Biomedical subjects

C M Dresler

Publications and source records attributed to C M Dresler.

8 recordsLinked to original sources

PubMed1992

Single lung transplantation for pulmonary hypertension. Technical aspects and immediate hemodynamic results.

Donor availability has limited the clinical applicability of heart-lung transplantation in patients with end-stage pulmonary hypertension. Satisfaction with single lung transplantation in other patient groups prompted its extension to patients with pulmonary hypertension. Nine patients with end-stage pulmonary hypertension underwent single lung transplantation. Important technical considerations included routine use of cardiopulmonary bypass, simultaneous closure of significant associated cardiac defects (n = 4), and use of remaining thoracic donor organs in multiple recipients (total thoracic transplants from eight donors = 21). Analysis of immediate postoperative hemodynamics suggests that early relief of pulmonary hypertension and improvement in right ventricular function can be expected. There was one postoperative death. Eight patients have been discharged and are alive and well at a mean follow-up period of 1 year. All eight survivors have returned to New York Heart Association functional class I from their preoperative levels of III or IV. These results support the use of single lung transplantation as a transplant option in patients with end-stage pulmonary hypertension. The question of long-term durability remains unanswered.

Adult↗

PubMed1991

The Washington University-Barnes Hospital experience with lung transplantation. Washington University Lung Transplantation Group.

OBJECTIVE: --To review our experience with lung transplantation, emphasizing recipient selection, choice of procedure, functional results, and outcome. DESIGN: --Retrospective review of patients who received lung transplants at Barnes Hospital, St Louis, Mo, between July 1, 1988, and January 31, 1991. SETTING: --Washington University School of Medicine, St Louis, Mo, and Barnes Hospital, a medical school and its affiliated referral hospital, respectively. PATIENTS: --Sixty-nine lung transplant procedures were performed in 66 recipients. Patients with clinically and physiologically severe lung disease were selected according to predetermined guidelines. Underlying diseases in the recipients included chronic obstructive pulmonary disease, alpha 1-antitrypsin deficiency emphysema, cystic fibrosis, pulmonary fibrosis, primary pulmonary hypertension, Eisenmenger's syndrome associated with an atrial septal defect, bronchiectasis, eosinophilic granuloma, and lymphangiomyomatosis. INTERVENTION: --Double-lung, bilateral sequential, and single-lung transplantations were performed. Eight patients underwent en bloc double-lung transplantations or a modification of this procedure with separate bronchial anastomoses. Thereafter, the bilateral sequential approach to replacement of both lungs was performed in 26 patients. Thirty-two patients underwent single-lung transplantations. MAIN OUTCOME MEASURES: --Pulmonary function tests, arterial blood gas levels, pulmonary artery pressure, pulmonary vascular resistance, and actuarial survival. RESULTS: --Actuarial survival at 1 year for the 66 lung transplant recipients was 79%. Actuarial survival at 1 year was 82% for the bilateral lung transplant recipients and was 90% for the single-lung transplant recipients. In patients with either restrictive or obstructive lung disease, pulmonary function tests and arterial blood gas levels improved markedly after lung transplantation. In patients with primary pulmonary hypertension or Eisenmenger's syndrome, the pulmonary artery pressure decreased and the cardiac index increased into the normal range after single-lung transplantation. CONCLUSIONS: --In carefully selected patients with end-stage lung disease, single-lung and bilateral lung transplantations can significantly improve functional capacity, with promising early actuarial survival statistics after 1 year.

Actuarial Analysis↗

PubMed1991

Bilateral sequential lung transplantation: the procedure of choice for double-lung replacement.

We recently described a technique for bilateral sequential lung transplantation that replaces the en bloc double-lung operation, a procedure that was accompanied by frequent problems with airway healing. Twenty-seven patients have undergone 28 bilateral sequential lung transplantations over the past 14 months. Eighteen patients had transplantation because of end-stage emphysema; 6, cystic fibrosis; and 1 each, obliterative bronchiolitis, usual interstitial pneumonitis with pulmonary fibrosis, and bronchiectasis. Cardiopulmonary bypass was used electively in the first 5 patients until it was recognized that the procedure could be done safely without it, and in only 3 additional recipients has it been employed. Mean ischemic time for the first lung was 276 +/- 43 minutes and for the second lung, 410 +/- 64 minutes. There have been five deaths, three in the postoperative period (11% operative mortality) and two late. The other patients are alive and well and do not require oxygen 2 to 15 months after transplantation. Mean forced expiratory volume in 1 second rose from 16% +/- 8% of predicted to 84% +/- 17% at 12 weeks. Six-minute walk values increased from a mean of 251 +/- 91 m to 666 +/- 42 m at 24 weeks. The excellent exposure afforded to both hemithoraces by the thoracosternotomy incision and the rare need of cardiopulmonary bypass have allowed us to offer the option of transplantation to patients who formerly would have been turned down because of previous pulmonary resection or pleurectomy. On four occasions, ventilator-dependent patients underwent successful transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Metabolic consequences of (regional) total pancreatectomy.

Little information has been reported on the metabolic characteristics of the totally pancreatectomized patient or the efficacy of medical management after radical pancreatic surgery. The prospective evaluation of 49 such patients, with 31% followed for 48 or more months, forms the basis of this report. The major immediate postoperative challenge is control of diarrhea and weight stabilization. Chronically patients have an increased daily caloric requirement (mean +/- SE, 56 +/- 1 kcal/kg), not wholly explained by moderate steatorrhea (fecal fat excretion, 16% +/- 2% of unrestricted fat intake). Despite persistent malabsorption, deficiencies in fat-soluble vitamin, magnesium, and trace element serum levels can be prevented in most patients. Pancreatogenic diabetes is characterized by (1) absence of the major glucoregulatory hormones insulin and glucagon, (2) instability, and (3) frequent hypoglycemia, with the latter parameters improving with rigorous home glucose monitoring. No patient has developed clinically overt diabetic micro- or macrovascular disease. Performance status in long-term survivors has been reasonable. However adverse chronic sequelae of the operation occur and include an unusual frequency of liver disease, characterized by accelerated fatty infiltration, and osteopenia, with an 18% reduction in radial bone mineral content noted in pancreatectomized patients studied more than 5 years after surgery.

Adenocarcinoma↗

PubMed1990

Complete foregut duplication.

Alimentary tract duplications are rare congenital anomalies with the majority identified in the pediatric age group. However, duplications may be seen in the adult population and require operative excision. A 53-year-old man was seen with vague, nonspecific symptoms and was found to have a complete esophageal and gastric duplication with communication to the normal alimentary tract. Appropriate-for-structure epithelium was noted throughout the length of the duplication.

Barium Sulfate↗

PubMed1987

Metabolic efficacy of enteral feeding in malnourished cancer and noncancer patients.

Total parenteral nutrition and enteral nutrition are the two available methods for supplementary nutritional support of malnourished patients. Although supplemental alimentation is beneficial in malnourished patients, it is unclear whether malnourished cancer bearing patients are successfully replenished with similar nutritional support. We studied the efficacy of 2 weeks of enteral nutrition on intermediary glucose and protein metabolism in malnourished tumor-bearing (TB) and non-tumor bearing (NTB) patients. Both TB and NTB patients showed equivalent suppression of endogenous glucose production (2.13 +/- 0.23 to 0.35 +/- 0.16 mg/kg/min and 2.35 +/- 0.18 to 0 mg/kg/min), suppression of alanine to glucose conversion (43.8 +/- 10.6% to 0.75 +/- 0.41% and 37.0 +/- 10.7% to 0.11 +/- 0.09%), attainment of positive nitrogen balance (-2.15 +/- 1.18 to 4.26 +/- 1.37 gN/d and -2.25 +/- 0.63 to 4.32 +/- 0.44 gN/d) and suppression of protein catabolism (2.39 +/- 0.13 to 1.10 +/- 0.27 gP/kg/d and 2.23 +/- 0.04 to 1.34 +/- 0.22 gP/kg/d). Following 2 weeks of enteral support, the TB patients differed from the NTB group with significantly elevated lactate levels (80 +/- 8 v 48 +/- 7 mg/L) and depressed plasma glycine levels (264 +/- 12 v 356 +/- 27 mumol/L plasma) and inability to replenish fat stores (triceps skin fold, 7.6 +/- 1.5 to 7.1 +/- 1.5 mm in TB v 5.9 +/- 0.7 to 8.0 +/- 1.2 mm in NTB). A significant reduction in whole body protein synthesis (2.08 +/- 0.19 to 1.84 +/- 0.18 gP/kg/d) in TB patients was obtained while NTB showed no significant change (1.86 +/- 1.3 to 1.91 +/- 0.26 gP/kg/d).(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗

PubMed1987

Extremity blood flow in man: comparison between strain-gauge and capacitance plethysmography.

Metabolic studies with substrate limb flux determinations require an accurate and simple method for measuring blood flow through the extremity. Two common, noninvasive methods used in recent studies are strain-gauge and capacitance venous occlusion plethysmography. The values obtained for forearm blood flow by these two methods are highly correlated in normal resting and seriously ill patients. The use of a fixed percentage of cardiac output as a measure of extremity flow was not indicative of the measured flow by either capacitance or strain-gauge plethysmography. Capacitance and strain-gauge plethysmography are comparable, noninvasive indicators of change in extremity blood flow in humans.

Cardiac Output↗

PubMed1986

Basal glucagon replacement in chronic glucagon deficiency increases insulin resistance.

To evaluate the role of glucagon in insulin-mediated glucose metabolism, we studied four men and four women, ranging in age from 30-73 yr (mean +/- SEM, 54 +/- 5) who had undergone complete pancreatic resection for cancer or chronic pancreatitis 16-58 mo previously. The patients had undetectable C-peptide levels and established lack of biologically active 3500 mol wt glucagon. Euglycemic insulin clamp studies were performed with a 40 mU X m-2 X min-1 insulin infusion in the basal, post-absorptive, insulin-withdrawn state, before and during the last 3 h of a 72-h glucagon replacement-dose infusion (1.25 ng X kg-1 X min-1). In four patients, hepatic glucose production was determined by a primed-constant infusion of 3-[3H]glucose. Monocyte insulin-binding studies, pre- and postglucagon, were performed in all patients. The 72-h glucagon infusion, resulting in mean plasma glucagon levels of 124 +/- 7 pg/ml, caused a significant rise in the mean plasma glucose level (249 +/- 8 versus 170 +/- 13 mg/dl preglucagon) and a sixfold increase in mean 24-h glucose excretion. Both with and without glucagon, euglycemic hyperinsulinemia achieved identical and complete suppression of hepatic glucose production. The mean glucose utilization rate (4.70 +/- 0.36 mg X kg-1 X min-1 preglucagon) was significantly decreased by glucagon replacement (3.83 +/- 0.31 mg X kg-1 X min-1, P less than 0.02). Mean glucose clearance was also diminished with glucagon (4.49 +/- 0.32 versus 5.73 +/- 0.45 ml X kg-1 X min-1 preglucagon, P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗