Doppler ultrasound and digital plethysmography to determine the need for sympathetic blockade after frostbite.

Thirty patients seen following frostbite injury during a 2-week period were treated with rapid rewarming in a saline bath. Vascular laboratory evaluations including digital plethysmograms and Doppler ultrasound mapping of digital vessels and distal palmar and pedal arches revealed three general degrees of vascular response to cold injury after rewarming. The most common, the hyperdynamic response, implying patent digital vessels, was often clinically apparent, with warm, red digits. Regional sympathectomy may be troublesome in these patients. Patients without a hyperdynamic response, including those whose Doppler and plethysmographic examinations were within normal limits for noncold exposed individuals, had evidence of vascular compromise at the digital level and benefited from regional sympathectomy with intra-arterial reserpine.

The risk of positive cultures for Candida in the critically ill patient.

It is frequently stated that a positive fungal culture is of little clinical significance unless the culture is obtained on repetitive blood specimens. We analyzed the mortality associated with a positive culture for Candida species in ICU patients from several locations over a 3-month period. Criteria for inclusion in this study were: (1) residence in the ICU for at least 4 days, (2) no GI tract alimentation during this period, and (3) administration of at least one antibiotic during this period. Forty-four patients fit these criteria; 23 had positive Candida cultures from at least one site and 12 (52%) died. Four of 21 patients (19%) who did not grow Candida died. Cultures of urine and sputum were most likely to be positive. Positive cultures from the urine, sputum, or wound were associated with at least a 50% mortality. This suggests that routine sputum and urine cultures may be of substantial clinical therapeutic and prognostic significance. Two patients had positive blood cultures and both died. No single class of antibiotics, surgical complications or underlying disease predisposed to these results. It is concluded that the presence of a single positive culture for Candida from any site in the critically ill surgical patient kept without GI alimentation and on any antibiotic is a grave prognostic sign which requires further attention.

Blood surface interactions in extravascular salvageable blood pools.

Anticoagulation largely prevents clotting and defibrination in extravascular blood pools. Systemic or local heparin may be more effective than local citrate phosphate dextrose in preventing coagulation in extravascular blood, if there is to be a lag period greater than 60 minutes between blood loss and collection. Nonanticoagulated extravascular blood in the thorax or peritoneal cavity is completely defibrinated within 20 minutes and is a potential risk in large autotransfusions. Blood in the thorax is better preserved than peritoneal blood after local or systemic heparinization.

Sedimentation and adhesion of platelets onto a horizontal glass surface.

An experimental method for measuring platelet adhesion to a glass surface and platelet sedimentation rate is described. Anticoagulated platelet-rich plasma is placed on a horizontal glass slide for various contact periods. The number of platelets adhering to the slide per unit area is recorded as a function of time. The experimental results are used to verify theoretical predictions which account for the effect of the slow sedimentation rate of the platelets and for their escape over the potential barrier between them and the solid surface. By a least-squares fit of the theoretical equation to the experimental data, both the platelet adhesiveness, in terms of P the probability to overcome the potential barrier, and the platelet sedimentation rate V are evaluated. A range of values of P and V for healthy humans is presented.

Physico-chemical explanation of blood cell adhesion in thrombus formation.

A model is suggested which assumes that the rate of deposition of cells is determined both by hydrodynamic factors and by Brownian motion over the potential barrier caused by London and double-layer forces in the immediate vicinity of the deposition surface. The height of the barrier in the potential energy of interaction between blood cells and various surfaces is analyzed in relation to the physical properties of the cells, surfaces, and solutions. Based on this analysis, the adhesion of platelets to injured blood vessel walls and to non-biologic materials, the lack of adhesion of red blood cells under the same conditions, the mechanism of ADP induced aggregation and the interaction with blood flow are explained. The qualitative predictions of the model are substantiated by available experimental information. Quantitative results are presented in terms of a time constant, which typifies a period of contact with a surface, during which appreciable deposition occurs.

The protective role of intraperitoneal antibiotic irrigation in contaminated penetrating wounds of the cecum.

Neomycin (500 mg.), polymyxin (500,000 U.), and bacitracin (50,000 U.) in one liter of saline, used as an abdominal irrigation solution, protects dogs against intraperitoneal infection and wound infections and markedly curtails adhesion formation after peritoneal contamination with cecal contents. Dogs treated with topical antibiotics after cecal puncture and local contamination were almost identical to control dogs without contamination. Equal volumes of saline irrigation offered no therapeutic advantage despite the theoretical benefit of diluting the bacterial and chemical challenge. Reported results are statistically significant (rho less than or equal to 0.05).

Delayed appearance of traumatic ventral hernia: a case report.

An unusual traumatic ventral hernia is reported, observed 6 months after its presumed cause. The delay in diagnosis, the benign appearance of the abdomen in the supine position, and the necessity for marlex mesh prosthetic repair in a large traumatic defect are all unusual features. Following repair the patient has remained asymptomatic.

Benign solid teratoma of the fallopian tube with rupture into the rectum: report of a unique rectal tumor.

Solid teratoma of the fallopian tube is rare. A case of a benign solid teratoma of the fallopian tube that ruptured into the rectum is presented. This is believed to be the first report of this occurrence, which should be included in the differential diagnosis of the rectal mass. Any suspicion of this lesion should mitigate against a posterior approach for resection, as the rectum can be expected to be fixed to other pelvic viscera.