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Biomedical subjects

S S Oparah

Publications and source records attributed to S S Oparah.

At least 19 recordsLinked to original sources
PubMed1991

Risk of aortocoronary bypass surgery in a low-volume inner city hospital.

Incidence of coronary heart disease deaths has been reported to be higher in low socioeconomic groups compared to affluent subjects. In addition, a higher mortality rate has been reported at centers doing fewer open heart surgeries. This article presents evidence in variance with these convictions. We report a single team's experience with coronary artery surgery on 76 low socioeconomic, predominantly black patients (84%) over a period of 8 years. The volume of open heart surgery per year was less than 20. The overall mortality rate of 5.3%, infection rate of 1.3%, and perioperative infarction rate of 7.9% are not significantly different from the reported experience of high-volume surgical centers on similar patients during the same period. Thus, it is possible to obtain comparable results of myocardial revascularization surgery in low-volume, socioeconomically disadvantaged, inner city minority populations.

Adult↗
PubMed1989

Unusually low mortality of penetrating wounds of the chest. Twelve years' experience.

Within a 12-year period ending in March 1984, 1109 patients with penetrating thoracic injuries were treated at King-Drew Medical Center located in south central Los Angeles. The average age of the patients was 28.1 years. There were 607 stab wounds and 502 gunshot wounds. Antibiotic prophylaxis was prescribed only for the 428 patients who had laparotomy, thoracotomy, and pulmonary contusion with hemoptysis. Of the 1109 patients, 105 had cardiac injuries. All patients with cardiac trauma underwent thoracotomy, and the mortality rate was 18.1%. Specifically, the mortality rate of gunshot wound of the heart 24.5% and that of stab wound of the heart, 11.5%. In contrast, of the 1004 patients without cardiac injuries, only 115 required thoracotomy and the mortality rate in this group was 0.8% (8/1004). The mortality rate was 69.6% in patients who had a thoracotomy in the emergency room but only 2.8% in patients who had a thoracotomy in the operating room within the first 24 hours after admission. In the 242 patients who had associated abdominal injuries, the mortality rate was 2.1% (5/242), as compared with 2.5% (22/867) for those who had isolated chest injuries. In the entire group, the incidence of complications was 5.1%, of which 1.8% were infectious complications. The presence of associated abdominal injuries did not influence the outcome. The mortality rate in noncardiac thoracic injuries is very low compared with that of cardiac injury. Because of the complexity of the injury, gunshot wound of the heart has the highest mortality rate.

Abdominal Injuries↗
PubMed1984

Outcome of thoracic esophageal carcinoma in blacks in the inner city.

This report is based on 45 cases of cancer of the thoracic esophagus in blacks residing in a socioeconomically depressed area of the inner city of South-Central Los Angeles. There were 30 men and 15 women, ranging in age from 26 to 89 years. Preoperative management, contraindications of surgery, and overall results are specified. The operative mortality rate was 14%. As a means of restoring continuity of the alimentary tract after resection of esophageal carcinoma, the stomach was preferred, although the colon was used in two instances. Five-year survival in this series was 14% in the operative group and 13% in the radiotherapy group; one of the surgical patients is still alive, and another one survived for 72 months. In the radiation group, no such incidence occurred. It is therefore concluded that surgery is the optimal palliation if there is an acceptable risk of mortality. When operative risks are unacceptable radiation therapy is used.

Adult↗
PubMed1983

Reliability of two-dimensional echocardiography in diagnosing fungal endocarditis.

Although the techniques of M-mode and two-dimensional (2D) echocardiography (echo) have been found to be useful in patients with bacterial endocarditis, the 2D findings of fungal endocarditis are not known. In this report, we present the case of a young female narcotic addict with Candida albicans endocarditis in whom we diagnosed a large vegetation by 2D echo. Decision for surgery was made solely on the basis of the 2D-echo findings. We feel that 2D-echo findings are reliable in diagnosing fungal endocarditis because, with this technique, the size, shape, mobility, and exact location of the vegetation can be better identified than by the M-mode echo. In addition, early diagnosis of fungal endocarditis helps in treating the patients with medical and surgical therapy which may result in lower mortality.

Adult↗
PubMed1983

Surgical and nonsurgical treatment of penetrating injuries to the cervical esophagus.

We presented two patients with gunshot wounds and one patient with a stab wound of the cervical esophagus, managed conservatively, which resulted in no deaths. Results of eight studies of cervical esophageal injuries are reviewed and presented in Table I. One must consider both the surgical and conservative methods of management in planning treatment for the given patient.

Adult↗
PubMed1983

A "wandering bullet" in the thoracic esophagus.

This paper describes a patient with a perforation of the thoracic esophagus that was not recognized for 30 hours. Curiously, this patient did well without surgical intervention. Therapeutic considerations for thoracic and cervical esophageal perforations are discusses.

Adolescent↗
PubMed1980

Tissue levels of doxycycline in the human lung and pleura.

Antibiotic concentrations in the human lung and pleural tissue were measured following intravenous administration of doxycycline. The average serum levels were 9.3, 7.0 and 3.0 micrograms/ml at 1, 2, and 3 hours; correspondingly, the lung tissue levels were 6.8, 3.5 and 2.3 micrograms/g. The pleural tissue antibiotic concentrations at the same time intervals were 2.5, 1.5, and 1.5 micrograms/g. This suggests that doxycycline is retained well by the lung and the pleura, well above the minimal inhibitory concentration of most of the common bacterial pathogens of the lung, and may be used in the treatment of lung infections caused by susceptible organisms.

Doxycycline↗
PubMed1979

Experience in the management of 50 consecutive penetrating wounds of the heart.

Fifty patients with penetrating wounds of the heart were grouped into three categories, based on the clinical severity of the injuries. Gunshot wounds consistently resulted in a higher mortality than knife wounds. Central venous pressure (CVP) was the single most important means of determining cardiac tamponade. The survival rates in the respective groups were 6, 79 and 100 per cent. The improved survival in our series was due to a rapid transportation system, increased awareness of the significance of cardiac injuries and an aggressive surgical approach.

Adolescent↗
PubMed1978

Penetrating gunshot wounds of the chest in civilian practice: experience with 250 consecutive cases.

Our experience indicates a continued rising incidence of gunshot wounds of the chest in the United States. During the past 4 1/2 years, 250 consecutive cases were treated at the King-Drew Medical Center in Los Angeles. Ninety per cent presented with a haemothorax or haemopneumothorax. Pneumothorax alone was present in only 3 per cent of cases. Twenty per cent had associated intra-abdominal injuries, involving mostly the diaphragm, liver, spleen and the gastrointestinal tract. Eighty per cent were treated with tube thoracostomy and among these there were 2 deaths, neither being related to the chest injury. About 16 per cent underwent thoracotomy with a mortality of 12.8 per cent, all the deaths being caused by severe cardiac wounds. The overall mortality was 2.8 per cent. The complication rate was 5.3 per cent, most complications occurring in patients with associated intra-abdominal and spinal cord injuries. The average period of hospitalization was 6.5 days. The management plan and the indications for the two courses of therapy are discussed.

Adolescent↗
PubMed1978

Traumatic thoracobiliary (pleurobiliary and bronchobiliary) fistulas: clinical and review study.

Thoracobiliary fistulas are rare complications of thoracoabdominal trauma, with high morbidity and potentially high mortality. Our experience with four cases and 12 other cases collected from the literature are reviewed. All patients were male and average age was 25 years. Five had blunt trauma, three had stab wounds, and eight, gunshot wounds. All had diaphragmatic and hepatic injuries. Bronchobiliary fistulas with biliptysis developed in seven patients. Fever, cough, chest and RUQ pains were the most common presenting symptoms. Pleural effusion and elevated right hemidiaphragm were the most common X-ray findings. Bile empyema developed in 2/3 of the patients. Early diagnosis, tube thoracostomy with adequate drainage of all subphrenic billious collections, and secure closure of all diaphragmatic perforations are essential in successful management of most of these fistulas. Thoracotomy, however, is indicated in chronic and complicated fistulas, and should not be delayed beyond 3 weeks. Judicious use of appropriate antibiotics is a necessary adjunct to adequate surgical management of these fistulas. All 16 patients survived.

Abdominal Injuries↗
PubMed1976

Osteolytic lesion indicating Pseudomonas sternal osteomyelitis.

Two cases of osteolytic lesion of the sternum were caused by Pseudomonas aeruginosa. Both were in heroin addicts, and both occurred as a delayed reaction to injury in an automobile accident. Bony curettage and appropriate antibiotic therapy were sufficient for diagnosis and cure. Tobramycin sulfate (3 mg/kg/day), a new aminoglycoside, was successfully used in both instances. Excision of the sternum was not necessary.

Accidents, Traffic↗
PubMed1976

Granular cell myoblastoma of the bronchus: report of 2 cases and review of the literature.

Granular cell myoblastoma of the bronchus is rare. Two patients are described, bringing the total reported to 44. Review of the literature shows that cough, chest pain, hemoptysis, and wheezing are frequent presenting symptoms and that distal atelectasis and recurrent or persistent pneumonitis are common roentgenographic findings. Though the histogenesis of this tumor remains controversial, most pathologists now believe that the cells have a neurogenic origin. Adequate open surgical resection is the treatment of choice.

Adult↗
PubMed1976

Penetrating stab wounds of the chest: experience with 200 consecutive cases.

The incidence of penetrating wounds of the chest is rising rapidly. Opinions continue to differ on their management. Our experience with 200 consecutive cases of stab wounds of the chest between 1972 and 1975 were reviewed. There were 176 males and 24 females. The average age was 31 years; about two-thirds of the patients were under 30. About 74% presented with hemothorax or hemopneumothorax; 21 presented with pneumothorax. Eleven per cent had associated intra-abdominal injuries. Seventy-nine per cent were successfully treated with tube thoracostomy. About 15% underwent thoracotomy, with three deaths (mortality, 10%); the mortality for cardiac wounds was 16%; overall mortality was 1.5%. The overall complication rate was 5.5%, most occurring in patients with cardiac wounds and associated intra-abdominal injuries. The average period of hospitalization was 6.5 days. Treatment was individualized. Indications for each course of therapy are discussed.

Abdominal Injuries↗
PubMed1976

Reduction of blood usage in open heart surgery.

A series of 142 adult patients undergoing open-heart surgery were studied. All known blood-conservativing methods were utilized in an attempt to use as little blood as possible. Hemodilution, autologous transfusion, prevention of wasting of blood, and management of postoperative anemia were the measures employed. An average of 2.66 units of blood were given per patient during the entire hospital stay. Twenty patients were not given any blood at all. The patients were removed from cardiopulmonary bypass without difficulty when the hematocrit reading was in the high teens or low twenties. Later in the postoperative period the patients seemed to progress without difficulty with hematocrit readings of 22 to 25 percent.

Blood Transfusion↗
PubMed1975

Mitral valve replacement with a turtleneck-disc prosthesis.

A 5 year experience in 100 patients with a turtleneck-cuff (Magovern) disc valve (Harken) is presented. The prosthesis was inserted into the atrioventricular position by a continuous suture technique. The operative mortality rate was 7 per cent and the late mortality rate, 8 per cent. Age, functional classification, multiple valve replacement, pulmonary hypertension, and reoperation did not influence the operative mortality rate. However, the incidence of late death was much higher among patients in Class IV than in Class III and was also greater when more than one valve was replaced. The incidence of combined early and late thromboembolic complications was 7 per cent. Peribasilar leaks or valve dehiscences were not encountered.

Adult↗
PubMedDate not supplied

Early thoracotomy for stab wounds of the heart.

Fifteen consecutive patients with stab wounds of the heart are reviewed. The left ventricle was stabbed in six patients and right ventricle in four. Sinus tachycardia was present in 54% and hypotension in 67% of cases. Central venous pressure recorded in ten patients was elevated in all but one. Generalized ST segment elevation was the rule among the available preoperative recordings. One patient had right bundle branch block. Thirteen of the fifteen patients had a thoracotomy and two had pericardiocentesis only. Sixty nine percent of the thoracotomies were performed within two hours of the injury. There was only one death of a patient who arrived with no blood pressure or heart sounds. An average follow-up of 20 months revealed long-term sequela of an asymptomatic ventricular aneurysm in one patient. Our unusually gratifying results support the approach of emergency thoracotomy in patients with penetrating cardiac trauma.

Adolescent↗