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Biomedical subjects

K L Franco

Publications and source records attributed to K L Franco.

8 recordsLinked to original sources
PubMed1992

Mechanical circulatory support decreases neurologic complications in the treatment of traumatic injuries of the thoracic aorta.

The surgical treatment of traumatic injuries of the thoracic aorta is controversial because a number of technical approaches have been recommended. Despite the technique employed, spinal cord ischemia continues to be a persistent problem. Nineteen patients with confirmed aortic injuries secondary to blunt trauma were treated at the Yale-New Haven (Conn) Medical Center from 1984 to 1991. The patients were analyzed in two groups: group 1 (n = 10) underwent repair using mechanical circulatory support and group 2 (n = 9) underwent repair without mechanical circulatory support. Sixteen patients survived. Three patients died of complications of multiple trauma. The groups were comparable with respect to aortic cross-clamp time, preoperative systolic blood pressure, and Injury Severity Score. Three patients in the nonmechanical support group developed neurologic complications (P less than .05). No patient in the mechanical support group had a neurologic complication. We believe that mechanical circulatory support reduces the incidence of neurologic complications following traumatic injuries of the thoracic aorta and should be used whenever clinically feasible.

Academic Medical Centers↗
PubMed1990

Heart-lung transplantation: initial experience in New England.

Between May 1988 and June 1989, five combined heart-lung transplants were performed. There were two males, age 16 and 19 years, and three females age 33, 34, and 19 years. Three patients had primary pulmonary hypertension, one had cystic fibrosis, and the fifth had doxorubicin-induced cardiomyopathy with associated pulmonary hypertension. All patients were severely restricted in functional capacity and were oxygen-dependent. Four grafts were distantly procured (ischemic times 1:15, 2:35, 2:45, 3:45); one was procured on-site (ischemic time 0:58). Four of five grafts functioned well (PO2 on FIO2 30% postoperatively: 102, 120, 180, and 129 torr). One graft (distantly procured with an ischemic time of 1:15) showed total failure of oxygenation secondary to fluid overload during donor surgery; the recipient could not be weaned from cardiopulmonary bypass. All patients were extubated 24 to 30 hours postoperatively. Rejection episodes have been infrequent and all have been successfully treated with pulse steroids. Four of the five patients are alive and well with normal cardiopulmonary function and normal functional capacity 15, 12, 8, and 6 months after surgery. Heart-lung transplantation is an effective therapy for properly selected patients with end-stage cardiopulmonary disease resulting from a variety of primary disorders.

Adolescent↗
PubMed1987

Management of postoperative bleeding after tonsillectomy.

Tonsillectomy is a safe operative procedure today, but hemorrhage remains a continuing problem. Excessive bleeding requires prompt attention by the surgeon and immediate treatment. Should local measures to control bleeding fail, external carotid artery ligation may be a life-saving procedure.

Carotid Artery, External↗
PubMed1984

Effects of reperfusion after acute coronary occlusion on the beating, working heart compared to the arrested heart treated locally and globally with cardioplegia.

To determine whether acutely ischemic myocardium could be more effectively salvaged by reperfusion on cardiopulmonary bypass (CPB) in the cardioplegia-treated heart than with reperfusion in the beating, working heart, 52 greyhound dogs underwent 3 hours of left anterior descending (LAD) occlusion and were randomly assigned to one of four groups. In Group I (19 dogs) the LAD occlusion was released at 3 hours and reperfusion continued in the beating, working heart for an additional 3 hours. Group II (six dogs), Group III (14 dogs), and Group IV (13 dogs) were placed on CPB and underwent 45 minutes of hypothermic ischemic arrest protected by aortic root potassium cardioplegia. In Group II, only aortic root potassium cardioplegia was given; in Group III, the ischemic area was perfused with potassium cardioplegic solution via a graft from the internal mammary artery (IMA) to the LAD. In Group IV, blood cardioplegic solution via the IMA-LAD graft was used. After the cross-clamp and local occlusion were removed, CPB was discontinued after an additional 45 minutes and reperfusion was continued off CPB for an additional 1 1/2 hours (total 6 hours). The ischemic area at risk was determined by injecting monastryl blue dye via the left atrium while the LAD was briefly reoccluded. After the animal had been sacrificed and the left ventricle had been sectioned, the area of myocardial necrosis was determined by nonstaining with triphenyltetrazolium chloride (TTC). For each group, the ratios of area of necrosis/area at risk (AN/AR) were calculated and postreperfusion arrhythmias were documented. Postreperfusion arrhythmias were noted in 11 of 12 animals in the beating, working heart group and only two of 24 in the combined CPB groups. The mean AN/AR was 66% +/- 2% in the beating, working heart (Group I), 59% +/- 6% after infusion of potassium cardioplegic solution into the aortic root (Group II), 57% +/- 6% with blood cardioplegia (Group IV), and 38% +/- 6.5% after global and local application of the potassium cardioplegic solution into the ischemic area (Group III). This study suggests that the reperfused ischemic myocardium will sustain less necrosis and less postreperfusion arrhythmias when the heart is protected by global and local cold potassium cardioplegia on CPB.

Acute Disease↗