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Biomedical subjects

W C Nugent

Publications and source records attributed to W C Nugent.

25 records · Page 2Linked to original sources
PubMed1991

Transesophageal echocardiography. Preliminary results in patients with traumatic aortic rupture.

Eleven patients with blunt chest trauma at risk for traumatic aortic rupture underwent transesophageal echocardiography to image the descending aorta. Diagnoses were compared with the results of radiographic studies. Ten of the 11 patients underwent arch aortography, with positive results in six cases. In one patient, the results of a computed tomographic scan were interpreted as consistent with aortic rupture. The results of transesophageal echocardiography were positive for ruptured descending aorta in three of six patients with positive aortographic findings, and negative in eight patients. All three patients with positive findings had the diagnosis of ruptured descending aorta confirmed at surgery. The remaining eight patients demonstrated no aortic morbidity. These preliminary findings suggest that transesophageal echocardiography is a useful technique for the diagnosis of ruptured descending aorta following blunt chest trauma.

Adult↗
PubMed1988

Pericardial flap prevents sternal wound complications.

By interposing a pedicle of pericardium between the heart and sternum, mediastinitis may be prevented and sternal healing facilitated. Between Jan 1, 1984, and mid-1986, before we began using the pericardial flap, the overall incidence of mediastinitis and/or sternal wound dehiscence was 2.73% (26 of 952 patients). This rate did not differ significantly among three surgeons (2.53%, 2.95%, and 2.69%). During mid-1986, two of the three surgeons adopted the use of the pericardial flap and used it on 226 of 270 patients. None of these 270 patients developed mediastinitis or sternal wound dehiscence. The third surgeon did not adopt the use of the flap and operated on 100 patients during the same period. In this group, there were three cases of mediastinitis. This difference was statistically significant. No specific complications attributable to construction of a pericardial flap were identified in our patients. We conclude that the routine use of a pericardial flap is a safe, simple, and effective means of preventing mediastinitis and/or sternal dehiscence following cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1983

Aortic valve replacement and coronary bypass in patients with severe stenosis of the left main coronary artery.

Adequate myocardial protection is difficult to achieve during operations for combined aortic valve disease and severe stenosis of the left main coronary artery. A double cross-clamp technique, which facilitates the delivery of cardioplegic solution to the myocardium, is described here. We reviewed the experiences of 11 patients, 6 of whom underwent operation using the new technique.

Aged↗
PubMed1982

Effect of the pH of cardioplegic solution on postarrest myocardial preservation.

The assumption that an alkaline cardioplegic solution is advantageous to the arrested heart is not supported by experimental evidence. Three groups of dogs were subjected to 2 hours of hypothermic arrest using a potassium cardioplegic solution of varying pH: group 1 (n = 8), pH 7.1; group 2 (n = 6), pH 7.4; and group 3 (n = 8), pH 7.7. Left ventricular (LV) function curves were obtained before arrest and after reperfusion, and the percent recovery of LV function was calculated. Coronary blood flow (CBF), oxygen and lactate use, and adenosine triphosphate and creatine phosphate were measured before and after arrest. Recovery of LV function was 83 +/- 4% (mean +/- SEM) in group 1 and 75 +/- 6% in group 2. LV function in group 3 was significantly depressed at 51 +/- 5% (p less than 0.01). Immediately after arrest, CBF and oxygen consumption were lowest in group 1 and highest in group 3 (p less than 0.01). CBF increased 23 +/- 9% in group 1, 110 +/- 29% in group 2 and 277 +/- 33% in group 3. Oxygen consumption was 2.2 +/- 0.4 vol/100 g/min in group 1, 3.63 +/- 0.5 vol/100 g/min in group 2 and 4.63 +/- 0.7 vol/100 g/min in group 3. All groups showed postarrest depression of adenosine triphosphate and creatine phosphate, but return of creatine phosphate to control was slowest in group 1 (p less than 0.01). These results indicate no advantage to an alkaline cardioplegic solution and suggest that an acidic cardioplegic solution, by inhibiting metabolism, may increase protection of the arrested heart.

Adenosine Triphosphate↗
PubMedDate not supplied

Increasing the value of cardiac care: the Dartmouth approach.

UNLABELLED: A cardiac services team at Dartmouth-Hitchcock Medical Center (DHMC) launched multiple efforts to improve the quality and value of their services. The team developed a critical path for coronary artery bypass grafting (CABG) and tracked important clinical outcomes, such as mortality rates and wound complications. The team also studied the patient's view of the process. Staff used focus groups and surveys to distill the "voice of the customer" into six quality characteristics and developed methods to better involve patients in clinical decision making and evaluation of treatment efficacy. RESULTS: CABG mortality declined from 5.7 percent in 1992 to 2.7 percent in 1994, 16 months after the critical path was developed. Mean total intubation time for patients following open-heart surgery was reduced from 22 hours to 14 hours. Median postoperative length of stay decreased from seven days to six for elective CABG patients. The number of patients discharged in five days or less increased from 20 percent to 40 percent. Readmission to the hospital following discharge remained stable, despite the shorter length of stay.

Cardiology Service, Hospital↗
PubMedDate not supplied

Factors related to rehospitalization within thirty days of discharge after coronary artery bypass grafting.

BACKGROUND: Early rehospitalization after coronary artery bypass grafting (CABG) is an expensive and frequently adverse outcome. Rehospitalization rates after various surgical procedures have been used as an indicator of quality of care. Determining the extent to which rehospitalization rates reflect patient case mix and severity of illness rather than quality of care requires detailed information regarding the patients, the care they received, and the reasons for their rehospitalization. METHODS: We conducted a nested case control study comparing 110 CABG patients who were rehospitalized within 30 days after discharge with 224 control patients. Control patients were randomly selected from patients undergoing CABG during the same time frame as the cases and were matched on age, gender, and priority of surgery. A detailed chart review provided information regarding treatment in the postsurgical period, in addition to the preoperative information collected on all CABG patients as part of an ongoing regional prospective study. RESULTS: The overall rehospitalization rate was 13.8%. The most common reasons for rehospitalization included: wound infection (19%), atrial fibrillation (13%), pleural effusion (11%), and thromboembolic event (10%). Preoperative severity of illness and comorbidity accounted for 24% of the total variance. After adjustment for these factors, discharge hematocrit less than 30% (OR = 2.01, p = 0.018) and several discharge medications including: antiarrhythmics (OR = 3.26, p = 0.047), diuretics (OR = 2.18, p = 0.055), beta blockers (OR = 0.44, p = 0.036), and long length of stay (more than 7 days; OR = 2.09, p = 0.029) were the most important predictors of rehospitalization risk. CONCLUSIONS: Although the reasons for rehospitalization after CABG are heterogeneous and related to patient severity of illness as well as comorbid status, several of the most common are potentially preventable and related to quality of care. Rehospitalization was not related to early discharge.

Case-Control Studies↗