious in hepatic injury; the effects of fibrin compounds on intra-abdominal adhesion formation is controversial. This study evaluated intra-abdominal adhesion formation in a rabbit devascularization model. Seventeen New Zealand rabbits were anesthetized and laparotomy was done. The uterine horns were abraded to punctate bleeding followed by bilateral uterine devascularization. Treatment consisted of 10 cc saline control (c) or FG applied to the uterine horns. Peritoneal lavage was done at 15 minutes for red blood cell (RBC) analysis. Autopsy was performed at 1 week. Adhesions were graded from grade 0 (no adhesions) to grade III (dense adhesions). Adhesion grading revealed no difference in average adhesion grade between FG and C with small bowel (1.0 +/- 1.3 vs 0.5 +/- 1.0); bladder (2.1 +/- 1.1 vs 2.4 +/- 1.2); or uterus (1.2 +/- vs 2.0 +/- 1.2). Adhesion grade was significantly less in FG compared to C for the colon and the abdominal incision (0.4 +/- 0.5 vs 1.7 +/- 1.1 and 1.2 +/- 1.1 vs 3.0 +/- 1.2; P less than 0.05 by t-test). There were no differences in lavage RBC count between FG and C (13.1 x 106 +/- 4.1 x 10(6) vs 8.7 x 106 +/- 3.2 x 10(6)). Fibrin gel significantly decreased incisional and colonic adhesions and reduced other abdominal adhesion formation by a nonhemostatic dependent mechanism.

Administration, Topical↗
PubMed1992

Triiodothyronine treatment maintains surfactant synthesis during sepsis.

BACKGROUND: Pulmonary compromise with altered surfactant metabolism is frequently noted during sepsis; triiodothyronine is necessary for normal surfactant synthesis. We evaluated the role of physiologic replacement of triiodothyronine during sepsis-induced hypothyroidism on surfactant synthesis and lung structural integrity. METHODS: Male Sprague Dawley rats (average weight, 330 gm) underwent sham laparotomy or cecal ligation and puncture; treatment was administered to rats that underwent cecal ligation and puncture by Alzet osmotic pump consisting of triiodothyronine (3 ng/hr) or saline control. The rats were killed 24 hours after serum triiodothyronine determination by radioimmunoassay (normal, 60 to 160 ng/dl). Surfactant was obtained by saline lavage. Lipid content was determined by Folch extraction; phospholipid content was verified by chromatography. Blinded histologic analysis of lung confluence and alveolar sparing was done in separate subgroups. Results are +/- SE. RESULTS: Control rats with sepsis were hypothyroid at 24 hours; rats given triiodothyronine were euthyroid (rats that underwent sham laparotomy, 67.7 +/- 4.9 ng/dl; control rats, 37.6 +/- 5.7 ng/dl; and triiodothyronine, 85.7 +/- 19 ng/dl; p less than 0.05 compared with triiodothyronine by analysis of variance). Surfactant production was significantly improved by triiodothyronine compared with control (60.7 +/- 22.6 mg vs 23.2 +/- 11.3 mg; p less than 0.05 by analysis of variance). Lung histologic integrity was maintained by triiodothyronine treatment during sepsis. CONCLUSIONS: Triiodothyronine supplementation may be beneficial in septic-induced pulmonary dysfunction.

Animals↗
PubMed1991

T3 preserves respiratory function in sepsis.

Sepsis produces profound hypothyroidism. This hypothyroid state is associated with altered lung metabolism and structural integrity. We studied the respiratory function of rats during sepsis-induced hypothyroidism with or without T3 treatment. Forty-four male Holtzman rats underwent cecal ligation and puncture (CLP). Treatment was administered at six hours after surgery consisting of intraperitoneal injection of T3 (15 micrograms/kg, n = 19) or saline (n = 25). At 20 hours (Group A) or 30 hours (Group B) following CLP, respiratory drive was assessed by serial occlusion pressure technique (P0.1). The rats were killed and static elastance determined by serial air inflation to 10 cc. The lungs were excised for weight determination. The P0.1 values were significantly greater in T3-treated animals over controls in Group A (9.3 +/- 0.7 vs. 6.6 +/- 2.2, p less than 0.05 by t test); elastance was significantly improved by T3 treatment in Group B (p less than 0.05 by two-way ANOVA). Lung weight, pH, pO2, pCO2, respiratory rate (RR), and mortality were not significantly different between groups. Control animals were hypothyroid by 20 hours after CLP (T3 less than 12.5 ng/dL) whereas T3-treated animals were euthyroid (T3 = 145 +/- 43 ng/dL). Pulmonary dysfunction frequently accompanies sepsis; the euthyroid state appears protective. We found a significantly improved respiratory drive in septic animals with T3 treatment. Lung elastance was similarly improved in late sepsis with T3 treatment. The data suggest that T3 treatment preserves respiratory function in septic rats as evidenced by respiratory drive and compliance.

Airway Resistance↗
PubMed1991

Beneficial effects of diltiazem in hemorrhagic shock.

The role of calcium channel blockade on metabolic alterations in a hemorrhagic shock model was studied. Experiments were performed on anesthetized Sprague-Dawley rats to evaluate the effect of diltiazem on hyperglycemia and hyperlacticacidemia following hemorrhagic shock. Rats were bled rapidly to a blood pressure of 40 mm Hg and maintained at that level for 2 hr. At 30 min into hemorrhagic shock, rats received either saline or diltiazem (1.2 mg/kg, i.v.) as treatment. Blood samples were obtained preshock and at 30-min intervals. Plasma glucose and lactate increased significantly in both groups at 30 min. Diltiazem treatment significantly reduced the plasma glucose and heart rate during hemorrhagic shock (P less than 0.05). Plasma lactate increased similarly in both groups. Survival analysis indicates significant (P less than 0.05) improvement in the diltiazem-treated group. These data suggest that diltiazem has a beneficial effect in hemorrhagic shock in rats.

Animals↗
PubMed1991

Inflammatory complications following penetrating cardiac trauma.

Two cases with pericardial and myocardial inflammatory complications following penetrating cardiac trauma are presented. A high index of suspicion with liberal usage of echocardiography, serial electrocardiograms, and careful patient follow-up will preclude this diagnostic oversight.

Adult↗
PubMed1991

Autologous fibrin gel: bactericidal properties in contaminated hepatic injury.

Fibrin glue is an effective hemostatic agent in a variety of clinical situations; its utility is limited by potential transmission of viral infection. We studied the bactericidal properties of fibrin gel (FG) in a murine contaminated hepatic injury model and in vitro by agar plate culture method. Intra-abdominal abscess formation and adhesion rate were assessed following controlled liver injury in association with abdominal contamination with 10(7) Bacteroides fragilis and hepatorrhaphy (H, n = 15) or FG (n = 12). Animals treated by hepatorrhaphy had a significantly greater intra-abdominal abscess rate (15/15 vs. 4/12, p less than 0.05) and adhesion rate (14/15 vs. 6/12, p less than 0.05) than animals treated with FG. Fibrin gel is bactericidal to Bacteroides fragilis, Enterobacter faecium, Escherichia coli, and Staphylococcus aureus but has no effect against Klebsiella pneumoniae or Pseudomonas aeruginosa; the plasma component appears active. Fibrin gel demonstrates significant improvement in adhesion formation and intra-abdominal abscess rate when compared with suture hepatorrhaphy. Fibrin gel appears protective in contaminated hepatic injury.

Abscess↗
PubMed1990

Efficacy of liver wound healing by secondary intent.

Nonoperative treatment of liver injury raises questions about liver wound healing (LWH) when the edges are not approximated by primary intent. The efficacy of LWH was studied in 18 dogs and 18 pigs with a total of 108 standard 6-cm injuries. The 36 injuries in six dogs and six pigs were compressed for hemostasis and then allowed to heal by second intent. LWH in these animals was compared to 36 liver wounds in six dogs and six pigs following primary closure (hepatorrhaphy) and 36 liver wounds after omental buttress plus hepatorrhaphy in six dogs and six pigs. Average wound breaking strength (WBS) of liver wounds was studied at 3 weeks (54 wounds) and 6 weeks (54 wounds) with a Chatillon tensiometer and microscopic analysis. The WBS of liver wounds was also compared to normal uninjured liver WBS. The porcine WBS at 3 weeks after healing by second intent (0.31 kg/cm2) was similar to the WBS at 3 weeks after healing by hepatorrhaphy (0.30 kg/cm2) and omental buttress (0.25 kg/cm2). Porcine WBS at 6 weeks after healing by second intent was significantly greater than WBS at 6 weeks after hepatorrhaphy or omental buttress. The canine WBS at 3 weeks after healing by second intent exceeded WBS at 3 weeks after hepatorrhaphy or omental buttress. Canine WBS at 6 weeks after healing by second intent exceeded WBS at 6 weeks after omental buttress and was similar to WBS at 6 weeks after hepatorrhaphy. WBS in all groups paralleled the extent of fibrosis seen on microscopic analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Management of chylothorax after blunt chest trauma.

Chylothorax following blunt chest trauma is rare; we found only 19 cases reported. We describe an unusual patient with chylothorax from closed chest injury. The diagnosis is made from thoracentesis or tube thoracostomy fluid. Thoracostomy in the definitive therapeutic modality. Nonoperative or, when necessary, operative treatment of chylothorax after blunt trauma can lead to a successful outcome in 90% of cases.

Chylothorax↗
PubMed1987

Wound healing of the injured spleen with and without splenorrhaphy.

Splenic wound healing was studied following splenorrhaphy and observational therapy for both canine and porcine splenic injury. The splenorrhaphy group included four adult male dogs and two adult male pigs studied 3 weeks postinjury. The observational therapy group included three dogs and three pigs examined at 3 weeks and three dogs and two pigs examined 6 weeks postinjury. The wound breaking strength (WBS) 3 weeks after splenorrhaphy was significantly greater than WBS of normal splenic tissue (0.41 vs. 0.71 kg/cm2 in dogs; 0.22 vs. 0.35 kg/cm2 in pigs). WBS 3 weeks after observant therapy for splenic injury in dogs was significantly less than normal (0.66 vs. 0.37 kg/cm2). No WBS differences were seen 3 weeks after observant therapy in pigs nor 6 weeks after observant therapy in dogs or pigs. Prolonged convalescence following splenic injury treated by repair or by observation appears unwarranted.

Animals↗
PubMed1987

Problems with 20 or more blood transfusions in 24 hours.

The case records of 128 patients receiving 129 transfusions of 20 or more units of blood within a 24-hour period at Detroit Receiving Hospital, between August 1980 and August 1985, were reviewed. In patients receiving 20 to 49 units of blood, without pre-existing disease or prolonged shock, the mortality rate was 36 per cent (15/42). In similar patients who had prolonged shock, the mortality rate was 61 per cent (27/44). If the patient had pre-existing disease and prolonged shock, the mortality rate with 20 to 49 units of blood was 92 per cent (12/13). All 13 patients receiving 50 or more units of blood died. Platelet counts were less than 50,000/microL in 50 per cent (51/102). The prothrombin time (PT) was prolonged by 5 or more seconds in 54 per cent (51/92). The partial thromboplastin time (PTT) was prolonged to more than 60 seconds in 45 per cent (42/94). There was no correlation between the PT, PTT, and amount of fresh frozen plasma (FFP) given. A coagulopathy was diagnosed clinically in 43 patients, but this did not correlate well with laboratory coagulation studies. The average core temperature of the patients was 32.9 +/- 1.7 C. Severe hypocalcemia with total calcium levels less than 6.0 mg/dL was found in 53 per cent (33/62). Ionized calcium levels Ca++ were less than 0.70 mmol/L in 56 per cent (24/43). Of the 82 deaths, 32 (38%) occurred in the operating room and 31 (38%) occurred within 48 hours from continued bleeding and/or shock. Twelve deaths (15%), from severe infections, occurred after 30 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗