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Polmear CM, Nathan H, Bates S, French C, Odisho J, Skinner E, Karahalios A, McGain F. The effect of intensive care unit admission on smokers' attitudes and their likelihood of quitting smoking. Anaesth Intensive Care 2018; 45:720-726. [PMID: 29137583 DOI: 10.1177/0310057x1704500612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We sought to estimate the proportion of patients admitted to a metropolitan intensive care unit (ICU) who were current smokers, and the relationships between ICU survivors who smoked and smoking cessation and/or reduction six months post-ICU discharge. We conducted a prospective cohort study at a metropolitan level III ICU in Melbourne, Victoria. One hundred consecutive patients who met the inclusion criteria were included in the study. Inclusion criteria consisted of patients who were smokers at time of ICU admission, had an ICU length of stay greater than one day, survived to ICU discharge, and provided written informed consent. A purpose-designed questionnaire which included the Fagerstrom test for nicotine dependence and evaluation of patients' attitude towards smoking cessation was completed by participants following ICU discharge and prior to hospital discharge. Participants were re-interviewed over the phone at six months post-ICU discharge. Of the 1,062 patients admitted to ICU, 253 (23%) were current smokers and 100 were enrolled. Six months post-ICU discharge, 28 (33%) of the 86 participants who were alive and contactable had quit smoking and 35 (41%) had reduced smoking. The median number of reported cigarettes smoked per day reduced by 40%. Participants who initially believed their ICU admission was smoking-related were more likely to have quit six months post-ICU discharge (odds ratio 2.98; 95% confidence interval 1.07 to 8.26; <i>P</i>=0.036). Six months post-ICU discharge, 63/86 (74%) of participants had quit or reduced their smoking. Further research into targeted smoking cessation counselling for ICU survivors is indicated.
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Affiliation(s)
| | | | | | | | | | | | - A Karahalios
- Research Fellow, Biostatistics Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria
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2
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Goldberg D, Kallan MJ, Fu L, Ciccarone M, Ramirez J, Rosenberg P, Arnold J, Segal G, Moritsugu KP, Nathan H, Hasz R, Abt PL. Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States. Am J Transplant 2017; 17:3183-3192. [PMID: 28726327 DOI: 10.1111/ajt.14391] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 01/25/2023]
Abstract
The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient-level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009-2012, 96,028 (3.3%) were a "possible deceased-organ donor." The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased-donors who become actual donors; range: 20.0-57.0%); and (2) organs transplanted per possible donor (range: 0.52-1.74). These metrics allow for comparisons of OPO performance and geographic-level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.
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Affiliation(s)
- D Goldberg
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.,Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - M J Kallan
- Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - L Fu
- The Bridgespan Group, New York, NY
| | | | | | | | | | | | - K P Moritsugu
- Former Acting Surgeon General of the United States, Great Falls, MT
| | - H Nathan
- Gift of Life Institute, Philadelphia, PA
| | - R Hasz
- Gift of Life Institute, Philadelphia, PA
| | - P L Abt
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA
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Barrett M, Nathan H, Vankayala H, Bieliauskas SL, Viglianti BL, Frankel TL. Recurrence of hepatocellular carcinoma at surgical incision site: case series and review of literature. Ann R Coll Surg Engl 2017; 99:e177-e119. [PMID: 28660820 DOI: 10.1308/rcsann.2017.0097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
First reported two decades ago, isolated incisional recurrence of hepatocellular carcinoma is an extremely rare clinical entity. We present two cases of recurrence: one recurring over 10 years after initial resection, and the second presenting with a port site recurrence 3.5 years following laparoscopic radiofrequency ablation. Clinical case presentation, including radiographical, pathological, laboratory and intraoperative images are reported, together with a review of the current literature surrounding this uncommon hepatocellular carcinoma presentation.
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Affiliation(s)
- M Barrett
- Department of General Surgery, University of Michigan Hospital , Ann Arbor, MI , USA
| | - H Nathan
- Department of General Surgery, University of Michigan Hospital , Ann Arbor, MI , USA
| | - H Vankayala
- Department of Oncology, Wayne State University, John D. Dingle VA Medical Center , Detroit, MI, , USA
| | - S L Bieliauskas
- Department of Pathology, University of Michigan Hospital , Ann Arbor, MI , USA
| | - B L Viglianti
- Department of Radiology, University of Michigan Hospital , Ann Arbor, MI , USA
| | - T L Frankel
- Department of General Surgery, University of Michigan Hospital , Ann Arbor, MI , USA
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Bostick GP, Kamper SJ, Haanstra TM, Dick BD, Stitt LW, Morley-Forster P, Clark AJ, Lynch ME, Gordon A, Nathan H, Smyth C, Ware MA, Toth C, Moulin DE. Pain expectations in neuropathic pain: Is it best to be optimistic? Eur J Pain 2016; 21:605-613. [PMID: 27739623 DOI: 10.1002/ejp.962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Pain expectancy may be an important variable that has been found to influence the effectiveness of treatments for pain. Much of the literature supports a self-fulfilment perspective where expectations for pain relief predict the actual pain experienced. However, in conditions such as neuropathic pain (NeP) where pain relief is difficult to attain, expectations for pain relief could be unrealistic. The objective of this study was to investigate the relationship between realistic/unrealistic expectations and 6-month, post-treatment outcomes. METHODS We performed a retrospective analysis of a large cohort of patients with NeP (n = 789) attending tertiary care centres to determine the association between unrealistic (both positive and negative) and realistic expectations with outcomes after multidisciplinary treatment. An expectation variable with three categories was calculated: realistic expectations were those whose expected reduction in pain was similar to the observed mean group reduction in pain, while optimistic and pessimistic expectations were those who over- or under-estimated the expected response to treatment, respectively. The association between baseline realistic/unrealistic expectations and 6-month pain-related disability, catastrophizing and psychological distress was assessed. RESULTS Univariable analyses suggested that realistic expectations were associated with lower levels of disability, catastrophizing and psychological distress, compared to unrealistic expectations. However, after adjustment for baseline symptom severity, multivariable analysis revealed that patients with optimistic expectations had lower levels of disability, than those with realistic expectations. Those with pessimistic expectations had higher levels of catastrophizing and psychological distress at follow-up. CONCLUSIONS These findings are largely congruent with the self-fulfilment perspective to expectations. SIGNIFICANCE This study defined realistic pain expectations with patient data. Examining the relationship between expectations between pain and disability in a large cohort of patients with neuropathic pain.
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Affiliation(s)
- G P Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - S J Kamper
- The George Institute for Global Health, University of Sydney, NSW, Australia
| | - T M Haanstra
- Department of Orthopedics, VU University Medical Center, Amsterdam, The Netherlands
| | - B D Dick
- Departments of Anesthesiology and Pain Medicine, Psychiatry and Pediatrics, University of Alberta, Edmonton, Canada
| | - L W Stitt
- LW Stitt Statistical Services, London, ON, Canada
| | - P Morley-Forster
- Department of Anaesthesiology, Pain Management and Peri-operative Medicine, Western University, London, ON, Canada
| | - A J Clark
- Department of Anaesthesia, Dalhousie University, Halifax, NS, Canada
| | - M E Lynch
- Department of Anaesthesia, Dalhousie University, Halifax, NS, Canada.,Departments of Psychiatry and Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - A Gordon
- Department of Medicine, Division of Neurology, University of Toronto, ON, Canada
| | - H Nathan
- Department of Anaesthesiology, University of Ottawa, ON, Canada
| | - C Smyth
- Department of Anaesthesiology, University of Ottawa, ON, Canada
| | - M A Ware
- Departments of Family Medicine and Anaesthesia, McGill University, Montreal, QC, Canada
| | - C Toth
- Fraser Valley Health Authority, Surrey, BC, Canada
| | - D E Moulin
- Departments of Neurological Sciences and Oncology, Western University, London, ON, Canada
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Luskin R, Nathan H. Eligible Death Statistic: Not a True Measure of OPO Performance nor the Potential to Increase Transplantation. Am J Transplant 2015; 15:2019-20. [PMID: 26031199 DOI: 10.1111/ajt.13361] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 01/25/2023]
Affiliation(s)
- R Luskin
- New England Organ Bank, Waltham, MA
| | - H Nathan
- Gift of Life Donor Program, Philadelphia, PA
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Toeg H, Nathan H, Rubens F, Wozny D, Boodhwani M. 508 Clinical Impact of Neurocognitive Deficits Following Cardiac Surgery. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mayo S, Heckman J, Shore A, Nathan H, Parikh A, Anaya D, Becker N, Pawlik T. National Trends In The Surgical Management And Survival Of Patients With Colorectal Liver Metastasis: A Population-Based Analysis. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boodhwani M, Hamilton A, de Varennes B, Mesana T, Williams K, Wells GA, Nathan H, Dupuis JY, Babaev A, Wells P, Rubens FD. A multicenter randomized controlled trial to assess the feasibility of testing modified ultrafiltration as a blood conservation technology in cardiac surgery. J Thorac Cardiovasc Surg 2010; 139:701-6. [DOI: 10.1016/j.jtcvs.2009.11.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 11/10/2009] [Accepted: 11/23/2009] [Indexed: 11/26/2022]
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Herman J, Redmond K, Nathan H, Laheru D, Edil B, Sugar E, Choti M, Pawlik T, Cameron J, Wolfgang C. Adjuvant Chemoradiation for Adenocarcinoma of the Body and Tail of the Pancreas: The Johns Hopkins Experience. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Bernat JL, D'Alessandro AM, Port FK, Bleck TP, Heard SO, Medina J, Rosenbaum SH, Devita MA, Gaston RS, Merion RM, Barr ML, Marks WH, Nathan H, O'connor K, Rudow DL, Leichtman AB, Schwab P, Ascher NL, Metzger RA, Mc Bride V, Graham W, Wagner D, Warren J, Delmonico FL. Report of a National Conference on Donation after cardiac death. Am J Transplant 2006; 6:281-91. [PMID: 16426312 DOI: 10.1111/j.1600-6143.2005.01194.x] [Citation(s) in RCA: 356] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A national conference on organ donation after cardiac death (DCD) was convened to expand the practice of DCD in the continuum of quality end-of-life care. This national conference affirmed the ethical propriety of DCD as not violating the dead donor rule. Further, by new developments not previously reported, the conference resolved controversy regarding the period of circulatory cessation that determines death and allows administration of pre-recovery pharmacologic agents, it established conditions of DCD eligibility, it presented current data regarding the successful transplantation of organs from DCD, it proposed a new framework of data reporting regarding ischemic events, it made specific recommendations to agencies and organizations to remove barriers to DCD, it brought guidance regarding organ allocation and the process of informed consent and it set an action plan to address media issues. When a consensual decision is made to withdraw life support by the attending physician and patient or by the attending physician and a family member or surrogate (particularly in an intensive care unit), a routine opportunity for DCD should be available to honor the deceased donor's wishes in every donor service area (DSA) of the United States.
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Abstract
Whether the number of organs available for transplant would be positively or negatively affected by providing benefits to families of organ donors has been debated by policymakers, ethicists and the transplant community at large. We designed a telephone survey to measure public opinion regarding the use of benefits in general and of five types in particular: funeral benefits, charitable contributions, travel/lodging expenses, direct payments and medical expenses. Of the 971 adults who completed the survey (response rate = 69%), all were from Pennsylvania households, 45.6% were registered organ donors, and 51.7% were nonwhite. Although 59% of respondents favored the general idea of incentives, support for specific incentives ranged from 53% (direct payment) to 84% (medical expenses). Among those registered as donors, more nonwhites than whites supported funeral benefits (88% vs. 81%; p = 0.038), direct payment (63% vs. 41%; p < 0.001) and medical expenses (92% vs. 84%; p = 0.013). Among those not registered as donors, more nonwhites supported direct payment (64% vs. 46%; p = 0.001). Most respondents believed that benefits would not influence their own behavior concerning donation but would influence the behavior of others. While benefits appear to be favored, their true impact can only be assessed through pilot programs.
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Affiliation(s)
- C L Bryce
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA.
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Lesemann M, Nathan H, DiNoia TP, Kirby CF, McHugh MA, van Zanten JH, Paulaitis ME. Self-Assembly at High Pressures: SANS Study of the Effect of Pressure on Microstructure of C8E5 Micelles in Water. Ind Eng Chem Res 2003. [DOI: 10.1021/ie0302387] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Lesemann
- Department of Chemical Engineering, The Johns Hopkins University, Baltimore, Maryland 21218
| | - H. Nathan
- Department of Chemical Engineering, The Johns Hopkins University, Baltimore, Maryland 21218
| | - T. P. DiNoia
- Department of Chemical Engineering, The Johns Hopkins University, Baltimore, Maryland 21218
| | - C. F. Kirby
- Department of Chemical Engineering, The Johns Hopkins University, Baltimore, Maryland 21218
| | - M. A. McHugh
- Department of Chemical Engineering, The Johns Hopkins University, Baltimore, Maryland 21218
| | - J. H. van Zanten
- Department of Chemical Engineering, The Johns Hopkins University, Baltimore, Maryland 21218
| | - M. E. Paulaitis
- Department of Chemical Engineering, The Johns Hopkins University, Baltimore, Maryland 21218
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13
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Rubens F, Nathan H. Cardiopulmonary bypass copolymer surface modification reduces neither blood loss nor transfusions in coronary artery surgery. Thorac Cardiovasc Surg 2002; 50:384. [PMID: 12457322 DOI: 10.1055/s-2002-35737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Nathan H. Beneficiaries should pay. Nature 2001; 412:477. [PMID: 11484021 DOI: 10.1038/35087752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
PURPOSE Organ procurement organizations (OPOs) operate under the premise that Americans would donate organs and/or tissue if placed in appropriate circumstances. This study evaluated opinions of Pennsylvania trauma surgeons regarding OPOs and organ donation. METHODS Ninety-six Pennsylvania trauma surgeons were surveyed and descriptive results calculated. RESULTS Ninety percent were familiar with criteria for organ donation, and about 76% would invoke their institution's brain death policy even if families did not desire to donate organs. A small portion did not routinely pronounce patients brain dead that met criteria. One fourth indicated trauma surgeons should have no role in requesting organs. A majority believed trauma surgeons should have a role in organ donation requests, either alone or with an OPO representative, and most indicated that they could influence a family's decision. CONCLUSION Requestor attitude is important, and our results show an overall positive attitude toward donation and a solid level of knowledge regarding donor eligibility. Hospital development programs to improve donation consent should emphasize decoupling of brain death discussion and donation request, work to improve staff attitudes about approaching patients, and address donor eligibility criteria.
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Affiliation(s)
- C M Johnson
- Department of Surgery, University of Missouri, Columbia, Missouri, USA
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Dupuis JY, Wang F, Nathan H, Lam M, Grimes S, Bourke M. The cardiac anesthesia risk evaluation score: a clinically useful predictor of mortality and morbidity after cardiac surgery. Anesthesiology 2001; 94:194-204. [PMID: 11176081 DOI: 10.1097/00000542-200102000-00006] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Cardiac Anesthesia Risk Evaluation (CARE) score is a simple risk classification for cardiac surgical patients. It is based on clinical judgment and three clinical variables: comorbid conditions categorized as controlled or uncontrolled, surgical complexity, and urgency of the procedure. This study compared the CARE score with the Parsonnet, Tuman, and Tu multifactorial risk indexes for prediction of mortality and morbidity after cardiac surgery. METHODS In this prospective study, 3,548 cardiac surgical patients from one institution were risk stratified by two investigators using the CARE score and the three tested multifactorial risk indexes. All patients were also given a CARE score by their attending cardiac anesthesiologist. The first 2,000 patients served as a reference group to determine discrimination of each classification with receiver operating characteristic curves. The following 1,548 patients were used to evaluate calibration using the Pearson chi-square goodness-of-fit test. RESULTS The areas under the receiver operating characteristic curves for mortality and morbidity were 0.801 and 0.721, respectively, with the CARE score rating by the investigators; 0.786 and 0.710, respectively, with the CARE score rating by the attending anesthesiologists (n = 8); 0.808 and 0.726, respectively, with the Parsonnet index; 0.782 and 0.697, respectively, with the Tuman index; 0.770 and 0.724 with the Tu index, respectively. All risk models had acceptable calibration in predicting mortality and morbidity, except for the Parsonnet classification, which failed calibration for morbidity (P = 0.026). CONCLUSIONS The CARE score performs as well as multifactorial risk indexes for outcome prediction in cardiac surgery. Cardiac anesthesiologists can integrate this score in their practice and predict patient outcome with acceptable accuracy.
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Affiliation(s)
- J Y Dupuis
- Department of Anesthesia, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Andrews JM, Nathan H, Malbert CH, Verhagen MA, Gabb M, Hebbard GS, Kilpatrick D, MacDonald S, Rayner CK, Doran S, Omari T, O'Young E, Frisby C, Fraser RJ, Schoeman M, Horowitz M, Dent J. Validation of a novel luminal flow velocimeter with video fluoroscopy and manometry in the human esophagus. Am J Physiol Gastrointest Liver Physiol 1999; 276:G886-94. [PMID: 10198331 DOI: 10.1152/ajpgi.1999.276.4.g886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
There is currently no ideal method for concurrently assessing intraluminal pressures and flows in humans with high temporal resolution. We have developed and assessed the performance of a novel fiber-optic laser-Doppler velocimeter, mounted in a multichannel manometric assembly. Velocimeter recordings were compared with concurrent fluoroscopy and manometry following 50 barium swallows in healthy subjects. During these swallows, the velocimeter sensor was situated in either the proximal (24 swallows) or the distal (26 swallows) esophagus. It signaled intraluminal flow following 46 of 50 swallows. A greater mean number of deflections were recorded in the distal compared with the proximal esophagus (4. 3 vs. 2.4, P = 0.001). The maximal flow velocity recorded did not differ between the proximal and distal esophagus (76.7 vs. 73.8 mm/s). No velocimeter signals commenced after fluoroscopic lumen occlusion. The velocimeter signals were closely temporally related to fluoroscopic barium flow. Upward catheter movement on swallowing sometimes appeared to cause a velocimeter signal. Manometrically "normal" swallows were no different from "abnormal" swallows in the number and velocity of deflections recorded by the velocimeter. This novel instrument measures intraluminal flow velocity and pressures concurrently, thus enabling direct study of pressure-flow relationships. Flow patterns differed between the proximal and distal esophagus.
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Affiliation(s)
- J M Andrews
- Department of Medicine, Royal Adelaide Hospital, Adelaide, South Australia 5000.
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Rubens FD, Ruel M, Lavallee G, Watson M, Robblee J, Wozny D, Nathan H. Circuits with surface modifying additive alter the haemodynamic response to cardiopulmonary bypass. Eur J Cardiothorac Surg 1999; 15:353-8. [PMID: 10333035 DOI: 10.1016/s1010-7940(99)00015-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Blood contact with synthetic surfaces during cardiopulmonary bypass (CPB), inevitably results in the activation of a variety of interrelated pathways of inflammation and coagulation that may contribute to postoperative complications in cardiac surgery patients. The objective of this trial was to evaluate clinical events and complement activation related to the use of a novel biomaterial, into which a surface modifying additive had been incorporated into the polymer used to prepare the bypass circuit. METHODS A prospective, double-blind trial was carried out with 34 patients randomized to surgery, with either a standard circuit or a circuit treated ('tip to tip') with the surface modifying additive. Variables recorded included perioperative haemodynamics, volume replacement, alpha-agonist and inotrope use. Terminal complement complex (SC5b-9) was measured using an ELISA. RESULTS Upon initiation of bypass, there was a decrease in mean arterial pressure (MAP) in the control group, not seen in the test group (P = 0.0005, ANOVA). There was a decrease in the total volume of replacement fluid given intraoperatively in the test group as compared with the control group (total plus prime; control 5.3 +/- 1.2 L, test 4.4 +/- 1.9 L, P = 0.03, Mann-Whitney test). There was a trend to decreased need for inotrope infusion in the test group after CPB (test 1/17, control 6/17, Fisher exact test; P = 0.085). No difference was seen in the generation of terminal complement complex between the groups either during or after CPB. CONCLUSIONS The decrease in blood pressure in the control group, upon the initiation of CPB, did not occur in patients undergoing CPB with the circuit prepared with the surface modifying additive. The decrease in blood pressure was likely associated with the increase in total administered fluids intraoperatively (approximately 1 l/patient) and perhaps the trend towards higher use of inotropes in the control patients as opposed to the test patients. These haemodynamic changes did not appear to be related to complement activation early in CPB.
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Affiliation(s)
- F D Rubens
- University of Ottawa Heart Institute, Ontario, Canada.
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DeJong W, Franz HG, Wolfe SM, Nathan H, Payne D, Reitsma W, Beasley C. Requesting organ donation: an interview study of donor and nondonor families. Am J Crit Care 1998. [DOI: 10.4037/ajcc1998.7.1.13] [Citation(s) in RCA: 201] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND: Approximately half of the families asked to consider donation of a relative's organs decline to give consent. Understanding the difference between stated public support of organ donation and actual behavior is key to decreasing the shortage of donor organs. OBJECTIVES: To gain insight into the experiences of potential donor families and to define features of the donation-request process and other factors that are associated with consent for organ donation. METHODS: A structured telephone interview was conducted with the immediate next of kin of 164 medically suitable potential organ donors. Interviews 30 to 60 minutes long were held with members of both donor and nondonor families 4 to 6 months after the death of the study participant's relative. RESULTS: Several factors were associated with consent for organ donation: characteristics of the patient and the patient's family, beliefs and attitudes about organ donation and transplantation, whether the family knew the deceased's wishes about donation, the family's satisfaction with the hospital care that their relative received, specific aspects of the donation-request process, and the family's understanding of brain death. CONCLUSIONS: Organ donation rates could be increased by enhancing the quality of hospital care and ensuring that the request for donation is handled in a way that meets the families' informational and emotional needs.
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DeJong W, Franz HG, Wolfe SM, Nathan H, Payne D, Reitsma W, Beasley C. Requesting organ donation: an interview study of donor and nondonor families. Am J Crit Care 1998; 7:13-23. [PMID: 9429679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Approximately half of the families asked to consider donation of a relative's organs decline to give consent. Understanding the difference between stated public support of organ donation and actual behavior is key to decreasing the shortage of donor organs. OBJECTIVES To gain insight into the experiences of potential donor families and to define features of the donation-request process and other factors that are associated with consent for organ donation. METHODS A structured telephone interview was conducted with the immediate next of kin of 164 medically suitable potential organ donors. Interviews 30 to 60 minutes long were held with members of both donor and nondonor families 4 to 6 months after the death of the study participant's relative. RESULTS Several factors were associated with consent for organ donation: characteristics of the patient and the patient's family, beliefs and attitudes about organ donation and transplantation, whether the family knew the deceased's wishes about donation, the family's satisfaction with the hospital care that their relative received, specific aspects of the donation-request process, and the family's understanding of brain death. CONCLUSIONS Organ donation rates could be increased by enhancing the quality of hospital care and ensuring that the request for donation is handled in a way that meets the families' informational and emotional needs.
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Affiliation(s)
- W DeJong
- Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115, USA
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Affiliation(s)
- E Servino
- Coalition on Donation, Richmond, Virginia, USA
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Abstract
To examine how a family's understanding of brain death may affect the decision to donate, an interview study was conducted with the immediate next of kin of 164 medically suitable organ donor candidates. Telephone interviews were conducted with members of both donor and nondonor families 4 to 6 months after the relative's death. Only 61% of the donor and 53% of the nondonor respondents said they had received an explanation of brain death. Few respondents reported that the hospital or organ procurement organization staff used visual aids to clarify or reinforce the information they were given. Next of kin who decided against donation had far less understanding of brain death than did those who decided in favor of it. Before making an organ donation request, healthcare providers must inquire about and address common misunderstandings people have about brain death. Healthcare teams should develop and be trained on a clear protocol for communicating with the families of patients who may be potential organ donors.
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Affiliation(s)
- H G Franz
- Partnership for Organ Donation, Boston, MA 02109, USA
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Abstract
BACKGROUND Right ventricular blood flow may be adversely affected during left ventricular assist device (LVAD) use leading to right ventricular (RV) ischemia and RV dysfunction. This study characterized normal RV blood flow responses to LVAD operation. METHODS Seven Yorkshire pigs weighing 74.4 +/- 3.4 kg underwent right coronary artery blood flow measurements with an ultrasonic flow probe and injection of radiolabeled microspheres. A Thoratec LVAD was used in either synchronous or asynchronous modes and RV loading was increased using a pulmonary artery snare. RESULTS The RV blood flow was compared between three regions that differed in proximity to the right coronary artery: proximal segment, mid-RV, and distal. The right ventricular distal flow was 0.93 +/- 0.07 mL x min-1 x g-1 compared with 0.74 +/- 0.06 mL x min-1 x g-1 at right ventricular proximal flow during control measurements (p = 0.0001). This difference was maintained during LVAD operation in either synchronous or asynchronous modes and also during pulmonary artery constriction. CONCLUSIONS Global RV flow is not adversely affected by LVAD use. A flow gradient occurs along the right coronary artery with the distal vascular bed having relatively less reserve, which may be more susceptible to ischemia in patients with preexisting coronary disease or RV distention during LVAD use.
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Affiliation(s)
- P J Hendry
- University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada
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Affiliation(s)
- H Nathan
- University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada
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Nathan H, Naveh N, Meyer E. Levels of prostaglandin E2 and leukotriene B4 in tears of vernal conjunctivitis patients during a therapeutic trial with indomethacin. Doc Ophthalmol 1994; 85:247-57. [PMID: 7924852 DOI: 10.1007/bf01664932] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A therapeutic trial of 1% indomethacin (Indoptic) eye drops was carried out in 21 children. Looking for possible mediators of inflammation in vernal conjunctivitis, prostaglandin E2 (PGE2) and leukotriene B4 (LTB4 levels in the tears of 9 patients were measured and the effect of the treatment on them examined. A control group of 10 unaffected children was added. Out of 42 eyes in which indomethacin treatment was instilled, only 17 remained in treatment through a 6-week follow-up period. In a few of them a moderate improvement was obtained. The mean level of PGE2 in the patients before treatment was found to be slightly lower than that in the control group, and it dropped even lower during treatment. The average LTB4 level found in patients before treatment was significantly higher than the control group; it decreased somewhat following treatment, but not significantly. This is the first report of elevated LTB4 levels in vernal conjunctivitis, previously not recorded in the literature, it points to the possible role of LTB4 in the pathogenesis of the disease. A constant relationship was observed between low PGE2 levels and high LTB4 content in the patients' tears during highly inflamed states of the eye. We conclude that: (a) indomethacin did not prove to be a highly effective topical treatment for vernal conjunctivitis; (b) PGE2 does not seem to be a dominant mediator of inflammation in this disease; and (c) LTB4, on the other hand, apparently has a role in the mechanism of inflammation of the disease, thus raising hopes for future addition to therapy.
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Affiliation(s)
- H Nathan
- Department of Ophthalmology, Rambam Medical Center, Haifa, Israel
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Yang SL, Smolinski S, Abrams J, Nathan H. Combined team effort in liver procurement and transplantation: 5-year experience of one organ procurement organization. Transplant Proc 1993; 25:2985-7. [PMID: 8266425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Combined team effort in liver procurement and transplantation has proven to be very advantageous as compared to same team effort in our experience. The incidence of primary nonfunction was almost identical between the two groups. We recommend that a combined team effort be used in liver transplantation to conserve the resources and ensure the safety of the transplant team. The practice of only a single local recovery team for all abdominal organ procurement should be encouraged.
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Affiliation(s)
- S L Yang
- Albert Einstein Medical Center, Philadelphia, Pennsylvania
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Abrams J, Smolinski S, Nathan H, Moritz M. Cadaveric renal transplant in the highly sensitized African-American patient. Transplant Proc 1993; 25:2479-80. [PMID: 8356639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A statistically significant difference was discovered when comparing the 1-year graft survival of CAUC and AA. The difference was due in part to nine AA failures that occurred within the first week posttransplant (Fig 3). Using a multivariant analysis both the AA and CAUC were found to be normally distributed in regard to CIT, HLA mismatch, transplant number, and PRA. If these traditional variables thought to have relevance on graft survival in cadaveric renal transplantation are ruled out as contributing factors other avenues must be explored. If credence is given to the theory that the difference in function between AA and CAUC is due to the difference in the number of transplants that failed within the first week then factors such as immunosuppressive therapy and noncompliance can also be ruled out. One possible area of explanation may lie in the area of specificity to HLA antibody. It is possible that these recipients received transplants from a donor to which they were sensitized. A closer analysis of donor and recipient HLA typing as well as the recipient's transfusion and transplant history is recommended. Despite the fact that all transplants occurred in the presence of negative preliminary and final XM's using American Society for Histocompatibility and Immunogenetics (ASHI) certified techniques (Table 2), transplant centers may wish to consider using a more sensitive XM technique such as flow cytometry for these patients. We hope that these recommendations will enable transplant centers to continue their commitment to transplanting the highly sensitized recipient.
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Affiliation(s)
- J Abrams
- Delaware Valley Transplant Program, Philadelphia, Pennsylvania 19103
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Yang SL, Abrams J, Smolinski S, Nathan H. Organ donation and referrals among African-Americans. Transplant Proc 1993; 25:2487-8. [PMID: 8356641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Solid organ referrals for AA have been growing since 1989. One third of AA referrals are in the 16 to 30 year age group with the majority of these males suffering traumatic injury. AA donors have increased from 11 in 1989 to 32 in 1992. This is in spite of AA and minority consent rates that are 20% to 30% below that of the CAUC group. This gap represents a vital opportunity for improvement. Increased education to minority groups with a message that considers the ethnic and cultural diversity of the minority community coupled with an increase in the number of minority transplant coordinators should help to increase the number of AA referrals and donors.
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Affiliation(s)
- S L Yang
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Abrams J, Nathan H. Recipient race does not influence waiting time for a cadaveric renal transplant--one organ procurement organization's experience. Transplant Proc 1991; 23:2607-9. [PMID: 1926500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There was no statistical significance to the differences in waiting time for cadaveric renal transplant by race. Whether for first transplant or second or greater, any differences in waiting time could not be accounted for by the recipient's race. CAUC made up 58% of the waiting list, 65% of the recipients, and 87% of the donors. The corresponding numbers for AA are: 38%, 29%, and 10%, respectively. More regional serum-sharing trays may be needed in order to expose recipients with high PRA to as many donors as possible in order to lessen their waiting time. It should be noted that fewer HLA mismatches occurred when donor and recipient race were identical. In light of this data, more study is needed to determine the relationship between donor and recipient race, corresponding HLA mismatches, and graft survival. If antigen-matching is found to increase graft survival, then an increase in minority donations will be required. Until that time, under the current allocation system and with the predominance of Caucasian donors, it is likely that Afro-Americans will continue to receive kidneys that have more HLA antigen mismatches than if Afro-Americans donated in numbers equivalent to their percentage of the waiting list.
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Affiliation(s)
- J Abrams
- Delaware Valley Transplant Program, Philadelphia, Pennsylvania 19103
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Korzeniewski P, Lang SA, Grant R, Loader C, Vaghadia H, Wong D, Waters T, Merrick P, Ali MJ, Dobkowski W, Cornelius T, Hawkins R, Varkey GP, Claffey L, Plourde G, Trahan M, Morris J, Dean DM, Yamaguchi H, Harukuni I, Naito H, Chan VWS, Mati N, Seyone C, Evans D, Chung F, Joffe D, Plourde G, Villemurc C, Hong M, Milne B, Loomis C, Jhamandas K, Priddy R, Archer D, Tang T, Sabourin M, Samanini N, Cuillerier DJ, Schuben A, Awad IA, Perez-Trepichio AD, Ebrahim ZY, Bloomfield EL, Zexu F, Zhengnua G, Qing Z, Balhua S, Miller DR, Martineau RJ, Wynands JE, Hill JD, Knill RL, Skinner MI, Novick TV, McLean RF, Kolton M, Noble WH, Sullivan PJ, Cheng DCH, Chapman KR, Ong D, Roraanelli J, Smallman B, Nathan HJ, Murphy JT, Hall RI, Moffitt EA, Hudson RJ, Pascoe EA, Anderson BA, Thomson IR, Kassum DA, Shanks A, Rosenbloom M, Sidi A, Gehrig TR, Fool JM, Rush W, Martin AJ, Cooper PD, Maltby JR, Johnson D, Hurst T, Mayers I, Wigglesworth DF, Rose DK, Kay JC, Mazer CD, Yang H, Beattie WS, Doyle DJ, Demajo W, Comfort VK, Code WE, Rooney ME, Clark FJS, Sutton IR, Mutch WAC, Thomson IR, Teskey JM, Thiessen OB, Rosanbloom M, Tang TKK, Robblee JA, Nathan HJ, Wynands JE, Eagle CJ, Belenkle I, Chan KL, Tyberg JV, Stockwell M, Zintel T, Gallagher G, Kavanagh B, Sandier A, Lawson S, Chung F, Ong D, Isabel L, Trépanier CA, Campbell DC, Randall TE, Growe GH, Scarth I, Sawchuk CWT, Ong B, Unruh H, Horan T, Greengrass R, Mark D, Kitts JB, Curran MJ, Lindsay P, Polis T, Coté S, Socci M, Wiesel S, Conway JB, Seyone C, Goldberg J, Chung F, Rose DK, Cohen MM, Rogers KH, Duncan PG, Pope WDB, Tweed WA, Biehl D, Novick TV, Skinner MI, Mathieu A, Villeneuve E, Goldsmith CH, Allen GC, Smith CE, Pinchak AC, Hagen JF, Hudson JC, Gennings C, Tyler BL, Keenan RL, Chung F, Seyone C, Matl N, Ong D, Powell P, Tessler MJ, Kleiman SJ, Wiesel S, Tetzlaff JE, Yoon HJ, Baird B, Walsh M, Hondorp G, Wassef MR, Munshi C, Brooks J, Nimphius N, Tweed WA, Lee TL, Tweed WA, Phua WT, Chong KY, Lim E, Finegan BA, Coulson C, Lopaschuk GD, Clanachan AS, Fournier L, Cloutier R, Major D, Sharpe MD, Wexler HR, Dhamee MS, Rooney R, Ong SK, O’Leary E, McCarroll M, Phelan D, Young T, Coghlan D, O’Leary E, Blunnie WP, Splinter WM, Splinter WM, Ryan T, Maguire M, Bouchier-Hayes D, Cunningham AJ, Kamath MV, Fallen EL, Murkin JM, Shannon NA, Montgomery CJ, Karl HW, Raymond J, Drolet P, Tanguay M, Blaise G, Garceau D, Dumont L, Omri A, Sharkawi M, Billard V, Bourgain JL, Panos A, Mazer CD, Lichtenstein SV, Bevan JC, Popovic V, Baxter MRN, Donati F, Bevan DR, Bachman C, Kopelow M, Donen N, Umôn DT, Kemp S, Hartley E, Sikich N, Roy WL, Lerman J, Cooper RM, Yentis SM, Bissonnette B, Halpern L, Roy L, Burrows FA, Fear DW, Hillier S, Sloan M, Crawford M, Blssonnette B, Sikich N, Friedlander M, Sandier AN, Panos L, Winton T, Benureof J, Karski J, Teasdale S, Cruise C, Skala R, Zulys V, Ong D, Chow F, Packota G, Yip R, Bradley J, Arellano R, Sussman G, Sosis M, Braverman B, Sosis M, Ivankovich AD, Manganas M, Lephay A, Fournier T, Kadri N, Ossart M, Sandier AN, Turner KE, Wick V, Wherrett C, Sullivan PJ, Dyck JB, Varvel J, Shafer SL, Fiset P, Balendran P, Meistelman C, Lira E, Sloan M, Nigrovic V, Banoub M, Splinter WM, Roberts DW, Rhine EJ, MacNeill HB, Bonn GE, Clarke WM, Noel LP, Ryan T, Moriarty J, Bouchier-Hayes D, Cunningham AJ, Sandier AN, Baxter AD, Norman P, Samson B, Hull K, Chung F, Mali N, Evans D, Cruise C, Shumka D, Seyone C, Leung PT, Badner NH, Komar WE, Rajasingham M, Farren B, Vaillancourt G, Cournoyer S, Hollmann C, Breen TW, Janzen JA, Crochetiere CT, McMorland GH, Douglas MJ, Kamani AA, Arora SK, Tunstall M, Ross J, Mayer DC, Weeks SK, Norman P, Daley D, Sandier A, Guay J, Gaudreault P, Boulanger A, Tang A, Lortie L, Dupuis C, Backman SB, Bachoo M, Polosa C, Moudgil GC, Frame B, Blajchman HA, Singal DP, Albert JF, Ratcliff A, Law JC, Varvel J, Hung O, Shafer SL, Fiset P, Balendran P, Burgess PM, Doak GJ, Duke PC, Sloan PA, Mather LE, McLean CF, Rutten AJ, Nation RL, Milne RW, Runciman WB, Somoggi AA, Haack C, Shafer SL, Irish CL, Weisleider L, Mazer CD, Bell RS, Dejonckheere M, Levarlet M, d’Hollander A, Taylor RH, Sikich N, Campbell F, McLeod ME, Swartz J, Spahr-Schopfer I, McIntyre BG, Roy WL, Laycock GJA, Mitchell IM, Morton NS, Logan RW, Campbell F, Yentis SM, Fear D, Halpem L, Sloan M, Badgwell JM, Kleinman S, Yentis SM, Britton JT, Hannallah RS, Schafer PO, Norden JM, Splinter WM, Menard EA, Derdamezi JB, Ghurch JG, Britt BA, Radde IC, Sosis M, Kao YJ, Norton RG, Volgyesi GA, Spahr-Schopfer I, Sosis M, Plum M, Sosis M, Smith CE, Pinchak AC, Hancock DE, Owen P, McMeekin J, Hanson S, Cujec B, Feindel CM, Cruz J, Boylen P, Ong D, Murphy JT, Dupuis JY, Nathan HJ, Cattran C, Wynands JE, Murphy JT, Kinley CE, Sulliyan JA, Landymore RW, Robblee JA, Labow R, Buckley DN, Sharpe MD, Guiraudon G, Klein G, Yee R, Black J, Devitt JH, McLellan BA, Dubbin J, Ehrlich LE, Ralley FE, Robbins GR, Symcs JF, Bourke M, Nathan H, Wynands JE. Abstracts. Can J Anaesth 1991. [DOI: 10.1007/bf03008442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Nathan H. Nifedipine after coronary bypass grafting. Ann Thorac Surg 1991; 51:693. [PMID: 2053981 DOI: 10.1016/0003-4975(91)90349-u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
"Mandatory" or required request for donation of the organs of patients dying in hospitals has been promulgated as a means of increasing the rate of organ harvest and alleviating the critical shortage of transplantable organs. Although the federal and many state governments have passed legislation to make such requests compulsory, the efficacy of this approach has not been demonstrated. Examination of the experience at our trauma center and in this region, before and after the enactment of a "strong" required request law by the State of New Jersey, did not reveal a statistically significant change in organ procurement. We conclude that such laws are unlikely to achieve the desired result in the absence of fundamental changes in the attitudes of the public and treating physicians.
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Affiliation(s)
- S E Ross
- Department of Surgery, UMDNJ/Robert Wood Johnson Medical School, Camden
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Nathan H. What the AOPO survey results mean. Association of Organ Procurement Organizations. Nephrol News Issues 1990; 4:30-1, 36. [PMID: 2320140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Patients with severe coronary artery disease were studied to determine if the preoperative assessment or intraoperative haemodynamic monitoring could predict the occurrence of myocardial ischaemia. Thirty-eight patients undergoing coronary artery surgery who had normal electrocardiograms before induction of anaesthesia were included. Leads II and CS5 were recorded on a Holter monitor and radial arterial and pulmonary artery catheters were used to measure haemodynamic variables. Eight patients developed ST-segment changes greater than or equal to 0.1 mV before sternotomy. Preoperative factors could not be used to predict which patients would develop ST-segment changes. In all 38 patients haemodynamic determinants of myocardial oxygen supply and demand remained within an optimal range despite evidence of ischaemia in eight. This syndrome of ECG changes in the absence of tachycardia and hypertension resembles the syndrome of silent ischaemia documented in awake patients. Our findings suggest that myocardial ischaemia may be caused by decreases in coronary blood flow not associated with changes in haemodynamic variables.
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Affiliation(s)
- H Smith
- Department of Anaesthesia, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario
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Abstract
An unusual case of a double testicular tumor, with different histology and the same marker chromosome, led to a search of the literature for cases of testicular tumors that were double, bilateral, or familial. The literature on abnormal chromosomes in tumors of the testis is also reviewed. After a discussion of the facts, it is suggested that most of the histological variants of germ cell tumors of the testicle are so closely related that they could be grouped together under the title of 'orchidomata'.
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Affiliation(s)
- F S Haddad
- Carl T. Hayden Veterans Administration Medical Center, Phoenix, Ariz
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Rosen A, Nathan H, Luciansky E, Orda R. The inguinal region: anatomic differences in men and women with reference to hernia formation. Acta Anat (Basel) 1989; 136:306-10. [PMID: 2609927 DOI: 10.1159/000146842] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fifty inguinal regions were dissected in anatomic human adult specimens, of which 26 were males and 24 females. The comparison of anatomic variations in both sexes showed that the distance between the public tubercle and the internal ring was larger, and the rectus muscle significantly wider in females. The diameter of the internal ring was larger in males, however, with significant variability. No differences were found regarding the presence or absence of the conjoint tendon. The anatomic variations may explain the sex differences in hernia formation.
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Affiliation(s)
- A Rosen
- Department of Surgery A, Assaf Harofeh Medical Center, Zerifin, Israel
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Abrams J, Nathan H, Jarrell B. Should AB kidneys be recovered routinely? Transplant Proc 1988; 20:755-6. [PMID: 3055490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- J Abrams
- Delaware Valley Transplant Program, Philadelphia, PA 19103
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Abstract
Only brief descriptions of the lienorenal ligament and the anatomical relationship between the tail of the pancreas and the hilus of the spleen have been reported in the literature. The anatomical variations in this region are of significant surgical importance. The lienorenal ligament was studied in 37 anatomical specimens. A classification of its variations is presented, and clinical-surgical applications are discussed.
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Affiliation(s)
- A Rosen
- Department of Surgery, A, Assaf Harofeh Medical Center, Zerifin, Israel
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Abstract
In 20 dissections of scoliotic cadavers, the changes of the structures in the posterior mediastinum in relation to the spine were found to be as follows. The aorta persistently followed and adhered to the abnormal curves of the spine. The azygos vein and the thoracic duct followed the aorta closely in its changes. The sympathetic trunk and the greater splanchnic nerves likewise followed the changes in the curvature of the scoliotic spine, but they were often disturbed in their course by vertebral osteophytes and by hyperostoses due to arthritis of the costovertebral joints. The esophagus preserved its normal straight course, unaffected by the scoliotic curves.
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Affiliation(s)
- H Nathan
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Lipschitz M, Bernstein-Lipschitz L, Nathan H. Thoracic sympathetic trunk compression by osteophytes associated with arthritis of the costovertebral joint. Anatomical and clinical considerations. Acta Anat (Basel) 1988; 132:48-54. [PMID: 3400418 DOI: 10.1159/000146550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hyperostosis (lipping) due to costovertebral arthritis was found frequently (84.3%) impinging on the sympathetic trunks (ganglia and cord), rami communicantes and roots of the splanchnic nerves on both sides of the spine in more than 1,000 dissecting room cadavers examined and 34 cadavers of adult and elderly people specially dissected. As a result of the compression, the affected sympathetic structures were angulated, deflected from their course, enlarged and often infiltrated with connective tissue. The possible symptoms which may result from this kind of compression are discussed.
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Affiliation(s)
- M Lipschitz
- Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
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Rosen A, Shikiar S, Nathan H, Oland J, Sayfan J, Orda R. Anatomical and computed tomographic studies of the pancreatic tail. Acta Anat (Basel) 1988; 131:188-91. [PMID: 3376721 DOI: 10.1159/000146511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The location of the pancreatic tail in the lienorenal ligament and its relationship to the splenic hilus were studied in 32 computed tomography (CT) scannings and in 37 autopsy specimens. We found several anatomical variations in both study groups: the pancreatic tail did not penetrate the lienorenal ligament in 24% of the autopsy specimens and in 37.5% of the CT group. The tail was adjacent to the splenic hilus in 29.7% of the autopsies and in 25% of the CT group. We classified the anatomical variations into 4 categories, three of which could be well demonstrated on CT with satisfactory correlation to the anatomical findings of the autopsy specimens.
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Affiliation(s)
- A Rosen
- Department of Surgery A, Assaf Harofeh Medical Center, Israel
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Abstract
Four hundred and fifty skeletons were examined, and age changes in the bony vertebral end-plates were grouped into six categories. The predominant patterns of each phase from infancy to senescence are presented. The formation of ridges and sulci that form peripherally are similar to those appearing in other epiphyses and may provide translational stability. When osteophytes appear with maturation, they are separated from the fused ring apophysis by a distinct sulcus.
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Affiliation(s)
- J G Edelson
- Department of Orthopedics, Poriya Hospital, Tiberias, Israel
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Nathan H. Monkeys aid study of dental problems. Dent Econ 1987; 77:114. [PMID: 3131163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Nathan H. Antiques provide unique decor. Dent Econ 1987; 77:102, 104. [PMID: 3330043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
The presence of osteophytes compressing the sympathetic structures in the thorax was found in 655 (65.5%) of 1,000 cadavers. In 60.4% of the affected cases, the compression was on the right side, and in 36.9% it was bilateral, although the right side was more severely affected. In 2%, the compression was on the left only. The highest frequency of compression was at the T8-10 level, the right greater splanchnic nerve being the structure most frequently involved. The sympathetic trunk itself (ganglia and cord) was affected only by osteophytes of vertebrae at the lowest thoracic levels; however, bony excrescences due to costovertebral joint arthritis were frequently found impinging on the sympathetic trunk and its rami communicantes at similar frequencies on both sides. The factors governing the characteristic compression of the sympathetic structures in the thorax are the typical development of the osteophytes and the special relations of the sympathetic structures to the vertebral column at the various levels. It is proposed that these observations are useful in understanding certain observed clinical conditions and act an anatomic baseline for research in the future.
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Affiliation(s)
- H Nathan
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Abstract
The sesamoid bones were studied in 100 hands and feet in 50 cadavers and in 1000 radiographs of the hands of South Sinai Bedouin children. The sesamoids of the metacarpophalangeal joint of the thumb and metatarsophalangeal joints of the hallux were always present in the dissections and radiographs. Other sesamoids were observed in the radiographs of the metacarpophalangeal joints of the index finger in 50% of the cases, the middle finger in 3%, the ring finger in 1% and the little finger in 70%. Sesamoids were also seen in 62% of the interphalangeal joints of the thumb. There are differences between the hand and the foot in relation to the occurrence of degenerative changes in the joints. In the thumb, the metacarpophalangeal joint is involved macroscopically in 75% of the cases, and only in 13% of the radiographs, with the pathological changes located in one or the other part of the joint. In the hallux, 40% of the cases are involved both macroscopically and in radiographs, but all the parts of the joint are affected.
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Nathan H. Association of retroesophageal right subclavian arteries with thoracic ducts terminating in the right venous angle. J Thorac Cardiovasc Surg 1987; 93:148-9. [PMID: 3796026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Nathan H. Association of retroesophageal right subclavian arteries with thoracic ducts terminating in the right venous angle; To the Editor:. J Thorac Cardiovasc Surg 1987. [DOI: 10.1016/s0022-5223(19)36490-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Thirty-four bony specimens of isthmic spondylolysis were examined and, in a significant number (32%), stenosis of the intervertebral foramen was noted. Although not emphasised in previous reports, this finding may be an important factor in the aetiology of nerve root compression when this is associated with spondylolysis and spondylolisthesis. Anatomical guidelines for adequate surgical decompression are suggested.
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