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Biomedical subjects

Charles C Miller

Publications and source records attributed to Charles C Miller.

41 records · Page 3Linked to original sources
PubMed2002

Is acute type A aortic dissection a true surgical emergency?

Untreated acute aortic dissection involving the ascending aorta (type A) is associated with a high early mortality owing to rupture. Despite advancements in surgical technique and critical care, early mortality remains high. Operative mortality may be related to the technical challenges associated with intervening on the acutely dissected aorta as well as the multiorgan insult it induces. In this article, we review our approach to acute type A aortic dissection with regard to diagnosis, initial medical management, surgical repair, and timing of repair.

Acute Disease↗
PubMed2002

Thoracoabdominal and descending thoracic aortic aneurysm surgery in patients aged 79 years or older.

OBJECTIVE: Advanced age has been reported as a predictor of increased morbidity and mortality in patients who undergo major cardiovascular reconstructive surgery. In this study, we evaluated the outcome of patients aged 79 years or older after thoracoabdominal and descending thoracic aortic aneurysm repair. METHODS: From February 1991 to May 2001, 854 patients underwent operation for thoracoabdominal or descending thoracic aortic aneurysm. Fifty-six patients were between the ages of 79 and 88 years at the time of surgery, and these patients were included in this study. Risk factors were analyzed for their impact on mortality and morbidity in these elderly patients with univariate analysis. RESULTS: In patients at low risk, the 30-day mortality rate was 7/42 (17%), compared with 7/14 (50%) in patients at high risk with emergency presentation, congestive heart failure, or diabetes (P <.03). Four patients (7%; 4/56) had neurologic deficits develop. No single preoperative risk factor was significantly associated with increased mortality or neurologic deficits. CONCLUSION: Thoracoabdominal and descending thoracic aortic aneurysm repair in elderly patients can be undertaken with acceptable mortality and morbidity, provided that patients are selected appropriately.

Age Factors↗
PubMed2002

Spinal cord protection during aortic cross clamping: retrograde venous spinal cord perfusion, distal aortic perfusion, and cerebrospinal fluid drainage.

OBJECTIVE: We investigated retrograde venous spinal cord perfusion (RVP), with the established adjuncts cerebrospinal fluid drainage (CSFD), and distal aortic perfusion (DAP) in the canine model. We then examined the clinical feasibility of RVP, DAP, and CSFD. DESIGN: Canine study: Twenty dogs were randomized to four treatment groups. All animals underwent 60 min of complete aortic cross-clamp. Group 1 was the control and received only aortic cross-clamp; group 2 DAP and CSFD; group 3 DAP, CSFD, and RVP; and group 4 CSFD plus RVP. Human study: Five patients underwent aortic graft replacement of the descending or thoracoabdominal aorta, while receiving CSFD, DAP, and RVP. RESULTS: Canine study: All animals in groups 1 and 4 awoke paralyzed. One animal each in groups 2 and 3 were paraparetic, with the remaining dogs neurologically intact. Groups 2 and 3 differed from groups 1 and 4 at p < 0.0001. Human study: No mortality or permanent complications were observed in this group. CONCLUSION: While RVP did not reduce neurologic injury, neither did it increase morbidity. In humans the method is technically feasible and free from major problems. Further animal studies and randomized trials are underway at our center.

Aged↗
PubMedDate not supplied

Factors influencing career choice among medical students interested in surgery.

PURPOSE: The number of applicants to general surgery programs has recently declined. We set out to determine factors that influence career choice among medical students. METHODS DESIGN: survey; SETTING: university medical center; PARTICIPANTS: fourth-year medical students; INTERVENTION: distribution and completion of the survey. PARTICIPANTS ranked 18 items coded on a Likert scale from 1 (not important) to 8 (very important). These factors were career opportunities, academic opportunities, experience on core rotation/subinternship, role model(s) in that specialty (mentors), length of training required, lifestyle during residency, work hours during residency, ability to obtain residency position, concern about loans/debt, call schedule, lifestyle after training, work hours after training, financial rewards after training, intellectual challenge, patient relationships/interaction, prestige, future patient demographics, and gender distribution in the specialty. Students were asked to provide gender, career choice, number of programs they applied to, and the number of programs at which they were interviewed. RESULTS: A total of 111 of the 160 surveys distributed were returned (69%). A total of 48 of the students were men, 31 were women, and 32 did not identify their gender. Nineteen students were interested in pursuing a career in surgery or a surgical subspecialty. Factors predicting surgery as a career choice were career opportunities (p < 0.04) and prestige (p < 0.003). Lifestyle during residency (p < 0.0007), work hours during residency (p < 0.008), and quality of patient/physician relationships (p < 0.05) were all significantly negatively correlated with the choice of a surgical career. Students pursuing a surgical career applied to greater than 31 programs compared with 11 to 15 for the nonsurgical students (p < 0.0001). CONCLUSIONS: Prestige and career opportunities are more important to students seeking surgical residencies. Concerns about lifestyle and work hours during residency and perceived quality of patient/physician relationships were deterrents to surgery as a career choice. These issues may need to be addressed to increase the number of applicants to surgical programs.

Career Choice↗