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Biomedical subjects

A Thomas Pezzella

Publications and source records attributed to A Thomas Pezzella.

13 recordsLinked to original sources
PubMed2004

Factors affecting early exsanguination and death in blunt thoracic aortic trauma.

The traditional approach to blunt thoracic aortic injuries has been expedient diagnosis and operative repair due to the significant risk of early exsanguination and death in initial survivors. Nonoperative management has been advocated in patients with multiple injuries to reduce the operative mortality. However, specific clinical parameters and diagnostic tests that may predict the risk of early exsanguination and death have yet to be identified. A retrospective analysis of 80 patients with these injuries was undertaken to identify factors associated with early exsanguination or death. Available aortograms were also examined and graded to determine their utility in predicting these outcomes. Early exsanguination and death were found to be associated with low systolic blood pressure on admission and with short duration from injury to diagnosis. Exsanguination was also associated with the total number of lesions in thoracic injuries, and mortality with age greater than 30 years. Aortographic appearance was not found to correlate with either outcome. Patients with blunt thoracic aortic injuries should continue to be managed expediently, with immediate surgical repair if not contraindicated by associated injuries, to avoid early rupture.

Adolescent↗
PubMed2002

Early surgical intervention for infective endocarditis.

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

Adolescent↗
PubMed1981

Congenital coronary artery-left heart fistulas: Report of three cases.

Of 59 patients who underwent operative correction of congenital coronary artery fistulas from May 1956 through May 1980 at our institution, three had fistulas that arose from the coronary artery and terminated in the left heart. The chief indication for surgical correction in such patients is the presence of symptoms or the development of complications, which include rupture, endocarditis, and congestive heart failure. The principal objective of repair is closure or obliteration of the fistulous communication and preservation of distal myocardial perfusion. Because symptoms and complications tend to occur with age, elective ligation is warranted during childhood, even in asymptomatic patients. The three cases described here, as well as the reviewed series of left heart fistulas, substantiate this fact. All three patients were symptomatic before operation and asymptomatic afterward.

Journal Article↗
PubMed1981

Surgical aspects of pulmonary paragonimiasis.

Pulmonary paragonimiasis is caused by the presence of the oriental lung fluke, Paragonimus westermani, within the lung parenchyma. The disease is indigenous to Korea. In a retrospective review of operative cases from 1972 through July 1979 at the National Medical Center in Seoul, Korea, eleven cases were analyzed. The mean age of the patients was 27 years, and all had a history of ingesting raw crustaceans. Diagnosis was based on history, positive skin test, and radiographic findings. The patients were treated with bithionil before undergoing surgery for severe pleural or pleuroparenchymal lung disease. There was one operative death. Long-term follow-up from 6 to 84 months indicated satisfactory results in ten patients. Our experience with this clinical entity forms the basis of this report.

Journal Article↗
PubMedDate not supplied

Residency training in the United States: what foreign medical graduates should know.

This communication provides useful information for Foreign Medical Graduates (FMGs) planning to pursue post-graduate residency training in the United States of America (USA). While the number of residency training positions is shrinking, and the number of United States graduates has steadily declined over the past decade, the number of FMGs has also steadily increased. Unfortunately, as a result of the terrorist attack of September 11, 2001, the problem of obtaining training visas and sponsorship by the Educational Commission for Foreign Medical Graduates (ECFMG) will remain major problems for FMGs. This present review is by no means exhaustive. It should serve as a guideline to more detailed and focused information. It is extremely important to network with friends, family, and professional colleagues regarding the subjective and objective aspects of pursuing graduate medical education (GME) in the USA. Though the process is very protracted and at times frustrating and depressing; the visa hurdle will be the ultimate barrier to overcome. However, majority of FMGs eventually achieve the ultimate goal of obtaining superb training and experience in the United States. We highly recommend the book by Kenneth V. Iserson entitled "Iserson's Getting Into A Residency: A Guide for Medical Students" published by Galen Press Limited, Tucson, Arizona (ref# 10). It is a very useful source of information for medical students and residents planning further residency training in the United States of America. Useful Internet addresses are listed in Appendix 1.

Africa↗