M McKenney

Publications (9)19.6 Total impact

• Article: Near-infrared spectroscopy reflects changes in mesenteric and systemic perfusion during abdominal compartment syndrome.

  J E Varela, S M Cohn, G D Giannotti, M O Dolich, H Ramon, J A Wiseberg, M McKenney
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  ABSTRACT: Continuous and minimally invasive near-infrared spectroscopy (NIRS)-derived gastric tissue oxygen saturation (GStO(2)) and muscle tissue oxygen saturation (MStO(2)) were evaluated in a clinically relevant porcine model of hemorrhagic shock and abdominal compartment syndrome (ACS). Phenobarbital-anesthetized swine underwent pulmonary artery catheter insertion for mixed venous oxygen saturation (SvO(2)) measurement and midline laparotomy to permit placement of a gastric NIRS probe, a jejunal (regional carbon dioxide [PrCO(2)]) tonometer, superior mesenteric artery (SMA) flow probe, and a portal vein oxygen saturation (SpvO(2)) catheter. A muscle NIRS probe was placed on the front limb. After randomization, Group 1 underwent hemorrhage and resuscitation. Group 2 had no hemorrhage or resuscitation. ACS was induced by peritoneal fluid infusion in both groups. A significant decrease in SMA flow, SpvO(2), GStO(2), SvO(2), and MStO(2) was observed after hemorrhage in Group 1 and with abdominal hypertension in both groups. GStO(2) significantly correlated with SMA flow (Group 1: r(2) = 0.90; Group 2: r(2) = 0.83) and mesenteric oxygen delivery (mesenteric oxygen delivery, Group 1: r(2) = 0.73; Group 2: r(2) = 0.89). MStO(2) significantly correlated with SvO(2) (Group 1: r(2) = 0.99; Group 2: r(2) = 0.65) and systemic oxygen delivery (SDO2, Group 1: r(2) = 0.60; Group 2: r(2) = 0.88). Tonometer-derived PrCO(2) values did not change at any time point in either group. NIRS measurement of GStO(2) and MStO(2) reflected changes in mesenteric and systemic perfusion respectively during hemorrhage and ACS.
  Surgery 04/2001; 129(3):363-70. · 3.10 Impact Factor
• Article: Digital imaging technology in trauma education: a quantum leap forward.

  S Cohn, M Dolich, K Matsuura, N Namias, O Kirton, D Shatz, M McKenney, D Sleeman, E Ginzburg, P Byers, J Augenstein
  The Journal of trauma 12/1999; 47(6):1160-1. · 2.48 Impact Factor
• Article: Hiding the scars of an appendectomy. New method of port placement.

  D Yarish, M McKenney, D Sleeman, L Martin, U Desai
  Surgical Endoscopy 11/1997; 11(10):1055-6. · 4.01 Impact Factor
• Article: Acalculous cholecystitis: the use of diagnostic laparoscopy.

  J Almeida, D Sleeman, J L Sosa, I Puente, M McKenney, L Martin
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  ABSTRACT: Acalculous cholecystitis (AC) carries a high mortality in the critically ill patient. This is partly due to the delay in its diagnosis. Clinical diagnostic examinations are often misleading. The purpose of our study was to evaluate the use of laparoscopy as a diagnostic tool in the evaluation of the critically ill patient suspected of having AC. From May 1993 to January 1994, we evaluated 10 critically ill patients. Mean age was 56 years (range 17-90 years). Nine of the patients were trauma victims (8 blunt, 1 penetrating). The other patient was postcoronary bypass surgery. The laparoscopy was done after a mean of 15 days (range 6-54 days) after ICU admission. All patients were receiving ventilatory support, and all patients had elevated temperatures of greater than 38.5 degrees C. Five patients had abdominal tenderness, and 6 had elevated liver function tests (LFT). Six laparoscopies were done under local anesthesia and IV sedation at the bedside, and 4 were done in the operating room. All patients tolerated the procedure well with no complications. The laparoscopic findings were gangrenous cholecystitis in 2 patients. They both underwent laparoscopic cholecystectomies in the operating room. We elected to drain a very distended gallbladder in 1 patient, who eventually was found to have an empyema of the chest. The other 7 examinations were normal. Six of these patients recovered and were discharged. Our results suggest that laparoscopy can be used in the diagnosis of acalculous cholecystitis. Its positive and negative findings are valuable in the treatment of the critically ill. It can be done safely at the bedside.
  Journal of laparoendoscopic surgery 09/1995; 5(4):227-31.
• Article: Reclosure of the open abdomen.

  D Sleeman, J L Sosa, A Gonzalez, M McKenney, I Puente, L Matos, L Martin
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  ABSTRACT: The open abdomen technique for the treatment of diffuse peritonitis has gained acceptance. Our approach has been to use the zipper technique with daily irrigations. Once the abdominal problem has resolved, the mesh and zipper are removed. Surgeons are reluctant to reoperate on patients with such prior treatment because of the anticipation of a hostile abdomen. Our study is a retrospective review of 12 patients who were treated with the open abdomen technique. At a later date, they underwent elective reoperation. The charts of 12 patients were reviewed. After initial injury, the patients were in the surgical intensive care unit. Reoperations were performed nine months (mean) after discharge from this facility. The reasons for reoperation were closure of enteric fistula (five patients) and closure of an ostomy (seven patients). The abdominal wall was reconstructed in nine patients. In the other three patients, the abdomen was entered through a lateral incision and the bowel was reanastomosed. All of the patients survived. There were five complications. Two patients had ischemic skin grafts successfully treated by hyperbaric oxygen therapy (HBO). Two patients had ischemic skin flaps that were covering mesh. They responded to HBO with minimal slough of superficial tissue. One patient had a low output fistula that closed after two weeks of total parenteral nutrition. A history of an open abdomen is not a contraindication to later operation. Bowel continuity can be restored and abdominal wall reconstruction can be performed safely. This can be done as early as three to four months after recovery from the original injury.
  Journal of the American College of Surgeons 03/1995; 180(2):200-4. · 4.55 Impact Factor
• Article: Laparoscopic repair of a gunshot wound to the diaphragm: a case report.

  N Namias, M McKenney, J L Sosa, D Sleeman
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  ABSTRACT: The application of laparoscopy to the surgery of trauma is rapidly expanding. We report a case of laparoscopic repair of a gunshot wound to the right diaphragm. We discuss a technique for repair, as well as a method to create and maintain pneumoperitoneum while avoiding tension pneumothorax.
  Journal of laparoendoscopic surgery 03/1995; 5(1):59-61.
• Article: Videothoracoscopy in trauma: early experience.

  J L Sosa, I Puente, L Lemasters, E Ginzburg, D Sleeman, M McKenney, L Martin
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  ABSTRACT: We present a series in which videothoracoscopy was used to evaluate and manage patients after thoracic trauma. We used this technique in 11 patients with thoracic injuries. We describe 5 representative cases. It was used successfully in 10 of 11 patients. Indications included evaluation of ongoing hemothorax, evacuation of clotted hemothorax and empyema, and decortication for persistent airleak. Etiologies included blunt trauma, stab wounds, and gunshot wounds.
  Journal of laparoendoscopic surgery 11/1994; 4(5):295-300.
• Article: Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma?

  M McKenney, K Lentz, D Nunez, J L Sosa, D Sleeman, A Axelrad, L Martin, O Kirton, C Oldham
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  ABSTRACT: Diagnostic peritoneal lavage (DPL) and computed tomography (CT) are the primary diagnostic modalities in the evaluation of patients with suspected blunt abdominal trauma (BAT). Diagnostic peritoneal lavage is fast and accurate but associated with complications. Computed tomography is also accurate, yet requires that patients be stable and transportable. A prospective study was designed to determine the utility of emergency ultrasound (US) studies in the initial assessment of BAT. Two hundred acutely injured patients with suspected BAT were evaluated with US. Patients were eligible for the study if they met trauma criteria and had suspected BAT. Subsequently, without knowledge of the US results, DPL or CT was performed. Ultrasound showed a sensitivity of 83%, a specificity of 100%, and an accuracy of 97% in detecting intra-abdominal injuries. Six injuries were missed but only one was felt to be significant. If US had been used in all 200 patients, 199 would have had appropriate care. We conclude US is reliable in the detection of free intraperitoneal fluid and may be used in place of DPL or CT.
  The Journal of trauma 10/1994; 37(3):439-41. · 2.48 Impact Factor
• Article: Stimulus attributes of reactivated memory: alleviation of ontogenetic forgetting in rats is context specific.

  R Richardson, D C Riccio, M McKenney
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  ABSTRACT: Numerous studies have shown that ontogenetic forgetting (infantile amensia) can be alleviated by a number of different types of reminder treatment. The present study extends the information about the alleviation of infantile amnesia by examining the "content" of the reactivated memory. Toward this purpose, one attribute of memory (environmental context) was examined in rats tested either shortly after training (preamnesic) or after 1-week retention interval. For the latter, a reactivation treatment was used to reverse infantile amnesia. At both intervals, a context shift resulted in impaired performance of a conditioned fear response. These findings demonstrate that environment context is an important component of the originally encoded memory as well as the reactivated amnestic memory. The implications of these results for both the reactivation of memory and general memory processes are discussed.
  Developmental Psychobiology 04/1988; 21(2):135-43. · 2.98 Impact Factor