Biomedical subjects

D L Paull

Publications and source records attributed to D L Paull.

7 recordsLinked to original sources

PubMed1992

Mitral valve reconstruction.

Modern repair techniques allow reconstruction rather than replacement of the mitral valve (MV) in the majority of patients requiring operation. Such patients are now older and more likely to have nonrheumatic MV disease than those treated in former years. A continuing experience with MV reconstruction was reviewed to determine its safety and efficacy. In 50 patients undergoing isolated MV reconstructions, there have been no postoperative deaths. In 36 patients undergoing mitral reconstruction combined with other cardiac procedures, there have been 5 deaths (14%). Three patients have required MV replacement for an inadequate repair as determined by evaluation during the repair or by intraoperative transesophageal echocardiography (TEE) following cardiopulmonary bypass. Overall complications have included five reoperations for bleeding, two perioperative myocardial infarctions, two strokes, and one aortic dissection. The majority of patients maintain an improved functional state after operation. Multiple reconstructive maneuvers are now available, and the elements of any given reconstruction depend on the pathoanatomy of the valve. Intraoperative TEE has been invaluable in planning, evaluating, and modifying repairs. At present, over 70% of all MV operations are reconstructions, and the most common recent indication for MV replacement is a malfunctioning prosthetic MV rather than native valve disease.

Adult↗

PubMed1992

Continuing experience with the automatic implantable cardioverter defibrillator.

The automatic implantable cardioverter defibrillator (AICD) is now used commonly in the management of malignant ventricular arrhythmias. Its use may obviate the need for antiarrhythmic drugs or endocardial resection. We reviewed our continuing experience with the AICD to determine its safety and efficacy. Since June 1987, 102 patients (mean age: 63 years) who survived out-of-hospital ventricular fibrillation or hemodynamically unstable ventricular tachycardia not associated with acute myocardial infarction underwent implantation of an AICD. There were three operative deaths and nine complications. Eighty-nine patients are alive. No patient has experienced sudden cardiac death. Forty-two patients (43%) have had 1 or more AICD discharges associated with symptoms of cardiac arrest. During AICD implantation, it appears preferable to configure lead placement by individual patient characteristics rather than by a rigid protocol. The relative safety and efficacy of the AICD support its use as an alternative to toxic medications or more dangerous endocardial resection in suboptimal candidates.

Adult↗

PubMed1990

Evaluation of the patient having cardiac surgery in the postoperative rewarming period.

Ensuring adequate oxygen delivery to the tissues with respect to oxygen demand is the treatment goal in patients undergoing coronary artery surgery (CAS). In this study we examined changes in temperature, arterial oxygen saturation (SaO2), cardiac index (CI), oxygen consumption (VO2), and mixed venous oxygen saturation (SvO2) over the initial 4-hour rewarming period in 36 patients having CAS. When patients were admitted to the intensive care unit the mean temperature was 36.27 degrees C, and it increased to 37.50 degrees C; SaO2 was 97.67% at the beginning and end of the 4-hour period; CI was 2.88 L/min/m2 and rose to 3.00 L/min/m2; VO2 was high at 0.320 L/min on admission and remained high at 0.290 L/min at the end of the 4-hour rewarming period; and SvO2 was 70.83% initially and declined to 66.53% in the same period of time. Continuous SvO2 monitoring was valuable in the ongoing assessment and management of the patients in stable, mildly hypothermic condition after CAS during the 4-hour postoperative rewarming period.

Aged↗

PubMed1990

Effects of position changes on mixed venous oxygen saturation in patients after coronary revascularization.

The purpose of this study was to investigate the effects of position changes on mixed venous oxygen saturation (SvO2) and to describe the mechanisms responsible for SvO2 changes reported to occur with position changes. The study was done from 4 to 8 hours after surgery in 34 patients after coronary artery bypass grafting. Subjects were put through a series of six position changes, including head of bed elevations and right and left lateral decubitus with return to supine between each. Each position was maintained for 30 minutes. SvO2, arterial oxygen saturation (SaO2), and oxygen consumption (VO2) were measured before and after each position change. Overall mean subject data demonstrated a decrease in SvO2 with each of the lateral position changes. The SvO2 did not drop below 60% in these mean data, and this drop returned to baseline by 5 minutes. There were no significant changes in the mean data for VO2 or SaO2. No significant correlation was found in the mean data between SvO2 and VO2 or SvO2 and SaO2 measurements. Trends were demonstrated in five specific cases that suggested a correlation between changes in SvO2 and changes in VO2 and SaO2. In conclusion, this study demonstrated that subjects were able to tolerate position changes with no clinically significant changes in SvO2, SaO2, or VO2.

Aged↗

PubMed1989

Early experience with the automatic implantable cardioverter defibrillator in sudden death survivors.

Medical management of life-threatening ventricular arrhythmias is difficult because of the toxicity and limited efficacy of antiarrhythmic drugs. The automatic implantable cardioverter defibrillator (AICD) offers protection against malignant ventricular arrhythmias and allows some patients to be managed without antiarrhythmic drugs. We reviewed our experience with the AICD to determine its safety and efficacy. Since June 1987, 24 patients (mean age 63 years) who survived out-of-hospital ventricular fibrillation or hemodynamically unstable ventricular tachycardia not associated with acute myocardial infarction had implantation of an AICD. None had inducible monomorphic ventricular tachycardia associated with ventricular aneurysm. Twenty-three had abnormal left ventricular function (mean ejection fraction 0.32). There were no operative deaths and three complications. At last follow-up (mean 8.9 months) 23 patients were alive. Eight patients had one or more AICD discharges associated with symptomatic or monitored cardiac arrest. AICD implantation can be performed with low risk and appears to be an effective alternative to antiarrhythmic therapy with toxic drugs.

Adult↗

PubMed1988

Introducer insertion of mini-thoracostomy tubes.

Introducer insertion of a small caliber chest tube is easily mastered, fast, and nearly painless. Outpatient management of spontaneous pneumothorax with a 12 F. polyvinylchloride catheter and a Heimlich valve appears both safe and economical in a selected group of patients. Introducer chest tube insertion is well tolerated, in contrast to the discomfort experienced during insertion of chest tubes by means of blunt dissection or trocar. In addition, the high risk of injury to the lung or other viscera by trocars is avoided.

Adult↗

PubMed1982

Appendiceal abscess.

Of 61 patients with appendiceal abscess, 32 were treated by incision and drainage without appendectomy, with 16% morbidity. Seventeen patients had incision and drainage with appendectomy, with 24% morbidity. One patient, admitted in septic shock, died without operation. Average hospitalization was shortest in the nine patients treated nonoperatively. Many patients with appendiceal mass or abscess do not require immediate operation. In the 42 patients discharged without appendectomy, the recurrence rate of appendicitis was 5% at 9.1 months' average follow-up. Thirty-two elective interval appendectomies were performed at an average interval of 96 days, with 13% morbidity. At interval appendectomy, those patients from whom a free fecalith had been removed at the time of drainage had the greatest degree of appendiceal destruction. Interval appendectomy is probably not necessary in such patients.

Abscess↗