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Biomedical subjects

J LoCicero

Publications and source records attributed to J LoCicero.

At least 19 recordsLinked to original sources
PubMed1997

The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt.

Hepatic hydrothorax is a rare complication of portal hypertension. Conservative therapy may be successful but refractory hepatic hydrothorax is not uncommon. Management of refractory hydrothorax is usually ineffective and can result in a worsened clinical status. Transjugular intrahepatic portosystemic shunts (TIPS) lower portal pressure and have been used in the treatment of refractory ascites. The aim of this study was to determine the efficacy of TIPS in the treatment of symptomatic refractory hepatic hydrothorax. A TIPS was placed in 24 consecutive cirrhotic patients with symptomatic refractory hepatic hydrothorax. Five patients (20.8%) were Child's/Pugh class B and 19 (79.2%) were class C. All had undergone multiple thoracenteses and were hypoalbuminemic. Mean follow-up was 7.2 months (range, 0.25-49 months). Fourteen (58.3%) of 24 patients had complete relief of symptoms after shunt placement and did not require further thoracentesis. Five (20.8%) additional patients required fewer thoracenteses. Five (20.8%) patients developed worsening liver function and died within 45 days. In eight (66.7%) of 12 patients with > or = 60 days of follow-up, the serum albumin increased by a mean of 1.2 g/dL (range, 0.1-2.2 g/dL). The Child's-Pugh score improved in 7 (58.3%) of these 12 patients and two patients improved from class C to class A. These two patients no longer require liver transplantation. This study shows that TIPS can be effective in the management of symptomatic, refractory hepatic hydrothorax. Clinical and laboratory improvement may be seen and liver transplantation may become unnecessary.

Female↗
PubMed1996

Spiral CT with multiplanar and three-dimensional reconstructions accurately predicts tracheobronchial pathology.

BACKGROUND: This study was designed to evaluate the clinical accuracy of multiplanar reconstructions and three-dimensional shaded surface displays compared with conventional transaxial computed tomography, bronchoscopy, and surgical pathologic findings. METHODS: Transaxial computed tomographic images, two-dimensional nonstandard multiplanar reconstruction images, and three-dimensional images obtained from patients with tracheobronchial disease were prospectively evaluated for the relationship to adjacent structures, lesion characterization, and surgical anatomic correlation before invasive procedures. RESULTS: Compared with conventional transaxial computed tomographic images, multiplanar reconstructions and three-dimensional shaded surface displays provided a correlative map of bronchoscopic and surgical anatomy in patients with benign and malignant tracheobronchial pathology. The longitudinal extent of abnormalities are better demonstrated on the multiplanar reconstruction and three-dimensional images, whereas the transverse extent of disease and relationships to adjacent structures were better shown on axial computed tomographic sections. CONCLUSIONS: Three-dimensional and multiplanar two-dimensional images are additive to transaxial computed tomography for evaluation of diseases involving the central airways. They are beneficial for planning invasive procedures. More importantly, they provide consistent, highly accurate measurements for routine follow-up and for future clinical trials.

Aged↗
PubMed1996

Dissemination of malignant tumors after video-assisted thoracic surgery: a report of twenty-one cases. The Video-Assisted Thoracic Surgery Study Group.

Video-assisted thoracic surgical techniques are widely used for biopsy and resection of thoracic tumors, but studies of long-term outcomes have not been reported. Dissemination of tumor by these techniques is a potential hazard. Therefore we surveyed the surgical members of the Video-Assisted Thoracic Surgery Study Group to determine whether tumor implants thought to be directly related to video-assisted techniques had occurred. Surgeons reported 21 cases. The sites of recurrence were the incision (n = 14), pulmonary staple line (n = 2), pleura (n = 2), both staple line and incision (n = 1), both pleura and incision (n = 1), and both pleura and staple line (n = 1). Review of these cases illustrates the pitfalls of present video-assisted techniques for malignant tumors of the thorax.

Adult↗
PubMed1996

Complex pleural effusion associated with a subphrenic gallstone phlegmon following laparoscopic cholecystectomy.

A 90-year-old man presented with a large right-sided complex pleural effusion 4 months after a laparoscopic cholecystectomy. An initial thoracic CT scan confirmed the presence of the effusion, and the results of thoracentesis on three separate occasions were consistent with an exudative process. Another CT scan of the chest with thin-section cuts through the diaphragm along with an abdominal ultrasound revealed a retrohepatic subdiaphragmatic gallstone collection that eroded into the right hemidiaphragm. Thoracoscopic evacuation of the phlegmon, removal of the spilled gallstones, and repair of the diaphragm resulted in resolution of the effusion.

Aged↗
PubMed1996

The combined cervical and partial sternotomy approach for thymectomy.

Removal of a normal appearing thymus gland may be necessary, particularly in patients with myasthenia gravis. Complete removal is a basic tenet of this type of operation. A combined cervical and upper sternotomy incision is described. This is appropriate for thymectomy in such patients because of the minimal morbidity and excellent exposure for the thoracic portion of the thymus gland.

Cervical Vertebrae↗
PubMed1996

Spiral CT with multiplanar and three-dimensional reconstructions accurately predicts tracheobronchial pathology.

BACKGROUND: This study was designed to evaluate the clinical accuracy of multiplanar reconstructions and three-dimensional shaded surface displays compared with conventional transaxial computed tomography, bronchoscopy, and surgical pathologic findings. METHODS: Transaxial computed tomographic images, two-dimensional nonstandard multiplanar reconstruction images, and three-dimensional images obtained from patients with tracheobronchial disease were prospectively evaluated for the relationship to adjacent structures, lesion characterization, and surgical anatomic correlation before invasive procedures. RESULTS: Compared with conventional transaxial computed tomographic images, multiplanar reconstructions and three-dimensional shaded surface displays provided a correlative map of bronchoscopic and surgical anatomy in patients with benign and malignant tracheobronchial pathology. The longitudinal extent of abnormalities are better demonstrated on the multiplanar reconstruction and three-dimensional images, whereas the transverse extent of disease and relationships to adjacent structures were better shown on axial computed tomographic sections. CONCLUSIONS: Three-dimensional and multiplanar two-dimensional images are additive to transaxial computed tomography for evaluation of diseases involving the central airways. They are beneficial for planning invasive procedures. More importantly, they provide consistent, highly accurate measurements for routine follow-up and for future clinical trials.

Adolescent↗
PubMed1996

Improvement of pulmonary graft after storage for twenty-four hours by in vivo administration of lazaroid U74389G: functional and morphologic analysis.

BACKGROUND: We examined the effects of in vivo administration of a potent inhibitor of iron-dependent lipid peroxidation, lazaroid U74389G, on lung preservation. METHODS: Lungs isolated from Sprague-Dawley rats (n = 23) were either immediately reperfused after removal (control, n = 8) for 2 hours by means of an isolated, pulsatile blood perfusion system or reperfused after cold storage (4 degrees C) for 24 hours in the University of Wisconsin solution with (n = 7) or without (n = 8) lazaroid. The lazaroid group had in vivo infusion of lazaroid U74389G (6 mg/kg) before lung harvest plus addition to the perfusate (50 mu mol/L) at the onset of reperfusion. Routine aerodynamics, hemodynamics, and blood gases were assessed during the perfusion period. Lipid peroxidation in the lung tissue was assayed with the thiobarbituric acid-reactive product, malondialdehyde. Histologic evaluation was performed with light microscopic and transmission electron microscopic analyses. RESULTS: All lungs in the University of Wisconsin solution group (24-hour storage without lazaroid) failed within 1 hour of reperfusion. Lungs in control and University of Wisconsin solution + lazaroid group survived the 2-hour perfusion period. University of Wisconsin solution + lazaroid group showed significantly better arterial oxygen tension values relative to those in the University of Wisconsin solution group (control, 85.2 +/- 1.9; University of Wisconsin solution, 53.9 +/- 3.2 [p < 0.05 versus control group and University of Wisconsin solution + lazaroid]; University of Wisconsin solution + lazaroid, 74.8 +/- 1.4; arterial oxygen tension (mm Hg) at 30 minutes). Lipid peroxide in University of Wisconsin solution + lazaroid group was significantly lower than that of the University of Wisconsin solution group (65.0 +/- 5.0 versus 495 +/- 105 nmol malondialdehyde/gm wet lung tissue; p < 0.01). Transmission electron microscopic analysis showed that University of Wisconsin solution + lazaroid group significantly attenuated lung damage when compared with University of Wisconsin solution group. CONCLUSION: Administration of lazaroids in vivo before organ harvest and in situ at the onset of the reperfusion enhances lung preservation in this model.

Animals↗
PubMed1996

Pulmonary actinomycosis: surgical considerations.

Pulmonary actinomycosis is a rare disease. Of 2,247 patients presenting with a radiological pulmonary opacity, 13 (0.6%) were identified with pulmonary actinomycosis in a 13 year period. Twelve of the 13 patients underwent thoracotomy and one had clinical diagnosis and subsequent medical treatment alone. Neither mortality nor major complications were observed. One patient had recurrent disease after surgery. The other surgical patients are well and free from disease at a minimum 6 month follow-up. Diagnosis of actinomycosis is frequently difficult because it often infects pre-existing cavitary disease in the lung. As a consequence, the infection may progress to stages which will not respond to medical treatment alone. Surgery then provides the best method to achieve diagnosis and ultimate treatment.

Actinomycosis↗
PubMed1995

Enhancement of extended lung preservation with a vasoactive intestinal peptide-enriched University of Wisconsin solution.

Vasoactive intestinal peptide (VIP) is a known pulmonary and bronchial vasodilator as well as an oxygen free radical scavenger. Since its effect as an additive to University of Wisconsin (UW) solution for lung preservation has been shown previously, the aim of this study was to determine the ability of VIP to improve lung preservation followed by reperfusion. Four groups of excised Sprague-Dawley rat lungs (n = 24) were studied using an isolated blood perfused working lung model. The first 3 groups of lungs were flushed and stored in UW solution at 4 degrees C for: (1) 4 hr, (2) 18 hr, and (3) 24 hr. Group 4 lungs were flushed with UW solution + VIP (1 microgram/ml) and stored in UW solution + VIP (0.5 microgram/ml) for 24 hr. After preservation, the lungs were reperfused to evaluate their functions for 2 hr or until lung failure occurred (arterial oxygen saturation less than 90% and/or appearance of bronchial fluid in the bronchial cannula). In the lungs stored in UW solution for 24 hr, failure occurred after 10 min of reperfusion and all functions were significantly altered. The addition of VIP to UW solution maintained the functional capacity of the lungs, recorded by lung resistance, lung compliance, elastic work, flow resistive work, shunt fraction, and blood oxygen tension. No statistical difference in these parameters other than shunt fraction was found when the VIP group was compared with the group preserved for 4 hr in UW solution. We conclude that lung preservation can be extended to 24 hr with the maintenance of lung functional capacity if VIP is added to UW solution.

Adenosine↗
PubMed1995

Lung preservation threshold in a compromised septic lung injury model.

BACKGROUND: Discrepancy between clinical and research works in lung transplantation could be due to differences between compromised clinical donor lungs and intact research lungs. The purpose of this laboratory study was to produce compromised lungs to compare with normal ones. METHODS: Sprague-Dawley rats were continuously infused with lipopolysaccharide (5 mg/kg) for 24 hours before organ harvest. Lungs were stored in University of Wisconsin solution at 4 degrees C for the following period: group 1: intact lungs, no storage (n = 12); group 2: septic lungs, no storage (n = 6); group 3: septic lungs for 6 hours (n = 5); and group 4: septic lungs for 12 hours (n = 5). All lungs were reperfused for 2 hours with venous blood using an isolated, pulsatile perfused lung system. RESULTS: Experimental variables were comparable between groups 1, 2, and 3. All septic lungs stored for 12 hours (group 4) failed within 1 hour of perfusion. CONCLUSIONS: These results indicate that compromised lungs with septic injury functioned at near control levels after 6 hours of preservation. Six hours may be a safe limit for human donor lungs, all of which are compromised in some way by the time of harvest.

Animals↗
PubMed1995

Impact of initial flush potassium concentration on the adequacy of lung preservation.

The effects of initial lung flushing with intracellular and extracellular fluid type solutions were studied in lungs stored with the University of Wisconsin solution. Excised Sprague-Dawley rat lungs (n = 39) were flushed first with one of the following solutions: (1) the University of Wisconsin solution (K+ = 140 mmol/L), (2) modified (low potassium) University of Wisconsin solution (K+ = 20 mmol/L), (3) phosphate buffered saline solution (K+ = 3.9 mmol/L), (4) modified low-potassium phosphate-buffered saline solution (K+ = 20 mmol/L), (5) modified high-potassium phosphate-buffered saline solution (K+ = 40 mmol/L), and (6) Euro-Collins solution (K+ = 115 mmol/L) followed by secondary flush with storage solution and cold (4 degrees C) storage in University of Wisconsin solution for 24 hours. The lungs were then reperfused in the isolated, pulsatile, blood-perfused working lung system for 2 hours or until lung failure. Blood gas analysis and shunt fraction, aerodynamic parameters (airway resistance, lung compliance, elastic work, and flow resistive work), and total pulmonary vascular resistance were measured throughout the perfusion period. The mean oxygen tensions (in millimeters of mercury) at 30 minutes after the onset of reperfusion for University of Wisconsin solution, modified University of Wisconsin solution, phosphate-buffered saline solution, modified phosphate-buffered saline solutions (20 and 40 mmol/L), and Euro-Collins solution were 56.1 +/- 4.2, 72.7 +/- 9.1, 87.7 +/- 6.9 (p < 0.01 versus University of Wisconsin solution; p < 0.01 versus Euro-Collins solution), 86.0 +/- 9.6 (p < 0.01 versus University of Wisconsin solution; p < 0.01 versus Euro-Collins solution), 87.9 +/- 7.7 (p < 0.01 versus University of Wisconsin solution; p < 0.01 versus Euro-Collins solution), and 53.5 +/- 6.0, respectively. All aerodynamic parameters in the lungs flushed with extracellular fluid type solutions were superior to those flushed with intracellular fluid type solutions. We conclude that the efficacy of initial flushing was essential for successful lung preservation and that extracellular fluid type solutions were superior to intracellular fluid type solutions, at least for flushing the lung before storage with University of Wisconsin solution. Potassium concentration in flushing solution should be 20 mmol/L or less to obtain appropriate flushing and subsequent adequate distribution of the storage solution.

Adenosine↗
PubMed1994

Magnesium cardioplegia reduces cytosolic and nuclear calcium and DNA fragmentation in the senescent myocardium.

Previous reports have indicated that the senescent myocardium is less tolerant to surgically induced ischemia and that diminished functional recovery is associated with alterations in cytosolic calcium ([Ca2+]i) accumulation. Recently, increased [Ca2+]i has been suggested to alter nuclear calcium ([Ca2+]n) accumulation. To investigate the relation between [Ca2+]i and [Ca2+]n, we subjected mature and aged rabbit hearts to normothermic global ischemia, either without treatment or after treatment with potassium cardioplegia, magnesium cardioplegia, or a combination of potassium and magnesium cardioplegia. The relation between altered [Ca2+]n and DNA fragmentation was also investigated. Our results indicate that [Ca2+]i was increased during 30 minutes of normothermic global ischemia without treatment in both the mature and aged hearts (p < 0.05). Accumulation of [Ca2+]i during global ischemia was reduced with the use of potassium, magnesium, and a combination of potassium and magnesium cardioplegia (p < 0.05 versus untreated ischemia) in both the mature and aged hearts. Levels of [Ca2+]n were unaffected by global ischemia or cardioplegia in the mature myocardium; however, in the aged myocardium, [Ca2+]n was increased during global ischemia and with potassium cardioplegia and was associated with increased nuclear DNA fragmentation (p < 0.05). The use of magnesium and a combination of potassium and magnesium cardioplegia attenuated [Ca2+]n accumulation and nuclear DNA fragmentation (p < 0.05). Control of [Ca2+]i and [Ca2+]n was associated with enhanced functional recovery during reperfusion. These results indicate that during normothermic ischemia, there is increased [Ca2+]i and [Ca2+]n in the aged myocardium, and increased [Ca2+]n is associated with increased nuclear DNA fragmentation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1994

Does every patient with enigmatic lung disease deserve a lung biopsy? The continuing dilemma.

STUDY OBJECTIVE: Define the negative predictive factors for survival in patients who undergo open-lung biopsy. DESIGN: Retrospective analysis from July 1988 through January 1992 (prior to widespread use of video-assisted techniques). Factors included in analysis were: oxygen therapy, requirement for intubation, and HIV status. Also analyzed were the accuracy of the preoperative presumptive diagnosis and the outcome of therapy. SETTING: University hospital in an urban area with active medical and surgical critical care services. PATIENTS: All patients who underwent open-lung biopsy during the study design period. Patients excluded were those with lung transplants and one patient who had a thoracoscopic biopsy. Forty-eight lung biopsies were performed and 31 patients without AIDS and 15 with AIDS. Twenty-four (16 without AIDS, 8 with AIDS) were receiving oxygen therapy, met intubation criteria, or were intubated and ventilated at the time of biopsy. The indications were undiagnosed nodular or interstitial lung disease. INTERVENTIONS: Presurgical evaluation included a preoperative diagnostic algorithm of transthoracic needle biopsy and nodular disease (9 patients) and at least one bronchoscopy with bronchoalveolar lavage and transbronchial biopsy in interstitial disease (22 patients). Seven patients with nodular disease and nine with infiltrate had no preoperative procedures. MEASUREMENTS AND RESULTS: Lung biopsy obtained at definitive diagnosis in 98 percent of patients. Biopsy significantly altered therapy in 79 percent (81 percent without AIDS, 73 percent with AIDS). Postoperatively, in-hospital mortality was 8 (17 percent): 5 (16 percent) without AIDS and 3 (20 percent) with AIDS p > 0.1. Mortality rates showed patients without respiratory compromise, 4.2 percent (7 percent without AIDS, 0 percent with AIDS); patients receiving oxygen therapy, 6 percent (10 percent without AIDS; 0 percent with AIDS); patients who met intubation criteria, 60 percent (33 percent without AIDS, 100 percent with AIDS); patients who were ventilated, 75 percent (66 percent without AIDS [p < 0.05], 100 percent with AIDS [p < 0.05]. CONCLUSION: We recommend that the decision for lung biopsy be individualized based on respiratory status.

AIDS-Related Opportunistic Infections↗
PubMed1993

Thoracoscopic management of malignant pleural effusion.

The diagnosis and management of pleural effusions have been well recognized over the years as indications for thoracoscopy. New technology has enhanced its appeal. Video-assisted thoracic surgery is a well-tolerated procedure that affords excellent visualization of the entire pleural surface. Directed biopsies of suspicious areas lead to a high diagnostic yield, particularly when compared with percutaneous biopsies. New algorithms reflect this fact. Video-assisted thoracic surgery now follows diagnostic thoracentesis as the next step in the evaluation of effusion suspicious for malignancy. Video-assisted thoracic surgery can also aid the lysis of adhesions, which might limit the effectiveness of surgical procedures to produce pleurodesis, and is an ideal tool for therapeutic management. It may be performed with general anesthesia or local anesthesia and sedation. All of the pleural fluid can be removed and this facilitates the procedure. With minimal instrumentation, pleurodesis may be performed by pleurectomy, mechanical abrasion, or talc sclerosis. Visually directed placement of chest tubes ensures adequate reexpansion of the lung.

Algorithms↗
PubMed1993

Video-Assisted Thoracic Surgery Study Group.

Both patients and the medical profession are quick to embrace new technology, particularly when it may replace an existing surgical procedure. Unfortunately, the rapidity of acceptance is rarely associated with careful evaluation. Laparoscopy is a recent example of such widely embraced technology. Studies of laparoscopy that yielded good comparative data to more traditional methods were slow to accrue. This led to the exposure of its shortcomings through governmental reports and the lay press. To prevent this from happening in thoracoscopy, two types of studies are required so that valid conclusions about the new technology can be drawn. The first is an accounting of the new technology as procedures evolve around it. The data collected in such a study should contain basic information, including the indications for the procedure, how it was performed, procedure length, associated complications, and patient outcome. Such information provides a broad profile of the technology, emphasizing from the outset its potential strengths and weaknesses. The second type of study involves a more detailed concurrent comparison of the specific procedures utilizing this technology to the established traditional methods. Such randomized studies help to firmly establish through scientific process the place of the new technology. The Video-Assisted Thoracic Surgery Study Group was organized in early 1992 to address these concerns. From an initial four surgeons the group has grown to include more than 41 institutions. Currently the group is collecting data in a registry and has established three clinical trials to evaluate video-assisted thoracic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗