Effects of quinidine and amiodarone on blood pressure during rapid ventricular pacing in coronary artery disease.
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Aged↗
Biomedical subjects
Y Shyr
Publications and source records attributed to Y Shyr.
Preoperative risk factor assessment in liver transplantation.
BACKGROUND: Despite the increasing success of liver transplantation, there is lack of objective data defining appropriate candidate suitability. This study was undertaken to determine preoperative risk factors that independently or in combination affected outcome after orthotopic liver transplantation. METHODS: We reviewed data on 229 consecutive adult liver transplant recipients. Thirty-one preoperative risk factors recorded at the time of listing and immediately before transplantation were analyzed. Outcome variables included hospital mortality rates, bacterial or fungal sepsis, and the need for renal support. RESULTS: The overall hospital mortality rate was 15.7%. Patients who were in the intensive care unit immediately before transplantation had the highest hospital mortality rate (32.6%; p = 0.006), incidence of bacterial sepsis (51%; p = 0.001), fungal infection rate (27.6%; p = 0.001), and need for renal support (38.7%; p = 0.001). Preoperative renal dysfunction was significantly associated with sepsis and was reflected in higher hospital mortality rates (29.5%; p = 0.011). Child-Pugh class C was associated with higher mortality rates (23.9%; p = 0.017), an increased incidence of bacterial (37.2%; p = 0.020) and fungal infection (20.3%; p = 0.049), and a 30.4% requirement for postoperative renal support (p = 0.004). CONCLUSIONS: These results emphasize the need for earlier referral and transplantation in patients with advanced liver disease. Further studies are needed to refine identified risk profiles and devise strategies to decrease morbidity and mortality rates.
Adult↗
Reamed intramedullary femoral nailing after induction of an "ARDS-like" state in sheep: effect on clinically applicable markers of pulmonary function.
OBJECTIVES/HYPOTHESIS: At present, the optimal treatment for appropriately resuscitated, multiply injured patients includes fixation of long bone fractures within twenty-four hours of injury. This management approach has been shown to decrease the incidence of pulmonary complications, multiple organ failure, and death. Some investigators have hypothesized that acute reamed intramedullary nailing of the femur (RIMNF) may result in pulmonary dysfunction as a result of the pulmonary fat embolization generated during this procedure. Patients with concomitant thoracic trauma may be at particular risk for this potentially severe complication. In an attempt to determine whether RIMNF can be safely carried out regardless of the severity of a pulmonary injury, we monitored the pulmonary effects of RIMNF in sheep in which an acute respiratory disorder (ARDS)-like state had been induced. Our hypothesis was that, if the pulmonary fat embolization that occurs as a result of RIMNF has a clinically significant effect, it would be detectable in an animal model in which a severe lung injury had been induced prior to the start of RIMNF. STUDY DESIGN: This was an acute experimental procedure performed on yearling sheep. METHODS: Reamed intramedullary nailing of the femur was performed in two groups of instrumented sheep. The first group had no pulmonary injuries. The second group had an ARDS-like state induced by intravenous infusion of perilla ketone prior to RIMNF. Perilla ketone increases pulmonary microvascular permeability without changing filling pressures and is used to induce a model of human ARDS. Hemodynamic and oximetric parameters were measured or calculated, as was pulmonary dynamic compliance during the experiment. RESULTS: Infusion of perilla ketone caused a significant pulmonary injury. RIMNF caused no additional significant effect on intrapulmonary shunt, mixed venous oxygen saturation, or dynamic compliance, which are clinically used to assess the severity of pulmonary dysfunction in injured patients. CONCLUSIONS: The fat embolization that occurs during RIMNF in an appropriately resuscitated sheep has no clinically significant effect on pulmonary function, even in the setting of a severe pulmonary dysfunction.
Animals↗
Length of operative procedures: reamed femoral intramedullary nailing performed with and without a fracture table.
OBJECTIVES: To determine whether performing reamed intramedullary nailing of the femur without the use of a fracture table decreases the length of operation. DESIGN: Retrospective. SETTING: Level 1 trauma center, Nashville. Tennessee. PATIENTS/PARTICIPANTS: Consecutively treated patients with fractures of the femoral shaft were treated with intramedullary nails from June 1986 to March 1996. INTERVENTION: Reamed intramedullary nailing of the femoral shaft was performed with the use of a fracture table or with the leg draped free on a radiolucent table. MAIN OUTCOME MEASUREMENTS: Length of anesthesia time, prep and drape time (from the point the anesthetized patient is turned over to the surgeons until incision), and intramedullary nailing time (from incision until end of surgery) for reamed intramedullary nailing of the femoral shaft performed with and without the use of a fracture table were compared. RESULTS: Univariate analysis showed statistically significant decreases in the length of prep and drape time, operative time, and anesthetic time when fractures were treated without the use of a fracture table. Multivariate analysis showed that use of a fracture table prolongs prep and drape time (plus twenty minutes), operative time (plus seventeen minutes), and anesthesia time (plus seventy-three minutes) when the covariates of age, sex, fracture location, learning curve, position of the patient, nail brand, and number of distal bolts are controlled. CONCLUSIONS: Reamed intramedullary nailing of the femoral shaft performed without the use of a fracture table is significantly faster than when the procedure is performed with a fracture table.
Adolescent↗
Bone age determination in children with Legg-Calvé-Perthes disease: a comparison of two methods.
In 100 children (17 girls, 83 boys) with Legg-Calvé-Perthes disease, the average chronological age, pelvis bone age, and hand-wrist bone age were significantly different for the girls (8.2, 6.9, and 7.0 years, respectively; p < 0.05) and the boys (8.2, 7.4, and 5.9 years, respectively; p < 0.05). For the girls, the chronological age was greater than the pelvis bone age and the hand-wrist bone age (p < 0.05); there was no difference between the pelvis and hand-wrist bone age. For the boys, the chronological age was greater than the pelvis bone age and the hand-wrist bone age (p < 0.05); the pelvis bone age was greater than the hand-wrist bone age and less than the chronological age (p < 0.05). The acromelic growth in Legg-Calvé-Perthes disease may explain why the more proximal pelvis bone age in boys was less delayed than that of the more distal hand-wrist.
Age Determination by Skeleton↗
Does intraarticular morphine improve pain control with femoral nerve block after anterior cruciate ligament reconstruction?
In a prospective, randomized, double-blinded manner, we compared the effects of a preoperative intraarticular injection of morphine (5 mg) or a placebo, combined with a postoperative femoral nerve block, on postoperative pain. Sixty-two patients underwent an arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. No statistical difference between the two groups was evident in terms of age, sex, weight, operative time, volume of bupivacaine received with the femoral nerve block, or tourniquet use or tourniquet time. Comparison of visual analog scale pain scores revealed no statistical difference between the groups at any point after the operation. Both groups had a significant decrease in visual analog scale scores after the femoral nerve block, with the lowest mean values 4 hours after the operation (morphine group, 1.7; placebo group, 1.4), and continuing to be significantly less through 24 hours (morphine, 2.6; placebo, 2.9). No significant difference in postoperative narcotic medication use was evident in the recovery room or at home. A post hoc power analysis revealed that the study power reached 87%, with a significance level of 5%. The postoperative femoral nerve block was effective, and intraarticular morphine provided no additional benefit.
Analgesics, Opioid↗