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Biomedical subjects

T Phillips

Publications and source records attributed to T Phillips.

At least 37 records · Page 2Linked to original sources
PubMed1987

Vertebral artery injury--diagnosis and management.

The literature on vascular trauma contains little information on the management of vertebral artery injuries. We have reviewed our experience consisting of 23 patients with vertebral artery injuries caused by 19 gunshot wounds, two stab wounds, one shotgun wound, and one blunt injury. Twelve patients sustained unilateral vertebral artery thrombosis, seven patients had vertebral AV fistulae (three jugular vein, four vertebral vein) and four patients sustained mural injury without thrombosis. Six patients (26.1%) developed major neurologic deficits of which five could be directly attributed to CNS missile injury. One patient had transient vertebrobasilar ischemia on the basis of a vertebral AV fistula. Four of the seven vertebral AV fistulae were managed solely by therapeutic embolization and two patients early in the series underwent surgical management alone. One patient had therapeutic embolization of the proximal vertebral artery and operative distal vertebral artery ligation for an AV fistula. The four patients who died (17.4%) did so as a direct result of their CNS missile injury. We conclude that: 1) unilateral vertebral artery occlusion seldom results in a neurologic deficit if there is a normal contralateral vertebral artery and PICA (posterior inferior cerebellar artery) blood supply is preserved; 2) accurate assessment of a vertebral artery injury requires contralateral vertebral arteriogram; 3) management of vertebral artery injury is simplified by proximal, and if possible distal, therapeutic embolization; 4) an anterior approach to the C1-2 vertebral artery is a satisfactory method of obtaining distal surgical control, obviating the need to unroof the bony canal of the vertebral artery; 5) angiography is necessary in penetrating neck trauma to identify occult vascular injuries.

Adolescent↗
PubMed1986

In vivo modulation of glutathione by buthionine sulfoximine: effect on marrow response to melphalan.

The effect of giving buthionine sulfoximine (BSO), 0.0265 g/mouse (6 mM), at 12 and 6 hr before treatment with melphalan--0.0 mg, 3 mg, 6 mg, and 9 mg/kg, was studied in C3H mice, and was compared with control groups that received normal saline 12 and 6 hr before identical melphalan treatment. BSO treatment resulted in depletion of GSH levels in bone marrow, liver, and muscle to 65, 13, and 41% of control levels, respectively. Hematological toxicity was assessed by measurement of CFU-S survival and peripheral white cell counts. CFU-S survival decreased with increasing doses of melphalan, but no difference was observed with BSO pre-treatment. Likewise, WBC counts following melphalan 9 mg/kg, were similar irrespective of BSO pre-treatment. These data suggest that the marrow toxicity seen with melphalan is not worsened by pre-treatment with BSO and that if tumors can be pre-sensitized with BSO, there may be a clinical role for melphalan/BSO drug combination.

Animals↗
PubMed1986

Early open reduction and internal fixation of the disrupted pelvic ring.

Early open reduction and internal fixation (ORIF) of extremity fractures in patients with multiple injuries has been demonstrated to be safe, improve survival, and decrease the incidence of respiratory failure. Complications leading to abandonment of planned operative fixation and death in several patients with pelvic fractures led us to initiate a policy of early ORIF of the disrupted pelvic ring. Early ORIF of the pelvis was performed in 15 multiply injured patients between May 1984 and August 1985. Patients ranged in age from 13 to 79 years, their Hospital Trauma Index-ISS scores ranged from 14 to 68, and number of preoperative transfusions ranged from 0 to 42. Types of fractures were A-P compression, two, lateral compression, one, vertical shear, seven, complex, two, and acetabulum with ring disruption, three. All patients were resuscitated, transported in pneumatic antishock garments, and evaluated by abdominal and pelvic CT scan (in two patients following celiotomy). Preoperative angiograms to assess retroperitoneal hemorrhage in eight patients resulted in identification and control of significant bleeding in five. The mean time from injury to pelvic stabilization was 38 hours. Seven patients underwent ORIF within the first 24 hours. In most cases simultaneous anterior and posterior internal fixation was performed with the patient in the lateral decubitus position. Excluding associated procedures, operative time averaged 5.1 hours. Intra-operative transfusions averaged 4 units (range, 0-11). Rigid fixation was achieved in all patients. Most patients were out of bed by the third postoperative day. No patient developed respiratory failure. Two patients developed wound infections. Modification of our technique has avoided this complication in the latter part of this series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Use of the contrast-enhanced CT enema in the management of penetrating trauma to the flank and back.

There have been few innovations in the management of penetrating trauma of the flank and back since that reported by Peck and Berne in 1981. During 1984-1985 our Trauma Service treated 119 patients with injuries in these areas. In 56 patients management was based on the results of the contrast-enhanced CT enema (CECTE), a computerized tomographic technique designed to delineate all of the retroperitoneal viscera by simultaneously opacifying the small bowel, duodenum, colon, GU tract, and major vessels. Specific radiographic findings were present on 44 scans. Twelve scans were negative. Six scans were considered indications for angiography because of the proximity of the identified missile wounds or their hematomas to major vascular structures. One of these arteriograms revealed a renal artery pseudoaneurysm which would otherwise have remained undiagnosed. In 30 cases the penetrating wounds were well delineated by CECTE, and their nature and location were considered appropriate for nonoperative management. None required subsequent exploration. In eight cases CECTE demonstrated that the wounds were located so as to place specific viscera at risk for significant injury, but no definite injury was identified. Five of these patients were successfully managed by further evaluation and close observation, two were explored, and one signed out of the hospital. No scan demonstrated extravasation from a hollow viscus. Overall, 52 of our 56 patients (92%) were successfully managed nonoperatively on the basis of the interpretation of their CECTE findings. CECTE can be useful in the management of stable patients with penetrating trauma to the back and flank by identifying the nature and location of the resulting retroperitoneal injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1986

An analysis of 161 falls from a height: the 'jumper syndrome'.

Vertical deceleration injuries represent a distinct form of urban blunt trauma. We reviewed 161 adult patients, admitted over 36 months, who jumped or fell from a height of one to seven stories and survived emergency department resuscitation. Charts and radiographs were analyzed to identify common injuries, complications, and causes of death. Those who fell five or more stories had a mean ISS of 41, for a predicted survival of 50% but actual survival of 83%. Virtually all these patients had multiple fractures. Sixty per cent of them presented in shock, yet more than two thirds had angiographically demonstrated retroperitoneal hemorrhage as their major source of bleeding. Thirteen patients had significant intra-abdominal injuries, with only one associated with major hemorrhage. Utilizing early diagnostic peritoneal lavage, ten of 13 patients explored had a therapeutic laparotomy. Hollow viscus perforations accounted for about one half of the abdominal injuries, including three duodenal injuries. Conclusions. 1) Patients who present in shock after falls from height are much more likely to be bleeding from retroperitoneal than intraperitoneal sources. 2) Early tap and lavage followed by emergency angiography and transcatheter embolization is the treatment of choice in this group of patients. 3) Although these patients often have multiple complex injuries, the prognosis for long-term survival is good. Therefore, we advocate early aggressive operation stabilization of fractures to permit patient mobilization, facilitate pulmonary toilet and nursing care, and to decrease long-term disability.

Abdominal Injuries↗
PubMed1986

Acute spinal cord ischemia: prevention of paraplegia with verapamil.

Although irreversible damage to the central nervous system has been considered inevitable after 6 min of circulatory deprivation, there has been evidence for almost 20 years that this may be the consequence of postischemic events. Recent investigations have implicated calcium-mediated phenomena as responsible for damage to neuronal cells in the reperfusion period. We studied the effect of verapamil on the neurologic sequelae of spinal cord ischemia using somatosensory evoked potential monitoring in a canine preparation of spinal cord ischemia. Ten mongrel dogs weighing between 20 and 30 kg each were divided into two groups. The experimental group was pretreated with 0.4 mg/kg verapamil and the control group received no treatment. The thoracic aorta was then occluded. Flow was restored 17 min after there was complete loss of somatosensory evoked potentials. Experimental dogs received additional doses of verapamil upon reperfusion and at 1, 2, 3, 4, 5, 6, and 10 hr after reperfusion. Four of five verapamil-treated dogs were able to walk postoperatively, whereas all of the control dogs suffered dense paraplegias (p = .02). We conclude that verapamil can ameliorate the sequelae of spinal cord ischemia and that this preparation is suitable for the study of the mechanisms of ischemic neuronal damage in an area outside the brain.

Animals↗
PubMed1986

Effects of intraventricular methotrexate on cerebrospinal fluid monoamine metabolites in rhesus monkeys.

Previous work suggested that methotrexate (MTX) may cause encephalopathy by inhibiting biosynthetic pathways for dopamine and serotonin in the brain. We examined this issue by measuring the neurotransmitter metabolites homovanillic acid and 5-hydroxyindoleacetic acid in the lumbar CSF of rhesus monkeys receiving continuous intracerebroventricular infusions of MTX or dichloromethotrexate. Infusion of the lowest dose (0.05 mg/day) produced a large (300%) rise in homovanillic acid levels and a modest elevation in 5-hydroxy-indoleacetic acid. During higher dose infusion, which was associated with clinical encephalopathy, the biogenic amine metabolites fell from their previous elevated levels. In one encephalopathic monkey, an injection of 1 mg of leucovorin produced a marked elevation in CSF monoamine metabolites within 1 hour and rapid clinical recovery. In contrast, leucovorin produced no change in monoamine metabolites in control animals. The data suggest that MTX may block egress of monoamine metabolites from CSF at the lower doses and suppress neurotransmitter turnover at toxic doses which cause encephalopathy. Serial measurements of CSF monoamine metabolites deserve further investigation as biochemical markers for toxic effects of MTX on neuronal metabolism in the CNS.

Animals↗
PubMed1986

African swine fever. I. Morphological changes and virus replication in blood platelets of pigs infected with virulent haemadsorbing and non-haemadsorbing isolates.

Replicating and mature viral particles were detected with the transmission electron microscope in blood platelets of pigs infected with virulent haemadsorbing and non-haemadsorbing African swine fever virus isolates. Although platelet numbers decreased terminally in infected pigs, the most noticeable morphological damage to these cells apparent in the last 2 days of the disease included cytoplasmic swelling, vacuolation, fragmentation and loss of dense granules.

African Swine Fever↗
PubMed1985

Hemipelvectomy, a lifesaving operation in severe open pelvic injury in childhood.

Near-complete traumatic hemipelvectomy probably carries an extremely high mortality rate. The usual techniques which have been used to control major hemorrhage associated with pelvic fractures such as transperitoneal vascular ligation, intra-arterial embolization, and packing are not applicable (14). Successful management requires prompt recognition of the nature of this injury so that surgical efforts may be directed at resuscitation and expeditious operative completion of the traumatic amputation. When this decision is made appropriately, the dual goals of control of hemorrhage and prevention of sepsis can be achieved. We report the management of a 7-year-old boy who sustained this injury after being struck by a tractor-trailer. In spite of massive resuscitation, hemorrhage could not be controlled and the child remained in shock. When it was recognized that he had sustained an incomplete traumatic left hemipelvectomy, it was surgically completed, permitting prompt control of the hemorrhage and restoration of hemodynamic stability. Intestinal and urinary diversion allowed an uneventful postoperative recovery without significant infection. Although hemipelvectomy appears to be a radical procedure in children with major pelvic injuries, it may be lifesaving and should therefore be considered in those with severe unilateral pelvic injury and uncontrollable hemorrhage. The potential for physical rehabilitation in the group of young, mostly male patients who have survived this injury appears to be unexpectedly good.

Accidents, Traffic↗
PubMed1985

The diagnostic superiority of computerized tomography.

One hundred three patients with blunt abdominal trauma were studied using computerized tomography (CT). By protocol CT was performed in hemodynamically stable adults either: before tap and lavage (T&L)--32 patients; after 'negative' (less than 20,000 RBC/mm3) or 'borderline' (20,000-50,000 RBC/mm3) lavage--28 patients; or to evaluate hematuria--43 patients. CT was performed after administration of oral and intravenous contrast. A comparison of T&L and CT was made in 60 patients. 16 of 42 patients with negative lavage had 22 injuries identified by CT. One of these patients with bilateral renal artery transection, mesenteric and pararenal hematomas died of a closed head injury. Six of 14 patients with borderline lavage results had nine injuries found on CT, including two with actively bleeding spleens confirmed at operation or angiography. One patient with a large retroperitoneal hematoma underwent successful control of hemorrhage by embolization. Only one injury, a paranephric hematoma found at operation was not identified preoperatively by CT. Seventeen of 85 patients with hematuria had GU abnormalities identified by CT. Findings included seven intrarenal hematomas or contusions, three fractures, three major renovascular injuries, four para- and six perinephric hematomas, and three collection system injuries with extravasation. The majority of these injuries were found in patients with more than 50 RBC/HPF; however, six of 47 patients with less than 20 RBC/HPF had abnormalities including a retroperitoneal bladder perforation and a renal mass (hypernephroma). Two bladder perforations and one urethral injury were identified by CT cystogram. Abdominal CT is more sensitive and specific than T&L or IVP.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1979

Combined modality therapy of hepatic metastasis. Northern California Oncology Group Pilot Study.

Twenty-two patients with adenocarcinoma metastatic to the liver were treated with rapid fractionation whole-liver irradiation (1350-2100 rads in 300-rad fractions) with simultaneous intrahepatic 5-fluorouracil (10-15 mg/kg/day) and intrahepatic Adriamycin 2.5-10 mg/m2/day) as part of a Phase I-II study. Of the 21 patients who completed therapy, 19 had colorectal carcinoma and 2 had metastatic adenocarcinoma of unknown origin. Objective response was judged by measurement of liver size, evaluation of liver function tests, and by liver scan or CAT scan of the liver. Ten of the 21 evaluable patients responded, yielding an overall response rate of 47.6%. The response rate in patients with colorectal carcinoma was 55% (10/19). At this time, median duration of response is 14+ weeks and median survival from onset of therapy is 15+ weeks. Hematologic and gastrointestinal toxicity were tolerable. No hepatic toxicity was documented. This combined modality therapy was found to be a safe effective method for the palliation of liver metastasis.

Adenocarcinoma↗
PubMed1978

Immunologic changes in regional lymph nodes of melanoma patients.

In tumor-draining lymph nodes, humoral immunity is diverted from individually specific, cytotoxic anti-membrane AB to less specific anti-cytoplasmic AB with progression of the disease. Auto-anti-anti-bodies and suppressor cells seem to be involved in the failure of control of metastasis.

Antibodies, Neoplasm↗
PubMed1973

Laparoscopy: the method of choice for sterilization and investigation of infertility.

The increasing demand for sterilization as a permanent and effective form of birth control leads one to consider the various methods available to achieve this end. Tubal cauterization and excision by laparoscopy appears to be a safe, efficient method.The technique used is carefully reviewed step by step. The absence of major complications in this series of 115 consecutive laparoscopies certainly supports the safety of the procedure. The low morbidity, short hospital stay and minimal time required appeal particularly to the working mother. The absence of an abdominal scar is also much appreciated. The procedure, when used for investigation of infertility, provides far more information than other current methods.

Adult↗