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Biomedical subjects

J G Hill

Publications and source records attributed to J G Hill.

At least 19 recordsLinked to original sources
PubMed2000

Emergency coronary artery bypass graft surgery in abciximab-treated patients.

BACKGROUND: Although the platelet antiaggregant abciximab is frequently used with percutaneous coronary interventions, results of emergency coronary artery bypass graft operations in patients recently treated with abciximab are poorly characterized. METHODS: During a 29-month period, 12 patients required emergency coronary artery bypass grafting within 12 hours (mean, 1.9 hours) of abciximab therapy. Our full standard heparin dose regimen was used (mean heparin dose, 53,000 U per patient). Each patient received a single platelet transfusion dose after protamine administration, and further blood products were transfused as necessary. Clinical outcome and transfusion requirements were compared with predicted results based on risk-adjusted historical patients. RESULTS: No patients died and none were returned to the operating room for coagulopathy-related bleeding. Per patient transfusion requirements were as follows: red blood cells, 3.6 units; apheresis platelets, 1.4 units; and fresh frozen plasma, 1.5 units. As compared with predicted values, there was no excessive incidence of mortality, stroke, or red blood cell transfusion requirements. CONCLUSIONS: Emergency coronary artery bypass graft operations using full-dose heparin can be performed successfully in acutely ischemic abciximab-treated patients. Prophylactic transfusion of platelets after protamine administration appears to be useful.

Abciximab↗
PubMed1998

The clinical relevance of chemosensitivity testing in ovarian cancer.

The aim of this study was to assess the role of in vitro chemosensitivity testing in ovarian cancer using the MTT assay. Cells were separated from solid biopsy or ascitic fluid samples from 73 patients with ovarian adenocarcinoma, FIGO stage III to IV, on presentation. A 48 h drug exposure was followed by the MTT assay to determine sensitivity. Patients were treated by conventional regimens containing platinum. There was a marked variation in sensitivity to the platinum drugs between individual patients. Clinical data were available for 37 patients. Eleven out of seventeen (65%) patients in the sensitive group had a complete response to therapy, compared with 3 out of 20 (15%) in the resistant group (p = 0.005). The overall survival rates were 36% for the sensitive group compared with 18% for the resistant group (p = 0.37). This study suggests that chemosensitivity testing in ovarian cancer may be effective in improving initial clinical response.

Adenocarcinoma↗
PubMed1998

Prevalence of occupationally related hand dermatitis in dental workers.

Occupationally related hand dermatitis has been attributed to frequent hand-washing, exposure to possible sensitizers and latex glove use. The authors conducted a study to determine the prevalence of occupationally related hand dermatitis in dental personnel. They found that 75 (19.2 percent) of 390 subjects self-reported they had a positive history of hand dermatitis. Further testing of 53 of these subjects indicated that only 9.4 percent reacted to the 45 allergens tested, and 3.8 percent had an allergy to latex.

Adult↗
PubMed1996

Esophageal foreign bodies in children: diagnosis, treatment, and complications.

OBJECTIVE: We performed this study to identify the role of radiology in the diagnosis, treatment, and complications of esophageal foreign bodies in children. MATERIALS AND METHODS: We retrospectively reviewed the charts and radiographs of 123 esophageal foreign bodies seen in 118 children at the Medical University of South Carolina from May 1980 through May 1995. RESULTS: Most foreign bodies were coins in the upper esophagus (69%) in infants less than 2 years old (65%) for fewer than 24 hr (60%). The presenting symptoms varied, with 20% of patients asymptomatic. Respiratory symptoms that mimicked upper respiratory tract infections or croup proved misleading with long-standing foreign body retention. Preexisting esophageal disease was present in 17% of patients. The Foley catheter method of foreign body extraction was attempted in 53 cases (43%) and was successful without complications in 46 (87%). Esophagoscopy was attempted in 72 cases (58%) and was successful without complications in 66 (92%). Three patients had major complications: a fatal aorticoesophageal fistula, an extraluminal migration of a coin, and a large esophageal diverticulum. Significant mucosal erosions were shown in six patients on radiologic studies after extraction. CONCLUSION: Early recognition and treatment of esophageal foreign bodies is imperative because the complications are serious and can be life-threatening. Radiology plays an important role in the initial diagnosis, in recognition of complications, and in treatment. The Foley catheter method of foreign body extraction can be used on some patients, but esophagoscopy remains the safest method of esophageal foreign body extraction.

Adolescent↗
PubMed1995

Blunt cardiac rupture. The Emanuel Trauma Center experience.

OBJECTIVE: To analyze the factors affecting outcome in patients with blunt cardiac rupture, including anatomical cardiac injury, associated injury, clinical presentation, age, mechanism of injury, diagnostic method, surgical intervention, and presence of vital signs in the field and on arrival. DESIGN: Retrospective review. SETTING: A community-based level I trauma center. PATIENTS: A consecutive series of 27 patients seen between 1984 and 1993. MAIN OUTCOME MEASURE: Survival with return to preinjury activity. RESULTS: Eleven patients (41%) survived resuscitation, surgery, and initial hospital care. Survivors had a lower mean Injury Severity Score (38) than nonsurvivors (62) (P < .05). Three (33%) of nine patients who arrived with no blood pressure or viable electrical heart rhythm survived. No patient survived rupture of two cardiac chambers. CONCLUSIONS: Patients with blunt cardiac rupture who present with cardiac arrest can survive. Nonsurvivors tend to have more associated injuries, as indicated by higher Injury Severity Scores. Our institution's overall survival rate of 41% (11/27) compares favorably with rates at other trauma centers.

Adolescent↗
PubMed1995

Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients.

BACKGROUND: Patients who have massive but potentially survivable injuries frequently die from complications of hypovolemia, hypoxemia, hypothermia, metabolic acidosis, and coagulopathy. Emergency cardiopulmonary bypass has been unsuccessful in preventing such deaths because it involves systemic anticoagulation that exacerbates coagulopathy. PATIENTS AND METHODS: A simplified extracorporeal cardiopulmonary life support (ECLS) system was assembled consisting of a centrifugal pump head, heat exchanger, membranous oxygenator, percutaneous cannulas, and heparin-bonded circuitry. The entire system has heparin-bonded surfaces. Patients were resuscitated with the system after femoral vein-femoral artery cannulation. ECLS was used to resuscitate massively injured patients who were deteriorating despite maximal conventional therapy. RESULTS: While receiving maximal conventional therapy, 6 patients developed hypothermia, metabolic acidosis, and coagulopathy causing pulmonary hemorrhaging and hypoxemia from severe underlying lung injuries. ECLS with heparin-bonded circuitry provided cardiopulmonary support and rewarming while physicians addressed coagulopathies and surgical bleeding and assessed survivability. Three patients survived. CONCLUSIONS: ECLS with heparin-bonded circuitry offers supplemental capability in the resuscitation and cardiopulmonary support of selected massively injured patients while their primary injuries are being evaluated and treated.

Cardiopulmonary Resuscitation↗
PubMed1995

Pancreatic surgery in children.

Pancreatic surgery in children is a relatively uncommon occurrence, and this unfamiliarity can be associated with significant morbidity and potential mortality. Surgical therapy of pancreatic disorders has been significantly facilitated by endoscopic retrograde cholangiopancreatography, which can now be performed in children with success rates equaling those in adults. This technique delineates pancreatic duct anatomy, which is an essential part of the diagnosis and surgical treatment of important pancreatic disease processes. Pancreatic diseases requiring surgical treatment in children can be placed into three categories: 1) congenital pancreatic ductal anomalies causing pancreatitis, 2) pancreatic trauma, and 3) pancreatic tumors. This article reviews the recent literature on pancreatic surgery in children, particularly highlighting the areas where a consensus of opinion does not exist.

Adolescent↗
PubMed1994

Interhospital transport of the patient on extracorporeal cardiopulmonary support.

Portable extracorporeal cardiopulmonary support systems have enhanced the resuscitation and support of moribund patients outside of the operating room environment. The literature documents the successful application of emergency cardiopulmonary support within the hospital setting. Clinicians have reported the use of helicopter and ground ambulance to transport patients requiring intraaortic balloon counterpulsation and fixed-wing transport of neonates requiring extracorporeal membrane oxygenation. As medical transport capabilities extend the sphere of tertiary care to outlying medical facilities, there is a role for extracorporeal cardiopulmonary support in the initial stabilization and safe transport of critically ill patients, via air or ground ambulance. Potentially, the early application of life-sustaining technology can lower mortality and morbidity in patients with a survivable pathology. This is a report on the experience with the resuscitation and interhospital transport of patients on extracorporeal cardiopulmonary support.

Adult↗
PubMed1994

Considerations for inter-hospital extracorporeal cardiopulmonary support resuscitation and transport.

The availability of commercial, pre-packaged extracorporeal cardiopulmonary support (ECPS) circuits, which are simplified for rapid set-up and priming, has made the intra-hospital resuscitation of moribund patients routine. The successful utilization of this technology in the emergent setting requires planning and the coordination of personnel familiar with the technology. Many issues must be addressed when a patient requiring life-sustaining support utilizing this technology at an outlying hospital, must be transported while on ECPS. After reducing the size and weight of the ECPS cart and obtaining Federal Aviation Administration approval for use during aeromedical transport, the Emanuel Hospital Mobile Surgical Transport Team (MSTT) was able to extend the use of emergency cardiopulmonary bypass to outlying medical facilities. The patients selected for transport, using ECPS, are a group of patients with a potentially survivable pathology unlikely to survive inter-hospital transport without such measures. This report describes our experience with inter-hospital transport of patients on ECPS with special emphasis on transport considerations.

Adolescent↗
PubMed1992

Emergent applications of cardiopulmonary support: a multiinstitutional experience.

The use of emergent portable bypass systems is increasing. Because of limited patient use in any one institution, a combined experience can better determine the applicability of these systems. A total of 187 patients from 17 centers were analyzed. Causes leading to bypass initiation were cardiac arrest (125 patients), cardiogenic shock (44), profound hypothermia (7), pulmonary insufficiency (9), and miscellaneous (2). Weaning from bypass was successful in 30.5% (57 patients). Sixty-four patients (34.2%) were transferred to standard bypass or other modes of circulatory assist. Of the total population, 40 patients (21.4%) were alive greater than 30 days. There were no survivors of unwitnessed arrests. Major diagnostic or therapeutic interventions were carried out on bypass in 74.9% of all patients. In survivors, 77.1% (37/48) had major therapeutic interventions as compared with 50.0% (67/135) of nonsurvivors. Emergency portable bypass systems can successfully resuscitate and support cardiac hemodynamics, although the underlying causes necessitating bypass remain difficult to correct. When corrective intervention can be performed, there is an increased chance of survival. Unwitnessed arrest, prolonged cardiopulmonary resuscitation, and lack of treatment options are relative contraindications. Appropriate patient selection and early application of these systems should lead to improved survival.

Adolescent↗
PubMed1991

Caring for our future: a report by the expert panel on the content of prenatal care.

The report of the Expert Panel on Prenatal Care entitled Caring for Our Future: The Content of Prenatal Care was presented to the Assistant Secretary for Health, James Mason, MD, on October 2, 1989. The Panel noted the need for attention not only to the mother and fetus, but also to the infant and family. Besides traditional medical care concerns, the importance of psychosocial and environmental patient and family needs was emphasized. The Panel felt that the addition of the pre-conception visit to routine prenatal care made care more effective. Suggestions as to visit timing and content were made. The Panel noted the need for further understanding of many of the activities performed routinely in prenatal care.

Female↗
PubMed1990

A feasibility study of the MTT assay for chemosensitivity testing in ovarian malignancy.

We assess the feasibility of using the MTT assay as a measure of cell viability in chemosensitivity testing in ovarian malignancy. The assay utilises the conversion of the tetrazolium salt MTT to formazan by dehydrogenase enzymes in living cells. We show that the optical density of the formazan produced from MTT is directly proportional to the number of live cells tested. Optimum MTT conversion occurred after 4 h incubation and dimethyl sulphoxide was found to be the most suitable solvent for the formazan. Seventy-five samples of ascitic fluid and/or solid tumour were collected from 56 patients with FIGO stage III-IV ovarian adenocarcinoma. Malignant cell suspensions with a viability greater than 75% were prepared from 95% of ascitic fluid and 75% of biopsy samples by simple techniques. The effect of cytotoxic drugs was assessed in 91% of patients included in the study. Variation in drug effect between patients was evident following a 48 h incubation period and was reproducible. Overall platinum and anthraquinone analogues produced the greater effect but resistance did occur. Our results mirrored reported clinical response rates. Only one sample tested against chlorambucil showed any drug effect. As this assay produces results in a high percentage of tests and is rapid and simple it appears suitable for prospective clinical trials to correlate the in vitro results with in vivo response.

Adenocarcinoma↗
PubMed1990

Use of biological glue to control pulmonary air leaks.

Biological glue is a natural adhesive generated by the interaction between fibrinogen (pre-glue) and thrombin to produce fibrin. The pre-glue is prepared from a single donor (to avoid the problems of pooled plasma) and stored as cryoprecipitate. Before being used it is thawed, dissolved in saline, and activated into an adhesive by the addition of topical thrombin. Biological glue was used prophylactically to prevent air leaks from bronchial suture lines and raw lung surfaces after pulmonary resections in six patients. In addition two new methods of using biological glue have been developed for the control of persisting air leaks. In selective intrabronchial tamponade the glue is instilled into the bronchial tree through a flexible bronchoscope, and in therapeutic pleurodesis it is instilled into the pleural cavity through a chest drainage tube. The air leaks were resolved in all cases. Seven procedures using selective intrabronchial tamponade were carried out in six patients. Four were immediately successful but three were not and required further interventions. Therapeutic pleurodesis alone was successfully carried out in one patient and as an adjunct to selective intrabronchial tamponade on two occasions. A thoracotomy was eventually needed in one of the seven patients.

Bronchi↗