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Biomedical subjects

F M Jara

Publications and source records attributed to F M Jara.

9 recordsLinked to original sources

Long-term results of esophagomyotomy for achalasia of esophagus.

Modified Heller's esophagomyotomy for achalasia of the esophagus was done in 145 patients at Henry Ford Hospital, Detroit, from 1951 to 1977. Information on current symptoms was obtained for 121 patients from a detailed questionnaire that was sent to all patients, from personal interviews, or from data obtained from patients' clinical records. Average period of follow-up was 85 months. Actuarial analysis of postoperative symptoms showed an incidence of reflux of 24% after one year and 48% after ten years; incidence of relief of dysphagia was 89% of all patients after one year and 81% after ten years. Continual surveillance of patients after esophagomyotomy must be stressed. Dissatisfaction with the results of this procedure prompted us to recommend that an antireflux operation be performed at the time of the initial procedure.

Esophageal Achalasia

Myocardial protection with methylprednisolone. Evaluation of viability of hearts subjected to warm ischemia before transplantation.

Methylprednisolone was given at different intervals before warm ischemia of the heart (37 degrees C. for 60 minutes), and viability of these hearts was evaluated after transplantation into the abdomen of another dog. Animals were divided into four groups: Group 1 received no methylprednisolone: Groups II, III, and IV received 30 mg. of methylprednisolone per kilogram 10 minutes, 60 minutes, and 120 minutes before warm ischemia. In all parameters measured, the animals of Group IV performed better than the other groups. It is concluded that methylprednisolone, when given 2 hours before warm ischemia, exerts a protective effect on the ischemic myocardium.

Abdomen

The infected pacemaker pocket.

Between January, 1963, and September, 1978, a total of 1,789 pacemakers were implanted at Henry Ford Hospital. Infection at the site of implantation developed in 19 instances for an incidence of 1.06 percent. The most common organism cultured was Staphylococcus epidermidis, and conservative treatment was successful with these patients. In all patients with organisms other than Staphylococcus epidermidis, reimplantation of a new unit in a new, clean site was required.

Adult

Surgical implications of pulmonary actinomycosis.

Four cases of pulmonary actinomycosis are presented. Resection was necessary in three cases before the diagnosis was established. A high index of suspicion for this disease is advised for the thoracic surgeon involved in the treatment of lung masses.

Actinomyces

The role of surgery in primary osteomyelitis of the chest wall.

Seven patients with primary osteomyelitis of the chest wall are described. All patients presented with pain at the site of infection, and four patients had a tumor-like mass that could easily be confused with a neoplastic process. All were heroin addicted and pseudomonas was the most common organism cultured. Conservative management with antibiotics for a minimum of 4 weeks is recommended with operation assuming a secondary role, namely, to assist in the initial diagnosis or in the form of limited resection of residual sinuses. Primary wide resection is discouraged.

Adult

Management of tricuspid valve insufficiency. Replacement with Hancock bioprosthesis or suture annuloplasty.

Forty-seven patients who underwent tricuspid valve replacement (TVR) or tricuspid annuloplasty (TA) combined with aortic (AVR) or mitral valve replacement (MVR) at Henry Ford Hospital, from 1971 to 1977 are reviewed. Thirty-three patients underwent TVR with a Hancock valve combined with MVR or AVR; hospital mortality was 30% (10 to 33) and was higher at the beginning of the series when smaller valves were used. No valve dysfunction has been seen with mean follow-up time of 36.7 months, ranging from 4 to 60 months. Good functional improvement was accomplished in all patients. Fourteen patients underwent TA; hospital mortality was 21% (3 of 14) with one late mortality (9%); good functional improvement was accomplished in all patients. However, one patient presented 11 months following surgery with tricuspid insufficiency after a period of improvement. For patients with severely deformed valves a large size Hancock valve is recommended. For insufficiency alone tricuspid annuloplasty is recommended.

Adolescent