PubMed Health⌕ Search

Biomedical subjects

J L Ochsner

Publications and source records attributed to J L Ochsner.

At least 91 records · Page 5Linked to original sources
PubMed1982

Iatrogenic right ventricular failure in tetralogy of Fallot repairs: reappraisal of a distressing problem.

A patient with tetralogy of Fallot experienced isolated right ventricular failure when the right coronary artery was occluded by an encircling suture at the time of closure of the ventricular septal defect. Recognition and correction of the problem allowed weaning from cardiopulmonary bypass and an uneventful recovery. Because ventricular septal defects in tetralogy of Fallot are usually anterior and subaortic, injury to the right coronary artery, in close proximity to the superior aspect of the defect, is a potential danger. When isolated right ventricular failure occurs immediately after repair, suture occlusion of the right coronary artery should be considered as a possible cause.

Child↗
PubMed1981

Improved operative risk after myocardial revascularization.

At Ochsner Medical Institutions from 1970 to 1979, 96 patients who had previously had myocardial revascularization later had a total of 136 noncardiac operations. There were no postoperative myocardial infarctions and only one noncardiac death. Transitory postoperative arrhythmias occurred in 3.6% of patients. It appears that myocardial revascularization protects the cardiac patient from myocardial infarction and cardiac-related deaths during and after noncardiac operations. Patients with cardiac disease scheduled for elective surgery should have exercise testing or coronary cineangiography or both to evaluate the severity and significance of the coronary disease. If significant coronary lesions are demonstrated that are amenable to a bypass procedure, the operative risk will be lessened by prior revascularization.

Adult↗
PubMed1981

Contrasting effects of vasodilators on oxygen tension and membrane potential of canine gastric surface epithelium.

Our purpose was to study the effects of three related vasoactive drugs on gastric epithelial oxygenation and metabolism. By means of an ultramicroelectrode technique, oxygen tension and transmembrane potential difference of surface epithelium were determined in an in vivo canine gastric chamber model. Intra-arterial papaverine (30 micrograms kg-1 min-1) caused a significant depression of epithelial PO2 and potential difference (PD), a transient inhibition of total gastric oxygen consumption, and a 70% increase in total gastric blood flow. Following cessation of the papaverine infusion, epithelial PO2 and PD continued to decline, whereas gastric blood flow and oxygen consumption return to baseline. Isoproterenol (0.0125 microgram kg-1 min-1), on the other hand, had no significant effect on epithelial PO2 and PD although it increased total gastric blood flow 33%. Dopamine (0.1 microgram kg-1 min-1) had no significant hemodynamic effects. To test the importance of papaverine-induced epithelial hypoxia, hydrochloric acid (160 mM) and sodium taurocholate (3 mM) were added to the epithelial bathing solution during intra-arterial infusion of either papaverine or isoproterenol. Necrosis and ulceration of the gastric mucosa were seen with the infusion of papaverine but not with the infusion of isoproterenol. Our results indicate that papaverine increases total gastric blood flow at the expense of nutrient blood flow to surface epithelium. We conclude that nutrient blood flow to surface epithelium is critical to the ability of the gastric mucosa to resist injury by luminal acid and bile. Furthermore, papaverine should not be used clinically to enhanced gastric blood flow because it is potentially injurious to the mucosa.

Animals↗
PubMed1981

Delayed pulmonary complications of ventricular aneurysm repair. Report of two cases and review of the literature.

Two patients referred to Ochsner Foundation Hospital after ventricular aneurysm repair had the delayed pulmonary complications of massive hemoptysis and bronchiectasis. Only three cases of infected ventricular aneurysm repair have been reported previously. The felt buttress used in aneurysm repair may be the seat of indolent infection or it may erode into pulmonary tissue with secondary infection. For anatomic reasons the lingular segment of the lung appears to be at increased risk of involvement. Symptoms led to the correct diagnosis in one case at 7 months and in the other at 3 years after the original operation. Infection may be prevented by appropriate measures. However, should such a catastrophe occur, aggressive surgical therapy with removal of all foreign material is mandatory.

Bronchiectasis↗
PubMed1980

Clinical spectrum of pulmonary hamartomas.

Pulmonary hamartomas are tumors that occur in the parenchyma or the bronchi. Through the lesions themselves are benign, they may be associated with malignant neoplasms or they may cause obstruction of the bronchi because of their location. Pulmonary hamartomas were resected in 29 patients at the Ochsner Medical Institutions during a 30-year period. Of these patients, 6 had symptoms related to concomitant malignancy and 3 had symptoms resulting from obstruction of the bronchi by the hamartoma. Surgical treatment ranged from enucleation to pneumonectomy. One patient died in the hospital of extensive bronchogenic carcinoma. In 2 others, carcinoma of the lung developed within twelve months after resection of a hamartoma. In this group of patients, 20% had concomitant or subsequent pulmonary lesions. Ten percent of the hamartomas were located in the bronchi, resulting in bronchial obstruction. A surgical approach is indicated for lesions that appear to be pulmonary hamartomas on roentgenograms.

Adolescent↗
PubMed1980

Positive end-expiratory pressure in the management of the patient with a postoperative bleeding heart.

This prospective study involves 406 consecutive adults who had heart operation with extracorporeal circulation. Fifteen patients (3.7%) bled at the rate of 200 ml per hour or more in the postoperative period. Thirteen of the 15 patients who bled had undergone coronary artery operation. After all clotting factors and, when applicable, hypertension had been checked and corrected, positive end-expiratory pressure (PEEP) was used in managing the bleeding of these patients. Before institution of PEEP, the average bleeding was 330 ml per hour for one to five hours. After PEEP was instituted in the 11 patients in whom bleeding was controlled, an average output of 25 ml per hour for one to ten hours was recorded. Patients were kept on PEEP for 5 to ten hours. In 7 patients hemorrhage was controlled with 10 cm H2O of PEEP; 4 required 15 cm of PEEP to stop bleeding; 3 were explored for continuous bleeding on 15 cm of PEEP; and 1 was explored because of hypotension on 15 cm of PEEP. In 11 of the 15 patients who bled postoperatively (73%), operation was avoided by judicious use of PEEP. We believe that PEEP increases mediastinal pressure and that the overdistended lung can obliterate some bleeding in the mediastinum, thus controlling bleeding in many of these patients.

Cardiac Surgical Procedures↗
PubMed1980

Long-term results of myocardial revascularization in early-onset arteriosclerosis.

The risk factors, anatomic disease states, and surgical results were compared between patients, who had coronary bypass operations before 40 years of age and patients who underwent bypass after 40. Elevated serum cholesterol levels were significantly more frequent in the younger group (P = 0.00704). However, these patients were a minority (12.6%) of the younger group the influence of elevated cholesterol levels on the subsequent course of the disease was minimal. The extent and location of coronary lesions and the states of ventricular function by ventriculograms were similar in the two groups. The surgical results were better in the younger group, but not to a significant degree. There were no operative deaths in the younger group and only two patients had perioperative myocardial infarctions. There is no justification for concern that the clinical course in early-onset coronary disease is accelerated. Also, the younger coronary disease patients are effectively treated by coronary artery bypass.

Adult↗
PubMed1980

Clinical comparison between patients with saphenous vein and internal mammary artery as a coronary graft.

From January, 1971, through May, 1978, the records of 1,239 patients who had comparable patterns of coronary artery bypasses were retrieved for study from the Ochsner computerized data bank. Seven hundred twenty-six patients had saphenous vein grafts (SVG) alone and 513 patients had internal mammary artery (IMA) grafts alone or in combination with SVG. Patients with IMA grafts had significantly improved survival over patients with SVGs, but after exclusion of biasing subgroups the improved survival was not reliably different (p = 0.1684). The percentages of patients who had unrelieved angina after operation were similar (5.0% versus 4.8%); the rates of nonfatal myocardial infarction and of postoperative congestive heart failure were also similar. When the recently done SVG bypasses were compared to those done before mid-1975, we found that unrelieved angina rates and nonfatal myocardial infarction rates were significantly improved in the recent group. We conclude that use of the SVG is indicated in some clinical situations and use of the IMA graft in others. Therefore, cardiovascular surgeons should be proficient in using both grafts.

Aged↗
PubMed1980

Massive air embolism during cardiopulmonary bypass. Causes, prevention, and management.

Massive air embolism during cardiopulmonary bypass is a frightening complication requiring immediate response and carrying strong medicolegal implications. From July, 1971, to July, 1979, there were eight instances of massive air embolism during 3,620 cardiopulmonary bypass operations. Five such accidents from other institutions are included in this report. Causes were (1) inattention to reservoir level, (2) reversal of pump head tubing or direction of pump head rotation, (3) unexpected resumption of heartbeat, (4) inadequate steps to remove air after cardiotomy, (5) high-flow suction deep in a pulmonary artery, (6) defective oxygenator, (7) use of a pressurized cardiotomy reservoir, and (8) inadvertent detachment of oxygenator during bypass. Prevention includes a systematic check of pump suckers and perfusion lines before bypass, a sensing device on the oxygenator reservoir, secure fixation of the oxygenator and avoidance of traffic around pump equipment, immediate cessation of pump and inspection for abnormal noise, use of standard maneuvers to remove air from the heart, and carotid compression with resumption of heartbeat. Immediate management of massive air embolism consists of placing the patient in a deep Trendelenburg position and making a large stab wound in the ascending aorta for retrograde drainage from the cerebrovascular bed. Temporary retrograde perfusion through the superior vena cava (SVC) may also be used. Subsequent steps are hypothermia with the resumption of cardiopulmonary bypass, elevation of blood pressure, steroids, ventilation with 100% oxygen, and deep barbiturate anesthesia. Among the 13 patients, there were four instantaneous deaths. Cerebral injury which resolved within a 2 month period occurred in three patients. The remainder had no neurologic sequelae. Nonfatal cerebral air injury may be associated with prolonged convalescence yet complete recovery, as compared to embolism from debris or clot, which offers a poorer prognosis.

Adult↗
PubMed1978

Iliac-mesenteric-atrial shunt procedure for Budd-Chiari syndrome complicated by inferior vena caval thrombosis.

A 33-year-old woman had a diagnosis of idiopathic Budd-Chiari syndrome complicated by inferior vena caval occlusion. Conservative medical therapy failed to control the symptoms of both portal hypertension and vena caval stasis. Therefore, a prosthetic shunt was placed from the right common iliac vein to the right atrium with a side-arm to the superior mesenteric vein. She exhibited almost complete relief of symptoms and the graft was documented to be patent two weeks postoperatively. In many instances aggressive surgical therapy may help these patients who, in the past, would have been relegated to symptomatic therapy.

Adult↗