A practical lesson in negative-pressure isolation ventilation.
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Air Microbiology↗
Biomedical subjects
S A Stuart
Publications and source records attributed to S A Stuart.
Recommendations for mechanical ventilation during donor care.
The organ procurement coordinator usually directs adjustments to the mechanical ventilator during donor care. It is often difficult to achieve optimal oxygen uptake and carbon dioxide removal while avoiding barotrauma or undesirable effects on the cardiac output. Interrelationships among a variety of ventilator parameters must be understood in order to achieve the desired goal of providing the best organs possible. These recommendations review the key ventilator parameters of tidal volume; positive end-expiratory pressure; auto-positive end-expiratory pressure; fraction of inspired oxygen; and flowrate and frequency and their interactions in controlling peak, plateau, and mean and end-expiratory airway pressures.
Adolescent↗
Routine intraoperative laparoscopic cholangiography.
BACKGROUND: Whether intraoperative laparoscopic cholangiography should be routine is debatable. METHODS: We reviewed the cholangiography experience in 669 consecutive laparoscopic cholecystectomies. RESULTS: Mean age of the patients was 39 years, 78% were female, and 29% had acute cholecystitis. Cholecystectomy was completed laparoscopically in 606 (91%). Laparoscopic cholangiography was completed in 562 (93%) and 348 (62%) were routine (no preoperative indication). The mean operating time in 1996 was 61 minutes. Out of the 348 routine cholangiograms, 17 demonstrated evidence of unsuspected choledocholithiasis. Five patients had choledocholithiasis documented by laparoscopic common bile duct exploration and/or endoscopic retrograde cholangiopancreatography. Two patients had normal postoperative cholangiopancreatography. One of 10 patients managed expectantly was readmitted postoperatively with obstructive jaundice. In 4 patients, routine cholangiography revealed unexpected anatomy, and in 2, this prevented misidentification and transection of the common bile duct. CONCLUSION: Laparoscopic cholangiography is safe, quick, detects unsuspected choledocholithiasis, and can prevent common bile duct transection. It should be routine.
Adolescent↗
Approach to management of the heartbeating 'brain dead' organ donor.
In recent years, transplantation has assumed an important role in the treatment of patients with end-stage diseases of most major organ systems. However, the greatest limitation in organ transplantation today is organ supply. Among factors that can affect the organ supply favorably, donor management has received the least attention. This review addresses management of the multi-organ donor within the intensive care unit. With an increased awareness of donor management issues and the application of a rational physiological approach, the supply of functional organs for transplantation can be increased.
Age Factors↗
Growth of heterotrophic bacteria and algal extracellular products in oligotrophic waters.
The unexpected observation of 200 to 400 coliform bacteria per 100 ml in an unpolluted pristine stream was studied within Grand Teton National Park, Wyo. The high numbers of waterborne bacteria occurred in mid- to late summer at a location where there was a coincidental bloom of an algal mat community. Periphyton samplers were used to measure the algal growth that coincided with the increase in number of bacteria. Laboratory studies followed the growth of various coliform bacteria in the supernatant obtained from a Chlorella culture isolated from the mat community. Mixed natural bacterial populations from the stream and pure cultures of water-isolated fecal and nonfecal coliforms increased by two to three orders of magnitude at 13 degrees C when grown in the algal supernatant. Radioactive algal products were obtained by feeding an axenic Chlorella culture C-labeled bicarbonate under laboratory cultivation at 13 degrees C with illumination. Radioactive organic material from the algae became incorporated into the particulate fraction of pure cultures of coliform bacteria as they reproduced and was later released as they died.
Journal Article↗
Aquatic indicator bacteria in the high alpine zone.
Selected waters from the high alpine zone within Grand Teton National Park, Wyoming, were analyzed for populations of indicator bacteria during the past three summers to determine the influence of various factors on the quality of these waters. In general the water quality was not significantly influenced by the presence or absence of human visitors but rather by the nature of the biological community through which the streams flowed. A minority of the coliforms that were recovered from all of the sites proved to be fecal coliforms. The fecal streptococci isolated were identified as the species that were found primarily in the fecal material of the native rodent and moose populations. It is concluded that management questions that relate to the carrying capacity of alpine areas should be approached with the aid of other biological parameters along with levels of indicator bacteria in the streams.
Altitude↗