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Biomedical subjects

D A Girod

Publications and source records attributed to D A Girod.

At least 19 recordsLinked to original sources
PubMed1998

Retrieval of "old" foreign bodies from the cardiovascular system in children.

Several techniques have been developed to retrieve catheter and guide wire fragments that have embolized to the heart and pulmonary vasculature. In most instances, retrieval of the embolized fragments is performed soon after the event has occurred. In this report, we summarize our experience with the removal of these fragments in 3 children after a significant amount of time had elapsed since the time of embolization. The embolized catheter and guide wire fragments were removed without any complications. We also describe the techniques used for their removal, and the problems encountered during the removal of these "old" foreign bodies.

Adolescent↗
PubMed1997

Third branchial anomalies. Avoiding recurrences.

Lateral cervical cysts, sinuses, and fistulas have been described as anomalies of the normal development of the branchial apparatus. Third branchial apparatus anomalies are rare and constitute less than 1% of all such cases. Three cases of third branchial cleft cysts and sinus tracts are presented. Two patients had previously undergone multiple attempts at extirpation. Complete removal of recurrent branchial anomalies is difficult because of scarring and fascial plane disruption. Recurrences were often the result of inadequate excision, possibly of the tract communicating with the piriform sinus. To avoid this we advocate endoscopy prior to initial resection of a suspected branchial cleft anomaly to identify any pharyngeal communication. A combined, simultaneous endoscopic identification of the piriform sinus tract with a lateral external cervical dissection facilitates complete resection. In recurrent cases, wide-field extirpation of the cyst, tract, and scar tissue is necessary to ensure complete removal of the branchial cleft anomaly. A review of the literature and of branchial apparatus embryology is also presented.

Adolescent↗
PubMed1997

Risk factors for pulmonary complications in the postoperative head and neck surgery patient.

BACKGROUND: Pulmonary complications are a primary source of increased cost and morbidity in surgically treated head and neck cancer patients. This study investigates potential risk factors related to postoperative pulmonary complications (pneumonia, adult respiratory distress syndrome (ARDS), and prolonged mechanical ventilation) in head and neck cancer patients. METHODS: Data from 144 major head and neck procedures performed at the University of Washington between 1985 and 1991 were retrospectively reviewed. Univariate and multivariate analysis were used to evaluate preoperative and perioperative variables identified as potential risk factors for postoperative pulmonary complications. RESULTS: Fifteen percent of patients had a postoperative pulmonary complication, (n = 21: 18 postoperative pneumonia; 2 ARDS; and 4 prolonged ventilation). The most common pneumonia pathogen was Staphylococcus aureus (62%). Univariate analysis identified smoking and weight loss as significant factors associated with pulmonary complications. The variables preoperative blood urea nitrogen, white blood cell count, and operative chest flap closure all approached but did not reach significance. Multivariate analysis of a subgroup of patients identified smoking history and perioperative antibiotic choice as the only independently significant variables. CONCLUSIONS: Patient smoking history was the primary variable related to postoperative pulmonary problems, with evidence of increasing risk with increased exposure. Other variables added only limited additional risk association information after multivariate analysis.

Analysis of Variance↗
PubMed1996

Surgical management of total anomalous pulmonary venous connection. Thirty-year trends.

BACKGROUND: Reports of surgical correction of total anomalous pulmonary venous connection (TAPVC) over the past 30 years indicate a general improvement in operative survival. However, prevention of late pulmonary venous obstruction continues to be a cornerstone of successful repair. The purpose of the study was to identify factors associated with improvement in perioperative mortality and to determine risk factors for death and reoperation due to pulmonary vein stenosis after repair of TAPVC. METHODS AND RESULTS: Using univariate and multiple regression analysis, we analyzed risk of early and late mortality and need for reoperation in 105 patients operated on between April 1966 and June 1995. Despite increased frequency of neonatal repair in the most recent time period (29% in 1966 through 1985; 55% in 1991 through 1995, P < .05), operative mortality declined (13% in 1966 through 1985; 0% in 1991 through 1995). The incidence of postoperative pulmonary hypertensive episodes and death related to pulmonary hypertension decreased significantly over the study period (P < .001). Aggressive preoperative elective medical stabilization and prophylaxis of postoperative pulmonary hypertensive episodes may have contributed to this improvement. By univariate analysis, preoperative pulmonary hypertension (P < .02) and preoperative pulmonary vein obstruction (P < .01) correlated with early mortality up to 1990 but not in the past 5 years. Multiple logistic regression analysis showed that only a small pulmonary confluence associated with diffuse pulmonary vein stenosis was an independent risk factor for early (P < .001) and late (P = .01) death as well as need for reoperation (P = .007). Type of TAPVC was not a significant risk factor throughout the three decades of our experience. At a median follow-up of 87 months, late survival was 98% (93 of 95 operative survivors), and all are NYHA class I. CONCLUSIONS: Improvements on surgical technique as well as preoperative and postoperative management account for the reduction in mortality and need for reoperation for most types of TAPVC. However, the presence of a small venous confluence and diffuse pulmonary vein stenosis remains a risk factor for adverse outcome.

Cardiac Surgical Procedures↗
PubMed1996

Right ventricular systolic function in adolescents and young adults after Mustard operation for transposition of the great arteries.

This study evaluates long-term ( > 10 years since surgery) right ventricular (RV) systolic function in patients who had previously undergone intraatrial baffle surgery for transposition of the great arteries. Studies suggest these patients are clinically stable and lead satisfactory lifestyles, but long-term ventricular performance is not known. Radionuclide angiocardiography was used to estimate RV ejection fraction in 58 patients a mean of 14 years after the Mustard operation. Repeat studies were performed in 32 patients. The absolute RV ejection fraction of 0.53 +/- 0.10 in our patients did not differ from normal values. Nine patients had a value < 0.42, placing them > 2 SDs below normal. Repeat RV ejection fraction decreased from 0.54 +/- 0.11 to 0.51 +/- 0.11 (p < 0.1) in 32 patients, and > 0.10 in 6. Thus, RV ejection fraction was abnormal in 9 of 58 patients (16%) evaluated > 10 years after a Mustard operation. Repeat studies demonstrate worsening in at least 6 of 32 patients (19%). These postoperative Mustard patients require continued evaluation, even in the absence of overt symptomatology.

Adolescent↗
PubMed1995

Effect of local epinephrine on cutaneous bloodflow in the human neck.

The effectiveness of local anesthetics is improved by the addition of a vasoconstrictor which increases duration of action and decreases both systemic toxic reactions and local bleeding. Epinephrine, the standard drug for vasoconstriction, has some limitations due to potential dose-related cardiac and local toxic effects. The authors examined the minimal effective epinephrine concentration required for maximal cutaneous vasoconstriction in the human subject so as to limit potential dose-related side effects. In a randomized, double-blinded prospective study, 23 patients undergoing head and neck surgical procedures under general anesthesia were enrolled to quantify the effect of subdermal infiltration of 1% lidocaine with epinephrine at varying concentrations on local cutaneous bloodflow utilizing laser Doppler flowmetry. A comparison of the onset of vasoconstriction and magnitude of diminished bloodflow was made for several commonly used concentrations of epinephrine, with 1% lidocaine and normal saline serving as controls. There were no significant differences (P > .05) between epinephrine concentrations of 1:400,000, 1:200,000, 1:100,000, and 1:50,000 when examining onset and magnitude of vasoconstriction.

Anesthesia, General↗
PubMed1993

Orbital decompression for preservation of vision in Graves' ophthalmopathy.

Graves' ophthalmopathy (thyroid eye disease) can result in progressive visual loss. The University of Washington (Seattle) experience in orbital decompression was reviewed for the years 1983 through 1990 to determine overall safety and outcome. Twenty patients underwent transantral decompression of 36 orbits for either steroid therapy failure, steroid therapy intolerance, or recurrence of optic neuropathy with tapering of the steroid therapy. Decompression successfully improved visual function in 33 of the orbits (92%) and a second decompression procedure was successful in another two (5%) of the orbits (6%). There were no major complications or cases of decreased visual function. Diplopia, present preoperatively in 17 patients (85%), was improved in eight patients (47%) and unchanged in nine patients (53%). However, of the three patients without preoperative diplopia (15%), one had development of new-onset diplopia postoperatively. Transantral decompression of the orbit offers a safe and effective therapeutic modality for vision-threatening Graves' ophthalmopathy.

Adrenal Cortex Hormones↗
PubMed1991

Ventricular function in the single ventricle before and after Fontan surgery.

To better delineate the importance of ventricular function in patients with a single ventricle and assess its relation to outcome after the Fontan procedure, 47 patients with a single ventricle were studied. Ventricular ejection fraction was estimated by radionuclide angiocardiography. Before Fontan surgery, ejection fraction was 0.57 +/- 0.10 (mean +/- standard deviation). This differed significantly from the normal mean left ventricular ejection fraction of 0.68 +/- 0.09 (p less than 0.001) derived in our laboratory by radionuclide angiocardiographic methods. Age, ventricular morphology and the presence of pulmonary artery band or systemic to pulmonary artery shunts had no statistical relation to ventricular ejection fraction in patients with a single ventricle. Serial preoperative evaluation in 15 patients over 3.8 +/- 1.3 years revealed no significant change in ventricular ejection fraction; however, increased atrioventricular valve regurgitation was documented in 4 of these 15. Modified Fontan procedure was performed in 24 of the 47 study patients; 7 have died, 1 has undergone cardiac transplantation and 1 faces possible transplantation. No difference was noted in preoperative ejection fraction between survivors and nonsurvivors. Ventricular morphology, age at Fontan surgery and operative factors such as bypass and cross-clamp time were not related to functional outcome. Preoperative ejection fraction of 0.52 +/- 0.08 decreased to 0.39 +/- 0.11 (p less than 0.001) when evaluated 1.16 +/- 0.44 years after Fontan surgery. In patients with a single ventricle (1) ventricular ejection fraction is less than that of the normal systemic ventricle; (2) during childhood, ejection fraction is not related to age or ventricular morphology; and (3) ventricular ejection fraction frequently decreases after a Fontan repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1991

Preoperative and postoperative "aneurysm" associated with coarctation of the aorta.

The reported incidence of aortic aneurysm after surgical repair or balloon angioplasty for aortic coarctation varies widely. To determine the incidence of aneurysm formation after surgery, preoperative and postoperative cineangiograms from 65 patients who underwent operation at age 1.5 +/- 3.4 years were examined. Repair included a prosthetic patch in 14 patients, end to end anastomosis in 28 and subclavian flap in 23. Aneurysm was documented by change in contour or irregularities in contour at the repair site or by abnormal dimensions at the repair site, defined by the ratio of the widest measurement at the repair site to the measurement of the aorta at the diaphragm. An aneurysmal bulge above the ductus diverticulum was identified in 14 (23%) of 60 patients preoperatively; the area showed no change 4.72 +/- 4.07 years after surgery. Significant changes at the repair site were seen in only three patients, all of whom had Dacron patch repair. One patient had a change in contour at the repair site, one had an abnormally high repair site to diaphragmatic aorta ratio and one had a progressive increase in this ratio. Thus, during childhood years, 3 (5%) of 65 patients were diagnosed as having aneurysm at the surgical repair site. In conclusion, 1) comparison with preoperative cineangiograms, especially for aneurysmal bulges above the ductus arteriosus, is essential before an aneurysm can be attributed to coarctation repair by any technique, and 2) aneurysm developed only in patients subjected to Dacron patch repair.

Aortic Aneurysm↗
PubMed1991

Anatomical correlates of functional recovery in the avian inner ear following aminoglycoside ototoxicity.

Tucci and Rubel have demonstrated functional recovery of the chick cochlea following aminoglycoside ototoxicity. The cochleae of these same animals were examined by scanning electron microscopy (SEM) in order to further understand this recovery process. Hatchling chicks were given daily doses of gentamicin for 10 days. Auditory-evoked potential measurements and examination of the cochlea by scanning electron microscopy were performed after survival periods of 5 days to 20 weeks. After 5 days of gentamicin exposure, there was near complete basal hair cell loss associated with a high-frequency hearing loss. Apical progression of damage with a broad-band hearing loss occurred over 4 weeks. At 20-weeks, hair cell counts were normal with a small high-frequency hearing loss. Hair cell regeneration played a major role in the functional recovery of the cochlea.

Animals↗
PubMed1991

Hair cell regeneration in the avian cochlea: if it works in birds, why not in man?

Hearing loss caused by cochlear hair cell loss is the most common process afflicting the hearing impaired. Recent studies in the avian cochlea following ototoxic drug and noise damage have demonstrated a remarkable capacity for anatomical and functional recovery. Hair cell regeneration has been shown to play a major role in this recovery process. Future studies may one day make hair cell regeneration or transplantation possible in man.

Animals↗
PubMed1990

Balloon pulmonary valvuloplasty: results of the Valvuloplasty and Angioplasty of Congenital Anomalies Registry.

Eight hundred twenty-two balloon pulmonary valvuloplasties were reported to the Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Before and after systolic outflow gradients were recorded in 784 valvuloplasties, and the gradient decreased from 71 +/- 33 to 28 +/- 21 mm Hg. The sites of residual obstructions could be ascertained in 196 patients. In these, the total systolic outflow gradients decreased from 85 +/- 41 mm Hg to 33 +/- 27 mm Hg. Of this total residual gradient, 16 +/- 15 mm Hg was transvalvar and 18 +/- 24 mm Hg was infundibular. The degree to which infundibular obstruction subsequently resolved was not determined in this study. The procedure was less effective in reducing outflow gradients in patients with dysplastic valves with or without Noonan's syndrome. There were 5 major complications (0.6%), including 2 deaths (0.2%), a cardiac perforation with tamponade (0.1%) and 2 tricuspid insufficiencies (0.2%). There were 11 minor complications (1.3%) and 21 incidents (2.6%). The incidence of major complications, minor complications and incidents was inversely related to age; it was substantially higher in infants and, in particular, neonates. Balloon pulmonary valvuloplasty is a safe and effective method of lowering pulmonary outflow gradients in infants, children and adults. Small transvalvar and varied infundibular gradients commonly are present at the end of the procedure. Assessing the full effect of the procedure requires intermediate-term follow-up and assessing the duration of relief requires long-term follow-up.

Adult↗
PubMed1990

Cor triatriatum: clinical presentation and surgical results in 12 patients.

Twelve patients with cor triatriatum have been seen at our institution since 1979. The clinical presentation, diagnostic evaluation, and surgical results are outlined in this retrospective review. Operation is the treatment of choice for this rare congenital cardiac defect. One patient died 1 day before scheduled operation, and 2 patients died postoperatively, yielding a surgical mortality rate of 17% and an overall mortality rate of 25%. Resection of the obstructing atrial membrane was performed using hypothermic cardiopulmonary bypass in all cases. Left atriotomy was performed in 6 patients, and right atriotomy was performed in 7. The two postoperative deaths occurred in patients who had serious associated cardiac defects. Associated anomalies include atrial septal defect, persistent left superior vena cava, and partial anomalous pulmonary venous return. The postoperative course has been excellent in all 9 surviving patients; all remain asymptomatic. Cor triatriatum is amenable to surgical repair with excellent results when diagnosed early and when not complicated by other severe cardiac anomalies.

Child, Preschool↗
PubMed1990

Assessment of ventricular function in infants and children. Response to dobutamine infusion.

A method to assess ventricular functional reserve in infants and children unable to perform dynamic exercise was evaluated. Left ventricular ejection fraction was measured by radionuclide angiocardiography at rest and during infusion of dobutamine in 5-15 micrograms/kg/min dosages. The only side effects noted were arrhythmias in two patients, who had similar ectopy documented previously. Group left ventricular ejection fraction increased from 0.40 +/- 0.21 to a maximum of 0.49 +/- 0.24 (P less than 0.001). Left ventricular ejection fraction at 5 micrograms/kg/min (0.44 +/- 0.23) was not statistically different from that measured during infusion of dobutamine at 10 micrograms/kg/min (0.48 +/- 0.24). The six patients receiving anthracyclines, who had relatively low function at rest and increased function during dobutamine administration, were continued on their anticancer regimen without deteriorating in condition. Absolute values of left ventricular ejection fraction correlated best with the prognosis in patients with idiopathic dilated cardiomyopathy or structural abnormalities; six out of ten patients whose left ventricular ejection fraction never rose above 0.40 have either died or are in transplant protocols. Thus, study of left ventricular function can be performed easily during dobutamine infusion, generating valuable prognostic information.

Antineoplastic Agents↗
PubMed1989

Clinical and hemodynamic course of infants and children with anomalous left coronary artery.

The clinical history of all 17 patients with anomalous left coronary artery presenting over the last 20 years was studied, with special emphasis on those who underwent reimplantation of the anomalous coronary artery into the aorta, a procedure that became our "treatment of choice" during this period. These patients were also evaluated for ventricular performance, residual mitral regurgitation, and wall integrity. Early in our experience with reimplantation, two patients died while we waited for them to achieve a more favorable size for surgery. Eight of nine survived reimplantation; three of these were under 1 year of age when operated upon. One of these eight patients has required additional mitral valvuloplasty, but all are doing well clinically up to 12 years after operation. Preoperative left ventricular ejection fraction of 0.37 +/- 0.16 increased to 0.67 +/- 0.07 (p less than 0.001) by 1 year after surgery, despite ventricular wall abnormalities in four patients. Thus reimplantation of the anomalous left coronary artery should be undertaken upon diagnosis, since surgery can be performed successfully in infancy, with resultant improvement in ventricular function and an adequate clinical condition for at least 12 years.

Adolescent↗
PubMed1989

Possible precursors of regenerated hair cells in the avian cochlea following acoustic trauma.

Hair cell regeneration following acoustic trauma to the avian cochlea has been documented using DNA labeling with tritiated thymidine. The goal of this study was to identify potential precursor cell populations for regenerating hair cells. Chicks were exposed in pairs to a 1500 Hz pure tone at 120 dBSPL for 18 h. The animals received repeated injections of 3H-thymidine over a survival period of 6, 15, or 24 h, 3 days or 30 days after the completion of noise exposure. One cochlea from each animal was processed for autoradiography and the other for scanning electron microscopy. Labeled, regenerated hair cells were present by 3 days after exposure and recovery from injury was nearly complete by 30 days. Examination of animals in short survival groups suggest that two precursor populations may exist. For inferior sensory epithelial damage, cuboidal or hyaline epithelial cells appear to serve as the precursor cell population for the regeneration of both hair cells and supporting cells. With isolated superior damage, however, supporting cells may be the precursor population.

Animals↗
PubMed1988

Surgical spectrum of aortic stenosis in children: a thirty-year experience with 257 children.

Aortic stenosis accounts for 5 to 6% of infants and children seen for surgical repair of congenital heart disease. The clinical presentation and reported results of operation for aortic stenosis are highly variable. This retrospective review was undertaken to assess our operative mortality and the degree of gradient reduction afforded by each of several surgical techniques used to treat aortic stenosis in children over a 30-year period. Two hundred fifty-seven patients ranging in age from 1 day to 19 years were operated on between 1957 and 1986. The indication for operation included asymptomatic patients with gradients greater than 50 mm Hg to patients in profound cardiogenic shock. The operative mortality for children older than 6 months was 4%, whereas neonates seen with critical aortic stenosis had a 60% mortality. The late mortality was 2%. Eighty percent of surviving patients to date have undergone cardiac catheterization after repair. This shows an overall reduction of 57 mm Hg in the left ventricular-aortic gradient. Patients with supravalvular aortic stenosis and discrete subvalvular aortic stenosis as well as patients undergoing aortic valve replacement showed a reduction in or elimination of associated aortic insufficiency, whereas patients undergoing aortic valvotomy or neonates having valvotomy had a significant increase in demonstrable aortic insufficiency. The incidence of third-degree heart block or cerebral emboli following operation for aortic stenosis was less than 1%. However, the incidence of late bacterial endocarditis following repair was nearly 5%; six of eleven cases occurred in the group with discrete subvalvular aortic stenosis. Twenty-nine (13%) of the 223 long-term survivors have undergone a subsequent procedure for relief of residual or recurrent obstruction; 12 have had insertion of an aortic valve prosthesis, 12 have had insertion of an apicoaortic conduit, and 6 have required repeat aortic valvotomy. These data demonstrate the low operative mortality and excellent hemodynamic benefit of surgical relief of single-level aortic stenosis in children older than neonates. Conduits placed for complex obstructions or operative procedures in neonates have acceptable hemodynamic benefits, but operative mortality remains high.

Adolescent↗