Lester R. Bryant

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.

Histiocytoma (fibrous xanthoma) of the lung.

Abstract A case of histiocytoma of the lung in a five year old child is presented. The appearance of the lesion at operation suggested that it was a malignant neoplasm, but subsequent study showed that it was benign. Several histiocytic tumors in locations other than the lung have proved to be malignant, and recurrence has followed incomplete removal of benign extrapulmonary lesions. Of twenty-two other reported pulmonary histiocytic tumors, including five in children, none has been malignant. It is suggested that these tumors should be treated conservatively by a wide local excision which includes a margin of uninvolved lung.

Infected Permanent Cardiac Pacemaker: Management Without Removal

Abstract Infected permanent cardiac pacemakers need not be removed. Local debridement and irrigation with antibiotic solutions have successfully eradicated the infection in 5 patients.

Subendocardial vascular distortion at small ventricular volumes

Abstract Greater distortion of subendocardial vessels compared to subepicardial vessels with decreasing ventricular volume was predicted from a simple mathematical model. The left ventricular wall near the base behaves as the wall of a sphere with changing ventricular volumes. Photomicrographs of barium injected coronary vessels at different ventricular volumes demonstrates the distortion of subendocardial vessels at small ventricular volumes. Venous obstruction was observed in the subendocardium of the contracted fibrillating heart following cardiopulmonary bypass. Small ventricular volume appears to predispose the heart to subendocardial hemorrhagic lesions.

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.

Experimental and Clinical Evaluation of Heparin-Impregnated Cloth-Covered Cardiac Valves Used Without Systemic Anticoagulation

Abstract The results of a pilot study to determine whether heparin-impregnated cloth-covered cardiac valves may offer increased protection against thromboembolism are reported. In animal studies the heparin-impregnated valves in the tricuspid position were encapsulated within 3 months by a thin, smooth, uniform neointima. In contrast, the control valves had a nodular accumulation of tissue with a thickness of 1 to 2 mm. In a clinical evaluation, 32 patients were managed in a standard fashion postoperatively with orally administered anticoagulants (Group 1) while 34 patients were given heparin-impregnated valves (Group 2). Six of the 32 patients in Group 1 had a cerebral embolic episode. In contrast, the Group 2 patients, without systemic anticoagulation, had a lower incidence of cerebral embolism (2 of 34). The use of heparin-impregnated cloth-covered valves without systemic anticoagulation did not increase the incidence of thromboembolism, and it may reduce the potential complications of anticoagulant therapy.

Transit time and bacterial overgrowth as determinants of absorptive capacity.

Abstract A detailed account is given of the hospital course of a newborn male infant who at 18 days of age underwent resection of all small bowel but 2.5 cm. of duodenum and 5 cm. of terminal ileum. He was maintained on parenteral nutrition while compensatory growth of the gut permitted him to exist by eating a diet supplemented with medium-chain triglycerides and enteric antibiosis. Elimination of the iodochlorhydroxyquin results in increased stool frequency and weight. As absorptive area decreases, transit time and bacterial growth seem to be critical determinants of absorptive capacity.

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.