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Biomedical subjects

J B Mark

Publications and source records attributed to J B Mark.

At least 19 recordsLinked to original sources
PubMed2006

Time of day effects on the incidence of anesthetic adverse events.

BACKGROUND: We hypothesized that time of day of surgery would influence the incidence of anesthetic adverse events (AEs). METHODS: Clinical observations reported in a quality improvement database were categorized into different AEs that reflected (1) error, (2) harm, and (3) other AEs (error or harm could not be determined) and were analyzed for effects related to start hour of care. RESULTS: As expected, there were differences in the rate of AEs depending on start hour of care. Compared with a reference start hour of 7 am, other AEs were more frequent for cases starting during the 3 pm and 4 pm hours (p < 0.0001). Post hoc inspection of data revealed that the predicted probability increased from a low of 1.0% at 9 am to a high of 4.2% at 4 pm. The two most common event types (pain management and postoperative nausea and vomiting) may be primary determinants of these effects. CONCLUSIONS: Our results indicate that clinical outcomes may be different for patients anesthetized at the end of the work day compared with the beginning of the day. Although this may result from patient related factors, medical care delivery factors such as case load, fatigue, and care transitions may also be influencing the rate of anesthetic AEs for cases that start in the late afternoon.

Anesthesiology↗
PubMed2001

Hemostatic effects of antithrombin III supplementation during cardiac surgery: results of a prospective randomized investigation.

Failure to suppress thrombin generation during cardiac surgery promotes fibrin generation, fibrinolysis, and a consumptive coagulopathy. Acquired deficiencies of antithrombin III may play a contributory role. We hypothesized that antithrombin III supplementation to normal physiologic concentrations would decrease thrombin generation and potentially reduce peri-operative bleeding. Twenty patients undergoing coronary artery bypass graft surgery were randomized for this prospective, double-blind, placebo-controlled study. Ten patients received antithrombin III supplementation (50 U/kg) by intravenous infusion prior to incision, and 10 patients received a placebo. Blood samples were obtained pre-operatively, at 1 and 2 h following initiation of cardiopulmonary bypass (CPB), and at 1, 3, and 24 h after completion of CPB. Samples were analyzed for antithrombin III, thrombin-antithrombin III (TAT) complex, and D-dimer concentrations. Cumulative blood loss was recorded at 6 and 12 h after CPB. No statistically significant differences in patient demographics or total heparin dose administered were observed between groups. As expected, plasma antithrombin III concentrations were maintained near pre-operative values in the treatment group, but not in the placebo group. Despite this difference, no statistically significant alterations in generation of TAT complex, D-dimer, or blood loss occurred between groups. Antithrombin III supplementation to maintain normal physiologic concentrations during CPB did not alter significantly thrombin generation, fibrinolytic activity, or blood loss in adults undergoing elective cardiac surgery.

Aged↗
PubMed2000

The history of surgery for carcinoma of the esophagus.

Carcinoma of the esophagus is a highly lethal disease in which surgical resection is part of every treatment regimen carried out with curative intent. The development of surgical resection of the esophagus for carcinoma has been a long and tortuous one. Its evolution depended not only on a thorough knowledge of surgical anatomy and technique, but also on important developments in endoscopy, radiology, anesthesia, nutrition, pulmonary physiology, and intensive care.

Digestive System Surgical Procedures↗
PubMed1997

Diagnosis and localization of bronchopulmonary air leaks using ventilation scintigraphy.

STUDY OBJECTIVES: To determine the usefulness of radioaerosol ventilation scans for the detection and localization of air leaks from the lungs or bronchial tree. DESIGN: Selected patients with suspected air leaks underwent ventilation scans. Retrospective analysis of data was carried out. SETTING AND PATIENTS: Twenty-eight hospitalized patients were included in the study. INTERVENTIONS: Ventilation scintigraphy using 99mTc-DTPA (technetium aerosol) was carried out in patients with air leaks. MEASUREMENTS AND RESULTS: Of the total group, there were 50% true-positive scans, 36% true-negative scans, and 14% false-negative scans giving a sensitivity of 78%, specificity of 100%, and accuracy of 86%. CONCLUSIONS: 99mTc-DTPA ventilation scintigraphy is useful in some patients with air leaks from the lung or tracheobronchial tree and may help to guide surgical intervention should this become necessary.

Bronchial Fistula↗
PubMed1996

Accelerated TPA for treatment of prosthetic valve thrombosis.

The first case of prosthetic valve thrombosis treated with an accelerated regimen of TPA is reported. The experience suggests that this therapeutic approach is feasible and may produce higher rates of patency for thrombosed prosthetic valves than other thrombolytic therapies currently available. This therapeutic strategy is worthy of further evaluation as a treatment for this disorder.

Aged↗
PubMed1996

Surgical aspects of non-small cell lung carcinoma.

Lung cancer is the leading cause of cancer death in both men and women in the United States. Although lung cancer has been treated aggressively by surgery, radiation therapy, and chemotherapy, alone or in combination, survival is still in the 12% to 15% range at 5 years. All curative treatment plans for patients with non-small cell lung cancer include resectional surgery. Despite the dismal outlook there is hope, because improvements in outcome for patients undergoing surgical treatment have been realized. Definite progress has been made in reducing operative mortality and morbidity, helping to increase long-term survival. Advances that have contributed to these successes include improved preoperative evaluation in staging and patient selection criteria, the use of newer techniques such as video-assisted or open limited resections in selected instances, and the use of neoadjuvant therapy. These topics are addressed here, as are techniques for locally advanced tumors and options for palliation.

Carcinoma, Non-Small-Cell Lung↗
PubMed1995

Clinical evaluation of continuous noninvasive blood pressure monitoring: accuracy and tracking capabilities.

A continuous, noninvasive device for blood pressure measurement using pulse transit time has been recently introduced. We compared blood pressure measurement determined using this device with simultaneous invasive blood pressure measurements in 35 patients undergoing general endotracheal anesthesia. Data were analyzed for accuracy and tracking ability of the noninvasive technique, and for frequency of unavailable pressure measurements by each method. A total of 25,133 measurements of systolic pressure, diastolic pressure, and mean arterial pressure (MAP) by each method were collected for comparison from 35 patients. Accuracy was expressed by reporting mean bias (invasive pressure minus noninvasive pressure) and limits of agreement between the two measurements. After correction for the offset found when measuring invasive and oscillometric methods of arterial pressure measurement, the mean biases for systolic, diastolic, and mean pressures by the pulse wave method were -0.37 mm Hg, -0.01 mm Hg, and -0.05 mm Hg, respectively (p < 0.001). The limits of agreement were: -29.0 to 28.2 mm Hg, -14.9 to 14.8 mm Hg, and -19.1 to 19.0 mm Hg, respectively (95% confidence intervals). When blood pressure measured invasively changed over time by more than 10 mm Hg, the noninvasive technique accurately tracked the direction of change 67% of the time. During the entire study, 3.2% of the invasive measurements were unavailable and 12.9% of the noninvasive measurements were unavailable. The continuous noninvasive monitoring technique is not of sufficient accuracy to replace direct invasive measurement of arterial blood pressure, owing to relatively wide limits of agreement between the two methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure Determination↗