PubMed Health⌕ Search

Biomedical subjects

A T Martella

Publications and source records attributed to A T Martella.

9 recordsLinked to original sources
PubMed2001

Hemodynamic effects of chest closure in adult patients undergoing cardiac surgery.

OBJECTIVE: To evaluate hemodynamic effects of sternal retractor removal and sternal closure after cardiopulmonary bypass and to correlate these changes with preoperative and intraoperative variables. DESIGN: Prospective. SETTING: University hospital. PARTICIPANTS: Fifty adults undergoing cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Arterial, pulmonary artery, and transesophageal echocardiography measurements were obtained immediately before and 1 minute after removal of the sternal retractor and immediately before and 1 minute after sternal closure. Retractor removal caused a significant decrease in cardiac index by 5.6% (p < 0.01), stroke volume index by 4.0% (p < 0.05), and mean pulmonary artery pressure by 4.8% (p < 0.001). Sternal closure caused a significant decrease in cardiac index by 7.7%, stroke volume index by 10.2%, and left ventricular end-diastolic area by 9.2% (p < 0.001) There were significant increases in pulmonary capillary wedge pressure and systemic vascular resistance by 9.1% and 10.8% (p < 0.01). There was no significant change in the ejection fraction area. The magnitude of decrease in stroke volume index with sternal closure correlated positively with end-diastolic area immediately before the closure. CONCLUSION: Chest closure is associated with significant hemodynamic changes and a change in the ventricular transmural pressure-volume relationship. Patients with lower preload immediately before closure are more vulnerable to a decrease in cardiac index. Based on the results of this study, volume appears to be the appropriate preventive and treatment option to limit the impact of chest closure.

Adult↗
PubMed1998

Intestinal permeability correlates with severity of injury in trauma patients.

BACKGROUND: Increased intestinal permeability (IP) and the release of toxic intraluminal materials have been implicated in the systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF) observed in patients after severe trauma. Previous studies of intestinal permeability have failed to demonstrate a correlation between early measurements of IP and indicators of injury severity. This study examines the relationship between standard measures of injury severity and the early (day 1) and delayed (day 4) changes in IP. Associations between IP and the development of SIRS, MOF, and infectious complications were also studied. METHODS: The metabolically inactive markers lactulose (L) and mannitol (M) were used to measure IP in 29 consecutive patients who sustained injuries that required admission to the surgical intensive care unit and in 10 healthy control subjects. Measurements were made within 24 hours of admission and on hospital day 4. Severity of injury was assessed by A Severity Characterization of Trauma (ASCOT), Trauma and Injury Severity Score (TRISS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Postinjury infections and parameters of SIRS and MOF were recorded. RESULTS: The IP of healthy volunteers (L/M, 0.025 +/- 0.008) was within the normal range (L/M < or = 0.03), whereas the average IP in injured patients was increased both within 24 hours (L/M, 0.139 +/- 0.172) and on the fourth hospital day (L/M, 0.346 +/- 0.699). No significant correlation between severity of injury and increased IP was seen within 24 hours of injury. A significant correlation was seen on hospital day 4, however, with all severity indices measured (ASCOT: r = 0.93, R2 = 0.87, p < 0.001; TRISS: r = 0.93, R2 = 0.87, p < 0.001; ISS: r = 0.84, R2 = 0.70, p < 0.001; RTS: r = 0.68, R2 = 0.47, p = 0.002; APACHE II score: r = 0.51, R2 = 0.26, p = 0.04). Patients with markedly increased IP (L/M > or = 0.100) experienced a significant increase in the development of SIRS (83 vs. 44%; p = 0.03) and subsequent infectious complications (58 vs. 13%; p = 0.01) and showed close correlation with the multiple organ dysfunction scores (r = 0.87, R2 = 0.76, p < 0.001). CONCLUSION: These observations demonstrate that the increased IP observed after trauma correlates with severity of injury only after 72 to 96 hours and not within the initial 24 hours of injury. A large increase in IP is associated with the development of SIRS, multiple organ dysfunction, and an increased incidence of infectious complications.

Case-Control Studies↗
PubMed1996

Mediastinoscopy for the evaluation and treatment of projectile injuries.

This case report describes the first use of mediastinoscopy for the evaluation of a projectile injury and concomitant removal of the projectile. The described treatment made it possible to avoid the significant morbidity associated with mediansternotomy or thoracotomy. Complications secondary to retained mediastinal foreign bodies including infection, migration, and perforation were also avoided.

Adult↗
PubMed1995

Priorities in general surgical training.

PURPOSE: We wished to determine which area of surgical resident training receives the highest priority--surgical technique, surgical judgment, or "book knowledge." We were also interested in how the programs addressed each area, particularly the teaching of surgical technique. METHODS: A questionnaire was distributed to the program directors and chief residents of all 289 general surgery residency programs in the United States. RESULTS: Answers were received from 144 chief residents (50%) and 152 program directors (53%). Programs to teach surgical judgment and technique were offered by 55 (36%) and 68 (45%) of general surgical residencies. Most program directors (83%) and chief residents (72%) considered surgical judgment the most important aspect of surgical training. Sixty-four percent of chief residents felt they were receiving adequate training in the technical aspects of surgery. Approximately half of the program directors felt that residents needed better training in the technical aspects of surgery. One hundred thirty programs (86%) had specific curricula for teaching "book knowledge." CONCLUSIONS: With the advent of minimal access surgery and the constant introduction of new instruments and procedures, new demands are constantly being placed on practicing surgeons. In order to prevent the further fragmentation of general surgery, a more structured approach to the early teaching of surgical skills should be considered.

Attitude of Health Personnel↗
PubMed1995

Decortication for chronic postpneumonic empyema.

BACKGROUND: Thoracic empyema after pneumonia continues to be a source of morbidity and mortality. Despite the widespread use of antibiotics, more than 50 percent of empyemas are secondary to a primary pulmonary process. An empyema present for four to six weeks is considered chronic and can severely restrict the movement of the entire hemithorax. STUDY DESIGN: Twenty-five adult patients with chronic, postpneumonic empyema required decortication at the Bronx Municipal Hospital Center between 1988 and 1990. Only patients with chronic postpneumonic empyema were included. All patients failed conservative treatment with antibiotics and tube drainage. Decortication was required to control infection and release the pulmonary entrapment. RESULTS: Patients were often debilitated from alcoholism (52 percent), drug addiction (32 percent), and chronic disease. Ten patients (40 percent) required additional operative procedures to control infection: two pneumonectomies, three lobectomies, three wedge resections, and two debridements of pulmonary abscess were performed. Preoperative plain roentgenographs and computed tomographic scans diagnosed the empyema in all cases; however, they were frequently unable to predict the operative findings. There was one recurrence and one mortality (4 percent). The average postoperative period of hospitalization was 18 days (seven to 30 days). CONCLUSIONS: Decortication remains a highly effective treatment for chronic postpneumonic empyema and may identify underlying complications that could account for a patient's poor response to conservative treatment. Pulmonary abscess and parenchymal necrosis may not be detected during preoperative evaluation.

Adult↗
PubMed1994

Continuous normothermic retrograde cardioplegia for valve surgery.

We have studied warm heart surgery, deemed as continuous warm blood cardioplegia and normothermic cardiopulmonary bypass (CPB), as an alternative to the technique of intermittent cold cardioplegia for valvular surgery. Between August 1990 and January 1994, 137 consecutive patients underwent valve repair or replacement using normothermic CPB. Eighty-six of these patients received continuous normothermic retrograde blood cardioplegia via the coronary sinus (CNRC). Fifty-one patients received intermittent cold blood cardioplegia (ICBC). All procedures were performed by the same surgeon (RWMF). The two groups were matched for age, sex, NYHA class, preoperative ejection fraction, diagnosis, procedure and activated clotting time. Warm blood cardioplegia was delivered continuously via the coronary sinus after antegrade arrest (oxygenated blood 1:4 to 1:3, 37 degrees C, 250-300 ml/min, maintaining coronary sinus pressures of 40-60 mmHg. Perioperative myocardial infarction was significantly less prevalent (4.6 vs. 8.0%; p < 0.05) in the warm cardioplegia group. Cardiac output immediately after bypass was significantly higher than before bypass only in the CNRC group (4.1 +/- 0.8 to 5.2 +/- 0.9 L/min; p < 0.01). CNRC patients had significantly higher incidence of spontaneous resumption of sinus rhythm at cross-clamp removal (80 of 86, 93%) compared to the hypothermic patients (14 of 51, 27%, p < 0.001). The time from removal of the aortic cross-clamp to discontinuation of CPB (reperfusion time) was significantly shorter in the warm cardioplegia group (43 +/- 7.4 versus 75 +/- 10.2 min; p < 0.001.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Delayed presentation of a penetrating suprarenal aortic injury: case report.

Death from exsanguination is the immediate outcome in more than 80% of penetrating wounds of the aorta. We report a case in which a gunshot wound to the upper abdomen produced a full-thickness laceration to the diaphragmatic aorta that was missed during the initial exploratory laparotomy. Only 3 days later did the patient develop symptoms of a vascular injury and require reoperation.

Adult↗