Biomedical subjects

J LoCicero

Publications and source records attributed to J LoCicero.

99 records · Page 6Linked to original sources

PubMed1981

Cesarean section while on cardiac bypass: report of a case.

The first case of cesarean section while the patient was on cardiac bypass with favorable outcome for both mother and perinate is reported. the surgery was necessary because of a thrombosed mitral valve prosthesis. The major management dilemmas posed by this unusual case stimulated a survey of the literature concerning maternal and perinatal outcome in pregnancies complicated by cardiac disease, cardiac surgery, prosthetic valves, and/or anticoagulation.

Adolescent↗

PubMed1980

Sepsis after gastroduodenal operations: relationship to gastric acid, motility, and endogenous microflora.

We reviewed 254 consecutive gastroduodenal operations done at Charity Hospital of Louisiana in New Orleans between June 1974 and June 1977. Forty-one septic complications occurred in 30 patients, for an overall infection rate of 11.8%. Statistically higher infection rates followed operations for bleeding gastric or duodenal ulcer, obstructed duodenal ulcer, gastric ulcer, and gastric malignancy when compared to those done for chronic uncomplicated ulcer or perforated duodenal ulcer. Of these 30 patients, 22 had a compromise of either gastric acidity or motility at the time of operation. These two factors appear to be most significant in controlling the organisms which reach the stomach from swallowed saliva or by reflux through the pylorus. The organisms most frequently causing infection after gastroduodenal operations are endogenous to the stomach and include aerobic enteric gram-negative bacilli and oral, penicillin-sensitive anaerobes. Exogenous bacteria such as Staphylococcus aureus are a less frequent cause of infection after these operations.

Adolescent↗

PubMed1975

Hemodynamics of the interposition mesocaval shunt.

Eighty interposition mesocaval shunts, using a knitted Dacron large diameter prosthesis, have been performed during the past five and one-half years. Patients were evaluated from the standpoint of protection from recurrent esophageal hemorrhage, shunt patency, encephalopathy and cumulative survival analysis. In a selected group of patients, hemodynamic measurements were also obtained in the pre, intra, and postoperative periods. These included measurements of wedged hepatic vein pressure, superior mesentric venous blood flow, and residual superior mesenteric, hepatic sinusoidal and inferior vena cava pressures following the shunt procedure. Additionally, direct shunt flow measurements utilizing a square wave of electromagnetic flowmeter were also performed. Results indicate that the shunt patency is 95%; adequate decompression of the portal system was accomplished; recurrent variceal hemorrhage did not occur if the shunt remained patent; the incidence of encephalopathy was low (11%); and the operative mortality for the entire series was 9%. Continued perfusion of the liver was documented in 44% of patients and appears to be a function of the residual total portal resistance largely controlled by inferior vena caval pressure at the level of graft replacement. Life survivhat the interposition mesocaval shunt appears to be an effective technique for the control of variceal hemorrhage, has important hemodynamic advantages and can be applied to most patients for the control of variceal hemorrhage due to portal hypertension.

Adult↗

PubMed1975

A half-century of experience in the management of colon injuries: changing concepts.

A total of 773 patients who sustained colon injuries during the period 1927-1974 at Charity Hospital of Louisiana in New Orleans was reviewed. For purposes of comparison the patients were grouped into three 15-year periods. The first period (1927-1942) represented patients treated in the pre-antibiotic era exclusively with exteriorization. The second period (1943-1958) included patients in whom a program of selective surgical treatment of colon injuries was instituted, and included the advent of antibiotics and improved resuscitation. The final period (1959-1974) represented the increased use of primary repair of colon injuries. In comparing the three consecutive periods there was a marked increase (106%) in the frequency of colon injuries, primarily due to gunshot wounds in young males. The average age of our patients during this last 15-year period was 27 years. The transverse colon was the most frequent site of the injury (37%) followed by the left colon (31%) and the right colon (20%). From 60 to 75% of the patients also had associated intra-abdominal or other injuries. The mortality from colon injuries has declined steadily from 67.5% in the initial period to a low of 9.2% during the past 15 years. This drop in mortality occurred despite the fact that a larger number of patients sustained associated injuries. When comparing the three methods of therapy, primary repair, repair with proximal colostomy, and exteriorization was used less frequently during the past 15 years. It was the exclusive form of therapy in all patients treated before 1942. With the advent of selective management and antibiotics we have seen a transition from exteriorization to primary repair without colostomy. During the past 15 years primary repair was used in 44% of the patients; repair with a proximal decompressive procedure was utilized in 22%; exteriorization was carried out in 33% of the patients. The selective use of primary repair has been associated with lower mortality, fewer complications, and a shorter hospital stay, despite the increasing incidence of multiple associated injuries in this latter group of patients. Based on these studies, a plea is made for the selective use of primary repair of colon injuries of patients in good general condition when the local injury to the colon appears to warrant such an approach=

Adult↗

PubMedDate not supplied

Will multimodality therapy solve the enigma of long-term survival for squamous cell carcinoma of the esophagus?

Squamous carcinoma of the esophagus is a disease with a poor prognosis which fortunately occurs seldom in the United States. Because patients present with more advanced disease here, surgical therapy has not equaled results reported from Asia. Although, claims of equality have appeared in the literature, radiation therapy alone has not been very effective for this disease. There are a myriad of small reports which extol a variety of combined approaches. Based upon a review of these series it is obvious that a Phase III trial is required to establish the best multimodality therapy for management of squamous carcinoma of the esophagus. Components of such a trial are reviewed and suggestions are made for design and reporting of such a trial.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Efficacy of multimodality therapy in gastric adenocarcinoma.

Multimodality therapy has not reproducibly improved the survival of patients with gastric adenocarcinoma. This is largely because the staging of disease has been imprecise and because the current regimens have only limited efficacy against advanced disease. Until staging is improved and active regimens are found, it will be difficult to identify synergism between surgery and other treatment modalities.

Adenocarcinoma↗

PubMedDate not supplied

Laparoscopy/thoracoscopy for staging: II. Pretherapy nodal evaluation in carcinoma of the esophagus.

Many surgical studies show a significant stratification of survival following resection of esophageal cancer based upon accurate pathologic staging. However, investigators are moving away from single modality therapy toward multimodality trials for the treatment of this disease. This presents a problem in staging of patients before therapy is begun. Chemotherapy and/or radiation therapy may alter the local tumor characteristics and nodal metastases, thus confounding evaluation of treatment results. Although CT scanning and transesophageal ultrasound help in assessing nodal status, they have not reached the precision necessary for study purposes. Pretherapy nodal staging using video-assisted exploration may provide the same level of accuracy as mediastinoscopy does for lung cancer.

Carcinoma↗

PubMedDate not supplied

Perfusion with lipopolysaccharide negative blood eliminates lipopolysaccharide induced lung injury.

We investigated whether perfusion with control blood improves pulmonary functions compromised by lipopolysaccharide (LPS) infusion. This was an animal study in a research laboratory at a university hospital by using Sprague-Dawley rats (n = 19), each weighing 325 to 350 g. All animals were pretreated with a 24 hour infusion of either LPS (5 mg/kg) or vehicle, after which, excised lungs were reperfused for 2 hours with either LPS+ or control blood. Three groups were studied: (1) group S (n = 6); LPS pretreated lungs reperfused with LPS containing blood to mimic persistent sepsis, (2) group N (n = 6); LPS pretreated lungs reperfused with control blood to mimic the removal of the septic blood components, and (3) group C (n = 7); vehicle pretreated lungs reperfused with normal blood as a control. Blood gas exchange, shunt fraction (Qs/Qt), alveolar-arterial oxygen gradient (A-aDO2), and variables for lung mechanics were measured. Leukosequestration was quantified with a myeloperoxidase (MPO) assay. The PO2 (mm Hg) values at 90 min after reperfusion in groups S, N, and C were 67.8 +/- 7.0*, 85.2 +/- 9.2, and 90.1 +/- 7.5, respectively (*p < 0.05; vs. group N and C). In addition to PO2, A-aDO2 and Qs/Qt significantly deteriorated in group S. MPO activity in the lungs after LPS infusion was significantly higher than that after vehicle infusion (1.7 +/- 0.3 vs. 0.12 +/- 0.04 units/g tissue; p < 0.001). Subsequent reperfusion with LPS+ blood (group S) increased MPO activity to 3.1 +/- 0.6 (p < 0.05), but reperfusion with normal blood (group N) caused a significant decrease to 1.1 +/- 0.2 (p < 0.05). MPO activity in group C did not significantly change compared with those after vehicle infusion. Reperfusion with control blood normalized lung function compromised by pretreatment with LPS and significantly reduced leukosequestration. These results favor the possibility that the removal of LPS+ blood components may eliminate septic lung injury.

Animals↗

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↗