Biomedical subjects

A Dajee

Publications and source records attributed to A Dajee.

9 recordsLinked to original sources

PubMed2001

Reoperative coronary bypass surgery using normothermic cardiopulmonary bypass: comparison with first-time procedures.

Redo coronary artery bypass grafting (CABG) is characterized by increased patient risk compared with first-time CABG. The reason for higher risk is not completely understood but it is logically related to inadequate myocardial preservation evidenced by the higher incidence of postoperative low-output syndrome. We compared normothermic cardiopulmonary bypass with cold blood maintenance cardioplegia in both first-time and redo CABGs to determine whether this single approach is appropriate for both instances. Five hundred seventeen consecutive CABG patients were retrospectively reviewed. Four hundred fifty-four first-time CABG procedures were compared with 44 redo procedures. All aspects of the operation were identical including myocardial preservation. Retrospective univariant analysis of both groups followed. Three clinical features distinguished first-time versus redo CABG. These were previous percutaneous transluminal coronary angioplasty (first-time 19% vs redo 71%; P < 0.001), preoperative intra-aortic balloon pump (first-time 38% vs redo 71%; P < 0.001), and Parsonnet risk score (first-time 11.7+/-8.2 vs redo 19.2+/-8.8; P < 0.001). Operative mortality for redo CABG was higher than in first-time procedures (3.4% vs 6.4%; P = not significant), although small sample size limited statistical significance. The length of stay was statistically longer in redo patients (8.7+/-10.8 vs 6.0+/-5.1 days; P < 0.01) and is related to a higher Parsonnet score, increased postoperative pneumonia, and failed percutaneous transluminal coronary angioplasty before redo CABG. We conclude that redo CABG is a different operation from first-time procedures and requires enhanced myocardial preservation. Normothermic cardiopulmonary bypass with cold blood maintenance cardioplegia does not appear to achieve this goal.

Aged↗

PubMed1997

Reduction pneumonoplasty for patients with a forced expiratory volume in 1 second of 500 milliliters or less.

BACKGROUND: Patients with severely impaired pulmonary function are considered at high risk for emphysema operations. We prospectively evaluated 44 patients with a forced expiratory volume in 1 second of 0.5 L or less undergoing reduction pneumonoplasty for dyspnea uncontrolled by medical management (confirmed by Borg and modified Medical Research Council dyspnea scales). METHODS: There were 28 men and 16 women (mean age, 66 years) with a mean preoperative forced expiratory volume in 1 second of 0.41 L (range, 0.23 L to 0.50 L). Preoperative therapy consisted of bronchodilators (100% of patients), oxygen (80%), and steroids (72%). Hypercarbia was seen in 80% of patients, and 66% had pulmonary hypertension. Unilateral reduction pneumonoplasty by a video-assisted thoracic surgical approach was performed in 34 patients, 6 patients underwent bilateral reduction pneumonoplasty by a video-assisted thoracic surgical approach, and 4 patients underwent bilateral reduction pneumonoplasty by a video-assisted thoracic surgical approach, and 4 patients underwent bilateral reduction pneumonoplasty by median sternotomy. Discrete emphysematous regions were resected using staplers with buttressing, and regions of homogeneous emphysema were plicated with KTP or neodymium:yttrium-aluminum garnet laser radiation. RESULTS: There was one death within 30 days, two additional deaths within 60 days, and five additional deaths within 1 year. Hospital stay averaged 12 days. Intensive care unit stay averaged 4 days. Subjective improvement was noted by 89%. Borg and modified dyspnea scores improved from 7.6 to 4.5 (p < 0.01) and from 3.9 to 2.35 (p < 0.01), respectively. Forced expiratory volume in 1 second was 0.62 L at 1 year, a 51% improvement (p < 0.001). Forced vital capacity was 1.32 L preoperatively and 2.05 L at 1 year (a 56% improvement) (p < 0.001). CONCLUSIONS: This experience documents that patients with severely impaired lung function can successfully undergo operation for emphysema. To obtain these results one must tailor the operative approach to the patient's disease.

Aged↗

PubMed1985

Pulmonary oncocytoma.

A pulmonary tumor composed of oncocytes was removed surgically from a 53-year-old man. Diagnosis was made after ultrastructural study. Pathological significance of this rare entity is briefly discussed and the literature reviewed.

Adenoma↗

PubMed1982

Pulmonary chondroma, extra-adrenal paraganglioma, and gastric leiomyosarcoma: Carney's triad.

The triad of pulmonary chondroma, extra-adrenal paraganglioma, and gastric leiomyosarcoma has been reported in five patients, all young women. The association of tumors apparently constitutes a syndrome. This paper describes the sixth affected patient, also a young woman, draws attention to the frequency of thoracic paraganglioma in the syndrome, and notes that the pulmonary cartilaginous lesion has frequently been misinterpreted as pulmonary hamartoma. Early exploration of the chest is indicated not only to rule out the possibility of metastatic gastric tumor but also to search for paragangliomas.

Calcinosis↗

PubMed1981

Experimental reversal of acute coronary thrombotic occlusion and myocardial injury in animals utilizing streptokinase.

Fresh autologous thrombus, 1.0 to 1.5 ml, was injected into the left anterior descending and/or left diagonal coronary arteries of 19 open-chest dogs to produce evolving acute myocardial infarction (AMI). Thrombotic obstruction was documented by coronary angiography. Multilead epicardial ECGs showed ST segment elevations of affected left ventricular (LV) areas within 2 minutes after thrombus injection, and LV segmental wall cyanosis with hypocontraction was observed within 10 minutes in the myocardial areas supplied by the thrombosed artery. Ten animals then received an initial dose of streptokinase (STK), 250,000 U (intravenous), followed by STK, 1000 to 3000 U/min (intracoronary), while nine control dogs untreated with STK received normal saline infusion. All but one STK-treated animal (all nine animals receiving intracoronary STK) had reestablishment of blood flow in the previously occluded vessels within 1 1/2 hours, disappearance of ventricular cyanosis, return of normal LV contractile function, and normalization of elevated ST segments within 1 hour after intracoronary STK therapy. In contrast, in the non-STK-treated control group, all animals had continued coronary obstruction, progressive ST elevations, and worsening LV cyanosis and hypocontraction until death or for more than 3 hours post thrombus; three control animals died of ventricular fibrillation (VF) within 1 hour of thrombus occlusion, three more died of VF within 2 hours post thrombus, and only three survived beyond 2 hours post thrombus. Postmortem examination of non-STK-treated animals revealed extensive residual coronary thrombus. All intracoronary STK-treated animals evidenced absence of residual coronary thrombus at postmortem examination. These data provide clinically relevant evidence that early intracoronary STK effects thrombolysis in AMI by reopening coronary vessels occluded by fresh thrombus, thereby protecting myocardium from further ischemia and necrosis, preserving LV function, and also reversing cardiac muscle injury.

Animals↗

PubMed1981

Spontaneous heterograft aortic valve failure.

Glutaraldehyde-treated porcine aortic valve prostheses have been in clinical use for ten years. The long-term durability of these valves remains unknown although they have functioned well in most large clinical series for more than five years. At the present time, several manufacturers produce bioprostheses mounted on flexible stents. This report concerns the failure of an Edwards porcine xenograft in the aortic position 15 months following implantation. At reoperation, the right and left coronary leaflets of the explanted valve were torn from the aortic wall. The loss of wall integrity suggests that during the process of mounting the xenograft on the flexible stent, the aortic walls of the bioprosthesis may have been thinned beyond a critical point of maintenance of wall strength. The pathological and clinical findings of similar cases are reviewed.

Aortic Valve Stenosis↗

PubMed1981

Diaphragmatic injuries.

From 1973 through 1978, 48 patients with diaphragmatic injuries from blunt or penetrating trauma to the chest and the upper part of the abdomen were seen at this medical center. Penetrating injuries were the cause of diaphragmatic perforation in 40 patients, while blunt injury was responsible in the remaining eight patients. The mean age of the patients was 30 years. Associated major trauma to other organ systems which accompanied the diaphragmatic lacerations accounted for three deaths. The extent of the diaphragmatic disruptions varied from 1 to 12 centimeters. There was not correlation between the size and location of the laceration and morbidity or mortality. The sequelae of strangulation of gastrointestinal viscera, mediastinal shift and delayed hernia were found in four patients. Eight patients had herniation of intra-abdominal contents, two as a result of penetrating trauma and six as a result of blunt trauma. Strangulation and necrosis of the intestine occurred in three patients, two of whom had delayed treatment. Deliberate effort must be made to identify diaphragmatic perforation at the time of the initial evaluation of injured patients with trauma to the thorax and abdomen. Prompt recognition and repair are required for survival.

Adult↗

PubMed1980

Heterograft cardiac valve prostheses: a five-year follow-up.

The major advance in the management of valvular heart disease over the past twenty years has been due to prosthetic valve operation. The bioprostheses have good hemodynamic function and a low rate of thromboembolism although the long-term durability is unknown. In this series of 25 patients with 27 valves implanted over five years, there was an 9% early mortality and a 12% late mortality. There have been no thromboembolic episodes. Primary valvular dysfunction requiring operation occurred in 7.4% (2 out of 27). All surviving patients are in New York Heart Association Functional Class I or II.

Aortic Valve↗

PubMedDate not supplied

Phrenic nerve palsy after topical cardiac hypothermia.

Evidence of phrenic nerve paralysis was found in 16 of 172 (9.3%) consecutive adult cardiac surgical patients who survived surgical procedures using topical cardiac hypothermia; two patients had bilateral phrenic nerve paralysis and 14 had left phrenic nerve paralysis. One or more pulmonary complications occurred in 13 of 16 patients (81.3%) with phrenic nerve paralysis while 80 of 156 (56%) had one or more pulmonary complications among patients who had no hypothermic phrenic nerve injury. Average postoperative hospital stay was 13.6 days for patients with left phrenic nerve paralysis, and 22.5 days for patients having bilateral phrenic nerve paralysis. This postoperative complication predominated in males; 15 of 16 (93.8%) of those in our series with phrenic paralysis were males, while 118 of 172 (68.6%) patients were males. Phrenic paralysis did not correlate with the length or degree of systemic hypothermia on cardiopulmonary bypass. No deaths were attributed to phrenic nerve injury. With a minimum of one year follow-up, 12 of 16 patients had return of normal diaphragmatic motion, four had residual paralysis when examined between 12 and 19 months postoperatively.

Adult↗