Search PubMed⌕ Search

Biomedical subjects

J H Calhoon

Publications and source records attributed to J H Calhoon.

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

Homograft patch repair for hemorrhagic mediastinitis.

Hemorrhage from the heart and great vessels is a potentially lethal complication of post-sternotomy mediastinitis. We report 2 cases in which a cryopreserved descending thoracic aortic homograft was used successfully to repair defects of the ascending aorta and right ventricle in the setting of active mediastinal infection. An overview of mediastinitis and management strategies for life-threatening mediastinal bleeding is included.

Aorta, Thoracic↗
PubMed1995

Ross-Konno procedure: a case study of a newborn.

The objective is to present a case study of a 2-day-old infant who undergoes a Ross-Konno procedure for correction of severe congenital aortic stenosis. This procedure involves replacing the stenosed aortic valve with a pulmonary autograft. The perinatal history, diagnostic data, and the operative procedure are described. Preoperative and postoperative nursing management is addressed including normal pediatric intensive care protocols. The infant's postoperative hospital course was 37 days. Mitral regurgitation and pulmonary hypertension are being managed with lisinopril.

Aortic Valve Stenosis↗
PubMed1994

Echocardiographic assessment of right and left ventricular function after single-lung transplantation.

To evaluate the impact of single-lung transplantation on right and left ventricular performance and to identify potential preoperative characteristics that could predict postoperative outcome, a large group of patients were retrospectively evaluated by means of serial Doppler echocardiography. Twenty-six of 57 consecutive single-lung transplant patients had satisfactory Doppler echocardiographic studies before and after surgery. A significant reduction in right ventricular diastolic and systolic areas and an increase in right ventricular fractional area were noted after transplantation. The left ventricular contractility remained unchanged. In addition, significant reduction in right atrial area, right ventricular free wall thickness, and tricuspid regurgitation were also seen. Paradoxical septal motion present in eight patients before the procedure resolved in all of them after single-lung transplantation. Transthoracic echocardiography is a useful technique to document improvement in right ventricular function in 63% of patients following single-lung transplantation. Preoperative paradoxical septal motion identifies single-lung transplant recipients who have the largest postoperative right ventricular area reduction and fractional area increase. Alternative imaging modalities should be sought for single-lung transplant candidates in whom conventional transthoracic echocardiography is suboptimal.

Adult↗
PubMed1994

Assessment of injury in transplanted and nontransplanted lungs after 6 h of cold storage with glutathione.

Single-lung transplantation after 3 h of hypothermic storage produces bilateral lung injury [pulmonary reimplantation response (PRR)]. We hypothesized that glutathione (GSH) hypothermic storage would protect both lungs from PRR for extended preservation times and that differences in injury and protection would be realized between the graft and the nontransplanted lung. Mongrel dogs underwent left single-lung autotransplantation after preservation for 5-6 h in Euro-Collins (EC) solution, EC plus exogenous GSH (EC+GSH), or Viaspan (VIA) at 4 degrees C. Lung injury was measured in both lungs after 1 h of reperfusion. EC dogs demonstrated significant increases in lung edema, lipid peroxidation, and alveolar neutrophil recruitment in the lung graft and to a less extent in the nontransplanted right lung compared with control dogs (P < 0.05). Edema, lipid peroxidation, and alveolar neutrophils were significantly reduced in both lungs from EC+GSH and VIA dogs compared with lungs from EC dogs (P < 0.05). An increase in large-pore permeability was measured in the lung graft from EC dogs compared with all other lungs. Bronchoalveolar lavage fluid lactate dehydrogenase and total protein concentrations were elevated in both lungs from all three groups of tranplanted dogs compared with those of control dogs (P < 0.05). These data suggest that GSH-containing solutions attenuate the PRR after 6 h of ischemic hypothermic storage but that the protection is incomplete. Mechanisms of injury affecting the lung graft during the PRR appear to differ from those affecting the nontransplanted lung.

Animals↗
PubMed1994

Single lung transplantation in patients with systemic disease.

OBJECTIVE: To report functional results and survival in patients undergoing single lung transplantation (SLT) for pulmonary involvement associated with systemic disease or prior malignancy, criteria traditionally considered contraindications to SLT. DESIGN: Case series. SETTING: The University of Texas Health Science Center at San Antonio. PATIENTS: Nine patients who have undergone SLT for end-stage lung disease: four patients with sarcoidosis; two patients with limited scleroderma; and three patients with prior malignancies (two with prior lymphoma and bleomycin-induced pulmonary fibrosis and one who received two bone marrow transplants for acute lymphocytic leukemia and subsequently developed chemotherapy-induced pulmonary fibrosis). MEASUREMENTS: Pulmonary function testing, exercise oximetry, quantitative ventilation-perfusion lung scanning. Actuarial survival. RESULTS: All patients had marked improvement in pulmonary function, exercise oximetry, and quantitative ventilation perfusion to the SLT. One patient with scleroderma died 90 days postoperatively from Pseudomonas pneumonia with a sepsis syndrome. One patient with sarcoidosis died 150 days postoperatively from disseminated aspergillosis. At autopsy, there was no evidence of recurrent fibrosis or sarcoidosis in the transplanted lungs in either of these two patients. The seven surviving patients have returned to work or school and are conducting all activities of daily living without pulmonary disability. The 1- and 2-year actuarial survival rates in these nine patients is 68.6 percent as compared with the 1- and 2-year actuarial survival rates of 66.3 percent and 55.8 percent in the remainder of our SLT group as a whole (n = 49). Despite pharmacologic immunosuppression, there is no evidence of recurrent malignancy in the 3 patients with prior malignancies. CONCLUSIONS: We conclude that carefully selected patients with end-stage lung involvement related to systemic disease or chemotherapy-induced fibrosis may benefit from SLT.

Adult↗
PubMed1994

Use of the flow-volume loop in the diagnosis of bronchial stenosis after single lung transplantation.

Bronchial complications, including stricture, stenosis, and/or anastomotic dehiscence, are a major cause of morbidity following single lung transplantation. This report describes a 19-year-old man with a diagnosis of end-stage pulmonary fibrosis secondary to prior chemotherapy for non-Hodgkins lymphoma who underwent single lung transplantation. The immunosuppressive regimen included cyclosporine, azathioprine, and methylprednisolone sodium succinate (Solu-Medrol) intravenously for six doses during the first 3 days postoperatively followed by oral prednisone. Sixteen weeks following transplantation, the patient complained of dyspnea. Spirometry revealed a decrease in FEF25-75 and the flow-volume curve demonstrated a bioconcave appearance. The flow-volume loop showed a relatively high initial flow phase occurring over the first 2 to 3 s followed by a low-flow phase. The expiratory phase also showed the same characteristics. Bronchoscopy revealed 75 percent stenosis of the bronchial lumen to the transplanted lung. A transbronchial biopsy specimen obtained at that time was consistent with acute rejection. The patient was treated with a methylprednisolone bolus. A repeated bronchoscopy showed the persistence of stenosis distal to the anastomosis. The patient underwent several bronchoplastic balloon dilatations without complete resolution of the stenosis and a stainless steel mesh stent was placed. Repeated spirometry showed marked improvement of the FEF25-75 and normalization of the flow-volume loop. We conclude that the flow-volume loop curve is a noninvasive procedure that may help monitor the patency of the bronchial anastomoses following single lung transplantation.

Adult↗
PubMed1993

Graft position and pulmonary function after single lung transplantation for obstructive lung disease.

Single lung transplantation (SLT) has become a therapeutic option for the treatment of end-stage obstructive lung disease. Between January 1989 and June 1990, there were 14 patients with end-stage obstructive lung disease who underwent SLT. Eleven of these patients were surviving at 1 year following transplantation. Three of the patients had received left-sided SLT, and eight had received right-sided SLT. In the patients receiving left-sided SLT, the native right lung radiographically appeared to compress the left lung graft. In the patients receiving right-sided SLT, the native left lung did not appear to compress the right lung graft. We hypothesized that right SLT may provide a functional advantage over left SLT for patients with obstructive lung disease. We compared pulmonary function test results before and after transplantation (approximately 3 and 12 months) and compared quantitative ventilation-perfusion lung scan results between the patients with left SLT and those with right SLT. Additionally, we compared graded-exercise test results at 3 and 12 months after transplant between the two groups. Our data revealed no statistical difference in pulmonary function test results or graded-exercise test results between the two groups, although patients undergoing right SLT showed greater increases in FEV1 and forced vital capacity than those undergoing left SLT. Quantitative ventilation and perfusion were greater to the graft in patients receiving right-sided SLT than in patients receiving left-sided SLT, most likely due to the larger size of the right lung. We conclude that there is no functional difference between patients undergoing left or right SLT for end-stage obstructive lung disease.

Adult↗
PubMed1993

Improvement in the diagnosis of bioprosthetic valve dysfunction by transesophageal echocardiography.

Transthoracic two-dimensional echocardiography has been considered the method of choice for the non-invasive assessment of bioprosthetic valves. Recently, transesophageal echocardiography has provided a better imaging window for detecting valve abnormalities not identified otherwise, but pathologic confirmation is essential to establish the role of new diagnostic techniques in clinical practice. Therefore, the purpose of this study was to evaluate the usefulness of transesophageal echocardiography in determining the etiology of bioprosthetic valve dysfunction. Transthoracic and transesophageal two-dimensional and color-flow Doppler echocardiography were performed on 44 consecutive patients with suspected bioprosthetic dysfunction who underwent surgical intervention. At surgery a total of 63 abnormalities in 44 bioprostheses were identified: 31 (49.2%) flail cusps, 14 (22.2%) vegetations, four (6.3%) abscesses, four (6.3%) dehiscences, and 10 (15.9%) stenoses. Transesophageal echocardiography was superior to its transthoracic counterpart for the detection of flail cusps (96.7% vs. 54.8%, p < 0.01), vegetations (85.7% vs. 42.8%, p < 0.01), abscesses (100% vs. 25.0%, p < 0.05), and dehiscences (100% vs. 25.0%, p < 0.05). All patients with flail cusps had severe regurgitation as evaluated by color-flow Doppler. In bioprosthetic mitral stenosis, both methods provided accurate estimates of valve area, while in bioprosthetic aortic stenosis, transthoracic Doppler velocity measurements allowed calculation of valve area in four of six patients. In two patients with high flow velocities, the valve area was not estimated because of an inability to measure the left ventricular outflow tract dimension. Conversely, the transesophageal approach provided measurement of the outflow tract in all six patients, but Doppler velocities were not obtained in any of them.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1992

Chronic intestinal pseudoobstruction in a patient with heart-lung transplant. Therapeutic effect of leuprolide acetate.

After orthotopic heart-lung transplantation and immunosuppression, a patient developed intractable nausea and vomiting in association with chronic cytomegalovirus infection. Chronic intestinal pseudoobstruction was documented by antroduodenal manometric study. The patient was treated with leuprolide acetate with resolution of symptoms and improvement of intestinal motility abnormality. This case demonstrates an association of chronic viral infection with acquired intestinal motor disorders. Gastrointestinal complications that are common after organ transplantation might be due to acquired neuromuscular disease. The potential efficacy of leuprolide in such neuromuscular disorders provides a rationale for diagnostic motility studies in patients with "functional" gastrointestinal disorders.

Adolescent↗
PubMed1992

Ventilation-perfusion inequalities during graft rejection in patients undergoing single lung transplantation for primary pulmonary hypertension.

We report herein data on single lung transplant (SLT) recipients with primary pulmonary hypertension (PPH). One patient did well following surgery but died on the 30th postoperative day due to cytomegalovirus pneumonia. The remaining two patients initially did well with unlimited exercise tolerance following transplantation, but then developed marked dyspnea on exertion and hypoxemia on postoperative days 144 and 120, respectively. Pulmonary function testing showed marked deterioration of function and transbronchial lung biopsy specimens revealed acute graft rejection in one patient and evidence of chronic graft rejection in the second patient. Quantitative ventilation-perfusion lung scanning demonstrated a marked decrease in ventilation to the transplanted lung in both cases associated with only a mild decrease in perfusion. This V/Q mismatch resulted in markedly decreased arterial oxygen saturations, widened alveolar-arterial oxygen gradients, and clinically debilitating dyspnea. We conclude that rejection may result in significant V/Q mismatch and hypoxemia in PPH patients undergoing SLT, which may limit the use of this specific type of surgery for PPH.

Female↗
PubMed1992

Case study: infant transplantation: a change of heart.

The majority of infant heart transplants are for the correction of hypoplastic left heart syndrome (HLHS). This article will describe the preoperative, intraoperative, and postoperative care for perioperative and pediatric intensive care areas implemented for HLHS infant heart transplantation at Medical Center Hospital, San Antonio, TX. The surgical procedure is given. Dimensions of psychosocial care and education of the parents are briefly described.

Cardiac Surgical Procedures↗
PubMed1992

Single lung transplantation. Factors in postoperative cytomegalovirus infection.

Thirty-one single lung transplantations were performed between March 17, 1988, and November 1, 1990. Postoperative infection, especially with cytomegalovirus, has been the major cause of morbidity and mortality. Eighteen of the 31 patients were receiving prednisone before transplantation. Every patient was prepared preoperatively with oral cyclosporine 5 mg/kg and azathioprine (Imuran) 2 mg/kg. Every patient received methylprednisolone for 3 days postoperatively, followed by prednisone 1.0 mg/kg/day, oral cyclosporine, and azathioprine. Ten patients additionally had cytolytic therapy with OKT3 and 12 with antilymphocyte globulin. Nine patients had no cytolytic therapy. Cytolytic therapy was chronologic, not randomized. Postoperative infection occurred in 20 patients, 13 of whom had cytomegalovirus infection. Preoperative use of prednisone did not correlate with postoperative infection, cytomegalovirus, or death. Postoperative infection occurred in 17 of 22 patients with cytolytic therapy compared with three of nine without cytolytic therapy (p = 0.035). Cytomegalovirus infection occurred in 13 of 22 with cytolytic therapy and in none of the nine without cytolytic agents (p = 0.003). Therefore preoperative prednisone does not appear to be a contraindication to single lung transplantation. Cytolytic therapy with either OKT3 or antilymphocyte globulin increases the prevalence of postoperative infection with cytomegalovirus and should not be used in patients undergoing lung transplantation.

Contraindications↗
PubMed1992

Chest trauma. Approach and management.

A synopsis of both blunt and penetrating thoracic trauma, this article outlines an approach to management for injuries to the lung, heart, esophagus, tracheobronchial tree, diaphragm, and major thoracic vessels. Also outlined are the management of rib fractures, scapula fractures, sternal fractures, and, in particular, flail chest with associated pulmonary contusion.

Aorta, Thoracic↗
PubMed1991

Cardiopulmonary exercise responses after single lung transplantation for severe obstructive lung disease.

The purpose of this study was to characterize cardiovascular and ventilatory responses to exercise in single lung transplantation (SLT) recipients with nonseptic, severe obstructive lung disease (SLT-OB). We also investigated whether the hyperinflated native lung in SLT-OB recipients could limit normal increases in tidal volume by mechanically constraining the transplanted lung, resulting in ventilation-perfusion imbalance in the lung graft. Data from six SLT-OB recipients (five women, one man) and six age-matched SLT recipients (two women, four men) with severe interstitial lung disease (SLT-IN) were compared. Resting arterial O2 and CO2 tensions were normal and comparable between the SLT groups. Spirometry results were reduced but comparable between SLT groups. Total lung capacity was significantly larger in patients with SLT-OB than in patients with SLT-IN. Diffusion capacity was not different between SLT groups when differences in alveolar volume were accounted for. Quantitative perfusion to the lung graft was comparable between the SLT groups, but quantitative ventilation was greater in patients with SLT-OB than in patients with SLT-IN. Maximum exercise capacity following SLT-OB was decreased, but was comparable to that of SLT-IN recipients. None of the SLT-OB recipients reached predicted maximum minute ventilation and only one experienced mild arterial O2 desaturation, suggesting peripheral muscle abnormalities from corticosteroid use and deconditioning as limiting factors rather than a ventilatory limitation. Tidal volumes at end exercise in the SLT-OB recipients were normal. Our quantitative lung scan and exercise testing data suggest that ventilation-perfusion imbalance and resulting gas exchange abnormalities from lung graft constraint and compression do not occur at rest or with exercise after SLT for obstructive lung disease.

Anaerobic Threshold↗
PubMed1991

Single lung transplantation. Alternative indications and technique.

Twenty-two patients have undergone 23 single lung transplants between March 1980 and April 1990 at the University of Texas Health Science Center at San Antonio. The actuarial survival rate is 77.27% at 12 months and 72.73% at 24 months. There have been no instances of bronchial dehiscence or stenosis, even though 13 of the patients were on a program of preoperative prednisone, every patient had high-dose perioperative methylprednisolone, and omental wraps were not used on any bronchial anastomosis. Of particular interest is the fact that three patients had primary pulmonary hypertension, three had secondary pulmonary hypertension, and 10 patients had chronic obstructive pulmonary disease, due in five cases to an alpha 1-antitrypsin deficiency. Each of these entities was previously thought to contraindicate single lung transplantation. Donor selection was based on an oxygen tension/inspired oxygen concentration ratio greater than 300, donor/recipient chest circumference within 3 inches, clear chest x-ray film, negative sputum Gram stain, and less than 6-hour estimated ischemic time. Harvest technique included donor prostaglandin E1 500 micrograms, topical slush, and pulmonoplegia with cold Euro-Collins solution. The heart and lung were separated in situ rather than the heart lung block being removed. A telescoping bronchial anastomosis was performed with 4-0 Prolene (not absorbable) sutures. We conclude that single lung transplantation has evolved into a simple operation, necessitating meticulous preoperative and postoperative care, which can be performed on a wide spectrum of critically ill patients with an acceptable mortality rate.

Adult↗
PubMed1986

Management of blunt rupture of the heart.

Ten patients with blunt heart rupture arrived in our emergency center alive during an 11-year period ending in 1984. Ages ranged from 19 to 65 years (mean, 35), and seven patients were male. Six patients presented with tamponade, three with hemorrhagic shock, and one with combined symptoms. Associated injuries averaged 2.25 organ systems per patient. All but one patient had surgery within 90 minutes of arrival. All patients had primary closure of the defect without cardiopulmonary bypass, five patients had subxiphoid window followed by sternotomy, two had right thoracotomy, two underwent left thoracotomy, and one patient was subjected to immediate sternotomy. Seven patients survived. Three deaths were due to irreversible hemorrhagic shock, two secondary to heart injury, and one from an associated liver injury. Prompt pericardial window with subsequent median sternotomy was successful for patients presenting with tamponade and immediate thoracotomy for those bleeding into a pleural cavity.

Adult↗