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Biomedical subjects

D M Voss

Publications and source records attributed to D M Voss.

12 recordsLinked to original sources
PubMed2000

Modified computed tomography peritoneography: clinical utility in continuous ambulatory peritoneal dialysis patients.

The purpose of the present paper is to review the indications, results, clinical correlation and implications for management of a modified CT peritoneography (CTP) technique in the evaluation of continuous ambulatory peritoneal dialysis (CAPD) patients. Forty CTP in 33 patients were reviewed by two observers blinded to clinical history or outcome. The CTP technique included 100 mL non-ionic intraperitoneal contrast, 1 h of ambulation and prone positioning during the CT. No precontrast or delayed examinations were performed. A CAPD-related complication was diagnosed in 33 of 40 (82%) CTP. Twenty-nine CTP were performed for evaluation of suspected dialysate leaks. In this group there were 18 leaks, a total of seven umbilical hernias (five as isolated findings) and five normal studies. Nine of 18 (50%) leaks resolved with conservative management and six of nine patients (67%) of the remainder continued CAPD after appropriate surgery. Seven patients were evaluated for scrotal swelling (one bilateral), and there were five communicating hydroceles (all with inguinal fat herniation and all surgically confirmed) and three non-communicating hydroceles (none of which progressed). Umbilical hernias were present in nine of 33 patients (27%). No false positive or false negative studies were identified. The CTP technique described provides accurate diagnostic information in the management of common CAPD-related complications, particularly dialysate leak, genital swelling, abdominal wall hernias and peritoneal adhesions. Computed tomography peritoneography directs appropriate conservative or surgical management.

Adult↗
PubMed1995

Percutaneous renal biopsy: an audit of a 2 year experience with the Biopty gun.

AIM: To review and audit our experience in the use of the semiautomated spring-loaded Biopty gun with ultrasound guidance for renal biopsy, and the results with those obtained eleven years earlier using the Franklin-modified Vim Silverman needle. METHOD: We reviewed retrospectively the hospital notes of all patients who under went a percutaneous renal biopsy over a 2 year period at Christchurch Hospital. RESULTS: There were 126 renal biopsies in 117 patients. Proteinuria (32%) remained the most common indication for renal biopsy. Renal transplant dysfunction (21%) was the next most common indication. IgA nephropathy was more frequently diagnosed than 11 years previously. Despite the use of a finer (18 gauge versus 14 gauge) needle, specimen adequacy was not jeopardised. Bleeding complications (7.9%) are still a significant occurrence with the Biopty gun. Complications in nine of the 10 cases developed within 8 hours of the biopsy. CONCLUSIONS: Over 50% of the renal biopsies were performed for the investigation of proteinuria or renal transplant dysfunction. The semiautomated spring-loaded Biopty gun with ultrasound guidance is easily used by the one operator but, in our experience, was not associated with a lower complication rate than the 14 gauge Vim Silverman needle. We now perform the elective percutaneous renal biopsy as a day case.

Adolescent↗
PubMed1982

Pressurized rapid cardioplegia versus administration of exogenous substrate and topical hypothermia.

Five hundred fifty-nine patients undergoing aortocoronary operation were analyzed retrospectively according to the type of myocardial protection implemented during the period of ischemia. In Group 1 (253 patients), a rapid method of hypothermic cardioplegia alone was utilized. In Group 2 (306 patients), slower infusion of the same solution with topical hypothermia was implemented. Cardiac isoenzymes (CPK-MB, LDH1, LDH2, serum glutamic oxaloacetic transaminase [SGOT]) and myocardial infarct index (MII) were measured postoperatively for 48 hours. Immediately after operation, a significant difference was found between Groups 1 and 2 in the CPK-MB isoenzyme mean value levels--12.1 versus 18.6 IU, p less than 0.01--and MII mean values--5.2 versus 8.1, p less than 0.01. CPK-MB variances between subgroups receiving two, three, and four grafts were significantly different in favor of Group 1. Differences were also found in LDH1, LDH2, total lactic dehydrogenase (LDH), and SGOT: Group 2 levels were significantly higher than in Group 1. There were ten intraoperative infarctions in Group 2 and none in Group 1. In 45% of the patients in Group 2, inotropic agents were necessary in the postoperative period versus none in Group 1. Spontaneous cardiac rhythm following ischemia occurred in 89.7% of the patients in group 1 versus 29% in Group 2. A method of pressurized high-flow rapid cardioplegia with intermittent reperfusions alone, seems to provide adequate protection of the myocardium during ischemia over a slower low-flow method of infusion combined with topical hypothermia.

Adult↗
PubMed1982

How should clear cardioplegia be administered? A method of rapid arrest with high flow and pressure.

Most of the currently described methods of administering cardioplegia appear to be less than optimal because of low flows utilized and slow cardiac arrest evolving over a period of several minutes. This may account for some reports of suboptimal protection, namely ventricular dysfunction and elevation of cardiac isoenzymes in the blood following operation. A method of pressurized injection of clear cardioplegic solution with immediate cardiac arrest (6 to 4.1 seconds) is described. The technique utilizes a 16 Fr. cannula under a driving pressure of 300 mm Hg, which gives an aortic root pressure of 80 to 105 mm Hg (mean 98 mm Hg). Monitoring of serum glutamic oxaloacetic transaminase (SGOT), creatine kinase (CK) MB, and lactate dehydrogenase (LDH1 and LDH2) isoenzymes was carried out in 200 consecutive cases of aorta-coronary bypass. Myocardial infarct index (MII), calculated from the CK disappearance value, measured a mean of 5.3. Peak value of CK-MB occurred immediately after operation (2 hours) and ranged from 10.2 +/- 2.6 IU for 30 minutes of ischemia to 13.3 +/- 4.2 IU for 61 minutes, gradually decreasing to less than 2 IU in 48 hours. None of the patients required inotropic agents postoperatively and 89.9% had spontaneous re-establishment of normal cardiac beat following coronary reperfusion. The electrocardiogram (ECG) failed to show any detectable myocardial infarction during this period of time. The system satisfactorily protected the heart for up to 70 minutes of ischemia. The total amount of cardioplegic solution used for 60 minutes measured 1,200 +/- 200 ml. Myocardial temperature dropped to 15 degrees C within 12 +/- 4.3 seconds. The method more closely approximates the ideal flows and pressures for the coronary vascular bed and size of the adult human heart.

Adult↗
PubMed1979

What is the probability that coronary artery surgery prolongs life?

Two-hundred and nine male patients who had coronary artery surgery from 1972 to 1974 at the Marshfield Clinic (MC) were compared with Veterans Administration (VA) coronary patients to determine the probability of coronary surgery prolonging life. The survival data includes operative and late cardiac and noncardiac deaths. Including the MC operative mortality rates but considering late noncardiac deaths withdrawn as alive at the time of death, the MC cumulative 5-year surgical survival rate is 93%. This is identical to predicted 93% 5-year survival rate for any man of 54.5 years, the average age of MC patients living in this geographic locale in 1973. Annual attrition rates, including the noncardiac deaths, are 1.4% for any man 1.5% per year for MC patients, based on MC 5-year survival data. It is probable that coronary surgery prolongs life by sharply reducing late cardiac deaths.

Coronary Artery Bypass↗
PubMedDate not supplied

Osteitis fibrosa cystica (brown tumor) in a patient with renal transplantation. Report of a case with aspiration cytodiagnosis.

The cytologic findings from fine needle aspiration of a left shoulder mass are described for a woman who had undergone renal transplantation and on whom an orthopedic consultation suggested the clinical possibility of a soft tissue sarcoma. The aspirate samples from multiple sites in the mass showed several multinucleate, osteoclast-type giant cells, spindly or fibrillary cells with ovoid nuclei and a significant amount of granular calcium. The needle aspiration cytodiagnosis was of critical importance since it saved the patient from invasive surgical intervention. This case emphasizes the role of needle aspiration cytology in providing a rapid cytodiagnosis of osteitis fibrosa cystica with a minimally invasive method.

Adult↗