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Biomedical subjects

J R Munns

Publications and source records attributed to J R Munns.

6 recordsLinked to original sources
PubMed2001

Perioperative factors as predictors of operative mortality and morbidity in pneumonectomy.

Pneumonectomy for lung cancer is associated with significant morbidity and mortality. Risk factors for the morbidity and mortality have been reported, but consistent conclusive data are undetermined. Current accepted 30-day mortality rates for pneumonectomy range from 7 to 11 per cent. The objective of this study is to determine whether various perioperative factors can serve as predictors of morbidity and mortality in pneumonectomy patients and to review outcome data on patients undergoing pneumonectomy for lung cancer. A total of 105 patients undergoing pneumonectomy for lung cancer from 1988 through 1998 are studied in a retrospective chart review. The main outcome measure is the 30-day operative mortality and morbidity. Complications occurring in 10 per cent or more of the patients included atrial fibrillation (33.3%), respiratory failure (23.8%), pneumonia (21.9%), and bronchopleural fistula (12.4%). The 30-day mortality rate was 10.5 per cent (11 deaths). By Fisher's exact test for Chi-square only three statistically significant mortality factors were identified: respiratory failure (P < 0.021), sepsis (P < 0.008), and male sex (P < 0.031); respiratory failure, sepsis, and sex were predictors of death. Significant correlation could not be made to predict postoperative morbidity. Overall long-term clinical outcome for pneumonectomy as lung cancer treatment was poor. Clinical judgment remains an essential factor when considering pneumonectomy as an option for lung cancer treatment.

Adult↗
PubMed2000

Bridge to recovery for postcardiotomy failure: is there still a role for centrifugal pumps?

BACKGROUND: Early implantation of centrifugal devices in patients with postcardiotomy cardiogenic shock may provide a bridge to recovery and allow subsequent long-term survival. METHODS: Since January 1989, 62 patients were supported with centrifugal pumps because of failure to wean from cardiopulmonary bypass. Indications were postcardiotomy cardiogenic shock (PCCS) (n = 60), bridge to cardiac retransplantation (n = 1), and right ventricular failure (n = 1). Patients' ages ranged from 23 to 78 years; 40 were men (65%), and 22 were women (35%). Twenty-two patients (35%) had a left ventricular assist device; 9 patients (15%) had a right ventricular assist device; and 31 patients (50%) had a biventricular assist device. Length of support ranged from 1 day to 19 days. RESULTS: Forty-two patients (68%) were weaned successfully; 27 patients survived to discharge (44%). Complications included bleeding (n = 41, 66%), renal failure (n = 28, 45%), and respiratory failure (n = 26, 42%). Currently, 23 patients survived 10 or more years (n = 1), 6 to 10 years (n = 7), 1 to 5 years (n = 10), and less than 1 year (n = 5). CONCLUSIONS: Centrifugal pumps are available, easy to use, and relatively inexpensive. Our experience justifies their continued use as a bridge to recovery for patients with postcardiotomy cardiogenic shock, despite the availability and increasing use of more expensive devices.

Adult↗
PubMed1989

Prolonged ventricular support using a centrifugal pump.

The Biomedicus centrifugal pump was required to provide prolonged ventricular support to 13 patients with hemodynamic instability: 11 after cardiovascular surgical procedures, 1 after myocardial infarction and 1 after failure of a heart transplant. The duration of support ranged from 3.5 hours to 9 days (mean 72 hours). Complications included bleeding in six patients, renal insufficiency in three and central nervous system deficit in three. Six patients (46%) were successfully weaned from the pump. The patient with graft failure had hyperacute rejection of a second heart. Five patients were discharged from the hospital. There was one death 8 months postoperatively. Prolonged ventricular support with the centrifugal pump may allow recovery of potentially reversible ventricular dysfunction in selected patients after cardiac surgical procedures.

Adolescent↗
PubMed1976

Effect of gastric bypass on gastric secretion.

Gastric bypass as a 90 per cent gastric exclusion operation was used in 393 patients with massive obesity to limit food intake. Stomal ulcer has occurred in 1.8 per cent of such patients or one ulcer per 140 man years of observation. The studies of indwelling fundic pH and of gastric acid secretion from the excluded stomach indicate that acid secretion is reduced after gastric bypass but that the acid, unbuffered by food in the excluded stomach, results in a lowered gastrin secretion after a meal. Thus, gastric bypass in inhibitory to acid secretion in most morbidly obese patients who do not have known acid peptic disease.

Achlorhydria↗
PubMed1975

Aneurysmectomy in the aged.

The records of 206 aneurysmectomy patients over the age of 70 years were reviewed. Increased three- and five-year mortality was seen with a variety of risk factors--cerebral vascular disease, cardiac disease, diastolic hypertension, renal disease, and cigarette smoking--but 30-day mortality was not affected. Age was not a significant risk factor. It is recommended that patients with aneurysms less than 7.5 cm be observed if multiple risk factors are present. Almost all patients with aneurysms greater than 7.5 cm should have resection to prevent death from rupture, although this will be short-term palliation in patients with multiple risk factors.

Age Factors↗