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1.
Transfusion ; 41(6): 790-3, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11399821

ABSTRACT

BACKGROUND: The transfusion of ABO-mismatched platelets has been associated with increased morbidity and mortality during induction therapy for acute leukemia and allogeneic progenitor cell transplantation. STUDY DESIGN AND METHODS: Reported here is a cohort study of 153 patients undergoing primary coronary artery bypass graft or coronary valve replacement surgery by two surgeons in one institution during 1997 and 1998. All statistics employed nonparametric two-sided tests (Mann-Whitney; Fisher's exact test). RESULTS: Patients receiving at least one ABO-mismatched pool of platelets had a significantly longer hospital stay, more days of fever, greater total hospital charges, and more RBC transfusions. Mortality, hours in the intensive care unit, days on antibiotics, and numbers of platelet transfusions were also greater in recipients of ABO-mismatched platelets, but these differences were of less statistical significance. When the analysis was restricted to the 139 patients who received no more than two pools of platelets, the trends for increased morbidity and mortality (8.6% vs. 1.9%; p = 0.10) in recipients of ABO-mismatched platelets persisted. The number of RBC transfusions required in this latter cohort was 50 percent greater (mean, 6.1 vs. 9.2; p = 0.02), despite the fact that the number of platelet transfusions given was similar (mean, 1.2 vs. 1.3 pools; p = 0.22). CONCLUSIONS: ABO-mismatched platelet transfusions are associated with unfavorable outcomes in cardiac surgery, a relationship that remains unexplained. As this association has been found in three cohort studies in various clinical settings, further investigation of this association is warranted.


Subject(s)
ABO Blood-Group System/immunology , Blood Grouping and Crossmatching , Platelet Transfusion , Aged , Coronary Artery Bypass , Female , Heart Valve Prosthesis , Humans , Male , Middle Aged , Postoperative Complications/mortality , Risk Factors
2.
J Am Soc Echocardiogr ; 11(1): 57-60, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9487470

ABSTRACT

This study investigated the phenomenon of ultrasonically induced lung hemorrhage in humans. Multiple experimental laboratories have shown that diagnostic ultrasound exposure can cause hemorrhage in the lungs of laboratory animals. The left lung of 50 patients (6 women, 44 men, mean age 61 years) was observed directly by the surgeon after routine intraoperative transesophageal echocardiography was performed. From manufacturer specifications the maximum derated intensity in the sound field of the system used was 186 W/cm2, the maximum derated rarefactional acoustic pressure was 2.4 MPa, and the maximum mechanical index was 1.3. The lowest frequency used was 3.5 MHz. This exposure exceeds the threshold found for surface lung hemorrhage seen on gross observation of laboratory animals. No hemorrhage was noted on any lung surface by the surgeon on gross observation. We conclude that clinical transesophageal echocardiography, even at field levels a little greater than the reported thresholds for lung hemorrhage in laboratory animals, did not cause surface lung hemorrhage apparent on gross observation. These negative results support the conclusion that the human lung is not markedly more sensitive to ultrasound exposure than that of other mammals.


Subject(s)
Echocardiography, Transesophageal/adverse effects , Hemorrhage/etiology , Lung Diseases/etiology , Adult , Aged , Aged, 80 and over , Animals , Female , Humans , Intraoperative Period , Male , Middle Aged
4.
Clin Cardiol ; 19(1): 74-6, 1996 Jan.
Article in English | MEDLINE | ID: mdl-8903543

ABSTRACT

This report describes the case of a giant aneurysmal right coronary artery connecting to the coronary sinus near its opening into the right atrium in a 70-year-old woman who presented with a recent onset of congestive heart failure. By coincidence, a secundum atrial septal defect was also present. The diagnosis and surgical management of this uncommon pathology are described.


Subject(s)
Coronary Aneurysm/diagnostic imaging , Coronary Vessels , Echocardiography, Transesophageal , Fistula , Aged , Coronary Aneurysm/diagnosis , Coronary Aneurysm/physiopathology , Coronary Aneurysm/surgery , Coronary Angiography , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Female , Fistula/diagnostic imaging , Heart Bypass, Right/methods , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/surgery , Heart Ventricles/diagnostic imaging , Humans
6.
Ann Thorac Surg ; 57(3): 748-50, 1994 Mar.
Article in English | MEDLINE | ID: mdl-8147654

ABSTRACT

Mycotic aneurysms of the ascending aorta are rare. We report the case of a 38-year-old woman with systemic lupus erythematosus being treated with steroids who presented with a large Neisseria gonorrhoeae ascending aortic aneurysm. She was successfully treated with surgical resection of the aneurysm and prolonged postoperative antibiotic therapy.


Subject(s)
Aneurysm, Infected/surgery , Aortic Aneurysm/surgery , Gonorrhea/surgery , Adult , Aneurysm, Infected/drug therapy , Aortic Aneurysm/drug therapy , Ceftriaxone/therapeutic use , Combined Modality Therapy , Drug Therapy, Combination/therapeutic use , Female , Gentamicins/therapeutic use , Gonorrhea/drug therapy , Humans , Vancomycin/therapeutic use
7.
Ann Thorac Surg ; 57(1): 221-2, 1994 Jan.
Article in English | MEDLINE | ID: mdl-8279899

ABSTRACT

Cardiac transplantation has become a relatively common procedure, with its limiting factor being the lack of donor hearts. The donor pool can potentially be increased by reevaluating donor criteria and performing innovative procedures on the donor heart, such as coronary bypass and valve repair. We present a recent case of donor heart mitral valve commissurotomy with successful transplantation.


Subject(s)
Heart Transplantation , Mitral Valve Stenosis/surgery , Myocardial Ischemia/surgery , Tissue Donors , Humans , Male , Middle Aged
8.
Ann Thorac Surg ; 56(6): 1390-1, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8267443

ABSTRACT

Congenital defects of the pericardium are rare. Surgical treatment is recommended to relieve symptoms and to prevent cardiac herniation and strangulation. The case of a symptomatic pericardial defect due to a dynamic obstruction of the coronary arteries is described. The diagnosis was suggested by plain chest film, echocardiography, and cardiac catheterization. Confirmation and successful surgical management were accomplished by video-assisted thoracoscopic pericardiectomy.


Subject(s)
Pericardium/abnormalities , Pericardium/surgery , Thoracoscopy/methods , Adult , Cardiac Catheterization , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/etiology , Echocardiography , Female , Humans , Pericardium/diagnostic imaging
9.
J La State Med Soc ; 143(11): 29-31, 1991 Nov.
Article in English | MEDLINE | ID: mdl-1753179

ABSTRACT

Mucocele of the appendix, a rare lesion, occurs in 0.3% of patients undergoing appendectomy. Only 46 cases of calcified mucocele have been reported. Complications reported include appendiceal intussusception, rupture resulting in acute abdomen, and infection. We report the case of a 74-year-old man with a calcified mucocele of the appendix that was discovered in the evaluation of a ureteral obstruction. During exploratory surgery, the patient was found to have a 6 x 5 cm appendiceal tumor and underwent a right ileocolectomy. Pathologic examination showed calcified mucous cystadenoma of the appendix. Calcification of a mucocele is believed to denote chronicity. Our case is the first report of ureteral obstruction secondary to calcified mucocele and the second calcified mucocele to be seen on computerized tomography. Calcified mucocele should be included in the differential diagnosis of any calcified tumor in the right lower quadrant.


Subject(s)
Appendiceal Neoplasms/complications , Calcinosis/complications , Cystadenoma/complications , Ureteral Obstruction/etiology , Aged , Appendiceal Neoplasms/pathology , Appendiceal Neoplasms/surgery , Calcinosis/pathology , Calcinosis/surgery , Cystadenoma/pathology , Cystadenoma/surgery , Diagnosis, Differential , Humans , Male
10.
South Med J ; 84(8): 1042-5, 1991 Aug.
Article in English | MEDLINE | ID: mdl-1882259

ABSTRACT

We have reported a case of complete transluminal migration of a retained laparotomy sponge that caused repeated partial small bowel obstruction. Diagnosis was made when roentgenograms showed multiple positions of the laparotomy marker. The sponge was surgically removed. This is the 69th reported case of complete transluminal migration and distal movement of a laparotomy sponge.


Subject(s)
Digestive System , Foreign Bodies , Surgical Sponges , Abdominal Pain/etiology , Adult , Foreign Bodies/diagnostic imaging , Foreign-Body Migration/diagnostic imaging , Humans , Laparotomy , Male , Radiography
11.
Ann Vasc Surg ; 5(4): 392-5, 1991 Jul.
Article in English | MEDLINE | ID: mdl-1878301

ABSTRACT

Aneurysms of the celiac artery are unusual lesions and account for only 4% of all splanchnic aneurysms. In recent years, the incidence has been noted to rise because of the increased use of sonography, computerized tomography, and arteriography. Although patients are often asymptomatic at the time of diagnosis, the risk of rupture is high; therefore, surgical resection should be undertaken in acceptable candidates. We report the case of a large celiac artery aneurysm treated with distal pancreatectomy and celiac artery aneurysmectomy.


Subject(s)
Aneurysm/diagnosis , Celiac Artery/surgery , Aneurysm/surgery , Celiac Artery/diagnostic imaging , Female , Humans , Middle Aged , Pancreatectomy , Preoperative Care , Tomography, X-Ray Computed , Ultrasonography
12.
South Med J ; 83(9): 1036-9, 1990 Sep.
Article in English | MEDLINE | ID: mdl-2402647

ABSTRACT

Urachal abnormalities are very rarely encountered in adults. Though the urachus is normally obliterated in early infancy, it may cause a lower midline lesion in adults. Urachal abnormalities can be classified into five groups: patient urachus, urachal sinus, vesicourachal diverticulum, urachal cyst, and alternating sinus. The medical records of Ochsner Medical Institutions were reviewed for the 31-year period 1957 to 1988. Forty-one patients were identified as having anomalies of the urachus, 11 of them in the adult age group (older than 17 years). All cases were documented by pathologic examination. All patients were treated surgically, with no resultant morbidity or mortality.


Subject(s)
Urachal Cyst/surgery , Urachus/abnormalities , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Urachal Cyst/diagnosis , Urachus/pathology , Urachus/surgery
13.
J Vasc Surg ; 12(3): 367-70, 1990 Sep.
Article in English | MEDLINE | ID: mdl-2169006

ABSTRACT

The case of an 18-month-old male who underwent a right hepatic lobectomy for hepatoblastoma with extensive involvement of the retrohepatic vena cava is presented. The retrohepatic vena cava was replaced with an expanded polytetrafluoroethylene graft. This graft was proved patent by ultrasonography 2 years after operation. The child has no evidence of recurrent hepatoblastoma. The results of grafting the retrohepatic vena cava have been notoriously poor. It is widely believed that a prosthetic vena cava graft cannot be expected to remain patent. Our experience with polytetrafluoroethylene and previous reports using Dacron and polytetrafluoroethylene have shown that long-term patency of retrohepatic vena cava replacement with synthetic graft can be successful.


Subject(s)
Blood Vessel Prosthesis , Polytetrafluoroethylene , Vena Cava, Inferior/surgery , Carcinoma, Hepatocellular/surgery , Follow-Up Studies , Hepatectomy , Humans , Infant , Liver Neoplasms/surgery , Male , Time Factors , Vascular Patency
15.
Ann Thorac Surg ; 49(3): 500-5, 1990 Mar.
Article in English | MEDLINE | ID: mdl-2178573

ABSTRACT

Congenital bronchoesophageal fistula is a rare anomaly that normally appears in adult life. Because of a recent case, we reviewed the literature on this lesion. There have been several reviews in the past but none has included all cases. The largest review included only two thirds of the cases (1966). Including our case, the number of reported cases is 100.


Subject(s)
Bronchial Fistula/congenital , Esophageal Fistula/congenital , Child , Female , Humans
16.
J La State Med Soc ; 142(2): 31-3, 1990 Feb.
Article in English | MEDLINE | ID: mdl-2307894

ABSTRACT

Foreign bodies in the esophagus, such as coins, meat, marbles, buttons, and chicken bones, are quite commonly encountered. We present the case of a fishing lure that was retrieved from the esophagus of a child. Since Louisiana is the "Sportsman's Paradise," it seemed appropriate to report this case in the Journal of the Louisiana State Medical Society.


Subject(s)
Esophagus , Foreign Bodies/diagnostic imaging , Animals , Child , Deglutition , Esophagoscopy , Foreign Bodies/therapy , Humans , Leisure Activities , Male , Radiography
17.
J Thorac Cardiovasc Surg ; 97(2): 303-8, 1989 Feb.
Article in English | MEDLINE | ID: mdl-2915565

ABSTRACT

Pulmonary dirofilariasis caused by Dirofilaria immitis, the dog heartworm, is a rarely reported pulmonary lesion. It appears as a solitary pulmonary nodule, and the diagnosis is not established until thoracotomy and subsequent histologic examination of the specimen are performed. Sporadic reports of pulmonary dirofilariasis in the United States total only 70 cases. The six resections of pulmonary dirofilariasis at the Ochsner Clinic represent the largest reported series of cases originating at a single institution. We present an overview of the pathogenesis of this disease, its clinical manifestations, pathologic and epidemiologic features, and geographic distribution. The prevalence of pulmonary dirofilariasis appears to be increasing; hence, thoracic surgeons and pathologists need to be alert to this cause of granulomatous pulmonary lesions.


Subject(s)
Dirofilariasis/pathology , Lung Diseases, Parasitic/pathology , Adult , Aged , Animals , Dirofilariasis/diagnosis , Dirofilariasis/transmission , Dogs/parasitology , Female , Humans , Lung Diseases, Parasitic/diagnosis , Lung Diseases, Parasitic/transmission , Male , Middle Aged
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