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Biomedical subjects

J LoCicero

Publications and source records attributed to J LoCicero.

At least 91 records · Page 5Linked to original sources
PubMed1986

Ruptured thoracic aneurysm: unusual manifestation and early diagnosis using CT.

Rupture of a thoracic aortic aneurysm across the posterior mediastinum into the right side of the chest is rare. The diagnosis may be delayed by the absence of expected findings in the left side of the chest. We recently encountered two patients with thoracic aneurysm rupture who came to medical attention initially because of right-sided pleural and/or extrapleural hematomas, which were accurately diagnosed preoperatively on the basis of computed tomography (CT) findings. Aortography, performed in one patient, added no useful information. Because CT accurately identifies the presence of pleural or extrapleural blood, as well as the underlying aneurysm or dissection, CT should be the first examination performed in cases of suspected thoracic aneurysm rupture.

Aged↗
PubMed1986

Comparative study of warfarin versus antiplatelet therapy in patients with a St. Jude Medical valve in the aortic position.

To determine the necessity of long-term warfarin anticoagulation after St. Jude Medical aortic valve replacement in adults, we evaluated the risks of thromboembolism, valve thrombosis, anticoagulant hemorrhage, and sudden cardiac death in two groups of patients. Group I consisted of 41 patients treated with conventional long-term warfarin therapy. Forty-two patients in Group II were treated primarily with antiplatelet therapy (aspirin, dipyridamole, or both); 17 of these patients received warfarin for a short time postoperatively and seven others received it intermittently during the study period. The groups were similar with respect to age, sex, associated cardiovascular disease, and length of follow-up (mean 29 months per patient). In the warfarin-treated group, three late sudden deaths occurred, one of which was preceded by a cerebrovascular accident, for a cardiac mortality of 2.7% per patient-year. There were eight major nonfatal complications (7.3% per patient-year), of which four were hemorrhagic and four embolic. In Group II, there was one sudden cardiac death (1.1% per patient-year) and four major complications occurred (3.2% per patient-year). Two of the complications were embolic and two were episodes of valve thrombosis, both necessitating reoperation. Although the incidence of serious morbidity in the warfarin-treated group was twice that of patients treated with antiplatelet therapy, there were no statistically significant differences in the rates of sudden death or major complications. These data suggest that antiplatelet therapy may be as effective as warfarin in preventing embolism from the St. Jude Medical valve in the aortic position. Valve thrombosis occurred in two patients, both receiving antiplatelet therapy (2.2% per patient-year). Whether this type of valve failure can be prevented by warfarin remains in question.

Adolescent↗
PubMed1986

Remote skin injury: a protean complication of open heart surgery.

In the 12-month period ending August, 1984, 14 adult patients (2.9%) developed within 24 hr following open heart surgery skin defects of varying magnitude remote from the incision site. Electrical injury secondary to a grounding defect was documented in two patients and suspected in one. Four patients' injuries were caused by the roller device when transfering from operating room table to intensive care unit bed. The remaining eight patients all had skin loss at sites of pressure on either the head, back, buttocks, or arm. Retrospective analysis showed no correlation with mean pressure during cardiopulmonary bypass (CPB), depth of cooling, length of time to rewarm, or the use vasoactive drugs. Subsequently, core temperature plus ten surface temperatures were monitored during and following CPB in ten patients. The data showed that during active cooling and rewarming, skin temperature actually lagged behind the core temperature (4 C). Thus, the skin appears to develop a relative oxygen debt during CPB which may decrease the threshold for skin injury particularly in older patients who may have other predisposing factors, such as obesity, generalized atherosclerosis, diabetes, or friable skin. Pressure points during positioning and subsequent skin trauma must be meticulously avoided in any patient undergoing CPB.

Adult↗
PubMed1985

Interhospital transport of patients with ongoing intraaortic balloon pumping.

During a 5-year period (1979 to 1983), 50 consecutive patients undergoing continuous intraaortic balloon (IAB) pumping were transferred from Evanston Hospital to Northwestern Memorial Hospital (16 miles), where they underwent cardiac operation. All patients had cardiac catheterization before transfer. Indications for IAB were cardiogenic shock (9 patients), postinfarction angina (18 patients), unstable angina (9 patients), evolving myocardial infarction (3 patients), accelerating angina or hemodynamic instability during cardiac catheterization (9 patients) and prophylactic insertion for high-grade left main stenosis (2 patients). Transportation after stabilization was uneventful in all patients. All patients underwent operative coronary revascularization. There was concomitant mitral valve replacement in 3 patients, acute ventricular septal defect repair in 1 patient, aortic valve replacement in 1, and ventricular aneurysmectomy in 1. Three patients (5%) died postoperatively. Nine patients (20%) had complications directly related to IAB insertion. One patient required femoral-femoral arterial bypass preoperatively, 4 patients had postoperative lower limb ischemia treated by IAB removal or thrombectomy and 1 patient had thrombocytopenia (less than 60,000/mm3), 1 false aneurysm, 1 anterior compartment syndrome and 1 prolonged bleeding at the insertion site. Interhospital transfer with IAB pumping in progress should not be restricted to patients with cardiogenic shock, but can be effectively used for all patients who require preoperative IAB insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Assisted Circulation↗
PubMed1985

Endocardial activation mapping and endocardial pace-mapping using a balloon apparatus.

The relation between endocardial activation mapping and endocardial pace-mapping was evaluated in 8 dogs while they were on cardiopulmonary bypass. Pacing or recording was accomplished by using a balloon apparatus (with 32 bipolar electrodes) inserted through a left apical ventriculotomy. Ventricular tachycardia (VT) was produced by occlusion followed by reperfusion of the left anterior descending coronary artery. During each VT, activation mapping was performed and early sites determined. Pace-map correlates (sites at which endocardial pacing produced a similar QRS morphology to that of the VT) were also determined. Isochronous maps were constructed for activation mapping and pace-mapping. There was a total of 29 morphologically distinct VTs. Groups were delineated according to correlations between activation mapping and pace-mapping. In 14 episodes of VT (group 1), pace-mapping confirmed the findings of activation mapping with all early sites being pace-map correlates (total number of early sites (tES) = 19; total number of pace-map correlates (tPMC) = 88; tES same as tPMC = 19). In 9 episodes of VT (group 2), there was a partial correlation between pace-mapping and activation mapping, such that pace-mapping when used with activation mapping appeared to further delineate the region of arrhythmogenesis (tES = 31; tPMC = 59; tES same as tPMC = 14). In 6 episodes of VT (group 3), there was no correlation between pace-mapping and activation mapping (tES = 15; tPMC = 0). With the balloon apparatus, endocardial activation mapping can be performed without the need for sustained monomorphic VT, and endocardial pace-maps may be generated easily.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Evaluation of the carbon dioxide laser for performance of gastrointestinal myotomies.

Using a conventional carbon dioxide laser set at 8-W continuous-wave energy, a technique was developed in the animal laboratory to incise only the muscularis of the pylorus leaving the mucosa and submucosa intact. Similar esophageal myotomies were performed with less success, due to the rich submucosal venous plexus causing obscuring hemorrhage and to the reapproximation of the longitudinal esophageal muscle over a 3-week period. The technique for esophageal myotomy requires further refinement, but pyloromyotomy appears applicable for controlled human trials.

Animals↗
PubMed1985

Clostridial myonecrosis of the chest wall complicating spontaneous esophageal rupture.

Spontaneous rupture of the esophagus (Boerhaave's syndrome) has a dismal survival rate without prompt surgical management. A variety of surgical regimens have achieved survival of 70% or greater; however, the postoperative course is frequently complicated by fistula, would infection, empyema, and sepsis. We report an unusual postoperative chest wound infection of clostridial myonecrosis, which presumably originated from the patient's gastric microflora. He was treated with immediate surgical debridement of all involved tissue, prolonged ventilation, total parenteral nutrition, and frequent dressing changes. The remaining defect was closed with a skin graft. Anaerobic wound infections of the chest wall and their management are discussed.

Clostridium Infections↗
PubMed1985

New applications of the laser in pulmonary surgery: hemostasis and sealing of air leaks.

In thoracic surgery, the laser has been used primarily as a destructive instrument (e.g., for extirpation of endobronchial lesions and for skin incisions). Previously, the carbon dioxide laser was used for its scalpel-like action but not for sealing. The neodymium:yttrium aluminum garnet (Nd:YAG) laser not only cuts but also seals blood vessels and bronchi. We have modified the CO2 laser technique to seal vessels and bronchi up to 3 mm on a cut surface by using low power in a defocused mode, and have evaluated the method in 12 dogs. Matched lesions in the lingula were sealed with each type of laser and compared with lesions closed by suture technique. These lesions were then evaluated at biweekly intervals up to 6 weeks following operation. All lesions demonstrated substantial air leak and bleeding prior to sealing. There was no bleeding or air leak (40 cm H2O of pressure) at any time after sealing (laser or suture). The CO2 laser sealing consistently produced the least damage both macroscopically and microscopically. However, this technique requires a relatively bloodless field. The Nd:YAG laser produced the deepest tissue destruction but functioned well under conditions of poor hemostasis. Suture closure produced large early injuries, which subsided gradually to approach the amount of damage seen with the CO2 laser. These studies demonstrate that the laser may be a useful adjunct to maximally preserve normal lung tissue and to seal bleeding, leaking, raw lung surfaces. Results of early clinical trials are also detailed.

Aged↗
PubMed1985

Experimental air leaks in lung sealed by low-energy carbon dioxide laser irradiation.

When a focused carbon dioxide laser beam strikes a surface of tissue, the light energy is converted instantly into thermal energy, causing cells directly in the laser's path to vaporize. Because the carbon dioxide laser's energy is well absorbed by water, this thermal effect is attenuated at a distance of 100 mu. If the laser beam is "defocused," the same thermal energy is dissipated over a larger area, causing only desiccation and melting of tissue without vaporization; however, the depth of injury remains shallow. This modified technique has been used to seal artificially created air leaks in the canine lung. Twelve mongrel dogs were anesthetized, intubated, and ventilated. The lingula was exposed sterilely through a left thoracotomy. A 1 X 3-mm hole was made in the lung at 1 cm from the edge. The created air and blood leaks were sealed with a defocused carbon dioxide laser beam set at 8 W (32 W/sq cm). Each tissue "weld" withstood 40 cm H2O of peak ventilation pressure without leak. At the time of reoperation three weeks later, there was apparent complete healing of the pulmonary surface. No air leaks were present. Histologic examination showed a small zone of amorphous coagulated pleura and lung overlying a zone of minimal atelectasis. Normal lung was present within 150 mu of the laser seal. This new technique was performed safely and easily with currently available carbon dioxide lasers in the laboratory. It is presently undergoing intraoperative trials in a controlled clinical setting.

Animals↗
PubMed1985

Complete surgical revascularization: the treatment of choice in young patients with multivessel coronary disease.

Since the advent of coronary angioplasty, nonoperative techniques to manage coronary artery disease have become attractive alternatives to coronary artery bypass grafting (CABG). To provide a standard against which new procedures could be judged, 123 consecutive patients less than 45 years of age who have had CABG since 1978 were systematically followed. The indications for operation were unstable angina or postinfarction angina (60%), life-threatening coronary anatomy with stable angine (36%), and sudden death or uncontrolled ventricular tachycardia (4%). Seventy-five patients had documented preoperative myocardial infarction, 55% within 30 days of CABG. An average of 3.2 vessels were grafted per patient; only 10 had single CABG. Complete revascularization was accomplished in 91% of patients. Five patients (4%) had myocardial infarction within 30 days of operation. No operative deaths or strokes occurred. The 6-year follow-up was 94.4% (the 5-year actuarial survival rate, 87.4%). There were four late deaths; two were due to myocardial infarction, one to prosthetic valve failure, and one to sudden death. At 2.7 years, 88.1% of the patients were NYHA Functional Class I; 85.4% continued full-time employment, and 98% considered their quality of life the same or better than before CABG. Five patients suffered myocardial infarctions during the follow-up period. Nine patients required reoperation: eight for graft occlusion (three less than 1 year, five greater than 3 years), and one for disease progression. These data confirm that complete operative revascularization remains the standard of therapy for young patients with multivessel coronary artery disease as evidenced by the absence of early mortality, the low incidence of morbidity, the excellent functional recovery, and the high return to gainful employment.

Journal Article↗
PubMed1984

Tracheo-carotid artery erosion following endotracheal intubation.

A case of tracheo-carotid artery erosion in a patient who required only endotracheal intubation is presented. This appears to be the first case reported in the world literature that was not associated with a tracheostomy. Etiologic factors leading to this complication include direct pressure from the tube tip, abrasions during intubation, mucosal damage from cuffs, and CPAP, even over a short time. Selection of an endotracheal tube with a high-compliance, low-pressure cuff, careful intracuff pressure monitoring, prevention of infection and hypotension, and improvement in the patient's nutritional and immunologic status will help to prevent this complication. Any patient bleeding more than 10 ml without cause should be suspected of having this complication. Rapid treatment is necessary for survival. Patients should be intubated and the cuff inflated. Bronchoscopic examination should be done in the operating room under general anesthesia with neck and chest prepped and draped. Median sternotomy or possibly right anterior thoracotomy is recommended. Resection of involved vessels has been successful.

Adult↗
PubMed1984

Pleural ascites without abdominal fluid: surgical considerations.

The presence of ascitic fluid in the pleural cavity in the absence of peritoneal fluid is rare. We have recently encountered two patients who presented with red-sided pleural effusions and no abdominal ascites. Both patients had diaphragmatic defects: One was an old traumatic diaphragmatic tear and the other a pinpoint spontaneous perforation. These cases are unique because the diagnosis of total ascitic fluid movement across the diaphragm was made during life, and the condition was surgically corrected. The literature concerning transdiaphragmatic movement of fluid is reviewed, and an operative approach is outlined.

Adult↗
PubMed1983

Complications following abdominal fascial closures using various nonabsorbable sutures.

With the use of the interrupted far-and-near fascial closure technique, four suture materials were compared: nylon, polypropylene and two brands of braided Dacron (Ethibond and Polydek). There were no wound dehiscences among the 96 patients studied. During the average follow-up period of 12 months, significantly more suture granulomas occurred with the braided Dacron than with the monofilament materials (p less than 0.05). Those that did occur with monofilament material occurred almost exclusively in thin patients.

Abdomen↗
PubMed1982

Efficacy of antibiotic prophylaxis in high risk gastroduodenal operations.

A double-blind, prospective and randomized clinical trial of the efficacy of antibiotic prophylaxis in gastroduodenal operations was studied in 39 patients over an 18 month period. All patients had clinical features that placed them at high risk for the development of postoperative wound or intraabdominal sepsis. In the placebo group of 20 patients seven gastric-related infections developed, while 1 of the 19 patients who received perioperative cefamandole had one gastric-related infection (p less than 0.01). The responsible microorganisms were those that are normal components of the oral or intestinal microflora. Nongastric-related infections and deaths did not differ significantly in the two study groups. The results of this study confirm the efficacy of the use of short-term perioperative antibiotic prophylaxis in patients undergoing gastroduodenal surgery for bleeding duodenal or gastric ulcer, obstructing duodenal ulcer, gastric ulcer or malignancy.

Anti-Bacterial Agents↗
PubMed1982

Brachial artery reconstruction after traumatic disruption.

We describe a series of 21 cases of traumatic disruption of the brachial artery that required surgical intervention. Stab wounds were most frequent (11), followed by gunshot wounds (six) and blunt trauma (four). Ten patients had associated upper extremity injuries including bone, nerve, and vein. Arterial repair with lateral sutures could be accomplished in only one case. Segmental resection of the artery required interposition grafts using autogenous saphenous or cephalic vein in 11 patients. No synthetic graft material was used, and prophylactic antibiotics were given to all patients. All patients are without sequelae a median of 12 months after operation. Complete neurovascular evaluation, including arteriography and venography where indicated, followed by prompt repair is necessary for a successful outcome. The cephalic vein was an excellent alternative for an interposition graft in this series of patients. Primary repair of concomitant injuries, use of perioperative prophylactic antibiotics, and rigid immobilization for a short period followed by active mobilization will yield the best results.

Adult↗
PubMed1982

Ossifying fasciitis.

Metaplastic bone is an uncommon finding in cases of fasciitis. It has been reported only in occasional cases in series of patients with nodular fasciitis, parosteal fasciitis, proliferative fasciitis, and proliferative myositis. Ossification is relatively common in cranial fasciitis of childhood, a form of fasciitis that may originate in cranial periosteum. We studied a patient with ossifying fasciitis that occurred along the adventitia of the femoral artery, at the site of an earlier angiographic study.

Adipose Tissue↗