Spontaneous pneumoperitoneum after scuba diving.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
D M Rose
Publications and source records attributed to D M Rose.
Purity of USP medical oxygen.
Explore the source record for details and available documents.
Carbon Dioxide↗
Radiofrequency ablation: a minimally invasive technique with multiple applications.
PURPOSE: Radiofrequency ablation (RFA) of soft tissue, which has recently been approved by the United States Food and Drug Administration, destroys tumor cells by delivering an electrical current through a 15-gauge needle. This study evaluated RFA for patients with hepatic malignancies considered unresectable because of their distribution, their number, and/or the presence of liver dysfunction. PATIENTS AND METHODS: Between November 1997 and February 1999, 50 patients with 132 unresectable hepatic metastases underwent RFA of tumors from 0.5 to 9 cm in diameter. There were 41 colorectal metastases in 22 patients, 13 hepatomas in seven patients, 37 neuroendocrine metastases in six patients, and 41 noncolorectal metastases in 15 patients. Real-time ultrasonography was used to guide RFA, and lesions were ablated by applying temperatures of approximately 100 degrees C for 8 minutes. Overlapping ablations were used for larger lesions. In patients with multiple lesions, RFA was performed simultaneously with cryosurgery, resection, and/or hepatic arterial infusion. RESULTS: RFA was undertaken percutaneously on an outpatient basis in 13 patients (25 lesions). The remaining patients underwent RFA via laparoscopy (21 patients; 58 lesions) or celiotomy (16 patients; 49 lesions); mean hospital stay was 1 and 5 days, respectively. RFA was the sole therapy in 28 patients and was additional therapy in 22 patients. At a median follow-up of 6 months, 27 patients were free of disease, 17 were alive with disease, and six had died of their disease (three colon, three melanoma). Three patients whose disease recurred at a prior RFA site underwent successful percutaneous RFA. Overall, there was a significant postoperative reduction in levels of carcinoembryonic antigen, alpha-fetoprotein, serotonin, and 5-hydroxyindoleacetic acid. Intraoperative ultrasonography identified unrecognized hepatic lesions in 12 of 37 patients (32%); these lesions were successfully ablated. When performed with cryosurgery, RFA reduced the morbidity of multiple freezes. DISCUSSION: RFA is a safe and effective alternative for the ablation of unresectable hepatic malignancies and when used adjunctively can reduce the morbidity of cryosurgery. Percutaneous and laparoscopic RFA can be performed effectively with less than 24 hours of hospitalization. Intraoperative ultrasonography is essential for accurate staging.
Adult↗
Determinants of weld strength in laser-assisted microvascular anastomosis.
Explore the source record for details and available documents.
Anastomosis, Surgical↗
Repair of ventricular rupture following mitral valve replacement.
Left ventricular rupture is reported to occur in 0.5-2% of patients following mitral valve replacement and results in a high mortality rate. Three types of left ventricular rupture have been identified, each attributed to a different mechanism. Failure of repair has been due to repeated tearing of the ventricular muscle and resulting hemorrhage. We describe the repair of left ventricular rupture following mitral valve replacement with buttressed dacron patch. The repair is designed to eliminate the tension placed on the suture line. In addition, specific recommendations are made to avoid left ventricular rupture during mitral valve replacement.
Female↗
Changes in circulating prostaglandin E and F2 alpha levels, cloacal temperature, and leukocyte counts in turkeys inoculated with Pasteurella multocida.
The inoculation of Pasteurella multocida (P-1059) intravenously into turkeys increased significantly the plasma prostaglandin (PG) F2 alpha levels to 157% of the control values and the plasma PGE levels to 171% of control values at 3 hr after treatment. At 12 hr, the cloacal temperature of the inoculated birds was significantly higher than that of the control. The leukocyte count of inoculated birds remained unchanged from that of the control. However, the differential leukocyte count shifted in favor of significant increases in heterophils and decreases in lymphocytes and monocytes at 6 and 12 hr after inoculation. This study provides evidence that increases in plasma levels of PGF2 alpha and PGE may be partly responsible for the clinicopathological manifestations of acute fowl cholera.
Animals↗
Early coronary artery bypass grafting for complicated acute myocardial infarction.
The occurrence of unstable angina or cardiogenic shock after an acute myocardial infarction characterizes a subgroup of patients with increased morbidity and mortality. To assess the efficacy of surgical revascularization in this cohort, 96 patients who underwent coronary artery bypass grafting within 6 weeks of an acute myocardial infarction were compared to 485 patients who underwent myocardial revascularization without recent infarction. Fourteen (15%) of the patients with acute infarction were in cardiogenic shock and 82 (85%) patients had unstable angina at the time of surgery. Preoperatively, the patients with acute infarction compared to the patients without acute infarction were older (+3.5 years), had an increased incidence of congestive heart failure (21% vs 13%), and had a lower mean ejection fraction (4% vs 65%). Preoperative intraaortic balloon support was used in 9 patients (65%) with cardiogenic shock, and in 16 patients (19%) with unstable angina. Mean interval to surgery from time of infarction was 14.9 days. Overall operative mortality was 7.3% (7 patients) for the acute infarction group 28% for patients with cardiogenic shock and 3.7% for patients with unstable angina compared to 3.7% for the group of patients without recent infarction. Earlier surgical intervention did not result in a significant increase in operative mortality. Discriminant analysis of the recent infarction cohort demonstrated that preoperative ejection fraction less than 45% and age greater than 70 were the most significant predictors of early mortality. Of the 89 patients surviving surgery, actuarial survival was 97% at 3 years with no late infarctions. At follow-up 95% of survivors were NYHA Class I or II.(ABSTRACT TRUNCATED AT 250 WORDS)
Angina, Unstable↗
Role of coronary angiography and coronary artery bypass surgery prior to abdominal aortic aneurysmectomy.
It is well recognized that patients with abdominal aortic aneurysms have a high incidence of coronary artery disease, and that the major cause of death in patients undergoing aneurysmectomy has been acute myocardial infarction. In order to assess the incidence of significant coronary artery disease, cardiac catheterization was performed on 42 consecutive patients with abdominal aortic aneurysms. Thirty-six patients (85.7%) had significant anatomic coronary artery disease. Interestingly, all 8 patients with ejection fractions of less than 50% had triple vessel disease or left main disease, and 12 of 34 patients with ejection fractions greater than or equal to 50% had triple vessel disease or left main disease. Of the 30 patients who were NYHA Class I or Class II, 14 (46.7%) had triple vessel disease or left main disease. All 20 patients with triple vessel disease or left main disease underwent myocardial revascularization 7 to 10 days prior to abdominal aneurysmectomy. No patients had a perioperative myocardial infarction either following coronary artery bypass surgery or abdominal aortic aneurysm resection, and there were no operative mortalities. Although this was not a randomized study, it would seem from these results that in selected patients, myocardial revascularization prior to abdominal aneurysmectomy can decrease the incidence of acute myocardial infarction and also decrease operative mortality. It is presently recommended that all symptomatic patients, patients with ejection fractions of less than 50%, and asymptomatic patients with ejection fractions of greater than or equal to 50% with positive exercise radionuclide angiography undergo cardiac catheterization prior to aneurysmectomy, and those patients with left main disease or severe coronary artery disease undergo myocardial revascularization prior to aneurysm resection.
Aged↗
Surgical management of infected median sternotomy: closed irrigation vs. muscle flaps.
Mediastinitis remains a serious complication of median sternotomy which requires prompt and aggressive surgical management. Debridement and closed irrigation has been the conventional mode of treatment. Failure to respond results in open drainage and delayed healing with its associated increased morbidity and mortality. Secondary closure with rectus muscle flaps has been a marked advance in the treatment of these patients. In an attempt to define guidelines for the treatment of mediastinitis complicating median sternotomy, a retrospective review of 2,400 cardiac surgical cases at St. Vincent's Hospital from 1977 through 1982 was performed. There were 25 cases (1%) of mediastinitis. Debridement and closed irrigation was successful in 16 patients (64%) with an average postoperative hospital stay of 19 days. Failure resulted in open drainage in 2 patients (8%) with an average hospital stay of 66 days and debridement and secondary closure by rectus muscle flaps in 7 patients (28%) with an average hospital stay of 28 days. There were no deaths in the entire series. Failure to respond to closed irrigation was not due to delay in diagnosis. The length of time between operation and the first sign of sternal dehiscence did not vary significantly. Sternal dissolution, the presence of anaerobic organisms, large volumes of purulent and necrotic material, however, were responsible for continued mediastinitis and further sternal dehiscence. Open irrigation and delayed closure with muscle flaps should be reserved for these patients and appears to decrease significantly morbidity and length of hospital stay. Surgical debridement and closed irrigation, however, remains the primary method of treatment of the less virulent forms of mediastinitis following median sternotomy.
Debridement↗