Harrison M. Lazarus

Patterns of acute vascular injury after intra-arterial barbiturate injection

Summary The rabbit ear was employed to study angiographic alterations induced by intra-arterial injection of thiopental sodium. Acute venoconstriction was the first angiographic abnormality detected, occurring fifteen minutes after Pentothal injection. One hour after injection, progressive venospasm and segmental thromboses were apparent; arterial spasm was minimal. Twenty-four hours after injection, segmental venous thrombosis was prominent. The arterial tree remained patent; however, artery wall irregularities suggested nonocclusive mural thromboses or intimal injury. Seventy-two hours after intra-arterial injection of thiopental sodium, well demarcated gangrene was evident and correlated with extravasated contrast medium. Angiograms demonstrated variable patency of the arterial tree. This study emphasizes the possible role of acute venous injury in the pathogenesis of intra-arterial barbiturate-induced necrosis. A pathophysiologic sequence that correlates our findings with previous experimental efforts by others is presented.

Acute occlusion of the infrarenal aorta

Summary Acute occlusion of the abdominal aorta is usually the result of either severe atherosclerosis followed by spontaneous thrombosis, blunt abdominal trauma, or aortic embolism. Four cases of acute infrarenal aortic occlusion are presented and the literature is reviewed to illustrate this rare but serious vascular catastrophe. These cases are of interest because they represent examples of the major pathogenic varieties of the abdominal aortic thrombosis. All four patients were correctly diagnosed preoperatively and all were relieved of the aortic obstruction with minimal morbidity and without mortality. Early diagnosis and an aggressive surgical approach are essential if this group of patients are to be managed successfully.

Adverse drug events in trauma patients.

BACKGROUND Adverse drug events (ADEs) are noxious and unintended results of drug therapy. ADEs have been shown to be a risk to hospitalized patients. The purpose of this study was to determine the rate and nature of ADEs in trauma patients and to characterize the population at risk. METHODS An electronic medical record, a hospital wide computerized surveillance program, and a clinical pharmacist prospectively investigated ADEs in 4,320 trauma patients from 1996 through 1999. RESULTS The rate of ADEs in trauma patients (98/4320, 2.3%) was twice that of non-trauma hospital patients (1,111/96,218, 1.2%, p < 0.001). Traumatized females had ADEs 1.5 times more often than traumatized males (2.7% versus 1.8%, p = 0.052). The medication class most often associated with ADEs was analgesics with 54% involving morphine and 20% involving meperidine. The most common ADEs were nausea, vomiting, and itching. Only one ADE was directly attributed to a medical error. CONCLUSIONS Trauma patients are at double the risk for ADEs. Analgesics are particularly associated with ADEs and use should be carefully monitored.

Therapeutic prevention of ischemia following intraarterial barbiturate injection

Abstract By using a method of grading angiograms, we have been able to quantify the degree of vascular injury following intraarterial barbiturate injection. We established that intraarterial heparin is a very effective means of therapy in the prevention of vascular injury and tissue loss following intra-arterial barbiturate injection. Intraarterial heparin as well as systemic heparin decreased tissue necrosis from a 65% loss of the extremity with no therapy to only 25% following intraarterial heparin therapy.

Decreased molecular weight of RNA transcribed following kidney storage

Abstract Nuclei were isolated from normal mouse kidneys and kidneys which had been stored at 37° for 60 min. The molecular weight of the RNA synthesized by the isolated nuclei was determined with polyacrylamide gel electrophoresis. Nuclei from stored tissue produced RNA of lower molecular weight than did nuclei from normal kidneys. The difference was due to altered synthesis and not accelerated degradation.

DNA strand breakage after kidney storage

Abstract Ischemia and storage cause single-stranded DNA breaks. The breaks become evident after 30 min of warm storage or after only 4 hr of cold storage. The number of breaks increases with increasing ischemia time. The DNA damage was detected by alkaline sucrose gradient analysis of the DNA.

Preoperative selection of patients for lumbar sympathectomy by use of the Doppler index

Yao and Bergan [8] have shown that an ankle systolic index of more than 0.25 is associated with a high rate of success from lumbar sympathectomy. This association has been borne out in our small series. We have also suggested that diseases that obviously compromise collateral circulation might be a relative contraindication to sympathectomy. Although incomplete, literature on collateral flow in relation to sympathectomy tends to confirm this idea. Consideration of such diseases as a contraindication to sympathectomy might further increase the success rate after sympathectomy. Regardless, ankle systolic index alone appears to be a reliable objective, non-invasive method of selecting patients with an increased chance of success from lumbar sympathectomy.

DNA degradation during organ storage

Es wurden Kerne aus isolierten Mäusenieren, die unter warmen und kalten Bedingungen aufbewahrt worden waren, isoliert. Nach der Bestimmung der Viskosität wurde das Molekulargewicht der kernhaltigen DNS während der Konservierung reduziert. Die Abnahme der DNS-Molekulargrösse bewirkt möglicherweise eine Kürzung der Überlebensdauer des isolierten Organs.

Peritoneal lavage with low morbidity.

Peritoneal lavage has proven to be a useful tool for evaluating abdominal trauma. We developed a technique that avoids the complications associated with the standard dialysis trocar and the minilaporatomy. This technique has been utilized by 51 different physicians in 132 cases with a single avoidable complication. The bladder was entered when the rule of emptying the bladder first was violated.

Increased template activity in injured tissue

Abstract Nuclei and chromatin, isolated from control and injured (1 hr at 37°C in saline) mouse kidneys, were tested for template activity by measuring RNA synthesis with E. coli RNA polymerase. The template activity of both the nuclei and the chromatin isolated from the ischemic kidneys was increased. Removing protein with 0.7 M NaCl from the chromatin eliminated this difference in template activity. The size of the RNA produced on the control and ischemic templates was the same as measured by polyacrylamide gel electrophoresis. The difference in template activity persisted under conditions in which reinitiation of the RNA polymerase was blocked. These results are consistent with an increased number of E. coli RNA polymerase binding sites in injured cells.