J. Kent Trinkle

Pulmonary Contusion: Pathogenesis and Effect of Various Resuscitative Measures

Abstract Pulmonary contusion (PC) was induced in anesthetized dogs by firing a .38 caliber blank cartridge against the chest wall. Studies of blood gases, lesion size, lung weight, and microscopical appearance were performed. Various forms of therapy which are commonly used in trauma victims were evaluated. The following conclusions were reached: untreated PC is not progressive; mechanical ventilation and furosemide therapy decrease the severity of the pulmonary lesion; administration of low-molecular-weight dextran and lactated Ringers solution increases the anatomical and physiological lesion; and central venous pressure is not an accurate index of crystalloid overload. The contused lung is very sensitive to administration of noncolloid fluids.

A Technique for Intercostal Nerve Block After Thoracotomy

Abstract Small Teflon catheters placed adjacent to the intercostal nerves through the operative incision may be used for intermittent injection of lidocaine following lateral thoracotomy. The method is especially useful for relief of pain in those patients for whom large doses of narcotic analgesics are potentially harmful.

Cardiac Valve Replacement in Patients with Severely Reduced Cardiac Output

Abstract The results are presented of cardiac valve replacement in 50 patients with a preoperative cardiac index of 1.6 L. per minute per square meter of body surface area or less. Mean cardiac index for the group was 1.42 L./min./ m. 2 , and the mean age was 48.1 years. Operative correction of more than one valve was required in 46% of the patients. Twenty-three hospital deaths resulted in an operative mortality of 46%. Seven deaths were related to technical errors, and 11 of the remaining 16 patients who died had significant myocardial fibrosis, myocardial necrosis, or coronary artery disease at postmortem examination. Eleven of the 27 survivors have subsequently died; the mean postoperative survival has been 21 months. Sixteen patients, or 32% of the entire group, are still alive and in Functional Class I or II (New York Heart Association) for one to seven years following operation. The results of operation in this group of patients suggest that irreversible myocardial damage may accompany longstanding valvular disease and emphasize the hazard which accompanies delay in valve replacement.

The metabolic effect of fluoride inhibition of anaerobic glycolysis during hemorrhagic shock

Abstract Sodium fluoride, a metabolic inhibitor which blocks an essential step in anaerobic glycolysis, was administered to cats prior to hemorrhage. Lower serum lactate (P = .01) in the animals receiving NaF indicates that anaerobic glycolysis was effectively suppressed. No significant differences in survival, pH, PO2, PCO2, or arterial and venous pressures were noted in a similar group of animals which did not receive NaF. These data suggest that anaerobic glycolysis accompanying hemorrhage merely reflects the presence of cellular hypoxia and is in itself of little or no metabolic significance.

A Two-Point Hook for Mitral Valve Excision

Abstract A new instrument is described that has been designed to facilitate excision of the mitral valve for prosthetic replacement.

Influence of thoracotomy and intrathoracic dissection on regional pulmonary blood flow

Abstract Serial lung scintiscans were made in 43 dogs to determine the influence of the operative incision, pulmonary hilar dissection, lung manipulation, and atelectasis on the regional distribution of pulmonary blood flow following thoracic operations. Control thoracotomy without hilar dissection was performed in 6 animals, 15 dogs had segmental or lobar resections, and segmental or lobar bronchial ligation was performed in 18. After control thoracotomy a maximal decrease in regional distribution of pulmonary blood flow to the operative side occurred 2 to 4 days after operation. Mechanical ventilation before performance of the lung scans restored regional blood flow to a near-normal state, and the effects of the operative incision had disappeared by the fourteenth day. Characteristics defects in regional blood flow occurred after segmental and lobar resections, but abnormal distribution was greatest from 2 to 7 days after operation. Redistribution of blood flow occurred earlier and was more complete after lower lobe than after upper lobe resections. The changes in arteriolar-capillary perfusion following induced atelectasis were nearly identical to those resulting from pulmonary resection.