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Biomedical subjects

J W Bolton

Publications and source records attributed to J W Bolton.

At least 19 recordsLinked to original sources
PubMed2001

Space-occupying lesions in the right ventricle of a patient with antiphospholipid syndrome.

A 29-year-old woman presented with shortness of breath, vague chest pain, and prominent intermittent ejection systolic murmur. Transthoracic echocardiography showed a large mass in the right ventricular outflow tract. Transesophageal echocardiography demonstrated two masses that were adherent to the tricuspid valve and intermittently prolapsed through the pulmonary valve. Computed tomography of the chest corroborated the echocardiographic findings. Currently, there are no definitive guidelines regarding the optimal management of right heart thrombi in patients with antiphospholipid syndrome. Our patient did not respond to a standard dose of rt-PA used in the treatment of pulmonary embolus. She underwent successful surgical resection of the thrombi without complications.

Adult↗
PubMed1998

Phrenic nerve injury following cardiac surgery: a review.

Phrenic nerve injury following cardiac surgery is variable in its incidence depending on the diligence with which it is sought. Definitive studies have shown this complication to be related to cold-induced injury during myocardial protection strategies and possibly to mechanical injury during internal mammary artery harvesting. The consequences are also variable and depend to a large extent on the underlying condition of the patient, particularly with regard to pulmonary function. The response of the patient may range from an asymptomatic radiographic abnormality to severe pulmonary dysfunction requiring prolonged mechanical ventilation and other associated morbidities and even mortality. Two cases are presented to demonstrate the variability in clinical responses to diaphragmatic dysfunction secondary to phrenic nerve injury from cardiac surgery. In addition, treatment strategies are reviewed including early tracheostomy and diaphragmatic plication, which appear to be the most effective options for patients who are compromised by phrenic injuries.

Cardiac Surgical Procedures↗
PubMed1996

Traumatic tricuspid valve injury: leaflet resuspension repair.

Blunt traumatic rupture of the tricuspid valve is exceedingly uncommon, and injury of the tricuspid valve due to penetrating trauma appears to be even more rare. Presented here is a case of tricuspid valve injury due to penetrating cardiac trauma repaired by leaflet resuspension 17 years later.

Adult↗
PubMed1995

Ross/Konno procedure for critical aortic stenosis in infancy.

Although the Ross procedure has been applied successfully to the pediatric age group, it may have its ideal application in the selected infant with critical aortic stenosis and complex left ventricular outflow tract obstruction with adequate ventricular function and size. Two neonates presented with critical aortic stenosis and complex left ventricular outflow tract obstruction, and a combined Ross/Konno procedure was performed successfully. These cases are presented along with a discussion of this topic.

Aortic Valve Stenosis↗
PubMed1994

Routinely performed multigated blood pool imaging (MUGA) as a predictor of postoperative complications of lung resection. A two-year retrospective.

The results of routinely performed multigated blood pool studies (MUGA) were compared with the presence of postthoracotomy complications in 46 adult men in a retrospective chart review. Pulmonary function measurements were also examined in relation to the presence of complications experienced. There was only one death, but survivable complications were not predicted by the MUGA results. The addition of MUGA as a routine preoperative cardiac screening technique did not result in increased ability to predict postoperative cardiopulmonary complications.

Gated Blood-Pool Imaging↗
PubMed1994

Determinants of achievement in stair climbing as an exercise test.

Physicians routinely discuss pulmonary function and its impact on prognosis or operative risk. Although many studies have related various measures of pulmonary function to postoperative outcome, there has been no study designed to determine which of the spirometric measures of pulmonary function tests reflects the actual abstract idea of pure pulmonary function. A homogeneous population of 70 male patients was subjected to pulmonary function tests and a simple stair climb. Measures of pulmonary function (including FEV1, FEV1%, FVC, FVC%, and MVV%) were factor analyzed in a measurement model of pulmonary function to obtain reliability and validity estimates in predicting performance on a simple stair-climb test. The analysis revealed several interesting aspects concerning the relative importance of the various spirometric measures of pulmonary function tests. The validity estimates of the pulmonary function measures were as follows: FEV1% = 0.917; FEV1 = 0.886; MVV% = 0.769; FVC% = 0.715; FVC = 0.694. Analysis indicates that the FEV1% was the single best spirometric indicator of pulmonary function when predicting the physiologic outcome (followed closely by the FEV1). In addition, the various spirometric measures of pulmonary function were not equally valid nor interchangeable in such analysis. Although the number of stairs climbed correlates well with pulmonary function (r = 0.626), the coefficient of non-determination (i.e., 1-r2) suggests that about 61% of the performance on the stair climb may be explained by other parameters (i.e., cardiac function, determination, altitude, etc.).

Exercise↗
PubMed1993

Two-dimensional echocardiography in the evaluation of penetrating intrapericardial injuries.

Patients with penetrating pericardial trauma whose vital signs stabilize after fluid administration may present a therapeutic dilemma. Two-dimensional echocardiography has emerged as a diagnostic technique to help determine whether surgical intervention may be required. We present 5 patients with penetrating pericardial trauma whose vital signs stabilized after fluid administration and who had minimal clinical findings. In 3 of these patients, a small effusion was seen; in 2 others, no abnormalities were noted. All 5 underwent surgical exploration and had major intrapericardial injuries. We conclude that a normal echocardiographic study does not rule out major intrapericardial injury in patients with penetrating chest trauma. Furthermore, small areas of effusion seen on echocardiography in these patients represent indications for surgical exploration.

Adult↗
PubMed1993

Internal closure of an aspergilloma cavity: report of a new technique and review of the literature.

We have described a case in which closure of an aspergilloma cavity was done internally when it was determined that pulmonary resection was too hazardous. There was an intense inflammatory reaction surrounding the aorta and pulmonary artery. In the absence of gross purulence and underlying parenchymal infection, this technique may be used to avoid the prolonged hospitalization and bronchopleural fistulas associated with external drainage procedures.

Aspergillosis↗
PubMed1993

Perioperative respiratory management in cardiac surgery.

The perioperative respiratory care of the cardiac surgical patient can present many challenges to the caring physician that he or she may not see among the usual patient population. Knowledge of the effects of the heart-lung machine on pulmonary performance, awareness of the anatomic changes brought on by the surgeon, and consideration of the patient's baseline cardiac and pulmonary function need to be addressed so that the pulmonary problems that they present can be managed optimally.

Analgesia↗
PubMed1993

Physiology of lung resection.

Although we speak intuitively about the effects of lung resection, little thought is given to the precise physiologic mechanisms. The effects of different thoracic incisions on the chest wall mechanics, the removal of pulmonary parenchyma on lung function, and the interaction of the cardiopulmonary apparatus all combine to result in specific physiologic derangements after thoracic surgery.

Abdomen↗
PubMed1992

Asymptomatic bronchogenic cysts: what is the best management?

The management of patients with uncomplicated bronchogenic cysts has evolved over the last decade with the development of more precise diagnostic techniques and a better understanding of the variable natural history of these lesions. Although an aggressive surgical approach is still indicated for infants and children, it is acceptable to treat asymptomatic bronchogenic cysts in adults in a conservative manner. Observation alone may be indicated for small, classic, asymptomatic cysts. The use of mediastinoscopy or percutaneous or transbronchial needle techniques for carinal or paratracheal cysts offers the option of fluid aspiration or wall biopsy, thus avoiding thoracotomy. An air-fluid level in the cyst, the presence of malignant cells in the aspirate or biopsy, the development of symptoms, or enlargement or recurrence of the cyst on follow-up examination mandates complete surgical removal at thoracotomy. This is also indicated for intraparenchymal bronchogenic cysts, which are more prone to bronchial communication and infectious complications and for which the distinction from a carcinoma with a cystic component may be difficult.

Bronchogenic Cyst↗
PubMed1992

Unusual complication of temporary pacing wires in children.

There have been numerous complications described concerning temporary epicardial pacing wires including infection, bleeding, and coronary artery graft disruption. We report a case in which the heart was ensnared by the pacing wire, resulting in cardiac decompensation during attempted removal. This complication may be avoided by assuring that a smaller loop of pacing wire remains in the pericardium.

Aortic Valve Stenosis↗
PubMed1991

Stair climbing as an exercise test to predict the postoperative complications of lung resection. Two years' experience.

The results of a clinically performed preoperative stair climb was compared to the presence of postthoracotomy complications in the retrospective hospital record review of 54 adult men. The stair climb was a maximum of five flights (125 steps) performed at the patient's rate and terminated at his request. Pulmonary function measurements and facets of the stair climb physiology were also examined in reference to the presence, type, and severity of complications experienced. Most minor complications such as transient arrhythmias, atelectasis, and pneumonia were clearly not predicted by the stair climb performance. The ability to climb three flights preoperatively most clearly separated those patients having the longer postoperative intubation and hospital stay, greater frequency of complications, and cumulative complication score (p less than 0.005). This retrospective study did not have sufficient numbers of fatal cardiopulmonary complications to exclude the possibility that these may be predicted by the results of this simple test.

Adult↗
PubMed1990

Effect of sorbitol gum chewing on plaque pH response after ingesting snacks containing predominantly sucrose or starch.

The purpose of this study was to determine the effect of chewing a sorbitol gum (Trident) for 10 minutes on interproximal plaque pH changes following ingestion of selected sucrose- or starch-containing foods. The snacks containing predominantly sucrose (and/or simple sugars) were chocolate bar, cream-filled cupcakes, cream-filled sandwich cookie, cherry pie and raisins. The snacks containing predominantly starch were oat cereal, granola bars, pretzels, potato chips and corn chips. Plaque pH responses were monitored using an indwelling wire-telemetry system in five adult panelists. The test design involved two sets of 5 x 5 Latin square randomization in which each set consisted of two series of tests. In the first series of tests, the fasted, resting plaque pH was recorded for 5 minutes, panelists ingested the designated snacks for 2 minutes, and the pH response was monitored for the remainder of a 2-hour period. In the second series of tests, the same procedure was followed through the snack ingestion. After the pH response to the snack was monitored for 15 minutes, the panelists were asked to chew one stick of sorbitol gum for 10 minutes and the pH response was then monitored for the balance of the 2-hour period. Results indicated that both the sugar- and starch-containing snacks tested in this study caused significant decreases in interproximal plaque pH. Chewing a sorbitol gum after ingestion of the snacks significantly reduced the demineralizing potential of the plaque. The chewing of sorbitol gum following the ingestion of snacks can be recommended as an adjunct to other caries-preventive oral hygiene measures.

Chewing Gum↗
PubMed1990

The impact of chewing sugarless gum on the acidogenicity of fast-food meals.

The objective of this study was to evaluate the effect of chewing sorbitol gum on plaque pH following the ingestion of acidogenic fast-food meals. Plaque pH response was monitored using an indwelling wire-telemetry system in five adult panelists. From a pilot study with 12 fast-food meals, the most acidogenic breakfast, lunch and dinner were selected for this study. In the first test, the fasted, resting plaque pH was recorded for 5 minutes; panelists ingested the selected meals for 10 minutes, rinsed thoroughly with 50 ml of tap water, and the pH response was monitored for the remainder of a 2-hour period. In the second test series, the same procedures were followed through the post-meal ingestion rinse. After the pH response to the meal was monitored for 5 minutes, the panelists chewed a sorbitol gum for 15 minutes in their usual manner and the panelists were encouraged to move the gum around their mouth, however, it appeared as if they favored the side of their mouth without the partial denture. The pH response was monitored for the balance of the 2-hour period. All panelists ate the test foods, with and without the chewing gum, according to a randomized-block test design. The results indicated that the use of sorbitol gum significantly raised the plaque pH, prevented the subsequent pH drops after the fast-food meal ingestion and reduced the pH curve area under 5.5.

Chewing Gum↗
PubMed1989

Failure of preoperative staging to assess unresectability in M0 bronchogenic carcinoma.

Despite extensive preoperative staging, unresectability of a bronchogenic carcinoma may not be known until an exploratory thoracotomy is done. Failures in anatomic staging occur because of inability to detect local extent of hilar lesions and inability to detect small deposits of metastatic disease. At the University of South Carolina, nine of 75 patients who underwent thoracotomies were found to be unresectable. Using an extensive staging protocol, the "back out" thoracotomy rate can be reduced to a minimum whereas no patient is denied a chance for surgical cure.

Carcinoma, Bronchogenic↗
PubMed1989

Submaximal invasive exercise testing and quantitative lung scanning in the evaluation for tolerance of lung resection.

Lung resection in patients with cardiopulmonary dysfunction is associated with increased risk. We studied 52 elderly male patients with airflow obstruction and a lung mass. Studies were performed at rest with routine ventilatory tests and lung scan quantitation of right-left lung function. Cycle ergometry exercise was then performed at 2 submaximal work loads (25 and 40 watts). Data were obtained using systemic and pulmonary artery catheterization for blood pressures, thermal dilution cardiac output, and blood gases. Twenty-nine patients underwent lung resection and seven failed to tolerate the procedure (death within 60 days or prolonged ventilator dependence). Those parameters most clearly separating the group tolerating surgery (n = 22) from the intolerant group (n = 7) were obtained during exercise and included: cardiac index (tolerant 5.5 +/- 1.3 vs intolerant 3.9 +/- 0.3 L/min/m2, p less than .01), O2 delivery (p less than .01) and calculated VO2 ml/kg/min (tolerant 11.3 +/- 2.1 vs intolerant 7.8 +/- 1.5 ml/kg/min, p less than .001). Pulmonary vascular pressures and calculated resistance did not predict intolerance. Calculated VO2 at 40 watts did not separate those patients who had survivable complications from those who did not (p much greater than .05). Multivariate analysis suggests that exercise VO2 is an important predictor of tolerance of lung resection because it reflects the effects of cardiac function and O2 transport. In our patients with COPD, submaximal exercise testing predicted intolerance of lung resection better than calculation using quantitative lung scanning. Exercise testing may accomplish this goal by uncovering deficits in O2 transport.

Aged↗