Biomedical subjects

W Suval

Publications and source records attributed to W Suval.

5 recordsLinked to original sources

PubMed1988

Partial versus complete arterial transection, fact versus fancy.

Traditionally, hemorrhage from the partially transected artery exceeds that from its completely divided counterpart. The clinical significance of this distinction is pertinent to the control of the hemorrhage in the field as well as in the operating room. To test the hypothesis the femoral arterial blood flow (Q) of seven anesthetized (pentobarbital, 30 mg/kg, IV) dogs, whose average weight was 19.5 +/- 0.9 kg, was measured before and after partial (25%, 75%) and complete transection of the artery distal to the transducer of an electromagnetic blood flow meter amplifier. Systemic arterial pressure (P) was recorded. Control Q was 72 +/- 14 (S.E.) ml/min, control P was 119 +/- 9 mmHg. Flow increased to 369 +/- 24 ml/min when partial laceration (25% lumenal diameter) was accomplished sharply; this increase was significant (P = 1.7 X 10(-6]. When the arterial division was near completion (75% lumenal transection), Q was 358 +/- 30 ml/min. This value was not significantly different (P = 0.80) from the value that resulted from complete transection of the femoral artery (320 +/- 41 ml/min). Arterial pressure fell transiently (11.5 +/- 1.7, 13.5 +/- 1.6, and 13.9 +/- 2.1 mmHg respectively) as a result of each injury but the apparent differences were not significant (P = 0.25). These observations from canine experimentation indicate that hemorrhage from the partially severed femoral artery is indistinguishable from that which results from its complete transection. In view of these findings in dogs, traditional concepts regarding such injuries in man should be viewed as unproven speculation.

Animals↗

PubMed1988

Unsuspected perforation in bleeding duodenal ulcers.

A combination of bleeding and perforation rarely occurs simultaneously in peptic ulcer disease. The charts of 127 patients undergoing surgery for either complication were reviewed (bleeding, 91; perforation, 36). Nine of 91 (9.9%) patients in the bleeding group were found at operation to have a unsuspected perforated duodenal ulcer. The operative mortality in the patients with the combined complications (44%, 4/9) was significantly higher than that in patients with bleeding alone (8/82, 9.8, P less than 0.001) or those with perforation alone (4/36, 11.00, P less than 0.025). The mean age of nonsurvivors was significantly higher than that of the survivors (74 +/- 8.01 vs 50.4 +/- 5.65 years, P less than 0.005). The duration of symptoms until operation was longer in patients who died (63 +/- 12.7 hours) than in survivors (40.2 +/- 6.02 hours, P = NS). All patients who died, and three of five survivors, had preoperative fever (greater than 99.0 F), leukocytosis (greater than 12,000/mm3), and persistent tachycardia despite adequate hydration and blood replacement. Perforation in bleeding peptic ulcers is not an uncommon finding, and was present in 9.9 per cent of patients. The presenting symptom of bleeding may obscure signs of perforation, delay surgery, and contribute to the higher mortality rate. The presence of fever, leukocytosis, and tachycardia despite adequate fluid and blood replacement warrants a suspicion of perforation in patients with bleeding peptic ulcer.

Adult↗

PubMed1988

Intra-abdominal infection following combined spleen-colon trauma.

The reality of late overwhelming post-splenectomy sepsis in adults as well as children has led to more frequent attempts at splenic salvage following splenic trauma. Less attention has been paid to early septic postoperative complications in the splenectomized patient. Associated colon injury has been believed to be a relative contraindication to splenic conservation. If splenectomy enhances the chance of early postoperative infection, then associated colon injury should be an indication for splenic salvage One hundred sixty one patients who had either splenic trauma (58), colon trauma (90), or combined spleen-colon trauma (13) were studied. All patients with splenic trauma had a splenectomy. There was a significantly higher incidence of intra-abdominal sepsis requiring reoperation in the spleen-colon patients (46.7%) than in either of the other groups (spleen = 5.7%, colon = 8.9%, P less than .002 for both comparisons). It is concluded that splenectomy enhances infection in the early postoperative period. When possible, combined spleen-colon trauma should be an indication rather than a contraindication for splenic salvage.

Abdomen↗

PubMed1986

Beneficial effects of ethanol on experimental burns.

Alcohol has been demonstrated to produce cutaneous vasodilation. The burn wound is characterized by a compromised microcirculation which is amenable to pharmacologic manipulation to improve the final outcome of the injury. Various agents including heparin, aspirin, nonsteroidal anti-inflammatory agents have been employed to maintain a patent microcirculatory bed. Ethanol has been used in the present study in a murine burn model as a vasodilator administered immediately preburn and post-burn. Preburn administration of ethanol significantly improved the mean burn severity at 48 hr compared to ethanol given post-burn. Ethanol, acting as a vasodilator, improves dermal circulation post-burn and reduces the overall extent of injury.

Animals↗

PubMed1985

Reoperation for sepsis.

A retrospective study of 50 patients undergoing reoperation for sepsis was performed to evaluate the ability of commonly available clinical and laboratory tests to predict the findings at reoperation and the outcome after operation. The influence of multiple organ failure on these parameters was also studied. No laboratory finding helped to predict operative findings. Computed tomographic scanning (80% accurate) was the most helpful radiographic procedure. A low total lymphocyte count and a high serum creatinine level both predicted a fatal outcome. No single organ failure or combination predicted a positive reexploration. Infection was found in 75 per cent of patients with multiple organ failure and 79 per cent of patients who did not have this syndrome. Patients having three-organ failure did have a significantly higher mortality. The mortality of a negative reexploration was 18.2 per cent, slightly lower than the 28.2 per cent mortality of patients with a positive exploration. No patient without organ failure died. The authors conclude that laboratory tests are not helpful in predicting the presence of infection on reexploration, that the decision to reoperate is one based primarily on clinical judgment, and that if reoperation is performed before the development of organ failure, the risk associated with a negative exploration is worth taking.

Adult↗