Search PubMed⌕ Search

Biomedical subjects

J B Mark

Publications and source records attributed to J B Mark.

At least 37 records · Page 2Linked to original sources
PubMed1995

Pain outcomes after thoracotomy: lumbar epidural hydromorphone versus intrapleural bupivacaine.

OBJECTIVE: To evaluate postthoractomy analgesia in patients receiving lumbar epidural hydromorphone versus intrapleural bupivacaine. DESIGN: A randomized, prospective, double-blind study. SETTING: A university-affiliated medical center. PARTICIPANTS: Twenty patients undergoing lateral thoracotomy for either pulmonary wedge resection, lobectomy, or pneumonectomy. INTERVENTION: Nine patients received epidural hydromorphone, and 11 patients received intrapleural bupivacaine in the postoperative period. MEASUREMENTS AND MAIN RESULTS: Severity of pain was assessed using a visual analog pain scale (VAPS) (0 to 100 mm) at 1, 3, and 5 hours. Patients receiving epidural hydromorphone had a statistically significant improvement in VAPS scores. Patients who received intrapleural bupivacaine did not achieve a significant reduction in pain scores. Nine of 11 patients in the intrapleural bupivacaine group had "failed" postoperative analgesia as defined by a VAPS greater than 30. Only 3 of 9 patients in the continuous epidural hydromorphone group had "failed" analgesia. CONCLUSION: Epidural hydromorphone is superior to intrapleural bupivacaine in achieving satisfactory pain outcomes during the first 5 hours after thoracotomy.

Adult↗
PubMed1995

Influence of jet direction on pulmonary vein flow patterns in severe mitral regurgitation.

Pulmonary vein flow patterns measured with transesophageal echocardiography have been used recently to assess the severity of mitral valve regurgitation. This study was designed to determine whether regurgitant jet direction selectively influences the pattern of flow in right and left pulmonary veins. Thirty-seven patients undergoing mitral valve repair or replacement for severe valvular regurgitation were studied intraoperatively with biplane transesophageal echocardiography. Regurgitant jets were classified by color flow mapping as central or wall, with the latter further classified as septal, lateral, anterior, or posterior in the two orthogonal scan planes. Pulmonary vein flow patterns were measured with pulsed wave Doppler ultrasonography and categorized as showing normal, blunted, or reversed systolic flow. Right and left pulmonary vein flow patterns were identical in the majority of patients studied (78%). Eight patients had discordant flow patterns. In seven of eight patients, the more abnormal pattern was seen in the right pulmonary vein, despite the fact that the regurgitant jets were directed centrally in four of these seven patients. Since discordant pulmonary vein flow patterns occurred in 5 of 15 patients (33%) with central jets, but in only 3 of 22 patients (14%) with eccentric wall jets, it is unlikely that mitral regurgitation jet direction per se causes predictable and selective unilateral alteration in pulmonary vein flow patterns.

Adolescent↗
PubMed1995

Comparative analysis of radiographic interpretation of orthopedic films: is there redundancy?

Cost containment is becoming the watchword in today's medical care environment. In an effort to determine possible areas of unnecessary patient cost secondary to redundant services, we decided to compare prospectively interpretations of plain orthopedic films by radiologists and orthopedists. Without performing a physical examination of the patient, orthopedic surgical attendings and radiology attendings independently read 507 consecutive radiographic studies of acute orthopedic injuries sustained by 438 patients. All readings were dictated, and the reports were reviewed by the senior author and statistically analyzed. The cost of the radiologists' readings was computed. Analysis of the two types of readings showed that both were highly sensitive and very specific, and that there was no statistically significant difference (p = 1.0) between them. The average cost of the radiologists' readings in the local area was approximately $16,100. There was no fee for orthopedic interpretations in this study. The authors conclude that because the two interpretations were accurate and not statistically different, interpretation of orthopedic films by a radiologist seems to be an unnecessary expense.

Bone and Bones↗
PubMed1995

"Blind" placement of plastic left double-lumen tubes.

A prospective analysis of placement of left-sided plastic double-lumen tubes in 100 patients is presented. Intubation of the left bronchus was successfully accomplished using only auscultation and clinical signs ("blind" placement) in 91 patients. Double-lumen tubes were positioned in less than five minutes in 84 patients. The most common problem encountered (30%) was initial intubation of the right main bronchus. Seven of these patients required bronchoscopic assistance to guide the tube into the left bronchus. There were four minor intraoperative complications due to DLT malposition that were recognized and corrected by withdrawing the tube slightly back in the bronchus. The plastic double-lumen tubes functioned properly during the procedure in all 100 patients.

Adolescent↗
PubMed1995

Oblique osteotomy for the correction of tibial malunion.

Fifteen patients had an oblique osteotomy of the tibia for the correction of a multiplanar deformity between January 1989 and March 1991; twelve were followed for an average of twenty-five months (range, twelve to forty-two months). Preoperatively, the average deformity in the coronal plane was 14 degrees (range, 30 degrees of valgus to 25 degrees of varus) and the average deformity in the sagittal plane was 13 degrees (range, 40 degrees of recurvatum to 23 degrees of procurvatum [angulation convex anteriorly]). The average leg-length discrepancy was 2.2 centimeters (range, one to six centimeters). No patient had a rotational deformity. After careful preoperative planning, all patients had an oblique osteotomy and placement of a lag screw and a neutralization plate. Somatosensory evoked potentials were monitored during any axial lengthening. A fibular osteotomy and lengthening of the Achilles tendon were performed as needed. Full weight-bearing on the extremity was prohibited until radiographic and clinical examination indicated that union had occurred, which was at an average of 4.5 months (range, three to six months). At the most recent follow-up examination, ten patients had an excellent result. The average correction in the coronal plane was to within 1 degree (range, 0 to 3 degrees) of normal and the average alignment in the sagittal plane was to within 2 degrees (range, 0 to 12 degrees) of normal. An average of 1.3 centimeters (range, 0.5 to 2.5 centimeters) of lengthening was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Flow reversal in the descending aorta: a guide to intraoperative assessment of aortic regurgitation with transesophageal echocardiography.

This study assessed the value of biplane transesophageal echocardiographic assessment of diastolic flow reversal in the descending aorta as an alternative to Doppler color flow imaging in determining severity of aortic regurgitation. In 45 patients undergoing cardiac operations, the severity of aortic regurgitation was assessed by semiquantitative grading of the width of the Doppler color flow regurgitant jet relative to the left ventricular outflow tract, and the presence of diastolic flow reversal was assessed with pulsed-wave Doppler measurements at three sites in the descending aorta. In four patients, the diastolic flow reversal method was the only available form of assessment because of inadequate visualization of the left ventricular outflow tract beneath a mitral valve prosthesis. Diastolic flow reversal in the descending aorta was not observed in patients without aortic regurgitation and was always present in patients with severe aortic regurgitation. Aortic valve replacement successfully eliminated descending aortic flow reversal in all 19 patients in whom it was present before valve replacement. Identification of diastolic flow reversal at multiple sites in the descending aorta with biplane transesophageal echocardiography helps to confirm the presence of severe aortic regurgitation and can serve as an alternative method of assessment when visualization of the left ventricular outflow tract is impaired.

Aged↗
PubMed1994

Localization of bronchopleural fistula using ventilation scintigraphy.

It can be difficult to localize or even lateralize the site of persistent bronchopleural fistula in patients who have undergone thoracotomy. If the site of persistent air leak can be identified noninvasively, it may be possible to repair the leak with thoracoscopic techniques and thereby avoid repeat thoracotomy. This article reports experience using 99mTc-DTPA ventilation scintigraphy to localize persistent bronchopleural fistulas in six patients. The site of bronchopleural fistula was identified in four patients. In the other two patients, no leak was identified, and the clinical course confirmed that a significant bronchopleural fistula did not exist.

Adult↗
PubMed1994

If I were king.

Explore the source record for details and available documents.

Health Care Reform↗
PubMed1993

Balloon method for detecting inadequate double-lumen tube cuff seal.

A method for detecting air leak when using a double-lumen endobronchial tube is described. The ventilatory circuit is directly attached to the lumen of the ventilated lung. A balloon is fitted snugly over the open lumen of the tube to the nonventilated lung. If lung separation is incomplete, the balloon will inflate with each ventilation.

Bronchi↗
PubMed1993

Intraoperative somatosensory evoked potential monitoring predicts peripheral nerve injury during cardiac surgery.

BACKGROUND: Brachial plexus injury may occur without obvious cause in patients undergoing cardiac surgery. To determine whether such peripheral nerve injury can be predicted intraoperatively, we monitored somatosensory evoked potentials (SEPs) from bilateral median and ulnar nerves in 30 patients undergoing coronary artery bypass surgery. METHODS: SEPs were analyzed for changes during central venous cannulation and during use of the Favoloro and Canadian self-retaining sternal retractors, events hereto implicated in brachial plexus injury. Brachial plexus injury was evaluated during physical examination in the postoperative period by an individual blinded to results of SEP monitoring. RESULTS: Central venous cannulation was associated with transient changes in SEPs in four patients (13%). These changes occurred intermittently during insertion of the cannula but completely resolved within 5 min. Postoperative neurologic deficits did not occur in these cases. Use of the Canadian and Favoloro retractors was associated with significant changes in 21 patients (70%). In 16 of these, waveforms reverted toward baseline levels intraoperatively and were not associated with postoperative neurologic deficits. Five patients demonstrated a neurologic deficit postoperatively. In each of these, SEP change associated with use of surgical retractors persisted to the end of surgery compared to the immediate pre-bypass period. CONCLUSION: Intraoperative upper extremity SEPs may be used to predict peripheral nerve injury occurring during cardiac surgery.

Brachial Plexus↗
PubMed1992

Improved surgical approach to left atrial appendage aneurysm.

Left atrial appendage aneurysm is a rare anomaly, which usually presents with arrhythmia or cerebral embolism. Diagnostic evaluation traditionally required cardiac catheterization, and surgical resection required cardiopulmonary bypass. Utilizing intraoperative transesophageal echocardiography and surgical stapling devices, we have streamlined our operative technique, allowing resection of a left atrial appendage aneurysm without cardiopulmonary bypass. This report of two cases treated over the past decade demonstrates the evolution of our surgical technique.

Adult↗