Defects of the Broad Ligament of the Uterus

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74780/1/j.1572-0241.1986.tb01505.x.pd

Lung injury produced by moderate lung overinflation in rats

In models using both intact animals and isolated lungs of rats, rabbits, lambs, and dogs, application of high airway pressure and resultant lung overdistension has been shown to cause lung injury. Under pathological conditions, the more normal portions of the lung may be subjected to relative overdistension when supranormal airway pressures are used. A small animal model of lung overdistension is presented here to demonstrate that lung injury can be caused by moderate lung overdistension. Rats were anesthetized with Ketamine and pentobarbital. A tracheostomy was performed and arterial and central venous catheters placed. The animal was placed in a plethysmograph and an infant ventilator was used to provide mechanical ventilation. In the first experiment, animals in group A (n = 6, control) were ventilated at tidal volume (TV) of 5 mL/kg for 5 hours. Animals in group B (n = 6) were ventilated at TV 15 mL/kg for 60 minutes and then were returned TV of 5 mL/kg for the remainder of the experiment. Animals in group C (n = 5) were ventilated at TV 20 mL/kg for 60 minutes and then returned to TV 5 mL/kg. Static lung compliance and arterial blood gasses were measured. Wet and dry lung weight were obtained after sacrifice. In the second experiment, animals in group D (n = 4, control) were ventilated at TV 5 mL/kg for 240 minutes and killed. Animals in group E (n = 4) were ventilated at TV 20 mL/kg for 60 minutes, returned to TV 5 mL/kg, and killed at 240 minutes. Fluorescein-labeled albumin was administered to each animal prior to mechanical ventilation. At sacrifice bronchoalveolar lavage was performed on the right lung. The left lung was fixed for microscopy. Hematocrit, venous oxygenation, and temperature remained stable throughout the experimental period. Group C animals had an elevated PO2 during high volume mechanical ventilation. By the conclusion of the experiment, animals in group B and C were acidotic. Lung compliance fell in all groups. Wet/dry lung weight and dry lung weight/body weight ratios increased in the TV 20 mL/kg group. Analysis of bronchoalveolar lavage fluid for fluoresceine in order to detect capillary-alveolar leak revealed no difference between TV 5 mL/kg (control) and TV 20 mL/kg animals. There was slight perivascular edema in the TV 20 mL/kg specimens. We have demonstrated in a whole animal preparation in rats that lung injury can result from mechanical overdistension with as little as 20 mL/kg for 1 hour.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31088/1/0000765.pd

Low oxygen delivery produced by anemia, hypoxia, and low cardiac output

In pentobarbital-anesthetized dogs, oxygen delivery (DO2) was measured by thermodilution cardiac output and cooximeter determined oxygen content, while oxygen consumption (VO2) was measured independently by spirometry. Oxygen delivery was decreased by isovolemic dilutional anemia, breathing hypoxic gas mixtures, or cardiac tamponade to reduce cardiac output. Baseline VO2 (cc/kg/min) for the three groups was 5.9 +/- 0.7 (anemia), 5.4 +/- 0.4 (hypoxia), and 5.6 +/- 0.1 (low C.O.) (NS). A critical level of oxygen delivery (DO2crit) was found at 9-10 cc/kg/min (anemia), 10-11 cc/kg/min (hypoxia), and 9-10 cc/kg/min (low C.O.) (NS.). Below this level, VO2 fell (became supply dependent) and lactic acidosis occurred, regardless of the mechanism of impaired oxygen delivery.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29062/1/0000095.pd

Predictors of postoperative outcome after general surgical procedures in patients with congenital heart disease

This study was undertaken to evaluate factors predictive of postoperative outcome after general surgical (GS) procedures in patients with congenital heart disease (CHD). All patients with a diagnosis of CHD who underwent a GS procedure under general anesthesia during a consecutive 10-year period were considered eligible for the study. The congenital heart defect was classified as either simple (ASD, VSD, PDA) or complex (endocardial cushion defects, transposition of the great vessels, tetralogy of Fallot), and the GS procedure as either major (intraperitoneal, intrathoracic, or vascular reconstructive) or minor (inguinal herniorrhaphy, vascular access). The overall mortality rate for the patient population was 12% (27 deaths among 226 procedures), minor procedures being associated with a 3% mortality rate (2 of 70 procedures), and major procedures with a 16% mortality rate (25 of 156 procedures). Incremental risk factors for mortality included a preoperative American Society of Anesthesiologists' (ASA) physical status class of IV or higher (P = .0003), a preoperative in-hospital stay of 10 or more days (P = .004), birth at a tertiary care center (P = .04), and emergency operations (P = .05). In the subgroup of patients less than 6 months old, weight of less than 2.4 kg at the time of surgery and a 1-minute Apgar score of less than 4 were additional independent risk factors (P = .04 and .01, respectively). By logistic analysis, previous corrective cardiac procedures, whether complete or palliative, did not significantly alter the postoperative outcome. The authors conclude that physiologically well-compensated patients with CHD can undergo elective operations at a low operative risk; however, poorly compensated patients undergoing urgent or emergent operations are at high risk. Previous corrective cardiac procedures may improve the overall outcome if the physiological state of the patient could be improved.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31485/1/0000407.pd

Platelet consumption during neonatal extracorporeal life support (ECLS)

This paper reports the results of a retrospective study of blood use and blood loss in 40 neonates during extracorporeal life support (ECLS). Immediately after onset of bypass 39±2.5ml platelets, 59.4±6.5ml packed red blood cells (PRBC) and 15.0±5.4ml fresh frozen plasma (FFP) per patient were needed. The average daily amount given per patient was 49.0±3.0ml of platelets and 48.0±3.4ml and 9.6±3.9ml of PRBC and FFP respectively. The 10 patients who had bleeding complications received 50.0±6.3ml/day of platelets compared to 49.0±3.4ml in the other patients. The majority of blood loss during the entire period of ECLS was from samples, averaging 43.0 ± 1.5ml/day. Neck wound drainage, 6.7±2.5ml/day per patient, lasted for the entire period.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68887/2/10.1177_026765919200700106.pd

Efficacy of anterior gastric fundoplication in the treatment of gastroesophageal reflux in infants and children

Anterior gastric fundoplication (AGF) has been performed at the University of Michigan since 1988. To objectively evaluate the long-term efficacy of the AGF, the authors performed a study of children who had undergone AGF between June 1988 and June 1990 (n = 46). Six of them died of unrelated causes. Twenty-two consented to follow-up evaluation that included parental interview, physical examination, upper gastrointestinal series (UGI), 24-hour esophageal pH probe monitoring (EpH), and a liquid-phase gastric emptying study. Twenty patients (74%) remained asymptomatic, patients exhibited gastroesophageal reflux (GER) by UGI, and three others by EpH. Three children were noted to have delayed gastric emptying. These results compare favorably with data previously reported from this institution of a 5-year follow-up of children after Nissen fundoplication. There is a trend toward improved efficacy (87% v 74%; P = .12), decreased reoperation rate (4% v 14%; P = .11), and less severe complications. The present study shows that AGF is effective treatment for GER when evaluated by objective studies and is comparable in therapeutic efficacy and safety to the Nissen fundoplication.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31949/1/0000902.pd

Cause of Death in Carcinoma of the Esophagus

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71723/1/j.1572-0241.1989.tb02497.x.pd

Distal intussusception of processus vaginalis: A cause of acute hydrocele

Acute obstruction of a patent processus vaginalis occurred in two boys, mimicking incarceration of an inguinal hernia. In fact, obstruction was caused by an intussusception of the processus vaginalis forming an intussuscipiens that occluded the hernia sac. This lesion, described previously in 1896 and in 1974, is one of the mechanisms by which an asymptomatic hernia or hydrocele becomes acutely symptomatic.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30698/1/0000343.pd