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Biomedical subjects

J W Jones

Publications and source records attributed to J W Jones.

At least 37 records · Page 2Linked to original sources
PubMed2002

Atrial fibrillation after coronary bypass: etiology and pharmacologic prevention.

Coronary bypass surgery is performed on over 400,000 patients each year in the United States. Atrial Fibrillation (AF) is the most common complication after bypass surgery. The significance of its occurrence lies not only in the potentially dangerous and physiologic derangement to patients, but also in the impact it has on the utilization of health care resources. Several clinical observations suggest that the occurrence of atrial fibrillation after bypass surgery has some unique features related to the perioperative circumstances. Numerous therapies, both pharmacologic and non-pharmacologic have been tested to prevent this tenacious problem. Its persistence continues to intrigue cardio-thoracic surgeons, cardiologists, anesthesiologists and the insurers alike. In this review we discuss the published literature on postbypass AF, with a special emphasis on pharmacologic prevention.

Adrenergic beta-Antagonists↗
PubMed2002

Treatment of oral candidiasis with methylene blue-mediated photodynamic therapy in an immunodeficient murine model.

OBJECTIVES: The purpose of this study was to evaluate the efficacy of using methylene blue (MB)-mediated photodynamic therapy to treat oral candidiasis in an immunosuppressed murine model, mimicking what is found in human patients. STUDY DESIGN: Seventy-five experimental mice with severe combined immunodeficiency disease were inoculated orally with Candida albicans by swab 3 times a week for a 4-week period. On treatment day, mice were cultured for baseline fungal growth and received a topical oral cavity administration of 0.05 mL MB solution at one of the following concentrations: 250, 275, 300, 350, 400, 450, or 500 microgram/mL. After 10 minutes the mice were recultured and underwent light activation with 664 nm of diode laser light with a cylindrical diffuser. After photodynamic therapy the mice were cultured again for colony-forming units per milliliter and then killed, their tissue harvested for histopathology. RESULTS AND CONCLUSIONS: The results indicate an MB dose-dependent effect. Concentrations from 250 to 400 microgram/mL reduced fungal growth but did not eliminate Candida albicans. MB concentrations of 450 and 500 microgram/mL totally eradicated Candida albicans from the oral cavity, resulting in reductions from 2.5 log(10) and 2.74 log(10) to 0, respectively. These results suggest that MB-mediated photodynamic therapy can potentially be used to treat oral candidiasis in immunodeficient patients.

Animals↗
PubMed2002

Necrotizing soft tissue infection of the chest wall.

Necrotizing soft tissue infection (NSTI) of the chest wall is a relatively rare but highly lethal surgical infection which has received little attention in the medical and surgical literature. The data reported are based on a literature review, including a Medline database search, and search of existing bibliographies. Twenty well-documented cases of primary chest wall involvement by NSTI were found. Thirteen patients were male. Patients' ages ranged from 10 weeks to 78 years. Thirteen patients were postoperative (65%). The diagnosis was initially considered in only 3 of the postoperative cases, a cause of significant delays in surgical treatment. Among those who lived long enough for their wounds to close, 2 had secondary healing, 5 experienced delayed skin grafting over the granulating wound, and 1 had skin grafting combined with muscle transfer. Mortality was 60%. Chest wall NSTI is a rapidly spreading, highly lethal infection. A high index of suspicion, early diagnosis, and aggressive approach are essential to its successful treatment.

Adolescent↗
PubMed2001

Multiple factor scoring system for risk assessment of acute pancreatitis.

BACKGROUND: The initial prognostic classification of a pathologic event has important implications for management, outcome, and resource utilization. A variety of prognostic classification methods have been developed, but none has thus far shown consistent predictive accuracy in individual patients. In an attempt to overcome some of the limitations encountered by earlier workers, we have developed a simplified system for evaluation and prognosis of acute pancreatitis. MATERIALS AND METHODS: We studied retrospectively 306 patients with acute pancreatitis. Nonstandard statistical calculations were used to create risk indices for pancreatitis severity for all 13 variables which were included in a standard chart. RESULTS: The risk assessment rule's correct prediction is 81.32% (sensitivity) and 93.95% (specificity) for severe and mild pancreatitis, respectively. The total accuracy is 90.20%. CONCLUSION: The results of this nonstandard small retrospective study seem promising. It should remain experimental until larger prospective studies confirm the usefulness of the method.

Acute Disease↗
PubMed2001

Recurrent Spigelian hernia: a rare cause of colonic obstruction.

Spigelian hernia is considered a surgical rarity. Recent articles describe only six recurrent hernias and a scant number of patients with colonic obstruction resulting from incarceration. A patient with intestinal obstruction resulting from recurrent Spigelian hernia with strangulated colon is described. The patient underwent tension-free repair using a prosthetic mesh. Recent literature suggests that the deficiency of connective tissue in patients with hernias justifies the widespread use of permanent mesh for tissue reinforcement and avoidance of recurrences. The rare case presented should be regarded as an illustrative example for application of the tension-free repair principle in the definitive management of recurrent Spigelian hernia.

Aged↗
PubMed2001

Tracheostomy: a risk factor for mediastinitis after cardiac operation.

BACKGROUND: We studied whether tracheostomy after coronary artery bypass grafting (CABG) is associated with higher incidence of mediastinitis and mortality, and whether shorter intervals between median sternotomy and tracheotomy are associated with higher incidence of mediastinitis. METHODS: Patients (n = 6,057) undergoing CABG since March 1977 were reviewed. Patients requiring tracheostomy and those developing mediastinitis were identified. Mediastinitis diagnosis required positive culture of mediastinal tissue or fluid. RESULTS: After CABG, 88 patients had tracheostomy performed (1.45%). Seven patients receiving tracheostomy after developing mediastinitis were excluded. Of the remaining 81 patients, 7 developed mediastinitis (8.6%) compared with 44 of 5,969 (0.7%) who did not require tracheostomy (p < 0.001). Mortality in tracheostomy patients was 24.7% (20 of 81) compared with 5.2% in patients not requiring tracheostomy (316 of 5,969; p < 0.001). Patients not developing mediastinitis had tracheostomy placement an average of 25 days after CABG compared with 18.7 days for those developing mediastinitis (p = 0.141). CONCLUSIONS: Tracheostomy after CABG is associated with increased incidence of mediastinitis and mortality. In this review, the time interval between CABG and tracheostomy was not predictive of mediastinitis. A larger sample size would be required to be confident that there is no correlation.

Aged↗
PubMed2001

Variability of myocardial perfusion defects assessed by thallium-201 scintigraphy in patients with coronary artery disease not amenable to angioplasty or bypass surgery.

OBJECTIVES: We sought to assess the variability of results obtained with thallium scintigraphy as a method for tracking the extent of myocardial ischemia in medically refractory patients with angina who are not suitable for coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty. BACKGROUND: New therapies are being evaluated for patients with "no option" angina in whom medical therapy has failed. Nuclear techniques, like thallium scintigraphy, are used in multicenter trials to evaluate whether such therapies improve myocardial perfusion. However, the variability of test results is unknown in this patient group in a multicenter study. METHODS: The Angina Treatments: Lasers And Normal Therapies In Comparison (ATLANTIC) study was a randomized trial of transmyocardial laser revascularization (n = 182). Patients underwent dipyridamole thallium stress tests at baseline and 3, 6 and 12 months after enrollment. The control group (n = 90) was treated with constant medical therapy during the study and is a relevant group to investigate test variability. Test variability over time was quantified by the mean absolute change in the percentage of reversible perfusion defects between baseline and follow-up. RESULTS: Baseline percent myocardium with ischemia averaged 17.0 +/- 13.7% and did not change during follow-up. However, variations in the percent myocardium with reversible perfusion defects over time amounted to an average of 6 to 8 percentage points, or 43% to 55% of the baseline value. Only approximately 13% of this variability was attributable to variability in image reconstruction and analysis. CONCLUSIONS: As demonstrated in the ATLANTIC study, percent myocardial ischemia in control subjects receiving constant medical therapy varied in individual patients by an average of approximately 50%. This may limit the utility of thallium scintigraphy to detect improved myocardial perfusion over time in response to therapy.

Coronary Disease↗