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Biomedical subjects

J L Ochsner

Publications and source records attributed to J L Ochsner.

At least 37 records · Page 2Linked to original sources
PubMed1995

Spontaneous torsion of the right lung: a case report.

Pulmonary torsion is an uncommon event and may occur spontaneously or after trauma or surgery. It may involve the entire lung or individual lobes. Early recognition with prompt intervention is required to prevent hemorrhagic infarction or gangrene and salvage parenchyma. Surgical options of detorsion or resection are dependent upon tissue viability. A case of spontaneous torsion of the entire right lung is presented that reflects the first successful nonresectional management of this entity to be reported. Guidelines for appropriate management are discussed based on an understanding of the etiology, pathophysiology, and natural history.

Female↗
PubMed1994

Cardiac transplantation after donor mitral valve commissurotomy.

Cardiac transplantation has become a relatively common procedure, with its limiting factor being the lack of donor hearts. The donor pool can potentially be increased by reevaluating donor criteria and performing innovative procedures on the donor heart, such as coronary bypass and valve repair. We present a recent case of donor heart mitral valve commissurotomy with successful transplantation.

Heart Transplantation↗
PubMed1994

Surgical management of esophageal cancer. A decade of change.

OBJECTIVE: To examine trends for use of transhiatal esophagectomy (THE) and to relate outcome variables to changes in use, controlling for preoperative risk. BACKGROUND: High operative morbidity and mortality rates are reported with conventional transthoracic esophagectomy (TTE). Transhiatal esophagectomy has been proposed as an alternative but is controversial. METHODS: In this retrospective study divided into early and late time periods, outcome variables were subjected to univariate and multivariate analyses. RESULTS: Use of THE increased significantly in the late period (p < 0.0001). Patients who had THE had significantly higher American Society of Anesthesiologists (ASA) risk scores (p < 0.001). By the late period, 92% of patients with ASA III/IV scores were resected by THE. Postoperative morbidity decreased significantly and operative mortality decreased from 15% to 0% (p < 0.01) between the early and late time periods. By multivariate analysis, ASA > or = III and TTE were associated with adverse surgical outcome. Pathologic stage determined disease-free survival, which was 37% at 3 years for all survivors. CONCLUSIONS: Increased use of THE results in better operative outcome and does not adversely affect disease-free survival.

Adenocarcinoma↗
PubMed1994

High-risk surgery as an alternative to transplantation.

Between April 1992 and April 1994, 185 patients were waiting for a cardiac transplant at our institution. Transplantation was performed in 118 of these patients. Twenty-six patients (14%) died while awaiting a donor heart: 13 of these were in the intensive care unit on multiple inotropic medications, mechanical support, or both; another 13 were either in the hospital on a single inotropic medication or at home with or without inotropic support. The remaining 41 patients were still awaiting transplantation at the end of the study period. During the same interval, 20 comparably ill patients who were referred to our institution for transplantation were considered for high-risk conventional surgical procedures. These patients underwent clinical evaluation to determine whether they had viable muscle that was salvageable and electrophysiologic status that was alterable. On this basis, these 20 patients underwent a variety of combined high-risk procedures. Two patients died; the operative mortality was 5% and the cumulative mortality was 10%. We conclude that these initial results support our original impression that mortality rates are higher in patients waiting for cardiac donation than in patients undergoing high-risk surgical procedures. Therefore, we will continue to investigate high-risk conventional surgery as an alternative to cardiac transplantation.

Aged↗
PubMed1994

Postpneumonectomy chylothorax: a logical approach to successful management.

Chylothorax is unusual as a postoperative complication following pneumonectomy. Although rare today, it can still manifest life-threatening consequences if not recognized and treated in a timely and appropriate manner. Management options range from a conservative approach to immediate re-exploration, each of which has been reported as successful. However, treatment of this entity has been characterized as ill-defined or controversial despite the fact that most approaches to this clinical problem are similar. A successful outcome of this unusual complication is presented based on early recognition and institution of logical principles of conservative management. Treatment should be neither ill-defined nor controversial.

Chylothorax↗
PubMed1994

Cardiovascular adaptation to cyclosporine-induced hypertension.

Arterial hypertension is a complication of cyclosporine therapy in heart transplant recipients. We studied cardiovascular adaptation to cyclosporine-induced hypertension by determining haemodynamic and echocardiographic indexes in 25 cardiac transplant recipients matched by mean arterial pressure, age, sex, height and weight to 25 patients with established essential hypertension. Twenty-five normotensive subjects matched by age, sex and body habitus were used as controls. Systemic vascular resistance was 15% higher (P = 0.07) and cardiac and stroke volume indices were 20% and 25% lower (P < 0.01), respectively, in the hypertensive cardiac transplant recipients compared with patients with essential hypertension. Patients with essential hypertension and hypertensive cardiac transplant recipients had greater posterior wall thickness and left ventricular mass index than normotensive subjects (P < 0.01); however, hypertensive cardiac transplant recipients had a greater left ventricular mass (245 +/- 7 vs. 223 +/- 8 g, P < 0.05) than patients with markedly established essential hypertension. Left ventricular ejection fraction was significantly lower in hypertensive cardiac transplant recipients when compared with either normotensives or patients with established essential hypertension. These results indicate that established essential and cardiac transplant hypertension are associated with markedly increased systemic vascular resistance. However, after heart transplantation, hypertension is associated with higher systemic vascular resistance, lower cardiac output, stroke volume and stroke work compared with patients with established essential hypertension at the same level of mean arterial pressure. The cardiac adaptation to cyclosporine-induced hypertension has more severe concentric left ventricular hypertrophy and impaired left ventricular systolic performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1994

Flexion and extension gap measurements in total knee arthroplasty after sacrifice of posterior cruciate ligament.

Twenty-three patients had 25 total knee arthroplasties. The flexion and extension gaps were measured before and after resection of the posterior cruciate ligament. The extension gap increased 2.0 +/- 0.2 mm in the medial compartment and 1.9 +/- 0.3 mm in the lateral compartment. The flexion gap increased 1.4 +/- 0.2 mm in the medial compartment and 2.3 +/- 0.3 mm in the lateral compartment. All increases were statistically significant.

Arthritis, Rheumatoid↗
PubMed1993

Thoracoscopic resection of pericardium for symptomatic congenital pericardial defect.

Congenital defects of the pericardium are rare. Surgical treatment is recommended to relieve symptoms and to prevent cardiac herniation and strangulation. The case of a symptomatic pericardial defect due to a dynamic obstruction of the coronary arteries is described. The diagnosis was suggested by plain chest film, echocardiography, and cardiac catheterization. Confirmation and successful surgical management were accomplished by video-assisted thoracoscopic pericardiectomy.

Adult↗
PubMed1993

Pericardioperitoneal window.

A technique to create a pericardial window is discussed. By creating a communication between the pericardial and peritoneal cavities, adequate drainage is obtained without the need for external draining systems. The technique is simple, easy to learn, and without serious complications.

Humans↗
PubMed1993

Recommendations for training in vascular medicine. American College of Cardiology Peripheral Vascular Disease Committee.

Each trainee in vascular medicine must be eligible for the board certification examination of the American Board of Internal Medicine or its equivalent. Training faculty, preferably at least two members, should meet the qualifications and training requirements described in this report. They must be dedicated, effective teachers and should spend most of their time in research, education and patient care related to peripheral vascular diseases. A curriculum of training should be established. Faculty experts in related specialties and in the related basic sciences should be available for teaching. The institution should have a fully equipped noninvasive vascular laboratory and areas where catheter revascularization techniques and vascular surgery are performed. The period of training should not be less than 1 year, preferably continuous.

Cardiology↗
PubMed1993

Induction immunosuppression with the monoclonal antibody OKT3 after cardiac transplantation.

The routine use of monoclonal induction immunosuppression with OKT3 after orthotopic heart transplantation remains controversial. This study examined the clinical response of prophylactic monoclonal induction immunosuppression versus standard triple-drug immunosuppression in 41 patients who underwent orthotopic heart transplantation from January 1989 to December 1990 at this institution. Of these, eight received monoclonal induction immunosuppression for a period of 10 to 14 days. All patients received identical triple-drug immunosuppression with the exception of cyclosporine starting on the fifth postoperative day in those who received OKT3. At 6 months the duration of hospitalization, freedom from rejection, incidence of infection requiring hospitalization, and serum creatinine in the monoclonal induction immunosuppression and triple-drug groups were compared. It was found that the length of hospital stay in the OKT3 group was 14.3 +/- 4.5 days, compared with 14.7 +/- 4.7 days in the triple-drug group and that freedom from rejection was 66% in the OKT3 group compared with 75% in the triple-drug group. In addition, it was found that the incidence of infection was 36% in the OKT3 group compared with 38% in the triple-drug group and that serum creatinine at 6 months was 1.36 +/- 0.26 mg/dl in the OKT3 group compared with 1.45 +/- 0.73 mg/dl in the triple-drug group. Finally, patient survival at 1 year for the monoclonal induction immunosuppression group was 100% compared with 91% for the triple-drug group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed1993

Analysis of graft healing in a new elastomer-coated vascular prosthesis.

The need for a vascular prosthesis that does not require preclotting is apparent. The use of biological biodegradable coatings may carry the potential disadvantages of undesirable healing, inflammatory or antigenic reactions, and increased thrombogenicity. A graft has been developed to minimize porosity by coating only the outer surface with a bioinert non-absorbable elastomer (mainly Silastic) so as to leave the inner surface unchanged. Thoracoabdominal aortic 8-mm grafts (ten knitted and five woven coated grafts, six uncoated Dacron grafts) 12 cm long were implanted in mongrel dogs for 6 months. Differences in patency and healing in coated and uncoated grafts were observed by angiography, and by scanning electron and light microscopy. Statistical analysis included Fisher's exact test and Student's unpaired t test. Clinically, no ill effects were noted in coated grafts, and the transinterstitial blood loss was similar to that in preclotted uncoated grafts. One graft in each group occluded for technical reasons. One knitted coated graft developed perigraft seroma. The woven coated grafts and control prostheses had similar handling properties; however, needles appeared to pass through the coated graft material more easily and with less suture drag. Scanning electron microscopy was used to demonstrate similar presence of endothelial-like cells in both groups. Comparisons between coated and control grafts using light microscopy were as follows: pseudoendothelium, 0.26 versus 0.31 mm (P not significant); inflammation, 0.21 versus 0.73 (P < 0.01); giant cell formation, 0.02 versus 0.80 (P < 0.01); fibrosis, 1.31 versus 1.80 (P < 0.03). Tissue ingrowth into and around the Dacron fibers from the outer surface was similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Giants.

Explore the source record for details and available documents.

Cardiac Surgical Procedures↗
PubMed1993

Atrioventricular valve competence after takedown to improve exposure during ventricular septal defect repair.

Although the atrioventricular valve and its attachments can sometimes obscure the superior margin of a ventricular septal defect, concern for valvular competence has made surgeons hesitant to take down the atrioventricular valve. Over a 10-year period, the right atrioventricular valve was taken down to improve exposure for ventricular septal defect repair in 40 patients at our institution, and follow-up echocardiographic studies to determine the degree of valvular regurgitation were available in 32. On the basis of the area of the color flow jet, valvular regurgitation was graded as none in 22 and trivial in 10. Heart block did not develop in any patient, and there were no deaths. Takedown and resuspension of the atrioventricular valve is a safe and effective technique that improves exposure for ventricular septal defect repair and does not adversely affect valve competence.

Cardiac Surgical Procedures↗
PubMed1993

Posterior cruciate ligament avulsion in total knee arthroplasty.

An anatomic study was outlined to measure the strength of the posterior cruciate ligament after total knee arthroplasty. This interest was precipitated by a patient whose posterior cruciate ligament ruptured 6 months after a total knee arthroplasty. Six unembalmed knee specimens (three bilateral) were mounted in a mechanical tension-testing machine, and proximal tibial total-knee bone cuts were performed at successive 2 to 3 mm depths. At each level, the ligament was tested at physiologic tension. The posterior cruciate ligament failed at 7 to 10 mm of bone resected, with an average failure at 8.6 mm.

Aged↗
PubMed1993

Cardiac assist devices: bridging and beyond.

Due to the high incidence of death while awaiting cardiac transplantation today, most major transplant centers have adopted the use of left ventricular assist devices in order to stave off the complications of end-stage heart failure and allow patients to maintain a good physiologic state going into heart transplantation. These devices are safe and may one day prove to be a substitute for the short supply of donor organs.

Equipment Design↗