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Biomedical subjects

J H Sanders

Publications and source records attributed to J H Sanders.

71 records · Page 4Linked to original sources
PubMed1976

Tracheal stenosis. A method of dilation with use of the fiberoptic bronchoscope.

Tracheal stenosis is not an uncommon sequel of prolonged endotracheal intubation. In some cases, immediate reconstruction is not feasible. We use the flexible fiberoptic bronchoscope and a lucent, tapered endotracheal tube for tracheal dilation. The fiberoptic bronchoscope is passed through a special T connector into the endotracheal tube and used to guide the tube under direct vision through the stricture.

Adult↗
PubMed1976

Surgical treatment of congenital unilateral pulmonary arterial stenosis with contralateral pulmonary hypertension.

This report describes the diagnosis and surgical treatment of a 48 year old patient with congenital right pulmonary arterial ostial stenosis, no intra- or extracardiac shunts and systemic levels of pressure in the main and left pulmonary artery with pulmonary vascular obstruction in the left lung. Operation consisted of a bypass graft of 10 mm woven Dacron from the main pulmonary artery to the distal right pulmonary artery producing an immediate 50 percent reduction in mean left pulmonary arterial pressure. Late postoperative evaluation revealed equal perfusion of both lungs, maintenance of the reduced pulmonary arterial pressure and improvement from New York Heart Association functional class IV to class I.

Arterial Occlusive Diseases↗
PubMed1976

Emergency aortic valve replacement.

The aortic valve was replaced as an emergency in twenty-seven patients between July 1970 and December 1974. Twenty-two patients had critical aortic stenosis and five had acute aortic insufficiency. The indications for emergency surgery were cardiac arrest in five patients, low cardiac output in four patients, and medically intractable pulmonary edema in eighteen patients. Cardiac catheterization was not undertaken in ten persons because of their critical condition. The clinical diagnosis in these patients was supported by noninvasive maneuvers. No surgical deaths occurred. Twenty-five patients are well, active and NYHA Class I at five to thirty-three months after surgery. There has been one late death and one patient has some residual exertional dyspnea. One patient required reoperation to relieve a clotted prosthetic valve. These results suggest that the patient with aortic valve disease may be offered a reasonable chance for survival, even when desperately ill.

Adult↗
PubMed1976

Aortic valve replacement with the Hancock porcine xenograft.

The Hancock porcine xenograft stabilized with the glutaraldehyde process was used for isolated aortic valve replacement in 71 patients from March, 1972, to July, 1975. Aortic stenosis was the primary diagnosis in 52 patients and aortic insufficiency in 19. There were 52 men and 19 women ranging in age from 18 to 82 years; 14 patients were older than 70 years. One patient was in Functional Class II, 50 in Class III, and 20 in Class IV preoperatively. Seventy-three patients undergoing Björk-Shiley aortic valve replacement during the same period are presented for comparison. The operative mortality was 3% (2 of the 71 patients); 4 of the remaining 69 patients (6%) died in the late postoperative period. No patient was placed on anticoagulation during the postoperative course, and there was 1 postoperative embolus in a patient with chronic atrial fibrillation (1.4%). With a mean follow-up period of 17 months, 60 patients are now in Functional Class I, 4 in Class II, and 1 in Class III. Seven patients have had transvalvular gradients and effective valve areas measured postoperatively that ranged from 32 to 5 mm Hg and 0.9 to 2.9 cm2 in 21 through 25 mm (OD) sizes.

Adolescent↗
PubMed1976

Tetralogy of Fallot with discrete fibrous subaortic stenosis.

This is the first reported case of discrete fibrous subaortic stenosis in tetralogy of Fallot. Transaortic excision of the subaortic membrane was readily accomplished. To detect this and other forms of left ventricular outflow-tract obstruction in tetralogy of Fallot before surgery, routine selective left ventriculography is advocated.

Adolescent↗
PubMed1976

Actuarial comparison of Hancock porcine and prosthetic disc valves for isolated mitral valve replacement.

From July 1970 through December 1974, 109 patients underwent isolated mitral valve replacement (MVR). A Harken prosthetic disc valve (DVR) was used in 53 patients and glutaraldehyde-preserved Hancock porcine xenograft (PVR) in 56 patients. The functional class, distribution of mitral valve pathology, and incidence of atrial fibrillation were similar in both groups. There were no operative and three (5.5%) late deaths in the PVR group and two (3.8%) operative and ten (19.5%) late deaths in the DVR group. Anticoagulants were not used in the PVR group; there were 3 nonfatal emboli (10%), all occurring in patients with atrial fibrillation and large left atria. Although anticoagulants were used there were 14 emboli (five in patients who died, nine nonfatal) in the DVR group (26.4%). In our experience, there is a significant reduction in morbidity and mortality, primarily from a reduced risk of thromboemboli, if a porcine valve is used for MVR. Anticoagulants should be used in patients with atrial fibrillation and enlarged left atria regardless of the type of valve used.

Adult↗
PubMed1975

Preoperative laparoscopy in diagnosis of acute abdominal pain.

During 1973, 56 patients on one of three general surgical services at the Peter Bent Brigham Hospital, Boston, Massachusetts, who were judged to require hospital admission for acute abdominal pain were dividied into two groups. This division was determined by whether or not the physician responsible thought a definite diagnosis could be established on clinical grounds. 27 patients were thought to have a definite diagnosis and underwent laparotomy without preoperative laparoscopy; at laparotomy, 6 of these patients (22%) had no operable lesion. An additional 29 patients had severe abdominal pain and required observation in hospital. An exact diagnosis could not be clinically established in these patients, and many would in the past have required exploratory laparotomy. These 29 patients underwent laparoscopy resulting in all but 1 (4%) having the presence or absence of intra-abdominal disease requiring operative intervention definitely established. At laparoscopy, diagnosis was made in 18 patients who did not require laparotomy while 11 had disease requiring laparotomy after laparoscopy. No complications resulted from laparoscopy. The difference in the median length of stay and hospital charges resulted in a saving of one and a half days in hospital and $87 when laparoscopy rather than explatory laparotomy determined that acute abdominal pain was caused by a condition not requiring surgical intervention.

Abdomen, Acute↗
PubMedDate not supplied

Aggressive blood conservation in coronary artery surgery: impact on patient care.

Data on 100 consecutive non-emergency coronary artery bypass (CABG) patients were analyzed retrospectively. Sixty-nine patients received no homologous blood (Group I). Thirty-one patients received a total of 118 units of blood products averaging 2.23 units of red cells (Group II). The average red cell transfusion rate for all patients was 0.7 units per patient. The median age for Group I was 61 and Group II was 68 years (p less than 0.05). The average number of grafts was the same for both (3 per patient) with 75% of Group I and 58% of Group II receiving internal mammary artery (IMA) grafts (p less than 0.05). Twelve of the Group II patients who received intraoperative transfusions on cardiopulmonary bypass to maintain adequate hemoglobin levels were older and had lower admission hematocrits: 36 +/- 0.8% compared to 41 +/- 0.5% for all other patients (p less than 0.05). Average postoperative blood loss was 889 +/- 38 ml for Group I and 1077 +/- 104 ml for Group II (p less than 0.05). Increased hemorrhage was correlated with bypass time and IMA use but not with preoperative heparin administration, pre-existing risk factors (diabetes, hypertension, etc.), bleeding time, post-bypass clotting time, age or number of grafts. Two patients in Group II and none in Group I required exploration for excessive postoperative hemorrhage. Mortality rate was 2% (both in Group II, neither transfusion related). Discharge hematocrits were the same for all at 29.4 +/- 0.4%. Among anemia-related postoperative symptoms, only sinus tachycardia was significantly higher in Group I (20%) compared to Group II (6.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗