Biomedical subjects
J W Jones
Publications and source records attributed to J W Jones.
Cardiopulmonary bypass in patients with previously completed stroke.
It has been assumed that patients with neurological residua after a completed stroke are at increased risk of neurological complications associated with cardiac operations requiring cardiopulmonary bypass. To evaluate these assumptions, we reviewed retrospectively 1,163 consecutive patients undergoing cardiac operations with cardiopulmonary bypass. Among these 1,163 patients were 43 patients having a previously completed stroke with neurological residua, but without clinically significant extracranial carotid artery disease. Forty-one underwent coronary artery bypass grafting; of these, 1 required concomitant aortic valve replacement, 1 had mitral valve replacement, and 1 had aortic valve replacement. There was one death in this group of 43 patients, due to massive pulmonary embolism. Only 1 of these 43 patients experienced new neurological symptoms after operation, which would appear to indicate that patients with a previous, completed stroke may not be at increased risk of neurological complications from cardiac operations requiring cardiopulmonary bypass.
Recurrent Mycobacterium bovis infection following a ferret bite.
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The results of functional endoscopic sinus (FES) surgery on the symptoms of patients with cystic fibrosis.
The relationship between cystic fibrosis (CF) and sinus disease has been appreciated since at least 1959. Unfortunately the standard methods used to treat sinus disease have been very unrewarding in the CF patients. We evaluated the long-term results achieved on 17 patients with CF that underwent FES surgery between July 1988 and January 1991. This group consisted of 16 pediatric and 1 adult patients with previously diagnosed CF, documented chronic sinus disease and nasal polyposis that had failed long-term maximal medical management. The patients, or their parents, were contacted and asked to rate the severity and frequency of their symptoms associated with chronic sinus disease, pre- and postoperatively. The specific symptoms evaluated were nasal obstruction, nasal discharge, postnasal drip, halitosis and cough. In addition, we attempted to measure the number of hospitalizations and the presence and frequency of headaches. We were able to show that, while there was no change in the relative health of patients as measured by the number of hospitalizations, there was a significant improvement in the quality of life. There was a marked decline in the frequency of nasal obstruction, nasal discharge and postnasal drip and a high level of patient satisfaction with the procedure. No changes were seen in the frequency or nature of the cough, halitosis or headache.
Renal artery stenosis after renal transplantation: the impact of the hypogastric artery anastomosis.
A review of 402 renal allotransplants performed during a 5-year period revealed 25 cases of transplant renal artery stenosis in 377 evaluable patients. To our knowledge this is the first large study of this transplant complication in which all patients received cyclosporine immunotherapy. The incidence of transplant renal artery stenosis was 6.6%. The mean internal from transplantation to onset of transplant renal artery stenosis was 11 months. No significant differences in atherosclerotic risk factors were detected between the groups with and without transplant renal artery stenosis. The incidence of acute allograft rejection was not increased in the stenosis group. There was no difference in the incidence of transplant renal artery stenosis following end-to-end (hypogastric artery) or end-to-side (common or external iliac artery) arterial anastomoses. Among patients having end-to-end hypogastric artery anastomoses the incidence of transplant renal artery stenosis was significantly greater (p < 0.01) when endarterectomy was required to render the hypogastric artery suitable for use. Percutaneous transluminal angioplasty was performed in 20 patients and open repair was performed in 18. After percutaneous transluminal angioplasty of hypogastric artery anastomoses, more additional procedures were required and there was a higher allograft loss rate when compared to percutaneous transluminal angioplasty of the external iliac artery. These data suggest that treatment of transplant renal artery stenosis in patients with end-to-end hypogastric artery anastomosis is more difficult and results in a higher morbidity rate than treatment in the external iliac artery group.
Interaction of coagulase negative staphylococci with lectins.
AIMS: To investigate the reaction of 118 blood culture isolates of coagulase negative staphylococci with a panel of seven lectins. METHODS: The interactions between the bacterial suspensions and lectins from Arachnis hypogaea (peanut agglutinin), Bauhina purpurea, Solanum tuberosum (potato starch), Triticum vulgaris (wheat germ agglutinin), Wisteria floribunda, Concanavalin ensiformis and Limulus polphemus (horse-shoe crab agglutinin) were assayed in microtitre plates incubated for 1 hour at room temperature then left overnight at 4 degrees C. Agglutinating activity was detected by examining the pattern of cell settlement compared with that of the controls. RESULTS: Lectins from Solanum tuberosum, Triticum vulgaris, Concanavalin ensiformis and Limulus polyphemus agglutinated 90% of the strains and displayed 11 agglutination patterns which were unrelated to species, clinical relevance, or antibiotic resistance. Fifty three per cent of the isolates fell into three reaction patterns and the other patterns were represented by nine or fewer strains. Replicate cultures investigated simultaneously gave consistent results, but some strains exhibited variation in agglutination patterns on repeat testing. CONCLUSIONS: Based on these observations lectin agglutination patterns seem to offer a method with potential for strain differentiation among coagulase negative staphylococci. Reproducibility may be improved by the use of biotinylated lectins and growing the coagulase negative staphylococci on defined media. Discrimination can be increased by the inclusion of other reactive lectins.
Selective topical cooling for myocardial protection.
Limitations of myocardial cooling using antegrade infusion cardioplegia have led to the routine use of topical myocardial cooling. However, topical myocardial cooling can injure the phrenic nerves, lungs and heart. Red blood cells are also discarded with the irrigation fluid. To evaluate the selective use of topical cooling, data were collected prospectively from 67 consecutive patients undergoing isolated coronary artery bypass operation. All patients received an inductive dose of 1 liter blood cardioplegia solution. Intramyocardial temperatures were determined in the distribution of the three major coronary arteries after the first 500 ml of cardioplegia solution was administered. If the three temperature readings were all < or = 20 degrees C, patients (group 1, n = 31) received no topical myocardial cooling. If any temperature was > 20 degrees C, patients (group 2, n = 36) received topical cooling while the second 500 ml cardioplegia solution was administered. Cardioplegia solution was subsequently administered at approximately 20-min intervals, at which time the patient did or did not receive topical myocardial cooling, depending on the selected group. Although patients in group 2 were older (mean (s.e.m.) age 63.3(1.6) versus 56.8(1.8) years, P < 0.05), the two groups were not significantly different with respect to sex, ejection fraction, risk factors, and class of the New York Heart Association. There were also no significant differences in the mean number of grafts per patient, use of the internal mammary artery, and cross-clamp or pump times. There were no deaths and only one patient (3%) in group 2 developed new Q waves.(ABSTRACT TRUNCATED AT 250 WORDS)
Hypoaldosteronemic hyporeninemic hyperkalemia after renal transplantation.
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Pregnancy following kidney donation.
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Unrecognized health problems diagnosed during living donor evaluation: a potential benefit.
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Stability of bupivacaine hydrochloride in polypropylene syringes.
The stability of bupivacaine hydrochloride injection 1.25 mg/mL in 0.9% sodium chloride injection in polypropylene syringes was studied. Plastic syringes containing bupivacaine hydrochloride 1.25 mg/mL in 0.9% sodium chloride injection or 0.9% sodium chloride injection alone were stored at 3 or 25 degrees C. A glass vial containing the admixture was stored at 25 degrees C as a control. For each condition, triplicate samples were observed immediately and 5, 11, 15, and 32 days after preparation for precipitation and color change and analyzed for pH and for drug concentration by high-performance liquid chromatography. No change in bupivacaine concentration was observed during the 32-day study period, nor was there any change in color or pH nor any development of precipitation. Bupivacaine hydrochloride 1.25 mg/mL in 0.9% sodium chloride injection in polypropylene syringes was stable for up to 32 days when stored at 3 or 23 degrees C.
Survey of dirofilariasis in Arkansas.
A card survey was sent to 340 veterinarians in the Urban, Delta, Highland and Coastal Plain regions of Arkansas. Veterinarians were asked to indicate numbers of dogs tested, confirmed Dirofilaria immitis positive, diagnostic techniques, frequency and period tested. A significantly greater percentage of dogs tested D. immitis positive in the Delta region as compared with the Urban region. There were no significant differences in the percentage of treated dogs on prophylaxis or the types of diagnostic tests among regions.
Successful percutaneous treatment of ureteral stenosis after renal transplantation.
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Employment and disability after renal transplantation.
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Percutaneous treatment of ureteral strictures after renal transplantation.
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Overseas training for doctors from developing countries.
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Usefulness of right ventricular indices in early diagnosis of cardiac tamponade.
Early diagnosis of postoperative cardiac tamponade is impeded by its clinical similarity to left ventricular failure. Moreover, the hemodynamic changes necessary to diagnose cardiac tamponade are detected by conventional monitoring technique only after clinical compromise. Early signs of cardiac tamponade and left ventricular failure were studied with emphasis on right ventricular function in anesthetized dogs. One group (n = 20) had cardiac tamponade produced by incrementally increasing pericardial pressure (2 to 20 mm Hg), and another group (n = 20) had acute left ventricular failure produced by successive ligation of the anterior descending coronary artery at the lower, middle, and upper thirds. Besides standard hemodynamic measurements, right ventricular function was examined with a rapid-response thermodilution catheter. During cardiac tamponade, cardiac output, right ventricular ejection fraction, right ventricular stroke volume, and right ventricular end-diastolic volume were significantly decreased from baseline values after a pericardial pressure of 8 mm Hg or more (p less than 0.05). Right atrial and pulmonary arterial pressures were not significantly elevated until 14 and 20 mm Hg of pericardial pressure, respectively. Although cardiac function in the left ventricular failure group was reduced after each ligation, right ventricular ejection fraction remained unchanged. This study suggests that right ventricular indices may facilitate earlier diagnosis of cardiac tamponade with greater accuracy.
Spinal oxygenation, blood supply localization, cooling, and function with aortic clamping.
Similar to other methods of organ preservation, "spinoplegia" may protect the spinal cord from the effects of oxygen desaturation during aortic cross-clamping. In porcine experiments, spinal cord O2 saturation was studied during intraoperative localization of the blood supply to the spinal cord using hydrogen; division of arteries not supplying the spinal cord; aortic cross-clamping for 60 minutes; and 60 minutes after unclamping. In 5 animals, 120 mL of cold saline solution with lidocaine (100 mg/dL) was infused into the aorta during aortic cross-clamping. During sequential localization, O2 saturation dropped by 40.02% (standard deviation, 20.16%) for T-14 artery testing versus a decrease of 17.27% (standard deviation, 11.88%; p = 0.0075) for L-5 artery segment testing in the control animals and returned to baseline thereafter. During aortic cross-clamping maximal O2 desaturation was 5% of baseline (15.7%; p less than 0.0001), which improved slightly by 30 minutes after clamping (48% of baseline +/- 37.37%; p = 0.048 versus maximum) and then returned to baseline (97.1% of baseline +/- 41%) with unclamping; 5 minutes later, hyperoxygenation occurred with a progressive decline thereafter (68% of baseline +/- 29.3%; p = 0.025, 45 minutes after unclamping versus baseline). The decrease in spinal motor evoked potentials was significantly less (p less than 0.02) in the treated group. Intraoperative hydrogen testing in 8 patients was demonstrated to be safe. It accurately localized reattached arteries, and O2 saturation of the spinal cord fell by 56% (standard deviation, 29%; p = 0.0025) with aortic cross-clamping. We conclude that spinal cord ischemia occurs with aortic cross-clamping in both animals and humans.(ABSTRACT TRUNCATED AT 250 WORDS)