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Biomedical subjects

J F Moran

Publications and source records attributed to J F Moran.

At least 55 records · Page 3Linked to original sources
PubMed1983

Long-term results of pulmonary resection for atypical mycobacterial disease.

From 1967 through 1981, 40 pulmonary resections were performed in 37 patients with Mycobacterium intracellulare infection. The patients ranged in age from 24 to 67 years, and 86% were men. Smoking and alcohol abuse seemed to be predisposing factors. Localized atypical mycobacterial infection unresponsive to chemotherapy was the operative indication for 38 of the 40 resections. All patients had cavitary disease. Mean length of preoperative drug treatment was 22 weeks. Sensitivity studies showed a very high incidence of in vitro drug resistance. Twenty-five patients were converted to sputum-negative status preoperatively; however, 23 of these had positive smears or cultures from their resected specimens. Resections performed included upper lobectomy in 31 patients, upper and middle lobectomy in 2 patients, upper lobectomy plus superior segmentectomy in 3, left completion pneumonectomy in 2, and wedge resection in 2. Two patients underwent staged bilateral upper lobectomies. There were no perioperative deaths. Complete follow-up in 33 patients (mean, 94 months) revealed only two reactivations at 3 and 5 years postoperatively. One of these patients is well following completion pneumonectomy 9 years after his first operation; the second patient responded to reinstitution of three-drug chemotherapy and is well 5 years later. Thirty-one patients have remained entirely free of disease. Excisional surgery remains the treatment of choice for localized M. intracellulare pulmonary infection.

Adult↗
PubMed1983

Surgical treatment of acute ascending aortic dissection.

Since adopting a policy of immediate operation on patients with acute dissection of the ascending aorta, 42 men and 6 women (ages 18-67 years) have been managed surgically. Thirty-two patients had graft replacement of the ascending aorta and resuspension of the incompetent aortic valve. One of these had a coronary graft. There were five deaths in this group. Eight patients required aortic valve replacement because of a diseased aortic valve as well as grafting of the ascending aorta, with one death. Three patients had resuspension of the aortic valve and primary repair of their dissection without mortality. Two patients were managed successfully with an intraluminal prosthesis and resuspension of the aortic valve. Another patient had successful repair with a valved conduit and reimplantation of the coronaries. Two patients dissected 4 and 6 years after aortic valve replacement and neither survived operative repair. Of the surviving patients, one required dialysis, one a femoral-femoral bypass graft, and one an axillo-femoral bypass graft. One patient required a pacemaker for heart block, and two underwent successful repair of suture line aneurysms, both occurring three years after operation. On the basis of this experience, prompt surgical intervention for acute ascending aortic dissection is the treatment of choice. A variety of techniques are available to repair the dissected aorta. Long-term results for resuspension of the aortic valve in acute ascending aortic dissection have been excellent and emphasize that valve replacement should be reserved for those patients found at operation to have a primary abnormality of the aortic valve.

Adolescent↗
PubMed1983

Osteomyelitis of the clavicle after Swan-Ganz catheterization.

Osteomyelitis of the clavicle is an uncommon complication of Swan-Ganz catheterization. The diagnosis should be suspected when the clinical features of fever and sterno-clavicular pain are present. Traditional roentgenograms may be falsely normal early in the disease. Radioactive isotope scanning may be helpful in establishing the diagnosis sooner, followed by tomography or computed tomography to better define the abnormality. Therapy should include long-term parenteral antibiotics and possible surgical removal.

Cardiac Catheterization↗
PubMed1981

Effects of oxygen toxicity on regional ventilation and perfusion in the primate lung.

Since the effect of prolonged exposure to high concentrations of oxygen on regional ventilation and perfusion has not been previously, a reproducible primate model of oxygen toxicity was developed to investigate the pathophysiologic changes that occur. Regional ventilation and perfusion were measured by 133Xe techniques in 10 baboons before and after 108 hours of continuous exposure to an inspired oxygen concentration of more than 90%. Arterial blood gases, shunt fraction (QS/QT), cardiac output, physiologic dead space (VD/VT), and pulmonary vascular resistance were also measured. Light and electron microscopic histology confirmed early pathologic changes of oxygen toxicity in every animal after exposure. PaO2 in room air decreased markedly after exposure from 90 +/- 4 to 46 +/- 5 mm Hg, and QS/QT rose to 30 +/- 2%. VD/VT, PaCO2, and pH were not altered by exposure to hyperoxia. Similarly, cardiac output and pulmonary vascular resistance remained unchanged. The distribution of regional ventilation and perfusion remained normal during and after prolonged high-oxygen exposure. Early oxygen toxicity was characterized by profound hypoxemia without regional ventilation-perfusion mismatch. Although impaired diffusion through a thickened alveolar membrane may be partially responsible for this hypoxemia, the markedly increased alveolar-arterial oxygen gradient when FIO2 = 1.0 indicates that shunting at the alveolar level (secondary to absorptive collapse or pulmonary edema) is a major cause of the hypoxemia.

Animals↗
PubMed1980

Quantitative radionuclide angiocardiography.

This study introduces a new method for calculating actual left ventricular volumes and cardiac output from data recorded during a single transit of a radionuclide bolus through the heart, and describes in detail current radionuclide angiocardiography methodology. A group of 64 healthy adults with a wide age range were studied to define the normal range of hemodynamic parameters determined by the technique. The normal radionuclide cardiac index averaged 3.25 +/- 0.75 liters/min/m2, the end-diastolic volume index was 62 +/- 16 ml/m2, the stroke volume index was 40 +/- 9 ml/m2, and the ejection fraction was 0.66 +/- 0.07. Radionuclide angiocardiograms were performed in patients undergoing cardiac catheterization to validate the measurements. In 33 patients studied by both techniques on the same day, a close correlation was documented for measurement of ejection fraction (r = 0.89) and end-diastolic volume (r = 0.89). Determination of the linear regression equation for the end-diastolic volumes obtained by the two methods (EDVcath = 1.26 x EDVRN - 7.56) permitted correction of end-diastolic volume and provided an approach for calculation of stroke volume and cardiac output. To validate the method of volumetric cardiac output calculation, 33 simultaneous radionuclide and indocyanine green dye determinations of cardiac output were performed in 18 normal young adults and correlated closely over a range of 4-17 liters/min (r = 0.94). These independent comparisons of radionuclide measurements with two separate methods document that initial transit radionuclide angiocardiography accurately assesses left ventricular function.

Adolescent↗
PubMed1980

Cardiac arrhythmias after chronic embolization of the sinus node artery: alterations in parasympathetic pacemaker control.

Embolization of the sinus node artery was accomplished in dogs by injecting rapidly hardening vinyl latex into the sinus node artery. Embolization immediately shifted the pacemaker to a junctional focus; however, with time postoperatively, the pacemaker shifted to an atrial site. Variable episodes of pacemaker failure, sinoatrial block, junctional rhythm, wandering atrial pacemaker and idioventricular escape rhythms were commonly observed on Holter monitor in isolation but only rarely when the dog was in the laboratory. Severe bradycardia (38.9 +/- 3.7 beats/min) was the predominant rhythm by 3-6 months postoperatively. In addition, these same dogs had a greater overall increase in heart rate after atropine than normal dogs (17.5 +/- 13.5 vs 116.6 +/- 15.9 beats/min above control; p less than 0.02). Responses to vagal stimulation in this group were abnormal, as long periods of asystole and bradycardia were observed after stimulation was terminated. These data suggest an alteration in parasympathetic pacemaker control after chronic embolization of the sinus node artery.

Animals↗
PubMed1980

EKG of the month.

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Electrocardiography↗