Connecticut medicine
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Connecticut medicine · Aug 1996
Mitral valve repair for mitral regurgitation utilizing intraoperative transesophageal echocardiography--late results.
Ninety consecutive patients underwent mitral valve repair for mitral regurgitation (MR) utilizing intraoperative transesophageal echocardiography (TEE). Fifty-nine males and 31 females between the ages of 31 and 88 with a mean age of 67.9 years were evaluated. Preoperative TEE demonstrated pathology involving the posterior leaflet in 28 patients, anterior leaflet in 21 patients, both leaflets in 19 patients, annular dilatation in 19 patients, and restricted leaflet in three patients. ⋯ Among the 65 patients followed over one year, 42 (64%) continue to have either none or trivial MR. Three patients had worsening MR requiring mitral valve replacement. Quadrangle resection for posterior leaflet repair and Duran "flip over" operation for anterior leaflet pathology had the highest success rate in long-term follow-up.
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Epidural endoscopy is a minimally invasive technology that is now in active clinical trials. This new technique allows the operator to visualize directly the epidural space and contiguous structures, thus allowing for detailed examination leading to a better understanding of the role of epidural adhesion in the development of sciatica.
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Connecticut medicine · Nov 1995
Factors associated with early onset pneumonia in the severely brain-injured patient.
An analysis of 125 patients with closed head injury was completed in order to identify the risk factors involved in the development of early pneumonia. Pneumonia was diagnosed in 60% of the patients. Early pneumonia developed in 47.8% of the patients. ⋯ Patients who had been intubated in the field were found to be at greater risk for the development of early pneumonia than those intubated in the hospital. Patients with early pneumonia had prolonged intubation times, intensive care unit stays, and hospital stays. This study suggests that a GCS score less than 5, evidence for swallowing disorders and aspiration, and field intubation are risk factors for early pneumonia in the brain-injured patient.
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Connecticut medicine · Dec 1994
Comparative StudyIsolated free fluid on abdominal computerized tomographic scan: an indication for surgery in blunt trauma patients?
A retrospective study of 792 patients who sustained blunt traumatic injury and underwent abdominopelvic computerized tomographic scan (CT) evaluation was performed. Patients who had free intraperitoneal fluid without evidence of solid visceral organ damage served as the study population. Sixty-six (8.3%) of patients were identified as having free fluid without evidence of solid organ injury. ⋯ Thirty-five patients (53%) had no sequelae of intra-abdominal injuries and required no surgical intervention. If patients with pelvic fractures are excluded, 10 (19.2%) of the patients required operative intervention for their injuries. It is our conclusion that free fluid as the only significant finding on CT scan in blunt trauma patients may be a harbinger of significant intra-abdominal injury, and that these patients need to be closely observed to decrease morbidity associated with these potential injuries.