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Biomedical subjects

D Dougenis

Publications and source records attributed to D Dougenis.

34 records · Page 2Linked to original sources
PubMed1996

Motility disorders of the esophagus before and after pneumonectomy for lung carcinoma.

It has been noticed that patients undergoing major lung resection may occasionally develop dysphagia. A prospective study was carried out to evaluate if preoperative or postoperative esophageal motility disorders (EMD) occur in patients subjected to pneumonectomy for lung carcinoma. Twenty-five normal volunteers served as control data and 13 patients, who successfully completed manometry before and after pneumonectomy, were included in the final analysis. Studies were performed using a Gaeltec Model 6 ct/sb, 6-channel intraluminal strain gauge transducer probe. Our results demonstrated that EMD occurred in some patients suffering from lung carcinoma. However, motility disorders were most evident following pneumonectomy. These findings may explain the several anecdotal reports of patients developing dysphagia following lung resection after a variable interval of time.

Adult↗
PubMed1994

Packing the chest: a useful technique for intractable bleeding after open heart operation.

Mediastinal bleeding can be a problem after cardiac surgery, either as a result of coagulation derangements or technical problems. We evaluated 100 patients, treated with temporary chest packing for intractable bleeding, of 9,383 undergoing open heart operations during a 10-year period. Preoperatively, 60 of these patients had one or more predisposing factors for bleeding. There were four predominant sites of hemorrhage: general ooze, needle holes of the aortic and atrial suture lines, inaccessible origin, and another specific place. The chest was packed in the operating room in 84 patients and in the intensive care unit in 16. Four methods of temporary chest closure were used: the skin alone, partial sternal approximation plus skin closure, full closure, and the wound open and covered by a Steri-drape dressing. The bleeding was controlled in 65 patients who had been packed once, and in 29 patients after reexploration and multiple packings, for a total of 94 patients (94%). Sternal wound infection, generalized sepsis, and sternal dehiscence was present in 24 patients, 8 of whom died. The venue for inserting or removing the packs did not affect the incidence of infections. Our experience suggests that packing of the chest after cardiac procedures for intractable bleeding allows a reasonable patient salvage rate and complication risks.

Adolescent↗
PubMed1993

Primary sternal osteomyelitis.

Primary sternal osteomyelitis is a rare condition. Only few cases have been reported in the English literature. We describe the case of a young woman presenting with persistent fever and chest pain. Radionuclide bone scan and computed tomography of the chest were consistent with metastatic neoplasm. Surgical intervention, however, revealed primary staphylococcal osteomyelitis and the patient was successfully treated with combined extensive surgical debridement and intravenous antibiotics.

Adult↗
PubMed1992

Is repeated coronary surgery for recurrent angina cost effective?

Between January 1980 and May 1988, 1363 patients underwent first time coronary artery bypass grafting (CABG) and 49 (3.6%) were reoperated for recurrent angina by the same surgeon in this unit. There were 42 males and five females with a mean age of 53.6 years. Mean time since first operation was 68.9 (37 SD) months. Prior to surgery only eight (16.3%) were still working. There were three hospital deaths and two late deaths at 2.5 and 3.5 years after surgery and one patient underwent cardiac transplantation at 1.5 years. Follow-up has been completed up to March 1989, mean 3.7 years, range 10-108 months. Questionnaires were sent to all patients concerning the financial and functional situation. Hospital expenses were calculated (a) prospectively for 15 consecutive first time CABGs and for five second time CABGs, (b) retrospectively from patients' records with the help of a simple computer programme. The final figures were corrected for inflation rates. The 1- and 5-year actuarial probability of angina-free interval was 87.5% and 40% respectively. Eight patients (12.2%) had no benefit, six (13.6%) had benefit but were not able to work, 16 (36.4%) were able to work but unemployed and 14 (13.8%) were fully employed producing a total salary of 69,072 pounds per annum. Hospital expenses were: first time CABG 3645-4049 pounds, second time CABG 6290-7235. The total for the entire group was 308 166 pounds. Repeated coronary surgery can be accomplished with reasonable mortality and has good late results.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1992

Management of chylothorax complicating extensive esophageal resection.

Between January 1983 and May 1987, 255 esophagectomies were performed for carcinoma of the middle (40 patients) or lower (215 patients) esophagus. All patients were operated upon through a left thoracolaparotomy and underwent a radical en bloc resection of the tumor along with all palpable mediastinal nodes. Ten patients had chylothorax develop postoperatively. There were seven men and three women with a mean age of 65.7 years (range of 37.0 to 81.0 years). Parameters that were statistically evaluated for possible correlation to increased incidence of chylous fistula were age, sex, site and size of tumor, histologic type, mediastinal lymphatic involvement and elective prophylactic ligation of the major thoracic duct (MTD) at the conclusion of the procedure. It was found that elective ligation of the MTD was associated with a lower occurrence of chylothorax (2.1 per cent) as compared with those with no routine ligation (9 per cent), p less than 0.05. The leak was successfully treated by repeated thoracotomy and mass ligation of the MTD in eight patients, while one patient underwent closed tube thoracostomy. In one instance, only a pleuroperitoneal shunt was performed. The over-all hospital mortality rate from chylothorax was 10 per cent and there was a late death because of pneumonia. We recommend prophylactic ligation of the MTD in all instances of extensive esophageal resection for the prevention of chylothorax, as well as early thoracotomy for the management of established leaks.

Aged↗
PubMed1991

Dissection of the two internal mammary arteries with maximal exposure and minimal adverse sequelae by means of an inexpensive, simple, atraumatic retractor.

The increasing use of internal mammary arteries for grafting, the possibility that both internal mammary arteries should be used, and the need for longer portions of these vessels should multiple sequential distal anastomoses be needed make a technique for safe and extensive dissection of these vessels important. We describe such a technique that uses a retractor adapter. This adaptation has considerably reduced our reluctance to use both mammary arteries and to dissect lengths that can be used for multiple distal anastomoses. It has also reduced the prevalence of undesirable side effects from retraction.

Dissection↗
PubMedDate not supplied

Fibrin glue for sealing the needle track after percutaneous lung biopsy: Part I--Experimental study.

PURPOSE: Evaluate the effectiveness of fibrin glue for the embolic occlusion of needle tracks following percutaneous lung biopsy (PLB). METHODS: Twenty-six rabbits underwent computed tomography (CT)-guided PLB using a coaxial system consisting of 19- and 22-gauge needles. Thirteen rabbits were used as controls (group A). In 13 other rabbits (group B), fibrin glue labelled with I131 fibrinogen and contrast medium was injected into the track. Both groups were examined by CT for the presence and severity of pneumothorax (mild: less than 20%; severe: more than 20%). Group B was also examined scintigraphically and their lungs were studied histologically. RESULTS: In group A, pneumothorax developed in eight animals (61.6%) and was severe in six (46.1%) whereas in group B, pneumothorax developed in five animals (38.5%) and was severe in one (7.7%). Though the difference between the two groups in overall incidence of pneumothorax was not significant (p > 0.1), it was significantly higher (p < 0.025) for severe pneumothorax in group A. No signs of systemic embolism were observed. CONCLUSIONS: Based on this animal model, fibrin glue is a safe and useful sealant following PLB and reduces the incidence of severe pneumothorax.

Animals↗
PubMedDate not supplied

Fibrin glue for sealing the needle track in fine-needle percutaneous lung biopsy using a coaxial system: Part II--Clinical study.

PURPOSE: Following percutaneous lung biopsy (PLB), we used fibrin glue as a sealant in 26 patients for the purpose of decreasing the incidence of pneumothorax. METHODS: All 26 patients (group A) had chronic obstructive pulmonary disease (COPD). The results for group A were compared with a control group of 32 patients (group B), also with COPD and in whom fibrin glue was not used. All biopsies were conducted under computed tomography (CT) using a coaxial needle system consisting of 19-gauge and 22-gauge needles. RESULTS: Pneumothorax developed in five patients (19.2%) in group A and in one instance, drainage was required (3.8%). In group B, pneumothorax developed in 13 patients (40.6%) and in six instances (18.8%) drainage was required. Comparing the use of chest-tube drainage in the two groups, a statistical significance was observed, p < 0.0025). No adverse reactions related to the fibrin glue were observed. CONCLUSION: Our results indicate that fibrin glue is a safe sealing material for lung PLB and serves to decrease the incidence and, in particular, the severity of pneumothorax, especially in high-risk patients.

Aged↗
PubMedDate not supplied

Comparison of forearm muscle dynamometry with nutritional prognostic index, as a preoperative indicator in cancer patients.

We studied 95 patients with cancer of the gastrointestinal tract in various sites. The aim of the study was to compare the forearm dynamometry vs the prognostic nutritional index which was reported by Busby et al, 1890. We used these methods as preoperative prognostic indicators for postoperative mortality and morbidity. The forearm muscle dynamometry has greater positive predictive value (58.33 vs 32.4%), higher sensitivity (77.78 vs 66.6%), and specificity (86.11 vs 65.28%) than the prognostic nutritional index. The forearm muscle dynamometry predicted the patients mortality with a high rate of sensitivity (100%). The results suggest that dynamometry is a useful, rapid, and inexpensive test. It is more accurate than the nutritional index, and can identify cancer patients at a high risk of developing major postoperative complications, and predict the postoperative morbidity and mortality.

Adult↗
PubMedDate not supplied

Recurrent catamenial hemothorax.

Endometriosis is a common cause of chronic pelvic pain and infertility affecting women of reproductive age, but the disease in rare conditions may be extragenital so may be present with a variety of symptoms. This is a report of an unusual case of pelvic endometriosis that presented with a recurrent hemothorax.

Adult↗
PubMedDate not supplied

Acute dissection of the internal mammary artery: a fatal complication of coronary artery bypass grafting.

A case of acute traumatic dissection of the right internal mammary artery is presented in a patient who had both IMAs grafted for recurrent angina 10 years after initial vein coronary revascularisation. The event was mistaken for spasm, but because of severe circulatory collapse no time was available to treat the patient appropriately. The purpose of this report is to facilitate the early recognition and avoidance of this potentially fatal complication.

Aged↗