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Biomedical subjects

T D Rafferty

Publications and source records attributed to T D Rafferty.

At least 19 recordsLinked to original sources
PubMed1987

A metropolitan experience with infrainguinal revascularization. Operative risk and late results in northeastern Ohio.

Despite being of fundamental importance, the late results of major arterial reconstruction rarely have been documented throughout a large metropolitan area. In this study of 932 patients entered into the computer registry of the Cleveland Vascular Society, 19 surgeons representing 13 community hospitals and referral centers in Cleveland and Akron report the intermediate-term outcome during a mean interval of 35 months after infrainguinal lower extremity revascularization performed in northeastern Ohio from 1978 through 1982. Operative risk (5%), the early amputation rate (7%), and actuarial 5-year survival (48% to 55%) for patients with rest pain or tissue necrosis were significantly worse (p less than 0.05) than comparable figures (0.6%, 0%, and 77%, respectively) for others who underwent procedures for disabling claudication. Although both materials had similar success above the knee, the cumulative 3-year patency rate of autogenous vein bypass to the distal popliteal (69% to 88%; p less than 0.05) and tibioperoneal arteries (43%; 0.05 less than p less than 0.1) was superior to the results of polytetrafluoroethylene grafts (32% to 50% and 19%, respectively). Moreover, polytetrafluoroethylene grafts required reoperations at three times the rate of vein grafts to maintain limb salvage.

Aged↗
PubMed1983

Plasma colloid oncotic pressure-pulmonary artery occlusion pressure gradient. A poor predictor of pulmonary edema in surgical intensive care unit patients.

Because Starling's equation contains four factors that theoretically influence fluid movement across the pulmonary capillary bed, we prospectively examined the relationship between the plasma colloid oncotic pressure (PCOP) minus the mean pulmonary artery occlusion pressure (PAOP) (the only two presently available clinically for measurement) and pulmonary edema determined in terms of percent venous admixture (Qs/Qt) and roentgenographically in 17 consecutive patients in a surgical intensive care unit to determine whether this PCOP-PAOP gradient could accurately predict the presence of pulmonary edema. The PCOP-PAOP gradient proved to be a poor predictor of pulmonary edema determined by these means. We believe this resulted from the inherent insensitivity of the PCOP-PAOP gradient as an estimate of the net intravascular filtration pressure, and Qs/Qt and roentgenograms as measurements of lung edema, as well as the multiplicity of variables involved in the genesis of pulmonary edema in the clinical situation.

Adult↗
PubMed1983

Skin-fold thickness, body mass, and obesity indexes and the arterial to skin-surface PO2 gradient.

Trends in transcutaneous oxygen tension (tcPO2) correlate closely with Pao2 in the absence of circulatory insufficiency. Individual variation, however, in the arterial to skin-surface Po2 gradient (Pao2-tcPo2 gradient) have limited the usefulness of tcPo2 measurements as precise indicators of Pao2. This individual variability in the Pao2-tcPo2 gradient has been speculated as being caused by "skin factors." This study was performed to examine the relationship between skin-fold thickness (triceps and infraclavicular), body mass index, body surface area, and ponderal index and the Pao2-tcPo2 gradient with a view to delineating correction factors that might be useful in increasing the accuracy of tcPo2 as an estimate of the absolute value of the corresponding Pao2. Skin-fold thickness measurements, body mass index, body surface area, and ponderal index were unrelated to the Po2 gradient. This was thought to be primarily due to an inherent inaccuracy of these measurements as indicators of stratum corneum thickness and dermal capillary depth, the major involved variables.

Adipose Tissue↗
PubMed1983

Comparison of bacterial adherence to ciliated and squamous epithelial cells obtained from the human respiratory tract.

Previous in vitro studies have suggested that bacterial adherence to buccal squamous epithelial cells may be a mechanism involved in postoperative colonization of the oropharynx. However, the relationship between bacterial binding to oral epithelial and ciliated respiratory cells is unknown. To investigate bacterial binding to other cells in the human respiratory tract, we measured adherence of Pseudomonas seruginosa to ciliated cells (from nose and trachea) and compared this to squamous cells (from buccal mucosa), Cell samples were collected from 16 noncolonized individuals undergoing either elective surgery or volunteer bronchoscopy. Adherence (mean +/- SEM) to tracheal cells (4.6 +/- 0.8 bacteria per cell) and to nasal cells (4.7 +/- 0.6 bacteria per cell) was similar. These values significantly (p less than 0.001) exceeded buccal cell adherence (0.9 +/- 0.2 bacteria per cell). Because cells from ciliated surfaces bind more bacteria than cells from squamous surfaces, bacterial adherence at these respiratory sites may involve different mechanisms. The enhanced bacterial attachment to ciliated cells may assume pathogenic importance when mucociliary function is impaired.

Acetylcysteine↗
PubMed1982

Transcutaneous PO2 as a trend indicator of arterial PO2 in normal anesthesized adults.

The transcutaneous technique of measuring PO2 (tcPO2) was studied in 30 adults with normal cardiovascular function undergoing nitrous oxide-enflurane or nitrous oxide-fentanyl anesthesia to determine the relationship between tcPO2 and PaO2. The tcPO2 was an accurate and clinically useful trend indicator of PaO2 (r = 0.9; p less than 0.0001). The ability to detect trends was unaffected by the type of anesthetic agent used. The technique was less useful in predicting absolute values for PaO2 (r = 0.86). It is suggested that more widespread application of such monitoring awaits definitive development of a halothane-resistant electrode.

Adolescent↗
PubMed1981

Transcutaneous oxygen and carbon dioxide monitoring. Use in adult surgical patients in an intensive care unit.

We evaluated a combined transcutaneous oxygen and carbon dioxide (tcPO2 and tcPO2) monitor in 33 adult surgical patients in an intensive care unit. Surgical procedures included cardiothoracic, general, vascular, and orthopedic operations. Ninety-three paired, transcutaneous values were compared with simultaneously determined arterial blood gas measurements. The correlation coefficient for PaO2 was .75 (P less than .01) whereas for PaCO2 it was .55 (P less than .01). Although statistically significant, individual transcutaneous values differed by as much as 50 mm Hg from levels determined from arterial samples. Such differences make it inappropriate to use this monitor to predict actual PaO2 or PaCO2. By contrast, continuous monitoring allowed observation of acute changes associated with respiratory-care procedures and cardiovascular decompensation. Such acute changes changes were appreciated on the tcPO2 tracing but not the tcPO2 tracing. We conclude that the tcPO2 monitor is a valuable trend indicator of cardiopulmonary dysfunction, but that the tcPCO2 monitor is not.

Adult↗
PubMed1981

Relationship between transcutaneous and arterial carbon dioxide tension in adult patients anesthetized with nitrous oxide-fentanyl and nitrous oxide-enflurane.

The transcutaneous technique of measuring carbon dioxide tension (tcPCO2) was studied in 30 adult neurosurgery patients undergoing nitrous oxide-enflurane or nitrous oxide-fentanyl anesthesia to determine the relationship between tcPCO2 and PaCO2. tcPCO2 was an accurate (r = 0.9) and clinically useful trend indicator of PaCO2. The ability to detect trends was unaffected by the type of anesthetic agent used. The technique was less useful in predicting absolute values for PaCO2 (r = 0.64). This technique may be particularly useful in situations in which control PaCO2 is essential to patient management.

Adolescent↗
PubMed1980

Hemodynamics in patients with severe toxemia during labor and delivery.

Three patients with severe pre-eclampsia-toxemia were studied with thermodilution tip pulmonary artery catheters. All patients were delivered by cesarean section with general anesthesia and endotracheal intubation. The left ventricular stroke work indices (LVSWI) of these patients were higher than those of normal nonpregnant subjects. There was no evidence of myocardial depression in terms of either cardiac index or the LVSWi-pulmonary capillary wedge pressure (Frank-Starling) relationship. Pulmonary arteriolar resistance (PAR) was found to be within or below the normal nonpregnant range, suggesting that in severe toxemia the pulmonary vasculature is not involved in a primary vasospastic process. At delivery a rise in cardiac index (CI) and mean pulmonary capillary wedge pressure (PCWP) occurred. The PCWP was higher in the postpartum period than prior to delivery. This was felt to represent an increase in circulating blood volume. The therapeutic significance of these findings is discussed.

Adolescent↗
PubMed1980

Invasive hemodynamic monitoring in critically ill pregnant patients: role of Swan-Ganz catheterization.

Pulmonary artery flow-directed (Swan-Ganz [SG]) catheters are widely accepted as an integral part of the modern management of critically ill patients. Their use permits rational therapeutic decisions to be made on the basis of continuously evolving indices of ventricular function. The information which may be derived from these monitors and the complications associated with their use are outlined. The related reports in the obstetric literature and the authors' 3-year experience are discussed. It is concluded that SG catheterization can be of value in the hemodynamically unstable parturient patient.

Adult↗
PubMed1980

Perioperative considerations in the management of tracheotomy for the obstructive sleep apnoea patient. Three illustrative case reports.

The perioperative course of three patients with obstructive sleep apnoea who underwent tracheotomy is presented as illustrative of the potentially life-threatening complications of management. It is concluded that this disease demands strict adherence to basic principles of airway management and close observation extending into the period after operation.

Adult↗
PubMed1980

Pulmonary artery flow-directed catheter use in the obstetric patient.

Pulmonary artery flow-directed (Swan-Ganz) catheters permit continuous central hemodynamic monitoring of unstable patients. They provide important information about left ventricular function, because left ventricular end-diastolic pressure is reflected by measurement of the pulmonary capillary wedge pressure. Furthermore, thermodilution-tip models permit rapid determination of cardiac output. This report presents 3 different types of problems in obstetric patients in whom management was greatly facilitated by the use of Swan-Ganz catheters.

Adult↗
PubMedDate not supplied

Complications of pulmonary artery catheterization of obstetric patients.

Twenty-one obstetric patients in whom pulmonary artery catheters had been inserted were studied. Complications were minor in nature and unassociated with adverse sequelae. They included transient premature ventricular contraction on insertion of the catheter in two cases and a ruptured balloon and a positive culture of the catheter tip in one case.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Transesophageal two-dimensional echocardiography in the critically ill--is the Swan-Ganz catheter redundant?

Swan-Ganz catheterization can facilitate intra-operative management of critically ill patients. The derived data lacks specificity, however, and, as such, is frequently misleading. This disadvantage, combined with recent advances in echocardiography imaging techniques, has resulted in increasing application of transesophageal (TE) two-dimensional echocardiography (2D-echo) to supplement and, in instances, to supplant conventional cardiac monitoring. This paper reviews the current status of single-plane TE 2D-echo as it pertains to evaluation of left ventricular (LV) volume status, performance, and ischemia. It is concluded that, while 2D-echo multiple-plane analyses provide an accurate representation of LV dimensions, interpretation of TE single-plane end-diastolic measurements should be limited to differentiation between extremes of LV volume. In contrast, corresponding estimates of LV ejection fraction correlate closely with overall performance, at least in cases without asynergy. Finally, the capacity of TE 2D-echo to detect LV regional wall-motion abnormalities can be particularly useful. Such abnormalities commonly represent early manifestations of ischemia and can, in addition, be predictive of subsequent outcome.

Cardiac Volume↗
PubMedDate not supplied

Intraoperative two-dimensional echocardiography and color flow Doppler imaging: a basic transesophageal single plane patient examination sequence.

Recent advances in technology have allowed application of transesophageal echocardiography to intraoperative care of critically ill patients. Early clinical application primarily involved evaluation of left ventricular regional wall motion. However, valid intraoperative use of transesophageal echocardiography should also encompass systematic assessment of the entire heart as well as the great vessels. This report describes a 10-step sequence of single plane, two-dimensional echocardiographic views which constitute a basic patient examination capable of being performed by a practitioner whose primary responsibility is the delivery of anesthesia care. A 5-step color flow Doppler examination sequence is also presented. These views complement the two-dimensional echocardiographic steps. Representations of methods for grading Doppler-defined valvular regurgitation complete the report.

Echocardiography, Doppler, Color↗