Corrado Marini - Academia.edu (original) (raw)
Papers by Corrado Marini
The American surgeon
The possible limitation of left ventricular (LV) relaxation during diastole is a concern for clin... more The possible limitation of left ventricular (LV) relaxation during diastole is a concern for clinicians and researchers utilizing dynamic cardiomyoplasty. This study was designed to evaluate the LV compliance at three different skeletal muscle tensions, in a normal heart and in a failing heart, created by propranolol infusion (11.6 mg/kg). A biventricular latissimus dorsi muscle (LDM) wrap was performed in 10 dogs. The LV pressure (Millar) and two minor axis dimensions (endocardial crystals) were measured. LV pressure-volume loops were constructed, and LV diastolic compliance was calculated. The measurements were obtained before wrap and after wrap at different LDM tensions with 0, 5, and 10 volts stimulation each time. These measurements were repeated after propranolol treatment. The results showed that LV diastolic compliance (dV/dP) was 1.79 before wrap and about 0.7 after wrap, and after propranolol, at various tensions and stimulations. LDM wrap decreased LV compliance significantly. LV compliance was not significantly affected by changing tension or voltage of stimulation in either the failing or the non-failing heart. The reduction in compliance may be an indication that LDM wrap causes a limitation of LV relaxation, which is one of wrap's deleterious effects.
Current problems in surgery, 2014
Perioperative Fluid Therapy, 2006
The Journal of Trauma: Injury, Infection, and Critical Care, 1994
During this study we investigated the yearly risk of radiation exposure for surgical residents (g... more During this study we investigated the yearly risk of radiation exposure for surgical residents (group 1, n = 8), emergency department (ED) physicians (group 2, n = 6) and nurses (group 3, n = 97) participating in the resuscitation of trauma victims in the emergency department of a 500-bed teaching hospital. Dosimeter readings of the three study groups were recorded monthly over the 1-year study period. During the study interval, 758 patients underwent resuscitation following trauma; 2098 portable radiographs (758 chest films, 758 lateral cervical spine films, and 582 radiographs of the pelvis) were obtained during the resuscitation phase of these patients. The total radiation exposure for group 3 was significantly greater than that for groups 1 and 2 (340 +/- 50 vs. 160 +/- 112 and 20 +/- 14 mrem, respectively, p < 0.01). Individual residents received a significantly greater amount of radiation than ED physicians and nurses (20 +/- 28 vs. 3.3 +/- 2.0 and 3.5 +/- 2.0 mrem, respectively, p < 0.05). However, despite repeated exposure to radiation, individuals in the three groups did not exceed the safety limits of 0.05 Gy/year set by the National Council on Radiation Protection and Measurements. Based on the results of this study, we conclude that trauma resuscitation teams can provide quality care to their patients without concern over the detrimental effects of radiation exposure, provided that the basic principles of radiation protection are followed.
Journal of Cardiac Surgery, 1991
This study was designed to determine the feasibility of anastomosing the internal mammary artery ... more This study was designed to determine the feasibility of anastomosing the internal mammary artery (IMA) and coronary artery with a carbon dioxide laser in a canine model. Twenty-two mongrel dogs were randomly assigned to two groups: group I (n = 11) underwent laser-assisted vascular anastomosis (LAVA) of the left IMA to the left anterior descending (LAD) coronary artery, whereas in group II (n = 11) the anastomosis was done with the conventional technique (handsewn). Laser methodology was used to micro-weld vessels utilizing a power of 200 mW with a spot size of 500 mu, producing an effective power density of 102 W/cm2 and energy fluence of 9,172 joules/cm2 in a continuous mode at a distance of 2 cm. The short-term patency rate, measured at 2 hours after completion of the anastomosis, was 100% in both groups. The time required to perform the LAVA in group I was significantly shorter than group II (6.27 +/- 0.47 vs 11.6 +/- 0.67 min, p less than 0.05). The mean anastomotic bursting pressure in group I was significantly lower compared to group II (348 +/- 8 vs 402 +/- 9 mmHg, p less than 0.05). Histologic evaluation of all vessels showed moderate thermal injury of the adventitia and media in the laser group. Scanning electron microscopy exhibited a smooth anastomotic area in group I, whereas endothelial and perianastomotic changes with multiple needle craters occurred in group II (conventional anastomosis).(ABSTRACT TRUNCATED AT 250 WORDS)
The Annals of Thoracic Surgery, 1994
58:911-6 behind the heart. Cardiopulmonary bypass was reinstituted, and the heart was carefully l... more 58:911-6 behind the heart. Cardiopulmonary bypass was reinstituted, and the heart was carefully lifted to find out the site of bleeding. No evidence of any bleeder could be found in spite of multiple efforts; specifically, there was no hematoma around the coronary sinus or the cardiac veins or anywhere on the posterolateral surface of the left ventricle. We were apprehensive about manipulating the heart too much with a mitral prosthesis in place. The ventricular mass seemed to be oozing from all over.
Annals of Plastic Surgery, 1989
A 47-year-old anemic Jehovah's Witness with Gardner's syndrome presented with a l... more A 47-year-old anemic Jehovah's Witness with Gardner's syndrome presented with a large abdominal wall desmoid tumor requiring extensive resection with a musculocutaneous flap reconstruction. At surgery a technique of acute limited normovolemic hemodilution (ALNH) was used to minimize blood loss and avoid blood transfusions. Complications that follow transfusions of homologous blood are reviewed, and a recommendation is made to use ALNH because of its advantages in those patients in whom significant blood loss is expected.
J Intensive Care Med, 1990
The Journal of Trauma, May 1, 1994
During this study we investigated the yearly risk of radiation exposure for surgical residents (g... more During this study we investigated the yearly risk of radiation exposure for surgical residents (group 1, n = 8), emergency department (ED) physicians (group 2, n = 6) and nurses (group 3, n = 97) participating in the resuscitation of trauma victims in the emergency department of a 500-bed teaching hospital. Dosimeter readings of the three study groups were recorded monthly over the 1-year study period. During the study interval, 758 patients underwent resuscitation following trauma; 2098 portable radiographs (758 chest films, 758 lateral cervical spine films, and 582 radiographs of the pelvis) were obtained during the resuscitation phase of these patients. The total radiation exposure for group 3 was significantly greater than that for groups 1 and 2 (340 +/- 50 vs. 160 +/- 112 and 20 +/- 14 mrem, respectively, p < 0.01). Individual residents received a significantly greater amount of radiation than ED physicians and nurses (20 +/- 28 vs. 3.3 +/- 2.0 and 3.5 +/- 2.0 mrem, respectively, p < 0.05). However, despite repeated exposure to radiation, individuals in the three groups did not exceed the safety limits of 0.05 Gy/year set by the National Council on Radiation Protection and Measurements. Based on the results of this study, we conclude that trauma resuscitation teams can provide quality care to their patients without concern over the detrimental effects of radiation exposure, provided that the basic principles of radiation protection are followed.
American Journal of Respiratory and Critical Care Medicine, 2001
Nitric oxide (NO) is postulated to play a key role in the pathophysiology of renal failure in sep... more Nitric oxide (NO) is postulated to play a key role in the pathophysiology of renal failure in sepsis. Whether the renal effects of increased NO are beneficial or harmful remains unclear. In a porcine model of lipopolysaccharide (LPS)-induced shock, we evaluated the effect of LPS on glomerular filtration rate (GFR) and renal blood flow (RBF). We then administered the nonselective nitric oxide synthase (NOS) inhibitor N(G)-L-arginine methyl ester (L-NAME), and compared its effects on GFR and RBF with those of S-methylisothiourea (SMT), a selective NOS inhibitor, and those of saline. We postulated that SMT, by maintaining constitutive NO, would be more beneficial than either L-NAME or saline. LPS infusion decreased mean arterial pressure (MAP), and increased cardiac output, RBF, and medullary NO content. The increased RBF was diverted to the medulla. There was no evidence of renal dysfunction in the saline-resuscitated group. Both NOS inhibitors increased MAP but decreased RBF, but only L-NAME reduced GFR and increased sodium excretion and renal oxygen extraction. We conclude that NO in endotoxemia is beneficial because it maintains RBF and GFR. Additionally, selective NOS inhibition did not offer any advantages over saline resuscitation.
The American surgeon
This study was designed to investigate the effects of ketoconazole, a thromboxane synthetase inhi... more This study was designed to investigate the effects of ketoconazole, a thromboxane synthetase inhibitor, on pulmonary and systemic hemodynamics and pulmonary function in experimental respiratory distress syndrome. Pulmonary artery infusion of oleic acid (PAIOA), 0.1 ml/kg, was used to cause lung injury. Ten dogs were randomized into two groups (Gps): Gp I (n = 5) acted as control, whereas Gp II (n = 5) were treated with IV ketoconazole (2.5 mg/kg bolus then 10 mg/kg/hour for 2.5 hours). Hemodynamics, extravascular lung water (EVLW), serum levels of PGE2, and TxB2 were obtained at baseline (BL) and at 30-minute intervals for 2.5 hours (T30-T150). After 30 minutes of PAIOA the mean arterial pressure (MAP) decreased significantly in both Gps (131 +/- 17 vs. 88 +/- 9 mmHg Gp 1, 119 +/- 9 vs. 79 +/- 8 mmHg Gp II, P less than 0.05); however, while MAP returned to BL values in Gp II, it remained significantly lower throughout the experimental interval in Gp I. Mean pulmonary artery pressure...
Surgical endoscopy, 2000
The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with sus... more The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected choledocholethiasis remains a controversial subject. There have been few studies exploring the role of intraoperative ERCP. Therefore, we set out to perform a retrospective review of 29 patients who underwent combined laparoscopic cholecystectomy (LC) and intraoperative ERCP (LC/ERCP). Our objective was to assess the feasibility of a one-stage approach using intraoperative ERCP. We identified 29 patients in whom LC/ERCP was attempted between January 1996 and November 1998 at a university-affiliated hospital with a large private faculty. Parameters reviewed included preoperative diagnosis, liver function tests (LFT), finding on transcystic cholangiogram (TCC), ERCP, stone retrieval, failure of ERCP, length of stay, morbidity, and mortality. Twenty-eight of 29 patients (97%) underwent successful combined LC/ERCP. Successful TCC followed by ERCP was performed in 21 of 26 patients (81...
The American journal of gastroenterology, 1992
The American surgeon, 2015
Cirugía Española, 2015
Duodenal injuries constitute a challenge to the Trauma Surgeon, mainly due to their retroperitone... more Duodenal injuries constitute a challenge to the Trauma Surgeon, mainly due to their retroperitoneal location. When identified, they present associated with other abdominal injuries. Consequently, they have an increased morbidity and mortality. At best estimates, duodenal lesions occur in 4.3% of all patients with abdominal injuries, ranging from 3.7% to 5%, and because of their anatomical proximity to other organs, they are rarely an isolated injury. The aim of this paper is to present a concise description of the anatomy, diagnosis, surgical management and treatment of complications of duodenal trauma, and an analysis of complications and mortality rates of duodenal injuries based on a 46-year review of the literature.
The Journal of Trauma: Injury, Infection, and Critical Care, 1990
ABSTRACT
The Annals of Thoracic Surgery, 1990
We investigated whether intravenous methylprednisolone (30 mg/kg) before 30 minutes of aortic cro... more We investigated whether intravenous methylprednisolone (30 mg/kg) before 30 minutes of aortic crossclamping and after 4 hours could enhance the effects of cerebrospinal fluid drainage on spinal cord perfusion pressure and postoperative paraplegia when proximal blood pressure was controlled with sodium nitroprusside and partial exsanguination. Dogs were randomized into three groups: group 1 (n = 61, control; group 2 (n = 7), steroids; and group 3 (n = 61, steroids with cerebrospinal fluid drainage. During aortic cross-clamping, blood pressure proximal to the clamp decreased significantly in each group compared with baseline ( p < 0.051, but did not differ among groups (group 1 = 82.2, group 2 = 82.1, group 3 = 86.6 mm Hg, p > 0.05). Mean distal pressure decreased from systemic values to 8.4, 8.5, and
Seminars in Thoracic and Cardiovascular Surgery, 1998
Postoperative paraplegia remains the most devastating complication of surgery of the descending a... more Postoperative paraplegia remains the most devastating complication of surgery of the descending and thoraco-abdominal aorta. Control of the proximal hypertension that follows cross-clamping of the thoracic aorta to repain aneurysms of the descending and thoraco-abdominal aorta is necessary to prevent left ventricular failure, myocardial infarction, and hemorrhagic cerebral events. Both pharmacological and mechanical modalities used to control central hypertension during aortic occlusion affect cerebrospinal fluid dynamics and spinal cord perfusion pressure. Sodium nitroprusside (doses >5 microg/kg/min), the most widely used pharmacological agent, decreases spinal cord perfusion pressure because it increases cerebrospinal fluid pressure and decreases blood pressure distal to the aortic cross-clamp. This effect cannot be prevented by drainage of cerebrospinal fluid. Nitroglycerin also decreases spinal cord perfusion pressure, but its effects on cerebrospinal fluid dynamics can be countered by drainage of cerebrospinal fluid. Active distal perfusion with left atrial-femoral artery bypass can provide adequate perfusion of the circulation distal to the aortic cross-clamp while simultaneously reducing cerebrospinal fluid pressure. This approach can maintain mesenteric and spinal cord blood flow, therefore preventing the multiple organ dysfunction syndrome caused by release of cytokines from the splanchnic district and decreasing the incidence of postoperative paraplegia from spinal cord ischemia. In cases of limited retroperfusion, partial exsanguination and cerebrospinal fluid drainage can be used in conjunction with left atrial-femoral artery bypass to prevent rises in cerebrospinal fluid pressure and maintain spinal cord blood flow above the threshold necessary to prevent neurological injury. The use of oxygenated perfluorocarbons in the subarachnoid space to provide passive oxygenation of the spinal cord during aortic occlusion remains experimental and requires further investigation.
The American surgeon
The possible limitation of left ventricular (LV) relaxation during diastole is a concern for clin... more The possible limitation of left ventricular (LV) relaxation during diastole is a concern for clinicians and researchers utilizing dynamic cardiomyoplasty. This study was designed to evaluate the LV compliance at three different skeletal muscle tensions, in a normal heart and in a failing heart, created by propranolol infusion (11.6 mg/kg). A biventricular latissimus dorsi muscle (LDM) wrap was performed in 10 dogs. The LV pressure (Millar) and two minor axis dimensions (endocardial crystals) were measured. LV pressure-volume loops were constructed, and LV diastolic compliance was calculated. The measurements were obtained before wrap and after wrap at different LDM tensions with 0, 5, and 10 volts stimulation each time. These measurements were repeated after propranolol treatment. The results showed that LV diastolic compliance (dV/dP) was 1.79 before wrap and about 0.7 after wrap, and after propranolol, at various tensions and stimulations. LDM wrap decreased LV compliance significantly. LV compliance was not significantly affected by changing tension or voltage of stimulation in either the failing or the non-failing heart. The reduction in compliance may be an indication that LDM wrap causes a limitation of LV relaxation, which is one of wrap&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s deleterious effects.
Current problems in surgery, 2014
Perioperative Fluid Therapy, 2006
The Journal of Trauma: Injury, Infection, and Critical Care, 1994
During this study we investigated the yearly risk of radiation exposure for surgical residents (g... more During this study we investigated the yearly risk of radiation exposure for surgical residents (group 1, n = 8), emergency department (ED) physicians (group 2, n = 6) and nurses (group 3, n = 97) participating in the resuscitation of trauma victims in the emergency department of a 500-bed teaching hospital. Dosimeter readings of the three study groups were recorded monthly over the 1-year study period. During the study interval, 758 patients underwent resuscitation following trauma; 2098 portable radiographs (758 chest films, 758 lateral cervical spine films, and 582 radiographs of the pelvis) were obtained during the resuscitation phase of these patients. The total radiation exposure for group 3 was significantly greater than that for groups 1 and 2 (340 +/- 50 vs. 160 +/- 112 and 20 +/- 14 mrem, respectively, p < 0.01). Individual residents received a significantly greater amount of radiation than ED physicians and nurses (20 +/- 28 vs. 3.3 +/- 2.0 and 3.5 +/- 2.0 mrem, respectively, p < 0.05). However, despite repeated exposure to radiation, individuals in the three groups did not exceed the safety limits of 0.05 Gy/year set by the National Council on Radiation Protection and Measurements. Based on the results of this study, we conclude that trauma resuscitation teams can provide quality care to their patients without concern over the detrimental effects of radiation exposure, provided that the basic principles of radiation protection are followed.
Journal of Cardiac Surgery, 1991
This study was designed to determine the feasibility of anastomosing the internal mammary artery ... more This study was designed to determine the feasibility of anastomosing the internal mammary artery (IMA) and coronary artery with a carbon dioxide laser in a canine model. Twenty-two mongrel dogs were randomly assigned to two groups: group I (n = 11) underwent laser-assisted vascular anastomosis (LAVA) of the left IMA to the left anterior descending (LAD) coronary artery, whereas in group II (n = 11) the anastomosis was done with the conventional technique (handsewn). Laser methodology was used to micro-weld vessels utilizing a power of 200 mW with a spot size of 500 mu, producing an effective power density of 102 W/cm2 and energy fluence of 9,172 joules/cm2 in a continuous mode at a distance of 2 cm. The short-term patency rate, measured at 2 hours after completion of the anastomosis, was 100% in both groups. The time required to perform the LAVA in group I was significantly shorter than group II (6.27 +/- 0.47 vs 11.6 +/- 0.67 min, p less than 0.05). The mean anastomotic bursting pressure in group I was significantly lower compared to group II (348 +/- 8 vs 402 +/- 9 mmHg, p less than 0.05). Histologic evaluation of all vessels showed moderate thermal injury of the adventitia and media in the laser group. Scanning electron microscopy exhibited a smooth anastomotic area in group I, whereas endothelial and perianastomotic changes with multiple needle craters occurred in group II (conventional anastomosis).(ABSTRACT TRUNCATED AT 250 WORDS)
The Annals of Thoracic Surgery, 1994
58:911-6 behind the heart. Cardiopulmonary bypass was reinstituted, and the heart was carefully l... more 58:911-6 behind the heart. Cardiopulmonary bypass was reinstituted, and the heart was carefully lifted to find out the site of bleeding. No evidence of any bleeder could be found in spite of multiple efforts; specifically, there was no hematoma around the coronary sinus or the cardiac veins or anywhere on the posterolateral surface of the left ventricle. We were apprehensive about manipulating the heart too much with a mitral prosthesis in place. The ventricular mass seemed to be oozing from all over.
Annals of Plastic Surgery, 1989
A 47-year-old anemic Jehovah's Witness with Gardner's syndrome presented with a l... more A 47-year-old anemic Jehovah's Witness with Gardner's syndrome presented with a large abdominal wall desmoid tumor requiring extensive resection with a musculocutaneous flap reconstruction. At surgery a technique of acute limited normovolemic hemodilution (ALNH) was used to minimize blood loss and avoid blood transfusions. Complications that follow transfusions of homologous blood are reviewed, and a recommendation is made to use ALNH because of its advantages in those patients in whom significant blood loss is expected.
J Intensive Care Med, 1990
The Journal of Trauma, May 1, 1994
During this study we investigated the yearly risk of radiation exposure for surgical residents (g... more During this study we investigated the yearly risk of radiation exposure for surgical residents (group 1, n = 8), emergency department (ED) physicians (group 2, n = 6) and nurses (group 3, n = 97) participating in the resuscitation of trauma victims in the emergency department of a 500-bed teaching hospital. Dosimeter readings of the three study groups were recorded monthly over the 1-year study period. During the study interval, 758 patients underwent resuscitation following trauma; 2098 portable radiographs (758 chest films, 758 lateral cervical spine films, and 582 radiographs of the pelvis) were obtained during the resuscitation phase of these patients. The total radiation exposure for group 3 was significantly greater than that for groups 1 and 2 (340 +/- 50 vs. 160 +/- 112 and 20 +/- 14 mrem, respectively, p < 0.01). Individual residents received a significantly greater amount of radiation than ED physicians and nurses (20 +/- 28 vs. 3.3 +/- 2.0 and 3.5 +/- 2.0 mrem, respectively, p < 0.05). However, despite repeated exposure to radiation, individuals in the three groups did not exceed the safety limits of 0.05 Gy/year set by the National Council on Radiation Protection and Measurements. Based on the results of this study, we conclude that trauma resuscitation teams can provide quality care to their patients without concern over the detrimental effects of radiation exposure, provided that the basic principles of radiation protection are followed.
American Journal of Respiratory and Critical Care Medicine, 2001
Nitric oxide (NO) is postulated to play a key role in the pathophysiology of renal failure in sep... more Nitric oxide (NO) is postulated to play a key role in the pathophysiology of renal failure in sepsis. Whether the renal effects of increased NO are beneficial or harmful remains unclear. In a porcine model of lipopolysaccharide (LPS)-induced shock, we evaluated the effect of LPS on glomerular filtration rate (GFR) and renal blood flow (RBF). We then administered the nonselective nitric oxide synthase (NOS) inhibitor N(G)-L-arginine methyl ester (L-NAME), and compared its effects on GFR and RBF with those of S-methylisothiourea (SMT), a selective NOS inhibitor, and those of saline. We postulated that SMT, by maintaining constitutive NO, would be more beneficial than either L-NAME or saline. LPS infusion decreased mean arterial pressure (MAP), and increased cardiac output, RBF, and medullary NO content. The increased RBF was diverted to the medulla. There was no evidence of renal dysfunction in the saline-resuscitated group. Both NOS inhibitors increased MAP but decreased RBF, but only L-NAME reduced GFR and increased sodium excretion and renal oxygen extraction. We conclude that NO in endotoxemia is beneficial because it maintains RBF and GFR. Additionally, selective NOS inhibition did not offer any advantages over saline resuscitation.
The American surgeon
This study was designed to investigate the effects of ketoconazole, a thromboxane synthetase inhi... more This study was designed to investigate the effects of ketoconazole, a thromboxane synthetase inhibitor, on pulmonary and systemic hemodynamics and pulmonary function in experimental respiratory distress syndrome. Pulmonary artery infusion of oleic acid (PAIOA), 0.1 ml/kg, was used to cause lung injury. Ten dogs were randomized into two groups (Gps): Gp I (n = 5) acted as control, whereas Gp II (n = 5) were treated with IV ketoconazole (2.5 mg/kg bolus then 10 mg/kg/hour for 2.5 hours). Hemodynamics, extravascular lung water (EVLW), serum levels of PGE2, and TxB2 were obtained at baseline (BL) and at 30-minute intervals for 2.5 hours (T30-T150). After 30 minutes of PAIOA the mean arterial pressure (MAP) decreased significantly in both Gps (131 +/- 17 vs. 88 +/- 9 mmHg Gp 1, 119 +/- 9 vs. 79 +/- 8 mmHg Gp II, P less than 0.05); however, while MAP returned to BL values in Gp II, it remained significantly lower throughout the experimental interval in Gp I. Mean pulmonary artery pressure...
Surgical endoscopy, 2000
The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with sus... more The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected choledocholethiasis remains a controversial subject. There have been few studies exploring the role of intraoperative ERCP. Therefore, we set out to perform a retrospective review of 29 patients who underwent combined laparoscopic cholecystectomy (LC) and intraoperative ERCP (LC/ERCP). Our objective was to assess the feasibility of a one-stage approach using intraoperative ERCP. We identified 29 patients in whom LC/ERCP was attempted between January 1996 and November 1998 at a university-affiliated hospital with a large private faculty. Parameters reviewed included preoperative diagnosis, liver function tests (LFT), finding on transcystic cholangiogram (TCC), ERCP, stone retrieval, failure of ERCP, length of stay, morbidity, and mortality. Twenty-eight of 29 patients (97%) underwent successful combined LC/ERCP. Successful TCC followed by ERCP was performed in 21 of 26 patients (81...
The American journal of gastroenterology, 1992
The American surgeon, 2015
Cirugía Española, 2015
Duodenal injuries constitute a challenge to the Trauma Surgeon, mainly due to their retroperitone... more Duodenal injuries constitute a challenge to the Trauma Surgeon, mainly due to their retroperitoneal location. When identified, they present associated with other abdominal injuries. Consequently, they have an increased morbidity and mortality. At best estimates, duodenal lesions occur in 4.3% of all patients with abdominal injuries, ranging from 3.7% to 5%, and because of their anatomical proximity to other organs, they are rarely an isolated injury. The aim of this paper is to present a concise description of the anatomy, diagnosis, surgical management and treatment of complications of duodenal trauma, and an analysis of complications and mortality rates of duodenal injuries based on a 46-year review of the literature.
The Journal of Trauma: Injury, Infection, and Critical Care, 1990
ABSTRACT
The Annals of Thoracic Surgery, 1990
We investigated whether intravenous methylprednisolone (30 mg/kg) before 30 minutes of aortic cro... more We investigated whether intravenous methylprednisolone (30 mg/kg) before 30 minutes of aortic crossclamping and after 4 hours could enhance the effects of cerebrospinal fluid drainage on spinal cord perfusion pressure and postoperative paraplegia when proximal blood pressure was controlled with sodium nitroprusside and partial exsanguination. Dogs were randomized into three groups: group 1 (n = 61, control; group 2 (n = 7), steroids; and group 3 (n = 61, steroids with cerebrospinal fluid drainage. During aortic cross-clamping, blood pressure proximal to the clamp decreased significantly in each group compared with baseline ( p < 0.051, but did not differ among groups (group 1 = 82.2, group 2 = 82.1, group 3 = 86.6 mm Hg, p > 0.05). Mean distal pressure decreased from systemic values to 8.4, 8.5, and
Seminars in Thoracic and Cardiovascular Surgery, 1998
Postoperative paraplegia remains the most devastating complication of surgery of the descending a... more Postoperative paraplegia remains the most devastating complication of surgery of the descending and thoraco-abdominal aorta. Control of the proximal hypertension that follows cross-clamping of the thoracic aorta to repain aneurysms of the descending and thoraco-abdominal aorta is necessary to prevent left ventricular failure, myocardial infarction, and hemorrhagic cerebral events. Both pharmacological and mechanical modalities used to control central hypertension during aortic occlusion affect cerebrospinal fluid dynamics and spinal cord perfusion pressure. Sodium nitroprusside (doses >5 microg/kg/min), the most widely used pharmacological agent, decreases spinal cord perfusion pressure because it increases cerebrospinal fluid pressure and decreases blood pressure distal to the aortic cross-clamp. This effect cannot be prevented by drainage of cerebrospinal fluid. Nitroglycerin also decreases spinal cord perfusion pressure, but its effects on cerebrospinal fluid dynamics can be countered by drainage of cerebrospinal fluid. Active distal perfusion with left atrial-femoral artery bypass can provide adequate perfusion of the circulation distal to the aortic cross-clamp while simultaneously reducing cerebrospinal fluid pressure. This approach can maintain mesenteric and spinal cord blood flow, therefore preventing the multiple organ dysfunction syndrome caused by release of cytokines from the splanchnic district and decreasing the incidence of postoperative paraplegia from spinal cord ischemia. In cases of limited retroperfusion, partial exsanguination and cerebrospinal fluid drainage can be used in conjunction with left atrial-femoral artery bypass to prevent rises in cerebrospinal fluid pressure and maintain spinal cord blood flow above the threshold necessary to prevent neurological injury. The use of oxygenated perfluorocarbons in the subarachnoid space to provide passive oxygenation of the spinal cord during aortic occlusion remains experimental and requires further investigation.