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Biomedical subjects

Jerry W Pratt

Publications and source records attributed to Jerry W Pratt.

9 recordsLinked to original sources
PubMed2006

Functional comparison of staple line reinforcements in lung resection.

PURPOSE: Staple line reinforcement with bovine pericardium and expanded polytetrafluoroethylene during lung resections has shown reduction in air leak incidence and duration. Small intestinal submucosa and polyglycolic acid-trimethylene carbonate, have been introduced as new reinforcements for nonpulmonary staple lines. We hypothesize that reinforcement of staple lines in lungs with commercially available materials will decrease staple line leak at increased pressures. DESCRIPTION: We evaluated 8 staple lines per reinforcement material (4 groups) and a control group (n = 40) in healthy living pigs. After resections (up to four per animal), the lungs were tested sequentially using hand ventilation to increasing pressures (5-75 cm H2O). The occurrence of pressure at which leaks was recorded. EVALUATION: All reinforced staple lines exhibited higher mean leak threshold when compared with the controls; however only small intestinal submucosa achieved significance when compared with the controls. CONCLUSIONS: Commercially available reinforcements allow pulmonary staple lines to tolerate higher intrabronchial pressures without demonstrating air leak. In addition, reinforcement with small intestinal submucosa imparts a significant advantage to the other reinforcements in terms of pulmonary staple line leak rate.

Anastomosis, Surgical↗
PubMed2005

Functional assessment of a new staple line reinforcement in lung resection.

BACKGROUND: A major complication of lung resection is prolonged leaking at the staple line. Staple-line reinforcement is performed routinely during these procedures using bovine pericardium (peri-strips) and expanded polytetrafluorethylene. Both materials have been shown previously to increase staple-line durability and reduce the overall incidence of prolonged air leaking after lung resection, specifically in lung volume-reduction surgery. Small intestinal submucosa (SIS) has had many applications in human tissues consequent to its absorption and healing profile, which are well documented in human and animal models. However, it had not been studied in reinforcement of pulmonary staple lines. MATERIALS AND METHODS: We hypothesized that SIS reinforcement of staple lines in healthy lung tissue would increase durability, as determined by leak rates at increased airway pressures as compared to nonreinforced staple lines. Eight healthy juvenile Yorkshire-cross pigs were subjected to bilateral apical lung resections; one side was reinforced with SIS. The lungs were then inflated to sequentially increase intrabronchial pressures (5-75 cm H2O) for 60-second intervals while the chest was filled with saline under direct visualization monitoring for air leak. RESULTS: Staple lines reinforced with porcine small intestinal submucosa had significantly better durability as determined by Kaplan-Meier survival calculations with respect to leak rate as a function of pressure. CONCLUSION: Reinforcement of staple lines with SIS allows pulmonary staple lines to tolerate significantly higher intrabronchial pressures without demonstrating air leak at the staple line.

Air↗
PubMed2003

The military surgeon and the war on terrorism: a Zollinger legacy.

BACKGROUND: One of Dr. Robert Zollinger's greatest contributions during his time in the Army Medical Corps was the development and utilization of mobile surgical units during World War II. After September 11, 2001, the medical services of the United States Air Force and Army were deployed to support combat casualties incurred during the war on terrorism. METHODS: Information is based on the authors' recent experiences in Operation Enduring Freedom. RESULTS: Over an 8-month period, nearly ninety combat casualties, resulting primarily from blasts and penetrating injuries, received surgical care in medical facilities in Southwest Asia provided by the joint efforts of Air Force and Army mobile surgical teams. CONCLUSIONS: The importance of lessons learned from this experience and from history, as well as the joint efforts of military medical services, should be applied to the future care of combat casualties.

Afghanistan↗
PubMedDate not supplied

Heparin-induced thrombocytopenia and thrombosis syndrome after cardiac surgery.

A case report of multisystem organ failure and limb loss associated with coronary artery bypass is reported. Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) occurs in 1% to 2% of patients suffering from thrombocytopenia associated with heparin or heparinoid use, which amounts to less than 1.4% of the cardiac surgical population. It carries a risk of significant comorbidity and mortality. Providers involved in the care of such patients should be well versed in the etiology and potential complications of HITTS, the treatment options, and alternative modalities of anticoagulation available for use.

Amputation, Surgical↗
PubMedDate not supplied

Victim of fashion: Endocarditis after oral piercing.

A case report of endocarditis after tongue piercing is presented. Body piercing is a form of self-expression that is achieving greater acceptance and wider practice in modern society. Even in healthy individuals, significant health risks exist with this type of physical adornment. Despite this fact, no significant regulatory mechanisms are currently in place to guide practitioners of this craft or to protect the recipients of body piercing. Medical professionals should join the American Dental Association in their opposition of the practice of intraoral/perioral piercing and should call for the development of legislation protecting the recipients of such practices, particularly the population of young people in whom this type of body art is becoming increasingly prevalent.

Adolescent↗
PubMedDate not supplied

Anterior mediastinal nonseminomatous germ cell tumor with malignant transformation: a case report.

OBJECTIVE: We report a case of a 21-year-old man who presented with the unusual symptoms of heart failure and was found to have an anterior mediastinal yolk sac tumor. METHODS: A review of the literature using the Ovid search engine was performed. RESULTS: The patient was treated with the current standard of neoadjuvant chemotherapy: bleomycin, etoposide, and cisplatin (BEP) with marked reduction in tumor size, followed by en bloc surgical resection. The final pathology revealed teratoma with malignant change: chondrosarcoma, adenocarcinoma, and poorly differentiated sarcoma. CONCLUSIONS: This is a rare initial presentation of an anterior mediastinal germ-cell tumor with treatment consisting of neoadjuvant therapy and surgical resection. In addition, we present the adverse and extremely rare malignant degeneration of this tumor.

Adult↗
PubMedDate not supplied

Radiation pericarditis and breast reconstruction: a surgical dilemma.

OBJECTIVE: To discuss a case of radiation pericarditis and the physiology of the disease, and to discuss the left thoracotomy as an effective alternative to median sternotomy for pericardiectomy in the treatment of complicated radiation pericarditis. DESIGN: A case report with accompanying discussion of the disease and literature search. SETTING: Keesler Air Force Base Medical Center, a military training facility and general surgery residency program. PARTICIPANTS: A single case report with review of literature. RESULTS: Left thoracotomy is an effective alternative to median sternotomy for the surgical treatment of radiation pericarditis, with a mild increase in pulmonary-associated complications. CONCLUSIONS: With an increase in the use of mediastinal radiation for treatment of malignant disease as well as the increase in women having reconstructive procedures of the breast, one may expect complicated cases of radiation pericarditis that may not be amenable to median sternotomy. Left thoracotomy may be an alternative to median sternotomy for pericardiectomy in cases of pericarditis complicated by cosmetic constraints.

Breast Neoplasms↗