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Biomedical subjects

M J Dougherty

Publications and source records attributed to M J Dougherty.

65 records · Page 4Linked to original sources
PubMed1993

Hepatic artery aneurysms: evaluation and current management.

Twelve patients underwent surgical treatment for hepatic artery aneurysm (HAA) at Mayo Clinic between 1979 and 1991. Six patients presented with symptoms, while in six the HAA was asymptomatic. Two HAAs presented with rupture: one ruptured into the portal vein and one iatrogenic rupture occurred during cholecystectomy. Ultrasonography and computed tomography were important for diagnosis, while arteriography was used for planning of the operation. All HAAs were true aneurysms, with atherosclerosis being the etiology in 10 of 12 patients. The common hepatic artery was involved in 11 patients. Nine of 12 patients had aneurysms in other locations and half had major concomitant operations in addition to HAA repair. One patient had hepatic artery ligation, while in eleven the artery was reconstructed. Graft patency was poor (25%) when the gastroduodenal artery was excluded from the repair. No hepatic morbidity occurred. Mortality was 100% (1/1) for emergent operation, and 9.1% (1/11) in the elective setting. Because of the prevalence of other aneurysms, complete vascular evaluation and close follow-up are recommended.

Aged↗
PubMed1993

Optimizing technical success of renal revascularization: the impact of intraoperative color-flow duplex ultrasonography.

PURPOSE: Technical problems with renal revascularization can be difficult to detect, especially with end points of transaortic renal endarterectomies or anastomosis of bypass grafts to small distal renal arteries. If missed, such technical mishaps may not be recognized until after operation, when the chance for timely renal salvage has often been lost. METHODS: To evaluate the value of newer color-flow duplex imaging, we performed intraoperative ultrasonography on 35 patients undergoing revascularization of 64 renal arteries, 29 patients undergoing transaortic endarterectomy, and 6 undergoing bypass grafting. Most patients (24/35; 69%) underwent concomitant aortic reconstruction. Ninety-four percent had hypertension, whereas 66% had associated chronic renal insufficiency. RESULTS: Technical abnormalities prompting operative revision were identified during surgery in 10.9% of reconstructed main renal arteries (7/64). These included two occlusions, three intimal defects, and one extrinsic tissue band after endarterectomy plus one graft anastomotic stenosis. Color-flow imaging revealed all of them. Technical defects were also associated with higher peak-systolic flow velocities (mean 2.62 m/sec; range 2.00 to 3.50 m/sec) than normal-appearing arteries (mean 1.34 m/sec; range 0.40 to 2.50 m/sec) (p = 0.004). Eighty-six percent of the defects (6/7) were immediately correctable. One patient required nephrectomy. Postoperative angiograms revealed two asymptomatic small branch-vessel occlusions (3%). Compared with preoperative levels (p < 0.01), both hypertension and renal insufficiency improved initially. The clinical outcome of patients requiring intraoperative revision did not differ from that of patients undergoing normal intraoperative studies. CONCLUSION: Intraoperative color-flow duplex detection and surgical correction of technical problems with renal revascularization have enhanced our technical success and been associated with long-term results comparable to those of patients undergoing normal intraoperative studies.

Aged↗
PubMed1992

Pulmonary hypertension predicts mortality and morbidity in patients with dilated cardiomyopathy.

OBJECTIVE: To ascertain whether pulmonary hypertension, as assessed noninvasively by continuous-wave Doppler of tricuspid regurgitation, can be an important independent factor in the prognosis of patients with ischemic or idiopathic dilated cardiomyopathy. DESIGN: Cohort study of consecutive patients with dilated cardiomyopathy in whom follow-up was obtained on all survivors for 28 months. SETTING: Outpatient cardiology private practice office in a tertiary care center. PATIENTS: Consecutive sample of 108 patients who presented for a scheduled office visit during a 15-month period. MEASUREMENTS: M-mode, two-dimensional, and Doppler echocardiographic examinations were done on all patients at entry into the study and on survivors 1 year later. All examinations included extensive pulsed- and continuous-wave Doppler evaluation for tricuspid regurgitation. MAIN OUTCOME MEASURES: Overall mortality, mortality due to myocardial failure, and hospitalization for congestive heart failure. RESULTS: Twenty-eight patients had a high velocity of tricuspid regurgitation (greater than 2.5 m/s), and 80 patients had a low velocity (less than or equal to 2.5 m/s). After 28 months of follow-up, the mortality rate was 57% in patients with a high velocity compared with 17% in patients with a low velocity (difference of 40%, 95% CI, 20% to 60%). Hospitalization for congestive heart failure occurred in 75% and 26% of patients, respectively (difference of 49%, CI, 30% to 68%). Eighty-nine percent of patients with a high velocity either died or were hospitalized compared with only 32% of patients with a low velocity (difference of 57%, CI, 42% to 72%). The peak velocity of tricuspid regurgitation was the only prognostic variable selected using stepwise logistic regression models for the three outcome events. CONCLUSION: Noninvasive assessment of pulmonary hypertension using continuous-wave Doppler of tricuspid regurgitation can predict morbidity and mortality in patients with ischemic or idiopathic dilated cardiomyopathy.

Adult↗
PubMed1992

Should patients with post-resection locoregional recurrence of lung cancer receive aggressive therapy?

The outcome of thirty-seven patients with a post-resection locoregional recurrence of non-small cell lung cancer treated with radiation therapy alone between 1979 and 1989 was compared to that of 759 patients with unresected non-small cell lung cancer also treated with standard radiation during the same period. Each patient's locoregional recurrence was staged using the current American Joint Committee on Cancer staging system. Comparison of pretreatment characteristics between the two groups, including age, sex, extent of weight loss, performance status, stage, and histologic subtype revealed fewer patients with greater than 5% weight loss (35 vs. 47%, p = 0.04) and more cases with squamous histology (54 vs. 28%, p = 0.01) among the patients with locoregional recurrences than those with newly diagnosed lesions. Over 80% of both groups had clinical stage III lesions. The median radiation doses were 56 and 59 Gy for recurrent and newly diagnosed cases (p = NS). For the patients with locoregional recurrences, the median time from resection to recurrence was 13 months (range: 3-118 months), and the recurrences were predominantly nodal in 25 cases, chest wall/pleural in four and at the bronchial stump in eight. When measured from the date of documented recurrence, the median survival time and 2-year actuarial survival rate of the patients with recurrent lesions were 12 months and 22%, as compared to 12 months and 26% for the newly diagnosed patients (p = NS). Freedom from documented locoregional tumor progression at 2 years was 30% for both groups. Patients with bronchial stump lesions had superior survival to those with nodal or chest wall recurrences, with a median survival time of 36 versus 9 months. A therapeutic approach to selected patients with post-resection locoregional recurrence of non-small cell lung cancer equally aggressive to that for newly diagnosed lung cancer patients is justified by these results, especially for patients with bronchial stump recurrences.

Adult↗
PubMed1991

Sarcomas of the gastrointestinal tract. Separation into favorable and unfavorable prognostic groups by mitotic count.

The authors reviewed the Massachusetts General Hospital experience with primary malignant stromal tumors of the gastrointestinal tract since 1962. Fifty-one of fifty-five lesions were leiomyosarcomas, and the most common anatomic location was the stomach (47%), followed by small intestine (24%), rectum (11%), colon (7%), duodenum (5%), and esophagus (5%). Most patients presented with gastrointestinal bleeding. There were peaks in age incidence in the fourth and sixth decades. All patients underwent surgery initially, and 40 of 55 had resections with "curative intent." Radiation therapy and chemotherapy were employed to a lesser extent, mainly in a palliative setting. The authors found that using number of mitoses per high-power field as the sole determinant of tumor grade yielded two very distinct clinical populations. Patients curatively resected with low-grade lesions had a better than 80% disease-free survival at 8 years, compared with a mean disease-free interval of only 18 months for high-grade lesions. In resectable disease, tumor grade appears to be the single most important prognostic factor. For gastric lesions there was no apparent advantage in extended resections compared with lesser resections encompassing all gross disease. Because of limited numbers of patients, no benefit could be demonstrated for adjuvant radiotherapy.

Adolescent↗
PubMed1991

Methods of reducing Ascogregarina chagasi parasitaemia in laboratory colonies of Lutzomyia longipalpis.

Ascogregarina chagasi is an aseptate gregarine parasite found naturally in populations of Lutzomyia longipalpis. Under intensive rearing conditions in the laboratory, the parasite is known to reduce longevity and egg production, therefore, it is thought to be a major contributing factor to the phenomenon of colony crashes. A study is described to test egg cleansing techniques, with a view to controlling this parasite in laboratory colonies. Methods used include washing eggs with formol, benzalkonium chloride and irradiating with ultraviolet light. It was concluded that cleansing with 0.1% formol solution was the most efficient method of controlling A. chagasi.

Animals↗
PubMed1989

Effect of alpha-adrenergic blockade on the cardiovascular responses to hypoxemia and hypercapnic acidosis in conscious dogs.

In order to evaluate the role of the alpha-adrenergic system in the systemic and renal hemodynamic changes of the acute combined blood gas derangement, seven conscious mongrel dogs in careful sodium balance (80 mEq/day for 4 days) were evaluated. Each animal was evaluated during combined acute hypoxemia (PaO2 = 35 +/- 1 mm Hg) and hypercapnic acidosis (PaCO2 = 56 +/- 2 mm Hg; pH = 7.18 +/- 0.01) with (i) vehicle (D5W) alone and (ii) alpha 1-adrenergic blockade with prazosin, 0.1 mg/kg iv. Mean arterial pressure increased during the combined blood gas derangement with vehicle. In contrast, mean arterial pressure fell during combined acute hypoxemia and hypercapnic acidosis with alpha 1-adrenergic blockade. The mechanism for abrogation of the rise in mean arterial pressure during the combined blood gas derangement by alpha 1-adrenergic blockade appeared to be through attenuation of the rise in cardiac output rather than an exaggerated fall in total peripheral resistance. These observations suggest that the alpha-adrenergic system is important in circulatory homeostasis during the combined blood gas derangement.

Acidosis↗
PubMed1984

Orbital recurrence of choroidal melanoma 20 years after enucleation.

A 54-year-old woman developed an orbital mass 20 years after enucleation of the left eye for a choroidal melanoma, which proved to be of spindle-A type. Computed tomography of the orbit suggested the diagnosis of a cavernous hemangioma, but orbital biopsy confirmed the diagnosis of recurrent malignant melanoma and the patient was managed by orbital exenteration followed by radiotherapy. The orbital recurrence was of the mixed cell type, suggesting a gradual 20-year transition of the spindle-A cells to spindle-B and epithelioid cells. We recommend that the selected surgical management of extrascleral extension of uveal melanomas be determined by the degree of extrascleral involvement and by whether the extrascleral extension is discovered clinically, at surgery, or in the pathology laboratory. We recommend that orbital computed tomography be performed periodically after enucleation in all patients who have orbital extension of uveal melanomas.

Choroid Neoplasms↗
PubMedDate not supplied

Converting from general anesthesia to cervical block anesthesia for carotid endarterectomy.

Between January 1, 1992 and June 30, 1998, vascular and general surgery residents performed 401 carotid endarterectomies (185 cervical block, 216 general anesthesia) under supervision of vascular attending surgeons. In January 1995, cervical block anesthesia was newly instituted. Initially anesthesiologists were randomly assigned to these cases and anesthetic technique was not standardized. At the surgeons' insistence later in the series, three specially trained anesthesiologists routinely administered cervical block anesthesia. As experience grew, surgeons realized that operating time greater than 2 hours and high neck dissections requiring mandibular retraction were poorly tolerated by cervical block anesthesia patients but that repeat carotid endarterectomies could be safely performed. Shunts were selectively inserted if significant electroencephalographic changes occurred or carotid stump pressures were less than 50 mm Hg systolic when general anesthesia was used; neurologic changes occurred when cervical block anesthesia was used; or there was a history of ipsilateral stroke for either anesthetic method. Despite an initial learning curve with cervical block anesthesia, the stroke-mortality rate was similar between the two groups (general anesthesia: 1.9% [four cerebrovascular accidents, two deaths]; cervical block anesthesia: 1.6% [two cerebrovascular accidents, two deaths]). Eight (12%) of the first 66 cervical block anesthesia patients were converted to general anesthesia compared to 2 (1.7%) of the most recent 119 patients with cervical block anesthesia (p = 0.03). After cervical block anesthesia was initiated, seven of the first eight repeat carotid endarterectomies were performed using general anesthesia compared to one of the most recent six repeat cases (p = 0.02). As surgeons' comfort with cervical block anesthesia increased, 94% (100) of the most recent consecutive 106 carotid endarterectomies were performed using this technique. These results suggest that carotid endarterectomy can be performed as safely using cervical block anesthesia as general anesthesia, specialized anesthesiologists are essential to achieve a successful outcome, selected repeat carotid endarterectomies can be performed using cervical block anesthesia, very cephalad lesions are best treated using general anesthesia, and surgical trainees can safely perform carotid endarterectomy under attending surgeon supervision if the operation is carried out expeditiously.

Anesthesia, General↗