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Biomedical subjects

R L Meng

Publications and source records attributed to R L Meng.

At least 19 recordsLinked to original sources
PubMed1990

A prospective study of the risk of an immediate adverse reaction to protamine sulfate during cardiopulmonary bypass surgery.

Protamine sulfate administration may cause life-threatening reactions. We prospectively examined the incidence of immediate adverse reaction after protamine in 243 patients who underwent cardiopulmonary bypass surgery. Twenty-six patients (10.7%) had reactions, and 1.6% had a precipitous drop in blood pressure immediately after protamine administration. Risk factors were previous exposure to protamine, diabetes, history of receiving protamine-containing insulin, and possibly vasectomy. However, neither a positive skin test nor a positive IgE ELISA for antiprotamine antibody predicted that a patient would have a reaction. C4a levels were increased in patients who had reactions as compared with age-, sex-, and cardiac disease-matched patients who did not have reactions, suggesting a role for complement in some reactions. Immediate adverse reactions to protamine are very common, and alternative therapies are urgently needed to eliminate the use of protamine.

Adult↗
PubMed1989

Experimental data acquisition and manipulation by microcomputer.

To improve experiment management, we developed a microcomputer system which automatically displays, collects, manipulates and stores data in real-time. Upon completion of all experiments, it automatically performs statistical analysis, prints graphs and stores the results. The components required to accomplish these tasks include: (1) a microprocessor and visual monitor; (2) transducers, each with preamplifier, filter and amplifier; (3) couplers from each amplifier to the computer; (4) software to direct display, manipulation, statistical analysis and storage of data; and (5) hardware to allow real-time graphic and hard copy display. The resulting system allows sampling rates up to 300 Hz and accuracy of 0.20% full scale, 0-200 mm Hg. It provides great flexibility, efficiency and reliability in data management, and thereby facilitates the organization and completion of research protocols. It simplicity of design and operation makes it easy to use, and it is extremely cost effective. We present a method of laboratory microcomputerization as a practical alternative for management of physiological experimentation.

Analog-Digital Conversion↗
PubMed1988

Coronary artery bypass grafting in patients with a tracheostoma: use of a bilateral thoracotomy incision.

The performance of cardiac surgical procedures via median sternotomy in patients with a tracheostoma can present difficult problems, including stomal necrosis, mediastinitis, and inadequate operative exposure. Bilateral thoracotomy is an alternative approach in such patients. This approach separates the stoma from the operative field and provides satisfactory exposure for internal mammary artery dissection and performance of coronary artery bypass grafting.

Aged↗
PubMed1988

Preoperative saphenous vein mapping for coronary artery bypass.

Saphenous vein mapping by real-time duplex ultrasound scanning allows for the confirmation of the presence of patent vein and determination of the anatomical course of the vein prior to aortocoronary bypass procedures. This technique has proven to be of value in patients whose veins are not evident by physical examination and in those whose length of conduit may be limited by previous vein stripping or thrombophlebitis.

Coronary Artery Bypass↗
PubMed1986

Coronary artery bypass grafting in dialysis patients.

Cardiac disease continues to be a major cause of death in patients undergoing long-term hemodialysis. The results of coronary artery bypass grafting (CABG) for severe coronary artery disease in long-term hemodialysis patients have been studied in a group of 12 patients who underwent CABG between January 1979 and December 1983. Hospital mortality was 8% (1 of 12 patients). This patient died of ventricular arrhythmia. Two late deaths occurred, 1 from peritonitis in a patient undergoing long-term peritoneal hemodialysis and 1 from metastatic renal cell carcinoma. The two postoperative complications (morbidity 17%) consisted of a sternal dehiscence secondary to mediastinitis and a perioperative cerebrovascular accident. Ten of the 11 hospital survivors experienced complete relief from angina. In the other patient the angina became easier to control with medication. Combining this series of patients with those previously reported in the literature allows determination of actuarial survival in a group of 25 patients followed up for 1 to 79 months (mean, 33 months). Actuarial survival was 83% at one year, 69% at three years, and 48% at five years. This is not significantly different from the survival of long-term hemodialysis patients who have coronary disease but have not undergone CABG. It appears that CABG, when performed in long-term hemodialysis patients, is associated with an only slightly greater risk of mortality and morbidity than CABG performed in routine patients. Although CABG provides considerable symptomatic relief of angina, no statistically significant change in actuarial survival can be demonstrated.

Aged↗
PubMed1986

Internal vessel occlusion: an improved technique for small vessel anastomosis.

During infragenicular bypass, internal occlusion of the distal vessel avoids unnecessary dissection and potentially damaging use of external clamps or vessel loops while improving exposure and patency. This technique is especially useful in patients with small or calcific vessels in whom distal reconstruction is necessary for limb salvage.

Humans↗
PubMed1985

Ask-Upmark kidney with contralateral renal artery fibromuscular dysplasia.

A case of Ask-Upmark kidney with coexistent contralateral renal artery fibromuscular dysplasia is presented with detailed light and electron microscopic findings. Both lesions are known to produce renin-mediated hypertension which was corrected in this patient by nephrectomy and contralateral renal artery bypass. Ask-Upmark kidney is briefly reviewed.

Adult↗
PubMed1985

Protamine-induced fatal anaphylaxis. Prevalence of antiprotamine immunoglobulin E antibody.

Protamine is used widely to reverse the anticoagulant effects of heparin and to delay the absorption of insulin. Although adverse reactions to protamine are reported infrequently and are usually mild, we recently observed the first fatal case of type I anaphylaxis resulting from protamine. This patient had previously been sensitized to protamine during cardiac catheterization and had high levels of protamine-specific immunoglobulin E in the serum. In a prospective study, we found that 10 of 19 diabetic patients (53%) who had received insulin containing insulin also had high levels of antiprotamine immunoglobulin E. In contrast, none of 27 nondiabetic healthy normal controls or 10 diabetics who had never received protamine or protamine-containing insulin had levels of antiprotamine immunoglobulin E over background. This study underscores the risks of routinely administering protamine to susceptible individuals and the need for alternative therapies.

Adolescent↗
PubMed1981

Acute ascending aortic dissection: surgical management.

The success of total aortic root replacement in conditions such as annuloaortic ectasia and complicated redo surgery has stimulated its use in acute dissection of the ascending aorta. We believe this radical approach is, in most cases, unwarranted, considering the excellent results with valve conservation. From 1970-1978, 20 consecutive patients with acute anterior aortic dissection and aortic insufficiency were operated at Rush-Presbyterian-St. Luke's Medical Center. Only one patient (5%) required reoperation for hemorrhage. The three operative deaths (15%) were associated with right coronary artery disruption, aortic-right atrial fistula and preoperative intrapericardial false lumen rupture. In eight patients, valve resuspension was combined with primary aortic repair and nine with ascending graft interposition, but aortic valve replacement was required in three because of annuloaortic ectasia or tissue friability. One patient treated by primary repair in 1971 underwent successful reoperation for redissection 7 years later (1.4% per patient-year risk of late reoperation), but the remaining 16 patients, followed 2-10 years, remain free of aortic insufficiency or recurrent aneurysm. This experience supports the use of valve reconstruction rather than replacement in most cases of acute anterior dissection of the aorta.

Acute Disease↗
PubMed1981

Survival following resection for second primary bronchogenic carcinoma.

A second resective procedure has been done on 64 patients with multiple primary bronchogenic carcinoma, and a third operation has been performed in six. Fifty-three initial resections and all repeat procedures were performed at Rush-Presbyterian-St. Luke's Medical Center. Six patients had synchronous primary cancers, and in the 58 with metachronous disease the cumulative probability of tumor-free interval was 47% at 3 years. The initial resection performed was pneumonectomy in seven, lobectomy in 40, and segmentectomy in 17 patients. At the second operation, segmental resection was done in 41, lobectomy in six, completion lobectomy in four, and completion pneumonectomy in 13 patients. At the third operation, segmentectomy was done in three, completion lobectomy in two, and completion pneumonectomy in one patient. Ten patients had a tumor of different histologic type identified at the second procedure, but all patients with three operations had the same tumor cell type in each specimen. Six patients died following the second operation (a postoperative mortality of 9.3%), but there were no deaths in the six patients undergoing three procedures. Cumulative survival following the second resection was 36% at 5 years, 22% at 10 years and 13% at 15 years. In summary, second or third surgical efforts for reappearing bronchogenic cancers are justified and have significantly prolonged survival. The use of segmental or subsegmental resective techniques have provided superior survival results.

Adult↗
PubMed1981

Ileovesical fistula: a rare complication of ileal diverticulitis.

Small bowel diverticulitis is an unusual condition but the development of a secondary enterovesical fistula is extremely rare. This report describes the second documented case of ileovesical fistula secondary to ileal diverticulitis. Definitive diagnosis was made by double-contrast enema and small bowel fluoroscopic examinations. Management should consist of dissection of the fistula with either resection or primary repair.

Aged↗
PubMed1980

Transjugular forceps retrieval of catheter embolus.

Intracardiac migration of an intravenous cathether was treated transvenously in 5 patients successfully. Using local anesthesia and fluoroscopic guidance, a bronchoscopy forceps was passed through the right jugular vein to the right atrium and afforded efficient and safe retrieval of the embolus. The direct route to the right atrium provided by the right internal jugular vein and the precise control offerred by the rigid forceps make this the preferred method of retrieval of a transvenous catheter embolus.

Adult↗
PubMed1980

Median sternotomy for synchronous bilateral pulmonary operations.

Since 1975 10 patients at Rush Medical Center have undergone synchronous bilateral pulmonary operations by median sternotomy. Nine had pulmonary metastases and one had bullous emphysema with recurrent spontaneous pneumothorax. Between three and 20 metastases were removed by wedge resection per patient, but right upper lobe anterior segmentectomy and left upper lobectomy were required in one patient. Bilateral bullae resections and plications improved pulmonary function in the patient with emphysema. The average hospital stay was 9 days, and the only complication was one reoperation for postoperative bleeding. Median sternotomy has been advantageous in selected patients with bilateral pulmonary disease because it allows one-stage completion of the required pulmonary procedures with minimal impairment of pulmonary function, shortened hospital stay, and maximal patient recovery.

Adolescent↗