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Biomedical subjects

J L Ochsner

Publications and source records attributed to J L Ochsner.

At least 73 records · Page 4Linked to original sources
PubMed1988

Functional comparison of posterior cruciate-retained versus cruciate-sacrificed total knee arthroplasty.

Gait of 11 patients with bilateral paired posterior cruciate-retaining and cruciate-sacrificing total knee arthroplasties (TKA) was studied preoperatively and two years postoperatively on walking and stair climbing. Five-year clinical and roentgenographic examinations were included in the study. Differences between the two prostheses were noted both in level walking and in stair climbing. On level walking, cruciate-sacrificed TKA had more flexion in loading response and increased flexion and varus moments with increased muscle activity of quadriceps and biceps femoris. Abnormal gaits common to both types of knee were decreased flexion in stance and decreased single-limb stance. Both knees had a stiff-legged gait during stance. On stairs, the cruciate-sacrificed TKA substituted soleus muscle activity for knee stability. The single-limb stance and range of motion were similar for both knees. In clinical terms, the cruciate-sacrificed TKA is less efficient and has greater medial loading and higher joint reaction forces that may affect durability of the prosthesis. The five-year knee scores, patient satisfaction, and roentgenographic examinations were equal for both sets of knees.

Adult↗
PubMed1987

Right ventricular failure: observations of the interrelationships affecting RV failure after aortocoronary bypass, valve surgery, and congenital heart defect repair.

Right ventricular dysfunction in adult coronary artery bypass surgery with or without ventricular aneurysm repair has not been a source of hospital mortality in our institution, whereas it persists as a cause of death not infrequently after repair of congenital heart disease and, on occasion, after valvular surgery. Although we have strong clues as to the true nature of this dichotomy, there are so many factors involved with open congenital heart repairs that the explanation is not certain. Considering the coronary anatomy, the character of right ventricular infarction, the total lack of reports of post-operative angiography, and our clinical results, we have not found sufficient evidence at this time to recommend bypass to right ventricular coronary branches. We believe that the use of a checklist of right ventricular dysfunction after congenital heart repair may result in detection of a reversible cause of right ventricular dysfunction that could be fatal.

Coronary Artery Bypass↗
PubMed1987

Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children.

Fifty-three neonates and seven pediatric patients were treated with extracorporeal membrane oxygenation from September 1983 until April 1986. Venoarterial bypass was achieved by cannulating the right atrium via the right internal jugular vein and the aortic arch via the right common carotid artery. In the neonatal group, 40 infants with acute respiratory failure were treated, and 36 (90%) survived. Five infants with congenital heart disease were treated and three (60%) survived. Among the eight patients with congenital diaphragmatic hernia, there were three (38%) survivors. In the pediatric group, four patients were treated for ventricular failure after cardiac operations. Two were weaned from bypass, with one long-term survivor. Three patients with acute respiratory failure were treated, with one survivor. salvaging high-risk neonates with minimal morbidity and mortality. It has also been useful in the support of infants with congenital heart disease and congenital diaphragmatic hernia. In pediatric patients one cannot expect to get results that are comparable to those found in neonates. Still, this modality can be useful in salvaging some moribund patients with pulmonary or cardiac failure, or both.

Extracorporeal Circulation↗
PubMed1985

The fuzzy foreign body fragment: a subtle roentgenographic clue to mediastinal vascular injury.

Foreign body injury to mediastinal vascular structures may be present in clinically stable patients who have sustained thoracic trauma. Angiography may occasionally fail to demonstrate such an injury which may lead to delay in surgical management. A subtle roentgenographic finding consisting of a fuzzy metallic fragment contiguous with the mediastinum on admission chest films suggested vascular injury in two patients and prompted surgical exploration. Despite preoperative hemodynamic stability and normal angiograms, major transmural injuries to the pulmonary artery and aorta were encountered in these two patients and were managed successfully.

Adult↗
PubMed1985

Extracorporeal membrane oxygenation for newborn respiratory failure.

Respiratory failure is the leading cause of death in the newborn. Conventional therapy is very successful with 80% of infants weaned from ventilatory support. For neonates with severe respiratory failure, unresponsive to maximal medical therapy, extracorporeal membrane oxygenation (ECMO) offers an alternative means of management. Venoarterial bypass is achieved by cannulating the right atrium via the internal jugular vein and the aortic arch via the right common carotid artery. A 5-inch roller pump is used to circulate the blood through a 0.4 or 0.8 m2 silicone membrane lung. Management includes heparinization, intravenous alimentation, antibiotic coverage, and reduction of FiO2 and airway pressure. Thirty infants aged 12 to 186 hours were placed on ECMO. Each met strict criteria designed to predict greater than 90% mortality. Time on bypass ranged from 37 to 250 hours. Success, defined by weaning from ECMO and ventilatory support, was achieved in 23. Twenty-one remain alive; 18 have excellent outcome with normal growth and development although follow-up is short (1 to 19 mos). These results corroborate reports from the pioneers of the technique and further support the use of ECMO for neonates with respiratory failure unresponsive to conventional therapy.

Extracorporeal Circulation↗
PubMed1984

Cold hemagglutination pathophysiology. Evaluation and management of patients undergoing cardiac surgery with induced hypothermia.

The widespread induction of systemic hypothermia and use of iced cardioplegic solutions in cardiac surgery may promote occasional cold autoagglutination. Routine laboratory methods used to detect cold-agglutinating autoantibodies may not take into account the extremely low temperatures that the heart and body may attain during cardiopulmonary bypass. Several cold-mediated complications have now been encountered during cardiac surgery in patients with both known and unsuspected cold-reactive autoantibodies. This review will provide the clinician with a working knowledge of the cold autoimmune disorders, a rapid method for differential diagnosis in unproved cases, and an ability to select techniques for reliable myocardial and renal protection in both known and unsuspected cases.

Anemia, Hemolytic, Autoimmune↗
PubMed1984

Median arcuate ligament syndrome with severe two-vessel involvement.

Intestinal angina is an unusual condition caused by decreased blood supply to the abdominal viscera. It has been hypothesized that at least two of the three vessels supplying the viscera need to be compromised to cause ischemia. On the other hand, compression of the celiac axis by the medium arcuate ligament, causing symptoms, has been reported. We described a severely symptomatic patient in whom this ligament completely occluded the celiac axis and severely narrowed the superior mesenteric artery. The condition was cured by division of the ligament.

Abdomen↗
PubMed1984

Surgical management of diseased intracavitary coronary arteries.

An intracavitary location of a coronary artery is rare in our surgical experience with myocardial vascularization. This variant has occurred in the right coronary artery (0.09%) and in the left anterior descending coronary artery (0.2%). The location of the lesion and the pathological condition, length, and size of the coronary artery may dictate exposure of an intracavitary coronary artery for proper revascularization. More commonly, surgeons are unaware of the intracavitary position and during intramyocardial dissection of an artery will open a cardiac chamber where the vessel traverses the cavity. Problems that arise are introduction of air, difficulty in exposure due to blood and depth of position, and obstruction of the coronary artery during closure of the myotomy. We report here on 13 patients who required revascularization of intracavitary vessels (four right coronary arteries and six left anterior descending coronary arteries). The location and length of the intracavitary portion of the artery determined the surgical management. The methods used to close the cavity varied. The techniques employed were simple closure; moving the artery into an aerial position with cavitary closure behind it; anastomosis in the intracavitary position with closure of the myotomy around the graft; or selection of an alternate distal site for anastomosis. All patients treated for intracavitary arteries were successfully revascularized without major complications.

Coronary Artery Bypass↗
PubMed1984

Homologous veins as an arterial substitute: long-term results.

From 1968 through 1982, 129 homologous vein grafts were used in 91 patients in the following positions: 75 in the femoropopliteal, tibial, or peroneal artery; 38 in the aortocoronary artery; 13 in the aortopulmonary artery; and one each in the atrioventricular fistula, carotid-subclavian artery, and brachial-radial artery. In the lower extremity patency ranged from 0 to 121 months (mean 22.4 +/- 4.4 months). All grafts were performed for limb salvage, and 75% of the patients had undergone previous operations. Cumulative patency by the life-table method showed that while 50% of grafts occluded by 1 year, 60% of the remaining grafts continued to be functional for more than 5 years. Fifty percent of the aortocoronary bypass grafts studied were occluded at 1 year. Eight of the 13 systemic pulmonary artery shunts were patent at time of death, revision, or total correction. Multiple revisions and thrombectomies are required to maintain patency of homograft veins. The outcome is variable and unpredictable. The inconsistency is due to the antigenicity of the graft. If one is committed to the necessary efforts required to ensure long-term patency, the homologous saphenous vein is a suitable substitute when autogenous tissue is unavailable.

Arterial Occlusive Diseases↗
PubMed1984

Elective cardiac operation in a patient with severe hemophilia and acquired factor VIII antibodies.

This paper describes a successful cardiac operation in a young boy with hemophilia, congenital heart disease, severe factor VIII deficiency, and an acquired high titer antibody to factor VIII. To our knowledge, there have been no published cases of elective cardiac operations in a person with severe hemophilia and an accompanying complex problem. Utilizing the team approach, we administered a megadose bolus of factor VIII concentrate preoperatively (eight times the calculated dose), followed by a continuous intravenous infusion at 500 units/hr throughout the procedure and at a reduced dose for the first 5 postoperative days. With the anamnestic rise in factor VIII antibody on day 5, activated prothrombin complex concentrates were substituted for factor VIII and provided continued adequate hemostasis during the remaining 9 postoperative days. The rapid infusion of large quantities of factor VIII was effective in neutralizing the low titer inhibitor and providing normal hemostasis during the procedure. In addition, activated prothrombin complex concentrates were substituted for factor VIII coagulant without recurrent bleeding or thromboembolic phenomena.

Antibodies↗
PubMed1983

Prolonged ileus after severe pelvic fracture.

The data derived from 105 severe pelvic fractures have provided guidelines for managing paralytic ileus associated with fracture. Fracture types I, II, IV, and double type III can be treated expectantly with a high degree of confidence that ileus will resolve within 2 days. Type III diametric fractures can be managed similarly for 5 days with a 70 percent (14 of 20 patients in this study) likelihood that ileus will resolve. However, should ileus in patients with diametric fractures continue longer than 5 days, parenteral nutrition should be started, since ileus will persist for an average of 2 weeks. A direct correlation between type of pelvic fracture, amount of retroperitoneal blood, loss and duration of ileus has been documented.

Acetabulum↗
PubMed1983

Technique and results of operative transluminal angioplasty in 81 consecutive patients.

Eighty-one consecutive patients with distal multivessel coronary artery disease underwent 93 attempts at operative transluminal angioplasty at the time of coronary bypass operation. Lesions chosen for angioplasty were those in coronary arteries that otherwise would not have been bypassed because of small size and/or inaccessible location; 53% involved the distal anterior descending artery. A guide wire-tipped catheter with a 2 mm balloon was found to be the more satisfactory of the two devices used. An operative "successful" dilatation was achieved with 75 lesions (81%). Eighteen "unsuccessful" dilatations occurred primarily because of inability to transverse the lesions with the catheter. Postoperative angiography was performed in 29 patients to study 31 lesions. In 20 of 28 "successfully" dilated lesions (71%), the stenoses were completely alleviated. Three lesions were found unimproved and in two lesions, the coronary arteries were occluded distally. Two bypass grafts, involving two lesions with extensive dilatation, were closed. Two patients had definite perioperative myocardial infarction, and there were no deaths in this series. Whereas calcification did not influence success, the length of the lesion was inversely proportional to a successful dilatation. Operative dilatation of short coronary distal lesions is safe, has a high percentage of success, and offers a larger distal runoff for coronary bypass grafts. Areas of normal coronary arteries should not be dilated. Careful attention to detail and proper selection of the lesions to be dilated are required. The technique should be used only to dilate arteries that otherwise would not accept a bypass graft.

Adult↗