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Biomedical subjects

R J Petersen

Publications and source records attributed to R J Petersen.

At least 19 recordsLinked to original sources
PubMed1996

Patient characteristics, safety, and benefits of same-day admission for coronary artery bypass grafting.

BACKGROUND: The move toward outpatient and same-day surgery has been phenomenal in the past several years. Efforts in this area have focused on limiting inpatient hospitalization, reducing ancillary services, and decreasing length of stay. METHODS: Two hundred seventy-six DRG 107 patients who were operated on at our institutions in 1994 and registered in The Society of Thoracic Surgeons National Cardiac Surgery Database were reviewed. There were 185 patients randomly admitted to the hospital on the day of operation and 91 patients admitted 1.78 +/- 1.94 days before. These patients were analyzed according to The Society of Thoracic Surgeons National Cardiac Surgery Database predicted risk group and expected operative mortality modules. Univariate analysis of all risk variables listed in The Society of Thoracic Surgeons National Cardiac Surgery Database were used to identify the difference between 176 elective procedure patients in the same-day admission group and 67 elective procedure patients in the non-same-day admission group. RESULTS: The same-day admission group had lower expected operative mortality (1.3% versus 2.9%), fewer female patients (17% versus 29%), younger age (62 versus 67 years), and fewer patients in the higher predicted risk group. Univariate analysis showed only age and ejection fraction variables were significantly different between the two elective groups. Comorbidities predictive of elective non-same-day admission revealed that age and New York Heart Association class IV were significant predictors. The length of stay was shorter and the total charges were less in the same-day admission group. CONCLUSIONS: There was no increase in preoperative, intraoperative, or postoperative complications in the same-day admission patients. Same-day admission was safe and cost-effective and could be carried out as a routine admission for several selected groups of patients.

Aged↗
PubMed1996

North American experience with the Perma-Flow prosthetic coronary graft.

BACKGROUND: The Perma-Flow prosthetic coronary graft is a 5-mm polytetrafluoroethylene tube into which is incorporated a Venturi flow restrictor. An aorto-superior vena caval fistula is created and coronary anastomoses are constructed proximal to the resistor in side-to-side fashion, where arterial pressure is maintained. From November 1992 through December 1995, eight investigational centers in North America have implanted this graft in 40 patients with inadequate autologous alternatives. METHODS: Patients were selected for inclusion in this study if coronary artery bypass grafting was required and adequate autologous conduit to complete revascularization was not available. Operative data were completed by the implantating surgeon and referred to a central center, the Minneapolis Heart Institute, for correlation. Follow-up was conducted by data coordinators at each institution, and follow-up data were obtained directly from these coordinators for inclusion in the study. RESULTS: Patient age ranged from 53 to 82 years, and 15 patients were undergoing reoperations (38%). On each Perma-Flow graft one to four coronary side-to-side anastomoses were constructed. In addition, left internal mammary artery (n = 26), greater saphenous vein (8), right internal mammary artery (4), and gastroepiploic artery (4) were used to complete revascularization. Aortic (2) or mitral valve replacement (1) was also carried out. There were seven operative deaths (18%) and two late deaths (4 and 6 months). After 1 to 37 months (mean, 13 +/- 9 months) of follow-up, 29 of 31 surviving patients are asymptomatic. Echocardiographic heart size has not increased from the postoperative value, indicating limited volume load has not affected heart size. Protocol catheterization (n = 32) in 28 patients 1 week to 1 year postoperatively revealed 7 of 73 studied coronary anastomoses (9.5%) and two distal extensions and resistors were occluded (7%). In 1 patient during sternal debridement at 1 year, no flow was found in the graft. CONCLUSIONS: The Perma-Flow graft is a useful adjunct to complete revascularization in patients with deficient autologous conduit.

Aged↗
PubMed1995

Long-term follow-up of the St. Jude Medical prosthesis in pediatric patients.

BACKGROUND: The St. Jude Medical prosthesis has become the most commonly used artificial heart valve, yet few data are available in the pediatric population. This study addresses results of the use of this prosthetic valve in pediatric patients over a 13-year time frame. METHODS: From January 1982 through June 1994, 73 patients (49 male) underwent 75 valve replacements using the St. Jude Medical prosthesis at Minneapolis Children's Medical Center. Follow-up was complete in 71 patients, with a mean follow-up of 39 +/- 32 months (mean +/- standard deviation; range, 4 to 142 months). RESULTS: Valves' positions were aortic in 36 patients, mitral or left atrioventricular valve in 34, tricuspid in 1, and double valve in 2. Patient age was 8 +/- 6 years, with a range of 1 week to 19 years. Sixteen patients were less than 24 months of age at valve replacement. Prior cardiac procedures had been performed in 82% of mitral patients, 58% of aortic patients, and all of the tricuspid and double-valve patients. Elective valve replacement was performed in 62 to 73 patients (85%). Seven patients (44%) less than 24 months of age had urgent valve replacement; 4 patients (7%) older than 24 months required urgent valve replacement. Overall early mortality was 8% (6 of 73); 36% (4 of 11) in the patients undergoing urgent valve replacement and 3% (2 of 62) in the elective group. All but one of the deaths were due to cardiac dysfunction. There were four late deaths, from 4 to 125 months postoperative, primarily caused by congestive heart failure or pulmonary vascular disease. Cumulative freedom from valve-related events was 93%, 85%, and 77% at 1, 5, and 10 years, respectively. Valve-related complications included thromboembolism (4), bleeding (5), perivalvar leak requiring reoperation (2), transient ischemic attack (1), and endocarditis (1). There have been no permanent strokes or mechanical malfunction. The majority of patients are currently managed with warfarin. Five surviving patients whose initial valve replacement was at age 24 months or younger have undergone repeat valve replacement (42%). Ninety-five percent of patients enjoy good health at follow-up. CONCLUSIONS: The St. Jude Medical prosthesis offers correction of valvular disease with low morbidity and mortality, and excellent functional result.

Adolescent↗
PubMed1995

Cost-effectiveness and predictors of early extubation.

BACKGROUND: This study examined predictors and cost-effectiveness of early extubation after coronary artery bypass grafting. METHODS: Six hundred forty-five patients admitted to intensive care units after coronary artery bypass grafting at our institutions in 1993 were reviewed. There were 455 male and 190 female patients, which included all patients in DRG 106 and DRG 107. The patients were categorized into three groups: group A (269 patients) were extubated in less than 12 hours (7.55 +/- 2.5 hours), group B (291 patients) were extubated between 12 and 24 hours (16.85 +/- 3.3 hours), and group C (376 patients) were extubated any time after 12 hours. RESULTS: The reintubation rate for the entire group was less than 1%. Univariate preoperative analyses revealed small differences between groups A and B: only 6 of 25 variables were found to reach statistical significance. Stepwise logistic regression analyses were carried out in 269 patients of group A and 376 patients of group C. Older patients (log of age, p = 0.0001), female sex (p = 0.0129; odds ratio = 1.634), use of preoperative diuretics (p = 0.0010; odds ratio = 1.965) and unstable angina (p = 0.0301; odds ratio = 1.544) were noted to be clinical factors associated with late extubation (> or = 12 hours). Early extubation was accomplished in 42%; however, further analysis revealed that many patients who were intubated overnight should have been extubated sooner. CONCLUSIONS: Early extubation shortened the postoperative length of stay, resulting in reduction of cost and resource utilization. The average hospital charge per patient was approximately $6,000 less in the early extubation group.

Aged↗
PubMed1986

Indium-111 labeled leukocyte imaging following hepatic artery embolization.

The use of In-111 labeled leukocytes for abscess localization is becoming well established. The first report of In-111 imaging following hepatic embolization is presented. A 45-year-old man with adenocarcinoma of the colon and metastatic liver disease was treated for intractable pain using particulate embolization of the hepatic artery. In-111 leukocyte imaging was performed to rule out abscess formation. The distribution of the labeled leukocytes demonstrated hepatic uptake commensurate with Tc-99m sulfur colloid (SC) images. Areas of embolization did not accumulate tracer. Pathologic examination at autopsy correlated with the distribution of the labeled leukocytes. Thus, therapeutic embolization did not alter the normal distribution of this tracer in functional hepatic tissue.

Adenocarcinoma↗
PubMed1985

Disposal of low-level radioactive waste. Impact on the medical profession.

During 1985, low-level radioactive waste disposal has become a critical concern. The issue has been forced by the threatened closure of the three commercial disposal sites. The medical community has used radioactive isotopes for decades in nuclear medicine, radiation therapy, radioimmunoassay, and biomedical research. Loss of disposal capacity for radioactive wastes generated by these activities, by the suppliers of radioisotopes, and by pharmaceutical companies will have a profound impact on the medical profession.

Legislation as Topic↗
PubMed1983

Effect of acetaminophen on the leukocyte-labeling efficiency of indium oxine In 111.

The effect of acetaminophen on the labeling efficiency of leukocytes with indium oxine In 111 was studied. A blood sample was obtained from eight healthy men before and after they received acetaminophen 650 mg every four hours for 24 hours. After dividing the plasma from each sample into three portions, leukocytes were separated and labeled with indium oxine In 111. In an in vitro study, 200 ml of blood was obtained from one of the men, and the plasma was separated into four portions. Acetaminophen in 95% ethanol was added to three of the plasma fractions to produce acetaminophen concentrations of 4, 20, and 100 micrograms/ml; ethanol was added to the fourth fraction as a control. Each plasma fraction was then subdivided into three aliquots, and leukocytes were labeled as in the in vivo study. Mean leukocyte labeling efficiencies in both studies were calculated from the ratios of leukocyte radioactivity to initial radioactivity in the samples, expressed as percentages. Leukocyte labeling efficiencies before acetaminophen administration ranged from 79 to 85%; after administration, labeling efficiencies ranged from 70 to 87%. No significant differences in mean labeling efficiency before and after acetaminophen administration were noted in any of the subjects. Leukocyte labeling efficiencies in all in vitro plasma fractions were reduced, ranging from 54 to 63%, but no significant differences in labeling efficiency between any of the plasma fractions were found. Using the labeling procedures in this study, exposure of leukocytes from healthy men to acetaminophen in vivo or in vitro does not affect labeling efficiency with indium oxine In 111.

Acetaminophen↗
PubMed1982

Detection of metastatic liver disease. Use of liver scans and biochemical liver tests.

The records of 94 patients with a known diagnosis of extrahepatic cancer having liver scan, biochemical liver tests (alkaline phosphatase, SGOT, lactic dehydrogenase, and bilirubin levels, and subsequent liver biopsy within a six-week period were reviewed. The sensitivity, specificity, and accuracy of the scan and biochemical tests in the detection of metastatic liver disease were calculated. The most sensitive single examination was the group of biochemical liver tests. Liver scans performed in the presence of normal biochemical test results were insensitive when compared with the liver scan alone or the liver scan in the presence of abnormal biochemical test results. The specificity and accuracy of all tests and test combinations were statistically equivalent. Screening for hepatic metastases in patients with cancer is best accomplished with the more sensitive and less expensive group of biochemical liver tests, reserving the liver scan for those patients with abnormal biochemical test results.

Alkaline Phosphatase↗
PubMed1975

Ethylcellulose perfluorobutyrate: a highly non-thrombogenic fluoropolymer for gas exchange membranes.

A novel fluoropolymer prepared from ethylcellulose by acylation with perfluorobutyryl chloride has been shown to be remarkably non-thrombogenic in vena cava and renal embolus ring implant tests. Gas permeabilities of this fluoropolymer are dufficient to make it highly attractive for membrane blood oxygenators, either in the form of a thin film supported by a porous substrate or as a thin coating deposited onto microporous substrates. The broad solvent solubility of this fluoropolymer allows it to be fabricated into membranes by pratical processes. Good adhesion of coatings of this polymer to rigid and semi-rigid plastic surfaces can be achieved in many cases. This fluoropolymer represents an important new biomaterial for use in blood handling and oxygenation devices.

Animals↗